by Ray Deonandan
This article first appeared in BioScan magazine in March, 2000, under the title “Response to Uncertain Risk – Using Deferral of Blood Donors As a Case Study”. It is reproduced here with the author’s permission.
Creutzfeld-Jakob disease (CJD) is an untreatable prion pathogen that Dr. Neil Cashman of the Centre for Research in Neurogenerative Diseases wouldnt wish upon [his] worst enemy. Dr. Cashman presented some of the science behind this terrifying disease at the last Toronto Biotechnology Initiative (TBI) breakfast meeting, citing his support for the Canadian Blood Services (CBS) new policy of banning UK donors for fear that some of them are CJD carriers.
Also present was Dr. Durhane Wong Regier, a founder of the CBS who left the organisation in protest over this new policy which she characterised as having introduced a real risk to defer against a hypothetical risk.
The recent outbreak of BSE (a bovine form of CJD) infection in UK cattle, resulting in the slaughter of more than a million animals, and in the deaths of 48 Britons who had supposedly ingested tainted beef and thus acquired a variant of CJD, prompted the CBS to change their donor policy to prohibit donors who had spent, in Dr. Wong Regiers words, an arbitrary time in the UK.. In seeming support of Dr. Wong Regiers declaration of arbitrariness, both Drs. Cashman and Penny Chan, the sessions emcee, agreed that the extent of the UK stay was determined by extrapolating its impact upon the blood supply, and not by measuring the incubation period of the prion.
While Dr. Wong Regier insisted that the policy did more measurable harm than good, Dr. Cashman felt that the CBS action was a reasonable and responsible thing to do, faced with a threat for which the science is unclear. But, countered Dr. Wong Regier, is this truly the best way to balance a hypothetical risk against the known risk of a depleted blood supply? She pointed out that it will cost the federal government $19 million to replace the diminished blood supply: money that could be spent to address known, quantified risks. The result, she claims, is that the reduced blood supply and re-directed funds would constitute a greater threat to Canadian health than would an unsubstantiated threat of CJD contamination, a disease for which there is as yet no evidence that humans can be infected via blood transfusions.
The Wall Street Journal called the CBS decision Mad Regulatory Disease, and the policy was widely chastised across the USA. However, in the days after the TBI meeting, the FDA announced that it was considering similar steps for its blood supply. As noted by all the TBI presenters, in a litigious environment such as ours, doing nothing is often politically more risky than doing something, even the wrong thing. Hence Dr. Wong Regiers insistence that the CBS policy –and, one might assume, the subsequent FDA policy were pressured political decisions made by those who had a commitment to act reasonably, not politically.
One of Dr. Chans slides best summarised the potential damage this policy may wreak upon our blood supply: over 30% of Canadian donors have travelled to BSE/CJD countries since 1980. But, since the horrors of HIV and hepatitis wrought by faulty Red Cross policies upon Canadian transfusion recipients, public sensibilities are delicate with regard to the safety and purity of donor blood.