Science  Science Now- Los Angeles Times March 28, 2017

Health experts have devised an aggressive plan to stamp out a viral disease that is fueling a sharp rise in liver cancer in the United States and killing 20,000 Americans per year.

Their national strategy for eliminating two types of hepatitis by 2030 hinges on persuading the federal government to purchase the rights to one or more of the costly new medications that can essentially cure hepatitis C.

That unprecedented step is one of a raft of recommendations issued Tuesday by the National Academies of Sciences, Engineering, and Medicine. The academies’ expert panel also recommended a campaign to vaccinate all adults against hepatitis B, expanding needle exchanges for intravenous drug users and a nationwide effort to identify and treat the legions of Americans who are unknowingly infected with either strain of the virus.

All these efforts should be coordinated by a single federal office, the panel proposed.
With about 2.7 million Americans infected with hepatitis C and 1.3 million people infected with hepatitis B, the stakes are high. A 2009 report estimated that the annual cost to Medicare of caring for hepatitis C patients alone would increase from $5 billion in that year to $30 billion in 2030. And that forecast didn’t include a new generation of expensive drugs.

The viruses that cause hepatitis B and C are spread through sexual contact, needle sharing and incidental exposure to infected blood. Most people with the viruses are unaware they are infected, which allows both strains to spread unchecked. Infection rates are especially high among ethnic minorities, prison populations and people who inject drugs. This last group accounts for 75% of the roughly 30,500 new hepatitis C infections every year in the United States.

Though infection causes no illness in its early stage, over time both strains can scar the liver, impair its function and give rise to malignancy. The nation’s unseen hepatitis epidemic is widely credited with making liver cancer the fastest growing form of malignancy and driving a dramatic increase in liver cancer deaths seen in the last decade. Hepatitis B and C also account for roughly 2,400 liver transplants each year.

The Food and Drug Administration has approved a few new antiviral medications to treat hepatitis C in the last two years. These therapies can completely clear the virus from a patient’s body in as little as eight weeks with a single daily pill.

But they haven’t been widely used for a single reason: cost. The price for a full course of treatment can range from $55,000 to $150,000. As a result, government insurance programs such as Medicaid and Medicare have limited their use to patients with late-stage disease, and private insurers have imposed onerous copayments, paperwork and delays on patients and their doctors. The panel’s experts estimate that by 2015 only 7% to 14% of patients known to be infected with hepatitis C had started treatment with the new drugs.

These drugs are among the most expensive oral medications in history, and will probably remain so until 2029, when the exclusive patent rights on the first of these new medications expires.

That’s why licensing one or more of the new-generation drugs is a key part of the panel’s plan. A licensing deal could cost taxpayers an estimated $2 billion, and the medications would then be used to treat government-insured patients whose access is now limited, including some 700,000 Medicaid beneficiaries, prison inmates and enrollees in the Indian Health Service.

Such an arrangement could save the United States well over $8 billion by 2030, the panel estimated. Far from disadvantaging the company that agrees to a deal, the move would broaden the reach of its product to patients who would not otherwise be treated, said Rutgers University Chancellor Dr. Brian L. Strom, who chaired the panel.

​“It’s a win-win for everybody,” Strom said Tuesday. “For the public, it’s a massive win” that would drive down the number of infected Americans spreading the virus unwittingly. And for at least one of the five drugmakers who manufacture these costly medications (Gilead Sciences, Merck, Bristol-Myers Squibb, AbbVie and Janssen), striking a voluntary licensing agreement could return handsome dividends on its investment in research and development, he added.
The drugs — marketed under such names as Sovaldi, Daklinza, Olysio and Zepatier — “are great products and we certainly wouldn’t want to undercut industry’s ability” to develop other such medications in the future, Strom said.
While legally allowed, the unconventional step of forging a licensing agreement between a drug manufacturer and the federal government comes at a pivotal moment in politics, medicine and public health.

Enter President Trump, who has said pharmaceutical manufacturers are “getting away with murder” and vowed to lower the cost of medications by negotiating new deals. On March 7, he tweeted, “I am working on a new system where there will be competition in the Drug Industry. Pricing for the American people will come way down!”

The National Academies panel said that nothing short of “unrestricted mass treatment of hepatitis C” will eliminate the disease by 2030. Delays imposed by the treatments’ high costs, they added, “would result in tens of thousands of needless deaths and billions of dollars in wasted medical costs” aimed at treating the cancers, cirrhosis and other liver diseases caused by untreated hepatitis C infection.

​TO CONTINUE: http://www.latimes.com/science/sciencenow/la-sci-sn-eliminating-hepatitis-20170328-story.html

COUNTER CURRENT
Tuesday, March 21, 2017
Researchers at the University of Florida have found that the theory of a “gateway drug” is not associated with marijuana – results from the Guttman scale indicated that alcohol represented the gateway drug, leading to the use of tobacco, marijuana, and other illicit substances. Furthermore, students who used alcohol “exhibited a significantly greater likelihood of using both licit and illicit drugs”.
In an interview with Raw Story, co-author Adam E. Barry said that his studies were intended to correct some of the propaganda that has infected American culture since the “Reefer Madness” era.

“Some of these earlier iterations needed to be fleshed out, that’s why we wanted to study this. The latest form of the gateway theory is that it begins with [cannabis] and moves on finally to what laypeople often call ‘harder drugs’. As you can see from the findings of our study, it confirmed this gateway hypothesis, but it follows progression from licit substances, specifically alcohol, and moves on to illicit substances,” Barry said. These findings walk hand-in-hand with a 2012 study from Yale that found that alcohol and cigarettes were much more likely than marijuana to precede opiate abuse.

Researchers used a nationally representative sample of high school seniors, evaluating data collected through the University of Michigan’s Monitoring the Future survey, which tracks drug use trends among youth in the US. Barry’s study focused on data collected from 14,577 high school seniors from 120 public and private schools in the United States.

By comparing substance abuse rates between drinkers and non-drinkers, the researchers found that seniors in high school who had consumed alcohol at least once in their lives “were 13 times more likely to use cigarettes, 16 times more likely to use marijuana and other narcotics, and 13 times more likely to use cocaine”.

In the sample of students, alcohol also represented the most commonly used substance, with 72.2 percent of students reporting alcohol consumption at some point in their lifetime. Comparatively, 45 percent of students reported using tobacco, and 43.3 percent cited marijuana use.

​TO CONTINUE READING: http://countercurrentnews.com/2016/12/gateway-drug-alcohol-not-marijuana/?utm_source=Facebook&utm_campaign=FB_Biz_Part&utm_

March 13th, 2017
​MANAGED HEALTHCARE CONNECT
​--Julie Gould (Mazurkiewicz)

   Recent data released by Trio Health show that the prevalence of hepatitis C drug patients diagnosed with Hepatitis C but not started on curative drugs, such as Harvoni (ledipasvir/sofosbuvir; Gilead) and Zepatier (elbasvir/grazoprevir; Merck), more than tripled between 2014 and 2016—signaling that payers continue to deny coverage despite increased marketplace competition and availability of discounts.
“There are no other disease states that I’m aware of where curative therapies are increasingly withheld from patients who are covered by commercial insurance plans, Medicaid or Medicare,” Nezam Afdhal, MD, professor of medicine, Harvard University, and chairman of Trio Health’s Scientific Steering Committee, said in a press release.
According to the data, although the number of treated patients continually decreases, the total number of patients seeking treatment for their condition continues to grow each year. On average, as of last September, 37% of patients who showed little-to-moderate traces of the disease were denied—a steady increase from 27% in October 2015. Likewise, 24% of those with advanced forms of hepatitis C were also denied—an increase from 15% during 2015. Overall, non-starts increased from 8% in 2014 to over 30% in 2016.
The data included evaluation of treatment patterns for use of all direct acting antiviral agents, including Harvoni, Sovaldi (sofosbuvir; Gilead), Epclusa (sofosbuvir/velpatasvir; Gilead), Viekira Pak (ombitasvir/paritaprevir/ritonavir/dasabuvir; Abbvie), Zepatier, and Daklinza (daclatasvir; Bristol-Myers Squibb).
“What is most surprising is that this trend is growing even though treatment cure rates are now above 90 percent, duration of therapy has been reduced to as little as eight weeks for the majority of patients, and real treatment costs are one-third lower than just a few years ago,” Dr Afdhal said. “In almost any other commercial setting, this would result in a significant expansion of market access, but with Hepatitis C, we’re seeing fewer patients receive care even though the number of patients seeking treatment continues to grow.”
It was reported that among commercial health plans 39% of patients with moderate disease activity did not start treatment after being prescribed therapy, and 36% of patients with severe disease activity also did not start.
TO CONTINUE READING: http://www.managedhealthcareconnect.com/content/hepatitis-c-treatment-coverage-denials-increase-sharply
--Julie Gould (Mazurkiewicz)

Despite official recommendations, most Americans born between 1945 and 1965 aren’t being tested for hepatitis C virus (HCV). That’s according to a new study, “Recent Hepatitis C Virus Testing Patterns Among Baby Boomers,” recently published in the American Journal of Preventive Medicine.
“Approximately 3.5 million people are chronically infected with hepatitis C virus (HCV) in the U.S., 80 percent of whom are baby boomers,” wrote Ahmedin Jemal, PhD, and Stacey Fedewa, PhD, of the American Cancer Society’s Surveillance and Health Services Research. “Most infected individuals are not aware of their infections despite availability of treatments that may reduce their risk of HCV-related diseases, including chronic hepatitis, cirrhosis and liver cancer.”
In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended that baby boomers should be tested for HCV to help control the spread of HCV-associated diseases. To investigate whether HCV testing actually increased following the USPSTF recommendation, researchers analyzed the medical data of 21,827 baby boomers.
Results showed that between 2013 and 2015, HCV testing slightly increased, from 12.3 to 13.8 percent.
Among insured adults, the prevalence of HCV testing was higher among those with Medicare plus Medicaid, Medicaid alone or military insurance. Testing was more frequent among men than women, and among people living with someone infected with HCV. Furthermore, those with less than or only a high school diploma were less likely to be tested for Hepatitis C than college graduates
 TO CONTINUE- https://hepatitisnewstoday.com/news-posts/2017/03/09/most-baby-boomers-not-getting-recommended-test-for-hep

By GILLIAN MOHNEYFeb 24, 2017, 12:03 AM E


The rate of fatal drug overdoses in the U.S. more than doubled since 1999, outpacing suicide and car accidents in 2015 as a cause of death, according to a new report by the Centers for Disease Control and Prevention.
CDC researchers examined data from the National Vital Statics System to see the effects of drug trends across the nation from 1999 to 2015.
Rates of fatal drug overdoses have dramatically increased since 1999, rising from 6.1 deaths per 100,000 people to 16.3 deaths per 100,000 in 2015, according to the CDC report.
That number is higher than the rate of death for suicides in the U.S., 13.4 deaths per 100,000, or the rate of death from car accidents, 11.1 deaths per 100,000 residents.
The overall number of deaths due to opioid overdoses quadrupled during the same time period, according to figures previously published by the CDC. Opioids killed more than 33,000 people in 2015, more than any year on record, according to the CDC, which estimates that 91 Americans die every day from an opioid overdose.
Some 500,000 Americans died from 2000 to 2015 as a result of the opioid epidemic, the CDC says.
People in all age groups were more at risk for dying from drug overdoses but those between their mid-40s and their 60s were hardest hit, according to the new report.
And despite persistent concerns over teens and young adults abusing drugs, middle-aged adults were the most likely to suffer a fatal overdose, according to the report.
People between the ages of 54 to 65 saw the biggest percent increase in fatal drug overdoses during the study period, rising nearly five-fold from 4.2 deaths per 100,000 to 21.8 deaths in 2015.
Americans between the ages of 45 to 54 had the highest rate of fatal drug overdoses overall in 2015, with 30 deaths reported per 100,000.
Dr. Caleb Alexander, a co-director for the Johns Hopkins Center for Drug Safety and Effectiveness, said the report shows overdose deaths related to opioids are increasing at an "incredible rate"
"Each year I think it's hard to imagine it getting much worse and yet last year we had the highest number of deaths on record," Alexander said.
Alexander pointed out that the data highlighted how many people the drugs have impacted from across various age groups.
"Sometimes there's this perception that this is a problem of only teenagers or young adults and nothing could be further from the truth," Alexander said. "Middle aged and elderly adults are also being affected by the epidemic."
The deadly spread of illicit opioids were also reflected in the numbers. The percentage of fatal overdoses related to heroin more than tripled from 8 percent in 2010 to 25 percent in 2015. Synthetic opioids also took a heavy toll accounting for 18 percent of fatal overdose deaths in 2015 up from 8 percent in 2010.
But the increase was not all due to opioids, the percent of drug deaths from cocaine increased slightly to 13 percent in 2015 compared to 11 percent in 2010.
The percentage of overdose deaths due to natural and semisynthetic opioids -- which includes prescription heroin drugs oxycodone and hydrocodone -- decreased from 29 percent in 2010 to 24 percent in 2015.

​To Continue:http://abcnews.go.com/Health/fatal-drug-overdoses-doubled-1999-cdc-finds/story?id=45697327