Veteran medical professionals work to research, treat and prevent liver disease.
Every year, the Taipei City-based Health, Welfare and Environment Foundation holds the Medical Dedication Awards to recognize those who have made significant contributions to enhancing Taiwan’s health care environment. Among the recipients of the awards this year were members of the Liver Disease Prevention and Treatment Research Foundation (LDRF), which has been touring local communities around Taiwan to conduct liver disease screenings for more than two decades.
Great progress has been made toward the eradication of liver diseases in Taiwan over the past 20 years, according to LDRF Executive Officer Yang Pei-ming (楊培銘). Statistics from the Ministry of Health and Welfare (MOHW) show that during the 1980s and most of the 1990s, chronic liver disease, including cirrhosis, was consistently ranked the sixth most common cause of death in the country. The number of cases began to decrease significantly around the turn of the century, with the illness falling to 10th place in 2016. There has also been a substantial decline in diagnoses of liver cancer, once the most common form of cancer in Taiwan.
According to Yang, a physician and professor emeritus at National Taiwan University’s College of Medicine (NTUCM), in the early 1980s, one out of every five or six people in the country were carriers of hepatitis B, a major cause of cirrhosis and liver cancer. This meant that Taiwan had one of the highest infection rates in the world. “We had little choice but to make progress toward controlling the disease,” he said. “Now the rate has dropped to below 1 percent among people under the age of 33.”
Sheu helped found LDRF together with his teacher Sung Juei-low (宋瑞樓), one of the first Taiwan physicians to specialize in hepatology. Sung was a graduate of Taihoku Imperial University’s Medical School, the forerunner of NTUCM founded during Japanese colonial rule (1895-1945). In the 1970s, he led an NTU Hospital research team that determined maternal transmission of hepatitis B was especially common via the birth canal. “Cesarean section was found to cause less infection than natural delivery,” Yang said. When hepatitis B vaccines became available in the early 1980s, Sung’s team began promoting the idea of universal inoculation. In 1981, he was put in charge of a committee under the Department of Health, reorganized as the MOHW in 2013, to oversee efforts to control viral hepatitis. Sung later became a major force behind the landmark 1984 vaccination program.
The Silent Organ
Despite measures put in place to reduce the frequency of hepatitis, Yang said he is sometimes frustrated by the reluctance of virus carriers to seek medical treatment. “Only around a third of them do so and another third go to clinics or hospitals just once or twice. The rest of them don’t seem to care about it at all,” he said. “The liver is a silent organ, meaning symptoms of a disease usually don’t develop until it has reached very advanced stages.” As a result, there has not been a significant decline in the death toll caused by chronic liver disease in “Old Taiwanese”—nationals over the age of 33—who did not receive hepatitis B vaccinations when they were young.
Yang and Sheu are also respectively CEO and president of the Taipei-based Good Liver Foundation, established in 2012 as an extension of LDRF. The organization operates the Good Liver Clinic in the capital’s downtown area. Sheu pointed out that the facility, which is part of the NHI system, was set up with the goal of helping form a hospital system specializing in the treatment and research of liver diseases.
Sheu insists that in the field of hepatology, there are still many issues and questions to be addressed to further bring down the number of hepatitis cases. “That’s why research and other efforts in fighting liver disease will not stop in the foreseeable future,” he said.