Wednesday, June 20, 2018

The sound of silence (More musings on paid plasma pros & cons)

Updated: 21 June 2018 (Fixed all links; added more)
Wrote first version of this blog a few days ago then pulled it. Why? I wrote it when angry, never a good idea. What got me mad was the following reality:
If there's one thing that gets my goat (or, in the vernacular, pisses me off), it's a campaign that's clearly orchestrated and perhaps indirectly funded by the likes of USA's far-right Koch brothers (Further Reading). I say indirectly because Koch biz is well known as a hidden maze of covert operations. Tracing funding is impossible. Like crime investigators, I don't believe in coincidence as outlined below.
The reality is the many letters to the editors, and so-called opinion pieces/commentary, that support paid plasma have 'coincidentally' flooded many Canadian papers as Health Canada's Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada considered the issue. Interestingly, several op-eds 'coincidentally' cite the same letter written to the Panel by Peter Jaworski (co-author of 'Markets without Limits:  - Further Reading) and 32 ethicists and economists, including two Nobel Prize winners and a recipient of the Order of Canada, as we are ever reminded. Walks, talks, and quacks like coordinated to me. 
I've since cooled off and developed a second thesis for the blog. Advocates on both sides of the paid plasma issue are talking past each other, both sides being certain they are right. Like current USA politics, polarization is extreme and we're all partisans, endlessly pounding home the same points to those who agree with us and to convince the larger public via endless op-ed pieces.

Disappointed that CBS and Health Canada are not more transparent about where Canada is headed on paid plasma. Both HC's Expert Panel (bit of a joke) and CBS have been less than transparent on the issue. CBS's position is understandable, Health Canada's not so much. This is the origin of the blog's title, The Sound of Silence.

So the blog's aim is to outline what I find wrong and weak about both anti-paid plasma and pro-paid plasma advocacy. Yes, my position is clear and I've said similar before over many years. One more time....

My view is that anti-paid plasma advocates (I'm one) who sound alarm about safety issues that are iffy at best do not do the cause any good. Yes, some risk exists since zero risk is impossible. Although paid plasma is as safe as volunteer plasma, largely due to the processes that fractionated products like intravenous immune globulin go through, plasma fractionation destroys KNOWN 'deadly' risks (HBV,HCV,HIV) but not necessarily future unknown transfusion-transmitted infectious organisms. But to focus on safety is non-productive. Why?

Because focusing on safety undermines two main legitimate arguments:
1. Paying for body tissues is unethical because it preys on the poor;
2. Culture of paid blood donation will undermine volunteer donations over time.

For more on unethical, see Further Reading (Musings on how paid plasma mirrors Rumpelstiltskin).

FACT: Valid statistics about decreased voluntary donations are hard to come by since no one knows what they would be if (1) paid plasma didn't exist and (2) national blood suppliers like CBS had made concerted efforts over the years to encourage and facilitate plasma donation.

The pro-side argues as follows, exemplified by Jawarski in 'Markets without Limits':  'If you may do it for free, you may do it for money' meaning selling body tissues and organs is moral because you can do it for free (voluntarily donate). And selling tissues / organs saves lives so must be good, conveniently ignoring or minimizing that it preys on the poor (Further Reading).

Another position pro-plasma advocates pound away at is that anti-paid plasma advocates in Canada and elsewhere are hypocrites. Let's face it, we are all hypocrites in some ways. I'm a vegetarian who wears leather shoes, believes in transitioning to renewable energy yet has flown a lot around the world and taken cruises, which contribute significantly to greenhouse gas missions. 

To me, not wanting to make Canada a paid-plasma haven like the USA, sucking the blood from the needy, is a legitimate ethical view. More legitimate than fear mongering that patients will die if we don't pay for plasma that can be fractionated into life-saving derivatives. Fear mongering conveniently serves the needs of Big Plasma and its billions in annual profits, And means nil will change, we'll be forever captive to the plasma industry, instead of promoting voluntary donation and developing innovative alternative treatments, and reining in off-label uses of products like IVIg. 

Another pro-paid plasma position is that anti-paid plasma advocates are all about unions wanting to save their members' jobs. Seems a knee-jerk reaction to public service unions supporting voluntary donations, often citing the iffy safety rationale. But please answer this: Under what scenario would unionized CBS workers lose their jobs to paid plasma private clinic workers, who presumably would not be unionized and paid much less to maximize profits to shareholders, as well as having poorer working conditions? Beats me.

In the latest propaganda piece ('Why we should pay Canadian donors for their blood plasma donations,' 13 June 2018), the authors feel compelled to write:
'Neither of us is in any sense funded by 'big plasma' or any other commercial interest. We are professors at universities (one at a Canadian public institution, and one at a private American one). We have no financial stake in this issue. We are merely doing our jobs as philosophers and ethics professors: namely, putting forward what we believe to be the very best argument on a matter of substantial public importance.'
Reminds me of 'the lady doth protest too much, methinks' (Hamlet). Note that Jaworski co-founded the Institute for Liberal Studies (Further Reading) and is an adjunct scholar at the libertarian Cato Institute (Further Reading - Behind the Cato Myth), created by the Charles Koch Foundation. Cato is anti-minimum wage, anti-union, anti-universal healthcare. You get the picture. And it's fair to judge folks by the company they keep, isn't it?

Not all Cato Institute positions are obnoxious to progressives like me, but among other policy positions, Cato is pro-tobacco, pro-private schools, pro-private prisons, in other words, pro-private anything like pro-paid plasma. And, of course, Cato thinks man-made climate change is exaggerated.

All these philosophers writing to papers and volunteering to author op-eds may be sincere advocates that paid plasma is the way to go, and are prepared to put patient needs above the poor who subsidize patient treatment risking their own health. Kinda reminds me of Trump's 'Amerika First'. My needs trump yours.

And pro-paid plasma advocates ignore that Big Plasma makes billions off the blood of the needy because markets rule (Further Reading). Instead they focus on the needs of patients, a legitimate concern, but have closed minds that voluntary plasma donation can significantly help. Until recently, plasma donation has never been promoted by CBS. Volunteers may not be able to supply all the plasma needed but why not try instead of letting paid plasma become the norm?
  • Once paid plasma is part of the culture, why would anyone donate plasma voluntarily?
Just a coincidence that pro-paid plasma philosophers, who seem to know each other via various networks, flood newspapers with pro-paid plasma pieces, just because they're doing their jobs?

Perhaps but clearly a coordinated effort. They may be sincere but do not support a heart of gold. Instead they support Big Biz, earning gold on the backs of the poor. As befits anyone who's part of the Koch-Cato right wing propaganda initiative.

As always comments are most welcome.

Again I use Simon and Garfunkel's ditty:
Over the years I've written many blogs on paid plasma, the last previous to this one on Dec. 29, 2017:

Look what they done to my song (Musings on how paid plasma mirrors Rumpelstiltskin) Note relevant links in Further Reading:
  • Twisted business of donating plasma for money (The Atlantic, 28May 2014)
  • WHO: The state of the international organ trade: a provisional picture based on integration of available information
  • Meeting an organ trafficker who preys on Syrian refugees (BBC, 25 Apr. 2017)
  • The body trade - Reuters series ('The chop shop')
  • Search on Google for organ trafficking(1.3 million hits, 29 Dec. 2017)
A rare look inside the Koch brothers political empire

Those ubiquitous libertarians (2014) - Discusses influence of the Koch Brothers in academia (much of it hidden); wonders about funding of Jaworski's Institute for Liberal Studies (ILS)

Multi-millionaire quietly funds network of right-wing groups active in fight to dismantle Canada’s public healthcare system (2017); Including funding ILS

Behind the Cato Myth (2012)

Why we should pay Canadian donors for their blood plasma donations (13 June 2018)

'Markets without Limits: Moral Virtues and Commercial Interests' (positive review)



  1. Anonymous8:18 PM

    Disheartening but true: your observation that advocates on either side simply do not listen to each other, being too concerned about entrenching their own positions, be their reasons be monetary or ethical.

    And the silence: not wanting to rock the boat with differing views for fear of consequences is likewise depressing.

    Thank you for this, and may it reach some ears attached to those with authority to bring about change.

  2. Thanks for the feedback. Much appreciated. About change, I'm not hopeful. Too many vested interests to maintain and entrench the status quo.