Penn study: OTC medications and supplements are most common causes of drug-induced liver failure

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Study upends common belief that prescription drugs are prime culprits in causing liver failure

IMAGE:This is David Goldberg, assistant professor of Medicine and medical director of Living Donor Liver Transplantation at the Perelman School of Medicine at the University of Pennsylvania view more

Credit: Penn Medicine

PHILADELPHIA - Drug-induced acute liver failure is uncommon, and over-the-counter medications and dietary and herbal supplements -- not prescription drugs -- are its most common causes, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The findings are published in the current issue of Gastroenterology.

One of the most feared complications of drugs and medications is acute liver failure, traditionally associated with a greater than 50 percent chance of dying without a liver transplant. Drug-induced liver injury, known as hepatotoxicity, is the second most common reason drugs are withdrawn from the market, behind cardiac toxicity, according to the U.S. Food and Drug Administration (FDA). The Penn authors, however, say this is based solely on abnormal liver tests, not actual liver damage. The real risk of acute liver failure that the researchers calculated was 1.61 per million people per year.

"Despite widely publicized cases of drug-induced acute liver failure related to acetaminophen and other medications, there are, until now, no studies to specifically evaluate the incidence of acute liver failure arising from drug-induced liver injury in the broader population," says senior author Vincent Lo Re, MD, MSCE, assistant professor of Medicine in the division of Infectious Diseases and assistant professor of Epidemiology in the Perelman School of Medicine at the University of Pennsylvania.

Lo Re and his team, including lead author, David Goldberg, MD, MSCE, assistant professor of Medicine and medical director of Living Donor Liver Transplantation at Penn, set out to uncover the incidence and outcomes of drug-induced acute liver failure in the United States through the analysis of data from an integrated healthcare system that is representative of the broader U.S. population.

They looked at data from Kaiser Permanente Northern California between January 1, 2004 and December 31, 2010, to assess the true impact of acute liver failure in the U.S.

Among the 5,484,224 patients evaluated, 62 were identified with acute liver failure, nearly half of which were drug-induced. Acetaminophen was implicated in 56 percent of cases, dietary/herbal supplements in 19 percent, antibiotics in 6 percent and miscellaneous medications in 18 percent.

Despite hepatotoxicity being the second most common cause of drug withdrawal from the market, acute liver failure, the most severe form of liver injury, from prescription drugs was rare, the team found. "We discovered that 75 percent of acute liver failure cases resulting from prescribed medication use were derived from over-the-counter products such as acetaminophen or herbal supplements," says Goldberg. "Prescription medications are an exceedingly rare cause of acute liver failure."

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Penn study: OTC medications and supplements are most common causes of drug-induced liver failure

WSU medical school bills take detour in House, Senate

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Bills that would give Washington State University the authority to start a medical school in Spokane have hit an unexpected detour.

OLYMPIA Bills that would give Washington State University the authority to start a medical school in Spokane bills that seemed on the fast track last week have hit an unexpected detour.

The House and Senate budget committees will hold hearings on the costs of a proposed medical school before legislative leaders will allow full votes in either chamber.

Supporters of the project said Tuesday its not a roadblock, but bill sponsors are surprised that legislation specifically rewritten to leave funding questions for later will need approval from the House Appropriations and Senate Ways and Means committees before facing full votes in each chamber.

We certainly hope the bill doesnt get caught up in overall budget negotiations, said Sen. Mike Baumgartner, R-Spokane.

Rep. Marcus Riccelli, D-Spokane, said the bills were written to split the discussion over a new medical school in Spokane. The first step was to rewrite state law to give WSU the authority to offer that medical education; the amount of money the state would provide for the school would be decided later.

State law currently restricts medical education to UW. The law, which has its roots in the Legislature settling a fight over education majors for the two institutions in 1917, is antiquated, Riccelli and Baumgartner both argue.

Companion bills in each chamber were amended to remove language that specifically directs the WSU regents to start a school, and instead merely give them the permission. Those passed out of each chambers Higher Education Committee last week with directions to go to the committees that schedule bills for a vote of the full chamber. A day or so later, they were rerouted to the budget committees.

The University of Washington has raised questions about past spending for its medical-school program in Spokane that was funneled through WSU when both schools were involved in the program. But thats reportedly not the reason the bills were referred to budget committees.

The nonpartisan legal counsel for the Senate Ways and Means Committee said the panel should consider the proposal because of its long-term budget implications, said Senate Majority Leader Mark Schoesler, R-Ritzville.

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WSU medical school bills take detour in House, Senate

Medical School to modify admissions requirements for 2017

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The University's Medical School is changing it up.

Beginning with prospective students entering in 2017, the Medical School has altered the admissions requirements for its applicants. Requirements previously included a list of eight courses in subjects such as organic chemistry and biochemistry. They now consist of qualities and experiences the Medical School looks for in its students.

Most of the new prerequisites are framed more broadly: rigorous experience in the humanities, academic strength and rigor in the fields of biology, chemistry and statistical methods and analysis; demonstrable knowledge of basic physical principles; and a clear and distinct experience in intellectual inquiry and active participation in the independent discovery of new knowledge.

Though these prerequisites may seem less specific than a list of classes, Rajesh Mangrulkar, associate dean for medical student education, expressed the opposite sentiment. He said the new requirements allow the admissions office to be more specific, telling the students the exact information the Medical School needs them to know prior to matriculation. He said listing a class title does not convey that information as effectively.

When you look at a course name, do you know what youre able to do because of having taken that course? Mangrulkar asked.

Steven Gay, assistant dean for admissions, also discussed the logic behind requiring proficiency in topics rather than class credit. He said the old requirements did not take into account that students may learn necessary material outside of the conventional classroom.

We see a number of students right now with advanced degrees, or who have spent extensive time in labs, Gay said. I think we should give students the opportunity if they are learning in those innovative and different ways not to have to repeat things unnecessarily.

Mangrulkar said the new application process is meant to create a dialogue in which students can reflect on how they have earned the knowledge they need, whether it be from a class or from another experience.

The student will be able to say, alright, these are the expectations, let me reflect on what Ive done and show how these all meet those different criteria, Mangrulkar said. Thats a better way to have a conversation than what weve had in the past, which is basically a student saying I took this class, is this okay?

Gay said that, though students have the freedom to gain knowledge in unique ways under the new requirements, taking classes is still the easiest way to fulfill the prerequisites.

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Medical School to modify admissions requirements for 2017

Education officials ask lawmakers to increase medical school funding past governor's proposal

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CARSON CITY, Nev. Nevada higher education officials on Tuesday asked legislators for three times more money than the governor has proposed to ramp up construction of a medical school in Las Vegas.

Nevada System of Higher Education officials presented their budget requests to a joint Assembly and Senate committee and asked for about $26 million for a medical school at the University of Nevada, Las Vegas.

In his proposed budget, Gov. Brian Sandoval allocated around $8.3 million over two years for the medical school. UNLV School of Medicine Dean Barbara Atkinson told lawmakers that increasing funding to $26.7 million over two years would help the school attract more donors and help with the accreditation process so it could begin accepting students in 2017.

"We're looking for a base of hard money support," Atkinson said. "Donors are going to feel very unsettled."

System of Higher Education Chancellor Dan Klaich also asked lawmakers for "bridge funding" for a number of rural community colleges and research institutions.

Great Basin College President Mark Curtis told lawmakers that changes to the state's funding formula meant the Elko-based school would see a reduction of $2 million from state allocations, after already cutting around $4 million in the past five years. Curtis said a one-time funding increase would help the college transition to a lower budget allocation.

"We're kind of at a pinch point relative to the funding formula," he said. "We believe it will take us an additional year and a half or so without doing any serious damage to the college."

In total, Klaich said the higher education system is requesting around $8.65 million in transitional money for Great Basin College, Western Nevada college, the Desert Research Institute and Boyd School of Law at UNLV.

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Education officials ask lawmakers to increase medical school funding past governor's proposal

Scholarship fund created to keep medical students in WNY

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Hoping to offset physician shortages in certain specialties, a group of doctors here has created a scholarship to encourage medical school students to stay in Western New York after they graduate.

The Western New York Medical Scholarship Fund recently awarded its first three recipients a minimum of $30,000 each annually for four years of education at the University at Buffalo School of Medicine and Biomedical Sciences.

The award winners must demonstrate financial need, graduate from a high school in one of the eight counties of Western New York, attend UB medical school and agree to practice in the region for an unspecified number of years.

The first three recipients are James Miller, a graduate of Frontier High School; Gina Sparacino, a Kenmore East High School graduate; and Alyssa Volmrich, a graduate of Holy Angels Academy.

Our goal is to keep more locally trained doctors in Western New York, Dr. John J. Bodkin II, co-chairman and founder of the fund, said in a statement.

Bodkin, a family physician at Highgate Medical Group, said similar programs in other cities have been successful.

We felt that if we could offer scholarships to Western New York students who went to high school here and have established family ties here, and then offer incentives, such as mentoring by local doctors, we could influence them to stay and practice here after graduation and residency, he said.

The funds goal is to raise enough money to sustain six to 10 scholarships a year over the next decade.

Organizations that have contributed a full scholarship include the Catholic Health System, Erie County Medical Center, HealthNow New York, Independent Health, Kaleida Health, Roswell Park Cancer Institute, and West-Herr Automotive Group, as well as the UB medical school and the UB Medical Alumni Association.

Contributors to the funds endowment include Amherst Ear Nose and Throat, Great Lakes Medical Imaging, Highgate Medical Group, Nephrology Associates of WNY, Northtowns Cardiology, Dr. Gerald Sufrin, WNY Urology Associates, Windsong Radiology Group and David M. Zebro, a principal of Strategic Investments & Holdings.

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Scholarship fund created to keep medical students in WNY

Sequencing the hookworm

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Ancylostoma ceylanicum genome provides researchers potential new drug and vaccine targets

WORCESTER, MA - In an advance that may potentially lead to new treatments for parasitic hookworms, scientists at the University of Massachusetts Medical School and Cornell University have sequenced the genome of the hookworm, Ancylostoma ceylanicum. The genome of the nematode that, according to some estimates, infects as many as 400 million people worldwide will help researchers find genes active during infection and devise new drugs or vaccines that target these genes. The study, which also includes researchers from the University of California San Diego and the California Institute of Technology, was published in Nature Genetics.

A debilitating tropical disease second only to malaria, hookworms are a leading cause of maternal and childhood morbidity in developing countries. They can live in the small intestine for as long as 10 years, drinking blood, robbing their hosts of iron and protein, interfering with absorption of critical nutrients and suppressing the immune system. Infection can lead to chronic anemia, as well as permanently stunt physical and intellectual development in infected children.

"The health burdens associated with soil-transmitted hookworms, especially in developing countries in Africa and the tropics are enormous," said Raffi V. Aroian, PhD, professor of molecular medicine at UMass Medical School and co-author of the study. "The only drugs we have to combat these parasites were developed to treat farm animals and are only partially effective. There is a tremendous need for a treatment for hookworms in humans that is safe, effective and affordable in the world's poorest countries."

Three species of hookworms can infect humans. People most commonly infected typically reside in poverty stricken areas with poor sanitation and are exposed to the worm through contaminated soil or food. Common in the American south 100 years ago, hookworms were virtually eradicated in the United States through improvements in sanitation and public health efforts during the early part of the 20th century.

Contemporary efforts to study the parasitic nematode have been hampered because the most common species, Necator americanus and Ancylostoma duodenale, cannot survive outside of a human host. This makes it difficult for researchers to study them in the lab and almost impossible to test new drugs and vaccines. It is why current treatments rely on drugs developed to treat similar worms in farm animals.

Though less common, because A. ceylanicum can infect and thrive in animals other than humans, such as rodents, it is an excellent experimental model for hookworm disease that allows scientists to study it in the laboratory. It also opens up the possibility that new drugs or vaccines for human hookworms can be designed and tested using A. ceylanicum.

"For this to happen, we first have to know as much as possible about A. ceylanicum's genes and the proteins they make," said Erich M. Schwarz, PhD, senior research associate at Cornell University and co-author of the study. "Until recently this would have been a very expensive and difficult undertaking, but next-generation technologies for analyzing DNA have made it possible for a small number of scientists to sequence and characterize the entire genome of an animal."

Isolating and sequencing DNA and RNA from hookworms during different stages of infection led to several significant findings. The A. ceylanicum genome constrains 313 million nucleotides, with 30,738 genes that encode for proteins and show gene activity. Researchers were also able to identify specific genes involved in infection. Among the genes identified were three large families of previously unknown proteins that are strongly synthesized during three different steps of infection. They also found more than 70 genes that likely encode for proteins which the worms need to survive but which are absent from mammals, making them possible drug targets. Finally, they found five genes that are extremely active in adult worms and are promising targets for vaccination because they are likely needed for feeding.

"The sequencing of A. ceylanicum adds to a growing number of genomes for parasitic nematodes that collectively infect over a billion people worldwide," said Dr. Aroian. "These genomes are crucial for inventing new drugs and vaccines against parasitic nematodes that rapidly evolve drug resistance and plague large populations in developing countries. With these new genomes we can begin rationally designing and testing treatments in the laboratory that can potentially benefit millions of people."

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Sequencing the hookworm

Funding approved for USF medical school in downtown Tampa

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TAMPA (FOX 13) -

The vacant one-acre site at the corner of Channelside Drive and Meridian Avenue in downtown Tampa is a step closer to becoming the new USF Medical School.

Thursday, the Florida Board of Governors, which governs the state university system, approved a $153 million plan, funding construction of the new Morsani College of Medicine and USF Heart Institute.

It's very important to be co-located. It's the right academic move for USF to be next to TGH, said USF President Dr. Judy Genshaft. Most of the students live downtown, and go back and forth to the campus, so there will be no additional costs to students.

The new school would put medical students much closer to Tampa General Hospital, the primary teaching hospital for the medical school. The location is also blocks away from USF CAMLS, the University's 3-story, 90,000 square foot, state-of-the-art simulation lab.

For the bigger Tampa Bay region, this is a game changer, says Tampa Mayor Bob Buckhorn. To now know that we are the vast majority of the way there to moving that medical school downtown for us is probably the most significant event that has occurred in the urban core in the last 20 years."

Tampa Bay Lightning owner Jeff Vinik, who donated the parcel of land to USF, released this statement:

"We are thrilled with today's news from Tallahassee and as a 'partner' with the University of South Florida on the project, we thank the Florida Board of Governors for their unanimous vote today. We look forward to making the Morsani School of Medicine and the accompanying Heart Institute one of the major anchors in our development district. We envision and embrace the vibrancy that USF and its students, faculty and staff will bring to downtown Tampa. This marks a great step forward."

The plan now must be approved by the lawmakers and Governor Rick Scott.

Under the current proposal, the University needs $57 million for the school, and an additional $50 million for the Heart Institute. Private sources would fund $41 million of the project.

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Funding approved for USF medical school in downtown Tampa

Let WSU open a medical school in Spokane

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Originally published February 26, 2015 at 6:21 PM | Page modified February 26, 2015 at 6:22 PM

AS a practicing physician and part of the management team at a large health-care organization in Seattle, Im constantly reminded of the many benefits that our region enjoys by having such a robust and forward-looking health-care infrastructure.

From Medic One to the development of new, cutting-edge drug therapies and medical devices, and pushing the envelope on delivering the best health outcomes for the lowest cost, we are innovators. All of this contributes to better care for patients.

But when it comes to one aspect of our medical infrastructure, namely that we have only one public medical school, our state lags in performance. This isnt just an inconvenience for qualified students who must leave our state to pursue their medical educations elsewhere, its a problem that affects the quality of life, economy and health of everyone who calls our great state home.

While we enjoy a high density of doctors in Seattle, not far outside the city limits the situation is much different. Travel to one of our states rural communities and the physician shortage is acute. Physician retirement, population growth and increased access to health care for previously uninsured people are making this problem worse.

There are currently two proposals on the table to grow medical education in our state. One would expand the University of Washingtons existing program. The other would establish a new medical school on Washington State Universitys Spokane campus.

These are the questions our state legislators are grappling with today, and I applaud them for their thoughtfulness. Disappointingly, however, some are characterizing this as an either-or decision. The truth is that we need both programs. Any solution that does not include establishing a new medical school will fail to meet the test of the challenges our state confronts.

The University of Washington School of Medicine is an outstanding medical school, and I am a proud graduate of that program. But in a state of more than 7 million people, UW admits only 120 students from Washington each year. This is the lowest per capita number of medical-school seats for any state with a medical school. Each year, more than 200 highly qualified Washington students get accepted to medical schools out of state, and many never return. These students deserve greater choice, and the best long-term option is to create a second medical school.

Even if we increase the number of students taught by the UW as it is proposing our state will continue to fall behind in meeting the needs of our underserved communities.

Because of the investments that have already been made by WSU in faculty and facilities, the cost of establishing a new medical school is much lower than it would be if we were starting from scratch. And the universitys proposed approach to medical education is a community-based model that would further keep costs low by utilizing existing clinical infrastructure across the state.

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Let WSU open a medical school in Spokane

A conversation families need to have, but don't

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He acknowledged that having a conversation about end-of-life measures such as cardiopulmonary resuscitation, and the consequences of not receiving it, does not come easily to many people.

"I think it's difficult for families because they don't know what might happen" to a loved one in the future, he said.

But waiting to discuss those issues until they actually need to be decided can make things worse.

"I think it's extremely difficult for families, because families are often forced into this position at the worst time," Volandes said. "And I blame doctors."

Volandes doesn't exempt himself from this finger-pointing. Doctors often know the treatment and procedures they are administering to terminally ill patients are ultimately futile, costly and the source of pain and stress.

Dr. David Goodman, a Dartmouth Medical School professor, in 2013 co-authored a study published in the Journal of American Medical Association that found that while there had been an increase in the use of hospice services over the prior decade, there also had been an increase in the use of intensive care units. The study found that while more people were going to hospice, many were going there just for a few days after being in the ICU.

Goodman has cited the case of his colon cancer-stricken sister, who died while undergoing a medical procedure just a day before she was supposed to enter hospice and spend her final days there.

"Poor communication leading to unwanted care is epidemic in many health systems," Goodman said at the time the JAMA report was issued. "The patterns of care observed in this study reflect needlessly painful experiences suffered by many patients, including my sister, and other friends and family members of the research team,"

Early in Volandes' book, he writes about being a young resident and treating a 78-year-old, terminally ill lung cancer patient, a mine worker and immigrant from Ukraine whose condition left him "too confused to have a lucid conversation," and who "lacked family members to guide his decision-making."

"So his medical plan was the default for all patients: Do everything possible to keep him alive," Volandes wrote.

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A conversation families need to have, but don't

Liberty Global (LBTYA) Stock Gains Today on Takeover Speculation

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NEW YORK (TheStreet) -- Liberty Global (LBTYA - Get Report) shares are up 1.28% to $53.16 in early market trading on Tuesday following reports that the international telecommunications and television programmer is a takeover target, according to theNew York Times Dealbook.

Though yesterday's report does not suggest that a deal is imminent, the article does suggest that Vodafone (VOD) is a potential suitor with an outside shot at acquiring the company, while media conglomerates Comcast (CMCSA) and AT&T (T) are also seen as potential players in the coming years.

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Liberty Global is the largest international cable television company in the world with a market cap exceeding $40 billion. Its customer base exceeds 27 million subscribers and it generates more than $20 billion in revenue annually.

The company denied being open to a takeover with CEO Michael Fries tellingthe paper that the company has no plans to sell at this time.

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Liberty Global (LBTYA) Stock Gains Today on Takeover Speculation

Here's a Reason Liberty Media (LMCA) Stock is Slumping Today

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NEW YORK (TheStreet) -- Shares ofLiberty Media (LMCA - Get Report)are down 0.59% to $39.62 in afternoon trading on Thursday after Deutsche Bank initiated coverage with a "hold" rating and a $43 price target.

"Our price target only implies 7% upside, which we find to be too limited, but we do point out that Liberty and its related companies have historically created significant value through making wise investments, effective capital allocation, financial engineering and tax structuring," Deutsche Bank noted about the media company.

This potential but limited upside comes from two sources, a narrowing of the net asset value (NAV) discount to 7.5% from an estimated 12% and the upside implied by the price targets for Time Warner (TWX) ($100) and Viacom (VIAB) ($83), the firm's analysts estimate.

Last year, Liberty attempted to merge with SiriusXM (SIRI), analysts said, adding that "Liberty Media has said it would consider another merger proposal under the right circumstances, and we see narrowing the NAV discount as the key to this."

Liberty Mediafocuses on the media, communications and entertainment industries through its ownership of interests in subsidiaries and other companies.

Separately, TheStreet Ratings team rates LIBERTY MEDIA CORP as a Hold with a ratings score of C. TheStreet Ratings Team has this to say about their recommendation:

"We rate LIBERTY MEDIA CORP (LMCA) a HOLD. The primary factors that have impacted our rating are mixed some indicating strength, some showing weaknesses, with little evidence to justify the expectation of either a positive or negative performance for this stock relative to most other stocks. The company's strengths can be seen in multiple areas, such as its revenue growth, expanding profit margins and largely solid financial position with reasonable debt levels by most measures. However, as a counter to these strengths, we also find weaknesses including deteriorating net income, disappointing return on equity and weak operating cash flow."

Highlights from the analysis by TheStreet Ratings Team goes as follows:

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Here's a Reason Liberty Media (LMCA) Stock is Slumping Today

Valentine's Day love dispute turns violent in Liberty County

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The Liberty County Sheriff's Office is searching for a Dayton man accused of shooting another man five times in a dispute over a woman early Saturday.

Police said Marshal Gerald Coffin, whose age was not released, confronted Victor Robert Pereida about 6:15 a.m. at the south Liberty County home that Pereida shares with a woman.

Witnesses told police that Coffin was in a relationship with the woman and confronted Pereida about his relationship with the same woman, according to officials.

Investigators said Coffin then shot Pereida four times in the torso and once in the leg with a .380 caliber semi-automatic pistol and fled.

Pereida, 50, remains in critical condition after being airlifted to a Houston hospital, according to the sheriff's office.

Coffin has been charged with aggravated assault.

Investigators said Coffin apparently lives in the 7100 block of Highway 90 in Dayton and drives a gold 1998 Ford Ranger pick-up truck. The Texas license number is AP8 0494.

If you have any information about Coffin's location, contact the Liberty County Sheriff's Office at (936) 336-4500.

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Valentine's Day love dispute turns violent in Liberty County