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

• Vet accused of secretly keeping family's pet alive for blood transfusions

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

• Canadian Society of Transfusion Medicine 2014 award winners

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)

• How to make fake blood cuts 

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

• Big pharma's relationship with your doctor needs some U.S.-style sunshine

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

• CBS CEO Graham Sher: Purchased plasma safe,essential 
• The article is in response to Payment for plasma bad policy 

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: 

• Twisted business of donating plasma for money (The Atlantic, 28 May 2014)

6. So sad

• Passing of George Garratty, March 17, 2014

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. 

• See 2012 interview

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: 

• Ontario Plasma Coalition (press release 13 May 2014)

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
• [See BC PBCO 'Intravenous immune globulin', including order forms]
• Total Plasma Protein Products program expenses increased to $469.5 million in 2012/2013 
• [See trends and usage information by provinces on CBS site]

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:

• Phase 3 trial of IVIG to treat Alzheimer's Disease

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

• List of current corporate affiliates
• Benefits of corporate affiliate program

FOR FUN
To follow-up on the 'so' theme, enjoy these renditions of a popular jazz ditty from long, long ago:

• C'est si bon (Eartha Kitt's French version)
• C'est si bon (Louis Armstrong's English version)

As always, comments are most welcome.