Surfing the NASH Tsunami

This conversation From the Vault starts with Chris Estes describing the processes he and his colleagues at the Center for Disease Analysis Foundation have used to build a disease model for NAFLD and NASH prevalence in 15 countries. Chris discusses some of the unique challenges that modeling NASH presents. Among other items, these include (a) spontaneous regression of disease; (b) “excess” mortality (mortality not from a liver disease where NASH is a contributing factor); and (c) interplay of demographics (gender, age, race, etc.) and co-morbidities (most notably Type 2 diabetes) with the disease.

When Chris ends his initial comments, Jörn...

Last week, Jeff McIntyre of the Global Liver Institute introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. Jeff, an expert reviewer of the report, returns with the Surfers to expand on the contents, its shortcomings and potential implications. Among the panelists are Veronica Miller of the Liver Forum and new guest, Hannah Mamuszka, who is founder and CEO of Alva10.

This wrap-up conversation explores what the panels believe will be the impact of the ICER document for different stakeholder communities. Louise Campbell focuses on how...

Last week, Jeff McIntyre of the Global Liver Institute introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. Jeff, an expert reviewer of the report, returns with the Surfers to expand on the contents, its shortcomings and potential implications. Among the panelists are Veronica Miller of the Liver Forum and new guest, Hannah Mamuszka, who is founder and CEO of Alva10.

Veronica begins this segment with comments alluding to the dichotomy of the biopsy. On one hand, there is an emergence of AI-assisted histological assessment of...

Last week, Jeff McIntyre of the Global Liver Institute introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. Jeff, an expert reviewer of the report, returns with the Surfers to expand on the contents, its shortcomings and potential implications. Among the panelists are Veronica Miller of the Liver Forum and new guest, Hannah Mamuszka, who is founder and CEO of Alva10.

The session begins with questions from Roger Green around the report’s dated figures on disease prevalence. This leads Louise Campbell to note the intensity an...

Last week, Jeff McIntyre of the Global Liver Institute introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. Jeff, an expert reviewer of the report, returns with the Surfers to expand on the contents, its shortcomings and potential implications. Among the panelists are Veronica Miller of the Liver Forum and new guest, Hannah Mamuszka, who is founder and CEO of Alva10.

Hannah begins this conversation by asserting that the report “understates the problem of the size of population we’re talking about.” She notes that it fails...

Last week, Jeff McIntyre of the Global Liver Institute introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. Jeff, an expert reviewer of the report, returns with the Surfers to expand on the contents, its shortcomings and potential implications. Among the panelists are Veronica Miller of the Liver Forum and new guest, Hannah Mamuszka, who is founder and CEO of Alva10.

In this opening conversation, Roger Green introduces the ICER document and prompts panelists to share initial impressions around the assumptions and platforms that underlie it...

Last week, Jeff McIntyre of the Global Liver Institute introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. Jeff, an expert reviewer of the report, returns with the Surfers to expand on the contents, its shortcomings and potential implications. Among the panelists are Veronica Miller of the Liver Forum and new guest, Hannah Mamuszka, who is founder and CEO of Alva10.

10:05 Introducing the Report
Jörn Schattenberg briefly revisits the relatively large datasets on these two drugs. Veronica is “quite astounded” that this repor...

Last year on Thursday, June 9th we covered #NASHDay 2022, the 5th annual celebration of International NASH Day by the world’s largest liver patient advocacy organization, the Global Liver Institute. To celebrate the occasion, Stephen Harrison joined Jörn Schattenberg, Louise Campbell and Roger Green to comment on one crucial trend or event that most signified what the last year has meant in the Fatty Liver community.

This conversation includes three sections:

This final segment with Jeff McIntyre of the Global Liver Institute (GLI) explores the panelists’ final thoughts around optimisms and worries for the Fatty Liver field going forward. Next week, the Surfersinvite you to join a live session covering the ICER draft pricing recommendations on resmetirom and obeticholic acid (OCA).

This exclusive opportunity for the Surfing NASH community to attend the live recording as audience members will take place on Monday, March 13th at 1700h CET, 1600h. In doing so, you will be able to voice questions and feedback on the pressing topic of imminent NASH drug ap...

The Surfers are joined by Jeff McIntyre of the Global Liver Institute (GLI) for a thought-provoking impromptu session on what’s happening thus far for the Fatty Liver field in 2023. Roger Green begins this conversation by introducing a timely Lancet paper which coincided with the previous episode's focus on pediatric and adolescent NAFLD and NASH. The US-based study suggests that in five randomly allocated centers from 2002 to 2018, annual increase in incidence of Type-2 diabetes among 10-19 year-olds was a staggering 5% per year. He connects these findings to aforementioned ideas around public health policy and nutrition. Louise Campbell comments on how th...

The Surfers are joined by Jeff McIntyre of the Global Liver Institute (GLI) for a thought-provoking impromptu session on what’s happening thus far for the Fatty Liver field in 2023. In this conversation, Jeff continues on collaborative work by GLI to more formally “medicalize” obesity as a term considerate of genetic backgrounds and metabolic dynaminisms. He relates this grappling around nomenclature to that experienced in the Fatty Liver forum. Comments shift toward the subject of nutrition and an ominous landscape of public health policy. Jeff calls for hepatology associations to join efforts in assessing package nutrition labeling, advocating for reduct...

The Surfers host a thought-provoking impromptu session on what’s happening thus far for the Fatty Liver field in 2023. Jörn Schattenberg leads this conversation with comments around diagnostic and therapeutic advancements following the momentum gathered at NASH-TAG in January. He points to the large number of abstracts (estimated at over 2500!) submitted to the upcoming EASL Congress held in Vienna this June. While drugs are leading the way, Jörn insists diagnostics are closely following and contributing to "excitement on both borders.” Roger Green notes activity around organizing trials that incorporate non-invasive endpoints.

Louise Campbell adds her highli...

The Surfers are joined by Jeff McIntyre of the Global Liver Institute for a thought-provoking impromptu session on what’s happening thus far for the Fatty Liver field in 2023. This session features Jeff’s insights around the imminent drug approvals of obeticholic acid and resmetirom. His analysis includes mixed levels of enthusiasm around a draft report from ICER which includes pricing estimates for these drugs. The contention lies in the draft’s reference to NASH as a non-progressive disease - a position which the panelists readily refute. Jeff’s positive note is that the report carefully considers patient perspective and he w...

The Surfers are joined by Jeff McIntyre of the Global Liver Institute for a thought-provoking impromptu session on what’s happening thus far for the Fatty Liver field in 2023. Jörn Schattenberg leads this conversation with comments around diagnostic and therapeutic advancements following the momentum gathered at NASH-TAG in January. He points to the large number of abstracts (estimated at over 2500!) submitted to the upcoming EASL Congress held in Vienna this June. While drugs are leading the way, Jörn insists diagnostics are closely following and contributing to "excitement on both borders.” Roger Green notes activity around organizing trials around...

The Surfers are joined by Jeff McIntyre of the Global Liver Institute for a thought-provoking impromptu session on what’s happening thus far for the Fatty Liver field in 2023. The panelists touch on topics which elicit responses ranging from positive excitement around scientific developments to head-scratching concern over public policy positions.

06:31
Jörn Schattenberg opens with comments on diagnostic and therapeutic advancements which follow the momentum gathered at an energizing NASH-TAG conference in January. He specifically points to the numerous abstracts (estimated at over 2500!) submitted that will contribute to a scientifically-stimulating EASL Congress held in...

This episode From the Vault comes from the 2022 Liver Conference, where over 400 liver disease stakeholders gathered in Scottsdale, Arizona for the event sponsored by the Chronic Liver Disease Foundation (CLDF). The main meeting ran on a Friday and Saturday and was preceded on Thursday by a half-day session devoted exclusively to NASH (NASH Connect). Episode 15.3 of Season 3 and its conversations capture some of the thinking that went into the program design and some highlights of the NASH-related sessions.

This conversation focuses on the issue of pediatric NASH and NAFLD. Naim Alkhouri discusses the urgent need to include...

In yet another topical debut, Surfing NASH explores pediatric and adolescent Fatty Liver disease, its alarming incidence rate and developing the field's understanding around how to treat a vulnerable subpopulation. The Surfers are joined in discussion by Naim Alkhouri and chief of Gastroenterology, Hepatology and Nutrition at Children’s Hospital Los Angeles, Rohit Kohli, for a special session which illuminates a public health crisis intimate to the two extremely knowledgeable guests.

Roger Green leads this final conversation with an apt metaphor. He suggests that a population facing increasing severity downstream is like dealing with a momentous snowball ro...

In yet another topical debut, Surfing NASH explores pediatric and adolescent Fatty Liver disease, its alarming incidence rate and developing the field's understanding around how to treat a vulnerable subpopulation. The Surfers are joined in discussion by Naim Alkhouri and chief of Gastroenterology, Hepatology and Nutrition at Children’s Hospital Los Angeles, Rohit Kohli, for a special session which illuminates a public health crisis intimate to the two extremely knowledgeable guests.

This conversation begins with Louise Campbell’s note that, on average, it takes 17 years for clinical trials to be implemented in real world settings. She asks whet...

In yet another topical debut, Surfing NASH explores pediatric and adolescent Fatty Liver disease, its alarming prevalence and developing the field's understanding around how to treat this vulnerable subpopulation. The Surfers are joined in discussion by Naim Alkhouri and chief of Gastroenterology, Hepatology and Nutrition at Children’s Hospital Los Angeles, Rohit Kohli for a special session which illuminates a critical issue intimate to the two extremely knowledgeable guests.

Jörn Schattenberg steers this conversation toward the cardiometabolic complications behind patients living longer with Fatty Livers. Naim describes a paper which sought to strengthen understanding of epidemiology by...

In yet another topical debut, Surfing NASH explores pediatric and adolescent Fatty Liver disease, its alarming prevalence and developing the field's understanding around how to treat this vulnerable subpopulation. The Surfers are joined in discussion by Naim Alkhouri and chief of Gastroenterology, Hepatology and Nutrition at Children’s Hospital Los Angeles, Rohit Kohli for a special session which illuminates a critical issue intimate to the two extremely knowledgeable guests.

Roger Green prefaces this conversation with the observation that as a pandemic of Fatty Liver disease grows at boggling speed, so too does NAFLD and NASH in younger po...

In yet another topical debut, Surfing NASH explores pediatric and adolescent Fatty Liver disease, its alarming prevalence and developing the field's understanding around how to treat this vulnerable subpopulation. The Surfers are joined in discussion by Naim Alkhouri and chief of Gastroenterology, Hepatology and Nutrition at Children’s Hospital Los Angeles, Rohit Kohli. This is a special session which illuminates a critical issue intimate to two extremely knowledgeable guests. Rich with invaluable insights, the panelists elaborate on the following major themes:

08:55
Roger Green prefaces this conversation with the observation that as...

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity. In this episode From the Vault,  Jeff Lazarus and Roger Green discuss the ease of creating valuable metrics in a comprehensive care model, while our three practitioners -- Stephen Harrison, Jörn Schattenberg and Louise Campbell -- dive further into how they be...

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity. This sample session comes from the just-released Season 2 debut which focuses comprehensively on a new chapter of the podcast and why 2023 might be “the best year ever” for Fatty Liver.

The group considers what made 2022 special. Mazen highlights Madrigal’s positi...

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity. This preview looks at drug choices prescribers can make today for patients with Type 2 Diabetes Mellitus and obesity that have positive impact on Fatty Liver disease. In addition to co-hosts Dr. Ken Cusi and Roger Green, panelists for this discussion include endocrinologist...

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity. This preview comes from our second episode which focused on the new AACE Fatty Liver Guidelines.

The panelists include four authors of the guidelines: first author Dr. Ken Cusi from the University of Florida, third author Dr. Diana Barb, also...

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity.

This sample session comes from the debut episode which focuses on research that has led AACE to issue guidelines, AGA to propose clinical care pathways and AHA to produce a white paper on the links between Fatty Liver Disease and...

This week, SurfingNASH.com is offering a 17-minute section of our new series, “The NASH Tsunami in Diabetes; Getting Ahead of the Rising Tide.” Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity.

This conversation is an opportunity for NASH Tsunami listeners to learn about the series and why to subscribe by listening to this 17-minute segment of a previously unpublished episode from October, 2022, that is as timely today as when it was...

In this conversation From the Vault, panelists preview the inaugural Innovations in NAFLD Care Workshop which took place in Barcelona on May 6 and 7, 2022.  Commentary considers the bulk of the Day Two Agenda which conveyed an overall theme that NASH treatment is integrated and multifactorial. The day starts with Jeff Lazarus discussing Comprehensive Care Models for NASH, the path there and desired endpoints. The rest of Session 4 focuses on two forms of technical support: integrating non-invasive tests for NAFLD into clinical practices outside the liver space and looking at the power of apps to transform the w...

For the first time, Surfing NASH takes a deep dive into the prospect of digital therapeutics, their ability to drive outcomes and the critical success factors for proper use and deployment. This is an increasingly apt topic which intermittently surfaces on the podcast but has never featured at the center of conversation. The Surfers are joined by Naim Alkhouri and two new guests with prominent focus in this space: Joe Rubinsztain, CEO and Co-Founder of ChronWell, and Mark Berman, CMO of Better Therapeutics.

In this final session, Roger prompts the panelists to share final thoughts around how...

For the first time, Surfing NASH takes a deep dive into the prospect of digital therapeutics, their ability to drive outcomes and the critical success factors for proper use and deployment. This is an increasingly apt topic which intermittently surfaces on the podcast but has never featured at the center of conversation. The Surfers are joined by Naim Alkhouri and two new guests with prominent focus in this space: Joe Rubinsztain, CEO and Co-Founder of ChronWell, and Mark Berman, CMO of Better Therapeutics.

In this session, the group continues to discuss the benefits behind having an app...

For the first time, Surfing NASH takes a deep dive into the prospect of digital therapeutics, their ability to drive outcomes and the critical success factors for proper use and deployment. This is an increasingly apt topic which intermittently surfaces on the podcast but has never featured at the center of conversation. The Surfers are joined by Naim Alkhouri and two new guests with prominent focus in this space: Joe Rubinsztain, CEO and Co-Founder of ChronWell, and Mark Berman, CMO of Better Therapeutics.

In this conversation, Joe details the inception of ChronWell and the company’s mission of...

For the first time, Surfing NASH takes a deep dive into the prospect of digital therapeutics, their ability to drive outcomes and the critical success factors for proper use and deployment. This is an increasingly apt topic which intermittently surfaces on the podcast but has never featured at the center of conversation. The Surfers are joined by Naim Alkhouri and two new guests with prominent focus in this space: Joe Rubinsztain, CEO and Co-Founder of ChronWell, and Mark Berman, CMO of Better Therapeutics. 

Naim leads this conversation by elaborating on his involvement in a feasibility study with B...

For the first time, Surfing NASH takes a deep dive into the prospect of digital therapeutics, their ability to drive outcomes and the critical success factors for proper use and deployment. This is an increasingly apt topic which intermittently surfaces on the podcast but has never featured at the center of conversation. The Surfers are joined by Naim Alkhouri and two new guests with prominent focus in this space: Joe Rubinsztain, CEO and Co-Founder of ChronWell, and Mark Berman, CMO of Better Therapeutics.

In this conversation, Joe and Mark detail their backgrounds and respective roles at two...

For the first time, Surfing NASH takes a deep dive into the prospect of digital therapeutics, their ability to drive outcomes and the critical success factors for proper use and deployment. This is an increasingly apt topic which intermittently surfaces on the podcast but has never featured at the center of conversation. The Surfers are joined by Naim Alkhouri and two new guests with prominent focus in this space: Joe Rubinsztain, CEO and Co-Founder of ChronWell, and Mark Berman, CMO of Better Therapeutics.

Among a plethora of discussion points unpacked, the panelists explore the following...

This week's episode From the Vault comes from Season 2, Episode 59.3. Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join Stephen Harrison, Louise Campbell, and Roger Green to discuss the groundbreaking paper “Advancing the Global Health Agenda for NAFLD.” This conversation focuses on what will happen now, why NAFLD is “the canary in the coal mine,” and how we can combine strengths in different parts of the world to make all of our programs more robust.

For Jeff, “what’s next” includes a third, smaller Delphi study as well as a greater focus on Sustainable Development Goals (SDGs) around en...

In the final conversation on AASLD’s new practice guidance, Roger Green contextualizes a new project he is embarking on with Ken Cusi. Together as co-hosts, they will be debuting a new podcast series from next week titled The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. The content featured will largely be targeted toward healthcare professionals who treat diabetic patients, the patients themselves and their caregivers. The NAFLD-diabetes dual prevalence is alarmingly high:

Late last week, AASLD published new practice guidance on the clinical assessment and management of NAFLD. The Surfers convene with Ken Cusi, who contributed to the previous iteration published in 2018, to explore its key features and implications. The updated document reflects the many advances pertinent to any practitioner caring for patients with NAFLD. This conversation focuses around the influence the guidance imparts outside of the US.

Jörn Schattenberg shares that an EASL guideline commission has been set forward which will refer to the AASLD guidance in supporting its development. Louise comments on the density of information m...

Late last week, AASLD published new practice guidance on the clinical assessment and management of NAFLD. The Surfers convene with Ken Cusi, who contributed to the previous iteration published in 2018, to explore its key features and implications. The updated document reflects the many advances pertinent to any practitioner caring for patients with NAFLD. This conversation focuses on the impact this guidance may have on patients: will it make a difference and if so, how?

Ken asserts his position that both patients and providers need to be educated on solutions available today. Measures range from effective diet modifications...

Late last week, AASLD published new practice guidance on the clinical assessment and management of NAFLD. The Surfers convene with Ken Cusi, who contributed to the previous iteration published in 2018, to explore its key features and implications. The updated document reflects the many advances pertinent to any practitioner caring for patients with NAFLD. This conversation introduces ideas around how the guidance describes use of biomarkers and NITs to either exclude advanced disease or identify those with a high probability of fibrosis.

Roger Green begins by recalling how the US addressed cholesterol 35 years ago. Reference labs were asked...

Late last week, AASLD published new practice guidance on the clinical assessment and management of NAFLD. The Surfers convene with Ken Cusi, who contributed to the previous iteration published in 2018, to explore its key features and implications. The updated document reflects the many advances pertinent to any practitioner caring for patients with NAFLD. This conversation introduces differentiating factors which define a Guidance document versus Guidelines.

The conversation starts with Ken introducing the new guidance by placing it in the context of the last five years of thinking about screening and treatment of Fatty Liver patients. He highlights...