FDA Ban On Blood Donated By Gay Men Upheld
NEAL CONAN, host:
Amid the HIV/AIDS epidemic of the early 1980s, the FDA banned blood donations from men who'd had sex with another man after 1977. The policy remains in effect to this day. Gay rights advocates protested the ban as both unfair and unwise.
Earlier this month, a government public health committee concluded the policy was, quote, "suboptimal," but voted to keep it in effect anyway.
Joining us now to talk about this law and the science behind it is Arthur Caplan, professor of bioethics at the University of Pennsylvania, with us today from member station WHYY in Philadelphia. Nice to have you back on the program.
Professor ARTHUR CAPLAN (University of Pennsylvania): Hey, Neal. How are you?
CONAN: I'm well, thank you. Did this ban make sense at one time?
Prof. CAPLAN: Well, I have to confess, I chaired the Advisory Committee on Blood, Safety and Availability for four years. That was the group that upheld the ban. During my time there, I tried to get the ban overturned.
It did make sense at one time. Back in the early '80s, we did not have very good testing for blood, and infectious agents like HIV virus could get into the blood supply. Blood, when you use it, is recombined. You take many different donors and sort of put them together. Sometimes you're making blood products like clotting factor a hemophiliac would use. And when you're making these combinations, it means one infected donor can influence thousands of other units of blood.
So very risky, very dangerous and indeed took a terrible toll in the early '80s on the hemophiliac community. They have to use blood products to stop their bleeding when they get injured. That clotting factor is crucial. It's made from blood. And sadly, thousands died because of slow action on the part of government to get at-risk donors out of the pool.
CONAN: Well, what's changed since then?
Prof. CAPLAN: So what's changed is better testing. And today I know listeners will have heard a little bit about mapping the human genome...
Prof. CAPLAN: ...but remember, we're also mapping genomes of viruses and bacteria. In fact, you'll remember, Neal, not too long ago there was a gentleman, Craig Venter, announcing he'd made a whole artificial bacteria by copying the genes of a bacteria. So we...
CONAN: First computer-created life form, he called it.
Prof. CAPLAN: First computer-created life form. So that's all of a piece with understanding what the component instructions are of different viruses and being able to identify them.
There's a fancy name, nucleic acid testing, NAT testing, that's used all over the blood supply today. And it works very, very well. What wasn't around in 1983 that led to a kind of horrible slaughter of hemophiliacs would not happen today in 2010 because we are carefully testing the blood supply. And when the committee said policy suboptimal, what they meant was we have this great test and yet we're still not being guided by the science.
CONAN: Well, another objection is that the ban assumes that all gay men are, by definition, high-risk donors and that all heterosexuals are, by definition, not.
Prof. CAPLAN: Another huge problem. So if you - the current policy is, if you ever had male-to-male sexual activity since 1997, once - excuse me, since 1977...
Prof. CAPLAN: ...you're out of the pool. Well, that means that other people who engage in risky behavior, if you have heterosexual partners, engage in unsafe sex practices, visit prostitutes, use IV drugs, you're not being excluded, sort of blanket exclusion in the way that gay men are. So it doesn't make any sense, except as a matter of discrimination, to exclude one risk group completely and let others sort of go with abandon, if you will.
So the testing is our best weapon. It really works well. The one tiny problem with testing is, if I do get infected with HIV, it takes a little while for that virus to get into my system and multiply enough so that I can be tested to know that I got infected. That's called the window period. And it probably takes at least a few weeks.
So it does make some sense to try and urge people who engage in any risky activities, sexual or IV drug abuse, to not be donors if they've done that, say, within the past 60 days, just being super safe.
CONAN: But those...
Prof. CAPLAN: Then...
CONAN:...those can be homosexual or heterosexual or both.
Prof. CAPLAN: They could be homosexual, heterosexual or both. A 60-day window, I think, would, you know, capture everything that might escape the current testing. And the other side of this is we need more blood donors. The blood supply in the United States - and again, you'll know this from the calls that go out every holiday. Fourth of July is coming. There's going to be a lot of demand for blood - car accidents, motor vehicle accidents. Donors are on vacation. You know, we're relying on a tiny percentage of Americans to supply blood. Numbers like one in 250 are the kind of numbers that account for who donates blood and an even smaller number of those people donate blood more than once.
Prof. CAPLAN: So you have very few Americans doing it. To be even a little more scary, older Americans, the World War II generation, gave more blood than younger people do today. So we need blood. And by excluding gay men, you're taking people out of the pool who might be able to help supplement this ongoing shortage that only gets worse of not having enough blood. We want safe blood, but we also want to have enough blood.
CONAN: We got this email from Michael(ph) in Oklahoma City. I came out as a gay man in 2002 when I was 21. Up to that point, I donated every 56 days. After I could no longer in good faith check the no to the MSM, a man-who-have-had-sex-with-other-man box on the donor form, I stopped donating even though I knew my blood was still safe to give.
I would love to donate again but you cannot donate unless it's been at least a year since you've had sex with a man. I think the law is still discriminatory. I always practice safe sex and get treated on a regular basis, which is more than I can say for most of my straight friends. It always breaks my heart when they're desperate for type A-negative blood and I have to tell them no. I finally have to - I finally had to have to have the OBI, the local blood bank, take me off their donor list. I shouldn't have to choose between my sexuality and saving lives.
Prof. CAPLAN: I agree with that. I think we have to understand that the terrible problems of the '80s left a deep, deep scar within the hemophilia community. They got ravaged by HIV. They had as bad an experience with death and morbidity as any group in America. So that lingers. You have to understand the reluctance to sort of go back to the gay men and allow them back in in the context of that terrible story.
But the science has moved. It doesn't make sense to just pick on one risk group out of many, heterosexual and homosexual. And as this email is telling us, sometimes people go in and donate blood anyway. We're relying on the test to pick them up, you know? Just because we have a policy doesn't mean that people aren't going to say, I don't care, I'm going to donate blood anyway.
CONAN: I'll check that box anyway, I don't care. Yeah.
Prof. CAPLAN: Yup. Yup.
CONAN: There - the - do you attribute the decision by the Advisory Committee on Blood Safety and Availability to hemophiliacs, that fear you were talking about?
Prof. CAPLAN: I do attribute it to fear. And I'll give you a little political background having been on this committee some years ago, but I get the politics of our blood supply, I think. Groups that rely on the blood supply every day, every week, every month to live - sickle cell anemia, hemophilia, people with immune disorders - they are concerned about safety. They're using blood products all the time and they want the safest blood supply possible. They're organized. They come to the committee meetings. They lobby.
There is no group of people who say I'm about to have a caesarian section and I'm going to need blood. I'm about to have a car accident and I'm going to need blood. We don't have, in other words, lobbies for groups of people who need blood unexpectedly or in emergencies or because of terrible accidents. So you hear much more in Washington about the groups that need blood every day. Safety tends to trump availability. That is to say, the groups that are there lobbying and arguing, their focus is safety, maximum safety. But the groups that are out there who need blood, and that might be any one of us on any given day, we're not in Washington. We're not organized because it's unexpected and it's an emergency.
CONAN: Well, how long do you think that this policy has been in effect even when the science suggests that it's no longer needed?
Prof. CAPLAN: A decade. And I thought this year we might actually get to the point where we overturned it. Other countries have. France has. Many other countries have done away with this ban for life, for one, male to male sexual contact 30 years ago. They haven't had any problems as far as I know with safety in their blood supply systems.
Senators were arguing and taking up the cause. People like John Kerry said it's time to get rid of this ban. I hoped that that would happen. I hope that fear and the history, the terrible history here might be able to be tamped down by reliance on the testing, but it still hasn't happen.
CONAN: There are at least one other group that is barred from giving blood and those are people who lived in Britain for the certain years when there was a mad cow disease or fear of mad cow disease and that it might - this includes me. I was the London bureau chief for a while. I can no longer give blood. Would that be picked up by this test too? Is that - has that time passed?
Prof. CAPLAN: It has - that test would not yet - those little bugs, they're called prions, and they actually are not testable. We don't have a test that picks them up yet. Still, the evidence that you can transmit that particular agent in blood donation is not there. In other words, if you looked at the United Kingdom, they don't have reams of people falling over from mad cow disease even though they had that terrible epidemic of mad cow disease. So, again, in trying to be safe, if you follow the policy of not taking donors who spent significant amounts of time in the UK and, by the way, in other countries where mad cow disease broke out, we probably have reduced the overall donor pool by about nine to 10 percent. So we don't have enough blood. We bumped out a bunch of people. I'm not saying there's no risk factor of getting mad cow disease in, but in England it hasn't happened. In laboratories, you don't see the - it's very tough to give a rat mad cow disease by transfusing blood from a rat that has mad cow disease, so it's next to impossible to do it.
So we're erring on the side of safety, but we continue to put ourselves in jeopardy of shortage.
CONAN: And this excess of caution - you must have empathy, though, for those who, as you say, rely on blood supply for their very lives.
Prof. CAPLAN: I have huge empathy. And I've sat there and watched discussions occur with pricing of these products going out of control because companies can gouge because they know they got these people over a barrel. I know what the history is for groups like the hemophilia community in terms of deaths that they went through. I understand the fear when you're sitting there, saying, every week, I've got to give my child a blood product, and I want that blood product to be safe. It's got to be safe. But the science has taken us in a better direction. We can at least protect against the HIV worries and other infectious agents, maybe not mad cow, but the other ones.
And I think overall, we'd still be better served if we got rid of the outdated discriminatory and not scientifically based policy. We're not - we're letting in a way too much caution drive us in a direction that winds up putting everybody at risk because we don't have enough donors.
CONAN: Arthur Caplan, thanks very much for your time today.
Prof. CAPLAN: My pleasure.
CONAN: Arthur Caplan, professor of bioethics at the University of Pennsylvania, with us today from member station WHYY in Philadelphia.
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