Gathering momentum for the way ahead: fifth report of the Lancet Standing Commission on Liver Disease in the UK

Abstract

Much has been achieved over the past five years in describing the escalating burden of liver disease from lifestyle causes and the impact on hospital and primary care. The section on alcohol in this report reiterates the need for fiscal regulation by Government if overall consumption in the country is to be reduced to improve health, voluntary agreements with the drinks industry having repeatedly been shown to fail. The influence of the industry in its lobbying activities is highlighted in a separate account and myths around the 'nanny state' are also exposed, with the Minimum Unit Pricing (MUP) policy having little influence on average drinkers, affecting mainly heavy drinkers of low cost alcohol products. Results from Scotland following introduction of MUP and with Wales to follow, are likely to seriously expose the weakness of England's position. Further data on the prevalence of obesity makes the need for a policy on adults even more apparent. The number of people with Type 2 diabetes and its complications continue to rise, as do cases of end-stage liver disease and primary liver cancers from Non-Alcoholic Fatty Fiver Disease (NAFLD). Also covered are the increased risks of co-existing obesity and alcohol as causes of the ten most common cancers, including breast and colon. An indepth analysis of both NHS and total societal costs is summarised, showing the extraordinarily large sums that could be saved or redeployed elsewhere in the NHS. On the plus side are the excellent results being obtained with the new antiviral drugs for hepatitis C (HCV) infection, making elimination of chronic infection a real possibility ahead of the World Health Organisation (WHO) target of 2030. Efforts to improve standards of hospital care for liver disease are described and new commissioning arrangements for primary and community care represent some progress in effective screening of high-risk subjects and the early detection of liver disease.

Early and late mortality following unscheduled admissions for severe liver disease across England and Wales

“…There is a known shortfall in specialist liver services resources across the UK, which has led to the establishment of a Lancet Commission on liver disease . A number of other studies have reported on late mortality following hospitalisation for severe liver disease, and how it varies according to the cause of death, with much of the evidence from Scandinavia .…”

Non‐invasive liver fibrosis scores are strongly associated with liver cancer mortality in general population without liver disease

“…An unmet clinical need is how to identify individuals in the general population with undiagnosed liver disease who are at risk of liver complications such as HCC . The early diagnosis of HCC is particularly important because of the poor prognosis and lack of curative options if HCC is diagnosed late in the course of the disease.…”

The hidden power of corporations

“…Some have specific goals, such as the Center for Indoor Air Research, which sought to undermine the evidence on the dangers of secondhand smoke 6. Others use a broad based approach that includes promotion of individual choice over collective action, supporting often ineffective educational campaigns rather than the legal or regulatory measures that tackle price, availability, and marketing of their products 7. This is exemplified in the use of the term “nanny state” to attack many of the most effective public health measures 8.…”