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This conversation picks up focusing on the program’s opening session: Epidemiology and Public Health. Roger, Louise and Jörn begin to unpack the field of NASH in terms of adopting a holistic, metabolic approach. Roger asks, “How much of NASH are we thinking about in a holistic metabolic sense versus how much do we pay lip service to that, but really focus on the liver?”

In response, Rachel poses a strong question for the surfers. “What do you hope to get out of this session with an integrated approach between specialties? And how is that going to move the field forward?” Jörn takes the first shot. He suggests that data and insights might point the field toward pathway refinement and help identify where patients are lost on this journey. Louise agrees, noting one specific point of challenge: liver patients frequently present too late in the journey.

Next, Roger offers his take. “One of the problems the liver has always had is that nobody knows how to measure fatty liver disease.” How will the field move forward? He suggests the way to appreciate the importance of fatty liver disease is to demonstrate how many metabolic diseases and deaths it contributes to, using direct links. “If anybody can provide data that says, if you see this in the heart, the kidney, wherever, that's likely to be a liver issue or more likely to be a liver issue.” From here, the field can start to broaden the context of liver health in a more holistic sense.

Rachel then provides her answer. She is looking for strategies to link fatty liver with cardiovascular disease. Suggesting the establishment of if, then statements, Rachel looks to elucidate what actionable results can be taken with those links.