Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Hepatitis C

Episode Date: May 16, 2023

The third Hepatitis to be discovered, appropriately named Hepatitis C, is an infection that primarily affects the liver, but often has non-specific symptoms. Dr. Sydnee and Justin trace the strange history of this virus, how it spreads, and why testing for it is more important than ever.  Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talkies about some books. One, two, one, of Miss God in Medicine. for the mouth. Hello, everybody and welcome to Saul Bones, a marital tour of Miscotted Medicine.

I'm your co-host, Justin McRoy. And I'm Sydney McRoy. How are you doing, Sydney? I'm hungry. Oh, man, yeah. Well, hi, hungry. Oh, no. I'm dad.

That's a dad joke. Yeah. That's a very daddy. Not daddy joke. No, that's not, that sounds different. That's a daddy joke. Oh, man, I mean, dad joke. Yeah. That's a very daddy. Not daddy joke. No, that's not, that's not, that's not different. That's a saddy joke. Oh man, I mean, Did you just call yourself a daddy? Did you just decide you're a daddy?

I don't actually have to have a positive or negative. Um, I, I made the girl so mad yesterday, I got into the carter school and they're both telling me how hungry and thirsty they are. And no matter what, they said, I just keep telling them that I'm dad, high hunger, I'm dad, high thirst, damn dad, they were ruinously frustrated with me.

It was, it was not a good scene. I don't know why I did it, honestly. I just wanted the challenge. I don't know. I was intentionally poking the bear. Yeah, I wouldn't do that when they're hungry, especially not. So the bear's over cause come out. That's what Tate says is a mad woman, right?

Uh-huh. Thank you, New York Times Crossword Puzzle. Thank you, New York Times Crossword Puzzle. That by the way, I'm gonna tell you, by the way, that piece at like 47 on the charts, that is not our fault for not knowing that track. Okay. Oh, well, I just like, I was gonna say, I like that we refuse to ask Riley, no, even though Riley would definitely have immediately known the answer to

that. Yeah. No way. Justin, we're not easy Too easy. I wanna talk about something else now. Okay. Is that how it works? You just do that, okay? Yeah, there's a topic that I realized we hadn't ever covered on solvents. And can I just say, sometimes I'm not sure that we have and I have to Google and find out if we have.

I Googled to see if we had and I can't find it, but I'm worried that I start to get worried that I'm wrong. I heard recently from a listener that we may have done Lice twice. to see if we had and I can't find it, but I'm worried that I start to get worried that I'm wrong. I heard recently from a listener that we may have done Lice twice, that we did do Lice twice, I should say. We did Lice twice? We did Lice twice. I wonder if it was different.

It's probably very different. It's probably different. We had a much different... Why are you just now talking to this now? I don't know. On the air. I didn't want to say it out loud. But so you said it out loud into a microphone and we're working on.

This is very stressful I have to go back and address this. I don't I don't think there's any way to address it's out there now It's out there in the world. We like episodes. We did we did I don't think we've talked about hepatitis C before I know we talked about hepatitis I believe talked about other hepatitides Is that a real word? Yes, oh what's a mouthful? But I do not I Best as I could Google and search our podcast history. Listen, can I tell you what, what, or you give me a look?

I'm not giving you a look. Can I tell you why I don't like to go back and search to see, have I just forgotten that we already covered this? Yes. Because I have to Google our podcast. And you don't like to do that? No. Because it's on the internet.

Because it's on the internet. And it's similar to googling oneself, which you don't like to do that. No. Because it's on the internet. Because it's on the internet. And I it's it's similar to googling oneself, which you don't want to do. Nope. You don't you also don't want to Google anything you create ever. Yes. Right. This is an this is an important role. You put it in the bottle. You check the bottle in the ocean. You do the best you can every time and try to hope do you try really hard. And that's that's what I'm doing. I'm trying really hard. I hope you try really hard and that's what I'm doing. I'm trying really hard. Anyway, we're going to talk about Hep C. It's something that's on my mind a lot because of the type of medicine I practice nowadays. I provide a lot of care for people with substance use disorder and people who use injection drugs.

Because of that, there's an overlap. There's a high prevalence of hepatitis C among that patient population. So it's something that I think about a lot. It's something that I'm currently signed up for extra CME continuing medical education courses to treat. I'll buy my Lonesome once I've completed all that coursework. He's loving.

You know, you don't really have to do that. I thought you might find this interesting. What do you mean? I am currently in the midst of doing a lot of extra CME, a lot of... And when I say that, what I mean is like I'm paying for self-study courses and modules and exams that I take, that I then receive credits for, which are important to maintain my licensure, but also like just for my own edification, so that when I manage different conditions, I know I'm competent, but there's no rule that says I have to do that.

Isn't that weird? I did not know that. I don't have to have done this extra CME that I'm doing in HIV and HFC so that I can manage these things. I'm just doing it. For the fun? No, I mean, because I mean, it's the right thing to do, but it's just weird that you

could also just manage those things if you have a medical license. That is weird. But I think it's good. I mean, I learn about stuff all the time. I don't need to. I think it's great for your brain. It's a level of trust they put in me as a professional that I'm not used to, like, my profession getting.

I don't know. I'm not used to getting that as a professional anyway, but I am doing all the right stuff. And now it's a great story to talk about now when we've talked about hepatitis C because it's curable. Is that a new thing? Relatively new, yeah. I mean, not like yesterday,

but in the grand scheme of medical history. Last week, the last couple weeks. No, not last couple weeks. Longer than that, but still newer. There are a lot of hepatitis viruses. We've talked about some of them on the show before. You're probably, you've probably heard of them. The word hepatitis, by the way,

just means inflammation of the liver. Anyitis is an inflammation. And any hepa is the liver. Yeah, the liver. We're referring to the liver. Hepatocyte. Except for a hepa filter. That's completely different.

It's a whole other thing. Hepatocyte sites are like cells and hepato liver cells. So hepa meaning liver and itis meaning inflammation, but then there are also viruses that can cause inflammation of the liver and we call those the hepatitis viruses. Okay. Got it. Got it. It's a, this one, hep C is a little RNA virus.

It's in the Flaviviridae family. We've talked about Flaviviruses before or Flaviviruses, what have you want to pronounce it? You like that, I remember. In that family, you also find things like Zika and Denge and Yellow Fever and West Nile. Some of the other things we've talked about ourselves in there. Hepatitis viruses get their own little genus or large genus as it were, filled with just those specific viruses that tend to all primarily affect the liver. They can do stuff outside the liver, but they're mainly a problem for the liver.

The way that Hep C works specifically, because each one has their own sort of little profile as to what exactly it does, how long it does it, how serious the complications can be, and how you get it. The way that you contract Hep C is usually through some sort of bodily fluid. Those can be like P or spit. Well, no, not exactly. I'm talking more like blood or a sexual fluid exchange. Nice.

So injection drug use is a major the primary mode of transmission. You can definitely contract Hep C that way and and many people do Sexual activity. There are a lot of health care exposures as well. That's actually a bigger concern. When I say a lot of, I mean, in relative to HIV, which I think is another worry people have when they get like a needle stick in a healthcare setting, hepatitis C is actually more easily transmitted in that way and is usually more of a concern. So you do see people who got Hep C through a health care exposure. I knew a colleague who had to sort of change at the time, had to change their

path in medicine to a different specialty because of an early career hepatitis C exposure and then developing the disease. Oh my gosh. Yeah. So you can get it that way. You can also get it through transfusions, not so much nowadays, but this was a threat, right? Prior to us having good screening, yeah, screening protocols for screening transfusion products, any sort of blood product, you could get it that way,

perinatal transmission. The virus primarily affects the liver, as you may imagine, after anywhere from one to three months after you're exposed. So there can be a lag. You can track hep C, and then it can be a little bit of time before you notice any symptoms. There's early symptoms, and not everybody gets acute symptoms immediately, in that initial infectious phase. Nothing cute about it. in that initial infectious phase. Nothing cute about it. But you get like some nausea, vomiting, maybe a fever, maybe some muscle pains, really

non-specific stuff, right? Like stuff that you wouldn't necessarily know. Now, if you start to become jaundiced or if your urine gets really dark because there's belly ribbon in it, so it looks like dark orange or if your stool's changed color, you would probably notice these things. Not everyone gets all of these symptoms though. So you wouldn't necessarily know you were infected. This is really important.

I'm pushing this idea that you wouldn't necessarily know you got it because that still remains a major problem, people not knowing that they have. And you want to free people. You want to free garlic, and there's a little bit more. No, I want to empower them with knowledge that allows them to make informed healthcare decisions about whatever screening tests they may need. Fair enough. Okay.

So you wouldn't necessarily know if you had it or not. Right. Okay. Some people can progress to liver failure in that initial acute phase, but the vast majority do not. That's pretty rare, actually. And there are some reasons why somebody might be more likely to develop the more severe complications.

Like if you also have another type of hepatitis, like HB or something, or if you're also co-infected with HIV, if you have damage to your liver already from alcohol or something like that. So there are some reasons why you may be at higher risk for initially having a more serious course.

Most people, you get the acute symptoms, they go away, and then they will progress to long-term hep C infection. So 70% are going to continue to sustain some damage from the virus, long-term. And then way down the road, that can result in things like cirrhosis, it can result in really serious things like hepatocellular, carcinoma, cancer of the liver. So it's a big deal to treat hep C. Okay. Because while some people are never going to have any of these complications and some people

get the virus, get sick, get better, and then don't ever have any issues again. The majority are going to have some sort of problem from it, minor major, some sort of problem. So, it is important that you know if you have it, that you get tested and that you get treated. Actually, this is a wide-ranging question, but I'm curious about it. Why is this the one where they do? And there's probably others and I'm looking forward to hearing about it. If you agree, why do we have like the

A and the B and the C for hepatitis? Because I feel like I was sitting here thinking like, man, my brain just like will not, we've talked about hepatitis at a billion times, my brain just like will not absorb the, the what hepatitis is and does. Like I can't hold on to any facts about it. I feel like it's the ABC thing. I think it's kind of confusing. And I don't know if there's other examples of us doing splitting things up that way or what's the purpose?

We split them up sometimes by genotype like that. Well, no, that's not genotype. We split. So we split them up by species. And then we can also split them further by like genotype and then split them even further by like sub-divisions of the genotypes. There's lots of different ways to split up. And I mean, all of them, I should say all, the vast majority of viruses are split up like

this. Okay. I think the reason that you hear about it more with hepatitis specifically is because they're very common well-known viruses and some of them use numbers and I don't know. Like 2019. Yeah, yeah, but like we also didn't talk about the other, well that was because it was 2019.

Oh yeah, yeah. But we also didn't talk about like other, well, that was because it was 2019. Oh, yeah. Yeah, sure. But we also didn't talk about like a lot of the other strains of coronaviruses before, because most of them weren't a big deal. Now, when they were a big deal, we did talk about it, right? SARS. Yeah. That's a coronavirus. Yeah, I just, yeah, I just felt like the lettering thing.

I don't know. It's just a way to denote different ones that have slightly different modes of transmission and different concerns should a person get them. But yeah, no, it's not unique to hepatitis. I just, they're very common. And so we talk about them a lot. And they're more serious, too. There are some viruses that are very, very common.

And we almost never talk about because the vast majority of the time they don't do anything. Again, I referenced coronavirus prior to COVID-19. Had you heard the word coronavirus prior to them? No. Okay. You have had a coronavirus prior to COVID-19. I had to, it's statistically we all have because for most, most of the other versions, it was a common cold. Right. So anyway, sorry, sorry, no, that's a good question. It's a we all have because for most of the other versions it was a common cold. Right. So anyway. Anyway, sorry, sorry. No, that's a good question. It's a good question.

And it does make it harder to remember, I think, what they all do. Other than generally, if it's a hepatitis, it's going to do something to the liver. Okay. That's good enough for me. Yeah. We can't find evidence. So the hepatitis virus only survives inside living organisms. So it's hard to find like clear evidence

that we have had hepatitis around since ancient times, right? Cause like those people are dead, cause they're ancient. That's true. Yeah. There's some evidence, like we always try to link this stuff to primate viruses. That's typically the way we go. Primate viruses.

Primate viruses. That's typically what we think, right? Like, there are probably the early precursors to our human hep C, probably with some sort of primate hep C or something like that, right? We're not sure, maybe. But nothing's been conclusive. So it could date back millions, you know, 35 million years. It could date back like 400 years.

We're not really sure. I hope nobody had to work very hard to obtain the information you've just passed on to me, because it's kind of pointless. I don't know. I feel bad for every research set, because they got to the end of that, and they're like, guys, I feel like I just wasted my time.

I don't know, 400 or a bajillion. I don't know. I feel like we know less about it than what I started. I'm gonna go. I'm gonna go into math. I get that. Well less about it than what I started. I'm going to go. I'm going to go into math. I get that. Well, it's always interesting to see where the, to trace the sort of family tree of these viruses.

But not always interesting, because sometimes what you end up with is 400 years or maybe like a bajillion years. So that's not always interesting, I would say. Okay. Well, in this case, maybe it's not interesting. Okay. So the other way we can kind of tell how old something is is by looking for like records of the symptoms and saying like, oh, well they didn't know what this was called yet, but

we can look back and see that sort of like constellation of symptoms in a person and go, oh, I know that that was. It's this disease, this bacteria, this virus, right? It's hard with hepatitis in general because the symptoms are really non-specific. It's sort of a longer time, right? Like from that initial infection to when you get symptoms, to when you might have serious complications, can be such a long drawn out process that at that point connecting it all without knowing the

disease-causing agent would be very difficult. And there are lots of things that can cause liver failure. So it would have been really hard to blame it on anything. What is interesting, I think, is that we actually would discover what would be one of the first treatment regimens, not so much what we used today, but one of the first real breakthroughs in treatment of Hepsi, was actually discovered before we knew about Hepsi. We figured out that first. That's wild. Yeah, so there's something called interferons, which are actually.

Yeah, that was, man, we didn't talk about that during COVID, did we? Inheritances like in my, I don't know. I'm sure we did. Interferons are produced by your body I'm sure we did. Interferrons are produced by your body in defense of innings, sort of invader primarily viruses, and they help make your immune response happen. Interferrons are really important, little messengers, that will tell your body to get it into gear and interfere with the virus continuing to grow and replicate within your body. So back in 1957, I British bacteriologist, Alec Isaacs and a Swiss microbiologist, Jean Lindonman, discovered these things.

And we thought, well, maybe we could put these in a bottle and give them to people when they're sick. Nice. And at that point, they seemed to work any time you had some sort of invader, any virus. So why couldn't they be used sort of like as a blanket treatment for viruses? Yeah. So when I say that the treatment was discovered

before the disease itself, it was a treatment for all sorts of viruses, if that makes sense. Yeah, yeah. Still. And it wasn't until the 70s that we did more research and we said, huh, these seem like they might prevent viral infection possibly. Maybe they have more broad-ranging, like with cancers. Maybe they can suppress cancers.

Like, we learned a lot about interferon. Long before we knew about the virus that interferon would be one of our first tools to treat. And we also didn't learn about Hep C first obviously, because then it would probably be Hep A. As you may imagine, we found two of the other hepatitis viruses before we found the hep C. Yeah, that's right. The woman who? Hep A and Hep B were discovered in the 60s and 70s. And it was one of those things where we found a test for Hep A, we found a test for Hep B. We started finding people with like,

what we saw is like a transmissible liver disease, epidemic liver disease. People were getting liver disease and it wasn't from some other environmental cause because it was in such it was spreading and so front like from the from an epidemiological standpoint we could look and go okay all these people got this liver disease something is contagious here so we test them for HEPA it's not that we test them for HEPB it's not that and then we go

there's something we don't know about yet. And that was the next journey that it took us a while to go on was, we know there's a virus, we know it's probably like these other two, but we can't see it or grow it or find it. Now, okay, is there a hepti? Yeah. Is there a hepti? Yes. Is there a hepti? Yes.

Is there a heptf? No. Good. That one, I didn't like saying heptf. Heptf. It sounded bad. No. So, we knew there was...

Hepatitis X is what I would like to have someday, but it seems like we're a long way away from that. It just seems like if I was going to have a cool cybert disease, it would probably be hepatitis X. Yeah. I mean, that does, probably be hepatitis X. Yeah. I mean, that does, and maybe hepatitis X is when it starts to work in our favor. Oh, that's the good one. That's the good one.

That's the one you want to have. So anyway, we knew there was a cause of liver disease we were missing. It wasn't one of these two that we know about, but we didn't know what it was quite yet. I'm going to tell you how we figured out what it was, but first we got to go to the Berlin Department. Let's go. Trans representation in media is at an all-time high with trans entertainers gracing the screens large and small. But trans voices, especially black trans voices, are rarely centered in our own stories.

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I'm Maddie Myers. And I'm Kirk Hamilton. We're the hosts of TripleClick, a video game podcast for anyone who likes games. Find us at MaximumFun.org or wherever you get your podcasts. Bye. or wherever you get your podcasts. Bye. All right, Sidney, fill me in. Okay, so it's the mid-70s at this point.

We know that there is something happen, especially like a lot of these cases, as you may imagine, were related to transfusion, to the transfusion of blood products, because this is before we had good screening for stuff. A lot of these cases, as you may imagine, were related to the transfusion of blood products, because this is before we had good screening for stuff. You would get a blood transfusion, and then you'd get liver disease afterwards.

We started to screen, and we saw some of these cases we can pin on hep B largely, but there's something else here. There's something different. It's a little bit off. It's a else here. There's something there's something different. It's a little bit off. It's a little different So the chief of the infectious disease section at NIH at the time, Dr. Alter started Like teasing this out and like basically pointed out that I have all these cases of transfusion related liver disease

You know, I've linked them to that. I can't find another cause and they definitely developed it afterwards. And they are negative for hepe or hepe and basically, they said, okay, well, we'll call it non-A non-B hepatitis. Oh, that's, wait, non-A, okay, non-A non-B hepatitis is the best y'all can come up with. That's what it was. And then- Not even non-A a nor B hepatitis. It was it was not non a non B hepatitis is what it was called So we know you have a hepatitis. It's not a or B That's the best we got for you. Sorry bad luck. So it took it was it would take a while So this is a 70s it wasn't till the late 80s that we made a lot of progress in that realm

We knew it was there. that's so frustrating, right? We knew it was there, but we just couldn't see it yet. I wouldn't they just call it hepatitis C. I don't understand. Well, they didn't know enough about what it was yet to firmly place it in that position. Okay, but they are agreeing that it's hepatitis, and it's not ARB, and then they're just sort of like

extending their pinky up to their cheek like, I'm ever tell. They are green that it's a hepatitis and it's not ARB and then they're just sort of like extending their pinky up to their cheek like, I'm ever tell. It's like it's hepatitis C, they just do it. The same doctor would finally use new technology molecular cloning in the 1988 to prove and announce yes, we have seen it. It is there. It is hepatitis C. All right, I know what happened. And by today's standards, by the way, what we now know is that probably of those original cases that he had set aside and said these are due to non-A non-B hepatitis, somewhere from 90 to 95% of those were hep C. I feel like, I know what's going happen. Is that Harvey alter was like,

maybe if it's weird enough, I won't even have to call it C and I can call it Hepatitis Harvey. Oh, there we go. He was hoping that he could name after himself but he's like, and this is C, we on that way. Who doesn't want to have a Titus named after themselves? Hepatitis Harvey is pretty good.

So at the time, so we needed a good test for it. Just because we had found it, doesn't mean we had a good test for it, just because we had found it, doesn't mean we had a good test for it, right? Right. Like, this has been an ongoing challenge throughout a lot of medicine. You can talk about this extensively with HIV. We knew there was something there. We understood a lot about it, but it took us a lot of, have a good test for it.

And so, if you don't have a test for it, it becomes really difficult to stop the spread of it to protect people from it. Sort of like, well, we saw that with COVID, right? Yes. Places stop tracking it and then spread. Yeah, we've seen all this in real time with COVID. And it was the same thing with Hep C. Now, at the time in Japan, the Japanese health ministry was working on a hepatitis B vaccine. And at the same time, the Emperor at the time,

Heroito, had developed cancer and was needing a lot of blood transfusions. So, they're already sort of in this area of technology. And basically, the Japanese health ministry is like, we need to, let's work with Kairan, the company Kairan, to develop a screening test for this new hepatitis because our Emperor is needing blood transfusions. And we don't want to accidentally give our Emperor this non-A non-B hepatitis this brand new thing.

So we need to test for it. So that was a lot of the impetus. I mean, obviously there was a, it was bigger than this, but it's an interesting anecdote about this big push that we need to get a test so that we can screen blood. And specifically, we've got somebody really important over here who we need to screen blood for. So now we care. Now we care. Now we're worried about it because we're king. And it also led to like briefly they called Hepatitis C the Emperor's new virus. All right. All right. Almost makes up for Hepatitis, neither a nor b.

Yeah. And there was like a lot of the company that did it was kind of like exclusive and Almost makes up for hepatitis neither a nor b. Yeah And they and they there was like a lot of the company that did it was kind of like exclusive and secretive about it like selling It just to the Japanese health ministry at first and all this and and it's not so not fair because it wasn't that the Emperor had the new virus It was that they were testing the blood for the Anyway So we know about the virus we can test for it. These are all big steps forward. And by the 90s, we really understood interferons, and we had a variety of them that we were developing for different viruses and eventually for cancers and all kinds of things. So throughout the 90s, you see various treatment protocols being approved by the FDA for hepatitis

C using different kinds of interferons. So, they're based on things where we already make in our own human bodies and then they synthesize those, make them and sell them for large amounts of money. And so, that was part of the problem with a lot of these early treatment protocols. They were extensive long courses of injections, of IV medications, like year long, some of them, multiple treatments. They have lots of side effects. Under best case scenario, like half were successful in the best cases, you know.

So it wasn't, these were not gonna be, it was very clearly on like, this is probably going to be the mainstay of treatment. And what was also interesting is that the companies who made these early medications, these interferons, actually, and this is such a double edged sword, they actually did a lot of work to create public awareness about HEPC and I would say, fear. They created patient advocacy groups. For what? To put pressure on public officials to demand more, more diagnosis and treatment of HEPC.

This wasn't a grassroots effort from patients up. This was large pharmaceutical companies creating the hepatitis C panic among patient advocacy groups that weren't real. They were all funded by pharmaceutical. Oh my gosh. Yeah. And like, it's so tough because like the reason they were doing that is because they had an incredibly

expensive drug that could be very lucrative for them if only people knew it existed. And then also, if they were scared enough to go get tested and find out they had Hepsi and then seek the drug. So nefarious motivation, but we do want people to be aware and get tested, not to be scared but to be informed and make good decisions again. But like the point was very much to like, okay, then we are driving consumers for our product, which you know, it's weird to see the pharmaceutical companies do something

bad. That's so worth. Well, and I mean, let's just like again, and I know I could say this time, blue in the face, when you have a for-profit healthcare system, the motivations of these companies are always going to be for profit. So we finally were able to, you know, it's interesting, we'd still not grown,

so to speak, the virus, if you can grow a virus, propagative virus, whatever word you wanna use, because as it live in, is it dead, it's a zombie, it's somewhere between. We didn't do that until 2005 when we were actually able to culture it in cells. And being able to do that, like, have, like, grow as much of the virus as you want, more or less, is really important if you're going to develop better drugs. So you've got to have the target dummies to beat up on. You can exactly, you need the dummies. And you also can like, I don't want to,

I mean, I'm not literally take it apart and look at it. But like, sort of on a molecular level, you're getting to look at all the pieces of it to see all of the places you could stop it, all of its weak points, you know? But whole classic one eyeballs. Viruses are not like the death star. There's usually more than one eyeballs. Viruses are not like the death star. There's usually more than one place.

Can you make it about sports? A sports one would be easier for me to sort of wrap my head around. So they started after that, you started to see brand new antiviral drugs being marketed. Again, still like they were called cures, but we weren't quite, it would take us a while before we got to the point where we have what we can confidently say are cures

for this infection now. It is interesting that there are some areas where Hepatitis C was particularly prevalent, specifically in Egypt, they had had this big campaign to eliminate another illness, just a semi-assist and trying to treat everybody for this, they used needles that had not been properly sterilized and actually led to a very large hepatitis C outbreak. Again, before we knew, it was hep C, we were still calling it non-A non-B hepatitis, and before we could find it and all that kind of stuff. The people who eventually- Was it typical to reuse needles back then?

Or was it just because there was a resource limited situation? So probably at this point, we're saying it was not typical, but yeah, limited resource situations. And then also like sterilization, you can have the best of intentions and your sterilization procedures fail. So like, there's a time period where we didn't know it was a problem. Then there's a time period where we knew it was a problem,

but in resource limited settings, stuff that shouldn't have happened happened. And then there's a time period where maybe we're even trying in all settings to do it right. But if your sterilization procedures aren't perfect, you can, and that's even worse, if you think you're sterilizing things, you know, and you're not. And then eventually we get to a point where like, we think you're sterilizing things. You know, and you're not.

And then eventually we get to a point where like we should never be sterilizing needles because we shouldn't use them more than once in a perfect world. Right. Right. So in 2020 by the way, there was a Nobel Prize awarded to altar and then who partnered with another Dr. Houghton and Rice for their work in hepatitis because it was such a huge discovery and understanding it has such a huge impact on the world today because it's important to know.

So worldwide, there are 58 million people living with hepatitis C virus. Wow. A lot of people, right? That's just a 2019 numbers. And an estimated 21% of those knew about it. Wow, that is sobering. Yes. This is why it's really important. And then even of those around 62% had been treated by the end of 2019. So we have, we really need to amp up efforts to get people diagnosed and then connect them

with treatment after they get that diagnosis. I think part of what we're up against is there has been this sort of nihilism around hepatitis C that it's hopeless. And if you get diagnosed, there's nothing we can do anyway. And that's not true anymore. There's a very effective, well-tolerated, safe, good side effect profile, cures available. It depends on your genotype and the subtype, and so all that can be figured out once you go see a healthcare professional.

But now we have a pill. There's a chance probably. So we can make sure. We have pills that you can take. So not even injections anymore. And the price tag has lowered dramatically, so they're covered a lot more easily. And we don't have the, we used to have a barrier that we would put on patients

that if you were still using injection drugs, we would not treat you for your hepatitis C until first it was six months then it was three months that you had been in recovery. That barrier is gone. It doesn't matter if you're still using injection drugs, you can access treatment and cure for your hepatitis C. All of this information still needs to get out to the public. There is a big world health organization campaign that they started prior to the pandemic, which I imagine it has.

I mean, it's like, it's too last. That's not it. But there's a goal of eliminating it by 2030, because this is possible. This would be possible. But before we get there, we need people to get tested. Yeah. And we need people to not fear that if it's positive, that there's nothing they can do, because we need them to have the information that if it is positive, there's treatment.

There's a cure. They can go access that. And it's affordable. In some parts of the world, all of this is with the caveat that I am talking from the perspective of an American physician who knows that my patients, if I can get them tested, I can get them access to affordable treatment. In many parts of the world, diagnosis treatment, these are gigantic hurdles that they have yet to overcome.

At the risk of putting you on the spot, are there guidelines for who shouldn't, shouldn't run out and get tested for hepatitis C? Definitely, if you have any sorts of high risk behaviors, so injection drug use, you need to be tested for epilepsy. If you have high risk sexual behaviors, so multiple partners unprotected sex, those are good reasons to get tested for hepatitis C. Over just hand stuff. Chest center.

If you've had blood transfusions, especially prior to, I believe the year's 1992 is what the blood banks will tell you, that is prior to us having good screening protocols. And those are people who should get tested. So, you know, there are a lot of people, for a while there, there was a whole push to get baby boomers tested because a lot of them may have been exposed to the virus back in the 70s prior to us really understanding or testing for screening for these medications. And there's still, as of yet, there's no vaccine available.

So we can't prevent it, but we are trying to cure it. Yes. And that go a long way towards getting rid of it. If we could get that vaccine, we could get that vaccine on. Yeah, that's a whole other conversation. It's a very difficult virus to vaccinate yourself against or to create a vaccine for, I should say. But there are vaccines for a hepe and hepe and whether you have hepsi or whatever, it's important to get your hepe and hepe vaccines because then if you,

even if you do contract hepsi, your risk is much lower of developing those severe complications if you don't have the other hepatitis viruses. You can drive through here in Huntington without a staunch assertion that everyone on staff has been vaccinated for Hep A. Absolutely. That was a big thing for a bit here. If you are concerned, if you've had any of those sorts of occurrences, it's a blood test, it's an antibody, it's a pretty quick, easy test to do and do not fear it because there are treatments, there are cures available. But knowledge is power.

And hepatitis X is power. Pure, unbridled power, coursing through your veins. That's what I'm offering it for 500 creds per hit. This is a scene from my future dystopian novel, HEPEX. hit. This is a scene from my future dystopian novel, HEPX. Thank you, man. I actually need to take the time to write that. Hey, everybody, thanks for listening to our podcast. Please don't steal my HEPX idea. We hope you've enjoyed yourself. We hope you learned a little something. Go get tested if you're in that demographic for a better term that said he was describing. It's been better to know, I think. Thanks to taxpayers for using their song medicines as the intro and outro of our program. And oh, hey, do you want to come see us perform

because you can, if you go to bit.ly, Ford slash, McElroy tours, and then you come see us in Columbus. The my brother, my brother me show May 19th. I know that's this Friday, right? Yeah, May 19th this Friday, you can come, uh, see us perform and you'll have a good time. And then you can watch my brother, my brother me after if you want, if you want to, I think shmanners might be doing it too

But don't quote me on that. I know we'll be there Assuming Cindy can avoid the traffic after her her Lecture that she's giving and it's gonna be a fun show bit. Oh, I ford slash. Sorry. Go ahead I'm not giving a lecture. I'm just attending a conference. See you me. We're talking. Yeah Sorry, Riley just walked the room scared. I know. I know. It's okay, Riley.

Come on down. You didn't tell her just partially. It scared the crew about me. I did. I want you after a court still buffering. I didn't know you were going to talk so long. That's going to do it for us. Thanks so much.

I'm just a macro. I'm sitting back, Roy. What do I say? Don't you hold your hand? Alright!