When I think about screening for liver disease I often find that tune from My Fair Lady, "Why Can't A Woman Be More Like A Man" running through my mind.
It is an odd mental tick I suppose. One of my favorite musicals connecting to a potentially terminal illness, but the challenge we face as liver patients would largely vanish if only a liver was more like a breast.
OK, I stretch the analogy a bit here but consider how cancer is managed. We search diligently for cancer and while there are significant differences between cirrhosis and breast cancer the statistics are interesting. There are around 40,000 deaths annually from each disease, but we search out the tiniest incidence of breast cancer that we can find and manage it aggressively but we ignore liver disease until it presents serious symptoms. Think about that for just a moment. Why would we test breasts regularly but intentionally ignore early liver disease?
The answer is that we don't have any pills and the treatment is dietary and lifestyle counseling which we suck at and have largely failed to do well. We see that from the obesity challenges our society is facing. Beyond that, historically we didn't have any useful and inexpensive tests to really measure the disease. Plenty of ways to explain the past, but today we do understand the bio-chemisty better and we do have ways to test for disease that hasn't caused symptoms yet.
One might think that we would be rushing forward with screening but we aren't. Among the reasons are that insurance doesn't really want to pay for wellness testing and it isn't the business model for medicine. There are efforts to change to a wellness model but what we have is a very entrenched system. We also still are faced with the fact that the best we have to offer is advice about how to eat better and the diet industry is a great example of a failure as people routinely yoyo up and down with their weight.
The Foundation believes that we should be screening the at risk liver population now and working on education about food because in the long run that will still be the best therapy even after they develop expensive pills. To that end we are sponsoring a screening project designed to make low cost testing available and to provide early warning to people before they become ill. If the subject is of interest here is a link to it.
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