The Revolutionary Changes in Hepatitis C Treatment
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March 2019; 61:2 IN THIS ISSUE: Pages 57–100 When vitamin supplements lead to harm: Biotin and its impact on laboratory testing Access to safe drinking water in First Nations communities and beyond Concussions and return-to-work considerations The revolutionary changes in hepatitis C treatment www.bcmj.org March 2019 Volume 61 • Number 2 contents Pages 57–100 61 Editorials A laughing matter, David R. Richardson, MD (61) Lessons, priorities, mindfulness, challenges, and epiphanies, David B. Chapman, MB (62) 63 President’s Comment Let’s be real, we need more failure Eric Cadesky, MD 65 News What Doctors of BC does for me, Jessie Wang (65) ON THE COVER Changes to GPSC fees (65) Some pregnant women don’t believe cannabis is harmful to their fetus (88) The hepatitis C treatment revolution Preventing overdose deaths among people recently released from a The development of direct-acting correctional facility (88) antiviral agents has reduced A model of global health engagement, Arun K. Garg, MD, Reza disease burden, expanded Alaghehbandan, MD, Suman Kollipara, MD (89) treatment options for patients with different hepatitis C UBC research examines living well while dying (90) genotypes or other pre-existing comorbidities, and significantly improved cure rates, which now exceed 95% with newer antiviral Clinical Articles agents. Eliminating hepatitis C infections in British Columbia is 66 now a realistic goal. When vitamin supplementation leads to harm: The growing popularity of biotin The BCMJ is published by and its impact on laboratory testing Doctors of BC. The journal John Fan, Morris Pudek, PhD, Andre Mattman, MD, Marshall Dahl, MD, Sophia provides peer-reviewed clinical Wong, MD and review articles written primarily by BC physicians, for BC physicians, along with 72 debate on medicine and medical The revolutionary changes in hepatitis C politics in editorials, letters, and treatment: A concise review essays; BC medical news; career Monica Dahiya, BSc, Trana Hussaini, PharmD, Eric M. Yoshida, MD and CME listings; physician profiles; and regular columns. Print: The BCMJ is distributed monthly, other than in January and August. 78 BC Centre for Disease Control Web: Each issue is available at Using population-level integrated health data to monitor and assess www.bcmj.org. patients’ progression across care and treatment continuums Subscribe to print: Email Sophia R. Bartlett, PhD, Terri Buller-Taylor, PhD, Mel Krajden, MD, Naveed Z. [email protected]. Janjua, MBBS Single issue: $8.00 Canada per year: $60.00 Foreign (surface mail): $75.00 79 Special Feature Subscribe to notifications: To receive the table of contents Access to safe drinking water in First Nations communities by email, visit www.bcmj.org and and beyond click on “Free e-subscription.” Helena Swinkels, MD, Sylvia Struck, PhD, Linda Pillsworth, Btech Prospective authors: Consult the “Guidelines for Authors” at www.bcmj.org for submission requirements. 58 BC MEDICAL JOURNAL VOL. 61 NO. 2, MARCH 2019 bcmj.org BC MEDICAL JOURNAL VOL. 61 NO. 2, MARCH 2019 bcmj.org 59 contents BC Medical Journal Vancouver, Canada 604 638-2815 81 General Practice Services Committee [email protected] Physician networks: Improving practice coverage, patient care, and www.bcmj.org physician support Afsaneh Moradi Editor 83 David R. Richardson, MD Obituaries Editorial Board Dr Peter Doris, John O’Brien-Bell, MB (83) Jeevyn Chahal, MD Dr Ralph William Spitzer, Arun K. Garg, MD (83) David B. Chapman, MBChB Elizabeth J. Watt, MD (84) Brian Day, MB Dr W. Donald Watt, David Esler, MD Amanda Ribeiro, MD Yvonne Sin, MD 85 Council on Health Promotion Cynthia Verchere, MD Can frailty be prevented? Or is it the inevitable decline in function that Managing editor Jay Draper accompanies aging? Steven Larigakis, MD Associate editor Joanne Jablkowski Senior editorial and 86 Special Feature production coordinator Kashmira Suraliwalla Ready or not for the CCFP exam Copy editor Paul Dhillon, MBBChBAO, Simon Moore, MD Barbara Tomlin Proofreader Ruth Wilson 92 WorkSafeBC Web and social media Concussions and return-to-work considerations coordinator David J. Rhine, MD Amy Haagsma Design and production Laura Redmond 93 CME Calendar Scout Creative Cover concept & art direction Jerry Wong 95 Classifieds Peaceful Warrior Arts Printing Mitchell Press 98 Back Page Advertising Proust Questionnaire: Dr Judith Hall Kashmira Suraliwalla 604 638-2815 [email protected] 99 Club MD ISSN: 0007-0556 Established 1959 Postage paid at Vancouver, BC. Advertisements and enclosures carry no endorsement of Doctors of BC or BCMJ. Canadian Publications Mail, Product Sales Agreement #40841036. © British Columbia Medical Journal, 2019. All rights reserved. No part of this journal may be reproduced, stored in a retrieval Return undeliverable copies to BC Medical Journal, system, or transmitted in any form or by any other means—electronic, mechanical, photocopying, recording, or otherwise—without 115–1665 West Broadway, Vancouver, BC V6J 5A4; prior permission in writing from the British Columbia Medical Journal. To seek permission to use BCMJ material in any form for tel: 604 638-2815; email: [email protected]. any purpose, send an email to [email protected] or call 604 638-2815. Statements and opinions expressed in the BCMJ reflect the opinions of the authors and not necessarily those of Doctors of BC or the institutions they may be associated with. Doctors of BC does not assume responsibility or liability for damages arising from errors or omissions, or from the use of information or advice contained in the BCMJ. The BCMJ reserves the right to refuse advertising. 60 BC MEDICAL JOURNAL VOL. 61 NO. 2, MARCH 2019 bcmj.org editorials A laughing matter “ o you have time to come in he used to be, and I am very thankful make fun of him when he no longer and say ‘hi’ to your sister?” that his underlying personality hasn’t made any sense. D “I have a sister? Why changed. He remains happy, pleas- Now, don’t get me wrong, this didn’t anyone ever tell me?” ant, appreciative, and easygoing. So disease is terrible and causes much This is a conservation I recently far he hasn’t demonstrated any sig- sadness. I am losing my father, my had with my father. He was referring nificant irritability or agitation and is mother has lost her partner, and my to my mother, but his addled brain blissfully unconcerned about his de- children have lost their grandfather. often mixes things up. You see, my clining mental functions. When I remember the man he was, father has Alzheimer disease. Over If you asked friends and family I suffer a little despair as to all that the last few years he has gradually to describe my father in one word, is missing. However, the humorous deteriorated to the point where his I’m pretty sure it would be jokester. things he does make the progression cognitive issues are now obvious to My father would never turn down of his dementia more tolerable, and I everyone. However, I suspect this an opportunity to goof around, make know he would encourage everyone dementing process has been going someone laugh, or dress up in some to laugh along if he could. So, if I gig- on for much longer than we know. funny—often inappropriate—cos- gle a little, I feel less guilty because My father is outgoing and constantly tume. This is the man most likely to I remind myself that making people joking, so he can make it seem like be found at the office in a gorilla suit, laugh has been his lifelong mission. he knows someone without ever ac- not necessarily on Halloween. I dis- Recently friends took him to vis- tually having to identify them. He tinctly remember him coming to my it my mother in hospital, which is a still talks to everyone, and he’ll tell parent-teacher interviews and draw- 30-minute drive from his house. Lat- me that he used to play golf with ing funny faces on the chalkboard. In er, I asked him how he got there, and complete strangers he meets at the old party photos he is often dressed after thinking for a while he stated, “I store. These confabulations fit seam- up as a woman holding a liquor bottle, think I walked.” lessly into the day-to-day situations but that’s another story. My parents’ After a chuckle, I thought to my- he is confronted with. (As an aside, house was often adorned with singing self that living with his dementia re- I suspect that he has been making Christmas trees, fish, dogs, etc. If my ally is a journey, and as we walk up his golf scores for years.) I’m not father knew he was going to get de- together I will do my best to support sure he is even aware of who I am at mentia, he would have probably made him with grace, love, and laughter. times. I still get glimpses of the man jokes about it and encouraged me to —DRR Men’s Sexual Health Program for your Patients with Erectile Dysfunction Shockwave Therapy - low intensity acoustic sound wave technology Platelet Rich Plasma Therapy (PRP Shot) Sex Therapy with a certified and experienced Sex Therapist No doctor referral is required. [email protected] 604-717-6200 www.pollockclinics.com BC MEDICAL JOURNAL VOL. 61 NO. 2, MARCH 2019 bcmj.org 61 editorials Lessons, priorities, mindfulness, challenges, and epiphanies e buried a colleague re- fully retired or had relinquished their at 2:15 a.m. from a different nurse re- cently. To be more precise, hospital privileges years ago. None of garding the same patient. I asked the W we said farewell to a now- them ever expressed regret over their nurse, in my most polite voice, why deceased colleague.