Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood

by Rose George

Location matters in the plasma business, and the biggest plasma business in the world is just over the border. More than forty years after J. Garrott Allen castigated the use of skid row sellers, the plasma industry in the neighboring United States still had a reputation for locating its clinics in poor areas populated by vulnerable people. Grifols, the global leader in plasma protein therapeutics, has nearly 150 clinics in the United States. Thirteen are along the Mexican border. There are four clinics in El Paso.43 A paper coauthored by someone with one of the best names in epidemiology, Cameron A. Mustard, examined the location of plasma clinics in the United States between 1980 and 1995 and found that the number of source plasma clinics operating in extreme poverty areas grew from 77 to 136. Commercial plasma clinics were five to eight times more likely to be located in areas considered high-risk than would be expected by chance. What was surprising was that “such clinics continued to operate in these areas well after the epidemiologies of HIV and HCV [hepatitis C virus] and the links between drug use, infection and blood product infection were established.” This, in dry science language, “is inconsistent with epidemiologic evidence that locating of commercial source plasma clinics—which provide cash compensation for plasma donation—in the midst of active drug markets and poverty represents a risk to blood system safety.”