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Journal of Health Politics, Policy and Law 27.1 (2002) 152-158



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Book Review

Blood Feuds: AIDS, Blood, and the Politics of Medical Disaster


Eric A. Feldman and Ronald Bayer, eds. Blood Feuds: AIDS, Blood, and the Politics of Medical Disaster. New York: Oxford University Press, 1999. 375 pp. $29.95 paper.

In medical terms, it would be hard to find a more vulnerable population than hemophiliacs. Before the invention of modern forms of treatment, victims of hemophilia were at constant risk of deadly injury. When the new clotting products were invented, hemophiliacs became less vulnerable to these effects. But, with the advent of AIDS, large portions of the hemophiliac population in most industrialized countries were killed by the treatments that, a few years before, had seemed their salvation. [End Page 152]

Blood Feuds, edited by Eric A. Feldman and Ronald Bayer, recounts how responsible parties in eight countries failed to protect supplies of whole blood and blood products from contamination by the AIDS virus and the calamities and conflicts over redress that followed. Disasters are in some ways inherently fascinating, so it may be no surprise that this book is a good read. But it also is rich in information, ideas, and analysis; a comparative study of how blood supplies were compromised was a superb idea, and the book is worthy of its subject.

This project originated in discussions "about the contours and content of AIDS policy disputes" (vii). Yet in studying the spread of AIDS to hemophiliacs and recipients of blood transfusions, the project became more of a study of blood issues than AIDS issues. Blood Feuds does provide some comparative perspective on national AIDS policy failings. Readers of Randy Shilts's classic And the Band Played On might conclude that American actors in the AIDS tragedy were especially venal or heartless or shortsighted. Apparently not. Yet the authors' major policy concern for the future is whether decisions about protecting the blood supply will be appropriate, and their explanations for the past focus on both national conditions and the specific contours of blood politics and policy.

Case studies of contamination include chapters on the United States, Japan, France, Canada, Denmark, Germany, Italy, and Australia. In addition to an overview by the editors, the study provides comparative assessments of four subjects: cultural perspectives on blood (Dorothy Nelkin), hemophiliacs' actions as an interest group (David Kirp), policies to maintain blood quality from the standpoint of the economics of information (Sherry Glied), and the intensity and course of postcontamination scandal (Theodore R. Marmor, Patricia A. Dillon, and Stephen Scher).

These essays show that decisions about AIDS and blood were made in the context of established institutional arrangements and ideas. The institutional arrangements emphasized voluntary donation, local monopolies, and national self-sufficiency (at least in theory). Some of the ideas involved legal distinctions (whether whole blood is a product that can be subject to liability law), and others involved notions about the inherent superior quality of domestic and voluntary blood. Hemophiliacs and their physicians were sadly reluctant to recognize a new threat and change their own behavior in part because they analogized the danger to the preexisting threat from hepatitis B. Having previously determined that the huge benefits of blood-coagulation factor VIII were worth the significant risks of hepatitis B infection, they were disposed to see AIDS as just [End Page 153] another risk. The blood policy world also shared an ideology, typified and promoted by Richard Titmuss's The Gift Relationship, which viewed blood received from voluntary donors as fundamentally safe and virtuous because of the donors' altruism. Hence in virtually all countries efforts to restrict donations challenged a fundamental assumption of the system: the donors' goodness protected product quality.

These common ideas, when combined with the extremely unfortunate epidemiology of AIDS (that infection could occur yet not produce noticeable symptoms for years), explain much of the infection of hemophiliacs and transfusees that eventually occurred. In this sense, victimization was inevitable. Nevertheless, national experiences differed as to both the timing of those protective measures...

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