You are here

The Giant Cover-up

Daily News Navigator


F. Edward Yazbak MD 

One of the most shocking and unforgettable CDC Mortality & Morbidity Weekly Reports (MMWR) I ever saw was that of September 24, 1982 titled: “Current Trends Update on Acquired Immune Deficiency Syndrome (AIDS) –United States. 

It started with: 

“Between June 1, 1981, and September 15, 1982, CDC received reports of 593 cases of acquired immune deficiency syndrome (AIDS).* Death occurred in 243 cases (41%)

The incidence of AIDS by date of diagnosis (assuming an almost constant population at risk) has roughly doubled every half-year since the second half of 1979 (Table 1). An average of one to two cases is now diagnosed every day. Although the overall case-mortality rate for the current total of 593 is 41%, the rate exceeds 60% for cases diagnosed over a year ago.

Almost 80% of reported AIDS cases in the United States were concentrated in six metropolitan areas, predominantly on the east and west coasts of the country (Table 2). This distribution was not simply a reflection of population size in those areas; for example, the number of cases per million – population reported from June 1, 1981, to September 15, 1982, in New York City and San Francisco was roughly 10 times greater than that of the entire country. The 593 cases were reported among residents of 27 states and the District of Columbia, and CDC has received additional reports of 41 cases from 10 foreign countries.

Approximately 75% of AIDS cases occurred among homosexual or bisexual males (Table 3), among whom the reported prevalence of intravenous drug abuse was 12%. Among the 20% of known heterosexual cases (males and females), the prevalence of intravenous drug abuse was about 60%. Haitians residing in the United States constituted 6.1% of all cases (2), and 50% of the cases in which both homosexual activity and intravenous drug abuse were denied. Among the 14 AIDS cases involving males under 60 years old who were not homosexuals, intravenous drug abusers, or Haitians, two (14%) had hemophilia A.** (3)

Reported AIDS cases may be separated into groups based on these risk factors: homosexual or bisexual males–75%, intravenous drug abusers with no history of male homosexual activity–13%, Haitians with neither a history of homosexuality nor a history of intravenous drug abuse–6%, persons with hemophilia A who were not Haitians, homosexuals, or intravenous drug abusers–0.3%, and persons in none of the other groups–5%.” http://www.cdc.gov/mmwr/preview/mmwrhtml/00001163.htm

I vaguely remember taking a deep breath and thanking my luck for having chosen “Pediatrics” as a specialty. 

That blissful period was short-lived… 

A few weeks later, the December 8, 1982 MMWR reported the distressing story, for a pediatrician, of a San Francisco male newborn with Erythroblastosis Fetalis (blood group incompatibility) who received several transfusions of whole blood, packed Red Blood Cells and platelets, from 19 different healthy donors while in the newborn nursery  and later developed AIDS. The parents and brother of the infant were in good health, the parents were non-Haitians, non IV drug abusers heterosexuals and the infant had no known personal contact with an AIDS patient.

An extensive investigation revealed that one of the blood donors, who was totally healthy at the time of the blood donation, had later developed symptoms and findings suggesting an immune deficiency disorder and had ultimately been diagnosed with AIDS. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001203.htm

Like any other pediatrician, I had always worried about any transfusion reaction in my little patients who needed “blood” or a “blood product”. Now I had to start worrying even more about giving any of them AIDS whenever I wrote an order for a transfusion of any kind. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001163.htm

A distinct and very scary risk had just been created. 

*** 

The next challenge for me came two years later. 

By then, I had been a school physician in two school systems for twenty years during which there had been relatively few real big problems. The tsunami of autism, behavioral disorders, ADHD and dyslexia had not yet overtaken schools. /2013-6-3-and-away-boston-schools-YazbakFE

A handsome brave 13- year- old young man and his equally tenacious Mom were fighting their Midwestern school system for his right to attend school even though he had been diagnosed with HIV/AIDS in December 1984. 

Ryan White was not from any of the West or East Coast AIDS hubs and neither he nor his family had anything to do with risky behavior. He was simply one of the first innocent and most unlucky children with hemophilia who had developed HIV/AIDS from transfusions of pooled blood products containing Factor VIII, the blood-clotting agent hemophiliacs lacked and desperately needed. 

Always well-dressed (often in a white shirt, red bow tie and a blue blazer) handsome Ryan was always soft-spoken, but certainly very convincing when he stated he was not a danger to anyone around him and he had the right to attend school. 

Ryan lived to make a lot of friends and to celebrate his eighteenth birthday. He died on April 8, 1990, just months before Congress passed the AIDS bill that bears his name, the Ryan White Comprehensive AIDS Resources Emergency Act or simply the CARE ACT. 

Since then, the US Congress has reauthorized the legislation in 1996, 2000, 2006, and 2009 and today that important bill is still called the Ryan White HIV/AIDS Program. http://hab.hrsa.gov/abouthab/ryanwhite.html 

At the time, Ryan’s plea attracted national and international attention. 

*** 

Thirty years ago, the FDA reacted swiftly to emergencies. Realizing that transfusion of whole blood and of blood components had to be promptly made as safe as possible the FDA supported, fast-tracked and quickly approved a reliable screening test for HIV antibodies in blood products. The test, produced and marketed by Abbott Laboratories was promptly used by blood banks in the United States to screen donors and even existing blood supplies. 

At about the same time, another US-based firm, Baxter Healthcare Corporation, developed a heat-treatment process capable of eliminating any chance to transmit AIDS in blood products, including clotting factors. That process was also promptly approved and made available. 

Both companies went into high gear and mounted major campaigns to inform laboratories and blood banks worldwide about their products. 

*** 

In July 1992, the world watched with interest a French drama unfold. Four prominent doctors were tried in a Paris tribunal and found criminally responsible for the infection of over a 1000 hemophiliacs with HIV/AIDS through the administration of AIDS-infected blood products. 

Of the patients listed in the legal action, 250 had already died by the time the trial started. 

The evidence presented in the French court was overwhelming: Reassured by the director of the FrenchNationalBloodTransfusionCenter (one of the four defendants) to continue “normal distribution of non-heated (blood) products as long as they are in stock”, the Center through its branches had unwillingly spread AIDS among the poor hemophiliacs. http://articles.latimes.com/1992-07-21/news/mn-4337_1_blood-products

***

The tragedy and cover-up of the HIV/AIDS epidemic among Japanese hemophiliacs seemed to be even more disturbing.

In the early years, AIDS was much less of a problem in Japan than in the United States. There is actually some evidence that the very first case of Japanese AIDS was the result of a treatment mishap: A Japanese hemophiliac developed and later died of AIDS and the cause of his death was kept secret by the Ministry of Health and Welfare in order to avoid alarm and fear among the country’s hemophiliacs.

Later on, because of the multitude of international reports of AIDS transmitted to hemophiliacs through transfusions, a Japanese expert advisory group was formed under the chairmanship of Japan’s leading hemophilia specialist. The experts met many times to discuss possible solutions to the problems, but ultimately decided to continue importing the U.S. blood products for the treatment of hemophilia without informing the public.

When the new and safer process was approved in the United States, Baxter – U.S. tried to get its heated blood products approved by the Ministry of Health and Welfare in order to import them to or even manufacture them in Japan. Unfortunately the Ministry delayed and delayed the approval for weeks and months.

Years later, the Japanese media claimed that the Ministry had stalled the approval of the new Baxter products for two reasons: The Ministry still had huge stocks of unheated blood products available in Japan that needed to be sold and Japanese pharmaceutical companies had not yet succeeded in developing a competing technology to manufacture their own safe blood products: The Japanese market would have simply become a Baxter – US monopoly and that was not acceptable.

The Ministry officials vehemently justified their position by insisting that there was a lack of consensus among experts that AIDS was blood-borne and … that the scientific evidence demonstrating the safety and efficacy of the new heated blood products was “inadequate”.

Although HIV-contaminated products had been distributed in Japan for a while, the delay in approving the safer heated blood products for months, after they had been approved and used in the US and in other countries, further contributed to the spread of HIV infection among Japanese hemophiliacs in a substantial way.

In an extensive report published in 1997 Fieldman stated: “Of the approximately 5,000 hemophiliacs in Japan, 40%, or 2,000, are estimated to be HIV-positive. With fewer than 2,000 reported cases of AIDS in Japan, and less than 5,000 people who have tested HIV-positive, hemophiliacs thus represent a large proportion of those affected by the disease. Hemophiliacs in Japan bear not only the burden of high rates of HIV infection; they have also long suffered from the dual hardships of a genetic disease and the social prejudice resulting from that medical condition. According to Yasunori Akase, the first Japanese hemophiliac to reveal publicly that he had AIDS, “There exists a terrible discrimination against us among doctors and hospital authorities. They make a lot of excuses [to avoid treating those with HIV/AIDS at their hospitals], such as being short of facilities and staff.

Hemophiliacs have been excluded from schools and jobs. Teachers have demanded that hemophiliac children bring evidence to school that they are not HIV-positive. Classmates have taunted those with hemophilia, saying “You are an AIDS patient.” Some employers have required adults to provide copies of HIV test results. Neighbors have shunned hemophiliacs whom they previously tolerated. A survey by the Friends of Hemophilia Society, Kyoto Chapter, found that hemophiliacs are routinely turned away by dentists,internists,surgeons, and pediatricians.”   http://www.jpri.org/publications/workingpapers/wp30.html

Dr. Fieldman’s report includes a detailed description of what happened in Japan during those dark few years and the successful litigation that followed. This sad chapter in a country with acknowledged superior medical practices is well worth a look.

In November 2000, Crowell and Mutsuko revisited the subject in:

“JAPAN: A Case of Delayed Justice.

The Health Minister Admits to a Government Cover-Up over HIV-Tainted Blood"

http://www.cnn.com/ASIANOW/asiaweek/96/0308/nat1.html 

More recently, a 2007 report titled “AIDS Blood Scandals: What China can learn from the World’s mistakes” reviewed the blood scandals in the United States, Japan, Canada and other countries, China’s experience and the legal issues of contaminated blood. 

“Though its unique social, cultural and legal context suggests that some solutions that have worked elsewhere may not be appropriate to China, the overall model—investigate, compensate, and clean up the blood supply—provides a framework that could be adapted to the Chinese context…” 

While conceding that comprehensive investigations and a thorough re-evaluation of blood regulations are time-consuming, the report stressed that “neither should be a prerequisite for or a condition of the urgent necessity to create a compensation fund. People living with HIV/AIDS have urgent medical and financial needs today, and further delay would only place them in a more precarious position.” http://www.asiacatalyst.org/news/AIDS_blood_scandals_rpt_0907.pdf 

***

Because ours is not a perfect world, and humans are humans, iatrogenic mishaps keep occurring and clever cover-ups need to be created. 

It would be simplistic to think that every drug maker discloses all questionable results and that companies that sell vaccines only market perfect products. 

It is equally ridiculous to believe that the causes of autism are still a mystery in a country whose “Rover” is touring Mars and whose astronauts jumped merrily on the moon surface, years ago. 

On the other hand, cover-up experts being also human, someone is doomed to eventually spill the beans. 

It would be great to see that day!

 

F Edward Yazbak MD – Falmouth, Massachusetts

7-15-2013