Attempts have been made to determine what influences the degree of inflammation in the liver since not all people with hepatitis C have the same degree of inflammation even with the same length of infection. It appears that route of infection and excessive alcohol intake may both be major factors causing more extensive inflammation. Some studies have shown that hepatitis was more severe and the progression to cirrhosis was sooner in blood transfusion recipients and in persons who consumed alcohol on a daily basis. The interaction between alcohol and hepatitis C is poorly understood, although it is generally accepted that alcohol makes the virus more active and potentiates the progression of liver disease.

There is still controversy as to whether genotype plays a role in the severity of the inflammation; some studies suggest that it does and others found no correlation. While some studies have suggested that genotype 2 caused more active inflammation, patients with genotype 2 were older, and there were differences between the quality and distribution of all the morphological lesions in the liver. As well, viral load as determined by PCR has been studied and appears not to be a factor relative to the severity of liver disease. These authors again confirm that genotype does not appear to be a factor

The time it takes for the progression of liver disease has been fairly well studied. On average it takes 18-20 years for the progression to cirrhosis and 25-28 years for the occurrence of liver cell cancer. It has also been shown that patients over 50 years of age progress more rapidly to cirrhosis and the time period is 1.8 times faster than younger patients.
 

News Release Mon 16 Nov 98--Mr. Adolf Huckschlag reports:

Following extensive international clinical and preclinical trials, Alta Natural Herbs & Supplements will now begin distribution of Hepatico in Canada. Upon reviewing 17 independent reports regarding the effectiveness of Hepatico on Hep-C, Alta Natural Herbs & Supplements launched independent human tests in Canada and the United States. Preliminary results have confirmed the overseas findings. Based upon the examination of the preliminary results and after comparisons to the European scientific data conducted between 1992 and 1996, Alta Natural Herbs & Supplements is verifying the validity of the effectiveness of Hepatico as a primary therapy for persons suffering from toxic and viral liver dysfunction.
 

Susan Campbell, RN, has been added to Dr. Anderson's staff. Susan was the coordinator of the Hoffman/LaRoche project into Pegylated Interferon (PEG IFN—a special type of IFN that requires a weekly injection as opposed to the current three times a week injections). Dr. Anderson was setting up a clinical trial in PEG IFN and convinced Susan to join his staff. Susan is a hepatology clinical research nurse and is in charge of his PEG IFN trial. In addition to that study, Susan is also in charge of three Hep B trials.

As new trials are started at the office, either Natalie and Susan will take charge, depending upon how busy they are at that time. I think this is a very good thing for all of us, as it will ultimately lead to an increase the number of clinical trials that Dr. Anderson can investigate.

Susan specialized in Pediatrics at the Winnipeg Health Sciences Center (Hospital) for 15 years prior to coming to BC. We would like to extend a very warm welcome to her and also express our early thanks for all the help she will undoubtedly be doing for us.

The PEG IFN study should be underway soon. This form of IFN will establish a more stable blood level and through that may be more effective. Interested individuals should contact Susan at (604) 876-5122 to learn more about the criteria for entering into the trial.
 

The Travel Assistance Program is sponsored by the BC Ministry of Health and Ministry Responsible for Seniors.

TAP was created to help residents of BC to access health care services that they cannot obtain unless they travel.

In other words, if you have to travel to get access to specialists in Vancouver, for example, the TAP program will pay for, or give you discounts for your travel costs, such as ferry fares, for you, your vehicle, and for an escort, if one is needed.

Please ask your doctor for a form to complete. You also need to contact MSP to verify your eligibility and to receive a confirmation number before you travel. (Phone number below)

You are eligible if you are a BC resident enrolled in the Medical Services Plan, and your travel expenses aren't covered by other insurance policies. There are regulations such as arriving at the ferry, for example, one hour before departure.

This program doesn't include meals, accommodations, car expenses, or local transportation. You must make your own travel and accommodation arrangements. You may obtain more information by calling MSP at 1-800-661-2668 from 8:30 am to 4:30 PM, Monday through Friday. You may also call 387-8277 in Victoria.
 

Sakaida I, Matsumura Y, Akiyama S, Hayashi K, Ishige A, Okita K First Department of Internal Medicine, School of Medicine, Yamaguchi University, Japan.

BACKGROUND/AIM: A herbal medicine, Sho-saiko-to (TJ-9), has recently been orally administered to patients with chronic liver disease in Japan and has been reported to inhibit the development of hepatocellular carcinoma. The aim of this study was to investigate whether TJ-9 has an inhibitory effect on the development of preneoplastic lesions and liver fibrosis in rats.

METHODS: The effects of the TJ-9 were examined using the choline-deficient L-amino acid-defined (CDAA) diet-induced liver fibrosis model in 16-week-old male Wistar rats.

RESULTS: TJ-9 (1% w/w) prevented fibrosis, as indicated by reduced hydroxyproline content in the liver and inhibition of the increase in a serum marker of fibrosis (hyaluronic acid), without reducing the increase in serum alanine aminotransferase and aspartate aminotransferase. TJ-9 also reduced the expression of type III procollagen alpha 1 mRNA in the liver, as well as the proliferation of myofibroblast-like cells (activated stellate cells, activated Ito cells). Furthermore, TJ-9 reduced the number of preneoplastic lesions, detected as enzyme-altered (glutathione S-transferase placental form-positive) lesions, in the liver.

CONCLUSIONS: These results indicate that the herbal medicine Sho-saiko-to (TJ-9) prevents fibrosis as well as preneoplastic lesions, not by inhibiting hepatocyte cell death but by inhibiting the activation of stellate cells, which are considered to be the main collagen-producing cells, leading to a reduction in the development of preneoplastic lesions. PMID: 9514543, UI: 98173478

Editors’ Note: The National Institutes of Health warn, "Interstitial pneumonia as an adverse reaction to the herbal drug was stated first under Adverse Reactions in the Precautions in April 1 1991. It was then further stated under General Precautions in December 1992. Since interstitial pneumonia was reported in patients with chronic active hepatitis C receiving shosaikoto concurrently with interferon when the indications for interferon were extended to include this disease in the spring of 1991, concomitant administration with interferon was contraindicated in January 1994."
 

As a number a therapies use plants in their healing work, confusion exists as to their differences. There are the culturally diverse medical systems of the world that use plants as the core of treatments, such as Ayurveda from India, Traditional Chinese Medicine and Islamic Unani medicine.

Amongst western therapies Homeopathy, Aromatherapy and the Bach Flower remedies make extensive use of herbs. The majority of drugs used in orthodox medicine are either derived from plants or are actually plant products.

Homeopathy is the main system of medicine other than Medical Herbalism that utilises plants in the treatment of disease, though in a fundamentally different way to Medical Herbalism. There is a common misconception that these two healing modalities are the same because they both employ plants.

Indeed, herbs are used by both approaches but in radically different ways, reflecting differences of philosophy and therapeutics. The holistic perspective being explored by their practitioners can complement each other, but only when the strengths and weaknesses of each are acknowledged and understood. There is not space here to give homeopathy the attention it deserves, but simply to compare the use of herbs in the two approaches.

As with other approaches to holistic medicine, homeopathy looks at the patients’ total picture, both body and mind within the social setting of their lives. The system originated in Germany around 1800, with the work of Samuel Hahnemann. He treated disease with a very low dose of drugs which themselves produced similar symptoms to those of the disease itself. This is the basis of the principle that like treats like.

About 60% of homeopathic remedies are botanical in nature, the rest being minerals, animal products or nosodes. These last remedies are highly diluted extracts of diseased tissue. These medicines are administered in extremely diluted form and are thought to work by influencing the vital force within the human body. The more the dose of the remedy is reduced so the more its potency is enhanced. This is why the homeopathic process of dilution is known as potentiation. The dilation of one part of the active remedy in ten parts of the solvent (usually water) is known as a potency of 1X. A one in a hundred dilution is 2X and so on to 200X dilution. A homeopathic mother tincture is similar to an ordinary herbal tincture.

A problem that gets in the way of mutual understanding between the two. therapies is the application of the concept of like treating like. Many of .the herbs in the homeopathic Materia Medica are prescribed in dilution to treat symptom pictures that a full dose of the herb supposedly causes. This may be the case with very strong or poisonous herbs such as belladona. or gelsemium, but the medical herbalist has problems with the homeopath’s ideas about many of the remedies both systems share. An example is the homeopathic remedy pulsatilla, known as Pasque Flower (Anemome pulsatilla) to the herbalist. A comparison of the symptom picture given for the homeopathic remedy is very similar to the indications for herbal dosages of the plant. As both approaches use the herb to treat similar things, this would appear to contradict the core idea.

The value of homeopathy in health care is undeniable, but its use of plants is in no way herbal. Selecting either therapy should be based upon attraction to one or other of their philosophical contexts recognising that there is little or no sharing of botanical medicine.

The Herbalist by David Hoffman, (c)1993 David Hoffman, Hopkins Technology
 

Director, Division of Antiviral Drug Products

From Brian Klein, HAAC-Hepatitis C Action & Advocacy Coalition

November 16, 1998

The FDA should not approve Rebetron for treatment-naive patients in its bundled form. A new advisory committee should be called to publicly review the FDA initial approval of this unprecedented bundled drug combination. This bundling is preventing many doctors and patients with hepatitis C from using these drugs effectively. I call for a review based on concerns of efficacy of these therapies as many patients need to realistically use them.

In an October 15 meeting with patient advocates, Dr. Robert Spiegel, Chief Medical Officer of Schering and Kathleen Hurtado, Vice President of Sales and Marketing, verbally agreed to develop a compassionate use program whereby patients could obtain ribavirin separately from them for use in combinations other than that used in Rebetron. While we wait to see if Schering is actually going to honor the word of their own representatives, the fact that they would suggest a program where HCV patients could obtain ribavirin separately admits to Schering's knowledge that there are safe and clinically effective legitimate uses for ribavirin other than in the Rebetron package; it belies all of their clinical safety and efficacy reasoning they say necessitates the bundled package.

Schering has no intention of unilaterally interrupting their profits or their plan to boost sales of Intron A through this unprecedented approval of Rebetron. Ethics and realistic patient needs in this case do not seem to be of real concern to them. Since the initial Rebetron approval, the FDA has been given facts from many patients on the insanity of this situation. The FDA has a chance to correct a mistake, and help patients to get appropriate treatment. Now it looks as if the FDA is about to make the same mistake twice, by not taking this chance to unbundle Rebetron and make ribavirin available separately with appropriate labeling.
 

Ann Intern Med 1997;127:875-881[Medline] .

Marcellin et al. studied a cohort of 80 patients with hepatitis C who had a sustained response to interferon alfa (IFN) therapy and were followed up to determine the durability of the response. These patients represented approximately 18% of an overall group of 450 treated with IFN at their institution. Sustained response was defined as a normal alanine aminotransferase (ALT) level each month for the first 6 months after completion of therapy and absence of hepatitis C virus (HCV) RNA in the serum 6 months after completion of therapy. HCV RNA was measured in the serum using the Amplicor assay (Roche, Nutley, NJ). HCV RNA titer was measured using the branched DNA assay (Chiron, Emeryville, CA). Follow-up ranged from 1 year after completion of therapy to 7.6 years (mean, 4 ± 2 years). At least one biopsy was performed in 69 patients after therapy, ranging from 1 to 6 years after therapy. Forty-eight of 69 patients underwent liver biopsies a year or more after completion of treatment. The mean interval to biopsy among these patients was 2.2 ± 1.3 years. Histology was scored using the Knodell scoring system. A 2-point reduction in score was noted as "improved," a 1-point reduction and no change was defined as "no change," and any increase was defined as "worsened." Over the follow-up period, 93% of patients had persistently normal aminotransferase levels and 96% remained HCV RNA seronegative. The overwhelming majority had an improvement in liver histology (94%) between the first and second biopsy. Furthermore, liver biopsy findings became normal or near-normal in 60%. HCV RNA was also undetectable in liver tissue after therapy in all patients who were tested. The treatment regimens were variable. Patients were treated with IFN, lymphoblastoid IFN-n1 or interferon-2a. Fifty (63%) were treated in a clinical trial, and 30 received standard open-label therapy. The majority of patients (75%) received IFN at a dose of 3 million units three times a week for 6 months. There was no deterioration in liver function in the 5 patients with cirrhosis and no progression to cirrhosis among the 75 patients without cirrhosis. Fatigue was present in 60% of the patients, and reportedly improved in all patients after treatment. Serum HCV RNA levels were determined for up to 7 years after completion of therapy. Data were available on 53% of responders at 4 years, 30% at 5 years, 18% at 6 years, and 2.5% at 7 years. Ninety-six percent remained negative for HCV RNA; 1 patient had a transient recurrence of viremia, and 2 patients experienced relapse at 24 and 36 months.

Comment. The study by Marcellin et al. provides important new information about the durability of the response to IFN in patients with chronic hepatitis C. Late relapse was uncommon in patients with hepatitis C who had a sustained response to IFN therapy, defined by the absence of HCV RNA in the serum and normal serum ALT levels 6 months after completion of therapy. Furthermore, liver histology was significantly improved or even normal after therapy in all such patients. This is the strongest evidence yet that a virologic "cure" is possible in chronic hepatitis C and, furthermore, that the natural history of hepatitis C is altered among patients with a sustained response. The only major limitation of this study is the small number of patients with prolonged follow-up and the lack of uniform histological evaluation, but these problems are common to all retrospective studies. Forty-eight patients underwent pretreatment biopsy and a posttreatment biopsy more than 1 year after the completion of therapy. Only 6 of 80 patients (8%) underwent biopsy 4 years after treatment. Liver HCV RNA was measured in a total of 27 patients, but at various intervals after therapy and apparently only once in each case. None of the 27 patients with a sustained response had HCV RNA in liver tissue, although 2 had measurable HCV RNA in the serum; it is not clear whether serum was tested at the same time as the liver. If so, this would provide additional evidence for persistence of extrahepatic replication sites for hepatitis C. The characteristics of the population described in the current report provide important additional insight into the factors predictive of a sustained response to IFN in chronic hepatitis C. The majority of patients was younger than 40 years and had the disease for less than 10 years. Most had serum-glutamyl transpeptidase (55%) and iron levels (83%) below the normal range. Furthermore, most patients were infected with non-genotype 1 (67%) and had serum HCV RNA titers less than 350,000 genome equivalents/mL (29%). Seventy-five of 80 patients (94%) did not have cirrhosis. Hoofnagle and Di Bisceglie recently reviewed the literature and found that genotype (other than 1) and viral titer (>100,000 genome equivalents/mL) were the two most important predictors of response (N Engl J Med 1997;336:347-356). Furthermore, genotype other than 1a or 1b was the best predictor of sustained response, which was greater than 40% in patients with genotype 2 or 3. Marcellin et al. confirm these previous observations and provide additional long-term serological follow-up about response to IFN in chronic hepatitis C. However, their study also shows that even some patients who would be considered poor candidates for IFN therapy may respond to standard doses of IFN. The sustained response was 6% among patients with cirrhosis, 33% in patients with genotype 1 infection, and 9% in patients with a viral titer greater than 3 million genome equivalents/mL. This is all the more impressive considering that the majority of patients (75%) were treated with only 3 million units of IFN- for 6 months. However, it is apparent that the sustained responders in this study generally had mild liver disease and were those probably at lowest risk of progression to advanced liver disease. Only 30% had "severe" chronic hepatitis (i.e., Knodell score >9). Therefore, this study once again confirms the difficult paradox in the management of patients with hepatitis C, namely, that the patients most likely to benefit from treatment with IFN are those who may be at the lowest risk of progression to worsening liver disease. Cost-effectiveness analysis may be one way to address the utility of IFN in patients with mild liver disease.
 

I have written to you previously.

I too am a Hepatitis C victim of the Tainted Blood Scandal, having contracted this disease in March of 1988 as a result of a motor vehicle accident and the 14 transfusions that I required to save my life during surgery. I have had the opportunity of setting up a support group in my area and we now have 16 members, ranging from the widow of a victim, through members who remain asymptomatic, to members who are on various interferon drug regimens. Their dismay is palpable.

This group has discussed their needs amongst themselves and has come up with suggestions for the government to consider, which might allow for the current package to be expanded to include all victims, with little or no additional cost to our Healthcare system or the Canadian taxpayer. These suggestions have been forwarded to all leaders of all parties as well as yourself—apparently to no avail.

We believe that our Federal Government has not truly considered some "No Cost Options." If the federal and provincial governments offered some or all of the following to the victims, enough might take part such that the funds that have been brought forward and budgeted would become sufficient to meet the needs of all the perishing victims. There are many amongst us who are currently able to continue working. Why not allow us to participate in the process of protecting ourselves, our families and our homes? Where is it written that it must cost so much?

Consider, please, for tainted blood victims:

. Lifetime "Tax-free" status for victim and partner

. Income tax deductions similar to "Disabled Deduction"

. Mortgage payment incentives similar to RRSP deductions or previously available RHOSP

. Reallocation of assets without income attribution via RRSP direct to mortgage pay out

. Increased child tax-credit where the child is a victim or the parent is unable to provide care due to illness

The foregoing are all "No Cost" options to either government, requiring no monies to fund the programs.

Consider, please, for tainted blood victims:

. For those victims who are able to continue working; make available income, mortgage, travel, life and health insurance programs at regular rates, charging the individual and/or by guaranteeing the excess mortality with a private insurer. Is this really different from Employment Insurance? The immediately preceding is a "Reduced Cost," potentially "No Cost" option.

Moreover, no one has assessed the needs of our suffering community on an individual basis. No one knows how many we are and what or how much is needed. The consideration of some of the foregoing coupled with an expression of the willingness to work together might actually serve to repeat a 2,000 year old miracle.

It is the opinion of our group that there are 2 issues here:

1) Tax impacts

2) Insurance aspects

I would like, once again the benefit of your thoughts prior to going to Ottawa and meeting with the MP. While there is probably no need to state this, please recall that my strategy involves developing peripheral, low/non-cost items, in order to expand and spread the existing "announced" programs (whatever they are) to include all of the tainted blood victims (primary and secondary) regardless of the date of disease contraction.

My final point: Just as a matter of interest, I was just speaking with the MP and he will make time available to me when I am able to come to Ottawa (I will try to make time over the next week). My impression is that he may be prepared to present this to Mr. Rock and may direct specific questions during "Question Period" which may serve to re-heat the issue. Also, he stated that he was definitely prepared to use his free mailing privileges to allow for a mailing of a document—questionnaire, suggestions etc (not clarified)—to the HepCAN list. This would serve to respond to the "no money" available position that the Society is currently experiencing.

Please note that this member is not a member of the Liberal caucus, but rather a member of HM's loyal opposition.
 

BRITISH COLUMBIA

Camp Church and Associates

Sharon Matthews / Kim Graham

4th Floor, Randall Building

Vancouver, BC V6B 1Z5

1-888-236-7797

Grant Kovacs Norell

Bruce Lemer

Grosvenor Building

930-1040 West Georgia Street

Vancouver, BC, V6E 4H1

Phone: (604) 609-6699 Fax: (604) 609-6688

Before August 1, 1986

Klein Lyons

David A Klein

805 West Broadway, Suite 500

Vancouver, BC V5Z 1K1

(604) 874-7171 or 1-(800) 468-4466

(604) 874-7180 (FAX)

also:

Dempster, Dermody, Riley and Buntain

William Dermody

4 Hughson Street South, 2nd Floor

Hamilton, Ontario L8N 3Z1

(905) 572- 6688

The toll free number to get you in touch with the Hepatitis C Counsel is 1-(800)-229-LEAD (5323).

ONTARIO AND OTHER PROVINCES

Pre 1986/post 1990

Mr. David Harvey

Goodman & Carr

200 King Street West

Suite 2300

Toronto, Ontario, M5H 3W5

Phone: (416) 595-2300

Fax: (416) 595-0527

INQUIRIES-CONTACT:

The Canadian Red Cross Society

4750 Oak Street

Vancouver, BC, V6H 2N9

1-(888) 332-5663 (local 207)

This information is for anyone who has received blood transfusions in Canada, if they wish to find out if their donors were Hep C positive.

If you would like more information about class action/compensation, you can contact:

Tricia Plunkett Tel. (250) 479-5369