Poots’ blood ban scientifically and medically sound. (Even if accepting blood from Britain is not.)

I don’t have strong views one way or the other on the recent judgement against the local health Minister. On one level, what’s wrong with levelling up with the rest of the UK? However, as Kilsally has pointed out in the past, the UK position is the exception rather than the rule.

In fact the Irish Blood Transfusion Service goes out of its way to explain why it is not a discriminatory practice based on identity but based on the risk attached to actions:

In order to assure the continued safety of the blood supply, we currently ask those people who may have a particularly high risk of carrying blood-borne viruses not to give blood.  This includes men who have ever had sex with another man / men. The reason for this exclusion rests on specific sexual behaviour (such as anal and oral sex).  The decision is not based on sexuality or orientation, only specific actions.

In fact, Ireland remains where most western countries are. Yet there has been some movement towards a one year deferral rather than a lifetime ban in countries like Italy and Spain.

As John notes a large part of the judicial review’s findings against Poots was based on a Wednesbury test of unreasonableness. This is based on the observation that blood collected in the rest of the UK under the new rules is accepted by the NHS in Northern Ireland, which the judge finds incompatible with the Minister’s stand against the contraction of a lifetime ban to a 12 month deferral.

Yet, as Newton Emerson points out in his Irish News column today, the Minister has a perfectly good scientific reason for sticking with lifetime ban.

When Britain replaced its lifetime ban with a 12 month deferral in 2011, the government took a remarkable cavalier attitude to the risk as presented by its own scientific advisory committee.

The committee had calculated that a five year deferral period would increase the risk of HIV getting into the blood supply by five per cent, so it recommended a ten-year deferral to cut that risk by half.

Now it has to be said that even that a five per cent [increase in current levels] risk is very low on current figures.

But the point is clear enough, that mediation of risk has in this case, a scientific base. The Minister’s ‘decision’ to stick with the lifetime ban (whatever his motivation) is highly defensible, even if his decision to keep on taking higher risk blood supplies from Britain is not.

,

  • Am Ghobsmacht

    Rory Carr came out with an (even more) interesting point recently:

    “What makes Poots’s prohibition on the acceptance of blood donations from gay men all the more ridiculous (& indeed somewhat heinous) is one’s understanding that openly gay men, that is those who are frank and open with the blood donor service about their sexual practises, are those most likely to have taken proper precautions during sex play and to have availed themselves of regular testing for symptoms of disease whereas those men who engage promiscuously with others in secret while denying any homosexual behaviour are those who pose the greater threat of donating infected blood.
    Yet such men, who could well include party colleagues or party members as well as constituents of theMinister, are not prohibited from offering donations. The Minister, it must be said, is not only insanely prejudiced, he is a dangerous idiot.”

    Run that against “The reason for this exclusion rests on specific sexual behaviour (such as anal and oral sex). The decision is not based on sexuality or orientation, only specific actions.”

    Yes, their initial actions place them more at risk yet at the same time they surely know better than most the risks involved and I’d be surprised if such awareness wasn’t given greater emphasis in their culture.

    Ergo, better an honest sodomite than a carefree lad about town so to speak.

    I acknowledge I’m saying this without any statistical back up or scientific know-how but I just find the idea strange that homosexual men who are benevolent enough to donate blood would be so selfish as to not have themselves checked on a regular basis.

    I think if Poots is on the money scientifically speaking then I would wager that it is by sheer accident rather than design and indeed a happy coincidence for the man.

  • Mick Fealty

    Lost me just about here:

    “I acknowledge I’m saying this without any statistical back up or scientific know-how”

  • babyface finlayson

    Am G
    “I just find the idea strange that homosexual men who are benevolent enough to donate blood would be so selfish as to not have themselves checked on a regular basis.”
    You would expect that people who give blood would be a self limiting group really and as such unlikely to want to donate if they have been engaged in high risk behaviour (whatever their orientation).And those careless about risk would hardly care to give blood at all,.
    If Poots had stuck rigidly to risk reduction he would have had a case perhaps, but the contradiction pointed out above suggests he is merely knee-jerking by instinct.

  • Am Ghobsmacht


    Lost me just about here:

    “I acknowledge I’m saying this without any statistical back up or scientific know-how”

    Just admitting that I don’t have access to any statistics regarding the habits of homosexual men and the frequency with which they get themselves tested.

    You know what it’s like here Mick, if you don’t have the evidence to hand you’ll get jumped.

    So I’m just saying that ” I just find the idea strange that homosexual men who are benevolent enough to donate blood would be so selfish as to not have themselves checked on a regular basis.”

    If they’re in the habit of getting themselves checked more often than your typical sinner then that surely deserves to be taken into consideration?

    I would have thought it a reasonable assumption but am very open to arguments to the contrary.

    Cos it is an assumption…

  • Mick Fealty

    Well that’s the judge resorting to Wednesbury. Whether the minister was in fact in position to turn down blood from GB is another matter.

  • Should point out that women who have had sex with men who have sex with men are also banned (12 months)

  • Mick Fealty

    It’s done risk modelling with reliably large data sets, not a wet your thumb stick in the air ‘ready reckoner’..

  • “The reason for this exclusion rests on specific sexual behaviour (such as anal and oral sex). The decision is not based on sexuality or orientation, only specific actions.”

    @Mick,

    As someone who used to work as a volunteer phone counselor for an AIDS Hotline let me expand a bit on your above explanation. Anal sex without a condom is high risk behavior if the other partner is HIV positive or his status is unknown. If he is known to be negative there is no risk involved. Oral sex for the person performing the act is dangerous only if he (or she) has cuts in the mouth or open tissue. Otherwise the semen goes to the stomach where it is promptly killed by stomach acid. For the person benefiting from the act, it is only high risk if the other person is a biter.

    Because of the ambiguities in determining partners’ HIV status, blood services like the Red Cross simply make a blanket ban in order to eliminate any serious risk of contamination and reassure the public. For bureaucracies blanket bans on any type of activity are always the easiest to defend.

  • Delphin

    It is the judgement of the Westminster government that blood donation is acceptably safe if a period of one year has elapsed after a man has had sex with another man. The rational behind this is that this gives time for antibodies to develop and so be picked up in the screening tests for HIV given to all donated blood.
    Most other countries consider this to be too risky and ban blood from sexually active gay men completely.
    Therefore it may be reasonable to adopt the majority approach, but because NI is part of the UK and part of the UK NHS, following GB practice on this issue is the only logical approach. I am assuming that NI is too small to be reliant on indigenous donated blood.
    I am surprised that the NI attorney general did not advise Minister Poots of this, or maybe he did and was ignored.

  • nilehenri

    spain does not have a life-time ban nor anything resembling it mick.
    however, you cannot donate blood in spain (nor in many other european countries) because you are a cjd risk. that’s uk citizenship for you.

  • weidm7

    Thanks Mick for posting this article, it’s important for those with open minds to understand that this was a scientifically based decision and homophobic or not, the minister made the right decision, even if he is one of themuns.

    The really worrying thing is that the judge called it an illogical decision because UK blood where there’s no ban would be used in NI. This is incorrect, keeping a lifetime ban in NI will still reduce the risk, even if only by a tiny bit and is therefore worth doing. If a judge of all people, who are very important in upholding democracy and the rule of law, can make such a basic error, where does that leave the integrity of our institutions?

    The whole debacle is another reason for teaching logical reasoning and thinking biases in schools.

  • gaygael

    Let’s take some historical context here.
    The blood ban was instituted in the eighties, amid hysteria over the HIV epidemic. Thee was no equality beyond decriminilisation. 67 England and Wales, 80 Scotland, 82 Northern Ireland.
    A blanket ban was easier and the recommendation of the experts.
    Fast forward 25 years and there have been huge strides in equality for lgbt people (but plenty still to come).
    The sabot recommendations suggested that best evidence was a one year deferral for msm. I am not sure where newton is getting this from and would be keen to get the context.

    Now let’s look at Poots form. Here he is in 2001.
    http://www.questia.com/library/1G1-78613511/homosexual-blood-donors-debate-causes-uproar-commision
    And on nolan in 2005 ralling against civil partnerships.
    http://youtu.be/y1cvmQhb6lU
    Then we have the ongoing adoption case for unmarked and same sex couples, which has has already lost and is taking to Supreme Court. Costing more and precedent suggesting he will lose, again.

    Then the blood ban and he is refusing to reveal his evidence and is appealing the info commissioners ruling. Wasting more money.
    He is entitled to these views, but as a minister for all, he is obliged to act in the interests of all and follow evidence and science when making his decisions. Will be very interesting to see what sort of flawed advice the ag gave him.

    Evidence based policy?
    Or just a vile reactionary intolerant homophobe who has let his own personal prejudices cloud his judgement. I think it’s clear cut.
    #givepootstheboot

  • Mick Fealty

    Nile, that’s my awkward syntax at play. I was attempting to cite them as examples of countries which like the UK had shifted policy.

  • Turgon

    So finally we re realising the obvious. Many countries (probably the majority of Western countries) have life time bans on homosexuals (amongst others) giving blood. Some are reconsidering which may be fair enough. However, the precautionary principle would suggest that allowing other countries to take the increased risk (and increased risk it is – even if small) first and seeing what happens might be a reasonable option.

    Poots may be exhibiting homophobic principles here or may simply be being cautious. None of us can see into his mind, however much we can speculate.

    The refusal to disclose advice might be because those who gave the advice may not want to be pilloried as homophobes over this decision in the way Poots has been. They are likely to be senior doctors who may not be convinced by the GB decision but may not want to be especially public about their advice given, they will have assumed, in confidence.

    The one place where Poots could be seen to be on shaky ground is accepting GB blood but as wiedem7 correctly states that part of the decision attenuates the reduction in risk from the lifetime ban but does not negate it. Again as weidem7 states the judge’s decision shows how little s/he understand about risk, how one calculates it and how one minimises it. There are certain risk reduction strategies (banning GB blood) which although they would reduce risk still further would create other disadvantages.

    Just think about the outcry if it is discovered that someone ended up getting HIV from blood given by a homosexual who had not participated in high risk behaviour for one year but was a late sero-converter.

    I find gaygael’s remark above a bit chilling. The ban was introduced not because of the HIV hysteria but because a large number of people with haemophilia developed HIV from contaminated blood. Most of them died as did a number of their wives.

    Finally my mother was banned from giving blood as she had had jaundice as a child. That was almost certainly not a form of hepatitis which would be relevant (Hepatitis B or C). However, she was still banned from giving blood. In a way that was discrimination. Discrimination in this case is entirely reasonable. The idea is to minimise risk that means some people will be banned from giving blood. We need to remember that there are two groups here. Yes there are those groups banned from giving blood but there are also groups at risk: those needing blood. They have a right to have their risk minimised as much as is practicable.

  • Greenflag

    I worry about the English (also Scots and Welsh ) . In the USA they won’t accept blood donations if one has lived in the UK or Ireland . This has nothing to do with HIV but everything to do with Creuz Jacobs disease (mad cow ) . In Ireland they won’t accept blood donations from USA originating individuals until they have been ‘quarantined ‘ i.e been in Ireland for at least 6 months – The reason is West Nile Virus .

    From the above one must assume that the English either ignore the dangers of contracting CJD from local English/Scots/Welsh blood donations or perhaps they get their blood from somewhere else ?

    And yet they are always short of blood . What are the statistical chances of contracting CJD from receiving a blood transfusion in the UK ? Do they test the blood for CJD ? I was told there is no test available ? Is that true ?Does anyone know ?

  • gaygael

    I have lots to say in response to turgon. Just not much time tonight.

    So let’s dissasemble anti gay rant.
    Firstly, the ban is msm. Men who have sex with men. Lesbian, gay and bisexual women can donate. And a significant number of men that identify as straight have also or at one stage had or have sexual relations with other men, hence the term msm. Not gay men, or gay and bi men, but rather msm.
    If we continue the conversation, please use correct terminology.

    The evidence issue is not about pillorying professionals or the attorney general but rather to have in the public realm the evidence upon which he made his decision. He has already appealed the information commissioners decision, and spent a substantial sum in fighting this. It is imperative, even for fairness sake and allowing Poots to publicly present his argument in favour of maintaining it. This must be eminently respected professors and experts in their field that advised Poots, so assured of their expertise that it outweighs that of the sabto committee, who I have put a link to below.
    https://www.gov.uk/government/policy-advisory-groups/advisory-committee-on-the-safety-of-blood-tissues-and-organs
    It is good that the uk is in the forefront of progressing equality and best scientific evidence.
    Poots was deemed irrational, in his importing of GB blood, despite a lower prevalence of HIV amongst msm in Northern Ireland, he could have been safer and met demand by taking msm blood at home and not accepting GB blood! But that’s only if you believe that he acted in the interests of safety not personal prejudice.

    Please see shot report on blood sfatety. Note in 2010, ‘Last year, according to the SHOT (Serious Hazards of Transfusion) Annual Report 2010 was the first year in which there have been no confirmed cases of transfusion-transmitted infection, from any source including bacterial contamination.’
    Blood safety has only got better and additionally all blood is screened and then plasma treated to kill residual infection. Note the emphasis is on bacterial. Not viral, which HIV and hepatitis both are and evidencing the msm exclusion.

    You find my remarks chilling. I find your casual acceptance and expected tolerance of your own homophobia disturbing and is symptomatic of the dying gasps of a defeated privileged oppressive group.
    Ignore historical context sure, it’s not relevant. if you bothered to pause and think, with thatcher gay bashing at conference in 88, section 28 and the transmissions leading to hysteria. These are of the zeitgeist, The prevalent homophobia, which I think you still hark to and the hence the blanket ban as an immediate fix.

    Your mother, and sympathy for her health, was not banned on a protected characteristic, such as sex, race or sexual orientation, but rather due to risk.

    I support a risk based assessment. I am msm, in a monogamous relationship and my HIV status is current thus summer. I am zero risk yurt still excluded. There are thousands of msm in the same boat.

  • sherdy

    Edwin: “Don’t blame me – its all Justice Girvan’s fault.’ lol

  • Mick Fealty

    Gaygael,

    “Poots was deemed irrational.”

    ‘Unreasonable’ is the actual word you are [not] searching for. And the judge applied the term to the decision, not the minister [that would be simple man playing on your part].

    What he was referring to is “the Wednesbury test”. Here’s the relevant passage from the original judgement:

    “…a person entrusted with a discretion must, so to speak, direct himself properly in law. He must call his own attention to the matters which he is bound to consider. He must exclude from his consideration matters which are irrelevant to what he has to consider. If he does not obey those rules, he may truly be said, and often is said, to be acting ‘unreasonably’.”

    In effect the judge decided that in the case of setting criteria for blood, the dependence on blood from GB (which lifted the lifetime ban for the MSM category) was unreasonably excluded from the Minister’s reckoning.

    He also pings him on breaching the ministerial code (and there may some interesting ramifications of that in another thread)

    He does not even hint that the Minister’s decision went against the weight of evidence from scientific modelling.

  • Sp12

    “The refusal to disclose advice might be because those who gave the advice may not want to be pilloried as homophobes over this decision in the way Poots has been.”

    Poots is a homophobe because of his general attitude to gay people, ‘unnatural’ and ‘abomination’ would be two words that spring to mind when I recall his pronouncements on gay people.

    Maybe he won’t reveal it as he got the advice from people who try to foist their absurd notions on how old the earth is, all based on access to an abacus and the dusty racial myths of pre-iron age farmers in the middle east.

  • John Ó Néill

    I think opponents of the ban argue that there is no evidence based study to show that there would be a statistically higher incidence of contamination of blood products from the category of gay men being excluded. Most medical opinion is based on incidence of HIV/AIDS amongst gay men and, presumably, public confidence in blood transfusion which is a matter of public information and education in general (and public confidence is chimeric at the best of times). So, the basis on which it is medically sound is what LGBT activists criticise as discriminatory as there is no scientific finding that has proven greater risk. If there is a peer-reviewed scientific study that proves greater risk, then obviously it could specify defined deferrals or an outright ban (I don’t think there is, though).

    Since Australian, Japanese and Swedish policy is identical to the UKs, whilst Canada and New Zealand have 5 year deferrals, I think saying that the UK is the exception is entirely untrue.

  • Delphin

    There is an expectation that judges dispense justice, having listened to the arguments they decide what is right. Not true – they make a decision based on law.
    In the Poots’s case, as Mick says, he did not consider the right or wrong of the Westminster administration’s decision over the one year rule. He considered Poots’s decision to have a different rule for NI.
    This was deemed unreasonable.
    I remain interested to hear what advice the AG gave to Poots

  • mark

    I tried to post this yeaterday, but I included links and it has been sitting in moderation since, so I’ll post it again without the links.

    According to the court papers relating to the judicial review the risk would increase by 0.001 cases per million donations – increasing from 0.227 cases per million donations to 0.228 cases per million donations.

    That works out as an increase of 1 case per billion donations.

    According to the Northern Ireland Blood Transfusion Service, they deal with 64,000 donations per year.

    This means that if we introduce a 12-month referral rather than a lifetime ban, and we maintain our current rate of donations, we can expect to see one extra case of HIV per 15,625 years.

    According to Poots himself in 2011, 500 patients in Northern Ireland need a blood transfusion each week. 500 people needing a transfusion every week for the next 15,625 years is over 406 million people.

    So, if you square the one extra case of HIV against the extra lives that may be saved over the next 15,625 years, then I’m not sure this ban is as scientifically or medically sound as claimed by some.

    It really is a mind-bogglingly small increased level of risk and I think it shows that the people using this increased risk as a justification either don’t understand just how tiny the increased risk is, or are being disingenuous when they claim that this is their justification for keeping the lifetime ban in place.

  • Mick Fealty

    John,

    Here’s the list of countries which have a stance on blood donations from MSM donors: http://goo.gl/Q0lWno. Italy, Spain and Chile have no ban or deferral.

    Here’s what the UK government’s Advisory Committee on the Safety of Blood, Tissues and Organs said on the unscientific business end of risk assessment (http://goo.gl/RFmA07):

    An acceptable risk could be described as a low risk but it should not be assumed that a smaller risk is necessarily more acceptable. Risks are less acceptable if they: are involuntary; inequitably distributed; inescapable; unfamiliar or novel; man-made rather than natural; cause hidden and irreversible damage; pose a danger to small children, pregnant women or future generations; damage identifiable victims; are poorly understood; and if they are subject to contradictory statements.

    Risk perception is complex and consequently, there is probably no single acceptable level of risk with regard to TTIs.

    And just in case anyone is getting confused, as I said in the first line above, I don’t have a personal horse in this race. I’m only arguing there is science, and an albeit weakening international consensus to back the minister’s stance.

    Delphin,

    Unlikely any of us will get sight of the AG’s advice, least of all the Minister of Health’s executive colleagues who have in the past broken collective responsibility when it has suited them to bring such material to the press to service their own political agendas.

    The AG’s advice is not law, its an opinion which the Minister is free to take or ignore. That goes for the opinion of departmental solicitors too!

  • Mick Fealty

    nile,

    In response to a prompt from you on another thread about ‘bad blood’ the cjd ban is on anyone who was actually in GB at the time: it applies equally to citizens of all countries, vegans, vegetarian, quality uninfected butchers and their spouses, etc.

    In other words, pretty indiscriminate… that’s the nature of these things. In the case of CJD, the window between infection and outcropping, if remember correctly, could be very lengthy indeed.

  • paulG

    Would it not make sense to hold a stock this higher risk blood which would be available for the those who believe those rather incredible stats or who see it as a Gay rights issue. If enough of them put their money where their mouth is (doubtful), it may provide a sufficient sample in 5 or 10 years to settle the issue.

    In the meantime, the Hospitals have a backup supply of blood so if the stocks ever become critical they could ration the safer blood to the kids and bring out the reserve for those with less time and bigger problems to worry about than HIV and Hep C.

  • PeterOHanrahanrahan

    @Greenflag

    Apparently there is a test for CJD out there somewhere; I can’t get arrested at any bloodbank here in Malaysia as they say they haven’t imported the ability to test the blood in-country at the moment.

    Poots’ serendipitous scientific backing gives one cause to think of broken clocks.

  • Let’s say that you have an incident whereby the Doctors tell you (or your next of kin) that you are going to die if you don’t have an immediate blood transfusion. Are you or next of kin going to care if there is a risk in receiving any blood? I know that I would rather take a risk than die.

  • cynic2

    Mick

    I am sorry but you are wrong. As per the summary released on the NI Courts Service website the judge concluded that

    ” for these reasons, the decision was irrational”

    http://www.courtsni.gov.uk/en-GB/Judicial%20Decisions/SummaryJudgments/Documents/Court%20allows%20challenge%20to%20lifetime%20ban%20on%20gay%20men%20giving%20blood/j_j_Summary%20of%20judgment%20-%20In%20re%20JR65%2011%20Oct%2013.htm

  • cynic2

    I also dont understand why Pootsie is just so focused on HIV. These days a high % of HIV + patients live to a ripe old age. Some variants of Hepatitis are just as likely to lead to an early death

    I also love the view that many MSM males are much more likely to engage in ‘risky’ oral sex than straight men or women. Not down our way they aint Edwin. You haven’t lived my son!

  • paulG

    Mr. Joe,

    As the blood hasn’t run out, the current question is if you (or next of kin) needed a life saving transfusion, would you want the blood with the current risk level, or the blood with the higher risk level?

    They will tell you that the risk is only a zillionth of one percent, but your years of doubting, questioning and checking figures produced by state employees tell you it’s probably much higher.

  • paulG,

    If there is a choice, then it’s a no-brainer.
    But, for example, I’ve considered a visit to Africa. If a got into an accident there even in a high risk HIV country and they told me I’m going to die without a transfusion, then that’s a no-brainer too.

  • paulG

    Absolutely Joe,

    We always make the best choice minimise the risk to our lives and those of our loved ones.

    What is giving me an unpleasant feeling about this, is that the people pushing the unnecessary change to increased risk, are extremely unlikely to suffer the consequences of it, but somebody will. Maybe a haemophilliac or car crash survivor, maybe a child.

  • cynic2

    Paul G

    Almost no risks are absolute and most aren’t cost free. The risk of HIV transmission from blood is incredibly small. So where do you stop in terms of controls which often give a false or irrational (the Judge’s words in this case, not mine) view o how effective the controls are.

    For example – lets suppose that research shows that if staff in every hospital operation were doubled patient mortality would drop by 1% – do we then say OK lets double the staff? How do we fund that? Would another option give a better solution?

  • paulG

    cynic2,

    if were proposed by the hospital as a sensible (almost risk free) cost saving measure, then I might be inclined to believe the rather fantastical figures (or at least believe they’re no more wrong than any of their other numbers).

    As it seems to be an attempt to bend medical policy to the social agenda of a noisy few, I am far more sceptical.

  • Greenflag

    @ PeterOhanrahan ohanrahan .

    ‘Apparently there is a test for CJD out there somewhere; ”

    Thanks for that info -but does the British Blood Bank use that test to screen donors or are people who may be carriers of CJD allowed to donate blood ?

    Or do the Blood supply authorities just ignore the issue just as Mr Joe above says he would do (as would anybody ) faced with a minute chance of contracting CJD or a 100 % chance of contracting Dr Death ?