Yes! We spot idiots!

But one pending sale particularly chills the blood. Plasma Resources UK was set up after a bout of deregulation in another sector, cattle feed, gave rise to mad cows and variant CJD, and so meant certain blood-based products could no longer be safely sourced from British donors. The outfit buys American plasma, and supplies it to the NHS as well as exploiting various derivatives globally. Lucy Reynolds of the London School of Hygiene and Tropical Medicine writes of infection risks, including HIV and hepatitis, that the profit motive could encourage plasma collectors to run. Sufficiently smart regulation might over-ride these dangers – so long as it can be devised.

Blood donation is a classic case study for behavioural economists. Donating for no reward provides a warm glow, but pay for it – or profit from it – and that glow disappears. Donations from the healthiest can dry up, while blood flows in from cash-strapped addicts and others. Plasma Resources\’ sale does not directly subvert British donations, but it could retard the World Health Organisation-endorsed objective of national self sufficiency, a goal that gives the best chance of keeping blood and money apart. It is the kind of point Whitehall\’s \”nudge unit\” might have made – had it not recently been put on the market.

Sigh.

Paying people to provide the blood does indeed seem to be a bad idea. It\’s one of those areas where the cultural or social reinforcement of \”doing the right thing\” really does appear to work.

Hurrah!

Which is why no bugger is suggesting that this should change.

Interestingly, we\’ve even got experimental evidence to support this. The US at some point started labelling blood as being from paid donors or from donations. There was a massive market move to preferring the donated blood: it was considered (and almost certainly was) to be of higher quality. As an aside, an interesting example of markets providing a flight to quality rather than a race to hte bottom.

With this of course no one is suggesting an expansion of the paid collection industry.

But whether the people who handle the blood, once collected, should be operating for profit or not is an entirely different questions. Agreed, you can argue it either way, whichever way you like in fact. But it is a very different question.

And only idiots would fail to make the distinction.

As to \”national self-sufficiency\”. Oh Aye? Why in hell did that become a goal? And how well is it going to work in places with 30% HIV in the population for example? Or even, with CJD potentially at large, which is the reason for the setting up of this importing company in the first place?

15 thoughts on “Yes! We spot idiots!”

  1. Your quote from The Guardian doesnt appear as a quote on any of my browsers, it just looks like something you are saying.

  2. @ Tank
    Try the link Tim gave.
    The Grauniad rant is factually wrong as well – imports from the USA started because they had developed superior technology for processing plasma in which the NHS decided not to invest, preferring to purchase certain blood products from the USA. After scandals about infections in NHS patients from polluted blood products from paid US donors, the US supplier improved its sterilisation process.
    It predated and had nothing to do with Mad Cow disease.

  3. I used to donate blood when I lived in Oz. Then the CJD thing happened, and I was informed that my blood would no longer be required after a certain date.

    I went to donate about a month before the cutoff, and informed the nurse that I was about to become donor non grata. She cheerily said, that’s ok, we’re still within the time limit. It’s a good job CJD can read the calendar.

  4. john77: It’s true that US plasma is used because of fears about vCJD. (Plasma Resources UK itself was set up only a couple of years ago, amalgamating the UK and US operations.)

    However, blood plasma donation is not the same as blood donation – it takes longer, so plasma donors in the US are usually paid. So both the Guardian and Tim are discussing the wrong issue.

  5. @ PaulB
    I was a blood donor from the early 70s and a platelets donor in the 1980s – the Blood Transfusion service took blood and platelets from UK volunteers but imported plasma from the USA . This was before mad cow disease was a problem except for farmers.
    The BBC article to which you link is getting on for twenty years later and irrelevant. If the Grauniad rant is relying on it is is lazy and inadequate research.

  6. john77: I don’t know what was happening in the 70s, but in the 90s the UK was processing its own plasma for about half the blood products needed. We stopped using UK plasma in 1998 because of vCJD. The Guardian is right.

    Tim: there’s evidence that many donors would be put off giving blood if a profit were to be made from selling the blood products. The Guardian has got a point.

  7. PaulB is right—giving plasma is a process that takes between 1-2 hours and has more of an immediate effect on the constitution than giving a pint of blood. The “payment” is compensation for that time, and from my anecdotal experience lots and lots of American plasma comes from university students.

  8. @ PaulB
    Apologies for sloppy wording: “imported plasma” should be “imported much plasma” to avoid people inferring that I meant “all plasma”
    “for about half the blood products needed”
    The ones where we didn’t have the technology because the NHS thought it was cheaper to import blood products than pay the licence fee for the technology. As in the 1980s, maybe/probably a smaller number of products
    Inter alia Factor VIII (sorry took me a few minutes to remember, after not discussing it for thirty years, it was specifically Factor VIII that was the reason given me why the BTS required far fewer plasma donors than platelet donors). We stopped importing Factor VIII because someone invented new technology http://www.haemophilialife.co.uk/haemophilia-information/treating-haemophilia/development-of-treatment-452.aspx. It is just possible that the NHS would have got its economics right if a lot of UK haemophiliacs hadn’t been infected through contaminated blood.
    If the Guardian is right that we stopped using UK-sourced human plasma because of vCJD but continued using UK-sourced human blood donations then *someone* is nuts. It is wrong to imply that Plasma Resources was set up as a result of vCJD as it was an US company purchased by the UK government in 2002.
    PS All survey results are affected by the phrasing of the question: it has to be pretty slanted to get people refusing to donate because the transfusion service/company recovers its costs – the NBTS has to recover its costs if only out of your and my income tax but I haven’t heard of anyone refusing to donate on those grounds.
    Of course voluntary blood donations are better quality than purchased because the price of time is excluded and employers in London and other major cities feel obliged to give staff time off to bleed: higher-paid staff tend to be healthier (part cause, part effect) so getting them to volunteer is preferable to paying the poor.

  9. @ bella gerens
    So does platelets. My boss was a very decent guy and allowed me time off to go to Barts. We took it for granted that my constitution was up to it – I was in the company’s half-marathon team and continued running the occasional marathon (and some shorter races) for another twenty years.
    Healthy university students are a good source for blood or plasma donations and they have, outside lectures, very very flexible working hours (I once stayed up all night to read an interesting monograph before the deadline to return it to the library). However paying for my time in the 1980s would have been out of the question as my added value was a few hundred £ per hour.

  10. john77: Plasma Resources UK was incorporated in 2002, as a UK holding company for the newly purchased US plasma company DCI. So the Guardian is right about that. (PRUK in its current form was created at the end of 2010 by transferring to it the UK blood products lab BPL.)

    It’s true that we stopped using UK-sourced plasma as a result of vCJD, but continued using UK-sourced blood. There’s an explanation of sorts here.

    The Guardian doesn’t deserve to be bashed for this story, which is right on the facts. (It could fairly be chided for the nonsensical aside about retarding achievement of national self-sufficiency.)

  11. Incorporated is NOT the same as set up.
    I have to get up before 7 am – will continue tomorrow night

  12. So Much For Subtlety

    As to [national self-sufficiency]. Oh Aye? Why in hell did that become a goal? And how well is it going to work in places with 30[percent] HIV in the population for example? Or even, with CJD potentially at large, which is the reason for the setting up of this importing company in the first place?

    It makes sense to have national self-sufficiency in blood products because it prevents the rapid transmission of new and unknown diseases. HIV spread as rapidly as it did in part because blood was shipped all over the world.

    Presumably there are dozens of diseases like HIV or vCJD in the blood supply. As long as they do not kill rapidly, we are unlikely to know. I hope people do follow up studies of people who get blood, but those people, by the very nature of the problem they need blood for, will die earlier so it will be hard to spot the problem anyway.

    Still, in general, we do not want diseases like HIV spreading rapidly across the world. We would like them to remain low-level local problems. For instance Japan-s HIV/AIDS problem was almost entirely a product of imported blood from America that had not been properly treated. Iran and Iraq both claimed the same about French imported blood.

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