Head of Finland's blood board tells of `open' ethos

Finland and Ireland might be fellow European states, but at times yesterday they seemed worlds apart.

Finland and Ireland might be fellow European states, but at times yesterday they seemed worlds apart.

Forget the different rates in HIV infectivity, and different responses to the AIDS crisis. It was Prof Juhani Leikola's talk of "mutual trust and dialogue" between haemophiliacs and service-providers which was particularly arresting.

In Finland, he said, the blood transfusion service was "quite open" with its problems. It would consult the haemophilia community, "giving the pros and cons of the different [treatment] options".

When the AIDS crisis broke in 1983, it sat down with physicians and patients and decided in a spirit of "mutual understanding" not to import any commercial concentrates where there were safety concerns.

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The situation in Ireland could not have been more different.

Before selecting which product to supply, the Blood Transfusion Service Board, in general, consulted just one treating doctor, Prof Ian Temperley, and only informally.

As for dialogue with haemophiliacs, one only has to recall the evidence of Mr Brian O'Mahony, chairman of the Irish Haemophilia Society, when he spoke of his frustration at the BTSB's refusal to release even basic information to patients.

The difference in approach appeared to reflect a different attitude to the importance of the Council of Europe recommendations on best practice in blood safety.

Such recommendations, the tribunal was told, were largely regarded as aspirational by the BTSB.

In contrast, Prof Leikola spoke of the Finnish blood board's efforts to comply with a 1983 recommendation to inform physicians and patients of the risks of HIV infectivity.

The results of such policies were reflected in the low levels of HIV infection in the haemophilia community. Of 180 Finnish haemophiliacs, only two were infected, both through locally made cryoprecipitate.

In contrast, at least 105 Irish haemophiliacs were infected, seven through BTSB Factor 9, one through cryo and the remainder through imported concentrates.

In defence of the BTSB, it undoubtedly was not as well placed to react to the AIDS crisis as its Finnish counterpart. Finland had been self-sufficient in blood and blood products since 1948.

To the BTSB's credit, it began heat-treating its Factor 9 to guard against HIV earlier than the Finnish blood board.

The BTSB was also shown in a positive light on the issue of hepatitis C. It began treating its products with solvent detergent technology in 1989, two years before its Finnish counterpart. About 60 per cent of Finland's haemophiliacs were infected with hepatitis C, a slightly larger proportion than in Ireland.

But, overall, the BTSB's response compared poorly, no more so than in the area of communication.

Prof Leikola said the Finnish blood board's policy of openness and dialogue created a confidence in its services which continues today, and a situation where media coverage "usually is very positive".

How the BTSB, or rather its successor, the Irish Blood Transfusion Service, would love to trade places.