S4-E48.2 - Reviewing TLM 2023 Part One (Cont.) - A Discussion With Tim Jobson
Dr. Tim Jobson of Predictive Health Intelligence joins Roger Green in our continuing review coverage of TLM 2023. Dr. Jobson discusses the studies he presented at the meeting and other work related to population-level screening for metabolic diseases, the importance of providing better care in areas with lower socio-economic status residents and the global value of population health management.
The conversation starts with Tim discussing the major impact that new medicines like resmetirom and new indications for GLP-1s will have on the entire treatment framework for MASLD and MASH, starting with increased interest in screening coming from physicians who will have medications they can use to treat patients. Roger identifies the ability to predict which patients will proceed from MASLD to MASH as a major area for improvement, which serves as a segue to Tim to discuss PHI's work.
PHI presented two posters at TLM2023, mostly focusing on deploying PHI's medical record-based case finding approach to identify specific patients badly in need of care but not receiving it. This is particularly crucial in what Tim describes as "areas of deprivation," with residents of lower socio-economic status. One poster addressed identification of untreated patients with Hepatitis B. The other focused on liver disease in these areas: similar rates of disease but far higher rates of advanced disease.
Tim's is particularly excited about population-level risk stratification and the ability to identify a "five-fold" increase in the people we can target early in adulthood based on their propensity to develop non-communicable disease later in life. This study will target 7% of the population, which he expects will make the program economically viable. Tim reports he has seen tremendous interest in this idea at the meeting, strikingly among US physicians, allied professionals and payers.
The conversation shifts from Tim's work to other issues in the meeting he found fascinating. He was powerfully struck by some of the data and drugs becoming available in Primary Biliary Cholangitis (PBC) and findings about modes of action in Primary Sclerosing Cholangitis (PSC), two rarer diseases vitally in need of better therapies.
Tim also asks where AI will fit into the emerging care paradigms. In this regard, one of his concerns regards the intrinsic biases in existing datasets when we try to predict which patients have more urgent need for a liver transplant among those on the list. Tim and Roger return to the issue of biases in the current dataset, and agree the biases are probably too "hard-wired" to eliminate, which means researchers will need to find ways to adapt...and, Tim believes, they will do so.
Looking at another issue that interested Tim, the discussion shifts to asking what the meeting is telling us about Hepatitis B and Hepatitis C. Tim notes that we are unlikely to meet the ambitious elimination goals we have set. Doing better will involve improved patient identification and motivation, which has two tiers of challenge. In developing countries, the data and data structures necessary to target patients simply do not exist. Even when they do exist, as in the UK, the system reaches only half-to-two-thirds of patients with clear signs of serious disease.
The right strategy for the solution is to pilot in a narrow swath of population, then go broader. As the conversation ends, Tim notes that the technology is here or will be shortly to achieve this goal.