Raise the Hammer

Good piece about a bad idea.

The Star covers this here :
http://www.thestar.com/life/2013/04/12/should_federal_and_provincial_regulators_allow_plasmaforprofit_clinics_to_operate_in_canada.html

The background to this story, which lies in the HIV epidemic ( and its hepatitis C shadow) is provided by Jacques Pepin in The Origin of Aids (Cambridge 2011). This is among the best works of history I have ever read. Pepin is professor in the Department of Microbiology and Infectious Diseases at Sherbrooke. He recruits and considers many kinds of evidence to produce plausible hypotheses of the emergence of the viral agent of the disease, its amplification in its human hosts and its eventual worldwide transmission. Many of Pepin's conclusions are probabilities only, though well supported. This is not the case with most of his chapter on the Blood Trade, in which he explains that the infection of haemophiliacs was only a portion of the problem. Also infected were the donors whose plasma had been processed to supply them.

Stated with maximum simplicity, this situation arose because of the development of a process called plasmapheresis, by which plasma - valuable for its many proteins - is separated from whole blood. The blood cells are returned to the donor along with fluids. This enables the donor to give plasma again within a few days or a week. However, this also meant that infectious agents could be transferred not only to the recipient of some part of the plasma, but also between donors if there was any lapse in equipment cleaning procedures. Accordingly, Pepin reports

"The first well-documented epidemic of HIV-1 among paid plasma donors occurred in a poor suburb of Mexico City where, in 1986, 281 donors were found to be HIV-infected, especially those that sold plasma ten or more times each month. Re-utilisation of blood collecting material was blamed. At the time there were thirteen plasmapheresis centres in the country, mainly in Mexico City and in states near the Texan border. Most donors were young men living in the per-urban shanty towns. They could sell their blood as often as every two to three days. By the time that the sale of plasma was prohibited nationwide in 1987, 7% of 9,100 paid donors were HIV-infected. In one of the plasmapheresis centres, HIV prevalence increased form 6% in June to 54% in November 1986. Other outbreaks among paid plasma donors were reported in Valencia, Spain and Pune, India...These outbreaks...were dwarfed by what happened in China in the early 1990s...There were several hundred plasma collection stations set up by blood product companies. In the most heavily affected provinces...approximately 250,000 paid donors acquired HIV. "

Yes, you read that right. 250,000.

Meanwhile, back in Haiti, a plasmapheresis centre operated by American investors and Luckner Cambronne, the head of the Tontons Macoutes, Duvaliers private militia, was exporting a maximum of 6000 litres a month to the U.S. from May 1971 to October 1972. When Cambronne was forced into exile by intrigues in Baby Doc's court, some of the shortfall in the supply was taken up by an outfit owned by Nicaraguan dictator Anastasio Somoza, which became the largest plasma collection facility in the world, processing up to 1,000 donors a day.

According to Pepin, "During the heyday of the plasma trade in the early 1970s, plasma was bought in at least twenty-five developing countries to be exported to pharmaceutical companies in the industrialized world. Apart from [Mexico, Haiti, and Nicaragua] the list included Belize, Brazil, Colombia, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Puerto Rico, Taiwan, Thailand and even African counties such as Lesotho."

This is the crux, I think. Reportedly, Canada gets some portion of its current plasma needs from the States. What can this mean? Since living conditions are very similar in both countries, presumably the U.S. has the same per capita plasma needs as Canada, so how can there be a U.S. surplus for export? Because payment allows it to be tapped? But who is being tapped, and what happens to them if something goes wrong? What if plasma demand in the States goes up, and increased payments are not enough to maintain the exportable surplus? (This is pretty much a sure bet. Better option your plasma futures today. The income stream will allow you to purchase your health care services in the future. Ain't capitalism wonderful?) Suppliers will of course be seeking approvals to collect from wherever there are probable sellers.

Apart from the secondary problems of safety and security of supply arising from error and fraud, there is the primary question of responsibility. Shouldn't Canadians be responsible for our own health care, rather than outsourcing the supply of parts? If Americans or Mexicans or Haitians or whoever are shipping out plasma rather than using it within their own health care systems, doesn't it mean that there is something wrong with those systems?