Surfing the MASH Tsunami

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This conversation includes the second half of Jörn Schattenberg's and Roger Green's interview with Donna Cryer. It focuses largely on Stephen's inclusive approaches towards bringing stakeholders to pivotal discussions. 

Donna starts this conversation by noting an important thing she learned early in her career: when patients, advocates and physicians work together, their collective power is far more than the sum of their individual impacts. She commends Stephen as one KOL who always made certain that patient voices (including Donna's) and organizations had seats and voices at the table. She says, "I will be forever grateful for all the times he held space..." to that Donna and other patients/advocates could be involved in a major discussion. 

Jörn concurs and notes that this podcast was a key element in sharing different stakeholders' perspectives throughout the entire MASLD community, particularly during the COVID-19 pandemic when meetings were held virtually.  Finally, Roger notes that Stephen sought to include allied health providers the same way Donna describes him including patients and advocates.

When Roger asked for "Harrisonisms", Donna does not offer a specific one. Roger recalls Stephen's surprise that Roger knew the meaning of the phrase "Hoddy Toddy" to Ole Miss grads and how he quickly integrated phrases of others into his own conversations and presentations. WIth that, the interview ends.

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This conversation includes the first half of Jörn Schattenberg's and Roger Green's interview with Donna Cryer. While the question is about Stephen's most outstanding contribution to MASLD, the focus is more on his remarkable ability to trigger increased awareness of MASH in many different ways.

Roger starts the conversation by asking Jörn and Donna to describe one outstanding contribution (okay, maybe two) that Stephen made to the field of MASLD. Jörn talks about Stephen's role as integrator, talking to all different kinds of players, designing trials, focusing on issues and needs of patients, regulators, investors. To Jörn, Stephen was "a lens focusing that something that was needed to spark the fire..." Picking up on this insight, Roger asks specifically about Stephen's role in the founding of NAIL-NIT (along with Mazen Noureddin). Jörn harkens back to Stephen's earlier work on the LITMUS Cohort Study and contributions to the field to describe the process that led him and Mazen to start NAIL-NIT, and notes the consortium's tremendous success to date.

Continuing this theme, Donna describes Stephen's ability to bring people together and his providing "unique space for having smaller, intimate conversations: when necessary. She cites NASH-TAG, another event he co-founded, as a meeting designed specifically for this purpose and a remarkably fertile place for making progress on big issues.  

Roger recalls Stephen bringing Donna to the early podcast to describe International NASH Day 2021, and goes on to comment that Stephen was the rare individual who embodied Malcolm Gladwell's three legs of the Social Virus stool: scientist, innovator and salesman. Although he doesn't say so in the interview, the implication is that Stephen's ability to play all these roles at once has sped the social awareness of MASLD and MASH and the efforts to advance solutions.

Finally, Roger recalls Stephen becoming "ticked" during an early SurfingMASH episode on the FDA's first Complete Response Letter for obeticholic acid as proof of his passion for the work.

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Global Liver Institute Founder and CEO Donna Cryer and hepatology researcher and industry executive Dimitar Tonev join Jörn Schattenberg and Roger Green to share memories of our co-founder and  MASLD leader Stephen Harrison.  

00:00:00 - Surf's Up: Season 5 Episode 16
Standard lead-in, including quotes from panelists

00:02:55 - Introduction
Roger describes the structure of this episode.

00:04:04 - Conversation with Donna and Jörn, including groundbreakers 
Good personal and professional news from Donna, Jörn and Roger.

00:07:32 - Stephen's most outstanding contribution to MASLD
In response to Roger's question, Jörn describes the breadth of Stephen's contributions and interests. To Jörn, Stephen was "a lens focusing that something that was needed to spark the fire." Roger asks him to discuss  Stephen's role in founding NAIL-NIT. Jörn's answer covers Stephen's earlier work on the LITMUS Cohort Study and other contributions to the field as well as  NAIL-NIT. 

00:10:34 - Personal notes about Stephen
Donna continues this theme by speaking to Stephen's ability to bring people together and his providing "unique space for having smaller, intimate conversations: when necessary. 

Roger talks about Stephen bringing Donna to the early podcast to describe International NASH Day 2021 and comments that Stephen was the rare individual who embodied Malcolm Gladwell's three legs of the Social Virus stool. 

00:14:33 - Stephen's advocacy of patient advocates and allied providers
Donna discusses having learned early in her career about the synergistic power of patients, advocates and physicians. She commends Stephen as one KOL who always made certain that patient advocates and organizations had seats and voices at the table, 

00:19:06 - "Harrisonisms" and Harrison stories
Donna did not have Harrisonisms. Roger recalled Stephen's surprise that Roger knew the meaning of the phrase "Hoddy Toddy" and how he quickly integrated phrases of others. WIth that, the interview ends.

00:21:39 - Meet Dimitar Tonev
Dimitar starts off by telling the audience a bit about his history. His "one unique thing" is about his competence as a skier. This leads Roger to ask about his description in the SurfingMASH note of a "clumsy skier." Dim states that Stephen's form wasn't the best but that he skied with energy and passion. He goes on to tell a story about breaking Stephen's glasses the first time they met and how Stephen was able to laugh about it with him.

00:26:41 - Stephen's visionary approach to trial recruitment 
Dimitar describes how Stephen developed his process for recruiting patients into what were then called NASH studies through the "first iterations of Summit," the idea of a site network. 

00:31:19 - Another Harrison innovation
Dim discusses one more innovation: recruiting in neighborhoods that received lower levels of medical care and then recruiting within families. Roger shares that this podcast started to educate sponsors and researchers about the ability to keep trials running in a site network like Summit. 

00:34:35 - What made Stephen Special and Wrap-Up
To Dim, Stephen special was his in his "enormous capacity to work long hours,"  Dim and Roger agree about the energy and enthusiasm Stephen devoted to everything he did. 

00:37:48 - Special Stephen stories
Dim tells a story about Stephen flying over the Atlantic with his family. You'll have to listen to learn it. He goes on share two more special stories about Stephen. .  

00:43:29 -Question of the Week
Roger asks listeners who attended DDW last weekend which paper or presentation struck them most forcefully, and why.

00:44:02 - Business report
This week's news on the Stephen Harrison memorial, our new private membership list, upcoming episodes, and listener updates.

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This week's vault looks back to SurfingMASH's Barcelona coverage in earlier years to identify one point we can use to evaulate progress in the field. In this case, we looked back one year to see that INCBCN focus on NITs was driven largely by work from NAIL-NIT.

Specifically, the 2023 version of NIT coverage at #SLDThinkTank 2024 was a discussion of real-world data from NAIL-NIT. The original conversation has a robust description:

Surfing NASH returns to review the 2023 Innovations in NAFLD Care Workshop (INCBCN) which concluded on 27 May in Barcelona. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss highlights and takeaways of the event with Louise Campbell and Roger Green.

This conversation captures the meeting in a broad sense by outlining its goals and reason for being. Jeff describes this year’s emphasis on expanding the community of practice beyond hepatology. For example, friend of the podcast and co-host of our Rising Tide series, Ken Cusi, chaired a session on the role of endocrinology and diabetology in the early diagnosis and management of NASH. In Jeff’s words, “We were trying to look at the liver more holistically and look at who else should be involved in a multidisciplinary approach.”

The discussion shifts to a review of the NASH-NITs Real-World-Evidence Summit. Jörn suggests that moving forward, the Summit ought to be expanded and broadened. After Jörn comments on the positive experience of facilitating hands-on engagement, Louise offers her take. She underscores that FibroScan testing requires adequate knowledge and training to be well-executed with precision. The group goes on to describe in detail what made the Summit unique and how it might grow in the future.

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This wrap-up conversation focuses on elements to add and reconsider for #SLDThinkTank 2025. One key concept was to broaden the set of stakeholders invited to participate. Another involved focusing on the broader idea of "preventive hepatology." 

This conversation starts with Roger Green asking the group what other topics from #SLDThinkTank 2024 the panel should discuss before closing. Jörn Schattenberg expresses the hope that future meetings will have a wider representation of patient advocates and allied health professionals. Jeff wishes a representative of WHO could have been there. Mike recommends broadening primary care presence, and Maja would like to see more on technologies, specifically citing proteomics and mass spectrometry as two examples. "As an outsider," Louise asks whether it is time to focus more intently on preventive hepatology and pre-screening. Jeff elaborates on the concept of preventive hepatology, anticipates that pre-screening will come from other specialties and notes that advocates and practitioners are focusing on preventive hepatology concepts without using that phrase. 

Finally, Roger asks the group how non-practitioners can help drive wider awareness and action. Group answers vary widely.  

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This conversation from #SLDThinkTank 2024 focuses largely on ways to improve delivery of screening services to patients. Along the way, participants reflect on the value of having Rezdiffra approved in the US and on its way to approval in other markets. 

As the conversation starts, Mike Betel transitions from a broader discussion of prevention to note that there are 94 FibroScan devices for all of Canada. Even these 94 are severely underutilized! Maja Thiele states that having a drug in market will motivate stakeholders throughout the system to screen more aggressively because they feel having an approved drug will enable them to help patients better. Louise Campbell asks whether the vision around utilizing FibroScan better included more creative approaches to site of delivery. This leads the group to discuss what will be necessary to improve utilization of these machines. Specifically, Mike asks who will coach allied health providers and physicians to use NITs (specifically scanners) as a way to open broader conversations on liver health.

Jeff says that the last few minutes of discussion provided a general flavor of what the Open Space session was like. and comments on why this kind of small meeting is the right design for thinking big and brainstorming openly. He notes the mandate to get "better bang for the buck." Mike says it was extremely helpful to have a large number of younger attendees. 

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As the Surfers dive deeper into the substance of #SLDThinkTank 2024, Jeff Lazarus describes the meeting agenda and anticipated outputs, and other panelists discuss how the "Magic Wand" exercise and other ideation elements produced some truly "Big Picture" insights.

The conversation starts with Roger asking participants to describe the meeting agenda and what they considered its highlights. Before describing the agenda, Jeff enumerates the paper(s) that will result from this meeting. He lists the ten major issues the group developed for the pursuit of ending MASLD and MASH as a global health threat and proceeds to describe and elaborate on several of these.

When Jeff finishes, Jörn recalls that at the end of the first session, the chairs gave participants a "Magic Wand" to achieve the broader goal of making dramatic progress in patient screening and treatment. He notes a consensus that "we ha[ve] mechanisms and biomarkers" but have major social, political and academic challenges ahead if we are to slow the rate of the pandemic meaningfully. To Jörn, the field may need to improve tests and clarify cutoffs, but the major issues require support from governments and payers paying for tests rather than asking patients to pay for their own. Maja notes how long and challenging "the road between research finding and then implementation" is. Mike and Jeff go on to focus on prevention issues as separate from treatment.  

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The first conversation from our #SLDThinkTank 2024 coverage explores the meeting design from two perspectives. Co-hosts Jeff Lazarus and Jörn Schattenberg discuss the overall design, after which participants Maja Thiele and Mike Betel share their reactions.  
The conversation starts with Jeff providing background and rationale for the #SLDThinkTank 2024 design. He starts by referring back to an initial meeting in 2019 and the first two years of INCBCN (Season 4, Episodes 13, 23; Season 3, Episodes 18, 24).  He then describes why he felt a small-group brainstorming approach might work better than the last two years of PowerPoint presentations and group questions. This agenda, which was designed to encourage dialogue that generated new answers to the largest questions in SLD, included five "hot topic" sections, two focused workshops and an innovative ideation concept called Open Spaces.

When Jeff finishes, Jörn describes how the highly innovative "Open Spaces" element actually worked in his section of the room.

Maja and Mike share their impressions of the meeting. Maja starts by praising the Open Space concept, which she describes as "especially fruitful" due to the diversity of attendees. After Mike seconds her comment about diversity, she goes on to describe what she did during Open Spaces. The rest of the group chimes in with points about the design.

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#SLDThinkTank participant Maja Thiele, a first-time guest, shares her professional history and the traditional "one thing the audience might not know about you if you did not tell them." In the process, she talks about her professional history and a current study, LiverAIM, for which she is leading a pivotal element. 

Two elements make this introduction unique. First, Maja's "One Thing" answer is a first among the 120+ guests that have appeared on this podcast. She is the first SurfingMASH guest who has actually served as a radio host (old podcasters like Roger live with awe and respect for radio hosts!) Second, Jörn Schattenberg asks her to discuss her pivotal role in LiverAIM, the largest randomized control trial ever anticipated in SLD. 

This episode provides not only an excellent understanding of a first-time panelist we hope will join us often in the future, but also an introduction to LiverAIM, a study that will likely be the focus of many SurfingMASH episodes in years to come.

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#SLDThinkTank 2024 co-chair Jörn Schattenberg and SLD Think Tank co-chair Jeff Lazarus, participants Maja Thiele and Mike Betel and SurfingMASH co-hosts Louise Campbell and Roger Green convene to discuss #SLDThinkTank, a conference designed to innovate solutions for addressing large issues, many involving public health,  in conquering MASLD. 

00:00:00 - Surf's Up: Season 5 Episode 15
Standard lead-in, including brief quotes taken directly from the episode.

00:02:45 - Introduction
Opening comments discussing the aggressive travel schedules of our guests. 

00:04:02 - Meeting Maja Thiele and LiverAIM
Maja introduces herself to our audience, including her "One Fact:" she has been a radio host in Denmark. Jörn mentions that Maja is about to start "the biggest randomized controlled trial in hepatology" through LiverAIM, an extremely ambitious project funded through the EU Innovative Health Initiative. 

00:12:47 - Groundbreaker
Each panelist shares one piece of good news from the previous week.

00:15:38 - #SLD ThinkTank 2024 design 
Jeff provides background and rationale for the #SLDThinkTank 2024 design, going back to an initial meeting in 2019 and the first two years of INCBCN (S4, E13 and E23; S3, E18 and E 24).  The event included five sections, two workshops and an innovative concept called Open Spaces. Jörn provides color about how Open Spaces actually worked. 

00:20:13 - Participants' experiences
Maja praises Open Spaces, which she describes as "especially fruitful" due to the diversity of attendees. After Mike seconds this comment, she describes her Open Spaces experience. 

00:25:53 - Meeting highlights 
Roger asks participants to describe their highlights from the meeting. Jeff describes the paper(s) that will result from this meeting, lists the ten major issues the group developed for ending the SLD pandemic, after which he elaborates on a few of these.

00:29:40 - The Magic Wand exercise
Jörn: at the end of the first session, chairs gave participants a "Magic Wand" to achieve their goals. He notes a consensus that "we ha[ve] mechanisms and biomarkers," but face major public and policy challenges if we are to slow the MASLD growth rate meaningfully.  Maja notes the long timeline from research to implementation. 

00:33:09 - Improving utilization
Mike discusses prevention separate from treatment: There are only 94 FibroScan devices in Canada, and even these are underutilized. The group discusses what will be necessary to improve scanner use in a future world where having medicines motivates medical stakeholders.

To Jeff, this discussion provided a sense of how the Open Space session worked and why this is the right design for big issues like "getting better bang for the buck." 

00:43:59 - NIT Summit 
Jörn discusses the NIT Summit, which preceded the #SLDThinkTank. He sees this as a first step toward acknowledging that we need to train more people and find ways to train them better.  Jeff agrees.

Maya describes Elliott Tapper's state-of-the-art talk on social media. Her takeaway: video is a valuable new format, especially for younger stakeholders. 

00:47:39 - Wrap-Up Questions
Roger asks the group what other topics from #SLDThinkTank 2024 to discuss before closing. No two panelists' answers are redundant.  Finally, Roger asks how non-practitioners can help drive wider awareness and action. Again, answers vary widely.  

00:55:45 - Question of the Week
Roger asks listeners to describe "one way that making better use of the tools we have today (diagnostics and medicines) can make a major dent in the MASLD pandemic."

00:56:38 - Business section
This week's news on increasing interest in SurfingMASH, our first newsletter, the Stephen Harrison Memorial page, upcoming episodes and this week's Vault.