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Manal Abdelmalek joins the Surfers to consider the three most important COVID-19 stories today.

The conversation focuses on the British variant, the new vaccines, and the physical and emotional toll the pandemic continues to take on front-line physicians and other healthcare workers. Stephen and Manal each have a sibling who works as an ER physician and they provide heart-wrenching stories on how tough the front lines are. Louise discusses how Britain is reacting to government policy designed to contain the new, more contagious COVID-19 variant. Roger discusses possible epidemiological trends and explains why the US may eventually follow the UK policy of delivering the first doses of the vaccine as quickly as possible. Thought-provoking in its own right, the discussion helps frame treatment and policy choices as well as the rest of this episode.

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Manal Abdelmalek joins the Surfers to discuss how recent COVID-19 news might affect Fatty Liver patients and what the medical profession and BioPharma companies can do to support patients better during this dangerous phase of the pandemic.

Manal Abdelmalek joins the Surfers to discuss the implications of the new British COVID-19 variant, availability of the Pfizer/BioNTech and Moderna vaccines and impact of social distancing on patients with Fatty Liver Disease. The discussion starts by surveying the current situation and goes on to discuss challenges for patients and provider and then keys to maximum success in conducting clinical trials and treating patients. In the end, Stephen Harrison and Roger Green propose big, bold solutions to improve diagnosis and patient care.

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Wayne Eskridge describes how hope fell and then rose as patients did not receive the drug approval they expected but then learned about exciting paths for new agents and non-invasive testing.

Wayne Eskridge describes his excitement as 2020 ends, saying "The quality of the work that's being done overall says that this is a far more tractable problem than we thought it was a couple of years ago. The level of sophistication that's being applied was undreamed of by the profession five years ago. So I'm very, very confident that we're going to see effective therapies," before cautioning, "How many jumps we have to get past to get there, I don't know." His excitement centers around very positive Phase 2 trials for multiple drugs with innovative modes of action and major advances in research and acceptance of non-invasive tests.

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Louise Campbell questions the implication of APASL and ALEH endorsing "MAFLD" as Fatty Liver Disease nomenclature and Stephen Harrison discusses behind-the-scenes activities to resolve this issue.

Louise Campbell "wonders" where increased support for adopting the term "MAFLD" (Metabolic-Associated Fatty Liver Disease) instead of NAFLD (Non-Alcoholic Fatty Liver Disease) "is going to take us in the next 12 months and how we are going to come to a resolution." In response Stephen Harrison provides background on how the dispute started and discusses the current multi-regional efforts to create consensus around a nomenclature that describes the range of Fatty Liver Diseases accurately.

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Joern Schattenberg discusses the public health implications of German newspapers beginning to discuss Fatty Liver Disease

For Joern Schattenberg, reading about Non-Alcoholic Fatty Liver Disease in a German newspaper "has two or three very important implications that we have discussed on the podcast in the past year," particularly in terms of educating patients with metabolic syndromes and families with obese children or adolescents. Increasing awareness of late-stage liver fibrosis and cirrhosis will bring short-term benefits to one set of patients, while reducing the frequency of liver disease in the young will have long-term benefits for these patients and the society at large.

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Ian Rowe discusses how streamlined use of ELF, FIB-4 and FibroScan improves cost effectiveness and patient satisfaction associated with NASH screening.

Ian Rowe comments on data from the landmark work he, Richard Parker and colleagues in Leeds, UK are conducting around the issue of population screening for NASH: "it's quite easy to show that you can identify more liver disease in the community and you can do so more efficiently." This short interview goes into detail.

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Guests Ian Rowe, Joern Schattenberg and Wayne Eskridge join the Surfers to discuss key lessons learned in 2020 about Patient Treatment and Perspectives.

Ian Rowe, Joern Schattenberg and Wayne Eskridge join the Surfers to explore some of the key lessons learned and issues uncovered in 2020. Ian Rowe discusses what population-level research in Leeds, UK, tells us about the benefits a streamlined liver testing model can yield not only in terms of better, faster diagnoses but also cost savings and improvement in patient satisfaction. Joern Schattenberg considers the implications when German mass media raises issues of Fatty Liver Disease in holiday season news stories. Louise Campbell questions what a patient-supported push to change the disease nomenclature from NAFLD to MAFLD implies for the future, while Stephen Harrison describes the emerging effort to get the most accurate and clearest nomenclature possible. Finally, Wayne Eskridge provides his perspective as patient and patient advocate on a year full of both happy surprises and disappointments and he finds himself surprised to be more optimistic at the end of 2020 than at the beginning.

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Roger Green discusses why despite widespread concerns, FDA's Complete Response Letter to Intercept did not cripple progress in NASH drug development.

Observers feared that after Intercept received its CRL, investment into NASH drug development would dry up and knowledge would slow. Instead, Roger Green describes how drugs that had reached Phase 2 development maintained sufficient momentum to move forward. As a result, therapeutic focus shifted from treating fibrosis in late stage patients (obeticholic acid's benefit) to treating the whole patient, including not only NASH but the full range of metabolic considerations. Net result: the vibrant, "boiling hot" market for NASH clnical trials and researchers that Vlad Ratziu described and the prospects that several exciting classes of NASH drugs will be here soon.

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Stephen Harrison summarizes a year of progress in improving the tests and analyses used to derive clinical endpoints necessary to initial drug approvals.

Despite reports earlier in the year, Stephen Harrison discusses the "aggressive, conscientious effort" an array of stakeholders is making to improve on the clinical endpoints that shape the decision to approve a Fatty Liver Disease drug before it has demonstrated positive outcomes for patients and the healthcare system. Three keys: (1) more rigorous human review of biopsy slides, (2) an eventual shift to incorporate Artificial Intelligence and, someday, (3) use of AI and non-invasive tests as a complete plan for developing these clinincal endpoints.

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Mazen Noureddin describes a year in which biopsy's shortcomings are revealed at the same time as non-invasive testing becomes better and produces more robust data.

Mazen Noureddin discusses the simultaneous loss of faith in biopsy as the clinical "Gold Standard" and the emergence of non-invasive tests that can become the standard and replace biopsy for three pivotal diagnostic needs:

1. Identifying patients at risk, those with fibrosis levels equal to or higher than F2 
2. Identifying patients who can serve as targets for clinical trial, which usually means they have NASH levels or at least N4 along with fibrosis greater than or equal to F2
3. Monitoring therapeutic responsiveness in both sets of patients over time without the need for serial biopsy.