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The drama ended, as do so many these days, in a courtroom. This particular chamber was long and low-ceilinged, with a wide dais at its front for the eight black-robed judges. Each of the four defendants sat flanked by tall policemen who gazed impassively from under the brims of their trademark pillbox hats. In keeping with the formality of French courts, the prosecuting and defense attorneys wore flowing black robes, which would dramatically sweep behind them as they rose to make a point. The only visible flaw in the decorum appeared among the audience members, some of whom wore T-shirts bearing inflammatory slogans. There were audible exceptions to decorum as well, as people would moan or shout "Non!" at a defendant's response, or when one man, the most vocal of the plaintiffs, would, as his doctor walked past, loudly hiss "Assassin!"
The plaintiffs in this trial were dying of AIDS. They charged that they had been infected through the negligence of the defendants—high officials in the French national transfusion service. In France, where the government until recently held a monopoly on blood and its derivatives, these men were supposed to ensure the safety of blood products. Instead, they allowed thousands of the nation's hemophiliacs to inject blood-derived clotting factors they knew to be contaminated. The defendants had done so because of a complicated mixture of paternalism, economics, and to some extent the limits of science, but the victims saw the incident more starkly. To them the affair was a matter of betrayal. The doctors on trial in the summer of 1992 were supposed to have embodied all that was noble in the French transfusion tradition—altruism,medicine, business, and technology. Instead, during the years of the "contaminated-blood affair" they came to symbolize the cynicism and expediency of a money-driven age.
The sense of betrayal surfaced in many places beyond the courtroom in Paris. For more than a decade the theme has been sounded in one locale after another throughout the world. In America, patients have filed hundreds of civil suits against doctors, drug companies, and even their own patient organizations, for abandoning their health to the expediency of the marketplace. In England, AIDS-infected hemophilia patients castigated their national transfusion service with reacting too slowly to the threat of emerging viruses. In Japan, patients charged that the government and drug companies criminally concealed the contamination, of blood products; as a result, some of the nation's most revered doctors have gone to jail. In Canada, the scandal of contamination spread so wide that the government held a series of hearings across the country that convulsed the nation with anger and shame.
Why those scandals erupted is one of the underlying questions of this book, a history of human blood as a resource and humanity's attempts to understand and exploit it. Blood is one of the world's most vital medical commodities: The liquid and its derivatives save millions of lives every year. Yet blood is a complex resource not completely understood, easily contaminated, and bearing more than its share of cultural baggage. Indeed, the mythic and moral symbolism of blood, which has been with us since ancient times, subtly endures. It clouded professional judgments and public perceptions in the AIDS scandals of France, Canada, and Japan, among others.
If one considers blood a natural resource, then it must certainly rank among the world's most precious liquids. A barrel of crude oil, for example, sells for about $13 at this writing. The same quantity of whole blood, in its "crude" state, would sell for more than $20,000. Crude oil, as we know, can be broken down into several derivatives, including gasoline, distillates such as diesel, and petrochemicals. Blood can be separated into derivatives as well. Spun in a centrifuge, it divides into layers-red cells on the, bottom, a thin intermediary layer of platelets and white cells, and an upper tea-colored layer of plasma. Each layer, in turn, can be used as various therapeutic products. Red cells can be transfused directly. White cells and platelets can be used to restore resistance or clotting ability to patients undergoing chemotherapy. Plasma, a resource in its own right, yields albumin for restoring circulation, clotting factors for patients with hemophilia, antibodies for vaccine production, and several other reagents and pharmaceuticals. Taken as a whole, the value of the derivatives in a forty-two-gallon barrel of crude oil would raise its price to $42. The price of the same quantity of completely processed blood would increase its value to more than $67,000.
Of course, blood is not processed by the barrel or handled in quantities anywhere near those of oil. (Only about sixteen million gallons of blood and plasma are collected annually worldwide—the equivalent of thirty-two Olympic-size swimming pools.) Indeed, the world market, for blood and its derivatives probably does not exceed $18.5 billion per year, versus $474.5 billion for petroleum, Yet one cannot avoid comparing the two resources. just like the oil industry, the blood trade involves collecting a liquid resource, breaking it into components, and selling the products globally. Red cells, being perishable, tend to remain within national borders, but certain portions of blood—plasma in particular—are traded among multinational companies and on a worldwide spot market. just as with oil, one region has become the premier harvesting ground, providing much of the resource for the rest of the world. The United States, with its liberal rules regarding collection, has become, known as the OPEC of plasma.
No wars have been fought over blood as they have been for oil, but the movement of blood has played an important role in our wars. A major anxiety about D-Day, for example, was whether enough blood could be stored to supply all the wounded that military planners had projected. In preparation for the Persian Gulf War, the military shipped massive quantities of blood to the battle zone for what they thought would be thousands of casualties. (Good fortune proved them wrong.) Such collections have always been secret, since intelligence services know that the mobilization of blood is a sure sign of an impending attack.
