A glimpse of the competition can be found by the jaw-dropping build-out of the University of California-San Francisco's Mission Bay campus , which is dedicated to bio and went from nothing to a major contender over the same decade. And this was achieved despite California's state budget crisis. It represents one path the Phoenix Biomedical Campus could have taken but didn't. Another is Houston's amazing Texas Medical Center . This is where I center my recollections of the bio effort and what succeeded and failed.

That said, total Arizona bioscience employment in 2010 was 21,084 vs. 62,386 in North Carolina. The state is a pygmy in research dollars and has birthed no significant bio company. Phoenix is nowhere near being one of the nation's top biotech/biosciences centers. [Updated] A 2012 Jones Lang LaSalle report ranks Boston, San Diego, the Bay Area, Raleigh-Durham, Philadelphia, Washington, D.C., New York, Los Angeles and Seattle the top "established" clusters in the Americas. The "emerging" clusters are Westchester/New Haven, Conn., Chicago, Denver, Cleveland-Columbus-Cincinnati, Salt Lake City, Dallas, southern Wisconsin, Florida, Indianapolis, southern Michigan and Atlanta. The top players are not much changed, aside from relative ranking, from a much-discussed 2004 assessment by the Milken Institute, with one exception. Minneapolis has moved into the "established" ranks. Most of the up-and-comers are new. Arizona and Phoenix are not mentioned.

A decade after Arizona, and especially Phoenix, embarked on an effort to build a biosciences cluster , this is how things stand. According to a report from the Battelle Institute, "Arizona’s bioscience industry continues to grow at a rapid rate. Industry firms have increased employment by 30 percent overall since 2001 and have even added jobs since 2007, a period which includes the deep national recession."

As I wrote in the previous post, Phoenix's leap into bio was driven by Mayor Skip Rimsza (right) and Deputy City Manager Sheryl Sculley. Having lost the Cardinals' stadium to exurban Glendale, Rimsza wanted to use downtown land assembled for the venue as a biomedical campus. Behind the scenes was rainmaker lawyer Dick Mallery, the last of the breed, doing what old-school Phoenix stewards always did: Know the pressure points, work the players, make the deal happen. World-famous genomics researcher Jeffrey Trent came home to set up the Translational Genomics Research Institute, or T-Gen, along with the International Genomics Consortium.

Critical backing also came from Gov. Janet Napolitano. ASU President Michael Crow set up the Biodesign Institute in Tempe and, among other things, went after Defense Department money to develop responses to biological attacks by terrorists. He also moved the College of Nursing to the new downtown ASU campus. The University of Arizona established its own bio program in Tucson and agreed to start a medical school on the biosciences campus in Phoenix. With important support from the Flinn Foundation, this became a statewide effort. But the vision was always to center the effort in downtown Phoenix. Trent hoped it could use Houston's world-class Texas Medical Center as a model, melding research, education and clinical work, while providing a platform to attract major private-sector investment.

Things went off the rails for a variety of reasons:

The Real Estate Industrial Complex was never on board; its mandarins never understood something that didn't provide a quick payoff from a speculative sprawl hustle on the fringes. They have no interest in downtown.

The impulse to make it a statewide endeavor quickly degenerated into the usual Balkanized battle. Every suburb wanted its piece of a pie that hadn't even been baked. For example, Chandler snagged a promising private testing company that should have been located downtown (it didn't last).

The University of Arizona couldn't overcome the entrenched Tucson faculty opposition to doing anything in Phoenix. Thus, the medical school got a slow start, and plans to relocate the school of pharmacy and other programs to the Phoenix campus were stillborn. Changes in the university's presidency further diluted support for what should have been a no-brainer, for the UofA to create a major presence in the state's population center.

Phil Gordon became mayor with much promise, but was unable, for a variety of reasons, to keep focus on the downtown campus (and Sculley, facing opposition from the old boys at city hall, went to San Antonio to become city manager). The campus lost momentum.

The established healthcare giants, especially Banner (whose CEO Peter Fine served on the original task force), were ambivalent about the initiative, particularly the plan to locate a hospital on the downtown campus. Thus, Banner quietly torpedoed an effort to build a new Maricopa Medical Center on the downtown campus to replace its aging and poorly located county hospital at 24th Street and Roosevelt. Both Banner and St. Joe's worried about competition if a clinical element — essential to the "bench to bedside" promise of the campus — came about. Banner's Good Samaritan is located a mile away from the bio campus.

No coherent economic development strategy was enacted to lure biomedical-related industries from Southern California and elsewhere or aid in startups. Efforts to speed technology transfer, with San Diego as a model, were hamstrung. Science Foundation Arizona similarly was held back for lack of legislative support.

Finally, the political complexion of the state shifted from Napolitano's "new Arizona" to Crazy Arizona. Legislative support for the biosciences, never strong, evaporated. St. Janet decamped for D.C. The remaining leadership, already ideologically predisposed against both science and Phoenix, could never understand as sophisticated an enterprise as the bio roadmap laid out in 2002.

The result, a decade later, is very different from what I and many others had hoped. The downtown Biomedical Campus has progressed very slowly. Work is finally starting on the UofA cancer treatment center. It will operate in partnership with St. Joe's, although in-patient treatments will take place at its hospital two miles away. The medical school is now a full-scale affair in a $135-million Health Sciences Education Building, not the tiny satellite of a few years ago. ASU has moved nutrition research into new lab facilities. St. Joes also has a modest research operation working with T-Gen which, importantly, is still there. Still, the site is not built out and what's there looks oddly suburban. No energy has spread across Seventh Street.

"Has it caught fire? No, it hasn’t caught fire," Mayor Greg Stanton told me. "The quality is there. The importance of keeping investment there will be a priority during my time as mayor. But this is a long-term play, not a short-term play."

The play will also migrate more than 20 miles away, to far north Phoenix, where it's likely ASU will establish a full school of medicine adjacent to the Mayo Clinic. The ground for this is being prepared with some Mayo research partnerships. This, rather than downtown, is where Stanton sees the big play. "ASU-Mayo over time will be even more important than what we’re doing downtown," he said, pointing out the availability of 600-plus acres (and the need to work with the state land department to acquire parcels) compared with about 30 acres downtown. "It will be a much larger employment center... We can quibble about enough density on the downtown campus. It's a legitimate debate. We did the best we could with the resources we had and the programs coming in." Now, he sees it as a priority to gain land adjacent to Mayo before it's auctioned off for strip malls and subdivisions.

"Great cities have to multi-task and multi-task effectively," he said. "We will take our place among the great cities. But an MD Anderson (the renowned Houston cancer center, part of the Texas Medical Center) is only going to happen in north Phoenix."

This no doubt seems a pragmatic answer. City Council is different from the one that supported the original vision and anti-downtown sentiment is percolating. Meanwhile, the suburbs are rushing to build their own cancer centers (MD Anderson is partnering with Banner in Gilbert). With this trend abetted by the Real Estate Industrial Complex, I can already smell a cancer-center bubble, however many Midwesterners develop melanomas from spending too much time in the sun.

Earlier this month, I made the long drive to survey this future. Once again, I asked myself, "Why is this hospital out here in the middle of nowhere?" But it was rhetorical. Mayo built there to be close to north Scottsdale, apparently got a good deal on empty desert land near where the 101 would run, and any sense of rational city planning was lost to the larger real-estate hustle. As is always the case here. Mayo and north Phoenix have the added benefit of being far from "the Mexican Detroit" of central Phoenix. This locale is only accessible by personal car. It will never see meaningful transit. This is only one aspect of the radical decentralization of assets and incoherent sprawl that are costly, inefficient and unsustainable. It's so very...1985 in an era where central cities are showing the most promise.

At one time, a "meds and eds" strategy centered on the Downtown Biomedical Campus held the promise of being a genuine game-changer. A dense node of research, education, clinical treatment and private-sector operations would hold the critical mass the region lacks. It would provide the "creative friction" of scientists, health-care professionals, students and entrepreneurs working closely together. It would be linked to the Biodesign Institutite and other research operations in Tempe by light rail. Abundant empty land in what Gordon absent-mindedly called "the Opportunity Corridor" — much of it also on light rail, all close to freeways — would be available for private enterprise (for example, biomedical manufacturing). Yes, this would help the state leapfrog beyond its unhealthy dependence on real estate. But it would save the central core from being the donut hole of the sprawl machine. This could have been the Texas Medical Center, where competing hospitals and medical schools make each other better. It could have been similar to South Lake Union, an urban technology campus that is influencing the world. It could have led the building of a more diverse economy in spheres far beyond bio. As importantly, it could have shown the robust potential for land-use methods other than sprawl. It was the metropolitan area's best chance to attract the most sought-after assets of the world economy: Talent and capital.

It didn't happen. It never will. If the crack-of-the-two-by-four-across-the-forehead of the Great Recession didn't get Arizona's attention about sustainability, scalability and the need for a diverse, quality economy, nothing will. As for the "long play," I'm not sure Phoenix has one aside from attempting to build more sprawl. All the other "just wait...it will eventually happen" schemes have come to tears. The play continues to be the same one used for more than half a century: Add more people, build more houses, shopping strips, malls and freeways, push farther out, the rest will follow. Yet with the exception of pro sports and the rise of ASU under Michael Crow, that hasn't happened.

Now any long play faces disruption from climate change, water challenges, bad air, a high-cost energy future, a huge underclass and the possibility of being distracted yet again from making serious responses to all this by another real-estate boomlet. It confronts the drag of putting a metropolitan area of 4.5 million people in the worst possible built configuration, in a hostile desert. Any long play will be even more unlikely to "just happen" in a world far more competitive and unstable than at any time in modern Phoenix's history.

With slow growth and a paralyzed federal government, the winners and losers are frozen nationally. Other countries are seeking to erode and take away our assets, not just on the cheap side but in research and advanced manufacturing. Given all this, it will be interesting to see where Arizona's bio effort sits a decade hence, especially if the cancer-treatment bubble bursts under the unsustainable costs of America's for-profit medical system.

[For further reading, here's urban scholar Richard Florida on why meds and eds alone can't revitalize cities.]