One of the fun but challenging things in medicine is engaging in a discussion on a given topic.
Recently, the CMAJ published a new guideline for the management of Hepatitis C from the Canadian Association for the Study of the Liver, stated as:
"Hepatitis C is
a disease that is underdiagnosed and undertreated in Canada. The guideline includes the recommendation to screen all people born between 1945 and 1975 for Hepatitis C."
This article in CMAJ (available in our Quick Links section) goes on to state that "
birth cohort screening would benefit population health outcomes. The birth cohort of 1945–1975 has the highest prevalence of chronic HCV infection, yet it is estimated that up to 70% of this group have not been tested for HCV.”
In 2017, the Canadian Task Force on Preventive Health Care in 2017 released their recommendations (view the document in our Quick Links section):
“This recommendation applies to asymptomatic adults who are not at elevated risk for hepatitis C. We recommend against screening for HCV in adults who are not at elevated risk.”
And then third parties weigh in. Joel Lexchin, a well known Evidence-Based Medicine advocate, points out two concerns with the CMAJ publication:
"The first is when committee members have a financial conflict of interest (FCOI) with companies producing products recommended in the guidelines. The second occurs when guidelines rely on poor quality evidence.
First, all eight authors of the CMAJ article, including the chair, declared FCOI with companies that produced the drugs recommended in the guideline. Second, the committee did not include an expert on evidence evaluation or someone representing the public or patients.
To guard against the corruption of guidelines, safeguards have been put in place. The U.S. Institute of Medicine (IOM), now the National Academy of Medicine, has
recommendations about the membership on guideline committees
. According to them, the chair and the majority of members should be free of FCOI and the committee should include an expert in the evaluation of evidence and a patient or public representative."
So there you have it so far. Do we initiate a mass screening of the Baby Boomer cohort? The Quality Team at the Hamilton FHT would be happy to bundle a strategy to search, contact, test and followup these patients, but is it time to do this now?
We would be interested in your thoughts.