James-Freeman-facebook wrote: Back in February 2015 I met a patient with Hepatitis C who was looking to access Harvoni.
What followed was a journey of exploration looking first the India, then to the Middle East, and then to China.
The goal was pretty simple - find a reliable legal way to get the right medications to the right patients.
While on the surface it might seem as simple as doctor writes script, patient gets medication, and 12 weeks later they are cured, it's not quite that simple. I won't attempt to speak for any other doctors but my personal concerns included
Can I just ignore it and make it someone else's problem?
- Is this legal? (YES)
- Am I allowed? (YES and NO)
- Are there any risks? (YES a truck load)
- What happens if something goes wrong? (SHTF)
Looking at each of these in turn.
In terms of simple legality I can as a GP write a script for just about anything (provided there is a valid medical reason). There is no doubt there is a valid reason to prescribe these medications - they work. A patient can legally import 12 weeks supply of a medication, provided it's not on the prohibited imports list (these medications are not), and provided they have a valid prescription a patient can possess these medications (like any other S4 or S8 medication - these are S4).
So now we move to the subject of being allowed. The first part of this is really the question "Will the medical board strike me off the register for doing it?" The answer to this is probably closer to maybe than yes or no. Doing it with due care and informed patient consent it should be a no. Done without due care and we definitely get into a grey area. The second part is that to order a Hep C viral load, or a genotype (and have it bulk billed under Medicare) a specialist has to authorise that testing. This is a pretty big deal given each test costs $200. Fortunately I have consultant colleagues willing to authorise the testing.
Now we get to the risks. These include things like:
- Do I know enough about these medications and their side effects to safely prescribe them? (Yes, I can look that up)
- How do I know the patient will actually get the right medications? (It's not like I'm sending them to a trusted pharmacy down the road)
- What if the patient does not reach SVR?
- Where does my implicit duty to treat end and my responsibility to do no harm begin?
Although I've only treated a small group of patients to date the expected side effects and complications are already evident - headaches, anaemia, and treatment failure. I expected to see them all and they are being managed on a case by case basis.
And then we get to the last question can I just ignore it? For me the answer was no, I would not be able to sleep at night knowing I could help, but chose not to..... Although for me the answer was no, I could not ignore it, I would not think any the less of a doctor who declined to be involved.
This site is not the work of any one person. It represents the combined efforts of a group of interested people to help make accessing these life saving medications possible.
Hello Dr. Freeman,
I am very happy and thankful you did not ignore it! (I marked the text from your post
And this is not just because I got cured, but also because the knowledge you and all other forum members shared here on Fixhepc is crucial in the efforts being made to eradicate HCV.
From my perspective, as former patient, I can say that HCV was a scary ghost not only because it was affecting my health, but also because of the fear "what if someone else, close to me, will become infected"
. This is a constant fear that almost all or many HCV patients have, like a parent living with the fear that the own child might get sick or someone fearing that the living partner or friends might get sick.
Now we have the knowledge how to get treated with generics and this knowledge may be used and shared with others.
Many thanks for all your efforts!