S2-E59 - Discuss the Global NAFLD Agenda publication With Lead Author Jeffrey Lazarus Surfing the MASH Tsunami

Lead author Jeffrey Lazarus joins the Surfers to discuss Advancing the Global Public Health Agenda for NAFLD, the major article recently published in Nature Reviews Gastroenterology and Hepatology. The article reports the results of a study with 218 Fatty Liver stakeholders in over 95 countries. Jörn Schattenberg, who participated in the entire exercise, joins Stephen Harrison, Louise Campbell and Roger Green to discuss the process, the insights and what comes next.

8:55  - Jeff Lazarus begins discussion by discussing Delphi process and scope 
13:13 – Jeff reports: No country scored over 50 on preparedness for the NAFLD pandemic and goes on to list the eight core issue areas for this initiative
14:49 – Jörn Schattenberg discusses his reactions as a participant in the process
16:29 - Stephen Harrison says clinicians will support document, then goes on to describe how healthcare practices in the US militate against thoughtful patient care
18:45 – Stephen’s wish: more data so we can provide stronger insights on prevalence
19:55 – Jörn elaborates on how an agreed public health agenda and care models could streamline diagnostic and treatment processes
20:35 – Jeff: we are a long way from strong global data…and we need that data to demonstrate the current and future cost of disease to policymakers
22:22 – Stephen: we know enough today to target post-menopausal females with marginally controlled diabetes
23:25 – Louise Campbell sees various systems' weaknesses and strengths as source for planning
25:01 – Louise: “I can’t fathom” the potential cost savings of earlier screening and treatment 
25:45 – Jeff discusses his Hepatitis C experience to say “This is how we start”
26:21 – Roger Green comments the dual awareness challenge: physicians do not think of NASH as even one disease when in fact it is two:  a metabolic NCD in F2 vs. serious  liver disease in F4
28:13 – Jeff describes the strong positive reaction of the Nature Reviews journals and others toward this paper
29:15 – Jörn: this kind of awareness will help us raise public and not-for-profit funding for related research initiatives
29:50 – Discussion shifts to “What comes next?”
30:01 – Jeff discusses ways the collaboration continues and notes that the liver community needs allies to make this happen
34:36 – Stephen: we need one messages to motivate patients to improve behavior and another to compel governments to spend 
36:07 – Jeff: we need governmental structures to support individual activities
36:20 – Louise: we need to increase education and focus on small behavioral steps people can achieve
40:11 – Stephen’s key place for impact: a simple global message for frontline providers that looks forward to when NITs become accepted and drugs are available
42:44 – Roger asks how this effort relates to the US multi-specialty Clinical Care Pathways initiative 
44:06 – Jeff:  Clinical Care Pathways  excellent, but we still need to focus on national health systems, sedentary lifestyle and patient education
45:37 – Jeff: Center for Disease Analysis forecasts a 2x – 4x growth in NASH cirrhosis between now and 2030 in the countries they have modeled
46:12 – Louise doubts our health systems can handle that kind of growth 
47:48 – Jeff: cirrhosis will “sneak up” on global health authorities
49:49 – Final question: one place we can have impact quickly
50:02 – Jörn: working with policy makers in Germany to develop a national strategy
50:26 – Louise: educating policy makers in the UK 
51:18 – Roger: develop a message that conveys the "two disease" idea
52:05 – Jeff:  longer term modeling to demonstrate scale of problem
53:10 – Roger asks, if incidence estimates are too high, will anticipated costs scare off US and other payers
54:11 – Jeff sees overestimation as a potential problem
56:03 – Business section