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Heart and Exercise, Smoking and Alcohol, Weight Management, Hepatitis C

Can running too much really be bad for the heart? A novel psychological approach to weight loss, new treatments for Hepatitis C and a reduction in binge drinking in young adults.

After recent headlines that running too much can be bad for your heart, Mark Porter talks to the Medical Director for the London Marathon to get an insider's perspective. A novel psychological approach to weight loss that asks why people are eating too much rather than just giving dietary advice. Plus new treatments for Hepatitis C and statistics showing a reduction in binge drinking in young adults.

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28 minutes

Programme Transcript - Inside Health

Downloaded from www.bbc.co.uk/radio4 

THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT.  BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

 

 

INSIDE HEALTH

           

Programme 7.

 

TX:  17.02.15  2100-2130

 

PRESENTER:  MARK PORTER

 

PRODUCER:  ERIKA WRIGHT 

 

Porter

Coming up in today’s programme:  Aaah – the youth of today! An all too common lament among older generations, but just how valid is it when it comes to the common vices like alcohol and tobacco? You might be surprised.

 

Hepatitis C – how a new generation of anti-viral drugs is set to revolutionise therapy.

 

And a novel approach to weight loss that focusses on the mind rather than diet sheets and exercise programmes

 

Clip

It sounds quite funny because you don’t very often get a group of people with a BMI of over 60 altogether in one room, it’s statistically quite unlikely to happen.  So what it did – we all had the same worries – I don’t go out because I’m worried what will happen when I do, I don’t walk down the street because I’m worried about what will happen when I do, I can’t get any clothes that fit me.  We all had the same anxieties.

 

Porter

And was that helpful for you?

 

Yes because I knew it wasn’t just me. It is quite isolating.

 

Porter

But first I have donned my running shoes and taken to the streets of London – something I last did in 2003 for the London Marathon. Back then I was running up to 30 miles a week and basking in the reflected glory of all the health benefits, particularly for my heart.  But a recent study from Holland has suggested that running too much can be harmful, indeed almost as harmful as doing too little.  So time to get an insider’s perspective.

 

Sanjay Sharma is Professor of Cardiology at St George’s Hospital and Medical Director for the London Marathon.

 

Sharma

One of the concerns I have about this study was that instead of really playing up the benefits of exercise the media seemed to focus more on the potential detrimental effects of exercise.  If you think about this paper you only have to do exercise very modestly to achieve the benefits and people who exercised a bit more than that seem to have done worse.  So the media have really focused on marathon runners and I’ve been contacted by several medical directors of marathons asking how we deal with this.

 

Porter

Because the implication was from the way it was portrayed in the press was that actually if you’re a marathon runner it’s possibly as bad for you as being a couch potato, it’s not quite that simple is it?

 

Sharma

No not at all.  The whole conclusion was based on very small numbers because we looked at the people that jogged very slowly, there were 500 of those, those that jogged moderately, there were 250 of those, but those that exercised very strenuously there were only 36.  So when you look at two deaths out of 36 the percentage looks crazy.  And this sort of thing would have caused a huge amount of anxiety among some of the participants, particularly if you’ve got the London Marathon coming up in April.

 

Porter

Because the reason that a lot of people do exercise from a heart point of view is that it keeps the lining of your pipes, if you like, the coronary arteries, it keeps them clear.  Is that effect carried all the way through – if you do a lot of exercise, if you’re an endurance athlete, are your pipes likely to be even clearer?

 

Sharma

You make a good point Mark.  There are emerging studies, clearly, that too much exercise may well be detrimental.  If we look at marathon runners, for example, and we do blood tests on them and we measure the biomarkers of so-called cardiac damage we find that about 50% of those people have high markers of cardiac damage after a marathon race.  And the question is what does this all mean, is this just a transient physiological phenomenon or are the long term effects something terrible?  Probably the most reliable source that too much exercise may be bad for some people is the fact that many veteran athletes, i.e. those that have been exercising for more than 21 years, do have a high prevalence of a rhythm disturbance called atrial-fibrillation which is a disease of the elderly, it’s the sort of thing that an 80 year old gets, it’s present in about 10% of octogenarians.  But if we look at 40 and 50 year olds it’s only present in about half a percent.  If we look at athletes it’s present in between five and 13%, far, far higher in veteran athletes.

 

Porter

What’s the underlying mechanism then for a lot of exercise paradoxically, possibly, damaging the heart?

 

Sharma

I suspect it’s a constant stretch of the chambers.  If we stretch the chambers very, very hard by putting a massive load on them in some people the chambers may give.  For example, if we exercise a lot our joints start to give, if we drink too much alcohol our liver starts to give, what’s to say that it’s not too much for this organ if you’re going to push it very, very hard for 25-30 years.  I’m not saying that this happens to everyone but I think there are a small number of vulnerable individuals who may succumb later in life due to too much exercise.

 

Porter

If you look at the running press there’s quite a lot of interest in this phenomenon called oxidative stress, can you explain what that is and how it might impact on the heart?

 

Sharma

Yes sure.  When we exercise we produce adrenaline and noradrenaline and these chemicals are important, they’re flight or fight hormones, they’re important to allow us to push ourselves.  Now these hormones can result in the production of certain chemicals called free radicals, they can accelerate a furring up of the arteries of the heart.  In fact there has been one paper amongst marathon runners that suggests that marathon runners are three times more likely to get calcification or furring in the arteries compared to non-runners.  But there’s only one paper of that type.

 

Porter

So the suggestion is that by over-exercising, if you like, you’re producing – let’s put it very simply – you’re producing more toxins to the lining of your pipes and that they’re doing some form of damage?

 

Sharma

That’s the current theory yes.  The question really is what becomes cardio-toxic?  And that is the question.  I think that’s the same as anything else, if you and I went to the pub Mark you may drink a pint and feel giddy, I may drink two pints and feel completely fine.  So one man’s treatment I believe is another man’s poison.  And what we don’t realise, at the moment anyway, and I think more studies are required, is what is the dangerous level beyond which people shouldn’t exercise.

 

Porter

I’m going to put you on the spot here if I may a little bit as an expert in this field, if people are listening out there and they are training for a half marathon, let’s say, what advice in general would you give, if you had to give some rough guidance based on what we know already where would you put that sweet spot if you like?

 

Sharma

Well the advice I have for all of those people that are running the marathon you’re already doing enough exercise, you’ve surpassed the amount of exercise that’s required to make you live longer and to obtain all the cardiovascular benefits and even to reduce your risk of dementia and certain cancers, so you’ve done all that.  There is no evidence at all that any more of this exercise is going to necessarily benefit you, but if you’re one of these individuals that has several risk factors for blocked arteries, such as if you’re a smoker, if you’ve got high blood pressure, a family history of heart disease, you’re the sort of person that should be aware of certain symptoms that may suggest that there’s something wrong with you, such as chest tightness when you run or breathlessness that’s disproportionate to the amount of exercise being performed and you’re experiencing symptoms like this you should seek medical help before embarking on something like this.

 

Porter

So let’s be clear about the marathon runners.  They’re already doing far more than they need to do from a health benefit, is there a level at which, in terms of a weekly training schedule, that you might worry about people from a heart point of view in terms of them doing too much?

 

Sharma

Again the studies suggest now that clearly that some people who exercise very hard may run into trouble later on, they develop atrial-fibrillation later on, they develop scarring in the heart and even excessive furring up of the blood vessels.

 

Porter

And the people in these trials what sort of distances were they covering?

 

Sharma

These are people that had run several marathons in the past but these are middle aged people, some of them reformed smokers, so the data is based on groups of individuals that are very select.  If you think about the London Marathon, for example, next year – just after next year – a million people will have completed the London Marathon.  And in that time we have had just 13 deaths out of a million runs.  And I’m not aware of many of these individuals running into serious problems with their heart.  One thing that is for sure that if you’re running the odd marathon, one or two, maybe three or four, then you’re probably going to be absolutely fine, provided that you’re prepared and you’ve trained adequately.  But if you’re one of these people that’s engaging in six to 12 marathons a year and doing something even more strenuous than that, such as the Iron Man, then I think you need to be aware that there is increasing evidence that too much of this type of exercise can cause tiring of the heart.  I think there is plenty of scope now to do research of what is the perfect maximum dose of exercise in terms of cardiac safety as opposed to cardiac toxicity.

 

Porter

Professor Sanjay Sharma.

 

Now, the Office for National Statistics has just released new data showing that binge drinking among young adults in Britain is on the wane.  The proportion admitting to bingeing having fallen from around one in three in 2005, to one in five in 2013. 

 

Dr Margaret McCartney is in our Glasgow studio and has been taking a closer look at the latest figures.  Margaret, the picture they paint differs somewhat from the general perception of what young people are getting up to doesn’t it?

 

McCartney

It does.  I was looking at some work done by the Joseph Rowntree Foundation in 2012 and they took a group of young people living mainly in London and asked them what their attitudes towards drinking – these were people who’d already said they didn’t want to drink too much – and there were lots and lots of reasons given.  But what was really interesting was these young people felt they were making a positive choice not to drink.  For many of them it was no big deal, it was a personal matter, not a moral choice, they didn’t see alcohol as bad, but they’d lots of other things they wanted to be getting on with, for example sporting achievements, academic achievements, stuff they wanted to get out and do.  They no longer wanted to have hangovers or feel as though their life was being impaired or losing control because of alcohol.

 

Porter

Which is not what older generations may think of the current youth in that they think that Friday and Saturday nights the streets are awash with drunken people.

 

McCartney

Yeah and certainly you don’t want to minimise there is still a big problem with binge drinking in this country, there are still a lot of people that are drinking far more than they should.  But I think it’s really important to look at where things are different and certainly there does seem to be a fairly consistent message coming out from young people of the UK is that they’ve chosen to go down a different path and they feel very positive about it as well.

 

Porter

Okay, what about that other common vice – tobacco?

 

McCartney

Again the data’s very interesting.  So Action for Smoking and Health, a campaigning charity, look at the amount of young people who are smoking regularly and they have found a consistent fall over the last couple of decades really.  In 1982 25% of 15 year olds said they smoked regularly falling to 12% in 2010 and 8% in 2013.  So the trend does seem to be going in the right direction.  Now there was data from earlier this year, generated jointly by NICE and Public Health England, who found quite marked regional variations.  So in some areas of the country there were up to 13% of 15 year olds smoking regularly and half that in other areas.  And certainly I’m still concerned that children in the most deprived areas are more likely to have poor outcomes with their health but equally I think we have to say well something is working, what is working and let’s do more of that as well.

 

Porter

Thank you very much Margaret.

 

And smoking in young people is a subject we are going to return too soon in light of the plain packaging debate. 

 

As always links to the latest ONS statistics and other data Margaret mentioned will be on her blog. Visit our website for more details.

 

Now, a new approach to weight loss.  And one that is helping Julie.

 

Julie

I was a plump baby, I was a fat toddler and through my teens I was generally quite overweight.  And then I lost a lot of weight at university, which I then put back on.  I’ve joined most slimming clubs and been very successful, six stone lost here, but then I would put eight stone on.  I lost a lot of weight when I got married.  I put two stone on within three months after I was married and then carried on putting it on.  Good for me is 12 stone, bad for me was 44.

 

Porter

That’s a big difference.

 

Julie

Yes, yes it is.  Sort of yo-yo carried on all my adult life.  Tried Weight Watchers, Slimming World, I’ve been to my GP – they’re all very supportive, they all help me to lose weight but none of them have tackled the problems that make me keep putting it back on.

 

Porter

Can I ask you what the main reason for wanting to lose weight is?

 

Julie

My health, my health was deteriorating dramatically.  You know I couldn’t walk down the street, I couldn’t drive a car really, not safely.  So it got to the point where I actually I really couldn’t see any way out of it.

 

Porter

Julie is enrolled on a novel programme for helping people with serious weight problems at the Specialist Weight Management Service here at my local hospital Gloucester Royal.  The programme centres on providing psychological rather than dietary support, a new approach aimed at the root of the problem – indeed it’s so new, that even as local GP I don’t know much about it. But I am here to meet the team and learn more.  Dietician Janet Passey helped set up the service.

 

Passey

The patients we’re able to see, because we have strict criteria as to who we can see, have to have a body mass index of 40 or more.  So the majority of our patients are between sort of 20 and 50 stone.

 

Porter

And what do you offer here that’s different from a standard approach?

 

Passey

I think the main difference is that our team is made up of 50% psychologists and 50% dieticians looking at the why of people’s eating, the reasons behind their weight gain and what’s maintaining their weight currently.  And for a lot of people they’re highly anxious, I think 64% of our patients are moderately to severely depressed, a lot are in pain.  So there are lots of issues that impact on their eating and for a lot of them they cope with life by eating.

 

Porter

So their overeating is a form of coping strategy to counteract some of the problems they have underlying, so if you don’t address those problems they don’t get better?

 

Passey

Absolutely, yes, so if you just literally focus on what they’re eating, try and patch that up, make changes to that, it doesn’t address the underlying problems.

 

Porter

Can you give me an example then of the sort of problems that you might unearth in someone and how you might address them?  I know every patient’s different.

 

Passey

I think people who have a weight problem tend to be lumped together as if they’re all lazy and greedy and that’s so far from the truth.  I can give an example of a patient who lost a child and that’s affected her whole life and she spent 20 years comfort eating on the back of that bereavement.  Another chap, that I saw last week, his wife died five years ago, he’d had no weight problem at all but his way of coping was to overeat.  Another lady has severe arthritis, her only way of blocking that pain is to eat.  I don’t think anybody knows why some people when they’re stressed go off food, some people turn to food, but food is such a widely available commodity that I think it’s an easy thing for people to turn to.

 

Bowen

My name is Dr Gail Bowen, I’m a clinical psychologist and I’m the clinical lead for the service.  I think we’re all aware that in weight and obesity there’s not a brilliant evidence base and we’re contributing to it as we go.  We like to treat people as individuals and look at their individual needs and draw on a range of different approaches.  So at the moment within the service we would use cognitive behavioural therapy, mindfulness techniques, we use a sort of newer model called acceptance and commitment therapy.  It helps people to increase their tolerance for sitting with perhaps difficult emotions or difficult thoughts, it incorporates getting more present in your life, connecting with your values that perhaps have fallen by the wayside as weight’s increased.

 

Porter

I mean is this fundamentally about making people more resilient?

 

Bowen

Resilience is a big part of it because if we can help people increase their resilience then they’re able to keep going at the times when perhaps their weight plateaus, in a conventional dieting model it might be easy then to give up.  We also use a lot of self-compassion models because we recognise in our patients we live in a culture where the media is very unfriendly to people with a weight issue, it’s very openly critical and quite hostile at times.  And patients have grown up with perhaps bullying at school, negative comments and they’ve internalised all of that, so our patients are very, very capable of criticising themselves, they have quite high levels of self-loathing at times.  So helping people take a more compassionate approach to themselves, particularly at times when it might feel a struggle to keep going because tackling weight is not easy, then adopting a more compassionate approach and internalising that can help people feel more resilient.

 

Porter

So this is an area of expert interest for you.  Where would you say people like me conventionally get it wrong when we’re looking at people who come to us for help with their weight, what are the sort of fundamental mistakes that so many of us are making?

 

Bowen

Yeah, well if I base it purely on the feedback that patients give us, it wouldn’t be for me to sit in judgement of my colleagues, the feedback we get most consistently is messages about managing weight are given in a very simplistic way, so it is well you just need to eat less, you just need to exercise.  And those messages being very difficult to hear if your relationship with food has become quite complicated, quite emotionally driven, if perhaps you have a range of difficult health conditions that make exercise quite difficult.

 

Julie

People think eat less, exercise more and that is true, you will lose weight if you do that, we know that’s a fact but for some of us – my BMI was over 60 and I was very fortunate I was part of a group that they do here of people who all have a BMI of over 60 and every one of us could have told you by heart the calories in anything you wanted to name, we could have named any programme you wanted – we’d done them all, Slim Fast, Cambridge Diet – and we were all still sitting here with a BMI of over 60 and there was a good reason.  We all had the same anxieties – will the chair fit me when I go out, I can’t go out because people will look at me, I can’t walk down the street because people will abuse me.  Things like that and we all had the same problems – couldn’t sleep most of us, because of course you can’t when you’re that sort of size, you sleep for three hours and you wake up.  And the course showed us self-compassion, sort of giving yourself a break.  So instead of going I’m on a diet, and I’m losing weight and it feels – it feels so good, you know you’re really, really happy and then there’s a setback and then that trigger goes off and it’s like you’re really rubbish, this is what happened before, it’s going to happen again and it does.

 

Porter

It’s a self-fulfilling prophesy.

 

Julie

Yeah exactly yeah.  And you get in that spiral and you can’t stop it.

 

Bowen

One of the advantages of being sat within, for myself, a health psychology service is there are a lot of really useful models we can draw on that help people understand normal part of changing your behaviour is falling off the waggon, all going absolutely pear shaped and if we build that knowledge in from the outset and help people understand that’s normal and it’s completely fine to bring that to the clinical room and say it’s been terrible this week, we can talk about it in a way that’s much kinder, must less critical and patients are able to increase their resilience that we’re going to expect this, we’re going to build it in from the outset and then we can keep going and perhaps we can look at damage limitation.  So people may still turn to food but perhaps in less volume.

 

Porter

So using the waggon analogy if we may.  Your aim is so that they don’t fall off the waggon quite so frequently and when they do they can get back on it quickly.

 

Bowen

Yeah but not to expect not to.   A big thing we have in this service is raising awareness so that I can spot the trigger signs, I can kind of catch it happening and it’s not a stone that’s gone on, maybe it’s just a kilo or two.

 

Porter

I think one of the things that I feel from my side of the consultation desk, if you like, is there isn’t a lot that I can do, it seems very difficult for us as healthcare professionals to intervene.  When we think in a medical model we tend to think of pills and potions and quick fixes and diet but the evidence suggests that none of these things work very well.

 

Bowen

And the evidence for obesity across the board suggests that – I mean our weight loss outcomes sound very modest to somebody who it doesn’t have expertise in weight they might think 30-40% of people getting a good outcome, the majority of people are not doing so well, and that is the case in obesity.

 

Porter

I’m intrigued to the roll of health here as a motivator.  I mean conventional medical teaching has it that if the doctor tells you that you’ve got to lose weight because it’s bad for your heart, it’s bad for your diabetes or whatever that that’s a very powerful motivator.  In your experience is that the case?

 

Bowen

It can be the case for some patients, for other patients having what seemed quite threatening messages – and if you don’t do this you will become diabetic so you need to take action now – particularly for people who might be quite emotionally vulnerable, quite high levels of depression where your resources are depleted and you’re already struggling to change your behaviour, that’s a negative message that will just grind you down more and make it less likely that you’re going to be able to engage in any meaningful attempt to manage your weight.

 

Passey

The traditional medical model of health is I’m the healthcare professional, I’m the expert, you’re the patient, you do what I say.  And certainly when I qualified as a dietician nearly 30 years ago I was trained to tell people what to do – politely but to tell them what to do.  And it patently doesn’t work. 

 

Porter

What proportion of patients coming to your programme would go on to have something like surgery – another intervention?

 

Passey

At the moment 10% are referred on to surgery.  An awful lot more come into the service thinking they need surgery because they’re not aware of any other option other than dieting and they’ve perhaps been dieting for 10, 20, 30 years and actually are heavier now than when they started and they see that as the only option.  It hasn’t worked and they think the surgery’s the only thing for them.  So I think we offer a different approach and we don’t give advice, we don’t judge them, we just work with them as an individual.  And a lot of them decide they don’t want surgery.

 

Porter

Because a lot of these people have successfully lost weight before but the weight’s come bouncing back on again, so how long have you been following people for?

 

Passey

We’ve actually been open since October 2011, so that’s one thing that we would like to monitor longer term and hopefully we’ll be able to do that.  But I need to perhaps stress that we’re also interested in not just weight loss but other measures.  So, for example, we find statistically significant improvements in quality of life, health, mood, self-efficacy, emotional eating, cognitive restraint, perceived control over weight and perceived confidence in maintaining their weight.

 

Porter

So to put it simply they’re – these people are lighter and they’re in a better place, they feel better about themselves?

 

Passey

Yes they do.  I think with a year’s worth of treatment we’re not going to solve their weight problem but if we can give them the toolkit and the confidence to keep things going then they will have longer term success than they’ve ever had with dieting.

 

Julie

At my worst I was having panic attacks and just anxious about absolutely everything and it’s the strategies that you are given.  Instead of me thinking oh in a year’s time I’ll be 10 stone lighter and life will be wonderful, I don’t think that now, I think actually it is today, you focus on the here and now and enjoying – I like enjoying talking to you – enjoying being here.  The meditation I struggle with, I’m not very good at the meditation part of it but when I have done that I have felt better again.

 

Porter

How long have you been involved in the programme here?

 

Julie

Eighteen months.  During that time I’ve lost 55 kilos.

 

Porter

That’s an incredible result.

 

Julie

Yes and I mean from my point of view it isn’t so much the weight loss it’s the fact that it’s stayed off and I feel that I can do this.

 

Porter

A slimmer and happier Julie. There are similar initiatives in other parts of the country but only a handful, so this type of support is not yet widely available on the NHS.  But there is more information on the service at Gloucester on our website.

 

Now a timely question from one of our listeners about recent advances in the treatment of hepatitis C. Timely because while treatments have been around for many years the advent of a new generation of drugs - direct acting anti-virals - means the outlook for people with hepatitis C has never been brighter.

 

At least 200,000 people in the UK are thought to have been infected with the virus, as many as half of whom are carrying the blood borne infection unwittingly. One in five of those infected will clear the virus naturally but the rest will go on to develop a slow burning infection that can lead to scarring and cirrhosis, liver failure and even cancer some 20-30 years later. And it is at this group that the new anti-virals will be targeted. So what difference will they make?

 

Geoffrey Dusheiko is Emeritus Professor of Medicine at University College London.

 

Dusheiko

There’s been a revolution of treatments.  So the first treatments that were applied some years ago was interferon, then ribavirin was added to interferon, that seemed to reduce relapse rates.  But we were stuck with interferon and ribavirin and pegylated interferon, which is a long acting interferon for probably 15 years.

 

Porter

Were they working well?

 

Dusheiko

They worked well.  Many hundreds of thousands of people have been treated with interferon and ribavirin and perhaps overall about 50% of them were cured of the hepatitis C.  It did depend upon gena type and the stage of disease.  They did not work well in patients with cirrhosis, the response rates were lower.  And unfortunately interferon and ribavirin frequently need to be given for up to a year and numerous side effects.  So in that sense they were not the final answer for hepatitis C.  And more recently we’ve discovered that some individuals have inherited innate immune response genes which precluded a response to interferon.  And in that group interferon worked abysmally.  We’ve moved beyond that into a watershed moment in the epidemic because we’ve been able to make the transition from interferon therapies to interferon free therapies which are much more effective, have much fewer side effects, can be given for a shorter period of time.  We’ve been through a first wave, we are now examining and licensing second wave treatments and third wave treatments are in the offing.  But these are remarkable because in some sub-groups virtually a 100% of individuals can be cured with very short courses, free of major side effects, and even patients with cirrhosis, who responded less well to interferon, are now responsive.

 

Porter

And that’s important with hepatitis C because a lot of these patients, by the very nature of the condition, are presenting very late.  I mean ideally we’d like to be using this drug early on would we not?

 

Dusheiko

That’s the critical question.

 

Porter

Can you give me some idea of what the sort of cost they would be to a unit that was prescribing them?

 

Dusheiko

They’re high cost drugs, the costs vary from £20,000 to some of the second wave drugs that are still used with interferon, to as much as £40,000 for a 12 week course and double that amount for a 24 week course.  As a society we have to decide at what point in time we can take drugs to individuals who have minimal fibrosis but are responsible for transmission of the disease.  And that’s an important point because the reservoir of infection, the transmission networks is occurring in those individuals who are still utilising drugs, for argument’s sake, those individuals are not at risk of immediate death from liver disease but they are responsible for the new cases of chronic hepatitis C and at some point in time we have to actually treat both those with end stage liver disease as well as treat those who’ve not got liver disease but are responsible for transmission to really defeat this epidemic.

 

Porter

I mean this is the first time I’ve heard my colleagues, who work in your field, talking about – you know they’re confident that they can cure this disease.

 

Dusheiko

No question.  The results that we’re seeing in the clinic closely mirror those that we saw in clinical trials.  There are some groups that are slightly more difficult to cure at the present time but for the other sub-types of hepatitis C the anticipation is that we will cure 95-100% of individuals.

 

Porter

And do we know that they are cured, I mean how long have been following these people up?  I suppose the worry is that the virus is still lurking there somewhere.

 

Dusheiko

I think you raise a very important point.  For patients with cirrhosis I would be very confident that the disease is arrested.  The big question is will we eliminate the risk of primary liver cancer which is a dreaded outcome of hepatitis C – probably not but most of us think that we will greatly reduce the risk of liver cancer but we’ll still need to keep patients with cirrhosis who were cured under surveillance.

 

Porter

So this treatment, we think, is effectively removing the virus altogether but of course the virus has been there a long time, it’s done a lot of damage and that we can’t reverse using these sorts of treatments.

 

Dusheiko

Yes your point is correct.  That does the point at what point in time we treat patients before it’s too late.

 

Porter

Professor Geoffrey Dusheiko.  And there are some useful links on the new drugs, as well as advice on who should be screened for hepatitis C on the Inside Health page of the Radio 4 website.

 

Just time to tell you about next week when I will be talking to a world expert on smart drugs taken by a growing number of students to improve their exam performance. And driving under the influence – what effect will new drug/driving legislation have on the hundreds of thousands of people who depend on strong painkillers to see them through the day? Join me next week to find out.

 

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