Matthew Taylor

I’ve written about the men who have sex with men blood donor ban before. Christopher Banks basically wins the debate with this comment. TL;DR: there is a huge list of deferral criteria, MSM aren’t being singled out and NZ Blood Service aren’t trying to be dicks, just trying to make the blood supply as safe as possible for people who find themselves in a situation where they need it.

“What’s more, gay men are not being singled out for deferral – if you look at the eligibility criteria on the New Zealand Blood Service website, you can be turned away for a variety of reasons, including your age, whether you’re on certain forms of medication, have been recently vaccinated, are pregnant, had sex with someone from a country with a high HIV prevalence, or lived in the UK for more than six months between 1980 and 1996 (due to the outbreak of variant CJD, or “mad cow” disease).

Dr Peter Flannagan, the medical director of the New Zealand Blood Service, is himself prohibited from giving blood due to the latter reason.

Though I’m sure the guilt trip from ads like the above isn’t appreciated.

In 2009 the New Zealand Blood Service (NZBS) changed their deferral criteria for donating blood based on a 2008 review. The men who have sex with men (MSM) ban was reduced from 10 years to five years—“You must not give blood for: five years following oral or anal sex with or without a condom with another man (if you are male)”. There will be another review of the criteria in 2013.

Other deferral criteria

About 12% of people who try to donate blood are deferred. The NZBS has a full list of deferral criteria on their website.

A one year deferral is in place for a woman who has had sex with a MSM, and for those who have had sex with a person who carries the hepatitis B or C viruses, or an injecting drug user, a sex worker, a person with haemophilia or related condition, or with a person who has lived in or comes from a country with high HIV prevalence. People who have worked as sex workers only in New Zealand can’t give blood for a year.

People who have worked as sex workers outside of New Zealand or who have lived in a country with a high rate of HIV (including sub Saharan Africa and parts of Asia) can’t give blood for five years.

People who have injected/snorted non-prescription illegal drugs or who have lived in the UK, France or the Republic of Ireland for a total of six months or more between 1980 and 1996, because of possible exposure to Creutzfeld-Jakob disease, are permanently deferred from giving blood.

New Zealand sex workers aren’t considered to be a high HIV risk because: “there have been only 20 women diagnosed with HIV who were known to be sex workers and three to four men who were reported to be infected by a sex worker in New Zealand.”

MSM bans around the world

New Zealand isn’t as strict as other countries. Hong Kong, Singapore, Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Netherlands, Norway, Portugal, Sweden and the UK have a lifetime ban on MSM donating blood. The US, Canada and Switzerland effectively do too, banning any men who have had sex with men after 1977.

Australia and Japan have a one year ban, South Africa has a six month ban, and Spain and Italy ban on behavior rather than the sex of sexual partners. Spain has a 12 month exclusion for anyone who has had more than one sexual partner in the last 12 months. The interpretation of Italy’s exclusion based on risky behavior is unclear and inconsistently applied—some centers still exclude MSM.

Blood safety

“Once a potential donor presents there is a three tier combination approach to safety: a questionnaire on behaviour followed by an interview, tests that are highly sensitive and specific are carried out on the donated blood, and (for manufactured plasma products) the use of physical and/or chemical methods to inactivate infectious agents.”

The HIV concerns that remain even though donated blood is tested relates to the early period following infection where the infection doesn’t show up on tests and relates to the risk that established infections aren’t picked up by testing or that infected blood is identified but fails to be removed from the system. The early “window period” for HIV averages to be about 12 days using Nucleic Acid Testing, which the NZBS tests with. A short deferral period of a year would eliminate the risk of window period infections. Longer deferral periods reduce the risk established infections present.

It’s thought that people with a higher risk of having HIV would also have a higher risk of having an “unknown or untested for infectious [agent]”.

The risk of the test system failing to detect an infection where “the marker is present” is very low because of the features of modern testing equipment used and because NZBS tests for each major virus twice. However “the test system may be unable to detect a rare form of the virus”.

“No transmissions have been documented in New Zealand since routine testing was introduced for these viruses… however… the low levels of risk are achieved by a combination of measures and are not solely due to the effect of blood donation testing.”

Australia’s one year deferral

About a decade ago, Australia dropped to a 12 month deferral for donors who have had male-to-male sex.

“Surprisingly in Australia, with a one-year deferral for MSM, though MSM are still over represented, the prevalence of HIV is only 4 per million donations, less than in New Zealand (11 per million donations). This suggests that there is either greater adherence to deferral criteria in Australia, or a higher rate of clinical HIV testing and therefore fewer undiagnosed infections, or the figures from Australia are incomplete.”

A study in Australia found there was no evidence of a significantly increased risk of transfusion-transmitted HIV subsequent to implementing the one year deferral period for MSM. In the one year deferral data the five MSM with HIV infections would have been excluded had they been honest and provided a complete history.

“We found no evidence that the implementation of the 12-month deferral for male-to-male sex resulted in an increased recipient risk for HIV in Australia. The risk of noncompliance to the revised deferral rather than its duration appears to be the most important modifier of overall risk.”

Harm

Donating blood is a valued social activity and the restriction based on sexual partners is indirectly homophobic which creates social exclusion and adds to stigma on the basis of male-to-male sex. In the US there is a group who have a “HIV prevalence 17 times that of their comparator: black versus white women”. There’s no call for a ban on that group from donating blood. Are we more sensitized to racism than homophobia?

“It does not distinguish between sexual acts… or whether a man has been in a monogamous relationship, but stigmatises any male same sex contact.”

But would a one year ban, like Australia’s, be any less discriminatory? There is an ethical requirement to protect the recipients of blood because they’ve been thrown into their situation. For indirect discrimination to be truly removed, there would have to be no ban on MSM. That’s unlikely until medical advances make it safe for the recipients of donated blood.

^{Image credit: Dave Herholz}

Some people in New York want people in the healthcare industry to be banned from wearing ties and jewelry after research has shown that neckties worn by doctors and other medical personnel are carrying infection-causing bacteria.

In 2004 researchers at the New York Hospital Medical Center of Queens found that nearly half (47.6%) of neckties worn by clinicians harbored “potential disease-causing bacteria”. Clinicians included physicians, physician assistants and medical students at the teaching hospital. For comparison they also tested neckties worn by security personnel. The odds were 8 times greater that a clinician’s tie would be harboring bacteria compared to the security personnels’ ties.

The researchers said that there’s no direct evidence that neckties transmit infections to patients, however a health center in St. Louis “saw a 50 percent drop in reduction in infections when a hygienic dress code was provided” (which I am assuming included other rules, including the banning of ties). A hospital in Indiana has had no reported instances of hospital-acquired infection because of their hygienic dress code.

Patients who get MRSA, which is a huge problem in hospitals, have average stays that cost almost twice as much and are for almost twice as long compared to non-infected patients. New York’s cost of medical malpractice insurance continues to rise as a result of awards paid out because of “preventable medical mistakes”, which includes infections acquired in the hospital. Senator Diane Savino says that “adopting a hygienic dress code for medical professionals means less infections, less lawsuits, lower medical malpractice premiums and more lives saved.”

Apparently this is too nanny state for some people even though the benefits for patients, hospitals and insurers could be significant and dress codes are already enforced in hospitals and elsewhere.

Do you think this is going too far?

^{Image credit: Daniel Zedda}

A group in San Francisco has collected enough signatures to get a proposal to ban circumcision included in their November ballot which would prohibit the circumcision of males under 18, even for religious reasons. Routine neonatal circumcision has been banned in South Africa and Finland. It’s also banned in Sweden but there’s an exception for religious reasons.

About 10-20% of newborn males are circumcised in New Zealand and Australia and it’s generally a safe procedure, “but there are risks of minor complications and some rare but serious complications” (Royal Australasian College of Physicians PDF).

The RACP continues: “the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent” and that “the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.” However, unfortunately they still go on to say that circumcision should be the choice of the parents weighing up potential harms and potential benefits. “The potential benefits include connectedness for particular socio-cultural groups and decreased risk of some diseases. The potential harms include contravention of individual rights, loss of choice, loss of function, procedural and psychological complications.”

Circumcision reduces the risk of urinary tract infections, sexually transmitted infections, cancer of the penis and cervical cancer. However, UTIs only occur in up to 4% of boys and the prevalence of UTIs decreases “quite dramatically” after the first month of life, circumcisions do not make a significant difference when STIs are low in the population like in Australia and New Zealand (“…circumcision does not provide significant protection against STIs and HIV, and is less effective than safe sex practices.”), cancer of the penis is “extremely rare with an incidence of 1 in 250,000 Australian men” and the HPV vaccine (and I assume smear tests) overshadow circumcision as protective measures for HPV.

It’s important to remember that infants are not having sex and so circumcision would not have the chance to prevent the transmission of diseases for many years. The potential health benefits of circumcision (except for UTIs) could still largely be gained by postponing circumcision until adulthood.

Hygiene or appearance reasons seem like a moot point too. It does not take a rocket scientist to work out how to keep an uncircumcised penis clean. In countries with low circumcision rates it’s unlikely a partner will have a strong preference for a circumcised partner, so it could in fact be argued that there are social/relationship benefits in not circumcising.

Maybe I am biased by my lack of religion, but religion or culture shouldn’t be an excuse for chopping off body parts either. This is illustrated by New Zealand’s law banning “female circumcision” which makes performing “any medical or surgical procedure or mutilation of the vagina or clitoris of any person” for reasons of “culture, religion, custom or practice” illegal.

Also, circumcision is nothing like ear piercing. Foreskin doesn’t grow back, an infant can’t consent and in ear piercing body parts aren’t being removed.

Circumcision of infants doesn’t focus on the child’s needs and interests and puts the boy through avoidable and unnecessary harm. There are risks involved that are “low in frequency but high in impact (death, loss of penis)”.

Letting someone decide for themselves as an adult “respect[s] the child’s physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future” and reduces the risk that “children [will] grow up to disagree with decisions that parents have made for them when they were young.”

When you circumcise a baby, you’re taking that choice away from the adult he will become. For every day of his adult life, he will have been, and will continue to be, denied the right to choose for himself as a result of what was done to him as an infant. (Paraphrased via)

Obviously if there’s an immediate medical need or the guy in question is a consenting adult, snip away. However infants do not have religions, are not able to refuse the surgery and therefore it should be illegal for circumcisions to be performed on them. Freedom of religion needs to include freedom from religion. The protection the law gives to females should be equal to the protection given to males. Maybe we need a Ministry of Men’s Affairs^*.

^{*To represent men on issues like: circumcision, depression, suicide, body image, school achievement and attendance, lifespan, domestic violence, drug use, unemployment and health research (totally unscientific experiment, but I thought this was interesting. There are 1217 results for men’s health in PubMed and 29464 for women’s health. 24900 results for men’s health in Google Scholar and 518000 for women’s health.)}

^{Image credit: Brad Brundage}

The death penalty is nothing new but it caught my eye because of Osama Bin Laden reportedly being killed and because of the “let’s shoot the looters” comments I saw on a Christchurch earthquake Facebook page.

Death to the death penalty (video)
Stop the death penalty (video)

Let’s assume that Bin Laden was killed and buried straight away in the… ocean? This example is interesting as he wasn’t killed after he was sentenced to death by a court. However Obama said he: “…[made] the killing or capture of Bin Laden the top priority…”

Whether Bin Laden was killed intentionally or not I’m not sure. Now his body is in the water so we might not ever know. However I found the outpour of support for Bin Laden’s death and even the celebration resulting on sites like Twitter extremely interesting. And a lot of people were celebrating. I wondered if all of those people would support capital punishment in less extreme circumstances, like for the murder of one person? Or whether this event has changed their views to support the death penalty?

Did this bring about justice? I say no. A civilized trial would have created justice, in my opinion. Some said that the celebrations were justified because it symbolized the fighting and winning against terrorism. Because a figurehead of terrorism was downed. But Bin Laden was just that, a figurehead. Did he encourage hate, hurt and violence? Yes. Did he pull the triggers himself? No. Will someone take over his place leading Al-Qaeda? Yes.

More importantly, does this mean I’ll be able to take my bottle of water through airport security now?

The permanence of capital punishment is concerning. How sure would you need to be of someone’s guilt to support an execution? What if mistakes were made? Are a few false positives alright?

Does the death penalty grant relief to the suffering victim’s families?

This editorial in the New York Times says no: ‘In an open letter to the Connecticut Legislature, relatives of murder victims — 76 parents, children and others — wrote that “the death penalty, rather than preventing violence, only perpetuates it and inflicts further pain on survivors.”’ The death penalty deepens the wounds and the pain of victims’ families and the accused’s family. It creates more victims and continues the cycle of violence.

This page has stories from inmates’ families on how they’ve been affected by an execution. Bill Babbitt turned in his brother for committing a murder and was under the assumption that his brother would get the help he needed. His brother who was a paranoid schizophrenic was sentenced to death. Robert Meeropol talks about having both of his parents executed when he was six-years-old.

The death penalty makes it easy to “solve” re-offending without having to deal with the policies behind parole. It’s also easy to say prison officers would be protected, when in reality issues surrounding staff security need to be sorted.

Instead of putting forward the death penalty as a solution for crime, let’s create better policies. Policies that identify youth that are at-risk of offending. Better mental health services. Let’s remind ourselves that people released from prison need support starting well before they’ve been released to successfully assimilate back into society.

Alternatives to capital punishment might be the way out. Harris County, Texas, District Attorney Johnny Holmes says “you’re not going to find 12 people back-to-back on the same jury that are going to kill somebody when the alternative is throwing away the key.”

Is there a humane way to kill someone?

By poisoning with the lethal injection? Where are those drugs coming from?

Texas was reluctant to release where the drugs they use in their death row come from. Besse Medical, apparently. Feigning ignorance, Besse say they “…[have] no way to determine what its customers, including the Texas corrections department, does with its products.”

That article reports a shortage of U.S. made lethal injection drugs and says states have had to import from overseas. As overseas countries ban the export of those drugs for use in executions (“that supply dried up after the British government in November banned its export for use in executions”) and drugs are imported from dubious sources or drugs are reappropriated, concerns should be raised over the quality and efficiency of the drugs being used. Are they going to kill someone quickly and painlessly? Oklahoma is using an anesthetic, pentobarbital, that’s used in animal euthanasia solutions.

What level of training do the people administering the drugs have regarding administration or dosage?

Short answer: University of Miami researchers say none. It appeared prisoners were assumed to be successfully anaesthetised if they were given a standard dose of thiopental, but this wouldn’t be true if the drug was given incorrectly, the execution took longer than anticipated or the prisoner had anxiety or serious substance abuse issues. After analyzing autopsy data for 49 prisoners who had been executed, researchers found that in 43 cases the concentration of anaesthetic in the prisoners’ blood were lower than required in surgery. Out of those 43, 21 of the concentrations “were consistent with [the prisoner] being aware of what was going on.”

…the researchers, led by Dr Leonardis Koniaris, said: “We certainly cannot conclude that these inmates were unconscious and insensate.”

“However, with no monitoring and with little use of the paralytic agent, any suffering of the inmate would be undetectable.”

They add: “The absence of training and monitoring, and the remote administration of drugs, coupled with eyewitness reports of muscle responses during execution, suggest that the current practice for lethal injection for execution fails to meet veterinary standards.”

As a society we can do better than a primitive band-aid on the long-term problem of crime.

See also: an eye for an eye ends up making everybody blind.

^{Image credit: World Coalition Against the Death Penalty}