Sunday, October 28, 2018

I will remember you (Musings on all those who died in tainted blood tragedies)

Updated: 5 Nov. 2018 
Canada's blood scandal, Further Reading
Responses to a Comments

Haven't written a blog for awhile and this one will be short. For October I'll  briefly comment on the ongoing attack on national blood suppliers like Canadian Blood Services and many others by gay activists. In Canada the designation is lesbian, gay, bisexual, transgender, queer, and two-spirit (LGBTQ2).

The blog was stimulated by two items at the AABB 2018 and the current UK Infected Blood Inquiry (Further Reading), both featured in TraQ's October newsletter under General and UK, respectively.

Recently, I've seen many attacks on Twitter accusing  CBS of discrimination. Almost all activists claim there never was a reason to ban or defer male homosexuals. When I've defended CBS by reporting the history of transfusion-associated HIV transmission in Canada, the blood supplier's perspective and its ongoing research, I've often been accused of being homophobic. Quite scary for an oldster but it won't ever stop me from voicing my opinions on controversial issues.

My take is that gays have suffered horrific discrimination over the years and many cannot differentiate blood supplier caution from larger societal historical wrongs. And most are too young to appreciate blood supplier's perspective and the need for nation-specific evidence-based policies. Suspect I'm being too generous here but won't elaborate. What the hell, I will. Could be dead wrong but sometimes when you've been unfairly repeatedly victimized, you see oppressors everywhere.

The blog's title derives from a 1995 song by Canadian Sarah McLachlan.

BACKGROUND
Activists worldwide see even a temporary ban of men who have sex with men (MSM) as discriminatory. Over the years in Canada the deferral has gone from permanent deferral to a 5 year deferral without MSM to a one year deferral without MSM and likely will soon become a 3 month deferral without MSM.

Gays see any deferral, no matter how short, as a holdover from an era of panic over AIDS in the early 1980s (Further Reading, NBC):
"They are just the latest chapter in a narrative that casts gay men as untrustworthy, promiscuous vectors of disease. We know scientifically we pose no greater threat than anyone else, but fear is a really powerful thing — especially fear of HIV."
I'll provide only this one news item but also see Google search for "gay blood donation discriminatory" in Further Reading, which yields 5,630,000 hits.

In Canada, Prime Minister Justin Trudeau was foolish to promise a change in CBS's MSM policy because it's not a political decision, it's science-based. Sadly, his error fueled much of the outrage by the gay community against CBS. The last thing our blood system needs is a political-based decision. We've been there, done that at the beginning of Canada's HIV/AIDS 'tainted blood scandal'.

BOTTOM LINE: As lifelong worker in transfusion as front-line medical laboratory technologist/scientist, supervisor-manager, educator, and consultant (54 yrs - Yikes!)  I've experienced the best of times and the worst of times. I firmly believe our blood supplier CBS is right to be cautious and base blood safety policies on evidence gathered in Canada (CBS MSM deferral policies, Further Reading).

As always, comments are most welcome. Please see the 4 comments below and my response to one (added Nov. 1, 2018).

ADDED Nov.1, 2018
Please see comments below. My reply to Shanta is as follows:

About your first point: If my comment that victimized LGBTQ2 see oppressors everywhere is true, it is probably because homophobia IS everywhere and doesn't magically stop at the front door of institutions because they reflect the values of the society that created them.

I'll grant that homophobia still exists everywhere in society, including in Canada as opposed to nations in which homosexuality is criminalised, including some nations where the death penalty applies. Source: Gay relationships are still criminalised in 72 countries, report finds. (The Guardian, 2017)

But I see it as more nuanced. Having worked for its predecessor Canadian Red Cross for 13 years, and for CBS over many years, mainly as a consultant with a brief stint as 'assman' managing CBS Edmonton's patient services laboratory, I do not believe Canadian Blood Services is a homophobic institution. I don't think CBS institutionalized policies of homophobia, including the ever decreasing ban on gay MSM donations. Individuals within any organization may be homophobic but I don't think there's evidence CBS per se is. Reasonable people can disagree on this point and I'll give my reasons below.

Shanta's second point relates to evidence-based policy-making. If the CBS MSM policy is purely based on evidence, we should be able to correlate each change over 30 years -- from permanent to 5-year to 1-year to the now anticipated 3-month deferral without MSM -- to the evidence that triggered each decision. If we can't do that, it's possible to conclude that policy-makers are influenced by more than just the evidence.

My view is that evidence-based policy-making on HIV and MSM is complex and affected by many factors including risk-modelling research, which is way above my pay grade (comprehension). For the record like many countries Canada moved from an indefinite deferral for any MSM to a five-year deferral in 2013, and to a 12-month deferral in 2016. Source: HIV donor testing. I believe the initial permanent deferral was justified and I've been labelled a homophobe on Twitter for it by  gay activists.

To be clear, national blood suppliers need to take into account many variables, including national HIV rates, data accumulated over many years because of the low prevalence of HIV, and the need to be cautious because of the incredible screw-ups that cost thousands of lives in what Canada refers to as the 'tainted blood tragedy,' the biggest PREVENTABLE public health disaster in our history.

CBS recognizes that 'MSM deferral is one of the most controversial deferral policies, and while blood safety remains paramount, issues of social justice and inclusivity highlight the need for its modernization.' See Developing more inclusive deferral policies for blood and plasma donors,

To Shanta's point, it's impossible for CBS to present clear cut evidence for each decision to decrease the deferral without MSM. The variables are too numerous. My view is that, yes, 'policy-makers are influenced by more than just the evidence.' But the elephant in the room is NOT homophobic discrimination, it's CBS's desire to err on the side of safety and caution to prevent a massive catastrophe of the 1980s (HIV) and 1990s (HCV) which resulted in Canada's blood supplier Canadian Red Cross Blood Transfusion Service being axed.

And let's face it, the emphasis on evidence-based medicine is relatively new.  Example: Choosing Wisely Canada launched on April 2, 2014.

FOR FUN
I chose a song by Canadian Sarah McLachlan to honour all those thousands who died and suffered from infected blood tragedies worldwide. Having lived through it in 1980s and 1990s I can never forget them. In early days of my career, I knew folks with hemophilia who came to blood centre to pick up their cryoprecipitate, then FVIII concentrate that killed so many. Two were Barry and Ed Kubin mentioned in Vic Parsons' book below.
FURTHER READING
It's still a ban': Gay blood deferrals still discriminatory, LGBTQ advocates say (NBC, 29 Nov. 2017)

Google search: "gay blood donation discriminatory"

AABB 2018
CBS on MSM Deferral Policies
Canada's Blood Scandal
UK Infected Blood Inquiry: October 2018 News

4 comments:

  1. I always admire your willingness to dive into controversy, Pat! I have 2 reactions that I hope you will consider. The first is about your remark that victimized LGBTQ2 see oppressors everywhere. If that is true, then it is probably because homophobia IS everywhere. It doesn't magically stop at the front door of institutions, even when those institutions that practice evidence-based science. Institutions reflect the values of the society that created them. That's what institution means. The second has to do with evidence-based policy-making. If the MSM policy were the pure product of evidence-based practice, as we all aspire it to be, then we should be able to correlate each change in the policy's 30-year history -- from permanent to 5-year to 1-year to the now anticapted 3-month deferral without MSM -- to the evidence that triggered it. Can we do that? And if the evidence is not there, then I'd conclude that the policy-makers are influenced by more than just the evidence.

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  2. Many thanks for the comments, Shanta. For those who do not know, we are friends and one-time colleagues who've known each other for years. If Shanta says something, I need to consider it carefully because I respect her views, though we may disagree. I'll add my comments to the blog's main text above.

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  3. Anonymous11:10 AM

    Thank you for another of your as-always enlightening blogs. I had been blissfully ignorant of the furor. I think there are well-meaning (?) folk who passionately enter into issues about which they have little understanding, folk who can easily be whipped up into 'action for a worthy cause' knowing nothing about the back story - perhaps as you have said - too young to remember/uncaring as to the history that brought us to this point.

    Like you, I agree with Shanta’s assertion that policy is affected by more than evidence.
    Clearly all policy makers operate under pressures of existing beliefs, government, administration, public relations, and critically, consequences of past practice, steps taken or not taken.

    On her other point, while there can be agreement that wide-spread homophobia exists and those affected by it may see everything through that lens, it does not follow that homophobia is what governs MSM policy.

    In response to the discrimination hue and cry, I cherry-picked this article to represent a respectful and reasoned approach. As I read it, these law students are about advocacy, which is much more likely than protest to lead to meaningful dialogue aimed at collaborative change.
    “…petition for the FDA to move away from the “Gay Blood Ban” and to a risk-based assessment of donors.”
    https://lgbtbar.org/bar-news/berkeley-law-students-peacefully-protest-the-gay-blood-ban/

    On reading again, I acknowledge that the article contains loaded words such as discriminatory, blatant homophobia, barred from donating, banned, archaic, that are bound to evoke negative emotion in spite of the aim to raise awareness and "ask for the FDA to make blood donation safer and more accessible for all people regardless of sexual orientation."

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  4. Many thanks, Anonymous for the thoughtful comments. The article you mentioned:
    Berkely Law Students Peacefully Protest the “Gay Blood Ban”

    Thank you for discussing further. I know many will not engage on this topic for diverse reasons but I'm glad some will in the spirit of shedding light on an issue that evokes strong emotions. Much appreciated.
    Cheers, Pat

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