T Nation

Sperm Banks and Homosexuals

Very interesting. Tag this at least under “bad logic” - and while Prof. Volokh isn’t trying to make a point on media bias, I find it an interesting coincidence that only the liberal advocacy group’s side of the story was reported:

[Eugene Volokh, May 16, 2005 at 9:07am]

Sperm Banks and Gays:

The Washington Post ran this story, written by its health reporter, on May 6:

http://www.washingtonpost.com/wp-dyn/content/article/2005/05/06/AR2005050600151.html

[i]A new Food and Drug Administration regulation scheduled to go into effect this month calls on sperm banks to reject anonymous donations from men who have been sexually active with other men within five years ? an effort to screen out potential carriers of the AIDS virus.

With a May 25 implementation day approaching, the long-debated regulation is being attacked as unscientific and bigoted by some gay groups that say the new rule stigmatizes gay men.

“This rule is based on bad science because the AIDS epidemic is an increasingly heterosexual epidemic,” said Kevin Cathcart, executive director of Lambda Legal Defense and Education Fund, which has asked the FDA to reconsider.

“We also know that sperm banks can test for HIV very well now and so can screen out any infected donor,” he said. “With that in place, why are gay men being rejected?” . . .[/i]

The story goes on … But nothing in the rest of the article says anything about what the FDA’s response to this criticism might be, or about what (if anything) seems to be the conventional wisdom from objective and reputable sources on who’s right here.

The closest the story comes to that is by saying “When the rule was adopted, acting FDA Commissioner Lester M. Crawford said it was developed with broad input and ‘in all cases, we carefully considered the comments we received in the proposed rule and made changes in the final rule when the science supported the change.’” But what exactly does the science say?

It is pretty obvious ? though perhaps some readers might miss it ? that “This rule is based on bad science because the AIDS epidemic is an increasingly heterosexual epidemic” is an unsound argument. The risk that any U.S. male homosexual is infected with HIV are over 10 times (likely considerably over 10 times) the risk that any U.S. male heterosexual is infected with HIV. (I’m extrapolating from the year 2000 new AIDS infection numbers listed here http://www.cdc.gov/hiv/stats/hasrsupp91/table7.htm , with a generous margin of error; I realize that this isn’t the same as current HIV numbers, but it’s close enough to get a confirmation of conventional wisdom, which is correct here. If anyone has more precise data, please let me know.) Given this, screening out those who are disproportionately likely to be at risk – of course, as well as trying to use other methods to screen out donors who don’t fit within the demographically most-at-risk categories, but who may have HIV nonetheless – may well be sensible. If there’s a flaw with the FDA policy, it is not that AIDS is an increasingly heterosexual epidemic (if it is that) even though in the U.S. it is still a highly disproportionately male homosexual epidemic.

But what about the argument that “We also know that sperm banks can test for HIV very well now and so can screen out any infected donor” ? “[w]ith that in place, why are gay men being rejected?”? Are HIV tests certain enough that the sperm banks can efficiently and completely reliable test sperm, for instance, by freezing the sperm, testing the donor six months after the donation ? six month seemingly being the period between infection and [nearly?] certain detectability ? and using the sperm only if the donor comes up clean? Or is there some significant possibility of error even then?

In either case, wouldn’t that information be useful in an article by a health reporter, more useful than just giving an advocacy group’s take on the matter (plus a general assurance of safety from the operator of a sperm bank that accepts sperm from gays), with no sense of what impartial scientists actually say, and no discussion of any possible counterarguments?

I should stress that I genuinely have no views on what the science is. For obvious reasons, I’d love it if sperm banks could 100% reliably test sperm for HIV. It may well be that Mr. Cathcart’s arguments are completely right.

But it seems to me that readers would like to have more than his arguments and those of a sperm bank operator that obviously has a stake in the matter. There should be some science on this out there somewhere, I take it, and some scientists who can speak to it, no? If there’s a conventional wisdom on the subject that comes from highly reliable scientific sources, let’s hear it. If the conventional wisdom is that we don’t know what the right answer is, let’s hear that. In any event, let’s at least hear the specific arguments from the other side.

I am not trying to make any claims here about media bias. My point is simply that the story just isn’t very useful to a typical casual reader who’s trying to get an objective sense of the matter. Not a grand journalistic felony, I realize – but it’s the sort of journalistic misdemeanor (or even infraction, if you prefer) that, when repeated as often as this one seems to be, makes for unhelpful newspapers and ill-informed readers.

As always, please let me know if I’ve missed something important here.

http://www.volokh.com/archives/archive_2005_05_15-2005_05_21.shtml#1116286876

Sperm Donations and Homosexuals:

I should stress again that my post this morning about the Washington Post article was not an attempt to explain who was right and who was wrong – rather, it was a criticism of the article’s failure to adequately explain both sides of the debate, and of its failure to summarize what the conventional scientific wisdom is on the subject.

For those who are interested in the substantive question, though, you can find what seem to be the controversial guidelines here: http://www.fda.gov/cber/gdlns/tissdonor.pdf (please let me know if I found the wrong document; I wish the Post online article had had a link to the right one). The guidelines suggest the elimination of a wide range of people who seem at risk for HIV (pp. 16-21), including male homosexuals, intravenous drug users, hemophiliacs, men who have patronized prostitutes (of any gender), and 16 other categories of people.

Interestingly, the guidelines do not include people who have had promiscuous heterosexual sex; I don’t know whether the FDA didn’t see this as a high enough risk factor for HIV transmission, or whether it had some other reason for this. Perhaps this is a reason to criticize the guidelines – but if it is, then again it would have been nice if the Post article had discussed the issue.

You can also find the FDA’s responses to comments – again, I hope these are the right ones – here. Here’s what they say about the exclusion of homosexual donors:

http://www.fda.gov/cber/rules/suitdonor.htm

[i]Some comments disagreed with considering homosexual men to be ?high risk donors? and disputed the scientific basis for excluding these men as donors. Many comments cited the efficacy of the blood test for HIV, with retesting after a 6-month quarantine, although one comment noted that HIV antibody testing is imperfect. Many comments disputed the public health benefits of the rule, although some applauded the agency for trying to craft safeguards to protect the public. . . .

In response to the comments suggesting that FDA should allow establishments to rely on HIV test results alone, or on quarantine and retesting, without screening for risk factors, FDA rejects that approach at this time. Although it is reasonable to expect that more sensitive nucleic acid amplification testing (NAT) will be available soon for reproductive tissue donors, even that testing may fail to detect early stage HIV and other infections, particularly because the level of viremia may be extremely low in the early stages of infection (Refs. 1, 2, and 3). Moreover, even the best test may fail to provide an accurate test result due to human error in running the test or in linking the test result to the correct donor. Accordingly, FDA believes that, based on the current state of testing and current knowledge about disease transmission, it is necessary to screen for risk factors as well as to test for diseases such as HIV. . . .

After the consultation, it was concluded that there is no new data that would warrant revising the 1994 guidelines. CDC and others also concluded that current data are not sufficient to allow the identification of lower-risk subsets of currently excluded population groups, and thus, to refine the exclusionary criteria. At the consultation, representatives of CDC encouraged the development of new data.

On December 14, 2001, we asked the Center for Biologics Evaluation and Research's (CBER) BPAC, whether there are existing data that identify subsets of men who have had sex with other men in which the incidence and prevalence rates for HIV, HBV, and HCV of the subsets are similar to the population at large. By a 10 to 0 vote, the committee advised that these data do not exist.

We have reviewed relevant legal authorities and disagree that these regulations discriminate or improperly abridge donor or recipient rights. We further note that, since FDA has tailored the rule's requirements to take into account an existing relationship between a donor and recipient (for example, FDA has not required quarantine and retesting for directed reproductive donors, permits the use of reproductive tissue from ineligible directed reproductive donors, and requires no testing for sexually intimate partners), the comments' remaining objections relate almost exclusively to anonymous donations of reproductive tissue. We will continue to examine the data on risk factors and, as new data are developed that justify changes to our guidance, we will make those changes in accordance with good guidance practice.[/i]

For more details, see the document. Again, I can’t speak to whether the FDA got this right – but wouldn’t it have been good for the Washington Post article to explain a bit about the FDA’s substantive defense of the guidelines (or, even if the FDA hadn’t defended them, what those who defend the guidelines say)?

This sounds like gay advocacy whining to me. Why aren’t they crying foul over the fact that during an interview we ask a potential male blood donor if they have had sexual contact with another man or a prostitute in the last year, and if the answer is yes, we reject them as a donor?

Because it’s about a million times cheaper than running a friggin’ western blot (AIDS VIRUS TEST) on every single unit of blood, that’s why! It seems to me that the same logic should apply to sperm donation or any other biological product donation. This isn’t about ethics I would think, this is probably about cost vs benefit.

I’m sorry guys, if you’re gay, you are a higher risk group (much higher) for HIV than someone else. I’ll stand up for you guys to get married and all that, but don’t whine to us about something minor like this… geez!

[quote]lothario1132 wrote:
This sounds like gay advocacy whining to me. Why aren’t they crying foul over the fact that during an interview we ask a potential male blood donor if they have had sexual contact with another man or a prostitute in the last year, and if the answer is yes, we reject them as a donor?

Because it’s about a million times cheaper than running a friggin’ western blot (AIDS VIRUS TEST) on every single unit of blood, that’s why! It seems to me that the same logic should apply to sperm donation or any other biological product donation. This isn’t about ethics I would think, this is probably about cost vs benefit.

I’m sorry guys, if you’re gay, you are a higher risk group (much higher) for HIV than someone else. I’ll stand up for you guys to get married and all that, but don’t whine to us about something minor like this… geez![/quote]

You are correct!

At the same time you are relying on someones honesty and donating to sperm banks pays good money.

The question should be asked but that will not stop gays from donating sperm.