Latest news with #HepC
Vox
3 days ago
- Health
- Vox
How 'the Grim Reaper effect' stops our government from saving lives
is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy. Last summer, the Congressional Budget Office released a report under the unassuming name 'Budgetary Effects of Policies That Would Increase Hepatitis C Treatment.' I read it because I am the type of person who is interested in the budgetary effects of policies that would increase hepatitis C treatment. Embedded in the report, though, was a point that will be important for just about anything the federal government tries to do to save the lives of Americans. Hep C is a nasty viral infection whose effects are, for a virus, unusually long-lasting. Untreated, it causes serious liver damage over the course of decades, leading to much higher rates of cirrhosis and liver cancer, all of which is very expensive to treat. But in the 2010s, a number of extremely effective antivirals, which randomized trials show cure upwards of 95 percent of chronic infections, came on the market. Like most new drugs, these antivirals are under patent and quite expensive; as of 2020, the cost of an eight-to-twelve week course of the drugs, usually enough to cure an infection, was between $11,500 and $17,000. Yet CBO concludes that the drugs are so effective, and the costs of treating patients with hep C who haven't been cured are so massive, that expanding treatment with these drugs reduces federal spending on hep C treatment and associated complications overall. Doubling the number of Medicaid patients getting the drugs would increase federal spending by $4 billion over 10 years. But over the same decade, the federal government would save $7 billion through reduced need for treatments like liver transplants and ongoing care for chronic cases. Put like that, this starts to sound like one of the rarest discoveries in federal budgeting: a free lunch. That means a policy that is good on its own merits (saving lives and preventing debilitating chronic disease) but also saves the government money. But the most interesting part of the report to me comes at the end. 'An increase in hepatitis C treatment could also affect the federal budget in other ways—for example, by leading to improved longevity and lower rates of disability,' the authors note. The latter point is pretty straightforward: If hepatitis C leads to disabilities that make people eligible for disability insurance and subsidized health coverage, then reduced hep C means lower spending on those programs. But (and this is me speculating, so blame me and not the CBO if I'm wrong) that effect is probably swamped by that of 'improved longevity.' Simply put: curing hep C means people live longer, which means they spend more years collecting Social Security, Medicare, and other benefits. That could mean that whatever cost savings the actual hep C treatment produces might be wiped out by the fact that the people whose lives are being saved will be cashing retirement checks for longer. I like to call it the Grim Reaper effect. The US runs a large budget deficit. It also provides far more generous benefits to seniors than to children or working-age adults. Per the Urban Institute's regular report on government spending for children, the ratio of per capita spending on senior citizens to per capita spending on children is over 5 to 1. Put together, the deficit and the elder-biased composition of federal spending implies something that is equally important and macabre: helping people live longer lives will, all else being equal, be bad for the federal budget. In an increasingly aging country, hep C is not the first place where the Grim Reaper effect has been felt, and it won't be the last. I don't have an easy fix for the situation, but it feels important to at least understand. Logan's Run economics One of the first and clearest cases of this longevity dilemma in budgeting came with cigarettes. The history of mass cigarette smoking in the US is surprisingly short. Per the CDC, American adults were only smoking 54 cigarettes annually per capita as of 1900. By 1963, that number had grown to 4,345. The development of automatic rolling machines, milder forms of tobacco, and mass marketing meant millions of working and middle-class Americans became pack-a-day smokers. But while the per capita average floated around 4,000 from the late '40s to the early '70s, it then began a precipitous decline. In 2022, the most recent year for which the Federal Trade Commission released data, Americans bought 173.5 billion cigarettes, or 667 per adult, less than a sixth of the peak, while fewer than 12 percent of American adults now smoke. Cigarettes are, of course, deadly, but they kill with a lag, usually after decades of regular smoking. That meant that in the late 1980s and 1990s, the US started to hit peak cigarette deaths, as adults who came of age during the smoking era started to get lung cancer and emphysema en masse, at numbers that less-addicted subsequent generations wouldn't match. The male death rate from lung cancer peaked in 1990, and the female death rate peaked in 1998. A flurry of economic research at the time tried to make sense of what this meant for the federal budget. Smoking harms your health. But it also shortens your lifespan. A useful 1998 Congressional Budget Office report noted that most research found that, over their lives, smokers spend more in health care costs (including more that goes on the federal tab) than non-smokers, even accounting for their shorter lifespans. But that picture changed once you added in pensions and other non-health spending. Economists John Shoven, Jeffrey Sundberg, and John Bunker in 1989 estimated that the average male smoker saved Social Security $20,000 (about $60,000 today) in benefits not paid. The figure for women, who live longer than men on average but earn less in wages and thus in Social Security, was about half that. 'It seems likely that the Federal budget currently benefits from smoking,' two Congressional Research Service researchers concluded in 1994, when the 'benefits' of early death to Social Security and Medicare were included. Malcolm Gladwell, in a thoughtful 1990 treatment of the problem in the Washington Post, was catchier: 'Not Smoking Could be Hazardous to Pension System.' Decades later, the CBO did a fuller analysis of the budgetary consequences of smoking in the aftermath of the large cigarette tax increase President Obama signed in early 2009 and proposals for further hikes. At first blush, the revenue raised from a cigarette tax should be easy to estimate: multiply annual cigarette sales by the amount of the tax. But obviously raising the price of the good will reduce the amount people buy; one major reason for cigarette taxes, after all, is to deter smoking. The CBO used a price elasticity of -0.3, meaning that a 10 percent increase in cigarette prices reduces the number sold by 3 percent. But the 2012 report was meant to go a step or two further, according to then-director Doug Elmendorf, who explained the backstory in a recent conversation with me. 'The effects of making people healthier are good for those people, obviously, but also perhaps good for the federal budget because the federal government pays for a lot of health care. If you're healthier, you don't need so much health care.' But at the same time, 'It was clear that if people were healthier, they would live longer, and that could have budgetary costs. It wasn't obvious offhand what the balance of those effects would be.' The 2012 CBO report tried to put all these effects together: the effect of lower smoking on reducing health-care spending (including government-funded spending) due to a healthier population, the effect on Social Security and other benefit spending from resulting longer lifespans, the effect of lower smoking rates on wages, and tax revenue from those wages. (The latter is often not included in formal CBO scores, as it tips closer to 'dynamic' scoring where the effect of legislation on the overall economy is included.) Over the first 10 years after a hike in the cigarette tax, they found that having a healthier population was more of a blessing than a curse, budget-wise. The health effects of a cigarette tax hike reduced federal health spending by over $900 million over a decade, even after accounting for people living longer and claiming more years of Medicare. By contrast, retirement programs only spent $183 million more because people lived longer. Swamping all that was a $2.9 billion increase in tax revenue from a healthier population capable of working and earning more. But that's just the 10-year effect. As the decades pass, the effect of longevity would grow and grow. First, Medicare costs would start to rise, as the cost of a longer-lived population began to swamp the cost savings of that population being healthier overall. (Even people who've been healthy for a long time can run up major health spending at the end of their now longer lives.) Social Security costs would keep rising, too. Fifty years in, these costs would overwhelm the benefits, and the cigarette tax's health effects would start costing the budget, on average. The point isn't 'cigarette taxes are good' or 'cigarette taxes are bad.' The point is that even a policy that saves lives isn't necessarily a slam dunk from the hard-eyed perspective of budget policy. Recent years provided a possibly even darker example. In 2022, the Medicare Trustees pushed back the date they expected the program's Hospital Insurance Trust Fund to be depleted by two years. They had several reasons, but a major one was that Covid-19 had killed hundreds of thousands of Medicare patients prematurely. Not only that, but 'Medicare beneficiaries whose deaths were identified as related to COVID had costs that were much higher than the average Medicare beneficiary prior to the onset of the pandemic.' Put another way: Covid killed off Medicare's sickest, and most expensive, enrollees. That meant the program was left with an overall healthier population, which by itself lowered medical costs by 2.9 percent in 2021. Similarly, a paper by a team of health economists earlier this year estimated that the 1.4 million excess deaths in the US due to Covid had the net effect of boosting the Social Security trust fund to the tune of $156 billion. That represented $219 billion in benefits that no longer needed to be sent, minus $44 billion in lower payroll tax revenues and $25 billion in new benefits to surviving family members. It all reminds one of Logan's Run, in which people are killed off upon hitting age 30 lest they take up too many of society's resources. That movie is a dystopia — but as a budget proposal, it'd score very well. It's good to save lives, actually The economists and agencies doing this math are, of course, only doing their jobs. We need to know what government programs will cost over the near- and long-run. These effects on health and life and death matter to those calculations. 'Members of Congress regularly thought that we were ghoulish for talking about how, if people live longer, there'll be higher benefits for Social Security,' Elmendorf recalls. 'But it's not ghoulish. Obviously, we want to live longer and members of Congress should try to help all Americans live longer. CBO's job — an analyst's job in general — is just to be honest about the likely effects.' But the fact that increased human longevity on its own worsens the budget picture should lead to some reflection. For one thing, it suggests that sometimes we should embrace policies simply because they're the right thing to do, even if they don't pay for themselves. Recall the hepatitis C treatments that prevent expensive long-term expenses for Medicaid, but might add on new costs by extending the benefits' lifespans. It's possible that, upon taking the latter into account, expanding access to hep C drugs costs the government money on net. It's a free lunch no longer. That's not a reason not to embrace the policy, though. Lots of things the government does cost money. The military doesn't pay for itself. K–12 schools don't pay for themselves. Smithsonian Museums don't pay for themselves. That doesn't mean those aren't important functions that it makes sense to put some of our tax dollars toward. Hep C treatment, I think, fits in that list, even if it's not literally free from a budget standpoint. Congress should also allow agencies like the CBO to do more to symmetrically account for the positive budgetary effects of longevity, along with the negatives. People who live longer, after all, often earn wages in those new years of life, wages that generate income and payroll tax revenues for the federal government. Moreover, people at the end of their careers are earning more money and hence paying more taxes than young people, meaning life extension helping people in their 50s and 60s might be especially good for tax revenue. The problem is that the CBO generally considers 'how many workers paying taxes are there' to be an economic effect and only considers it in special 'dynamic' scores of legislation, in which the economic consequences of them are taken into account. Dynamic scoring has been a topic of great controversy for decades, going back at least to the Bush II administration, but the rule Congress sets for CBO on when to use dynamic scoring results in CBO applying dynamic scoring very rarely in practice. A middle ground option, though, would be something called 'population change' scoring, in which CBO considers the direct effects of a change in the population (through longer lifespans, say, or immigration) on the level of employment and tax revenue, without doing a full, more complicated dynamic score. That would make its accounting of the effects of longer lives less biased: the budgetary benefits would be counted alongside the costs. We should also consider the aspects of our budget situation that make the longevity effect a reality. One is the US's long-standing, bipartisan choice to run massive budget deficits, even during relative boom times. One arithmetic consequence of that choice is that it makes the continued existence of every American a net loss for the country's books. That's not the main reason to avoid large deficits during booms, but it's a somewhat toxic byproduct all the same. The other aspect driving this effect is the choice to invest government resources very heavily in seniors relative to other age groups. This is due in large measure to the US choice to provide universal health care for seniors but not other age groups, and due to our lack of investment in very young children and working-age adults compared to other rich nations. There is no law of nature saying the US has to weigh its priorities that way. As long as we do, the numbers will imply that it's better for the budget for people to die before they get old.
Irish Examiner
16-07-2025
- Irish Examiner
Cork man sprayed liquid from syringe into garda's face during attempted rescue
A garda trying to save a man from self-harming or taking his own life forced his way into a bathroom but was sprayed in the face and eyes with brown/red liquid from a syringe and now the culprit has been jailed for 18 months. 'This was an assault using a syringe. The guard was only there to assist you and to stop you from taking your own life. Gardaí are entitled to go about their duties without risk of serious illness and assault,' Judge Helen Boyle said at Cork Circuit Criminal Court. A prison sentence of two and a half years with the last 12 months suspended was imposed on Trevor Murphy, aged 37. The incident occurred on February 8, 2024, when gardaí responded to a report of a man threatening self-harm at an apartment at Millerd Square, Millerd St, Cork, where Trevor Murphy was residing at the time. On arrival Gardaí were admitted by family members who said he had locked himself into the bathroom. He had heroin and needles and was threatening suicide. He said he would assault gardaí if given an opportunity. Members of the garda armed support unit had to force their way into the bathroom where the accused said: 'What the fuck do ye want?' And he brandished a syringe and needle with a brown/red liquid, and sprayed the contents across the face and into the eyes of one of the guards as he violently resisted arrest. The officer was later blood-tested and was negative for HIV, Hep B and Hep C. Judge Helen Boyle said: 'Your drug use exacerbates your mental health difficulties. I am satisfied you have done your best to stay away from drugs and to mind your mental health since this. You have made great efforts to recover from alcohol and drug use.' The judge added that the signed plea spared witnesses and saved the state the time and expense of a trial. Imposing a total sentence of two and a half years, Judge Boyle suspended the final year of the sentence.
Scottish Sun
27-05-2025
- Health
- Scottish Sun
I had no idea I had hep C for 40 years – my GP failed to tell me I tested positive as it slowly destroyed my life
Click to share on X/Twitter (Opens in new window) Click to share on Facebook (Opens in new window) FRANK Jamieson says his GP practice failed to tell him he had a potentially deadly virus - more than 20 years after he tested positive. 'It has ruined my life", the 58-year-old, from Inverclyde, in Scotland, said. Sign up for Scottish Sun newsletter Sign up 1 Frank believes hepatitis C might have affected his ability to have children Credit: SWNS "I have suffered from depression for a long time and have lost everything". Frank was only told last October that he had hepatitis C, which he likely contracted 40 years ago during a leg operation after a road accident in 1984. Hep C is a blood-borne virus which, left untreated, can cause liver cancer and liver failure. It usually displays no symptoms until the virus damages the liver enough to cause liver disease, at which point it can cause fatigue and difficulty concentrating. 'My health was so bad, and I had no idea why," Frank said. "It turned out they were all symptoms of hep C,' he added. It is also linked to cardiovascular disease, mental health issues, kidney disease and musculoskeletal pain. Frank's infection is part of the wider contaminated blood scandal, which saw thousands in Scotland and the UK infected with hepatitis C and HIV from NHS blood products in the 1970s and 80s. He later discovered his GP surgery, Ardgowan Medical Practice in Greenock, knew he tested positive back in 2002, with results confirmed in January 2003. 'The surgery had my results but they never passed them on,' Frank said. Infected Blood Inquiry: Police should look into prosecutions says Labour MP 'After all those years of going to the doctor, and that information being on my file, they are blaming me.' Frank's positive test came just as he and his now wife were preparing for another round of IVF. 'I had my blood tests taken in late 2002 because my now wife and I were set to go through another round of IVF,' he said. 'We had two unsuccessful tries on the NHS and were going to pay for a third.' But that Christmas, both lost their jobs when the company closed, halting their plans. 'Our lives fell apart. We still got married, but we couldn't afford the IVF, so we weren't able to try again,' Frank explained. What is the infected blood scandal? More than 30,000 people in the UK were infected with HIV and hepatitis C after being given contaminated blood products in the 1970s and 1980s. As many as 140,000 bereaved parents, children and siblings of victims may also be able to claim compensation in their own right Two main groups of NHS patients were affected by what has been called the biggest treatment disaster in the history of the NHS. Firstly, haemophiliacs - and those with similar disorders - who have a rare genetic condition which means their blood does not clot properly. People with haemophilia A have a shortage of a clotting agent called Factor VIII, while people with haemophilia B do not have enough Factor IX. In the 1970s, a new treatment using donated human blood plasma was developed to replace these clotting agents. But entire batches were contaminated with deadly viruses. After being given the infected treatments, about 1,250 people in the UK with bleeding disorders went on to develop both HIV and hepatitis C, including 380 children. About two-thirds later died of Aids-related illnesses. Some unintentionally gave HIV to their partners. Another 2,400 to 5,000 people developed hepatitis C on its own, which can cause cirrhosis and liver cancer. It is difficult to know the exact number of people infected with hepatitis C, partly because it can take decades for symptoms to appear. A second group of patients were given contaminated blood transfusions after childbirth, surgery or other medical treatment between 1970 and 1991. The inquiry estimates that between 80 and 100 of these people were infected with HIV, and about 27,000 with hepatitis C. In total, it is thought about 2,900 people have died. He added: 'Hepatitis C can cause infertility. We would have known that then if we'd had the results.' The practice told Frank patients had to call within seven days for test results - but they have no record of him ever making that call. 'I asked them, where were the results all those years? Were they sitting in a drawer until I phoned?' he added. The virus caused Frank severe health problems, including nerve and joint pain and Raynaud's phenomenon - symptoms that appeared five years ago. 'I have been suicidal' Fortunately, Frank, who worked as an engineer until ill health forced him to give up work, is now free of hep C after undergoing anti-viral treatment. He is now under the care of the SAMH charity (Scottish Action for Mental Health) as well as the NHS's local community mental health team. They are helping him manage his depression and ongoing health challenges. 'I have been suicidal,' he said. 'Right now, I don't want to be here.' Frank hopes to raise awareness so others in Inverclyde don't suffer the same fate. 'There might be other people out there who have missed blood test results, who have hep C or something else and who don't know,' he warned. Now free of the virus after antiviral treatment, Frank is determined to hold his GP practice accountable. 'I want justice. I want to be heard, and I want Ardgowan Medical Practice to take responsibility for what happened,' he said. His complaints to the Scottish Public Services Ombudsman were rejected due to the passage of time. But Frank is pursuing support through the Scottish Infected Blood Support Scheme - a body that helps people infected by NHS blood products with compensation and support. 'My journey is just beginning,' he said. Ardgowan Medical Practice declined to comment when approached by the Greenock Telegraph. The Sun has also contacted the Practice, who again, declined to comment.
Daily Mirror
19-05-2025
- Health
- Daily Mirror
NHS to ask millions of patients new question to find more infected blood victims
People aged 29 and over who newly register with GP practices in England are to be asked if they had a blood transfusion prior to 1996 Health officials are implementing a new initiative to identify Brits who may have unknowingly received infected blood. Starting immediately, anyone aged 29 or over who registers with a GP practice in England will be asked if they underwent a blood transfusion before 1996, according to NHS England. If the answer is yes, they will be offered a test for hepatitis C, known as a silent killer, as symptoms can go undetected for decades, leading to significant liver damage. The hepatitis C virus is transmitted through blood-to-blood contact and affects the liver. Without treatment, it can cause severe liver damage. Approximately half of the 800,000 people who register with a GP annually were born after 1996, so around 400,000 will be asked about their blood transfusion history. The new questions for patients will remind them of possible reasons for having had a blood transfusion, including accidents, complications during childbirth, surgery, or other medical treatments. If diagnosed, patients can receive antiviral medication for several weeks, which cures over nine out of 10 hepatitis C cases. The Infected Blood Inquiry's recommendation for the health service to "find the undiagnosed" has led to this initiative. Over 30,000 people in the UK were tragically infected with HIV and hepatitis C from contaminated blood and blood products during the 1970s to the early 1990s, resulting in over 3,000 deaths and ongoing health issues for survivors. "The failures of the contaminated blood scandal have had a horrifying impact for patients and their families for decades, and I would like to reiterate our deepest apologies for the role the health service played in the suffering and loss for so many," Professor Sir Stephen Powis, NHS England's national medical director, said. He continued: "The NHS is dedicated to implementing the inquiry's recommendations and this simple change to the GP registration process for patients is a vital step forward in ensuring that nobody affected by contaminated blood is living undiagnosed and unsupported. "By routinely checking their risk when anyone signs up to a new GP and offering fast Hep C tests where necessary, we will ensure any undiagnosed cases can be found and treated as quickly as possible, while enabling thousands more to receive the reassurance of a negative test." The current inquiry into the scandal is scrutinising the "timeliness and adequacy of the Government's response to compensation" for the victims, anticipating a report later in the year. The Infected Blood Compensation Authority revealed that as of 6 May, 677 individuals have been invited to initiate their claims, with 106 payments already made, amounting to over £96 million. Any adult in England aged 18 and above can request a free hepatitis C home test from
Powys County Times
19-05-2025
- Health
- Powys County Times
NHS rolls out plans to find more infected blood victims
Health officials have launched a new scheme to help identify people who may have unknowingly been given infected blood. People aged 29 and over who newly register with GP practices in England are to be asked if they had a blood transfusion prior to 1996, NHS England said. If they did have a transfusion before 1996 they will be offered a test for hepatitis C, which is known as a silent killer because people can be infected unknowingly for decades before symptoms start and significant damage has already been done. Hepatitis C is a virus that is passed on through blood-to-blood contact and infects the liver. Without treatment, it can cause serious damage to the liver. Around half of the 800,000 people who register with a GP each year were born after 1996, meaning some 400,000 will be asked about their blood transfusion history. NHS England said the new questions for patients will remind them of possible reasons they may have had a blood transfusion, including after an accident, complication during childbirth, surgery, or other medical treatment. People in he UK who had a blood transfusion before 1996 are being urged to get themselves tested for hepatitis C – new NHS figures shared with @PA show that thousands have ordered tests alreadyMy story: #infectedblood — Ella Pickover (@ellapickover) May 29, 2024 If a person is diagnosed they can be given antiviral medication for several weeks, with this treatment curing more than nine out of 10 patients with hepatitis C. The Infected Blood Inquiry, which examined the scandal in depth, recommended that the health service should work to 'find the undiagnosed'. More than 30,000 people in the UK were infected with HIV and hepatitis C after they were given contaminated blood and blood products between the 1970s and early 1990s. And more than 3,000 people have died as a result while survivors are living with lifelong health implications. 'The failures of the contaminated blood scandal have had a horrifying impact for patients and their families for decades, and I would like to reiterate our deepest apologies for the role the health service played in the suffering and loss for so many,' said Professor Sir Stephen Powis, NHS England's national medical director. 'The NHS is dedicated to implementing the inquiry's recommendations and this simple change to the GP registration process for patients is a vital step forward in ensuring that nobody affected by contaminated blood is living undiagnosed and unsupported. 'By routinely checking their risk when anyone signs up to a new GP and offering fast Hep C tests where necessary, we will ensure any undiagnosed cases can be found and treated as quickly as possible, while enabling thousands more to receive the reassurance of a negative test.' The inquiry into the scandal is currently examining the 'timeliness and adequacy of the Government's response to compensation' for victims, with a report expected later this year. The Infected Blood Compensation Authority said, as of May 6, 677 people have been asked to start their claim and 106 payments have been made, totalling more than £96 million.
