An elevation in serum bilirubin level of more than 2 times ULN with associated transaminase rise is an ominous sign. This indicates severe hepatotoxicity and is likely to lead to mortality in 10% to 15% of patients, especially if the offending drug is not stopped ( Hy's Law ).   This is because it requires significant damage to the liver to impair bilirubin excretion, hence minor impairment (in the absence of biliary obstruction or Gilbert syndrome ) would not lead to jaundice. Other poor predictors of outcome are old age, female sex, high AST .  
When it was introduced in the 1950's, drugs containing thalidomide were widely used and marketed as safe in places around the world including Europe, Australia, Japan and Canada ( #Franks, et al, 2004 ). Thalidomide, however, was not approved by the United States Food and Drug Administration (FDA) until 1998. This is largely due to the courageous tenacity of Dr. Frances Kelsey , who in her first month at the FDA , refused to approve the drug without more evidence showing that it was safe in humans ( #Rouhi, 2005 ). She was particularly concerned about what effects the drug could have on the embryo of a pregnant woman taking the drug. Despite the pressures that the drug companies put on her, she was resolved in her decision and would not be moved until sufficient testing had been done ( #Rouhi, 2005 ). Her actions are thought to have saved the United States from a serious medical tragedy that could have potentially affected tens of thousands of lives.
My concern is my options for pain relief are limited due to my insurance coverage (MediCare/MediCal) and my question is this., if the medications I am on right now which do work (morphine 60 mgs every 12 hours and oxycodone 10 mg (2/day) work and they can't find anything else that does work, both the pain management doctor and my primary care doctor don't want me on these meds long term but I talked to a friend who is also a pharmacist and suffers from RA and she said I need to get a second opinion from a different pain management doctor because I have every right to be on these pain meds if they work. I'm not sure, however, what to ask when I phone the doctor's office so I don't make a series of visits to different doctors only to find the same attitude in these doctors as well. I am not abusing my meds and I discussed this with my friend (the pharmacist). She said she sees a lot of people who are addicted coming to the pharmacy trying all kinds of tricks to get the pain med they are addicted to and she sees no evidence of that in me. I am scared. I was in so much pain before I got put on these meds and I hope they do find something else that works as well but if they take me off these meds and I go back to the way I was, I will be bed ridden and have to have home health care on a permanent basis and I'm only 58 years old. Any suggestions on the best way to handle this.