Showing posts with label Graham Sher. Show all posts
Showing posts with label Graham Sher. Show all posts

Sunday, July 27, 2014

Don't worry, be happy (Musings on the safety of our blood supply)

Updated: 1 Aug. 2014 (If you've visited before, refresh your browser)

 Below is a copy of a Comment made to the earlier bog, Turn,Turn, Turn. and my reply to it. I decided to write a separate blog because Turn was getting too long and the Comment stimulated other aspects of the paid plasma issue, most noteworthy, safety.

 The safety aspects I'll touch upon include 
  • Foolproofing. Our blood experts assume blood safety is now foolproofed (no longer susceptible to human incompetence, error, or misuse) because the blood tragedies of the 80s and 90s are of historical interest only. 
    • Put another way, many blood experts (thought leaders) developed an arrogance that exudes, 'We're so much smarter now.' 
    • They base it on implementing quality systems, improved blood screening tests, and more stringent government regulation. 
  • Cost constraints, mainly affecting the nature and number of staff.
    • Despite the best foolproofing tools (see Further Reading below), not all facilities can afford them.
    • And humans working short-staffed and under pressure, and those with less formal education, are more prone to human error, especially if the system itself is flawed due to cost constraints. 
The blog's title derives from a Bobby McFerrin ditty from 1988.

 First, Anonymous's comment from the Turn blog:
Anonymous wrote: Two quotes from G. Sher that appear 4 days apart in the media. PLEASE include this in a future blog!
“Canadian Blood Services has successfully managed the blood and blood products supply for Ontarians for more than 15 years. We are confident in the safety and sustainability of the current blood and blood products system in Canada, and we recognize Ontario’s role in preserving voluntary blood and plasma donation in this province.”
Dr. Graham Sher
CEO, Canadian Blood Services
Ontario official press release July 22, 2014
Anonymous: A quote from Friday just four days prior:
Dr. Graham Sher, CEO of Canadian Blood Services, is concerned about “the mischaracterization of this as a safety issue, as opposed to a public policy issue.” 
“People are caught in a paradigm from 30 years ago and are saying that paid plasma donors are unsafe and therefore we shouldn’t be allowing a paid facility in Canada because it’s an unsafe thing to do and people are going to die as a result. That, to me, is fear-mongering and it’s inaccurate.” 
Equating paid donors with an unsafe product would mean 80 per cent of the plasma drugs in Canada aren’t safe. And that’s simply not true, says Sher, calling them “extraordinarily safe.” 
“We may have moral objections and philosophical objections to paying,” he says. “But let’s not make it an issue about safety when it’s not about safety.”Sher says that as long as Canadian Plasma Resources operates safely and doesn’t impact the voluntary donor base, it would have “no objection to existing side by side with this company.” 
Toronto Star, Isabel Teotonio
Anonymous: To say that transfusion medicine with [is] totally safe is to believe in a perfect product. That is arrogant and dangerous. I want CBS to understand the ever present risk and be vigilant and consistently working to minimize this risk. To do less will lead down the dark road of the Red Cross and unknown catastrophes.
My response to Anonymous

To be fair, CBS CEO Sher called plasma derivatives 'extraordinarily safe' but I agree the impression he creates is that they are 'totally safe'.

And I suspect that his carefully crafted public comments inadvertently create mixed messages. Dr. Sher likely thinks he's been perfectly clear:
  • CBS supports a voluntary blood donor system.
  • CBS supports Ontario's right to protect a voluntary donor system.
  • Paid plasma is safe (as safe as voluntary donor plasma).
  • Object to it on moral and philosophical grounds, but not safety.
  • If a paid plasma company operates safely and doesn't adversely affect voluntary donation, CBS would not object to existing side by side with it.
That last bit is a tad weaselly. We may not know if paid plasma centres or manufacturers of plasma derivatives or non-profit blood suppliers like CBS operate safely until an inspection or 'tainted blood' disaster shows they didn't. Sure, they all must meet stringent government regulations and be periodically audited, but errors happen all the time. And not just historically.

Mistakes (systematic and individual) regularly occur today. For example:

#1. In 2012 the USA's FDA fined the American Red Cross $9.59 million for violating blood safety rules. Note this is 2012, not 1982 or 1992.

Sometimes audit findings seem trivial, i.e, nitpicking that's unlikely to translate to patient harm. But ARC violations were serious, not trivial. All of the violations merit discussing but I'll choose just one, one that health professionals, indeed everyone, can relate to:
  • Most of the regional operating centres of the Red Cross were seriously understaffed.
Understaffing has long been a reality in health care. Why? Cost constraints and cutbacks. The powers that be usually opt to cut staff or substitute more highly educated, and therefore more expensive, staff with less educated, cheaper staff that are trained on the job and supervised by fewer well educated, expensive staff.

A classic example is CBS's 'donor care associates' mentioned in my blog of Nov. 2013:
  • Lest we forget (Musings on accountability of national blood suppliers)
The blog dealt with CBS's 2013 Report to Canadians, which mentioned cost a whopping 747 times.  
Cost savings apparently applies to worker bees, not top CBS executives. In 2012-13 CBS executives earned $283,000 to $342,000, with the CEO Sher earning $560,000. No doubt all well earned. To get top talent, you must pay top dollar. Just odd how cost savings seldom translate to executives.
As a joke I created a cartoon about possible other CBS 'care associates'

Understaffing played a role in ARC's blood safety violations. Staffing levels invariably adversely affect blood safety. We often get away with it, until we don't.

#2. Another example of systematic and individual staffing issues and ineffective government regulation  is shown by this news item:
Note this happened in 2014 in Hazelton, PA, USA, not a third world nation. Besides inadequate staffing, among many findings the state Department of Health concluded:
  •  The governing body was ineffective in carrying out their responsibilities to approve, implement and enforce standards of quality management and improvement for the hospital by failing to ensure the chief executive officer provided a safe setting for patients receiving blood.
In Canada, our current government's commitment to science versus saving money (in the run-up to a 2015 election) is suspect. Not wanting to become too political, but our government has cancelled Statistics Canada's long-form census and been accused of muzzling scientists, even to the point of investigation by Canada's Information Commissioner. 

I wonder if Health Canada, the government body charged with regulating and protecting our blood supply, has been adversely effected by staff cuts due to the government's desire to balance the budget prior to an election. 

They've taken a long time to rule on Canada's paid plasma collection centres, having first held a round table (closed to the public) in April, 2013. In July 2013 I wrote a blog about it:
  • Day tripper (Musings on HC's instructions to the jury on paid plasma)
Still no answer a year later. Why?

#3.  A key part of expert certainty of the safety of our blood supply is all the pre-donation screening questions, post-donation tests and manufacturing processes used, especially for plasma derivatives like IVIg. The blood supply in developed countries is safe today, much safer than in the past. 

But the blood supply not totally safe. Many things can go wrong:
Seems foolproof, no? Except it isn't. The system only works for transfusion-transmitted infections we know about.

For example, in 1994 it was discovered that the plasma derivative Rh immune globulin in Ireland had been contaminated with HCV in 1977-78 from a singe donor. Plasma derivatives are made from 1000s of donors and it only takes one to escape detection.
  • HCV wasn't discovered until the late 1980s. 
  • At least 390 Irish women were shown to be infected with HCV-RNA. 
  • By 1998, €206 million (~$300 million CDN in today's money) was paid to these women and others infected with HCV via transfusion.
In Canada, at least 30,000 Canadians were infected with HCV between 1986 and 1990. And all because  Canada's experts failed to use surrogate tests for non-A, non-B hepatitis (as was done in the USA) because they judged the tests to be unscientific. Compensation to Canadians infected with HCV during this time totaled over $1 billion.

BOTTOM LINE
I dig that the blood supply in developed nations like Canada is exceedingly safe compared to 20-30 years ago. But I prefer to be skeptical vs championing, 'Don't worry, be happy,' as CBS CEO Graham Sher does.

ADDED 31 JULY (amended 1 Aug. 2014)
In reply to the Comment below from Anonymous (Curtis), whose main points were:

1. Anonymous: You state that he [Dr. Sher] inadvertently sends mixed messages. I contend that he rides the fence on purpose. I have it from reliable sources that CBS wants of offload the cost of collecting plasma. They are just not efficient at it and look to the US model as a way to achieve this. 
My reply: You're likely right that CBS CEO Sher tries to have it both ways, given how CBS closed Thunder Bay's plasma collection facility in 2012. I blogged about it, noting that CBS obfuscated its real reason for closing the centre: Operating a Canadian plasma centre is more expensive than buying surplus plasma from the USA.
2. Anonymous: This is why Ian Mumford of CBS was part of the Dublin Consensus Statement that everyone points to as a paper that outlines the successful co-existence of the private sector and the public sector in the plasma industry. 
My reply: The Dublin consensus is like politics in which we all agree on motherhood and apple pie:
  • Dublin Consensus Statement on vital issues relating to the collection of blood and plasma and the manufacture of plasma products
Reality is often different:
For interest, according to LinkedIn, Mumford is responsible for ensuring CBS consistently provides high quality transfusable, plasma protein and stem cell products to customers at the right time, at the right place, and at the right cost. Likely the last is most important, given CBS's focus on cutting costs to satisfy provincial pay masters. 
3. Anonymous: I contend that Dr Sher when asked by his employer... the government of Ontario he does what a loyal employee does and that is make them look good. 
My reply: CBS is funded by all Canada's provinces and territories except Quebec (which operates Héma-Québec), not just Ontario. According to CBS's website, Canada's Health Ministers are responsible for the overall expenditure of public funds but do not have the power to direct operational decisions of the Board of Directors or Canadian Blood Services staff.
But your point has merit. Sher's pronouncement on the Ontario government's proposed legislation to ban paid plasma was to be expected, in that there was no way he could be political and publicly contradict a provincial government's policies. 
4. Anonymous: However, I also know that he has been privately petitioning for the Ont Govt to let CPR open.
My reply: Assume you have it on good sources, but I can't give such an accusation credence without confirmation. All  can say is, if true, it would not surprise me. It fits with Sher's public statements:
FOR FUN
Love this song with the reggae beat I learned in Jamaica, circa 1969.
As always, the opinions are mine alone and feedback is most welcome.

FURTHER READING
These resources are for those who want to explore some of the issues affecting blood safety in-depth.

Plasma derivative safety
Foolproofing (Applies mainly to hospital based transfusion where computers are seen as answer to human error.)
Staffing
It's hard to find reports on inadequate staffing, mainly because overworked professionals, especially those in the laboratory, fear that, by speaking out, they'll suffer repercussions, not just to their current job but in their careers.



Posted by Blut at 3:50 PM 3 comments
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Saturday, May 10, 2014

C'est si bon (Musings on TM news that is so good and not so good)

Updated: 29 May 2014
May's blog is a take-off on cartoonist Gary Clement's weekly feature, 'Week in Review' in Canada's National Post, e.g, Week of Apr. 20-26, 2014. I love them because they capture the week's news with a smile.
The blog's title derives from an old ditty by Eartha Kitt, C'est si bon (It's so good).

The topics include an eclectic selection of news items in TraQ's newsletter in the first quarter of 2014. C'est si bon is an attempt to write shorter blogs. I'd love your feedback. Shorter is so good or not so good? Keep returning because I'll add the odd 'So...' periodically.

 A version of the blog (without some of the Comments below) is available on the BBTS website.

 1. So creepy
You take your dog to a vet and are told that the pet needs to be euthanized within 24 hours. Six months later you get a call from a former employee of the veterinary clinic who tells you that your pet was still alive and being bled for plasma to transfuse to other dogs. Say what?

 2. So deserving
The CSTM promotes excellence in TM for Canadians. The 2014 CSTM award recipients are, indeed, deserving. I'm fortunate to know them all. 
  • Wendy Owens
  • Dr. Lucinda Whitman
  • Ann Wilson
  • Crystal Oko
3. So nerdy (added 11 May 2014)
Clever and simple, this is the type of chemistry trick we used to love in school. The kid in us still smiles, especially if we're nerds at heart.

 4. So overdue
By the end of 2014, the USA's Physician Payment Sunshine Act will require drug companies to report every transfer of value (as little as $10) to doctors and academic hospitals on a public website. Canada needs to do the same.

 Think it's overkill? Think again. See CMA President Dr. Louis Hugo Francescutti's take on doctors and drugs. Big Pharma's influence on docs has stunk for a long time.

5. So predictable
Dr. Sher's key points (my analysis):
  • After the tainted blood scandals of the 1980s and '90s, Canada created a safe and secure system that is the envy of the world and did it using science, evidence- and risk-based decision making.
  • Drs. Ryan Meili and Monica Dutt, the authors of Payment for plasma bad policy, may not understand that blood donation and plasma donation are distinctly different, so Dr. Sher will clarify.
  • Whether to allow paid plasma donation is a legitimate public policy debate about Canada's societal values and norms but is not an issue of product safety due to today's system and technologies.
So to all you 'worry warts' out there, don't sweat about whether paid plasma is safe. It definitely is. To Canada's elite evidence-based TM scientists, it's only about whether our values can embrace paying for plasma donations. Oh, by the way, without paid plasma patients will die.

As to the Ontario government's attempt to ban paid plasma, as predicted, the minority government has fallen and with it, all legislation.

 Added 29 May, 2014: 'Must read' on paid plasma: 


6. So sad
The January 2014 issue of the AABB journal Transfusion reported that George Garratty, PhD, retired as associate editor of the Immunohematology section of Transfusion after 31 years of service promoting papers on red blood cell serology.

 George was an icon to TM medical technologists. We will miss him dearly. 
IN REPLY to Anonymous (11 May 2014)

Anonymous finds CBS CEO Dr. Graham Sher's public pronouncements on paid plasma in Canada both confusing and unreliable. Me too.

CEO Sher says that he doesn't want paid plasma clinics to open in Canada but, at the same time, he contends that paid plasma is needed to meet current demands for plasma derivatives in Canada and globally. Canada can only meet 30% of its needs. Moreover, he suggests that, without paid plasma, patients would die.

Dr. Sher's key learning point: Like it or not, patients in Canada and the world need paid plasma.

 The flaw in that argument is that Canada has never truly promoted plasma donation. Indeed, CBS closed a plasma collection facility because it was cheaper to buy plasma from the USA and (sadly and stupidly) obfuscated its reasons for the closure.

 Dr. Sher also contends that today paid plasma is safe because of 'donor screening and testing, plasma quarantine, and technology that inactivates viruses, and several purification steps.' He's right, as far as it goes.

But this reasoning assumes that no emerging infectious disease agents will appear that may escape the detection, inactivation, and purification steps involved in producing plasma derivatives. It also assumes that manufacturing errors will never occur.  And that, with today's system,  a disaster like hepatitis C contaminating Rh immune globulin can never again occur.

 Perhaps CEO Sher suffers from cognitive dissonance, i.e., discomfort from holding conflicting beliefs. He contends that paid plasma is safe, and patients need paid plasma derivatives, but he doesn't want paid plasma clinics in Canada because CBS's voluntary donation system works well. Huh?

 Cognitive dissonance aside, Dr. Sher is a clever man and has CBS spin doctors (communication specialists) advising him. He knows what he's doing. Any obfuscation is covered by emphasizing evidence-based decisions.

Just like Canadian Red Cross medical experts did when rejecting surrogate tests for non-A, non-B hepatitis (now hepatitis C), which resulted in tens of thousands of Canadians being infected with HCV.

Who can argue against evidence and science? Anyone who questions the safety of paid plasma is automatically and conveniently designated as non-scientific.

In reply to Unknown (12 May 2014)

Unknown asked, 'Is there something in it for CBS and Dr Sher in supporting American paid plasma?'

Great question. What follows are possibilities. First, I believe CBS CEO Graham Sher to be an honorable man who mostly believes what he says or, paternalistically, believes he's doing the right thing for Canada by protecting our TM system from non-scientific types.

But it's not that simple. As AABB President it's possible he's drunk the Kool-Aid of American-style transfusion medicine, given the schmoozing he's no doubt done with Big Pharma and the laboratory diagnostic firms who support AABB, as well as with so-called not-for-profit transfusion labs that operate as businesses.

Or maybe he's into Real Politik, focussing on practical rather than ethical issues.

 What's in it for CBS to support paid plasma? It prevents CBS from spending money to promote free plasma donation and to build and maintain plasma collection facilities. Both earn brownie points with CBS's provincial paymasters.

 What's in it for Graham Sher to support paid plasma? It's about the money, stupid. Money CBS can save by NOT maintaining collection facilities and staff, as above.

 IN REPLY to Anonymous (13 May 2014)
Thanks to Anonymous, who supplied a link to yet another lobby group to promote paid plasma in Canada and noted that Canadian Plasma Resources has deep pockets: 
The press release is classic PR spin (emphasis is mine):
Made up of deeply concerned Ontarians, the Ontario Plasma Coalition was launched to address the provincial government's irresponsible handling of Ontario's plasma supply and its attempts at banning compensated donations with Bill 178. In partnership with Canadian Plasma Resources, the Coalition was formed following thousands of responses received through PlasmaForOntario.ca.
Who knew that 1000s of deeply concerned Ontario citizens were practically marching in the streets to protest its irresponsible government's move to ban paid plasma?

 Sheesh, you'd think the world would come to an end if Canadian Plasma Resources (CPR) didn't operate its paid plasma collection facility next to a homeless shelter and a centre for addiction and mental health. 

CPR built its facilities without Health Canada's approval, at least without its official approval. Who knows what went on behind close doors, including possible collusion by CBS (as in, 'Would you object?' Answer: 'No'). 

To me, CPR should shove its PR campaign where the sun don't shine. Just kidding!

 IN REPLY to Anonymous (26 May 2014)
Thanks to Anonymous who commented, 
"So sad" - that it has come to this - money and big pharma. Blood was one of the last vestiges of old fashioned medicine....
With the ability to manufacture fractionated plasma products, blood became big biz for Big Pharma more than 70 years ago. A few facts and figures (hope eyes don't glaze over):

According to CBS's 2012-13 Annual Report (Management Analysis) in Canada demand for plasma protein products (PPP), such as immunoglobulin (paraphrased):
  • Has grown exponentially, with annual growth averaging 8% 
  • Ig utilization represents ~43% of the total cost of the PPP program
  • Softening of Ig utilization is driven by the provinces and territories taking measures to manage escalating Ig demand 
  • For example, in British Columbia, all requests for Ig use are screened to make sure that Ig is used in accordance with provincial guidelines
  • Total Plasma Protein Products program expenses increased to $469.5 million in 2012/2013 
Since immunoglobulins represent 43% of the PPP program cost, that's ~$201.9 million of Canadian taxpayer money going to Big Pharma for this one product alone. That's small potatoes to the Big Pharma companies who supply CBS, who then supplies it free of charge to hospitals (and their patients). But Canada is but one of many customer countries who purchase products like intravenous immune globulin (IVIG).

Big Pharma pours mega-bucks into funding research aimed at increasing its use (and then convincing physicians to use their products). For example:
As noted, blood became big biz with the ability to fractionate plasma proteins:
  • Beginning in the 1940s with Cohn fractionation to produce albumin
  • Factor VIII concentrate to treat hemophilia in the 1960s (and we know the tragic consequences of that)
  • Business really took off in the 1980s with the ability to produce IVIG
  • See History of Plasma Fractionation
IN REPLY to Anonymous (26 May 2014)
Anonymous asked who AABB's corporate members were. I suspect Anonymous means commercial entities, as opposed to non-profit institutional members like  transfusion services and blood centres. See
FOR FUN
To follow-up on the 'so' theme, enjoy these renditions of a popular jazz ditty from long, long ago:
As always, comments are most welcome.
Posted by Blut at 7:46 PM 13 comments
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Sunday, March 16, 2014

Hey Jude (Musings on why paid plasma makes it worse, not better)

Last updated: 29 May 2014 
This months blog is a two-fer. The title is a take-off on the best Beatles song ever, Hey Jude.

The blog was motivated by the recent decision of the Ontario government to introduce legislation to ban paid plasma. (Yikes! In the first version, I forgot the lead. Unforgivable. See BBTS blog's advice.)

#1. BBTS BLOG
I'm delighted and honoured to be a guest blogger for the BBTS:
Born to be Wild? (Musings on how to blog for transfusion professionals)

The BBTS blog is about how to blog as a transfusion medicine professional. Take a peek. The advice can be applied to e-mail messages too.

#2. MARCH BLOG
However, this month I cannot resist blogging on a recent development in Canada involving paid plasma clinics.

On March 14, 2014 one of Canada's provincial governments, Ontario, decided to ban paying for plasma (and all blood donations), as had already been done in Quebec (see Further Reading).

Humour me with a few simple thought experiments. Probably best to think of them as 'What If' games.

'What If' Game #1
What if I represented Canadian experts who told you that surrogate tests for non-A, non-B hepatitis used in the USA were scientifically unsound.

The tests had poor sensitivity (missed many true positives) and poor specificity (detected many false positives) and would threaten the blood supply by preventing many perfectly safe blood donors from donating. Plus the testing was expensive.

Then I asked for a vote on doing surrogate testing on all blood donations or not. Based on expert opinion, you'd probably vote not to do it, right?
Game #1 Outcome Turns out that because Canada's TM experts prevailed, thousands of Canadian recipients of blood donations were needlessly infected with what we now call hepatitis C. Despite the flawed surrogate tests, they would have prevented many HCV cases in transfusion recipients. See
'What If' Game #2
What if I told you that concentrated Factor VIII to treat hemophilia had several advantages over the existing treatment, cryoprecipitate, including a known quantity of Factor VIII and more convenient storage. Doctors touted it as 'latest and greatest' advancement.

Then I asked for a vote on using cryo or Factor VIII conc. Based on expert opinion, you'd probably vote for using only Factor VIIII concentrate, right?
Game #2 Outcome Turns out that Factor VIII concentrate was made from the plasma of 10s of thousands of blood donors and it only took one donor to be infected with the then unknown human immunodeficiency virus (HIV), that causes AIDS. The saviour of patients with hemophilia turned out to be a death sentence for many.
'What If' Game #3
What if I told you that Factor VIII concentrate transmits several deadly diseases but, when heat-treated Factor VIII became available, and was shown not to transmit HIV, we should still give the unheated product to hemophiliacs.

After all, experts contend that most hemophilia patients are likely already infected and we have mega-bucks worth of product in storage. As well, if we don't give the unheated product to them, many would suffer life-threatening hemorrhages.

Then I asked for a vote on transfusing the existing stock of Factor VIII concentrate to likely already-infected hemophilia patients. Based on expert opinion, you'd probably vote for using unheated Factor VIII concentrate, right? We have the stock, it'll save money, and they're already infected.
Game #3 Outcome Turns out that this expert decision cost the lives of many hemophiliacs who were NOT already infected. How the experts reasoned will never be known.
Unlike US President Nixon, minutes of key meetings by decision makers (Can. Red Cross physicians and their provincial paymasters) were destroyed. I kid you not. 
To their credit, a few Canadian physicians opted for using single-donor cryoprecipitate, thereby protecting their hemophilia patients from HIV.
LEARNING POINTS
We decide based on what we know at the time and rely heavily on perceived experts.But we only know what we know. We don't know what we don't know.

And experts can be oh so wrong, as expertly detailed by Canada's Krever Commission (see below) and, more superficially, in my What If games above. Which is why I'm not onside with our TM experts on Canada's further venture into paid plasma.

Of course, you can also make an ethical case that Canada should not go down the path of paying for plasma.

ONTARIO UPDATE (Added 17 Mar. 2014)
Canadian Plasma Resources is a private company in Ontario whose sole purpose is to pay for and collect plasma for further manufacturing.

In Canada the safety of the blood supply is a federal responsibility that falls to Health Canada but whether plasma donors can be compensated rests with provincial and territorial governments.

On March 14, 2014, the government of Ontario issued this press release:
Among other things, it plans to introduce legislation to ban paying for blood in Ontario (as Quebec does now). Canadian Plasma Resources has plans to open plasma clinics in Toronto and nearby Hamilton, Ontario.
See Further Reading for news items on the announcement and background info on the issues. I'll update with more news items as they become available.
The case against paying for plasma is discussed on Impact Ethics: Making a difference in bioethics:
The authors are from Dalhousie University, Halifax, NS, Canada:
  • Matthew Herder, Asst Professor, Faculties of Medicine and Law
  • Francoise Baylis, Professor and Canada Research Chair in Bioethics and Philosophy
Included in the article is a copy of their submission to Health Canada, which is well worth a read too:
Of course, the issue in Ontario is far from settled:
  • First, after wide consultation, the legislation has to pass in Ontario's legislature. 
  • Second, Ontario has a minority government with an election required by Oct. 1, 2015, with strong polling support for three parties. 
  • Third, there will be blowback from vested interests.
REPLY TO COMMENT(Added 18 Mar. 2014)
This is in reply to the comment below from 'Anonymous', a hemophiliac who contracted HIV and HCV in the 1980s. He ended by predicting that 'the smoking gun will be IVIG for our next round.' Please see my reply to him below, which I'll expand upon here.

 I'll briefly comment on the safety and ethics of paid plasma, which is fractionated into plasma derivatives such as IVIG. 

Safety
First SAFETY. In a commentary that CBS CEO Graham Sher authored in the Toronto Star in March 2013 ('Prohibiting pay-for-plasma would harm patients'), Dr. Sher wrote (summarized by me):
  • Manufacturers must be licensed and meet stringent quality and safety standards.
  • Safety procedures built into fractionation are extensive, and include donor screening and testing, plasma quarantine, technology that inactivates viruses, and purification steps. 
  • These products are extraordinarily safe. 
  • Many studies show plasma products from paid donors are as safe as those manufactured from volunteer donors.
All medical experts stress that plasma derivatives such as IVIG are extremely safe when it comes to transfusion-transmitted infectious agents. They stop just short of claiming they are 100% safe, because such a claim could come back to haunt them.
No one wants to be in Dr. Noel Buskard's shoes when on behalf of the Canadian Red Cross he denied a link between AIDS and blood products. (2 min. CBC video. Sorry for the 45 seconds of ads).  
Dr. Buskard quit the Red Cross in 1991 saying that it had developed a “fortress mentality” when confronted with the tragedy. He became a noted whistleblower, who in 2001 was awarded the 'Whistleblower Award' from the B.C. Freedom of Information and Privacy Association. (Source: A tribute on his death in 2011)
Ethics
Because plasma derivatives are relatively safe, some against paying for plasma say it's best to concentrate on the ETHICS of paid plasma. I'm not going to regurgitate the many complex rationales for and against paying for plasma. For one thing, it's above my pay grade and expertise.

 To quote CBS CEO Sher, the ethical case for paying is that the derived products are 'extraordinarily safe' and patient lives would be threatened without paid plasma: 
  • The reality is that thousands of patients depend on these life-saving fractionated products, and without those produced using plasma from paid donors we would not be able to meet patients’ needs...When lives are at risk, that’s simply not an option.  
The ethical case against paying for plasma includes the reality that 
  • Commercial plasma collectors exist to make money. 
  • Exploiting the poor and vulnerable and selling to the highest bidder are what drives for-profit enterprises. 
  • Witness Canadian Plasma Resources building a clinic next to a homeless shelter. 
Is this really a path Canadians want to take? Matters not what happens in the USA or elsewhere. That's not us.

 Hypocritical?
Some call this position hypocritical since we use products made from paid plasma in other countries. Perhaps. 

 But is it any more hypocritical than CBS closing a Canadian plasma collection centre saying demand for 'plasma for transfusion' was down, and at the same time outsourcing plasma collection to the USA because it was cheaper? Then having its CEO claim that lives are at risk if we don't use paid plasma?

 CBS Annual Report 2007-2008 (p.22): 
This year, we also re-introduced the collection of source plasma at our existing plasmapheresis sites ...laying the foundation for CBS to improve our plasma sufficiency - one of the basic principles of the blood supply as outlined in Justice Krever's report.
CBS Announces closure of Thunder Bay Plasma Centre (29 Mar. 2012)
Over the past two years, new replacement products and a decline in hospital demand have led to a decrease in the need for plasma for transfusion. 
CBS Financial Report March 2011 (p.32)
In 2010/11 CBS started a pilot program to purchase surplus recovered plasma from the United States (collected by organizations with an FDA licence) which will continue in 2011/2012.
Report to Canadians 2012/2013, Management Analysis (p.43)
As self-sufficiency is not operationally or economically feasible in a volunteer, non-remunerated model, CBS strives to maintain a sufficiency of 30% for Ig. The demand for Ig continues to rise in Canada and internationally, and to meet our needs CBS purchases surplus recovered plasma (from voluntary donations) from the United States for fractionation, which increased by 4,572 litres or 17.0% in 2012/2013 over 2011/2012.  
'Don't let the perfect be the enemy of the good.'
So, yes, hypocrisy abounds on all fronts. It would be preferable (perfect) if we didn't need to use plasma derivatives sourced from paid plasma anywhere, but to me, banning paid plasma clinics in Canada is preferable (good). Not PEFECT, but GOOD.

 To return to the comments made by Anonymous below, I've discussed the IVIG safety issue and that history shows we can never be certain about blood safety. About his introduction: I am a hemophiliac that got HIV and HCV in the 80's, I'd like to end with
  • The tragedy of Factor VIII Concentrate (19 min. CBC video you won't soon forget. Take time to watch it sometime. As transfusion professionals we owe it to Canada's hemophiliacs and to ourselves.)
Added 29 May 2014: 'Must read' on paid plasma: 
'FOR FUN'
Hey Jude is a 1968 song by Paul McCartney, with an interesting origin.

Regardless, Hey Jude is about trying to make something that is bad better. Paying for body organs and tissue, including plasma, is a bad idea.
  • Hey Jude (Paul McCartney, Live in Red Square)
Hey Jude, don't make it bad. Take a sad song and make it better...
As always, the ideas are mine and mine alone. See comments below. More comments are most welcome.

Also, don't forget Born to be Wild? (my first blog for the BBTS)

Further Reading
Posted by Blut at 7:36 PM 8 comments
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Saturday, February 08, 2014

We are the world (Musings on sharing TM resources)

Updated: 10 Feb. 2014
February's blog is on transfusion medicine resources, including blogs and twitter. [Like all blogs, please check again as revisions invariably occur.]

The blog's title derives from a 1985 song written by Michael Jackson and Lionel Ritchie for 'USA for Africa.'

The blog's theme was triggered by discovering that CBS had removed the Vein to Vein section of its transfusionmedicine.ca website, a site that Kathy Chambers and I developed for CBS in 2001-2003. CBS assessed that some content had become outdated and some was now well covered by other resources. Both true.

The V2V site went up in 2004, ~10 years ago, a long time in transfusion medicine. It's possible that some elements may be revised based on community needs and re-published on the site, but that's just a maybe.

You can still see snapshots of the V2V site because organizations exist that archive websites. This link is the archived site from Sept. 2012.
[Note: Literature references and other external links are still active but don't work on web archives.] 
But that got me thinking about TM resources and who uses them. As explained in January's blog - 'Mommas don't let your babies grow up to be lab techs' -  in reply to Robina's comment (#2 in Addenda), fewer and fewer medical laboratory technologists read TM journals. The same may be true for physicians and nurses.

About online TM resources, I encourage you to ask and answer these questions for yourselves:
  • What resources exist? Who created them and why?
  • Who uses them and why? 
  • Are they useful in your practice?
Perhaps most importantly, should industrialized nations share resources with those in the developing world? In a way, it's similar to whether we in the West should focus on 'Charity begins at home' and give less or nil in foreign aid to poorer nations. And what's the right balance on that continuum?

What follows is my take and I've selected only a few of many useful online resources. Many more exist and your choices may differ from mine.

Please let me know if I've missed an exceptional resource and specify why.

Criteria I use to assess online TM resources:
  • Is content created by credible health professionals, preferably acknowledged experts?
  • Are references to scientific literature included?
  • Is content current and, if older, still relevant today?
  • Even if country specific, is content generalizable to other locales?
  • Who's behind the site? [Usually in About Us] 
  • Who funds the site? Do they have an agenda? If yes, what is it?
  • Does the site follow the entire Swiss HON 'Code of Conduct'?
 A few useful TM resources, in no particular order:

WEBSITES 

 CANADA
Canada has many websites that share incredible resources that took much time, expertise, and funding to create. In each case, developers could have hogged the resources, kept them secret on an organization's intranet.

But, like Australia, the UK, and others, they bravely and generously decided to make them public via the Internet so all could see, share, offer feedback on, perhaps even criticize.

For those who know these sites, bear with me. I'll try to feature a few goodies that may be new to you.

1. BC PBCO 

BC's Provincial Blood Coordinating Office was the first PBCO created in Canada (1997). Among other things, that's reflected in them having the vision to snap up the generic domain name, pbco.ca. [Couldn't resist the joke.]
Sorry!
Sorry, PBCO pals!
Seventeen years later, BC PBCO remains a leader in blood utilization management, information management, and quality management, as well as in sharing educational and other resources via its site and TraQ's (see below). For example:
2. TraQ
Disclosure: I'm TraQ's content coordinator and webmaster.

TraQ has several unique strengths, including:
3. ORBCoN

Among its many exceptional resources, ORBCoN hosts
AUSTRALIA
Australia has long been a leader in developing and sharing blood safety educational resources. Some examples:
UK
The UK too has always generously shared its TM resources and they've led in many key areas. For example:
USA
The best transfusion resources in the USA are the AABB's. I've been a member since 1975 (Yikes!). Please consider that when I criticize the organization. It must be doing something right.

Many of AABB's best resources are restricted to members. But some are available to all, e.g.,

SOCIAL MEDIA
Many of today's 'mature' health professionals diss social media as being sound and fury, signifying nothing, as Shakespeare had Macbeth say about life:
Life's but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing. 
Still, I recommend blogs and Twitter, if they meet criteria as above, as being worthwhile resources for TM professionals.

Social media are democratic, meaning anyone can spout off (I'm a prime example). But health professional bloggers and tweeps shouldn't, and do not, get an audience without earning the respect of peers for the content of the offerings.

Unless they're celebs like Justin Bieber and Katy Perry, who each have over 46 million followers on Twitter. Celebs can be total ______ (fill in the blank with an appropriate word) and still have millions of followers eagerly gobbling up their drivel.

A significant characteristic of social media is that, unlike the websites mentioned above, individual blogs and twitter accounts can be created by anyone for free. The only cost is the time and effort of the people (bloggers and tweeps) who participate and contribute.

BLOGS
1. Musings on transfusion medicine (You are here)
Granted, it's shameless self-promotion to include my own blog. This blog began in 2004 and will have its 10th year anniversary in October. This entry is the 119th individual blog. [As is obvious, I'm long-winded with many rants inside just waiting to be released.]

Many blogs exist (although, not many on TM). Blogs should be taken with a huge grain of salt because they represent one person's biased perspective. Blogs can be thought of as short compositions on a single subject written from the author's personal perspective.

In essence blogs are like newspaper editorials, which represent an individual or group's opinion, e.g., that of the owner, publisher, editor, or editorial board.

Musings on TM represents my opinions alone. A natural tendency is to go against prevailing orthodoxy. To me so much of what people believe, including transfusion professionals, results from speaking to the same people, perhaps a few dozen, day in and day out.

What inevitably results is 'group think'. Spending time in an echo chamber, where you constantly hear your views parrotted back to you, leads to believing your views are conventional wisdom, i.e., Doesn't everyone think that?

In revolt, I'm an iconoclast and this blog provides the medium to oppose what most of us accept as 'truth'.

Still, I hope the blog's ideas are more than a 'nutball sounding off' and represent
  • Constructive criticism
  • Fresh perspective
  • Sound reasoning (Well, mostly...)
If not, the Comments section of the blog (~ Letters to the Editor in newspapers) allows readers to counterbalance my often biased views.

2. A few other transfusion blogs exist but they don't turn my crank using the criteria above. If you know of a good one, please let me know.

TWITTER
Created in 2006, Twitter is a late comer to social media and initially was much ridiculed for its limit of 140 characters and some users tweeting trivialities, e.g., what they ate for breakfast, etc.

But gradually people realized the power of Twitter and saw how it could changed media, politics, business, and more.

I love Twitter for its ability to share news and resources. If you're curious about the world and an information junkie, beware! It's addictive.

1. Cyber Bloodbanker @transfusionnews

Again, forgive the self-promotion. I've 7 Twitter accounts, 4 of them serious (well, relatively so), especially the one above, and 3 spoof accounts strictly for fun. Two are transfusion-related with few followers (only tweet when CBS actions warrant a humorous response):
For transfusion news judged useful or interesting to others, I'll immediately put a link to it on @transfusionnews.

For those new to Twitter, you can register and never tweet, just follow others. Or, if that's too much, a simple approach is to bookmark the account's page and visit it when the mood strikes.

2. Other Twitter accounts
Many of the major TM players tweet and are worth following. Some examples:
LEARNING POINTS
  1. Did you notice that most recommended websites were from countries with publicly funded health care and blood systems? Sharing is good.
  2. All resources on TM websites in Australia, Canada, and UK are available to anyone with Internet access. In a way, it's a version of foreign aid.
  3. Social media is in its infancy but will become ever more powerful as it transmogrifies who controls the message.
FOR FUN

No one says World Wide Web anymore but the web allows us in the West to share resources with those less fortunate around the globe.

Which led me to this month's music choice:
Also see
As always, comments are most welcome.


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Saturday, January 11, 2014

Mommas, don't let your babies grow up to be lab techs (Musings on what TM journals imply about med lab technologists/scientists)

Last updated: 3 Feb. 2014 ('Tweeks' +ADDENDA below)
Happy New Year, everyone. January's blog is a crude attempt to identify the state of transfusion medicine in developed nations in 2014 and, particularly, where my medical laboratory colleagues (vs nurses and physicians) fit in the grand scheme according to TM journals.

The title is a take-off on a song covered and made famous by Waylon Jennings and Willie Nelson.

To be clear, I and most of my cohort had wonderful careers as medical laboratory technologists working in transfusion medicine. We experienced the glory years where our specialty, immunohematology (blood group serology) was exciting and rewarding. But, my friends, the times they are a changin', and have been for a long time.

At the start of a new year, I wondered if transfusion medicine journals had become more relevant to working medical laboratory technologists / scientists and decided to use the January 2014 issue of the AABB journal Transfusion as an indicator.

The same challenge faces TM nurses and physicians - of all the knowledge needed to keep current, how many papers are truly useful? (What RNs and MDs would read of direct relevance won't be dealt with here, mostly because it's beyond my pay grade.)

Also, I wondered if the New Year issue would identify what's hot, and not hot, in TM.

It's a thought game I play with every issue of the TM journals I read. With a background as a medical laboratory technologist and educator, what would I read? Frankly, I read many papers just for fun, out of curiosity and as bathroom reading. (Easily beats People magazine and edges Canada's Macleans.)

But most adult learners, including busy TM professionals, want immediate usefulness. They tend to take time to read resources that they can apply instantly and directly in their jobs.

So, specifically, what would I read in January's Transfusion that is of immediate relevance to me, assuming I still worked as a frontline worker, instead of playing around on the Internet, looking for resources to share with all involved in transfusion medicine?

My assessment for practical relevance includes several factors:
  • How closely does the author's locale fit my situation?
  • Do I know the authors personally or by reputation as thought leaders?
    • Love this buzz word, meaning influential. 
    • How many colleagues would you name as thought leaders?
  • Does the paper deal with something I have some control over and can evaluate and implement?
  • Who funded the research? 
  • Which competing interests do authors identify?
CUTTING DOWN TREES FOR WHAT?
As an aside, one thing I noted in the Jan. issue was how only the editorials (10 pp.) and letters (3pp.), i.e., 5% (13 of 258 pp.) of Transfusion's January pages, were new. The rest were published and available online mainly in April-June, 6-8 months earlier.

Does Transfusion's publisher, Wiley, need to continue to cut down trees for 5% of new content? How about asking AABB members and other subscribers if online access suffices?
After all, how many TM professionals exist who cannot access the Internet? No doubt some in developing nations, but even there, electronic copies may be easier to access than paper ones.
MY WINNERS (Transfusion, Jan. 2014)

1. The 'Transitions' editorial, only because the title is irresistible. Transitions of what? AABB, the journal's focus, or even TM itself? I had to know.
Turns out the editorial was about changes to Transfusion's editors.Of special note to me was the retirement of George Garratty, PhD as associate editor of the Immunohematology section after 31 years of service promoting papers on red blood cell serology. His successor is Connie Westhoff, SBB, PhD, who also handles Blood Group Genomics. Garratty will continue to serve Transfusion as a member of the editorial board.
George is an icon to TM medical technologists - see this interview, similar to these 'dudes' and others:
Over the years I've noticed how some physicians, at best, patronize PhDs and, at worst, denigrate them for their lack of clinical expertise (usually among fellow physicians, almost never to their face). Which is why this sentence on George Garratty from the Transfusion editorial struck me:
'Even though he is not a clinician, he demonstrated a remarkable ability to marry the serologic aspects of manuscripts with clinical implications, adding value to this section for laboratory technologists, immunohematology researchers, and laboratory directors who supervised technical activities and who are required to interpret these findings for practicing clinicians.'
Patronizing? I can only imagine what the author thinks of medical laboratory technologists. Can we ever have 'remarkable ability to marry the serologic aspects of manuscripts with clinical implications' or marry anything to the be-all and end-all supremacy of clinical? And if not, are we lesser beings in the TM pecking order?

And what about nurses? They're clinical but do they cut it with docs for their clinical expertise or are they forever designated as handmaidens to physicians? Just asking, you do your own answering.

 2. Transfusion Medicine Illustrated. Who doesn't love neat photos?
An unusual cause of red plasma: Due to concern for cyanide exposure, a burn patient was treated with hydroxocobalamin. Red discoloration was subsequently seen in her plasma, urine, and wound dressing. 
Many causes of discolored body fluids exist (e.g., ingesting food coloring, rapid hemolysis), but in this case the clinical scenario suggested it was due to the dark red color of hydroxocobalamin.
 Is it similar to red pee after eating beets? <;-)

3. 'Hospital-based transfusion error tracking from 2005 to 2010: identifying the key errors threatening patient transfusion safety' and not just because its authors are Canadians but because we all need to know what errors are made in order to prevent them. From the abstract:

 During 5 years at Sunnybrook in Toronto, errors occurred at every point in the transfusion process, with the greatest potential risk of patient harm resulting from inappropriate ordering of blood products and errors in sample labelling. Specifically:
  • 15,134 errors were reported, a median of 215 errors/mth:
    • 9083 (60%) on the transfusion service (TS) 
    • 6051 (40%) on the clinical services 
  • 23 errors resulted in patient harm:
    • 21 on clinical services and two on the TS 
    • 21 of 23 harm events involved inappropriate use of blood 
  • Errors with no harm were 657x more common than events that caused harm 
  • Most common high-severity clinical errors:
    • Sample labeling (37.5%) 
    • Inappropriate ordering of blood (28.8%)
  • Most common high-severity error in TS: 
    • Sample accepted despite not meeting acceptance criteria (18.3%) 
  • Cost of product and component loss due to errors: $593,337
4. 'Record fragmentation due to transfusion at multiple health care facilities: a risk factor for delayed hemolytic transfusion reactions.' 
The paper deals with errors due to record fragmentation, a risk that exists whenever people are treated in regions without a common information system for patient records. With increasing mobility of the workforce, the risk is ever-present and widespread.
From the abstract:

Multisite transfusions were common. For patients seen at both of two nearby hospitals, antibody records were frequently discrepant. Findings support the need for interfacility sharing of transfusion records, particularly at the regional level. More specifically:
  • Antibody discrepancies occurred in 64.3% (27/42) of cases 
  • Most common discrepancy was failure of one facility to detect an antibody
5. 'Successful management of severe hemolytic disease of the fetus due to anti-Jsb using intrauterine transfusions with serial maternal blood donations: a case report and a review of the literature.'
The authors are from Muscat, Oman but a case report dealing with HDFN is a magnet to most techies because some immunohematology and other laboratory data are sure to be present.

The case was notable because anti-Jsb is an extremely rare antibody. 100% of Caucasians and 99% of blacks are Js(b+) and maternal blood was used for 4 intrauterine transfusions.

LEARNING POINTS
#1. Besides the editorial and TM illustration, as a busy medical laboratory technologists/scientist who worked in a large tertiary care facility and earlier in a combined transfusion service-blood centre, I would probably have read three papers comprising 19 useful pages of 258 (~7%) of January's Transfusion.

Keep in mind I would have read more out of curiosity as a bench technologist and because, after becoming an educator, I wanted to be at least familiar with all aspects of TM, even if it was in the purview of nurses and physicians.

WHO READS JOURNALS?
Think for a moment: How many of today's med lab techs in the transfusion service, especially cross-trained ones who rotate in the blood bank, hematology, and clinical chemistry - but also TM specialists - would read any of these papers?
First, even specialists would lack access to Transfusion unless they were AABB members or had journal clubs that discussed published research or were at university hospitals where staff were given access. Not many.  
Experiment: Ask your TM colleagues (medical technologists, nurses, physicians):
  • How many read Transfusion (or the equivalent specialty journal in your country)?
  • If a medical technologist, assuming they're members and receive a journal as part of membership, how many read even a few articles in their general professional journal? Ex:
    • AJMS in Australia
    • CJMLS in Canada
    • IBMS Newsletter in UK 
    • Lab Medicine or Clin Lab Science in USA
2. Transfusion complications and errors continue to be a concern. Besides papers 3 and 4 above, three other papers deal with transfusion complications and risks (See TOC below).
To Ben Franklin's famous quote, 'In this world nothing can be said to be certain, except death and taxes,' we can surely add, 
Nothing is more certain that transfusion errors and complications will occur despite our best efforts. [See UK's SHOT]
3. What's hot? Looking at the Table of Contents (TOC), Transplantation and Cellular Engineering and Transfusion Practice have the most papers (6 each).

The first section (sounds oh so important - love use of engineering) fits with AABB's attempt, and transfusion medicine in general, to move from blood transfusion (waning in an era of transfusion complications and blood conservation) to a more viable, emerging field like stem cell transplantation.

Kinda like dentists expanding their practices by promoting teeth whitening for all and braces for more and more kids?

The second (Transfusion Practice) validates AABB and transfusion MEDICINE in general as mainly in the control of physicians. Doh!

4. What's not hot? Immunohematology and Immune Hematologic Disease (the anti-Jsb case study) has the fewest papers (1 each). And even there, I wouldn't read the Immunohematology paper as it deals with basic research using mouse red cells ('Transfusion of murine red blood cells expressing the human KEL glycoprotein induces clinically significant alloantibodies').

All I can say on what's hot, what's not, is Plus ça change, plus c'est la même chose. [If needed, a translation]

BOTTOM LINE
You may disagree with my assessment of read-worthy papers for medical lab technologists/scientists in Transfusion's Jan. 2014 issue. If you agree or disagree, please let me know in Comments section or by private e-mail.

As noted, I cannot evaluate the articles from the perspective of busy TM nurses and physicians. Decide for yourself (Transfusion TOC in Further Reading below) which of the papers' titles would motivate you to read them.

ADDENDA
#1. (12 Jan. 2014) In reply to Roger (see Comments below): Thank gawd for ARC's journal, Immunohematology. One place where those of us in the lab can still enjoy and learn about blood group serology, a dying art.

#2. (13 Jan. 2014) In reply to Robina (see Comments below):

Robina, I agree that a significant reason for so few 'serological studies' being published is that routine blood group serology is not as innovative and ground-breaking the way it was, especially in the 1960-80s.

Soon thereafter, and extending into the 21st C, red cell serology papers were often comparisons of various automated systems with manual techniques and then with each other.

Other factors abound, including:

EVOLUTION OF TESTING
1. Waning of serologic studies as pretransfusion testing became assessed for clinical relevance. Ex:
2. With the invention of PCR and DNA sequencing, blood group discoveries began to focus on DNA analysis to determine blood group inheritance. For example, see Willy Flegel's
  • Rhesus site at the University of Ulm (static since 2009)
3. Molecular genotyping. Applying DNA analysis to typing blood group antigens started in the early 1990s and continues to make inroads into routine use. I blogged about this in 2010:
4. Shifting priorities.
-As labs became more automated
-As regulation extended beyond blood centres to transfusion services
-As governments instituted cutbacks on health care funding,
research into the following became higher priorities:
  • Competency training, assessment, and audits for compliance
  • Reducing errors in patient identity, blood administration and blood ordering
  • Improving blood utilization, especially for plasma derivatives like IVIg 
As well, the funding of transfusion safety officers to help with the above meant that blood group serology all but disappeared from the research radar.

HUMAN RESOURCES
Besides the above factors, secondary causes for the paucity (sorry, cannot resist the word) of published papers on red cell serology include the nature of the TM workforce. The following are my views and I could be wrong.

Olden Days vs Today
1. Once medical directors of transfusion services and blood centres had sufficient budgets and staffing to allow a lab technologist to work part-time on a research project under supervision and with support.

Today, this is generally untrue. Staffing is stretched to the max just to get the real work done.

Research projects exist in a few places but typically dealing with new priorities and where the medical director has access to research funding or to students in a local university CLS/MLS program. And also where, because of affiliation with a university, medical directors have an incentive to publish papers as it earns prestige, promotion and salary increases, no matter how minimal. 

2. With the advent of regionalization, centralized testing and automation, it's possible to operate transfusion services with fewer staff, and less well trained ones. The few existing transfusion specialists are swamped with administrative, education, human resources, and management issues.

As for the 'trench workers', regardless of education and training, they often feel less valued by employers (knowing they are disposable if the right technology comes along) or, in the case of blood centres, if the right 'care associate' can be trained to do their job. See my joke on the practice.

Hence, many have evolved into 9-5ers, taking pride in their daily job, but unlikely to put in the extra hours that goes invariably with research. Of course, some do want to excel and go above and beyond, but the numbers are small.

Well, these are a few stream-of conscious ideas for why blood group serology papers are increasingly rare in major TM journals.

Please see Robina's follow-up comment below about the situation in the UK.

 #3. (3 Feb. 2014) In reply to Anonymous(see Comments below):

Yes, the Globe & Mail article on paid plasma clinics in Canada is interesting. Health Canada is into its second year of deliberating whether to license the clinics and notes that each province can decide to allow paid plasma clinics (or not).

The CBS quotes are interesting. Most notably, Graham Sher, CBS's CEO seems to have shifted ever so slightly in how he presents the CBS position.

For example in a commentary he authored in the Toronto Star in March 2013 ('Prohibiting pay-for-plasma would harm patients'), Dr. Sher wrote (summarized by me):
  • On Safety
    • Manufacturers must be licensed and meet stringent quality and safety standards.
    • Safety procedures built into fractionation are extensive, and include donor screening and testing, plasma quarantine, technology that inactivates viruses, and purification steps. 
    • These products are extraordinarily safe. 
    • Many studies show plasma products from paid donors are as safe as those manufactured from volunteer donors.
  • On Security of Supply
  • A safe system must ensure security of supply. 
  • 1000s of patients depend on life-saving fractionated products (plasma derivatives).
  • Prohibiting paying donors for plasma would deny patients access to these products, both here in Canada and around the globe. 
In the Globe and Mail piece, Marc Plante (CBS Communications Specialist) reiterates Dr. Sher's March 2013 commentary, whereas Sher is quoted as telling a panel audience at an October 2013 production of Tainted:
  • “Would I be happy if they [paid plasma clinics] never opened their doors here? Never did business here? Absolutely.”
Perhaps an attempt to modify his earlier statements where he seemed to to come across as an advocate for paid plasma?

I also thought it interesting that the Globe and Mail quoted Janet Conners. Also see
Comments are most welcome.

FOR FUN
And just because I'm in a 'Willie Nelson frame of mind':
FURTHER READING


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