Episodes
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This week's vault looks back to SurfingMASH's Barcelona coverage in earlier years to identify one point we can use to evaulate progress in the field. In this case, we looked back one year to see that INCBCN focus on NITs was driven largely by work from NAIL-NIT.
Specifically, the 2023 version of NIT coverage at #SLDThinkTank 2024 was a discussion of real-world data from NAIL-NIT. The original conversation has a robust description:
Surfing NASH returns to review the 2023 Innovations in NAFLD Care Workshop (INCBCN) which concluded on 27 May in Barcelona. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss highlights and takeaways of the event with Louise Campbell and Roger Green.
This conversation captures the meeting in a broad sense by outlining its goals and reason for being. Jeff describes this year’s emphasis on expanding the community of practice beyond hepatology. For example, friend of the podcast and co-host of our Rising Tide series, Ken Cusi, chaired a session on the role of endocrinology and diabetology in the early diagnosis and management of NASH. In Jeff’s words, “We were trying to look at the liver more holistically and look at who else should be involved in a multidisciplinary approach.”
The discussion shifts to a review of the NASH-NITs Real-World-Evidence Summit. Jörn suggests that moving forward, the Summit ought to be expanded and broadened. After Jörn comments on the positive experience of facilitating hands-on engagement, Louise offers her take. She underscores that FibroScan testing requires adequate knowledge and training to be well-executed with precision. The group goes on to describe in detail what made the Summit unique and how it might grow in the future.
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This wrap-up conversation focuses on elements to add and reconsider for #SLDThinkTank 2025. One key concept was to broaden the set of stakeholders invited to participate. Another involved focusing on the broader idea of "preventive hepatology."
This conversation starts with Roger Green asking the group what other topics from #SLDThinkTank 2024 the panel should discuss before closing. Jörn Schattenberg expresses the hope that future meetings will have a wider representation of patient advocates and allied health professionals. Jeff wishes a representative of WHO could have been there. Mike recommends broadening primary care presence, and Maja would like to see more on technologies, specifically citing proteomics and mass spectrometry as two examples. "As an outsider," Louise asks whether it is time to focus more intently on preventive hepatology and pre-screening. Jeff elaborates on the concept of preventive hepatology, anticipates that pre-screening will come from other specialties and notes that advocates and practitioners are focusing on preventive hepatology concepts without using that phrase.
Finally, Roger asks the group how non-practitioners can help drive wider awareness and action. Group answers vary widely. -
Episodes manquant?
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This conversation from #SLDThinkTank 2024 focuses largely on ways to improve delivery of screening services to patients. Along the way, participants reflect on the value of having Rezdiffra approved in the US and on its way to approval in other markets.
As the conversation starts, Mike Betel transitions from a broader discussion of prevention to note that there are 94 FibroScan devices for all of Canada. Even these 94 are severely underutilized! Maja Thiele states that having a drug in market will motivate stakeholders throughout the system to screen more aggressively because they feel having an approved drug will enable them to help patients better. Louise Campbell asks whether the vision around utilizing FibroScan better included more creative approaches to site of delivery. This leads the group to discuss what will be necessary to improve utilization of these machines. Specifically, Mike asks who will coach allied health providers and physicians to use NITs (specifically scanners) as a way to open broader conversations on liver health.
Jeff says that the last few minutes of discussion provided a general flavor of what the Open Space session was like. and comments on why this kind of small meeting is the right design for thinking big and brainstorming openly. He notes the mandate to get "better bang for the buck." Mike says it was extremely helpful to have a large number of younger attendees. -
As the Surfers dive deeper into the substance of #SLDThinkTank 2024, Jeff Lazarus describes the meeting agenda and anticipated outputs, and other panelists discuss how the "Magic Wand" exercise and other ideation elements produced some truly "Big Picture" insights.
The conversation starts with Roger asking participants to describe the meeting agenda and what they considered its highlights. Before describing the agenda, Jeff enumerates the paper(s) that will result from this meeting. He lists the ten major issues the group developed for the pursuit of ending MASLD and MASH as a global health threat and proceeds to describe and elaborate on several of these.
When Jeff finishes, Jörn recalls that at the end of the first session, the chairs gave participants a "Magic Wand" to achieve the broader goal of making dramatic progress in patient screening and treatment. He notes a consensus that "we ha[ve] mechanisms and biomarkers" but have major social, political and academic challenges ahead if we are to slow the rate of the pandemic meaningfully. To Jörn, the field may need to improve tests and clarify cutoffs, but the major issues require support from governments and payers paying for tests rather than asking patients to pay for their own. Maja notes how long and challenging "the road between research finding and then implementation" is. Mike and Jeff go on to focus on prevention issues as separate from treatment. -
The first conversation from our #SLDThinkTank 2024 coverage explores the meeting design from two perspectives. Co-hosts Jeff Lazarus and Jörn Schattenberg discuss the overall design, after which participants Maja Thiele and Mike Betel share their reactions.
The conversation starts with Jeff providing background and rationale for the #SLDThinkTank 2024 design. He starts by referring back to an initial meeting in 2019 and the first two years of INCBCN (Season 4, Episodes 13, 23; Season 3, Episodes 18, 24). He then describes why he felt a small-group brainstorming approach might work better than the last two years of PowerPoint presentations and group questions. This agenda, which was designed to encourage dialogue that generated new answers to the largest questions in SLD, included five "hot topic" sections, two focused workshops and an innovative ideation concept called Open Spaces.When Jeff finishes, Jörn describes how the highly innovative "Open Spaces" element actually worked in his section of the room.
Maja and Mike share their impressions of the meeting. Maja starts by praising the Open Space concept, which she describes as "especially fruitful" due to the diversity of attendees. After Mike seconds her comment about diversity, she goes on to describe what she did during Open Spaces. The rest of the group chimes in with points about the design. -
#SLDThinkTank participant Maja Thiele, a first-time guest, shares her professional history and the traditional "one thing the audience might not know about you if you did not tell them." In the process, she talks about her professional history and a current study, LiverAIM, for which she is leading a pivotal element.
Two elements make this introduction unique. First, Maja's "One Thing" answer is a first among the 120+ guests that have appeared on this podcast. She is the first SurfingMASH guest who has actually served as a radio host (old podcasters like Roger live with awe and respect for radio hosts!) Second, Jörn Schattenberg asks her to discuss her pivotal role in LiverAIM, the largest randomized control trial ever anticipated in SLD.This episode provides not only an excellent understanding of a first-time panelist we hope will join us often in the future, but also an introduction to LiverAIM, a study that will likely be the focus of many SurfingMASH episodes in years to come.
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#SLDThinkTank 2024 co-chair Jörn Schattenberg and SLD Think Tank co-chair Jeff Lazarus, participants Maja Thiele and Mike Betel and SurfingMASH co-hosts Louise Campbell and Roger Green convene to discuss #SLDThinkTank, a conference designed to innovate solutions for addressing large issues, many involving public health, in conquering MASLD.
00:00:00 - Surf's Up: Season 5 Episode 15
Standard lead-in, including brief quotes taken directly from the episode.
00:02:45 - Introduction
Opening comments discussing the aggressive travel schedules of our guests.
00:04:02 - Meeting Maja Thiele and LiverAIM
Maja introduces herself to our audience, including her "One Fact:" she has been a radio host in Denmark. Jörn mentions that Maja is about to start "the biggest randomized controlled trial in hepatology" through LiverAIM, an extremely ambitious project funded through the EU Innovative Health Initiative.
00:12:47 - Groundbreaker
Each panelist shares one piece of good news from the previous week.
00:15:38 - #SLD ThinkTank 2024 design
Jeff provides background and rationale for the #SLDThinkTank 2024 design, going back to an initial meeting in 2019 and the first two years of INCBCN (S4, E13 and E23; S3, E18 and E 24). The event included five sections, two workshops and an innovative concept called Open Spaces. Jörn provides color about how Open Spaces actually worked.
00:20:13 - Participants' experiences
Maja praises Open Spaces, which she describes as "especially fruitful" due to the diversity of attendees. After Mike seconds this comment, she describes her Open Spaces experience.
00:25:53 - Meeting highlights
Roger asks participants to describe their highlights from the meeting. Jeff describes the paper(s) that will result from this meeting, lists the ten major issues the group developed for ending the SLD pandemic, after which he elaborates on a few of these.
00:29:40 - The Magic Wand exercise
Jörn: at the end of the first session, chairs gave participants a "Magic Wand" to achieve their goals. He notes a consensus that "we ha[ve] mechanisms and biomarkers," but face major public and policy challenges if we are to slow the MASLD growth rate meaningfully. Maja notes the long timeline from research to implementation.
00:33:09 - Improving utilization
Mike discusses prevention separate from treatment: There are only 94 FibroScan devices in Canada, and even these are underutilized. The group discusses what will be necessary to improve scanner use in a future world where having medicines motivates medical stakeholders.
To Jeff, this discussion provided a sense of how the Open Space session worked and why this is the right design for big issues like "getting better bang for the buck."
00:43:59 - NIT Summit
Jörn discusses the NIT Summit, which preceded the #SLDThinkTank. He sees this as a first step toward acknowledging that we need to train more people and find ways to train them better. Jeff agrees.
Maya describes Elliott Tapper's state-of-the-art talk on social media. Her takeaway: video is a valuable new format, especially for younger stakeholders.
00:47:39 - Wrap-Up Questions
Roger asks the group what other topics from #SLDThinkTank 2024 to discuss before closing. No two panelists' answers are redundant. Finally, Roger asks how non-practitioners can help drive wider awareness and action. Again, answers vary widely.
00:55:45 - Question of the Week
Roger asks listeners to describe "one way that making better use of the tools we have today (diagnostics and medicines) can make a major dent in the MASLD pandemic."
00:56:38 - Business section
This week's news on increasing interest in SurfingMASH, our first newsletter, the Stephen Harrison Memorial page, upcoming episodes and this week's Vault. -
SurfingMASH's last year-end interview with Stephen Harrison took place in 2022. Louise Campbell and Roger Green join Stephen to discuss a promising year in MASH drug development and the podcast itself.
At the time, this was the description of the interview posted in Buzzsprout:In the Season 3 NAFLD Year-in-Review conversations series, Surfers Jörn Schattenberg, Louise Campbell and Roger Green embark on a string of interviews with a handful of Key Opinion Leaders who made headlines and advances in Fatty Liver disease in 2022. In this exclusive segment, podcast co-founder and former co-host, Stephen Harrison, joins Louise and Roger to discuss the year-in-review as recorded before Madrigal’s breaking announcement of the Phase 3 MAESTRO-NASH results last week.
From the outset, Stephen admits there were “a lot of pleasant surprises” this year, alluding to the multiple positive Phase 2 trial results among other recent press releases. He anticipates several exciting modes of action becoming available in the imminent future. The interview goes on to look at advancements made in methodology of interpreting liver biopsies, understanding the limitations of biopsy and degrees of mitigation in response to those shortcomings. Stephen also offers in-depth investigation into the uptake of NITs as conditional clinical trial endpoints, something he sees as a process whose momentum keeps growing and strengthening.
Throughout this session, Stephen provides speculation as to what the promising new year holds for the Fatty Liver field. In his words, 2022 revealed “the most incremental advances in the field of NASH in the past decade.” He adds that, like this year, 2023 is primed to be pivotal. Surf on for the full-length, insight-laden interview with a remarkable physician and Principal Investigator making tremendous contributions to the pursuit of putting a major dent in Fatty Liver. -
Manal Abdelmalek and Naim Alkhouri join co-hosts Jörn Schattenberg, Louise Campbell and Roger Green to reflect on the greatest professional accomplishments of co-founder and former co-host Dr. Stephen Harrison.
Naim Alkhouri starts this conversation by describing the two prospective epidemiology papers Stephen co-authored at San Antonio Military Medical Center in 2011 and 2021, an innovative design that provided early estimates of the breadth of MASLD and MASH in an asymptomatic population. He goes on to discuss Stephen's work on FAST and other NITs and finishes by remembering Stephen's exceptional work in drug development, culminating in the recent FDA approval of Rezdiffra.Manal Abdelmalek starts her comments by recalling that Stephen developed the BARD score and, years later, celebrated that it had been supplanted by better tests. After commenting on his impact in drug development, she describes him as "visionary" and says Stephen was "not a one man show. He thought about networks and collaborations and how to move a field forward with speed and agility."
Louise Campbell also reflects back on the BARD score and the process by which Stephen came to accept that the nomenclature change was a necessary thing. She closes her comments by reflecting on his persistence and innovation in drug development and finishes with a Harrisonisms about the value of failure and learning in the development of the product WD-40.
Finally, Roger Green discusses how Stephen's desire to tear apart his failures and learn from them resulted in the landmark paper that challenged how biopsies were being read and interpreted in clinical trial design, and also agrees with an earlier comment from Manal about how innovative the original design for Pinnacle Clinical Research was.
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Manal Abdelmalek and Naim Alkhouri join co-hosts Jörn Schattenberg, Louise Campbell and Roger Green to share personal memories of co-founder and former co-host Dr. Stephen Harrison.
Naim Alkhouri starts the conversation by describing how he met his "friend and mentor," Stephen. He recalls coming to San Antonio in 2017 to work with a different research group and contacting Stephen. Stephen told Naim he had "made the wrong decision" by not joining his team instead. Nonetheless, Naim persisted, and the two began a rich, rewarding friendship and research experience, which Naim describes in greater detail.Jörn Schattenberg says that Naim's story resonates with him. Stephen "support[ed] younger people in the field," including Jörn when he was starting his career in Germany. Historically, there had been challenges in conducting clinical trials in Germany, but Stephen worked with Jörn to overcome these and create a stable structure and base for conducting MASH trials. Jörn notes that the relationship Naim described applies not only to the two of them, but also to many other young researchers.
Manal Abdelmalek recalls meeting Stephen in the earliest days of MASH, when a few young researchers shared posters in a "dark corner" of an AASLD meeting. Manal was impressed by Stephen's energy, warmth, curiosity and confidence that what was then called NAFLD would be "big" someday.
Louise Campbell recalls meeting Stephen in the early days of SurfingMASH and always being appreciative of his support for nurses and allied professionals and the role they play in patient treatment. She goes on to note that the SurfingMASH podcast's growth affirmed the vision that Stephen and Roger Green had when they started the podcast.
Finally, Roger Green shares his story of meeting Stephen at NASH-TAG 2019 and being impressed with how his energy suffused the entire space. Roger goes on to describe the process by which he and Stephen started the podcast and decided to expand its scope.
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Manal Abdelmalek and Naim Alkhouri join co-hosts Jörn Schattenberg, Louise Campbell and Roger Green to rshare some of their favorite "Harrisonisms" - words, phrases and verbal memes associated with co-founder and former co-host Dr. Stephen Harrison.
Naim Alkhouri starts by stating two of his favorite Harrisonisms, two that SurfingMASH listeners know well: "is the juice worth the squeeze?" and "Keep It Simple, Stupid." He goes on to add one that never appeared on the podcast, "FAIL stands for First Attempt In Learning," which he used frequently in discussed failed clinical trials.
Manal Abdelmalek shares several phrases she describes as "words to live by." Two of these are "don't you don't take yourself too seriously " and "There will be failures. The worst ones possible are those that you don't grow and learn from." She discusses how human, approachable and down-to-earth Stephen was, and closes with a story about him ordering a hamburger and "American French Fries" at a gourmet restaurant in Paris because that was all he really wanted to eat.
Louise Campbell shared a Harrisonism she heard for the first time at Stephen's funeral about the difference between wisdom and knowledge: "Wisdom was knowing that a tomato was a fruit, and knowledge was knowing not to put it in a fruit salad." She goes on to comment on the joy he took in living a life of service.
Finally, Roger adds two favorites of his own: "the liver is the canary in the coal mine," and that when Roger heard Stephen ask whether the juice was worth the squeeze, he always followed it with "is the view worth the climb?" Roger goes on to tell a story about Stephen's older brother, Ken, responding personally to every social media post-mortem to Stephen he could find because it is what Stephen would have done, and Ken's comment about Stephen's basic humility and dedicating his accomplishments to "God's glory."
Finally, Naim tells about story about Stephen's interest in wine and Naim's in shopping and how they merged in a single vignette about Stephen and his daughter Anna Lauren in Paris. -
The sudden passing on April 23 of our co-founder and colleague Stephen Harrison sent shock waves throughout the global SLD community. This week, Manal Abdelmalek and Naim Alkhouri join Jörn Schattenberg, Louise Campbell and Roger Green to remember and pay tribute to an exceptional leader, role model and human being.
00:00:00 - Surf's Up: Season 5 Episode 14
Episode introduction, including brief quotes taken directly from panelists.
00:03:11 - Introduction
Roger introduces the podcast. The three key opinion leaders, Jörn Schattenberg, Manal Abdelmalek and Naim Alkhouri, discuss their fast-paced, high intensity travel schedules.
00:04:41 - Groundbreaker: a special memory of Stephen
In place of a traditional SurfingMASH groundbreaker, Roger asks each panelist to share a special memory of Stephen. In turn, panelists discuss how they got to know Stephen and/or the role he has played in their lives. Summaries cannot do the emotion of these recollections justice.
00:17:30 - One Harrison accomplishment
Roger asks the group each to describe an accomplishment that Stephen has left the field. Each panelists provided at least 2 or 3, with no redundancy.
00:23:52 - "Harrisonisms" and wrap-up
In closing, Roger asks panelists each to provide a favorite "Harrisonism." Answers varied, although every group member recalled Stephen's question, "Is the juice worth the squeeze."
00:33:33 - Question of the Week
Roger asks how listeners feel their lives or work were affected by Stephen Harrison, either directly or indirectly.
00:33:56 - Business Report
This week's news on our new newsletter, future conversations, and the Vault, plus more on how we plan to honor Stephen. -
This vault conversation looks back to our coverage of International NASHDay 2023, the predecessor title to this year's Global Fatty Liver Day.
Thursday, June 8 was International #NASHDay 2023 and the podcast hosted a special session featuring patient advocates Gina Villiotti Madison (NASH kNOWledge), Marko Korenjak (European Liver Patients' Association) and Michael Betel (Fatty Liver Alliance). With co-hosts Louise Campbell and Roger Green, the group shares both a positive and sobering discussion around the Fatty Liver public health epidemic and its impact on younger generations now and into the imminent future.
Roger starts this conversation by asking Louise to provide more information about the U.K. Parliament debate that had just commenced. Louise notes that MPs from all parts of the UK participated and that they were extremely well-informed on childhood NAFLD and other issues. She notes that members told stories of their own weight loss and government promise to brief MPs on liver disease on an interim basis going forward. One MP said he did not like the term living with obesity, which is considered patient sensitive, because it implies that obesity is a permanent condition. This leads to Roger's closing question which asks each panelist to envision what their organizations' key 2024 International #NASHDay activities might be. While their answer are aligned with what they did for the International #NASHDay 2023, listen for some different twists and new directions.
This is a particularly important and moving episode that captures a range of topics pertinent to the patient perspective and, more broadly, stepping up to NASH. -
This closing conversation introduces two new concepts: the idea that MASH has so many facets that it is comparable to the metaphor of blind people touching an elephant, and the provider mandate to "rule the liver out" when assessing patients with metabolic diseases.
Roger cites the parable of the blind people touching the elephant as a metaphor for liver disease, which is a precursor for multiple seemingly unrelated diseases (cardiovascular and extra-hepatic cancers, to name two). He says the point is to teach liver disease to healthcare professionals as "the elephant," not its different parts. Louise agrees and suggests that the simple action point for liver disease-as-elephant is to "rule the liver out" when assessing the various related diseases. The test for this must be "cheap" and "accessible;" it does not exist anywhere in the world today.
Roger suggests that the "Keep It Simple, Stupid" approach to liver disease incorporate the two simple action items discussed in this episode. For patients, act now, get screened. For providers, rule the liver out.
In lieu of a final question, Roger asks panelists to describe one specific initiative they know of that is part of Global Fatty Liver Day. Mike describes a screening activity in Calgary. He describes a "mistake" last year in letting patients eat healthy food before being scanned. Louise assures him that eating healthy foods will affect scan outcomes less than 1% of the time. Jeff discusses the successes of street teams around the world, who screened 77,000 patients as part of International NASH Day 2023.
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Jeff McIntyre uses the discussion between Louise Campbell and Mike Betel as a jumping-off point for discussing some of the larger care challenges and barriers associated with MASH patient care.
Jeff says the previous conversation between Louise and Michael provides "a really great synopsis" of the challenges and barriers to patient diagnosis and care. He reports that the Global Liver Institute is planning to release its first "Best Practices in LIver Health Policy" report. For GLI, these challenges are more complex due to the need to find solutions that will work in countries around the world. He also states that GLI believes the system needs to be intentional not only about diagnosis but also health system follow-through. This requires patient access and country systems set up for success. Roger raises the issue of having safe spaces for people to exercise in less developed countries. Louise recommends tier systems so that the solution for each country reflects the country's economics. Roger discusses a recent study showing a link between food insufficiency in 4-year-olds and MASLD and MASH later in childhood. Jeff describes the Stockdale paradox: policymakers cannot get caught up in the big picture without dealing with the short-term issues ahead of longer-term success.Jeff describes two US health policy cases that reflect the Stockdale paradox: the VA's initial decision (later reversed) to require biopsy for Rezdiffra and lobbying by the giant food companies to have added sugar included in the list of attributes of healthy food.
Louise describes "a big to-do" in the UK about children's teeth and access to dentists because poor dental health drives a 7x increase in the risk of liver cancer. She would like to see a generalized dietician who can work with patients on the range of metabolic issues. Mike says it "scares" him about where to start small. Louise gives an example of boiling water before dressing wounds and taking other health actions in Angkor Wat, which led to dramatic declines in diarrhea and the spread of many diseases. -
This conversation focuses on what happens after or around patient screening, addressing the challenges caused by using GLP-1s and dual incretin agonists to treat concomitant conditions before looking at the patient's liver, and then the opportunities that can come from on-site scanning and immediate feedback.
Jeff starts this conversation by noting the popularity and widespread discussion around anti-obesity medications, which also have effects on MASH. He says this could "lead to a tricky couple of years" if results include decreased willingness to participate in clinical trials and/or decreased demand for fatty liver drugs from patients already on incretin agonists like semaglutide or tirzepatide. Generally, he expresses a concern that all this will lead to a decline in focus on the liver.Louise discusses activities in her two home countries, UK and Australia. She starts by noting that interest in the healthcare system picks up when patients go to their primary care physicians seeking care for a given disease, in this case, liver disease. She goes on to note that "liver disease is a small portion of poor liver health," which leads to cardiovascular disease and extra-hepatic cancers. Thus, she says screening should identify patients with poor liver health in order to educate and intervene with these non-hepatic conditions. She describes data in her possession that says 33% of Australians who believe they are healthy have poor liver health, and that most of these are post-menopausal women. She says there is a mismatch between patient needs, perceived resource demand, and funds available to support these resources.
Mike asks Louise to comment on scanning as an educational activity. Before answering his question directly, she discusses the value of on-site patient questionnaires in improving the quality and perceived value of the overall visit. Next, she discusses how she uses the sharing of scan results with the patient to generate a deeper patient understanding of the disease and activate conversation on how patients can help themselves better. Mike agrees based on his experience learning about his high CAP score, then lowering the level. Louise discusses steps treaters can take if the first intervention doesn't work.
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This conversation centers around the Global Fatty Liver Day 2024 theme and the rationale behind focusing on screening.
It starts with Jeff describing how much has changed in MASLD in the past year and why this calls for a new focus. Jeff identifies the breadth of the global challenge of treating MASLD and related conditions, which is far broader than "just having one medicine for one aspect of the disease in one country." To Jeff and GLI, the best immediate path forward is to bring more patients into the system through screening, which provides the rationale for GLI's theme for the day, "Act Now. Get Screened."Roger states that this effort will drop a large number of patients "in the top of the funnel," and notes that earlier podcasts demonstrate limited adoption of clinical care pathways or other ways to manage an increased patient volume. He asks Jeff where the care pathway issue fits in the "Act Now. Get Screened" vision. Jeff states this is an issue for the entire field, not just patients, and that the field needs to collaborate on a turnkey way for PCPs to screen easily.
Roger describes the concern raised Naim Alkhouri (Season 4, Episode 50.3) that the current clinical care pathway approach might create chaos in the system. Also, Roger asks whether US reimbursement policy is far enough along for the various actors to participate. Roger asks about the most effective action that patients and advocates can take. Jeff replies, "Get Screened."
Mike Betel suggests that while this may be an issue for the entire field, he believes the onus for keeping this issue in front of providers must come from patients assertively asking questions and seeking support. Jeff agrees, but describes the relationship between patient and provider in this case as "symbiotic."
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On April 23, the global MASLD community lost one of its giants when SurfingMASH Co-founder Stephen Harrison passed away unexpectedly. Co-hosts Louise Campbell and Roger Green and guests Jeff McIntyre and Mike Betel each share a memory of Stephen.
Jeff McIntyre starts this conversation by remembering Stephen as a fellow Southerner and, in addition to his many professional accomplishments, a person who could cut through high-level discussions with a "pithy little West Texas saying" that would make a complex or abstract concept clear. Mike Betel starts his comments by talking about Stephen's older brother, Ken, who wrote personal messages back to every comment he could find on social media, which was a remarkable task in its own right. Mike discusses how often he heard Stephen speak and how many times he interviewed Stephen for various Fatty Liver Alliance posts or events. Mike concludes with a story about Stephen talking for five minutes while Mike's audio was malfunctioning and then doing a second take remarkably similar to the first. Louise discusses being on the podcast with Stephen for years and regrets that he will never cook her a deep-fried turkey. She recalls his hobby of building elaborate sand structures on the beach with his family while he ran around the world, putting a large dent in MASLD. Roger starts by describing the first time he saw Stephen at NASH-TAG 2019 and how his larger-than-life presence and exceptional energy suffused a room of 200 people. He continues by using a favorite "Harrisonism" about being thankful that they didn't stop after WD-39 because WD-40 was the 40th effort to create the product we know today, and comments that for Stephen as Principal Investigator, Rezdiffra was his WD-40. Finally, Roger says he "just lost it" when reading the Walt Whitman poem "O Captain, My Captain," which Scott Friedman posted on LinkedIn as a tribute to Stephen.After the personal comments, Roger says that next week's episode will be a tribute to Stephen from some of his closest friends in the global MASLD community.
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Fatty Liver Alliance Founder and President Mike Betel and Global Liver Institute Vice President for Liver Programs Jeff McIntyre join Louise Campbell and Roger Green to preview the premier MASH event for patient advocates, now known as Global Fatty Liver Day, which falls on June 13.
00:00:00 - Surf's Up: Season 5 Episode 13
Episode introduction, including brief quotes taken directly from panelists.
00:02:37 - Introduction/Remembering Stephen Harrison
Roger introduces the podcast. Each panelist shares a memory of Stephen Harrison.
00:11:44 - Groundbreaker
Each panelist shares one piece of good news from the previous week.
00:15:18 - Jeff Discusses Global Fatty Liver Day
Jeff starts by discussing how GLI came to its 2024 theme: "Act Now. Get Screened." Roger comments that this will require health systems to expand in scale and sophistication and shares Naim Alkhouri's critique (Season 4, Episode 50.3) of the current approach. He asks if US reimbursement policy is sufficiently developed and what patients can do. Jeff replies, "Get Screened."
00:25:46 - Fatty liver and obesity
Jeff notes the popularity and widespread discussion around anti-obesity medications, which also have effects on MASH. He expresses concerns that all this will lead to reduced focus on the liver.
00:26:43 - UK and AUS
Louise discusses activities in her two homes. Rather than focusing on liver disease, she prefers "poor liver health," which leads to cardiovascular disease and extra-hepatic cancers.
00:31:10 - Scanning patients as educational tool
Mike asks Louise to comment on scanning as an educational activity. Louise discusses the ability to generate an effective description and activate conversation when she delivers scan results right at the time of the patient visit. She then discusses the next steps if the first one doesn't work.
00:35:40 - Challenges and barriers for patients
To Jeff, the previous conversation between Louise and Michael provides "a really great synopsis" of the challenges and barriers to patient diagnosis and care. He announces that the GLI is planning to release its first Best Practices in Policy report. These challenges are more complex due to the need to find solutions for diagnosis and health system follow-through that will work around the world.
00:43:10 - Battles around healthy lifestyle policies
Jeff describes two challenging US health policy cases: the VA's decision (later reversed) to require biopsy for Rezdiffra and giant food companies lobbying to include added sugar as a healthy food item. Louise links the sugar question to "a big to-do" in the UK about children's teeth and access to dentists because poor dental health drives a 7x increase in the risk of liver cancer and advocates for generalized dietician training.
00:47:56 - The liver as elephant
Roger cites the parable of the blind people touching the elephant as a metaphor for a myopic view of liver health. He advocates teaching "the whole elephant" to healthcare professionals. Louise proposes an action point of "rule the liver out" before testing for related diseases. Roger suggests this is a dual mandate. For patients: Act Now. Get Screened. For providers, Rule the Liver Out.
00:51:21 - Initiatives for Global Fatty LIver Day and wrap-up
In lieu of a final question, Roger asks panelists to describe one specific initiative that is part of Global Fatty Liver Day. Mike and Jeff each describe screening activities.
00:58:13 - Question of the Week
Roger asks what listeners can do in their work to support the two simple mandates: act now, get screened, and rule the liver out.
00:58:44 - Business Report
This week's news on audience metrics, future episodes and this week's Vault conversation. -
One theme in this week's episode involves different ways to use NITs in drug development and assessing the value of older drugs in MASH. This conversation, from our review of last September's FDA workshop on NITs, considers two additional roles that NITs might play in drug development.
The conversation includes Jörn Schattenberg, Louise Campbell, Roger Green, and guest Laurent Castera. The original post has an excellent description:
This conversation begins with a discussion of a point from a previous episode in 2022 about the difference between NITs to qualify patients for trials versus to evaluate the efficacy of drugs. This point stems from the idea that the way disease regresses may not be the same way it progresses. Laurent notes that NIMBLE and LITMUS have demonstrated important results with large data over the last two years. Jörn comments on the limits of using transaminase as a key NIT and Laurent replies by discussing a study over time that shows faster early declines on liver stiffness and slow declines over time as therapy might shift from reducing inflammation to regressing fibrosis. Louise shifts focus to ask about the relationship between kilopascal drops related to lifestyle change, specifically to ask whether these are false positives or real effects. Laurent notes that BMI is a confounder for liver stiffness and that CAP might help assess this issue. Finally, in response to a question from Louise, Laurent answers that we do not know about some of the key changes in test scores, and need to know more.
Plenty more ideas are explored as this is both a fascinating and pivotal workshop which covers a range of topics on NITs with presentations by the some of the field's most innovative and knowledgable contributors. If you have questions or comments around the workshop, NITs, drug development or any other themes addressed in this episode, we kindly ask that you submit reviews wherever you download the discourse. - Montre plus
