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I recall my first conversation with Dr Williams, nearly forty years ago in November 1980. Adrian Eddleston had accepted my application to join him as a research fellow in immunology on the Liver Unit pending an interview with the head of department. Laura, my first daughter, decided to make an entry on the morning of the interview, not unexpectedly since childbirth after a certain point never is, but certainly not on any planned schedule. I rang the Liver Unit very early that morning to apologise for my failure to attend the interview and to my surprise went straight through to Dr Williams. I had expected some warm words of congratulation, but the message was very short and simple. If I really wanted to work on the unit I must visit as soon as possible. I took that advice and attended for an interview the following week (we only discussed sailing) and as with so many people who preceded or followed me with “Roger” as our mentor it was the point in a career when Hepatology became the only option. That first conversation made me realise the professional commitment that he expected of himself and his colleagues. That conversation also instilled a feeling that persisted over 40 years in all my contacts with Roger that I had never quite worked hard enough. I have never met anyone with such a strong work ethic, nor anyone so driven to continue to research into liver disease. Often a difficult character, with views he held strongly, he earned the respect of all of us in the field and I will remember him with both respect and affection that only increased over 40 years. One word sums him up: unique.
He established the Liver Unit at King’s College Hospital in 1966, leading it for 30 years, by which time the unit was recognised internationally as one of the foremost liver centres for both clinical practice and clinical research. The early work in Acute Liver Failure in particular, was ground-breaking and established a clinical model that has since been copied everywhere. His contribution to clinical practice in Liver Transplantation was a first both in Europe and the UK and several years passed before other UK centres followed his example. Undoubtedly, physicians trained in his unit (or their trainees) comprise a majority of leading Hepatologists now practising in the UK, with many others trained on the Liver Unit leading similar units across the world. Perhaps only two UK physicians are recognised universally as giants in our field with professional lifespans exceeding many decades, namely the late Professor Dame Sheila Sherlock and Professor Roger Williams. He was awarded the order of CBE in the Queen’s Birthday Honours list of 1993, recognition of his outstanding contribution to medicine in the UK and in particular to Hepatology. In 2006 he was further honoured by the Queen, when included in a celebration for those who had continued to contribute to public service beyond the age of 65 years.
On his “retirement” from King’s College Hospital in 1996 Professor Williams continued his career in Hepatology as Professor of Hepatology and Director of the newly established Institute of Hepatology at University College London and also held an appointment as an Honorary Consultant Physician at UCLH NHS Foundation Trust; then in 2010 he established and became Director of the Institute of Hepatology and Foundation for Liver Research, where he remained at work 60 years from the start of his career in liver disease.
He was hyperactive in research (more than 2,500 original peer reviewed papers in a 60-year career with 340 published in the past 10 years); he continued to present keynote and ‘state of the art lectures’ (over 60 in his career with 25 since “retirement” in 1996); he continued to receive recognition from colleagues across the globe and received multiple awards for his contribution to Hepatology including highpoints such as the Hans Popper Life Achievement Award of the International Liver Congress in 2008, the Distinguished Service Award of the International Liver Transplantation Society in 2011 and most notably the Distinguished Achievement Award of the American Association for the Study of Liver Disease (AASLD) in 2013, the first and only time this award had been made to a UK Hepatologist. Similar career recognition by the European Association for the Study of the Liver had been planned for the annual meeting this year.
A major contribution to our field in the past decade was the Lancet Commission on Liver Disease in the UK alongside The Lancet’s Dr Richard Horton. This multi-disciplinary group, both created and held together by the force of Professor William’s character, has now published six annual reports with a seventh under review. Each of these highlights the worrisome prevalence of liver disease and liver cancer in the UK population, problems that increase year on year, are linked clearly to poverty and compounded by inequity of access to adequate liver services. He has illustrated the clinical problem for the next generation to resolve.
Professor Williams spent his life in Hepatology and BASL will undoubtedly celebrate the life of our own pioneer when large gatherings become possible once more. But for now, our thoughts are with his wife Stephanie, his family and his colleagues at the Institute of Liver Studies.
BASL is seeking expressions of interest for the post of President Elect.
The President Elect is nominated and elected by the membership and will work with the BASL President from September 2020 and take up the role of President at the end of the Business Meeting of the Association in September 2021.
The President is the Chairman of the Association and serves for two years and Chairs the Annual Scientific Meeting and the meetings of the Governing Board. Public Affairs are also managed by the President, who liaises closely with the Secretary and Treasurer, and other members of the Governing Board, as required.
The post of President shall be registered with Companies House in the UK as a Director of BASL and registered with the Charities Commission as a Trustee.
Please send your nominations, clearly stating the position that your nomination is for, to the BASL Secretariat email@example.com by the deadline of 09:00 on Monday 10th August 2020.
Candidates wishing to be considered for election will require one BASL member to propose them and a second BASL member to confirm their suitability for the role in writing.
If more than one candidate is nominated, the Secretariat will arrange for an election of the BASL membership. A personal statement, containing no more than approx. 300 words, will be required from each candidate. He/she will be elected by a simple majority of BASL members voting.
The newly elected post will be announced at the next Business Meeting of the Association during BASL2020 in September.
If you need any more information, please contact firstname.lastname@example.org .
This guidance represents the professional advice from the British Association for the Study of the Liver, British Society of Gastroenterology, British Transplantation Society, NHS Blood & Transplant and input from the British Liver Trust.
The patients in the groups below are advised to shield and should consult the government web-site for advice on what that entails:
1. Patients with chronic liver disease who are on immunosuppressants
Data: There are as yet no large enough datasets to support/refute this approach and thus this is based on clinical judgement.
2. Any patient with liver cirrhosis and decompensation or complication as defined by presence/recent history (within 12 months) of ascites, hepatic encephalopathy, hepatocellular carcinoma, variceal bleed or synthetic liver dysfunction.
Data: This is supported by data from the COVID-HEP registry that indicates that patients with decompensated liver cirrhosis have an unadjusted mortality rate 5-28 times higher than patients with liver disease without cirrhosis.
3. Patients who are actively on the liver transplant waiting list or who have received a liver transplant
Data: This is supported by data from NHSBT that indicates that patients who have had liver transplant have an unadjusted mortality rate of 25%.
Shielding is for a patient’s protection rather than a legal obligation. The need for shielding can be flexed further on a case by case basis in consultation with your healthcare team.
Application of this guidance
There are 3 elements:
1. Categorisation as high vulnerability – the guidance above should clarify that. This should be notified to employers etc.
2. Recommended response to that categorisation – This is nationally set, under review and changing with updated guidance from PHE and the CMO. Recommendations are based on complex factors including the current national categorisation of the pandemic, geography, occupation, local and national disease prevalence, R rates, risk factors for exposure etc.
3. Patient choice – Based on the above, patients, with support from clinical teams, are equipped to make personal decisions about what they will then do. Issues to weigh up will include home and family circumstances including age range of those at home and nature of accommodation, the person’s mental health, overall wellbeing, employment status and financial position.
Gilead Sciences Global Grant Program Supporting Investigator-Sponsored Research in COVID-19: COMMIT™ (COvid-19 unMet MedIcal needs and
associated research exTension)
In an effort to further address the unmet medical need in COVID-19, Gilead Medical Affairs is launching the COMMIT program.
Gilead will consider support for research proposals that meet one of the following criteria:
• Expand data on clinical course and outcome in vulnerable populations
• Long-term sequelae
• Real world safety and effectiveness of remdesivir used alone or with other agents.
Projects from across the world will be considered for research grants of up to 250,000 USD each. Gilead will not consider proposals that request COVID-19 screening costs (including test kits) or proposals that request remdesivir or other study drug.
Applications will be accepted from 1st July to 3rd August 2020.
For more information on Gilead Sciences 2020 COMMIT program and how to apply, please visit: https://www.gilead.com/science-and-medicine/research/investigator-sponsored-research/covid19-commit-rfp .
Each year BASL presents the Dame Sheila Sherlock research prize, one of the highlights of the annual meeting. This prize is awarded annually to recognise the enormous contribution of Dame Sheila Sherlock to the development of Hepatology as a discipline in its own right.
Dame Sheila was involved in the foundation of the British Liver Club in 1961, which subsequently evolved into The British Association for the Study of the Liver (BASL). She was one of our past presidents and the first recipient of The BASL Distinguished Service Award. In keeping with Dame Sheila’s enthusiasm for fostering young researchers, this eponymous research prize is awarded to young investigators without substantive posts in either medicine or science for their research contributions in the field of Hepatology.
The winner will receive free registration to the meeting, an award and a prize of £1,000 and an invite to deliver the prize lecture at the BASL Virtual Annual Meeting on 21st - 23rd September 2020.
To apply, please send one A4 sheet outlining your research and another A4 sheet listing up to 5 related publications.
Please send submissions to email@example.com before the deadline of 09:00hrs on Monday 3rd August 2020.
The Andy Burroughs Young Investigator Award was set up in honour of the late Professor Andrew Burroughs.
Professor Burroughs was an eminent and world renowned Professor of Hepatology and Consultant Physician/Hepatologist and among his many achievements include his wide area of expertise in cirrhosis and portal hypertension and significant contribution to liver Transplantation.
This prize is awarded to young investigators who have contributed to clinical or translational research related to liver disorders who are in training or within 2 years of taking up consultant positions (or equivalent); this year the winner will receive free registration to the meeting, an award and a prize of £1,000 and an invite to deliver the prize lecture at the BASL Virtual Annual Meeting on 21st - 23rd September 2020.
To apply, please send one A4 sheet outlining the research and another A4 sheet listing up to 5 related publications.
Please send submissions to firstname.lastname@example.org before the deadline of 09:00hrs on Monday 3rd August 2020.
On Friday 24th April Dr John Walshe celebrates his 100th birthday, and I am sure that we would all wish to send him our best wishes and heartfelt congratulations on this auspicious day. Reaching this age is a tremendous achievement, but his historic contributions to Medicine, and in particular to our current knowledge of Wilson’s disease, its diagnosis and treatment, are unique, and generations of patients with this condition owe their lives and health to him.
So John, we revere you beyond words, and send our best wishes and thoughts to you on this special day.
Dr John Walshe was born on the 24th April 1920 in Kensington, London, to Francis and Bertha Marie (née Dennehy) Walshe. His father was a Consultant Neurologist at the National Hospital for Nervous Diseases, Queen Square; knighted in 1953, Sir Francis was a distinguished, internationally known neurologist. He was elected FRS in 1946.
John Walshe’s first association with Cambridge University was when, as a schoolboy in 1938, he went there to sit his First MB examination. He was accepted at Trinity Hall, Cambridge to study medicine and qualified BA in 1942. He then did his clinical studies at University College Hospital in London (UCH), qualifying MA, MB BChir (Cantab) in 1945. He served with the Royal Army Medical Corps in the Middle East Command between 1946 and 1948, spending time also in Greece and Cyprus. After this he returned to UCH.
His journey towards Wilson’s disease started in the early 1950s at UCH. He was working under Professor Charles Dent, a pioneer in metabolic diseases, and studying changes in amino acid metabolism in liver disease, and in particular in urine using paper chromatography. In one study he found an additional band in the urine, and thought that he might have discovered a new amino acid. However, the patient involved was on penicillin and it transpired that this was ‘penicillamine’, a metabolic product of penicillin. This work was published in the Quarterly Journal of Medicine in 1953. He moved on.
The next event, central to Wilson’s disease and involving his extraordinary mind and insight – an exceptional example of ‘translational medicine’ – occurred in the USA. During his year as a Fulbright Scholar on the Liver Unit at Boston City Hospital (Harvard Medical Unit) in 1955, the hepatology team were approached by the neurological team for advice on the management of a patient with Wilson’s Disease who was not improving as they had hoped on the treatment then available (parenteral British Anti-Lewisite). John Walshe’s scientific insight, knowing the chemical structure of penicillamine, led him to suggest (while crossing a walkway on the way back to their laboratory) that penicillamine might bind copper and lead to its excretion. A small amount of penicillamine was procured. He took some himself (remembering one of Professor Dent’s sayings: ‘You must never give an unknown compound to a patient if you are not prepared to take it yourself’) (see Walshe, 2019), and having no untoward effects, some was then given to the patient. Urine analysis showed an increase in copper excretion.
When he returned to England, he continued to study penicillamine in patients with Wilson’s disease and published the first pivotal papers on a group of patients in 1956. The place of D-penicillamine as an oral treatment for Wilson’s disease has remained ever since, has saved lives and improved the lives of innumerable patients in the ensuing 60 plus years. Many patients have remained in touch with him from those early and subsequent years.
Penicillamine may be associated with adverse effects, and it was because of a patient’s inability to continue with treatment that John Walshe (on the advice of Dr HBF [Hal] Dixon, in the Department of Biochemistry at Cambridge University) chose triethylenetetramine (trientine) dihydrochloride as an alternative copper chelator, and this has also become one of the mainstays of the treatment of Wilson’s disease. Dr Walshe also published early observations on zinc treatment (developed by others in Holland and the USA) and on ammonium tetrathiomolybdate.
In his long career he has published more than 150 papers and book chapters on Wilson’s disease and its link with copper metabolism, both from his own unit and with collaborators abroad. Many deserve mention, but space does not allow. I would, however, like to make note of his invaluable research assistant Kay Gibbs, and his collaboration with Professor Diane Wilson Cox in Canada, a pioneer in molecular genetics of Wilson’s disease.
Most of his career was spent in Cambridge, as Reader in Metabolic Disease and Director of Research in the Department of Medicine between 1957 and 1987. He was also an Honorary Consultant Physician at Addenbrooke’s Hospital, Cambridge, during this period.
He obtained his MRCP in 1952/3, and was awarded his FRCP in 1964, and Doctor of Science (ScD, University of Cambridge) in 1965. He was honoured with an MD (honoris causa) by the University of Uppsala in 1994. He was the Bertram Louis Abrahams lecturer at the Royal College of Physicians of London (‘The Biochemical Lesion in Wilson’s Disease’) in 1966. He has also given the Hudson Memorial Lecture in 1983, and the Worshipful Company of Pewterers’ Lecture at the National Hospital of Nervous Diseases, Queen Square, in 1995. In 1977, he was awarded the gold medal in therapeutics of the Worshipful Company of Apothecaries.
After his retirement from the University of Cambridge and Addenbrooke’s Hospital in 1987, he was given an honorary senior lectureship at UCL and became an Honorary Physician at UCH, allowing him to continue Wilson’s disease clinics at UCH and then the Middlesex Hospital, until finally ‘retiring’ in 2000. Dr Godfrey Gillett, a Consultant in Metabolic Medicine from Sheffield, joined Dr Walshe in these specialist clinics, and continues with them today.
Since this final retirement, Dr Walshe has continued to take an interest in his former patients from his home in Cambridgeshire and regularly attends the annual meeting of the Wilson’s Disease Support Group – UK (a support group for patients, their friends and families, founded in 2000) of which he is Honorary President.
In 1958 he and his wife Ann, who sadly died in 2011 after 55 years of marriage, settled in a wonderful 17th Century Grade II listed house in Hemingford Grey, north of Cambridge. He still lives there cared for by his daughter Susan and son-in-law Philip. His other daughter Clare lives near Oxford.
Throughout his life John Walshe has had a wealth of interests in many areas, but was a very keen photographer particularly of churches and stained glass windows. In his early years at Cambridge he took a particular interest in brass rubbings, making a record of those at Ely Cathedral which he later gave to the Dean of Ely, and which he believes are now stored at the University Library. His house is packed with historic artefacts from around the world, including model elephants – a connection with Wilson’s disease, since patients were asked to draw an elephant to give an assessment of the neurological features of their condition. This appealed to both children and adults.
John Walshe is a polymath, a translational scientist and expert clinician who has changed the lives of patients with Wilson’s disease worldwide. He has remained focussed on this often neglected, challenging and rare disease for much of his professional life. His latest paper on Wilson’s disease (published in the Quarterly Journal of Medicine) was in 2016 when he was 96 years old: incredible – and rarely matched by any other clinician scientist.
John – we are honoured to have benefitted from knowing you, to have enjoyed your encyclopaedic knowledge and to have been able to apply your lifetime’s work to the benefit of our patients.
Many, many congratulations on this very, very, special birthday.
Dr James Dooley
Emeritus Reader in Medicine
UCL Institute of Liver and Digestive Health
(Royal Free Campus)
Hampstead, London NW3
I would like to acknowledge the help of Professor Graeme Alexander, Dr Godfrey Gillett, Dr Bill Griffiths and Dr Rupert Purchase, and the following sources, in writing this account:
JM Walshe. Copper: Quest for a Cure. Bentham Books, eBook, 2009
JM Walshe. Wilson Disease: My Involvement – A Brief Reminiscence. In: Clinical and Translational Perspectives on Wilson Disease. Ed Kerkar N, Roberts EA. Academic Press, 2019.
Dr John Walshe. Biography on the Hemingford Grey Parish Council Website. By Esther Harrod
Rupert Purchase. Dr John Walshe and the treatment of Wilson’s disease (prepared for the Wilson’s Centenary Meeting in 2012).
Rupert Purchase. An Archive of Dr John Walshe’s Publications
Shorvon S, Compston A. Queen Square. A History of the National Hospital and its Institute of Neurology. Cambridge University Press, 2019.
With the outbreak of COVID-19/Coronavirus, many patients have asked for clarification on how the COVID-19 threat affects their current liver management.
Here are some FAQs regarding the impact of COVID-19 on patients with liver disease or specifically those with cirrhosis or those undergoing treatment for Chronic Hepatitis B (CHB).
Q: What should I do if I have an existing liver condition?
A: If you have had a liver transplant or are taking immunosuppressive medication for autoimmune hepatitis, it’s critical that you stay at home and shield yourself to avoid being exposed to COVID-19. For a full list of clinically vulnerable groups advised to shield themselves for at least 12 weeks during the COVID crisis visit; https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19.
Patients with cirrhosis and specifically those with decompensated cirrhosis should follow the advice on strict social distancing to protect themselves. However, if you are on antiviral therapy for CHB without established liver disease (significant fibrosis or cirrhosis), you should not be at any increased risk from COVID-19. In this case, you should continue to take your antiviral therapy and follow the advice for the general population; work from home if possible and maintain social distancing to reduce your risk of contracting the virus.
Notably, the majority of hospital and specialist clinics have made arrangements for antiviral therapy, and other medications usually prescribed in these clinics, to be prescribed in advance over the coming months. In some cases, medications will be couriered to patients to minimise hospital visits and potential exposure to COVID-19. In addition, routine laboratory tests and surveillance imaging will be deferred for many patients. Please liaise directly with your treating Physician to ascertain what plans are in place for your care during the COVID crisis.
If you are experiencing symptoms of COVID-19, such as a fever, myalgia or a dry persistent cough, you should call NHS 111 immediately. Do not visit your local GP surgery or walk-in clinic. Instead, self-isolate at home and visit the NHS website for advice: https://www.nhs.uk/conditions/coronavirus-covid-19/ .
Q: Where can I find up-to-date information about Coronavirus online?
A: It is important to get accurate, up to date information about COVID-19, please see the Public Health England website: https://www.gov.uk/government/organisations/public-health-england .
There are many fraudulent and inaccurate sources of information circulating on the internet. Therefore, it is critical that you obtain and share information from reputable sources like Public Health England.
Professor Patrick Kennedy
Consultant Hepatologist & Gastroenterologist at Barts Health NHS Trust
The government previously had asked patients receiving immunosuppression for a liver transplant or autoimmune hepatitis to be shielded. As no central register exists for patients with autoimmune hepatitis on immunosuppressive medications, individual hospitals with the help of specialists have been identifying these patients for shielding.
NHS England is asking that both lists of these patients should be passed onto the COVID19 lead within their hospital by Monday 13th April. They will then pass this information onto NHSE.
Can you please ensure this information is passed onto the relevant person within your Trust?
Professor Guruprasad Aithal
On 22nd March, the British Government announced that 1.4 million people identified by their doctors would be shielded through self-isolation for 12 weeks (https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19). Recent government announcements have indicated that the liver patients to be included in the ‘shielding group’ should be those receiving immunosuppression for a liver transplant or for autoimmune hepatitis. Self-isolated patients’ clinical care should continue safely, some may also need additional support from social services (https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance/covid-19-guidance-on-home-care-provision).
All liver transplant patients will be contacted using the NHS Blood and Transplant register with information. As no central register exists for patients with autoimmune hepatitis on immunosuppressive medications, individual hospitals need to identify these patients, therefore, please prioritise writing to these patients (a draft letter template 'letter to AIH patients on Immunosuppression' can be downloaded from the website 'members area' under 'All Resources' or by request to email@example.com ). Letters sent to the patients should also be copied to GPs to permit primary care coding as COVID-19 AT RISK. Proactive day care unit therapeutic paracentesis service, tele-clinics and helplines are vital for continuing care of these patients. Reducing hospital visits and admissions for non-COVID-19 illness can reduce further spread of infection.
Thriving amidst this, Hepatology registrars at the Translational Gastroenterology Unit in Oxford have set up a registry to capture clinical outcomes of COVID-19 in patents with liver disease or transplantation (https://covid-hep.net/). Learning should continue even in crisis and conflicts.
Professor Guruprasad P. Aithal