EXPLAINER: Clinical experts involved in care

In response to a post by @JOANNEinAUS (finally) I have started a thread explaining the role of various clinic staff in providing care for your hep B. I’ll start off by saying that this is from my experience as a patient and someone who has worked with clinicians (but isn’t one). Also this is from an Australian experience and roles might vary from country to country. Would love if any @HealthExperts want to contribute too.

  • General Practitioner (GP) - Usually your primary care provider that you can see on a regular basis. Specific knowledge about hepatitis B can be variable, as they are not specialists. Can order blood tests and refer to specialists (below).
  • Gastroenterologist - Someone who specialises in the whole digestive system (intestines, stomach, liver, colon, pancreas, etc.)
  • Hepatologist - Someone who specialises in the liver. A type of gastroenterologist. They will generally have a much better idea about hepatitis B.
  • Infectious Disease Specialist - Someone who specialises in understanding viruses, bacteria, and fungus that infect people.
  • Oncologist - Someone who specialises in cancer, and will only usually be involved if there is a diagnosis of liver cancer.
  • Registered Nurse - Can provide further education and follow-up referral information.
  • Nurse Practitioner - Registered nurses who continue their education to receive a Master’s degree in a specific field and have greater capacity to provide care.

Not involved in health care

  • Virologist - A scientist trying to understand viruses. Title does not denote medical training and is not involved in providing health care.
  • Epidemiologist - A scientist trying to understand the spread of infections. Title does not denote medical training and is not involved in providing health care.

TT

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Hi all, thanks Thomas for identifying the care team but we can’t forget the nurses!! Many of the GI docs and Hepatologists pass their patients to the registered nurses (RN’s) for further education and follow-up referral information. In addition, increasingly Nurse Practitioners (these are registered nurses who continue their education to receive a Master’s degree in a specific field) are included as part of the care team for all specialities - cardiology, surgery, anesthesia, orthopedics, etc. Always, Joan

Thanks Joan! I was hoping you would chime in with your nursing experience. I’ve added these suggestions to the list.

Cheers,
Thomas

Thanks for the list @ThomasTu - so which experts would likely come up with the cure or a combination of health professionals?

Hi @JOANNEinAUS,

Great question! I think @john.tavis will have a better idea of the entire pipeline and full panel of experts involved. But as a first attempt of summarising, I think cure will be developed by a combination of experts, including:

  • Virologists - to work out how the virus works (and identify weak points to target)
  • Cell biologists - to investigate how the cell and virus interact
  • Biochemists - to develop drugs that target particular parts of the cell/virus
  • Immunologists - to understand how to help the immune system clear the virus

Any cure would have to be tested first in cellular or animal models, which involve a lot more staff (e.g. veterinary experts). Then, clinical trials which require clinicians, trial nurses, project managers, etc. etc.

Along the way, you’ll need pharmaceutical industry partners to develop ways to manufacture and distribute the cure (again, a whole bunch of specialised experts involved there too).

What I’d like to ensure in the future is that the affected community are also involved in directing all of these people towards a cure that works for as many people as possible and addresses our concerns as a community.

TT

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Hi all,

Thomas has the outlines of the team needed to develop a drug correct, but the expertise needed is wider.

The process for a new antiviral drug starts with virologists such as Thomas and me who identify weaknesses in the virus and develop ways to measure what happens when your alter the target. Many virologists are also immunologists, depending on the type of studies they do. The next folks who usually get involved are medicinal chemists (for small molecule drugs such as Entecavir) or biochemists (for immunomodulators like Interferon alpha). The biologists (virologists & immunolgists) and the chemists & biochemists work closely together to repeatedly test different variations of the drug candidates, gradually making them better and safer. Once a pretty good candidate is identified, then pharmacologists join the team to make sure the drug candidate can last long enough in the body and reach the right spots to do its job. Again, this is a repetitive process, with the full team trying many variations till the drug candidate is good, safe, and properly targeted in the body. This cycle also includes formulation scientists who figure out what to mix the drug candidate in so it can be safely stored until use and absorbed by the body when taken. At this point, veterinarians are involved because some studies must be done in animals as it is impossible to predict properly how a drug candidate may work in people. Once a drug candidate is proven to work well in animals and cell culture, then physicians and regulatory specialists become involved. The physicians know how to treat people with the drug candidate and measure how it is working in them. The regulatory specialists are needed because it is critical that human studies be done in a highly ethical manner that protects the safety of the study volunteers, and the laws covering that type of work are strict and incredibly complex. The human studies occur in stages–Phase I tests safety in a small number of people, Phase II continues safety testing in a larger group of people and defines the dose/timing of the drug candidate in people. Phase III studies are large. They continue safety testing and measure whether the drug does its job well enough to merit being licensed. Clinical studies also bring governmental regulatory agencies (ie, the USA Food and Drug Administration) into the process to regulate the clinical trials and decide whether a new drug can be licensed. Biotechnology and/or major pharmaceuticals companies are involved in most of this process (usually many of the folks discussed above work for companies) because developing a new drug usually costs well over 1 billion US$, so the companies’ ability to raise investment funds is critical.

I hope this helps.

john.

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6 posts were merged into an existing topic: Prioritisation and funding for HBV research - how to help