Surfing the MASH Tsunami

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Surfing NASH is joined by Tim Jobson, Co-founder of Predictive Health Intelligence, to discuss a system by which historic blood test results are combined and analyzed to flag patients in need of intervention. This conversation begins with focus on the dual issues of patient data and proactivity. Roger Green states that “the careful and intelligent use of early data to empower patients to know when to ask about their own health” should yield a myriad of benefits. Louise Campbell agrees and comments on how patients feel when the system is proactively supporting them. Louise then asks what happens when the system produces an inaccurate diagnosis. Tim notes that this system provides data to clinics so that they can make the decisions. This minimizes the chance of systematic error and discourages autonomic reliance while still supporting patients in self-managing their health.  

The conversation continues on the issue of patient data, concluding with Roger’s observation that the passionate belief in protecting data is half-right. He reasons that patients (like all people) favor protected data against those who would take advantage of it. However, most are comfortable with affording accessibility to those who use their data to improve patients’ health and general life.

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Surfing NASH is joined by Tim Jobson, Co-founder of Predictive Health Intelligence, to discuss a system by which historic blood test results are combined and analyzed to flag patients in need of intervention. This conversation starts with a dialog between Tim and Roger Green around how simple the data and computations in this system appear to be. Roger describes a benefit in terms of patient throughput and asks whether Predictive Health has investigated along these lines. Tim agrees with the assumption but indicates that this work has yet to be accomplished. Finally, he underscores that this tool can help locate and recruit patients for research studies. Jörn Schattenberg agrees with the idea before asking whether the system processes natural language, or in his anecdote, scraps of paper from years ago found in the patient file. Tim suggests this to be easy enough to execute within the system and will become more powerful as use of the system expands.

From here, the conversation shifts to patient reactions. Tim notes that, in general, reactions have trended universally positive. Specifically, patients do not seem concerned that the health system has their identified data, something vastly different from what administrators believe and say. As the conversation winds down, Roger asks Jörn how he feels this work will align with the clinical care pathways initiative he is spearheading with Jeff Lazarus. Jörn confirms it will align well, indeed.

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Surfing NASH is joined by Tim Jobson, Co-founder of Predictive Health Intelligence, to discuss a system by which historic blood test results are combined and analyzed to flag patients in need of intervention. This conversation starts with Jörn Schattenberg asking questions around the underlying system and whether the algorithm is “plastic?” This is based on the set of conditions that the algorithm has to exist with missing data and that what is missing may vary from patient to patient. In addition to these conditions, analysis has to be time-sequenced. In response, Tim dives into the details of how these things actually work within this Predictive Health system. Specifically, he comments on how simply looking at ALT and platelet levels longitudinally can improve overall patient assessment by exceptionally large margins.

Louise Campbell joins to commend the system and ask Tim whether there is pressure to utilize less often to save money. Tim explains that his team is running a full economic analysis to demonstrate massive potential savings the NHS can yield by adopting this system upfront rather than dealing with the financial burden of treating downstream disease progression. Interestingly, it seems health administrators in his region seem to feel the same way, at least intuitively. The rest of the session goes on to address questions around measuring impact and explore simple ideas around how to execute this technology and its processes.  

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Surfing NASH is joined by Tim Jobson to discuss what he describes as a “combined informatics and clinical program simultaneously.” In this conversation, Tim begins by describing his background and how he came to partner with expert clinicians and specialists in healthcare IT to address how we can better identify liver patients in need of intervention. In partnership with former colleague Neil Stevens and his local NHS Trust, Tim led a grant application that gave rise to Predictive Health Intelligence where he holds the roles of Medical Director and Chief Investigator. Tim expounds the journey of improving understanding around how patients with liver disease could be diagnosed earlier by accessing and combining the results of previous blood tests. There are thousands of patients in any given region in the UK who have taken blood tests in multiple, unconnected offices. The system which Tim is working on aggregates a large number of these blood tests and searches for patterns in individuals. If a target pattern presents, the patient is summoned for a visit which can lead to treatment or an intervention. 

Jörn Schattenberg is the first co-host to share an impression. His two questions: whether they are looking at earlier stage patients and what have been the flavors of patient responses? Surf on to hear Tim’s response. 

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Surfing NASH is joined by Tim Jobson, founder of Predictive Health Intelligence, to discuss applying analytics to sieve through and distill invaluable data otherwise dormant in the NHS record systems. Tim, a Consultant Gastroenterologist and Fellow of the Royal College of Physicians, has firsthand experience with the shortcomings and frustrations around undiagnosed liver disease. Illustrating the pursuit of a solution, he walks us through the journey of developing a simple tool that can identify patients at risk of liver disease by analyzing the results of blood tests given throughout their lives. Also featuring in this session are Surfers Jörn Schattenberg, Louise Campbell and Roger Green, who pose compelling questions and share insightful perspectives on this particularly pertinent subject to the podcast.

Tim begins by providing his background and how he came to partner with expert clinicians and specialists in healthcare IT to address how we can better identify patients. A pivotal validation came in the form of funding from the National Institute for Health Research to establish Predictive Health Intelligence and create a software and system that works quickly and straightforwardly. He notes that this project is a “combined informatics and clinical program simultaneously,” where the building of new clinical pathways is a key part of their process and aims.  An important idea emerges: instead of waiting for inbound referrals, Tim is focused on how to proactively engage in outreach to those who likely may not come to attention until presenting with decompensated cirrhosis. At this point, the challenge around collecting patient data is acknowledged but explored in more detail later in the conversation. Once approved, the task targets organizing, curating and systematizing this data in a way that enables end users to search for, identify and investigate patterns of blood tests. This approach offers tremendous value in its ability to analyze cumulative results as opposed to deriving insights from a single point in time. By demonstrating area under the curve and introducing trend lines in an easily deployed case-finding search engine, frontline treaters are better equipped to pick up patients.

From here, the other panelists inject a series of thought-provoking questions, starting with Jörn’s focus on the patient response to this new pathway. Thus far, Tim is pleased to have received positive feedback and expects to conduct a comparative analysis as outreach expands. Jörn next prompts a thorough look into the computational components of this project. Tim explains a key to the system lies in “prepping the data” so that queries can generate cohorts of interest in mere seconds. This is an evolving effort that he works on closely with developers to craft bespoke technological solutions.  Louise asks about what barriers, financial or otherwise, stand in the way of outreach efforts. Tim states that specifically financial barriers are being combatted with economic analysis to demonstrate the massive potential savings NHS can experience by adopting these preventative measures. Discussion segues back to computational power and the integration of assessing for the wider metabolic spectrum. Roger suggests that such a technology can offer an effective optical validity test before he shifts thoughts toward integration with other pathways.

As the session continues, Tim fields numerous prompts which delve into patient engagement, elements of data privacy, physician responses, the future of this project and much more. This is yet another eye-catching profile of an innovative technology in the Fatty Liver space contending to solve an immensely relevant challenge. Surf on for the full feature, and if you want to voice your own questions, be sure to write us here. 

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As the podcast hosts insights from our very own audience this week, we are extending three additional conversations from recent reviews of a particularly exciting NASH-TAG 2023. This session features dialogue from a one-on-one interview with Donna Cryer, hosted by Roger Green.

The episode begins with Roger mentioning what he found to be one of the most striking statistics from the meeting: an IQVIA study captured only 200,000 total ICD-10 codes for NASH in a total US population that should have yielded 16 million such codes. To Donna, this underscores a significant need: we have to find physicians that want to treat patients. As she puts it, “it would do more harm than good” to send patients to doctors’ offices before doctors are activated to screen and treat. Roger identifies a dilemma: if patients aren’t visiting doctors, doctors will not feel motivated to learn. However, if patients are seen by unmotivated doctors, a negative information loop emerges. Donna notes lessons from the hepatitis care cascade and that at the outset, there is the need to screen an “enriched population” with higher probability of NASH. Roger suggests this is easier in the US, where electronic health records are standard. In much of the rest of the world, ALT tests are not part of a standard blood panel and too many records are on paper. Donna then emphasizes the need to dramatically increase advocacy and energy among medical stakeholders. She also points to what drug and diagnostic companies can do to energize physician practices to identify the patients needing treatment after a drug is approved. Finally, Roger asks Donna to rate her level of enthusiasm emerging from NASH-TAG. He offers a scale ranging from 1 to 6, where 1 represents “thoroughly depressed” and 6 represents “over the moon.” Her response addresses organization around regulatory science in a way that makes what is undeniable inevitable. Surf on to hear her gauge.

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This week, Surfing NASH has focused on community engagement and incorporating insights and perspectives from the listeners. If you enjoy our content, we kindly ask that you submit a review wherever you download our episodes. We also encourage our audience to write us questions and look forward to integrating your on-ground experiences and ideas in the weekly discourse. Most important of all, we whole-heartedly thank you for your continued support as we set out to put a major dent in Fatty Liver disease in 2023 and beyond.

Stay safe and surf on!

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As the podcast hosts insights from our very own audience this week, we are extending three additional conversations from recent reviews of a particularly exciting NASH-TAG 2023. This session highlights perspectives from patient advocates Tony Villiotti and Michael Betel as they join Louise Campbell and Roger Green for coverage of the first day at the conference.

The discussion begins with an idea from Tony and Michael that the cascading momentum the field is experiencing picked up steam at AASLD in November and carried on through the MOSAIC meeting in December. For advocates, the enthusiasm is largely centered on the likely approval of drugs in the near future and the sense of urgency this places, as Tony puts it, on expanding efforts to “get the message out.” Michael notes the importance of educating primary care physicians that there is something besides diet and exercise to support treatment. Louise adds that the alignment of specialties around screening is also critical to advancing Fatty Liver care. In response to a question from Michael, she makes explicit her belief that multidisciplinary alignment and statements will increase enthusiasm further. From there, Mike goes on to ask how the fact that diabetes and obesity patients might be on GLP-1s or dual agonists before being tested for liver disease might affect perceptions of the frequency of liver disease and/or the value of therapy. The remaining conversation focuses on the issue of how long patients must be on a medication. Louise likens it in her mind to autoimmune diseases, which will have flairs requiring medication. As the session winds down, Louise is discussing the breadth and depth of education she would like to see in the various medical stakeholder communities.

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This week, Surfing NASH has focused on community engagement and incorporating insights and perspectives from the listeners. If you enjoy our content, we kindly ask that you submit a review wherever you download our episodes. We also encourage our audience to write us questions and look forward to integrating your on-ground experiences and ideas in the weekly discourse. Most important of all, we whole-heartedly thank you for your continued support as we set out to put a major dent in Fatty Liver disease in 2023 and beyond.

Stay safe and surf on!

Send us Fan Mail

As the podcast hosts insights from our very own audience this week, we are extending three additional conversations from recent reviews of a particularly exciting NASH-TAG 2023. This session features highlights from the wrap-up episode chat with Amy Articolo and Naim Alkhouri joining Jörn Schattenberg and Roger Green.

The leading question asks the panelists to rate their levels of enthusiasm emerging from the conference in Deer Valley. The scale ranges from 1 to 6, where 1 represents “thoroughly depressed” and 6 represents “over the moon.” A similar question at the conclusion of NASH-TAG 2022 elicited 4s and 5s… This time the answers ranged from Roger’s relatively conservative “6” to 6.5 or 7 from the rest. The optimism primarily was a result of the idea that two Phase 3 drug trials appear to have hit FDA’s efficacy and safety standards, with resmetirom meeting the EMA’s more challenging “regress fibrosis while lowering NAS score” standard. Jörn describes the implications of this as having proven that “it’s doable and druggable.” Roger adds, and Amy agrees, that the efficacy levels the two drugs hit appear to leave significant room for new drugs and combination therapies to improve efficacy. From there, the group goes on to discuss the implications of what we are learning about the impact bariatric surgery can have on NASH. This leads Naim to make a cogent comment which Jörn describes as “hitting it out of the park.” Listen to the full segment to hear this powerful viewpoint.

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This week, Surfing NASH has focused on community engagement and incorporating insights and perspectives from the listeners. If you enjoy our content, we kindly ask that you submit a review wherever you download our episodes. We also encourage our audience to write us questions and look forward to integrating your on-ground experiences and ideas in the weekly discourse. Most important of all, we whole-heartedly thank you for your continued support as we set out to put a major dent in Fatty Liver disease in 2023 and beyond. 

Stay safe and surf on!

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In a thematic debut, Jörn Schattenberg and Roger Green host interviews with three listeners from the Surfing NASH community to discuss four prominent questions around:

• the “straightjacket” of biopsy
• how we think about “tests” when not classed as "NITs" as compared to biopsy
• how do we all become better centered on patient needs
• the idea of combination therapy

In this final installment, Clinical Development lead at Sonic Incytes, Caitlin Schneider, joins Roger to discuss NASH-TAG 2023 and the future of Fatty Liver. After discovering that Caitlin and Roger share one unusual detail in their pasts, they dive into a discussion of the conference. Sonic Incytes developed and markets Velacur™️, an in-office imaging solution. Not surprisingly, much of Caitlin’s focus revolves around imaging diagnostics and their benefits against biopsy and larger imaging technologies like MRE and MRI-PDFF.

Each guest in these fully-featured interviews shares on-ground experiences which collectively cast invaluable light on how the information featured in Surfing the NASH Tsunami is digested and applied in everyday life. As the podcast enters its fourth season, and embarks on affiliated journeys like the Rising Tide series, we hope to grow our community engagement. If you enjoy our content, we kindly ask that you submit a review wherever you download our episodes. We also encourage our audience to write us questions and look forward to integrating your on-ground experiences and perspectives in the weekly discourse. Most important of all, we whole-heartedly thank you for your continued support as we set out to put a major dent in Fatty Liver disease in 2023 and beyond.

Stay safe and surf on!

Send us Fan Mail

In a thematic debut, Jörn Schattenberg and Roger Green host interviews with three listeners from the Surfing NASH community to discuss four prominent questions around:

• the “straightjacket” of biopsy
• how we think about “tests” when not classed as "NITs" as compared to biopsy
• how do we all become better centered on patient needs
• the idea of combination therapy

In this second installment, Jerry Mabary joins Roger to discuss NASH-TAG 2023 and the future of Fatty Liver. Jerry previously appeared on the podcast when he worked at Echosens and led their side of the LIVErHEALTHY launch. Now he has joined Chronwell, a LIVErHEALTHY partner and GE practice management support firm. As befits his background, Jerry’s conversation reflects heavily on non-invasive testing as well as the role digital apps will play in patient treatment. He weaves all this into an integrated vision of Fatty Liver care that incorporates the issues with the role of biopsy present and future. Finally, he notes ideas around the impact combination therapy will have on treatment over time.

Each guest in these fully-featured interviews shares on-ground experiences which collectively cast invaluable light on how the information featured in Surfing the NASH Tsunami is digested and applied in everyday life. As the podcast enters its fourth season, and embarks on affiliated journeys like the Rising Tide series, we hope to grow our community engagement. If you enjoy our content, we kindly ask that you submit a review wherever you download our episodes. We also encourage our audience to write us questions and look forward to integrating your on-ground experiences and perspectives in the weekly discourse. Most important of all, we whole-heartedly thank you for your continued support as we set out to put a major dent in Fatty Liver disease in 2023 and beyond.

Stay safe and surf on!