A Bloody Shame
by Howard Fienberg
The American blood supply is in a stranglehold. The U.S.
Food and Drug
No trace of nvCJD has ever been
found in the
Two years ago, the Food and Drug Administration (FDA)
banned Americans who have spent more than six months in
Is this sound policy-making? There is still no evidence
that nvCJD can spread via blood transfusion.
Indeed, a special council of the American Medical Association concluded three
years ago that "epidemiological studies show no evidence that
transmission can occur through blood." Further, while many researchers
agree that mad cow disease is linked to nvCJD, they
do not know how. No one knows quite how the disease can get transmitted. Does
it take one mad cow-infected hamburger or years of continuous beef-eating? We
have no clue. Why did the millions of Britons who ate tainted beef in the
eighties only result in more than a hundred cases of nvCJD?
We have no idea. And what about the similar lot of American eaters of British
beef (before it was banned in 1989), when not one nvCJD
case has appeared in the
Overall, if there is any risk, it is probably low. A little over a hundred people have died from nvCJD. If the disease lives up to its earlier media hype, these victims could just be the tip of the iceberg. But recent projections depict a relatively limited threat to public health - it is possible that the disease could top out at less than a few hundred cases.
If the risk of nvCJD to the
blood supply is entirely theoretical, how can we decide whom to bar from
donating blood? With the bovine version of mad cow disease all but eliminated
from the British landscape, when can we mark a cut-off for the risk there?
The most recent FDA and Red Cross proposals were spurred by small outbreaks
of mad cow across
The precautionary principle, invoked to justify destroying a significant part of the nation's blood cache, dictates that it is better to be safe than sorry. But risks must be balanced; swerving to avoid one risk usually sends you careening into several more risks you might not have considered at first.
Jeanne Datiotis, president of America's Blood Centers, explains that the "greatest risk to the blood supply is not having enough," and that continues to be our problem. On the demand side, more surgeries and an ever-graying populace lead to ever-increasing demand. Meanwhile, on the supply side, although some 60 percent of Americans are eligible to donate blood, less than 3 percent do (not counting the temporary surge in donation after 9-11). The increasingly harsh bans on donors seem to target older, well-traveled donors, who are also traditionally the most reliable ones. New donors are hard to find and expensive to attract. But more importantly, they can carry all sorts of diseases, which we know to be transferable (unlike nvCJD). According to estimates from the American Association of Blood Banks, about 25 per 10,000 blood donations test positive for hepatitis C, between 9 and 17 per 10,000 test positive for HIV, and about 6 per 10,000 test positive for hepatitis B.
The impact of the blood bans is already being felt. The
Wary of repeating past mistakes with the blood safety, like the spread of AIDS, the FDA and Red Cross have become blinded by hyper-cautious instincts. Proper caution should derive from a reasonable assessment of cost and benefit, not the insane fear of poorly-understood risks. While we can't expect good sense from an organization that collected far more blood that it needed in the wake of 9-11 and ended up having to discarding most of the proceeds, we should expect more thoughtfulness from our federal authorities.
If a case of mad cow were one day found in the
See the original: http://www.tcsdaily.com/article.aspx?id=110402C
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