Sweet Dreams (Musings on a recent transfusion-related nightmare)

Updated: 28 Feb. 2015 (see CBS's Dr. Sher audio clip at end)

February's blog derives from news items in TraQ's monthly newsletter that resulted in my dreaming from a 'what if' perspective.

The title derives from a Eurythmics ditty that I've used several times before. Was reminded of it again from this Twitter post from @SantaCruzbio:

For links to news items and resources, see Further Reading at the blog's end.

I HAD A DREAM 
Dreamt I was a Canadian who had a blood transfusion in 2018 and contacted a debilitating, deadly disease. Turns out 1000s of folks around the globe got the same transfusion-associated disease and many died within a few years before they discovered a treatment that works for many, but not all, and not forever. 

THE DISEASE
The disease I contacted was named 

• Arrogant Scientific Syndrome by Highly Analytical Tossers after those who allowed it to happen (ASSHAT for short). 

At first ASSHAT appeared in homosexual and bisexual males, so was deemed sexually transmitted and soon it showed up in IV drug abusers, presumably via contaminated needles. 

Hence, the perspective developed that it was the victim's fault - THEM - and wouldn't affect WE- those of us outside those groups. In other words, the typical WE-THEY bigotry. 

I DREAMT THE NEWS TODAY, OH BOY...
In my dream, here are but 6 things that happened in Canada, and no doubt occurred elsewhere, given that government bureaucrats, medical administrators, and physicians (sometimes the same individuals wearing different hats) are similar the world over.

1. The transfusion medicine community naturally denied ASSHAT was transfusion-transmitted until the evidence was overwhelming. They knew the blood supply was safe, so much safer than before. After all, the new transmissible disease test for hepatitis B had been implemented ~10 years ago. We felt safe.

2. At first the blood supplier chose not to screen out high-risk donors for fear of blood shortages, aided by interest group lobbying.

3. The blood supplier and its government funders were so concerned about saving money that they cut corners, in secret, of course. Specifically, they chose

• Not to purchase a safer blood product for hemophiliacs in order to use up contaminated inventory, apparently thinking they were likely already infected, so what the hey! Or perhaps they thought better to give contaminated products than none at all, given the dangers of severe bleeding? Maybe they thought they were leveraging existing inventory to save money. Who knows?
• To delay implementing a test for ASSHAT because money was tight.

4. Someone, who knows who or how, destroyed key documents, minutes of meetings) of the Canadian Blood Committee. This group influenced, if not outright decided, most of the above decisions.

5. At an individual level, a paternalistic physician chose not to tell an older man's wife that her husband was ASSHAT-positive because the physician was sure they were not having sex. No doubt he thought he was being kind. Wrong! The wife came down with ASSHAT and sued the physician, which is how we found out about it.

6. Ultimately, police laid 32 criminal charges against senior scientists at Health Canada, the Canadian Red Cross Society and Armour Pharmaceutical Co. Guess how many were convicted?

OUTCOME
In Canada a commission of inquiry was set up ~12 years later in 2030 and completed its report in 2034. That was 16 years after I contacted ASSHAT. 

But I was one of the 'lucky ones' who was still alive. And I benefited because the federal government  offered $120K in 'humanitarian assistance' in exchange for a promise we would not sue. The provinces later offered $30K/year for life. 

Those who got variant ASSHAT, resulting from the blood supplier failing to use surrogate tests used in the USA, threatened to sue for equal treatment and the government paid out millions of dollars. 

Many of those affected by both diseases died before compensation was available. Sometimes I suspect maybe that was the idea.

Then I dreamt that I was British and had a worse nightmare. The inquiry into ASSHAT offered only one wimpy recommendation after 6 years of inquiry, held more than 25 years after the ASSHAT tragedy. I had died by then.

LEARNING POINTS
Think what happened in my horrific dream couldn't happen, that it's just too far out, too sci-fi? Think again. It already has. Think it couldn't happen again? Why? The physicians and blood administrators who made the decisions decades ago were smart, caring people. But not infallible when confronted with financial constraints, interest group lobbying, and political pressure.

Canada was one of the few, maybe only, countries that held an extensive legitimate inquiry into what is typically called in the media, the tainted blood scandal. 

Canada's Krever Commission had 50 recommendations. The first was to compensate victims. Recommendation 2:

• Blood is a public resource.
• Donors should not be paid.
• Sufficient blood should be collected so that importation from other countries is unnecessary.
• Access to blood and blood products should be free and universal.
• Safety of the blood supply system is paramount.

But apparently paying blood donors is now okay, at least for plasma, because we are so much smarter today and our technology is so much better. Sure it is. 

As always the views are mine alone and comments are most welcome.

FOR FUN
I chose Sweet Dreams as the music for the blog because it's ironic. My dream was not a Sweet Dream but rather a nightmare. Nonetheless, I love this ditty:

• Sweet Dreams [are made of this] (Annie Lennox, Live 8, Hyde Park, London, 2005)

Sweet dreams are made of this.
Who am I to disagree?
I travel the world and the seven seas
Everybody's looking for something.

Some of them want to use you.
Some of them want to get used by you.
Some of them want to abuse you.
Some of them want to be abused.

Thanks to Anonymous (see Comments below) for link to this video by CBS CEO Dr. Graham Sher:





Also thanks to Anonymous for 

• Audio clip (~10 mins): CBS CEO Graham Sher's interview (CBC, The Current, 25 Feb. 2016) 
• Transcript of interview
• Apparently, the manufacturing process for plasma derivatives kills anything and everything. Why even test plasma collected for fractionated products? Maybe the price of IVIg would come down?

FURTHER READING

• Videos
• If you watch only two, watch 
• The tragedy of FVIII concentrate (1994:19 mins 14 secs)
• Canadian Red Cross denies link between AIDS and blood products (1984:2 mins)
• And the band played on (Must watch movie - 2 hrs 21 mins)
• Canada's Supreme Court: Krever Commission can lay blame (1997: 2 mins 27secs)
• Canada: After 18-mth trial, judge rules "no crime" in actions of 4 doctors and U.S. pharmaceutical company (2007: 2 mins 57 secs)
• All acquitted in tainted blood scandal  (news item)
• NS, Canada, first to compensate victims (1993: 2 mins 34 secs) 

Canada

• If you read only one item, read this:
• Krever Inquiry (Andre Picard, 2006 (edited 2014), The Canadian Encyclopedia)
• Recent news
• Paid plasma clinic officially opens doors in Saskatoon (18 Feb. 2016) | CPR will pay donors $25 for plasma
• Op-ed: Plasma donation system needs vigorous debate (18 Feb. 2016)

• Krever Commission: Final report. Commission of Inquiry on the Blood System in Canada (1997)
• Volume 1 (For overview)

• Tainted-blood compensation incomplete as deadline nears (2010)

UK

• Background: 
• What is the Penrose Inquiry? (Mar. 2015)
• Key questions in Penrose Inquiry (Mar. 2015)
• Penrose Inquiry - Report (25 Mar. 2015)
• One recommendation: That the Scottish Government takes all reasonable steps to offer an HCV test to everyone in Scotland who had a blood transfusion before September 1991 and who has not been tested for Hepatitis C Virus.
• Contaminated blood victims ‘left to beg for compensation’ (Jan. 2015)
• Penrose report: Blood scandal inquiry branded a ‘whitewash’Contaminated blood scandal financial moves needed urgently, committee told (9 Feb. 2016)