By Bill Remak  - 12/20/2002                                                                

Chairman, California Hepatitis C Task Force

wmremak@californiahcvtaskforce.org

(707) 773-4922

        Over the last five years our society has heard more and more about a liver disease called hepatitis C. The media has dubbed it the "silent killer" and the "silent epidemic" because it takes 20 to 30 years under normal conditions until it manifests serious damage to the liver and impacts the infected persons quality of life.  Most people do not know that they are infected until they are symptomatic or their family doctor chances on some abnormal blood tests related to the liver. Although it can lead to complications that cause cirrhosis, liver failure, liver cancer and death, the medical community is confident that in 15% to 25% of the cases that become infected, that their immune system fights off the disease and no physical damage occurs.  The remaining percentage of people may respond to treatments currently being used, which may cause them to be cleared of the virus from about 40% to 80% of the time depending on what strain or genotype they have. The most prevalent strain in the United States provides encouraging results in only about 40% of the patients. There are other factors that may exist where those affected are too advanced with liver disease to be considered for treatments and have to turn to surgical procedures or even a liver transplant. Over 2000 men, women and children on the UNOS list died while waiting for a liver transplant this year. This virus is transmitted through blood contact and before 1992 there was no test to detect this virus at blood banks so those that received blood prior to that time and also those who did not apply or practice universal blood precautions, were at risk. How much at risk? More than five times greater than contracting HIV or AIDS! Something to think about in this day and age where tattooing and piercing is very commonly done by non-professionals who do not take proper health precautions. The Centers for Disease Control estimates that 1.8 % of our general population is infected. We know that if you include homeless persons and prison inmates that this figure could well exceed 2.2 percent of our nations population.  Could this virus be transported and a delivery system devised to transmit this virus in such a way as to be used by a terrorist to cause damage or threaten our security, our way of life or our financial stability? Well, it not likely that as an agent, this would be very effective, but it has not been studied! If used in this manner, it would have to be done manually by an individual using infected blood to contaminate others, spraying it on surgical equipment, injecting it into blood bags for surgical use or directly into patients.  Feasible but not practical.  Ineffective physically in reducing one's ability to function in the short term. A person who is exposed in a controlled setting such as a nurse being accidentally stuck by a contaminated syringe may take six to eight weeks before they could provide an accurate test result to detect the virus and determine either positive or negative exposure by currently available measurements. In any case many believe that in 20 to 30 years from now there is hope that we will have very effective treatments to rid one of this disease and perhaps even have developed a vaccine. We must consider that the conditions regarding our security systems in hospitals, laboratories and blood banks needs to be studied as an issue of national security and we should look carefully at the potential possibilities of malicious transmission of this virus. The psychological ramifications of not knowing if one has been infected could cause serious panic if citizens are not otherwise considered at high risk and cannot find an explanation for their exposure. This issue undoubtedly needs further study. The cost of treating this disease is staggering and even considering the current rates of chronic infections, our state health care systems are powerless to absorb this great financial strain. Hepatitis C is among the ten most costly diseases to treat. Must we be afraid? Currently this disease at it present rate annually kills more than five times the number murdered on September 11^th by terrorists. No one wants to see that statistic increase!  If we do not know, then how will we know what to fear? How can we best be prepared?  We are better off being in the know or at least our government must invest some serious time and money to research this to find out! This is our right. We can argue this in similar terms to Anthrax or Smallpox and TB and some will say this is apples and oranges. Talk to a patient in misery and he or she will tell you, especially when they are suffering greatly, that they just want for it to be all over. How long must we fight our shadow? What ghost will tomorrow bring? It is time to change our course!  We should be saving lives, not taking them. ]    12/20/2002

Comments:

"That was an interesting and thought provoking article you wrote about the potential of bio-terrorism and blood born pathogens like Hepatitis C.  Definitely something for our Government to think about!"

Steve Kersker

"I wrote it to give some balance to this incredible focus on bio-terrorism and an attempt to remind them that there is a bigger battle already going on and not to dismantle our health system under the guise of war. Thatwould give terrorists an easy victory. Unless I created the thought of an association, they just would not see it."

Bill Remak

"This topic requires this kind of language to get the point across."

Phyllis Borchardt

"Interesting article and I sent it out on the listserv."

Phyllis Beck

"I think it's a good idea to put this out. We need a mechanism to get more attention. All the attention is given to small pox when really more attention needs to be given to a "real" threat that is already at our doors. As much as I hate to say it, we need to get people concerned...."

Kathie Lustig

"The article is provocative."   Liz Poulsen

"Steve Kersker phoned me from Florida and I said I just wanted to get people thinking about it and encouraged it to get distributed to as many as possible especially the media. I told him that it really isn't important who puts their name on it, as it is the issue that is important. The whole thing with this Homeland Security and Bo-terrorism hype is that our executive branch is oblivious to our plight as citizens who are faced with homelessness and dying of treatable diseases and reducing our education systems to rubble. Many more are suffering here than will die in this "war" on distant soils. The money being tossed away would otherwise cure cancer, hepatitis, AIDS and other diseases, send a dozen people to the moon and back, bring our economy back to stability, deal with our country's massive substance abuse problem head on and reduce our staggering unemployment. It is time we shout and take a stand and fight back using the democratic system to do it. We are not being protected but rather we are being abandoned.

Tonight I watched 60 minutes in horror to learn that firms were pirating medications for transplant patients, cancer, hepatitis and aids patients as these are the most costly prescribed drugs, and were diluting them and putting them back into the market place right under the noses of the major pharmaceutical manufacturers who knew about it and didn't even report it to the FDA for fear those consumers would go to their competitors!

Tampering With Prescription Drugs?

http://www.cbsnews.com/stories/2002/12/20/60minutes/main533860.shtml

CBS News Online."

Bill Remak