Saturday, May 14, 2016

I'm looking into hepatitis C treatment policies.
These articles from the Tennesean on hep C in prison would be a good candidate for the Pulitizer.

Part of my homework last night was to watch Dallas Buyer's Club. It was about HIV rather than HepC, but the policy questions are similar.
HepC is the number 1 infection disease killer, more than AIDS. Co-infections are common.
About 20% of Tennessee inmates have hepC, and only a handful are getting treatment. CCA is a private prison in TN with maybe 700 or more hep c cases. CCA and I go way back.
I haven't worked out the details here, but there may be an angle. Meanwhile it's interesting research.
I can buy the meds for the cure online for $1500 via India, but the cost for the treatment here is $84K, $1000 a pill. CVS and some insurance companies have arranged discounts, but that's the list price.

IRB's, institutional review boards, don't like to approve research studies on prisoners.
But here it seems like a phase iii trial on tennessee prisoners, who voluntarily would participate,
could get them treatment at no or nominal cost, save lives, reduce risk to other prisoners, and generally make things better. So it probably won't happen.
To make it more fun, throw in some genome reading at $1000 a person, on a least some subset,
for more data. IRB's don't like that either. Who would pay? TN, or CCA. Abbvie, or one of the other companies, could provide the meds at no charge in exchange for the data, or just allow the generic meds from india to be used.. The institutional setting allows for longer followthrough than in most studies, and factors like diet and setting are more controlled. Good science, good public policy,
but politically difficult to implement.
If I wanted to follow up further, and in general I have very poor followup, I could draft a proposal
that would be a proposed consent decree for CCA or the TN prison system, that would get everybody tested, or at least able to opt into testing, get followup RNA testing, encourage separate housing for the infected to reduce the spread, get treatment for those infected with either low-cost generics from india, or no-cost from the manufacturers, as part of a clinical trial, phase 3, that prisoners could opt into. Those who don't opt in should go to yet another separate housing unit, a kind of quarantine.
Part of the goal is to work on the public health problem that tennessee takes rapists, puts them in a facility where they contract hepC, and then puts them back out on the street.
We could replace that with a program where they get cured and get trained as outreach people to identify high risk people who need testing and treatment options.
Meanwhile the companies get some data, at less than usual cost. If it had the whole genome testing, that drives up the price a bit, but gets the company some new data if doesnt have now. And make that data available to science generally, to see if there are any correlations with what genotypes wind up incarcerated. So my proposal incorporates a bit of mad science, some frugal economics, a public health perspective, good for the prisoners, good for the institution, good for the drug companies, good for the public, good for science, so it could never happen.....

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