A Lively History of Blood Highlights the AIDS Epidemic

Last month, the French AIDS scandal of the 1980s limped to a close with the acquittal of Laurent Fabius, prime minister from 1984 to 1986, and his social affairs minister Georgina Dufoix. The two held office during the period from April to September 1985 when Abbott’s HIV screening test for blood was available but not used in France because, the lawsuit charged, the government chose to wait until a French version of the test was available.

Edmond Hervé, health minister under Mrs. Dufoix, was convicted of two cases of negligence but received no sentence for the convictions. In an earlier trial in 1992, three of four lower-level defendants were found guilty.

More than 4,000 French citizens, mostly hemophiliacs, were infected with HIV from contaminated blood. However, in his book Blood: An Epic History of Medicine and Commerce (New York, Alfred A. Knopf, 1998), Douglas Starr points out that most of these infected hemophiliacs had seroconverted years before any screening test was available.

He writes that the poor judgment of the French officials “possibly caused the unnecessary contamination of anywhere from 70 to 350 additional hemophiliacs—an unforgivable number, but not the holocaust that many had assumed.”

In his book, Mr. Starr cites two other factors he considers more significant in allowing contaminated blood into the French system: the continued use of blood collected from prisoners despite their known high rates of AIDS and the lack of any screening of blood donors.

“In the years before the ELISA test,” he writes, “sociological screening stood as the best defense against the disease, weeding out the most likely carriers.” In the United States, a retrospective study from the Irwin Blood Bank in San Francisco found that before ELISA testing was available, the blood bank’s voluntary self-exclusion procedures eliminated 86% of the high-risk donors, thus preventing thousands of cases of transfusion-related AIDS.

Blood Banks Warned

However, such screening came late in America as well. As early as January 1983, the blood industry was warned that AIDS was almost certainly due to a blood-borne virus and that gay men represented a high-risk donor pool. At a meeting at the CDC, Dr. Bruce Evatt, a hemophilia specialist, presented data on eight known hemophilia AIDS cases, two other suspected cases, and 37 more possible cases awaiting investigation.

Dr. Tom Spira of the CDC then presented the options for protecting the blood supply: using hepatitis B testing as a surrogate marker for AIDS and excluding members of high-risk groups from donating blood. “We went into that meeting expecting it to be a snap,” Dr. Evatt told the author. “How could anybody doubt the data we’d accumulated, the trends? We thought it was a no brainer.”

Two days after the meeting, the country’s major blood banking organizations met and issued a statement saying that the case for blood-borne transmission was inconclusive. Surrogate testing and questioning donors about their sexual preference were not recommended.

Although some of the most intriguing chapters of Mr. Starr’s book are devoted to the AIDS epidemic, the bulk of the book is a sweeping and entertaining history of blood in medicine and as a commodity, from the first documented blood transfusion in the 17th century (when one of Louis XIV’s court physicians transferred the blood of a calf into a madman in an attempt to cure him) right up to current research on the use of artificial blood products. It is that rarity, a scientific book that is also a “good read.”