Sur­geon at Stan­ford takes on hepati­tis B glob­ally

China Daily (USA) - - ACROSS AMERICA - By LIA ZHU in San Fran­cisco li­azhu@chi­nadai­

At the Asian Liver Cen­ter of Stan­ford Univer­sity, a se­ries of black and white pho­tos on the walls tells the “un­told story” of a mid­dle-aged man in China’s He­nan prov­ince whose whole fam­ily died of liver cancer and he died of the same dis­ease years later.

“This [photo gallery] is a re­minder of why we are do­ing all of this, why we are help­ing to ed­u­cate the pub­lic, and try­ing to change the laws to im­prove aware­ness of pre­ven­tion and treat­ment of hepati­tis B,” said Sa­muel So, founder and di­rec­tor of the Asian Liver Cen­ter.

“Some­times when peo­ple talk about sta­tis­tics, we tend to for­get peo­ple,” said So, a pro­fes­sor at Stan­ford’s School of Medicine and a trans­plant sur­geon.

Though he could make more money in the op­er­at­ing room, So spends much of his time trav­el­ing be­tween Chi­nese main­land, Mon­go­lia, Viet­nam, Laos, and re­cently In­done­sia and the Philip­pines, spread­ing the word about hepati­tis.

“How many lives can I save by cut­ting out liver cancer? Very few. But mil­lions of lives can be saved if chil­dren are vac­ci­nated and many more peo­ple are treated,” said So, who also serves as a spe­cial ad­viser on vi­ral hepati­tis to the World Health Or­ga­ni­za­tion.

Born and raised in Hong Kong, So came to the US for higher ed­u­ca­tion. Af­ter grad­u­at­ing from the Univer­sity of Min­nesota in 1973, he went back to Hong Kong and con­tin­ued his med­i­cal stud­ies at the Univer­sity of Hong Kong un­til 1978.

Af­ter serv­ing as a med­i­cal of­fi­cer of the Hong Kong gov­ern­ment, he re­turned to Min­neapo­lis in 1980 and worked as a trans­plant sur­geon.

At the time, the Mid­west did not have large num­bers of Chi­nese or Asian peo­ple, and al­most no one was in­fected with hepati­tis B. It wasn’t un­til he moved to San Fran­cisco, home to a large Asian com­mu­nity, that he re­al­ized the ex­tent of the hepati­tis B and liver cancer prob­lem.

The rea­son is chronic hepati­tis B in­fec­tion is un­com­mon in white Amer­i­cans, said So. About one in 1,000 white Amer­i­can adults has chronic hepati­tis B, com­pared with about one in 12 Asian-Amer­i­can adults, ac­cord­ing to the US Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC).

“I looked around the coun­try and no one was do­ing any­thing about it. It seemed no one cared about hepati­tis, a dis­ease that kills so many peo­ple in Asia,” said So.

He found that im­mi­grants from Asia were not aware of the dis­ease’s risks, the im­por­tance of test­ing and treat­ment and the link be­tween hepati­tis and liver cancer.

“Chi­nese peo­ple don’t like to talk about cancer and hepati­tis be­cause of dis­crim­i­na­tion,” said So. “Then we found that doc­tors in the US didn’t re­al­ize the im­por­tance of test­ing and how to care for the pa­tients, be­cause it’s not well taught in med­i­cal school.”

So founded the Asian Liver Cen­ter at Stan­ford Univer­sity in 1996 to put an end to the high rates of chronic hepati­tis B and liver cancer in AsianAmer­i­can com­mu­ni­ties and Asia.

In the past 20 years, the cen­ter has spear­headed ad­vo­cacy and ed­u­ca­tion ef­forts to im­prove the ca­pac­ity of the US health care sys­tem to pre­vent and con­trol hepati­tis B and liver cancer through a strat­egy called CARE (col­lab­o­ra­tion, ad­vo­cacy, re­search and ed­u­ca­tion).

They part­ner with the CDC, the Depart­ment of Health and Hu­man Ser­vices (HHS) as well as pol­icy mak­ers to in­crease na­tional aware­ness and na­tional pol­icy changes.

In 2008, the HHS for the first time rec­og­nized hepati­tis as a dis­ease with one of the great­est health­care dis­par­i­ties in the US.

In 2010, So re­ceived a CDC Honor Award for mo­bi­liz­ing peo­ple and re­sources in ways that have changed global pub­lic health poli­cies re­lated to hepati­tis B. He was rec­og­nized in 2014 by the White House for global and na­tional lead­er­ship.

Dur­ing his ser­vice on the board of the In­sti­tute of Medicine of the Na­tional Acad­e­mies, So’s re­search caught the at­ten­tion of US pol­icy mak­ers.

As a re­sult, HHS re­leased a na­tional ac­tion plan in 2011 for pre­ven­tion and con­trol of vi­ral hepati­tis in the US, lead­ing to screen­ing and vac­ci­na­tion be­ing cov­ered by health in­sur­ance as of 2016. For the first time, the hepati­tis B vac­cine for adults is free.

Cur­rently in the US, two in three peo­ple liv­ing with hepati­tis B don’t know they are in­fected. Of those test­ing pos­i­tive, only one in three is con­nected to a doc­tor; and of those un­der a doc­tor’s care, only half get treat­ment.

“The key mes­sage in the US is to get more peo­ple tested and treated. Over time, you can cut down the deaths of liver cancer and cir­rho­sis by over 50 per­cent,” said So.

But the prob­lem will not go away if peo­ple in­fected in Asia are not treated or pro­tected, said So.

About 75 per­cent of Asian-Amer­i­can adults are for­eign born, many from coun­tries with a high preva­lence of chronic hepati­tis B in­fec­tion, ac­cord­ing to the CDC, which es­ti­mates that 95 per­cent of chronic hepati­tis B in the US is im­ported.

China has the big­gest bur­den of chronic vi­ral hepati­tis in the world — around 100 mil­lion peo­ple (93 mil­lion with hepati­tis B and 8 mil­lion with hepati­tis C), or 25 per­cent of all peo­ple liv­ing with chronic hepati­tis in the world.

With­out mon­i­tor­ing and treat­ment, 15 per­cent to 25 per­cent of those liv­ing with chronic hepati­tis B, and 10 per­cent of those liv­ing with chronic hepati­tis C will die from liver cancer or cir­rho­sis, he said.

In 2006 to 2008, the Asian Liver Cen­ter pro­vided a prov­ince-wide free hepati­tis B vac­ci­na­tion pro­gram in Qing­hai prov­ince, the first of its kind in China, to im­mu­nize more than 500,000 chil­dren.

“It’s so sad so many peo­ple die at a young age. Liver cancer is among the lead­ing causes of death for mid­dle-age peo­ple in China, the pro­duc­tive peo­ple who could have been sup­port­ing their fam­i­lies,” he said.


Sa­muel So, founder and di­rec­tor of the Asian Liver Cen­ter at Stan­ford Univer­sity, tells the story of a Chi­nese man who lost his en­tire fam­ily to liver cancer be­fore dy­ing of the same dis­ease him­self.

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