In a prior post, I shared my heretofore reluctance to prescribe medications for my hepatitis C (HCV) patients.  In summary, after consideration of the risks and benefits of the available options, I could not persuade myself — or my patients — to pull the trigger.  These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another specialist who had a different view on the value of HCV treatment.

I do believe that there is a medical industrial complex that is flowing across the country like hot steaming lava.  While I have evolved in many ways professionally over the years, I have remained steadfast that less medical care generally results in better outcomes.

There was an astonishing development in HCV treatment that caused me to reevaluate my calculus.  New treatment emerged that was extremely safe and amazingly effective.  Now, nearly all patients with HCV can be cured by taking pills — no injections — that only rarely cause side effects.  Over the past 2 years, I have had many successes treating patients who on my advice had declined prior treatment options.

If you now have HCV, how can you refuse a safe medicine that works superbly?

This has been a game changer and the pharmaceutical companies should be congratulated on these breakthroughs.  There are several outstanding drugs currently available.  Initially, a 12 week course of treatment cost about $1,000 a day, clearly a pricey option.  And, if you believe that every HCV patient in the country should be treated, which may be up to 5 million people, do a cost calculation which might crash your computer.

To those who demonize the pharmaceutical industry for sport, would such a monumental research effort have even been undertaken without the promise of a huge profit?  Would you take a huge risk in your business without the hope of realizing a robust profit?  It takes years and tens of millions of dollars to do drug development, and most of these efforts fail either along the way or after the drug has hit the market and safety concerns arise.

I’m not suggesting that this industry is filled with Eagle Scouts.  We have all read about numerous excesses and even illegalities in the drug trade.  But, if we want real pharmaceutical breakthroughs, and not just another heartburn or hypertensive medicine, then we need to provide incentives for undertaking this research.

Market forces have substantially lowered the cost of HCV treatment, but it is still expensive.

Patients come to my office already informed about current HCV treatment.  Many are referred to me by physicians expecting me to treat them.   The drugs are safe and effective and approved by the FDA.   Although I still feel we are overtreating, my arguments for holding back have been somewhat dismantled by the new pharmaceutical developments.  Am I now at the vanguard of the medical industrial complex?

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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