“I remember every patient I have lost and I have always put myself in their position, swapped their families with mine and visualised how they would react in similar conditions. And I have seen the good fight from ordinary patients, seen how their minds never give up till the end. Each of them has taught me more than just science — humanism,” says Dr Cyriac Abby Philips, the Kerala-based hepatologist, better known online as “The Liver Doc.” Few doctors in India inspire as much admiration and irritation in equal measure as him.On social media, he has built a formidable reputation as a crusader of scientific medicine, dismantling wellness fads, calling out dubious supplements, questioning Ayurveda’s unchecked claims and taking on an industry far larger than himself with the solidity of a data analyser and the aggression of a street fighter. Often considered a maverick, Dr Philips says, “On social media, you need to be loud to be heard so that real science has an audience. It’s sad that what I say is what any doctor and man of science would say.” But in the real world, as a student of the classical history of medicine, he goes back to the original meaning of the word ‘doctor’ — an instructor. And that’s what he does by the patient’s bedside, helping them and their families beat death, understand it, endure it and sometimes, even find dignity within it, stories of which have made up his new book, The Liver Doctor: Stories of Love, Loss and Regeneration.That’s why, despite being trained at the Institute of Liver and Biliary Sciences in Delhi, he chose to return to Kochi where he works at the Rajagiri Hospital so that he can save ordinary lives from what is becoming the top 10 causes of death nationwide — liver disease. Yet it is silent and very few understand it. “There is a huge challenge in medicine and healthcare today, both for doctors and patients. I call it the loss of the true heart of medicine, which is humanism. The heart of medicine is empathy, and that is what medical training is actually supposed to offer. Now medicine is mostly business. I want to teach people how to live life,” he says.What modern medicine should beWith the burden of healthcare being shouldered by the private sector rather than the public sector and patients feeling like commodities, Dr Philips says he wants to reclaim that space where medicine feels the way it is supposed to feel — deeply caring, empathetic and compassionate. “There are very few diseases that doctors can truly cure. Infections are one example because we have antimicrobials. But beyond that, what can we cure completely? Most diseases we can only reverse, slow down, halt, manage, or improve life expectancy for. That is where the true practice of medicine shines. Treating a patient is not just diagnosing and prescribing medicines. It is about going on a journey with them. In my field, chronic liver disease patients stay with you for years — sometimes for life, until they die or undergo liver transplantation,” he says.The second reason for writing was personal. “The book became a way of decompressing emotionally. As a doctor, one of the hardest things is understanding limits. Patients come with expectations, but there are limits to what medicine can do. Sometimes you know the patient is not going to survive. First, you have to accept that yourself, and then you have to help the patient and family accept it too. That is how clinical medicine works for many diseases. For me, this book became a way to depersonalize all those emotions I had internalised over the years,” says Dr Philips.Why does the liver seem fickle?Is sudden deterioration something unique to the liver? Someone can seem perfectly healthy and yet collapse suddenly. “This is what we call acute liver failure — where a perfectly healthy person suddenly develops severe liver failure and may even require ventilation support. Because the liver is the most resilient organ, has huge functional reserves or backup tissue and masks early distress, a person seems healthy until vital functions — detoxification and blood clotting — collapse, triggering sudden, life-threatening complications. This is triggered by sudden, severe damage rather than long-term wear and tear as a result of drug toxicity, viral infections and autoimmune disorders,” says Dr Philips.The second is acute-on-chronic liver failure, where someone already has chronic liver disease or cirrhosis (scarred liver because of hepatitis or alcohol use) and then suffers another injury or insult that pushes the liver into failure. “The first category of patients finds it harder to reconcile emotionally because they are otherwise healthy individuals who suddenly become critically ill,” he adds.Story continues below this adWhich hepatitis virus is most harmful?Dr Philips sees a geographic pattern. “In north India, Hepatitis E is one of the commonest causes of acute liver failure followed by drug-induced liver injury. In south India, Hepatitis A is more common. Meanwhile, chronic viral hepatitis patterns differ geographically. Chronic Hepatitis B is very common in north India, whereas in Kerala, where I work, chronic Hepatitis B and C are less common,” he says.Misinformation is bigger than the diseaseMany liver diseases are actually preventable which, Dr Philips believes, become serious because of misinformation and lack of awareness. That’s because the liver is the only organ capable of regenerating itself and even a slight lifestyle modification in the early stages of damage — such as mild fatty liver or early-stage hepatitis — is enough. “People think only alcoholics develop liver disease, but that is not true. I have seen patients who drank only socially or two to three times a week developing cirrhosis. That’s because even a safe amount of alcohol can be an accelerator if liver disease runs in the family. And Indians are predisposed genetically,” says Dr Philips.That’s the reason why food and lifestyle matter too, topped with exercise. Dr Philips says that exercise doesn’t mean signing up at a gym but 150 minutes of simple brisk walking, jogging, cycling or swimming a week. Obesity, diabetes, hypertension, hypothyroidism, and metabolic disorders increase liver risk too. “Some factors are modifiable — sleep, exercise, diet, weight management. Genetics is not. If you control the modifiable factors, you reduce your risk significantly,” says Dr Philips.Why LFT is more misleading than accurateHe also warns against being content with just a Liver Function Test (LFT). “It is actually a misleading term. The liver has more than 500 functions and a LFT only provides limited information about inflammation or severe dysfunction. It does not measure liver performance. People need to pay attention to silent metabolic risk factors. Family history is extremely important because liver disease can skip generations. We have identified multiple families where cirrhosis appeared across generations due to genetic mutations combined with metabolic disorders. So, watch out for diabetes, obesity, hypertension, high cholesterol, high uric acid and thyroid disorders. If these are present, the minimum screening should include blood count, LFT and ultrasound. If platelets are low, LFT is abnormal, or ultrasound shows fatty liver, further evaluation is needed, including Fibroscan.”Story continues below this adNever ignore Hepatitis B and CEveryone should test for Hepatitis B and C at least once in their lifetime. North India has a high burden of chronic Hepatitis B. While Hepatitis B is preventable through vaccination, Hepatitis C is treatable with proper medications.Paracetamol vs drug-induced liver injuryWhen it comes to drug-induced liver injury, Dr Philips cites several instances of paracetamol abuse. “It is actually one of the safest medicines available for pain and fever when used properly. Problems arise only when people take extremely large doses at one time — usually 8 to 10 grams or more — often in cases of poisoning or suicide attempts. That is how it damages the liver. In the UK, paracetamol overdose is one of the commonest reasons for liver transplantation. Sometimes parents accidentally overdose children because they panic when a fever doesn’t come down,” says Dr Philips.For a healthy adult, a dose of about 4–6 grams per day for 3–4 days is generally safe. For someone with chronic liver disease, the intake should be around 2–3 grams per day for 3–4 days. “Most people never come close to dangerous levels. A standard tablet is 500 mg. Even during a fever, most people only take four or five tablets a day, which is usually safe. The danger comes from consuming very large doses,” he explains.Supplements and wellness cultureDr Philips admits to being at the receiving end of bullying, harassment, trolling and enormous pressure for upholding science and taking on unproven efficacies of herbal supplements and unregulated concoctions. “I begin the book with the case of a woman who died after having unregulated protein powder supplements thinking they would supplement her diet. She was just caught unawares. Ever since blind faith in herbalists has been waning over the past five or six years because we now have data to prove everything. Data is the only way to fight belief systems. The challenge is that alternative medicine is tied to culture, religion, politics, and tradition. So, when you criticise it, people think you are attacking identity itself,” says Dr Philips.He has often been asked that if modern drugs originate from plants and natural compounds, why criticise ayurveda? However, drug makers use scientific methods to isolate beneficial compounds, determine safe doses, study side effects and test efficacy rigorously. “People lack critical thinking and some doctors do too. Critical thinking should be taught in schools and also be part of MBBS education. My biggest hurdle was not just fighting alternative medicine promoters, but dealing with members of my own profession who endorse it. Integrative medicine is just business, not patient care and functional medicine is nothing but sophisticated packaging of fringe medicine,” he says.Story continues below this adDr Philips rates alcohol and alternative medicine as equal risks for liver health, the only difference being people know that alcohol is a known poison and carcinogen while supplements are marketed as beneficial, healthy, and natural — often without evidence. “Nowadays makers even quote very small studies which aren’t even peer-reviewed. This false sense of safety is dangerous.”From a liver toxicity perspective, he has seen abuse of ashwagandha, giloy and turmeric supplements. “Turmeric in food is fine because absorption is naturally low. But the supplement industry modifies formulations using pepper extracts or nano-formulations to increase absorption dramatically — and that can become hepatotoxic. Italy has actually banned turmeric supplements because of liver injury cases,” says Dr Philips. India’s liver crisis is not merely about alcohol, Hepatitis or obesity but about a society increasingly vulnerable to misinformation, commercialised wellness and delayed diagnosis.