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The Blood Supply

Bad Blood

The following is excerpted from BLOOD: AN EPIC HISTORY OF MEDICINE AND COMMERCE (ISBN 0-688-17649-6) by Douglas Starr (pgs. 207-212). The book is available on Amazon.com.

Chapter 12: Bad Blood

The blood business boomed in the 1960s and '70s. The enterprise had become so decentralized by now that no one knew how much was collected, although most estimates put it well above six million pints a year in the U.S. alone, easily surpassing peak collections during the war. The liquid's uses multiplied as well, as Cohn's dream of component therapy approached realization. Rather than using whole-blood transfusions, doctors increasingly administered individual components such as red cells, white cells, platelets, and plasma. Plasma itself was giving way to an increasing number of fractionation products, including albumin, gamma globulins, blood-typing sera, and clotting factors for people with hemophilia. Doctors used more blood in more ways than ever before.

At this point the blood business divided. Hospitals and blood banks continued collecting whole blood, but plasma became an industrial affair. A new process called plasmapheresis propelled the separation. The system involved removing blood from the donor, centrifuging it to separate the plasma, and then re-infusing the red cells. The procedure was uncomfortable and could take a couple of hours (at least until it was automated in the mid-1980s), which made it necessary to pay the donors.

Plasmapheresis proved invaluable to the drug industry, allowing manufacturers to harvest greater volumes of the raw plasma they desired. The process was safer than harvesting whole blood, since removing only plasma did not lead to anemia. Furthermore, while it takes weeks for the body to regenerate red cells, plasma can be replenished in a couple of days. All this meant that drug firms could collect more often than before: Previously they had had to wait a couple of months between purchases of blood from a given donor; now they could buy from him twice a week -- 104 times a year instead of 6.

What happened next can best be envisioned by imagining that someone invented a very fast and cheap way of drilling for oil at the same time that the industry discovered petrochemicals. Almost overnight, the collection business boomed. Hundreds of new plasma centers sprang up to meet the demands of the burgeoning "biologics" industry, as it came to be called. Some belonged to the drug firms that had pioneered fractionation under Cohn; others belonged to small independents, specializing in collecting and selling the raw material. Like drilling rigs at an oil field, they sprouted wherever the resource seemed promising -- around army bases and college campuses, in downtrodden neighborhoods, and along the Mexican-American border. From there the "source plasma" was sent to the nation's biologics manufacturers, who, in order to process it economically, pooled it in vats containing thousands of pints.

New classes of people became involved -- shadier buyers, more desperate sellers. Experts had warned about the potential for abuse. During a 1966 conference at Cohn's Protein Foundation, Dr. Tibor Greenwalt, a leader in nonprofit blood banking, cautioned against "exploiting for its proteins a population which is least able to donate them" -- yet that gave little pause to commercial entrepreneurs. Tom Asher, a fifty-year veteran of the plasma industry who worked as a manager for the Hyland division of Baxter Laboratories, ruefully recalled that his company set up its first center at Fourth and Town streets in Los Angeles -- "absolute dead center, Skid Row. We'd immunize donors with tetanus to increase their antibodies for tetanus gamma globulin. When hurried, our doctor, who was also the bouncer, would occasionally give them shots of tetanus antigen right through their trousers." Later the company took to "bankrolling all sorts of characters" to meet the booming demand for source plasma, many with questionable ethics. Another Los Angeles center, called Doctors Blood Bank and run by two local pathologists, paid donors in chits redeemable at a local liquor store.

Stuart Bauer, a writer for NEW YORK magazine, investigated the world of down-and-out plasma sellers by becoming one himself. After a loved one died of transfusion-related hepatitis, Bauer went undercover, donning old clothes and selling his plasma thirteen times over a period of seven weeks. His tale was a bleak one of hardened collectors and avaricious doctors, and of the winos, addicts, malnourished, and destitute whose plasma they "farmed" at the center in Times Square. Among the chilling scenes in his article is one about the experience of donation:
The pain of insertion comes in three overlapping waves. The first two waves -- the puncturing of the skin and the piercing of the radial vein -- are dicey enough, but stubbing a toe or biting the tongue are really worse. It is the third wave, the least painful part, that carries the freight. For when the body of the catheter is fitted inside the vein, distending it, it catches you -- of all places -- in the heart, which registers the intrusion with a chilly "ping." When the next beat comes the heart's resumption has a choked rhythm . . . and you resolve from here on in to cater to your heart. But the only favor it occurs to you you can do is not to breathe too deeply. So you take in air in miserly little sniffs. And root for your heart as you would for a long-distance runner who had stumbled. ...

"Ever wonder what it's like?" [he asks the nurse].

"... Wonder what what's like?"

"Being on the other end of a hollow needle the size of a swizzle stick? ... It's like being impaled on the antenna of a car radio, that's what it's like."
Later he describes a scene in which the doctor at the center finds an elderly donor lying quite still with his mouth and eyes open. "How are we today, Sydney?" he asks the old man. But Sydney is dead. After the body is removed, the doctor remarks that during his years of association with the center the man had donated almost half a million cubic centimeters of blood. " 'One always hates to lose a veteran donor with a gamma globulin like his. ...'"


Reprinted by permission of the author from BLOOD: A HISTORY OF MEDICINE AND COMMERCE by Douglas Starr. Copyright © 1998 by Douglas Starr. New York: Alfred A. Knopf, Inc.



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