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Artillery Row

Infected blood and infected institutions

Decades on from the beginning of the infected blood scandal, our institutions still fail to align themselves with the truth

Anyone who looks into the final report of the Infected Blood Inquiry will find a villain who suits their prejudices. Leftists will find the Thatcher government. Neoliberals will find the NHS. Populists will find dubious experts (and Kenneth Clarke).

All of them are right — Or, at least, are right to some extent. Costs were prioritised above public safety. Groupthink infected state institutions. Excessive reliance was placed on the opinions of one expert, Arthur Bloom, whose expertise was real but who had made a catastrophic series of misjudgements.

The scandal concerns the infection of tens of thousands of British patients, most of whom suffered from haemophilia, with HIV and hepatitis C after receiving contaminated blood or blood products, most of which had been imported from the US. HIV and hepatitis C were still quite mysterious conditions, of course, but enough evidence was available that a disaster was taking place that different treatments should have been used. At least 3000 people would die after being infected.

An interesting theme of the report concerns the truth. Time and again, it was considered expedient to hide the facts or to manipulate them. Clinicians and the health service failed patients, the report concludes, by (among other things): 

— Failing to tell people of the risks of treatment of transfusions, and failing to seek their consent on a properly informed basis.

Failing to offer people reasonable alternatives to treatment or transfusions.

— Delaying informing people of their infections by weeks, months and sometimes years.

The sheer horror of this is worth underlining. First patients were not informed that they could get sick and then patients were not informed that they were sick. Hideous.

A dishonest attitude prevailed long after people had been infected. There was:

— Repeated use of inaccurate, misleading and defensive lines to take which cruelly told people that they had received the best treatment available.

Moreover, there was:

— A lack of openness, transparency and candour, shown by the NHS and government, such that the truth has been hidden for decades.

It is absurd that the report is being released today, decades after the events that it describes, but no one wanted a proper investigation at the time.

Of course, it is not always easy to know the truth. I can hardly castigate researchers who made scientific mistakes in trying to understand HIV and Hepatitis C when I don’t know the difference between O positive and O negative blood. But there is a difference between misunderstanding and misstating the truth.

The report contains a shocking variety of different flavours of obscurantism. We all know politicians lie. Yet more insidious can be mistreatment of the facts. For example, one can say something technically true yet be dishonest by omission. Conservative politicians who did not want to accept that AIDS was being transmitted by American blood products latched onto the claim that there was “no conclusive proof” that this was the case. Politician after politician — including Lord Glenarthur, Parliamentary Under Secretary of State at the Department of Health and Social Security, and Kenneth Clarke, Minister of State for Health — trotted out this line. But while there was indeed “no conclusive proof” that did not mean that the officials did not have, to quote a briefing note from the time, “evidence … suggestive that this is likely to be the case”. This does not mean every politician and civil servant who made use of this claim knew about that evidence — making it difficult to locate individual cases of dishonesty — but some did, meaning collective dishonesty seeped throughout the system. As the report states:

This line to take, while technically correct, was indefensible. It did not spell out the real risk. It gave false reassurance.

The report also seems to gently indict the way in which political correctness can obscure the facts. Creating advice for blood donors, the Department of Health and Social Security were surprisingly averse to discouraging people who posed a serious risk from donating out of a fear of “adverse publicity”. For example, it discouraged blood donations if someone was a gay man with “many different partners” but not if they had had “many different partners”, and it discouraged blood donations from people “who inject drugs” but not from people who had injected drugs. This could have had serious consequences, as one donor could infect many people.

As the report states, “strong incentives to maintain the status quo often exist, and require a strong countervailing force”

Encouraging a culture of honesty in institutions depends on there being the right incentives. There was no single driving force behind the complacency and disingenuousness that enabled the infected blood scandal. There was a stew of bad incentives. Clinicians were attached to existing treatments because of their “convenience of use and the extent to which the speed and ease of infusion permitted patients to enjoy a fuller life”. More rigour would have been more expensive. Pharmaceutical companies were paying for experts to take expensive trips to conferences (with “the very best restaurants, the river cruises” et cetera). Once the scandal had begun, changing course would have incurred individual and institutional embarrassment on a massive scale, encouraging the digging of an ever bigger hole (and, of course, in literal terms, ever more graves). As the report states, “strong incentives to maintain the status quo often exist, and require a strong countervailing force”.

The report is late — too late — but its lessons are relevant to our world as well as to the 1980s. “Government should not be embarrassed to admit that it does not know the true facts,” it states, “If the truth is that it does not.” In the COVID-19 pandemic, we saw the government and its experts going from saying that there was “weak evidence” behind the use of masks to stop the spread of COVID, to saying that masks had “a great deal of value”. What changed to justify such a shift in certitude? It isn’t clear. But perhaps certitude was never justified at all.

“Citizens need to be trusted with the truth,” the report states, rather than being “misleadingly reassured” or subjected to “extravagant claims”. This, I presume accidentally, an indictment of the government’s enthusiasm for “nudging” — the psychological manipulation with a smile approach that Gary Sidley, among others, has dissected in these pages. Of course, as citizens who are aware of the incentives towards untruthfulness among the authorities, we should be on the lookout for misleading reassurance and extravagant claims ourselves.

It isn’t something that the report goes into but health officials, and political authorities, should be aware of how much political correctness can incentivise bad science and bad advice. The hapless Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation, claimed in March 2020 that “stigma” was more dangerous than COVID-19. In 2022, some experts downplayed the extent to which promiscuous sexual activity among gay men was behind the spread of monkeypox. Then promiscuous gay men sensibly reduced their sexual activity and the threat of monkeypox receded. 

There were many other elements to this scandal (the report as a whole is made up of seven giant volumes). There is a great deal else that institutions and individuals can learn. But if we can’t be honest then we can’t learn anything. Truth opens the door to knowledge.

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