A Conversation with Robert S. Brown Jr., MD, MPH

Issue: February 2016

In this issue, HCV Next asks five questions of Robert S. Brown Jr., MD, MPH, vice chair, Transitions of Care, and interim chief, division of gastroenterology and hepatology at Weill Cornell Medical College in New York.

Brown completed his bachelor’s degree at Harvard College and received his MD from New York University. It was then back to Beth Israel Hospital in Boston for his internship and residency. Brown then went to the west coast again — this time at the University of California-San Francisco Medical Center — for a fellowship in gastroenterology and hepatology. While there, he attended the University of California at Berkeley and obtained a Master of Public Health degree.

Robert S. Brown Jr.

His primary specialty is transplant hepatology, but he is also board certified in internal medicine and gastroenterology.

Who has had the greatest influence on your career?

I have had the good fortune of working with some great transplanters. As a fellow, John Lake, MD, was my hepatology mentor. John P. Roberts, MD; Jean C. Emond, MD; and Nancy L. Ascher, MD, PhD, were the surgeons there. They instilled a love not only of transplant hepatology, but also of the team spirit that builds the transplant field. Nancy and John taught me most of what I know about post-transplant management. Jean taught me about a comprehensive liver program. Jack taught me the principles of clinical research and got me started in that direction.

What advice would you offer a medical student?

Keep an open mind. Be passionate about everything you do. Find the field where the people inspire you. Look around and find the people who you like and are most like you, and go into that field.

Don’t think in categories; think in tasks. Think about how much time you want to spend in the office, how much time you want to be doing procedures, how much time you want to spend on research, do you want to teach, how much time do you want to spend on an inpatient service vs. an outpatient practice. If you start thinking about those questions, you will figure out a career that involves most of the things you like and few of the things you don’t like.

What was the defining moment that led you to your field?

I always knew that I wanted to do something surgical. I liked intervention. I thought I might be a plastic surgeon to do reconstructive surgeries on babies that required it. But I also really wanted to have relationships with patients over time, so I chose medicine. GI was attractive because it was procedural and because it offered the chance to build those patient relationships. When I did my first rotation on the transplant service at UCSF, it had all the elements: surgery, long-term patient relations, the sickest patients with a chance to make them well. Once I spent my first month on that rotation, there was nothing else.

Have you ever been fortunate enough to witness or to have been part of medical history in the making?

I was part of the first NIH consensus conference summarizing the early results of living donor that led to my first paper in The New England Journal of Medicine. Then after the unfortunate donor deaths, I was asked to serve and eventually chair the living donor guideline committee for the United Network for Organ Sharing.

Our team is now helping lead laparoscopic left lobe living donation to make the operation safer, more acceptable and thus more applicable. This is what I’ve been working toward since my time at UCSF, and this direct impact on saving lives has been incredibly satisfying.

What area of hepatology interests you most now?

Right now the biggest questions surround the HCV patients with the most advanced disease. Can we make people better so they don’t need a liver transplant or come off the list? We also have to think about whether antiviral treatment puts HCV patients at a disadvantage, if it’s better to treat them after the transplant. Patients with small cancers are also interesting. If we ablate those cancers or do a resection, will curing HCV prevent the cancer from returning and therefore, avoid transplant? Those are the biggest unanswered questions in hep C right now.