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The High Cost of Hepatitis C

The High Cost of Hepatitis C
Hepatitis C is the most common blood-borne infection in the U.S., affecting four million Americans. We'll explore the cost of the disease to society, and how clean needle exchange programs can prevent its spread.

Behind the Story: Hepatitis C and Needle Exchange


This is a rush transcript created by a contractor for KPBS to improve accessibility for the deaf and hard-of-hearing. Please refer to the media file as the formal record of this interview. Opinions expressed by guests during interviews reflect the guest’s individual views and do not necessarily represent those of KPBS staff, members or its sponsors.

ALAN RAY (Host): You're listening to These Days on KPBS. Good morning, I'm Alan Ray in for Maureen Cavanaugh. Hepatitis C is an infectious disease that affects the liver. In it's chronic form, it's a serious illness that can result in longterm health problems and even death. It can be contracted in a variety of ways. The main risk factor in the spread of Hepatitis C, though, is intravenous drug use. Hep C is now the most common blood borne infection in the United States but healthcare workers say there is a simple way to cut down the spread of the disease. They advocate clean needle exchange programs for IV drug users. Well, what for some seems simple and a practical solution is for others an ideological deal breaker. We're joined on These Days by KPBS health reporter Kenny Goldberg. Good morning, Kenny.

KENNY GOLDBERG (KPBS Health Reporter): Good morning.

RAY: And by Dr. Anthony Martinez, Assistant Professor of Medicine at UCSD in the Division of General Internal Medicine. Good morning, Doctor.

DR. ANTHONY MARTINEZ (Physician and Professor of Medicine): Good morning.

RAY: May we call you Tony?


DR. MARTINEZ: Yeah, absolutely.

RAY: Okay. Kenny, a little bit of background first here. You went to New York City and investigated the needle exchange program there. A little bit of background, why did this all come up? Where did the idea come from?

GOLDBERG: It came up originally because the County publishes a report on infectious diseases they have to track, everything from AIDS to malaria and tuberculosis. And they had a ten-year summary of infectious diseases and Hepatitis C had the second highest growth rate of any infectious disease they track, second only to Chlamydia. And I said, boy, what's this all about? And so the more investigation I did into it and the more looking into the whole thing, I said, boy, I'm going to do something on Hepatitis C because it's really something that's under publicized.

RAY: Now what particularly did you find that surprised you in your investigation into Hepatitis C?

GOLDBERG: Well, how widespread it is. I mean, it's much more widespread than HIV. As you were saying in the intro, it's the most common blood borne infection in the United States. A lot of people have it and don't know it because it can linger in the liver causing scarring for years, even decades, before it manifests itself so somebody could be actually very sick with Hepatitis C and not have any symptoms.

RAY: Okay, now you talked to a number of people who actually have the disease at various stages. You talked to a guy by the name of Charlie Navarro.

GOLDBERG: Yeah, and what's interesting about Charlie is, he really exemplifies how most people get the disease.

CHARLIE NAVARRO (Hepatitis C Patient): This was before we went to a concert. It wasn't in the back of an alley or it wasn't 50, 60 times. I was never addicted. All I tried was once or twice and, unfortunately, with the crowd I was with, we shared needles.

RAY: Dr. Anthony Martinez, Tony, how common is it for Hep C to actually be transmitted through IV drug use?

DR. MARTINEZ: Well, this is very common. We see it even with one-time use. The risk is very high. It was extremely common, as well, going back into the sixties, seventies, and a lot of these patients are just manifesting symptoms now being that the natural history of the disease is so long. But we still see it among young intravenous drug users. A lot of them don't have proper education about safe needle practices, safe use practices, so it still remains a significant problem.

RAY: Can you talk about the difference between acute and chronic Hepatitis C?

DR. MARTINEZ: Acute infection is the initial period right after the patient is exposed to the virus and what happens is the virus remains latent in the liver doing its damage and it's sort of like a silent type of thing. As you guys have already mentioned, you don't have a lot of symptoms. Even initially, you may not manifest anything. A lot of times these patients are diagnosed late in the disease and they already have evidence of significant hepatic damage.

RAY: Okay, let me ask, if I get an annual physical and I have a complete blood test or if I give blood, would Hep C show up in its early stages in either of those tests?

DR. MARTINEZ: Not necessarily. A lot of times you'll see elevations in the liver enzymes, in the, they're called, the transaminases. And this isn't always the case, however. A lot of times those enzymes can be completely normal and you can still have advanced liver disease and not know it. So it's not a typical screening test that you would have in a routine physical exam. You would need to have a test specific for Hepatitis C antibody in order to detect it.

RAY: Okay, now we talk about IV drug use as a primary driver and contagion agent for Hepatitis C. We talk about that also with HIV but HIV is also spread through sexual contact. Is that also the case with Hepatitis C?

DR. MARTINEZ: It's biologically plausible, yes, but the – it's very low. I mean, the risk is probably under five percent in a monogamous relationship. That's not to say that it cannot happen. Any bodily fluids, any blood exposure, it's a possibility. We've isolated detectable virus even in saliva, the crevicular fluid in your oral cavity, they've isolated low levels of virus. And that's not to say that it can be spread by kissing or utensil sharing, anything like that, but any bodily fluids, it is biologically plausible that it could be spread.

RAY: Can you talk about exactly how it damages the liver? What does it do?

DR. MARTINEZ: Basically, what happens is that the virus, it sort of attacks the liver and it's kind of like a shock and awe type thing with the immunity. It basically overwhelms the immune system initially and then it sort of goes quiet and almost disappears for a little bit. And it's very efficient in changing itself and mutating, and it replicates very quickly. And basically what happens, it causes inflammation that ultimately results in scarring and with enough scarring, you can develop cirrhosis, which is basically end-stage liver disease. And one of the biggest complications at that point is hepatocellular carcinoma.

RAY: Hmm. So that basically, you're talking about liver cancer.

DR. MARTINEZ: Exactly.

RAY: Okay, how is Hep C treated?

DR. MARTINEZ: Basically, we use a combination therapy of an antiviral medication called Ribaviran, this is a pill, and we also use an injection called pegylated interferon, and that's given once a week and treatment course varies between six months and close to a year.

RAY: Kenny, you talked to people who had gone through the treatment. It's not very pleasant.

GOLDBERG: No, it isn't. It causes flu-like symptoms, it's very painful. People can have very irritating side effects and because the treatment takes so long, when they have those side effects there's a tendency to want to just stop because it's so miserable.

RAY: Tony, does – If we begin the treatment and stop it, does that create a problem in which you actually foster the disease moving faster?

DR. MARTINEZ: Not necessarily moving faster. What we're mainly concerned about, being that it is a viral agent, we worry about resistance that we could, by stopping and stopping (sic), and we've seen this in HIV, you worry that the virus is going to change itself so that the medications won't be as effective.

RAY: Okay, we're talking to KPBS health reporter Kenny Goldberg and to Dr. Anthony Martinez, an Assistant Professor of Medicine at UCSD in the division of General interest – General Internal Medicine. We'd like you to join the conversation at 1-888-895-5727, 1-888-895-KPBS. Kenny, talk a little bit about what you saw in terms of prevention. How does it work in terms of a needle exchange program, say, in San Diego? We don't have one in the county but talk about the city program.

GOLDBERG: Well, the City of San Diego has a mobile needle exchange program that's funded by a private agency and it operates twice a week for about three hours a week in North Park and one in East Village. And it's a mobile exchange where people can walk up to this mobile van. If they bring in dirty needles, I believe up to 50, they can exchange them for clean syringes. They also offer clean shooting equipment like alcohol wipes, cookers, things like that. And the whole concept behind it is, is harm reduction. In other words, we know people are going to shoot drugs so if they do so, we want them to do it as safely as possible so they don't spread infectious diseases like Hepatitis C and HIV.

RAY: Okay, the City of San Diego supports this program. Is it publicly funded?

GOLDBERG: It is not publicly funded. It's privately funded. Now in contrast with the City, the San Diego County Board of Supervisors is adamantly against clean syringe exchange. They don't support it at all. And I spoke to Supervisor Diane Jacob, who's the chair of the board, and she offers her opinion of it.

DIANE JACOB (San Diego County Board of Supervisors): I think it particularly sends a wrong message to our kids. It sends the message to our kids that, as county government, if we gave out clean needles for illegal drug use that we condone illegal drug use, and we don't and it's wrong.

RAY: Okay, so you went to New York City as well because we know they have a well established program and there was one really stunning statistic. Before they brought the program there, like 54% of IV drug users were HIV positive?

GOLDBERG: That's right. And then in the early nineties, in response to that, the New York State legislature passed a law that permitted clean syringe exchange and about nine years later the, once they instituted clean syringe exchange in New York, the HIV rate among IV drug users in the city went down to 15%, so it had an enormous affect.

RAY: Now I didn't know about the City of San Diego program. It's not well advertised. I'm wondering, is there better public relations for the program in New York? Do you see it more widely advertised?

GOLDBERG: Well, you don't see it more widely advertised but there are many more programs. They have 12 about the city that serve all different neighborhoods, all different boroughs, plus they have – in New York, they have what's called peer exchange where specially trained people can go to street corners, they can go to parks, they can go to wherever IV drug users hang out and distribute clean needles and collect dirty ones.

RAY: Now when you were in New York City, you talked to a woman by the name of Daliah Heller.

GOLDBERG: Daliah Heller's the Assistant Health Commissioner in charge of drug abuse and drug abuse programs. And they have a completely different attitude towards IV drug users and towards the concept of clean syringe exchange.

DALIAH HELLER (Assistant Health Commissioner, New York City): The City has been supportive of syringe exchange since the early 1990s because there's been a recognition that it's a public health intervention. We recognize that as people continue to use drugs, they also have the right to protect themselves and their loved ones and their communities from disease.

RAY: Tony Martinez, how effective does medicine find clean needle exchange programs are in the prevention of the spread of Hepatitis C?

DR. MARTINEZ: Oh, very effective. I mean, this is so uncontroversial it's – the science is there. In peer reviewed literature, this is very well documented, very well studied. There's no question that this reduces the rates of communicable disease. You know, and another important thing to understand about needle exchange programs, it's not just exchanging needles. These people who are dedicated to working in those operations, preventionists, are also advocating to get patients into treatment. So one of the things that's not often talked about is that the actual uptake into treatment is pretty good, and this is supported by the findings in the literature. So it's not just, you know, giving out clean needles and that’s it; it's also encouraging people to get into treatment, get involved in their care, get screened for some of these communicable diseases that we're discussing. So it has more downstream effects than just giving out clean needles.

GOLDBERG: Yeah, you know, you're absolutely right because SANDAG, the San Diego Association of Governments did a study of the San Diego private needle exchange program and they found that one out of five clients that use the program actually entered treatment.

DR. MARTINEZ: That's right.

RAY: Okay, there is the argument though that if you let kids see this sort of thing happening that they're going to somehow be attracted to illegal IV drug use. Is there any indication that that happens?

DR. MARTINEZ: No. There's been, again, numerous studies that have – haven't given any support to that argument. In fact, they've shown that there's reductions in crime rates, there's reduction in the number of needles that are, you know, left in the streets that children could potentially be exposed to. There's no indication in any of the literature that the rates of drug use actually go up. To the contrary, the studies find that, you know, that it's just not the case.

RAY: Now if you're talking about products for treatment like interferon and things like that, you're talking about substantial costs over prolonged periods of time. Can you compare the cost of treating somebody with Hepatitis C to the cost of a needle exchange program?

DR. MARTINEZ: Oh, it's monumental. I mean, this treatment isn't cheap. You know, we've only talked about two of the medications that we use. To mitigate some of the side effects, we additionally usually add two additional shots, sometimes other medications. There's other studies that are involved in the workup of Hepatitis C. Patients who ultimately develop cirrhosis and need to go on the transplant list, that's expensive. To get a new liver is very costly. To go through hepatocellular carcinoma treatment is extremely costly. So the cost benefit of providing clean needles and investing in prevention, it – the balance is tipped in its favor. I mean, the cost of this stuff, it's, you know, it's staggering.

RAY: And, Kenny, I think you said the cost of a liver transplant is somewhere near a quarter of a million dollars?

GOLDBERG: Yes, and it could be more if there's a lot of pre-treatment and post-treatment. If a person needs to be repeatedly hospitalized afterwards, yeah, it could be very, very expensive.

RAY: Tony, does that cost also take into account the anti-rejection drugs for a lifetime?

DR. MARTINEZ: Oh, yeah. Yeah, absolutely. No, these needle programs, needle exchange programs, they've been shown to be cost effective. That's without a doubt.

RAY: Okay. You're listening to These Days on KPBS. I'm Alan Ray, in for Maureen Cavanaugh. Talking with KPBS health reporter Kenny Goldberg about his four-part series on the epidemic of Hepatitis C and how to deal with it. Also talking with Dr. Anthony Martinez. He is an Assistant Professor of Medicine at UCSD in the division of General Internal Medicine. We'd love to talk to you, too. 1-800 – Make that 1-888-895-5727, 1-888-895-KPBS. You're listening to These Days on KPBS.


RAY: You're listening to These Days on KPBS. I'm Alan Ray, in for Maureen Cavanaugh, talking with KPBS health reporter Kenny Goldberg and with Dr. Anthony Martinez, Assistant Professor of Medicine at UCSD in the division of General Internal Medicine. Talking about the epidemic of Hepatitis C in the United States. Now, Kenny, you found in talking with Diane Jacob—and I know you've found in talking with others—almost a complete disconnect between the politics and the faith of this, of dealing with the problem, and the real world practicality in the medicine.

GOLDBERG: That's right and, as Tony was saying, I mean, the science and the research shows overwhelming support for the efficacy and the practibility of clean syringe exchange yet in this county the politicians just don't support it and that's because of their personal beliefs; it has nothing to do with science. And so I think that what's at the crux of my four-part series is this disconnect between science and public health.

RAY: Tony, how much does that complicate the practice of medicine?

DR. MARTINEZ: Oh, well, it definitely complicates things. I mean, here we have an intervention that we know works and we're not utilizing it. So, basically, we're standing by watching idly as more people become infected and, you know, are going to need treatment, are going to need some of these longterm therapies and interventions to deal with their chronic disease.

RAY: All right, let us go to the telephones. We'll say good morning to Derek in National City. Good morning, Derek. You're on These Days.

DEREK (Caller, National City): Hi. Thanks for taking my call. It seems like we're spending a lot of money on extending the life of drug users whether it's needle exchange programs or healthcare. It seems that a better use of the money would be to educate young children on the dangers of drugs and prevent them – so that we have a much lower rate of drug users to begin with.

GOLDBERG: Well, that's an interesting point. I think what we find out, though, whether it's using drugs or alcoholism or practicing safe sex, it's one thing to give out information but it's quite another to get people to behave in the correct way. And so the concept behind syringe exchange is it's a matter of harm reduction. So in other words, if people are going to have sex, they should use condoms and other methods of protection. If somebody's going to shoot drugs, and we know they will, then it's important for them to do it safely and to use clean equipment so they don't spread disease.

RAY: Tony, how does a doctor look at a statement like that?

DR. MARTINEZ: Well, I mean, I agree with Kenny. You're not going to eradicate this problem. People are always going to use drugs despite your best efforts to prevent it. There's just no way around it. So I think we have a responsibility to do the damage control and reduce the risk if we're able to.

RAY: Okay, speaking of damage control, let's talk to Bob in Ocean Beach. Bob, you have actually had Hepatitis C for some time, is that correct?

BOB (Caller, Ocean Beach): Yeah, you bet. Good morning, you guys.

RAY: Hi.

GOLDBERG: Good morning.

BOB: Okay, I guess – Yeah, I don't want to enter into the controversy about, you know, needle exchange or anything like that but what I did want to say is I was just listening and, you know, you were using the words like 'epidemic' and 'chronic' and things like that. And Hepatitis C certainly is a problem but what I wanted people to know is, you know, I don't want people to get so – I don't want people to hear these things and I think like what happens with a lot of people with a lot of illnesses it's like you just don't want to know, so they don't go get tested with it. I've had Hepatitis C for 30 years. When I first contracted it, they didn't even know what it was. It was called like – they classified it as serum hepatitis. And I've never had any treatment for it and my doctors have said like with a lot of people – a lot of people just learn to live with this illness. And even that almost sounds kind of bad. It's like it doesn't affect me at all. I'm 51 years old, and my energy levels are way, way above everybody else's that I know. I mean, I surf religiously. I work two jobs. I mean, I'm a super healthy guy, and my body has just learned to live with it. So I guess what I wanted to say is, I want to encourage people, go get tested for it, don't let these things scare you off. Go get tested for it. If you find out what level that you are at, and then once you do that, you can deal with it. But it's not a death sentence. It's not, you know, this horrible, horrible illness. My understanding is three percent of people that have it actually die from it and the majority of people just learn to live with it.

RAY: Have you done anything medically with your life since you found out you had what was then serum hepatitis?

BOB: Yeah, you bet. What I did was, I mean, I continued, you know, like the one guy that was on here, he talked about, you know, he just used intravenous drugs a couple times. I used for 20 years and I got clean 12 years ago and immediately started on, you know, got – I got a job and that kind of stuff and got some medical benefits and I started on a course of action. And they took me through the whole course, what eventually ended up was doing a liver biopsy to actually see what extent of damage had been done to my liver. And there's like four levels that you can end up with and I ended up at a level 1, which is the least amount of damage. And my doctor told me at that point, Bob, you don't need interferon, you don't need anything, just, you know, continue to live a really healthy lifestyle. And that's the other comment I guess I wanted to make, is that when you do have this disease, if you continue to drink, if you continue to use drugs and those kinds of things, it is really going to exacerbate the illness and you will definitely suffer some consequences. And even just an unhealthy lifestyle without those things will cause problems.

RAY: Okay, Tony, talk about that. The liver's an extremely resilient organ, we know that. But is there a tipping point even after 30 years at which all of a sudden there is a problem, possibly? Or is Bob in that really lucky cohort of the population that simply will just never get really sick with it?

DR. MARTINEZ: Yeah, he's actually – He actually is one of the lucky ones. In a certain percentage of people, what we see is that the disease doesn't necessarily advance. And what Bob was referring to with the liver biopsy is an important point. You know, we do do a liver biopsy in many cases, it depends on what type of Hep C you have, and it helps us to determine if you are an appropriate candidate or if you do need treatment. And, as Bob indicated, he was a stage 1, which is a very early stage. Being that he had the disease for 30 years and it hasn't advanced beyond a stage 1, it's reasonable to defer treatment in a patient like him. And, you know, he's right, you live a healthy lifestyle, you don't drink, you don't overuse certain medications, and you can, you know, do things that favor yourself from developing more advanced disease. A lot of patients who have more advanced, stage 2, stage 3 and beyond, those patients we highly recommend treatment for because it's progressing.

RAY: Okay, now, Kenny, you actually went to gatherings of people involved in needle exchange program in New York. Did you get the sense from these people that they were looking at a death sentence or what sense did you have of how they were feeling about the disease they had or that they were trying to avoid?

GOLDBERG: No, I didn't get a sense they felt it was a death sentence. I mean, it really, like Tony says, it really depends on the severity of it. Some people, if they have advanced cirrhosis, I mean, they're very ill and they'll – I spoke to one woman here locally that's on the transplant list for a liver transplant. She also developed liver cancer so, I mean, it can get very serious. But I went to a Hepatitis C support group in New York where people are just looking for answers and how we can – how they can maintain their health and all that kind of stuff and I might add that the cure rate for Hepatitis C is about 50%, so that's not bad.

RAY: In medical terms, that is actually not bad at all, is it, Tony?

DR. MARTINEZ: No, and actually that 50% refers to patients who are what we call genotype 1, which is a certain type, it's about 50%. If you get into the other genotypes, two and three, the rates of response are actually, you know, significantly higher, can be as high as 70, 80, 85%. So the treatment outcomes are good depending on what type that you have but, overall, it's very good.

RAY: You're listening to These Days on KPBS. I'm Alan Ray, in for Maureen Cavanaugh. We're talking with KPBS health reporter Kenny Goldberg about his series on the spread of Hepatitis C, and Dr. Anthony Martinez, Assistant Professor of Medicine at UCSD in the division of General Internal Medicine. We're joined on These Days by San Diego City Councilman Scott Peters. Good morning, Scott.

SCOTT PETERS (Former San Diego City Councilman): Good morning, guys. It is former councilman. But I just did want to call in because I was on the city council when we voted in some pretty – after some pretty contentious hearings to support needle exchange because most of us saw the public health benefits of it. And I just wanted to respond to Kenny's comment that politicians in the area didn't support it because, clearly, at the City we saw the benefit of the program for the community. And I particularly just wanted to give credit to Toni Atkins, who was my colleague at the time, who represented North Park, who was – It took a lot of courage for her to say that she saw the benefits of this so much that she would put this in her community. And I think she deserves a lot of credit for that and we think the program is great for the community.

GOLDBERG: Can I ask, before we lose you on your cell phone here, can I ask if it is truly meaningful for the City to say it supports something but not provide the financial resources to make it happen?

PETERS: Yeah, we had to make zoning decisions. We had to allow that land use so, you know, it was just a – even though the health advocates came to us and said, look, City, we're not even asking you to pay for this, we just want you to zone – to rezone the area in East Village and in North Park for these uses because of the tremendous public health benefit. It was still very contentious. And it took the support of the City Council to make it happen. And it would have been a harder question, I grant you, Alan, if we'd been asked to pay for it. I'm not quite sure that it would've been so easy but it took a lot of courage, especially for Toni to say, you know, I see the benefit of this for the whole community as a whole despite the opposition of many of my own constituents.

GOLDBERG: Well, you know, you make an excellent point that some San Diego city politicians supported it, including, I might add, the mayor of San Diego, Mayor Sanders. He supports it and he's a former police chief. In fact, I asked him about it once and he says, well, the CDC says x-y-and-z and, therefore, I'm going to follow their lead. What I meant by politicians don't support it, I meant the county politicians in particular.

PETERS: Okay, I'm sure – I'm just not sure that everyone in the public made that distinction. I understood that's what you meant.

RAY: All right, former San Diego City Councilman Scott Peters, now on the – I believe you're a Port Commissioner, are you not now?

PETERS: Yes, sir.

RAY: Indeed. Congratulations, and thank you for calling.

PETERS: Thank you very much for the show.

RAY: You're listening to These Days on KPBS. I'm Alan Ray, in for Maureen Cavanaugh. And we'd like you to join the conversation at 1-888-895-KPBS, 1-888-895-5727. Suzy in Encinitas, good morning. You're on These Days.

SUZY(Caller, Encinitas): Good morning. My husband was diagnosed with Hep C after taking a blood test for an insurance policy. And our best guess is that he contracted it when he was a teenager and had a series of surgeries that involved lots of blood transfusions and maybe there was no screen for Hep C at that time. Anyway, he went through the treatment with ribavirin and interferon for a year and now there is no evidence in a blood test that he has Hep C or has ever had Hep C but it's on his medical records. So I'm wondering if there is any effort for it in the patient advocacy arena to recognize these treatments as a cure for Hep C so he can get insurance.

RAY: Well, let me – May I also ask if your husband has done anything in the way of lifestyle changes or does he avoid alcohol out of concern for the liver even after he's cured?

SUZY: Oh, right. He has the healthiest lifestyle of anyone I know. He maybe has a glass of wine every night or every other night but he leads a very healthy lifestyle of exercise and diet and is quite fit.

RAY: Can I ask you if insurance paid for the treatment and do you have any idea how much you paid for it?

SUZY: I think the treatment was part of a study through UCSD, I believe.

RAY: Okay. Okay. Well, that's – I guess that's the best way…

SUZY: No, I don't think we did pay for it.

RAY: All right, okay. Hey, thank you very much.

SUZY: Thank you.

RAY: That is Suzy. We are going to go back to the phones. In La Jolla, talk to Jane. Good morning, Jane. You're on These Days on KPBS.

JANE (Caller, La Jolla): Good morning. My mother was diagnosed with end-stage renal failure in January and she did receive some transfusions in the hospital when she was hospitalized originally. When she was assigned to a dialysis center about a month later, they had her segregated off to one side and when she asked why that was happening, she was told that she had Hepatitis C markers. When we contacted her doctor, the doctor said that there was treatment necessary but that she did have these markers or some evidence of Hepatitis C. So my question is, what does that actually mean? We haven't gotten a satisfactory answer from any of her physicians, neither the nephrologist or her primary physician as to, you know, what does that mean? I mean, we know that now she has to be separated from the other people at the dialysis center but other than that, there's no explanation that's been given to us in terms of what does that mean for things she should be looking for, or does that means she's going to develop Hepatitis C fully or…? We just haven't gotten good answers.

RAY: Tony?

DR. MARTINEZ: Yeah, well, you know, that's interesting. She probably tested positive for the Hepatitis C antibody, which means that she has been exposed. If she has not been checked for, we call it, the Hepatitis C viral load and it's the number of copies of the virus that are in the bloodstream, that would probably be the next step to see if she actually has active disease. At this point, assuming that she was positive for the hepatitis antibody, all you can say is that she was exposed to it at some time or another. Now whether or not she had active disease and if she's an eligible treatment candidate, you know, it's hard to comment on that. She has end-stage renal disease. Usually we're more careful with those patients and maybe we don't treat them. But you really need more data, you need more information as to the status of the Hepatitis C.

RAY: Well, let's talk about information as it relates to public policy. Kenny, actually one of the most arresting things I heard in the series was Diane Jacob's response when you asked her what information might change your mind.

GOLDBERG: That's right, and when I did that interview, I was really shocked when she said that because basically what she's saying is, there's no information that you could present to me that would make me take a – even take another look at this let alone change her mind. And that really implies a very closed attitude about it.

RAY: Tony, then how do you, as a doctor, or how to doctors as a group deal with that kind of a challenge in dealing with public health policy and politicians?

DR. MARTINEZ: Yeah, you know, I heard that interview and it's really a shame that we've based public health policy on morality when, really, this should be rooted in science. There's just no reason for it. And we're going to pay the price down the line when more of these patients get sicker and require more costly interventions.

RAY: Tony, thank you very much.

DR. MARTINEZ: Pleasure.

RAY: That's Dr. Tony – Anthony Martinez. He's an Assistant Professor of Medicine at UCSD in the division of General Internal Medicine. Kenny Goldberg, KPBS health reporter, outstanding series.

GOLDBERG: Thanks very much, Alan.

RAY: Very nicely done. You can see Kenny's series on our website,, and thanks to you for calling. If we weren’t able to get to you, it's just because we just had a lot of information here to get in a very short period of time. You're listening to KPBS, These Days. I'm Alan Ray, in for Maureen Cavanaugh. We're going to take a quick break and when we come back, we're going to talk about news in the Imperial Valley.