Blood - An Epic History of Medicine and Commerce

Douglas Starr
London: Little, Brown, 1999; £20
ISBN 0316911461

Blood in its myriad of preparations has become a mainstay of modern medical practice. It is easy to forget that transfusion has been common medical practice only since 1915, when the anticlotting properties of sodium citrate were discovered.

This book traces the history of blood use, from using "gentle calf" blood in France in the 17th century to tame madmen up until the tragedy of AIDS contamination in a multibillion dollar industry.

The author debates whether blood can be considered a natural resource, like oil. A barrel of crude oil sells for around $13 (£8) (1999 prices), but when it has been "cracked" it is worth around $42 (£27). A barrel of blood is worth around $2 000 (£1 280); to buy the products derived from it would cost you more than $67 000 (\P42 900).

Until reading Blood I had, naively, never thought about the politics involved in blood production. Blood in France was not initially screened for HIV as the government held up certification of an American test to promote the French alternative. Unfortunately, the test was not ready until months after the American product hit the marketplace.

The history of the use of various blood products is traced in some detail. The morale boosting properties of albumin in the second world war for allied troops, as well as the folly of the Germans in accepting blood only from certified Aryan donors all receive attention. The relief of haemophiliac families in having a reconstitutable factor VIII concentrate is also movingly described, despite the later AIDS epidemic that resulted from the treatment.

Blood provides a compelling overview of the politics and science of "the elixir of life." Despite some of the murky business practises revealed, I am definitely off to donate some of my (B positive) blood.

Alex Brooks, third year medical student, GKT, London Email: email


studentBMJ 2000;08:175-216 June ISSN 0966-6494