I am glad they’re screening for it. I was born to someone who had the virus, but didn’t know I had Hep C myself until I submitted myself to an exceptionally thorough STI testing panel. I say exceptional, because the standard ones I’d done throughout college and early adulthood do not happen to include that particular test. So I feel a bit lucky to have been able to get diagnosed and treated in my mid-20s, before the disease could do much damage.
Hep C screening at least once for adults >= 18 is recommended and considered standard of care in the United States. I checked my medical records and I have a negative Hep C result in an old checkup when I was younger, and another one from a new provider who insisted on a big panel of standard testing for new patients (despite me having no risk factors).
It’s unfortunate that your early providers dropped the ball. I wonder if they assumed you had already been tested for some reason?
Crazy how different healthcare is in different countries.
In the UK once you've had your childhood vaccinations it's entirely possible you'd simply never see a doctor again in your life until you're ready for your prostate exam in older life.
There are no regular checkups or preventative care on the NHS for mid life adults unless you're proactive
I presume you're not a woman, because there's cervical screening for women aged 25-64 every five years. Also depends on what you mean by "mid life", but there's breast screening offered to women aged 50-70 and bowel cancer screening offered to people from 50 to 74 every two years.
There are real trade-offs with screening, and screening too much has harms as well as too little, although I'm not qualified to make a judgement on where that line sits relative to where it is in the UK.
This is the real reason women live longer than men.
Doctors won't see me unless I'm dying, or at least tell them I am. And I am, if I understand things correctly, which I might not tbh, in a high risk group for prostate cancer, given that I was diagnosed with chronic prostatitis at 22. I've even asked for checkups but was denied. And where I live you can't really pay for health care (but you can pay to skip the line, which I guess is almost the same thing).
What country are you in? Not challenging, I'm gathering perspective.
I am in the US with health insurance through my employer and I get blood tests every 6-12 months to check for abnormalities as well as a standard interview for how I'm feeling and whatnot. Also have a few prescriptions that require 3-month checkins.
The Netherlands seems to be more or less similar, although I’ve had a mixed bag with medical knowledge an experience during emergency care: excellent to middling.
When I lived for a while in the UK, my GP strongly suggested close monitoring for a couple of things, and we saw improvements in some measures with lifestyle changes. Others were “we’ll keep an eye on it, if it gets bad, off you go for an inpatient visit to get you an extra 10 good years”.
Back in the Netherlands I have to get pushy and even a bit obnoxious at my GP before they even consider the concern, let alone schedule a blood test.
The HPV vaccination eliminates most forms of cervical cancer. Australia reports a 95% drop in cervical cancer in the cohorts that got mandatory widespread HPV vaccinations. I didn't look into how that changed pap smears.
From a US perspective, even this seems wild to me. I've always been told that at least an annual physical exam with bloodwork is highly recommended as the standard of care for adults of all ages.
Not everyone chooses to get them, of course. But ACA insurance plans here offer at least one annual physical exam free of charge (considered preventative care).
Cynically - this sounds like an opportunity to sell you more medical care.
The NHS isn't perfect, but one of the things it does well because of it's structure is minimise costs holistically. It's cheaper to treat conditions early, so usually implements appropriate screening to catch things. If they don't do regular checkups like this it's because they're of minimal value.
It's free if you don't bring up things that should technically have been a dedicated own appointment.
The idea behind physicals is they're considered preventative care... catching problems early, often before there's any overt symptoms. For example, checking your cholesterol and A1c levels before they progress to heart failure or diabetes.
Once you're showing symptoms, you've left the realm of preventative care and it's now diagnostic/treatment for a established issue.
(ACA only provides 100% free coverage for visits that are 100% within the "preventative care" box.)
Annual exams were included in the ACA but as I understand it there is no evidence to show that they improve health outcomes. I had one once in 15 years when it was incentivised by my employer (presumably trying to show that we were low risk to reduce the rates they paid?) but otherwise my doctor has never tried to book me for one.
I think I'd prefer the UK system where if you worry something is wrong you can see a doctor free of charge.
Anecdotally, I've found yearly physicals with full blood workup very helpful in heading off issues before they become much larger issues. For example, a random blood marker pointed at mold exposure. I thought that was strange, I didn't think we had any mold. Then I tore open one of my ceilings, there was a very slow leak in the bathroom above the top of that drywall was covered in mold. I replaced all of that drywall, and that blood marker shot down, and a few others improved drastically, and my energy levels improved. By going regularly, you get to see the trend lines on various things - those other markers had been going in a worrying direction over time.
I wonder how accurate that is. As in, these screenings are meant to detect early signs of issues like diabetes, liver problems, cholesterol, blood pressure, and so on. Is the case that many people are healthy and don't need it? That we haven't had a long enough sample time to know how screening in the 30s affects outcomes in the 60s?
Actually, I would've have assumed the other way - that the NHS was better than the US system. Which was why I was shocked when you said health checkups aren't allowed before age 40. :)
US healthcare plans offer an annual physical exam every year at all ages. Looking at the UK NHS website, it seems to be only offered there after age 40, and limited to once every 5 years? Am I reading that right?
> Actually, I would've have assumed the other way - that the NHS was better than the US system.
I thought it was relatively uncontroversial that the major problem with US healthcare is not quality but cost. And the UK NHS is widely regarded as one of the lower quality implementations of single payer in any modern social democracy [0].
That's not quite true - there's a 5 yearly Health Check which is offered to those over 40 with no other known health issues (in England, but Scotland/Wales/NI have similar schemes).
Local councils are responsible for arranging invitations for those not currently registered with GPs, so it ought to be more or less universal - though there are inevitably a few people who'll slip through the net.
It's pretty basic, but the evidence suggests it's been reasonably effective at dealing with the "he didn't see a doctor for 40 years and then just dropped dead from a heart attack" stereotype.
well what did you do during covid? Even if your school/employer didn't require vaccination during covid, most schools I attended at different phases of my life, well before covid, required some new vaccine or other. I think in the US it's pretty hard to get through school without visiting a doctor after childhood vaccines.
I get my vaccines at the pharmacy. At my current age its flu and COVID every year. TDAP every decade. I'll be adding more once I'm in my 50s, which is rapidly approaching.
That's interesting, I haven't ever been required to do that. I tend to have an annual checkup around my birthday, though it isn't really a physical exam anymore, more of a "hey lets do some blood tests and discuss if there's anything noteworthy we should talk about." They quit actually poking and prodding about the time I turned 45 or so. Doctor says the physical is mostly a waste of time.
I have never seen or heard of this requirement before. I don’t even see how it could be enforced. What would even be the point, the insurer (even if employer funded) is not allowed to deny or price coverage based on health risks of the insured.
Well that's interesting. Mine always say it is covered, I've never had an insurer (in the US) say its required. I could see it for certain types of life insurance, maybe?
> In the UK once you've had your childhood vaccinations it's entirely possible you'd simply never see a doctor again in your life until you're ready for your prostate exam in older life.
It's entirely possible to do this in the US, too, but it's not the default path. I know some people who think it's a point of pride to brag that they haven't been to a doctor in 20 years. I know other people who never miss their annual checkup and are frustrated that their doctors won't order every test they hear about from their podcasts. The US approach to healthcare is varied and confusing to outsiders, even if you remove all of the unreasonably complex insurance stuff from the equation.
> There are no regular checkups or preventative care on the NHS for mid life adults unless you're proactive
If you wanted to request an annual checkup, could you ask for one and get it without problem? Or would they require a specific reason to visit?
I'm not a big proponent of restricting speech but "Ask your doctor about..." advertising should be banned in the USA. If you don't have medical training you're in no position to decide what medical conditions you may have or what treatments might be appropriate. If you want to be a doctor, go to medical school.
The idea of advertising prescription drugs is absolutely bonkers in and of itself. If I recall correctly, the only reason they say "Ask your doctor about..." was a regulatory compromise that allowed such advertising. Telling the general public to simply "take Procrapin for their constipation" was deemed too extreme: The general public doesn't have the medical training to diagnose themselves or recommend treatment, but instead the manufacturer was allowed to urge the general public to nag their doctor about a medicine--that was seen as fine.
The last insurance carrier I had, through an ACA Marketplace plan, has an incentives program for members. If you go see the PCP for an annual checkup, you get about $50. If you "go paperless" 100%, you get another $50.
There are about four incentives altogether, and the money is loaded on a Prepaid Visa card that is branded by the insurance carrier. The funds are not restricted, and you can spend them on anything where Visa is accepted. The cards are sometimes cycled out and replaced, but I do not know if the funds had an expiration date. There were no fees to hold the funds, and no fees to spend them.
One of my employers had that incentive but only for one year. I assume they wanted to demonstrate that as a population we were low risk but after testing us once there was no reason to do so again.
> “There are no regular checkups or preventative care on the NHS for mid life adults unless you're proactive”
This isn’t quite true. There is a free “NHS Health check” for adults aged 40-72, which you’re supposed to do every 5 years and includes basic checks like blood pressure and cholesterol. I certainly get messages from my GP nagging me about it from time to time.
> In the UK once you've had your childhood vaccinations it's entirely possible you'd simply never see a doctor again in your life until you're ready for your prostate exam in older life.
It is not customary in the UK to see a doctor at regular intervals for checkups?
You can get sti tests and other tests as and when required or requested. I have had blood pressure checks, blood diagnostics etc offered regularly by my doctor. Usually they are just to rule things out but they definitely offered.
To be fair, almost nobody is going from childhood vaccinations > late-middle age without seeing a doctor. And when you do go with an ailment general blood tests seem pretty standard these days at GP's along with standard vitals checks. They also do preventive care where necessary. Every woman is invited for cervical screening once they turn 25 and then every few years until they're in their 60's. Regular mammograms are also a thing after a certain age/depending on risk factors. Bowel cancer screening too. STI testing is free and, depending on where you live, done by post. Also depending on your definition of 'childhood' there are a few vaccines given when you're a teenager (HPV for example). And if you ever travel you'll be visiting the doctor for vaccines then too.
I don't think I've been to a doctor in close to 40 years, except for treatment of a few acute injuries. I've had a few vaccine boosters, but I get those at a pharmacy.
And even in the US the Hep C screening recommendation is new. Before 2020 it was only recommended (and therefore covered by most US insurance carriers) for people who injected drugs, had received a blood transfusion or product before 1992, or born between 1945-1965.
You had me curious about what I was tested for, also in the northeastern USA in the 2010s. It looks like they included Hep C when my PCP ordered STD tests in 2015, along with most of the tests the other commenter mentioned. I'm glad they caught yours in time to treat it well!
In Europe I don't think it's commonly done. For example, the standard Dutch MSM STI test [1] covers HIV, Syphilis, Chlamydia, and Gonorrhoea only while Trichomoniasis, HPV 2 and Herpes are rather common. That being said, it's freely available at most hospitals.
Herpes screening is discouraged in the US unless symptoms are present as the widely available IgG tests have terrible specificity. While the false negative rate is practically 0, they have a false positive rate of around 20%. The only high-accuracy confirmatory test (at least in the US) is the Western Blot but there's only a handful of labs in the country that offer it.
The current tests would result in a substantial fraction of the population running around thinking they have a highly stigmatized STI that they in fact do not have with little to zero ways of getting a more accurate test.
Seems like both HSV-1 and HSV-2 seroprevalences are actually rather low in the Netherlands.
As for STI testing: Serological testing is pretty meaningless regarding infection risk and direct viral detection is only done on visible lesions for differential diagnostics AFAIK. You can shed the virus without lesions, HSV-1 can be contracted without direct mucosa contact, and while HSV-1 is associated with oral herpes and HSV-2 with genital herpes, both types can cause lesions anywhere on the body. Sure someone without positive antibody status very likely can't transmit it, but that's a very small minority of people of relevant age.
I believe talking to Americans about "herpes" can be misleading, as it's weirdly stigmatized over there and people seemingly conflate visible "cold sores", genital herpes and antibody status.
Incidentally, genital herpes and HSV-2 in general is more common in the US, which may be a direct outcome of this cultural dynamic. Due to lower incidences of early oral HSV-1 infections, compared to most western Europe, Americans are more likely to get infected with genital herpes of either type, but in particular HSV-2, too. Prior oral HSV-1 infections are somewhat protective.
Most of the stigmatization of HSV in the US is mostly the result of pharmaceutical companies trying to create a market for HSV antiviral drugs. In the 1980s they ran ads that equated HSV with leprosy. Since that was also the time of the AIDS scare the public was probably very susceptible. Even in my childhood I remember ads on TV for the antiviral drugs promising a way of "living a normal life" despite HSV infection.
That's crazy. Herpes can't be cured, so the implication of those ads can only be to "hide" the infection. Additionally, those antivirals aren't effective at preventing outbreaks unless you take them every day, which would be insane unless you are an unfortunate soul who is prone to constant outbreaks.
Hep C isn't commonly sexually transmitted so it's odd they would test for it. It's more of a concern in certain occupations, like healthcare, where you may come into contact with blood.
Note that doesn't include HSV (especially 2) which can be transmitted asymptomatically, and even with a condom. The medical establishment doesn't consider it a concern, but it's worth having both parties check.
The problem with screening for HSV is that the HSV IgG tests are pretty terrible (the blood antibody tests). They have a false positive rate around 20% and re-running the tests several times won't yield different results. This would result in more people thinking they have HSV but don't than people who actually have it.
A disease that can stay silent for years, but is also highly curable once detected, seems like exactly the thing you want to screen for more aggressively
Good for you! Could you share the name of that particular test here? I'm confident I'm clear but might want to include that test in case I need to in the future.
i think during that time / place it was risk based - if you didn't know your parent had it (or didn't tell your dr), and weren't an intravenous drug user, etc. its likely no one would have screened for it.
