Betty J. Dong, PharmD ’72, is the recipient of the 2019 Daniel B. Smith Practice Excellence Award from the American Pharmacists Association (APhA) for her trailblazing career in clinical pharmacy and her “superb teaching and on-the-mark clinical guidance around drug therapy” to pharmacy and medical students, and residents.
The award recognizes a pharmacy practitioner, in any practice setting, who has distinguished himself or herself through outstanding performance and achievements. Dong received the award at the March 2019 APhA Annual Meeting and Exposition in Seattle, Washington.
Dong is a faculty member in the UCSF School of Pharmacy’s Department of Clinical Pharmacy, and she holds a joint appointment in the UCSF School of Medicine’s Department of Family and Community Medicine. She is a world expert on human immunodeficiency virus (HIV) and hepatitis C medication therapy and a staunch advocate for academic freedom.
“I have always considered Betty Dong to be the ‘clinician’s clinician,’” said B. Joseph Guglielmo, PharmD, dean of the UCSF School of Pharmacy. “The profession is indebted to Betty for her many impactful contributions to successful practice models.”
Walking a new path
Dong, who became interested in pharmacy as a profession after writing high school papers on PCP, LSD, and thalidomide, graduated with a doctor of pharmacy degree from UCSF in the middle of the transformative 9th Floor Project, which put pharmacists in clinical settings for the first time.
Dong in 1972
Embracing the spirit of the change, Dong broke new ground for the profession. Soon after graduating, she accepted a grant-funded position with the Family Medicine Program at San Francisco General Hospital (SFGH, now Zuckerberg San Francisco General Hospital [ZSFG]) as the clinical pharmacist member of a multidisciplinary team of clinicians, which included physicians, a nurse practitioner, and a social worker.
She was so successful that she was asked to continue at SFGH as the clinical pharmacist for the new Family Medicine Inpatient Service. Her decision would soon put her in the middle of an epidemic and one of the biggest health emergencies of the day.
An HIV expert from the early days
In the late 1970s and early 1980s, as Dong’s practice took root at SFGH, health care providers noticed a surge of young men entering the hospital and clinics with rare cancers and pulmonary infections. The cause was HIV, a virus associated with AIDS, a disease that wouldn’t even have a name until 1983.
Dong managed the drugs for HIV patients, which, at the time, meant treating the cancers and pneumonias that would result as a patient’s immune system wore down. Treating these opportunistic infections was the only way of helping HIV infected patients until the advent, decades later, of highly active anti-viral medications.
“(Dong) guided us in providing state-of-the-art treatment, allowing thousands of patients to live longer and better,” UCSF HIV expert Ronald H. Goldschmidt, MD, said. “She taught that entire generation of pharmacy students, medical students, and residents how to treat HIV and avoid or minimize the many toxicities of the medications for opportunistic infections.”
San Francisco was a national epicenter of HIV, and Dong’s experience soon became invaluable to the rest of the country as the disease spread. Along with Goldschmidt, who started the Clinician Consultation Center at ZSFG, a CDC and Ryan White HIV/AIDS-funded hotline, Dong provides to this day expert consultation for clinicians on the topic of HIV/AIDS treatments.
Along the way, Dong also became an expert on hepatitis C (HCV), another blood-borne disease that often accompanies HIV. HCV treatments have evolved from two brutal and prolonged treatment options to an expensive cure.
In 2014, Gilead Sciences launched a HCV treatment that cures the disease nearly 100% of the time but costs $94,500 for a full course of therapy. There are now just as effective, but less costly as well as generic, versions available for roughly $35,000 a full treatment. Dong, who provides HCV care in ZSFG’s Family Medicine clinics, says the treatments are an excellent deal.
“You’re helping to prevent new infections and curbing the costs of treating an individual over their whole life,” Dong says. “The research shows that most people who get cured don’t get reinfected. It’s really a bargain for the whole health system.”
A force for academic freedom
In 1987, Dong accepted a grant to investigate whether generic thyroid medications worked as well as a brand-name drug. To her surprise, the results showed no differences between them. Choosing the generic medications would save health care system and patients $356 million a year, Dong and her co-authors concluded.
Dong was ready to publish the findings, but the grant’s sponsor, the company that made the brand name product, cited a portion of the contract that gave the company exclusive authority over the publication of the findings.
The company tried to discredit Dong’s research and even hired private investigators to harass her. But she refused to back down.
The ensuing legal imbroglio would last nearly a decade and test Dong professionally and personally. The study results would eventually run unedited in JAMA on April 16, 1997, accompanied by an editorial on the entire experience. The company’s efforts to stifle the results were the subject of scathing coverage in the Wall Street Journal and Nature and culminated in an interview of Dong by Leslie Stahl on 60 Minutes.
“It made everyone more aware of conflicts of interest in academic publishing and helped create better policies,” she said of the incident.
A decorated career
Dong has consistently created new jobs for herself in unexpected places, including a two-year stint working at San Quentin State Prison. She still works in the HIV and HCV clinics and at the ZSFG’s Family Medicine clinics, as well as provides care for people taking anti-coagulation medications, and medications for hypertension and diabetes. She also provides education and reviews drug interactions for patients starting HCV treatment in the UCSF Liver Disease and Liver Transplant Clinic.
Dong is the author of 53 peer-reviewed publications, 61 book chapters, and 51 poster presentations at various pharmacy and medical meetings. In 1988, she received the Outstanding Teaching Award from the UCSF School of Medicine for her teaching in the Department of Family and Community Medicine. In 2010 Betty was selected as the Distinguished Alumnus of the year by the UCSF Pharmacy Alumni Association.
Dong is a fellow of the American Society of Health-System Pharmacists (ASHP), the California Society of Health-System Pharmacists (CSHP), the American College of Clinical Pharmacy (ACCP), and the APhA, and she was inducted into the National Association of Practitioners in 2012. In 2001, she received the Clinical Pharmacist of the Year Award from CSHP and in 2004 the ACCP Clinical Practice Award.
“I have had multiple opportunities to positively affect patient care and provide education to peers and students,” Dong said in an interview. “I love my job, because I feel that I am doing my part to contribute to bettering society.”
She is teaching in the School’s newest doctor of pharmacy curriculum, and she’s impressed with the students and their critical thinking skills. “We’re engaging students earlier and making them ask questions,” Dong said. “Teaching is really fun if you get students who are interested, motivated, and want to learn.”
Her advice for building a career is to be fierce and find jobs that need doing. “I created most of the positions I’ve had myself,” Dong said. “Go into clinics or other settings, determine what is needed, and then fill that role.”
Dong is the second recipient of the Daniel B. Smith Practice Excellence Award, joining the School’s former dean, Mary Anne Koda-Kimble, PharmD ’69, who received the award in 2002.