Who will apologise for plasma therapy? It was a disaster for Covid-19, govt hospitals knew

Hospitals shelved ICMR's reports that plasma therapy wasn't good. It was still rolled out, and people paid the price writes DR KABIR SARDANA in The Print



Plasma therapy was administered to Covid-19 patients during the second wave in India | Wikipedia


The closing pages of the 18th-century masterpiece fiction The Story of the Stone revealed the essence of the Tao’s message. In Lao Tzu’s words, it means that “Things are not as they seem, that the Eloquent may Stammer, that Perfection may seem Flawed, that Truth is Fiction, Fiction Truth.”

The truth is neither black nor white, it’s grey—the handling of the second wave of Covid-19 is a testimony to that fact.
Disaster that escaped public eye

In the midst of the second wave of Covid-19 with panic all around, a lot of therapeutic disasters were played out, and without a doubt, they were inspired by a lack of knowledge. Instead, they were fueled with a desire for one-upmanship and copycat fame. Some of the doctors unwittingly orchestrated this therapeutic mess. On one side, we had the armchair experts who were not running Covid-19 centres and had shut down their institutes. On the other, doctors in central government hospitals like the Ram Manohar Lohia Hospital in Delhi were running Out Patient Departments (OPDs) and wards. They were possibly following half-baked regimens with little proof, as there were lives at stake.

While some medications were possibly harmless and cheap like Ivermectin or HCQS, the others were ridiculously expensive, and no one was wiser about their efficacy. One of them was plasma therapy. Of course, the Indian medical system and healthcare did not have the time for a randomised trial to test a placebo. But the origin of the mess was thus created right here in the capital of the country.

One may ask—who would be the expert to decide on its efficacy? The clear answer is a clinician in a hospital, handling patients with an active plasma extraction centre. But what transpired is that a centre dedicated to liver care with nil experience in Covid-19 treatment proposed the idea that plasma might help. Then came the now-famous statement of Chief Minister Arvind Kejriwal, saying that Delhi opened the first plasma bank in the world. That set off a chain reaction, and within a few weeks, hospitals followed suit.

It wasn’t the solution

Plasma is a component of the blood that is believed to have antibodies to diseases. Here, it was believed that Covid-19 patients would benefit from such therapy. This was when even the use of Intravenous immunoglobulin (IV IgG), a related plasma-based therapy that had been available for years, wasn’t effective in most disorders. This was also when we all knew that the so-called antibody tests of Covid-19 patients are negative or low positive. In fact, what is even more comical is that the quantity of antibodies in plasma is probably too little to do anything. And the ultimate irony is that therapy works in isolation, but here we had a plethora of medicines being administered, and it was not possible to pinpoint what was working behind the treatment.

Plasma does not come cheap, as it has to be extracted from patients. Thanks to the CM calling for plasma donation with great zeal and fanfare, the concept spread like wildfire. Intermediaries and ‘scamsters’ came in, and patients paid lakhs to get treatment, that too with dubious efficacy. Most doctors were inundated with calls for plasma, and we didn’t know what and where to arrange it for so many patients.

I know of patients who sold their belongings and went broke, partly because of plasma therapy and of course, Remdesivir, which has now been yanked off from all the guidelines. One of the members of our department, who had recovered from Covid-19, needed to give plasma to her own grandfather. He was admitted to the hospital, administered plasma but to no avail.

Trading fact for fame

Therefore, it is a must to understand the value of a placebo trial. Here, an identical-looking therapy is given to assess whether the active therapy—plasma, in this case—does anything substantial. A 30 per cent response rate is considered to be mostly placebo, or inactive, and that is the value of a placebo-controlled study.

There are numerous variables that determine the success of therapy in Covid-19, and assigning the credit to plasma showed a remarkable lack of foresight. At this juncture, the Indian Council of Medical Research (ICMR), in a multicentric study published in the British Medical Journal (BMJ), found that plasma wasn’t so good. But the public opinion swayed by the hospitals who pioneered the concept pilloried the paper and trashed it. Such was the distrust in our own country’s research that none wanted to get off the plasma bandwagon. Countless patients spent their life savings on what was a highly questionable therapy. And the charade continued till the second wave subsided.
The breakthrough

As always, we waited for a foreign journal to agree to a local finding, which was not surprising to a lot of us in the government hospitals. The landmark paper in the New England Journal of Medicine (NEJM) showed that there was “No significant differences in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo.” It has been cited 455 times since it was published in February 2021. The number exceeds the citations of any of the papers published by the ‘experts’ who rolled out an untried therapy on the nation.

To add insult to injury, a section of the print media, which studiously avoided criticising them because their publications were the benefactors of full pages advertisements on plasma banks. To make it worse, some of the names suggested for the Padma awards this year included the plasma therapy pioneers.

Who takes the responsibility?

In retrospect, what needs to be asked is—who will pay for the loss of life savings and the death of patients who were given plasma therapy? Who will fill in the gaps for the distrust in medical care? Will the experts apologise? Who will apologise for pillorying the ICMR’s report that could have nipped this in the bud? But no one really apologises for such things in India.

As Donald Keough said, “The truth is, we are not that dumb and we are not that smart.” The plasma blitzkrieg was neither dumb nor smart; it was callous, and someone should be paying for the negligence today or tomorrow.

These Tory quacks and charlatans are beyond belief

Armando Ianucci in The Guardian

For some time now, Conservative strategist Lynton Crosby has been reassuring his adopted party they will reach “crossover”. This is the term he’s been using to describe the moment when they take over the lead from Labour in the polls and push ahead.

The date of crossover, rather like the rapture, keeps being pushed back. It was meant to be Christmas last year, but nothing of significance happened then apart from a particularly good Dr Who special. January was also disappointing, February was frigging desolate and March passed without a squeak. Now we’re in the middle of April, what TS Eliot described as “the cruellest month”: for the Tories that’s proved true, with Labour and Conservative still stuck on more or less 33%.

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It would be easy then for David Cameron to give up on Mr Crosby and his promise of good polls ahead; except, he can’t. Lynton Crosby is his Designated Bastard, the man his party has paid fistfuls of money to order all of them about and get them to do whatever it takes to win. It’s the stuff of tradition for Tory governments to get in an expensive Designated Bastard at election time; it’s the line of life, a cycle of comfort. The Designated Bastard arrives, tells them not to be pussies, puts up posters about Labour’s tax bombshells, flashes up cartoons of the Labour leader in the pocket of someone, or being the poodle of someone, sitting on someone’s lap, wearing someone’s hair, or being stuck up someone’s arse.

Usually, the party pays devoted attention to the Designated Bastard. First, because he’s so expensive but really because he’s such a Bastard. He gets them to do things they’ve spent the past five years being ordered not to under any circumstances. For five years, they’ve been clenching their teeth and talking about partnership and coalition. They’ve been pushing Big Societies and feeling everyone’s pain by sobbing that we’re all in it together.

Then the Designated Bastard comes along and tells them it’s OK now to junk all that, to accept that most of us voters are mean and self-interested, and that any appeal to our immediate material needs and to our deepest fears will work. The Designated Bastard will explain to them that to win, they’ll need to ignore those who won’t vote for them, and, if need be, to legislate against them. If it involves pushing welfare cuts for the young unemployed in order to pledge cuts to inheritance tax for the wealthier, then that’s what needs to be done. If it involves tempting council home occupants with the right to buy, at the expense of an already depleted social housing market, then it’s just tough teats to everyone. He’s a Bastard and he’s just telling you what you already know but never thought yourself capable of: you need to go in and display your inner Bastard to your constituents. It’s always worked and like the sun coming up it will happen again.

Except, this time, it seems not to be. Lynton Crossover hasn’t worked. And that’s a problem, since there is no plan B. The Tories believe in tradition and the tradition has always been that being a Bastard works. So panic sets in. Once panic starts, rational political behaviour falls apart. Hence the true “crossover” we got last week – the much commented on swapping of clothes brazenly taking part in the Labour and Conservative manifestos. Labour painted themselves as the party of fiscal rectitude, while the Tories went crazy on uncosted spending commitments. In this crazy looking-glass politics, Labour turn out to be the party with the most conservative financial commitment to the NHS, while the Conservatives are the most profligate.

This muddle has been a long time coming. For decades now, each main party has been defining itself on how similar it is to the other and how different it is from its own past. New Labour stole Thatcherite prudence and Cameroonian Conservativism detoxified its nasty image by going green and socially aware. Like two galaxies drawing closer to each other, it’s no wonder they ended up in a massive swirl of confusion. The spinning can’t be stopped: if anything, it gets faster and faster until you can’t tell which one is which.

Labour’s paranoia about looking like Old Labour I can understand: battered for so long by a mostly rightwing press, it still clings to a suspicion that even in this digital age the old tabloid headlines still affect people’s opinion. The Tory volte-face I find truly extraordinary, though. Normally, this type of trickery is done with just words. Last election, it was the verbal gymnastics contained in such slogans as “Vote Blue, Go Green” or that most perfect of semantic paradoxes, “Vote for Change: Vote Conservative”. It’s a basic trick with words, in which you take a word and insist it means its opposite. The more you insist, the greater chance people will believe you.

This time round, though, there is something desperate about the trick. They will “spend” on the NHS more than Labour, but that spending will be funded by carrying on with their “track record” on the economy. They’ll block Scottish MP’s voting on certain tax laws but that will somehow keep the UK united. They will rail against recklessness, but concede a European referendum to stave off a threat to their support and pledge billions in public spending based on no more than an inkling the economy’s going to keep growing.

All this time, they’ll muffle this panic with words such as “steady” and “on course”, words used to conceal an unsteady veer away from stability. They’re like bad magicians who, at the moment of subterfuge, simply shout: “What’s that?” and point to the other side of the room in the hope we’ll turn away.

This isn’t wordplay – this is charlatanism pure and simple. David Cameron is indulging in basic quackery, trying to sell you stuff he knows doesn’t work. He’s doing it with our money and he’s conjuring with people’s lives. We know there’s no magic; the money will come from the cuts and deficit reductions and benefit targets and financial squeezes on those Cameron knows won’t be voting for him anyway. It’s the bastardly misuse of the public purse and the final proof, if any were needed, that he is unfit to lead his country and his party unfit to govern.