As the elections get closer and the debates are finally over, I feel a need to add one more comment. Again please excuse the fact that I’m becoming medically political, but I can’t help it…nor it seems can the Brits! The recent issue of the British journal, Lancet had in it’s World Report section a summary of the US presidential candidates’ outline on health policies. Once more the positive aspects of the Affordable Care Act for women was emphasized: “In addition to an array of free preventative healthcare services that the law requires for all patients, the ACA also empowers the US Department of Health and Human Services to add other preventative healthcare benefits specifically for women. These additional benefits which took effect in August, include HIV testing and all birth-control methods approved by the FDA.” The article’s author reminds us that Romney opposes the law’s requirement that employee sponsored plans cover contraception. But remember most Americans have health policies through their jobs! And although most voters in United States will be looking at the issues of domestic health reform (or I hope they might at least consider it), their are those who might want to factor in proposed global health policies and expenditures.

President Obama has expanded funding for the President’s Emergency Plan for AIDS Relief (PREPAR), which has a goal of providing treatment to 8 million people worldwide by 2015. The Romney campaign has declined to answer questions about the fate of such initiatives should Romney win the presidency. He did make a statement last July at the International AIDS Conference in Washington DC praising ” the significant progress in research, education, delivery of drugs” and said that more needed to be done. He went on to say ” America is a compassionate nation it has been -  and must continue to be – a beacon of hope for innovative research and support as we seek to overcome the global challenge of AIDS.” But that does not mean he will support ongoing or increased global health initiatives. He is running on a campaign of decreasing government expenditures. And unless overturned, automatic cuts in foreign and domestic spending are scheduled to take effect in January if Congress fails to trim the budget by about $1 trillion from the federal budget.

So there we are…neither campaign has explicitly promised to increase support for future research and science. But if you care about our domestic health and welfare, as well as that of women and children in the world we live in, I hope you will consider the specificity of statements, the promises and the health related agendas of the candidates when you vote.

Once more, the baby boomers are a generations at risk. (Aside from our risk of getting old!)  New guidelines released by the Centers for Disease Control (CDC) recommend that all adults born from 1945 through 1965 be tested for hepatitis C virus infection. It turns out that 1 in 30 baby boomers is infected and doesn’t know it. Hepatitis C is spread through infected blood products. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was commonly spread through blood transfusions and organ transplants. It can also be spread by sharing needles, syringes or other equipment to inject drugs and medications. It can be transmitted through needle stick injuries in health care settings. (This is an ongoing health risk for doctors and nurses; I have been stuck several times during surgery, especial in my resident days and believe me I was subsequently tested… thankfully negative!) Hepatitis C can also rarely be spread by sharing toothbrushes and razors with someone who is infected or by having sexual contact with an infected person. Finally, hepatitis C can also be passed from a pregnant woman to her baby.

If symptoms occur, they do so 5 to 7 weeks after exposure. These can include nausea, loss of appetite, vomiting, abdominal pain, pale stool, joint pain and yellowing of the skin or eyes. But many people who contract acute hepatitis C  don’t have these symptoms and remain clueless about their infected state for decades! Unfortunately, despite the absence of symptoms, they can infect others with the virus. And after decades, the virus can cause severe health problems.

Here is what the CDC lists as serious long term affects of hepatitis C:
For every 100 people infected with hepatitis C, about
75-85 people will develop chronic hepatitis C infection and of those,
60-70 people will go on to develop chronic liver disease
5-20 people will go on to develop cirrhosis over a period of 20-30 years
1-5 people will die from cirrhosis or liver cancer.

The CDC Agency estimates that one-time testing for all of us would identify more than 800,000 cases of hepatitis C infection and ultimately save more than 120,000 lives that would otherwise be lost to infection- related liver cancer and other liver diseases.

Bottom line: If you are over 40, you are at risk for having unknowingly contracted hepatitis C. You should be tested!

The September 19th issue of JAMA had a brief and very interesting scientific discussion on the biology of fat cells and the endocrine pathways leading to obesity. I thought I would try to put this article into “lay” terms that we could all understand (I had to read it several times until I sort of got it); so here it goes…
The fat cell or adipocyte is not simply a droplet of fat; it is metabolically active and indeed constitutes a mini endocrine system involved in the regulation of our energy balance. It contributes to the development of diabetes, cardiovascular disease, and cancer.

Fat cells secrete a hormone called leptin in proportion to the amount of lipids they contain. More leptin is secreted from women’s fat cells then from men’s given the same amount of lipid content. Leptin enters the brain where it acts on several groups of nerve cells (neurons) in the hypothalamus. These inhibit appetite and promote an increase in metabolic rate and energy expenditure. Leptin deficiency can cause starvation type responses that include increased appetite and reduced energy expenditure. But obese individuals have high leptin levels so it appears that a leptin deficiency is not a cause for their obesity. Apparently, obesity induces leptin resistance in the brain so that increased leptin levels are not registered and have no impact on food intake or body weight. (My take on this is that attempts to change leptin levels in an obese person will not have an impact but increasing leptin recognition might.)

Adiponectin is another hormone that is secreted by fat cells. Adiponectin levels decline with increasing obesity, especially if there is central or abdominal obesity. This hormone has positive metabolic aspects; it increases sensitivity to insulin, has anti-inflammatory impact, and appears to be protective of the heart muscle cells and the beta cells that produce insulin in the pancreas. So, when the wrong and/or over abundant fat cells lower adiponectin levels, conditions such as coronary heart disease and diabetes are more likely to occur.

Another substance, interleukin 6, is secreted by fat cells in proportion to the amount of fat. Higher levels of Interleukin 6 cause insulin resistance. (This means that more insulin has to be secreted after the intake of food in order to “handle” the resultant glucose levels; remember, high insulin levels promote fat deposition.) The more fat we have, the more interleukin 6 is made and a vicious cycle is instituted that creates additional fat!

There is another hormone that has been widely discussed in articles dealing with obesity; it’s called Ghrelin. It’s secreted by cells in the stomach. (I know this is becoming a complicated bio physiology lesson…sorry, but I hope you will bear with me.)  Ghrelin levels increase following fasting and prior to meals. Once a person is actually eating, Ghrelin levels decline. This hormone stimulates hunger by acting on neurons in the brain in the “appetite” area of the hypothalamus. Lowering ghrelin levels would decrease ones appetite. So stay tuned to future anti ghrelin therapies.

I’m almost done… Nerve cell groups in the part of the hypothalamus that regulate food intake and metabolic rate are called POMC neurons. These neurons secrete neuropeptides (proteins) that activate receptors to inhibit hunger and regulate levels of insulin and glucose in the blood. And now I’ll get to something that you might really want to know… how the new anti-obesity drug called Locasarin works. It activates serotonin receptors that are expressed by the POMC neurons and hence helps them do their job; decreasing appetite, increasing metabolism and ultimately promoting weight loss. Locasarin has received FDA approval but is not yet available.

Bottom line: Too many adipocytes not only contribute to unsightly bulge, they also promote an ongoing cycle of weight gain and ultimately lead to diseases such as diabetes, coronary heart disease and cancer. The fat cell is not an inert droplet of fat…it is a complex mini gland. The more scientists and physicians understand what it does, and how to diminish its development and “behavior,” the better we will be able to impact the current epidemic of obesity.