Claude Cloquin was a bear of a man, big red beard, huge appetites, loved food, and women, and whiskey. French, of course, but he belonged in Alaska.
It was a little surprising to meet him in Dhaka, where we fiddled with cholera for a year, neither of us making much headway. He originally went to Bangla Desh to vaccinate for smallpox. He’d done his best work in Somalia, a “ring vaccinator.” They’d isolate a case, treat it, and vaccinate everybody in a 2 km radius. Earlier, he’d carried the live attenuated virus into the heart of the Congo, just when and where SIV made the jump to HIV. Some people blamed that on Claude’s group, with their Green Monkey kiney cell cultures the live vaccine required. What else did the monkeys have, that was injected as well? These unintended consequences were plausible, but it was just an urban legend, they finally said.
I met him in 1982. He’d come to vaccinate the villages near Barisal, a pretty good sized town near the mouth of the Ganges, after Rahima Banu got the disease in 1975. She lived, they encircled it, and that was that. Only humans get smallpox, and after that, they didn’t. Where else was a smallpox man to go?…Next! Cholera. He stayed.
In the 50s and 60s, about 2 million people died of smallpox every year. Then…pfffft! It was over.
In 1975, two-year-old Rahima Banu contracted last known case of naturally-occurring variola major Smallpox.
That was about as cool as medical cowboys could get. I wanted to be on that team.
Cholera was tougher, no good vaccine then or now. Grants were tightening during Reagan’s time, as taxes dropped along with NIH funding. It seemed like a good time to go make money instead.
Came home, wound up in Birmingham, treating hepatitis, various kinds- usually alcohol, or hepatitis B or autoimmune hepatitis, or hepatitis A if you ate the wrong raw oysters.
And an odd one, Non A, non B hepatitis, whatever the hell that was.
It turned out the NANB patients didn’t get very sick, rarely got jaundiced, usually didn’t know they had the disease until late in the game. It was transmitted by shared needles for the most part. Many of the '60s and '70s kids had some wild hair, so sharing wasn’t rare. Those same kids were generous with their blood donations. So if I had a GI bleeder, there was a 7% chance I’d give him NANB hepatitis with each blood transfusion. That changed after Houghton’s group isolated the virus in 1987, renamed it Hepatitis C. Blood transfusion hasn’t transmitted hepatitis C since 1992.
Antiviral treatments arrived in the late 90s, lousy, for the most part, with cure rates in the 30-40% range, many toxicities, dose limiting side effects. It was something, but not much.
Unless they drank a great deal, cirrhosis wouldn’t develop for 30 years- the disease just smolders. Not treating them wasn’t the worst option. I’d give them a run of the miserable injections and pills. If they failed, tell them to come back when new treatments became available.
Now they are, and here they come.
I saw 5 in a row today, all with relatively quiet hepatitis C, all apparently eligible for the astonishingly expensive 3 month treatment. One pill per day, no real side effects, about $100,000. Apparently cures 100%, or nearly.
The drug companies’ usurious rates caught the medical insurers’ actuaries with their pants down, so they stall and postpone, and refuse treatment for the not sick yet patients (the ones I most want to treat- easy, long term survivors), trying to run out the clock on the patent, get the patients to die of something else, or wait until they get cirrhotic to treat them. That last bit is like cleaning up the luncheonette after a bomb went off.
It’s a budget buster, sure enough. But by and by one of Dennis’ cousins will bring a class action case, then it’ll get easier.
I think I am seeing the end of an epidemic- one that only breached our consciousness around the time I got into practice. I’m pretty sure I’ll treat the last of them before I retire.
A couple of my partners don’t like to treat hepatitis C…some blame can be ascribed to the patients, I guess. But the Irish believe in recklessness to the depths of our souls. They could be my cousins, who’s to judge?
Besides, to cure a disease is no small thing.
Not as cool as Claude…but not bad.