People who are lost can walk in a circle and get back to where they started. It is a bit like that for the patient community.  In 2020 we were getting ready for the FDA to hold an adcom meeting on the Intercept drug Ocaliva. Adcom is where they take public testimony and as patients we wanted to speak. This was to be the first drug that had met the targets set by FDA for a NAFLD/NASH therapy. We all knew it wasn't a perfect solution but when there is no therapy at all it was a place to start and we were very hopeful.

My grandson asked about our family tree for a school project and I found myself thinking about the changing character of our society and wondering how we have become so dysfunctional.

I have been fortunate to have lived in a region that may be one of the last parts of the country to have retained aspects of the society that settled the West in the 1800's.  Both sides of my family were part of the wagon train movement that came west and settled in Idaho.

The new guidance for managing NAFLD/NASH has been officially published. This is the official guidance by the American Association for the Study of Liver Disease (AASLD) and it is intended to provide primary care and other providers with the information they need to provide care for their patients. A key element for us is that it supports early intervention for high risk patients and provides clear guidance for how to risk stratify and to determine who needs referral to a specialist.

Very few parents would say that they wouldn't take risks to save their child.  In fact many people would try to protect unrelated children from harm. These impulses are just part of our nature. But what are the limits to that? At what point do we stop being concerned about harm to our own or other children?

OK, this is a really strange question for a patient health blog but stay with me for a little while.

When I was a newly diagnosed patient with cirrhosis, one of the things that offended me was that my doctors had followed practice guidelines that said not to screen for asymptomatic disease. I had to be hospitalized before I learned anything about my liver getting sicker for at least a decade. Many of you can relate to that, as you have told your stories in the groups.

It hasn't been officially published yet, but the new guidance by the American Association for the Study of Liver Disease (AASLD) will soon release new practice guidance. Here is a summary slide of the key points.

We have been asked by a colleague to help distribute this study on stigma to the patient community. Please find below information about this opportunity to share your thoughts and contribute to NAFLD research by completing an anonymous survey:

INTERCEPT RESUBMITS NEW DRUG APPLICATION TO FDA FOR OBETICHOLIC ACID IN PATIENTS WITH LIVER FIBROSIS DUE TO NASH

A SURPRISE CHRISTMAS PRESENT FOR PATIENTS WITH FIBROSIS. IF YOU WOULD LIKE TO READ THE PRESS RELEASE CLICK HERE.

A bit of history may be helpful to many. Obeticholic Acid (OCA) was filed with FDA in 2019 but FDA didn't go through with a planned patient meeting called an adcom and instead issued what they called a complete response letter in June of 2020 and raised questions about safety.  They did not reject the application they just punted.  The department was going through some reorganization at the time and from a patient perspective we did not believe the sequence was proper but we were stuck with it.  Most companies would have abandoned the effort at that point.  To their great credit Intercept believed in the drug and continued their studies to answer the safety questions that had been raised.  Now they have much more data and good evidence of safety which we believe should resolve that issue.

Madrigal Pharmaceuticals today released strongly positive results for its NASH drug Resmetirom which are far superior to what almost anyone expected.

Their strongly positive results were across the board for the pivotal MAESTRO-NASH study in patients with fibrotic NASH. Resmetirom achieved highly statistically significant results in two key primary endpoints with both daily oral doses, 80 mg and 100 mg, relative to placebo. Specifically:

Patients who have been on this journey with me over the years know my story, but for the new folks, I've been a test dummy and I've been able to track my progress with my darned cirrhotic liver over the years. Here is a chart of my progress through June of 2020. Notice that I've confirmed my progress with both Fibroscan and MRE and I have progressed from a Fibroscan of 21.5 at diagnosis to 9.6 in 2020. Technology is advancing and I recently had an opportunity to get a Velacur test, a new kid on the block offering liver tests.

I was saddened to see our most commonly searched terms within The Wellness League's FindHelp tool. We know the community is fragile and has many health issues but nearly 53% said food was their biggest concern. Imagine that, in a society where excess calories are our biggest driver of long term illness, the unwell struggle with food issues.

We presented a poster of the State of NAFLD/NASH Care in America survey at the annual conference of the AASLD, the American Association for the Study of Liver Disease, last week. If you would like to look at a pdf click on the image below.

Of shoes and ships, of sealing wax and cabbages and kings -- and NAFLD and NASH and how we treat those things.

The Foundation's recent State of NAFLD/NASH Care in America survey highlighted the problem of the lack of understanding of liver disease, even after a visit with a specialist. How do we manage a disease when only 13% of patients understand it even after seeing a specialist?

I want to invite you to a short webinar to introduce you to a key project of the Foundation that is just coming to life.

We all have many needs that are outside the doctor/patient issues we usually talk about. We need patient oriented tools to help with the many non-doctor issues that we face. The Wellness League is our effort to help by making the connection to services easier. If you can't attend go ahead and register and we will send you the recording.

The first I ever heard of NASH was when I was diagnosed with cirrhosis.  Couldn’t be I wasn’t a big drinker.  As I went through several years of trying to understand my situation and get a proper management program I learned that I could have been warned of this slow moving progressive disease years earlier.  I would have had a very good chance to avoid stage 4 liver disease had I just been properly screened.  The fact that there are millions just like me who have advancing disease and don’t know it was a key reason for the creation of the Fatty Liver Foundation.

This note is an invitation to a webinar about managing social isolation. It will be September 28th, 12:00 EST.

I'll explain below but click this link to register.

No one plans to become sick and alone, cut off from meaningful human contact and dying slowly. Humor me for a bit and picture yourself being in solitary confinement and being quite ill. Your cell bars are not metal but the pain and fatigue of chronic illness can become so heavy that breaking free is very difficult.

When you think about how we, as a patient community, live day to day what do you think the top 5 concerns are for this broad and very diverse group of people?

OK Wayne just a darned minute, why should I look at another search engine. I get so sick of all the ads.

Me too, that's why this site is ad free and dedicated to patients. Give it a look at least.

CLICK TO TRY THE NEW WELLNESS LEAGUE SEARCH TOOL

A patient support project of FLF.

Do you need help with any of these and don't want to see a lot of ads?

• Health
• Food
• Housing
• Goods
• Transportation
• Money
• Patient Care
• Education
• Work
• Legal

¿Por qué la población hispana en los Estados Unidos está siendo altamente afectada por la enfermedad de hígado graso no alcohólica (NAFLD)?

La prevalencia de la enfermedad de hígado graso no alcohólica (NAFLD), es una creciente pandemia afectando a millones de personas en el mundo. Actualmente en los Estados Unidos una de cada tres personas presenta la enfermedad, y desafortunadamente la mayoría no lo sabe.

La población hispana en los Estados Unidos es uno de los grupos principalmente afectados por esta enfermedad. La alta prevalencia de comorbilidades presentes en los hispanos como diabetes, obesidad, hipertensión, hiperlipidemia y enfermedades cardiovasculares son algunos de los principales factores de riesgo asociados con la prevalencia de NAFLD. Los hispanos son uno de los grupos que, si son diagnosticados, presentan estadios de la enfermedad más avanzados y en muchas ocasiones tienen un peor pronóstico.

CLICK HERE TO PARTICIPATE IN THE NAFLD/NASH CARE SURVEY

The patient community is very large, but a broad understanding of the challenges we face is lacking. In peer groups patients often express their opinions of the care they have received. Patient experiences cover the entire range from very good to very bad.

There are existing patient surveys but they are usually driven by academia. I thought it would be a useful and simple thing to capture a view of the patient experience from the patient perspective so it should be simple to get a large group of patients to engage. Seriously, what could make more sense than patients speaking up about their experiences?

We recently offered a flash survey to our members asking for their views on whether the term "fatty" included in the name of nonalcoholic fatty liver disease (NAFLD) was stigmatizing.  Here is a link to the results.

Results of the Flash Survey on Stigma in the name NAFLD