Safe Blood: Purifying the Nation's Blood Supply in the Age of AIDS.

Safe Blood.- Purifying the Nation's Blood Supply in the Age of AIDS, by Joseph Feldschuh with Doron Weber Free Press, 180 pp., $19.95) 0 FORESTALL bigotry in any of his children, my father used to tell us that since my mother had received blood from a black man after her first pregnancy, we were all part black (except, I guess, the one born first). Only later did we learn that it could have been a black man and that genetically speaking this was utterly irrelevant. Anyway, it did work, or at least none of us did grow up racist, and it's a nice example of how when we talk about blood and blood donations, there's a lot of emotional and symbolic play that goes on.

The main point of this book is that the nation's blood supply is far less safe than we've been led to believe-that it is a veritable cornucopia of pathogens. "The number of diseases known to spread through the blood has grown and multiplied," write the authors. "Today, infections that can be transmitted through blood transfusion include: non-A, non-B hepatitis; hepatitis B; AIDS [HIV]; cytomogalovirus infection; Epstein-Barr virus; HTLVI; HTLV-II; syphilis; and malaria. Other rare infectious complications are: HIV-2; Chagas's disease, brucella abortus; salmonella septicaemia . . ." There are tests to detect many of these, says co-author Joseph Feldschuh-himself a physician-but none are perfect and some are pretty far from. Moreover, he says, the American Association of Blood Banks and the American Red Cross, the two largest blood-collecting and -distributing organizations in the country, far from being the altruistic, non-profit enterprises they claim to be, are out to make a buck even if this includes playing down some of the risks of their product. He recounts the shameful, now-well-known episode in which blood banks essentially conspired not to put into effect AIDS screening methods that could have protected blood recipients but would have offended some homosexual groups.

To be sure, say the authors, there are some methods individual recipients can use to reduce their risks, such as blood salvaging, in which the patient's blood is caught in a container and put back into his system during an operation, or preoperative autologous blood donations, where a patient facing elective surgery can have his own blood taken and saved weeks in advance. But all of these have drawbacks. The real solution, say Feldschuh and Doron Weber, is fresh frozen blood, which sounds like something you'd find on a Transylvanian restaurant menu but simply means giving blood well ahead of time and then freezing it, save for the platelets, which current technology cannot freeze well. This way the blood can be kept more or less indefinitely (ten years, according to FDA regulations), rather than be thrown out if the person doesn't need it within six weeks.

The first problem with Feldschuh's thesis is a common one: to add emphasis to the solution, one is always tempted to overstate the problem. True, there are lots of nasties floating around in blood, and more are being discovered all the time; but, aside from the HIVs, the reason they're only being discovered now isn't that they never existed in the blood supply before; rather, it's that the art of viral detection is steadily improving-as is the art of viral screening. In fact, the blood supply is far safer now than it has ever been.

Clearly this is a book that would not have been published but for the AIDS crisis, yet even Feldschuh and Weber admit that the risk of getting the disease via transfusion is a fraction of the risk of getting hepatitis B. Not that this keeps the authors from pumping up the risk of AIDS-related transfusion as high as possible. For instance, they cite a much-ballyhooed study released in the June 1989 issue of the New England Journal of Medicine (NEJM) to the effect that a tremendous number of "silent infections" are not showing up in HIV antibody tests. Feldschuh says the study has "to date not been disputed." Funny thing, because my own highly publicized book disputed it, referencing numerous published studies to show that the NEJM study was an aberration. Further, the December 14, 1989, NEJM contained no fewer than five additional studies used by their authors to refute the first one.

Whether Feldschuh is deceitful or just plain sloppy, calculations using false or outdated figures permeate this book. For AIDS prevalence data, for example, he relies on such authorities as Masters & Johnson and an outdated estimate from the federal Centers for Disease Control which was substantially lowered ten months before Safe Blood came out.

And if the problem has been exaggerated, what of the proposed solution, fresh frozen autologous blood? Go back to the main problem with the non-frozen variety: it's only good for elective surgery. In case of emergency, the blood used is the blood on hand, which isn't very likely to be the patient's own, sitting in a freezer perhaps thousands of miles away and taking about an hour and a half to thaw in any case. Further, there is the real possibility that however much blood you stored it will not be enough-patients have sometimes received a hundred or more units during a 24-hour period. Now multiply that by the low probability of needing blood in the first place, which you must multiply by the ever-shrinking possibility of infection via transfusion, and the probability that your fresh frozen blood is going to do you any good is mighty low. Yet up-front costs for this procedure will be about $300 depending on how much blood is stored, and monthly maintenance costs will be around $50. Thus, we're talking pretty hefty insurance compared to the probability of risk. In a country in which a third of the population can't afford health insurance, something people are virtually certain to use, Feldschuh and Weber's solution seems best suited for those of us who can drive to the autologous-blood storage facility in a new Porsche or BMW.

Speaking of which, it bears noting that Feldschuh is the president of a corporation which is, sure enough, an autologous-blood storage facility. In other words, his book pushes his product. This is not unlike asbestos-removal companies that put articles in school magazines expounding on the terrors of low-level asbestos exposure. In and of itself, Feldschuh's pecuniary interest is not an indictment of the book, but it is curious that he makes such a big deal over the American Red Cross and individual blood banks being out for a profit. Clearly, the misleading material in this book demands an explanation, and the bottom line on it could be Feldschuh's corporate bottom line.