NR AEBP
AU Fogden,M.; Whitehorn,K.; Starr,D.; Persaud,R.; Hannaford,R.; Barbara,J.A.J.; Love,E.; Robinson,A.; Ferguson,E.; Turner,G.; Wallington,T.; Klein,H.; Franklin,I.; Fry,R.; De Wit,J.
TI Panel Discussion. Millennium Festival of Medicine - Transfusion 2020 - 18 October 2000.
QU Transfusion Medicine 2001 Apr; 11(2): 136-45
PT journal article
VT
Panel Discussion: Millennium Festival of Medicine - Transfusion 2020 -18 October 2000
Mike Fogden
The chairman introduced Dr Raj Persaud, Consultant Psychiatrist at the Maudsley Hospital, Dr Liz Love, Consultant Haematologist with the National Blood Service (NBS), Dr John Barbara, Consultant microbiologist for the NBS, Ms Katharine Whitehorn, journalist, ex vice president of the Patient's Association and 'agony aunt' for Saga magazine, and Mr Richard Hannaford, Health correspondent for BBC Radio. They joined the four speakers for the panel discussion. The Chairman asked each of them to make an opening statement.
Katharine Whitehorn
I think that the public actually does have an appalling perception of risk, or none. The trouble with the press, and I think my colleagues would agree with me, is we deal in extremes. The scientific journals perhaps don't and the heavy papers don't.
I agree with what the last speaker said about accentuating the positive because the only way to get over this problem is to emphasize good stories. Stories are what stick in people's minds. So I hate to say, don't trust my profession, but I don't actually think that the public has got a good perception of risk and I don't know how you're going to make it better.
Douglas Starr
Speaking as an American journalist who specializes in medicine, I worry that people in forums like this often don't compare like with like. They compare good doctors to bad journalists; yet there's a whole spectrum of journalism out there.
We find in our country that journalism is diverging: the bad stuff is getting worse and the good stuff is getting better. I am sure you are finding that here as well. The good journalists in our country know the difference between absolute and relative risk; they know to include the denominator when they are talking about a study; they know that the worst-case scenario is probably very unlikely and they know to put things in context. In the graduate programme that I co-direct we teach our young journalists that when they look at a study they should ask about the significance, the scientific context, and look for the social context. If it's a food study, they should ask whether people should change their behaviour based on the study or whether it's merely a curiosity. So I think the paradox my colleague is talking about certainly exists. But just as Richard Titmuss took a caricature of the American blood supply in doing his analysis, I think that what I've heard is a bit of a caricature of what's going on in science and health journalism, at least in our country.
Raj Persaud
We have heard why a lot of people are very bad at perceiving risk and we have to try and understand what's going on in terms of the mechanism by which people think about risk.
One theory that's come up from psychology is basically that we think about risk depending on the images that come to mind whenever an idea is presented to us. For example, the trouble that the nuclear power industry has had persuading us that nuclear power is safe is related to the image that comes to mind when you hear about nuclear power, i.e. atom bombs exploding and it's the association of this image in your mind that largely determines risk.
Think about another very popular power source, petrol, something we use every day: if we had been introduced to petrol as something that is used in napalm, which it is, then we might have a very different perception of the risk of using petrol. So one of the key issues is the images that come to mind, and here of course the media presents a problem because by definition the media is very interested in the extraordinary, the unusual. If it's usual and typical there's no point reporting it. So images that abound in our society are images that are actually about the unusual and the very rare. The trouble is these images are now very available to the public and therefore massively distort their perception of risk. Here a very interesting paradoxical situation arises.
Suppose I was a nuclear power engineer and I was trying to persuade you about the safety of the nuclear power plant I had just built, one of the things I might do is start going through in great detail all the safety features I had built into my nuclear power plant. Safety features designed to prevent very rare events occurring. But every single time I mention a safety feature to you I bring to mind this rare event that I am telling you is not going to happen, and every time I bring it to your minds you are beginning to think about how possible it might be. So the very act of discussing safety features in great detail itself calls to mind the image of something bad going wrong, and that is why it influences dramatically people's perception of risk. After I told you about 150 safety features I had built into my plant you might think to yourself, 'Blimey, if it needs that many safety features it must be a very dangerous plant indeed'.
That is actually precisely what I would argue, perhaps rather provocatively, is going wrong with the way the blood transfusion, blood industry, is communicating risk. The more you talk about the technology that you build in to screen blood, the more you bring to mind the things you are screening out. So, paradoxically, I would argue that you are having a counter-productive effect, because you are bringing to mind people's concerns about the very rare things that might go wrong.
There has been some research, which I would again argue perhaps rather provocatively, might have the kernel of the answer to this. I am a bit cautious about presenting it because it runs a little bit at variance with some of the data we have seen presented already, but it's no surprise to get two psychologists in a room who don't agree with each other. There is some research from America which looked at what the population estimated was the risk of catching AIDS from blood. The group of people who were found to believe there was the lowest risk of catching AIDS were blood donors. So people who donated blood tended to think there wasn't a very high chance of getting AIDS from blood. Now, why was that? Surely one of the reasons for that is that people who donate blood are familiar with themselves and the kind of people who give blood and they know that the kind of people who give blood tend to be from very low-risk populations and it's that familiarity with that group that influences their views of risk.
So I would argue that one of the things you may want to think about is moving away from the technological argument and focusing instead on the fact that the kind of people who tend to donate blood are your best safety measure of all. By definition, they are the kind of people who are very unlikely to have the risk factors that people are concerned about.
One final point I want to make is about the psychology of persuasion. Persuasion is always very difficult. If I was to try and persuade you of my point of view, let's call it (b), and you have a different point of view to me, let's call it (a), and say I was successful and I moved you from (a) to (b) and you now agreed with me. Somewhere along the line you would have to accept that (a) your previous belief was incorrect. Somewhere along the line you would have to accept that you were wrong and I have got to tell you that one of the fundamental laws of psychology is that people don't like to accept they were ever wrong. Whatever persuasive campaign you mount cannot implicitly tell people that they were wrong, because that's a campaign that's going to fail.
Richard Hannaford
I would just add one point. There is a tendency amongst journalists to regard anyone in authority as having something to hide. Jeremy Paxman put it very succinctly once when he said 'I always interview politicians with a thought in my mind, what are these bastards trying to hide'. There is, I think, a tendency amongst journalists to do that and if there was any suspicion that health professionals were avoiding a subject, that would be like a red rag to a bull. I do health scare stories virtually every week. One definition of a scare story could be that it's inconvenient to someone or it causes discomfort to someone, and often that someone is the health professional themselves because it makes them have to do something differently or explain themselves more often. Health scare stories aren't always bad. Health scare stories are only scares depending on where you stand.
John Barbara
We are often accused in the Blood Service of only being concerned about cost, and currently nothing could be further from the truth. We have a very safe blood supply. It didn't just happen like that. Elements of donor selection, elements of sophisticated testing and increasing sophistication in the testing have made the supply safe. But, how far do you go? Jim Aubuchon in the United States tries to analyse cost and benefits. You might argue about the detail and the accuracy but overall I think the messages that come out are clear. If you look at cost effectiveness as measured in the dollars you have to spend per year of life extended, how much do you pay for every year of life extended? ALT liver enzyme testing is still done in some countries, even though we test all the blood for anti-HCV. If you do this, you are spending 8 million dollars for every year of life extended. You have to ask: 'is this sensible, is this the best use of limited resources?'
I want to show you an analysis of comparative risks that Kate Soldan and I derived, from Kenneth Calman's analysis of everyday risks (Fig. 1). Calman's risks are risks that anyone in the population can be subject to, whereas, of course, with HIV and hepatitis C you actually have to have had a transfusion to be at risk. When you compare where our transfusion risks come, HIV risk comes out at minimal to negligible, comparable with the risk of dying by being struck by lightning. Look at hepatitis C: when we use modern technology that enables us to use genome testing directly, our yield with that test is something like 1 in a million. We are again in the risk of being struck by lightning. I hesitate to put these facts in front of you now because we have heard that nobody believes the facts or understands them, but these are the facts as they are and I think that's important for the rest of the debate.
Elizabeth Love
I am here because of my role in the Serious Hazards of Transfusion scheme. This is a UK-wide confidential and anonymized scheme for the reporting of serious hazards of transfusion of blood and blood components launched in November 1996.
Currently, we have just under 80% participation of our hospitals in this scheme. This is an overview of fully analysed questionnaires for the three years since the scheme was launched (Fig. 2). The vast majority of hazards fall into the category 'incorrect blood component transfused'. That is, all types of incorrect transfusions including the wrong component and also including ABO-incompatible transfusions, but it is not solely composed of ABO incompatibility.
Then we have acute transfusion reactions, delayed transfusion reactions and post transfusion purpura, transfusion-related acute lung injury, transfusion-related graft-vs.-host disease and this very small percentage of transfusion-transmitted infections, which is 3%. If you look more closely at the incorrect blood components transfused, this is attributed to a number of different errors, and in fact we had in these 309 cases over 500 errors in total.
You can see that they are at all stages of the transfusion process from collection and administration through to the laboratory, sample requests and one or two emanating in the Transfusion Centre. If we again look at the outcome of all the hazards reported, and the overall mortality and morbidity of these 575 cases, fortunately the vast majority are related to little or no morbidity but there are some deaths: 28 deaths in the 3 years are attributable to transfusion. A number of other deaths are possibly related to the transfusion, making quite a significant number, 37 in all.
Then we have a few deaths unrelated to the transfusion itself. In 111 cases where there was major morbidity, there were a number of situations such as coagulopathy related to the transfusion and sensitization to rhesus D antigen.
If we try to put this into some kind of context, in the whole of that period, about 9 million components were issued in the four UK Blood Services and Ireland. If we look at the total figures for incorrect blood transfusion, bearing in mind we may have incomplete reporting, and this includes all types of incorrect blood transfusion, this comes to a figure of 1 in 31 000. If we look at the risk of death or major morbidity in all categories this is about 1 in 60-70 000. The risk actually fits into the minimal risk or even moderate risk category discussed by John Barbara.
We have tried in the SHOT scheme to formulate some main messages which we need to communicate better, if not to the general public, certainly to the hospitals. Incorrect blood incidents are avoidable errors; the bedside check is the final vital step in preventing these errors, but basically errors at any stage in the transfusion process can result in an incorrect blood transfusion and multiple errors often contribute to this.
There are other potentially avoidable causes which are receiving attention, transfusion-related acute lung injury and bacterial contamination of platelets. There are on-going discussions and studies now in both these areas. So I just want to leave you with those facts which I hope will contribute to the discussion as we go on this afternoon.
Angela Robinson, Medical Director (National Blood Service)
How can we frame the message so that within the hospital they are actually aware there is a much greater risk of getting the wrong blood in the hospital than getting vCJD and so forth? How can we frame it so that people actually understand?
Mike Fogden
I think part of the NHS 10-year plan is to create a climate that hospitals are safe places so I suspect what you are asking, Dr Robinson, may in fact be rather difficult to deliver.
Richard Hannaford
I think you've got an uphill task. Most people generally have a very strong attachment to their hospitals and hospitals have a very good reputation for safety and care. It's the odd stories that the media pick up and broadcast and amplify. However, it depends what message you want to get across.
The SHOT information scares me very much. If you start talking about safety and then you show some statistics where people die for this, that and the other, then that confuses people and introduces the idea of danger. I have seen those figures before, actually reported on them, and every time I look at them I think what the hell happened there? Every one is an individual incident, but then lumped together it just looks so big and scary.
I would take it from a different view; I would say ignore the safety, if you like, and talk about benefit and talk about positive messages. Unless you have to respond to questions about safety and incidents, always look at the benefits and always look at the quality side of things and promote those positive stories.
Mike Fogden
This looks a bit like emphasizing the subjective whilst the objective information, as Dr Robinson has told us, is that hospitals are not particularly safe places. One's subjective view is that you go to hospitals so that you will, so to speak, be made safe.
Eamonn Ferguson
If you see transfusion as a preventative act, which it is, then presenting information as a gain frame, as a benefit (lives saved/numbers not infected), would have a major impact. Presenting it as a loss frame, as negative (lives post/infections), is going to be detrimental.
You are presenting the data as mortality or morbidity for 'x' number of units transfused per year. You only have to turn it around on its head and you can present it as how many lives are saved each year and it is exactly the same figure but presented as lives saved rather than lives lost.
This goes back to subjective knowledge as we said earlier: it's how people visualize and remember things and how they bring things back from memory. That's why knowledge isn't the predictor of risk. People don't know what the numbers mean. If you say 1 in 100, people don't know what that means. They have no concrete perception of it. It's got to be in something that's tangible for people to get hold of and they can imagine. If you want to present it as a benefit the benefit has also got to have a visual component.
Douglas Starr
Do any of you have the Norton antivirus programme on your computers? If so, did you ever go into the introduction where there's a film about how they've got all their technicians working day and night to make sure that no viruses get through; and if there's a new one it'll only be about a day before they catch it? Does that sound familiar to you? I think you might find that a useful model.
I come from a country where everything is so media manipulated - from what beverage you drink, to what movie you watch, to what presidential candidate you vote for - that the people actually prefer to be told the unvarnished truth as mature adults. In your case the truth is not that you're static institutions like banks (in fact, if you got rid of the word bank you might be better off in a sense). The truth is you are an incredibly dynamic state-of-the-art enterprise.
You've got some of the brightest people in the country working like crazy to make sure that if something should get into the blood supply you'll catch it as soon as possible. This image gives an entirely different version of what you're doing, and a more truthful one as well. You're not standing around flat-footed waiting for something to happen. Of course there are risks in blood processing: welcome to Life. But the truth is, you've made the risks vanishingly small and you won't rest until they are smaller and smaller and smaller.
I think that's a more realistic public image, and treats the donors and the patients as mature people. It might be something to consider rather than the approach of 'shall we tell them this, shall we not tell them this'. Just tell them the truth about what you do, in its full context and complexity.
Raj Persaud
I agree with that and I think the Norton antivirus program is a very good analogy to use. One of the powers of it, implicit in their marketing, is heightening their credibility as people who are very good at what they do and put your trust in us. The experts you are talking about working in the blood transfusion industry are regarded by doctors as experts but doctors and medical experts have suffered a loss of credibility recently.
I think there's an issue about our marketing of our expertise and I wonder whether any of the journalists want to comment on that. There's a sense in which doctors pronouncing on how safe something is has much less status today than it had 50 years ago. If anything it arouses suspicions of what we're trying to hide.
Richard Hannaford
Look on the Internet at the MORI site, it's very interesting. They have a public confidence monitor there and journalists are still beneath doctors.
Gill Turner, CJD Support Network
Just a wider comment about communication. A fortnight ago I was at the European Health Forum meeting in Salzburg about advice and information. With the growth of the Internet the majority of the public have got more access to information than they have ever had. However, it's about the quality of that information, where it's coming from and the raised expectations and perceptions of the general public.
I think that's why we get so many phone calls when a fear is raised in the papers or in the media. The public come to us and I think it's possibly a good idea for patients in hospitals and different disciplines to have somebody that the public can have access to if they've got questions or fears. We often get people ringing up when they're due to have a blood transfusion. They can't get access to a consultant and they can't ask their questions about their fears. The way forward is to make better access to good quality knowledge for the person who raises the question.
Katharine Whitehorn
I agree with you but I don't think the Internet is all the answer. I work with people who are over 50 and they are stumbling towards it. I think these health helplines, such as the Health Information Service, are a much more useful way for people to get quick information.
Gill Turner
Yes, but we're getting people who contact us who have gone through the Internet. If they've got a diagnosis of CJD they go to the Internet and they put in the word CJD and they get 1000 sites and may be only a few are good quality. It's all about fears raised.
People have got to know where they can go for good quality information The general public have to have easy access to that and know where they can access that information.
Tim Wallington (National Blood Service)
We're here in part as blood transfusion professionals to share a problem and the problem is illustrated by John Barbara's slide. Data from the States shows the kind of money you spend trying to deal with risk. We know the perception of risk is one thing you have to get into a debate. We want a debate, we don't want to sit here pontificating. We should be trying to inform a debate that's about assessing, handling risk and how much of its resources the community at large wishes to put into blood safety.
Resources for health care are finite. Can we have some comment on that? How do we handle it? How do we decide that nucleic acid testing (NAT) testing for the release of all cellular products is worth it or not? I think that's a very important debate. How can we get the public at large involved in that? Are the psychologists saying that we can't really because people won't understand the detail? What part does the journalist have to play?
I had a long chat recently with Richard Hannaford about sheep and vCJD. How do you put that problem in proportion? How do you share your uncertainties, because there are so many? It's a very important area for us.
Harvey Klein
I'd like to just comment on that. Many of these decisions are political decisions and they are political decisions because that's what the general public want.
You saw the graph on HIV antigen testing. When this test became available it was predicted that it would have very little value. We in the States made a terrible error of actually doing a study on that. We spent about 2 million dollars and looked at 513 000 blood donations in an 8-week period of time (so people couldn't donate twice) and found that in fact there wasn't a single donation which was picked up by the antigen test that was not picked up by the antibody test that we'd already been using for several years.
We made the predictions then that this was a terrible test in terms of cost-effectiveness. The Federal Drug Administration's (FDA) commissioner then said 'We will introduce this test because that is in fact what the general public wanted'.
Blood is different and a small change, almost unmeasurable change in safety, was what the public wanted at that cost. In the United States, after the AIDS epidemic, one could get those kinds of data to say that is in fact what they want. To make the argument that those dollars could have been better spent, at that point in time, was not helpful. Dollars were not going to be spent to house the homeless, they were not going to be spent to vaccinate children against hepatitis B; they were either going to be spent to put in HIV antigen testing for that small improvement in safety or they would probably build a battleship somewhere in Mississippi.
I think there is an important political element here. Who are we, as health professionals, to say to the general public, whose dollar it is after all, in the United States and here, that you can't do that if you think that's the best way to spend your health dollar? The problem of course of changing the perception of the general public as to whether that is in fact a risk is monumental and if someone has a way to do that I applaud them.
A tainted blood supply is something the public does understand and at least the American public in the wake of the AIDS epidemic was unwilling to accept almost any risk at all. A decade from now that might be quite different but certainly here, with vCJD, you are seeing the same thing that we saw with the AIDS epidemic; so you are doing things that science tells you are not terribly effective, if effective at all, but you are not necessarily spending your money unwisely, I would argue.
Mike Fogden
I'm not sure whether the public perception is that they are worried about CJD. They weren't worried about it in relation to beef on the bone; in fact, they took a great delight in going out and getting beef on the bone surreptitiously.
Tim Wallington
When I was talking to the media about vCJD recently, the taxi drivers who were carrying me about were saying 'Oh it's not that BSE business again is it, what a load of rubbish, it can't be very important'. The terrible problem of hindsight is to be wise after the event. Quite an influence on the decisions that are being made now in terms of blood safety in this country is fear that we'll get it wrong, and that is understandable. I think if we don't understand the risk, but we know that there might be a risk, then we have to do our best in that context. The public will pillory us if we turn out not to have been wise after the event.
Katharine Whitehorn
I think there's a large element of growing distrust of reassurances. I think this is part of the trouble. Nothing was more disgusting than John Gummer pushing a beefburger into his child's mouth and I think my journalistic colleagues would agree with me that we're trained never to believe anything until it's been officially denied. The more scares you have the more you don't trash the initial stage where they say 'look it's perfectly alright or its minimal' because that's a cumulative effect.
Ian Franklin Medical Director (Scottish National Blood Transfusion Service)
The other problem people have providing reassurance comes back in some respects to how we (and I don't necessarily mean the Transfusion Services), certainly in this country, and Ireland, treat people who have been affected when something has gone wrong or something has happened they didn't even know about.
Repeated Health Ministers refuse to give compensation to these people. Now whether that's right or wrong, I don't know. My feeling is that unless something's going to happen in this respect we are not closing the loop. The message starts saying 'well how are we going to care for these people who slip through the net?' There's not going to be many of them but there are going to be a few. If they are going to have to drag themselves through the courts, if they are going to have to get postcode access to healthcare, get interferon in one health district and not in another, that has got to stop. I think we've got to say 'OK, the blood in the bag is safe. We'll keep trying to improve the tests but maybe we won't throw another 10 million pounds in this direction because it's safe enough already. But the 3 or 4 people a year who actually do get disadvantaged by that decision we'll make sure they get adequate compensation without having to shout.'
Richard Hannaford
Cost-effectiveness: that's a political decision because if it's effective then it works. But does it work sufficiently? That's a cost-effective decision. That, at the moment (for some drugs and treatments), is a decision for the National Institute for Clinical Excellence. But in the main most people expect that decision to be made by politicians, advised by their officials. I think to talk about having a campaign to inform the public presupposes a position that you already have, rather than a neutral position of providing advice and then allowing ministers to make their decision. That's of course if you trust the ministers in the first place.
Douglas Starr
When you get into questions of positive and negative 'spin' you start doing a job that's not yours and not ours, but belongs to the PR club. So you might be better off to emphasize context. If you're not afraid of uncertainty - because life is uncertain, and science is uncertain - I think you'll be able to get away from the patriarchal mode where the doctor knows everything.
It's OK to say, when a journalist calls you, 'I don't know that yet, we're really trying to find out, we think in about a month we may have some interesting results that may get us a bit closer to the answer.' Stop looking for these thresholds of 'we know, here's what we're going to tell you, we're going to spin it this way.' You're not in control of this process and neither are the journalists. If you put things in a context it helps everybody understand in a more mature way.
Harvey Klein
Clearly we do need to keep reinventing ourselves, there's no question about that. A couple of years ago I gave a talk entitled 'Cytokines, are they the new antibiotics' and I firmly believe they are. We can now take a stem cell and we can make whatever we want out of it virtually, and the day may come when we'll grow all kinds of things, not only blood as I suggested this morning but also kidneys, livers and everything else. Those are the things that we see now but we have no idea what's going to happen two years from now that's going to change direction entirely.
So yes, I think if we keep thinking in the old framework and making ourselves more efficient at what we do we'll clearly miss the boat. A lot of businesses no longer exist because that was the way of thinking.
I think a lot of the problem, if you want to define it that way, is the expectation that we disappointed during the AIDS epidemic with blood transfusion because as I said in my opening remarks, blood was good. My father coming back from the war could say only how many people it had saved and open heart surgery suddenly was possible because of blood transfusion. Organ transplantation and cancer chemotherapy were made possible by blood transfusion and then there was AIDS and somehow the expectations about blood transfusion, which were very good, suddenly were dashed.
Let's think about cancer chemotherapy for a moment, as an example. While the medications that we use to treat cancer are terrible, we don't even have to talk about the side-effects and we rarely cure the cancer. I won't say rarely, but frequently we don't cure it and we tolerate all kinds of horrible side-effects but we are looking for better things and no-one is really criticising those drugs as toxic because I think it's understood as to what they are and what they do.
I think we no longer really send the message that we increasingly are doing really good things with blood. When someone is in a train accident and is taken to a hospital their life might be saved simply because there is blood available, and it's a very good thing. So I think part of the problem was the expectation and the mythic quality perhaps that blood has had over the centuries that it is good and suddenly it became something that wasn't quite so good.
Richard Fry (National Blood Service)
As the person responsible for blood collection in the National Blood Service, I am very interested in the quality vs. quantity debate. A question for Harvey in that. Clearly from your presentation you're struggling to meet demand but I also get the impression that the political agenda says that we actually will not increase our risk from negligible to minimal to help meet demand. Is that how you see it?
Harvey Klein
No, I hope I didn't give you that impression. I think that negligible risk is in some ways being forced upon us, but the political decisions are curious, as political decisions frequently are.
In the US we are not being forced to leuco-reduce blood at any cost because that doesn't seem to be something that makes our blood supply significantly safer, even though, in fact, it does a lot more than NAT testing does to make blood safer.
I think there are certain things that are forced upon us by the political process and other things that may be forced upon you or upon France or upon Australia. I think it is a fine balance between quality and supply and I think only when supply really does come to the public's attention is there going to be an outcry, but I fear that the outcry isn't going to be why do you make the blood so safe that we don't have any more, it's going to be why didn't you do a better job of collecting it and I am sure that is going to be the issue and I think we'd better be ready for it.
Jeroen De Wit
I am from the Netherlands, from the Dutch Blood Supply Foundation. Thinking of the Norton antivirus approach: we do what we can, and we'll implement anything useful that we can find. The discussion will be: can we afford maximum safety or do we have to supply optimum safety because maximum safety is unaffordable. The antivirus approach might be unaffordable.
The political factor judges what we can afford for a certain sector in health care because what we spend left cannot be spent right. You would like to take into account public perception, but one of the problems might be that public perception can't be frozen. If you take into account public perception in 2000 to base a decision on, you will be asked to explain it in 2010 and in the meantime public perception could be very different so the explanation might be very badly accepted.
Legislation might be another solution. There are different laws on blood transfusion, a country's specific laws or European legislation on blood. If you deviate from the Norton antivirus principle you might make choices that might not fit with legislation, at least in Europe. Might it be a solution that like the United States product liability on blood products and blood components should be differently applied? Should it be a service instead of a product?
Mike Fogden
Who wants to comment on that? That is a very big question and of course one that we are grappling with, as I mentioned at the outset this morning, in our Courts of law at this very point in time. Interestingly, I'm not going to talk about the case, but the legal underpinning of the case is in fact that under the Consumer Protection Act blood is a product and, as you say, if it were a service things would be quite different.
Angela Robinson
I asked our lawyers this very question and the answer's very interesting on whether we're a product or a service. It doesn't really matter in the long term because it's just how you prepare the case; if it's product liability then the onus is on us as the blood supply actually to provide all the evidence, if it's the other way round, clinical negligence, then the onus is on the claimant to produce all the evidence, but at the end of the day it's the same thing.
Richard Hannaford
When I first joined the BBC there was a very strong tradition of you just give the facts and you don't give any editorial, you don't make any judgements yourself. Nowadays there's a lot more emphasis on saying 'what does this mean', 'how do you interpret this' and I think when someone asks you 'what are the risks, I'm going to have a transfusion, should I?', what they are saying is would you, in my circumstances.
Tim Wallington
Maybe we ought to have an enormous pie chart, thinking about all the advice about being positive, and we show the number of transfusions that didn't cause a problem and the tiny slither showing what we have seen is a problem from SHOT. Because we've concentrated on problems and made them the whole pie, split it up into little bits, and the perception was gosh, these are terrible numbers; but we've lost sight of the bigger denominator.
Richard Hannaford
The trouble is I wouldn't cover that as a story.
Katharine Whitehorn
I think the disaster stories always start as news stories, and the good news on the whole is in the feature pages, because you can set it up around familiar figures who have interesting personalities, good stories with a happy ending. But that's longer and it needs pictures and it takes time. So to counteract the news stories that are always going to be 'shock/horror'. I think you have to initiate good feature stories and you know there are two rules for reading newspapers quickly. One is if you want good news go to the feature pages, the other is to cut short your news reading and just skip anything in the future tense.
Raj Persaud
Going back to the title of the Conference, which is about 2020 and the future, and people asking have they got a future in terms of the future of the industry.
At the Maudsley Hospital where I work and teach, a lot of junior doctors come to me and ask for career counselling and they are asking about their future and I put to them a question that comes as a bit of a surprise. Instead of talking about what they want to do I ask them 'what are you good at'. I think you might want to ask yourselves that, as an industry, what are you good at and look at that as maybe some guidance for the future.
One of the things you are good at is when you've decided to mount a campaign to increase recruitment into blood transfusion, with your TV campaign and so on, you've been remarkably successful. and not only successful in a sense of just the number of people who come forward to donate blood, but when you're doing that you're also altering the perception and image of what blood is about. I would focus on that, because you're good at that, and it's best to play to your strengths, and the more people you recruit into giving blood the more you are influencing the image because, going back to the statistic I gave earlier, the group of people who trust blood the most are the people who give blood. Because they are familiar with themselves, they are familiar with the other kind of people who do it and I would make that the image, the kind of people who give blood are a safe group and I would focus on that, because you're good at that anyway.
Douglas Starr
If you wait to contact the press until you've had a tragedy or want to place a good story, you're too late. Don't wait for the event. You should be in touch with your local medical reporters; educating them, sending them packets saying 'I don't want to bother you, just put this in your file.' So God forbid, if there is a transfusion reaction and someone dies, the reporter says 'this is the first time in 30 000 transfusions something's happened, here was the leak in the system, here's how they're addressing it.' It will be tragic, of course but it may not be front page news - or if it is front page news it will have context. In the heat of the moment it's hard for reporters to get context so don't wait for the event.
Member of audience
I'm thinking of a story and a good picture of blood transfusion. We have two kinds of people who stay by our side. One, the blood donor associations provided we are in good hands with them and we really feel that they are our partners. Good partnerships will work even in life's critical moments. The other category are the chronically transfused patients. I think we have not really touched that point here today. How much could the blood donor associations and the patient associations help in developing the future of blood transfusion by minimizing their fears for risk?
Mike Fogden
Perhaps I could recommend to you our annual report which was published last Friday. It does actually start off with a story on that sort of theme.
Katharine Whitehorn
This just ties in with what I was saying earlier. If you think of the perception of insulin, which is wholly good, that diabetics are kept alive by this, and we've all read a million stories about diabetics and stories about people who are, I forget the phrase used, but regularly transfused, then that would be the kind of happy story that would build it up as a positive picture.
Mike Fogden
Thank you everyone, in particular Dr Virge James and her team who organized this meeting. We go away being a little better informed; whether that actually translates itself into anything tangible that can be perceived, only time will tell.
MH Blood Component Transfusion/adverse effects; Blood Donors/supply & distribution; *Blood Transfusion/*adverse effects/trends; Creutzfeldt-Jakob Syndrome/etiology; Forecasting; Human; Risk Factors
SP englisch
PO England