which reflected a lack of consensus about the nature and magnitude of the threat (especially among physicians and public health officials who were unprepared for the unique epidemiological pattern of AIDS), and uncertainty about the costs, risks, and benefits of the proposed control strategies.

RECONSIDERING THE EVIDENCE: FURTHER ATTEMPTS TO FORMULATE POLICIES

In the interval between the decisions of early 1983 and discovery of the virus that causes AIDS in early 1984, public health and blood industry officials became more certain that AIDS was a blood-borne disease as the number of reported cases of AIDS among hemophiliacs and transfused patients increased. As their knowledge grew, these officials had to decide about recall of contaminated blood products and possible implementation of a surrogate test for HIV. Major opportunities to reconsider the policies of early 1983 arose at meetings of the FDA's Blood Product Advisory Committee (BPAC) in July and December 1983.

On May 11, 1983, Hyland Therapeutics recalled a lot of AHF concentrate when it discovered that the product had been manufactured from pools containing plasma from an individual subsequently diagnosed as having AIDS. The NHF issued a medical bulletin and a chapter advisory in conjunction with the recall, stating:

It is not the role of the NHF to judge the appropriateness of corporate decisions made by individual pharmaceutical companies. However, we urge that patients and treaters recognize the need for careful evaluation of blood products and note that such a recall action should not cause anxiety or changes in treatment programs. … The NHF recommends that patients maintain the use of concentrates or cryoprecipitate as prescribed by their physicians. If you have any questions regarding this matter, they should be directed to your treating physician and/or the NHF [NHF, 1983].

On June 22, 1983, the American Association of Blood Banks, the Council of Community Blood Centers, and the American Red Cross issued a second joint statement, stating that "it appears at this time that the risk of possible transfusion-associated AIDS is on the order of one case per million patients transfused. There is a risk that widespread attempts to direct donations, while not increasing the safety of transfusions, will seriously disrupt the nation's blood donor system." Directed donation is the process by which the patient in need of blood or blood components identifies persons (usually friends and family) to provide the needed units rather than utilizing blood from the hospital blood supply. The directed donation programs were an administrative and logistical



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