Allowing sexually active gay men to donate blood is not worth the risk

Gay men will now be able to give blood as Government restrictions are officially lifted, the Department of Health (DoH) has said.

A lifetime ban on blood donation by men who had had sex with another man was put in place in the UK in the 1980s as a response to the spread of Aids and HIV.

But following a review by the Advisory Committee on the Safety of Blood, Tissues and Organs (Sabto), men who have not had homosexual sex within a year will be able to donate if they meet certain other criteria.

The move will be implemented in England, Scotland and Wales.

Men who have had anal or oral sex with another man in the past 12 months, with or without a condom, will still not be eligible to donate blood, the DoH said. They said this was to reduce the risk of infections being missed by testing and then being passed on to a patient.

Sabto’s advisory panel, comprising leading experts and patient groups, carried out its review based on the latest available evidence and found it could no longer support the permanent exclusion of men who have had sex with men. They considered the risk of infection being transmitted in blood, attitudes of potential donors in complying with the selection criteria and improvements in testing of donated blood.

Dr Lorna Williamson, NHS Blood and Transplant's medical and research director, said: ‘The Sabto review concluded that the safety of the blood supply would not be affected by the change and we would like to reassure patients receiving transfusions that the blood supply is as safe as it reasonably can be and amongst the safest in the world. There has been no documented transmission of a blood-borne virus in the UK since 2005, with no HIV transmission since 2002.’

I have just listened to a BBC interview (still on line) where a bisexual man called John said that there was still not ‘equality’ and that there should not be even a twelve month waiting time. It was explained to him that this waiting time would still be in place because the incubation period for hepatitis B, which is carried in blood, is six months – and that the twelve month ban was there for reasons of patient safety. I might add that the time for sero-conversion for HIV (during which you can infect others but do not have detectable antibodies) is 20-90 days and can also be as long as six months.

Why am I unhappy about this new policy? I simply believe that allowing gay men who have been sexually active to donate blood is just not worth the risk.

First, the conclusion of the latest research is that over 10% of men who have sex with men (MSM) already knowingly defy the current lifelong ban. This suggests that many will also knowingly defy the twelve month ban and this will increase the risk of transmission, especially if John’s reaction above is in any way representative.

Second, the number of new donors this policy will produce will be very small. According to the Wellings’ survey only 2.6% of men report ever having had sex with men and the vast majority of these will have been active in the last year. Also two thirds of gay men participate in anal sex. So it will be only a very small fraction of an already small starting percentage who will even be eligible.

Third, the risks of HIV transmission with anal sex are very high indeed, 18 times higher than in vaginal sex. The risk of an HIV positive person passing the virus on in the course of a relationship involving anal sex is around 40% explaining why gay men are such a high risk group (see also original source).

Fourth, a subset of gay men are extremely promiscuous and the risk of HIV transmission goes up with the number of partners one has. Despite the popular media image of homosexual monogamy, several large early studies from the 1970s revealed that less than ten percent of homosexual men or women had ever experienced a relationship of greater than ten years duration. In one large early study, 74% of male homosexuals reported having more than one hundred partners in a lifetime, and 28% more than 1,000; 75% reported that over half of their partners were strangers. A more recent review of six studies showed that 87% of gay men displayed levels of promiscuity parallel to those of unmarried straight men with an average of five or six sexual partners in the last five years. But a significant minority were promiscuous to an extent seen rarely in straight men. 14.4% had 20-100 sexual partners in the previous five years and 4% had over 100!

So in summary – most gay men engage in high risk anal sex, some are extremely promiscuous, and a significant proportion lie about it. It’s simply not worth the risk allowing them to give blood given the small number of gay men who would actually qualify under the new guidelines.

If one person gets HIV from blood donated by a gay man it will be a tragedy. Banning all gay people giving blood donations may debar some who would very much like to help in this way. But safety should be the overriding priority. In a free society we accept, for reasons of public safety, that some people are not able to do what they very much would like to do – in all sorts of contexts other than blood donation.

In a much-quoted editorial published in Vox Sanguinis in 2004 J P Brooks argued that ‘The rights of blood recipients should supersede any asserted rights of blood donors’

The abstract of his review summarised the arguments as follows:

‘Some gay men have argued that the laboratory testing of blood is so accurate that continued deferrals based upon sexual activity are unnecessary and unjust. They also assert that they have a right to donate blood. There has been much debate over altering the rule barring donation from men who have had sex with other men since 1977, with blood organizations disagreeing over the best course of action. Two studies have indicated that changing the rule would increase the risk of human immunodeficiency virus (HIV) transmission. This dilemma is part of a broader issue, namely: what are the responsibilities of blood services to blood donors and recipients? Blood services should base decisions regarding donor suitability on science rather than on their donors’ desires. Blood services must recognize that the rights of blood recipients should supersede any asserted rights of blood donors.’

Quite!

But the final word goes to Andrew Marsh of Christian Concern who was interviewed on Radio Five Live breakfast show this morning.

He made the point that the safest donors, with respect to HIV, are those who have only had sex within the context of marriage, and that if there was no sex outside marriage there would be no HIV. Well now, there’s a radical idea!

New studies confirm obesity as significant risk factor for cancer - but are we being open and honest about it?

Amidst the media feeding frenzy over phone hacking lots of significant news continues to pass largely under the radar.

This week, for example, we have had two news stories drawing attention to the link between obesity and certain forms of cancer which have had very little media coverage.

The first, ‘Cancer rate rising in middle-aged’, relates to a report from Cancer Research UK showing that whilst cancer survival rates have doubled since the 1970s, nevertheless the risk of developing cancer in middle-age has risen by over 20% in a generation.

Data show that in Britain in 1979, 44,000 people aged 40-59 developed the disease, compared with 61,000 in 2008.

CRUK said the rise for men and women was partly due to better screening, but also lifestyle factors like obesity. In women, use of the contraceptive Pill, drinking more alcohol, having children later and being overweight have increased breast cancer risk.

The second, ‘Obesity leading driver of breast cancer’, relates to research, also from CRUK, showing that obesity is the biggest lifestyle factor behind the most common form of breast cancer in older women. Alcohol and then cigarettes are the next largest culprits.

One in eight women in the UK develop breast cancer in their lifetime, data shows, and the majority of these tumours are ‘hormone sensitive’ meaning their growth is fuelled by hormones. Too much stored fat in the body raises the level of these ‘sex’ hormones.

According to the BC, experts say women should be made aware of these modifiable risk factors. Dr Julie Sharp, of Cancer Research UK, said: ‘This is an important study as it helps to show how alcohol and weight can influence hormone levels. Maintaining a healthy body weight and reducing alcohol consumption are key to reducing breast cancer risk.’

So there you are. If you didn’t know this before then you do now.

But do most people at risk actually know this? And if not why aren’t they being told?

And why is it an issue that is seldom, if ever, addressed by the church?

Well there’s a question!

NICE and GP consortia. What criteria should we use in deciding how to distribute scarce medical resources? Some help from St Paul.

The government’s drug rationing body, NICE, is to lose its power to turn down new medicines for use in the NHS, but will continue to write guidelines for doctors on the best treatments for their patients.

In addition, the current limit on the cost of new drugs – around £30,000 per quality adjusted life year (QALY) – will be scrapped from 2014.

The move seems to have been driven, at least in part, by David Cameron’s election announcement of a £200m fund for new cancer drugs. Some of these drugs had previously been blocked by NICE because of their minimal benefit and very high cost.

Instead, after 2013, groups of GPs – consortia – will be responsible for deciding whether a drug should be funded or not.

These consortia will be allocated more than £70 billion of funding, divided up according to each area’s population and level of ill-health. Out of this they will fund everything, from hospital operations, to district nurse visits, to drugs.

The Daily Mail has welcomed the move as a ‘victory for patients’ under the headline 'Penny-pinching' NICE stripped of power to ban life-saving drugs’.

By contrast, Polly Toynbee, writing for the Guardian sees ‘Big Pharma’ as the winner and predicts ‘more ineffective drugs and higher prices’.

Unusually I find myself agreeing more with Polly Toynbee on this occasion.

She argues that, ‘Every health system is rationed, always was, always will be’ and sees Health Minister Andrew Lansley (pictured) as caving in to ‘a toxic combination of Daily Mail anecdotes of dying patients desperate for a few more months of life and intense lobbying by a pharmaceutical industry that has campaigned long and hard against the one body that kept NHS drug costs under a modicum of control’.

But given that decisions will always need to be made about which treatments will be supplied to whom what criteria should these new GP consortia use?

Clearly the first two criteria will be effectiveness and cost. The former will still be assessed by NICE on the basis of the available evidence in peer-reviewed medical journals and the latter will hopefully be effectively controlled by government.

But the number of drug treatments of medicines that are ‘effective but expensive’ that can be funded will be limited in order to ensure that other treatments can still be supplied to other patients.

It is inevitable that some patients will have to miss out. So what criteria should they use to decide who gets a given drug and who doesn’t?

Should it be ‘first come first served’? Or is it actually right to discriminate? And if so, on what grounds?

The Apostle Paul tackled a problem of resource allocation in his first pastoral letter to Timothy involving the question of which widows should be supported by the church. Care for widows, orphans and aliens are key priorities throughout Scripture for God’s people – but if funds are limited how does one decide between cases?

Paul laid out three key principles.

First, there should be genuine need. ‘Give proper recognition to those widows who are really in need.’ (1 Timothy 5:3) This must have involved some kind of objective test or assessment. Help was not to be given just because people asked for it and especially not just to those who asked loudest. It is right to assess whether need is really genuine and often it is the voiceless whose need is greatest (Proverbs 31:8). One assumes that the church therefore would have had have to define some specific level of genuine need that was measurable and quantifiable.

Second, the person had to have no other means of support available to them. ‘If a widow has children or grandchildren, these should learn first of all to put their religion into practice by caring for their own family and so repaying their parents and grandparents, for this is pleasing to God… Anyone who does not provide for their relatives, and especially for their own household, has denied the faith and is worse than an unbeliever.’ (vv4, 8) This principle was applied because it was recognized that funds were limited: ‘If any woman who is a believer has widows in her care, she should continue to help them and not let the church be burdened with them, so that the church can help those widows who are really in need.’ (v16) Paul also specifically advised against supporting younger widows, because doing so would encourage dependence and idleness (vv 11-15).

Third, the person had to have proved, by their responsible behaviour and service of others, that they deserved such support. ‘No widow may be put on the list of widows unless she is over sixty, has been faithful to her husband, and is well known for her good deeds, such as bringing up children, showing hospitality, washing the feet of the Lord’s people, helping those in trouble and devoting herself to all kinds of good deeds.’ (vv9, 10)

Of course, if the resources of the early church had been in unlimited supply, there might not have been a need to place limits. But they weren’t, and therefore decisions had to be made. Resources aren’t unlimited for us either – even in the affluent West.

Perhaps these three principles – genuine need, no other means of support and responsible behaviour – might also be a good place to start when drawing lines on the allocation of limited health resources and tax payers’ money.

David Nutt’s report on the harmful effects of alcohol should prompt the government to adopt evidence-based protection strategies

Alcohol is more harmful than heroin or crack, according to a study published in medical journal the Lancet.

The report, which is co-authored by former UK chief drugs adviser Professor David Nutt, ranks 20 drugs on 16 measures of harm to users and to wider society. Each drug was scored for harms including mental and physical damage, addiction, crime and costs to the economy and communities.

Tobacco and cocaine were judged to be equally harmful, while ecstasy and LSD are among the least damaging.

The modelling exercise concluded that heroin, crack and methylamphetamine, also known as crystal meth, were the most harmful drugs to individuals, but alcohol, heroin and crack cocaine were the most harmful to society.

When the scores for both types of harm were added together, alcohol emerged as the most harmful drug, followed by heroin and crack. The system ranked alcohol three times more harmful than cocaine or tobacco. Ecstasy was ranked as causing one-eighth the harm of alcohol.

The findings run contrary to the government's long-established drug classification system, but the paper's authors argue that their system - based on the consensus of experts - provides an accurate assessment of harm for policy makers.

The authors concur with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy.

Prof Nutt told the BBC: ‘Overall, alcohol is the most harmful drug because it's so widely used. Crack cocaine is more addictive than alcohol but because alcohol is so widely used there are hundreds of thousands of people who crave alcohol every day, and those people will go to extraordinary lengths to get it.'

He said it was important to separate harm to individuals and harm to society.

Christian Medical Fellowship has regularly contributed to the debate on the dangers of alcohol misuse.

Currently 37% of the population drinks more than the recommended number of units of alcohol per week. The NHS bill for alcohol abuse is an estimated £2.7bn a year and the most recent figures show hospital admissions linked to alcohol use have more than doubled in England since 1995.

Alcohol was the main or secondary cause of 207,800 NHS admissions in 2006/7, compared to 93,500 in 1995/96. The figures include hospital admissions for a specific alcohol-related condition – such as liver disease, but also admissions where alcohol is a contributory factor but not the main cause – such as falls due to drunkenness.

According to the World Health Organisation, alcohol has the third largest burden of disease globally.

Christian Medical Fellowship has previously backed Chief Medical Officer Sir Liam Donaldson in his call for a minimum price for alcohol. Under this proposal, no drinks could be sold for less than 50 pence per unit of alcohol they contain. The proposed measure would add around £1 a month to the drinks bill of a moderate drinker – but more for those heavy drinkers who were at risk. After ten years such a move would lead to 3,400 fewer deaths and 100,000 fewer hospital admissions a year.

In combating the epidemic of alcohol misuse the government needs to embrace solutions that are properly evidence-based. The previous government’s education-based 'sensible drinking' strategy for countering alcohol misuse is not evidence-based, but is rather built on the false presuppositions that an intemperate minority contribute the bulk of alcohol-related problems in the community and that people make rational and objective decisions about their drinking.

Research shows clearly that alcohol-related morbidity and mortality are directly related to the quantity of alcohol consumed by a population, which in turn is directly related to the availability and acceptability of alcohol in that population. Price is the major determinant of alcohol consumption, and taxation is a very effective preventive tool.

The so-called prevention paradox is based on the observation that, while very heavy drinkers do incur more alcohol related problems, they are a small minority. Alcohol-related problems occur much less frequently amongst the moderate majority, but this population is very large indeed. So, the mathematics of a lower problem rate amongst a very large number of people can still result in a larger overall number of problems than does a high rate amongst a very small number.

In other words, the people who are not recognised as misusing alcohol often contribute the bulk of alcohol-related problems in a community. The paradox is that prevention of alcohol problems in a population can therefore require us to give as much attention to the moderate majority as the intemperate minority.

Are British Christians too fat? Almost certainly! But what should we be doing about it?

New research this week has shown that two-thirds of Britons are overweight or obese – making us the fattest country in Europe.

We are also the fourth fattest nation in the world behind only Australia (71.1 per cent), the US (69.9 per cent) and the United Arab Emirates (68.4 per cent).

According to research company Datamonitor, a quarter of Britons are obese (15 million), with a body mass index (BMI) of 30 or more, while four in ten of us (25 million) are overweight (BMI>25),

This means more than 40 million British people are deemed to be at an unhealthy weight.

The figures were published this week as a separate study showed that the number of people admitted to hospital for obesity-related illnesses has shot up by more than ten times in the past decade.

The health risks of being overweight are significant. Obesity isn't just an issue of personal health. The cost to the NHS and to the wider economy - because of increasing time off work - is estimated at about £7 billion per year, of which £1 billion is direct health service costs.

The risks are higher as BMI increases for type 2 diabetes (20 times greater for those who are very obese), cancer (10 per cent of all cancer deaths among non-smokers are related to obesity), coronary heart disease, stroke, high blood pressure (85 per cent of hypertension associated with a BMI greater than 25) and fatty liver (affects 90% of obese people and may lead to cirrhosis).

How fat are you? If your BMI is over 25 then maybe it is time to take action.(You can calculate your own BMI easily online)

Weight loss in principle is fairly simple. If you are overweight (>25) or obese (>30) you can lose weight either by eating less or by exercising more. Recommended daily calorie intake varies from person to person, but there are guidelines for calorie requirements you can use as a starting point.

UK Department of Health Estimated Average Requirements (EAR) are a daily calorie intake of about 2,000 calories per day for women and 2,500 for men. The key is to make your input (in food) match your output (in activity). If input is greater that output you will gain weight. If input is less than output you will lose weight.

But which is easier – to eat less or exercise more?

About 500 fewer calories per day (that’s one McDonald’s quarter pounder or one large chocolate milkshake!) over the course of a week (ie. 3,500 calories) will result in a one pound loss for an average person.

But to lose a pound through exercise the same person would have to run almost 30 miles at 8 minute mile pace! (Calorie burn calculator here)

So you can see that it’s far easier to eat less than exercise more.

The Bible tells us that physical training is of some value – and of course it is – but the key thing if you want to avoid obesity and all its attendant health risks is to eat less.

Are British Christians too fat? If US data is any thing to go by (and remember we are almost as fat as the Americans!) then the answer is a big ‘yes’. Because in the US, the more Christians per state, the higher the level of obesity. (see diagram above)

Christians do seem to be at least as prone to obesity as those in the general population.

But when did you actually last hear a sermon on overeating or exercise?

Maybe that’s part of the problem.

A much fuller treatment of the issue of obesity from a Christian perspective can be found on the CMF website. See Facing the Obesity Epidemic