Should an immediate ban be imposed on blood donors possibly infected with nvCreutzfeldt-Jakob disease?



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The issue
On September 15, 2000, it was reported in the British medical journal, The Lancet, that a disease very similar to nvCreutzfeldt-Jakob (nvCJD) disease could be transmitted between sheep via transfusion. This prompted Australia to consider a ban on all potential blood donors who might be infected with nvCJD.
The proposed ban has meet with the support of all state and territory health ministers and seems likely to be in place by early next year. The principal source of contention seems to derive from those such as the Queensland Health Minister, Wendy Edmond, who believe the ban should be imposed immediately, and those such as Meryl Dorey, president of the Australian Vaccination Network, who argue that the ban should have been imposed some years ago when the threat was first suspected.
nvCJD is a fatal brain disease thought to be related to Britain's notorious Mad Cow disease. It is feared that some of those who ate cattle infected with Mad Cow disease subsequently developed nvCJD as a result. The additional fear is that those who have contracted nvCJD may be able to transmit the disease via blood donations.
The proposed Australian ban would prevent such people donating blood. Those to be prohibited for this reason would have had to have lived in Britain for six months or more between 1980 and 1996, the period during which it is believed the likelihood of eating beef products contaminated with Mad Cow disease was greatest.

What they said ...
'Once a risk is identified, even if it's a theoretical risk, the blood bank must take whatever reasonable measures it can to ensure public safety. That must happen even if it means a drop in eligible donors'
Dr Kerryn Phelps, the federal president of the Australian Medical Association

'... if we can't get new donors it will curtail some surgery. People will suffer because we may not have enough blood for the operations and emergency procedures that we need'
Dr Michael Wooldridge, the federal Health Minister



Echo Issue Outline 2000 / 31 - 32
Copyright © Echo Education Services
First published in The Echo news digest and newspaper sources index.

Issue outline by J M McInerney

Background
Bovine spongiform encephalopathy (BSE) or Mad Cow Disease
This condition was first recognised in the United Kingdom in 1986. It is usually seen in adult cattle. It currently infects more than 55% of milking herds in the UK. It has now been reported in Oman, Switzerland, France, Germany, Canada, Denmark, Portugal and Italy. There have been no reports of this disease among cattle in Australia.
Cattle with BSE appear alert but agitated and anxious. As the disease progresses, the animal's walk becomes exaggerated and it falls frequently. It develops twitching and muscular spasms. The animal loses weight and its movements become frenzied. It is prone to aimless headbutting. The disease is ultimately fatal. It has a long incubation period. It can be anywhere between two and five years before an infected animal displays symptoms.
Under new laws all cattle detected with the disease now have to be slaughtered and their carcasses buried or burned.
The disease is thought to have been spread throughout the United Kingdom and on the Continent via the remains of infected beasts. Animal carcasses were rendered down and processed as cattle feed. The brains and spinal columns of infected animals are most likely to have spread the disease.
Animal remains are no longer able to be used as an ingredient in cattle feed in Britain and Europe as an attempt to prevent the further spread of the disease.

TSE, Creutzfeldt-Jakob disease and the possible spread of BSE to humans
BSE is one of a large number of infections of this type that can affect the brains of animals of many species. Collectively these diseases are known as transmissible spongiform encephalopathy (TSE). A TSE is any form of a disease that can be transmitted from one animal to another and will produce sponge-like changes in the brain (that is, some brain cells die and the gaps or holes they leave give the brain tissue a sponge-like appearance when examined under a microscope.) A post-mortem examination of brain tissue is the only way of conclusively diagnosing TSE.
The active agent causing TSE is thought to be a "self-replicating" protein (a prion) rather than a bacterium or virus. This agent is extremely resistant to heat and to normal sterilisation processes. It does not evoke a detectable immune response or inflammatory reaction in host animals.
The form of this disease which afflicts humans is Creutzfeldt-Jakob disease. This condition is very rare. It occurs once in every 1,000,000 people in a year. There are three main types of CJD.
Sporadic CJD accounts for 85 per cent of cases. It affects people between the ages of 50 and 75 years. It afflicts one person per million per year. It produces a rapidly progressive dementia and results in death usually within four to five months. The means of transmission is currently unknown.
Familial CJD accounts for some 10 to 15 per cent of cases. Its symptoms and duration are the same as sporadic CJD. It is caused by an inherited mutation in the gene encoding prion protein.
Iatrogenic CJD accounts for some five per cent of cases. The transmission of the disease occurs via contaminated surgical instruments, the transplantation of corneas, or the use of human growth hormone contaminated with CJD. (This growth hormone used to be extracted from the pituitary glands of cadavers.)
There is also at least one suspected case in Great Britain of the disease having been passed from mother to child, possibly in utero.
A fifth, extremely rare form of CJD, is Kuru contracted from handling (or eating) contaminated brains. It appears to occur only in certain regions of New Guinea where ceremonial cannibalism of brain tissue was practised.
New variant Creutzfeldt-Jakob disease (nvCJD, sometimes referred to as variant Creutzfeldt-Jakob disease or vCJD) was first described as a distinct condition, with different features from classical CJD, in 1996.
nvCJD tends to affect younger people than classical CJD and the duration of illness is longer. Of the first 14 cases to be described, the average age at onset was 29, and the median duration from onset to death was 14 months.
It is a devastating, ultimately fatal, neurological condition. Its initial features are subtle and diagnosis is difficult in the early stages. The 14 cases first diagnosed presented with psychiatric and sensory symptoms. Most had depression, personality change or withdrawal, 12 had delusions and nine had hallucinations.
Following the development of neurological signs, the disease progressed rapidly with impaired mental functioning, involuntary movements, immobility, dependency, loss of speech, coma and eventually death.
nvCJD is thought to be linked to the epidemic of Bovine Spongiform Encephalopathy (BSE) in cattle. It is suspected that a small percentage of people who ate offal from cattle infected with BSE (often as mince or hamburgers) have subsequently developed nvCJD. Results of laboratory experiments on mice appear to support this theory.
nvCJD has a molecular marker that is absent in other human CJD and is present in BSE. It also has transmission characteristics that are almost identical to BSE. Transgenic mice with human genes are susceptible to BSE.
There is currently concern that people infected with nvCJD but not yet displaying symptoms might spread the disease through blood donations.
The incubation period (that is, the time between initial infection and when symptoms are displayed) may be as long as ten to forty years.

Internet links

The United Nations World Health Organisation (WHO) has a fact sheet giving detailed information on Creutzfeldt-Jakob disease. This includes a simple explanation of TSEs, an overview of all forms of CJD, including nvCJD, and a useful discussion of the probable connection between nvCJD and BSE.
This is a very good introduction to the topic. It can be found at http://www.who.int/inf-fs/en/fact180.html

The British Online Tutorial site has an interactive tutorial on BSE. This is an excellent treatment of the topic and begins with some graphic material on Kuru, a TSE peculiar to some regions of New Guinea and thought to be spread through the practice of ceremonial cannibalism to honour the dead.
It gives information on TSE in a clear and detailed manner and includes some very good cross-sections of infected brain tissue.
(Please note: this site claims that there is currently no evidence that TSE can be transmitted via transfusion. The latest research published in The Lancet in on September 15, 2000, suggests that transmission can occur through contaminated blood products.)
The relevant Online Tutorial can be found at http://www-micro.msb.le.ac.uk/Tutorials/cow/cow1.html

Information Concerning BSE for the Scientific World is another British site which aims to provide the data needed to understand bovine spongiform encephalopathy [BSE, or "Mad Cow Disease"].
The pages also contain background information for those with little initial knowledge. This includes definitions of terms, the biology of transmissible spongiform encephalopathies, a history of BSE and some of the research findings re BSE.
This is another valuable introduction to the topic.
The site can be found at http://sparc.airtime.co.uk/bse/

The University of Illinios has an excellent section of its site dealing with BSE. The site begins with a general introduction to the topic. At the bottom of this introduction are links to specialist entries covering a wide range of sub-topics. These include control measures in Great Britain; transmission of TSE; prions - believed to be the disease causing agent; the genetics of prion diseases and the possible link between BSE and CJD.
The information provide is comprehensive and quite technical, however, it is very clearly explained. This is an extremely useful site for those seeking clear, detailed information on this issue.
The site can be found at http://w3.aces.uiuc.edu/AnSci/BSE/

The University of Northern Iowa's Department of Biology has a very useful site giving information on prion diseases. The site includes a comprehensive treatment of CJD, a detailed treatment of BSE and information on prions as disease agents. This is very clear and readable.
The site can be found at http://www.bio.uni.edu/cei/prion.html

The British Eletronic Telegraph is currently free and searchable over a three year period. It has a large number of articles dealing with bovine spongiform encephalopathy (BSE) or Mad Cow disease. One article of interest deals with Japan and Australia considering banning as blood donors those who had lived in the United Kingdom for a period of at least six months between 1980 and 1996.
The article is titled 'Japan and Australia may ban 'BSE' blood' and was written by Barbie Dutter in Sydney and Juliet Hindell in Tokyo. It was published on August 19, 1999.
It can be found at http://www.telegraph.co.uk/et?ac=003495036434060&rtmo=aqXqWhqJ&atmo=tttttttd&pg=/et/99/8/19/wblo19.html

Another useful Eletronic Telegraph report deals with the recent findings published in The Lancet suggesting that CJD may be transmitted via blood products.
The report is titled 'Transfusion fears over spread of human BSE' and is written by David Derbyshire, The Electronic Telegraph's Science Correspondent. It was published on September 15, 2000.
It gives a detailed report of the Scottish findings published in The Lancet on the same day.
The report indicates that researchers from the Institute for Animal Health in Edinburgh took blood from sheep infected with bovine spongiform encephalopathy (BSE), but as yet showing no symptoms, and injected that blood into healthy sheep. One of the transfused sheep is now showing symptoms of BSE.
The full text of this Electonic Telegraph report can be found at http://www.telegraph.co.uk/et?ac=003495036434060&rtmo=aqXqWaqJ&atmo=tttttttd&pg=/et/00/9/15/nbse15.html

The British scientific magazine New Scientist has a web site. The archives of this site are available only to subscribers, however, the site makes collections of articles on selected topics available to the general public. One of the topics treated in this way is BSE. The New Scientist index providing links to all its recent BSE/CJD articles can be found at http://www.newscientist.com/nsplus/insight/bse/articleindex.html

A New Scientist article dealing with BSE was published on September 20, 2000. It deals with the recent Edinburgh research indicating that a sheep contracted TSE after being inoculated with blood from another infected sheep which was still asymptomatic.
The article is titled 'Bad blood' was written by Emma Young. It can be found at
http://www.newscientist.com/nsplus/insight/bse/bse.html

The Sydney Morning Herald has a report detailing the response of Australian authorities to Canada's decision to ban from donating blood those who had lived in Britain between 1980 and 1996.
The article is titled 'Bloody nightmare'. It was published on May 19, 1999 and was written by Gerard Noonan.
The article is a valuable one. It not only deals with the response of Australian authorities to the threat of blood-borne Creutzfeldt-Jakob disease, it gives a wide-ranging overview of the adequacy of Australian attempts to address the possibility of AIDS and hepatitis being spread through blood products.
The article can be found at http://www.smh.com.au/news/9905/19/text/features5.html

On September 20, 2000, the ABC's Lateline current affairs program telecast an interview with Professor Richard Smallwood, the Commonwealth Chief Medical Officer.
Professor Smallwood recommended the Australian ban on blood donors who had lived in Britain between 1980 and 1996 be put in place. He explains the reasons for the ban and its possible impact on Australian blood supplies.
In the introduction to the interview comments are given by Dr Robin Mortimer of the Australasian College of Surgeons and Tony Keller of the Australian Red Cross Service.
The interview and its introduction can be found at http://www.abc.net.au/lateline/s185240.htm

The following day, September 21, 2000, the ABC's 7.30 Report telecast a similar report including comments from Professor Smallwood and Tony Keller. The report can be found at http://www.abc.net.au/7.30/s185184.htm

On the same day, September 21, 2000, Radio Nation's PM program broadcast an interview with Professor Bruce Baraclough, the president of the Royal Australasian College of Surgeons. Professor Baraclough recommended that people planning elective surgery should donate their own blood in advance.
The interview with Professor Baraclough can be found at http://www.abc.net.au/pm/s185053.htm

Arguments in favour of the imposition of an immediate ban
1. Creutzfeldt-Jakob disease is fatal and recent tests have suggested it can be transmitted via blood
products.
On September 15, 2000, the British medical journal, The Lancet, published findings of an Edinburgh research team that suggest that nvCJD can be transmitted via blood transfusion. The researchers transfused blood from an infected sheep to healthy sheep. After 610 days, one of the healthy sheep began to show signs of the disease.
The researchers believe that their findings have ramifications for human recipients of blood possibly contaminated with nvCJD.
Those who are concerned at the possibility of nvCJD being transmitted via blood transfusion further note that the disease is invariably fatal and that there is currently no known treatment or cure.
Dr Kerryn Phelps, the federal president of the Australian Medical Association, has stated, 'We have a blood transfusion service which has a duty of care to the community to maintain as safe a blood supply as possible.'
Dr Phelps has further stated, 'Once a risk is identified, even if it's a theoretical risk, the blood bank must take whatever reasonable measures it can to ensure public safety. That must happen even if it means a drop in eligible donors.'

2. The disease can be transmitted by people who are not yet displaying symptoms and its incubation period is not yet known.
The sheep whose contaminated blood was transfused into uninfected sheep was asymptomatic. This has led health authorities and others to suspect that people infected with nvCJD but as yet displaying no symptoms might still be able to transmit the disease when they donated blood.
The long incubation period of between 10 and 40 years makes it very difficult to know how many Britons and others may have been infected with the disease and thus be potentially able to give it to others through transfusions.
The Commonwealth Chief Medical Officer, Professor Richard Smallwood, has stated, 'It's not yet possible to say whether there is going to be a large epidemic in people in the UK ...'

3. Those who lived in Great Britain between 1980 and 1996 may have contracted Creutzfeldt-Jakob disease by eating contaminated meat products.
The 1980 to 1996 time frame has been identified as the period in which most human exposure to bovine spongiform encephalopathy, or Mad Cow disease, occurred in Great Britain through beef products such as hamburgers, sausages and pies. To be banned from giving blood the potential donor must have lived in Britain for at least six months over the period specified.
This time frame was endorsed by the United States Food and Drug Administration when it was making its initial recommendation that there be a ban placed on possibly infected donors.
Some 70 Britons are believed to have died as a result of nvCJD, however, difficulties in diagnosis have led some to suggest that the number infected with the disease may be significantly greater.
It has further been noted that the long incubation period may also mean that there are many more victims of the disease than authorities are currently aware of.

4. Many other nations have already banned from donating blood those who may have contracted Creutzfeldt-Jakob disease
New Zealand, the United States, Britain, Canada, Austria and Japan have already imposed bans on donors who lived in Great Britain in the period from 1980 to 1996.
The United States Food and Drug Administration (FDA) first called for this ban in August, 1999. It was originally intended that the ban be put in place in February 2000. Difficulties with compliance resulted in the ban being imposed across the United States on April 17, 2000.
Critics of Australia's policy ask why this country is still debating the issue some twelve months after the United States resolved the matter and why we still have no ban in place when at least six other nations, including New Zealand, Canada and the United States, do.

5. The ban should have been imposed in July-August 2000, if not before.
The possibility of an Australian ban on potential nvCJD-infected blood donors was raised as early as May, 1999, when Canada imposed its ban. New Zealand had also imposed a similar ban in 1999. The United States Food and Drug Administration had called for a ban in August, 1999. In July/August 2000, the Australian states and territories had considered a similar ban and rejected the idea. Critics have been unimpressed by the apparent slowness of the Australian response.
Meryl Dorey, president of the Australian Vaccination Network wrote a letter to The Australian which was published on September 19, 2000. Ms Dorey states, 'Again the Australian Government is a day late and a dollar short in protecting the health of its citizens.
Two years ago, New Zealand banned blood donations from people in danger of transmitting CJD. What did Australia do? Nothing.'
Referring to the current proposed ban, the Queensland Health Minister, Wendy Edmond, has stated, 'It is essential that the change commences immediately ... a three month delay is not acceptable.'

Arguments against the imposition of an immediate ban
1. The likelihood of those who lived in Britain between 1980 and 1996 having Creutzfeldt-Jakob disease is very slight.
Referring to the risk faced by people who had lived in Britain for at least six months in the period between 1980 and 1996, Professor Richard Smallwood, the Commonwealth's chief medical officer, has stated, 'The risk is so small that people are likely to be struck down by something else.'
Professor Smallwood has sought to reassure the millions of Australians who have visited Britain during the risk period that there is no expectation that they will have contracted nvCJD.

2. The likelihood of the disease being transmitted through blood products is slight.
This point has also been made by Professor Richard Smallwood. Professor Smallwood has stated, 'I think the thing that does need to be emphasised is that the risk is likely to be minute, and this is a precautionary measure.'
A similar comment has been made by the federal Health Minister, Dr Michael Wooldridge. Dr Wooldridge has claimed, 'The risk is tiny and the risk is theoretical.'
Up to this point there have been no known cases of nvCJD being transmitted to human recipients via transfusion. The only evidence that the disease is transmittable in this way comes from animal experiments and even under laboratory conditions which aim to test possible means of transmission the likelihood of the disease being disseminated in this manner appears slight.

3. The ban is likely to result in a significant reduction in the current number of blood donors in Australia.
It has been suggested that the ban is likely to result in a loss of some five per cent of regular blood donors. This represents some 25,000 to 30,000 donors a year.
The Australian Red Cross Blood Service has stated that it would have to make up at least 60,000 units (about one million units are donated each year).
There is concern that this will cause a significant shortage of blood, including that needed for emergency procedures. The federal Health Minister, Dr Michael Wooldridge, has stated, 'It may be if we can't get new donors it will curtail some surgery. People will suffer because we may not have enough blood for the operations and emergency procedures that we need.'
Professor Smallwood has stated, 'We can't afford to put the blood supply at risk in swapping a potential risk for a real one.' Authorities believe that the danger to public health which would result from an immediate loss of five per cent of donors is greater than the risk represented by nvCJD.

4. The Red Cross Blood Service will need time to boost donor numbers before the ban is put in place.
The Australian Red Cross Blood Service is expected to get a $7 million commonwealth-state funded package. The purpose of the funding is to finance an extensive advertising and promotional campaign to encourage new donors to give blood and those who already donate to give more often.
Any ban in Australia will not be put in place for at least two to three months after it is agreed to by the various state and territory health ministers.
This lead-in period is primarily to allow the Red Cross Blood Service to recruit the new donors it will need to prevent a significant shortfall. A spokesperson for the federal health Minister, Dr Wooldridge, has satted, 'If ... [a ban] happens it's not sometghing that's going to be imposed as of tomorrow morning ... it would be done in a timeline that's designed to give the blood bank time to come up with full plans and to ... come up with a proper education campaign.'
Current donors who will be prevented from making donations when the ban comes into force are being asked to continue donating until the ban is actually put in place. There appears to be concern that if these people were to self-defer immediately then this would cause a dangerous shortage in Australia's blood supplies.
Tony Keller, chairman of the Australian Red Cross Blood Services, has stated, 'It's very important that donors don't self-defer. We really will have a crisis of supply, particularly for platelets used in cardiac surgery and (leukemia) treatment ...'

5. The blood supply can never be completely risk free.
It has been argued that no blood supply can ever be completely without risk. Managing a nation's blood supply is said to involve calculating what is the level of acceptable risk relative to the necessity of supplying those blood stocks required for surgery and other emergency procedures.
In this case, it has been claimed, there is already the remote possibility that blood supplies may already have been contaminated by donors infected with nvCJD and unaware of their condition.
Some commentators have suggested that we need to adopt a moderate approach to the regulation of our blood supplies. It is argued that Australians need to be aware firstly that our blood stocks are of a very high quality and secondly that some minimal level of contamination is virtually unavoidable.
Professor Smallwood has stated that the Australian community needed to accept that zero-risk blood did not exist.
'We can't be perfect. Councils of perfection won't work,' Professor Smallwood has claimed. 'So we can't eliminate risk entirely and if we go too far down that track we will compromise the blood supply.'

Further implications
Some of the consequences of the way in which Australian health authorities have responded to the risk of nvCJD transmission via blood transfusions will only become apparent with time.
Given the long incubation period, any Australian who has contracted nvCJD via a transfusion is unlikely to begin showing symptoms for some time. (Those infected in the early 1980s might be expected to exhibit some symptoms now, however in the early 1980s there were very sources of infection in the United Kingdom and so very few people are likely to have contracted the disease.)
International speculation about the probable extent of nvCJD varies widely. The worst case predictions foretell a disaster; the best case scenario estimates some 80 to 100 cases all told. As there are currently some 70 cases in Britain, the best case scenario appears rather optimistic.
The immediate impact of the donor ban on Australia's blood stocks will depend the success of the campaign to recruit new donors. If this campaign is not particularly successful then there are likely to be shortages of blood.
It is interesting to note that Professor Bruce Baraclough, the president of the Royal Australasian College of Surgeons is recommending that people planning elective surgery donate their own blood in advance. Health authorities in Australia have not previously recommended this practice. Indeed it has been seen as likely to undermine the current system which relies on altruistic donations for general use.
On July 28, 1999, it was made public that a Melbourne schoolgirl had contracted HIV through a blood transfusion.
Prior to their daughter's surgery, the girl's parents had sought to make a directed donation, that is, to donate blood specifically for their daughter's use. Victorian transfusion policy did not then allow this practice and so the parents were refused.
In August, 1999, largely in response to this case, Victorian policy changed and parents became able to make directed donations for the use of their children.
Fear of shortages and possible public apprehension about the disease-free status of available blood stocks may see an increasing tendency for people to donate blood for their own use and the use of family members.
It has been suggested that debate about Australia's blood supply policies must be conducted more publicly. Such public debate, it has been claimed, is all that is likely, in the long-term to give the public a realistic appreciation of what level of safety it can expect from Australia's blood supplies.


Newspaper items used in the preparation of this outline
Available as a press cuttings package (with an issue outline reprint): price: $26.50 (NO LONGER AVAILABLE)

Sources
The Age
18/9/00 page 3 news item by Kerry Taylor, 'Ban British blood donors: minister'
19/9/00 page 5 news item by Darren Gray and Mary-Anne Toy, 'Blood shortage fears as CJD ban likely'
20/9/00 page 5 news item by Darren Gray, 'Talks expected to back blood curbs'
21/9/00 page 2 news item by Darren Gray, 'National blood ban to effect 915,000'
22/9/00 page 5 news item by Farah Farouque, 'Store your blood, patients urged'

The Australian
18/9/00 page 1 news item by John Kerin, 'Blood ban to hit supplies'
19/9/00 page 25 news item by John Kerin and Sarah Stock, 'Shortage no bar to blood donor ban
19/9/00 page 32 letter from Meryl Dorey, president, the Australian Vaccination Network, 'Health guards need shot in the arm'
21/9/00 page 23 news item by John Kerin, 'Trade-off: riskier blood or shortages'
22/9/00 page 25 news item by John Kerin and Ben Mitchell, 'Patients told: give your own blood'
22/9/00 page 32 editorial, 'Safety and healing are in the balance'


The Herald Sun
18/9/00 page 26 news item, 'Mad cow blood ban'
18/9/00 page 30 news item, 'Mad cow disease hits tot'
19/9/00 page 26 news item by Andrew Probyn, '100,000 donors face mad cow blood ban'
21/9/00 page 27 news item by Andrew Probyn, 'Mad cow blood donor ban grows'
22/9/00 page 26 news item, 'Gradual ban on donor blood'

Analyses of TWO newspaper item on this issue

Article analysis one

Analysis of an editorial

The editorial was published under the heading 'Safety and healing are in the balance'
It was published in The Australian on September 22, 2000.

This editorial appears to have two principal purposes. On one hand it seems to be suggesting that the decision to ban possible carriers of nvCreutzfeldt-Jakob disease was a difficult one to make and may be too cautious a one. On the other it is seeking to encourage current donors to continue giving their blood.

The editorial's heading is intriguing. It suggests that there is a balance to be struck between 'safety' and 'healing'. This is an unusual notion because under most circumstances we would imagine that safety and healing went together. The implication in this heading, that sometimes they are on opposite sides of the scales, is disturbing and would encourage the reader to read on.

The editorial is divided into four paragraphs. The opening paragraph is a little unusual as it plunges the reader, without any preamble, into the current debate surrounding Australia's blood supplies. It states that the recent ban on donors possibly brought into contact with mad cow disease suggests 'that blood supplies in Australia are not absolutely safe.' This is a deliberately frightening statement that is then immediately qualified. The second sentence acknowledges that this 'sounds alarming' but that 'it should not worry us unduly'. The language is cautious and moderate, but it is subtly putting a position. Yes, we should be concerned about the quality of our blood supplies, but not, the editorial implies, excessively so. There is the suggestion that the recent ban on donors may in fact be excessive. The use of the second person plural, 'it should not worry us' is intended to draw the reader into adopting the view being presented here. The use of the second personal plural helps to establish a commonality of interest between the reader and the writer.
The paragraph goes on to reassure the reader that our blood supply is as safe as it has ever been and that any risks involved are 'minuscule'. It states that what is significant about the recent decision is that it is leaning toward additional blood screening procedures that 'will rule out more people from donating blood for only a marginal increase in safety.' These are assertions which may not be automatically accepted by readers. They are likely to want to know exactly what the chances of contracting nvCJD are if the ban is not imposed and, even if the risk is 'minuscule', they may not believe it should be taken.
Interestingly, in paragraph two, the editorial anticipates that readers may want to guard against the risk of any disease transfer 'no matter how small'. Again, the phrasing of this sentence, with the final emphasis falling on 'no matter how small' makes this concern seem excessive. The editorial goes on to balance this 'risk' against the 'benefits' derived by 'thousands of people each year' from blood transfusions. The use of the phrase 'thousands of people' is clearly meant to suggest that the benefits gained from transfusions are great. It also contrasts strongly with the supposed 'marginal' or 'minuscule' risk of receiving a contaminated transfusion.
In paragraph three the editorial changes its emphasis. It gives a brief history of the Red Cross' involvement in blood collection. This apparently dates from 1929. The intention may be to imply that the service has been in operation for over seventy years, and has made few significant mistakes in that time. What the paragraph emphasises primarily, however, is the importance of the 'generosity' of blood donors. This vuluntary donation system is presented as an extension of the 'humanitarian spirit of the International Red Cross'. The intention seems to be to strengthen the readers' sense of the value and nobility of the voluntary donor system via this association. We are told that 'countless people have received the precious gift of life'. Though a clich‚, this phrase, 'the precious gift of life' is likely to impress on readers the fundamental importance of donating blood. The whole paragraph reads like an appeal for additional blood donors.
Paragraph four draws the two strands of the editorial together. It refers again to the decision to 'defer donations because of the vCJD scare'. (Note the reference to 'scare' suggesting there may be no substance to concerns about the spread of this disease and that the health authorities' responses may be an over-reaction.) It then suggests that not only donors possibly carrying CJD may drop out but that 'there is every possibility that many more than the 30,000 people directly affected ... will be deterred from donating.' This is implicitly an appeal that all donors continue to give blood.
The paragraph ends with a call for more open debate about the safety of our blood supplies. It suggests that only such open debate will reassure the public that proper choices about the regulation of our blood supplies have been made. The implication of the editorial is that in this instance the choice made has been overly cautious. It is likely that most readers would like a more genuine debate and a more comprehensive treatment of both sides of this issue than is presented in this editorial. The call for such debate is, however, likely to be endorsed by most readers.
The editorial is obviously directed toward a well-informed readership. It makes few concessions to its readers and generally assumes that they are already reasonably well versed in the issue. Its paragraphs are all of a substantial length. There is little variety in sentence length. Most are quite long and some are quite convoluted. It is interesting to note, however, that when the disease being discussed is first mentioned its connection with 'mad cow disease' is all that is cited. It is only then that the less well-known Creutzfeldt-Jakob disease is referred to.

Article analysis two

Analysis of a news report

The report is titled, 'Trade-off: riskier blood or shortages'
It was written by John Kerin and published in The Australian on September 21, 2000.

The report deals primarily with a paper submitted by the Australasian Society of Blood Transfusion Specialists to a national inquiry on blood safety. It also makes some reference to a recent decision by state and territory health ministers to prevent all potential carriers nvCreutzfeldt-Jakob disease from donating blood.

The headline is a bold statement of an apparent choice in public health. It suggests that we have either to decide to have blood supplies that are less safe or to risk a shortfall in the blood available for transfusions and other emergency procedures. The headline appears faces the reader with a difficult dilemma. Neither option appears attractive and the prospect of either is likely to concern readers sufficiently to encourage them to read on.

The lead paragraph is merely an expansion of the headline. "Australians must accept a higher risk of contracting disease from blood transfusions or risk future chronic shortages ...' This disturbing prediction, which is presented more as a fact than a possibility, is attributed to 'a group of eminent specialists' who are in the next paragraph identified as Australasian Society of Blood Transfusion Specialists. The groups statement, coming as it does from and expert and apparent reputable source is likely to be accepted by a majority of readers and is likely to provoke considerable apprehension.

Paragraphs two and three continue to elaborate on the views presented by Australasian Society of Blood Transfusion Specialists. The supposedly 'marginal increase in safety' from improved screening procedures is referred to, as is the increased costs such procedures would create. The conclusion drawn is that there will be 'a national shortage of blood and donors'.

Up to this point the article appears quite unbalance. That impression is strengthened through the next three paragraphs which give direct quotes from an emergency ward doctor, Dr Venita Munir. The doctors views are introduced as 'underlining at grassroots level' the fears of the Australasian Society of Blood Transfusion Specialists. The impression created is that both the specialists in the area and the hands-on 'grassroots' practitioner share the same view - that additional tests may be excessive and will result in a dangerous shortage of blood. The effect of the direct quotes from Dr Munir is quite powerful. His statements clearly and forceful outline a potential emergency situation and given his in the field experience are likely to be accepted by readers as accurate.

It is not until paragraph seven that an opposing view is presented. This position is put by Dr Kerryn Phelps, the national president of the Australian Medical Association. Dr Phelps is also a highly reputable source and her views, too, are quoted directly and expressed forcibly. However, given their position in the article, they are likely to have less impact on the reader than the views of Dr Munir and the Australasian Society of Blood Transfusion Specialists.

However, in paragraph nine, the article goes cite further support for Dr Phelps' views. The support comes from a family whose two sons contracted hepatitis C from contaminated blood products. One of the young men affected is also quoted directly and the ages of both boys is given. One is 16 and the other is 19. Their youth is likely to evoke the reader's sympathy. However, it is revealed they are haemophiliacs. While on the one hand this may create further sympathy for them, on the other it places them in a special, high risk group, re blood transfusions, as their condition requires them to have transfusions far more often than the average person. The reader might decide that it is not appropriate to apply screen procedures to the nation's blood stocks which may only be of benefit for a small at-risk group.

The article then gives background information on the inquiry to which the
Australasian Society of Blood Transfusion Specialists paper was presented and to cite Australian Bureau of Statistics estimates of the number of people who are likely to be precluded from giving blood by the recent ban. The figure cited is 800,000. This seems an extreme presentation of this estimate as other articles supplying the same information have noted that only some 30,000 current donors are likely to be affected. The 800,000 would appear to refer largely to potential donors, who are unlikely to have decided to give blood irrespective of the ban.

The article then concludes by quoting Red Cross estimates of the cost of the education campaign that will be needed to recruit new donors and with a further quote from the
Australasian Society of Blood Transfusion Specialists paper. Paragraphs eighteen and nineteen quote extensively the views of Dr Mark Dean, the president of the Australasian Society of Blood Transfusion Specialists. Dr Dean recommends an education campaign aimed at health authorities so that they can appreciate that Australia needs a low risk blood supply not a no risk supply.

The overall effect of the article is to support the views of the Australasian Society of Blood Transfusion Specialists. They are presented first and last in the piece and at significantly greater length than opposing views. Thus the article does not display the neutrality a reader might expect of a news report. The article does not however, adopt a sensationalist view of the topic. It highlights the dangers involved only to the extent that it stresses the danger of blood shortages if more exhaustive blood screening procedures are adopted. It does not attempt to frighten the reader with the propect of blood-borne diseases.