Blood business: how the US plasma market works

Фото: Depositphotos

A story about the plasma donation market in the United States — its design, the risks of the spread of infectious diseases, dirty centers, and forced donations. The Atlantic. ForumDaily gives an article in translation VC.ru.

I needed money. That is why I was sitting in the plasma donor room on one of the forty couches, next to which were instruments for measuring pressure and a centrifuge. The assistant dressed in a white dressing-gown (you can work here without medical education and without a certificate of a nurse) raised my hand. In a large bottle, he separated my plasma from the blood, and then returned the blood back to the blood vessels so as not to disrupt the flow of nutrients in the body.

Before leaving, they gave me a calendar with payment notes. I can get money if I come twice a week. I was even promised a $ 10 bonus for the next visit.

"Plasmers" are paid through a special debit card - every time they use it, a commission is deducted from them. During the examination, the clinic employee slowed down only when he told me about the payment scheme. Did he know how desperately my position was? His attitude in the spirit of "Do not worry, you will pass" could be a sign of leniency, benevolence, or unprofessionalism.

The procedure went smoothly. I left with the hope that next month I will be able to pay for the apartment with money from the "plating". In American donor centers, all visitors are given brochures with the information that “plasma donation is safe,” and all side effects are only “fatigue and bruising.”

In addition to this, mine said: “Our employees will tell you about other possible side effects,” although I don’t remember to say something to me. However, the next day I felt much more significant consequences of my decision.

It was as if I had become a lizun, a sort of sklyzka shapeless toy. Much more tangible than simple "fatigue", and much more dangerous - everything happened unexpectedly.

Suddenly I felt so exhausted that I could not stand on my feet. As soon as I got to the couch, I turned off and slept for five hours in a deep sleep. Fortunately, it happened at home. I combine the work of a teacher and freelancing. Waking up, I wondered: what if it happened during the main work?

What was it? The first swallow of imperceptible physiological changes, the reason for which was the formation of plating (possibly, hard work and poverty aggravated them). Then I began my investigation.

Фото: Depositphotos

Biotest, CSL Plasma, Yale Plasma. So are called some of these companies in the state of New Mexico where I live. Maybe in other states as well. Or OctaPharma, or Biolife. In the United States, about 70% of the global plasma volume is collected. The United States is known in the industry as OPEC plasma collectors. But why plasma?

Proteins secreted from plasma in institutions like Biotest, needed for the manufacture of a variety of drugs that are produced by commercial corporations. The industry originated in the 1950-ies due to the emergence of many new drugs for patients with hemophilia. Plasma collection centers in the donation world have always worn the scarlet letter A.

Hospitals, Red Cross cells, and non-profit agencies that rely on voluntary donations reject the plasma collection centers' performance model, because of the money donors can lie about their condition and donate inappropriate blood. And when you donate blood, the risk increases.

Before the AIDS crisis, plasma collection practices were almost unknown to anyone, but the medical community still assumed that the standards were high enough and everyone followed them. It was a big mistake. As a result, patients with hemophilia suffered from the hands of unscrupulous plasma collectors.

In 1960 and 1970, plasma-gathering companies decided to reduce costs and turned to prisons: prisoners received $ 5 to $ 10 for a plating session. Because of this, about half of people with hemophilia in the United States contracted AIDS through plasma-based drugs. The percentage of cases was higher than among homosexual men at that time. Because of the outbreaks of AIDS around the world, this has become one of the most famous scandals in the pharmaceutical industry.

Patients with hemophilia sued the company. During the trial, it turned out that a major distributor of drugs continued to sell the “old product” after it became known that he was infected. It turned out that all this complied with both federal and local legislation, and the company was practically not punished.

By the nineties, the reputation of the industry had completely deteriorated, the Americans stopped donating plasma, and federal legislation tightened. The more information was distributed about the "rezlinga", the less people trusted the collectors.

Фото: Depositphotos

Now many plasma drugs for hemophilia patients are outdated, but the industry is thriving because of the sale of albumin — a remedy for burns — and an immunoglobulin for intravenous administration. It helps to treat disorders of the immune system and neurological diseases.

In the US, the industry has returned - and in a big way: with the help of friendly advertising with an emphasis on helping society and the country's economic problems. During the Great Recession in America, the number of donor centers increased - at least hundreds of new institutions opened - and donation sessions: from 12,5 million in 2006 to 23 million in 2011.

After monopolization, the industry has changed. Now it consists of five transnational corporations that operate in the United States under the supervision of the Food and Drug Administration: Baxter International from Deerfield, Illinois, Australian CSL, Talecris of Research Triangle Park from north carolina Griffols from Spain and Octapharma from Switzerland.

The sixth major player can be Biotest AG, commercial offshoot of the Netherlands NCO Sanquin. Since 2008, the annual revenue of the entire plasma-based pharmaceutical market has grown from about $ 4 billion to $ 11 billion.

In Santa Fe, New Mexico, where I live, there is always a crowded, but clean collection center Biotech Plasma. Albuquerque, with a population of 552 804 people, the largest city in the state, was less fortunate - three centers work there, and I wouldn’t go to any one, regardless of how much money was needed.

Yale plasmalocated on the boulevard where beggars gather, reminds a pawnshop. On the window of the facade posted ads about games in the lotto. Inside there is little space. Another center CSL Plasma, bigger, but there are no chairs in it. Donors sit on the floor or stand in long queues for rezling. When I asked the young employee if he could squat down, he told me that the CSL had refused to sit, so that "homeless people would not gather."

Plasma is collected in containers (this is called “plasma pool”) to prepare for the fractionation process, after which it can be used. The larger the plasma pool, the cheaper it will be to process - this is just one example of how the industry “cuts corners,” said Dr. Lucy Reynolds, a researcher at the London School of Hygiene and Tropical Medicine.

The larger the pool, the higher the profit. Although large pools of plasma are checked more carefully (due to modern tests, cases of infection with hepatitis C and AIDS are extremely rare), experts from the health sector have recently been concerned about the global spread of donor plasma. If a similar AIDS pathogen enters the system, the damage to human health will be much stronger than before.

Also in American centers, there is a payout policy with a focus on people who need small amounts right now: $ 50 for the first five visits, then $ 60 per week if you take the plasma twice during the specified period.

I talked to the Albuquerque Plasters, almost all of them asked me not to give their names in the material.

“When I go to the center, I feel like a lab rat,” says Ron, a 33-year-old single father and an unemployed school teacher. He became a plasma six years ago to provide for a newborn son. In the center closest to his house, he was refused to take plasma due to a number of noticeable tattoos, but in a “less clean place” he was nevertheless accepted.

Ron did not have any noticeable side effects, but he is still afraid that they will appear: "They say that there are no long-term consequences, but the employees look like corporate robots, I don’t really believe them."

The poor man with bloodshot eyes, standing at the CSL center, called himself Bubba and said that he was homeless and an alcoholic. As a teenager, Bubba suffered a serious head injury and 15 has been taking plasma for years. He has no side effects, but sometimes his arm hurts a lot. He also constantly falls asleep on the sofas that stand in the centers. Bubba once fainted when he stood in line at the CSL, but he still needed the money, so he didn’t refuse to make money.

At first, Bubba was worried that, due to excessive drinking, he could not pass the blood protein test, but then he discovered that if he drank a bit of ketchup before going to the center, he would pass all the tests.

Bubba knows that theoretically donors like him — homeless, alcoholics, or people who have suffered serious injuries — should be sent to prison for providing false information. "Everybody lies. No one answers their questions honestly, ”he admits.

After talking with Bubba, I thought that other countries did not want to allow trade in plasma on their territory and more successfully restrict the import of plasma collected for money from the United States for precisely this reason. Should we ban a homeless alcoholic from taking plasma - for his safety and ours?

Gabriela, the 51-year-old mother of three children, started to build eight years ago when she was fired from the civil service because of the reduction. She admits that she began to lie on medical examinations when she realized that she was too thin to be weighed. Gabriela, in her words, "put on excess clothing to meet the minimum kilogram in 49." She knows that other plasters, often homeless, use foot weights for this purpose.

48-year-old Kevin Crosby became a plasma ten years ago to provide a six-year-old daughter. “For some reason I felt empty every time. And the next day was often tired. Then, about five years ago, when I worked as a security guard and went out on the night shift, this strange fatigue fell on me again. I do not know what happened, but I woke up on the floor. The bosses blamed me for falling asleep, but I know it was a swoon, ”he recalls.

Crosby fainted several times - once it happened even behind the wheel: “I had to curb. I sat there for a few minutes and could not come to my senses. Terribly frightened.

Other Western countries are very careful, if they allow commercial plasma collection on their territory at all. Their authorities set mandatory two-week intervals between visits to the centers. They must be very surprised when they find out how things are in the US.

After all the conversations, it seemed to me that two sessions a week was simply unwise. The rate needs to be revised. Do not forget about the possible health problems to which donors are exposed: stress, poor nutrition and poor conditions in donation centers.

I talked to thirty permanent donors. CSL and Yale Plasma. More than half of them reported constant tingling in the limbs, pain, weakness in the legs and severe dehydration. They admitted that they actually live on the streets, lie on medical examinations and use different “tricks” to circumvent the tests for the level of protein in the blood. Under such conditions, the plating became hard work for them, but as many said, “there will be nothing to eat without the plating”.

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