Biotech Values

[DewDiligence]

HBV market: This is a follow-up
to the recent NYT story on the
high prevalence of disease among
east Asian immigrants in NYC,
which suggests that the magnitude
of chronic HBV in the U.S. (and
Western Europe) may be under-
estimated to a significant degree.

http://www.nytimes.com/2006/05/13/nyregion/13epidemic.html

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A Queens Doctor Finds Fighting Hepatitis B Is a Frustrating Task

May 13, 2006
By COREY KILGANNON

Dr. Sing Chan, a hepatologist in Flushing, Queens, has been getting more and more invitations for lunch lately from pharmaceutical representatives seeking to interest him in new drugs developed to treat the hepatitis B virus.

As the number of new cases reaches a staggeringly high rate among recent Chinese immigrants in New York City, drug companies are descending upon doctors and pharmacists; marketers of fancy herbal remedies are pushing their products on Chinese radio; and the many shops along Flushing's Main Street that sell traditional Chinese herbs are stocking products with natural ingredients that claim to purify the liver.

A study released this week reported that east Asian immigrants in New York City run a far greater risk than other Americans for the hepatitis B virus. The study, led by researchers at the New York University School of Medicine, was certainly not news to Dr. Chan, whose client list has come to be dominated by Chinese immigrants living around Main Street in whom the virus has been detected.

The virus, which can lead to diseases like liver cancer and cirrhosis, has plagued Asian immigrants for decades, and the number of patients who test positive for it keeps rising in areas like Flushing.

"The numbers are going up all the time," Dr. Chan said. "Doctors are just not doing enough to test patients for hepatitis B. Infected patients tell me, 'I've had plenty of blood tests but they never checked for hepatitis B.' "

Because hepatitis B is endemic in many Asian countries, where it is transmitted largely from mother to child, growth in the number of Asian immigrants in New York and across the country has made the disease a broad, expensive health problem. In the 2000 census, there were 800,000 Asians in the city, with roughly half from China.

Hepatitis B, like hepatitis C, is generally contracted through the blood, and is not transmitted through casual contact with infected people. Hepatitis A, which is caused by a different virus, can be transmitted through food, but hepatitis B cannot, with very rare exceptions.

"They spent one day teaching us about this in medical school," Dr. Chan said. But now doctors and authorities can not ignore the scores of patients flocking to the modest medical clinics and offices tucked away in commercial suites just off Main Street, above noodle shops, bubble tea lounges and karaoke bars.

Dr. Chan and his colleagues in Flushing are frustrated. They are scrambling to introduce a reluctant population of recent Chinese immigrants to medical advances in treatment of the virus, including early detection and medication that can suppress it.

"New patients say they are shocked when they find out they have the virus," he said. "Then they admit that many of their friends and relatives have it. You get a lot of old people who come and know they have it, but they say, 'My doctor always said nothing can be done for it.' "

That is no longer so. Over the past decade, an array of new drugs has become available to treat chronic infection and suppress the virus so that it causes little or no harm. Usually, they must be taken for a lifetime.

"When I tell young Chinese people they have to take a lifetime worth of drugs for a virus that is currently giving them no symptoms, they don't understand that," he said. "Then they refuse and they remain carriers and can pass the virus on."

For many Chinese immigrants, he said, hepatitis B has long carried a stigma. Many people were told it is incurable and not to speak about it for fear one would be vilified as a carrier.

"A lot of people don't want to come forward because they are undocumented and can't get health insurance," said Ming-der Chang, vice president of Asian initiatives for the American Cancer Society, which reports high incidence of liver cancer among Asian immigrants in New York City. "They don't want to be seen as carriers of the virus."

A 45-year-old man who emigrated from China 10 years ago said he avoided being tested for the virus because he lacked money and health insurance. Getting a hepatitis B diagnosis would mean a stigma that would affect his ability to rent a room, get work and make friends, he said.

"I was worried I would be discriminated against," said the man, who was granted anonymity because of his illegal status and his reluctance to reveal to his friends that he has hepatitis B. "People still think the virus can be spread by food and contact. Many poor immigrants come and live close together in small rooms and don't want to live close to someone who has it."

In January 2005, the man developed liver cancer, caused by untreated hepatitis B, doctors told him. A yearlong regimen of chemotherapy has shrunk his tumors to the point where his doctors are optimistic about his survival, he said.

Dr. King-Chen Hon, a gastroenterologist with an office on Main Street, said that a steady stream of new patients now come in complaining of the virus. By then, they are yellow from jaundice or have liver problems, including cirrhosis or cancer. But many come in with no clue that they are infected and no real symptoms. Then they test positive.

Dr. Pat Basu, a hepatologist in Forest Hills, Queens, said there is a high incidence of hepatitis B among the Bukharan immigrants who live near his office. There is also a high rate among the South Asian populations of Indians, Pakistanis and Bengalis in Elmhurst and Bukharans in Forest Hills, doctors there say.

But it is among Chinese immigrants that the numbers are highest. The study found that 15 percent of east Asians in New York — as many as 100,000 people — are chronic hepatitis carriers, an infection rate 35 times the rate found in the general population.

Some people with hepatitis B cannot afford Western medicine or had no success with it, and turn to traditional Chinese herbal medicine, seeking to restore their health among the pungent aromas of the stores that sell lotus seeds, ginseng root, ginkgo, shark cartilage and fish oil.

Sam Zhang, 33, walked into one such store on Main Street and browsed among the glass jars of dried fish, seahorses and hundreds of varieties of tea. He bought $200 worth of herbal liver purifier for his mother, Li, 53, who has hepatitis B. He bought a month's supply of an herbal remedy to purify the liver, for $200.

"Our doctor said not to try any traditional Chinese medicine because it's not approved by the F.D.A.," said Mr. Zhang, who emigrated from Fujian Province in 1990 and owns a restaurant in Flushing. "But nothing else worked, so we'll give it a try."
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