17 May 2022: Ironside - D

Live from London in front of a studio audience, its Question Time.

On the delay in notifying people, did it constitute a public health risk: He said it would have been much better to do it, it was difficult to say how much of a risk, but couldn’t say it couldn’t have been.

On “implicated” plasma products, was it a “low” risk to those who received it: He said that like general blood use, statistically it is low, but if you are the one it gets, and your exposure is from many sources, then the risk is high.

On leuko-depletion, what was the basis for saying it could have been done earlier: He mentioned examples from other countries, it did carry a cost, but there are other advantages such as reducing the risk of CMV from white cells. He said it took three years in the UK. He only got involved because the colleague who would have been involved was on holiday and he had to cover.

On having a blood test available for CJD: He said it would be useful not just for individuals, but also as a prevalence study, like the appendix study. He said there was no reason he could think of it could not be developed.

On how far away it could be for a test could be developed: He said it is unfortunate it hasn’t happened earlier, but he cannot say about how long.

On tissue samples and best practice on informing relatives: He thinks there are standards, and he has helped the CJD Network (voluntary group for those affected by CJD), on giving and not giving consent, and on changing your mind. He said some guidance is on the MRC website.

On the principle of consent for post-mortems and retention of samples: He was involved in the tissue bank establishment and its consent systems, consent is fundamental to all aspects of autopsies, it must be informed consent, and he continued to support good practice and provide information on treating bodies with dignity.

On his own practice as a pathologist: He would firstly check the consent form for completeness and if there are any restrictions. If there are questions or uncertainty, clarification would be sought before proceeding.

On haemophilia stored samples: He listed various body parts, organs, etc. that are part of storage, and offered the reasons why that material was so useful to have. He assured that ethical permissions is firstly obtained.

On the work involving haemophiliacs, the “interesting findings”: He mentioned the HIV locations in the body, the brain and any structural effects, the way of crossing the blood/brain barrier, comparisons with people who were treated in different ways, and what happens when HIV is controlled in the rest of the body but the brain is not fully covered by those treatments.

On pathologies related to different parts of the body: He said the burden of disease is wider in haemophiliacs due to the various other infective material. He said it has been published, mainly by Dr Bell.

Questions from the Chair included asking about “clearance”. It may be a matter of the amount of infection, or a minimum threshold to allow clearance. Sir Brian asked about the 1% risk, “risk of what”. It is the level above normal when intervention would be required.

Prof Ironside briefly commented about the horrifying nature of these diseases and expressed his gratitude for those who gave consent to progress knowledge and develop solutions, and gratitude to his colleagues from the surveillance unit.

The Chair thanked the witness for his thoughtful approach to giving his answers, something that not all witnesses bring to their oral evidence, and his obvious expertise on the subject.

I briefly spoke with Prof Ironside as he was leaving the podium. He was happy to have been asked to give evidence. He hoped it was helpful. If there is anything else people want to ask in the future, he is happy to provide answers if he can.