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A Conversation with Ira M. Jacobson, MD
In this issue, HCV Next asks five questions of Co-Chief Medical Editor Ira M. Jacobson, MD. Jacobson is chief of the division of gastroenterology and hepatology and Vincent Astor Distinguished Professor of Medicine at the Joan Sanford I. Weill Medical College of Cornell University, and also serves as an attending physician at New York-Presbyterian Hospital, Cornell Campus.
Ira M. Jacobson
Jacobson graduated summa cum laude from Yale University. After completing his medical degree at Columbia University College of Physicians and Surgeons, he moved on to complete his residency at the University of California, San Francisco, and received board certification in internal medicine. Next was a fellowship in gastroenterology at Massachusetts General Hospital and Harvard Medical School, after which he received board certification in gastroenterology.
His primary areas of interest include hepatology, infectious diseases and endoscopy. He has served as principal investigator on a number of landmark studies and delivered lectures around the United States and globally.
What was the defining moment that led you to your field?
One occurred when I was a student in my third-year clerkship at Columbia Presbyterian Hospital. There was a patient with advanced cirrhosis who had a number of manifestations of liver failure, and I found myself absolutely fascinated by the protean effects of end-stage liver disease. It brought home to me the myriad physiological functions the liver serves “below the radar” of everyday consciousness and made me interested in the pathophysiology of various systemic manifestations like ascites, encephalopathy and internal bleeding.
The second was when I was interviewed for an internship by Marvin H. Sleisenger, MD, at the VA Hospital in San Francisco. In several stacks on the floor of his office were copies of his recently published, now classic text on gastroenterology. This was a book I had already learned to love to thumb through at a moment’s notice. I was fascinated by diversity of organ systems and disease entities one deals with as a gastroenterologist. I admired Dr. Sleisenger greatly as a teacher and as a versatile clinician when he made rounds at UCSF. Much later, in one of those ironies of life, I became the chief of gastroenterology and hepatology at Cornell, a position in which Dr. Sleisenger had served many years before.
Who has had the greatest influence on your career?
Ralph L. Nachman, MD, was chairman of medicine at Cornell when he named me division chief of gastroenterology and hepatology in 1998. It gave me an opportunity that does not come along frequently in academic medicine: the opportunity to assume a position of academic leadership from a background heavily oriented toward clinical practice that even included a stint in private practice. Dr. Nachman consistently made me feel that I was capable of doing bigger things that I believed I was capable of doing. I would regularly leave his office feeling inspired. Dr. Nachman was a leading hematologist and biomedical scientist who gave a clinician an opportunity to lead one of his major divisions.
What advice would you offer a medical student today?
If you have a passion for a particular area, pursue it to the utmost. Let your passion take you where it will, as opposed to trying to calculate what the best area will be. The passion part worked well for me. When I went into hepatology and the study of viral hepatitis in particular, I did not necessarily have the foresight to realize that the causative agent of a disease called post-transfusion non-A, non-B hepatitis would be responsible for this vast reservoir of heretofore-unexplained liver disease in the community. Following my area of interest led me to this extremely fruitful and productive endeavor that has been fulfilling intellectually, clinically and academically.
What area of research in hepatitis most interests you?
What it has always been: the development of antiviral therapy for viral hepatitis. Along with liver disease, infectious diseases have always sparked my interest. When I was an intern at UCSF, a dynamic ID fellow, Don Ganem, MD, gave the house staff a lecture on hepatitis B and the causative virus. The hepatitis B e-antigen had just been discovered. I became extremely interested in the mysteries underlying the biology of hepatitis viruses, what they were capable of doing to the human liver and how to conquer them. Even with all the work already done to drive the current paradigm shift in HCV therapy, there is still important work to be done. Simultaneously, we face the great challenge of eradicating HBV infection as the next major leap in viral hepatitis therapy.
Have you ever witnessed medical history in the making?
All health care providers in the field of viral hepatitis are part of history in the making right now. I consider myself privileged to have a seat at the table with international leaders who are helping to drive a revolutionary shift in the way we treat HCV. It is humbling to be part of such a movement.