Just Two Things...

We were thinking about how we could cover President Bush's announcement about Sudan and the also-major news about the Nigerian presidency, and we immediately knew who we needed to talk to and who you might appreciate hearing from...Dr. Jendayi Frazer. She's sharp, smart, knows her stuff and is, literally, on the move...

A fresh squeeze of behind-the-curtain juice:
We knew we wanted to talk to her, just didn't know where, how and when (you know, all the essentials...who needs them, right?). Guess you can say we were lingering between wishful thinking and actualizing the "get." The long-short? Fabulous Tell Me More head honcho (or honchette?) producer Marie Nelson was able to track her down and, as it turned out, she was actually in Africa attending the Nigerian president's inaugural festivities. But there was one condition to her talking to us — it had to happen "now," as in right then and there. Yeah, crazy I know. She wasn't cold about it at all, just one of those get-in-where-you-fit-in kind of situations...she has a robust calendar.

Of course, any interview deserves its fair share of preparation, but in this business, when someone says now or never...you go with what you know and the rest is on a wing and a prayer. Besides, what were we supposed to say..."Umm...sorry, Ms. Frazer. We'll catch up with you later"? Not! She's U.S. Assistant Secretary of State. A no-brainer there.

In the end, we thought it went well. You be the judge. Take a listen and let us know what you think...

Moving on to the FDA and gay blood.

One of our producers put us on to this story. Not that it was breaking news, but we were intrigued by the fact that for over twenty years its been widely accepted that any man who's had sex with another man since 1977 is banned from donating blood. Ever.

Thought this could prompt interesting (and, of course, mixed) thoughts, especially if you're a routine blood donor, or if you've ever received blood that is not your own. Across the board, everyone seems to agree that it's a matter of public safety. Few arguments there.

But I'm particularly interested in knowing what you thought about a point our guest, Joel Ginsberg, raised. He argues that heterosexual men or women — who in some cases, have an even more extensive sexual history than some homosexuals — are not held to the same degree of precaution, nor is their sexual promiscuity perceived as potentially hazardous as gays.

Just a note that we did reach out to the FDA on this. We haven't yet heard back from them (we might at a later time), but you can learn more about the policy here.

What are your thoughts on this?...On Ginsberg's arguments?

Told you this morning we had a good show in the works. I try and live up to my word...

Comments

 

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What about the window between exposure and detection? I do not believe the ban should be lifted. We should practice more conservation of blood products and encourage blood donations from donors who have no "history".

Sent by Brenda J. Ferguson | 11:35 AM | 5-31-2007

As always, this is a far more complex issue that the "sides" express. First, the prevalence of hepatitis and HIV various populations is the real issue, not what or who the populations are. Yes, SOME heterosexuals are much more promiscuous than SOME homosexuals--but the annual infectious disease incidence is the real point. A recent opinion piece by Arthur Caplan fails to recognize that it is NOT just HIV that is at issue, and the window period he refers to for HIV may be true, but there is a much LONGER window period for Hepatitis B, and this virus kills people too. Therefore, there probably is some middle ground that is reasonable. A male whose last male contact was in 1978 (or '87 or '96) and tests negative and has no OTHER risk factors is probably a safe donor. BUT, we don't have the data to quantify when such individuals should be allowed to donate. Is it one month,one year, two years, five years?

More logically, a study designed specifically to answer the question should be undertaken, and emotional opinion withheld until some data upon which a logical decision can be made becomes available.

We need to expand the donor pool, and irrational restrictions should be removed, but replaced with rationally determined restrictions, not limits determined in popular press in unreferenced writings.

Sent by Dennis Gastineau | 11:39 AM | 5-31-2007

There is always the window period to consider but what about the potential for errors and accidents within the collection process? Isn't there the potenial for exposure to the health care worker if an accidental needle stick were to occur? Although the screening process should rule out a potentially positive donor, is there absolute certainty that every donor is truthful or accurate when questioned? Can we also be certain that no errors will be made in the handling and labeling of these products before transfusing into a recipient?

Sent by anonymous | 12:44 PM | 5-31-2007

If a married couple, Shirley and Bob, each have sex with THE SAME MAN, Shirley may donate blood after 12 months. Bob, however, is permanently deferred (banned) from donating blood. I smell discrimination.

Sent by Tiffany Borrine, St. Louis, Missouri | 6:07 PM | 5-31-2007

I was not impressed that NPR did not address the true issue which underlies the current screening mechanism. I am a hemophiliac infected with HIV and HCV through the "first" blood disaster in the '80s. The real issue is that new pathogens are emerging all the time, and some may take the form of blood-borne pathogens. When a new blood-borne pathogen emerges, it will strike the same high risk populations that it always does. This was the the Gay community (which is why AIDS was originally call GRID (Gay Related Immune Defficiency), and why it also tends to first affect the intervenous drug use community (who exchange needles), who are also excluded for life.

If the Gay community had really been successful in changing their sexual behaviour, they would not be the prime source of new AIDS cases (still!), and more importantly, they would not evidence a higer degree of other less dangerous infectious risks, like STDs and LGV.

So all you need is a new pathogen that has a long incubation period, that these groups will contract, and then pass on to the blood using community (if the high risk groups are allowed to donate).

I don't want to be the guy who explains to these new victims that "well, we could have prevented it, but you know sexual discrimination and all, we did not wish to take a strong stance". "Sorry about that".

As for the American Red Cross and their ilk, these are the same losers who failed to take action to exclude these groups back at the beginning of the AIDS crisis, until finally Dr. Don Francis of the Centers for Disease control, banged his fist on the table and to paraphrase, said "Give me a number for blood-borne deaths you will be satisfied with, because everytime I come back to you, you say that is not enough to be conclusive. Just give me the number, and I will return then".

These organizations have absolutely no credibility on this issue, and it is surprising that memories fade so quickly (well, thank God, not at the FDA).

Depending upon the incubation period MSMs could have been involved in monogamous safe practices for many years, but if they picked up silent viruses (until a co-factor hits, or they finally become activated), when they were younger and more sexually active, the current monogamy is not much consolation.

Patients need the safest blood supply that they can achieve, and these exclusions help achieve it.

Finally, if I had told somebody in the late 1970s that I thought a strange monkey virus was going to mutate to humans, infect the blood supply, and kill millions. I probably would have been gently given a sedative.

Like I said, there will be other blood-borne pathogens and they will follow the blood borne routes (MSM, IDU and finally blood recipients if the change is made).

NPR should ask the patient groups what they think next time, it seeks to do such a one sided report.

Sent by James Kreppner | 7:07 PM | 5-31-2007

James--thanks for the tip about patient groups. We tried for several days to get the FDA to appear on the program, not sure why they declined--even dismissing the issue as not "newsworthy" (which I don't grasp since they published a detailed statement on their website, to which we linked on our site--and to which I referred in my questions-- seems to me they hoped somebody would read it. ) But I have to say: I understand the intensity of feeling on your part--to the degree I can without walking in your shoes---but I'm interested in why you're so quick to dismiss the report as "one-sided" when it's clearly a report on one side. Isn't that like criticizing beer for not being wine? And I appreciate Dennis for pointing out how complex an issue this is--I confess I had not given this issue a thought until my producer brought it up--and it made my ears perk up--for the record, the Red Cross hasn't wanted my blood in years--first because I traveled to funky places they didn't like, like East Africa--then because I was pregnant or nursing--and most recently--get this--because my heart rate was too high. YEAH it was high--I ran to the donation station because I had forgotten my ID, had to go back to get it, and was rushing to get there before they closed. all of which I explained. But they kicked me to the curb anyway. Go figure... Thanks to all who are refining our thinking

Sent by Michel Martin ( host) | 12:01 AM | 6-1-2007

Thanks for your response Michel. I did appreciate seeing it. With respect to your attempts to donate blood, the blood bankers are governed by detailed FDA regulations. Their actions really show nothing about the good intentions of the blood bankers who are required by law to abide by those standards.

Secondly, I thought that you would want to be balanced (I find that NPR usually is). Isn't that why you tried to have the FDA make an appearance? This issue has immense repercussions and if that is not explained from all sides, your listeners get a dangerous distorted picture. To use your analogy, it is not about beer vs. wine, its about whether wine is good or bad for you. If there is a disagreement, I think your listeners would like to understand both sides of the argument.

That being said, I recognize that you are completely right that there was no pretence that this was the full story. I sort of lost it in anger when I made the comment that you should fully consult the next time you wish to do a one-sided report. That was obviously an illogical statement. If you wish to be one-sided, then, of course, you will not fully consult. What I meant to say, was that the report was one sided and I thought you should have done a full story. I want to say "fair and balanced" but FOX has twisted those words to mean something completely alien.

Anyway, I apologize for going a little overboard (its because I know so many future lives rest on the outcome of this issue). You certainly did make a good faith effort to present the other side by inviting the FDA. Unfortunately, everyone keeps getting drawn to AIDS, when in fact there are much more serious issues to consider. I am not so sure the FDA might not have been totally focused on HIV as well, so it might not have been a big help anyway.

I think anyone going in for surgery or treatment for an accident wants only the safest blood, which is not an unreasonable request. The system exists for them, not for donors, who, while they are greatly appreciated, do not have a "right" to put others at risk.

I understand why you were excluded on the first two counts (pregnancy, nursing and potential Transfusion Related Lung injury in the recipient (TRALI -often deadly when it occurs) (caused by antibodies - I won't bore you with an explanation here, you can always look it up). I also understand the exclusion relating to certain countries.

However, on the last issue, the rule was put into effect to protect donors, but was clearly abused in this situation by blood collection staff who wanted to close the clinic. I mean they could have taken your heart rate 10 minutes later, when it would have been normal, if they had really wanted your donation.

Anyway, I apologize again for any unwarranted crticism. I am just very concerned that political pressure and half-pictures will yield a very dangerous change that people won't fully understand the implications of, and for obvious reasons, I don't wish to see a repeat of my situation in another 10-15 years (with something new).

Personally, I am safe these days because I no longer use a blood-derived product, and it is a genuine concern for others that drives me on this issue.

Thanks for listening.

Sent by James Kreppner | 6:24 PM | 6-1-2007

I am a blood service professional working in the UK, and was also a haemophilia physician in the 1980's when the AIDS issue, then Hepatitis C, became apparent. I had to tell a lot of my patients that they were HIV positive - perhaps this colors my view, but I make no apology for that. I am with James Kreppner on this one, and not especially because of HIV. Recent publications [Danta M et al. Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviors. AIDS 2007 May 11; 21:983-91.] suggest that Hepatitis C may also be an issue, and other publications have shown that some of these Hepatitis C viruses are mutants that may not become positive in the test we use for longer than the current regular viruses. Human herpes virus 8 is also associated with ???men who have sex with men??? behavior. I am also concerned that any new virus, unknown right now, could first appear in men who have sex with men. We wouldn???t know until too late, just like HIV. My colleagues in the US seem less concerned about this, and perhaps like Arthur Caplan are more anxious that the blood supply will run out. In the UK, where we also have problems with variant CJD as a transfusion issue, we are working as hard as we can to reduce waste, improve evidence for the appropriate use, and train staff in best practice. All of these should be addressed before we consider reducing the safety of the blood supply, even if the reduction in safety is hard to measure right now.

Sent by Ian Franklin | 3:51 AM | 6-13-2007

The is no such thing as "no history". Everyone that has had any kind of sexual contact with another person has history. If we eliminated history, we would would have mostly the priests left, and even that is questionable.

The more responsible position is to determine which type of history has the most relevance to disease transmission. Questions like: Have you had more than one sexual partner in the last week? month? year? lifetime? each will expose a different level of risk in both heterosexual and homosexual individuals. Each will result in the loss of potential donors, with the last question resulting in the greatest loss, but highest level of safety. Obviously, the quantity of the blood supply would be in jeopardy if we used "lifetime".

Better questions can improve the safety of the blood supply while also increasing eligibility, important as the population ages and there are fewer individuals in good health that can donate.

I think that a series of questions can be created that will track better with a risk model. Questions meant to identify the combination of intraveous drug use, diversity of sexual partners over short periods of time, and unprotected sex within the period it takes to seroconvert, would equally weed out high risk heterosexual and homosexual individuals.

Even if it turns out to be unequal, at least it will be risk based. Another benefit, every donor will become keenly aware of which factors that put them at risk of life threatening disease.

Many sexually hyperactive straight individuals do not know that they are at higher risk of disease contraction than homosexuals.

It is unfair to assume that a new virus will strike homosexuals first. West Nile, EEE, HPV, SARS come to mind. What is true is that new diseases are likely to strike individuals with close (or intimate) contact with a large concentration of the vector. While many assume it to be gay men, in reality, it is often sexually active individuals that are the vectors.

Sent by anonymous | 4:51 PM | 7-18-2007

I don't know if anyone will read up on this It looks like this has been up for a couple months since anyone has looked at it but, there is a test that cuts the window down remarkably. The new NAT (nucleic acidic test) can pick up HIV/AIDS and hepatitis within the first two weeks of a person coming in contact with the diseases. The American Red Cross is current with the test and will not allow a blood donation unless you agree to the test.

Sent by Bernie Holmes | 3:05 PM | 7-25-2007

All of this is really great information. But has anyone thought of those Bisexual males who sleep with men and women, then the women they sleep with go sleep with other men. Later that women or her future partners go to donate.. aren't they at as much risk as the bisexual male who had sex with the female who then had sex with the male?? So, to ban the homosexual men of the bisexual men is really complicated. When an individual goes to the Donor's office to donate they don't list their sexual history, how many people and if those individuals are bisexual/homosexual and have had any STDs of anything of that nature! There is lots of research and many other things to think about before accepting blood from a donor who is heterosexual.

Sent by Anonymous | 2:51 AM | 11-28-2007

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