What a blood plasma-for-profit clinic means for public health care
[ http://www.macleans.ca/society/what-a-b ... eath-care/ ]
The federal government has quietly approved a plasma-for-profit clinic in Saskatoon, drawing fiery criticism from politicians, scientists and patients
Anne Kingston January 14, 2017
Three days before Christmas 2016, jingly seasonal music fills the air at Canadian Plasma Resources (CPR) in Saskatoon, located in a non-descript building in a quiet industrial stretch. In one direction, a strip of pawn shops; in the other, the Saskatchewan Polytechnic. Prospective donors are greeted by an artificial Christmas tree, a Purell dispenser and screening restrictions: medications they can’t be taking, that they must be between 17 and 61 years of age and weigh at least 50 kg. They’ll need SIN documentation, proof of a current fixed address, and government-issued photo ID. A young man is filling out a 42-question donor form, with queries from “At any time since 1977, have you received money or drugs for sex?” to “Are you aware of a diagnosis of Creutzfeldt-Jakob disease among any of your blood relatives (parent, child, sibling)?” Another 21 questions will be reviewed during a nurse’s examination.
Inside, the plasmapheresis room betrays no hint of holiday bustle: only four of 34 reclining chairs are occupied—three women and a man, all middle-aged. A TV plays overhead as straw-coloured plasma courses through tubes. A staff member ferries plastic containers filled with the golden liquid—the protein- and antibody-rich component remaining after white and red blood cells, platelets and other cellular components are removed—to the back for processing and freezing. For their time, typically an hour and a half, donors receive a $25 Visa gift certificate—or they can donate that amount to a charity for a tax receipt. Unlike full blood, which can be donated every two months (three for women), plasma can be given weekly. Frequent CPR donors are eligible for bonuses; “Super Hero Rewards” members qualify for monthly draws with quarterly draws for “silver” and “gold” donors with “prizes valued at over $2,000.” CPR’s recruitment techniques include social media and ads in university bathrooms. The location now has 800 registered donors, only 30 per cent of their 2,500-donor target, says CEO Barzin Bahardoust.
Canadian Plasma Resources is not Canada’s first paid plasma operator: the former Cangene in Winnipeg has paid for plasma with a rare antibody since the 1970s, and more recently has been collecting regular plasma. But the cascade of events surrounding CPR’s ill-fated entry into the Ontario market in 2013 put it in the crosshairs. CPR’s proposed locations, next to a Toronto men’s shelter and Hamilton methadone clinic, led to a public outcry and 2014 provincial legislation banning payment for blood products passed unanimously; Quebec has had a similar law since 1994. Police raids of CPR’s Toronto location and its threat to sue the provincial government, made headlines. Health Canada’s licensing of CPR’s Saskatchewan location in February 2016—and its proposed entry into New Brunswick this year and British Columbia thereafter, with stated plans to have 10 centres operational by 2020—has divided not only provinces, but patient groups and politicians as it exposes the backroom politics and economics that course through the once-public Canadian blood system.
The very mention of selling blood product resonates in a country scarred by the “tainted blood scandal” of the ’70s and ’80s. Bureaucratic negligence, regulatory malfeasance and corporate greed contributed to Canada’s greatest health care tragedy, one that saw more than 8,000 Canadians die—and more than 30,000 afflicted—from blood infected with HIV and hepatitis C. The details are horrific. Montreal brokers, who imported blood from Arkansas prisoners, relabelled it “Canadian blood” and then exported it, leading to hepatitis C outbreaks in Canada and internationally.
The resulting inquiry, a five-year investigation, produced a 1,200-plus page report in 1997. Justice Horace Krever referred to a “nationwide public health calamity.” Blame didn’t lie only with the Canadian Red Cross reacting too slowly to the AIDS crisis, [ http://www.macleans.ca/society/health/h ... t-started/ ] Krever concluded; it was systemic failure driven in part by the profit motive. His report recommended people “should not be paid for their donations, except in rare circumstances.”
The Krever report shaped the current volunteer-based public blood system: Health Canada is the regulator, responsible for blood safety. Canadian Blood Services (CBS) [ http://www.macleans.ca/news/canada/heal ... -one-year/ ] and Héma-Québec were founded in 1989 to manage the country’s supply of blood and blood products. What Krever could not have anticipated, however, was the explosive rise of a market for plasma. Fresh plasma, collected from voluntary donors in Canada, is used for transfusions. Of this there is no shortage, with demand declining as keyhole operations require less and less blood. Demand is soaring, however, for “source plasma,” a raw ingredient pooled before fractionation, a processing technique that separates it into component parts for treatments: albumin for burns and trauma, factor VIII to help clotting in people with hemophilia and other bleeding disorders, and intravenous immunoglobulin (Ivig) for infections and immune disorders. The Ivig market is growing at an estimated eight to 10 percent a year, with Canada one of the highest per capita users. Ivig product can run $7,000 per treatment—and more than $200,000 annually. Plasma is the stuff of pharmaceutical alchemy: A donation that nets a donor $25 can yield pharmaceutical products worth at least $300, hence the proliferation of paid-plasma centres in the U.S., Germany, Hungary and the Czech Republic.
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