I like the pack of straws analogy for probability.

I explain 90% as being like pickingfrom a pack of 10 straws. 1 person gets the short one, 9 don’t.

When I grew up straws were more common than revolvers and Russian Roulette. The scene from the movie “The deer hunter” put me off that game. Great guitar tune though….

[video]https://youtube.com/watch?v=sA_qnNrVelc[/video]

Hi Serg,

I was sitting in the room when this was presented:

http://ilc-congress.eu/high-rate-cancer-recurrence-hepatitis-c-patients-despite-successful-virus-eradication-direct-acting-antiviral-therapy/

In the Italian study, medical records of 344 HIV-negative patients with HCV related cirrhosis, who did not have active HCC, were analysed. All patients had received treatment with one of the following DAA combinations: sofosbuvir and simeprevir (34%), 3D combination* (22%), sofosbuvir and ribavirin (17%), sofosbuvir and daclatasvir (16%) and sofosbuvir and ledipasvir (10%). Occurrences of HCC were assessed by comparing baseline enhanced-ultrasonography and MRI/CT-scans with those taken during the six month post treatment follow-up.

Sustained virologic response was achieved in 89% of patients at 12 weeks post treatment. At 24 weeks post treatment, active HCC was detected in 7.6% of all patients (n=26) without a history of HCC – deemed to be a ‘standard rate’ by the study authors. However, in the 59 patients who had a previous history of HCC, a ‘high rate’ of 29% (n=17) redeveloped the condition.

Which is not the study you are looking at. The upshot was that in cirrhotics the headline numbers were:

1) 7.6% for all participants (26/344)
2) 29% for those who had previously had an HCC (17/59)
3) 3.1% for participants who had not had an HCC before (26-17=9)/(344-59=285) ie 9/285

All participants were assessed with MRI for current HCC prior to starting, and patients with a past history of HCC were not excluded.

Unfortunately although Interferon may provide some HCC protection when it comes to all cause death patients who have a second round of interferon have a 9.7% mortality rate compared to 6.4% taking placebo so the interferon adds ~ 3.3% mortality, and you still have the HCC risk from the cirrhosis.

http://www.everydayhealth.com/hepatitis/second-round-of-interferon-for-hepatitis-c-may-be-fatal-2345.aspx

Hi A.L,

Please read this – it’s informed, balanced and passed peer review:

http://onlinelibrary.wiley.com/doi/10.1111/liv.13157/full

Pharma spends 1.3% of gross revenues on R&D and 25% on marketing. They are laying waste to the public purse (both government and insurance) while not delivering what we, as in the world, need ie more new novel antibiotics. I think I use the words “strangling the goose that lays the golden eggs” and like it or not, it is totally accurate.

At the moment health care costs are increasing by 7% pa in most of the western world. GDP growth is 3%. That 4% annual gap means healtcare budgets DOUBLE – in real terms – within 20 years (they will on the current trajectory quadruple in actual dollar value).

In Australia healthcare costs 9.8% of GDP. Double that and we get to 20% (what it currently is in the USA) but that 9.8% is also 28.6% of consolidated revenue – so double that and over 1/2 our budget is going on health which leads to what do we give up to fund it? Education, roads, ports, prisons? The money has to come from somewhere.

And what is the major line item in the health budget? Pharma.

Sofosbuvir existed for 10 years before Gilead bought it as a nearly done deal, and would have hit the market regardless, at a lower price and with the direct result that some of the 500,000 HCV patients who died last year (about the same number that got treated) would be alive and well, enjoying time with family and friends.

Gilead are one of the worst examples, but far from the only one. I also recommend this short letter to you, and the 2 minute video from Bloomberg at the end:

http://fixhepc.com/blog/item/30-a-new-plan-for-pbs-pricing-negotiations.html

Do you want know the worst thing about SVR?

Chances are you’re going to live long enough to see the western health system implode under the weight of the sort of greed that would make even Gordon Gecko blush.

Those who cannot remember the past are condemned to repeat it

– George Santayana

Across the course of history there have been some bad things happen. People in power, and alive at the time have put in place “red tape” to try to prevent future generations having the same issues. Over time memory fades and the voices for change gather momentum.

Take BREXIT for example. As imperfect as the European Union might be the 70 year period of relative peace and prosperity that follows WWII has no parallel in history. Prior to that European countries were routinely at war with each other.

Take Donald Trump as another example, his nationalism and plan for a wall to keep Mexicans out – the parallels to Hitler pre WWII should be evident to any student of history.

Take the whys and wherefores of the US housing meltdown: http://www.huffingtonpost.com/robert-weissman/deregulation-and-the-fina_b_82639.html

Here’s a great article from the Harvard Business Review: https://hbr.org/2009/07/shareholders-first-not-so-fast

In the 1950s and 1960s, the stakeholder was king. CEOs saw their role as one of balancing the interests of the various groups that touched their companies—customers, employees, suppliers, shareholders, and the community at large. This reflected the executives’ sophisticated understanding not only of their role as stewards of the valuable resources entrusted to them but also of their own enlightened self-interest: Each of these groups was essential for organizational success. What was true then is even more so today, in an age of knowledge work, outsourcing, global supply chains, and activist interest groups.

Liver inflammation – killing liver cells – kills cancer cells and normal cells so it is not entirely surprising that treating the HCV, and the damage it is causing, has this result.

It’s important to remember that in the absence of treatment liver cell death, liver failure and decompensated cirrhosis is the outcome.

Treating early, before cirrhosis, is a good option.

With cirrhosis the alternative to treatment is allowing the disease to run its course, and that tends to end badly once this stage is reached.