Podcast appearances and mentions of jeff lazarus

In this week's episode, Jeff Lazarus discusses the idea that the MASH community, including patient advocates, live in a "bit of a bubble," where the clinicians with whom they interact are part of the MASH community. Last year's ICER Public Comments session exposed them to an FDA Advisory Board of hepatologists...and it was a very different experience. Last year's conversation notes reveal what happened and the advocates' reactions:In March 2023, Jeff McIntyre (GLI) introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. The Surfers dedicated an episode to expand on the contents, its shortcomings and potential implications with special guests Veronica Miller (Liver Forum) and Hannah Mamuszka (Alva10). In this conversation, SurfingMASH revisits the topic after a public comments session that took place last week. In doing so, patient advocates and friends of the podcast Mike Betel (Fatty Liver Alliance), Tony Villiotti (NASHkNOWledge) and Wayne Eskridge (Fatty Liver Foundation) join co-hosts Louise Campbell and Roger Green to share a range of impressions.Roger begins by asking the group how the word empathy fits into this discussion. Tony shares that he was upset by the majority viewpoint of 15 featured voting members on a number of different issues. For example, 40% of these voting members suggested that a drug approval would have no impact on a caregiver's life. Tony asserts the importance behind people needing to be aware of the impact of NAFLD/NASH not only on the patient, but also the families and those close to them. Speaking from personal experience, Wayne shares that he was perplexed on the document's position that NAFLD/NASH is not considered to be a progressive disease. This leads Louise and Roger to insert comments around the pricing and economic analysis surrounding the discussion. As the conversation winds down, Mike returns to the conundrum of the voting results. Listen on to hear why his reaction was, “I literally fell out of my chair.”

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.

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.

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.  

#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 15Standard lead-in, including brief quotes taken directly from the episode.00:02:45 - IntroductionOpening comments discussing the aggressive travel schedules of our guests. 00:04:02 - Meeting Maja Thiele and LiverAIMMaja 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 - GroundbreakerEach 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' experiencesMaja 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 exerciseJörn: 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 utilizationMike 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 QuestionsRoger 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 WeekRoger 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 sectionThis week's news on increasing interest in SurfingMASH, our first newsletter, the Stephen Harrison Memorial page, upcoming episodes and this week's Vault.

After Michael Charlton finishes discussing research he finds compelling, Jörn Schattenberg and Louise Campbell each describe one item they have been focusing on recently. Michael mentions the recent JAMA publication of a small, randomized controlled trial exploring the use of low-dose aspirin in biopsy-confirmed MASLD patients, which he describes as "a tremendous result." The results suggest benefits in terms of both fat fraction (PDFF) and transaminase levels. Jörn provides more detail about the trial. While the sample size was small, the results were highly promising. There is much to learn here from a larger RCT and also from understanding the biological mechanism better, but the group agrees this is a promising development.Roger Green asks his fellow Surfers to discuss one item that has attracted their attention in the past week. Jörn Schattenberg goes first and discusses the upcoming Innovations in SLD Think Tank 2024. He expresses excitement that changes in format should yield unique, high-value benefits. Roger notes that Jörn and his co-chair Jeff Lazarus will discuss the think tank's results during the episode posting on May 15. Louise mentions her constant pursuit of finding ways to improve prediction with FibroScan.  In doing so, she found a study indicating correlation between the Dietary Inflammation index score and kilopascal level on FibroScan testing. Investigators are exploring the use of this index in an array of non-liver diseases related to metabolic syndrome or chronic kidney disease, but the correlation with kilopascals is fairly clear. Louise would like to see research looking at controlled attenuation parameter, since she can usually "see a fat change faster than a stiffness change." 

This conversation ties up several issues related to MASH and the new MASLD nomenclature that the panel did not touch on earlier in the episode. These range from the impact the nomenclature might have on other elements of treatment to the impact of this effort over time. Finally, the panelists grade the process to date (they admit, their views might be a bit biased) and signs of success. Roger Green starts this conversation by asking what impact panelists believe the new MASLD nomenclature might have on NITs. From one perspective, Meena Bansal notes that it should have no impact given that NAFLD/NASH and MASLD/MASH map so similarly on top of one another. From a different perspective, Jeff Lazarus asks whether the nomenclature and accompanying guidelines from professional societies will result in more testing. The group aligns around the idea that patients living with Type 2 diabetes are an excellent target for increased testing with NITs given the high overlap of the two groups. Maru Rinella comments specifically that all efforts to tie T2DM to MASLD as frequently common metabolic diseases will be helpful and that discussing the proper use of NITs might be one way to make this connection. Louise Campbell agrees that increased focus on "Healthy Livers, Healthy Lives" will drive exactly these kinds of discussions. The rest of the episode consists of Roger asking panelists three questions, to which they respond: What might change over the next year or two? Meena believese that approval of a drug will drive significant growth in the learning curve and, with that, enhanced disease awareness and understanding. Jeff suggests that this will not take the form of a transition from NAFLD to MASLD, but instead that people first learning about the disease will use the new nomenclature properly. Mike Betel notes that on the Fatty Liver Alliance website, ~98% of searches are simply for "fatty liver disease." Over time, he anticipates this will change and also that websites like FLA will address "fatty liver" queries in terms of new nomenclature. Impact on ICD codes. Meena, who is doing significant work in this area, answers that the goal is to have no impact but simply a smooth cutover. How the group would grade its work on this activity to date. As Jeff notes, answers from the people who led the process are likely to be quite biased, but all gave fairly high grades. 

This conversation focuses on the Delphi process for a new MASLD nomenclature. It starts with Jeff Lazarus describing what a Delphi process is and how it worked here. Jeff and two other key players in this process, Maru Rinella and Meena Bansal, describe what they consider some of its greatest strengths as well as one thing they wish had worked out better.Jeff's description focuses on the four rounds of data gathering and some key activities that transpired before the formal process began. He goes on to identify what he considers some of the pivotal outputs of this one. In particular, Jeff describes the focus on patients with alcohol and diet issues, and the naming of a new discreet disease for these patients (MetALD) as being “revolutionary.” Roger Green agrees with Jeff's assessment that the naming of MetALD was an important outcome and that the process had clear benefits in this way. He goes on to ask why people opted out of the process. Maru Rinella comments that some people opted out after the third phase due to disagreements with the direction of the activity. Roger refines the question to ask why people opted out in the first place. Jeff and Maru note the amount of work required for this kind of activity, and he, Maru Rinella and Meena Bansal all describe that not all invitees understood how important this process would be upon first invitation. Jeff and Maru go on to mention that the participation rate was high, somewhere around 80%.Roger asks what could have gone better. Maru, Jeff and Meena Bansal each note groups for which they wish participation had been broader, including possibly a broader representation of stakeholders (notably, more patients, although Maru notes this was not for lack of trying) and more organizations or countries.

This conversation shifts from the rearview to the path ahead. Louise Campbell starts by asking about the role of Allied Health Providers in the process. After this issue, process leaders Maru Rinella, Jeff Lazarus and Meena Bansal discuss how this will roll out as we move ahead.It starts with Louise Campbell asking why there Allied Health Providers did not play a larger role in the Delphi process. Maru Rinella replies that, in her vision, this group's involvement will be critical in the rollout and message development but less so in a Delphi process that was mostly about hashing out, as Maru puts it, “the nuances of the disease.” To Maru, this is also the place where patient voice brings the most pivotal value. Meena Bansal notes that there were some PAs and NPs in the Delphi process. Meena Bansal agrees that their role will be critical in discussions on how to communicate the disease to the patient (a topic we return to in later conversations). Louise appreciates, accepts and largely agrees with this discussion. Roger Green shifts focus from the past process to ask about the rollout phase: when it began, what it will include and when it might end. Meena says it will never end. Jeff Lazarus comments that while publication was the formal rollout, even before then groups were vying to be the first to change their names. He also noted that the article was published simultaneously in several journals with broad, rapid uptake in the literature. Since the key is to raise awareness and educate the population, he considers the speed and breadth of uptake a major sign of success. Maru Rinella comments that journal participation has been generally excellent.

This conversation focuses on how the new MASLD nomenclature might improve providers' explanations of MASH to patients. Louise Campbell describes new opportunities, while Meena Bansal describes how focusing on metabolism provides a richer opportunity for providers to explain to MASH patients why fat on the liver matters.Louise Campbell starts this conversation by discussing a new NHS program providing primary care centers with VCTE units they can use to screen patients for MASLD and MASH. She points out that this will provide a unique opportunity to present the new MASLD nomenclature to primary care and allied health providers in a way that connects immediately to diagnosing patients and educating them properly about their disease. She notes that at the patient level, the discussion is still likely to focus on excess fat on the liver but presents the idea of "fat" in a less stigmatizing way.Meena Bansal focuses more specifically on exactly how provider-patient conversations might change. For years, she suggests, physicians have written "hepatic steatosis" on patient charts, but then told patients they "just have a little fat on the liver." In her view, the new nomenclature will take the word "just" out of the discussion and present the "little fat on the liver" as part of a metabolic syndrome that requires treatment. She goes on to mention another source of excitement: the ability to consider MetALD patients as part of the same MASLD community and add them to Mt. Sinai's longitudinal patient registry, which will likely become a rich source of MetALD data.Earlier in the episode, Jeff Lazarus had mentioned his excitement at the growing role and publicity for the "Healthy Livers, Healthy Lives" initiative. Louise notes that increasing focus on liver awareness and awareness of the importance of liver health, as discussed in Season 5 Episode 2, aligns neatly with Meena's disease description and the new communication opportunities for new physician and allied health specialties.

This conversation focuses on the issues and visions that led to the identified need for a new MASLD nomenclature. Maru Rinella and Jeff Lazarus discuss the original goals of the process and how focus broadened and shifted throughout.It starts with Maru Rinella describing what she terms “an existential crisis” for the field around a publication suggesting changing the name of the disease from “non-alcoholic” fatty liver disease to “metabolic” fatty liver disease. She considers this the main impetus for key global players to converge. Jeff Lazarus notes that stigma and several other processes came into the discussion. Maru and Jeff agree that the participant recruitment process came in two phases, one where it was hard to get participants and a later point where it was to manage the size of the exercise. Jeff felt the tipping point happened when people understood how the Delphi process would work and also the need for this to succeed. Maru felt that people had to grasp the implications of a consensus process, which Delphi is. As the conversation ends, another leader in the process, Meena Bansal and a patient advocate participant, Mike Betel of the Fatty Liver Alliance, describe how they came to enroll.

The process of creating a new MASLD nomenclature for the condition formerly known as Fatty Liver Disease was a multi-year process with unique challenges and complications. Three leaders in the process, Maru Rinella, Jeff Lazarus and Meena Bansal, and patient advocate Mike Betel join Louise Campbell and Roger Green to discuss the process, transition and rollout.00:00:00 - Surf's Up: Season 5 Episode 3Co-hosts Louise Campbell and Roger Green sit with Maru Rinella, who co-chaired the New Nomenclature process, Jeff Lazarus, who oversaw the entire Delphi process, Meena Bansal, who played a key role and co-moderated the 2023 AASLD session, and patient advocate Mike Betel to discuss the entire process from inception to today and beyond.00:03:57 - Meet Meena BansalDr. Meena Bansal, Division Chief at Mt. Sinai Hospital in New York, discusses how she became involved in liver disease and her current research interests, and shares one fact about herself that might surprise you. 00:05:47 - GroundbreakerPanelists share one piece of good personal or professional news from the previous week.00:08:22 - Characterizing the Nomenclature ProcessMaru and Jeff discuss the original goals of the process and how focus broadened and shifted throughout.00:16:02 - How the Delphi Process WorkedJeff describes the overall process. Roger asks about people who chose not to participate at the outset, which leads to a discussion about the overall rate of participation. Roger then asks what might have worked better, which leads Maru, Meena and Jeff to discuss groups they wish had been better represented. 00:27:05 - The Role of Allied Health ProvidersLouise asks why Allied Health Providers did not play a larger role throughout the process. Maru and Meena differentiate between providers' roles in the early process and the mechanics of rolling out to the patient community.00:29:38 - Focusing on the RolloutRoger's question about the rollout leads Jeff to focus on some of the key early stage events. Jeff and Maru go on to discuss the high level of participation from key journals.00:33:32 - Early AwarenessMike Betel brings a piece of data on physician awareness from the pre-test of a study he is conducting in Canada, which serves as a conduit into the entire topic of who is aware of the nomenclature today and how knowledge will spread over time. 00:38:56 - The New Message for Patients Louise notes that the upcoming UK effort to bring VCTE screening to primary care will provide an effort to define and characterize the disease for patients. Meena comments that providers have done this informally for years, but while the message used to be that the patient "just has fat on the liver," this nomenclature will formalize the disease, remove "just," and focus the patient on therapy.00:39:15 - MetALD - A New Disease in the SLD FamilyRoger states that in his mind, the newly defined disease MetALD is a major positive outcome of the process. Maru, Meena and Louise each describe ways this new definition will aid diagnosis and treatment, Mike notes that the message still must be tailored for each patient. 00:43:55 - Implication for Diagnostics The group discusses the idea that while the nomenclature will not lead to new diagnostic tests, it might lead to increased and more appropriate use of the tests that exist.00:48:25 - The Future of the NomenclatureRoger asks the group where this process will be in a year and five years. Answers vary.00:51:58 - Grading the Process So FarRoger asks panelists how they grade the process to date. Grades are high although, as Jeff notes, they are grading their own work.00:55:27 - Business ReportNews on audience metrics, the upcoming Question of the Week, next week's epidemiology discussion and this week's Vault conversation

Surfing the MASH Tsunami kicks off its 2023 wrap-up conversations with Jeff Lazarus, the 2023 winner of the Distinguished Scientific Achievement Award from the American Liver Foundation. He discusses three core MASLD-related opportunities for which he played a key role in 2023: the Research in Action initiative, the new MASLD nomenclature process and the Healthy Livers, Healthy Lives coalition.Most of this discussion focuses on Jeff's work leading the Research in Action coalition. As Jeff notes, this was the first time the MASLD "field has set its own agenda." Absent governmental or not-for-profit agencies driving the discussion, a group that has grown to over 400 collaborators published its own action agenda in AASLD and EASL publications. Jeff discusses the process through which he built this consensus, focusing on domains identified in earlier meetings: (i) treatment and care; (ii) models of care; (lll) increased awareness; and (iv) leadership. Jeff feels the legitimacy of this activity comes from "casting the net wide" with a series of Wilton Park meetings and from demonstrating how far MASLD lagged behind other non-communicable diseases in terms of goal development, structured support and public presence. Another key element in the initiative's success was a side event at the World Health Assembly led by the four major hepatology organizations, including not only AASLD and EASL but also APASL, and ALEH. Efforts to create parity with other non-communicable diseases will result in increased funding and "massive" increases in awareness.Today, the other NCDs mention other related metabolic diseases but not MASLD or MASH. Another example of the lack of urgency around MASLD: NIH just put out a call for funding for HIV, which Jeff notes might not be as high a priority in 2024 as MASLD.At this point, Jörn Schattenberg joins the conversation to congratulate Jeff on his recognition and award and also to discuss how important it is to the entire community that Jeff plays the role he does. In response, Jeff comments that one benefit of the Award is that it ratifies the importance of the kinds of consensus building and application of public health initiatives in MASLD space.From here, Jeff and Jörn step further forward to discuss the importance of funding prevention and education programs, done by governments in the EU and perhaps public or private players in the US. Jörn discusses the multidisciplinary nature of the Barcelona meeting they co-chair and how it provides outreach beyond hepatology. Jeff continues the thought to discuss the importance of social determinants of health (for example, food insecurity) in a world where healthy foods cost far more than more common alternatives (basmati rice costs 3x basic white rice).Roger asks how the new nomenclature is proceeding. Jeff says it is doing quite well in that there is significant global buy-in. Major centers around the world are adopting the new nomenclature for their meetings and clinics, but, Jeff notes, it is difficult for physicians to explain the disease to patients without using the words "fat" or "fatty."As the conversation winds up, Jeff notes the importance of bringing primary care to the education and outreach processes and the goal of doubling the number of patients screened over the next four years. The conversation closes on this note: much that must be done, but confidence that the energy to achieve these big goals is coalescing properly.

Fatty Liver Alliance President and Founder Mike Betel, a leading patient advocate for MASLD/MASH patients, joins Roger Green in our continuing review coverage of TLM 2023. Mr. Betel discusses presentations and events he found most valuable to patient advocates. He also discusses the new MASLD nomenclature and Fatty Liver Alliance's upcoming 2nd Annual Primary Care NAFLD & NASH Summit.The conversation starts with Mike paying the event a profound but slightly backhanded compliment. He comments that interest in some sessions was so strong that organizers did not leave sufficient space for everyone who wanted to attend. As he pointed out, even the "overflow rooms" were overflowing for some sessions! Mike then paid the event a profound complement: the content of the sessions, coupled with his ability to interact with Key Opinion Leaders, made for a meeting that provided him with insight and enthusiasm into where the field is heading. Mike shifts focus slightly to praise Madrigal Pharmaceuticals for the Public Service Announcement the company premiered at this event. He describes himself as "blown away" by the 2:30 video. Mike notes, and Roger agrees,  that virtually everyone he spoke with at the conference who saw the PSA felt the same way. In response to Roger's question, Mike offers that what makes the PSA so special is that it focuses on "a real person and a real community interacting" in ways that portray real-life with humor and, at the same time, commitment. He mentions a couple of specific items he particularly likes and goes on to note that as of the end of conference, the video had already received 500,000 views online. Mike goes on to discuss one scientific paper he found compelling, a presentation by Prof. Arun Sanyal about the Eli Lilly incretin triple-agonist retatrutide. He cites Arun's comment that in over 90% of the obese patients in this study, the drug reduced liver fat so much that patients' fat levels were defined as "normal." Roger goes on to note that there are three triple-agonists in development, the other two being Altimmune's pemvidutide and Merck/Hanmi's efinopegdutide.  Shifting focus, Mike congratulates Dr. Jeff Lazarus on being recognized with the Distinguished Scientific Award from the American Liver Foundation. jeff's work over his career has spanned major public health efforts in HIV, Hepatitis C, COVID-19 and Fatty Liver diseases, but his most recent effort was spearheading the Delphi process around the nomenclature change. Roger commends the work that Jeff, Ken Cusi and a few others have made in reaching across specialties and countries to foster and promote clinical care pathways. Mike commends a presentation by Jeff and Mazen Noureddin  talking about "a united voice for liver health." Next, the conversation shifts to discuss the new nomenclature, which received significant attention at TLM 2023. Mike comments that while nomenclature is moving ahead, widespread change will hinge on endorsements from regulators, professional organizations and the pharmaceutical industry. Roger notes two specific steps forward: a comment from George Makar of FDA that the agency sees the terms of interchangeability and reports from Profs. Sanyal and Quentin Anstee that the old and new definitions map identically for 95-98% of patients. The last part of the discussion focuses on Fatty Liver Alliance's upcoming primary care event. Mike discusses some highlights of the conference and tells listeners how to find it. The podcast ends with a call to action for community-wide engagement in liver health, underscoring the necessity for collaborative efforts to broaden the understanding of liver disease, enhance patient care, and adapt to the evolving medical landscape.

In a monumental moment for combatting Fatty Liver disease, NICE has published the much anticipated evidence-based recommendations on FibroScan for assessing liver fibrosis and cirrhosis outside secondary and specialist care. Such a positive announcement comes at no better time than during the Surfing NASH  coverage of International #NASHDay 2023 . This conversation features hepatology researcher and KOL, William Alazawi, and new guest Vanessa Hebditch who serves as Director of Communications and Policy at the British Liver Trust. The panelists, alongside Louise Campbell and Roger Green, celebrate and comment on the new guidance on FibroScan use in the UK.This conversation starts with Roger providing a brief background on the Surfing NASH coverage of the NICE-FibroScan question. Vanessa is invited to share the work that her organization has done on this issue. She starts by describing the obligation that NICE has to take feedback from multiple stakeholders. She details a 16-month history of the discussion around this issue and the British Liver Trust's role in it. In the process, Vanessa elaborates on the value of anecdotes and patient-centered data in persuading NICE committees to think more expansively about the value of FibroScan and facilitating an alliance of professional societies in support of this campaign. Louise notes how revisions in data and models coupled with new perspectives led to a change in the NICE vision over time and produced this result. Will discusses the value of FibroScan and preventive hepatology, asserting that the level and nature of necessary data to prove the value of this intervention does not yet exist. He says that at the same time advocates promote use, these same stakeholders should "put our feet to the fire to produce evidence that will support the activity." Louise agrees and notes that the protocols will require those doing the scans to be trained and then assessed to assure quality. Finally, she agrees with Will that the stakeholders need to collect data from all locations to assure quality and that no such process exists today. Roger points out that previously on the podcast, Jeff Lazarus reported back in 2021 that the UK scored higher than any other country in its preparation for the NASH pandemic. Although it scored only 50 points on a 100-point scale, the joint NICE Guidance and NHS Funding initiative have the potential to boost that score significantly and start to build a demonstration model for other countries. Done right, it's an exciting, albeit challenging prospect.If you have questions or interest around NICE and FibroScan use, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

On May 6 and 7 2022, over 100 NAFLD stakeholders convened in Barcelona and on-line for the inaugural Innovations in NAFLD Care 2022 conference (#INCBCN.) Surfing the NASH Tsunami was there, with Jörn Schattenberg serving as event co-chair and Louise Campbell and Roger Green moderating sessions. This episode From the Vault is less a formal recap of the meeting than recollections of key moments and messages from the co-founders and Surfers.This discussion starts with #INCBCN co-founder Jeff Lazarus and Roger Green what Jeff considered the successes and surprises of the conference. Jeff speaks about the “palpable” energy of the attendees, the number of people who attended virtually and engaged through Q & A and the range of issued addressed at the conference as three strong positives. On a more prosaic note, he also mentions how well the technology worked throughout the meeting. Roger Green suggests that much of the energy came from merging three separate streams of activity — medical specialists, primary care and patient advocates — into a single conversation that touched on all three groups' issues. He also suggests that having Marcus Ranney and Jeff to share a digital health vision of the future added additional energy and the prospect of what Roger calls “radical patient empowerment.” As co-founder Jörn Schattenberg and then Louise Campbell join the conversation, levity ensues as the four discuss the surprise closing statement from Jeff and Jörn and then a more serious tone as the group discusses the benefits that multidisciplinary conversation brought to all the participants.

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 closing conversation continues to cover the highlights of the second day,  including the EU Pearl program and the debate about the value of curing NAFLD and NASH with a vegetarian diet or not. The session goes on to capture final thoughts and ideas which will be carried over into future programs. Listen on to hear each respond to a set of closing questions around a truly unique and innovative program. If you have questions or interest around the Innovations in NAFLD Care Workshop 2023, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

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 starts with Jeff commenting on patient needs and a specific question which Alina Allen raised around whether people should be diagnosed earlier and do the harms outweigh the benefits? Jeff notes that this is a significant mistake, recalling his own experiences with the Hep-C community. The group next detours briefly into the impact that the FDA ADCOM on obeticholic acid has on all of these issues before shifting to discuss the second day. Jörn talks about the idea that while there were a limited number of posters at the meeting, the posters that were there were excellent and engaging in the way that researchers could discuss them in detail. Jeff summarizes Alina Allen's talk about how to use AI and diagnostics. Jörn points out that we need more standardized patient reports if we were to use this data in AI because the data has to be standardized to take advantage of it. The end of the session takes an entertaining twist, so listen on to find out more.If you have questions or interest around the Innovations in NAFLD Care Workshop 2023, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

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 revolves around the term preventive hepatology which was the focus of a roundtable. Roger asks whether taking a FibroScan into the community qualifies as preventive hepatology. Jörn suggests it might so long as the patient is properly identified. Jeff identifies one of the earliest papers on preventive hepatology from 2008 titled Minimizing symptoms and optimizing care. He goes on to promote the idea that the process of prevention needs to start earlier. This leads Roger to point to a moment of constructive disagreement in the meeting. He suggests that preventive hepatology needs to actually start before the patient ever gets to the hepatologist. Jeff mostly agrees and notes that on one level it all starts with Sustainable Development Goals outlined by WHO. Louise describes the idea that preventive hepatology is about more than the liver alone which leads Roger to throw out the term preventative metabolic health. Jörn suggests this to be an excellent ideal, but in a siloed health system we have to start by bringing disciplines together to break down those silos as INCBCN is designed to do. As the session winds down, the group comments on the endocrinology session that Rising Tide co-host Ken Cusi chaired. The audience enjoyed seeing how these endocrinologists are focused on fatty liver disease with what Jörn describes as a practical view on extending liver care and management.Listen on to discover the details revealed in the full episode. If you have questions or interest around the Innovations in NAFLD Care Workshop 2023, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

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.Listen on to discover the details revealed in the full episode. If you have questions or interest around the Innovations in NAFLD Care Workshop 2023, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

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 starts with a focus on the opening session which is titled The Fatal Triple and End-Organ Injury. Embedded in the recap is the topic of alcohol consumption and how it contributes to Fatty Liver disease. The idea emerges that a standard unit of drink varies in definition and that there may be benefit to gathering structured consensus on the definition. The second part of this conversation considers facilitating FibroScan testing in different patient settings.Listen on to discover the details revealed in the full episode. If you have questions or interest around the Innovations in NAFLD Care Workshop 2023, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

Surfing NASH returns to review the second 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.00:00 Introduction06:14 Holistic thinking and expanding the community of practice08:00 NASH-NIT Real World Evidence Summit09:48 Louise on FibroScan proficiency 15:02 The Fatal Triple18:52 Alcohol consumption and consensus around standards of drink24:12 Exploring ideas of preventative hepatology31:38 Session 2: Endocrinology and Diabetology in the early diagnosis and management of NASH35:43 Poster presentations37:02 Session 3: NAFLD Diagnostics40:42 Session 4: NAFLD Treatment and Care 47:13 Closing question: any surprising audience responses?Listen on to discover the details as revealed in the full episode. If you have questions or interest around the Innovations in NAFLD Care Workshop 2023, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

Surfing NASH returns to preview the second Innovations in NAFLD Care Workshop (INCBCN) to be held in Barcelona from 26-27 May, 2023. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss what makes the event unique with Louise Campbell and Roger Green.Roger opens with a question around the involvement of non-physicians at the Workshop. Jeff again notes the presentations by esteemed nutritionist, Shira Zelber-Sagi, and epidemiologist, Harriet Rumgay. He also highlights patient organizations that have been reached out to for participation in a roundtable. Lastly, he says feedback will be welcomed to help strengthen the future of the program and its direction. Louise then shares her thoughts on participating in last year's panel and injecting the strength of nursing perspectives.From here, Roger asks what the panelists anticipate in the meeting that has yet to be covered. Jeff underscores the importance of facilitating interactive sessions that prompt engaged discussion and plenty of questions. Jörn states that this is not a lecture on drugs and basic science, but an opportunity to harness developments and empower practitioners and patients alike with energized talk around how to use it.If you enjoy the episode, have questions or interest around its contents and Fatty Liver disease, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

Surfing NASH returns to preview the second Innovations in NAFLD Care Workshop (INCBCN) to be held in Barcelona from 26-27 May, 2023. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss what makes the event unique with Louise Campbell and Roger Green.In this final conversation, Roger asks what sort of impact the Workshop will have. Specifically, he wonders what indicators in the next six months would be the signal of success. Jeff notes that last year's meeting resulted in the publishing of an article in Nature's new Open Access journal, Communications Medicine. Envisioning how the meeting plays out this year, Jeff believes it would be a great sign in November to have people asking to return and lining up funding for 2024. Roger next asks how an intimate meeting of this size will translate an impact into the broader population. Jeff suggests that by having KOLs in attendance, they can take the experience back to their practices and share findings with colleagues. He emphasizes his hope that the impact will make its way out and that this is a meeting oriented to making change and not just publishing another abstract. “This is really about top line presentations coupled with exciting, engaged discussions.”For the final question, Roger asks how the agenda will impact the next 12 months and what will grow to be a bigger focus for 2024. Surf on to find out.If you enjoy the episode, have questions or interest around its contents and Fatty Liver disease, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

Surfing NASH returns to preview the second Innovations in NAFLD Care Workshop (INCBCN) to be held in Barcelona from 26-27 May, 2023. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss what makes the event unique with Louise Campbell and Roger Green.Roger leads this conversation with the note that for this year, Surfing NASH will be working closely with the conference to provide timely coverage from Barcelona. He then asks Jeff to elaborate on some of the feedback received from last year's inaugural meeting. Immediately Jeff underscores that this meeting fills an important gap between the heavy-hitting conferences in NAFLD and NASH. Specifically, the INCBCN Workshop exists to explore dynamic and nuanced insights into both liver disease and holistic liver health in a smaller, more multidisciplinary forum. He recaps receiving positive feedback and what considerations are informing the follow-up program. It's important to Jeff that leading KOLs in a range of disciplines from around the world have an opportunity to explore their ideas in an engaged setting. One of last year's success indicators was that people stayed in the room, interacting from the moment of arrival in the morning through later in the evening. Jörn joins to note his enthusiasm around the practical component of this workshop in that it invests in ideas of implementation and engaging stakeholders beyond hepatology.From here, Roger leads discussion into a breakdown of the Day 1 sessions. Jeff first expresses excitement for an opening talk by Ramon Bataller which considers alcohol intake alongside Fatty Liver diseases. This presentation focuses on the reality that many of those living with NAFLD and NASH do in fact consume alcohol. Jeff then points to the whole of Session 2 where Ken Cusi has organized a panel focusing on the challenges of Fatty Liver from a diabetes perspective. Lastly, Jeff notes an impactful lecture by Harriet Rumgay titled the Epidemic Burden of NAFLD and Cancer. This talk reminds that much of the daily work in liver health serves cancer prevention and primes Episode 13.2 for a deeper look into this topic.If you enjoy the episode, have questions or interest around its contents and Fatty Liver disease, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

Surfing NASH returns to preview the second Innovations in NAFLD Care Workshop (INCBCN) to be held in Barcelona from 26-27 May, 2023. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss what makes the event unique with Louise Campbell and Roger Green.Jörn begins this conversation by noting the diverse, cross-disciplinary involvement of the event. He also shares details of an abstract he will be presenting on liver stiffness. Roger then returns to the idea of linking Fatty Liver and cancers. He recalls last week's episode when Hannah Mamuszka noted the alarming degree to which all obesogenic cancers are related to Fatty Liver disease. Jeff notes the roundness of Day 1, citing the benefit of hosting a holistic discussion which features viewpoints on alcohol, diabetes and cancer. Jörn adds that by looking at the liver, we are empowering the patients and educating on their individual risk, ultimately informing in terms of cancer prevention. At this point, Louise expands on the importance of early screening in populations who are unaware of their liver health and the need to drive education for those at risk to know when and what to ask their providers. She notes the nonlinear progression to liver cancer, a recently recurring theme on the podcast. She then goes on to commend the convergence of fields, citing the various associations' (including the American Heart Association and American Diabetes Association) growing inclusion of Fatty Liver in recommendations around risk assessment.Roger connects the idea that endocrinologists are working in terms of cancer prevention. He reasons that if 70% of their patients have NAFLD, and if NAFLD elevates the risk of HCC, then “every time you treat a diabetic patient, you need to think about what you're doing in the context of avoiding cancer.” As the conversation winds down, Jörn mentions a pre-event on the opening morning called the NASH NITs Real World Evidence Summit, which lends to a more hands-on training around which biomarkers to use and implementation. Here, he explains, the experience aims to familiarize those who don't work with these tests everyday to gain the skills and confidence to effectively screen for Fatty Liver diseases.If you enjoy the episode, have questions or interest around its contents and Fatty Liver disease, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

Surfing NASH returns to preview the second Innovations in NAFLD Care Workshop (INCBCN) to be held in Barcelona from 26-27 May, 2023. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss what makes the event unique with Louise Campbell and Roger Green. This conversation picks up with concluding comments around Day 1 in Barcelona. Jeff elaborates on a Patient Organisation session that closes with a roundtable discussion. For this discussion, Juan Mendive of the World Organization of Family Doctors will discuss primary care perspectives.Moving into Day 2, Jeff shares that friends of the podcast Alina Allen and Mazen Noureddin will be opening with two exciting topics. Alina will be giving a presentation titled Automation, Artificial Intelligence and Machine Learning for Patient Identification and Risk Stratification. Following, Mazen will be detailing How to Overcome Barriers of Implementation - Bridging the Gap Between Science and Current Care Pathways. This opening session is chaired by Maru Rinella. Following is an industry session which will see a discussion featuring Peter Rydqvist (Madrigal Pharmaceuticals, Sweden) and Jeppe Zacho (Novo Nordisk, Denmark). Later and as part of a treatment and care session there will be an entertaining debate on whether being vegetarian offers a cure for NAFLD (led by Shira Zelber-Sagi and Camilla Dalby Hansen). This session also features a presentation by Stephen Harrison titled Medical Therapy in the Near Future. Stephen will also be joining Jeff in the final session to discuss Steven health equity in Fatty Liver disease and addressing disparities. Joining this session will be Zobair Younossi to discuss payer perspectives, Juan Pericàs on socioeconomics and Patrizia Carrieri on risks and interventions for women with NAFLD.If you enjoy the episode, have questions or interest around its contents and Fatty Liver disease, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com.Stay Safe and Surf On!

Surfing NASH returns to preview the second Innovations in NAFLD Care Workshop (INCBCN) to be held in Barcelona from 26-27 May, 2023. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss what makes the event unique with Louise Campbell and Roger Green.From the outset, Jeff underscores that this meeting fills an important gap between the heavy-hitting conferences in NAFLD and NASH. The INCBCN Workshop exists to explore dynamic and nuanced insights into both liver disease and holistic liver health in a smaller, more multidisciplinary forum. He recaps receiving positive feedback and building a follow-up program from last year's inaugural event which witnessed state-of-the-art talks by leading KOLs across differing specialties. Jörn notes his enthusiasm around the practical component of this workshop in that it invests in ideas of implementation and engaging stakeholders beyond hepatology.From here, Roger leads discussion into a breakdown of the sessions comprising the two days. Jeff immediately expresses excitement for an opening talk by Ramon Bataller which considers alcohol intake. He next points to Session 2 where Ken Cusi has organized discussion on the challenges of Fatty Liver from a diabetes perspective. Lastly, Jeff notes an impactful lecture by Harriet Rumgay titled the Epidemic Burden of NAFLD and Cancer. This talk reminds that much of the daily work in liver health serves cancer prevention. Roger recalls Hannah Mamuszka's note from last week on the degree to which all obesogenic cancers are related to Fatty Liver disease.At this point, Louise expands on the importance of early screening in populations who are unaware of their liver health and the need to drive education for those at risk to know when and what to ask their providers. She notes the nonlinear progression to liver cancer, a recently recurring theme on the podcast. She goes on to commend the convergence of fields, citing the various associations' (including the American Heart Association and American Diabetes Association) growing inclusion of Fatty Liver in recommendations around risk assessment. Concluding Day 1, Jeff elaborates on a Patient Organisation session that includes a speaker from the World Organization of Family Doctors.Moving into Day 2, friends of the podcast Alina Allen and Mazen Noureddin will be opening with two exciting topics. Alina will be giving a presentation titled Automation, Artificial Intelligence and Machine Learning for Patient Identification and Risk Stratification. Following, Mazen will be detailing How to Overcome Barriers of Implementation - Bridging the Gap Between Science and Current Care Pathways. Later there will be an entertaining debate on whether being vegetarian offers a cure for NAFLD (led by Shira Zelber-Sagi and Camilla Dalby Hansen). The group then discusses the input of allied health professionals in the program and a few additional elements yet to be mentioned, including Zobair Younossi on payers and a talk by Stephen Harrison. As the session winds down, Roger asks the panelists what the impact of this event will be and how will it inform next year's program. Stay tuned for more exclusive coverage from Barcelona and view the full program here. If you enjoy the episode, have questions or interest around its contents and Fatty Liver disease, we kindly ask that you submit reviews wherever you download our discussions. Alternatively, you can write to us directly at questions@SurfingNASH.com. Stay Safe and Surf On!

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity. In this episode From the Vault,  Jeff Lazarus and Roger Green discuss the ease of creating valuable metrics in a comprehensive care model, while our three practitioners -- Stephen Harrison, Jörn Schattenberg and Louise Campbell -- dive further into how they believe this model will improve care.KEY POINT: Broadening the number and diversity of health care providers assigned to each individual patient will improve care by improving focus on the areas that count. It is important that system designers ask the right questions and answer them rigorously in context; it is undesirable for the systems to look more or less identical.If you enjoy episode 9 and its introduction to Rising Tide, please visit our website and sign up to listen to the full discussions and more exclusive content. We also kindly ask that you submit reviews wherever you download our discussions or, alternatively, write to us directly at questions@SurfingNASH.com.

In this conversation From the Vault, panelists preview the inaugural Innovations in NAFLD Care Workshop which took place in Barcelona on May 6 and 7, 2022.  Commentary considers the bulk of the Day Two Agenda which conveyed an overall theme that NASH treatment is integrated and multifactorial. The day starts with Jeff Lazarus discussing Comprehensive Care Models for NASH, the path there and desired endpoints. The rest of Session 4 focuses on two forms of technical support: integrating non-invasive tests for NAFLD into clinical practices outside the liver space and looking at the power of apps to transform the weight management process. Session 5 focuses on pharmacotherapy, including use of current pharmacotherapy in weight loss and diabetes and some of the future agents that will come into use over the next few years. Finally, Session 6, which Roger Green will moderate, pulls together a diverse set of panelists to consider the NAFLD/NASH Roadmap in the context of social media and digital transformations. Listening to this conversation provides a clear sense of how broad the scope of Day Two issues will be.In the interest of time, this summary does not list the names of the speakers giving each talk. This is an absolutely first-class global faculty. If you are curious, visit the meeting program to learn who these exceptional speakers are. 

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.

In the Season 3 NAFLD Year-in-Review conversations series, Surfers Jörn Schattenberg, Louise Campbell and Roger Green embark on a string of interviews with a handful of Key Opinion Leaders who made headlines and advances in Fatty Liver disease in 2022. In this exclusive segment, Jeff Lazarus opens in full disclosure admitting that, overall, 2022 has been a tough year in health care as “everyone is overwhelmed” while we all try to emerge from the pandemic. Regarding the status of Fatty Disease, Jeff is more optimistic as this year witnessed movement outside of hepatology into the space of diabetes societies and primary care meetings. Such collaborative energy is needed “to understand the metabolic syndrome and not just silos.” Jeff goes on to cite a return to an in-person Wilton Park meeting as an example turning point for such synergies.The conversation evolves to consider targets, goals, endpoints and some small distinctions between each in the framework of public health. Jeff notes that we will need what he describes as a “drugs-plus approach” to address Fatty Liver disease - similar to that vaccines were not the single defense in combating the COVID pandemic. While drug therapies may be the cornerstone for fatty liver disease, there remains the need for lifestyle interventions through diet and exercise. As Jeff indicates, this mission is larger than hepatology alone. While a wider net of stakeholders establish clinical care guidelines in the context of professional societies, there still lacks, in example, a technical strategy coming from an organization such as the W.H.O. Jeff believes establishing work around the Sustainable Development Goals is important in showing the connection between different targets and the liver. He extends this idea to connect socioeconomic variables to liver health outcomes.The group also explores the idea that when drugs become available to market, treater interest picks up because there is encouragement from the fact that something that can be done. Jeff hopes this positive energy will also recruit more resources in the form of nutritionists and dieticians. He raises questions around imagining what new models of care look like, and how do we improve communications and teamwork. His response: the availability of drugs and the imminent availability of drugs will set fire to the changes that will need to follow. He adds comments on the importance of addressing the policy arena and ensuring policymakers and health authorities are aware of the potentially deadly, highly prevalent condition. They need to be aware that there are soon to be approved and available drugs, and that the majority of this population is undiagnosed. Jeff further reasons that Fatty Liver is in need of a more proactive approach that identifies and educates on the risks of disease progression before advanced fibrosis takes hold. As the conversation winds down, the group investigates the implications and process behind ongoing discussion on nomenclature.

The latter half of December marks the Surfing the NASH Tsunami annual NAFLD Year-in-Review. In Part 2 of this Season 3 finale, Surfers Jörn Schattenberg, Louise Campbell and Roger Green interview Mazen Noureddin, Ken Cusi and Jeff Lazarus to discuss putting a dent in Fatty Liver disease in 2022 and beyond. This episode features compiled excerpts from our respective guest interviews. Each interview in its entirety will debut as independent segments released throughout the week.Surf on to hear the diverse and powerful perspectives provided by a handful of the field's Key Opinion Leaders who made headlines and advances in Fatty Liver disease in 2022.

Roger Green starts this interview with Jeff Lazarus by asking what Jeff has been focusing on since the Barcelona conference in May. Jeff describes his extensive daily efforts to develop and garner support for a global consensus strategy on COVID-19, similar to his work on a global consensus statement on Fatty Liver disease. (This was the topic of Season 2, Episode 59.) Like the Fatty Liver work, his COVID-19 consensus work included representatives from over 200 countries with an array of public, academic and not-for-profit portfolios. However, he suggests that the high levels of agreement and, sometimes, virtually unanimity evident in the Fatty Liver work was impossible to match on an issue as immediate and terrifying as COVID-19.Roger then asks about the NAFLD Nomenclature Conference. Jeff describes the conference as a midway point for a Delphi process to explore the prospect of assigning a new name(s) in the description of fatty liver diseases. Jeff describes the six principles any name change must achieve:AffirmativeAccurate Adaptable Adoptable Applicable Able.The rest of this conversation covers prospects for success of the Nomenclature effort and the nature of the challenges ahead.

Roger starts by asking Jeff to describe his role in the NAFLD Summit and to discuss any other presentations of interest outside of his own. Jeff shares that he will be talking about evolving models of care and future implications. His interest in the session stems not just from his presenting, but from the session title, "Epidemiology, Disease Modifiers and Models of Care," and the opportunity it presents to, as Jeff puts it, "hammer home" the importance of integrated care and pathways. He also mentions the importance of the sessions covering NITs, which are pivotal to the way forward, new approaches to lifestyle modification and drug clinical trials and development. The conversation shifts Jeff's other activity in Dublin: meeting with industry and other colleagues to build momentum for an upcoming meeting at Wilton Park to build on the momentum of the 2021 global consensus statement on NAFLD. (This was the topic of Season 2, Episode 59.)  The conversation veers into two other topics of relevance. First, Jeff draws a link between the importance of viewing liver disease in a truly multi-disciplinary context with the broadening of presentation topics at major meetings. He points out that if we want colleagues from other medical specialties to join in efforts to contain the coming NAFLD pandemic, medical meeting agendas must include enough topics of interest to them to broaden the prospective set of attendees. The second issue involves engaging the WHO to incorporate liver disease into its global health priorities.

The 8th Paris NASH Meeting takes place on September 8th & 9th, where key opinion leaders from both sides of the Atlantic come together to present pivotal learnings and host exciting discussions on fatty liver diseases. Surfers Roger Green, Louise Campbell, and Jörn Schattenberg are joined by Rachel Zayas to discuss this year's program and provide preview commentary on talks and sessions of interest.Roger opens the floor by asking everyone to highlight what specifically stands out to them on the program to look forward to. “Brave one go first.”Rachel notes a presentation in Session 2: Clinical Aspects, titled Controversy: are HIV infected patients more at risk of NASH? Emerging data and insights will be discussed as to why the prevalence of NAFLD, NASH and subsequently fibrosis present higher in HIV-infected patients in comparison to the general population. Rachel hopes the prompt leads to speculation on how to improve patient stratification. She suggests the field is moving beyond ideas of personalized medicine to what is described as a more intentional approach. Jörn echoes Rachel's interest in this topic. There is the need to address not only individuals, but also a group of overlooked patients that call for an intentional and stratified investigation into potentially shared biomarkers. Session 2 also features a discussion on type 2 diabetes sub-populations with varying outcome profiles, solidifying the Clinical Aspects leg as a ‘can't miss' for the whole group.Next, Louise calls attention to the opening session and her interest in the integration of the liver under cardiometabolic health. “That's where we're going to find the breadth and depth of patients for future NASH studies.” She asserts that a larger recruitment to clinical trials will be required in the next 3 to 5 years to move the field forward.Roger relates the relevance of last week's episode on finding the right combinations for NASH therapy. Friday afternoon features a look into the current status and future directions in NIT-based drug development and clinical management of NASH.The conversation shifts to comparative outcomes of the Barcelona meeting and its focus on pathways before transitioning into part 2 of this episode: a one on one interview with Prof. Jeff Lazarus. Much of Jeff's summer was spent working in preparation for the impact COVID will have on the northern hemisphere this autumn. However, he also managed to attend the NAFLD Nomenclature Conference in Chicago. The conference is described as a midway point for a Delphi process that explores the prospect of assigning a new name(s) in the description of fatty liver diseases. What was determined is that should a name change occur, it needs to be organized through global consensus and consistent with the following 6 principles:AffirmativeAccurateAdaptableAdoptableApplicableAbleRoger believes that the meeting was successful at strengthening consensus on this topic. He then asks Jeff to describe his role in the NAFLD Summit and to mention any other presentations of interest outside of his own. Jeff shares that he will be talking about evolving models of care and future implications. Specifically, he is also interested in attending discussions and panels around the impact of NITs in addition to the topic of personalized medicine. Likewise, Roger expresses an interest in emerging technologies before offering a final question - or, rather, a request for commitment. Will Jeff return to the podcast to disclose what occurred at the Wilton Park meeting this October? It seems he might, after a few weeks digestion. Stay tuned, stay safe and surf on.

Surfers Louise Campbell and Jörn Schattenberg are joined by patient advocate Robert Mitchell-Thain, liver nurse Michelle Clayton, and healthcare consultant Stephen Callaghan to talk about their unique perspectives in the process of pathway development for NAFLD. In doing so, the group looks for ways to incorporate the 17 Sustainable Development Goals (SDG) established by the United Nations - an urgent call for action on health, economy, and starvation amongst other human rights issues.Earlier this year, Jörn co-authored a paper titled, A sustainable development goal framework to guide multisectoral action on NAFLD through a societal approach (2022). Jörn talks about the process and intention behind the paper. He recalls that leading author, Jeff Lazarus, sought to incorporate the SDG and its applicable targets to the challenges posed specifically by NAFLD. The group identifies a lack of representation in authorship and discusses how to improve on this. It is agreed that developing a pathway requires the contribution of nurses, patients and patient advocates, and other allied health professionals.

Surfers Louise Campbell and Jörn Schattenberg are joined by patient advocate Robert Mitchell-Thain, liver nurse Michelle Clayton, and healthcare consultant Stephen Callaghan to talk about their unique perspectives in the process of pathway development for NAFLD. In doing so, the group looks for ways to incorporate the 17 Sustainable Development Goals (SDG) established by the United Nations - an urgent call for action on health, economy, and starvation amongst other human rights issues.Earlier this year, Jörn co-authored a paper titled, A sustainable development goal framework to guide multisectoral action on NAFLD through a societal approach (2022). Louise begins by asking Jörn about the process and intention behind the paper, and how it champions the SDG. Jörn recalls that leading author, Jeff Lazarus, sought to incorporate the SDG and its applicable targets to the challenges posed specifically by NAFLD. The paper is formulated by consensus using The Delphi Process, whereby two rounds of interdisciplinary discussion decided on 16 deliverable targets relevant to NAFLD. It aims to determine what is important to be addressed by politics and those involved with research funding.Michelle notes this paper is absent of nurses, patient advocates or other allied professional contributors. Robert joins to reframe Michelle's concerns, asking how do we do it better next time? He seeks a more genuine multisectoral representation in what could only then be dubbed as a truly societal approach. Jörn acknowledges these shortcomings and agrees that, as the paper stands, it can be seen as a physician's viewpoint. Louise reckons that the paper serves a foundation and that if it were to be further developed, now is the time to introduce different perspectives.The conversation turns to the next steps of establishing such a framework. Stephen Callaghan provides an anecdote from his time contributing to the development of a pathway for HIV. The driving message is that not every stakeholder comes from a clinical environment. As such, the group agrees that herein lies the importance of communication. Robert states that most patients are relating in terms of describing symptoms and other quality of life issues. Some of the more complex metrics understood by specialists may not translate outside of the professional circle. Michelle then highlights the critical role of nurses positioned as a more conversational contact with the ability to identify risk factors and promote liver health. Both points resonate with Jörn. He explains that the SDG paper emphasizes a need for funding for nurses. He also shares Robert's concern surrounding the power gap that can negatively impact the patient's ability to contribute pathway development.Next, Stephen speaks to the reality that “everyone is fighting their own corner” in advocacy and diagnostics. Robert relates, stating the matter is complex and that the community should come together to offer more than one answer to patient questions. Jörn alludes to Stephen's position as a generalist to combat this issue. The conversation then shifts to education. Louise notes that liver health is not engaged with at a school level. She suggests that liver health as an outcome be incorporated from an earlier age. This familiarity could fundamentally assist the more ‘generalist' approach. Michelle mentions potential pushback and the group revisit the need for more patient resources. Beyond access to affordable nutrition, communities require safe spaces and opportunities for exercise.Final thoughts are shared and each expresses their eagerness for building an inclusive, robust framework. The success of such a framework requires many players, and Stephen hopes to translate strategies from past successful pathways to place liver disease on a higher agenda.

On May 6 and 7, over 100 NAFLD stakeholders convened in Barcelona and on-line for the inaugural Innovations in NAFLD Care 2022 conference (#INCBCN.) Surfing the NASH Tsunami was there, with Jörn Schattenberg serving as event co-founder and Louise Campbell and Roger Green moderating sessions. This week's episode is less a formal recap of the meeting than recollections of key moments and messages from the co-founders and Surfers.While the question in this conversation comes from Roger Green, who asks about controversies, the two pivotal controversies center around views of patient empowerment. The conversation begins where the last one ended, which Louise Campbell and Roger Green commenting that calling the entire disease class simply "Fatty Liver Disease," as proposed by Primary Care participant @Jean Mareis, would remove a controversial issue and foster stronger communication between doctor and patient. In response, Jeff Lazarus and Jörn Schattenberg note that there is an ongoing delphi exercise led by Jeff and his team, which will report on July 8 and 9. From here, the discussion around controversy shifts focus to the varying reactions to #HumanEdge founder Marcus Ranney's presenting about #biohacking and his developmental Mito app. Questions ranged from how much data to put in patients' hands to where analysis should be controlled. This element wraps up with Jörn Schattenberg noting the research value of the data that Human Edge proposes to collect. The last part of this conversation covers plans for the 2023 conference and congratulates Jeff as he departs.

On May 6 and 7, over 100 NAFLD stakeholders convened in Barcelona and on-line for the inaugural Innovations in NAFLD Care 2022 conference (#INCBCN.) Surfing the NASH Tsunami was there, with Jörn Schattenberg serving as event co-chair and Louise Campbell and Roger Green moderating sessions. This week's episode is less a formal recap of the meeting than recollections of key moments and messages from the co-founders and Surfers.This discussion starts with #INCBCN co-founder Jeff Lazarus and Roger Green what Jeff considered the successes and surprises of the conference. Jeff speaks about the "palpable" energy of the attendees, the number of people who attended virtually and engaged through Q & A and the range of issued addressed at the conference as three strong positives. On a more prosaic note, he also mentions how well the technology worked throughout the meeting. Roger Green suggests that much of the energy came from merging three separate streams of activity -- medical specialists, primary care and patient advocates -- into a single conversation that touched on all three groups' issues. He also suggests that having Marcus Ranney and Jeff to share a digital health vision of the future added additional energy and the prospect of what Roger calls "radical patient empowerment." As co-founder Jörn Schattenberg and then Louise Campbell join the conversation, levity ensues as the four discuss the surprise closing statement from Jeff and Jörn and then a more serious tone as the group discusses the benefits that multidisciplinary conversation brought to all the participants.

Last week, all three #NASHTsunami co-hosts participated in the inaugural Innovations in NAFLD Care (#INCBCN) 2022 conference in Barcelona. Today, co-chair Jeff Lazarus joins Jörn, Louise and Roger in reviewing the conference's high points and key messages.The meeting itself brought a diverse group of Fatty Liver stakeholders to Barcelona last week to explore NAFLD care from several distinct perspectives. Research Key Opinion leaders discussed not only advances in medicines and diagnostics but also the best ways to utilize what is available today. Patient advocates shared their goals, victories and frustrations working within the current system. Primary care physicians discussed some challenges in incorporating a whole different set of disease screens and thinking into their overloaded practices and ways computing power can help identify patients who need help. Finally, entrepreneur Dr. Marcus Ranney shared a visionary app called Mito that his company, Human Edge, is developing.This episode is less a recap of the meeting itself than a discussion of its key themes and highlights. The Surfers share their own impressions of the event along with feedback from other attendees. The conversation conveys the enthusiasm and energy present in the room throughout the conference. Along the way, it touches on some of the key concepts presented at the conference.The final segment of this episode is an abbreviation of a 1:1 interview Roger Green conducted with Marcus Ranney on the specific history of how he came to develop Mito and a broader discussion of the power that decentralized data and analytics can have in improving the health of any patient with a hand-held phone that connects to the internet.

This week's episode and conversations preview the inaugural Innovations in NAFLD Care Workshop, premiering in Barcelona on May 6 and 7. Surfing the NASH Tsunami is a Media Partner for this conference. We will be conducting and posting interviews from the conference, co-host Roger Green is moderating a panel there, and Surfing NASH will present a follow-up episode on Wednesday, May 11.This conversation previews Sessions 4, 5 and 6, which comprise the bulk of the Day Two Agenda. The overall theme of the day is that NASH treatment is integrated and multifactorial. The day starts with Jeff Lazarus discussing Comprehensive Care Models for NASH, the path there and desired endpoints. The rest of Session 4 focuses on two forms of technical support: integrating non-invasive tests for NAFLD into clinical practices outside the liver space and looking at the power of apps to transform the weight management process. Session 5 focuses on pharmacotherapy, including use of current pharmacotherapy in weight loss and diabetes and some of the future agents that will come into use over the next few years. Finally, Session 6, which Roger Green will moderate, pulls together a diverse set of panelists to consider the NAFLD/NASH Roadmap in the context of social media and digital transformations. Listening to this conversation provides a clear sense of how broad the scope of Day Two issues will be.In the interest of time, this summary does not list the names of the speakers giving each talk. This is an absolutely first-class global faculty. If you are curious, go to the meeting program to learn who these exceptional speakers are.

This week's episode and conversations preview the inaugural Innovations in NAFLD Care Workshop, premiering in Barcelona on May 6 and 7. Surfing the NASH Tsunami is a Media Partner for this conference. We will be conducting and posting interviews from the conference, co-host Roger Green is moderating a panel there, and Surfing NASH will present a follow-up episode on Wednesday, May 11.This conversation focuses on the first two sessions of the Innovations in NAFLD Care 2022 workshop. Jeff Lazarus defines Session 1 as "Epidemiology for Action." His underlying point: NAFLD is part of the metabolic family of diseases, but many of the specialties that treat other diseases in the metabolic famliy are not trained even to look for liver disease. As Jeff notes pointedly, "when we review the cardiology guidelines and we don't see liver mentioned except for the word to deLIVER on better cardiological outcomes, you know we have a problem." The epidemiologic numbers are staggering in their own right (25% of adult population with NAFLD, 25% of these with NASH; 25% of these with cirrhosis), but the point here is that many different specialists treat these patients without ever being taught or encouraged by guidelines to screen for liver disease. This session starts a presentation asking, "Is NAFLD/NASH a Public Health Challenge in 2022?", followed by presentations on cardiovascular links to NAFLD and NASH and the "Fatal Triple" of Obesity, Type 2 Diabetes and NAFLD/NASH. Jörn Schattenberg follows Jeff by presenting the second session, which focuses on the role screening must play and effective strategies and tactics. The first presentation in this session focuses on a clinical care pathway for screening. The second focuses on a UK-based program that computes test results for general practitioners, thereby simplifying their task of identifying patients at risk. The third goes back to the beginning of the clinical care pathway to discuss "How and Why to Identify NAFLD in Primary Care?"In the interest of time, this summary does not list the names of the speakers giving each talk. This is an absolutely first-class global faculty. If you are curious, go to the meeting program to learn who these exceptional speakers are.

This week's episode and conversations preview the inaugural Innovations in NAFLD Care Workshop, premiering in Barcelona on May 6 and 7. Surfing the NASH Tsunami is a Media Partner for this conference. We will be conducting and posting interviews from the workshop, co-host Roger Green is moderating a panel there, and Surfing NASH will present a follow-up episode on Wednesday, May 11.This conversation between co-host Roger Green and the co-chairs and co-founders of the Innovations in NAFLD Care 2022 workshop, Jeff Lazarus and Jörn Schattenberg, focuses on the factors that drew each man towards these issues and to create this kind of event. For Jeff Lazarus, this is the third wave on what he describes as his own liver Tsunami, starting with his work on HIV, moving to Hepatitis C because many of the same people living with HIV were also living with Hep C and then, once he realized that prevalence of cirrhosis and hepatocellular carcinoma (HCC) was growing despite these effort, to look at NASH as the looming source of a pandemic of severe liver disease. Jeff notes that whereas HIV and Hepatitis C were well defined diseases when he became involved and there were effective therapies for both these diseases NASH is quite different: a less-than-clearly defined disease with no discrete new agents in market. Jörn Schattenberg came from quite a different perspective. Jörn started as a clinical and academic hepatologist, treating patients and working in drug and diagnostic development. His first exposure to public health came while working on a cost effectiveness paper with Jeff. As he became increasingly involved with public health and policy, he learned how complex it is to build a consensus to organize effective treatment for NASH patients.Jeff's and Jörn's stories comprise the bulk of this conversation. The only other thought comes from Roger Green, who comments that one thing the three conditions have in common is the inappropriate stigma attached to patients with each.

Conference founders and directors Jeffrey Lazarus and Jörn Schattenberg join Roger Green to preview the inaugural Innovations in NAFLD Care 2022 conference, scheduled for May 6 and 7 In Barcelona and on-line. Jeff Lazarus describes this conference as "looking at Fatty Liver disease from a Public Health perspective." As Jörn Schattenberg expressed, this has been a process over "incredibly productive years" of "just pulling people together and getting this into a movement that I think finally leads up to the conference we're having now."This process has already produced half a dozen or more papers on issues relating to NAFLD, cost and public health, overseen a process by which over 200 countries participated in a three-stage Delphi process, created a consensus statement, held a workshop in January and, now, sponsored this inaugural conference.After Jeff and Jörn finish discussing the motivations to create this process and how they feel about activities to date, the discussion turns to a session-by-session review of the Conference. Jeff Lazarus leads the review of the first session, which he describes as "epidemiology for action," an effort to motivate a broader set of healthcare providers, including endocrinologists, cardiologists, primary care physicians, nutritionists, allied health professionals, to think about the liver of each patient they treat when working them up. As Jörn points out, the title of this session includes the provocative phrase "Measuring a Silent Condition," which was intended by its authors to convey the scale and hidden nature of the challenge.Discussion shifts to the next two sessions. Session Two focuses on screening and Session Three focuses on treating NAFLD patients in different care settings. While the topics may be different, the sensibilities behind the two sessions are similar: we need to bring a broader swath of health professionals to this effort and to provide them with tools that make it as simple as possible for them to play a role.Discussion of the Day Two agenda starts by discussing the importance of patient organizations and advocates in driving this process forward, then shift to the three sessions that will take most of the day. The title of Session Four conveys focus on the multidisciplinary management of care; the talks focus on comprehensive care pathways, the best way(s) to integrate non-invasive liver tests outside the clinical trial setting and, finally, the ability of digital technologies and information to create apps and programs that produce effective weight management results. The Title of Session Five conveys focus on the future of pharmacotherapy, but two of the talks discuss obesity and diabetes medications that may be available today. Finally, Session Six constitutes a far-ranging group discussion covering all the elements of the meeting so far, wrapped around the broad question of the ways that social media and digital transformation can help inform care pathways and comprehensive care plans for NAFLD patients.This description lists the sessions and summarizes their focus because an effort to describe in detail will require more characters and writing space than Buzzsprout provides. Suffice it to say that this conference is the most complete manifestation to date of the unique perspective and Jeff and Jörn have shared on earlier episodes of this podcast.

The Innovations in NAFLD Care 2022 Series includes a recent webinar and a hybrid meeting planned for Barcelona in May. This new event is a key new element in the effort to drive more holistic multi-specialty approaches toward diagnosis, treatment and management of patients with NAFLD and NASH. In this conversation, Stephen Harrison, Louise Campbell and Roger Green join Professors Schattenberg and Lazarus in discussing structural issues and social determinants of health that are shaping the growing Fatty Liver pandemic and why education is so important to combatting the pandemic.

The Innovations in NAFLD Care 2022 Series includes a recent webinar and a hybrid meeting planned for Barcelona in May. This new event is a key new element in the effort to drive more holistic multi-specialty approaches toward diagnosis, treatment and management of patients with NAFLD and NASH. In this conversation, Stephen Harrison, Louise Campbell and Roger Green join Professors Schattenberg and Lazarus to consider innovative elements for this and future programs and to discuss the outcomes they would like this program (and others like it) to produce.

The Innovations in NAFLD Care 2022 Series includes a recent webinar and a hybrid meeting planned for Barcelona in May. This new event is a key new element in the effort to drive more holistic multi-specialty approaches toward diagnosis, treatment and management of patients with NAFLD and NASH. In this 10-minute conversation, Professors Schattenberg and Lazarus outline the social and health system factors that motivated them to create this program.

The Innovations in NAFLD Care 2022 Series includes a recent webinar and a hybrid meeting planned for Barcelona in May. This new event is a key new element in the effort to drive more holistic multi-specialty approaches toward diagnosis, treatment and management of patients with NAFLD and NASH. In this conversation, Stephen Harrison, Louise Campbell and Roger Green join Professors Schattenberg and Lazarus in reviewing the program scope and agenda elements with an eye toward the most important ways to increase patient awareness of NAFLD and NASH.

Program co-chairs Jeff Lazarus and Jörn Schattenberg join the Surfers to discuss their "Innovations in NAFLD Care 2022" series and how it promotes the broader NAFLD Public Health Agenda.This far-ranging discussion focuses on the Innovations in NAFLD Care 2022 webinar and event series with the goal of understanding what makes this series special and why it is so important today. The NAFLD Public Health Agenda is challenged with high prevalence levels, year-on-year double-digit increases in the number of newly-diagnosed cirrhosis patients, worsening of diets and exercise regimens brought about by the COVID-19 pandemic and an array of issues stemming from the lack of efficacious and tolerable medicines approved for this indication.

This conversation is part of SurfingNASH's 2021 NAFLD Year-In-Review. Professor Jeffrey Lazarus of ISGlobal and the University of Barcelona joins Louise Campbell and Roger Green to discuss the emerging NAFLD public health agenda. Jeff Lazarus comes to the effort to create a global NAFLD Public Health agenda from his experiences spearheading similar efforts in HIV and Hepatitis C. The conversation begins with Jeff describing the path by which he shifted focus from each liver disease to the next. Just as reduction in HIV transition rates revealed the high level of Hepatitis C infections among HIV patients (particularly intravenous drug users), the reduction in Hepatitis C incidence following advent of the direct-acting antivirals revealed still-significant levels and growth rates of liver cirrhosis. This in turn revealed the degree to which NASH is driving the continuing growth of cirrhosis in the global population. It also revealed the degree to which efforts to reduce or eliminate NAFLD were lacking a strategy, an idea of the burden or sense of economic consequences. From here, the discussion shifts to looking at similarities and differences between HIV and Fatty Liver Disease. One key similarity: a patient can have this disease for a long time before having to address it. A key difference: the steps one takes to combat infectious disease vs. what is more of a "lifestyle" disease.Next, the group discussed  Jeff's path to help shape a global consensus around the need to treat Fatty Liver and an action plan regarding how to do so. The first key was to determine how many countries are prepared to deal with NAFLD. Answer: out of 102 the group explored, none were prepared. This led to a two-year process with 218 global stakeholders to develop a global consensus statement on goals and actions, which we discussed on S2 E59. With these pieces in place, the global stakeholder group is working on a framework of sustainable development goals.In response to a question from Louise regarding the impact of COVID-19 on these efforts, Jeff stated public leaders have not and will not educate the public on the impact of diet and exercise on the disease.. As a result, NAFLD Public Health advocates need to educate leaders on why public safety and nutritious diets are goals for fighting Fatty Liver. NOTE: It emerges that the countries with the best public preparedness for NAFLD are those that take guidance from hepatologists.In response to a question from Roger, Jeff suggested the attitude that bad health behavior is an individual right but paying the costs of the result disease is a social cost is not new.  Specifically, he noted that this attitude is not different from what we see with tobacco or alcohol. He went on to discuss the importance of promoting public health, not only as a way to improve individual behaviors but also to create and focus advocates. Today, he states, we are failing both to diagnose the disease earlier and to invigorate providers, patients and social actors to behave in ways that reduce the rate and severity of what is in many ways a lifestyle disease.A comment by Roger about the relationship between urgency and action leads Jeff to discuss the "terribly unsexy"attribution fraction, a statistical analysis that estimates the percentage of severe liver outcomes that are attributable to a specific disease (for example, NAFLD vs. Hep C.)As the conversation closed, Jeff discussed his priorities for 2022: (i) to create and work with partnerships to take actions that give life and substance to the consensus recommendations; and (b) to create more consensus opportunities around the work of Wilton Park and possibly a similar meeting in the Americas. 

This conversation is part of SurfingNASH's 2021 NAFLD Year-In-Review. Co-host Dr. Stephen Harrison joins Louise Campbell and Roger Green to review five key NASH themes that emerged in 2021, while simultaneously discussing the year for Surfing the NASH Tsunami.It seems fitting that the first SurfingNASH event of 2022 should include Stephen, Louise and Roger. In this thoughtful, fast-moving conversation, Stephen identifies what he considers five key areas where the Fatty Liver community has progressed in the past year:1. Call to action -- 2021 saw two separate, vitally important calls to action to share the scope of the upcoming NASH pandemic with the medical community at large and begin to create forums and processes to develop an agenda and care practices that would reach far beyond hepatolotgy all the way to primary care and other specialties that have historically had little to do with the liver. Jeff Lazarus work with colleagues at Wilton Park and in over 100 countries to evaluate the current status of NASH diagnosis, treatment and screening around the world and to being developing a public health agenda. At around the same time, a multidisciplinary panel of US opinion leaders organized by AGA published a general call to action and a specific Clinical Care Pathway, starting at diagnosis, that included multiple specialties and, for the first time, set out to define a way specialties can work together in identifying patients at risk, screening them for disease, and then treating as appropriate.2. Natural History -- 2021 saw publication of two major papers on the natural history and progression of the disease. One paper produced by Stephen, Naim Alkhouri and a range of associates, evaluated a large group of seemingly healthy middle-aged men who receive treatment at the San Antonio Military Medical Center and mirrored a smaller study 10 years earlier. The two studies were fairly consistent in determining that slightly over one adult in three has demonstrable NAFLD and one in seven or eight has documentable NASH. The difference in the populations was that while approximately 2% of the 2011 sample exhibited F2 or F3 NASH, that number almost tripled ten years later. These papers and Dr. Arun Sanyal's work published later in the year in the New England Journal of Medicine indicated that we can project a steadily increasing trend line for cirrhosis cases, with growth in most major markets at 10-12% per year.3. Drug Development --news here was mixed, although Stephen points out that we have learned from each failed trial. SurfingNASH discusses this topic frequently, so suffice it to say that as the year ends, three medications recruiting or conducting Phase III trials and several other exciting, innovative agents have already demonstrated some positive Phase II results.4. Weight loss surgery -- Stephen feels that the SPLENDOR study, which we discussed recently on the podcast (S2 E60), merits notice because of what it suggests about the ability of dramatic weight loss to halt or reverse cirrhosis. There are drugs in development right now that appear capable of producing the same levels of weight loss shown with bariatric surgery, which provides hope that we can eventually stabilize and perhaps regress fibrosis levels in cirrhotic patients.5. Non-invasive testing -- Several different modes of non-invasive testing have made progress during the year, ranging from liquid tests that received FDA approval and/or enhanced their commercialization capabilities to published research suggesting that MR Elastography (MRE) has compiled much of the data necessary to prove outcomes with greater clarity and confidence than biopsy. Stephen shared his belief that 2022 will be the year when academics, drug developers and regulators begin to align around a strategy to move beyond biopsy with deliberate speed.None of these items are new, but the way Stephen organizes them is clearly worth a long listen.

The last half of December marks our annual NAFLD Year-in-Review. Episodes 62-64 each include ~20 minute segments of longer interviews with Stakeholders who have made a dent in Fatty Liver disease in 2021.In this episode, Louise Campbell and Roger Green are joined by Stephen Harrison, Jeff Lazarus and Andrew Scott. Conversation topics vary widely, with Stephen describing on what he sees as the five key themes in his NAFLD 2021 Year-in-Review, Jeff focusing largely on the public health agenda and Andrew discussing the steps by which patient advocacy is becoming an increasing force in public and private Fatty Liver disease discussions. Each guest is a leader in his topic. Each brings intellect, insight, experience and energy to the topic and this interview. Each is worth a serious listen...The conversation with Stephen also provides the three weekly episode co-hosts an opportunity to look back on the breakthrough year for Surfing the NASH Tsunami in 2021.This vacation is posting after SurfingNASH.com shut down for a year-end break, so timestamps will be coming early the first week in January.

This conversation is part of SurfingNASH's 2021 NAFLD Year-In-Review. Professor Kenneth Cusi of the University of Florida joins Louise Campbell and Roger Green to discuss the NASH multidisciplinary initiative organized under the aegis of AGA the resulting paper of Clinical Care Pathways.In 2021, Ken Cusi played an integral role in the NASH Multidisciplinary initiative fostered under the aegis of the American Gastroenterological Association (AGA) and leading to the paper "Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease," originally published in "Gastroenterology". This conversation begins with Ken mentioning some of the motivations and sources that led to the creation of the multidisciplinary group behind the Clinical Care Pathway paper and the earlier "Preparing for the NASH Epidemic: A Call to Action." Ken starts this conversation by discussing the momentum that is building around taking a disciplined, multidisciplinary approach to the emerging NASH pandemic. He cites recent US publications based on the NHANES database and work done in Europe by Jeff Lazarus and Wilton Park as being major driving forces. The discussion moves on to Ken's prediction that 2022 will be a "great year" based on new or updated guidelines from AASLD, AACE and the American Diabetes Association plus Phase 3 studies coming forward for semaglutide, lanifibranor and resmetirom. Louise Campbell notes that not only are medical groups collaborating, but in the UK, food companies have requested more robust food labeling guidelines from the government there. Ken goes on to predict "a convergence of awareness" around the clinical care pathway and using FIB-4 as a first stage test. He notes that ELF and ProC3 will become commercially available, which will augment testing capabilities and goes on to discuss some larger studies taking place to better define risk for different elements of the population. Louise Campbell asks what is likely to change over the next 2-3 years, at which point Ken discusses the increasing momentum he believes will lead to more testing, increased data generation and studies and a broader awareness of the role the liver plays in overall metabolic health. Roger asks how the new testing and patient vigilance will fit into an already overcrowded patient visit workload. Ken suggests that placing FIB-4 results and guidance on electronic medical records will increase primary care awareness and action by itself. This energy is offset somewhat by a lack of compensation for primary care and endocrinologists who identify patients with cirrhosis and also by the emotional exhaustion of treating patients through the COVID-19 pandemic. From here, the group goes on to discuss the processes through which screening and diagnosis are likely to become more widespread and treatment will become better integrated. In the end, Ken discusses the reasons he is highly optimistic about where the entire NASH field is heading in the years to come.

The last half of December marks our annual NAFLD Year-in-Review. Episodes 62-64 each include ~20 minute segments of longer interviews with Stakeholders who have made a dent in Fatty Liver disease in 2021. In this episode, Louise Campbell and Roger Green are joined by Manal Abdelmalek, Kenneth Cusi and Jörn Schattenberg.Highlights:3:26 – Manal Abdelmalek introduction and discussion: opportunities in the new drug pipeline and ways to treat using older agents until new agent arrive5:06 – Manal: urgent to treat cirrhosis when it appears. Reversal may not be “achievable;”  but blunting progression can provide stability  9:51 – We learn more about heterogeneity of cirrhosis patients all the time. Some day, genetics will pinpoint each patient's outcome to avoid so we can treat accordingly12:20 – Louise: would a combined database of multiple cirrhosis drug study patients provide richer insights?14:05 – Manal: let's “shelf,” not "trash," drugs that had promising NIT results but missed in Phase 2b or 3 histology 18:57 – Louise: Manal does well to remind us how to use older drugs to stabilize cirrhosis patients. 21:05 – Manal: until new drugs become commercially available in 2-5 years, using older drugs better will be key 23:07 – Ken Cusi introduction and discussion: development of multi-disciplinary activities and clinical care pathways24:10 – Ken: New data on prevalence and etiology of NASH cirrhosis spurred multi-specialty activities 24:41 – Key insight drivers: NHANES analyses, endorsements from medical societies and global journals, work of Jeff Lazarus and Wilton Park27:01 – 2022 a “great year:"  new/updated guidelines, major Phase 3 trials progressing 30:00 – Louise:  AGA critical care pathway work and collaboration among specialties pivotal, positive and extending to related consumer industries 31:26 – Ken: 2-3 years from now, foresees “convergence of awareness” to expand FIB-4 and other simple tests to more patient risk subgroups. 33:25 – Study in progress: screening large number of patients to determine NASH prevalence among non-diabetic patients 35:34 – There was significant debate whether to include screening for T2D patients in  the 2018 AASLD guideline recommendations37:03 – Louise: Fatty Liver disease has far broader implications than simply for the liver38:41 – Roger: asks how liver testing and vigilance will fit in  schedules and practices of already overburdened providers 39:55 – Ken:  requires a of simple, inexpensive, easily accessible  Stage 1 tests like FIB-4, was key to its selection42:22 – Jörn Schattenberg introduction and question: how are cost effectiveness analyses progression44:25 – Jörn: 2021 has been “an exceptional year” for NASH 46:04 – Collaborated with Vlad Ratziu and others to produce cost of illness study published in Liver International in 2021 49:39 -Louise:  why does it feel like we study cost effectiveness only for expensive new drugs and never measure cost effectiveness of inaction?50:38 – Jörn: value of monitoring relies on measuring related risks from cardiovascular and other systems52:22 – Roger:  re Louise's question, most cost effectiveness work evaluates a specific new expenditure, not a global “what if”55:44 – Jörn: quality-of-life, which has clear economic costs, strongly associated with NAFLD 57:14 – Roger: Using HER to identify patients at risk might be a more palatable way to target education and information 59:50 – Jörn: An Optum database algorithm built by NIDDK provides a look at how to target1:01:09 – Episode ends

Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join Stephen Harrison, Louise Campbell, and Roger Green to discuss the groundbreaking paper "Advancing the Global Health Agenda for NAFLD." This conversation focuses on what will happen now, why NAFLD is "the canary in the coal mine," and how we can combine strengths in different parts of the world to make all of our programs more robust.For Jeff Lazarus, "what's next" includes a third, smaller Delphi study as well as a greater focus on Sustainable Development Goals (SDGs) around the environment and possible diet. As it continues, Stephen Harrison discusses ways to persuade patients (and perhaps societies?) to change habits, practices, and beliefs radically to fight this disease. Louise Campbell returns to the issue of SDGs to discuss how advocates can leverage the increasing volume of liver cancer patients to represent larger related issues, which leads Jeff Lazarus to comment on how prevalent and costly liver cancer is today, compared to other cancers. In the end, Stephen Harrison recommends a two-item impact strategy: clear messages supported richly through large, high-impact multimedia campaigns.

Lead author Jeffrey Lazarus joins the Surfers to discuss Advancing the Global Public Health Agenda for NAFLD, the major article recently published in Nature Reviews Gastroenterology and Hepatology. The article reports the results of a study with 218 Fatty Liver stakeholders in over 95 countries. Jörn Schattenberg, who participated in the entire exercise, joins Stephen Harrison, Louise Campbell and Roger Green to discuss the process, the insights and what comes next.8:55  - Jeff Lazarus begins discussion by discussing Delphi process and scope 13:13 – Jeff reports: No country scored over 50 on preparedness for the NAFLD pandemic and goes on to list the eight core issue areas for this initiative14:49 – Jörn Schattenberg discusses his reactions as a participant in the process16:29 - Stephen Harrison says clinicians will support document, then goes on to describe how healthcare practices in the US militate against thoughtful patient care18:45 – Stephen's wish: more data so we can provide stronger insights on prevalence19:55 – Jörn elaborates on how an agreed public health agenda and care models could streamline diagnostic and treatment processes20:35 – Jeff: we are a long way from strong global data…and we need that data to demonstrate the current and future cost of disease to policymakers22:22 – Stephen: we know enough today to target post-menopausal females with marginally controlled diabetes23:25 – Louise Campbell sees various systems' weaknesses and strengths as source for planning25:01 – Louise: “I can't fathom” the potential cost savings of earlier screening and treatment 25:45 – Jeff discusses his Hepatitis C experience to say “This is how we start”26:21 – Roger Green comments the dual awareness challenge: physicians do not think of NASH as even one disease when in fact it is two:  a metabolic NCD in F2 vs. serious  liver disease in F428:13 – Jeff describes the strong positive reaction of the Nature Reviews journals and others toward this paper29:15 – Jörn: this kind of awareness will help us raise public and not-for-profit funding for related research initiatives29:50 – Discussion shifts to “What comes next?”30:01 – Jeff discusses ways the collaboration continues and notes that the liver community needs allies to make this happen34:36 – Stephen: we need one messages to motivate patients to improve behavior and another to compel governments to spend 36:07 – Jeff: we need governmental structures to support individual activities36:20 – Louise: we need to increase education and focus on small behavioral steps people can achieve40:11 – Stephen's key place for impact: a simple global message for frontline providers that looks forward to when NITs become accepted and drugs are available42:44 – Roger asks how this effort relates to the US multi-specialty Clinical Care Pathways initiative 44:06 – Jeff:  Clinical Care Pathways  excellent, but we still need to focus on national health systems, sedentary lifestyle and patient education45:37 – Jeff: Center for Disease Analysis forecasts a 2x – 4x growth in NASH cirrhosis between now and 2030 in the countries they have modeled46:12 – Louise doubts our health systems can handle that kind of growth 47:48 – Jeff: cirrhosis will “sneak up” on global health authorities49:49 – Final question: one place we can have impact quickly50:02 – Jörn: working with policy makers in Germany to develop a national strategy50:26 – Louise: educating policy makers in the UK 51:18 – Roger: develop a message that conveys the "two disease" idea52:05 – Jeff:  longer term modeling to demonstrate scale of problem53:10 – Roger asks, if incidence estimates are too high, will anticipated costs scare off US and other payers54:11 – Jeff sees overestimation as a potential problem56:03 – Business section

Professor Arun Sanyal and Stephen Harrison provide a 40-minute briefing on fibroblast growth factor (FGF) agents and why they are so important to the future of NASH and NAFLD therapy. This conversation detours into health policy and screen fail rates before returning to consider the 2-5 year implications of FGF drug therapies.After a simple opening from Roger Green, this conversation includes 4 key elements:Health Policy1:24 - Arun Sanyal discusses directions that Fatty Liver policy in India is heading, along with some its unique features (for example, focus on rural health)2:58 - Louise Campbell discusses the gap between how the best British programs (as identified in Jeff Lazarus's paper) organize and operate as compared to what the recent British Liver Trust study tells us about overall Fatty Liver care in the U.K. After Roger makes a commitment to return to health services policy in future episodes, Louise asks a question about how high screen fail rates appear to be in this study. Stephen Harrison notes that these are not particularly high for a NAFLD or NASH study and explains why.7:28 - Roger asks his final question, which is how panelists believe FGF 21s will be used 5-7 years from today. Arun Sanyal provides the first answer, which looks at FGF-21s and NASH in the context of metabolic diseases and discusses how GLP-1 and SGLT-2 agents that were originally indicated solely for Type 2 Diabetes have broadened indications and use by demonstrating benefit in related non-communicable metabolic diseases,10:05 - The other panelists add smaller points to Arun's exceptional and global statement. Stephen concurs completely with one important addition: If FGF-21s demonstrate potent anti-fibrotic effects in NASH patients, this will give them a unique role in first line therapy. Louise follows up with her belief that uptake of these agents might mimic some of the Hep C drug and Roger concludes by saying that the entire range of FGF effects is not widely known and, as a result, it is difficult to predict how widespread use might be.

Jeff Lazarus and Roger Green discuss the ease of creating valuable metrics in a comprehensive care model, while our three practitioners -- Stephen Harrison, Jörn Schattenberg and Louise Campbell -- dive further into how they believe this model will improve care. KEY POINT: Broadening the number and diversity of health care providers assigned to each individual patient will improve care by improving focus on the areas that count. It is important that system designers ask the right questions and answer them rigorously in context; it is undesirable for the systems to look more or less identical.

Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join the Surfers to discuss how they developed the care models for their recent paper, "Defining Comprehensive Models of Care for NAFLD."The authors researched care models around the world to find the ones that work best, and then developed eight foundational recommendations for co-ordinated NAFLD care centers. In this conversation, lead author Jeff Lazarus discusses the influences on his career that converged in his decision to help shape comprehensive care models for the coming NASH pandemic. Next, co-author Jörn Schattenberg described the challenges the solo hepatologist faces when treating NASH patients today, and how this kind of comprehensive systems approach will help him offer better care.

Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join the Surfers to discuss their recent paper, "Defining Comprehensive Models of Care for NAFLD." In this vitally important paper, the authors researched care models around the world to find the ones that work best, and then developed eight foundational recommendations for co-ordinated NAFLD care centers.Jeff Lazarus brings a career of experience in analyzing and building health systems and, separately, in viral hepatitis and HIV to exploring the challenges of the upcoming NAFLD epidemic. He invited Jörn Schattenberg, among others, to serve as the team for this project. Jeff and Jörn discuss what a systems approach to NAFLD care looks like and what each of them learned along the way. Stephen Harrison, Louise Campbell and Roger Green each brig their unique perspectives about the practice of hepatology, issues of NAFLD and general systems theory to a stimulating discussion with an array of issues and answers.

In this episode, Dr. David Hanscom continues his discussion with Dr. Jeff Lazarus about medical hypnosis. Dr. Lazarus explains why chronic pain is the condition it is most effective for treating. He talks about how it can help patients focus on an outcome they want, amplify that desire in the mind,  and allow them to self-regulate to feel better and achieve their desired outcome. He details the specific approach he uses in his practice. For more information, visit his website at: www.JeffLazarusMD.comJeffrey Lazarus, MD, FAAP, is a Stanford-trained, board-certified pediatrician. He is an expert in the practical use of medical hypnosis for the treatment of headaches, nocturnal enuresis (bedwetting), gastrointestinal conditions, and tics (with and without Tourette syndrome), performance anxiety, and chronic pain. He has published articles and chapters on these topics and is the creator of Keeping the Bed Dry®, a comprehensive home video program that incorporates medical hypnosis to help children and adolescents with bedwetting. He has also created Controlling Your Gut Feelings®,” a home video program that incorporates medical hypnosis, cognitive behavioral therapy strategies, and motivational interviewing techniques for patients with irritable bowel syndrome, functional abdominal pain.

In this episode, Dr. David Hanscom continues his discussion with Dr. Jeff Lazarus about medical hypnosis. Dr. Lazarus explains why chronic pain is the condition it is most effective for treating. He talks about how it can help patients focus on an outcome they want, amplify that desire in the mind,  and allow them to self-regulate to feel better and achieve their desired outcome. He details the specific approach he uses in his practice. For more information, visit his website at: www.JeffLazarusMD.com Jeffrey Lazarus, MD, FAAP, is a Stanford-trained, board-certified pediatrician. He is an expert in the practical use of medical hypnosis for the treatment of headaches, nocturnal enuresis (bedwetting), gastrointestinal conditions, and tics (with and without Tourette syndrome), performance anxiety, and chronic pain. He has published articles and chapters on these topics and is the creator of Keeping the Bed Dry®, a comprehensive home video program that incorporates medical hypnosis to help children and adolescents with bedwetting. He has also created Controlling Your Gut Feelings®,” a home video program that incorporates medical hypnosis, cognitive behavioral therapy strategies, and motivational interviewing techniques for patients with irritable bowel syndrome, functional abdominal pain.

In this episode, Dr. David Hanscom talks with Dr. Jeff Lazarus about medical hypnosis and how he uses it to successfully treat a wide variety of conditions from headaches and irritable bowel syndrome, to Tourette's syndrome and chronic pain. He explains what medical hypnosis is, and the technique he uses with patients to help them train their minds so they can get better. He shares several moving examples that demonstrate the effectiveness of medical hypnosis. For more information, visit his website at: www.JeffLazarusMD.com Jeffrey Lazarus, MD, FAAP, is a Stanford-trained, board-certified pediatrician. He is an expert in the practical use of medical hypnosis for the treatment of headaches, nocturnal enuresis (bedwetting), gastrointestinal conditions, and tics (with and without Tourette syndrome), performance anxiety, and chronic pain. He has published articles and chapters on these topics and is the creator of Keeping the Bed Dry®, a comprehensive home video program that incorporates medical hypnosis to help children and adolescents with bedwetting. He has also created Controlling Your Gut Feelings®,” a home video program that incorporates medical hypnosis, cognitive behavioral therapy strategies, and motivational interviewing techniques for patients with irritable bowel syndrome, functional abdominal pain. 

In this episode, Dr. David Hanscom talks with Dr. Jeff Lazarus about medical hypnosis and how he uses it to successfully treat a wide variety of conditions from headaches and irritable bowel syndrome, to Tourette's syndrome and chronic pain. He explains what medical hypnosis is, and the technique he uses with patients to help them train their minds so they can get better. He shares several moving examples that demonstrate the effectiveness of medical hypnosis. For more information, visit his website at: www.JeffLazarusMD.comJeffrey Lazarus, MD, FAAP, is a Stanford-trained, board-certified pediatrician. He is an expert in the practical use of medical hypnosis for the treatment of headaches, nocturnal enuresis (bedwetting), gastrointestinal conditions, and tics (with and without Tourette syndrome), performance anxiety, and chronic pain. He has published articles and chapters on these topics and is the creator of Keeping the Bed Dry®, a comprehensive home video program that incorporates medical hypnosis to help children and adolescents with bedwetting. He has also created Controlling Your Gut Feelings®,” a home video program that incorporates medical hypnosis, cognitive behavioral therapy strategies, and motivational interviewing techniques for patients with irritable bowel syndrome, functional abdominal pain. 

Membahas tentang buku yang ditulis oleh Jeff Lazarus, seorang praktisi kesehatan, pecinta hewan dan pembicara di bidang komunikasi interpersonal yang menceritakan tentang karakteristik yang kita sayangi dari hewan peliharaan kita yang dalam konteks ini seekor anjing yang ternyata dapat kita pelajari dan terapkan pada diri sendiri untuk meningkatkan kualitas hubungan kita dengan orang lain disekitar kita --- Support this podcast: https://anchor.fm/tentangbuku/support

For World AIDS day, The Lancet HIV Deputy Editor Philippa Harris talks to Jeff Lazarus and Nikos Dedes about the importance of good health-related quality of life and the barriers people living with HIV face in achieving this.

In episode 7 we chat to Jeff Lazarus live from L.A and he tells us how he has revolutionised personal branding and how to write a best selling book.

What is Dogtology? Well, you’ll have to read the book to find out all the details, but author Jeff Lazarus is here to chat with me about this term that he coined. Have you noticed that dogs and cats seem to be everywhere you look nowadays? They are used in commercials and advertisements, and the pet industry has EXPLODED in the last decade. Do we worship our dogs and cats? You may not think you do, but once you listen to what Jeff has to say you may quickly realize just how much our lives are centered around our furry companions. Jeff’s hilarious books Dogtology and Catakism are delightful reads that every pet owner can relate to. And, the books aren’t all about humor. There are also some great tips for communicating with your pets and understanding what they are trying to tell you. In this week’s podcast episode, Jeff explains how he came up with the idea behind these books. He also explains how to go about getting your book idea off the ground, if that’s something that you’ve been thinking about.

2pm ET / 1pm CT / 12pm MT / 11am PT (Outside US: Dial 00 + 1 + 714-464-4891) Viki Winterton interviews Jeff Lazarus!  Jeff Lazarus is a leadership coach, speaker, trainer, adjunct professor, and creative who innovates and builds roads not yet traveled. He has an MBA from Pepperdine University and a BA in interpersonal and organizational communication from California State University, Long Beach. He combined his passion for animals with his teachings on communication releasing Listen Like a Dog in 2016. Jeff is an observer to the practice of cat worshipping and advocate, as well as a serious dog lover and advocate. After finally having his Cat Mitzvah, way past age thirteen, he wrote the whimsical books CATAKISM and DOGTOLOGY. 

Health and Lifestyle Contributor Monica Leighton on celebrating Thanksgiving safely with your pets. | Bestselling author Jeff Lazarus' latest release "Dogtology" is the humorous and enlightening exploration into the dog/man relationship | Michael Malhotra, Founder of Dibsies Personalization Station with unique holiday pet related gift ideas. | "Noelle", bestselling author Greg Kincaid's latest release is the heartwarming holiday story about the strength of family and the love that comes from pets. | Award winning equestrian Alex Schlappman describes a lifelong passion that becomes her dream come true.

Health and Lifestyle Contributor Monica Leighton on celebrating Thanksgiving safely with your pets. | Bestselling author Jeff Lazarus' latest release "Dogtology" is the humorous and enlightening exploration into the dog/man relationship | Michael Malhotra, Founder of Dibsies Personalization Station with unique holiday pet related gift ideas. | "Noelle", bestselling author Greg Kincaid's latest release is the heartwarming holiday story about the strength of family and the love that comes from pets. | Award winning equestrian Alex Schlappman describes a lifelong passion that becomes her dream come true.

How effective are your listening skills? And how much stronger would your relationship be if you could “listen like a dog?” Dogs instinctively know not to interrupt us, finish our sentences, and offer unsolicited advice or text us instead of talking to us. And if we're smart, asserts best-selling author Jeff Lazarus, we'll strive to be more like them. Citing a Cornell study's finding that we have one-third fewer good friends now than we did before social media came along, Jeff will share the mistakes we make when we think we are communicating. A health science consultant with an MBA from Pepperdine University, Jeff taught public speaking at the university level and conducted numerous workshops on listening, presentation skills, and customer engagement. His new book “Listen Like a Dog” was inspired by his late dog Roamy and is the  follow-up to his #1 bestseller, “Dogtology.” The book's website is www.listenlikeadog.com.

www.DogCastRadio.comIn a fun interview with author Jeff Lazarus, find out about dogtology. Are you a dogtologist? Spoiler alert: you probably are! Plus hear from Judith Broug about how she and a good friend founded Service Dogs UK which helps veterans of the armed forces and emergency services cope with PTSD. It's an inspiring story. And in the DogCast Radio News, hear about the dogs who have had lucky escapes of one sort or another, and the scientist who wants to help our dogs - and us - to live longer.

www.DogCastRadio.comIn a fun interview with author Jeff Lazarus, find out about dogtology. Are you a dogtologist? Spoiler alert: you probably are! Plus hear from Judith Broug about how she and a good friend founded Service Dogs UK which helps veterans of the armed forces and emergency services cope with PTSD. It's an inspiring story. And in the DogCast Radio News, hear about the dogs who have had lucky escapes of one sort or another, and the scientist who wants to help our dogs - and us - to live longer.

Jon Patch chats with Jeff Lazarus, author of Listen Like a Dog. Although they don't understand most of our verbal language, dogs listen with their entire being. They don't interrupt us, finish our sentences, offer advice, try to top our stories or text us instead of talking to us. Dogs pay extremely close attention by studying facial expressions, observing body language, watching eye movements and listening to our voice patterns. Now bestselling author Jeff Lazarus is returning the favor in his new book, Listen Like a Dog: And Make Your Mark on the World. Questions or Comments? Send them to: jon@petliferadio.com More details on this episode MP3 Podcast - Listen Like a Dog with Jon Patch

  Many people feel they have a book inside of them and aspire to write. Far too often, the book just stays inside of them instead of the individual grabbing a pencil and putting it down on paper. Not so with Jeff Lazarus. Jeff, author of the just-published book "Dogtology" shares how he got the book out of his mind and onto paper.

Jon Patch talks to Jeff Lazarus, author of Dogtology: Live. Bark. Believe. Dogtology is a humorous exploration of man's fanatical devotion to Dog. In this book, Lazarus makes the case that Dogtology has become a bone-a-fide belief system on par with the world's great philosophies and religions. Questions or Comments? Send them to: jon@petliferadio.com More details on this episode MP3 Podcast - Dogtology: Live. Bark. Believe. with Jon Patch