A Conversation With Zobair M. Younossi, MD, MPH

In this issue, HCV Next asks five questions of Zobair M. Younossi, MD, chairman of the department of medicine at Inova Fairfax Hospital and vice president for research at Inova Health System in Falls Church, Va.

Younossi received his MD from the University of Rochester School of Medicine and Dentistry in New York in 1989 (Alpha Omega Alpha). He then moved to Scripps Clinic and Research Foundation in La Jolla, Calif. To complete a fellowship in gastroenterology and hepatology. During this time, he also earned an MPH at San Diego State University School of Public Health where he received the Hanlon Award and Outstanding Student Award at San Diego State University. His next position was as Staff Hepatologist and Senior Researcher at the Cleveland Clinic Foundation.

In addition to an extensive bibliography of publications in gastroenterology and hepatology, Younossi has served as the co-editor of Liver International, the associate editor for Evidence Based Gastroenterology, and as an editorial board member for Hepatology. He has served on multiple boards, including the Authority Board of the Virginia Biotechnology Park, the Board of Trustee of Chronic Liver Disease Foundation and the Vice Chairman, Inova Health System Foundation Board.

What was the defining moment that led to your field?

My interest in hepatology became obvious during my fellowship in GI. It was the most interesting and intriguing part of medicine to me because it required not only thinking about complex diseases that impact mortality or survival of individuals but also severely impair their quality of life. I wanted to be involved in an area of medicine that will keep me engaged in something that enhances patients’ quality of life as well as their quantity of life. Since liver disease also has tremendous impact on health care costs, I have also been quite interested in cost of care for patients with liver disease. By focusing on the comprehensive outcomes of patients with liver disease (clinical and quality) in the context of delivering the most cost-effective care, I have increasingly been interested in the area of value-based medicine and to use these principles to maximize value for our patients with liver disease.

What area in hepatology most interests you and why?

There are a number of areas of research that I have been engaged. From the very early stages of my career, I have been interested in the assessment of patient-reported outcomes in patients with liver disease such as hepatitis C. Simultaneously, I have spent a great deal of time focusing on health care economics related to liver diseases. These two areas and my general interest in clinical hepatology have led to my interest in the implementation of value-based medicine in hepatology. These issues are important from the patient perspective, health care provider perspective and from the societal perspective.

Another liver disease that I have been involved with since the beginning of my career is non-alcoholic fatty liver disease. Specifically, over the past two decades, I have primarily focused on the epidemiology, clinical and economic impact of NAFLD in the United States and globally.

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

From the beginning of my career to today, there have been three things that have been truly miraculous.

The first is the discovery of HCV and the recent development of treatment regimens with almost 100% cure rates. This spans a 25- or 30-year period, which is essentially my whole career. It has been absolutely amazing to be part of this and witness this amazing advancement in the field of hepatology.

The second is liver transplantation. When I was in training, liver transplantation was considered an experimental treatment. Now it is the standard of care with excellent long term outcomes.

The third is the appreciation of the most common liver disease worldwide: non-alcoholic fatty liver disease. We are understanding this disease more, which means we can develop better diagnostic and prognostic tests and better treatment options for these patients.

What’s up next for you?

I have been very blessed to have an ideal career. I have been able to combine clinical, translational and health service research with clinical practice of hepatology. Additionally, I also have administrative responsibilities as chairman of medicine and VP of research. This combination of three or four different things which, for me, has been quite rewarding and enjoyable. I wouldn’t want to focus on one of these areas alone, so I hope to continue to do a combination of these areas that I enjoy.

In terms of research, we are going to continue to work on the issues related to quality of life, value-based medicine, non-alcoholic fatty liver disease and outcomes research in hepatology in general.

Who has had the greatest influence on your career?

I have been fortunate to know three individuals who served as mentors for me, although I was never trained directly by them. On the research side, Gordon Gayatt, MD, MSc, distinguished professor in the Department of Clinical Epidemiology & Biostatistics at McMaster University in Ontario, Canada, mentored me in quality of life research. Another is Anthony Tavil, MD, a colleague at Cleveland Clinic who exemplifies a wonderful clinician and a great man. The third is Willis Maddrey, MD, Adelyn and Edmund M. Hoffman Distinguished Chair in Medical Science and Arnold N. and Carol S. Ablon Professorship in Biomedical Science at the UT Southwestern Medical Center. He has been a kind and encouraging colleague to me.

Disclosure: Younossi reports no relevant financial disclosures.