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Why Are We Not Testing More People For Hepatitis C?

blood transfusion
makelessnoise via Flickr
Today, donated blood is screened for the Hepatitis C virus. But people who received blood prior to 1992, when screening began, shoud get tested, says NYU medical ethicist Art Caplan

The majority of people who have Hepatitis C don't even know they have it. So why are we not testing more people for it? WHYY’s The Pulse asked New York University Medical Ethicist Art Caplan what is standing in the way.

This story was originally published by The Pulse, a project of WHYY.

"It's a complex set of factors, but the major one is it's a low incidence disease, despite the fact that many, many Americans have it," he told Pulse host Maiken Scott. "It's only probably two percent of the overall population."

That, coupled with the relatively high cost of general screening, and earlier treatments not being as effective as they are now has resulted in less screening and less people knowing they have it. Now, he says, we've suddenly got a very effective intervention that seems to work –without side effects.

"To make an analogy that's strained, but somewhat similar," he says, "no one wanted to talk about impotence for a very long time in men and then came the erectile dysfunction drugs. And now they talk about it every minute on sports events --so out of the closet it came when a treatment appeared."

But that treatment comes with a cost

"It's clear that Medicaid programs in different states can't really afford the prices. The VA is exceedingly nervous about the impact of this new drug on its budget. There's only one answer to this. We're going to have to bargain down the price or guilt and shame down the price. The price must be driven down," says Caplan. 

That's a tough battle since Hepatitis C has long been a silent epidemic, getting very little attention, despite being a problem for decades. The disease spreads through blood to blood contact, often through sharing needles.  So, if we start putting more attention into screening and focusing on at-risk groups, who should we screen?

Caplan says we should start with people who come into the emergency room, who may have overdosed, or those who are in drug treatment programs. We'd also want to reach out to people who have donated blood and turn out to be in an at-risk group, and people who've received blood before 1992 [before the nation's blood supply started getting screened for Hep C], if we have records on them.

"It's not easy, but it could be done," Caplan says.