Acetaminophen Pushing up Liver Failure Rate in US

The percentage of cases of acute liver failure caused by an overdose of acetaminophen increased considerably from 1998 to 2003, with unintentional overdose accounting for at least half of these cases, a new US study published in the medical journal Hepatology, December 2005 shows.

Acetaminophen, known in some countries as paracetamol, is the active ingredient in painkillers like Tylenol and Panadol. Too much can cause serious liver damage.

People with chronic pain, depression and those who abuse substances, including alcohol, may be particularly at risk for unintentional acetaminophen overdose, Dr. Anne M. Larson of the University of Washington in Seattle and colleagues report in Hepatology.

"Efforts to limit over-the-counter packaging size and to restrict the prescription of narcotic-acetaminophen combinations (or to separate the narcotic from the acetaminophen) may be necessary to reduce the incidence of this increasingly recognized but preventable cause of acute liver failure in the United States," according to Larson and her colleagues.

The researchers analyzed data on 662 consecutive patients treated for acute liver failure at 22 US tertiary care centers between 1998 and 2003. During that time, the annual percentage of acute liver failure cases due to acetaminophen rose from 28 percent to 51 percent.

Among the 275 cases determined to be acetaminophen-related, 48 percent were unintentional overdoses, 44 percent were suicide attempts, and intent was unknown in 8 percent. Many characteristics of the unintentional and intentional overdose groups were similar, while their clinical outcomes were not different.

Patients who unintentionally overdosed were older than those who attempted suicide, more likely to use several products containing acetaminophen and took longer to seek care after symptoms developed. Seventy-nine percent reported taking the medications for pain.

Depression was reported by 24 percent who unintentionally overdosed, compared with 45 percent of patients who intentionally overdosed.

"Overall, 178 subjects (65 percent) survived, 74 (27 percent) died without transplantation, and 23 subjects (8%) underwent liver transplantation," Larson’s group found.

The investigators say there is a relatively narrow range between an effective dose of acetaminophen and a dangerous dose. They say that "consistent use of as little as 7.5 grams per day may be hazardous." One extra-strength Tylenol tablet contains half a gram of acetaminophen in the US. In Australia standard strength paracetamol tablets and capsules are 500 mg.

The standard dose for adults and children over 12 years of age is one to two 500 mg tablets every 4 to 6 hours if necessary with a maximum of 8 tablets in 24 hours. The dose for children aged 7 to 12 years is half to one tablet every 4 to 6 hours with a maximum of 4 tablets in 24 hours.

In an editorial accompanying the study, Dr. John G. O’Grady of King’s College Hospital in London points out that a 1998 rule in the UK restricting over-the-counter sales of acetaminophen to 16 grams led to a 30 percent reduction in hospital admissions for cute liver failure related to the drug, and France’s rule limiting sales to 8 grams has also been effective.

"The required judgment from society, the medical profession, and other interested parties, is whether that level of restriction is too high a price to pay," he concludes.

I have personally seen several people, mainly young people below 30 years of age, die in intensive care due to overdose of this drug. In some of these cases the patients had taken an overdose as a cry for help, not because they intended to effectively suicide. Tragically, they thought that this drug was safe.

This isn’t at all surprising since the drug is actively and specifically marketed as a very safe drug. The pediatric form is also promoted as safe. Little wonder then that so many people overdose with this drug and become shocked to discover they are dying. Almost nothing can be done for the majority of them. Once severe liver damage has occurred, there is very little that can be done other than a transplant and these are typically impossible in acute cases.

There are several safer alternatives. The alternative used should reflect the cause of the pain and the individual’s specific requirements, such as a need to avoid salicylates for example. In many cases physical treatments would be best, in others rest and relaxation, in yet others a herbal remedy.

While for a headache a person might take willow bark, for the pain associated with osteoarthritis the glucosamine and chondroitin combination was recently confirmed by researchers to be effective. Indeed, this latter treatment was shown to be superior to acetaminophen.

Try to avoid using acetaminophen (or paracetamol) if you can. If you still decide to use it, please take great care to minimize your use. Always avoid stockpiling the drug as availability to overdose quantities has been shown to correlate with higher incidence of liver damage and death.

According to a report released on Tuesday by the Trust for America’s Health (TFAH), hospitals are not prepared to handle the patients who would arrive after a disaster or a pandemic, most states have few plans in place for coping, and the federal government has not taken charge of such preparation.

President Bush released an influenza pandemic plan with great fanfare last month. Despite this and even though federal health experts have been issuing dire warnings for years, little has actually been done to get the nation ready, according to the report.

"While considerable progress has been achieved in improving America’s health emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face," the report’s authors state.

"To achieve an appropriate level of preparedness, efforts must be rapidly enhanced and accelerated, requiring improved policies and funding at all levels of government," added the report, based on a survey of 20 public health experts, who evaluated 12 aspects of health emergency preparedness.

The Trust report said the effects of Hurricane Katrina, which devastated Gulf of Mexico states in August and September, showed the poor level of U.S. preparation.

"The response to Hurricane Katrina was a sharp indictment of America’s emergency response capabilities," said Lowell Weicker, president of the Trust’s board and a former senator and governor of Connecticut, in a statement.

"This report provides further evidence of the major gap between response ‘plans’ and ‘realities.’ We need to get real in our planning for health emergencies."

There is no doubt that effective planning, including special skills development and practice, repays generously in terms of better health outcomes for regions and countries affected by various disasters. Some disasters by their nature can wipe away all the best laid plans in very short order. This means that preparation must include distributed response provisions including effective transport and communication.

Health is something I constantly attempt to persuade people to accept as a personal responsibility. However, it is also important to recognize the corporate or community dimension to health. This is a shared responsibility and it is one that governments must show effective leadership in engendering.

Back on October 12 I posted a Smallpox Vaccination Warning to help ensure the warning from the FDA didn’t go completely unnoticed. Today the Smallpox vaccinations that post referred to are back in the news. Why is that?

Well, it seems that vaccination marketing folks deemed the reaction to the earlier FDA warnings were quite mild (probably, barely noticable). So now they are using that information to condition people’s thinking.

What should you think? Well you should think that the vaccination people (whoever they are, it really doesn’t matter) are wonderfully open and honest people who confess all of the problems they cause. You must think this so that you will be amenable to the coming push to persuade you to go along and get vaccinated.

Of course, you should also think that such open and honest people are totally believable. Why exactly? That’s simple, so you’ll believe them when they tell you that black is white, or at least an acceptable gray. After all that’s what they’re doing when they say vaccination is quite safe, it only kills a few and makes hundreds sick when several thousands are vaccinated, and that’s fine isn’t it.

Vaccinated for what? Well, that doesn’t really matter either for now. Preferably vaccinated for anything and everything recommended. Trust us, is the subliminal message, we think only of your wellbeing.

Here is the Reuters news item.

Smallpox vaccine triggers few bad reactions-studies

CHICAGO (Reuters) – One hundred out of nearly 38,000 U.S. emergency workers inoculated with smallpox vaccine became seriously ill from the shot, which experts termed a relatively low rate of adverse reactions, their report said on Tuesday.

In 1980 the World Health Organization (WHO) declared smallpox eradicated globally, while childhood inoculations in the United States ceased in 1971.

But fears of a bio-terror attack employing the virus prompted the U.S. government in 2003 to create the voluntary vaccination program for so-called first responders such as police and health care workers.

The U.S. Centers for Disease Control and Prevention in Atlanta monitored reactions to the vaccine among the 37,901 emergency workers, finding that 722 suffered "nonserious adverse events" while 100 others became seriously ill.

Most reactions showed up within two weeks of the shot, with 21 involving inflammation of muscular tissue or a membrane around the heart, lead researcher Dr. Christine Casey wrote. Ten patients had ischemic events such as strokes that had not been seen before, two had skin eruptions and one developed inflammation of the brain.

Eighty-five patients recovered after a hospital stay, two suffered permanent disabilities, 10 had life-threatening illnesses and three died, the report published in this week’s issue of the Journal of the American Medical Association said.

Improved screening for potential heart, skin or other problems would cut down on adverse reactions and a smallpox vaccine under development may reduce them further, it said.

Another vaccination program begun earlier inoculated nearly 600,000 members of the U.S. military.

A related study in the journal said the two U.S. vaccination programs had triggered relatively few adverse neurological reactions, and most were mild.

Out of more than 600,000 people inoculated in the two programs, 214 had adverse reactions ranging from transitory headaches to cases of encephalitis, a potentially dangerous inflammation of the brain and spinal cord, researchers at the Centers for Disease Control said.

Other infrequent reactions including Guillain-Barre Syndrome, a temporary inflammation of the nerves, causing pain, weakness, and paralysis in the extremities; and Bell’s palsy, a paralysis of the facial muscles.

One person who suffered a seizure died.

The facts are that vaccination, apart from being unnecessary, is unavoidably dangerous. Furthermore, there are no longterm studies on its effects on your immune system, or anything else for that matter. Again I ask, are you happy to accept all the risks like a lab rat in this gigantic ongoing experiment, just so a few people can stay rich?

Personally, knowing that vaccination isn’t necessary, but a huge con perpetrated by the pharmaceutical industry supported by a narrow minded and self-interested medical profession and their political functionaries, I always feel for the individuals and families who constitute the acceptable casualties in the marketing campaigns. Next time you find yourself agreeing that a small number of deaths or serious and permanent illnesses is quite acceptable for the wider good (a rather pathetic utilitarian position), consider how you’d feel if those people were your parents, children, other family and friends. Next time, they very well could be.

Well the hype has settled but the ‘bird flu scare’ marketing still goes on. I have an entry on my own MyYahoo page that shows the following.

The Coming Influenza Pandemic?
December 5 Flu Update–US government says worst case is 1.9 million dead Americans in a flu pandmeic – 1 day ago
December 4 Flu Update
December 3 Flu Update–Is Tamiflu useless? – 2 days ago

And you can add to that the following item shown elsewhere on my page that is hot off the wire.

 Chinese girl is latest human bird flu victim

Now, granted, the flow has dropped off dramatically. It isn’t even daily in my brief sample above, just two days in three, or three in four counting today’s latest news. But look at how emotive those headlines remain. Make no mistake, that kind of news is designed to sell. Frighten yes, but this is just to motivate people to buy.

You can sample my response to the bird flu hysteria and calculated marketing in the following posts.

• Bird Flu Hype – 17 October
• Money Motivates Bird Flu Hype  – 17 October
• Bird Flu Profiteering – 25 October
• Bird Flu Hype Harmful, Not Helpful – 25 October

As you can see, I consider the hype to actually be harmful to health and wellbeing. I therefore consider this to be a moral issue, one the hype purveyors need to consider.

One person, Dr Tim O’Shea from San Jose, California, has documented some of the money relationships in this sorry mess. You will recognize some names here.

THE MONEY BEHIND AVIAN FLU

As with the marketing of smallpox vaccine in 2002 [8] and the marketing of SARS in 2003 [6], it’s a fairly safe bet the threat of avian flu will disappear as soon as the money has been spent stockpiling the drugs and vaccines. That’s the usual pattern. Count on it.

The two remedies for avian flu being hawked daily from every quarter are Tamiflu and a new flu vaccine.

Let’s look behind the scenes a little and see whose money is on the line here, and who would benefit from the sale of enough of these drugs for the entire world.

First Tamiflu.

In 1996 two drug giants – Hoffman LaRoche and Gilead Sciences agreed to split the world between them. Gilead had invented a new type of flu drugs called neuraminidase inhibitors, which included Tamiflu. [9] The deal was that LaRoche could research and market the drug worldwide, and Gilead would be paid residuals. Forever.

Gilead Sciences, located in Foster City, California, joined the NASDAQ 100 in 2001. Its 2004 revenues were only $1.3 billion, [9] but that’s about to change.

From 1997 until the time he was sworn in as Secretary of Defense in 2001, guess who had been Chairman of the Board of Gilead Sciences. Donald Rumsfeld. Don’t believe it? Good. Look at the Dept of Defense website. [10] At present Rumsfeld continues to receive stock and benefits from Gilead, and is a major shareholder. [11]

Another member of Gilead’s Board of Directors is George Schultz, whom you may remember as Secretary of Treasury under Nixon. [9] One of the financial directors of the Vietnam war, Schultz is still technically alive.

So. How does the financial future of Gilead appear, with sales of Tamiflu?

Best estimates at present: between $1 – 1.8 billion. And that’s just for the US market. [12, 13] Such a figure would double Gilead’s total income for 2004. Just for one drug.

Taking the global market into consideration, sales revenue from Tamiflu is virtually "unlimited." [13] A sacred word for investors.

The US Senate approved $3.9 billion for Tamiflu purchase back in Sept 2005 with virtually no discussion. [13] And Gilead smiled.

But the best news for investors is that the Tamiflu windfall will be around for a long time. Again, from the WHO FAQ sheet:

"At present manufacturing capacity, which has recently quadrupled, it will take a decade to produce enough oseltamivir to treat 20% of the world’s population." [5]

Oseltamivir – that’s Tamiflu.

Keep asking yourself: who would benefit from the threat of pandemic?

You can see the whole excellent article at Dr O’Shea’s website where you’ll be able to find the sources he cites above. I encourage you to read the whole article because it articulates quite clearly just what a giant scam this bird flu fiasco really is. Luckily people seem to have short memories because many people should be quite embarrassed by their rhetoric.