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00:00:00 - Surf's Up: Season 6 Episode 13 
Louise Campbell, Jörn Schattenberg and Roger Green continue their discussion of some major issues from earlier this year, while co-authors Aleksander Krag and Stine Johanset join Roger to discuss their recent publication in The Lancet, titled "Screening for Advanced Liver Disease." 

00:04:45 - Major Issues of the First Six Months: Integrated Patient Management

Louise drives this conversation based on two related issues she sees emerging: (i) increasing opportunities for motivated patients to manage their own health and (ii) managing the total patient in an environment where people may be taking incretin agonists as if they are consumer drugs. With increased access to scanning, providers can monitor patients (and patients can self-monitor) more closely. However, some of the issues a provider might find are tricky: patients who undertake what Louise describes as "the sneaky areas patients think are normal, but are probably contributing to disease" due to miseducation or no education on healthy eating and lifestyle, or patients purchasing and using incretin agonists through consumer channels, but possibly at subtherapeutic doses. Vigilance and probing are key here, but health systems will need to train more people on the types of probing that uncover underlying issues and behaviors that patients mistakenly believe to be healthy.

 00:21:02 - Newsmakers: Aleksander Krag and Stine Johansen discuss Screening for Advanced Liver Disease

Last month, The Lancet posted online an article from Stine Johansen, Fredrik Åberg, Emmanuel Tsochatzis and Aleksander Krag, titled "Screening for Advanced Liver Disease." The article aims to update the Wilson and Jungner criteria, originally developed in 1960, to address modern needs and issues. In this conversation, Professor Krag and Dr. Johansen join Roger Green to discuss their article. 

There are many nuances and high points to cover in this thoughtful, fairly lengthy conversation, but the key point is that screening a mass population for HCC or cirrhosis has an entirely different set of issues and criteria compared to the screening usually discussed on this podcast, which involves identifying a population at increased risk for MASLD or MASH and screening them. 

00:54:42 - Major Issues of the First Six Months: Changes in US Health Policy and Potential for Dynamism in the In-Office Scanning Market 

Roger drives this conversation, focusing on two very different, yet very important issues: the first is the increasing dynamism of the in-office scanning market, with leader Echosens developing new products and services, while companies like e-Scopics, Sonic Incytes, and Mindray (Hepatus) are introducing new devices with competing profiles. Roger discusses the idea that some scanners keep all data resident in the machine, while others send it immediately to the cloud. Louise suggests that we should welcome any reliable scanning device to the market. 

Separately, he lists some concerns about how the Trump Administration's focus on cutting services to the poor, coupled with Robert F. Kennedy Jr.'s distrust of pharmaceuticals and mainstream health research, might limit the number of Americans with access to healthcare and the kinds of care they can access. 

At the end of this conversation, Roger asks Jörn and Louise what they consider major issues for the next six months.

01:11:40 - Business Report and Wrap-Up