Hepatitis B : Lurking in HIV's Shadow

The story of the hepatitis B outbreak in Gujarat has not received the attention it deserves. More so because Hepatitis B is not the typical jaundice that comes around in the monsoon season every year and then trails off as the rains dry up. This variety of Hepatitis is chronic in nature; has no cure and is potentially more dangerous than HIV and AIDS, the mode of transmission for both being the same.

At last count thirty four people had been felled by the virus and this piece of news need not be the last word on the subject as The Gujarat health department says that this death toll could raise, as about 50 persons are still being treated in different hospitals. It has now been established that unsafe syringes and injection needles has caused the spread of hepatitis B in the Gujarat town, what is now being seen as one of the biggest hepatitis B outbreaks in the country.

Following the inevitable knee jerk reaction, the government has clamped down on many doctors and chemists claiming medical negligence. Doctors have apparently been using unsterilized and used recyclable syringes meant for single use but it is quite likely to be a case of too little action and too late. Although the cases of hepatitis B have thus far been found in Modasa taluka of the Sabarkantha district, it is quirt possible that the virus may be spreading in neighbouring districts also as the use of unboiled syringes and disposable syringes being recycled is not likely to be confined to just one location. The hepatitis B virus is transmitted through contact with the bodily fluids of an infected person. The virus can be transmitted via unprotected sex or sharing of contaminated needles. Pregnant mothers also tend to pass it on to their babies.

Chronic carriers have an increased risk of developing liver disease such as cirrhosis or liver cancer, because the hepatitis B virus steadily attacks the liver. Considering that these are exactly the methods by which HIV spreads, Hepatitis-B virus (HBV) remains a major public health problem with an estimated 350 million carriers worldwide, out of which 40 million are in India. HBV is more infectious than Hepatitis-C or the Human Immunodeficiency Virus (HIV) and chronically infected individuals readily infect unvaccinated members and sexual partners. Hepatitis B is a disease more lethal than AIDS, claiming more lives in a day than the latter does in a year.

The whole episode highlights at least three things. Firstly, the depths to which the medical profession continues to sink: doctors, let alone contribute to any cure or healing are now actively contributing to patient deaths, breaching the sine qua non of the medical profession of doing no harm. Secondly, the need for blood safety and prevention of transfusion associated infections in the country has come to the fore and though because of the spotlight has been there for long on the blood banks to screen blood, not just to rule out Hepatitis B but also HIV, a lot still remains to be done.

Thirdly Hepatitis B is an expensive disease to treat and the results are not usually so encouraging, with an efficacy of only 30-40 percent. However, a relatively affordable vaccine is available to prevent it and Hepatitis-B vaccination has now become the part of the primary immunization of infants in many countries and is being administered in many parts of India in the National Immunization Program. But this is not generally known and widely administered in India, which is why the people in Sabarkantha fell victim to it in the first place. May be the deaths occurring in Gujarat and the international attention it is drawing, will make a difference in the numbers of people queuing up for the vaccine and the government making it available at far more cheaper rates than presently available.

Cancer Patients: dying a thousand deaths

In spite of the advance of medical sciences in many fields , cancer is an area where in spite of a lot of progress , things haven't changed much on the ground. The patient still usually has to go through a prolonged treatment and at the end of which there is nothing called a cure in most instances. What you get is a stage of remission usually and even when you are in remission you are always looking over your shoulder to check for recurrences and in the many cases I have known , sooner or later cancer seems to catch up with you and more often than not , the prognosis progressively deteriorates.

Added to that is the burden of cost. Cancer treatment has always tended to bes expensive for several reasons – the treatment is prolonged for one , the treatment is also not available every where – typically the cheapest treatment available would be in the handful of regional cancer centers run by the government and the travel itself is fraught with costs and logistical expenses.
In spite of the fact that cancer strikes all sections of society and only perhaps lung cancer is associated with a clearly defined high risk behavior , which means that not much preventive measures can be really taken, the disease suffers from neglect. Conditions like HIV and AIDS which have got vocal activist groups taking up the cause of treatment care are able to garner funds from both the government and international philanthropic donors but cancer patients are not so lucky.

Apart from the fact that the very diagnosis of this disease spells worries for a cancer patient’s family, what hits even harder is the exorbitant amount of money charged by the pharma companies for the drugs that are crucial for a cancer patient’s survival at an advanced stage. Till recently the fact that Indian pharmaceutical companies reverse engineered many of the drugs and made them available at comparatively cheaper prices made them some what accessible.

This climate is slowly changing. The newer and more effective drugs which a patient would reach for tom try and prolong life or alleviate symptoms are also the most expensive and the changing patent laws in India more or less make them inaccessible. To cite an example , the multi national Novartis had filed a case in the Madras High Court, challenging the clause of the Indian Patent (Amendment) Act, which does not grant patents to medicines that are new forms of an existing drug or are “ever-greened” rather than being innovations. The patents office in Chennai refused to give patents to Novartis’ leukemia drug Gleevec on the grounds that it was “ever greened”, in February 2006.

Till the litigation in the Chennai patent office, many well known Indian forms were manufacturing the generic product end selling it for a fraction of the multi national's own product. However with Gleevec now having gone into litigation and the patent laws changing their color in conformity with trade laws , many firms have quietly stopped producing the drug. They do not want to invest in a contentious product without the law having been settled. This means that leukemia patients , who could have befitted from the generic versions of Gleevec, now have to purchase the hugely expensive product from Novartis or go without it..... or take the potentially explosive route of purchasing he drug by selling off home and hearth and eventually becoming bankrupt- a scenario by no means uncommon in India and in situations far less prohibitive than cancer.

Even the modified and much harsher patent laws of today which protect the interests of the producer than the consumer provide for the government to suspend the laws of patent and produce drugs generically if in the instance of a public health emergency. But in spite of the fact that cancer is one of the three top causes of death in the country , the government has so far looked the other way and not acknowledged it to be so. Although HIV and AIDS has received the attention it deserves and more there are other pressing public health needs which have not received their due attention. And mean while cancer patients and their families suffer a thousand miseries in their life time facing the burden of expenses and disease that they do.