3). Their studies are designed and

orchestrated by academic centers, and the involvement of community physicians and/or their patients is encouraged. These studies are meant to answer questions never answered by other published reports and are designed to better serve our patients. Answers to a variety of clinical issues that pertain to a disease can be achieved by something as simple selleck screening library as recording daily coffee intake! In previous nonresponders to treatment for CHC, intake of three or more cups of coffee per day was associated with both enhanced viral clearance and a reduced rate of disease progression!15, 16 Ability to conduct ancillary studies allows for one study to provide multiple answers to several aspects of the one disease (e.g., sociocultural, immunologic, radiologic, and serologic), all of which are clinically relevant, but less likely to interest Selleckchem Y-27632 the “industry,” but nevertheless factors that may influence patient compliance and care and/or outcome. The studies emanating from the Hepatitis C Antiviral Long-term Treatment against Cirrhosis consortium alone have, to date, resulted in 64 clinically

relevant peer-reviewed publications! Both hard clinical findings and blood-test results were incorporated into one of the first combined measures of outcome, the Child-Turcotte-Pugh Score, first designed to predict postoperative outcome after surgical maneuvers for portal hypertension. More recently, another combined measure of liver function, the Model for End-Stage Farnesyltransferase Liver Diease (MELD) score, also specifically developed to predict the likelihood of postoperative survival after triangular intrahepatic portosystemic shunt (TIPS) insertion, is now employed universally to assess

the “optimal timing” for a transplant in patients with liver failure. A recent MELD remodel, which adds serum sodium, may be even more reliable.17 It is much harder to predict outcome in patients with presymptomatic disease—those we most often see in clinics in 2011. In the 1960s, most were diagnosed only once their liver disease was advanced. For example, of patients with AIH recruited to the trials of prednisone in the 1960s, nearly all had end-stage liver disease; hence, over a relatively short period, it was possible to appreciate that those randomized to placebo had a significantly higher mortality rate than those who received prednisolone.18 Fifty years later, patients with AIH rarely present with liver failure, though some are given this diagnosis even though they are asymptomatic! This begs the question whether AIH always shortens the person’s life. So, before we treat all AIH cases, we need to know if the survival of asymptomatic cases is as bad as for those with symptomatic disease.