S3-E49.2 - Cancer vs Liver Disease Management: Political Pressures and Metaphorical Issues

Send us Fan MailAmidst a shifting diagnostic pathway, the UK’s National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. Professor Ian Rowe and Dr Kathryn Jack discuss navigating a scarcity of relevant data for evaluating pathway development alongside Surfers Roger Green and Louise Campbell. Roger prompts this conversation by asking the group whether there is a developed paradigm for how to adopt technology in places where the data is arriving in real time. He notes the difference between how this process is approached in open markets such as the US versus data-reliant markets similar to the UK. Ian describes a process used in oncology called “commissioning through evaluation,” where the NHS pays for medications while collecting the necessary real-world data to conduct evaluation. This point introduces political influence on decision making processes. Roger notes the resulting polarity in healthcare expenditure between the US and the UK. Roger continues to spur discussion on the political pressures and metaphorical issues that shape the differences between cancer and liver disease management. Louise analyzes the linkages between poor liver health and non-hepatic cancers, insisting on a more robust consideration of the liver-to-cancer link. Ian mentions the ever increasing challenge for hepatology of treating more aggressively and effectively with NITs while simultaneously conducting research on the best way to do so. Kate suggests utilizing the nurses and allied health professionals that are willing to become involved in research and drive the required data forward. At this point, Professor Will Alazawi joins the panel with an impressive debut. He returns to the idea that due to stigmas, liver and cancer do not occupy the same imagination in the general public. His ideas link socioeconomic strata with liver outcomes, suggesting marginalized patients are more likely to encounter complications of liver disease.