When Dr. Douglas Dieterich was completing his residency in internal medicine at Bellevue, in 1981, something happened that would portend the future of his own career: One of his co-workers, a nurse on his floor, died of complications of hepatitis after she accidentally stuck herself with a contaminated needle. For Dieterich, the death was a tragedy, but an anomalous one. He had no idea then that within a decade, hepatitis C would become a personal crusade, one that would place him at odds with many of his colleagues.
When Dieterich started his practice, hepatitis C was still an unidentified "street disease" largely confined to heroin addicts who shared intravenous needles. But in the early eighties, Dieterich, who treated a large number of aids patients, began to see hepatitis C -- one of the more virulent opportunistic diseases that targeted immune-compromised people -- crop up more frequently. Eventually, Dieterich says, more of his HIV-positive patients were dying from hepatitis-related liver disease than were dying of aids.
Even then, almost all of Dieterich's hepatitis C patients were intravenous drug users, many of them from racial and sexual minorities. By 1989, however, his caseload began to include a significant number of upper-middle-class professionals, many of whom insisted they had no obvious risk factors for the disease. "I was suddenly seeing a lot of little old ladies who had undergone transfusions, people who had done drugs just once or twice decades ago and had no idea they were infected. Now, after years of slowly, often silently, progressive disease, their livers were failing."
Even more disturbing, he says, he began to see a small but growing number of men and women who almost certainly contracted the disease sexually, since they had no other risk factors. "That's when I decided to pull the alarm."
A mild-mannered 48-year-old family man who commutes to his East 37th Street office from Long Island, Dieterich is an unlikely medical rabble-rouser; the walls of his office are lined with impressive Establishment credentials: chief of gastroenterology/hepatology at Cabrini, chairman of the HIV Independent Physicians Association, chief of the New York chapter of the scientific-advisory committee of the American Liver Foundation.
But Dieterich says he became increasingly angered at his colleagues' lackluster response to the rising incidence of hepatitis C cases, and especially by their failure to endorse more-widespread testing for the virus. "It's apparent to me that we have the makings of a crisis here that is in some ways like the aids crisis in its early days," he says. "The fact is, the magnitude of this disease is a lot larger than the medical Establishment is letting on."
Not surprisingly, the early medical and media response to HIV -- or the lack of it -- haunts the current debate over hepatitis C. Like aids in the eighties, "hepatitis C is . . . almost a stealth disease for many medical practitioners," reported the British medical journal The Lancet in a recent issue. "Tracking the incidence of HCV is nearly impossible. . . . Symptoms are lacking or nonspecific in at least 80 percent of newly infected patients, chronic liver disease develops insidiously and takes decades to present." In the U.S., the conservative estimates are that there are now 4 million people infected with the virus. "Two percent of the adult population here is infected," says Dieterich. "Worldwide, the numbers infected are probably more than four times that of HIV."