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“Hepatitis C is the only chronic viral infection that’s curable with treatment and it will prevent them from ever falling off the cliff.” Patients can expect about a year of antiviral therapy, given both by injection and in pill form; the drugs have significant side-effects, but Shah said better-tolerated medications that would be taken for a few months are in the pharmaceutical pipeline. Last year, the U.S. Centers for Disease Control and Prevention recommended that all Americans born from 1945 to 1965 be tested for hepatitis C. Recently, the Canadian Liver Foundation echoed that call for a national screening program. But it stretched the birth-year period to 1975, reflecting the prevalence of hepatitis C among immigrants from regions where the disease is endemic, including northern Africa, southern Italy, Eastern Europe, and Central and Southeast Asia. The foundation also questions the Public Health Agency of Canada’s (PHAC’s) estimate of 242,500 cases across the country, suggesting the figure is likely closer to 400,000. Currently, Canada has no population-based screening program for hepatitis C, in which a simple blood test looks for antibodies to the virus. Instead, PHAC recommends doctors test patients who engage in such risky behaviours as injection drug use or certain sexual practices. However, Shah said international studies have shown this approach is inadequate for picking up infections. “What we know is probably about 40 per cent of people who are infected have no risk factors.” As well, such screening programs rely on doctors asking about risky behaviours — which are often highly stigmatized — and patients admitting to them, he said. “The fact that we don’t talk about hepatitis C and the lack of public awareness, I think contributes to the stigma immensely,” said Shah. “(A patient) may have got hepatitis C through a blood transfusion, but when they tell someone else they have it, the immediate assumption is they must have used drugs.” And because most cases of liver failure result from cirrhosis due to alcohol abuse, patients who deny being heavy drinkers often aren’t believed until blood tests come back positive for hepatitis, he said. “I think a national screening program will help to destigmatize the condition because it’s something that everyone is at risk for.” But it’s critical that anyone who tests positive for hepatitis C antibodies have followup care, including a test for active infection with the virus.
Medical Association. Cunningham has been practising medicine since 1986 and works in a hospital emergency department on Vancouver Island. The report doesn’t address the issue of whether there are too many specialists for the Canadian health care system, in which operating room time and budgets are fixed. But it makes it clear that doctors are competing for resources. The report also pinpoints reasons why newly certified specialists are having trouble finding work: older doctors are delaying retirement; established surgeons are protecting their precious (often only one day a week) operating room time so young doctors aren’t getting the hospital/surgical positions they covet; and a lack of cohesion in medical resource planning and coordination between medical schools, governments and hospital or health care authorities. As well, there are relatively new categories of health professionals encroaching on doctors’ territory, such as advanced practice nurses, nurse practitioners and physician assistants. Respondents to the survey were graduates of Canada’s 17 medical schools and/or Canadian residency training programs in fields such as cardiac surgery, neurosurgery, nuclear medicine, ophthalmology, radiation oncology, urology, critical care, gastroenterology, general surgery, hematology and medical microbiology. The report does not include data on family doctors. While about one in five specialists or subspecialists said they are having challenges finding jobs, another 22 per cent of newly certified specialists said they are taking locum positions or other various part-time positions. Locums assume another doctor’s duties during holidays or extended absences. In the survey, 40 per cent said they weren’t happy they had to do that. Dr. Dave Snadden, associate dean of education at UBC medical school, said since the report is based on a survey with a response rate of about onethird (43 per cent in B.C.) of 4,233 doctors polled, it has to be seen as less than perfect from a research methodology perspective. He defended UBC’s approach to matching residency training positions with community needs and noted that is one reason why UBC has been pushing for more and more family medicine residencies. Those in medical schools now, or planning on going to medical school, should know there’s a great demand for specialists like psychiatrists, pediatricians and general internists, while there is less demand for specialists such as cardiac surgeons.