I recently wrote about my view that for the first time a cirrhosis patient could look forward to real medical therapies. A few folks felt that I was planting false hopes and that such miracles weren't going to happen. In light of that, I thought I might provide a broader view of the situation today.
Some of you are old enough to remember that not so long ago Hep C was unknown. We called the illness non A non B hepatitis. Today we have a cure. A miracle perhaps but also a lesson.
I spent my life as an engineer and I guess that gives me a somewhat different perspective than those in the health sciences. That relates to this discussion if we step back and consider what the difference is between science and engineering.
We live is a magical time for the scientists. We have powers undreamed of a generation ago. For example, you might watch a few videos about some of the many new tools recently available to researchers and consider what it means to have tools like this.
SEEING THE UN-SEEABLE FROM THE DISCOVERY CHANNEL
From living cells to the atoms themselves
These are certainly interesting you say but what does that have to do with a treatment for my NASH? That is the question. Was it fair for me to say that actual therapies are on the horizon?
Discovery isn't made in a vacuum. You don't just find truth one day in your laundry. Progress is built brick by brick upon the efforts of those who have gone before, and most importantly it depends upon the tools available to do the work. This is where the line between science and engineering exists.
Science is the discovery of things that are unknown. It is the probing at the boundaries of knowledge, imagining what might explain some unanswered question and proposing how to prove or disprove that idea. Usually the quest began because of some mystery or anomaly exposed by the current generation of tools. Answering this new question becomes the realm of the engineer because new machines or ways of solving problems must be developed in order to probe the workings that produced the question.
OK, a bit theoretical here, but what does that have to do with therapies for liver disease? I'm glad you asked. The solutions to great problems go step by step. In the beginning there are so many unknowns you are just searching for any kind of unifying idea. As you learn about the details the future possibilities gradually become more clear. At some point you learn enough that you can say with confidence "This is a solvable problem". You may know for certain that you don't have the answer yet, but you do know that there is one and that you can find it.
That is where we are with diseases like NASH and cirrhosis. Our tools have advanced to the point that we can watch live cells operate in real time. we can see to the very fundamental core of the processes that they do. Even though it is mind bendingly complex we know that we can understand and manipulate the chemistry of those cells.
We are now doing the engineering, the construction of a solution and we are quickly kicking the scientists to get out of the way and find new frontiers to explore because our tools and knowledge are advanced enough to build solutions, not to just look for relationships. That is why I am not speaking of miracles when I say that we can see therapies on the horizon. The timeline is murky but not impossible to glimpse anymore. When a problem becomes that of exactly how do we do this? Instead of can it be done at all? We have crossed an important threshold and in medicine that battle has changed in just the last few years. The message then is this
If you can force your heart and nerve and sinew
to do their turn long after they are gone,
and so hold on when there is nothing in you
except the will that says to them hold on.
Yours is the liver that can endure
and what is more, survive to a cure.
Apologies to Kipling, our best to you and yours. Remember diet is critical to your liver. In case you forgot, here is a place to start again.