Articles Posted in Liver disease

Champagne_1050x700-300x200Here’s hoping the holidays are going well for one and all. But, even as they fly away, moderation and some common sense about the seasonal celebrations is worth keeping in mind.

It can pay, for example, to be careful about what you eat in this festive time. Researchers at the RAND Corporation have just issued a study that finds that consumers are “more likely to choose unhealthy foods from November to December, and the subsequent holiday pounds they gain account for 60 percent to 70 percent of the weight they gain per year.” We’re all too inclined, the researchers said, to feast on “nutritionally undesirable foods” such as sugar-sweetened beverages, chocolates, cookies, candy, and ice cream, leading to added pounds that, alas, don’t go away quickly or easily. Bah, humbug, perhaps to these findings based on information on eating habits of 400,000 South Africans who were followed for four years? Or maybe the calorie-conscious might want to consider the Washington Post’s menu of party options and alternatives?

Or how about following the New York Times’ timely report on how the holidays—with their increased eating and drinking and staying up late or sleeping in—confuse our livers, those vital organs that researchers say closely follow circadian rhythms as they help to filter the blood and to regulate critical body chemistries to process food and liquids, including alcohol.

hep-c-imageAlthough the partisan wrangling over what’s next with American health care seems to ignore the maddening realities confronting patient-consumers,  a new look at the plight of poor Kentuckians provides a harsh look at the collision of many major health policy controversies including soaring drug prices, the Affordable Care Act, and the prescription drug abuse crisis.

Stat, the online health news site, deserves credit for the grim picture it painted of health care dysfunction in the nation’s heartland. Kentucky has been ravaged not only by opioid drug abuse, including record numbers of overdose deaths, it also is struggling with a stark, related rise in diseases.  In particular, cases of Hepatitis C have skyrocketed by 364 percent in Kentucky and surrounding states. Infections are growing most among young, rural whites, and to the growing concern of public health officials, Kentucky is recording increasing numbers of cases in which pregnant moms are infecting their babies.

Hepatitis C, a viral infection that damages the liver and is a factor in 19,000 Americans’ death annually, can lurk in the body for long periods before becoming deadly. As many as 4 million Americans may carry it and not know it until their liver damage becomes severe. The virus (depicted in the illustration above) spreads among addicts of pain-killing medications because they too often progress from prescription pill-popping to shooting up other increasingly powerful opioids like fentanyl and heroin.

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Although food-related health risks likely will be dipping a little with Americans’ outdoor feasting winding down with the summer-ending Labor Day holiday, state and federal health officials have confirmed they are investigating an outbreak of hepatitis A in Virginia, Maryland, West Virginia, and North Carolina.

At least 70 infections have been linked to tainted frozen strawberries used in frozen smoothies served in various locations of the Tropical Smoothie Café chain. The firm has apologized publicly for any issues created by its products and said it voluntarily pulled the berries as soon as it learned of their contamination.

Although hepatitis A is not the most severe from of the viral liver infection, half of the 44 consumers infected in Virginia were sickened sufficiently to require hospitalization.

cdc-hepc-testCalifornians have gotten an unpleasant taste of the policy complexities caused when Big Pharma sets sky-high prices for life-changing drugs: State health officials say they need to set aside $1 billion to pay for increasing numbers of qualified patients on the state’s Medi-Cal program to receive a costly new treatment for Hepatitis C.

Two drugs, Sovaldi and Harvoni, have been hailed for their positive outcomes in treating Hep C, a blood-borne liver destroying disease. Until recently, it was chronic, largely untreatable, and often led to the deaths of patients who often acquired their infection due to sharing needles for illegal drug use.

California has 14,300 hepatitis C patients on Medi-Cal, the state’s Medicaid program, and they’re eligible for therapies because they’re enrolled in managed care programs in which the state pays commercial insurers sums for care. California and the federal government will join in paying for the Hep C drugs and treatment.

339-CloseupWeighBeamHuman failings vex doctors, too, and their biases against the overweight, especially women, may be detrimental to quality of  care. White practitioners also may benefit from racial bias, earning significantly more than their colleagues of color.

Stat, the online health news site, delves into the less discussed issue of physicians’ prejudice against patients who are heavy, if not obese, resulting, as one clinician says, in “inadequate health care, and preventative advice, and counseling, and support, and treatment—because the focus is on weight instead of managing risk factors.”

Doctors, like patients themselves, may be perplexed and frustrated that some patients carry lots of pounds and can’t seem to shed them, adding to an array of proven health issues, including heart, lung, liver, and kidney problems, as well as diseases like diabetes and cancer.

Let’s give credit where it’s due: Transplant surgery, in popular lore, has become one of modern medicine’s most miraculous practices, not only saving individual lives but also blazing new frontiers about the functions of organs in the body and providing insights of large significance into the workings of the human immune system. This progress hasn’t come without considerable cost to health care as a whole — and recent developments should prompt some deep thinking on how transplants work now.

First, let’s look at the disturbing study that suggests that wealth gives patients needing a transplant an edge when it comes to getting an organ. As the Associated Press notes in describing the research just presented to the American Heart Association, “You can’t buy hearts, kidneys or other organs but money can still help you get one. Wealthy people are more likely to get on multiple waiting lists and score a transplant, and less likely to die while waiting for one …[This work] confirms what many have long suspected — the rich have advantages even in a system designed to steer organs to the sickest patients and those who have waited longest. Wealthier people can better afford the tests and travel to get on more than one transplant center’s waiting list, and the new study shows how much this pays off.”

Who is to blame for this seeming inequity or gaming of the system? The United Network for Organ Sharing, or UNOS, has a government contract to run the system that decides who among 100,000 Americans waiting for various organs will get one suitable for transplant. The independent body “considers medical urgency, tissue type, distance from the donor, time spent on the waiting list and other factors.” Despite criticism of its practices, such as occurred when Apple tycoon and California resident Steve Jobs got on the liver transplant list in Tennessee, UNOS allows patients to traverse the country seeking the optimal situation for themselves and possible procedures. To even get on the lists, however, the patients–each time–must fork over, depending on the organ the need, anywhere from $23,000 to $51,000 for various suitability tests. Ouch.

Rarely does the law of supply and demand have a sadder application than in the world of organ donations, and the latest case of too much need and too few resources has states doing battle with each other.

According to a story on TheHill.com, “A heated redistricting battle has gripped the nation’s heartland this fall, but instead of votes, the debate has centered on livers.” Many congressional representatives from Midwestern and Southern states are disputing how the United Network for Organ Sharing (UNOS) wants to allocate livers.

UNOS is a private nonprofit outfit that manages the nation’s organ transplant system under contract with the federal government.

Last week we wrote about the commercial and regulatory shortcomings concerning acetaminophen in general and Tylenol in particular. The investigative news outfit ProPublica followed up that comprehensive story with others about how the risks of Tylenol are not well understood by consumers, and how acetaminophen drugs can be made safer.

Approximately 150 people die every year from accidentally taking too much acetaminophen, and thousands more end up in hospitals and emergency rooms for treatment from acetaminophen poisoning. A telephone poll of 1,003 adults by Princeton Survey Research Associates showed that half of the respondents were not aware of safety warnings for acetaminophen, although 8 in 10 said that overdosing on it could have serious side effects.

More than one-third said it was safe to mix Tylenol with another medicine containing acetaminophen, such as NyQuil. That’s disturbing from an accidental overdose point of view-more than 600 different medicines contain acetaminophen.

Readers of the blog are familiar with the risks of acetaminophen, the active ingredient in Tylenol. Although this widely available, over-the-counter analgesic (pain medicine) is considered to be safe when taken at recommended doses, certain ordinary uses can damage or destroy the liver.

A described in a blockbuster investigative report by ProPublica.org, the FDA has long been aware of the science proving that acetaminophen can be risky, aware that the margin between the amount that helps and the amount that can harm is smaller than that of other over-the-counter pain relievers.

McNeil Consumer Healthcare, the unit of Johnson & Johnson that manufactures and promotes Tylenol, also understands the potential danger. The company has even promoted Tylenol’s safety in ads that say it’s the pain reliever “hospitals use most,” and the one “recommended by pediatricians.” See ProPublica’s companion piece on how confusion in pediatric dosing has killed some children due to inadvertent overdosing by their parents, and how the manufacturer and the FDA reacted to these unnecessary tragedies with glacial speed.

Our August newsletter about dietary supplements included some cautionary advice about some so-called “natural” supplements that can cause significant harm. One was Reumofan, a product manufactured in Mexico and marketed as a remedy for pain.

The FDA had issued a warning earlier this year about it after receiving several adverse event reports, including stroke, gastrointestinal bleeding, liver problems and worsening glucose control.

Last week, the feds raised the volume of concern about Reumofan after additional reports of bleeding, strokes and even death, according to AboutLawsuits.com.

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