In his new book, The Liver Doctor: Stories of Love, Loss and Regeneration, noted hepatologist Dr Cyriac Abby Philips moves beyond textbooks and medical jargon to tell deeply human stories of liver illness, loss, and survival. Blending science with narrative non-fiction, he examines the myths, misinformation, and missed opportunities that continue to shape liver health in India.
Why did you choose narrative non-fiction over a conventional medical book?
I always loved writing, especially fiction. The medical case report, the most basic form in which doctors are trained to describe anecdotal human suffering, is one of the most beautifully dehumanising inventions we have. We strip the person out and call what remains objectivity. I realised I did not want to write a louder version of that. I wanted to put the people first, and the science was only for what happened to them.
Why do myths about protein restriction and bland diets persist in liver disease?
It’s intuitive, it’s ancient, and it’s precisely backwards. A cirrhosis patient is often quietly starving in plain sight, losing muscle, and the single most dangerous thing you can do is restrict their protein. The old idea was that protein would flood the brain with ammonia and tip the patient into encephalopathy. We now know, that the malnourished, muscle-wasted liver patient does far worse than the well-fed one, and that adequate protein protects rather than harms. The book spends time in dismantling many such myth.
“For long we thought of fatty liver as a punishment for drinking. We missed the larger catastrophe building inside the sober, vegetarian, teetotal households”Dr Cyriac Abby Philips, hepatologist
Why is jaundice so widely misunderstood in India?
Nobody can see a failing liver, but everyone can see the eyes change colour. We become fixated on the symptom and ignore the cause. Jaundice is not a disease. It’s a smoke alarm—the colour of bilirubin backing up because something upstream has gone wrong. The deadly mistake people make is approaching quacks. They take the patient to someone who promises to “bring the yellow down”. They feel reassured when the colour fades, never understanding that it does not mean improvement.
What are the most preventable causes of acute liver failure today?
Acute liver failure is rarely fatal. It’s usually a sequence of small, avoidable decisions arriving all at once. Sometimes it’s paracetamol taken in genuine overdose, or sometimes in tragic ignorance. Then there are the “gentle and natural” herbal preparations, often potent enough to dissolve even a young liver in a matter of few weeks. In India, we also see hepatitis A (vaccine preventable) and E (following good hygiene prevents this), transmitted through contaminated water and food—making liver failure as much about sanitation as about biology.
Is India prepared for the coming wave of fatty liver disease?
For long we thought of fatty liver as a punishment for drinking. We missed the larger catastrophe building inside the sober, vegetarian, teetotal households. Fatty liver does not need alcohol. It needs modern Indian life: sedentary job, high-calorie breakfast, and rising metabolic disorders. Unfortunately, we also carry a particularly cruel genetic trait, where a person can look entirely slim, never touch a drink, and still be quietly accumulating dangerous fat in a liver. If we won’t acknowledge it honestly, soon a generation of seemingly healthy people will be battling cirrhosis.
What is the most dangerous liver myth you encounter repeatedly?
The deadliest myths are also the most comforting one. It’s the belief that there a ‘jaundice’ expert out there. That the yellow eyes can wait until after the festival. That the swelling abdomen is just weight gain. That we will see a real doctor once we have tried the family remedy I have lost more patients to delay than to any single disease. And the delay is almost always built out of false reassurance or myth.