There is an appropriate irony in the fact that the Minister for Health, Mr Cowen, should now find himself under attack from his political Opposition for what has been claimed to be tardy action by his Department following yet another scare story about the possible transmission of Bovine Spongiform Encephalopathy (BSE) to humans. The Minister, who was never slow in drawing his verbal gun to bombard his predecessor in office, has been significantly quieter since he took on the complex responsibilities of his governmental position. It may be mildly chastening for him to discover that issues surrounding disease transmission can indeed be complicated and not always susceptible to the hurly-burly of political battle.
That said, the current subject of political accusations - the withdrawal of Amerscam Pulmonate II from use as a diagnostic adjuvant to the X-ray investigation of certain lung disorders - is an issue of totally different proportions from the scandalous contamination of the national blood supply by hepatitis C, and will almost certainly prove to have no medium or long-term ill-effects among those 270 or so patients in whom the substance was used in this State. The accusation levelled against the Minister is that his Department was tardy in notifying those patients in whose cases this commercial albumen-based diagnostic agent was used. Given that the product was withdrawn from use by its manufacturer on November 18th, and the withdrawal was notified to the Department of Health on November 26th, and given that it was withdrawn because of a theoretical rather than a proven risk, there can hardly be sustainable arguments about delay.
The theoretical risk lies in the fact that a human blood donor who subsequently died of Creutzfeldt Jakob Disease (CJD) - the nearest human equivalent of BSE - had been the donor of the blood used in the production of the albumen, and nobody knows for certain whether the prion protein which can be found in both BSE and CJD is transmissible in albumen. The most widespread scientific belief is that it cannot survive unless contained in a tissue cell, and there are no recorded cases of transmission via blood or albumen. But it is scientifically impossible to prove a negative, particularly in instances where (as in the cases of BSE and CJD) significant basic facts remain unknown, so caution rather than proof must dictate such actions as may be taken.
Caution must also dictate how the information of a remote risk of exposure is provided to those patients in a case such as this. CJD has a long incubation period and there is no diagnostic test available to confirm or refute its existence in humans before quite advanced symptoms appear. In addition, there is, as yet, no known treatment which will eliminate the prion protein or cure CJD. Before telling people they might be at risk, there must be some form of counselling available to them, should they want it, to explain how small is the risk, and how to cope with the information provided, in the most supportive and reassuring way possible. Of course the Department must take time (and undertake widespread consultation) to try to ensure that the information does not, of itself, do far more harm than the very small risk involved here.
Meanwhile, it needs to be reaffirmed that there seems no likelihood of catastrophe in this instance. So far, the responsible agencies appear to be responding effectively to what may well turn out to be no more than a media scare.