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The Liver Meeting, A patient's view of the state of the art

There are two big conferences in the world for people who deal with liver disease.  EASL is in Europe in the spring and AASLD is in the US in the fall. This is where the latest research is released, where the cutting edge of knowledge about the disease is shared, and where the future of liver medicine can be glimpsed.  It is a time for the superstars of the field to strut their stuff and be recognized by their peers and it is a window into the best of today and a glimpse of what we as patients can look to in the future.

We will follow this note with a more useful review of information we hope will be useful to you as patients, but I wanted to share a general perspective of what I see happening broadly.

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Announcing the NAFLD Screening Fund on NASDAQ


This is just an update. Almost no one actually watches these little closing bell ceremonies but they are a nice part of our historical record. It was interesting to be mentioned on the big screen on Times Square for a half an hour. Here is a link to the event announcing the NAFLD Screening Fund.

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Announcing the NAFLD Screening Fund

The Fatty Liver Foundation is launching a public private partnership fund with the long-term goal of screening a million asymptomatic, undiagnosed individuals a year for nonalcoholic fatty liver disease (NAFLD).

NAFLD and its serious advanced version nonalcoholic steatohepatitis (NASH) are epidemic but largely unknown to people. These diseases have subtle symptoms until late stage when they are diagnosed as cirrhosis. Most people know cirrhosis as a disease of alcoholism, and the end result of destruction of the liver is the same, but the cause is different. NAFLD is primarily a disease caused by food. It was unknown before calories became abundant and obesity became common.

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FIRST TIMES -- Do you remember yours?

A first time is often a turning point, a new direction or a different way.  They come in an infinite variety but must flower in their season. Click the First Time button for a 25 second snippet of great wisdom.

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COVID Booster - to jab or not to jab that is the question

I wrote about the danger of Delta while it was still just a problem for India.  Regular readers may recall my comment about it coming to your town.  We all know the tune for old folks and those with other illness at this point but it is important to understand that there is more to the story.  A booster is now available to some and I see questions about whether it is a good idea to get it.  I've had the booster but before I tell you my results lets step back and ask if the risks we face are the same with Delta as they were with our old chum Wuhan. A good measure is dying so a look at some case fatality rates might be fun.

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There is a new ELF in town, sorry no magic this time, but important anyway

ELF, cute little name but what does it mean to liver patients?

ELF was just approved as a blood test for fibrosis by the FDA and this is an important step in the efforts to develop better tools for diagnosing advanced liver disease and getting away from liver biopsy.

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The CDC talked to me like an adult, sadly I woke up, it was just a dream

I'm sympathetic to the challenge the CDC faces but I hate the way they dumb down their messages about this virus. By talking to us like we are 6th graders they just add to the confusion.  There are things you need to understand about this virus so that you can respond appropriately. See the summary notes below.

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Survey says...liver patients need to be identified to be more aware of their risks

Recently, we sent out a survey to our community to get an idea about COVID-19 vaccines and their impact among immunocompromised people with liver disease. We knew we were posing this survey to our community, which is likely more informed and focused on fatty liver disease, so these results should be considered in that context. Though we did not achieve statistical significance with any of our findings, thanks to you, we got over 100 responses and found some interesting, yet not completely surprising, insights. Click on the image below to see the top line results from the survey.


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Virus mutation factories, how might you become one of them?

Twenty million people with the liver disease NASH, or non-alcoholic steatohepatitis, are also more likely than the average person to be infected with the COVID Delta variant and suffer from long COVID. Many of these chronically ill will become variant factories increasing the risk of developing new and deadlier strains. We’re working hard to prevent that, aren't we?

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Medical care, I don't know whether I'm mad or sad, It is worse than I feared

I really want to be mad at someone, but who?


You are here because you have an interest in health. Suppose you had a dangerous condition that takes a decade or two to develop but had no symptoms. Would it matter to you if no one told you?

Buzz off you say???  Life is like that you say, lots of things happen to people. There's nobody to blame. It's in the fine print on the back of the ticket. Life isn't fair and no one gets out alive. Don't waste the energy thinking it can be better?

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PPAR (say pee par) not a short putt, a potent liver disease drug

PPAR -- Peroxisome proliferator-activated receptor

Lanifibranor by Inventiva leads the way

Wayne, you must be crazy to think I'll read something that starts out like that!!!

Be calm, I promise, it will make sense and if liver disease interests you this will be worth your time.

Therapies for NAFLD/NASH have been an elusive target and recent history is littered with promising molecules that many thought were finally going to lead to treatments for our disease. This is not a trivial problem. People are dying and our weapons are coffee and vitamin E.

Don't get on me about lifestyle right now.  I know that tune but I also connect through our peer groups with thousands of people who need more than that and drugs will be part of a proper management of this disease if we can ever find something that works.

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MADRIGAL PRESENTS, Resmetirom a leader in NAFLD/NASH drug development

Becky Taub and Paul Friedman, the founders of Madrigal Pharmaceuticals, are heroes of mine.

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One good TERN-101 deserves another, comments about a NASH clinical trial

There has been a lot of disappointing news about NAFLD/NASH therapy research this past year.  I thought you might enjoy a look at some new data that is very encouraging. Terns Pharmaceutical just reported very positive 12 week results of the drug TERN-101. Below is a chart from their report about changes in results using a fairly new non-invasive test by Perspectum, the Liver MultiScan measuring a value called cT1 or corrected T1.  I'll explain it a bit later but for the moment just know that it is an indirect measure of fibrosis.  Click the image to see a larger view.  As a phase 2 study this is a small number of patients but the effect on their livers in only 12 weeks is among the best early data that we have seen.

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Leapfrog liver disease funding, a proposal for a better way

We all know the issues. Too much disease, no treatments, a looming health crisis made worse by the pandemic. We are here on International NASH day and it seems like an apt time to wonder if there might be a better way.  If you haven't registered for the event I invite you to do so by clicking on the image below, but I also invite you to think about the future of research and how we as patients can support a better way.

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COVID mutations, vaccines, chronic disease -- things you need to know

Infection rates and vaccine failures - some points to ponder

We have been seeing the headlines about the COVID tragedy in India as hospitals turn patients away and the nation runs out of oxygen as people are literally dying in line waiting to refill oxygen tanks. India faces a historic crisis and you probably imagine the densely packed cities and poverty are the cause. But wait, what about the REST OF THE STORY?

If you or someone you care about has a chronic disease, there are things about the story of India that will likely affect you in coming months. I've written about COVID variants before, click here for a review. The UK strain has become the dominant variant in the US and it has done that because it is about 50% more infectious than the Wuhan original. The University of British Columbia recently released an actual image of the UK variant spike protein which helps us understand that. The image is an amazing science story about how they could take this picture but a story for another time.


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ARGH not another webinar, too many I know but this may help you

I remember Google before it became mostly an advertising farm.  To be able to get to information easily was magic. Today no matter where you go it is a parade of ads and cleverly designed hustles. Like search, now that video is so easy to do, the webinar world has exploded with ads. Since we don't sell anything and our only interest is having you not die of liver disease, getting past all the noise so that you might consider joining us is a real challenge.

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I can see clearly now, the patient journey through liver land

I can see clearly now (I love this)

click here for a bit of fun

but click on the image to register

Our upcoming webinar is Wednesday the 28th at 12:00 EST. If you are a patient or care about what patients have to say you should register.

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COVID mutations, you need to care about this

There are issues with the COVID virus and its mutations that are important if you have comorbidities and you can't get the information from headlines. As you re-engage with society a little information can help you decide what you will do.


We have all seen these picture of the coronavirus with all the spikes sticking out of the surface. The virus is really a remarkable construction. We all know that the molecules of life can change or mutate which can alter the way the various elements can react to their environment. The spikes of the corona virus are its key to infection. If one of them connects with an appropriate cell in a host it can attach and infect that cell. An important fact is that conceptually, all of those spikes could be different. In practice they are not but each could harbor a mutation and in the case with COVID we are seeing mutations that make it even more infectious. A short summary of what we know. Keep in mind that things are changing fast.

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Intention to diagnose - does your doc intend to diagnose NAFLD?

In the doctor/patient relationship there is a physician process which is called the "intention to diagnose". That may seem odd, but diagnosis requires a deliberate action by the doctor. You may be more familiar with the idea of the "intention to treat". You may have heard the argument that there is no value in identifying a condition if it can't be fixed and in that case there is no intention to treat so no intention to diagnose.

As a liver disease patient you may have learned about your condition when you were fairly advanced. Why does that happen? Is it a lack of the intention to diagnose, a failure of diagnosis, inadequate tools or training, or is something else happening? We are hosting a webinar on Wednesday the 17th at 12:00 Eastern.  We will be discussing non-invasive testing with a couple of experts, Dr Mona Munteanu and Dr Stephen Harrison, and we will talk about the diagnosis problem and the several tools available for detection and monitoring


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Non-invasive screening and genomics in NAFLD



We have had a series of webinars about the disease and cutting edge research.  Now we would like to focus on the future for the patient.  Covid wrecked our plans for SUNN-2, the next step in our plan to eventually screen 1,000,000 patients a year for liver disease, but with vaccines we can begin to think about that future.

I'd like to invite you to a webinar where we will look to the future and some of the tools that are going to help us in our battle with the noncommunicable diseases that have become the scourge of our time. Let me challenge you to step back from COVID for a couple of minutes and think about health more broadly. One small step is to attend this webinar.

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