Thursday, December 28, 2017

Look what they done to my song (Musings on how paid plasma mirrors Rumpelstiltskin)

Updated: 6 Apr. 2022
When I was a small child my grandmother always read me fairy tales and later had books for me to read. One of my favorites was Rumpelstiltskin originally published in 1812 by the Brothers Grimm, Jacob and Wilhelm (Further Reading). Since then the story has undergone many variations.

For the holiday season it seems appropriate to write a feel-good blog and I've done that in past years. (Further Reading) But recent news items made me think of Rumpelstiltskin. At its heart it's a fairy tale about greed and those who happily exploit others for personal gain.

What follows is my transfusion-related version of Rumpelstiltskin. Recall that fairy tales are often filled with scary, gruesome violence but somehow children thrive on them. Perhaps they're a way of exposing children to anxiety, fear, sorrow, and surprise and let them come away with new tools for managing their emotions?

Keep in mind that fairy tales are medieval (even prehistoric) morality tales and morality features in my Rumpelstiltskin tale. Of course, fairy tales derive from compelling stories told and retold over many centuries that have survived without being written, until folks like the Grimms put them on paper (Further Reading).

The blog's title derives from a 1970 ditty by Melanie Safka, known professionally as Melanie.

There's no executive version. Why read the blog? I hope it resonates with all transfusion professionals. If you disagree, I'm delighted and would love to see your comments. But you need to read the fairy tale to appreciate its meaning as a gestalt.

Once upon a time there was a poor man in America who had a beautiful 18-year old daughter. His wife had died years ago and he struggled to support himself and his daughter and worried how he'd pay for her upcoming post-secondary education.

Now it happened that he read an advertisement by a paid plasma collection company and saw that his daughter could transform her plasma into gold.

He couldn't donate because he didn't meet donation criteria, specifically he had spidery veins and blood draws were difficult. He called the blood collection facility and, to make an impression, he said, "I have a young daughter who can become a lifelong plasma donor."

The representative replied, "Great. If your daughter is as you say, then bring her to the plasma collection center tomorrow and we'll put her to the test."

When the girl went to the plasma collection facility, a staff member greeted her and asked for a current, valid photo ID, proof of her Social Security number, and proof of her current address. Then she underwent the standard process, as outlined in the example in Further Reading.

Even though she was afraid, she completed the online questionnaire and eventually donated her plasma, knowing she would please her Dad and would be able to pay for her own education. She vowed to do her best to transform her plasma into gold.

After multiple donations, because she could not afford protein-rich food, the young woman's protein levels fell below eligible plasma-donor criteria. It was then that her father introduced her to Mr. Rumple Stiltskin, a short man full of energy, indeed the prototype of an entrepreneurial hustler. Mr. S. said, "If plasma donation is kaput, I can help you transform your stem cells into gold. But I need a payment in return. What will you give me?"

"A body organ," said the girl, after thinking long and hard. She had a friend who donated a kidney to her brother, a living, directed donation, and the friend was doing well with one kidney.

Rumpel got her hooked up with a brokerage company overseas that brokered tissues and body organs for clients worldwide. The clients bought stem cells and used them to treat all sorts of conditions, even those for which evidence did not exist. But they touted themselves as helping patients, and who knows, maybe sometimes they did. Certainly they had many sports and entertainment celebrities praise their stem cell and platelet rich plasma injections as 'miraculous'.

She was paid a pittance for her stem cells compared to what recipients paid, but it helped since the plasma money-stream had dried up.

Later Rumpel came to collect on her promise. He said, "I'll harvest one of your kidneys. You'll earn a great deal for it. But in return I'll need another payment.'

The girl did not know what to do, but, now in too deep, and asked what she must do to collect her kidney money. I have nothing more that I can give you."

Rumpel replied, "Then promise me, whenever it happens, your first child."

Who knows what will happen, thought the poor man's daughter, Maybe I won't have a child. Not knowing what else to do, she promised the little man what he demanded. In return Rumpel once again paid for her body part, this time a harvested kidney.

A few years later, after graduating from college and getting a well paid job in Silicon Valley that supported her and her father, she met the love of her life. Within a year she delivered a beautiful child into the world. She had forgotten all about  the little man, Rumpel, but suddenly he appeared in her hospital room and said, "Now give me that which you promised."

She was frightened and offered the little man all the money she had saved if he would let her keep the child. But Rumpel said, "No. Something alive is dearer to me than all the money you now have. This kid will be a gold mine of body tissues and organs."

Then the young woman began crying so much that the little man uncharacteristically took pity on her and said, "I will give you three days. If by then you know my real name, then you shall keep your child." Of course, he felt certain she could not.

She spent the entire night thinking of all the names she had ever heard. Then she did a Google search on what names existed. When Rumpel returned the next day she showed him a huge printout of all the names she had retrieved. The little man scanned the pages and said, "None of these is my name."

The second day she sent inquiries to her Facebook, Instagram, and Twitter accounts as to what unusual names existed. Finally, she recited the oddest and most curious names she'd heard of to the little man.

But he always answered, "That is not my name."

On the third day someone on Twitter replied that he saw a comical little man in front of a house on his street dancing and chanting:
Today I'll bake; tomorrow I'll brew,
Then I'll fetch the new child,
It is good that no one knows,
 ____________ is my name. 
You can imagine how happy the young woman was when she heard that name. Soon afterwards the little man came in and asked, "Now, Madam, what is my name?"

She first asked, "Is your name 'Plasma for Humanity'?"
"Is your name 'If it Saves Lives It's OK'?"
"Is your name perhaps, 'First We Take Paid Plasma, Then We Take It All'?"

"The devil told you that! The devil told you that!" shouted the little man, and with anger he decided he needed to expand outside the USA.

 He set his eyes on the Great White North, Canada. Sure it was the land of universal health care, but these sappy socialist suckers could probably be sold anything if packaged right.

He concocted his plan of attack and called it 'The 7 Habits of Highly Successful Plasma PACs'. After all, he wanted to create a well funded, coordinated lobby group to influence decisions made by Canada's government on paid plasma. And plasma would be but the first step of many body tissues and organs.

1. Get well meaning stooges to tout the benefits of paid plasma. Probably right-leaning provincial politicians and the odd academic or two.

2. Pump up how Canada needs a more secure supply of plasma. A supply chain dependent on the USA has never been more at risk, given its current POTUS. He breaks long-standing negotiated international agreements in a New York minute. His protectionist, America first rhetoric suggests he's happy to tell the rest of the world to 'eff-off' so long as he can crow (tweet) to fans that he's made America great again, whatever that means.

Plus, of course, the Canadian dollar, with a fluctuating exchange rate vs the U.S. dollar, lately not to Canada's advantage, presented a major risk of unexpected cost increases.

3. Have the plasma industry fund as many research projects as possible to create markets for plasma and its derivatives that don't yet exist. For example, it doesn't matter if platelet rich plasma or IVIG works or not for a particular condition, so long as gullible, suffering folks think it might.

4. Encourage paid-plasma acolytes to fear monger. Promote that without an ever-increasing supply of plasma-derived products, 1000s of folks who depend on them will die. Make sure that patient groups funded by paid plasma's Big Pharma, and reliant on its plasma-sourced derivatives, see this as true. Post-truth arguments that play on emotion trump reality every time.

5. Get Health Canada to set up an Expert Panel to validate paid plasma as a good option under the guise of assessing the security and sustainability of Canada's immune globulin product supply. Be sure to have respected Canadian physicians on the Panel as well as U.S. reps, preferably someone with shares in Big Pharma.

6. Have the Panel apply the sexy, scientific 'risk-based decision-making framework' to the paid plasma issue and security of Canada's supply. (Further Reading) That's sure to clinch the argument.

7. Make the Panel's proceedings un-transparent and as hard to follow as possible. No need to upset the natives with what's truly happening. There's even a Canadian precedent. During times of regionalization and centralization, hospitals often kept staff in the dark because the powers-that-be didn't want to upset them, believing the 'poor little dears' couldn't handle the truth.

ORGAN TRAFFICKING  (See Further Reading for links)
Organ trafficking hasn't gone away, it's likely become more common. In 2007 the WHO published a paper on international trafficking in body organs. Excerpt:
The most common way to trade organs across national borders is via potential recipients who travel abroad to undergo organ transplantation, commonly referred to as “transplant tourism”....
“Transplant tourism” involves not only the purchase and sales of organs, but also other elements relating to the commercialization of organ transplantation. The international movement of potential recipients is often arranged or facilitated by intermediaries and health-care providers who arrange the travel and recruit donors. The Internet has often been used to attract foreign patients. Several web sites offer all-inclusive “transplant packages” – the price of a renal transplant package ranges from US$ 70 000 to 160 000 (Table 1).
The Middle East is increasingly a hot spot for the body organ trade. See 'Meeting an organ trafficker who preys on Syrian refugees' below. Here's an associated 2 min. 36 sec. video:
See Further Reading for more. 

Will Rumpel's Plasma PAC Plan work? Will my Rumpelstiltskin fairy tale come true? Or am I mistaken? Time will tell.

Musings: Is all change good? Selling plasma strikes me as morally wrong. Not just that it inevitably exploits the poor and earns Big Pharma $billions (spins plasma into gold) but that it diminishes us as humans when our body tissues are bought and sold (marketed) as commodities. And once you start it's a slippery slope. If plasma, why not stem cells? If stem cells, why not organs like kidneys? If body organs, why not everything?

As noted, organ trafficking flourishes today and involves live donors and recipients wealthy enough to travel and pay. And even once dead, your body parts have buyers. See 'The Chop Shop' in Further Reading below.

This song was written and recorded by Melanie Safka 47 years ago for her 1970 'Candles in the Rain' album. The ditty fits the blog because it expresses how I feel about the blood system I've worked in all my life and loved, and is now changing in ways I thought it never would.
I love this song for its clever lyrics:
Look what they done to my song, ma.
Look what they done to my song.
Well it's the only thing
That I could do half right
And it's turning out all wrong, ma.
Look what they done to my song.
Look what they done to my brain ma
Look what they done to my brain
Well they picked it like a chicken bone
And I think I'm half insane ma
Look what they done to my song.  
Wish I could find a good book to live in
Wish I could find a good book
Well if I could find a real good book
I'd never have to come out and look at
What they done to my song
As always, comments are most welcome.

Fairy tale origins thousands of years old, researchers say (20 Jan. 2016, BBC)

Fairy tale of Rumpelstiltskin

First time plasma donors (one example of paid plasma process)

Health Canada: Expert Panel on Immune Globulin Product Supply & Related Impacts 
      Members of the Expert Panel

Trafficking in Human Organs: An Overview (21 Oct. 2020, Govt. of Canada)
Meeting an organ trafficker who preys on Syrian refugees (BBC, 25 Apr. 2017)
The body trade - Reuters series ('The chop shop')
 Human Trafficking (Global Investigative Journalism Network)
Search on Google for organ trafficking (56.9 million hits, 6 Apr. 2022)