in Glens Falls, New York, who was associated with Scientology. Andrew and his wife, Esther, began taking Scientology courses, and Andrew asked to sign up for a Purification Rundown. The process, according to its designer, Scientology founder L. Ron Hubbard, would purge the body of toxins, including those from IV drug use and LSD. Andrew was refused the treatment because he had once received shock therapy, so he visited another alternative medical man, who prescribed a similar toxin-cleansing regimen. For a month or two Andrew ingested huge amounts of niacin (vitamin B3). “You start off on 50 or 100 milligrams of niacin, and by the time you’re finished you’re up to 5,000 milligrams a day—and that is not good for a compromised liver,” he said as he pushed down the plunger on a Bodum of tea. In fact, high doses of niacin have been linked to severe and even fatal liver injury.
About two years later Andrew returned to the practitioner, who tested his muscles. Andrew, reading upside down, saw “hep C?” on the doctor’s note sheet. He asked the doctor why he had written that.
“He said, ‘I’m wondering if you have hep C,’” Andrew recalled. “I said, ‘Well, I’ll go and get tested.’ So I did.”
In 1997 he learned he did have hepatitis C. Testing revealed 4 million bits of HCV in each milliliter of his blood. He visited more than one doctor who suggested treatment with interferon. “I never went back because I didn’t trust them,” Andrew said.
He said he knows a famous Spanish singer who tried to cure his hep C with interferon, and after five months the man’s marriage nearly broke up from the stress of treatment. Another friend told him, “Don’t you dare. My mother died from interferon.” On top of knowing about the horrible side effects of the drug, Andrew learned he was infected with hepatitis genotype 1a. Unlike some other types of hep C, which could be treated back then for twenty-four weeks, Andrew would have to do interferon for a year. “Instinctively, I didn’t want to go near it,” he said.
He carried on with alternative medicine. Sometimes he would go to four practitioners at a time. “I’ve been as obsessive about wellness as I was about unwellness,” he told me. He said alternative medicine helped him for at least eighteen years after he contracted hep, which he believed occurred in the 1980s.
Of many possible ways he may have acquired hep C, Andrew said, he suspects a tube he used to snort cocaine was the culprit. He said Tiffany’s jewelers used to sell cocaine straws for $175, which was a lot of money for most people in the eighties but not much for Andrew’s high-rolling friends. Andrew described the party toy as a shiny tube of silver, eight to ten inches long. Because it was so long, it often clogged up. He and his friends would scrape out the cocaine with paper clips. The straw could have had anybody’s blood on it, which may have given him hepatitis, Andrew said.
While blood could conceivably get on a razor or on a cocaine straw and transmit hepatitis C, transmission through medical tools is far more common. In fact, medical tools were the most common method of transmission until the mid-1990s. Historically, worldwide, most hepatitis C infections have been passed along by inadvertent medical exposure. Someone who has hep gets treated at an underequipped medical unit or mobile clinic; syringes, tubes, or vessels don’t get sterilized properly; and zing—that person’s hep C seeps into another person’s blood. It can be passed along through the same or other routes ad infinitum. . . or until everyone in the branching trail has been cured.
THE FIRST REPORTED incidence of the spread of hepatitis though contaminated medical tools occurred in 1883 in Bremen, Germany, at a shipbuilding company. A public health inspector discovered that hepatitis had been spread through cowpox inoculations that took place at the factory. Doctors collected and mixed the discharge from many patients who had cowpox, a mild disease, and the fluid was applied to scrapes on people’s skin to protect them against smallpox. About two hundred workers at the shipbuilding factory came down with hepatitis, out of thirteen hundred who had been inoculated.
During World War II, at least 26,771 soldiers who received a vaccine for yellow fever came down with hepatitis. It was hard to sterilize syringes, especially on the battlefield, where conditions were brutal and unpredictable. Close to 200,000 cases of hepatitis were reported among U.S. soldiers. Not long after the war—in 1950—transmission of the disease reached its peak.
The first disposable syringes, introduced in the 1950s, should have prevented most transmission of the disease in medical settings, but sloppy medical practices still occurred sporadically, especially in underdeveloped countries. In 2010 a study in Brazil of 256 blood donors showed a high probability that dental patients would acquire hepatitis C from improperly sterilized instruments. Aside from the home use of syringes among the patients, root canals and surgical removal of tartar were cited as the main methods of transmission.
From the 1950s to the 1980s, Egypt carried out a program to vaccinate people against schistosomiasis, also known as bilharzia and commonly called “snail fever.” The disease is spread by parasitic flatworms that live in freshwater snails that burrow into the skin of swimmers. The flatworms enter the person’s blood vessels and lay eggs that can attach to body tissues, usually in veins that drain the intestines or the urinary tract. About 240 million people worldwide suffer from snail fever. Each year more than 200,000 people die from the disease. Egypt’s vaccination campaign used contaminated needles and syringes, and hepatitis C spread throughout the populace. As a result, at least 10 percent of Egyptians aged fifteen to fifty-nine became infected with hepatitis C.3
Vietnam is also high on the World Health Organization’s hepatitis C crisis list because of faulty medical practices. Jenny Heathcote, winner of the 2015 University Health Network Global Impact Award for her work in hepatology, told medical students that in Vietnam “there are so many outbreaks, the health system doesn’t bother screening for the virus.”4
Western nations have spread the virus through contaminated medical equipment too. The Centers for Disease Control and Prevention in the United States reported that between 2008 and 2015, ninety-six patients were infected with hepatitis C at hemodialysis clinics in eighteen separate outbreaks. In Canada, Dr. Gary Garber, chief of infection prevention and control for Public Health Ontario, told me he had noticed a disturbing trend. In several colonoscopy clinics, patients had contracted hepatitis C. When a new case of hep C arises in someone who has no risk factors, the agency goes through the patient’s medical history. “An investigator probably said, ‘Oh isn’t that interesting? The person had a colonoscopy. Two patients before them had hepatitis C,’” Garber said to me on the phone.5
In a specific 2014 case, Waterloo Region Public Health investigated a case of hep C in a patient who had no risk factors other than a visit to a colonoscopy clinic the day before Christmas. The agency then found another patient with hep C who went through the same procedure on the same day at the same clinic. The investigation turned up another three infected patients who had visited the Tri-City Colonoscopy Clinic on Christmas Eve. The genetic makeup of the virus in all five cases was too similar to be a coincidence. Eight other patients treated that day were virus free. So were the clinic’s staff members. No specific means of transmission was found in the clinic. The health agency worked with the clinic to improve its techniques, and the clinic stayed open.6
This was a relatively small medical outbreak compared with one that happened in Nebraska. In 2000 and 2001, ninety-nine cancer patients at a chemotherapy clinic at the Fremont Area Medical Center came down with an odd strain of hepatitis C. The oncologist who had treated them blamed the outbreak on patients’ previous behaviors. But all of the patients tested with the same genotype, 3a, a rare genotype in the United States, suggesting a common means of transmission. Investigators discovered that a nurse in the clinic had reused bags of saline (apparently, to save money). Hep-tainted blood passed from patient to patient through the saline used to flush their chemotherapy ports. Dr. Tahir Javed, who ran the clinic, knew of the practices yet allowed them to go on. During the investigation, Javed fled to his native country, Pakistan, where he was subsequently appointed
