This conversation focuses on challenges in treating patients with NASH cirrhosis and implications for drug development. Jörn Schattenberg begins by discussing several of the elements that make treating patients with NASH cirrhosis especially challenging because treating cirrhosis is challenging, treating NASH is challenging and NASH cirrhosis presents complications of its own. Stephen Harrison continues the discussion by considering drug development, starting with the historic view that we develop drugs for advanced fibrosis first and cirrhosis later. He then raises several reasons this perspective might be changing.