Sometimes what is not said is more eloquent than what is. The implicit often has a more powerful effect on the imagination than the explicit; as Emily Dickinson put it, “Success in Circuit lies.” A recent article in the New England Journal of Medicine about Hepatitis C was eloquent in its omissions.
Hepatitis C is a virus infection which for many years causes no symptoms but which often goes on to produce chronic liver disease, cirrhosis, and cancer. About 85 percent of people infected with the virus develop chronic liver disease.
The article in the NEJM is titled “Hepatitis C in the United States.” The authors provide an estimate of the number of people infected with the virus: between 3.2 and 3.5 million.
The infection can now be treated so as to prevent its long-term consequences. Unfortunately, the treatment is expensive: about $70,000 per head for a full course, according to the authors. If every person who tested positive for the virus were treated, the cost would therefore be between $224,000,000,000 and $245,000,000,000. That is some stimulus to the economy!
The cost of treatment might come down (or, of course, go up, as new and costlier treatments are discovered). Not everyone who is infected needs treatment. Perhaps a vaccine will be developed and the problem in effect will go away. For the moment, though, we must deal with the silent epidemic – as the assistant secretary for health, Howard Koh, called it – with the tools now available to us.