Blood Feud
The human cost of mad-cow hysteria.

By Julian Morris, director of International Policy Network and the editor of Rethinking Risk and the Precautionary Principle.
August 22, 2001 10:00 a.m.

ast week's announcement of a possible cure for variant Creutzfelt-Jakob disease (vCJD) comes as wonderful news. It also calls into question the wisdom of some of the "precautionary" measures taken with regard both to BSE (Bovine Spongiform Encephalopathy) and to its human equivalent, vCJD.

BSE, or "mad cow" disease, is a truly postmodern disorder — its psychological and legislative effect far outweighing its physical impact. Since it was first detected in the early 1980s, BSE has struck hundreds of thousands of cattle, most of them in the U.K. But even as the number of cattle affected has dwindled, over the past decade, fears about BSE's effects on humans have only grown. In response, governments have imposed a spate of ultra-precautionary regulations, the net effect of which is almost certain to be harmful.

Concern about BSE first arose in Britain in the late 1980s, when scientists suggested it might cause a similar brain disorder in humans (Creutzfelt-Jakob disease). Fears were initially allayed by government scientists, who affirmed that the link was only hypothetical. Nevertheless, the British government banned the use of rendered meat and bone meal as animal feed, and imposed stringent restrictions on the sale of potentially affected tissue to humans. (We might have known something was up when John Gummer, then U.K. Minister for Agriculture, fed hamburgers to his children on TV.) Then, in 1996, scientists in Edinburgh announced the discovery of a new variety of vCJD, which they suggested might be linked to BSE. And the fearmongers had a field day.

Variant CJD is a horrible disease, and one can only feel pity for sufferers and their families. But vCJD is also exceptionally rare, affecting fewer than two people in a million. The majority of cases are sporadic, caused by normal aging of the body's repair mechanisms. A very small number are caused by an inherited abnormality. And some have also been traced to medical procedures, including corneal transplants and injections of human growth hormone.

Just over 100 cases of variant CJD have been identified since 1994. In spite of millions of dollars of research and thousands of hours of government inquiries, the cause of vCJD remains mysterious, and any link to BSE is far from being proven.

Even if vCJD is caused by exposure to BSE-infected material, it now seems unlikely that more than a few hundred people will succumb. First, because in spite of more vigilant monitoring, the observed incidence of vCJD is not increasing rapidly enough to justify more catastrophic predictions. And second, because it seems highly likely that a cure, such as that now being investigated, will be found.

Yet, in June, the fearmongers were out again, urging policymakers to take action to prevent exposure to vCJD from infected blood. What's bizarre is that not a single case of CJD has ever been traced to a blood transfusion. Indeed, even assuming CJD is transmissible, the risk of infection from blood donated by someone with CJD is vanishingly small. The infective agents are protein clusters called "prions" that have become damaged or "misfolded." These prions are capable of self-replication; when they come into contact with healthy prions, they cause them to become likewise misfolded, leading eventually to a tangle of spongy material. There are, however, very few prions in blood to begin with (which is why no blood test for CJD has so far been developed), and so the likelihood of transmitting the infection in this way is tiny.

If vCJD were transmitted by blood transfusions, people in Britain and other European countries would be at a much higher risk of exposure to it. Over the past 10 years, 30 to 40 million blood transfusions have been conducted in the U.K. — including several from people who subsequently died from vCJD. And yet not a single case of vCJD has been detected among recipients of blood or blood products.

So it seems unlikely that vCJD can be transmitted through blood or blood products. Nevertheless, regulators around the world have imposed restrictions on the use of blood that might have come from donors possibly harboring vCJD. In 1998, the U.K. banned the use of blood donated by Brits in the manufacture of blood products. (Britain now imports blood factors from the U.S.) Several countries, including France and Spain, have banned blood donations from people who have spent long periods of time in the U.K. More recently, the American Red Cross — which collects 45 percent of blood donations in the United States — decided to ban blood donations from anyone who has spent more than three months in Britain, or six months in Europe, since 1980.

The Red Cross decision is particularly serious, as it will lead to a reduction in the availability of blood and blood products not only in the U.S., but globally. In total, about 8 percent, or 400,000, of the Red Cross's current blood donors will become ineligible.

New York City is already postponing 8 percent of all operations because of the shortage of blood. Out of excessive caution over a hypothetical risk, it seems the public is to be exposed to real risks. Thousands of people will have to wait longer for elective surgery, with resultant complications and discomfort. In some cases, even patients who require blood for emergency procedures may have their operations delayed. Some will probably die. People who rely on blood factors — such as those with immunodeficiency or hemophilia — will either pay more for their medication, or will suffer. Some will die.

Further, while the Red Cross is not permitted to claim that its blood is safer than that of any other supplier, its move is likely to contribute to the public confusion over the risk of vCJD. And, of course, federal regulators may feel pressured to extend the same level of regulation to other blood suppliers. The U.S. Food and Drug Administration (FDA) has already overreacted to the threat of vCJD, by banning blood donations from anyone who spent more than six months in Britain at any time between 1980 and 1996. Last week, the FDA's Transmissible Spongiform Encephalopathy Advisory Committee (TSEAC) — a supposedly 'scientific' body — recommended that the current ban be extended to anyone who lived in Britain for more than three months between 1980 and 1996, and to anyone who was in Europe for five years or more in that same period. Ironically, one of those supporting the extension of the ban was Stanley Pruisner, the same researcher who claims to have discovered a cure for vCJD.

But if the FDA is really concerned about risks of transmission, these recommendations actually don't go far enough. After all, if it's logical to ban donations from one person with a minuscule chance of being infected — then it must make sense to ban donations from every other potentially infected person. To be fair, there is presumably a link between the length of time a person has lived in a place and the number of roast-beef dinners they might have had there. But if BSE causes vCJD through infection, then presumably all it takes one dodgy plate of steak tartare (or Steak Americain, as they call it in Brussels). In which case, all Americans who have visited Switzerland — which has had several hundred cases of BSE — should also be banned from giving blood. And what about those Americans who ate British beef prior to the import ban in 1989? And, conversely, shouldn't all those vegans from Portland and Missoula be exempted?

The Red Cross is a private organization and is entitled to make whatever decisions it wants with regard to donors — however stupid, and however harmful to the public. (Though it could be argued that as a recipient of government largesse, it should be forced to accept some responsibility for its actions.) The risk we now face, however, is that FDA officials will feel obliged, in spite of scientific evidence, to force other blood suppliers to comply with similar restrictions. The recent TSEAC recommendations certainly suggest this is likely.

In an environment of heightened fear over the risk of vCJD, the FDA will no doubt seek the option that minimises blame. To keep supplies "absolutely" safe, it might soon have to ban imports of blood and blood products from other countries altogether. Eventually, no doubt, the government would come under pressure to ban exports of blood, and blood products, too — after all, we can't have poor people in the U.S. dying while American blood goes to treat wealthy foreigners. The ensuing trade war could bring new meaning to the term "blood feud."

In deciding how to regulate blood products, perhaps the FDA commissioners could ask themselves this question: Imagine you are about to die from a life-threatening condition that could be prevented by a blood transfusion. Would you want the transfusion to be delayed by several hours, so the hospital could wait for blood from a vegan who's never travelled abroad? Or would you be willing to accept the unquantifiably small possibility that the blood you receive is contaminated with vCJD?