Heart of Gold (Musings on pimping for paid plasma)

Updated: 15 Oct. 2017 (Fixed dead links)

This blog is the fifth in the series of commercialization of the blood supply. It outlines why I think paying for plasma is not where Canada wants to go. Paying for plasma makes me wonder 

• What is our body worth?

 It doesn't sit right. Everything about it seems anti-Canadian. As youngsters quip, 'It's not your parent's Canada."

The title derives from Canadian Neil Young's 1972 classic, 'Heart of Gold.'

From the prior blog:

“From Health Canada’s perspective this is not a safety issue. The paid plasma issue is public policy that has to do with our culture and our values. And that needs to be addressed as a collective community.... 

But as we're looking at that, we should realize that 70 per cent of what we need is imported from the United States, where the donors are paid. So isn't this a bit of a double standard? You can't pay at home, but you can pay abroad."

Fact is, Canadians are being asked to allow blood donors to be paid for their plasma. Indeed, major players now pimp for paid plasma:

1. We need paid plasma to supply the plasma derivatives that Canadians need. (CBC CEO Graham Sher)
2. There's nothing unethical about it. (CHS President David Page)
3.  70% of what we need is imported from the USA, where donors are paid. So to deny Canadians the right to be paid would be hypocritical. (Robert Cushman, director general of Health Canada’s Biologic and Genetic Therapies Directorate)

AND....Health Canada wants to hear from Canadians whether paying for plasma fits our culture and values. That doesn't exactly translate into the government regulator wanting to know if we think selling our plasma is ethical or moral. Those are weighty topics (see Further Reading below). 

No, it's whether selling part of our body parts fits with Canada's culture and values. 

My, oh my. My first reaction is what is Canada's CULTURE. Has anyone figured this out yet? My best guess on our culture is:

• Molson's Canadian beer commercial

Secondly, how do we reconcile Quebec's CULTURE and VALUES with the Rest of Canada (ROC)? In Quebec, selling plasma is illegal. In Manitoba it's been done for years. Now powerful forces want it to be the norm for the ROC.

MUSINGS
I view paying for run-of-the-mill plasma as anti-Canadian for 4 reasons.

#1. IT'S ANTI-CANADA's HEALTH CARE SYSTEM
Plasma and its expensive derivatives are definitely part of Canada's health care system. 

CBS spends much taxpayer money on plasma derivatives. The money goes directly to Big Pharma.

DOES THIS JIVE WITH CANADIAN HEATH CARE PRINCIPLES?

One thing that sets us apart from our USA neighbours, where plasma is routinely bought, is the Canada Health Act and its 5 principles. 

1. Public administration means its non-profit and run by a public authority (government).
2. Comprehensiveness means all NECESSARY services are covered.
3. Universality means EVERYONE is covered to an equal level. 
4. Portability means you can TAKE IT WITH YOU within Canada and when travelling abroad. 
5. Accessibility means REASONABLE ACCESS to services without financial or other barriers. 

These principles can be interpreted as Canadian culture and values. Where do commercial plasma collection clinics - which would become part of our health care system - fail to meet Canada's values?

Simply put, commercial plasma clinics fail because they go against the spirit of the Canada Health Act in that they are for-profit. 

We already pay mega-bucks to private firms (Big Pharma) for IV immunoglobulin and a myriad of other plasma derivatives. 

Today, CBS, Health Canada, and patient advocacy groups like the Canadian Hemophilia Society propose to add to commercialization of our blood supply by allowing plasma clinics to pay the poor for plasma and re-sell to Big Pharma at a profit. 

#2. IT'S HYPOCRISY
Commercial plasma collection clinics fail because they create a HYPOCRITICAL situation.

If paying for plasma is acceptable, why not allow paying for whole blood donations? How about paying for other tissues like skin? How about paying for organ donation? 

Plasma is no different than any other body tissue. To say otherwise would surely be HYPOCRITICAL.

But wait - I can hear the protests. Plasma derivatives are different than other body tissues and organs. Besides screening donors with questions and near fool-proof infectious disease testing, plasma derivatives undergo a manufacturing process guaranteed to wipe out viruses and bacteria. 

Oh, I get it. If we can nuke other body tissues and keep them viable, then it's perfectly acceptable to pay for them too?

#3. IT UNDERMINES VOLUNTARY BLOOD DONATION

Commercial plasma collection clinics fail because they undermine our volunteer blood donor system. Forget that volunteer and paid donors co-exist in the USA. The USA has always been more business, for-profit, oriented than Canada. 

When it comes to private health care and making a buck any which way, Canadians are 'just not that into it.'

• Payment for blood donors comes to Canada

Dr. Lois Shepherd of Queen's University in Kingston, Ont. and past-CSTM President, is dismayed by the move away from the altruistic donation model previously embraced in Canada. She considers the safety concerns surrounding volunteer versus paid donors to be somewhat moot since all blood is thoroughly checked for transmissible diseases.

"For me, the bigger concern is that we do rely on volunteer blood donors in Canada, and if we're attracting younger people to be paid donors as plasma donors they are going to be pulled out of a population of people that might potentially be committed red cell whole blood donors."

Shepherd noted that Canadian hospitals are top users worldwide of drug products derived from plasma and demand is constantly increasing. She said it's hard to watch the voluntary system be "nibbled away."

#4. IT EXPLOITS THE POOR 
To me, paying for plasma or any body tissue and organ is wrong. Why? 

Because paying exploits the vulnerable. Oh, advocates can claim it's just university students earning a few extra bucks, perfectly harmless. But to the poor who donate plasma, it's exploitation, plain and simple, similar to medical tourism.

Sadly, medical tourism now flourishes:

• Medical Tourism: the Reality, the Challenges 
• The state of the international organ trade: a provisional picture based on integration of available information

Do Canadians want to pay for plasma donations? Since we accept plasma derivatives from paid plasma donors elsewhere, must the answer be Yes to avoid the hypocrite label?

Many of my colleagues are likely to acquiesce to the big kids on the block, who not only support it, but actually pimp for paid plasma. 

Prevailing orthodoxy says, get on board. Why fight the inevitable?

My view is that “Lost causes are the only ones worth fighting for” as Jimmy Stewart's character intimates in the classic film, 'Mr. Smith Goes to Washington.'

BOTTOM LINE
Paying for plasma is no different than paying for any body tissue. Is this where Canadians want to go? 

Blood, plasma, and any part of the human body should not be a commodity. To commercialize it, cheapens us all.

Nothing wrong with entrepreneurs. Canada has many. But their main benefit is to create a significant number of jobs and increase government tax coffers, so that the entire society benefits, not just company shareholders, 

Plasma clinics don't do that. Rather they suck money from tax payers to Big Pharma. The number of jobs created is minimal. 

It's all about the GOLD, not the heart of gold.

FOR FUN
Canada, like the UK, and other Commonwealth countries, has a strong history of volunteer blood donations. We take pride in our tradition of believing the role of government is to ensure the good of all. We know that our citizens care for each other and do not need monetary incentives to do the right thing.

The sentiment is epitomized by Neil Young's Heart of Gold.

I want to live,
I want to give
I've been a miner
for a heart of gold.

It's these expressions
I never give
That keep me searching
for a heart of gold
And I'm getting old.

FURTHER READING

• Mcleod J. Is it ethical to pay blood donors? (blog) (15 Apr. 2013)
• Rodriguez del Pozo P. Paying donors and the ethics of blood supply. Journal of Medical Ethics 1994; 20: 31-35.
• The Canadian Bioethics Companion. Chapter 7: Organ Donation

As always, comments are most welcome.