Well-placed advocacy

Tyndall has provided a thoughtful commentary on hepatitis C treatment and is duly respectful of nonmedical determinants of health, which are heavy influences on hepatitis C epidemiology.1 As a physician providing frontline care for patients with this disease, I caution against presuming scarcity and approaching this problem with a treatment-or-prevention paradigm. We’ve applied this paradigm in the past with HIV and drug-resistant tuberculosis, only to find that treatment is actually a very good weapon in the prevention arsenal.

Although Tyndall 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 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 with the standard of care. As a service provider to Canada’s most vulnerable people, who are already at an increased risk of suffering (poor, homeless, indigenous, women and children suffering from abuse, mentally ill), I am compelled to find ways to provide even better care than the standard to my patients.

Yes, the new hepatitis C 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? I am going to place my advocacy where it belongs: with the latter.