Researchers present highlights of recent liver disease studies
Practice consolidation presents way to survive market shifts
Crystal Awards honor member achievements
State-of-the-Art Conference will discuss timing of surgery for IBD
Council chair leaves enduring impact
AASLD President’s Profile



Researchers present highlights of recent liver disease studies

Cholestatic liver disorders and portal hypertension were two of the eight areas covered in the Research Highlights session on Saturday. Most of these studies were preclinical or preliminary in nature and have implications for future clinical practice.

Ulrich Beuers, MD, of the University of Amsterdam’s department of gastroenterology and hepatology, summarized data from four studies. In the first, published in the Journal of Immunology, Leung and colleagues used 6-bromohexanoate to induce primary biliary cirrhosis in guinea pigs. Based on serological and immunohistochemical evidence, 100 percent of the animals were shown to have automitochondrial antibodies, a hallmark of primary biliary cirrhosis (PBC). A longer follow-up of 18 months showed that the animals developed autoimmune cholangitis.

“These data implicate that environmental factors may play an important role in the development of autoimmune disease,” Dr. Beuers said.

Arenas and colleagues from Spain described in the Journal of Clinical Investigation a potential mechanism that explained the clinical practice of using ursodeoxycolic acid (UDCA) and glucocorticoids in treating PBC in patients who do not respond to UDCA alone. UDCA and dexamethasone were shown to upregulate the expression of two isoforms of AE2. Increased expression of these isoforms was also shown to correspond to increased activity.

In discussing data from Stedman and colleagues, the role of the farnesoid X receptor (FXR) was clarified in animal models that had null expression for FXR, which were published in the Proceedings of the National Academy of Sciences.

Dr. Beurs noted that the study strongly suggests a potential clinical role for FXR antagonists (not agonists) in the treatment of obstructive cholestatic liver disorders.

The final study published in Hepatology (from Umemura and colleagues) suggested that liver biopsies can provide significant information in the clinical evaluation and diagnosis of autoimmune pancreatitis.

Vijay Shah, MD, professor of medicine at the Mayo Clinic College of Medicine, Rochester, MN, discussed data from six articles published in Hepatology that weighed the experimental treatment of portal hypertension, new approaches to detect varices using non-invasive approaches and treatment approaches to variceal bleeding.

Two articles from two Spanish groups showed that angiogenesis plays an important role in portal hypertension, at least in animal studies.

The first paper from Tugues and colleagues discussed how sunitinib, an antiangiogenic inhibitor, decreased inflammatory infiltrates and fibrosis in cirrhotic rats. Sunitinib inhibited viability of human stellate cells and angiogenesis from endothelial cells. In fact, reducing blood vessel formation resulted in reduced fibrosis.

Also, an article from Fernandez and colleagues combined inhibition of vascular endothelial growth factor (using rapamycin) and platelet-derived growth factor (using imatinib), significantly reducing splanchnic neovascularization in portal vein-ligated rats.

Given that endoscopy is the gold standard for diagnosing varices, two studies showed that less invasive procedures may have a role for diagnosing esophageal and gastric varices. In the two studies discussed, computed tomography and capsule endoscopy have high sensitivity and a positive predictive value for detecting varices. However, the accuracy is still insufficient for clinical practice.

In the treatment of varices, Dr. Shah indicated that although patients and physicians both prefer band ligation to the use of beta-blockers, the latter are still used possibly as per suggested guidelines. In the final study discussed from Bosch and colleagues, it was shown that recombinant factor VIIa cannot yet be used for treating esophageal variceal hemorrhage.

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Practice consolidation presents way to survive market shifts

Practice consolidation and mergers empower GI practices to offer a greater range of services cost efficiently. Offering details on efficiency during Saturday’s AGA Institute Practice Management Course was Michael L. Weinstein, MD, in his presentation “Lessons from the Trenches, Is Bigger Better?”

“Consolidation is about quality and better value and not just about the numbers (business volume),” said Dr. Weinstein, leader of the 50-physician Metropolitan Gastroenterology Group, Washington, DC.

Larger GI practices are better able to withstand probable shifts in the GI marketplace, some of which include incorporating electronic health records and performing quality and outcomes measurement, according to Dr. Weinstein.

A major benefit of physician consolidation includes improving quality of care through knowledge sharing and specialization, Dr. Weinstein noted. Consolidation also enhances better administrative practice management, more effective marketing, more sophisticated information technology systems, purchasing economies and greater leverage in negotiating contracts with payers.

“Size does matter, and there are benefits to consolidation,” Dr. Weinstein said. Nevertheless, “consolidation is not so much about (practice) size, but what you do with it.”

In his presentation “Legal Issues in Practice Mergers,” David Klatsky Esq., a mergers attorney with McDermott, Will & Emery, Los Angeles, said antitrust is one of the biggest GI practice merger issues.

“The law prohibits business combinations that would likely result in significant lessening of competition or tend to create market power,” Klatsky said. “The bottom line is that the government is very unlikely to challenge physician practice mergers unless they create a very high percentage of market share.”

As an example, Klatsky said that one practice merger in Allentown, PA, would have resulted in the entity grabbing 92 percent of market share, so the merger was blocked. Generally, any challenged physician practice mergers are likely to be dismissed if they result in less than 30 percent market share, Klatsky noted.

He also described various physician consolidation options — a merger, asset purchase and corporate formation. In the merger option, one practice is totally taken over and incorporated into the purchasing practice, with the purchasing practice accepting the assets and liabilities. The asset purchase is treated much like a stock deal, where the purchasing practice buys all stock of another practice. The purchaser does not pay tax on this transaction and takes no liabilities from the practice being purchased, Klatsky said. The other tax-free and liability-free option is corporate formation, combining all practices into on entity.

“The most important thing you can do in putting together a practice merger is getting to know each other,” Klatsky said. “I can’t emphasize that enough. There are so many important decisions you will make, and you need to know the type of person your potential partner is.”

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Crystal Awards honor member achievements

ASGE will present its top honors tonight during the 2008 ASGE Crystal Awards. Hosted by ASGE and the ASGE Foundation, this fourth annual event will highlight the important achievements of award recipients who have shared their expertise and strengthened both the specialty and the society. The event will begin at 6:30 p.m. on the USS Midway, a retired aircraft-carrier-turned museum docked in San Diego Harbor.

The Rudolf V. Schindler Award
ASGE’s highest honor, the Rudolf V. Schindler Award, will be presented to David A. Lieberman, MD, FASGE. This award is given to a member whose accomplishments in endoscopic research, teaching and/or service to ASGE exemplifies the standards and traditions of Rudolf V. Schindler, MD, founder of the American Gastroscopic Club, the forerunner of ASGE.

Dr. Lieberman, professor of medicine and chief of the division of gastroenterology at Oregon Health Sciences University and the Portland Veterans Administration (VA) Medical Center, received his medical degree from the University of Michigan, Ann Arbor.

An internationally recognized expert on colon cancer screening, he is chairman for the VA Cooperative Study #380, which used colonoscopy to screen asymptomatic subjects. His colon cancer research has been recognized nationally and internationally.

He is the director of the Clinical Outcomes Research Initiative, supported by the NIH since 1999. The project has created a national endoscopic data repository for research, with more than 40 peer-reviewed publications to date. His other research has focused on reflux esophagitis and Barrett’s esophagus.

A former ASGE president, Dr. Lieberman served as associate editor of Gastrointestinal Endoscopy from 1994 to 1996. In 2006, he was inducted into the Association of American Physicians.

In 2006, he was named a member of the NIH National Commission on Digestive Diseases. Dr. Lieberman is the chairman of the Multi-Society Task Force on Colon Cancer Screening, and he was one of the principle authors of the 2008 Colorectal Cancer Screening Guidelines. He serves as secretary general for the International Digestive Cancers Alliance.

President’s Award
The President’s Award distinguishes an individual as making exceptional contributions to the society and its mission whether through organized volunteer opportunities or singular initiatives supporting the goals of ASGE. Awarded at the discretion of the ASGE president, this year’s honoree is Yang K. Chen, MD, FASGE. He will be honored for his years of ASGE service and outstanding reputation as a master endoscopist, educator and mentor.

Dr. Yang Chen earned his medical degree from the University of the Philippines and completed a fellowship in gastroenterology at Mayo Clinic College of Medicine, Rochester, MN. He is currently a professor of medicine and section head of gastrointestinal endoscopy in the division of gastroenterology and hepatology at the University of Colorado School of Medicine. Dr. Chen also serves as clinical practice director and director of endoscopy at the University of Colorado Hospital.

He has served on numerous ASGE committees, including as chair of the Web Editorial Board and course director and faculty for many ASGE-sponsored educational programs. He currently is associate editor of Gastrointestinal Endoscopy. His commitment to education also is demonstrated by directing various hands-on endoscopy courses and for mentoring fellows and junior faculty.

Master Endoscopist Award
Gregory B. Haber, MD, will receive the Master Endoscopist Award, which recognizes physicians who spend the majority of their time in patient care and are recognized regionally or nationally for their expertise and longitudinal contributions to the practice of gastrointestinal endoscopy.

Dr. Haber earned his medical degree from the University of Toronto in 1970, and he completed his specialty training in internal medicine in 1975 and gastroenterology in 1978. After training at the University of Bristol, he returned to the University of Toronto as a faculty member in the division of gastroenterology.

He served on the staff of Wellesley Hospital and St. Michael’s Hospital at the University of Toronto for 25 years, and he is currently the director of the division of gastroenterology at Lenox Hill Hospital, New York.

He is one of the world’s foremost experts on the treatment of digestive diseases and a prolific researcher. His research has been funded by numerous peer-reviewed agencies and the pharmaceutical and medical device industries. He was an associate editor of Gastrointestinal Endoscopy for eight years, as well as a member of the board of Endoscopy and Techniques in Gastrointestinal Endoscopy.

Distinguished Educator Award
Physician as educator is the focus of the Distinguished Educator Award, which recognizes one or more doctors’ contributions to the education of fellows through endoscopy seminars, participation in national postgraduate courses and published scholarly reviews or educational materials, including videos. This year’s awards will go to Gregory G. Ginsberg, MD, FASGE, and Lawrence J. Brandt, MD, FASGE.

Dr. Ginsberg received his medical degree from Thomas Jefferson University School of Medicine and completed internal medicine residency training, gastroenterology fellowship and advanced endoscopy training at Georgetown University Medical Center. He is a professor of medicine at the University of Pennsylvania School of Medicine, where he is a member of the gastroenterology division and executive director of endoscopic services at the University of Pennsylvania Health Systems, Philadelphia.

His clinical and research interests are in the development of new endoluminal techniques and the evaluation of new technologies for the diagnosis and management of digestive and related disorders.

He has been director or co-director of several ASGE postgraduate courses; has served on the ASGE Postgraduate Education Committee; has been a contributor to the ASGE Learning Center library; has participated in numerous ASGE sponsored hands-on training, research and clinical symposia; and has been on the faculty for the ASGE Annual Postgraduate Course for the past 10 years.

After receiving his medical degree from the State University of New York Health Sciences Center, Brooklyn, Dr. Brandt completed his postgraduate medical education at Mount Sinai Hospital, New York, including his fellowship in gastroenterology. He then served the U.S. Army as a gastroenterology specialist stationed in Stuttgart, Germany. Following his military discharge, he joined the staff of Montefiore Medical Center in the Bronx, where he currently is chief of gastroenterology and a professor of medicine and surgery at Albert Einstein College of Medicine.

An honorary member of the Argentine and Dominican Republic’s Societies of Gastroenterology, he was invited to join the Davidoff Society of the Albert Einstein College of Medicine in 1990. In 2007, he was named Best Teacher in the department of medicine by the house staff. He also completed three terms as a member of the American Board of Internal Medicine subspecialty section in gastroenterology.

Distinguished Endoscopic Mentoring Award
Dennis M. Jensen, MD, FASGE, will be honored with the Distinguished Endoscopic Mentoring Award.

Dr. Jensen earned his medical degree from the University of Washington Medical School, Seattle, and completed a medical internship and first-year medical residency at the University of Oregon and Affiliated Hospitals. After he served the U.S. Army Medical Corps as a preventive medicine staff officer, he completed a second-year medical residency at Wadsworth Veterans Administration (VA) Hospital, Los Angeles, and a fellowship in gastroenterology through a joint program of the University of California, Los Angeles, and Wadsworth VA Hospitals.

A professor of medicine at the David Geffen School of Medicine at UCLA, he also is the associate director of the Center for Ulcer Research and Education (CURE) Digestive Diseases Research Center and the key investigator at CURE. In addition, he is a full-time staff physician in the division of digestive diseases at the UCLA Center for the Health Sciences, where he is also director of the gastrointestinal endoscopy section.

He has been the principle investigator or co-investigator on multiple studies jointly funded by the NIH and the National Institute of Diabetes and Digestive and Kidney Diseases. Also, he currently holds a Merit Review grant and has received other research funding from the VA, Department of Defense, ASGE and industry.

Dr. Jensen sits on several editorial boards and is a regular reviewer for such peer-reviewed journals as Gastrointestinal Endoscopy, New England Journal of Medicine, Annals of Internal Medicine and Journal of the American Medical Association.

Dr. Jensen has served on numerous committees of the ASGE and has served as a councillor on the ASGE Governing Board.

International Service Award
Created to recognize outstanding service by an international member who has made long-term contributions to GI endoscopy, as well as an individual who has been a strong supporter of the educational and research mission of the society, the International Service Award will go to Joseph R. Armengol-Miro, MD.

Prof. Armengol-Miro, who studied medicine in Barcelona, Spain, specialized in internal medicine, laboral medicine and gastroenterology. He is currently a professor of digestive endoscopy at the Autonomous University of Barcelona and chief of digestive diseases and endoscopy service at the University Hospital Vall d’Hebron. He also is founder and director of the World Institute for Digestive Endoscopy Research.

He is a member of the ASGE International Committee and serves as an associate editor for Gastrointestinal Endoscopy. His contributions include serving as president of both the Spanish Foundation of Digestive Endoscopy and the Spanish Society of Medical and Surgical Gastrointestinal Endoscopy. He was acting president of both the Spanish Endoscopy Society from 1986 to 1990 and the European Society for Gastrointestinal Endoscopy in 1995 and 1996.

Honorary Membership
Honorary Members of the ASGE are selected by the society for their contributions to GI endoscopy. This year’s honorees have made outstanding and enduring contributions to the specialty and continue to support GI endoscopy through education, research and leadership. This year’s recipients will be:
• Miguel Munoz-Navas, MD, University Clinic of Navarra, Pamplona, Spain
• Guido Villa-Gomez Roig, MD, Instituto De Gastroenterologia Bolivia-Japones, La Paz
• Kenjiro Yasuda, MD, Kyoto (Japan) Second Red Cross Hospital

Endoscopic Research Awards
After undergoing a rigorous peer-review process, ERAs are presented to physicians who received the highest scores for projects in basic and clinical endoscopic technology research. This year’s recipients will be:
• Samir Gupta, MD, University of Texas Southwestern Medical Center, Dallas
• Peter D. R. Higgins, MD, PhD, MSc, University of Michigan, Ann Arbor
• Robert H. Lee, MD, University of California San Diego
• Mandeep Sawhney, MB, MS, Beth Israel Deaconess Medical Center, Boston
• Ma Somsouk, MD, MS, University of California San Francisco

AstraZeneca Endoscopic Research Award
• Anna Buchner, MD, PhD, Mayo Clinic Jacksonville, FL

Olympus Endoscopic Research Award
• Amandeep K. Shergill, MD, San Francisco Veterans Affairs Medical Center

TAP Endoscopic Research Award
• Tyler Stevens, MD, MS, Cleveland Clinic Foundation

Quality Endoscopic Research Award
• Fasiha Kanwal, MD, MSHS, St. Louis University School of Medicine

Michael V. Sivak, Jr., MD, FASGE, Endoscopic Research Award
The Michael V. Sivak, Jr., MD, FASGE, Endoscopic Research Award is a special grant named for Dr. Michael Sivak Jr., who was the editor of Gastrointestinal Endoscopy from 1997 to 2004. This year’s recipient will be Amit Rastogi, MD, University of Kansas School of Medicine, Kansas City.

ASGE Given Capsule Endoscopy Research Award
Offered to physicians for projects specific to capsule endoscopy research, the ASGE Given Capsule Endoscopy Research Award is made possible through the generous support of Given Imaging, Inc. This year’s recipient will be Gerard A. Isenberg, MD, FASGE, Case Medical Center, Cleveland.

Career Development Awards
The Career Development Awards support junior investigators who are working toward an independent research career in any area of endoscopic research. These awards are supported by educational grants from Cook Medical and Olympus America.
• 2008 Cook Medical Career Development Award: Amandeep K. Shergill, MD, San Francisco Veterans Affairs Medical Center
• 2008 Olympus Career Development Awards: Mohammad A. Al-Haddad, MD, Indiana University School of Medicine, Carmel, and Fay Kastrinos, MD, Brigham Women’s Hospital, Boston

Audiovisual Awards
The Audiovisual Awards recognize outstanding educational productions related to GI endoscopy techniques.
• Audiovisual Award Winner: Roy M. Soetikno, MD, Veterans Affairs Palo Alto, CA, and California Pacific Medical Center, San Francisco
• Audiovisual Award Recipients: Tae Yoon Lee, MD, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, and Tae Hee Lee, MD, Institute for Digestive Research, Digestive Disease Center, Soon Chun Hyang University Hospital, Seoul, Republic of Korea

PENTAX Advanced Fellows Video Awards
• Rajesh N. Keswani, MD, Washington University School of Medicine, St. Louis
• Daniel K. Mullady, MD, Brigham and Women’s Hospital, Boston
• Field F. Willingham, MD, MPH, Massachusetts General Hospital, Boston

Diversity Awards
The Diversity Award is granted to physicians who submitted outstanding abstracts for DDW®, promoting gender- and minority-related health-care research.
• Gender Research Award: Jay J. Yamin, MD, University of Massachusetts, Memorial Health Care, Boston
• Minority Research Award: Kenneth J. Vega, MD, University of Florida Health Science Center, Jacksonville

Cook Medical Don Wilson Award
The Cook Medical Don Wilson Award provides advanced fellows or junior faculty with the opportunity to train outside of their home country with a premier GI endoscopist or group to advance their training. The award was named to honor Dr. Don Wilson, who was a strong advocate and supporter of international education and training in GI endoscopy. The awards are underwritten by a grant from Cook Medical.
• Elena Dubcenco, MD, St. Michael’s Hospital, Toronto, Ontario
• Oleg Ponyatov, MD, Niazov Treatment and Consulting Center, Ashgabat, Turkmenistan

Congressional Service Awards
• Senator Mike Crapo (R-ID)
• Congressman Kendrick B. Meek (D-FL)

ASGE ConMed Award
The ConMed Award recognizes an outstanding manuscript written by a fellow and published in Gastrointestinal Endoscopy. This award, supported by an educational grant provided by ConMed, will go to Christopher Lynch, MD, University of Kansas Medical Center, Kansas City, MO.

Florence Lefcourt Award
• Felice Schnoll-Sussman, MD, Jay Monahan Center for Gastrointestinal Health, New York-Presbyterian Weill Cornell Medical Center, New York

NOSCAR™ Research Awards
The Natural Orifice Surgery Consortium for Assessment and Research™ (NOSCAR) Research Subcommittee announced 14 grant recipients in December 2007. The funds, granted through the Covidien Research Fund, support fundamental research in the emerging transdisciplinary therapy known as Natural Orifice Translumenal Endoscopic Surgery™ (NOTES), an approach that could ultimately represent a major paradigm shift in minimally invasive therapy and patient care.

ASGE and SAGES would like to thank Covidien for their generous support toward NOTES research.
• Edward Auyang, MD, Northwestern University Feinberg School of Medicine, Chicago
• Stacy Brethauer, MD, Cleveland Clinic Foundation
• David Desilets, MD (two awards), Baystate Medical Center, Tufts University
• Annette Fritscher-Ravens, MD, Homerton University Hospital, London
• Jeffrey Hazey, MD, Ohio State University Medical Center, Columbus
• Kai Matthes, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
• Robert O’Rourke, MD, Oregon Health and Sciences University, Portland
• Eric Pauli, MD, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey
• Cyrus Piraka, MD, University of Michigan, Ann Arbor
• Benjamin Pulouse, MD, University Hospitals, Case Medical Center, Cleveland
• Patricia Sylla, MD, Massachusetts General Hospital, Boston
• Philip Wai Yan Chiu, MD, Prince of Wales Hospital, The Chinese University of Hong Kong
• Timothy Woodward, MD, Mayo Clinic, Rochester, MN


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State-of-the-Art Conference will discuss timing of surgery for IBD

The treatment of IBD patients hinges not only on medical and surgical options but also on the timing of interventions. The Monday SSAT State-of-the-Art Conference will feature six presentations and a panel discussion focusing on the optimal timing of surgery.

“We’ve tried to address a range of issues in this decision making on when to do surgery,” said Richard Hodin, MD, conference coordinator. “Some issues are about Crohn’s disease, some are about ulcerative colitis and some are about both.”

The speakers will address factors that complicate the treatment of IBD, including side effects of medications, signs of dysplasia and the development of abscesses, which can all affect the optimum timing of surgery.

Following their presentations, speakers will form a panel to review treatment options in real cases. Each presenter also will write a summary review of the topic for publication in the Journal of Gastrointestinal Surgery.

The effect of treatment on patients and fetuses will be addressed in “Pregnancy: Before, During and After,” by Robin McLeod, MD. She will review the many factors to consider when treating female IBD patients of childbearing age.

“Young women of childbearing age are commonly the right age group for getting these diseases,” said Dr. Hodin. “We will discuss the medicines used to treat the disease, as well as surgery. If a young woman has the disease, maybe she should have the surgery and try to get well, and then get pregnant. If a woman is on medications, she may be contraindicated during pregnancy. Another important issue is that the surgery itself can negatively impact a woman’s ability to get pregnant, perhaps because of scar tissue in the pelvic region.”

Victor Fazio, MD, in “How Medicines Impact Surgical Complications,” will discuss recent studies on the effect of medicines.

“The various medicines used to treat Crohn’s or colitis all have potential side effects, especially on the immune system,” said Dr. Hodin. “There is evidence that some patients taking specific medications will suffer more complications after surgery, perhaps due to effects on their immune systems and their ability to heal.”

The implications of the discovery of dysplasia will be reviewed by David Rubin, MD, in “My Colon Biopsy Shows Dysplasia.” He will talk about whether surgery is the best — or only — option.

“There is a lot of debate regarding dysplasia. It is a precancerous lesion, but may be a marker for a more worrisome field defect,” Dr. Hodin said. “Does the patient with dysplasia have cancer somewhere else? Do you operate right then or do you repeat the colonoscopy to confirm dysplasia and/or screen for actual cancer?”

“Some people say that if it is high-grade dysplasia you do surgery and if it is low-grade you can wait. Other people say that if you have a low-grade dysplasia that you should go to surgery right away,” he said.

The indications and timing for surgery in patients who have severe colitis that does not respond to initial medical therapy will be reviewed by Bruce Sands, MD, in “Fulminant Colitis.”

“A lot of issues come up when the usual medical therapies for colitis are failing. Should you perform surgery right then or try more powerful medications, risking potential side effects and the possibility that the patient will get worse while waiting for the surgery?” asked Dr. Hodin.

James Fleshman, MD, will address abscesses and infections, focusing on the best time for surgery in “Pyogenic Complications of Crohn’s.”

“Depending upon the nature of the infection, the question is whether surgery should be done, and, if so, when is the best time in relation to that infection,” said Dr. Hodin.

Dr. Hodin is professor of surgery at Harvard Medical School and surgical director of the Massachusetts General Hospital Crohn’s and Colitis Center, Boston. Dr. McLeod is a professor of surgery at the University of Toronto. Dr. Fazio is chair of the department of colorectal surgery at the Cleveland Clinic. Dr. Rubin is an associate professor of medicine at the University of Chicago. Dr. Sands is an assistant professor of medicine at Harvard Medical School. Dr. Fleshman is a professor of surgery at Washington University School of Medicine, St. Louis.

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Council chair leaves enduring impact

As DDW® Council chair, Carlos Pellegrini, MD, has endeavored to balance the needs of the four DDW societies — AASLD, AGA Institute, ASGE and SSAT — over the past six years. At this year’s DDW, Dr. Pellegrini will complete his tenure, leaving a lasting impression with his fellow Council members.

“I got to know him while working on the Council, and I’m an unabashed fan,” said Lawrence S. Friedman, MD, DDW Council secretary treasurer. “He’s a smart, energetic and enthusiastic leader. He’s a consensus builder, and he has a dazzling personality. He just has all the ingredients to make things work.”

Thanks to his firm, fair and good-natured manner, the work of the Council was always constructive.

“Carlos has a graceful, light manner, but there is steel underneath and, when necessary, he’ll take charge and redirect the meeting,” said ASGE President Grace Elta, MD, FASGE. “The Council meetings have been collective and productive, and he has been able to elevate the Council so that DDW and its benefits to the societies come first.”

Dr. Pellegrini said that he has made it a tenet to look after DDW — not after any one of the organizations, but after the combined educational venture.

“Once you are viewed as fair, trust increases among the members and very soon, when confronted with a problem, all you have to do is ask those who are in conflict to meet outside and solve it by themselves, or come back without a solution which forces the chair to make that decision for them,” Dr. Pellegrini said. “Everyone soon realizes that it is better to give a little than to have someone else make the decision for you.”

With 45 percent to 55 percent of DDW attendees coming from outside the U.S., Dr. Pellegrini reached out to embrace this large contingent, helping to bring Spanish and Japanese translations to many of the DDW sessions. He also led the Council in adding the position of the secretary-treasurer.

Dr. Pellegrini is a professor and chair of the department of surgery at the University of Washington, Seattle. Dr. Elta is a professor of medicine at the University of Michigan, Ann Arbor. Dr. Friedman is professor of medicine at Harvard Medical School and Tufts University School of Medicine, Boston, chair of the department of medicine at Newton-Wellesley Hospital and assistant chief of medicine at Massachusetts General Hospital.

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AASLD President’s Profile

AASLD President Arthur J. McCullough, MD, is a champion for AASLD and its efforts to be the leading organization focused solely on advancing the science and practice of hepatology. However, he’s not one to allow the association to rest on its laurels.

“We’re a sound organization in terms of educating and promoting science. In the area of liver disease, we’re the premier organization that does that. We’ve been very successful, but I want to make sure that we embrace clinicians and clinical scientists,” said Dr. McCullough, a professor of medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

Imperative to supporting the membership is to provide alternative funding sources.

“In the face of diminishing funding from pharmaceutical companies and decreased funding from government agencies, the most important thing right now is to strengthen our financial basis so we can continue to supply grants for fellows and researchers,” said Dr. McCullough, who is also chairman of the department of gastroenterology and hepatology at the Cleveland Clinic.

With NIH funding 10 percent of grant applications, the ramifications are far-reaching, he noted.

“There are a lot of good, established people who may not get funding. If you close a lab, you lose the ability to train another generation of investigators and the development of new innovations in liver disease is impaired,” he said. “We won’t even have the people to perform clinical trials.”

One method to combat such a decline in resources will be AASLD’s Bridge Funding program, which will allow for the support of a small number of established investigators to “bridge the funding gap” and help them maintain their labs.

The Bridge Funding will be supported by internal funds, which will be shored up via new fundraising initiatives to increase the association’s endowment and support liver scholars, hepatology fellows, nurse practitioners and the like. To reach this goal, AASLD is considering strategies for fundraising consistent with its strategic plan.

Beyond supporting researchers in their labs, Dr. McCullough said that AASLD needs the funding in order to continue to deliver high-quality continuing medical education, such as through its Annual Meeting, DDW® and Single Topic Conferences (STC).

“We have a lot of educational symposia, but each STC, for example, costs more than $120,000,” he said. “They are all very valuable, but we have to find ways to sustain them.”

Another focus for Dr. McCullough is to extend AASLD’s outreach to clinicians. He brought a third Presidential Plenary to DDW, and he has proposed that AASLD widen its electronic presence to include a Web-based journal, which will be devoted to clinical trials and public policy.

While AASLD honors its members with the Distinguished Achievement Award and Distinguished Service Award, Dr. McCullough has spearheaded the addition of a third award to honor nonscientists — the Distinguished Clinician/Educator Award, which will be presented for the first time at this year’s AASLD Annual Meeting.

AASLD has long strived to meet the needs of its subspecialty members, and Dr. McCullough has additionally supported that by working to supplement programming at the Annual Meeting — programming for pediatricians and transplant surgeons.

“AASLD has a number of active committees, and we could not function without them. They are extremely important,” he said, “but there has been some under representation by these smaller, but important AASLD groups.”

While AASLD already has developed a close working relationship with the European Association for the Study of the Liver, Dr. McCullough is heading efforts to enhance collaborations with other international associations. In March, AASLD held a global summit of international organizations to pursue mutual areas of interest.

“These are exciting times for hepatologists in light of a palette of new and exciting therapies for our patients, but we must be creative and forward thinking in establishing financial stability for the organization,” Dr. McCullough said.

AASLD President Arthur J. McCullough, MD
Arthur J. McCullough, MD, is a professor of medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University and chairman of the department of gastroenterology and hepatology at the Cleveland Clinic.

After Dr. McCullough earned his medical degree at the State University of New York, he completed his internal medicine training at the Cleveland Clinic Foundation. He obtained his fellowship training in gastroenterology at the Mayo Clinic College of Medicine, Rochester, MN. He joined the faculty at Case Western Reserve University in 1980.

Dr. McCullough has served on various AASLD committees, including the Basic and Clinical Research committees, the Education Committee, Program Evaluation Committee and the Nominating Committee. He has also participated in the AASLD Strategic planning retreat and the AASLD abstract selection process, and he has served on the American Liver Foundation Grants Selection Committee.

Dr. McCullough, who has authored more than 140 articles, is a past associate editor of Hepatology and has served on the editorial boards of Hepatology and Gastroenterology Digest.

His research interests include the investigation of the pathophysiology and treatment of non-alcoholic steatohepatitis and alcoholic steatohepatitis, study of the normal response of protein and energy metabolism during feeding and how the presence of cirrhosis affects that response, and the further delineation of the causes of abnormal energy and protein metabolism in cirrhosis, while evaluating new nutritional and pharmacologic strategies in vivo to correct malnutrition in chronic liver disease.

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