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Thoughts at a hinge point in liver disease management

Everyone writes uplifting letters this time of year. Personally Rosemary and I are doing well and our best hopes are for all of you as we speed toward the next chapter of our lives. The GRAND CONJUNCTION of Jupiter and Saturn reminded me of my youth and the AGE OF AQUARIUS.  Something for those with a few minutes for a bit of nostalgia.

There are a lot of mixed currents in this section of the river of time that we find ourselves.


One comment about things that make me mad before I look to the future. Now that COVID vaccines are really happening I have a very self serving anger toward our government. The vaccines are a modern miracle but in Europe patients with liver disease are in the high priority group. Here liver is barely mentioned even though its co-morbid role with the rest of the body makes it a central player. The analysis failure of our system should not be happening. Just remember this chart and know that you are largely on your own if you have liver disease.


Actions by the FDA in their decision not to care what we, as patients, thought about obetacholic acid, the first potential treatment for NASH, still agitates me. I'm old enough to know better. All bureaucracies claim to care what people think but do exactly what they want regardless of the feedback they receive. I'm reminded of a book called the "The Peter Principle". It explains agencies by showing that people in a hierarchy tend to rise to their "level of incompetence": employees are promoted based on their success in previous jobs until they reach a level at which they are no longer competent and there they stay.

There are exciting advances being made in drug development but the time horizon is still lengthy for treatment. There is, however, exciting progress in non-invasive testing and we are moving Beyond The Biopsy with blood based markers and we are making some really important progress.

The development of blood based analysis of liver health will be even more important than therapy. Early identification of disease and the ability to monitor the disease over time is so very important. We can't control what we cannot measure so I am really happy with the progress being made in this area.

We are working on some new programs to help advance blood based testing but I wanted to let you know that this aspect of our disease management is moving quickly.

This table has a lot of information about various blood initiatives and I've included it to give you a sense of the work. Click on the picture and you can see a larger pdf of it. It is interesting if you are into the details but it provides a sense of the level of work being done on this very important part of combating liver disease so I've included it here mostly as a visual which illustrates that point.


Despite the pandemic and all of the disruption and delay there are a lot of good things happening and I will be bringing news of some of them to you soon.