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Blood Banks’ Test Rejection Criticized

ASSOCIATED PRESS

The American Red Cross and other blood-bank groups refused to adopt a screening test in January, 1983, publicly contending there was no hard evidence people could get AIDS from transfusions. But internal documents show Red Cross officials acknowledged that the disease could be transmitted through blood.

The nation’s three major blood collectors--the Red Cross, the American Assn. of Blood Banks and the Council of Community Blood Centers--said in a joint public statement on Jan. 13, 1983:

“The presently available medical and scientific evidence that AIDS can be spread by blood components remains incomplete. . . . We do not advise routine implementation of any laboratory screening program for AIDS by blood banks at this time.”

The groups refused to adopt the test for hepatitis B, a surrogate test that Centers for Disease Control officials said could have been in place by March, 1983. The current AIDS or HIV test hadn’t been developed yet, but nearly all AIDS patients--homosexual men, hemophiliacs and intravenous drug users--also had suffered from hepatitis B at some time and produced antibodies to fight it that stayed in their blood.

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The blood groups maintained that the test was too expensive, that it would produce a million false positives, and that there was no hard evidence that people could get AIDS from transfusions, despite CDC officials’ assertions that the disease posed a serious threat to the blood supply.

Privately, however, officials at the Red Cross believed that AIDS could be transmitted through blood, according to internal documents obtained by the Associated Press.

Paul Cumming, the Red Cross planning and marketing manager, wrote in an internal memo: “The available evidence strongly suggests that AIDS is transmissible” through blood.

“As time goes on we are liable to get more and more pressure to utilize” blood tests and donor screening. “CDC increasingly needs a major epidemic to justify its existence,” Cumming wrote a colleague on Feb. 5, 1983.

“To the extent the (blood) industry . . . sticks together against CDC, it will appear to some segments of the public, at least, that we have a self-interest which is in conflict with the public interest, unless we can clearly demonstrate that CDC is wrong,” Cumming wrote.

“In the short run, our position has all the earmarks of a lose-lose one. The question would seem to be, how do we minimize the short-run loss and hopefully gain in the long run?”

In one document, Cumming did a cost-benefit analysis and assigned a $500,000 value to each transfusion recipient who would be protected from AIDS by the blood test.

The memos are among thousands of pages of documents that, at the Red Cross’s request, were placed under protective orders by judges in various transfusion cases. The orders prohibit public disclosure of the documents, but the AP obtained them privately from sources familiar with the issue.

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The CDC estimates that 6,567 Americans have developed AIDS from transfusions since 1981. Only 29 of those cases were caused by transfusions received after March, 1985, when blood banks nationwide voluntarily began using a new HIV test. HIV, or Human Immunodeficiency Virus, was discovered as the cause of AIDS in 1984.

The CDC said it doesn’t know how many of the 6,567 have died of AIDS or how many other people are HIV-positive as a result of transfusions but haven’t yet developed AIDS.

Cumming, in a recent telephone interview, rejected any second-guessing of his actions.

“Given the same information, the same environment at that time, I don’t see that we made any mistakes. . . . There was no scientific evidence,” said Cumming, a statistician who now does consulting work for the Red Cross and federal agencies. “We made the best decisions it was possible to make.”

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Cumming said the hepatitis B blood test “was not a good test, by any criteria I know for a test” because it would have produced 1 million false positives.

The Red Cross, which takes donations through its 45 blood services regions, is custodian of half the nation’s blood supply and sells blood and its components to about 3,000 hospitals.

Questioned recently, the Red Cross said the effectiveness of the hepatitis B blood test was “an open question” in 1983. “Had there been evidence indicating the efficacy of any surrogate test, the Red Cross would have implemented it,” the organization said in a statement.

The Red Cross noted that its blood banks began in 1983 asking homosexual men with multiple partners not to donate blood. It started using direct questioning of potential donors in January, 1991.

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Because AIDS takes an average of seven years to develop, many victims have only recently discovered their illness from infected transfusions or clotting factor they received between March, 1983 and March, 1985. Clotting factor is a concentrate of blood from hundreds of donors which hemophiliacs inject to stem uncontrolled bleeding.

Victims and their families have filed an estimated 500 lawsuits around the nation against hospitals, the Red Cross and other blood banks, according to Lawrence Gostin, a professor at Georgetown University Law Center. Nearly all the cases have been settled out of court.

“The misery that was promulgated by this benign inaction killed thousands of people,” said Dr. Donald Francis, who was an expert on epidemics and AIDS at the federal Centers for Disease Control in the 1980s.

Now a research official at Genentech Inc. in San Francisco, Francis sometimes testifies as an expert witness for plaintiffs in AIDS transfusion suits.

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“Here was a group of certainly not evil people, who thought they were doing the right thing . . . who got caught up in a force that was anti-CDC, anti-action,” Francis said in a telephone interview.

Dr. Gerald Sandler, a Red Cross official, publicly criticized a CDC study in early 1984 that warned of the risks of AIDS-tainted transfusions.

But in an internal memo, Sandler told a colleague in January, 1984: “Problems related to transfusion-associated AIDS are increasing and require resolution. . . . No clear plan has been developed by the national blood-collection organizations to counter the increasingly apparent risk of (AIDS from transfusions) which, potentially, threatens all persons.”

Asked about the memo, Sandler, now director of blood donor services at Georgetown University Medical Center, said it was “an internal attempt to look as open-mindedly as possible on an issue.”

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The documents also show that one of the Red Cross’s blood services regions, based in San Jose, Calif., rejected the national organization’s official policy against the hepatitis B test.

Dr. Pearl Toy, then director of regional blood services for the San Jose region, wrote in March, 1984, to Sandler, who was associate director for medical and laboratory services at the Washington headquarters:

“A clear consensus was developed at our medical advisory committee meeting on March 24, 1984, to perform (hepatitis B antibody) testing in our region.”

A later memo shows that testing began in June, 1984.

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