Go East
Authors: Markus Peck-Radosavljevic
Journal: Journal of Hepatology (2013)

Dear friends of EASL,More than 20 years ago we witnessed several big changes to the geopolitical situation in Europe. It started with the disintegration in South Eastern Europe with the state formally known as Yugoslavia breaking up into several independent states. And it continued with the fall of the iron curtain and the break-up of the USSR into Russia and a larger number of countries including the Baltic States and the CIS countries. The opening of the borders of many of those countries lead to rapid economic changes that preceded the political integration of several Eastern European Countries into the European Union in 2004, in 2007 and finally in 2013. Despite the dramatic economic and political changes in many of the Eastern Countries, healthcare in many of those has not improved at the same pace. This may be related to the fact that health is not the first priority area when big social and political changes are happening. But this may also be due to the fact that health at least within the European Union remains a Member State issue that is much more dependent on local regulations and custom than the more general rules of the Union would allow for in the area of economy or finance. And several of the new Member States were particularly affected by the financial crises of 2008 and are still suffering from its aftermath, leaving less money for health related issues and innovation in healthcare.These changes within Europe and the neighboring countries have also had a profound effect on professional medical associations like EASL. For many years we have been reaching out to our fellow hepatologists, gastroenterologists, and infectious disease specialists from neighboring countries to invite and join our community and to integrate into the European framework of liver specialists through participation in the International Liver Congress and many other educational activities. This outreach was rewarded with success: EASL membership statistics show a steep increase in membership for those countries with the Top 5 being Romania, Turkey, Russia, Bulgaria, and Croatia with increases of more than 400% in some of these countries. Likewise, we are witnessing a good increase in participation at the educational and scientific sessions at the International Liver Congress from year to year from our Eastern and South Eastern neighbors. And even the active participation in our meeting as measured by the submission of abstracts from these countries has improved a lot. At least two of these countries can now be found amongst the top 20 submitters of abstracts.At the same time there are still some quite significant gaps in knowledge about liver disease, training in the management of liver disease, and research training in liver disease in many of those countries beyond the recognized centers of excellence. When EASL was compiling the data for its White paper on the burden of liver disease in Europe [[1]Blachier M. Leleu H. Peck-Radosavljevic M. Valla D.C. Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data.J Hepatol. 2013; 58: 593-608Abstract Full Text Full Text PDF PubMed Scopus (901) Google Scholar], a lot of blanks remained on the map, particularly relating to published data outside the field of viral hepatitis. And when reviewing the applications for the EASL fellowship program in the past two years, we noticed that very few came from Eastern European applicants. EASL recognizes that waiting for things to improve by themselves might not be enough and is determined to play a much more active role to homogenize expertise and training in all of Europe and its neighboring countries. In order to do this, the EASL business plan for the next few years should include three focus areas:Clinical training in many countries is already at a high standard in a few centers of excellence but a similar standard cannot be achieved in many smaller centers in the region. Improving this situation would require a joint effort of local professional medical societies together with EASL to organize local trainings at a higher standard because many of the physicians in the more remote areas will not have the opportunity to frequently travel to EASL events.We need to foster interest in clinical research and provide training in clinical research beyond centers of excellence, which are already integrated into the international clinical trials landscape. In particular, we should try to raise interest in conducting local investigator initiated trials that will help to document standards and improve the quality of care in those countries.And last but not least we need to provide research training in translational research: participation in the young investigator master class and engagement with the EASL fellowship program including Entry Level, Sheila Sherlock, and Physician Scientist Fellowships should be an integral part of achieving this goal.But EASL also recognizes that developing a fruitful strategy to advance towards those goals cannot be achieved by the EASL governing board on its own. We need to integrate scientists and educators from Eastern Europe and neighboring countries into an advisory body that will provide us with the necessary local knowledge to make use of our resources in the most efficient way.So while in the 19th century the right thing to do for gold-diggers was to go West, in the 21st century the call is out for hepatologists to go East: this is not about finding gold, it is about getting the best of patient care and research into a large geographic region with a high burden of chronic liver disease and a large unmet need to take care of it. Dear friends of EASL, More than 20 years ago we witnessed several big changes to the geopolitical situation in Europe. It started with the disintegration in South Eastern Europe with the state formally known as Yugoslavia breaking up into several independent states. And it continued with the fall of the iron curtain and the break-up of the USSR into Russia and a larger number of countries including the Baltic States and the CIS countries. The opening of the borders of many of those countries lead to rapid economic changes that preceded the political integration of several Eastern European Countries into the European Union in 2004, in 2007 and finally in 2013. Despite the dramatic economic and political changes in many of the Eastern Countries, healthcare in many of those has not improved at the same pace. This may be related to the fact that health is not the first priority area when big social and political changes are happening. But this may also be due to the fact that health at least within the European Union remains a Member State issue that is much more dependent on local regulations and custom than the more general rules of the Union would allow for in the area of economy or finance. And several of the new Member States were particularly affected by the financial crises of 2008 and are still suffering from its aftermath, leaving less money for health related issues and innovation in healthcare. These changes within Europe and the neighboring countries have also had a profound effect on professional medical associations like EASL. For many years we have been reaching out to our fellow hepatologists, gastroenterologists, and infectious disease specialists from neighboring countries to invite and join our community and to integrate into the European framework of liver specialists through participation in the International Liver Congress and many other educational activities. This outreach was rewarded with success: EASL membership statistics show a steep increase in membership for those countries with the Top 5 being Romania, Turkey, Russia, Bulgaria, and Croatia with increases of more than 400% in some of these countries. Likewise, we are witnessing a good increase in participation at the educational and scientific sessions at the International Liver Congress from year to year from our Eastern and South Eastern neighbors. And even the active participation in our meeting as measured by the submission of abstracts from these countries has improved a lot. At least two of these countries can now be found amongst the top 20 submitters of abstracts. At the same time there are still some quite significant gaps in knowledge about liver disease, training in the management of liver disease, and research training in liver disease in many of those countries beyond the recognized centers of excellence. When EASL was compiling the data for its White paper on the burden of liver disease in Europe [[1]Blachier M. Leleu H. Peck-Radosavljevic M. Valla D.C. Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data.J Hepatol. 2013; 58: 593-608Abstract Full Text Full Text PDF PubMed Scopus (901) Google Scholar], a lot of blanks remained on the map, particularly relating to published data outside the field of viral hepatitis. And when reviewing the applications for the EASL fellowship program in the past two years, we noticed that very few came from Eastern European applicants. EASL recognizes that waiting for things to improve by themselves might not be enough and is determined to play a much more active role to homogenize expertise and training in all of Europe and its neighboring countries. In order to do this, the EASL business plan for the next few years should include three focus areas: Clinical training in many countries is already at a high standard in a few centers of excellence but a similar standard cannot be achieved in many smaller centers in the region. Improving this situation would require a joint effort of local professional medical societies together with EASL to organize local trainings at a higher standard because many of the physicians in the more remote areas will not have the opportunity to frequently travel to EASL events. We need to foster interest in clinical research and provide training in clinical research beyond centers of excellence, which are already integrated into the international clinical trials landscape. In particular, we should try to raise interest in conducting local investigator initiated trials that will help to document standards and improve the quality of care in those countries. And last but not least we need to provide research training in translational research: participation in the young investigator master class and engagement with the EASL fellowship program including Entry Level, Sheila Sherlock, and Physician Scientist Fellowships should be an integral part of achieving this goal. But EASL also recognizes that developing a fruitful strategy to advance towards those goals cannot be achieved by the EASL governing board on its own. We need to integrate scientists and educators from Eastern Europe and neighboring countries into an advisory body that will provide us with the necessary local knowledge to make use of our resources in the most efficient way. So while in the 19th century the right thing to do for gold-diggers was to go West, in the 21st century the call is out for hepatologists to go East: this is not about finding gold, it is about getting the best of patient care and research into a large geographic region with a high burden of chronic liver disease and a large unmet need to take care of it.