Alcoholic liver disease

During the 1950s and '60s when the debate about the relative contribution of alcohol toxicity and malnutrition to alcohol related liver damage was raging in the United States,' Britain was more interested in other forms of liver disease. As awareness ofthe size of the alcohol problem grew in this country,2 3 research work at the Liver Unit began to reflect the changing situation. Immunology was already well established at King's and the development of a new lymphocytotoxicity assay by Thomson and colleagues provided a useful tool for investigating immunological changes in alcoholic liver disease.4 These studies have continued over the past 15 years with the aim of identifying the precise mechanisms involved and why some patients have a propensity to progressive liver damage, even when alcohol is discontinued.5 These investigations naturally lead to attempts to identify groups of individuals especially susceptible to alcohol induced liver injury. This was the main focus of research in the 'middle period' from the late 1970s onwards. Research into alcoholic liver disease expanded considerably in 1979 with the formation of a multidisciplinary Alcohol Research Group by Michael Davis and John Saunders. This group extended its work into biochemical mechanisms of liver damage in conjunction with the MRC Human Biochemical Genetics Unit. It also established a programme of research into the underlying alcohol dependency and psychosocial factors. The group, which was supported by the Department of Health and Social Security, forged close links with the Addiction Research Unit at the Maudsley Hospital. This resulted in a more comprehensive approach to management, including psychological as well as medical treatment.6 The third main area of work has been in the