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摘要
摘要
Essence and emblem of life--feared, revered, mythologized, and used in magic and medicine from earliest times--human blood is now the center of a huge, secretive, and often dangerous worldwide commerce. It is a commerce whose impact upon humanity rivals that of any other business--millions of lives have been saved by blood and its various derivatives, and tens of thousands of lives have been lost. Douglas Starr tells how this came to be, in a sweeping history that ranges through the centuries. With the dawn of science, blood came to be seen as a component of human anatomy, capable of being isolated, studied, used. Starr describes the first documented transfusion: In the seventeenth century, one of Louis XIV's court physicians transfers the blood of a calf into a madman to "cure" him. At the turn of the twentieth century a young researcher in Vienna identifies the basic blood groups, taking the first step toward successful transfusion. Then a New York doctor finds a way to stop blood from clotting, thereby making all transfusion possible. In the 1930s, a Russian physician, in grisly improvisation, successfully uses cadaver blood to help living patients--and realizes that blood can be stored. The first blood bank is soon operating in Chicago. During World War II, researchers, driven by battlefield needs, break down blood into usable components that are more easily stored and transported. This "fractionation" process--accomplished by a Harvard team--produces a host of pharmaceuticals, setting the stage for the global marketplace to come. Plasma, precisely because it can be made into long-lasting drugs, is shipped and traded for profit; today it is a $5 billion business. The author recounts the tragic spread of AIDS through the distribution of contaminated blood products, and describes why and how related scandals have erupted around the world. Finally, he looks at the latest attempts to make artificial blood. Douglas Starr has written a groundbreaking book that tackles a subject of universal and urgent importance and explores the perils and promises that lie ahead.
评论 (5)
出版社周刊评论
The codirector of Boston University's graduate program in science journalism shows how it's done in this exemplary study of the role that blood has played in human affairs. Although Starr begins the story centuries ago, he concentrates on modern times. Throughout his coverage, information about advances in biology and physiology is introduced as needed, often enabling the reader to share in the excitement of scientific discovery. But this book is about much more than just biology. The politics of blood play a central role, from our race with the Germans during the Second World War to develop a system to enable battlefield transfusions to the squabbling and animosity present among the various blood collection agencies in the U.S. As Starr makes clear, as the global traffic in blood and blood products has expanded into a multibillion-dollar operation, the financial bottom line has begun to outweigh the importance of medical benefits. In riveting fashion, Starr explains how business practices enabled the AIDS virus to permeate the world's blood supply, leading to thousands of unnecessary deaths, particularly among hemophiliacs. Truly frightening are tales of the harvesting of blood and plasma from indigent and unhealthy third-world natives and the unwillingness of governments, third- and first-world alike, to take action to protect their citizens. Clear-eyed and wrought with superb attention to detail, this is first-class science writing, with a striking message. 16 pages of photos, not seen by PW. (Sept.) (c) Copyright PWxyz, LLC. All rights reserved
《书目》(Booklist)书评
From antiquity well into the nineteenth century, doctors frequently bled--extracted blood from--their patients. Indeed, Gutenberg's second publication was a calendar for bloodletting. During the early decades of the twentieth century, scientists started learning about blood types, collecting techniques, and processing methods. Karl Landsteiner, one of the great pioneers in the field, was, Starr relates, also an unusual scientist in that he was so modest that he asked Sinclair Lewis to respond for him when he received the Nobel Prize. Starr also describes the important work during World War II of Janet Vaughan, Charles Drew, and others who improved the supply of blood at home and at the front. One of Blood's most fascinating episodes is about calm, perfectionist Edwin Cohn, who did so much for blood fractionation and for increasing the availability and usefulness of the parts of the life-giving substance. And then there is the quite recent story of AIDS. Starr uses humor and a knack for analogy to make many points; for example, he trenchantly notes both the Nazis' refusal to allow anything but Aryan blood into the veins of the master race and the American Red Cross' long insistence on keeping the blood of whites and blacks separate. The story of Blood is one of appalling greed, altruism at its best, and much in between; thoroughly documented and smoothly written, it deserves broad, continuing success. --William Beatty
Choice 评论
Starr's thoroughly absorbing and original tale, written in lively, accessible prose, traces the story of blood from ancient times--when it carried symbolic and magical connotations--to the 20th century, when blood, now recognized as a biological constituent, became "one of the world's most vital medical commodities." Always a part of the human conceptualization of health and vitality, from the early Greeks through the 19th century, blood was regarded as an essential component of salubrious balance. Bloodletting, a practice for 2,500 years, was common in Western, Arabic, and Indian medicine as treatment for illness and psychic malaise. Yet, not until the start of the 20th century did blood became the focus of medical research, regarded as an element of human anatomy, and only then did its life-saving attributes become therapeutically available. Starr describes the evolution of blood transfusion technology and the recognition of blood types, plasma, and gamma globulin; blood preservation, the development of blood banks, and how blood became a critical determinant of the Allied victory in WW II; the corruption of the blood supply in the 1970s and '80s as blood, traded on an international free market, became a source of hepatitis and AIDS, and how these diseases ravaged the hemophiliac community, dependent on frequent blood transfusions for life-saving blood clotting. All levels. J. P. Brickman; United States Merchant Marine Academy
Kirkus评论
Seasoned journalist and former field biologist Starr writes an outstandingly lively history, based largely on archival research and interviews, of an unexpectedly dramatic topic: the international science, economics, and politics of blood transfusion. The topic subsumes several others: methods of collecting and storing blood, of deconstructing it (isolating out its several components, especially the clotting agent Factor VIII, so crucial to the health of hemophiliacs), and screening it for disease. The story begins in the 17th century, when the French doctor Jean-Baptiste Denis first transfused calf's blood into a crazed patient, inducing a fever that temporarily cured him of syphilis. It proceeds up until the late 20th century, when angry hemophiliacs, infected with HIV by contaminated blood, brought suits against doctors and blood banks in Japan, France, and America. In between, Starr recounts the heroic transfusing efforts of donors, doctors, and military personnel during WWII, which saved countless front-line soldiers' lives; the postwar competition among modern blood banks; and the rise of the blood-buying business, which too often exploited the poor and unhealthy. Several tensions move the drama: between medical professionals and service-minded laypeople; between government health agencies and business-oriented blood banks; and between views of blood as purchasable commodity and as humanitarian gift. The history of bloodsanguine though it is by definitionis thus far from uniformly rosy. Starr, an accomplished storyteller, weaves his plot around the great, eccentric, and sometimes tragic personalities of blood history, lightening it with humorous anecdotes, as of Bela Lugosi (alias Dracula) donating blood to American servicemen during WWII in order to make good on his ``ill-gotten gains.'' A potentially dramatic tension Starr might have explored further, in his final chapters on AIDS, is between the two politically vocalbut otherwise very differentcommunities of HIV-infected hemophiliacs and gay men. Transfused into such good narrative history, blood will interest even those who can't stand the sight of it. (16 pages photos, not seen)
《图书馆杂志》(Library Journal )书评
Starr, codirector of the graduate program in science journalism at Boston University, energetically plunges into the social, ethical, and economic history of one of the most mysterious and culturally pertinent resources in human history: our very blood. He starts with the first blood transfusion, from a calf to a man, in 1667 Paris and runs through the changing mythological landscape, medical advances, and the political (and certainly military) power associated with possessing a rich blood supply. He closes with a discussion of contemporary issues, such as the threat posed by regarding blood as a commodity. This is science writing at its best: well researched, socially relevant, and highly enjoyable. (LJ 8/98) (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
摘录
摘录
The drama ended, as do so many these days, in a courtroom. This particular chamber was long and low-ceilinged, with a wide dais at its front for the eight black-robed judges. Each of the four defendants sat flanked by tall policemen who gazed impassively from under the brims of their trademark pillbox hats. In keeping with the formality of French courts, the prosecuting and defense attorneys wore flowing black robes, which would dramatically sweep behind them as they rose to make a point. The only visible flaw in the decorum appeared among the audience members, some of whom wore T-shirts bearing inflammatory slogans. There were audible exceptions to decorum as well, as people would moan or shout "Non!" at a defendant's response, or when one man, the most vocal of the plaintiffs, would, as his doctor walked past, loudly hiss "Assassin!" The plaintiffs in this trial were dying of AIDS. They charged that they had been infected through the negligence of the defendants--high officials in the French national transfusion service. In France, where the government until recently held a monopoly on blood and its derivatives, these men were supposed to ensure the safety of blood products. Instead, they allowed thousands of the nation's hemophiliacs to inject blood-derived clotting factors they knew to be contaminated. The defendants had done so because of a complicated mixture of paternalism, economics, and to some extent the limits of science, but the victims saw the incident more starkly. To them the affair was a matter of betrayal. The doctors on trial in the summer of 1992 were supposed to have embodied all that was noble in the French transfusion tradition--altruism, medicine, business, and technology. Instead, during the years of the "contaminated-blood affair" they came to symbolize the cynicism and expediency of a money-driven age. The sense of betrayal surfaced in many places beyond the courtroom in Paris. For more than a decade the theme has been sounded in one locale after another throughout the world. In America, patients have filed hundreds of civil suits against doctors, drug companies, and even their own patient organizations, for abandoning their health to the expediency of the marketplace. In England, AIDS-infected hemophilia patients castigated their national transfusion service with reacting too slowly to the threat of emerging viruses. In Japan, patients charged that the government and drug companies criminally concealed the contamination of blood products; as a result, some of the nation's most revered doctors have gone to jail. In Canada, the scandal of contamination spread so wide that the government held a series of hearings across the country that convulsed the nation with anger and shame. Why those scandals erupted is one of the underlying questions of this book, a history of human blood as a resource and humanity's attempts to understand and exploit it. Blood is one of the world's most vital medical commodities: The liquid and its derivatives save millions of lives every year. Yet blood is a complex resource not completely understood, easily contaminated, and bearing more than its share of cultural baggage. Indeed, the mythic and moral symbolism of blood, which has been with us since ancient times, subtly endures. It clouded professional judgments and public perceptions in the AIDS scandals of France, Canada, and Japan, among others. If one considers blood a natural resource, then it must certainly rank among the world's most precious liquids. A barrel of crude oil, for example, sells for about $13 at this writing. The same quantity of whole blood, in its "crude" state, would sell for more than $20,000. Crude oil, as we know, can be broken down into several derivatives, including gasoline, distillates such as diesel, and petrochemicals. Blood can be separated into derivatives as well. Spun in a centrifuge, it divides into layers--red cells on the bottom, a thin intermediary layer of platelets and white cells, and an upper tea-colored layer of plasma. Each layer, in turn, can be used as various therapeutic products. Red cells can be transfused directly. White cells and platelets can be used to restore resistance or clotting ability to patients undergoing chemotherapy. Plasma, a resource in its own right, yields albumin for restoring circulation, clotting factors for patients with hemophilia, antibodies for vaccine production, and several other reagents and pharmaceuticals. Taken as a whole, the value of the derivatives in a forty-two-gallon barrel of crude oil would raise its price to $42. The price of the same quantity of completely processed blood would increase its value to more than $67,000. Of course, blood is not processed by the barrel or handled in quantities anywhere near those of oil. (Only about sixteen million gallons of blood and plasma are collected annually worldwide--the equivalent of thirty-two Olympic-size swimming pools.) Indeed, the world market for blood and its derivatives probably does not exceed $18.5 billion per year, versus $474.5 billion for petroleum. Yet one cannot avoid comparing the two resources. Just like the oil industry, the blood trade involves collecting a liquid resource, breaking it into components, and selling the products globally. Red cells, being perishable, tend to remain within national borders, but certain portions of blood--plasma in particular--are traded among multinational companies and on a worldwide spot market. Just as with oil, one region has become the premier harvesting ground, providing much of the resource for the rest of the world. The United States, with its liberal rules regarding collection, has become known as the OPEC of plasma. No wars have been fought over blood as they have been for oil, but the movement of blood has played an important role in our wars. A major anxiety about D-Day, for example, was whether enough blood could be stored to supply all the wounded that military planners had projected. In preparation for the Persian Gulf War, the military shipped massive quantities of blood to the battle zone for what they thought would be thousands of casualties. (Good fortune proved them wrong.) Such collections have always been secret, since intelligence services know that the mobilization of blood is a sure sign of an impending attack. If the analogy between blood and oil is provocative, it is where the comparison breaks down that the story of blood becomes especially compelling, and life-changing to those who have been caught in its sweep. For one thing, oil does not transmit disease, a critical consideration in the blood trade. A slip in quality control at a refinery may result in the loss of a few dollars, but a mistake in blood processing can infect thousands of people. Second, whereas oil companies pay handsomely for drilling rights, blood collectors pay nothing or very little for their raw material, since donating is thought of as an act of human kindness. Such an arrangement, however admirable, can distort people's judgments. Think, for example, how the leaders of the oil industry would react if Saudi Arabia provided crude oil for free: They would bend over backward (even more than they currently do) never to offend their benefactors. So it had been with the blood collectors: When faced with the necessity of refusing blood from certain people to minimize the spread of viral disease, they found themselves reluctant to offend their cherished donors. As a result, public safety was compromised. The most telling difference between the two resources, however, is the one that reaches into our cultural past. Though oil serves as a critical resource, it carries no particular cultural baggage. Blood, in contrast, is laden with meaning. The descriptive cliché, "the elixir of life," barely touches on the liquid's mystical, religious, and patriotic significance. The Bible mentions blood more than four hundred times: "The life of the flesh is in the blood," says Leviticus, equating blood with life itself. Blood is considered so holy in the Old Testament that the law specifically forbids its consumption, which is why Jehovah's Witnesses, who interpret the Bible literally, refuse transfusions. The Egyptians saw blood as the carrier of the vital human spirit, and would bathe in the liquid as a restorative. It is because blood conveyed strength to the Romans that gladiators were said to have drunk the blood of fallen opponents. Doctors from the medieval to the Victorian era assumed blood to have fantastical powers, draining it to remove evil humors, transfusing it to pacify the deranged. Our own culture attaches great value to blood, with the blood of Christ as among the holiest sacraments, blood libel as the most insidious slander, the blood-drinking vampire as the most odious demon. The symbolic power of blood does not confine itself to mythology, for it has affected the behavior of doctors in modern times. The Nazis, in their perversity, refused transfusions from non-Aryan blood donors--condemning their armies to chronic shortages--and composed intricate charts of the presumed blood-related traits of the various races. Even the democracies were tainted by blood prejudice: During World War II, as America fought a racist enemy, the military maintained separated blood stocks from black and white donors for fear of offending white soldiers' sensibilities. Most recently, the persistent belief that blood products collected among their countrymen had to be inherently pure contributed to bad decision-making in the tainted-blood scandals of France and Japan. Thus, the story of blood cannot be limited to the twentieth century, when doctors began to use it for transfusions. The narrative reaches back into antiquity, as an undercurrent to the history of medicine and civilization. It spans the globe over the course of several centuries, periodically surfacing in dramatic ways, from the first blood experiments, during the Age of Enlightenment, to the genetic-engineering labs that one day may render transfusion obsolete. The story of blood is one of metamorphosis, of a liquid that became symbolically transformed as society learned how to deconstruct and manage it. As such, the history divides itself into three eras, each reflecting the spirit of its age. The first period, described in the section "Blood Magic," involves the transformation of blood from a magical substance to a component of human anatomy, capable of being isolated and studied. This section covers the period from antiquity to the early twentieth century, the time when the concept of blood moved from the magical to the biological; when blood became recognized as a therapeutic liquid transfusible from one creature to another. It is a measure of the symbolic power of blood that the first transfusions were used to treat not blood loss or anemia but insanity. The second era, covered in the section called "Blood Wars," describes the transformation of blood from a scientific curiosity to a strategic materiel. During the first few decades of the twentieth century, medical scientists began to master the resource, learning the techniques of mass collections, storage, and the separation of plasma. These advances occurred just in time for World War II, the greatest spilling of blood that the world has ever known. That conflict decisively altered blood's cultural significance--from the mother liquid of all health and disease, to a strategic resource, devoid of mystical overtones yet essential to human enterprise. The change became irreversible when Dr. Edwin J. Cohn of Harvard, working under a military contract, found a way to fractionate plasma into its many constituents. This technology, analogous to the "cracking" of oil, along with the freeze-drying of plasma, gave the Allies an enormous advantage over the Axis powers, whose blood-related technology was primitive. It also set the stage for a postwar global blood industry. The final section, "Blood Money," describes how the liquid that saved so many lives became the basis for a global industry. A small group of drug companies dominates the plasma business, analogous to the "Seven Sisters" of oil. In their quest to harvest the resource, those drug firms set up "plasma mills" in America's skid rows, buying from the residents, who often included drug addicts and indigents. Later, seeking new sources of raw material, they imported plasma from the Third World, notably Central America--a practice of dubious safety and morality. So politically explosive was the idea of harvesting the resource from the poorest of the poor that in one Central American country the populace rose up, destroying the facility and sparking a revolution. Meanwhile, the business of whole blood boomed as surgical advances such as open-heart surgery and organ transplants required ever-larger transfusions. (A single liver transplant may require fifty units of red cells.) Whole blood, collected on a nonprofit basis by the Red Cross and community blood banks, became the target of fierce competition as the "benevolent" collectors struggled for dominance. If the global blood business has been tainted by an element of exploitation, it must also be seen as tremendously beneficial. Countless lives have been saved by transfusions, not to mention plasma-derived pharmaceuticals. People with hemophilia, who have been using clotting factors since the late 1960s, have seen their average life expectancy double. Yet the same therapeutics that brought life to so many have also transmitted disease: If blood and plasma products could be routinely distributed among millions, so too would any pathogens they harbored. During the blood-products boom of the 1970s, blood-related hepatitis rates soared, killing tens of thousands of hemophiliacs and transfusion recipients. By the end of the decade, doctors thought they had solved the hepatitis problem, only to be confronted by another virus that spread in an identical pattern--HIV. Though tainted blood products only caused a small portion of the AIDS epidemic (the disease was mainly spread through sexual contact and intravenous drug use), they took an enormous toll. More recently, another public health crisis has begun to unfold--the silent epidemic of blood-borne hepatitis C. It is ironic that, after all the transformations of blood wrought by modern medicine, HIV and other viruses revived the medieval image of blood as the bearer of evil humors and death. Today we confront a resource simultaneously safer and more threatening than before. Many nations, having learned from the AIDS crisis, have instituted virus screening-and-removal procedures. This has made blood more expensive, an ominous development in an era of shrinking health budgets. Furthermore, we can no longer complacently assume safety, since new diseases threaten to emerge. Meanwhile, poor nations, with little access to modern equipment, face unprecedented risks of blood-borne diseases. In order to address the inherent risks of the resource, some companies are creating artificial blood substitutes, immune to the pathogens that afflict humans. Even if those products someday appear, they will likely be expensive, prolonging the disparity between nations that have modern blood products and those that do not. Thus blood distribution, like that of other critical resources, will continue to raise questions of equity and social justice. This, then, is the story of blood--the chronicle of a resource, the researchers who have studied it, the businessmen who have traded it, the doctors who have prescribed it, and the lay people whose lives it has so dramatically affected. The book is also a challenge to those who distribute, regulate, and use the resource. Indeed, a lasting tension in the history is how we view this most human of commodities. Is it a gift of charity or simply a pharmaceutical? Can a single resource be both, and if so, what are the safest and most ethical ways to manage it? The answers to such questions will determine the future of this precious, mysterious, and hazardous material. Excerpted from Blood: An Epic History of Medicine and Commerce by Douglas Starr All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.目录
Preface | p. xi |
Part 1 Blood Magic | |
1. The Blood of a Gentle Calf | p. 3 |
2. "There Is No Remedy As Miraculous As Bleeding" | p. 17 |
3. A Strange Agglutination | p. 31 |
Part 2 Blood Wars | |
4. Blood on the Hoof | p. 53 |
5. Prelude to a Blood Bath | p. 72 |
6. War Begins | p. 88 |
7. Blood Cracks like Oil | p. 101 |
8. Blood at the Front | p. 122 |
Part 3 Blood Money | |
9. Dr. Naito | p. 147 |
10. Dr. Cohn | p. 163 |
11. The Blood Boom | p. 186 |
12. Bad Blood | p. 207 |
13. Wildcat Days | p. 231 |
14. The Blood-Services Complex | p. 250 |
15. Outbreak | p. 266 |
16. "All Our Lots Are Contaminated" | p. 299 |
17. Judgment | p. 322 |
Epilogue: Blood in a Post-AIDS Society | p. 345 |
Notes | p. 357 |
Acknowledgments | p. 415 |
Index | p. 419 |