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.

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

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

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

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

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

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

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.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SurfingMASH's last year-end interview with Stephen Harrison took place in 2022. Louise Campbell and Roger Green join Stephen to discuss a promising year in MASH drug development and the podcast itself.

At the time, this was the description of the interview posted in Buzzsprout:

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, podcast co-founder and former co-host, Stephen Harrison, joins Louise and Roger to discuss the year-in-review as recorded before Madrigal’s breaking announcement of the Phase 3 MAESTRO-NASH results last week.

From the outset, Stephen admits there were “a lot of pleasant surprises” this year, alluding to the multiple positive Phase 2 trial results among other recent press releases. He anticipates several exciting modes of action becoming available in the imminent future. The interview goes on to look at advancements made in methodology of interpreting liver biopsies, understanding the limitations of biopsy and degrees of mitigation in response to those shortcomings. Stephen also offers in-depth investigation into the uptake of NITs as conditional clinical trial endpoints, something he sees as a process whose momentum keeps growing and strengthening.

Throughout this session, Stephen provides speculation as to what the promising new year holds for the Fatty Liver field. In his words, 2022 revealed “the most incremental advances in the field of NASH in the past decade.” He adds that, like this year, 2023 is primed to be pivotal. Surf on for the full-length, insight-laden interview with a remarkable physician and Principal Investigator making tremendous contributions to the pursuit of putting a major dent in Fatty Liver.