From Journal for Nurse Practitioners
Herbal Supplements: Talking With Your Patients
Joyce K. Anastasi, PhD, DrNP, FAAN, Lac; Michelle Chang, MS, Lac; Bernadette Capili, DNSc, NP-C
Authors and Disclosures
Posted: 02/01/2011; Journal for Nurse Practitioners. 2011;7(1):29-35. © 2011 Elsevier Science, Inc.
Abstract and Introduction
Abstract
The popularity and prevalence of herbal products and dietary supplements in the US has grown steadily. Patients are increasingly using them to prevent disease, complement conventional therapies, and promote well being and health. Nurse practitioners play a critical role in discussion, communication, and education of herbal supplement use. This article provides a review of commonly used herbal supplements regarding recent evidence for efficacy, possible drug interactions, and safety considerations.
Introduction
Approximately 38 million US adults use herbal and dietary supplements.[1] In 2009, Americans spent $5.03 billion on herbs and other botanical supplements, and their sales are steadily growing.[2] From Sam's Club to natural food retailer Whole Foods Market, even convenience stores sell herbal supplements such as ginkgo and echinacea alongside aspirin. Patients are regularly using herbal products to self-treat medical conditions, complement conventional therapies, and maintain their overall health and well-being. Most patients receive their information about herbs and supplements from their friends, family, and the Internet but rarely from their healthcare provider.[3]
Since the US Dietary Supplement Health and Education Act (DSHEA) became law in 1994, vitamins, minerals, and herbal supplements are presumed to be safe and freely available. However, the FDA does not regulate dietary supplements, and there are no pre-market safety or efficacy studies required. If a dietary supplement has safety issues once it is on the market, the FDA can take action against the manufacturer by issuing a warning or removing the product. In 2007, the FDA issued its final current "good manufacturing practices" (GMPs) regulations to maintain that dietary supplements are processed consistently and meet quality standards. While improvements have been made in the oversight of supplements, issues of quality and safety continue. In 2010, the US Government Accountability Office (GAO) released a report finding trace levels of lead and other contaminants (within levels accepted by the FDA and EPA) and examples of deceptive or suspect marketing claims.[4]
Despite increasingly common usage, only one-third of patients tell their physician about their use of supplements.[1] Physicians do not commonly ask patients about their complementary and alternative medicine (CAM) use, and patients may feel uncomfortable discussing it. But concomitant use of herbal supplements with prescription drugs or over-the-counter (OTC) medications can put patients at risk for a variety of serious drug interactions. Herbs and drugs often interact when they use the same transport or metabolic protein, commonly cytochrome P450 (CYP) enzymes, glucuronosyltransferases (UGT), and P-glycoprotein (Pgp), resulting in induction or inhibition activity.[5] However, many factors, including the dose, schedule, and route of administration, can affect the potential drug-botanical interaction. If the botanical and drug are administered at different times, it is less likely that a clinically relevant interaction will occur.[5]
Garlic (Allium Sativum)
Purported uses: hyperlipidemia, hypertension, atherosclerosis, cardiovascular disease (CVD), cancer prevention
Evidence to date: The active sulfur compounds alliin, allicin, and ajoene may inhibit platelet aggregation, reduce plaque formation, increase fibrinolysis, and modestly reduce blood pressure. The exact effects of garlic on CVD and cerebrovascular events are unclear. Randomized controlled trials (RCTs) on hyperlipidemia conducted in the early 1990s suggested garlic powder tablets lowered lipid levels, but trials since then have not reported any statistically significant effects on plasma lipid concentration with similar dosages and in similar populations.[6] A meta-analysis suggested antihypertensive effects, but further research is needed to clarify its effects on CVD.[7] Population-based studies have shown increased dietary garlic consumption may be associated with a decreased risk of developing stomach and colorectal cancer, but supplements do not seem to offer the same benefit.[8]
Adverse effects/safety considerations: Prolonged bleeding time, gastrointestinal (GI) complaints, breath and body odor. Discontinue use at least 7 days before surgery.
Drug interactions: Garlic may induce CYP3A4 activity. It decreases the plasma concentration of saquinavir and chlorzoxazone and may interact with chlorpropamide, ritonavir, fluindione, cyclosporine, docetaxel, and paracetamol.[9] Several case reports have suggested that garlic affects platelet functions and blood coagulation, but two clinical trials have found that garlic did not alter the pharmacokinetics or pharmacodynamics of warfarin.[9]
Saw Palmetto (Serenoa Repens)
Purported uses: benign prostatic hyperplasia (BPH)
Evidence to date: Saw palmetto may inhibit 5-alpha-reductase and demonstrate anti-inflammatory activity. The data conflict with some studies suggesting it may improve mild to moderate symptoms of BPH, such as reducing nocturia and improving urinary flow rate,[10, 11] while a recent Cochrane Review suggests it is not more effective than placebo.[12] To firmly establish efficacy, more well-designed RCTs are necessary.
Adverse effects/safety considerations: Current data suggest that saw palmetto is well tolerated by most users and is not associated with serious adverse events. The majority of adverse events are mild, such as GI complaints, and are similar to placebo. It may prolong bleeding time, as there has been one case report of intraoperative hemorrhage, but a recent RCT showed no evidence of serious toxicity.[13]
Drug interactions: There have been no reported herb/drug interactions to date.
Ginkgo (Ginkgo Biloba)
Purported uses: CVD, memory loss, dementia, Alzheimer disease, tinnitus, asthma, bronchitis, intermittent claudication
Evidence to date: The terpenoids, bilobalide and ginkgolide, may improve blood flow through increased release of nitric oxide, and the flavonoids' antioxidant, anti-inflammatory activity appears to be neuroprotective.[14] Most clinical studies have been conducted with a standardized extract of ginkgo, EGb761. Early studies indicated ginkgo may improve cognitive performance in patients with dementia,[15] but more recent studies have shown conflicting evidence. The National Center for Complementary and Alternative Medicine (NCCAM)-funded Gingko Evaluation of Memory (GEM) study, the largest and longest RCT, found no scientific evidence that it decreases the incidence of dementia or Alzheimer's disease in elderly adults and was ineffective in slowing cognitive decline.[16, 17] A secondary analysis of the GEM study reported that ginkgo biloba did not reduce incidence or mortality from CVD. However, it may reduce the risk of peripheral vascular disease and suggests further studies may be useful.[18]
Adverse effects/safety considerations: GI complaints, prolonged bleeding
Drug interactions: Ginkgo may inhibit or induce CYP3A4, -2C9, -2C19. Pharmacokinetic trials have shown it reduces plasma concentrations of alprazolam, omeprazole, ritonavir, and tolbutamide. Case reports indicate it may react with antiepileptics, thiazide diuretics, ibuprofen, risperidone, rofecoxib, trazodone, midazolam, efavirenz, and warfarin. Case reports have also implicated ginkgo with bleeding events, but two clinical trials have shown no effect on international normalized ratio (INR) and platelet aggregation.[9]
Echinacea (Echinacea Purpurea, Echinacea Augustifolia, Echinacea Pallida)
Purported uses: common cold, upper respiratory infections, immunostimulant
Evidence to date: The alkylamides stimulate phagocytosis or macrophage activation, modulate cytokines (such as IL6, IL 8, and TNF alpha), and enhance leukocyte mobility. Clinical studies are mixed; echinacea may be effective for the treatment of colds, but evidence for prevention is lacking. Current evidence suggests it may reduce the incidence and duration of the common cold.[19]
Adverse effects/safety considerations: GI complaints, rash
Drug interactions: Echinacea may modulate the CYP3A4 enzyme system and interact with caffeine and midazolam.[5]
Milk Thistle (Silybum Marianum)
Purported uses: Hepatitis, cirrhosis, hepatotoxicity, diabetes
Evidence to date: The biologically active constituent, silymarin, may have a hepatoprotective effect in the course of liver diseases such as HCV and in hepatoxicity produced by exposure to certain medications, alcohol, and drugs. However, evidence is inconclusive. A large, NCCAM-funded, Phase II study is underway to evaluate the safety and efficacy for treatment of chronic hepatitis C. One RCT showed it reduced hepatotoxicity associated with chemotherapy in children with acute lymphoblastic leukemia.[20] Preclinical data for diabetes and cancer are promising but limited, and more research is recommended.
Adverse effects/safety considerations: GI complaints
Drug interactions: Milk thistle may inhibit CYP3A4 and UGTs. Milk thistle does not seem to affect indinavir in healthy patients or those with HIV.[21]
St. John's Wort (Hypericum Perforatum)
Purported uses: mild to moderate depression, seasonal affective disorder, anxiety
Evidence to date: Hyperforin is the major constituent in St. John's wort (SJW) responsible for its antidepressant activity by selectively inhibiting serotonin, dopamine, and norepinephrine reuptake in the central nervous system. Most studies have shown SJW to be superior to placebo in the treatment of mild to moderate depression, as effective as sertraline or other SSRIs, and have fewer side effects than standard antidepressants.[22, 23]
Adverse effects/safety considerations: Similar to the side effects of SSRIs, it may cause GI upset, rashes, headache, and photosensitivity. If taken concomitantly with SSRIs, it may interact and result in serotonin syndrome.
Drug interactions: SJW's ability to induce the cytochrome P450 system, particularly 3A4, -2C9, -2C19, and/or intestinal P-glycoprotein, reduces plasma concentrations of a variety of drugs, including the immunosuppressants cyclosporine and tacrolimus; antiretrovirals indinavir and nevirapine; antigcoagulants warfarin and phenprocoumon; cardiotonic digoxin; antiarrhythmics ivabradine and talinolol; calcium channel blockers nifedipine and verapamil; statins simvastin and atorvastatin; oxycodone; omeprazole; oral contraceptives; cancer drugs imatinib and irinotecan; benzodiapenes alprazolam, midazolam, and quazepam; and antidepressants buspirone, bupropion, and amitriptyline. It has been to shown to cause serotonin syndrome when combined with SSRIs (paroxetine, sertraline, venlafaxine, nefazodone) and receptor antagonists. It may also interact with fexofenadine, chlorzoxazone, lopinavir, methadone, and theophylline.[24]
Ginseng
There are different species of ginseng, and the following two are the most common:
American Ginseng (Panax Quinquefolium)
Purported uses: diabetes, cancer prevention and treatment, fatigue, immunostimulant, athletic performance, anti-aging
Asian Ginseng or Korean Red Ginseng (Panax Ginseng)
Purported uses: sexual dysfunction, cancer prevention, immunostimulant, stamina, cognitive function, diabetes, HIV/AIDS
Evidence to date: Limited studies have been conducted on ginseng's purported benefits. Its active constituents, ginsenosides, may modulate angiogenesis. American ginseng has been shown to reduce postprandial glucose levels in type 2 diabetes, but more research is needed.[25] A specific, standardized extract may shorten the duration of colds or acute respiratory tract infections when taken preventatively.[26] A recent pilot study suggests benefit in decreasing cancer-related fatigue but warrants more definitive research.[27]
Adverse effects/safety considerations: Possible adverse effects are mild and similar to placebo, including insomnia and GI complaints. Ginseng may have estrogenic actions and should be used cautiously by patients with hormone-sensitive cancers.
Drug interactions: American and Asian ginseng may reduce the effects of warfarin and increase the hypoglycemic effect of insulin and sulfonylureas.[25, 28] There are case reports of panax ginseng interacting with phenelzine.[9]
Black Cohosh (Cimicifuga Racemosa)
Purported uses: menopausal symptoms such as hot flashes, vaginal dryness, mood swings, dysmenorrhea
Evidence to date: Black cohosh may have estrogenic effects, relieve the vasomotor symptoms of menopause, and enhance bone formation. A number of randomized, double-blind, placebo-controlled trials have been conducted, and the evidence does not consistently establish efficacy. Some studies have suggested a benefit,[29, 30] but others have failed to show efficacy in comparison with placebo.[31, 32] Black cohosh in combination with SJW and other multibotanicals may provide benefit in alleviating climacteric complaints than alone.[33]
Adverse effects/safety considerations: GI discomfort. There have been case reports of possible hepatotoxicity associated, but no serious liver-related diseases were observed or reported in trials.[34]
Drug interactions: It may inhibit CYP2D6 and increase cytotoxicity of doxorubicin and docetaxel.[35]
Green Tea (Camellia Sinensis)
Purported uses: hyperlipidemia, hypertension, atherosclerosis, CVD, cancer prevention and treatment
Evidence to date: Green tea is abundant in polyphenols, such as flavanoids and phenolic acids. Flavanoids, including epigallocatechin gallate (EGCG), epigallocatechin (EGC), epicatechin gallate (ECG), and epicatechin (EC), are referred to as catechins. These seem to be responsible for many of the proposed benefits of green tea and may confer cardiovascular protection by possibly increasing HDL cholesterol and decreasing LDL cholesterol and triglycerides.[36] One RCT showed a theaflavin-enriched green tea extract lowered LDL and total cholesterol.[37]
Population-based studies examining the association between green tea consumption and mortality have yielded inconsistent results but may have beneficial effects on hypertension and appears to be safe and well tolerated.[38] The possible chemopreventive effects of green tea have shown promise in preclinical studies but remain inconclusive. Results from observational studies on the association between green tea consumption and cancer of the digestive tract, lung, liver, and prostate are insufficient and conflicting.[39]
Adverse effects/safety considerations: Most of the adverse effects result from the caffeine content, such as GI upset, insomnia, and irritability. There have been case reports of liver problems associated with people taking multibotanical supplements with concentrated ethanolic green tea extracts and one case report of acute hepatitis associated with the use of a marketed green tea infusion.[40]
Drug interactions: Evidence is inconclusive, but green tea may inhibit CYP3A4. Green tea may inhibit the therapeutic efficacy of bortezomib and other boronic acid-based proteasome inhibitors.[41]
Valerian (Valerian Officinalis, Valeriana Radix)
Purported uses: insomnia, anxiety, mood disorders
Evidence to date: The active constituents, valepotriates, may have a sedative effect, and valerenic acid may activate gamma-aminobutyric acid (GABA) receptors, which are involved in sleep regulation. Most studies have not reported significant improvement in objective sleep outcomes and evidence for its use in insomnia management is inconclusive. However, a recent meta-analysis concluded that it may be effective for a subjective improvement of insomnia and considered for some patients, given its safety.[42] In regards to efficacy for anxiety, there is insufficient evidence.
Adverse effects/safety considerations: GI complaints, drowsiness
Drug interactions: There is little evidence of herb/drug interactions reported to date. Valerian may effect a modest increase in alprazolam but is unlikely to produce significant effects on CYP3A4 or CYP2D6 metabolic pathways.[43] Animal studies have shown valerian to enhance the sedation time induced by barbiturates.[44] It may have synergistic effects with benzodiazepines and other sedating agents.
Recommendations for Practice
It is important for NPs to be aware of current evidence-based interventions to answer patient questions and concerns honestly, knowledgeably, and safely. Upon assessment, be nonjudgmental and unbiased in attitude about a patient's choice to use supplements. By developing an open rapport, NPs enable patients to feel comfortable sharing information.
Ask your patients if they take any dietary supplements and prompt them for specific amounts and frequency. If you have patients on medication(s) and are uncertain about their interactions with a supplement(s), be sure to do further research or contact your pharmacist. Have patients bring their supplements (bottles, tubes, containers, packaging, etc.) to their visit. Also, make sure to document all information in the patient's record. The following questions should be helpful:
Which herbs/supplements are you taking?
Is the product USP verified or does it follow GMP guidelines?
Why are you taking it?
Who recommended you to take it?
When did you start?
Why did you start?
How often and how much are you taking?
Advise patients to stop taking herbs at least 7 days before any surgery. Avoid taking them altogether if pregnant or nursing. Advise patients to not take herbs and medications together or at the same time. Be alert to possible adverse effects and interactions with lab tests. Check the ingredients carefully for any possible allergens. Advise those patients taking dietary supplements to read and follow the label instructions. Don't exceed recommended dosages or take the herb for longer than recommended. Advise patients to ask any questions, particularly about the best dosage to take.
References
Sidebar 1
Sidebar 2
Wednesday, February 2, 2011
Hepatitis C;Simple formula to predict response to peginterferon/Ribavirin Geno 1
Source: Hepatol Res
Simple formula to predict response to peginterferon alpha2b and ribavirin combination therapy in genotype 1 chronic hepatitis C patients with high viral loads
Itoh Y, Nishimura T, Hashimoto H, Yamaguchi K, Niimi T, Yokomizo C, Fujii H, Minami M, Yasui K, Mitsuyoshi H, Okanoue T, Takehara T, Hiasa Y, Onji M, Yoshikawa T; Hepatology Research 41 (2), 126-132 (Feb 2011)
Aim: We advocate a simple formula which can conveniently predict the outcome of Peg-interferon (IFN) alpha2b and ribavirin (RBV) combination therapy for genotype 1 chronic hepatitis C (CH-C) with high viral load.
Methods: A total of 338 (group A: 230, Group B: 108) genotype 1 CH-C patients treated with Peg-IFN alfa-2b and RBV were enrolled.
Clinical parameters differing significantly between sustained virological responders (SVRs) and non-SVRs in group A were categorized, then a simple formula to predict SVR was constructed and re-evaluated in group B.
Another formula containing hepatitis C virus amino acid mutations/substitutions also was constructed. Results: In group A, gender and HCV RNA load<1000 KIU were significant predictors of SVR by multivariate logistic regression analysis.
A simple formula was constructed (formula A): male gender (point 2) + HCV RNA load<1000 KIU (3) + platelet counts ≥15 × 10(4) /mm(3) (1) + age<60 (1).
In group A, score (0-1) predicted SVR rate 23.8% (2-4): 48.1% and (5-7): 70.2%. According to this formula, score (0-1) predicted SVR rate 7.1% (2-4): 38.6%, and (5-7): 70.3% in group B. Information on HCV amino acid mutations/substitutions seemed to add some accuracy.
Conclusions: This simple formula can be used to roughly determine, at the patients' first/second visit, the probability of response to Peg-IFN alpha2b and RBV combination therapy for genotype 1 CH-C with high viral load.
Simple formula to predict response to peginterferon alpha2b and ribavirin combination therapy in genotype 1 chronic hepatitis C patients with high viral loads
Itoh Y, Nishimura T, Hashimoto H, Yamaguchi K, Niimi T, Yokomizo C, Fujii H, Minami M, Yasui K, Mitsuyoshi H, Okanoue T, Takehara T, Hiasa Y, Onji M, Yoshikawa T; Hepatology Research 41 (2), 126-132 (Feb 2011)
Aim: We advocate a simple formula which can conveniently predict the outcome of Peg-interferon (IFN) alpha2b and ribavirin (RBV) combination therapy for genotype 1 chronic hepatitis C (CH-C) with high viral load.
Methods: A total of 338 (group A: 230, Group B: 108) genotype 1 CH-C patients treated with Peg-IFN alfa-2b and RBV were enrolled.
Clinical parameters differing significantly between sustained virological responders (SVRs) and non-SVRs in group A were categorized, then a simple formula to predict SVR was constructed and re-evaluated in group B.
Another formula containing hepatitis C virus amino acid mutations/substitutions also was constructed. Results: In group A, gender and HCV RNA load<1000 KIU were significant predictors of SVR by multivariate logistic regression analysis.
A simple formula was constructed (formula A): male gender (point 2) + HCV RNA load<1000 KIU (3) + platelet counts ≥15 × 10(4) /mm(3) (1) + age<60 (1).
In group A, score (0-1) predicted SVR rate 23.8% (2-4): 48.1% and (5-7): 70.2%. According to this formula, score (0-1) predicted SVR rate 7.1% (2-4): 38.6%, and (5-7): 70.3% in group B. Information on HCV amino acid mutations/substitutions seemed to add some accuracy.
Conclusions: This simple formula can be used to roughly determine, at the patients' first/second visit, the probability of response to Peg-IFN alpha2b and RBV combination therapy for genotype 1 CH-C with high viral load.
HBeAg-negative HBV ;Virological suppression does not prevent the development of HCC
Source: Gut
Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s) starting with lamivudine monotherapy: results of the nationwide HEPNET.Greece cohort study;
Papatheodoridis GV, Manolakopoulos S, Touloumi G, Vourli G, Raptopoulou-Gigi M, Vafiadis-Zoumbouli I, Vasiliadis T, Mimidis K, Gogos C, Ketikoglou I, Manesis EK, for the HEPNET.Greece Cohort Study Group; Gut (Jan 2011)
Objective
To evaluate the risk and predictors of hepatocellular carcinoma (HCC) in HBeAg-negative chronic hepatitis B patients of the large HEPNET.Greece cohort study who received long-term oral antivirals starting with lamivudine monotherapy.
Design Retrospective analysis of HCC incidence in HBeAg-negative chronic hepatitis B patients from a retrospective-prospective cohort who were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy for ≥12 months. Setting A nationwide network of liver centres.
Patients 818 patients were included: 517 with chronic hepatitis B only; 160 with compensated cirrhosis; 56 with decompensated cirrhosis; 85 with unclassified disease severity.
Interventions
All patients were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy. Main outcome measures Development of HCC. Results During a median follow-up of 4.7 years, HCC developed in 49 (6.0%) patients. The 5-year cumulative incidence of HCC was higher in patients with cirrhosis than in those with chronic hepatitis B only (11.5% vs 3.2%, respectively; p<0.001).>60 years old, respectively (p<0.001).
Virological on-therapy remission did not significantly affect the incidence of HCC in all patients or those with cirrhosis, but it showed a trend for lower HCC incidence in patients with chronic hepatitis B only (p=0.076). In multivariate analysis, age, gender and cirrhosis were independently associated with HCC risk regardless of virological remission.
Conclusions
Long-term therapy with nucleos(t)ide analogue(s) starting with lamivudine monotherapy does not eliminate HCC risk in HBeAg-negative chronic hepatitis B. The risk of HCC is particularly high in patients with cirrhosis, who should remain under HCC surveillance even during effective therapy. Older age and male gender remain independent risk factors for HCC, while virological on-therapy remission does not seem to significantly reduce the overall incidence of HCC.
Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s) starting with lamivudine monotherapy: results of the nationwide HEPNET.Greece cohort study;
Papatheodoridis GV, Manolakopoulos S, Touloumi G, Vourli G, Raptopoulou-Gigi M, Vafiadis-Zoumbouli I, Vasiliadis T, Mimidis K, Gogos C, Ketikoglou I, Manesis EK, for the HEPNET.Greece Cohort Study Group; Gut (Jan 2011)
Objective
To evaluate the risk and predictors of hepatocellular carcinoma (HCC) in HBeAg-negative chronic hepatitis B patients of the large HEPNET.Greece cohort study who received long-term oral antivirals starting with lamivudine monotherapy.
Design Retrospective analysis of HCC incidence in HBeAg-negative chronic hepatitis B patients from a retrospective-prospective cohort who were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy for ≥12 months. Setting A nationwide network of liver centres.
Patients 818 patients were included: 517 with chronic hepatitis B only; 160 with compensated cirrhosis; 56 with decompensated cirrhosis; 85 with unclassified disease severity.
Interventions
All patients were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy. Main outcome measures Development of HCC. Results During a median follow-up of 4.7 years, HCC developed in 49 (6.0%) patients. The 5-year cumulative incidence of HCC was higher in patients with cirrhosis than in those with chronic hepatitis B only (11.5% vs 3.2%, respectively; p<0.001).>60 years old, respectively (p<0.001).
Virological on-therapy remission did not significantly affect the incidence of HCC in all patients or those with cirrhosis, but it showed a trend for lower HCC incidence in patients with chronic hepatitis B only (p=0.076). In multivariate analysis, age, gender and cirrhosis were independently associated with HCC risk regardless of virological remission.
Conclusions
Long-term therapy with nucleos(t)ide analogue(s) starting with lamivudine monotherapy does not eliminate HCC risk in HBeAg-negative chronic hepatitis B. The risk of HCC is particularly high in patients with cirrhosis, who should remain under HCC surveillance even during effective therapy. Older age and male gender remain independent risk factors for HCC, while virological on-therapy remission does not seem to significantly reduce the overall incidence of HCC.
Vertex"Telaprevir" Wants CDC To Recommend Hep C Screening
Vertex Urges CDC to Recommend Hep C Screening, To Nudge “Second Tsunami” of Patients
Luke Timmerman 2/2/11
If Vertex Pharmaceuticals gets its way in talks with U.S. public health officials, most people over 50 could soon get blood tests to screen for hepatitis C infections at the doctor’s office. If the U.S. Centers for Disease Control and Prevention (CDC) agrees this is a good idea, it could prompt another 1 million patients who don’t realize they are infected to come out of the woodwork and start clamoring for Vertex’s new hepatitis C drug over the next few years.
The Cambridge, MA-based biotech company (NASDAQ: VRTX), which has operations in San Diego, has joined other drugmakers in supporting studies they hope will persuade the CDC to recommend routine screening for hepatitis C, Vertex CEO Matt Emmens said in a recent interview. The company is one of the sponsors of what’s called the Viral Hepatitis Action Coalition, a public-private partnership with the CDC, which is conducting studies known as BEST-C. These studies could determine how effective it is to screen patients for hepatitis C infection more widely.
These studies, which are expected to cost a total of $3.6 million, could be worth billions to Vertex if they show that screening random Baby Boomers is worthwhile.
An estimated 600,000 patients in the U.S. are expected to seek treatment that could include Vertex’s drug, or a rival offering from Merck, if the FDA clears the new drugs for sale as analysts expect in the middle of this year. The two new protease inhibitors are being hailed as major steps forward, as they have been shown to roughly double cure rates of hepatitis C, a viral infection that damages the liver over many years. Vertex’s drug, telaprevir, has shown it can push the cure rate up as high as about 75 percent, while cutting the treatment time in half to about six months. That means patients don’t have to endure such a long period of flu-like symptoms, which has traditionally discouraged many patients from getting treatment.
The new advance from Vertex, demonstrated in a trio of pivotal clinical trials, has created this huge wave of pent-up demand from patients and doctors. Knowing this, many analysts have projected the product will be pretty much an instant hit, topping $2 billion in U.S. sales after just a couple years. But then, some expect sales to taper off, as many of the most motivated patients get cured, and don’t need the drug anymore. Essentially, they see Vertex possibly becoming a victim of its own success.
That’s not how it will play out, says Emmens, a marketing veteran who spent much of his career at Merck. An estimated 3.2 million to 3.9 million people in the U.S. have chronic hepatitis C infections. That’s a lot more than the initial wave of patients, which is mostly composed of people who sought treatment before but relapsed. Besides those patients, many more candidates are Baby Boomers who don’t know they contracted the hepatitis C infection decades ago through unprotected sex, IV drug use, or blood transfusions from contaminated supplies. Many of these infections lie dormant for about 20 years or more, but are just now starting to emerge over the decade to come, Emmens says. Some patients won’t see symptoms at all, and as the AP pointed out in this solid feature last month, it’s hard to tell which infected patients are likely to get the worst symptoms. The unluckiest ones will end up suffering severe liver scarring (cirrhosis), liver cancer, liver transplants, and ultimately, premature death.
Connecting with that massive crowd of patients, who aren’t motivated to seek treatment today because they don’t see any really bad symptoms yet, is one of the big marketing challenges Vertex faces. The company is planning to spend some of its $1.3 billion cash hoard on a public awareness campaign designed to urge people to get tested to see if they have the virus, Emmens says. But even more important than the ad campaign, Vertex is hoping the CDC will recommend …Continue Reading...............Next Page »
Luke Timmerman 2/2/11
If Vertex Pharmaceuticals gets its way in talks with U.S. public health officials, most people over 50 could soon get blood tests to screen for hepatitis C infections at the doctor’s office. If the U.S. Centers for Disease Control and Prevention (CDC) agrees this is a good idea, it could prompt another 1 million patients who don’t realize they are infected to come out of the woodwork and start clamoring for Vertex’s new hepatitis C drug over the next few years.
The Cambridge, MA-based biotech company (NASDAQ: VRTX), which has operations in San Diego, has joined other drugmakers in supporting studies they hope will persuade the CDC to recommend routine screening for hepatitis C, Vertex CEO Matt Emmens said in a recent interview. The company is one of the sponsors of what’s called the Viral Hepatitis Action Coalition, a public-private partnership with the CDC, which is conducting studies known as BEST-C. These studies could determine how effective it is to screen patients for hepatitis C infection more widely.
These studies, which are expected to cost a total of $3.6 million, could be worth billions to Vertex if they show that screening random Baby Boomers is worthwhile.
An estimated 600,000 patients in the U.S. are expected to seek treatment that could include Vertex’s drug, or a rival offering from Merck, if the FDA clears the new drugs for sale as analysts expect in the middle of this year. The two new protease inhibitors are being hailed as major steps forward, as they have been shown to roughly double cure rates of hepatitis C, a viral infection that damages the liver over many years. Vertex’s drug, telaprevir, has shown it can push the cure rate up as high as about 75 percent, while cutting the treatment time in half to about six months. That means patients don’t have to endure such a long period of flu-like symptoms, which has traditionally discouraged many patients from getting treatment.
The new advance from Vertex, demonstrated in a trio of pivotal clinical trials, has created this huge wave of pent-up demand from patients and doctors. Knowing this, many analysts have projected the product will be pretty much an instant hit, topping $2 billion in U.S. sales after just a couple years. But then, some expect sales to taper off, as many of the most motivated patients get cured, and don’t need the drug anymore. Essentially, they see Vertex possibly becoming a victim of its own success.
That’s not how it will play out, says Emmens, a marketing veteran who spent much of his career at Merck. An estimated 3.2 million to 3.9 million people in the U.S. have chronic hepatitis C infections. That’s a lot more than the initial wave of patients, which is mostly composed of people who sought treatment before but relapsed. Besides those patients, many more candidates are Baby Boomers who don’t know they contracted the hepatitis C infection decades ago through unprotected sex, IV drug use, or blood transfusions from contaminated supplies. Many of these infections lie dormant for about 20 years or more, but are just now starting to emerge over the decade to come, Emmens says. Some patients won’t see symptoms at all, and as the AP pointed out in this solid feature last month, it’s hard to tell which infected patients are likely to get the worst symptoms. The unluckiest ones will end up suffering severe liver scarring (cirrhosis), liver cancer, liver transplants, and ultimately, premature death.
Connecting with that massive crowd of patients, who aren’t motivated to seek treatment today because they don’t see any really bad symptoms yet, is one of the big marketing challenges Vertex faces. The company is planning to spend some of its $1.3 billion cash hoard on a public awareness campaign designed to urge people to get tested to see if they have the virus, Emmens says. But even more important than the ad campaign, Vertex is hoping the CDC will recommend …Continue Reading...............Next Page »
Hepatitis C and B;Fibrosis severity in Hepatic steatosis/insulin resistance
Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection
Salvatore Petta1, Calogero Camm? 1, Vito Di Marco1, Fabio Salvatore Macaluso1, Marcello Maida1, Giuseppe Pizzolanti2, Beatrice Belmonte3, Daniela Cabibi3, Rosa Di Stefano4, Donatella Ferraro4, Carla Guarnotta3, Giovanna Venezia1, Antonio Craxì1
Article first published online: 30 JAN 2011
DOI: 10.1111/j.1478-3231.2011.02453.x
© 2011 John Wiley & Sons A/S
Issue
Liver International
Abstract
Background and aims: Steatosis and insulin resistance (IR) are the major disease modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated these features in patients with chronic hepatitis B (CHB). We aimed to assess the prevalence and the factors related to steatosis and IR in CHB patients, compared with CHC subjects, and to evaluate the potential association between these features and fibrosis severity.
Material and methods: One hundred and seventy consecutive patients with CHB (28 HBeAg positive, 142 HBeAg negative), were evaluated using liver biopsy and metabolic measurements and matched for sex, age and body mass index with 170 genotype 1 CHC patients. IR was defined if HOMA-IR more then 2.7. All biopsies were scored for grading and staging by Scheuer's score, and the steatosis was considered significant if more then 10%.
Results: The prevalence of significant steatosis was similar in both CHB and CHC patients (31 vs. 38%; P=0.14). IR rate was significantly higher in CHC than in CHB patients (42 vs. 26%; P=0.002).
Severe fibrosis (F3–F4), at multivariate analysis, was independently associated with older age (OR 1.050, 95% CI 1.009–1.093), steatosis more the 10% (OR 4.375, 95% CI 1.749–10.943), and moderate–severe necroinflammatory activity (OR 8.187, 95% CI 2.103–31.875), regardless of HBeAg status, in CHB patients, and with older age (OR 1.080, 95% CI 1.028–1.136), IR (OR 2.640, 95% CI 1.110–6.281), steatosis more then 10% (OR 3.375, 95% CI 1.394–8.171), and moderate–severe necroinflammatory activity (OR 8.988, 95% CI 1.853–43.593) in CHC patients.
Conclusions: CHB patients had high steatosis prevalence, similar to CHC controls, but lower IR rate. Both steatosis and IR in CHC, and only steatosis in CHB, are independently associated with fibrosis severity.
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02453.x/abstract
Salvatore Petta1, Calogero Camm? 1, Vito Di Marco1, Fabio Salvatore Macaluso1, Marcello Maida1, Giuseppe Pizzolanti2, Beatrice Belmonte3, Daniela Cabibi3, Rosa Di Stefano4, Donatella Ferraro4, Carla Guarnotta3, Giovanna Venezia1, Antonio Craxì1
Article first published online: 30 JAN 2011
DOI: 10.1111/j.1478-3231.2011.02453.x
© 2011 John Wiley & Sons A/S
Issue
Liver International
Abstract
Background and aims: Steatosis and insulin resistance (IR) are the major disease modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated these features in patients with chronic hepatitis B (CHB). We aimed to assess the prevalence and the factors related to steatosis and IR in CHB patients, compared with CHC subjects, and to evaluate the potential association between these features and fibrosis severity.
Material and methods: One hundred and seventy consecutive patients with CHB (28 HBeAg positive, 142 HBeAg negative), were evaluated using liver biopsy and metabolic measurements and matched for sex, age and body mass index with 170 genotype 1 CHC patients. IR was defined if HOMA-IR more then 2.7. All biopsies were scored for grading and staging by Scheuer's score, and the steatosis was considered significant if more then 10%.
Results: The prevalence of significant steatosis was similar in both CHB and CHC patients (31 vs. 38%; P=0.14). IR rate was significantly higher in CHC than in CHB patients (42 vs. 26%; P=0.002).
Severe fibrosis (F3–F4), at multivariate analysis, was independently associated with older age (OR 1.050, 95% CI 1.009–1.093), steatosis more the 10% (OR 4.375, 95% CI 1.749–10.943), and moderate–severe necroinflammatory activity (OR 8.187, 95% CI 2.103–31.875), regardless of HBeAg status, in CHB patients, and with older age (OR 1.080, 95% CI 1.028–1.136), IR (OR 2.640, 95% CI 1.110–6.281), steatosis more then 10% (OR 3.375, 95% CI 1.394–8.171), and moderate–severe necroinflammatory activity (OR 8.988, 95% CI 1.853–43.593) in CHC patients.
Conclusions: CHB patients had high steatosis prevalence, similar to CHC controls, but lower IR rate. Both steatosis and IR in CHC, and only steatosis in CHB, are independently associated with fibrosis severity.
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02453.x/abstract
Hepatitis C Daily News; Telaprevir Feb 2 2011
Good Morning Folks,
For years now I have been a loyal visitor of a blog written by Dr. Joe Galati. However, just for the record it has nothing to do with the fact he is incredibly handsome, it has more to do with way he wears that white coat. Today when I wandered over to his blog I found this;
by Dr. Joe Galati on February 1, 2011
In a recent report, there are continued signs that Telaprevir in combination with Interferon and Ribavirin will have significantly increased rates of clearing the hepatitis C virus. New agents against hepatitis C are due for FDA approval in the second half of 2011. For the past three years, we have been fortunate at Liver Specialists of Texas to have been participating in these clinical studies, and remain active with over 15 ongoing hepatitis C research studies. If you are interested in research opportunities, call us 713-794-0700. The full article is posted below.
In patients with chronic hepatitis C, combining telaprevir with ribavirin and peginterferon alfa-2a or 2b yielded sustained virologic response rates of more than 80%, regardless of which type of interferon or which dosing regimen of telaprevir was used, Dr. Patrick Marcellin and his colleagues reported in the February issue of Gastroenterology...continue reading...
In patients with chronic hepatitis C, combining telaprevir with ribavirin and peginterferon alfa-2a or 2b yielded sustained virologic response rates of more than 80%, regardless of which type of interferon or which dosing regimen of telaprevir was used, Dr. Patrick Marcellin and his colleagues reported in the February issue of Gastroenterology...continue reading...
HCV Advocate as always is hard at work and just published their Feburary Newsletter...love it !
February 2011 HCV Advocate
In This Issue:
An article about the priority review given for boceprevir and telaprevir in the United States and the European Union. In addition, telaprevir has been grant priority review in Canada.
Alan Franciscus, Editor-in-Chief
“News Briefs” contains an overview of important news stories, including the first real collaboration between HCV pharmaceuticals, new guidelines on acetaminophen dosage, pilot programs for the HCV aged-based testing initiatives, and the use of medicines to prevent the recurrence of hepatitis C after liver transplantation.
Alan Franciscus, Editor-in-Chief
HCV Snapshots” for February are devoted to research on the association between HCV, stroke and heart disease
Lucinda K. Porter, RN
“HealthWise”’s topic this month is a further exploration of the heart and HCV
Lucinda K. Porter, RN
No one does it better, right !
.
From another great site; HIV and Hepatitis
Liz Highleyman has more on HCV and the risk of stroke ;
.
Hepatitis C Patients May Have Increased Risk of Stroke
SUMMARY: People with chronic hepatitis C virus (HCV) infection appear to have a higher likelihood of dying from strokes than uninfected individuals, according to research reported in the December 2010 issue of Stroke. Over 17 years of follow-up, nearly 3% of HCV seropositive people died due to cerebrovascular events, compared with 1% of HCV negative people; furthermore, the risk of stroke death rose with increasing HCV viral load.
SUMMARY: People with chronic hepatitis C virus (HCV) infection appear to have a higher likelihood of dying from strokes than uninfected individuals, according to research reported in the December 2010 issue of Stroke. Over 17 years of follow-up, nearly 3% of HCV seropositive people died due to cerebrovascular events, compared with 1% of HCV negative people; furthermore, the risk of stroke death rose with increasing HCV viral load.
Anadys Starts Phase 2b Study of HCV Polymerase Inhibitor ANA598
SUMMARY: Anadys Pharmaceuticals announced this week that it has begun treating the first participants in a Phase 2b clinical trial of its investigational hepatitis C virus (HCV) polymerase inhibitor ANA598. The new drug will be tested in combination with pegylated interferon plus ribavirin in both previously untreated patients and people who did not achieve sustained response to prior therapy.
Latest News From Medical News Today
Little Decline Found In Hepatitis C Infections Among Injection Drug Users
01 February 2011A recent 20-year study of injection drug users (IDUs) in Baltimore found a significant decline in new cases of HIV infection but only a slight decline in new cases of hepatitis C virus (HCV) infection...
01 February 2011A recent 20-year study of injection drug users (IDUs) in Baltimore found a significant decline in new cases of HIV infection but only a slight decline in new cases of hepatitis C virus (HCV) infection...
Hepatic Vein Thrombosis Following Liver Resection
01 February 2011Patients undergoing liver surgery have long been considered to be at low risk of venous thromboembolism. However, pulmonary embolism has recently emerged as an increasingly frequent and potentially fatal complication following liver resections.
A Diagnostic Marker In Hepatocellular Carcinoma
01 February 2011E2F5 is a member of the E2F transcription factor family, and plays a key role in cell growth and proliferation. Overexpression of E2F5 has been reported in various human cancers, but not in liver cancer, and its biological...
HIV
Researchers Identify Novel HIV Replication Strategy in Macrophages
SUMMARY: HIV appears to use a previously unrecognized strategy to reproduce in macrophages, according to research published in the December 10, 2010, Journal of Biological Chemistry. This mechanism allows the virus to hide out in these long-lived immune cells and continue replicating, even in the absence of its usual genetic building blocks, and offers a potential new target for anti-HIV therapy.
SUMMARY: HIV appears to use a previously unrecognized strategy to reproduce in macrophages, according to research published in the December 10, 2010, Journal of Biological Chemistry. This mechanism allows the virus to hide out in these long-lived immune cells and continue replicating, even in the absence of its usual genetic building blocks, and offers a potential new target for anti-HIV therapy.
Tuberculosis Coinfection Increases Risk of Mother-to-Child HIV Transmission
SUMMARY: HIV positive women coinfected with tuberculosis (TB) are more likely to transmit HIV to their babies during pregnancy, according to a study described in the February 1, 2011, Journal of Infectious Diseases. These findings underline the importance of TB treatment and use of antiretroviral therapy (ART) to prevent HIV transmission.
SUMMARY: HIV positive women coinfected with tuberculosis (TB) are more likely to transmit HIV to their babies during pregnancy, according to a study described in the February 1, 2011, Journal of Infectious Diseases. These findings underline the importance of TB treatment and use of antiretroviral therapy (ART) to prevent HIV transmission.
Computer Model System Helps Clinicians Select Best Antiretroviral Drug Combo
SUMMARY: The HIV Treatment Response Prediction System (HIV-TRePS) -- a free web-based tool developed by compiling treatment data from thousands of HIV patients around the world -- can help clinicians predict which combination antiretroviral therapy (ART) regimens are likely to work for a specific individual, according to research reported in the January 8, 2011, issue of AIDS Patient Care and STDs. In 2 studies, the system helped select regimens that produced greater viral suppression with fewer pills.
SUMMARY: The HIV Treatment Response Prediction System (HIV-TRePS) -- a free web-based tool developed by compiling treatment data from thousands of HIV patients around the world -- can help clinicians predict which combination antiretroviral therapy (ART) regimens are likely to work for a specific individual, according to research reported in the January 8, 2011, issue of AIDS Patient Care and STDs. In 2 studies, the system helped select regimens that produced greater viral suppression with fewer pills.
.
JAMA.
Teenage girls and young women infected with HIV get pregnant more often and suffer pregnancy complications more frequently than their HIV-negative peers, according to new research led by Johns Hopkins investigators. National Institutes of Health, Doris Duke Charitable Foundation
.
1 hour ago Two drug classes -- a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) -- are equally effective as the centerpiece for an initial treatment regimen for HIV-positive children, researchers reported.
..
Study Examines Incident Hepatitis C Infection in HIV-Infected Men
Hepatitis C is a leading cause of illness and death for individuals infected with both HIV and hepatitis C. Recent reports from around the world demonstrate that hepatitis C is emerging as a sexually transmitted infection among HIV-infected men who do not inject drugs. However, many HIV-infected men do not receive continued screening for hepatitis C throughout their HIV care. Hepatitis C symptoms often do not manifest themselves until the later stages of the illness, so people are not as likely to know that they have become infected and hence need further testing and treatment. Researchers examined the role of later acquisition of hepatitis C in HIV patients in a new study published in Clinical Infectious Diseases, which is currently available online.
Hepatitis C is a leading cause of illness and death for individuals infected with both HIV and hepatitis C. Recent reports from around the world demonstrate that hepatitis C is emerging as a sexually transmitted infection among HIV-infected men who do not inject drugs. However, many HIV-infected men do not receive continued screening for hepatitis C throughout their HIV care. Hepatitis C symptoms often do not manifest themselves until the later stages of the illness, so people are not as likely to know that they have become infected and hence need further testing and treatment. Researchers examined the role of later acquisition of hepatitis C in HIV patients in a new study published in Clinical Infectious Diseases, which is currently available online.
In the study, 1,800 HIV-infected men had an initial negative hepatitis C blood test result, with at least one subsequent test. At the time of their initial negative hepatitis C results, 94 percent were receiving antiretroviral therapy for HIV and 6 percent reported current or prior injection drug use.
Ultimately, 36 patients were subsequently diagnosed with hepatitis C. Of those, 25 percent reported an injection drug use history, although 75 percent reported no current or previous injection drug use.
“Screening HIV-infected patients for hepatitis C only once upon entry into HIV care is not sufficient,” according to study author Lynn E. Taylor, MD, of Brown University in Providence, R. I. “The standard of care needs to change. HIV-infected persons should have access to ongoing screening for hepatitis C. Doctors and patients may not be aware of or freely discuss all risk behaviors that may lead to hepatitis C infection. These behaviors are often stigmatized. Patients may not feel comfortable discussing these risk factors nor may they be aware of all the ways in which hepatitis C may be transmitted via blood.”
###
Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. For more information, visit http://www.idsociety.org/
Fatty Liver Disease
ScienceDaily has an interesting article on Fatty Liver disease, if you have been diagnosed with the disease you may find the concept of the entire article interesting; " A new research finding showing a strong relationship between complex microbial ecologies in human intestines and the common but serious medical condition known as fatty liver illustrates this paradox." The researchers concluded; "More research will be required to determine the extent to which bacterial populations play a role in fatty liver development in the general population, but our results strongly suggest that there may be a link in some people."
Liver Cancer
Chemoprevention of hepatocellular carcinoma in chronic hepatitis C
Recent Results Cancer Res. 2011;188:85-99.
Morgan TR.Gastroenterology Section, VA Long Beach Healthcare System, 5901 E. Seventh Street - 11, Long Beach, CA, 90822, USA, timothy.morgan@va.gov.
Abstract
Hepatitis C virus (HCV) infection causes chronic hepatitis, which can progress to cirrhosis and hepatocellular carcinoma (HCC). The incidence of hepatocellular carcinoma in the United States tripled between 1975 and 2005, and is expected to increase further, and to remain elevated for more than 20 years. Curing hepatitis C infection in patients with cirrhosis through treatment with peginterferon and ribavirin reduces the risk of developing hepatocellular carcinoma. Several noncurative treatments also appear to reduce the risk of hepatocellular carcinoma in patients with chronic hepatitis C.
Prospective studies report a reduced incidence of hepatocellular carcinoma among patients treated with a mixture of carotenoids with or without myo-inositol, with vitamin K(2), or with polyprenoic acid (an acyclic retinoid). Uncontrolled and/or retrospective studies have reported beneficial effects of treatment with Sho-saiko-to, glycyrrhizin and ursodeoxycholic acid on hepatocellular carcinoma incidence.
Meta-analyses of epidemiologic studies show a reduced risk of hepatocellular carcinoma among liver disease patients who drink two or more cups of coffee per day. Numerous agents prevent or reduce hepatocarcinogenesis in animal models. An ongoing Phase II clinical trial is evaluating S-adenosylmethionine (SAMe) as a potential chemopreventive agent in hepatitis C cirrhosis. Overall, these data suggest that chemoprevention of hepatocellular carcinoma in patients with chronic hepatitis C is an achievable objective.
PMID: 21253791 [PubMed - in process]
.
Predicting The Spread Of Cancer From The Level Of Tumor Protein
02 February 2011
02 February 2011
Researchers at the National Institutes of Health and the University of Hong Kong have discovered that high levels of a particular protein in cancer cells are a reliable indicator that a cancer will spread...
.
Patients And Physicians Rally On Capitol Hill To Tell Congress YES! We Can Beat Liver Tumors
02 February 2011
02 February 2011
YES! Beat Liver Tumors, a nonprofit organization dedicated to the support of patients diagnosed with primary or metastatic liver tumors, announced it will host its first advocacy day on Capitol Hill on Monday, Feb. 7, 2011...
.
Diagnostic tool for tumor grading in hepatocellular carcinoma
Pre-operative liver biopsy in cirrhotic patients with early hepatocellular carcinoma represents a safe and accurate diagnostic tool for tumor grading, finds February's Journal of Hepatology.
Knowledge of pre-operative tumour grade is crucial in the management of hepatocellular carcinoma because it can influence recurrence and survival after surgery.
The accuracy of pre-operative needle core biopsy in tumor grading has been assessed in only a few studies with conflicting results.
The accuracy of pre-operative needle core biopsy in tumor grading has been assessed in only a few studies with conflicting results.
Dr Antonio Colecchia and colleagues determined the long-term safety and the overall accuracy of needle core biopsy in assessing tumor grading in subjects who had undergone liver resection for a single hepatocellular carcinoma.
The research team evaluated 81 cirrhotic patients with hepatocellular carcinoma who had undergone needle core biopsy before liver resection.
The cumulative mortality was 17% from all causes
The cumulative mortality was 17% from all causes
Journal of Hepatology
Only patients with a single HCC and with at least a 5-year-follow-up were included.
Tumor grading was scored according to a modified Edmondson–Steiner classification including well/moderately vs poorly-differentiated.
In the 81 patients with a solitary hepatocellular carcinoma tumor grade was correctly identified by needle core biopsy in 91% hepatocellular carcinomas.
The research team observed that needle core biopsy overall sensitivity and specificity were 65% and 98%, respectively.
The team noted that the positive predictive value was 92% with a negative predictive value of 91%.
The researchers observed no major complications.
The overall survival rates at 1, 3, and 5 years were 83%, 62%, and 44%, respectively.
The recurrence rate after a 5-year-follow-up was 56% for low grade, and 82% for high grade tumors.
The overall survival rates at 1, 3, and 5 years were 83%, 62%, and 44%, respectively.
The recurrence rate after a 5-year-follow-up was 56% for low grade, and 82% for high grade tumors.
Dr Colecchia's team concludes, "Pre-operative needle core biopsy can be performed on early hepatocellular carcinoma cirrhotic patients because it provides histologically useful information for hepatocellular carcinoma management with good accuracy and a low complication rate."
J Hepatol 2011: 54(2): 300-5
02 February 2011
Off The Cuff
WASHINGTON -- With Monday's ruling by a federal judge that the healthcare reform law is unconstitutional, legal experts foresee a showdown in the Supreme Court, where the outcome could go either way...keep reading..
..
.
Public Release: 2-Feb-2011 Second Annual National Bed Bug Summit
Fifteen members of the Entomological Society of America gave presentations at the Second Annual National Bed Bug Summit: Advancing Towards Solutions to the Bed Bug Problem, held by the US Environmental Protection Agency in Washington, DC, Feb. 2, 2011. The meeting focused on what is being done to combat bed bugs, the importance of educating consumers, improvements in prevention and control techniques, controlling bed bugs in schools and public housing, and on the state of bed bug knowledge and future research needs.
Contact: Richard Levine
Contact: Richard Levine
.
Healthy You
..
Public Release: 2-Feb-2011 Food Research International
Food scientists at the University of British Columbia have been able to pinpoint more of the complex chemistry behind coffee's much touted antioxidant benefits, tracing valuable compounds to the roasting process.
.
Liver, Dietary Proteins Key In Fertility
02 February 2011
02 February 2011
When you think about organs with an important role in reproduction, the liver most likely doesn't spring to mind. But a new report in the February issue of Cell Metabolism, a Cell Press publication, shows that estrogen...
..
New York / Heidelberg, 2 February 2011
.
.
Drugs warning – check the label
Patients may be unaware of potential drug side-effects due to inconsistent labelling
.
A new study highlights inconsistencies in black box warnings - medication-related safety warnings on a drug's label - and argues for a more transparent and systematic approach to ensure these warnings are consistent across all drugs within a same category, and any additions to warnings, on the back of a drug withdrawal for example, are done within a reasonable and uniform time period. The work by Orestis Panagiotou and John Ioannidis and colleagues from the University of Ioannina School of Medicine in Greece and Stanford University School of Medicine in the USA is published in Springer's journal Journal of General Internal Medicine.
Black box warnings are the strongest medication-related safety warnings that can be placed in a drug's labelling information, according to the FDA. Their purpose is to highlight major drug-related risks. Because serious drug-related adverse events tend to be down to the pharmacological class of drug rather than to the individual drug, most black box warnings are typically applied to all members of a given class of drugs.
Patients may be unaware of potential drug side-effects due to inconsistent labelling
.
A new study highlights inconsistencies in black box warnings - medication-related safety warnings on a drug's label - and argues for a more transparent and systematic approach to ensure these warnings are consistent across all drugs within a same category, and any additions to warnings, on the back of a drug withdrawal for example, are done within a reasonable and uniform time period. The work by Orestis Panagiotou and John Ioannidis and colleagues from the University of Ioannina School of Medicine in Greece and Stanford University School of Medicine in the USA is published in Springer's journal Journal of General Internal Medicine.
Black box warnings are the strongest medication-related safety warnings that can be placed in a drug's labelling information, according to the FDA. Their purpose is to highlight major drug-related risks. Because serious drug-related adverse events tend to be down to the pharmacological class of drug rather than to the individual drug, most black box warnings are typically applied to all members of a given class of drugs.
Panagiotou and team looked at how consistent black box warning labelling is across same-class drugs in order to assess whether some drugs fail to carry a warning when black box warnings exist for other drugs in the category, as well as whether there are differences in the time it takes to add a warning to drugs in the same class. They studied the labels of 20 drug classes (176 drugs in total) selected from the USA's 'Top 200 Drugs for 2008 by Sales'. Of these 20 categories, 10 had at least one black box warning while the other 10 had none.
The authors identified differences in 9 of the 20 classes, with 15 black box warnings not present on all the labels of drugs in the same class. For 10 of these 15 different warnings, the information was included elsewhere on the labels as simple warnings or text. For the remaining 5, the black box context was not found anywhere else on the drugs' labels. Significantly, withdrawn drugs tended not to have a black box warning before their withdrawal and the reason for their withdrawal rarely became a black box warning for the other drugs in the same category.
In addition, among the 10 drug classes with at least one warning, there was a considerable time-lag in black box warning acquisition in 8 categories, ranging from 2 months to 14 years in some cases.
The authors argue that labels should mention and justify why a major recognized risk is not an issue for a particular agent in the same class, where other members have demonstrated major toxicity. In their view, unjustified omission of a black box warning may leave patients largely unaware of potential risks.
Orestis Panagiotou and colleagues conclude: " Our findings imply that the process of black box warning acquisition requires transparent and systematic rules, as well as clear justification for the presence of, or lack of evidence for, specific major risks for individual drugs."
Reference
1. Panagiotou OA et al (2011). Different black box warning labelling for same-class drugs. Journal of General Internal Medicine; DOI 10.1007/s11606-011-1633-9
The full-text article is available to journalists on request.
More information about this journal:
Journal of General Internal Medicine
1. Panagiotou OA et al (2011). Different black box warning labelling for same-class drugs. Journal of General Internal Medicine; DOI 10.1007/s11606-011-1633-9
The full-text article is available to journalists on request.
More information about this journal:
Journal of General Internal Medicine
..
Gallstone disease associated with increased mortality in the USA
Gallstone disease associated with increased mortality in the United States, reports this month's issue of Gastroenterology.
Gallstones are common and contribute to morbidity and health care costs, but their effects on mortality are unclear.
Drs Constance Ruhl and James Everhart examined whether gallstone disease was associated with overall and cause-specific mortalities in a prospective national population-based sample.
The research team analyzed data from 14,228 participants in the third US National Health and Nutrition Examination Survey who underwent gallbladder ultrasonography from 1988 to 1994.
The cumulative mortality was 17% from all causes
Gastroenterology
Gallstone disease was defined as ultrasound-documented gallstones or evidence of cholecystectomy.
The underlying cause of death was identified from death certificates collected through 2006.
Mortality hazard ratios (HR) were calculated using Cox proportional hazards regression analysis to adjust for multiple demographic and cardiovascular disease risk factors.
The research team found that prevalence of gallstones was 7%, and of cholecystectomy was 5%.
During a follow-up period of 18 years or more, the cumulative mortality was 17% from all causes, 7% from cardiovascular disease, and 5% from cancer.
Mortality hazard ratios (HR) were calculated using Cox proportional hazards regression analysis to adjust for multiple demographic and cardiovascular disease risk factors.
The research team found that prevalence of gallstones was 7%, and of cholecystectomy was 5%.
During a follow-up period of 18 years or more, the cumulative mortality was 17% from all causes, 7% from cardiovascular disease, and 5% from cancer.
The researchers noted that participants with gallstone disease had higher all-cause mortality in age-adjusted, and multivariate-adjusted analysis.
A similar increase was observed for cardiovascular disease mortality, and cancer mortality.
Individuals with gallstones had a similar increase in risk of death as those with cholecystectomy.
Dr Ruhl and colleague commented, "In the US population, persons with gallstone disease have increased mortality overall and mortalities from cardiovascular disease and cancer."
"This relationship was found for both ultrasound-diagnosed gallstones and cholecystectomy."
02 February 2011
From Scope; I love Scope and just for the record its not because there are over 153 Stanford physicians that work out on a daily basis, just putting it out there.
A new study is showing the growing popularity of complementary and alternative medicine (CAM): Use among U.S. adults increased by 14 percent between 2002 and 2007. WebMD reports: CAM, which includes such practices as yoga, massage, herbal medicine, and meditation, has been increasing in popularity for many years. In 1990, a third of all Americans had used some form of CAM. By 2002, the number of people who had tried CAM had nearly doubled. The numbers, [Dejun Su, PhD, a sociologist at the University of Texas - Pan American] and his colleague Lifeng Li report, remain on the rise.
From Medscape
Abstract
The popularity and prevalence of herbal products and dietary supplements in the US has grown steadily. Patients are increasingly using them to prevent disease, complement conventional therapies, and promote well being and health. Nurse practitioners play a critical role in discussion, communication, and education of herbal supplement use. This article provides a review of commonly used herbal supplements regarding recent evidence for efficacy, possible drug interactions, and safety considerations.
The popularity and prevalence of herbal products and dietary supplements in the US has grown steadily. Patients are increasingly using them to prevent disease, complement conventional therapies, and promote well being and health. Nurse practitioners play a critical role in discussion, communication, and education of herbal supplement use. This article provides a review of commonly used herbal supplements regarding recent evidence for efficacy, possible drug interactions, and safety considerations.
Introduction
Approximately 38 million US adults use herbal and dietary supplements.[1] In 2009, Americans spent $5.03 billion on herbs and other botanical supplements, and their sales are steadily growing.[2] From Sam's Club to natural food retailer Whole Foods Market, even convenience stores sell herbal supplements such as ginkgo and echinacea alongside aspirin. Patients are regularly using herbal products to self-treat medical conditions, complement conventional therapies, and maintain their overall health and well-being. Most patients receive their information about herbs and supplements from their friends, family, and the Internet but rarely from their healthcare provider.[3]
Approximately 38 million US adults use herbal and dietary supplements.[1] In 2009, Americans spent $5.03 billion on herbs and other botanical supplements, and their sales are steadily growing.[2] From Sam's Club to natural food retailer Whole Foods Market, even convenience stores sell herbal supplements such as ginkgo and echinacea alongside aspirin. Patients are regularly using herbal products to self-treat medical conditions, complement conventional therapies, and maintain their overall health and well-being. Most patients receive their information about herbs and supplements from their friends, family, and the Internet but rarely from their healthcare provider.[3]
Since the US Dietary Supplement Health and Education Act (DSHEA) became law in 1994, vitamins, minerals, and herbal supplements are presumed to be safe and freely available. However, the FDA does not regulate dietary supplements, and there are no pre-market safety or efficacy studies required. If a dietary supplement has safety issues once it is on the market, the FDA can take action against the manufacturer by issuing a warning or removing the product. In 2007, the FDA issued its final current "good manufacturing practices" (GMPs) regulations to maintain that dietary supplements are processed consistently and meet quality standards. While improvements have been made in the oversight of supplements, issues of quality and safety continue. In 2010, the US Government Accountability Office (GAO) released a report finding trace levels of lead and other contaminants (within levels accepted by the FDA and EPA) and examples of deceptive or suspect marketing claims.[4]
Despite increasingly common usage, only one-third of patients tell their physician about their use of supplements.[1] Physicians do not commonly ask patients about their complementary and alternative medicine (CAM) use, and patients may feel uncomfortable discussing it. But concomitant use of herbal supplements with prescription drugs or over-the-counter (OTC) medications can put patients at risk for a variety of serious drug interactions. Herbs and drugs often interact when they use the same transport or metabolic protein, commonly cytochrome P450 (CYP) enzymes, glucuronosyltransferases (UGT), and P-glycoprotein (Pgp), resulting in induction or inhibition activity.[5] However, many factors, including the dose, schedule, and route of administration, can affect the potential drug-botanical interaction. If the botanical and drug are administered at different times, it is less likely that a clinically relevant interaction will occur.[5]
Check out all the info, free registration required
Garlic (Allium Sativum)
Saw Palmetto (Serenoa Repens)
Ginkgo (Ginkgo Biloba)
Echinacea (Echinacea Purpurea, Echinacea Augustifolia, Echinacea Pallida)
Milk Thistle (Silybum Marianum)
St. John's Wort (Hypericum Perforatum)
Ginseng
Black Cohosh (Cimicifuga Racemosa)
Green Tea (Camellia Sinensis)
Valerian (Valerian Officinalis, Valeriana Radix)
Recommendations for Practice
References
Sidebar 1
Sidebar 2
Saw Palmetto (Serenoa Repens)
Ginkgo (Ginkgo Biloba)
Echinacea (Echinacea Purpurea, Echinacea Augustifolia, Echinacea Pallida)
Milk Thistle (Silybum Marianum)
St. John's Wort (Hypericum Perforatum)
Ginseng
Black Cohosh (Cimicifuga Racemosa)
Green Tea (Camellia Sinensis)
Valerian (Valerian Officinalis, Valeriana Radix)
Recommendations for Practice
References
Sidebar 1
Sidebar 2
January 31, 2011 — The seventh edition of the US Department of Agriculture guidelines for healthy eating were released online today and include 23 key recommendations for all Americans, as well as 6 additional recommendations for specific population groups.
US Department of Agriculture dietary guidelines were first developed in the United States in 1980, and the previous (sixth edition) guidelines were released in January 2005. For the latest guidelines, a panel of 13 nutrition experts was convened to determine whether revisions were warranted, and to provide suggestions.
Linda Van Horn, PhD, RD, LD, from Northwestern University in Chicago, Illinois, chaired the 13-member Dietary Guideline Advisory Committee. For 18 months, the committee reviewed the scientific and medical literature regarding the role of diet and nutrition in health promotion and disease prevention.
"The overarching differences include emphases on managing body weight through all life stages and on proper nutrition for children throughout," the authors note. "Also, research on eating patterns is incorporated for the first time, and the eating patterns presented now include vegetarian adaptations," they add.
The report, which includes recommendations for Americans aged 2 years and older, as well as those at increased risk of chronic disease, incorporates 2 new chapters: "The Total Diet: Combining Nutrients, Consuming Food" and "Translating and Integrating the Evidence: A Call to Action."
US Department of Agriculture dietary guidelines were first developed in the United States in 1980, and the previous (sixth edition) guidelines were released in January 2005. For the latest guidelines, a panel of 13 nutrition experts was convened to determine whether revisions were warranted, and to provide suggestions.
Linda Van Horn, PhD, RD, LD, from Northwestern University in Chicago, Illinois, chaired the 13-member Dietary Guideline Advisory Committee. For 18 months, the committee reviewed the scientific and medical literature regarding the role of diet and nutrition in health promotion and disease prevention.
"The overarching differences include emphases on managing body weight through all life stages and on proper nutrition for children throughout," the authors note. "Also, research on eating patterns is incorporated for the first time, and the eating patterns presented now include vegetarian adaptations," they add.
The report, which includes recommendations for Americans aged 2 years and older, as well as those at increased risk of chronic disease, incorporates 2 new chapters: "The Total Diet: Combining Nutrients, Consuming Food" and "Translating and Integrating the Evidence: A Call to Action."
"Taken together, the Dietary Guidelines recommendations encompass two overarching concepts," Dr. Van Horn and colleagues write in the executive summary. These are to "maintain calorie balance over time to achieve and sustain a healthy weight," and to "focus on consuming nutrient-dense foods and beverages."
With respect to maintaining calorie balance and a healthy weight, the authors suggest that "people who are most successful at achieving and maintaining a healthy weight do so through continued attention to consuming only enough calories from foods and beverages to meet their needs and by being physically active."
With respect to maintaining calorie balance and a healthy weight, the authors suggest that "people who are most successful at achieving and maintaining a healthy weight do so through continued attention to consuming only enough calories from foods and beverages to meet their needs and by being physically active."
They add that a healthy eating pattern "limits intake of sodium, solid fats, added sugars, and refined grains and emphasizes nutrient-dense foods and beverages." These include "vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds."
Some Foods and Nutrients Should Decrease, Some Should Increase
The new guidelines specifically suggest decreasing the intake of various foods and nutrients, including limiting sodium to 1500 mg in about half the US population. Consumption of saturated fats, dietary cholesterol, trans fatty acids, solid fats, added sugars, and refined grains should all be limited. If alcohol is consumed, it should be consumed in moderation, the guidelines state.
In contrast, intake of vegetables, fruits, grains, and fat-free and low-fat dairy products should all be increased. Lean proteins including seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds should be emphasized.
The guidelines also suggest that foods providing more potassium, dietary fiber, calcium, and vitamin D should be selected. "These foods include vegetables, fruits, whole grains, and milk and milk products."
The new guidelines specifically suggest decreasing the intake of various foods and nutrients, including limiting sodium to 1500 mg in about half the US population. Consumption of saturated fats, dietary cholesterol, trans fatty acids, solid fats, added sugars, and refined grains should all be limited. If alcohol is consumed, it should be consumed in moderation, the guidelines state.
In contrast, intake of vegetables, fruits, grains, and fat-free and low-fat dairy products should all be increased. Lean proteins including seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds should be emphasized.
The guidelines also suggest that foods providing more potassium, dietary fiber, calcium, and vitamin D should be selected. "These foods include vegetables, fruits, whole grains, and milk and milk products."
Guidelines for women who are pregnant or breast-feeding or who wish to become pregnant, as well as all individuals aged 50 years or older, are also included.
Professional Associations Respond to New Guidelines
Professional associations with a stake in nutrition have spoken out about the new guidelines. The American Institute for Cancer Research (AICR) states in a written release that it welcomes the 2010 Dietary Guidelines for Americans, and that it strongly supports the emphasis on plant-based diets.
Professional Associations Respond to New Guidelines
Professional associations with a stake in nutrition have spoken out about the new guidelines. The American Institute for Cancer Research (AICR) states in a written release that it welcomes the 2010 Dietary Guidelines for Americans, and that it strongly supports the emphasis on plant-based diets.
"For years, the science on cancer risk has shown that diets emphasizing a variety of vegetables, fruits, whole grains and beans are cancer-protective," notes Susan Higginbotham, RD, PhD, director of research at AICR, in a statement.
"A plant-based diet means moderating meat intake, not eliminating it altogether," Dr. Higginbotham said. "We're thrilled to see obesity prevention, and thus cancer prevention, being placed front-and-center, where they belong."
However, the American Heart Association maintains that the new guidance for sodium content is too high. Although the dietary recommendations advise people at risk for high blood pressure or who already have hypertension to reduce daily sodium intake to 1500 mg, the rest of the population is still advised to limit intake to 2300 mg sodium per day.
"The [American Heart Association] recommends a daily sodium consumption limit of less than 1500 mg a day for all Americans, and is concerned that this two-part recommendation does not go far enough to protect the health of all Americans," the organization states in a news release.
Meanwhile the American Society of Nutrition congratulates the US Department of Agriculture and the Department of Health and Human Services on issuance of the 2010 Dietary Guidelines.
American Society of Nutrition spokesperson Connie Weaver, PhD, who served on the 2005 Committee, notes that the "most impressive new aspect of the 2010 Dietary Guidelines is the call to action for all sectors of the society to become involved in ensuring that all Americans have access to nutritious foods and opportunities for physical activity and to facilitate individual behavior change through environmental strategies."
No commercial support was involved in the current report. The authors have disclosed no relevant financial relationships.
USDA. Dietary Guidelines for Americans, 2010. Released January 31, 2011.
Check out the Full text
More Americans Turn To Lower-Cost Alternative Meds, Especially Whites
01 February 2011The use of complementary and alternative medicine (CAM) therapies experienced a significant growth in the United States in the last decade, and a new analysis finds that CAM use becomes more likely when access to...
01 February 2011The use of complementary and alternative medicine (CAM) therapies experienced a significant growth in the United States in the last decade, and a new analysis finds that CAM use becomes more likely when access to...
MedShape Applauds FDA Action Against Illegal Homeopathic HCG Weight Loss Products
01 February 2011MedShape Weight Loss Clinic, a national leader in safe and effective weight loss, announced its strong endorsement of the Food and Drug Administration (FDA) statement released on Jan...
New on this blog;
It has taken years for HCV to receive the attention it so badly needs. Because this disease hits so close to home my anger leaves me bitter as I look around to see who is to blame.
First, this country has been slow to fund needle exchange programs, the US government forbade funding for such services until 2009 when the federal funding ban was lifted. I am appalled at our governments indifference; restraining communities by not funding these programs until a few years ago.
Secondly, it's evident that this disease has never played out well in the media. Could it be that from day one HCV was toted in the press as the "baby boomer" disease? The term gained popularity with journalists when it was first reported that baby boomers account for two out of every three cases of chronic Hepatitis C. Obviously this is accurate, however for me the term "baby boomer" is nothing more then negative connotation insinuating "1960/70's" drug users, all in the hopes of making a journalistic headline more eye-catching...read more..
10,000 Hepatitis C patients could hold the key to better treatment
The Medical Research Foundation, an independent registered charity established by the Medical Research Council (MRC), has donated nearly £2 million to establish a clinical database of 10,000 patients infected with hepatitis C virus (HCV).
This will enable a UK-wide network of researchers to find new ways to tackle the deadly infection.
While there has been considerable progress in the scientific understanding of the disease in recent years, it is currently extremely difficult to track effectively the spread of HCV and to understand the biological roots of the illness.
Dr John McLauchlan will lead the project at the newly-established Medical Research Council - University of Glasgow Centre for Virus Research in partnership with Professor Will Irving at Nottingham University. Patients will be recruited from clinical centres across the UK currently providing care to HCV patients. The initiative will create HCV Research UK, a consortium of clinicians, academics and healthcare professionals, which aims to promote collaborative research into HCV infection across the UK.
The lack of strategic surveillance of the disease in the UK has also made it harder for doctors to determine why some patients can develop symptoms as soon as they are infected, while others only go onto develop cirrhosis of the liver after many years. By collecting and analysing clinical samples taken from patients, the project will also help researchers examine why certain patients fail to respond to treatment.
At least 250,000 people in the UK are thought to be infected with HCV, the blood-borne virus, which can cause severe liver damage in up to 20 per cent of patients. HCV is ten times easier to contract than HIV, with prisoners and drug users particularly vulnerable to infection.
Dr John McLauchlan at the MRC-University of Glasgow Centre for Virus Research says:
“With Hepatitis C rates continuing to rise and place an increasing strain on healthcare resources, it’s crucial that we attack this disease on as many fronts as possible. By creating a well-structured resource, we hope that it will stimulate both clinical and fundamental research into HCV infection in the UK and form the basis for many future studies.”
Ends
About the Medical Research Foundation
The Medical Research Foundation is an independent registered charity established by the Medical Research Council (MRC). The Medical Research Foundation receives legacies and donations from the giving public.
The aims of the Medical Research Foundation are to promote medical research anywhere in the world, and in particular, to support research training, public engagement with research and the dissemination of research results for the improvement of human health. The Medical Research Foundation aims to support research that complements and extends that supported by the MRC. The Medical Research Foundation’s trustees recently granted an award to Dr John MacLauchlan and colleagues to establish a national HCV resource. The name used to refer to the ‘Trust Funds administered in connection with the Medical Research Council’ charity (registration number 250696)
www.mrc.ac.uk/MRF
This will enable a UK-wide network of researchers to find new ways to tackle the deadly infection.
While there has been considerable progress in the scientific understanding of the disease in recent years, it is currently extremely difficult to track effectively the spread of HCV and to understand the biological roots of the illness.
Dr John McLauchlan will lead the project at the newly-established Medical Research Council - University of Glasgow Centre for Virus Research in partnership with Professor Will Irving at Nottingham University. Patients will be recruited from clinical centres across the UK currently providing care to HCV patients. The initiative will create HCV Research UK, a consortium of clinicians, academics and healthcare professionals, which aims to promote collaborative research into HCV infection across the UK.
The lack of strategic surveillance of the disease in the UK has also made it harder for doctors to determine why some patients can develop symptoms as soon as they are infected, while others only go onto develop cirrhosis of the liver after many years. By collecting and analysing clinical samples taken from patients, the project will also help researchers examine why certain patients fail to respond to treatment.
At least 250,000 people in the UK are thought to be infected with HCV, the blood-borne virus, which can cause severe liver damage in up to 20 per cent of patients. HCV is ten times easier to contract than HIV, with prisoners and drug users particularly vulnerable to infection.
Dr John McLauchlan at the MRC-University of Glasgow Centre for Virus Research says:
“With Hepatitis C rates continuing to rise and place an increasing strain on healthcare resources, it’s crucial that we attack this disease on as many fronts as possible. By creating a well-structured resource, we hope that it will stimulate both clinical and fundamental research into HCV infection in the UK and form the basis for many future studies.”
Ends
About the Medical Research Foundation
The Medical Research Foundation is an independent registered charity established by the Medical Research Council (MRC). The Medical Research Foundation receives legacies and donations from the giving public.
The aims of the Medical Research Foundation are to promote medical research anywhere in the world, and in particular, to support research training, public engagement with research and the dissemination of research results for the improvement of human health. The Medical Research Foundation aims to support research that complements and extends that supported by the MRC. The Medical Research Foundation’s trustees recently granted an award to Dr John MacLauchlan and colleagues to establish a national HCV resource. The name used to refer to the ‘Trust Funds administered in connection with the Medical Research Council’ charity (registration number 250696)
www.mrc.ac.uk/MRF
Tuesday, February 1, 2011
Hepatitis C; A Forced Legacy
Good evening folks, its always a good day when the "experts" bring attention to Hepatitis C..
Reported in the media today is that HIV among IV users has declined while HCV hasn't. According to Shruti H. Mehta of the Johns Hopkins School of Public Health, "More must be done to reduce the transmission of hepatitis C. With IV use on the rise and the fact that sharing a needle just one time can transmit the virus, researchers warn that "HCV is nearly 10 times more transmissible by IV use than HIV."
For instance, in rural southern Ohio's Scioto County IV use is thriving, with oxycodone being the drug of choice. Reported back in December by the Associated Press were these hard facts; "Scioto County's per capita rates of murder, fatal overdoses and hepatitis C infections have in recent years been outranked only by Ohio's biggest urban areas. The DEA considers the county one of the worst places in the country for prescription painkiller abuse, with more people abusing per capita than almost anywhere else."
,
It has taken years for HCV to receive the attention it so badly needs. Because this disease hits so close to home my anger leaves me bitter as I look around to see who is to blame. .
First, this country has been slow to fund needle exchange programs, the US government forbade funding for such services until 2009 when the federal funding ban was lifted. I am appalled at our governments indifference; restraining communities by not funding these programs until a few years ago..
Secondly, it's evident that this disease has never played out well in the media. Could it be that from day one HCV was touted in the press as the "baby boomer" disease? The term gained popularity with journalists when it was first reported that baby boomers account for two out of every three cases of chronic Hepatitis C. Obviously this is accurate, however for me the term "baby boomer" is nothing more then negative connotation insinuating "1960/70's" drug users, all in the hopes of making a journalistic headline more eye-catching. .
The anger I feel is likely the product of my own insecurities. Living in the shadow of the mistakes of my adolescence has caused this fury to fester. Because of my irresponsible actions I carry a debt my psyche must constantly pay. Having to face my children, having to explain to them why I had to undergo treatment, having them contribute to the exoneration of my sins is something I will carry with me until the day I die. But hey, they should understand right? I'm a baby boomer and this disease is my legacy. .
I personally believe this term fueled the stigma attached to HCV in the same way the media years ago deemed HIV "A Gay Mans Disease". We lost years of missed opportunities for awareness in the press, all in the name of sensationalized journalism. I assume the majority of journalists simply used the "term" to convey the large population infected with HCV. However, innocently enough they sent a message that this disease is a disease of drug users. .
Not all baby boomers contracted HCV through drug use. They too are weary of the term, the stigma, the continued attachment of this disease to drug use. .
The kids that are using right now are not aspiring drug addicts. Frankly, neither were we. These kids start out by experimenting, getting caught up with the feeling they get from the first injection which turns into two, then three, and ends with addiction. The kids who never escape their addiction, if they live long enough, grow into forty year old addicts. With many of them living with HIV, HCV or HBV. With that we have another group of adults who do go on to embracing sobriety, these people gain wisdom often only seen by overcoming adversity. .
We can only hope these young people will realize the outcome of addiction: HCV, HIV transmission, or the transmission of other blood-borne pathogens. Hopefully the awareness of these dangers will lead these kids to either stop using or walk into a clinic and take advantage of needle exchange programs. These kids are lost, as we were so many years ago. Maybe this time we can act a little faster, maybe this time we can show some of them another way..
Subscribe to:
Posts (Atom)