Lovers and Livers by Jacalyn Duffin: a Look at The Dangers of The Hepatitis C Disease

Introduction

It has generally been accepted by the medical community as a fact that hepatitis C is a dangerous liver disease caused by the hepatitis C virus. That being said, it is worth considering the reasons for which this fact is accepted; is it perhaps due to some irrefutable visual proof or some universal symptomatic expression? In her book Lovers and Livers, Jacalyn Duffin explores this phenomenon as a function of historical preconceptions, how the law constructs disease and natural history (Duffin, 2005). From Duffin’s well-backed case study, it can be elucidated that this medical fact is not accepted solely because it captures a purely natural state of affairs but also because it is dependent on the complexity of human action.

Historical Preconceptions of Hepatitis

Hepatitis certainly poses no exception to the fact that disease constructs emerge from the murkiness of historical preconceptions; they are constantly revised to fit both intellectual and moral premises of the time. Before any category of hepatitis had been clarified, indeed before the cause was even guessed at, this Greek word was used to define diseases situated in the liver that caused chills, fever, pain, yellowed skin, and general malaise. Indeed, to the father of modern medicine, Hippocrates, and his many disciples, “hepatitis” meant any disease of the liver and was usually associated with jaundice (Duffin, 2005). As time went on, more and more specific classifications were elucidated. This example illustrates that the earliest preconception of the disease is dependent on human action; specifically, how we decided to classify the disease in the first place. The definition of any disease is at the mercy of the most recent scientific knowledge and techniques, and these change with every human action towards new discoveries. Who is to say that hepatitis C will not be further divided into categories? Furthermore, as scientific advancements continue, our understanding of hepatitis C may evolve, potentially leading to more nuanced definitions that better capture the disease's complexities. That being said, it is arguable that yes, though in the past, the medical facts of a disease were subject to change certainly in modern times, with all of our new technologies (such as the microscope) and knowledge, we have irrefutably defined hepatitis C as its own entity; thus, its definition is no longer dependent on human action. Compelling as that belief may be, the most recent history shows that, as ever, disease definitions are made off of historical preconceptions. AIDS, frightening due to its horrendous effects, had a profound effect on how hepatitis was defined (Duffin, 2005). AIDS has served as a model for hepatitis C (which was first defined by that name shortly after the initial AIDS outbreak in the '80s) as it was another disease spread by transfusion of blood and sex. Hepatitis C was another disease that could be used to blame patients for their afflictions; it was seen as punishment for ‘bad behaviors’ such as homosexuality, drug use, promiscuity, and homelessness (Duffin, 2005). With the appearance of AIDS, hepatitis C was no longer a natural state of affairs but an act of Providence from a higher power and a way of eliminating the unworthy and sinful; at the time, the actions of many defining the diseased were tailored to this belief.

The Influence of Law on Disease Definition

What's more, historical preconceptions can further manifest themselves into more permanent fixtures that take the form of the laws that govern society; once more, human action can impact how a medical fact is accepted. An inquiry on the Blood Systems in Canada by Horace Krever looked at the government compensations allotted to those patients who had been given hepatitis C from a government-approved blood transfusion. The distribution of these compensations presented a sizable problem. In general, those having been afflicted with AIDS were much more likely to get a sizeable compensation (Krever, 1997). The difficulty with a hepatitis C prognosis is that, while the disease can kill you and generate great misery, it doesn’t necessarily mean that it will or when; in fact, there could be no suffering in some people that harbor the virus. The big question is how we define hepatitis C patients. Are those who carry the virus but present as asymptomatic still considered to have the disease? Certain countries, like Italy, established that payment would only be given to those people who showed liver damage; this is how those afflicted by hepatitis C were established (Duffin, 2005). It is a fact that hepatitis C is a dangerous liver disease caused by the hepatitis C virus; however, it is not a definition independent of human action. After all, people with symptomless hepatitis C are not even seen as victims of disease in the eyes of the law (Duffin, 2005). However, who is to say that other ailments in a person’s life other than liver damage specifically are not caused by hepatitis C? The interplay between legal systems and medical understanding highlights the complexity of defining disease; laws can both reflect and shape societal perceptions of illness.

The Role of Blood Transfusions in Hepatitis C Transmission

From our history of blood transfusions, it is clear that the natural history of hepatitis C depends on both the route of infection and the presence of other diseases. Up to 80 percent of people exposed to hepatitis C through blood transfusion went on to develop chronic infection; 8,000 to 10,000 people die each year in the United States from complications (Centers for Disease Control and Prevention, 2020). Weakened as many of the patients were already, the presence of a foreign virus is often a stress that cannot be handled. Hepatitis C is a disease defined by human action; had there not been so many blood transfusions conducted, it is very unlikely that this scale of infection could have occurred nor the virus discovered. The widespread practice of blood transfusion not only facilitated the spread of hepatitis C but also played a crucial role in the identification and understanding of the virus, demonstrating the interconnectedness of medical practices and disease prevalence.

Conclusion

Despite the irrefutable facts classifying hepatitis C as a liver disease caused by a viral infection (a definition based off of a purely natural state of affairs), human action serves as the more potent method of disease classification. Medical facts, as described by the esteemed Jacalyn Duffin, are at once the summation of historical preconceptions, the law, and the natural history of a disease (Duffin, 2005). When looked at from a human perspective, there is no feature of the world independent of human action; there is so much that depends on one’s point of reference. Our understanding of hepatitis C, and indeed any disease, is a testament to the intricate interplay between scientific discovery, societal beliefs, and historical context.

References

• Centers for Disease Control and Prevention. (2020). Hepatitis C questions and answers for health professionals. Retrieved from https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm
• Duffin, J. (2005). Lovers and livers: Disease concepts in history. University of Toronto Press.
• Krever, H. (1997). Commission of Inquiry on the Blood System in Canada. Ottawa: Canadian Government Publishing.