Secretary General’s Farewell
Authors: Jean-Michel Pawlotsky
Journal: Journal of Hepatology (2009)

The European Association for the Study of the Liver (EASL) has established itself as the leading pan-European association of medical professionals dedicated to promoting liver research and care in Europe. The growing success of EASL reflects the increasing medical importance of liver diseases, as well as the quality and vitality of European research in this field. Leaving the position of EASL Secretary General after four years in the (non-oval) office gives me the opportunity to look back at our achievements and think about the challenges ahead. EASL was founded 45 years ago, as a small group of investigators interested in liver research and care. Its growth during successive years has been steady, but slow. EASL’s metamorphosis started about 15 years ago, thanks to the vision of Christian Bréchot, then EASL Scientific Secretary. The creation of the position of Administrative Secretary, aimed at ensuring political and administrative continuity at the highest level of the Association, and the establishment of an embryo of a centralized office (in fact with Isabelle Porteret, Christian’s hospital secretary, in the room beside his office) were the first steps towards a professional organization. His successors (Mario Mondelli, Andrew Burroughs, Detlef Schuppan, Jordi Bruix and Massimo Levrero) and their Scientific Committees continued to build on these foundations. The day of my election as EASL Scientific Secretary, during the Annual Meeting in Paris in April 2005, I found a wealthy association efficiently running its scientific and educational activities and its successful Annual Meeting. EASL was ready to face the challenges of a modern scientific association in the changing environment of the early 21st century. The reinforcement of the political and administrative structure of EASL appeared from the beginning as a top priority. Switching the scientific leadership of the old EASL “Scientific Committee” into the clear political leadership of a reinforced, more experienced “Governing Board” was the first step, which was achieved in April 2006 through the approval by the EASL Business Meeting of a new Constitution. Extending up to 48 years the upper age limit of incoming Scientific Committee members and increasing the total number of Governing Board members to 10, all of different nationalities, including the two Educational Councillors and the Treasurer who have no age limit, brought invaluable experience, political skills and perspective into the EASL Governing Board. The creation of the position of Vice-Secretary, number 2 in the hierarchy of the Association and future Secretary General, provided the opportunity for an efficient executive pair at the highest level of the Association, while ensuring sufficient training for the incoming Secretary General. With a better form of government, EASL was ready for further changes. Making even more appealing an already successful and attractive Annual Meeting was a challenge. The growing interest of the pharmaceutical industry in liver diseases, especially viral hepatitis, was felt to be an opportunity to grow, but also a threat to the integrity and diversity of our programmes. How could we surf on the wave without being swept away? The first decision was to create a Late-Breaker session. Since then, these sessions have attracted cutting-edge science, a very large audience, and exceptional media coverage, making them one of the highlights of the EASL Annual Meeting. The decision was also made to substantially increase the educational offer during the Annual Meeting sessions. The number of Early Morning Workshops was progressively increased from 8 to 24 (12 per day) and the number of thematic EASL Symposia from 3 to 12, while a number of educational pre-meetings, organized jointly with various sister organizations, were run in the morning preceding the start of the EASL Post-Graduate course. In parallel, the schedule of the Annual Meeting sessions was definitively fixed and the readability of the scientific programme was improved. In order to ensure that a majority of our attendees could find something of interest at any time during the meeting, the sessions were organized to follow four parallel streams, from the early morning to the end of each day: viral hepatitis, basic science, general hepatology, and liver transplantation/hepatocellular carcinoma (the latter was introduced this year in Copenhagen). Room was given to the patients’ representatives who can speak at the Opening General Session and for the first time this year will organize a workshop during the Annual Meeting. Through the creation of the EASL Recognition Awards, which are presented every year during the second General Session of the meeting, EASL has been proud to honour the men and women who wrote the history of European and International hepatology. These ceremonies have been deeply moving. Overall, these changes have met with success since the attendance at our meetings has jumped from approximately 4500 to nearly 7500 participants at the Annual Meeting in Milan in 2008, bringing the EASL Annual Meeting to a size comparable to the Annual Meeting of the American Association for the Study of Liver Diseases (AASLD), with a very high level of satisfaction. The EASL Annual Meeting became “The International Liver Congress™’ this year. This is a protected trademarked denomination, which offers a number of opportunities for future educational and scientific, as well as fundraising, developments. Besides its Annual Meeting, EASL runs a number of scientific and educational activities throughout the year. It was decided that EASL would now offer full funding and centralized practical organization of the EASL Monothematic Conferences, allowing their scientific organizers to concentrate on the scientific programme only. The success of the clinical, but also the basic EASL Monothematic Conferences is amazing. It clearly shows the need, besides the Annual Meeting, for smaller thematic scientific conferences that revive the spirit of the Association as it stood 20–30 years ago. EASL Special Conferences were created with the intent to cover broader topics and attract a larger number of attendees than Monothematic Conferences. The first EASL Special Conference on “Hepatitis B and C Viruses Resistance” convened over 800 participants in Paris, France, in February 2008. It was jointly organized with the AASLD, the Asian-Pacific Association for the Study of the Liver (APASL), the Latin-American Association for the Study of the Liver (ALEH) and the International Association for the Study of the Liver (IASL). The next EASL Special Conference will be held in Bologna, Italy, in autumn this year on the topics of Non-Alcoholic Fatty Liver Disease (NAFLD)-Non-Alcoholic Steatohepatitis (NASH) and many other special conferences will follow. The past few years have seen the emergence of new modes of communication and teaching. EASL decided to webcast several of its educational events, including the Annual Meeting Post-Graduate Course and EASL Monothematic Conferences considered to be of broad scientific interest. The lectures can be watched on the web or podcasted for subsequent viewing. EASL webcasts also offer the unique possibility of recreating a slide library from the full collection with a few keywords and a simple click. More recently, the EASL e-series have been launched as a new learning experience. E-series are state-of-the-art presentations by world-recognized experts providing in-depth coverage of a single topic for on-line viewing, download or podcast. The success of EASL’s e-learning programmes has been immediate and early access to EASL webcasts and e-series is now among the principal reasons for new EASL members to apply. The challenge of establishing a strong relationship with other continental liver societies and building a more global alliance has been taken very seriously. In November 2005, a Memorandum of Understanding was signed between EASL and AASLD, establishing a privileged relationship between the two societies. Since then, a number of events have been co-organized, co-funded or endorsed by the two societies on both sides of the Atlantic Ocean. The dialogue and cooperation between EASL and AASLD is constant, friendly, and constructive. Solid links have also been established with ALEH, which materialized with the organization of an ALEH–EASL–AASLD Post-Graduate Course during the last ALEH Bi-Annual Meeting in Venezuela in September 2008. Latin-American fellows were also selected by ALEH to attend an EASL School of Hepatology. EASL is now present in China, where it co-organizes every year an “EASL Annual Meeting Highlights” programme with the Chinese Society for Liver Diseases. International collaborations have been further expanded by the launch, on the initiative of EASL, of an Annual Global Liver Summit of continental liver societies’ top executives. Better harmonization of the societies’ policies and common initiatives are expected. As one of the two principal continental liver societies, EASL has the crucial mission of influencing liver disease management decisions as well as reimbursement and management policies in Europe and abroad. The decision to launch a Clinical Practice Guidelines programme was a major step forward for the Association. The ability of the European liver society to guide diagnosis and management of liver diseases on an exclusively science-driven basis is indeed of utmost value in a medical world too often governed by the pharmaceutical industry and the regulatory agencies, with little intellectual input from the academic world. Thanks to the involvement of a number of Clinical Practice Guidelines panellists and external reviewers and to the efforts of the EASL Governing Board, their success has been immediate. The outstanding impact of the EASL Clinical Practice Guidelines on Management of Chronic Hepatitis B, in Europe and far beyond, reinforced the determination of EASL to pursue this effort and cover a large number of clinical and therapeutic areas. As a leading scientific association, EASL’s responsibility is also to seek policy recognition for the focus of its activity, so as to shape an environment conducive to research and health initiatives on liver diseases. This is why we decided to launch an ambitious Public Policy initiative in order to address the fact that, in spite of their high prevalence, morbidity and mortality, liver diseases are all too often neglected by both national and European Union (EU) policy-makers. EASL’s goal is to shape the European policy environment in order to win recognition of liver diseases as a major cause of illness and death affecting too many patients in the EU. The objectives of EASL’s European advocacy and communications strategy are to make liver diseases a priority both in EU public health policy and research policy; to raise EASL’s profile as an association and to establish its members as points of reference and key advisors to European policy makers; and to increase awareness amongst citizens about the causes of liver diseases, prevention and screening. This is a long-term effort, the results of which will not be known for many years to come. However, tangible results can already be acknowledged: EASL is now recognized as the scientific interlocutor by all major European stakeholders; the collaboration with the patients’ associations (the European Liver Patient Association, ELPA, and the World Hepatitis Alliance) has been fruitful and several important decisions have been made under the combined influence of EASL and patients’ groups at the European level; last, but not least, liver diseases have now more weight in the research funding calls of the Commission’s 7th Framework Programme. These efforts must now be sustained and extended. The extension and growing complexity of EASL activities made professionalization of EASL administration and everyday handling an absolute and urgent need. In this respect, the opening, in January 2009, of the EASL Office in Geneva, is the most important step forward of our association since its creation. The EASL Office will provide the Association with the operational capacity to function with dedicated, faithful, independent personnel. The administrative, financial, political and operational tasks of EASL will be handled by four full-time professionals, while two additional EASL officers will run the central office of the Journal of Hepatology that will become operational with the next international editorial team. This new structure has already profoundly transformed the management of the Association, which now reaches the level of organization of the most successful international scientific societies. Taking into account EASL growth and extended missions, the EASL Governing Board has been working, with the EASL staff and branding professionals, to give EASL a new unified brand identity. The starting point for this branding process has been the creation and design of a new EASL logo, which will be phased in over the next weeks to months through our different publications, meetings, our website and other communication tools. This was the last, important symbolic change of a long list. EASL’s current relative wealth is the result of the growing interest over the past few years of the pharmaceutical industry in viral and tumoral liver diseases in a relatively liberal environment regarding both scientific society funding and sponsored meeting attendance. Worrisome signals recently came from North America indicating that this situation might not last for ever. The difficult economic times, ongoing and expected pharmaceutical company mergers, as well as foreseeable changes in the European regulatory environment make the current EASL economic model unviable on the mid to long term. The establishment of a strong and efficient fundraising policy, independent of direct sponsorship by the pharmaceutical industry, is the principal challenge our association will have to face in the coming years. The new EASL leadership and the EASL Office are strongly committed to this vital task. Despite being an association of individuals, EASL will have to face crucial national and international challenges. Internally, the influence, representation, and participation of individual EASL members from the smaller west European nations and, most importantly, from east European nation will have to substantially increase. A better gender balance is also needed. Externally, the reinforcement of the links with AASLD is an absolute priority. Continental scientific societies represent the only credible academic counter-power against government and private sector interests. The goal of Clinical Practice Guidelines written together by both societies is achievable. Speaking with one voice to international stakeholders and policy makers, controlling the flow of scientific information and being able to generate independent international clinical trials addressing scientific and clinical practice issues is possible. In this respect, the creation of Clinical Research Networks or Consortia and the establishment of strong transatlantic relationships is a credible and useful approach. The recent creation of an EASL-Chronic Liver Failure (EASL-CLIF) Consortium, tightly connected with a similar network in North America, is a first step in the right direction. Reinforcement of our links with other societies, such as ALEH and APASL, either bilateral or within the Global Alliance, is also an important challenge if one thinks that the vast majority of liver patients live in these areas, where the level of clinical hepatology is high, the economy growing and bench research booming. The relationship between hepatology and gastroenterology has always been complex and emotive. The question of making hepatology an independent “specialty” in Europe has been raised a number of times. EASL’s position is that this issue can be addressed only at a national level, should it be desirable. Years ago, EASL joined a number of other, generally smaller, scientific societies, in the United European Gastroenterology Federation (UEGF), the role of which was to organize the yearly United European Gastroenterology Week (UEGW), a scientific and educational event in which EASL was responsible for the liver programme. Recent reorganizations and initiatives indicate that UEGF may evolve to become the European Gastroenterology society. This is excellent news as such a society is needed. Nevertheless, the move implies that EASL will have to leave this organization and establish a new, constructive relationship with it. There is room in Europe for two independent scientific societies which do not overlap in their objectives and collaborate to organize events whereby each society is responsible for its own programme. Our American colleagues have shown us that this was possible. EASL is ready for these changes. I took up the position of EASL Scientific Secretary in 2005 without any particular joy or happiness. Reaching this position had never been a dream or a career objective. It just happened, thanks to Jordi Bruix, and I was aware of the enormous task and challenges ahead. I am now leaving the position of EASL Secretary General with pride, joy and no regrets. Leading EASL has been an extraordinarily exciting experience, but EASL is not everything, and other exciting experiences are ahead. I am looking forward to these new challenges. I would like to thank the Governing Board members I worked with, many of whom became my friends. Some days (and nights) will remain in our memories for ever. I would like to thank Laetitia Bru, who helped me run EASL for 4 years through calm and storms, for her courage, involvement and tenacity: EASL owes her a lot. I would like to thank Grégoire Pavillon who accepted the task of building the new EASL Office with passion and enthusiasm. I would like to thank the editorial team of the Journal of Hepatology for having made a better and better journal and supported EASL’s growth and changes. I would like to thank the EASL members for their support and the participants in all our activities who, day after day, build the success of EASL. I would finally like to thank Daniel Dhumeaux, my mentor, all my collaborators, and my family. Doing this job for four years needed support from the ones who count. Through the successes and failures, the good decisions and mistakes, I have learnt, and for this, I would like to thank you all. Long life and good luck, EASL ! Paris, April 3, 2009