 Recently, a new story came on my TV and although I'd heard of it before, I hadn't actually really taken too much notice. Please excuse my ignorance, this time round the story peaked my interest. It's a worldwide scandal that has spanned decades and turned what was sold as a wonder treatment into a nightmare that has affected hundreds of thousands of people, reducing the life expectancy of many, making others seriously ill and in some cases would even kill its victims. Scarily those affected wouldn't necessarily be aware until it was too late. All whilst government officials and pharmaceutical companies failed to even admit there was a problem. Our blood is a vital component in all of us. Do we dealt a hand in life in which there is a genetic issue with it is bad enough. Let alone then becoming infected with HIV or hepatitis by accident. Today we'll be looking at the infected blood scandal and welcome to Plainly Difficult. Part 1. Blood Clots. This is blood. Well, not really. It's actually proper blood that I've bought from eBay. But for the purpose of this video it will stand in for the real stuff. When a human body is cut, blood vessels beneath the skin are damaged and we bleed. This is all pretty basic biology. Assuming you are still alive, your heart continues to pump and it pushes out of that blood. In the cut, the vessel linings trigger the release of clotting factors. Your blood, which is now escaping your body, start clumping together to form a barrier or a clot. So this works by these things called platelets and they clump around the gap. The platelets have thrombin receptors on their surfaces that grab serine thrombin molecules, which then converts soluble fibrogen into fibrin at the wound site. Fibrin is vital as it creates long strands of insoluble protein, which creates a mesh that, you know, holds everything together and stops you from bleeding to death. To help link the fibrin bonds, a pro-enzyme called Factor 8 is needed. This is what links the fibrin, making that vital mesh above the platelet plug. The complex world of a blood clot in stopping a bleed is pretty much reliant on Factor 8 working, or that the body is able to create the factor in the first place. Not having Factor 8 can cause extensive bleeding, from even minor cuts to easily bruising, all the way to severe bleeding inside joints and a pretty nightmare-ish scenario of bleeds on the brain. Low Factor 8 production is called Hemophilia A. There is also B and C, which is efficiencies in other clotting factors. It's a genetically inherited condition with no cure. Thus treatment is an ongoing process that requires replacing the missing blood clotting factors. The disease had been described throughout history as a cause of someone dying from a minor trauma, but its scientific study wouldn't really start until the 19th century. For a long time treatment was ineffective or outright dangerous, as during the early 1900s aspirin was recommended. Not good as we know that also prevents clots. Part 2- An effective treatment. Treatment in the 1950s and 1960s was in the form of frozen plasma. The creamy yellow fluid part of blood after platelets and red cells are separated off. Plasma does contain the vital factor 8. This is all well and good, but the concentration of the factor is so low that a large amount of blood is needed. It was a really inefficient way to treat hemophilia, which required a lot of time in hospital and came with the risk of vascular overload. If only there was a better way. Well, Dr. Judith Graham-Poole, a researcher at Stanford University, would publish a major breakthrough. She discovered that the precipitate left from thawing plasma was rich in that vital factor 8. The breakthrough meant the greater concentration of factor 8 could be administered to patients. This had massive benefits for hemophiliacs. They could be administered with the concentrate in emergencies of heavy bleeding, during elective surgery, and even self-administer the factor products, alleviating the need to attend lengthy hospital infusion sessions. Finally, sufferers had the chance at a more normal life. As such, life expectancy for severe cases dramatically increased. In order to produce a batch of factor concentrates, multiple plasma donations were mixed together. Donations that had come from different people. Up to 40,000 donors are stated by the UK Hepatitis Trust. Although they now had a better form of treatment, it was still reliant on human donors of blood, which creates an issue. You see, not a lot of people just out the kindness of their own heart donate blood. I'm not saying it's out of cruelty, but more out of inconvenience. Donating blood isn't the worst thing in the world, but is hardly on the list of many's most enjoyable experiences. No one really likes to be jabbed with a needle. Even I'm guilty of this. I donated blood some years back and never got round to doing it again. And thus, there was the supply issue. Part three, untested blood. In order to get that much needed blood, sometimes incentives were offered, usually in the form of financial. This attracted some of the more shall we say, monetarily depleted individuals. This group of people were sometimes from high-risk groups themselves, such as drug users, prisoners, prostitutes, clinically ill, and even in some rare cases, the freshly dead. This may not have been an issue if diseases weren't transmissible via the concentrated factor products. But it was. And the main disease that was transmitted, especially in the 1970s, was hepatitis. Remember the up to 40,000 donors used in the creation of factor-concentrate batches? Well, if just one of the donors was infected with hepatitis, then the virus had a very high chance of being transmissible to a product recipient. In the early 1970s, blood wasn't regularly tested for hepatitis. It was known, however, that hemophiliacs were becoming infected with the virus. Right from the get-go, concentrate products were considered controversial. The World Health Organization, at the time, recommended that countries source their blood products internally, and not from other countries. This was to reduce the risk of certain viruses being transmitted from donors across countries and even continent. The US federal government in 1973 began advocating for a fully voluntarily produced blood donation supply. But for the pharmaceutical companies, there wasn't a ready supply. And thus, they continued paying for donations, even allegedly targeting the high-risk demographics due to the ease of recruitment. This wasn't solely a United States issue. Over here in the UK, we could only be self-sufficient for around 50% of the nation's requirements. As such, a lot of blood was imported from, you guessed it, US pharmaceutical companies, which in turn created greater demand for blood, which made the same companies target even more at risk of demographics. Some companies even sourced blood from outside the US borders from less developed countries. This created an even more distorted picture of who was donating. Even though transmission of hepatitis was known, concentrated factor blood products continued to be delivered to patients. And by the early 1980s, there was a new disease that hemophiliacs had started to contract. Part four, an unknown virus. It is the 5th of June 1981, and five cases have been reported of a very rare lung infection, present in previously healthy young men. The five men also have a number of other rare infections, hinting at some kind of impaired immunity condition. The numbers of this strange condition would increase and in July 1981, the CDC would release a mobility and mortality weekly report. Another strange occurrence linked to the new disease was the heightened cases of Kaposi's sarcoma, a very rare skin cancer. Initially, in the US, these initial cases were really only seen in a few particular groups. Homosexual men and intravenous drug users. But another group would start to show the same symptoms, and that was hemophiliacs. In July 1982, the CDC reported that three hemophiliacs had acquired the disease, or have been treated with factor blood products. At the time, the mystery disease was called GRID, or Gay-related Immune Deficiency. But evidence was showing it wasn't a homosexual only issue. As such, the term AIDS acquired immune system deficiency syndrome was coined. It's becoming increasingly clear that AIDS was being spread to hemophiliacs, who in most cases weren't from the highest risk groups, and that spread was coming from infected blood products. In 1983, the pharmaceutical companies producing factor products were aware of the risk. One such company was CUTTA. It was the biological division of pharmaceutical company Bayer. In January, a CUTTA official acknowledged in a letter reported in The New York Times that there is strong evidence that AIDS can be passed on via plasma products. The CDC warned about the risk of blood products and the risk of catching AIDS. This was going to be bad for business. CUTTA, officially to its suppliers, was trying to save sales, saying, AIDS has become the center of an irrational response in many countries. This is of particular concern to us because of unsubstantiated speculations that the syndrome may be transmitted by certain blood products. There was clearly a significant risk to the public using contaminated blood, with even one donor out of thousands being able to put the whole batch of blood products at risk. And this denial wasn't just located to the US. In November 1983, UK MP, Kenneth Clark, publicly stated, there is no conclusive evidence that AIDS is transmitted by blood products. This helped the continuation of plasma imports to the UK from the US. But even at this time, it was widely accepted, as noted in the later Penrose Inquiry, that all hemophilia clinicians at this stage clearly believed that commercial blood products could and were transmitting AIDS. UK official statements on the disaster would move a little bit in January 1984, when Lord Glen Arthur said, it remains the case that there is no conclusive evidence of the transmission of AIDS through blood products, although the circumstantial evidence is strong. But there was an alternative to untreated factor 8 concentrate, and it was being developed in the early 1980s. Part 5 A Safer Alternative In 1981, the West German government licensed the method of heat treating plasma. The company that brought the new product was Behringwerk AG, and their process involved heating at 60 degrees the factor concentrates for up to 10 hours. This process reduces the risk of contamination, but came at a cost of 40-90% less yield in factor concentration. Thus this increased the cost of production of factor products. Gradually pharmaceutical companies moved towards heat treating products, although I should say that they were far from perfect and would be improved in the amount of time required for heating would increase, but they were a step in the right direction. The last US company to get approval for the new heat treated products was, you guessed it, Cutter, and this was in February 1984. They were in possession of a financial conundrum. They had loads of old treated factor products to get rid of. Now they could have stopped selling the older treated products. There was even a voluntary understanding between the factor concentrate producers and the FDA that the untreated products would be phased out of US circulation, but Cutter had another plan. The new treated blood was beginning to sell well once it was brought to market, but Cutter still had the old products burning its pockets. Cutter decided to, and as I said in an internal memo, to review the international markets again to determine if more of this product can be sold, and this was stated in a New York Times article. Basically a case of don't shite on your own doorstep. Cutter would later say the reason for this was due to a shortage of plasma for treated blood products production. However, as far as September 1984, Cutter was still using some of their limited plasma stock to produce the cheaper untreated product. There was still a market for the older products. Not all countries were quick to approve the new heat treated factor products. However, Cutter hadn't actually applied for permission either, most notably in Taiwan, which approval wasn't sought until mid 1985. Again, from the same New York Times article, Cutter reportedly in an internal memo said the company had too much old product in stock. So that it could sell off the older remaining stock, Cutter held off introducing the newer stuff in its non-western markets. When Hong Kong hemophiliac started transmitting HIV, Cutter tried to ease concerns with its distributors by saying there was no severe hazard. By mid 1985, most markets were refusing the untreated factor product. The FDA couldn't ignore the dumpster fire any longer and ordered the pharmaceutical companies to stop selling untreated products worldwide. Cutter complied in July 1985. But the heating process used for factor products only reduced the chance of infection, not stopping it completely. The big game changer came in the form of blood testing for HIV, which would go quite a long way to eliminating infection from the pool. HIV testing began in 1985, but it wouldn't be fully employed in blood donation until the 1990s. It started in the UK in 1986. By 1992, hepatitis C could also be effectively detected. And an even greater advancement would come with recombinant blood products, which is a form of synthesized factor product which virtually eliminates all disease transmissions. Part six, living with the failings of others. Now to be infected with HIV in the 1980s was not only a potential death sentence, it also had quite a significant social stigma. Many were ostracized. It was a mix of fear of the unknown, and although many hemophiliacs weren't part of the gay community, they were also rounded up in the horrific homophobia of the time. Sandra's lost her part-time job because colleagues thought she was a health risk. Fern Sheldon, who owns the baker's shop in Tamworth, claims Sandra was not sacked but decided to leave after staff complained. Many lost their jobs due to the ignorance surrounding the transmission of HIV and AIDS. For the longest part of the contaminated blood crisis, victims weren't even informed that the products they had been given had the risk of transmitting an infection. But it wasn't just HIV. Transmitting hepatitis C can result in severe liver damage, mainly due to symptoms taking a while to appear, delaying identification and treatment. The numbers of people infected is pretty staggering, with around 6 to 10,000 hemophiliacs transmitting HIV and AIDS in the USA, and 1,200 in the UK, and across the globe 10,000 more were exposed. In the UK, a shocking 76% of those who use commercial clotting factor products became infected with HIV. As far as here in Blighty goes, the blood scandal hasn't had any government or pharmaceutical companies properly admit liability. But although in August 2022, compensation was paid out to victims, but other countries in some cases were just as bad. In France, allegedly some politicians held back accepting screened blood products until a domestic company reached the market, essentially allowing the untested blood products to get through. Canada's Red Cross failed to track down infections in 1985. Italy was slow to inform and prevent the spread of HIV through contaminants, and Japan was slow to ban untreated blood products. However, the scandals victims there did receive the better amounts of compensation at just over $400,000 each, although it's no consolation for getting HIV and hepatitis. Compensation in the US was settled in 1997 at $600 million for more than 6,000 hemophiliacs infected in the United States in the early 1980s. Each person received an average estimation of $100,000. Victims are still living with the ramifications of greed and ignorance from over 40 years ago, but the tragic thing is those alive living with the horrific illnesses are the lucky ones. So many thousands in fact have passed away, it really is a largely unknown modern tragedy. This is the Plain Difficult Production, all videos on the channel Creative Commons Actuation Share Light License. Plain Difficult Videos produced by me, John, in the currently very warm corner of southern London UK. I'd like to thank my Patreon and YouTube members for your financial support and the rest of you for tuning in every week. I have Instagram, Twitter, or X, and a second YouTube channel, so check them out if you want to see more random things that I make. And all that's left to say is thank you for watching and Mr Music, play us out please.