Robert G. Gish, MD


November 12, 2010

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Hello, I'm Robert Gish. I will be starting as Chief of Hepatology at the University of California, San Diego, in San Diego, California, on December 1, as well as being Medical Director, Center for Hepatobiliary Disease and Abdominal Transplantation.

I'm here at the AASLD [American Association for the Study of Liver Diseases] 2010 in Boston, and I'd like to comment on this year's President's Choice lecture[1] for Medscape. This lecture focused on the findings of the Institute of Medicine study, Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C.[2]

What are the findings and what are the clinical implications for hepatitis B and C?

Dr. Koh, during his presentation, talked about the new affordable care and portability insurance act that was put in place by our government. First, they wanted to raise awareness. It was emphasized that there are at least 5 million people who are infected with hepatitis B and C today. I think there are really 7 million people infected, and during his presentation, Dr. Koh at least hinted at that possibility. Very importantly, whatever the denominator is, we think at least two thirds of individuals do not know that they are infected at this time.

The goals are to attain the highest standard of health and to mobilize medical and community leadership to focus on hepatitis B and C. There is also a new Healthy People program that starts in December 2010, focusing on life, quantity, quality, equity, promotion of healthy behaviors, and also changing the environment to change the individual's and the community's health.

There are at least 3 major at-risk communities that need to be focused on with respect to viral hepatitis. These are the Asia-Pacific Islander community, those individuals with high-risk sexual behavior, and those with high-risk behavior in general who may have blood or needle exposure.

Another major point was to bring guidelines about viral hepatitis from many different organizations and make those consistent, so the community can get a consistent message about screening, surveillance, linkage to care, and vaccination, as well as behavior modification.

There was another major emphasis on developing multidisciplinary teams. We have a major workforce shortage. We need more liver specialists, more engagement from the infectious disease community for viral hepatitis B and C, and more primary care, and this includes nurses, nurse practitioners, and physician's assistants.

New screening efforts are going to be promoted by the Centers for Disease Control and Prevention (CDC). There was also an emphasis on current screening programs such as the San Francisco HBV [hepatitis B virus] free program that I've been involved with for more than 3 years. In San Francisco, we have screened nearly 8000 individuals and have found a prevalence rate in the 3% to 7% range for hepatitis B. New York City is replicating this program, and there's a move underway to actually have a US-wide HBV free program.

Now, the Trust for America's Health has also come into effect and is setting up a collaboration, not just with the AASLD, but across the CDC and many other leadership organizations, to help bring this Institute of Medicine program into full effect. Health and Human Services is putting together a task force with the Health Resource Services Administration, the Food and Drug Administration, and the CDC. Importantly, we need to educate providers to enhance screening and linkage to care and [we need] to decrease vaccine-preventable diseases by implementing a much higher and more effective vaccine policy. We want to decrease high-risk behavior and, of course, protect our healthcare worker colleagues.

Systems of care can be both amplified and enhanced. Federally qualified community health centers will probably double the number of individuals that they take care of, from 19 million to 40 million. Integrating programs that are already in place with HIV care and addiction medicine was also emphasized. We want to enhance vaccinate rates, and the emphasis on this across all these programs was brought forward. Networking with the American College of Physicians, the American Academy of Family Practitioners, and nurse practitioner organizations was also discussed.

In closing, many fantastic ideas and concepts were put forth during this lecture, but we need to confirm that financing will follow this important proposed structure.

Thank you for joining us. This is Robert Gish for Medscape.


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