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Contaminated haemophilia blood products were a serious public health problem in the late 1970s up to 1985.These products caused large numbers of haemophiliacs to become infected with HIV and hepatitis C. The companies involved included Alpha Therapeutic Corporation, Institut Mérieux (which then became Rhone-Poulenc Rorer Inc., and is now part of Sanofi), Bayer Corporation and its Cutter Biological division, Baxter International and its Hyland Pharmaceutical division.[1] Estimates range from 6,000 to 10,000 haemophiliacs in the United States becoming infected with HIV.[1][2]Factor VIII is a protein that helps the clotting of blood, which haemophiliacs, due to the genetic nature of their condition, are unable to produce themselves. By injecting themselves with it, hemophiliacs can stop bleeding or prevent bleeding from starting; some use it as often as three times a week.[3]Initial concernsConcentrated form of Factor VIII.In 1981 concern was growing over an unidentified infectious disease associated with immune system collapse that would later become known as AIDS. In the U.S. it was found mostly in homosexual men and intravenous drug users, while in France doctors were finding it in a more diverse group of patients.[4] On July 16, 1982, the United States Centers for Disease Control and Prevention (CDC) reported that three haemophiliacs had acquired the disease.[3] Epidemiologists started to believe that the disease was being spread through blood products, with grave implications for haemophiliacs who had routinely injected themselves with concentrate made from large pools of donated plasma, much of which was collected by commercial plasmapheresis prior to routine HIV testing, often in cities that had large numbers of homosexuals and drug users and in some prisons.[3][5] Without an accurate infection test, health officials had no way to determine how many plasma donors carried it.In January 1983, the manager of plasma procurement for Bayer's Cutter Biological division acknowledged in a letter that "There is strong evidence to suggest that AIDS is passed on to other people through ... plasma products."[3] In March 1983, the CDC warned that blood products "appear responsible for AIDS among haemophilia patients."[3] By May 1983, a Cutter rival began making a heat-treated concentrate and France decided to halt all clotting concentrate imports.[3]Cutter feared losing customers, so according to an internal memo, Cutter "want[ed] to give the impression that [they were] continuously improving our product without telling them [they expected] soon to also have a heat-treated" concentrate.[3] The process rendered the virus "undetectable" in the product, according to a government study.[3]By June 1983, a Cutter letter to distributors in France and 20 other countries said that "AIDS has become the center of irrational response in many countries" and that "This is of particular concern to us because of unsubstantiated speculations that this syndrome may be transmitted by certain blood products."[3] France continued using older style, untreated concentrate through August, 1983.[3]Sales to Asia and Latin AmericaOn February 29, 1984, Cutter became the last of the four major blood product companies to get US approval to sell heated concentrate.[3] Even after Cutter began selling the new product, for several months, until August 1984, the company continued making the old medicine.[3] One reason was that the company had several fixed-price contracts and believed that the old product would be cheaper to produce.[3]Bayer officials (responding on behalf of Cutter) issued a statement, stating that Cutter continued to sell the old medicine, "because some customers doubted the new drug's effectiveness", and because some countries were slow to approve its sale. The company also said that a shortage of plasma, used to make the medicine, had kept Cutter from manufacturing more of the new product."[3] Bayer officials also claimed that an overall plasma shortage in 1985 kept Cutter from making more heat treated medicine; however, because Cutter was using some of its limited plasma to continue making the old product, they may have contributed to the shortage.[3] While Bayer said that "procedural requirements" imposed by Taiwan slowed down their ability to sell the new product, according to The New York Times, Hsu Chien-wen, an official at Taiwan's health department, said in 2003 that Cutter had not applied for permission to sell the heated medicine until July 1985, a year and a half after doing so in the United States.[3] Cindy Lai, assistant director of Hong Kong's health department, said that Cutter needed only to get an import license in the 1980s to sell the newer product in which "It normally [takes] one week."[3]While the new product was selling well for Cutter, a Cutter company meeting notes that "There is excess nonheated inventory", which resulted in the company deciding to "review international markets again to determine if more of this product can be sold."[3] Cutter decided to sell millions of dollars of the older medicine to Asia and Latin America while selling the new, safer product in the West, to avoid being stuck with large stores of a product that was proving increasingly unmarketable.[3]In late 1984, when a Hong Kong distributor asked Cutter about the newer product, records show that Cutter asked the distributor to "use up stocks" of the old medicine before switching to its "safer, better" product.[3] Several months later, once haemophiliacs in Hong Kong began testing positive for HIV, some local doctors began to question whether Cutter was dumping "AIDS tainted" medicine into less-developed countries.[3] Cutter denied the allegation, claiming that the unheated product posed "no severe hazard" and was in fact the "same fine product we have supplied for years."[3] By May 1985, when the Hong Kong distributor told of an impending medical emergency, asking for the newer product, Cutter replied that most of the new medicine was going to the US and Europe and there wasn't enough for Hong Kong, except for a small amount for the "most vocal patients."[3]The United States Food and Drug Administration helped to keep the news out of the public eye. In May 1985, the FDA's regulator of blood products, Harry M. Meyer Jr., believing the companies had broken a voluntary agreement to withdraw the old medicine from the market, called together officials of the companies and ordered them to comply.[3] Cutter's notes from the meeting indicate that Meyer asked that the issue be "quietly solved without alerting the Congress, the medical community and the public" while another company noted that the FDA wanted the matter solved "quickly and quietly."[3]At the same time, a Cutter official wrote that "It appears there are no longer any markets in the Far East where we can expect to sell substantial quantities of nonheat-treated [medicine]" and stopped shipping unheated concentrate in July 1985.[3]According to The New York Times, doctors and patients contacted overseas said they had not known of the contents of the Cutter documents. The effects are close to impossible to calculate. Since many records are unavailable and because it was a while until an AIDS test was developed, one cannot know when foreign haemophiliacs were infected with HIV – before Cutter began selling its safer medicine or afterward.[3]The New York Times found these largely unnoticed documents ("internal memorandums, minutes of company marketing meetings and telexes to foreign distributors") as part of the production in connection with the American haemophiliacs lawsuits described below.[3] Sidney M. Wolfe, director of the Public Citizen Health Research Group, which has been investigating the industry's practices for three decades, called them "the most incriminating internal pharmaceutical industry documents I have ever seen."[3]On August 22, 2003,[6] MSNBC's Scarborough Country had Bayer on their "Rat of the Week" segment. Speaking with Mike Papantonio, a legal advisor to the show, they discussed the 2003 New York Times article referenced above, saying that the product (known by Bayer to bear the risk of contamination) was "dropped ... in Japan, Spain and France." As of 2003, the United States Justice Department had yet to investigate any corporate executives.In 2006, Iraqis infected with HIV sued Baxter and Sanofi.[7]Specifics by countryThis scandal has led to a number of court cases worldwide.CanadaMain article: Royal Commission of Inquiry on the Blood System in CanadaIn Canada, by the time blood tests began in late 1985, about 2,000 people were infected with HIV and up to 60,000 with Hepatitis C.[8] Three suits were brought against the Canadian Red Cross by people who had received tainted blood, two of whom subsequently died of AIDS and the third HIV positive.[8] In April 2001, the Supreme Court of Canada found the Canadian Red Cross guilty of negligence for failing to screen blood donors effectively for HIV infection.[8]FranceMain article: Infected blood scandal (France)In France, an estimated 4,000 people, many haemophiliacs, were given blood infected with HIV.[8]A former Health Minister was convicted for failing to adequately screen the blood, leading to the deaths of five people from AIDS, and the contamination of two others during a key period in 1985.[8] Two other government officials that continued to use the old unheated stock in 1985, when a heated product was available, were sent to prison.[3] Allegedly, all three politicians delayed the introduction of United States blood-screening test in France until a rival French product was ready to be sold on the market.[8]IranIn Iran, as of 2001, the former head of Iran's blood transfusion centre went on trial (a Dr. Farhadi along with two other doctors) facing several charges including negligence for importing HIV-tainted supplies from France after patients contracted HIV. The case followed complaints by families of some 170 people, many of them children, suffering from haemophilia and the blood disease thalassaemia.[8]Approximately 300 Iranians were infected with the tainted blood, according to Iran's Ministry of Health. Iran is the only country that has not received compensation from France, according to Fars News.[9] Laurent Fabius visit to Iran after the Iran nuclear deal (his first visit after the infected blood scandal) raised controversy and anger among some Iranians and in social media.[10]IraqIn 1986, officials from Saddam Hussein's Health Ministry had determined that at least 115 Iraqi haemophiliacs had contracted AIDS from clotting agents imported from France and Austria.[11] According to Said I. Hakki, the director of the Iraqi Red Crescent Society, 189 haemophiliacs, from 6 months to 18 years old, contracted HIV from blood products that Institut Mérieux and Immuno sold to Iraq from 1982 to 1986; undetected, the virus later spread to at least another 50 more Iraqis, through sexual intercourse, childbirth or breast-feeding.[11]In August 2005, the 35 or so survivors, along with the families of the ones who died, and the Iraqi Red Crescent Society have sued the Health Ministry and Institut Mérieux of France and Immuno AG of Austria, two corporations who either acquired or succeeded the companies that sold tainted blood products to Iraq.[11] Institut Mérieux is now part of Sanofi-Aventis, while Immuno AG was acquired by Baxter International in 1996.Several of the infected haemophiliacs spoke with The New York Times in 2006 about life under Hussein's rule. They were forced to "sign a pledge vowing not to work, marry, attend school, use public swimming pools or barbershops, visit a doctor’s office or tell anyone about their condition", punishable by death.[11] The families' homes had warnings painted on them, telling neighbours to stay away because the house was contaminated with HIV and even uninfected siblings were not allowed to marry.[11] As of 2006, the infected haemophiliacs receive about $35 a month in government assistance, but no HIV medication.[11]IrelandMain article: Lindsay TribunalThe Lindsay Tribunal was set up in Ireland in 1999 to investigate the infection of haemophiliacs with HIV and Hepatitis C from contaminated blood products supplied by the Blood Transfusion Service Board.ItalyAngelo Magrini, the head of a haemophiliacs' association, said that as of 2001, 1,300 people, including almost 150 children, had died in Italy from infected blood infusions since 1985.[8]An Italian court in Rome ordered the Health Ministry to pay damages to 351 people who contracted HIV and Hepatitis C through blood transfusions; the court said that the ministry was too slow to introduce measures to prevent the virus being spread by donated blood, and did not establish proper checks on plasma and plasma-derived products.[8] Although almost 100 of the victims had already died, the court ruled that their families were still entitled compensation.[8]JapanMain article: HIV-tainted blood scandal (Japan)In Japan, the Health Ministry did not ban unheated products until December 1985, despite knowing that they were contaminated.[8] As a result, over 1,400 Japanese haemophiliacs were exposed to HIV, and more than 500 were believed to have died by 2001.[8]In November 1995, a case involving Japanese haemophiliacs settled, resulting in $420,000 for each victim, with $235,000 coming from industry and the rest from the Japanese government.[1] This was much higher than the results being discussed in the United States cases.[1]In February 2000, three former drug company executives accused of selling blood products tainted with HIV were given prison terms.[8]However, in March 2001, a Tokyo court cleared the former top AIDS expert of professional negligence over the scandal.[8]PortugalIn Portugal, more than 100 Portuguese haemophiliacs were infected with the AIDS virus after receiving transfusions of contaminated plasma that had been imported and distributed by the public health service.[8] In 2001, a court indicted Leonor Beleza, a former health minister, for propagating a contagious disease during her time in office during the 1980s.[8]United StatesIn 1993, top executives of three companies (Baxter International, Rhône-Poulenc and Alpha Therapeutic) met with leaders of the haemophilia community to outline the terms of a $125 million offer.[1] Rejecting the offer, David Shrager, a plaintiffs' lawyer, filed a class action lawsuit with Jonathan Wadleigh as lead plaintiff on behalf of American haemophiliacs.[1] Shrager had previously negotiated a favourable settlement on behalf of Canadian haemophiliacs and then established a panel of claimants, led by Wadleigh, to advise him and other lawyers.[1] In early 1995, the United States Court of Appeals for the Seventh Circuit in Chicago decertified the lawsuit, saying it might bankrupt the industry.[1]There became a split between Wadleigh and Corey Dubin (another named plaintiff) who favoured appealing the Seventh Circuit decision to the Supreme Court of the United States, to protect the rights of all affected haemophiliacs, not just those who had already sued, while Shrager wanted to shift gears and pursue the separate federal proceeding that had consolidated hundreds of individual lawsuits that had been filed against the producers.[1] By June 1996, the differing groups reconciled, looking for industry settlement proposals.[1]Meanwhile, the clotting producers were quietly settling many claims. Individual lawsuits continued to fail because most states had laws shielding blood products from traditional product liability claims.[1] However, discovery was producing damaging documents contending that the companies had collected blood from high-risk donors like homosexuals and prisoners, intensifying informal settlement negotiations.[1] James and Matthews, using source plasma clinic address data, and a spatial/demographic model of illicit drug markets, reported data showing that during the period from 1980–1995, US source plasma clinics were over-represented in so-called "underclass" or extreme-poverty census tracts, and simultaneously demonstrate that link these same census tract types to active illicit drug markets.[12]In 1997, Bayer and the other three makers agreed to pay $660 million to settle cases on behalf of more than 6,000 haemophiliacs infected in United States in the early 1980s, paying an estimated $100,000 net to each infected haemophiliac.[2][3][11][13] The settlement consent decree denied attorney contingent fees and provided a $40 million fund to pay attorneys as ordered by the court.[14]Soon after the settlement, because the New York state statute of limitations required people to file a lawsuit within three years of discovering an illness, New York Governor George Pataki signed a bill allowing people infected by blood products, or their survivors, two years to bring product liability suits against the manufacturers.[13] While the settled class members are barred from filing suits against the companies, the bill allowed an estimated additional 75 eligible persons to file suits.[13]The plaintiffs alleged that the companies manufactured and sold blood factor products as beneficial "medicines" that were, in fact, contaminated with HIV and/or HCV and resulted in the mass infection and/or deaths of thousands of haemophiliacs worldwide. The companies' failure to follow US federal law and conduct tests against viral hepatitis increased the risk of plasma containing HIV entering plasma pools.
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