In This Issue
U.S. Scores Dead Last Again in Healthcare Study 1
Old Drugs Find New Use in Hep C 3
Waiting for Better HCV Treatment: Living in the Gap 3
HCV Rapidly Develops Resistance to Direct-Acting Agents, Indicating Need for Multidrug Combos 5
FDA Approves First Rapid HCV Antibody Test 6
Court Date for Doctor Linked to Hep C Outbreak 6
U.S. Scores Dead Last Again in Healthcare Study
By Maggie Fox
WASHINGTON (Reuters) Jun 23, 2010 - Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system, according to a report released on Wednesday.
The United States ranked last when compared to six other countries -- Britain, Canada, Germany, Netherlands, Australia and New Zealand, the Commonwealth Fund report found.
"As an American it just bothers me that with all of our know-how, all of our wealth, that we are not assuring that people who need healthcare can get it," Commonwealth Fund president Karen Davis told reporters in a telephone briefing.
Previous reports by the nonprofit Fund, which conducts research into healthcare performance and which promotes changes in the U.S. system, have been heavily used by policymakers and politicians pressing for healthcare reform.
Davis said she hoped health reform legislation passed in March would lead to improvements.
The current report uses data from nationally representative patient and physician surveys in seven countries in 2007, 2008, and 2009.
In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey.
Australians spent $3,357, Canadians $3,895, Germans $3,588, the Netherlands $3,837 and Britons spent $2,992 per capita on health in 2007. New Zealand spent the least at $2,454.
And yet Americans get less for their money, said the Commonwealth Fund's Cathy Schoen.
"We rank last on safety and do poorly on several dimensions of quality," Schoen told reporters. "We do particularly poorly on going without care because of cost. And we also do surprisingly poorly on access to primary care and after-hours care."
The report looks at five measures of healthcare -- quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.
"On measures of quality the United States ranked 6th out of seven countries," the group said in a statement.
U.S. patients with chronic conditions were the most likely to say they got the wrong drug or had to wait to learn of abnormal test results.
Overall Britain, whose nationalized healthcare system was widely derided by opponents of U.S. healthcare reform, ranks second, the Commonwealth team found. The Netherlands ranked first.
"The findings demonstrate the need to quickly implement provisions in the new health reform law and stimulus legislation that focus on strengthening primary care, realigning incentives to reward higher quality and greater value, investing in preventive care, and expanding the use of health information technology," the report reads.
Critics of reports that show Europeans or Australians are healthier than Americans point to the U.S. lifestyle as a bigger factor than healthcare. Americans have higher rates of obesity than other developed countries, for instance.
"On the other hand, the other countries have higher rates of smoking," Davis countered. And Germany, for instance, has a much older population more prone to chronic disease.
Every other system covers all its citizens, the report noted and said the U.S. system, which leaves 46 million Americans or 15% of the population without health insurance, is the most unfair.
"The lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen," the report reads.
Old Drugs Find New Use in Hep C
(Ivanhoe Newswire) June 9, 2010 -- You know what they say about "old dogs" and "new tricks." But apparently, researchers in England didn't pay any attention and may have pumped new life into some old medications.
Academics at the University of Leeds have found medications like the anti-diabetic drug Metformin and the obesity drug AICAR can prevent the hepatitis C virus from replicating in the body. The two drugs work by stimulating an enzyme called AMP kinase (AMPK), which regulates energy within our cells. This is the very enzyme that the hepatitis C virus represses to enable it to replicate.
"We're very excited about these findings," Professor Mark Harris from the University's Faculty of Biological Sciences, was quoted as saying. "These drugs are already on the market. We think it could be an enormous step forward in the battle against the virus."
Researchers have already filed a patent on the discovery, and the teams will soon kick-start a small-scale clinical trial with The University of Nottingham. This will provide a greater evidence base upon which future clinical trials can be constructed.
Source: The University of Leeds, June 7, 2010
Waiting for Better HCV Treatment: Living in the Gap
Lucinda K. Porter, RN
In 1997, I muddled through 3 months of treatment for chronic hepatitis C virus (HCV) infection. The prescribed medication was interferon, self-administered three times weekly. Since I have genotype 1, my chances of eliminating the virus were low (less than 10%), so it was no surprise when I didn't respond to treatment. Waiting for better treatment was my best option.
A year later, combination therapy of interferon and ribavirin was introduced, along with better success rates. I decided to wait for better HCV drugs based on my resistant genotype and my recent experience with interferon therapy. In 2002, a modified version of interferon known as pegylated interferon or peginterferon, became available; this new version administered with ribavirin gave me a nearly 50% chance of success, so I took the plunge. I responded to
treatment, and went through a 48-week course. The bad news was that the virus returned after treatment was discontinued; the good news was that the condition of my liver improved dramatically.
I have options. I could try a daily course of consensus interferon or a 72-week course of peginterferon and ribavirin. These seem extreme to me given the condition of my liver. Knowing that science is working on better treatments, and there are some very promising ones in the pipeline, I prefer to wait.
Graceful waiting is an act of courage and patience. I cling to the fact that my liver is in excellent condition. Simultaneously, I am acutely aware that record damage from HCV is forecasted, due to the fact that the majority of those with HCV, the aging Baby Boomers, have lived with this virus for a long time. The number of those with HCV-related advanced liver disease will quadruple in the next 10 years—from 30,000 to 150,000. Those with liver cancer will triple from 5,000 to 15,000; mortality rates are rising.
Waiting for the next round of HCV treatment feels like living in a gap, straddling the past and a future that I try to imagine. As someone with vast experience of living in the gap, I have picked up some tips for how to live well while waiting for science to discover better treatment for HCV:
Tip #1: Don't be a victim—be your own hero. Waiting is an active process. While waiting for better treatment, a frustrated patient once told me, "I feel like I am sitting around and doing nothing while the hepatitis C is eating away at my liver." Don't sit back and let this happen. Use this time to assess your choices and design a plan for how to live well. Commit to this plan and act on it today.
Tip #2: Take care of your entire body. You may have a liver disease, but statistically you are more likely to die of an unrelated medical condition. While you are at it, take care of your mind and spirit too.
Tip # 3: Get a life. It's easy to dwell on HCV, especially when we are first diagnosed. However, after awhile, thinking about HCV all the time can become an obsession that may hurt more than help. Strike a balance between the need to stay current and the need to be free from thinking about HCV.
Tip # 4: Imagine health. Visualization, positive self-talk, and imagination are powerful tools. We can use them to our advantage or detriment. If all we can think about is how tired and befuddled we are, it doesn't leave room for much else.
Tip # 5: Stay connected. Find people, with or without HCV, who are vital and wise. I found it necessary to let go of unhealthy relationships, and surrounded myself with people who had gumption. Someone wrote, "Life isn't about waiting for the storm to pass. It's about learning to dance in the rain." If I was going to dance in the rain, I wanted to be with other dancers.
Tip # 6: Strive for the healthiest lifestyle you can. This is courage in action. Lao Tzu said, "A man with outward courage dares to die: A man with inward courage dares to live." Start small. I don't smoke or use alcohol. I eat well, maintain my weight, am active, and I meditate. This took years to achieve. I gave up alcohol first, then cigarettes. Exercise came next. I am still working on meditation. It's a process. If I tried to change all of me at once, I would have given up.
Tip # 7: Live in health, not fear. HCV is scary, and it is reasonable to freak out about it. However, fear and worry don't help, so when you are ready, consider giving up fear. Amy Tan wrote, "If you can't change your fate, change your attitude." Attitude can change everything.
Tip # 8: Surround yourself with positive messages. Mary Kay Ash, founder of Mary Kay Cosmetics said, "If you think you can, you can. And if you think you can't, you're right."
Tip # 9: Live in gratitude. There is a Chinese proverb that states, "We count our miseries carefully, and accept our blessings without much thought." Are you counting your blessings or your troubles?
Tip # 10 Keep your sense of humor. The English poet, Lord Byron wrote, "Always laugh when you can. It is cheap medicine." In addition to scientifically-proven health benefits, humor lightens even the heaviest load.
It takes stamina to live in the gap, and sometimes I get sidetracked from my determination.
When I feel sorry for myself, I think about Lance Armstrong. He survived testicular cancer that had metastasized to his brain and lungs, later going on to win the Tour de France seven times. Even more impressive is Lance's return from retirement. He said, "Anything is possible. You can be told that you have a 90-percent chance or a 50-percent chance or a 1-percent chance, but you have to believe, and you have to fight."
The reality is that new and better treatments are always going to be around the corner. I've seen enough change that although I appreciate the progress; I don't get overly excited about the next great thing in the pipeline. What I want to see are hard core results. While waiting for the evidence, my priority is to stay healthy, no matter what.
Living in the gap is much like being in training. It is a declaration of intent to stay healthy no matter what. It is medicine without taking drugs. When we dare to live well, we serve others by honoring ourselves.
For more information on how to stay healthy while living with HCV, check out: A Guide to Healthy Living with HCV.
Source: HCV Advocate July Newsletter
HCV Rapidly Develops Resistance to Direct-Acting Agents, Indicating Need for Multidrug Combos
June 18, 2010 - Standard therapy for chronic hepatitis C using pegylated interferon plus ribavirin can cause difficult side effects and only clears the virus about half the time, leading researchers to evaluate a large number of direct-acting oral drugs that target specific steps of the viral lifecycle.
But HCV mutates easily and rapidly as it replicates, which allows for emergence of drug resistance mutations. Recent research indicates that resistance mutations are common, and in order for these agents to have prolonged effectiveness without interferon, some people may require "cocktails" of as many as 4 drugs that work in different ways.
Below is the text of a press release issued by the University of Illinois at Chicago summarizing the modeling study:
Combination of Direct Antivirals May Be Key to Curing Hep C
Chicago -- May 5, 2010 -- A combination of antiviral drugs may be needed to combat the drug resistance that rapidly develops in potentially deadly hepatitis C infections, a new study using sophisticated computer and mathematical modeling has shown.
Using probabilistic and viral dynamic models, researchers at the University of Illinois at Chicago, Oakland University and Los Alamos National Laboratory predict why rapid resistance emerges in hepatitis C virus and show that a combination of drugs that can fight three or more mutated strains may be needed to eradicate the virus from the body. They compared their model with data from a clinical trial of the new direct-acting antiviral medication telaprevir.
The findings are published in Science Translational Medicine.
Hepatitis C is a progressive liver disease that can lead to cirrhosis and liver cancer. Current standard treatment is a combination of the antiviral drugs interferon and ribavirin for a period of 24 to 48 weeks -- a regimen that is long and expensive, carries side effects, and is successful only in about half of patients.
Intensive effort has focused on developing direct antiviral drugs. But the virus is genetically diverse, and so may be particularly prone to develop resistance, said Harel Dahari, research assistant professor of hepatology in the UIC College of Medicine and one of the paper's co-authors.
One way to combat resistance would be to administer multiple drugs, each with a different mechanism of inhibiting the virus.
"We found that rapid emergence of resistance to these types of drugs is due to a population of viruses already present, allowing the resistant virus to become the dominant strain," said Dahari.
The researchers suggest that a combination of new antiviral drugs will be needed to fight all of the resistant virus strains and achieve better cure rates for the disease.
"We are moving to a new era where we can treat these patients with direct-acting agents against the virus, in which we specifically target the life-cycle of the virus," Dahari said.
replace the standard treatment, four or more different types of direct drugs may
be needed, Dahari said. However, some patients may need fewer drugs. It depends
on the level of the virus in their blood, among other factors.
It is frustrating for patients to go through a long, difficult treatment and know that they might not be cured, said Dr. Scott Cotler, associate professor of medicine at UIC and a hepatologist who treats patients at the University of Illinois Medical Center's Walter Payton Liver Center.
"Patients are looking forward to a day when they don't have to take interferon and ribavirin," said Cotler. "But as we are learning with this study, if we are going to need four different direct drugs, it is going to be awhile before we get there. Now at least we know where the goal line is."
Dahari suggests that future treatment that includes the standard treatment and direct antivirals, such as telaprevir or boceprevir, will be tailored to each patient and that using direct antivirals may also shorten the duration of treatment.
Investigator affiliations: Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM; Department of Mathematics and Statistics and Center for Biomedical Research, Oakland University, Rochester, MI; Department of Medicine, University of Illinois, Chicago, IL.
References: University of Illinois at Chicago. HCV Rapidly
Develops Resistance to Directing-acting Agents Indicating Need for Multidrug Combos. Press release. May 5, 2010
FDA Approves First Rapid HCV Antibody Test
June 28, 2010 — The US Food and Drug Administration (FDA) has approved the first rapid blood test for antibodies to the hepatitis C virus (OraQuick HCV Rapid Antibody Test; OraSure Technologies, Inc) in patients aged 15 years and older who are at risk for HCV or have signs/symptoms of hepatitis.
According to information on the company Website, the portable device uses a test strip that detects all HCV genotypes in about 20 to 40 minutes from samples of oral fluid, fingerstick/venipuncture whole blood, or collected serum/plasma. Test accuracy is greater than 99% with whole blood and serum/plasma samples but is somewhat less accurate with oral samples.
Once the sample is collected, the device is inserted into the buffer, and results are read on the device face as nonreactive (1 line) or reactive (2 lines). Mixing with the buffer solution is required for all samples not obtained orally.
"The OraQuick HCV test efficiently identifies previously undiagnosed HCV infected individuals who are at risk," said Eugene R. Schiff, MD, from the University of Miami School of Medicine, Florida, in a company news release. "We at the University of Miami found this test to be user-friendly, practical and an important tool for rapid HCV antibody detection."
"Approval of OraQuick means that more patients can be notified of their HCV infection faster so that they can consult with their physicians for appropriate health measures," said Jeffrey Shuren, MD, JD, director of the FDA's Center for Devices and Radiological Health, in an agency news release. "Getting faster treatment is an important public health step to control this dangerous disease."
The FDA notes that the point-of-care test is not approved for HCV screening purposes in the general population.
Source: Medscape Medical News
Court Date for Doctor Linked to Hep C Outbreak
LAS VEGAS – June 11, 2010 -- Disgraced physician Dr. Depak Desai, who operated several southern Nevada clinics linked to the 2008 Hepatitis C outbreak, is due in court Friday to face charges of racketeering, negligence and insurance fraud
Dr. Desai was indicted last week, more than two years after the outbreak that infected 106 people and forced 50,000 to be tested for hepatitis C, B and HIV.
Authorities said workers a Dr. Desai's clinics, including the Endoscopy Center of Southern Nevada, reused vials of injected anesthetic on patients, increasing the spread of the viruses.
Two of Desai's employees, Keith Mathahs and Ronald Lakeman, have also been arrested and charged in the case.
The Southern Nevada Health District spent $16 million during its two-year investigation into the outbreak.
Desai was stripped of his medical license in February. He is currently on house arrest.