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
Abbotts 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 hemophiliacsan 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
banks voluntary self-exclusion procedures eliminated 86% of the
high-risk donors, thus preventing thousands of cases of
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
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
wed accumulated, the trends? We thought it was a no brainer.
Two days after the meeting, the countrys 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. Starrs
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 XIVs 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.