Misplaced advocacy: What does better hepatitis C treatment really mean?

Mark Tyndall

doi:10.1503/cmaj.150612

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Well-placed Advocacy
Bonnie R. Larson

Posted on: 13 January 2016

Posted on: (13 January 2016)
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Well-placed Advocacy
Bonnie R. Larson, Family Physician
Dr. Tyndall has provided a thoughtful commentary on the current state of hepatitis C treatment, and is duly respectful of non-medical determinants of health, which are heavy influences on hepatitis C epidemiology. As a physician providing frontline care for patients infected with this disease, I would caution against presuming scarcity and approaching this problem with an either (treatment)-or (prevention) paradigm. We...
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Dr. Tyndall has provided a thoughtful commentary on the current state of hepatitis C treatment, and is duly respectful of non-medical determinants of health, which are heavy influences on hepatitis C epidemiology. As a physician providing frontline care for patients infected with this disease, I would caution against presuming scarcity and approaching this problem with an either (treatment)-or (prevention) paradigm. We applied such a paradigm in the past with HIV and drug resistant tuberculosis, only to find that treatment is actually one very good weapon in the prevention arsenal.
Although the author does advocate for resources to be spent "upstream" at the level of prevention and addiction treatment, he does not recognize that finding a way to treat ALL cases of hepatitis C would actually be part of a complete prevention and harm reduction strategy. We must avoid the trap of assuming that we are slaves to limited resources, and instead continually seek innovative ways to provide our patients the standard of care. And I, as a service provider to Canada's most vulnerable individuals (poor, homeless, indigenous, women and children suffering from abuse, mentally ill), am compelled to find ways to provide even better care than the standard, to my patients who are already at increased risk of suffering.
Yes, the new HCV treatment regimens are expensive. Does that mean we should ration those treatments based on cost, or fight hard for a fairer price and good access for all? As a health equity professional, I am going to place my advocacy where it belongs: the latter.
Conflict of Interest:
None declared
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Competing Interests: None declared.