March 20, 2014

Does it really matter?

by Opiferum
March 20, 2014


Story telling has always been a powerful medium for humans to express their experiences, so as to share with an audience that might be moved and enlightened by the details of a personalized series of events.  Each of us has a very unique story regarding our lives spent with or without the hepatitis C virus (HCV).  As well, we all have a distant memory of when we discovered being infected with the virus and how it felt to hear those impending words, “You’ve got hepatitis C.”  But can you remember when it came to trying to explain it to someone else? No doubt you can, whether it was your GP, liver specialist or a loved one asking the dreaded question, “So how did you get it?”  Your first thought might have been, “Does it really matter?”  It still might be that you do not think it really matters, especially if you have undergone treatment and come out the other end without the need to think about these things anymore.  But the way in which a person comes to be infected with hepatitis C does matter, even if someone chooses not to disclose it.  

Yet discussion amongst people living with hepatitis C often focuses on the question of whether source of transmission really counts.  On the other hand, much debate circulates about the level of risk associated with certain behaviors known to spread the virus.  Whilst the majority of current HCV infections are a result of unsafe drug use, surprisingly, this isn’t always the topic of conversation, either.  Not surprisingly, there still are many, many people living with hep C that are too scared to come forth and admit to the way in which they were infected.  Some people argue that it does not matter how an individual was infected with HCV.  When someone says that it doesn’t matter, it could be their way of trying to help someone feel better who might be affected by stigma because of a past or present history of drug use.  After all, the hep C virus is often assumed only to affect “druggies” or “junkies”.  Whilst such unacceptable language is slowly fading within the hepatitis C community, for those that remain ignorant and know nothing better, this kind of discriminating language and association still prevails.  

If the way in which a person gets infected with the hepatitis C virus was simply not an issue, then awareness regarding the fact it is a blood-to-blood disease would not be a point in need of further clarification.  After all, why not just say it is a disease of the liver that can lead to cancer? Simply because it is not just a disease of the liver.  More specifically, it is a blood-borne virus that infects the liver and will lead to cirrhosis of the liver if left untreated.  What is more, the way I was infected with hepatitis C is not necessarily the same way in which you were infected.  Between you and I, there are similarities and differences that might also reflect the chronological timeline of the virus, such as when some sources of transmission were previously very risky but are not so much anymore, such blood transfusions.  Today, I belong to the highest risk group, not to mention the most stigmatized and therefore marginalized: people who have a past or present history of using drugs which has led to exposure to the virus.    

The way in which you or a loved one came to live with the hepatitis C virus is a very personal and sometimes sensitive subject. However, it can also be a question with an answer that can help the HCV community to build a much greater awareness, if only we can all take the time and effort to remain mindful and knowledgeable of each other’s experience.  From our personal stories, we can learn from one another how to bring our attention to where it might not have been focused previously.  We can create a more extensive support system as we continue to become more mindful of what it means to live with hepatitis C, because hepatitis C simply does not discriminate for the reasons we might.  When a person comes forth with their story, it also allows for someone else to see and feel first-hand that it is ok not only to live with hepatitis C, but to own their own unique story, too.  

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Baby Boomer Hep C Screening Practical in Emergency Department

Medscape Medical News

Fran Lowry
March 20, 2014

Baby boomers account for about 75% of hepatitis C infections in the United States, but most don't know they are infected. Now, several studies have shown that the emergency department is an ideal place to screen this population.

Hepatitis C disproportionately affects nonwhites, Medicaid recipients, the uninsured, and people of lower economic status. These are populations known to use the emergency department as a primary source of medical care.

"We now have data from 2 different sites in the country that are doing hepatitis C screening of baby boomers in the emergency department," said James Galbraith, MD, from the University of Alabama at Birmingham.

"We are showing similar yields of previously unknown hepatitis C infection in 2 different demographic groups. The important thing is that such screening is very feasible," he told Medscape Medical News.

The screening of baby boomers has been done in the Alabama emergency department since September 2013. Dr. Galbraith presented preliminary findings at The Liver Meeting in 2013, as reported at the time by Medscape Medical News.

He presented additional data from his continuing experience in Alabama and new data from the Memorial Hermann–Texas Medical Center, in Houston, at the International Conference on Viral Hepatitis 2014 in New York City.

"Memorial Hermann has been screening baby boomers for hepatitis C using a little different methodology, but they have had very similar results," Dr. Galbraith said.

“The important thing is that such screening is very feasible.”

In Alabama, all emergency patients get a primary assessment by a nurse. If they were born between 1945 and 1965, they are asked if they have ever been tested for hepatitis C and, if so, what was the result.

If they do not know the answer to either question, they are informed of the Centers for Disease Control and Prevention (CDC) 2012 recommendation that all baby boomers get a 1-time screening test for hepatitis C, and that such a test will be performed during their emergency department visit unless they decline.

If they do not opt out, the electronic record automates an order for a hepatitis C screen that is performed in the emergency department lab, using the Abbott ARCHITECT anti-hepatitis C assay, which returns a result in 29 minutes.

If required, linkage to care starts 2 or 3 days later with a phone call to the patient from the linkage-to-care coordinator, Dr. Galbraith explained.

The procedure at Memorial Hermann is somewhat different.

The decision to offer hepatitis C screening is made by residents and physicians on the basis of the patient's history and physical exam. The screening tests, if done, are batched and run once a day, not while the patient is actually in the emergency department. People who test positive get a letter in the mail reporting their result and then a phone call from a nurse who provides linkage to care.

Despite these procedural differences, prevalence rates are similar at the 2 sites, Dr. Galbraith said.

Of the 1421 baby boomers screened at Memorial Hermann, 9.9% tested positive for the hepatitis C antibody. Of the 1259 screened at Alabama, 11.1% tested positive.

Black Patients at Greatest Risk

At Memorial Hermann, 61% of people testing positive were men; at Alabama, 65% were. The higher prevalence in men is the trend "we see nationally," Dr. Galbraith said.

The prevalence is also higher in black people. At Memorial Hermann, 51% of patients testing positive were black; at Alabama, 61% were. White patients accounted for 37% of patients testing positive at both emergency departments.

For baby boomers tested at Alabama, the prevalence of positive results was higher in black than in white patients (13.3% vs 8.0%).

"This definitely fits with what we know. Based on data from the CDC, black people are disproportionately affected and are accounting for a high number of individuals testing positive," he said.

Virtually all of the patients at both sites were uninsured or were covered by Medicaid. "Only 11% of antibody-positive patients at Alabama had private insurance," Dr. Galbraith reported.

High Cost of Screening

Such screening programs do come with a high cost. At Alabama, the annual cost of screening was $250,000, which could be a barrier to widespread baby boomer screening in the United States.

This study reinforces the feasibility of birth-cohort-based hepatitis C screening in the academic emergency department setting, said José Zuniga, PhD, MPH, president of the International Association of Providers of AIDS Care.

However, "it also highlights some of the obstacles, including unreimbursed costs and the need to make adjustments in the clinical practice culture to convince already busy physicians and nurses to add hepatitis C screening to their many responsibilities," Dr. Zuniga told for Medscape Medical News.

The study was funded by the Centers for Disease Control Foundation and Gilead Focus. Dr. Galbraith and Dr. Zuniga have disclosed no relevant financial relationships.

International Conference on Viral Hepatitis (ICVH) 2014: Abstract 59. Presented March 17, 2014.


You're not alone: Medical conspiracies believed by many

By Andrew M. Seaman

NEW YORK Wed Mar 19, 2014 7:33am EDT


(Reuters Health) - About half of American adults believe in at least one medical conspiracy theory, according to new survey results.

Some conspiracy theories have much more traction than others, however.

For example, three times as many people believe U.S. regulators prevent people from getting natural cures as believe that a U.S. spy agency infected a large number of African Americans with the human immunodeficiency virus (HIV).

J. Eric Oliver, the study's lead author from University of Chicago, said people may believe in conspiracy theories because they're easier to understand than complex medical information.

"Science in general - medicine in particular - is complicated and cognitively challenging because you have to carry around a lot of uncertainty," Oliver said.

"To talk about epidemiology and probability theories is difficult to understand as opposed to 'if you put this substance in your body, it's going to be bad,'" he said.

For the new study, he and his colleague used data from 1,351 adults who answered an online survey between August and September 2013. The data were then weighted to represent the U.S. population.

The participants read six popular medical conspiracy theories and then indicated whether they had heard of them and whether they agreed or disagreed with them.

Like the theories about conspiracies to infect African Americans with HIV and to prevent citizens from accessing alternative medicines, the other theories on the list had mistrust of government and large organizations as themes.

They include the theory that the government knows cell phones cause cancer but does nothing about it, that genetically modified organisms are being used to shrink the world's population, that routine vaccinations cause autism and that water fluoridation is a way for companies to dump dangerous chemicals into the environment.

Some 49 percent of the survey participants agreed with at least one of the conspiracies.

In fact, in addition to the 37 percent of respondents who fully agreed that U.S. regulators are suppressing access to natural cures, less than a third were willing to say they actively disagreed with the theory.

With regard to the theory that childhood vaccines cause psychological disorders like autism and the government knows it, 69 percent had heard the idea, 20 percent agreed with it and 44 percent disagreed.

The only conspiracy theory with which more than half of the respondents disagreed was that a U.S. spy agency infected a large number of African Americans with HIV.

The survey results suggest people who believe in medical conspiracy theories may approach their own health differently, the researchers said.

For example, while 13 percent of people who did not believe in any conspiracies took herbal supplements, 35 percent of those who believed in three or more theories took supplements.

Overall, the researchers say people who believed in conspiracies were more likely to use alternative medicine and to avoid traditional medicine.

"Although it is common to disparage adherents of conspiracy theories as a delusional fringe of paranoid cranks, our data suggest that medical conspiracy theories are widely known, broadly endorsed, and highly predictive of many common health behaviors," the researchers write in JAMA Internal Medicine.

Oliver said the findings may have implications for doctors.

Instead of viewing patients who believe in conspiracy theories as crazy, he said doctors should realize those patients may be less likely to follow a prescription regimen.

"It's important to increase information about health and science to the public," he said. "I think scientific thinking is not a very intuitive way to see the world. For people who don't have a lot of education, it's relatively easy to reject the scientific way of thinking about things."

SOURCE: JAMA Internal Medicine, online March 17, 2014.


Hep C incidence up among most races/ethnicities

By: RICHARD FRANKI, Family Practice News Digital Network


The incidence of acute hepatitis C increased 51.6% among whites from 2010 to 2011, the last year for which data are available, the Centers for Disease Control and Prevention reported.

Over a 2-year period, American Indians and Alaskan Natives had a 137% increase in acute hepatitis C virus (HCV) infections, going from 0.46 reported cases per 100,000 population in 2009 to 1.09 cases per 100,000 in 2011, according to data from the CDC’s National Notifiable Diseases Surveillance System.

These increases were accompanied by smaller rises in HCV incidence among blacks (up 27.3% from 2010 to 2011) and Hispanics (up 21.4% from 2010 to 2011). Asians and Pacific Islanders, who have the lowest rate among the major racial/ethnic groups, saw their HCV incidence drop almost 29% – from 0.07 per 100,000 to 0.05 – from 2010 to 2011, the CDC noted.