Articles Posted in Liver disease

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, “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, 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

Too many people are being exposed to life-threatening infections because clinicians fail to follow safe practices when administering medicine by injection or infusion.

According to a recent study in Medical Care, the journal of the American Public Health Association, at least 130,000 patients were put at risk between 2001 and 2011 for pathogens including hepatitis and HIV.

As the Centers for Disease Control and Prevention (CDC) noted in response to the study, “In this age of high-tech care, it is difficult to imagine that these types of basic infection control breaches still happen.”

In their youth, baby boomers were perceived as the luckiest generation yet of Americans. But thanks to their unprecedented freedom and the boundary-pushing nature of post-World War II America, boomers disproportionately suffer from something nobody wants: hepatitis C.

As a result, the Centers for Disease Control and Prevention (CDC) is recommending that all baby boomers be tested to see if they are harboring the virus that causes problems, or if they already have been compromised by its presence.

Hepatitis is inflammation of the liver. It also refers to viral infections that affect the liver, most commonly hepatitis A, hepatitis B and hepatitis C. Hepatitis C can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Read more about hepatitis here, and about the threat it presents when caregivers are careless.

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