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The Blood Supply

Bad Blood


Not all those who sold their plasma were exploited. Some donors, with rare blood types or immunity factors, could sell their plasma at a premium. This was especially true of women who had developed a sensitivity to the Rh factor, the condition in which a baby with Rh-positive blood triggers an immune reaction in its Rh-negative mother. Two disciples of Karl Landsteiner, Drs. Philip Levine and Alexander Wiener, had shown that an Rh-negative woman could be immunized against the disease by injecting her with Rh antibodies immediately after the birth of her first Rh-positive child, and by the late 1960s this injection became commercially available. The source of this rare antibody -- called "Big D" in blood-banking circles -- was other Rh-negative mothers who had given birth to an Rh-positive child. The women most prized for plasma donation were "high-titre" mothers whose antibody concentrations were unusually high. A woman with such a rare combination of biology and circumstance could become wealthy from selling her plasma several times a month. One such woman, Dorothy Garber of Miami, Florida, had such a high concentration of the Big D antibody that she was able to earn more than $80,000 a year.

For every Dorothy Garber, however, there were thousands of less fortunate sellers -- the unemployed, indigent, and substance-addicted -- who would line up outside the centers in ragged neighborhoods to sell their plasma for $10 a pint. A "high percentage of our donors are either illiterate or functionally illiterate," the director of a South Carolina plasma center run by Cutter Laboratories wrote in an undated memo. "They have great difficulties reading words with more than two syllables and even more trouble understanding the meaning [of] those words. I am fairly sure most of the other Plasmacenters have the same problems."

The most disenfranchised group of donors was prisoners, who became an important source of plasma-derived products, mainly gamma globulin. Gamma globulins can be fractionated from anybody's plasma, but the best way to gather them is to find someone who has been exposed to a disease and has produced a high concentration of the antibodies in question. One way to collect gamma globulins would be to comb the population for survivors of diseases such as rabies or tetanus. A far more practical method is to inject a donor with a light dose of the pathogen and wait a few days for his immune system to gear up. This "hyperimmune" plasma can be fractionated to produce a highly concentrated and specific gamma globulin.

Prisoners proved ideal for this procedure. They were desperate enough to need the money (or furlough time, the reward in some prisons) but not likely to disappear, as were the transients from Skid Row. Soon prisons became an important source of gamma globulins for pharmaceutical firms such as Cutter and Hyland and the subcontractors who served them. Unfortunately, they operated in a regulatory vacuum. Under so-called short-supply provisions governing vital resources, drug companies could buy certain materials from unlicensed, uninspected vendors. Plasma was one such vital material. So, although federal health and safety rules covered the drug companies that processed the plasma, they exempted the smaller firms that merely collected it. A dangerous situation developed in which drug companies maintained reasonably safe and hygienic prison centers but the subcontractors who supplied them often did not.

The most notorious of these cases involved a chain of prison facilities owned by an Oklahoma physician named Austin R. Stough. Stough was a prison doctor for the Oklahoma State Penitentiary when he became aware of the emerging market for plasma. He opened a plasma center in the penitentiary, then expanded to institutions in Arkansas and Alabama. There he injected volunteer prisoners with the antigens for several diseases, collected their hyperimmune plasma, and sold it as raw material to the major biologics firms. By the mid-1960s, Stough had set up centers in five prisons in the South and was supplying the raw material for a quarter of the nation's hyperimmune gamma globulin.

Soon the prison donors started getting sick. One man nearly died when a technician reinfused him with someone else's red cells; another expired after a series of injections designed to boost his antibodies to whooping cough. Hepatitis rates jumped at several of the prisons. Five months after Stough's center opened in Kilby Prison in Alabama, the hepatitis rate among inmates soared from zero or one case a month to fifteen, then entered a sustained rate of twenty to thirty cases a month, including four deaths. Then forty-two men became sick at two other prisons in Alabama. "They're dropping like flies out here," said a penciled note from an inmate at Kilby. By the time the epidemic had run its course, the National Communicable Disease Center in Atlanta (the forerunner to the Centers for Disease Control) reported that 544 cases could firmly be linked to Stough's operation and that the real number probably approached a thousand. They could not make an exact estimate, because many health records had been lost or destroyed.

There was no doubt as to the cause of the infections. Stough ran a sloppy operation, with poorly trained technicians and unsanitary equipment. Even his customers knew it -- an inspector for Cutter Laboratories reported that he was "appalled" by the conditions. Yet, right until the time that Stough was forced to abandon his plasma business, the major drug firms remained a loyal clientele. To them it was a question of supply. Having cultivated corrections officials with generous retainers, Stough had gained unparalleled access to the resource. Besides, reasoned the companies and federal officials, gamma globulins did not transmit hepatitis -- as far as they could tell, the products derived from prison plasma were safe. Coldly and legally speaking, what happened to the prisoners was not really their concern.

Such indifference could not last for long. Dark stories were emerging about commercial blood and plasma in America, about a system that was poorly regulated and out of control. It also became evident that American blood products were not entirely safe. They had become tainted by a virus that, spread through transfusions and contaminated plasma, was killing hundreds, perhaps thousands, per year.

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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