19 ms·
Hepatitis C kills more Americans than all other infectious diseases combined
- kwhitefoot 7y agoWebMD (https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-c https://www.webmd.com/hepatitis/digestive-diseases-hepatitis...) says that 3.9 million people in the US have this disease, more than 1 in 100 of the population. And https://hepatitisc.net/what-is/statistics/ https://hepatitisc.net/what-is/statistics/ says that worldwide abou 70 million, again roughly 1 per 100. This seems rather a lot. What is missing from the statistics I have been able to find is any breakdown by location, lifestyle, diet, etc. The only hint is that the majority of injection-drug users are infected and that poor blood screening in the past has contributed. If this disease is so widespread it seems to me that public health measures that prevent or reduce the risk of infection must, in the long run at least, be necessary. What measures might they be and is there anything that an individual can do to reduce their risk?
- yakz 7y agoAntiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000. The price of other hepatitis C drugs is also high: Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatment https://www.healthline.com/health/hepatitis-c/treatment-costs#2 https://www.healthline.com/health/hepatitis-c/treatment-cost...
- idclip 7y agoJesus how much did these drugs cost to develop? Are these numbers justified?
- ohyes 7y agoIt’s priced based on ability to pay. US it will be 100,000 other countries it will be less.
- Cougher 7y agoIt isn't priced on the customer's ability to pay: it's priced on the companies' ability to gouge.
- ohyes 7y agoWell, it is discriminatory pricing. If someone isn’t saying it is too expensive you haven’t priced the product aggressively enough. In the US market the profit was maximized at 100k, in other markets the profit is maximized at a lower price level because almost no one can afford 100k.
- r_singh 7y agoYup, the generic version of the drug is price at $384 per bottle of 28 pills in India Here's an article on how the patent did not affect it's price in India: https://m.economictimes.com/industry/healthcare/biotech/pharmaceuticals/patent-not-to-affect-hepatitis-c-drug-price-in-india-gilead-sciences-inc/articleshow/52228499.cms https://m.economictimes.com/industry/healthcare/biotech/phar...
- lawn 7y agoAbility to pay? Is that a joke? Considering that 40% of Americans can't cover a $400 emergency expense[0], what makes you think they can pay $84,000 for a 12-week treatment? [0]: https://money.cnn.com/2018/05/22/pf/emergency-expenses-household-finances/index.html https://money.cnn.com/2018/05/22/pf/emergency-expenses-house...
- jacquesm 7y agoMaximized for the total bottom line it isn't a joke. That some people die is not a consideration for those that control access to these drugs, the question is how many people should die in order for them to make the most money of the ones that stay alive. Think of the ones that die as marketing.
- ameister14 7y agoDrug R&D includes failures - not saying they aren't for profit companies but there is significant cost (in the billions yearly) and risk in running a pharmaceutical research company
- spaginal 7y agoThese drugs are priced this high for the sake of health insurance and the screwy pricing market based around it. When you get the final bill with the “adjustments” and “discounts” it will be far less. If you signaled to the provider you are paying cash it’s far less. My physical therapy was $1200 a visit to my insurance provider, and magically $40 out of pocket once my insurance cut off my covered trips.
- Tharkun 7y agoDrug development is incredibly costly. It's also something of a long term gamble. It can take 10-20 years to develop a new drug. A lot of that time is spent testing safety and waiting for approval. As a drug company, you need to have several new drugs in your pipeline at any given point, or you'll be seriously fucked if one (or more) of your products don't pan out. It's basically a high-risk-high-reward type of gambling situation. Imagine having thousands of people on payroll, some working on drug design, some designing experiments to test the drugs, some doing the legal paperwork to get drugs approved etc, and suddenly the patent for your best selling drug expires and your latest drug doesn't work. You're pretty much boned.
- dfsegoat 7y agoThe development costs per a Forbes analysis are as follows: > "The median per-drug R&D spending of companies that developed more than six drugs – that’s only 8 companies – was $5.8 billion." ...so that is $5-6B USD per drug DEVELOPED in large companies. Gilead - maker of Sovaldi/Harvoni for HepC treatment - has been on a development tear of late, and almost certainly falls into that range IMO [2]. For companies that produce fewer drugs - the estimates are between $700M-$1B per drug. Note these are prices for drug R&D only ("development") - there is no guarantee those drugs developed make it to market ("approval") - Over 90% do not. edit: source links 1 - https://www.forbes.com/sites/matthewherper/2017/10/16/the-cost-of-developing-drugs-is-insane-a-paper-that-argued-otherwise-was-insanely-bad https://www.forbes.com/sites/matthewherper/2017/10/16/the-co... 2 - https://en.wikipedia.org/wiki/Gilead_Sciences#2010_to_2019 https://en.wikipedia.org/wiki/Gilead_Sciences#2010_to_2019
- yoloClin 7y agoI imagine those numbers wouldn't be all that reliable for a bunch of reasons - companies would have vested interests in over or under reporting costs for various reasons, technology progressions mean previously expensive to develop drugs may be cheaper if they were to be redeveloped now, and sample size probably wouldn't be large enough for the raw data to be used when bankrolling pharma research ventures. Edit: I should contextualise this by noting I have basically no experience with pharma so grain of salt blah blah
- idclip 7y agoI dont think you should be downvoted because thats valid, yet hard to use as an argument, paranoia. The basic assummption in cryptography is “assume the target system is already compromised” so i would wager you are partially correct. Its just that its not the whole story, especially if u think that private persons get massssive discounts if they try to privately pay (from reading below comments about quotes to insurance companies vs private people). Its a sad dynamic thats probably ruining more loves than it should.
- dfsegoat 7y agoI think your points are fair. Sample size for their analysis was about 100 drugs. FDA approves about 25 per year. My main point is that drug development is more expensive than most realize. Beyond R&D, a lot of that cost is in postmarketing (after approval) safety studies and surveillance- to catch side effects not observed in clinical trials. This process can be made somewhat more efficient as you suggested, but at the end of the day a human is reviewing every side effect report and reporting those back to regulatory agencies etc. I am not qualified to discuss the economics re: your point on pharma r&d - drug discovery is it’s own thing aside from actual drug development.
- deleted 7y ago[deleted]
- inasio 7y agoIt cost exactly 11 billion for Gilead to "develop" Sofosbuvir (they bought Pharmasset who discovered the drug [1]) [1] https://en.wikipedia.org/wiki/Sofosbuvir#History https://en.wikipedia.org/wiki/Sofosbuvir#History
- refurb 7y agoThey didn’t buy an approved drug, they bought a clinical lead. They still spent a ton getting it approved.
- save_ferris 7y agoThat is so depressing to read. US pharma companies are completely out of control, there’s absolutely no reason a 12 week treatment should cost around the mean annual US income. Can’t imagine having to decide to risk my entire financial future to deal with Hep C.
- mc32 7y agoI would hope that as more people test and get treated and the drug production gets ramped up, the price should go down significantly. A couple of decades ago only people like Magic Johnson could afford HIV drugs, for example.
- whatshisface 7y ago>there’s absolutely no reason a 12 week treatment should cost around the mean annual US income. What if it was synthesized in 5,000 steps from pure gold or something?
- gcatalfamo 7y agoBut is it though?
- whatshisface 7y agoI can't find any references that say the cost of manufacturing it or inventing it, so the only indication we have that it is expensive is the high price. Interferon is an entire protien so it can't be that cheap.
- Bnshsysjab 7y agoI’m not trying to disregard the need for cheap treatment, but by preventing pharma from developing drugs that they profit from kills all R&D. I’d be open on a success based public funding where IP becomes public domain, but I doubt big pharma would ever pull that trigger. I’m thankful for modern day drugs, like PReP and PEP (pre and post hiv exposure drugs), vaccines and cancer treatments to name a few, it just sucks that those less fortunate don’t have access yet.
- dd36 7y agoThere’s a $300 treatment on the way: https://www.dndi.org/2018/media-centre/press-releases/new-affordable-hepatitis-c-combination-treatment-shows-97-cure-rate/ https://www.dndi.org/2018/media-centre/press-releases/new-af...
- coder1001 7y agoor go to India now and be treated for $1k [1]? [1] https://www.medicaltourismmag.com/article/hepatitis-c-treatment-india https://www.medicaltourismmag.com/article/hepatitis-c-treatm...
- 3fe9a03ccd14ca5 7y agoIt’s basically to the point where it’s: > Go to <any country outside the US> and be treated for <fractional amounts>
- wtdo 7y agoAs an American, how does that work in practice? I know I can go to Vietnam and be treated for a small amount (I was in a Vietnamese hospital for a couple of days due to a really bad strep infection and dehydration as I was unable/unwilling to swallow, and in a separate incident, also had a round of rabies shots after being bitten by a dog there). I figured it was cheap because everything is cheap there and no one there could afford it otherwise, not because of government insurance. But if I go to Australia, Canada, UK, or any other country, how do I get access to this cheap healthcare without becoming a citizen or paying taxes? Do I qualify just by nature of being there with a valid visa?
- tonfa 7y ago> But if I go to Australia, Canada, UK, or any other country, how do I get access to this cheap healthcare without becoming a citizen or paying taxes? You'd likely pay more than a resident/citizen who may not pay or may a token amount. But this full price will still be very small in comparison to US (eg full price of doctor's consultation in France is like 25 EUR). Even Switzerland which is expensive for Europe in terms of healthcare is cheap comparatively (a simple ER visit might be a few hundreds, not thousands).
- Allower 7y agoId rather die than give them the satisfaction of successfully charging me that ridiculous amount.
- trimbo 7y agoThey're priced this way because they're 80-90% cheaper than the previous treatment. Previously, with no cure, HepC patients would have eventually had a liver transplant. Liver transplants cost between $500K-$1M. Of course, it also requires a liver, so many would die waiting for a liver. As you noted, the drugs have become much cheaper. Mavyret is ~1/2 the cost of Sovaldi, the first drug on the market (replaced by Harvoni). Mavyret actually only has an 8 week treatment, which is an improvement over the 12 weeks of Harvoni. The competition within these drugs became so fierce that, despite these prices, no new ones are planned (last I read). In fact, one you listed here has been off the market for over a year https://www.empr.com/home/news/two-hepatitis-c-virus-infection-treatments-to-be-discontinued/ https://www.empr.com/home/news/two-hepatitis-c-virus-infecti...
- deith 7y agoPro-tip: it doesn't actually cost $500K-1M to transplant a liver (which you get for free).
- pc86 7y agoDo you have a source for this?
- dajohnson89 7y agoI think he means we're all born with a liver. And transplanting your liver is a matter of walking.
- 0xB31B1B 7y agoIt costs an insane amount of money. 1) there is a large infrastructure around organ donations that needs to be maintained 2) it generally requires the organ (and some times doctor) to be flown on a private jet from where the organ comes from to the person receiving the transplant 3) transplant surgery is a very long procedure requiring multiple specialists 4) recipient is on a lifelong course of drugs (literally like a handful of expensive drugs every day) that suppresses their immune system so the body doesn’t reject the organ Source: wife is a doctor at research hospital
- stevespang 7y agoCould it be that those recommending everyone get screened have a financial interest, or investments in those companies that produce the medicines . . . stranger things have happened . . .
- bra4you 7y ago"Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatment" I assume that your healthcare covers this. Otherwise cheap imports are available from India, e.g. https://roidgear.net/hepatitis-c https://roidgear.net/hepatitis-c
- deleted 7y ago[deleted]
- refurb 7y agoThese are the list prices. Due to competition, net prices came down considerably as the different company try and get market share. Current prices are closer to $30,000 or less per dosing regimen.
- jokowueu 7y agoIf you go to Egypt it's much cheaper http://www.tourncure.com/en/ http://www.tourncure.com/en/
- gengchun88 7y agoIf you are talking about a virus only affect small amount of population, I can understand this marketing strategy. But Hepatitis C. is a virus infects 143 million, which means it even with a $10k profit margin for one in ten here should be at least $1 Trillion profits. A company like BMS do expanding like $20 billion annually. For me all most like they could afford to operate like half of century for just one drug. No way it is sold for almost $100k price for just breaking even. Correct: Sorry it was Gilead Science developed Harvoni. So $22B revenue minus $8 operating incoming.
- inasio 7y agoNo, Gilead didn't develop Harvoni/Sovaldi/Sofosbuvir, it was originally discovered by Pharmasset, and then Gilead bought them for 11 billion [1] [1] https://en.wikipedia.org/wiki/Sofosbuvir#History https://en.wikipedia.org/wiki/Sofosbuvir#History
- gengchun88 7y agoOh, thanks. That simplified R&D cost calculation. $11B for $3.5 m persons in U.S. and 90% successful rate means R&D cost(merge cost) definitely less than $4k per person.
- Jnr 7y agoIn some EU countries treatment for hepatitis C is already included in the government sponsored healthcare program.
- chimeracoder 7y ago> Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000. It's worth noting that, in the US, almost nobody is actually paying those prices. Most insurance plans these days cover HCV treatment, and even insurance companies aren't paying those sticker prices to the pharmaceutical companies when they cover these drugs.
- mister_hn 7y agoCan't they be covered by Health Insurance companies?
- ZoomStop 7y agoMy dad passed away in August due to Hep C complications. Very true that anyone who has done anything that can put you at risk should be tested. The treatment is criminally expensive but it is curable with it. Sadly my dad, the a-typical medically procrastinating male, didn't start on Sovaldi until it was too late and he died before he could complete treatment.
- shaftoe 7y agoI get their point about stigma, but as someone who has never injected drugs, I'm having a hard time caring about getting screened for this. How do they intend to actually roll out a massive testing operation (everyone under 80) when likely most people hear the details and respond with "meh, not me"?
- latortuga 7y agoAlso blood transfusions, which could be a wide variety of folks that have had routine surgeries, including, for example, c-sections.
- big_chungus 7y agoSeconded. I have zero risk factors: no tattoos, sex, drugs, cuts on suspicious objects, etc. There is no reason for me to get tested to avoid someone else being uncomfortable. The value of the comfortability of a random stranger to any one is near-zero.
- astura 7y agoThe U.S. Preventive Services Task Force doesn't roll out any screening programs, their job is simply to make clinical recommendations. So they are saying to clinicians "if you have a patient between 18 and 80 then current evidence suggests that screening for Hep C is more beneficial than harmful on a large scale, even if the patient has no symptoms." Plus governments would likely use recommendations to base laws around this stuff, something like passing a law that says "insurance companies must cover the cost of Hep C testing even in the absence of symptoms" and military officials may make Hep C screening as a part of a standard military physical. Of course, I've found most clinicians ignore evidence based recommendations, but that's a different topic entirely....
- thex10 7y ago> 70% to 90% of older injection-drug users are infected. If you have the unique misfortune of being born to one of those older users, do get tested. I was asymptomatic when I tested positive a few years ago, at the age of 25. It was a surprise to the medical professionals involved, as I have no drug using history, no tattoos, in otherwise perfectly good health. I did get the super expensive pills, and they cured me in eight weeks (and I'm extremely grateful my insurance at the time covered the cost). My liver's doing OK, but who knows whether the disease contributed to my chronic depression. Still, I consider myself lucky to have caught it when I did.
- xvilka 7y agoDoes anyone know what research is being done on creating the vaccine and what are the causes that prevented creating one?
- at_a_remove 7y agoWikipedia has a brief summary, but it is a similar issue as we see with colds and HIV: a highly variable exterior shell for the virus. About six years back, scientists found one region that is mostly "conserved," the docking station that latches onto a particular receptor in liver cells. Hepatitis C, like HIV, comes in different groups, and it has six to target.
- xvilka 7y agoThanks a lot, that explains the struggle.
- _ink_ 7y agoWhy only in the US?
- grzm 7y agoThat was the scope of the report. From the first paragraph of the submission: > "The hepatitis C virus now kills more Americans than all other reportable infectious diseases combined -- including HIV. Acute cases of HCV have increased 3.5-fold over the last decade, particularly among young, white, injection drug users."
- astura 7y agoThe recommendation was issued by the U.S. Preventive Services Task Force who is funded by the American government whose job it is to issue evidence based preventive medical recommendations for only the American population based on data relevant to the American population. The U.S. Preventive Services Task Force has neither the authority nor the funding to make Hep C testing recommendations for other countries. Other countries may have similar issues and their medical task forces may issue similar recommendations, or Hep C might be extremely uncommon in other countries and their medical task force may make different recommendations.
- ken 7y agoIt looks like the standard blood "Donor Battery" includes anti-HCV, so regular donors are already being screened. Of course, you shouldn't donate blood for the purpose of getting tested for a disease.
- koheripbal 7y agoThere is a question on the blood donation form that asks if you are donating for the purposes of testing yourself. If you answer yes, then your donation is discarded.
- ken 7y agoThere's no one universal questionnaire. No such question exists at any blood center I've donated at. If you answer any question in a way that would lead to the blood being unusable, they wouldn't go to the effort of taking a donation just to discard it. At least, my local blood center doesn't.
- hep_c_throwaway 7y agoUsing a throwaway for obvious reasons. Like many of you, I'm a young and healthy guy. I haven't taken a sick day in years. Since I'm young and healthy, I didn't see the need to take an annual physical exam. Scheduling doctor's appointments is such a hassle. I'm sure many of you feel the same. So when I was diagnosed with Hepatitis C, it came as a complete shock to me. The shock was due to two reasons: 1. I wasn't involved in any of the "high risk" activities associated with Hepatitis C, which are intravenous drug use and tattoos. 2. I regularly went to the doctor's when I was a child, so there was at least 20 blood tests done back then. None of tests caught the Hepatitis C back then. Since Hepatitis C is a chronic condition for most people, if I didn't catch mine early, it would have been found much later in life when all of the damaged has been done. I only caught my Hepatitis C because I wanted to an elective cosmetic medical procedure. It was my own vanity, plus pure luck, that caught it. When I was a child, I was covered under the government's and my parents' health care plans. When I entered college, I was enrolled under the mandatory student health care plan. After I entered the work force, I was covered under my employer's health care plan. All this health care was fully paid for, either through tax dollars, or my parent's contributions, or my own contributions, and I stupidly chose not to utilize it, because I was young and healthy. If you don't want to end up like me, then please heed my advice: all of you are under-utilizing the medical services that you have already paid for. You should research what kind of screening and preventive care is included in the health care plan that you purchased and then take full advantage of them. It's better for you since you live longer. It's better for your insurance company since screening and preventive care is much cheaper than paying for treatments down the road. It's better for your government since they get to collect more tax dollars over your longer lifespan. And it's better for me since I make a living using the software and services that you guys provide. I can stick around and do a AMA if you guys have any questions for me.
- crobertsbmw 7y agoDid you ever figure out why you got HepC? Did you conclude that you had it from birth, or did you remember that you stepped on a nail while traveling in Vietnam?
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- LinuxBender 7y agoThis is likely going to be an unpopular question and maybe I m just really naive, but is the protein really so complex to synthesize that a kit could not be made to make a small batch at home? I ask this because I have recently been studying what is required to produce non naturally occurring amino acids and while not trivial, it can be done. Are there not biohackers that figure these things out as a hobby? I know, totally unsafe, but if your only other option is death, then I think such discussions should be on the table. Derivative works so to speak.
- hep_c_throwaway 7y agoI paid $1300 for a 12 weeks course of generic Harvoni from India. I paid using credit card and it arrived within a week. Normally I'm a law-abiding citizen, but as you said, if it comes down to choosing between violating intellectual property laws and death, it's an easy choice to make.
- chmod775 7y agoConsidering even a 12 week vacation in India while you undergo treatment is cheaper than the alternative and also legal, the pricing of the US drugs is very... interesting. There's probably plenty of other countries where you could get treatment for cheap too.
- greenyoda 7y agoHardly anyone with a regular job can just decide to take a 12 week vacation. You'd either have to convince your employer to let you take an unpaid medical leave (and you'd need to have enough savings to survive for 3 months), or you'd need to quit your job and hope to find another when you get back (not that easy for those outside the tech industry).
- DrAwdeOccarim 7y agoThat's a great question. In this case, the drugs are small-molecules (https://en.wikipedia.org/wiki/Ledipasvir/sofosbuvir https://en.wikipedia.org/wiki/Ledipasvir/sofosbuvir) and they're complicated ones at that. So trying to make that at home would be impractical. But you're on to something I've been personally interested in for a while. You can make proteins at home in cells, but to get them pure enough for injection is near impossible without expensive manufacturing equipment and testing equipment. I think the real win is going to be using mRNA coding for the protein of interest formulated in lipid nanoparticles. This type of idea would be easier to make sterile and have basically no risk of endotoxin/virus issues recombinant proteins have. I give it 10 years before garage biohackers start really getting this idea to work.
- brobot182 7y agoWhat about Hepatitis C++
- oleg_k 7y agoI’m working on direct-to-consumer STD testing in JasonHealth.com . Some thoughts on Hep C testing: Hep C Antibody is a very inexpensive test. We charge $25 for it. It takes a long time for the body to produce the antibodies after infection. This test is only 90% sensitive after 12 weeks ( https://www.hepatitisc.uw.edu/go/screening-diagnosis/acute-diagnosis/core-concept/all https://www.hepatitisc.uw.edu/go/screening-diagnosis/acute-d... ). Testing shortly after possible infection with this test is not effective. The best early detection test is Hepatitis C Viral RNA, Quantitative, Real-Time PCR. It’s able to detect infection 2 weeks after. The absolute best testing protocol after suspected infection is what doctors use for needle-stick. Test the person who may be spreading the infection immediately using the RNA test. If RNA is detectable start the short course of Hep C drugs on the person who might be infected. This will avoid acute Hep C infection altogether. Hep C testing is very popular direct-to-consumer. For us, patients usually get it as part of full STD screening ( https://www.jasonhealth.com/l/std-testing https://www.jasonhealth.com/l/std-testing ). About 80% of Hep C tests are ordered as part of that. Anecdotally, it’s not usually ordered by MDs as part of STD screening. Hopefully, these new guidelines will change that.
- samstave 7y agoNice. It would be really great if you guys were to partner with other helping infrastructure, such as recovery centers, salvation army, homeless shelters etc... Getting more people tested for treatments on all levels is a good thing, IMO
- blacksmith_tb 7y agoAbsolutely - but inexpensive testing may not help much when the cost of treatment is in the tens of thousands of dollars[1]. 1: https://www.medicalnewstoday.com/articles/323767.php#drug-types-and-costs https://www.medicalnewstoday.com/articles/323767.php#drug-ty...
- chimeracoder 7y ago> the cost of treatment is in the tens of thousands of dollars[1]. It really isn't. That's like walking in to a car dealership, asking how much the car is, and then accepting the salesman's first offer at face value. In reality, insurance will typically cover HCV treatment in the US. Because there's so much competition between HCV drugs, the insurers are able to negotiate deals that are less than a tenth of what the sticker price is.
- hypewatch 7y agoHep C is a curable disease that doesn’t have any symptoms. It also tends to infect the most vulnerable among us - heroin addicts. So the root cause of this issue is not the disease itself but our society and health system. These victims are not receiving the testing and treatment they need because they choose not to or (more likely) can’t afford to go to the doctor.
- inasio 7y agoFrom a purely epidemic control point of view the most rational path is to test this population as often as possible (every 6 months or less) and treat them immediately if testing positive. If you find people that reinfect rather than a bad thing this means you are being able to reach a core at-risk group.
- jxramos 7y agoHere's the crux point... """ ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects. "With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or does not need screening -- and it avoids the sometimes uncomfortable discussion with the patient about why they have been labeled as high risk and needing further screening." """ I think the fact that high risk populations rock the medical boat so globally already makes medicine awkward regardless of avoiding uncomfortable discussions. All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. It's the next immediate question that gets raised when you evaluate 'why do I need another HIV test' or whatever other blood test it is that medicine pushes on you. Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. But from the patient who knows what virtue they live or don't live some of these tests just come off as absurd knowing your own life history and the absolute absence of risks you deliberately avoid in life. One step of indirection is not much to jump over for one who naturally asks the next immediate question.
- DoofusOfDeath 7y agoThis seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals. As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems. On the other hand, as someone with chronic mild obesity, I'm grateful for government-funded research for treatments of hypertension, stroke, idiopathic cancer, etc. And to some extent I could, if motivated enough, keep my bodyweight down. I guess there are two issues then. The politics of shared costs/benefits, and attending my personal struggles with only being empathetic to problems that I myself experience.
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- jp57 7y agoThe article says nothing about the false positive and false negative rates of the test, and proceeds as if the screening is infallible. Even given what was said in the article, one has to assume that the incidence of the infection in the general population is quite low—probably measured in basis points—which means that the false positive rate of the test would have to be very low to get a high positive predictive value. It may well be so, but we'd need to know that (and the costs of treating the uninfected) to understand whether universal testing is really warranted
- inasio 7y agoThe two key groups in western countries are baby-boomers (likely acquired the infection from dentists/doctors reusing needles), and intravenous drug users. The best bang for your buck is in testing and treating this last population, but you have to be careful and try to do followups to prevent reinfection. It's worthwhile to test the baby boomer population as many of them could require liver transplants soon if not detected
- inasio 7y agoI worked for 5 years doing epidemic modeling for HCV, from right around when the first generation of the modern treatments became available (Sofosbuvir, etc). When I started working it was immediately clear that Sofosbuvir et al were a total game changer, and for a while my research was based on figuring out who to treat first: people very sick but that were not spreading the disease, or people with few symptoms that were actively spreading the disease Here are a few interesting things (in my opinion) that are not so well known about HCV: - Prior to 2015 you could cure HCV, the standard of care was ribavirin with pegylated interferon. If you were lucky and had the right HCV genotype you would take a whole bunch of pills and injections for 48 weeks, with a 50% chance of cure. The side effects were pretty bad though, people I met that took it compared it to chemo. - Currently there are treatments available that will cure any HCV genotype, on people with advanced liver disease (cirrhotic), coinfected with HIV, with >95% success rate. One pill per day with basically no side effects. - In western countries there are a whole bunch of HCV positive baby boomers, in many cases unaware that they are infected. Epidemically they are not transmitting the disease, but they have been chronic for many years and are having liver issues - Again in western countries, the epidemic is being driven mostly by active intravenous drug users, typically young, and often with other co-morbidities (mental health issues, HIV, etc). Re-infection is possible, so HCV eradication will be tough - There is controversy as to whether you can transmit HCV sexually, at the least it is much harder than transmitting HIV. Conversely active intravenous drug users that share needles will almost certainly have HCV, with HIV being harder to transmit this way - In other countries the situation can be very different. Egypt in particular has around 20% HCV prevalence, the story goes that the UN funded a program to eliminate schistosomiasis in the 1980s via vaccination, but the campaign did a lot of shared needles AMA I guess
- ineedasername 7y agoThe HN headline should be changed to match the article. The current one does not encompass the content nearly as well.
- ineedasername 7y agoThe "reportable disease" qualifier must be an important distinction here. The article doesn't say how many Hep C deaths there are, but a search showed about 19,000 annually. That's a far cry from 50,000 estimated pneumonia deaths, and still just under the estimated 20,000 MRSA deaths.
- findyoucef 7y agoMy mom is a physician who has treated hepc for years. But the problem these days is convincing insurance companies to pay for the treatment. Unfortunately having the disease isn't enough for them pay. :-/