Aids victims were doomed by economics: Julian Nundy reviews the evidence at the trial in Paris of doctors accused of giving tainted blood to haemophiliacs

EVERY working day for the past six weeks, a man with the tiny red ribbon of the Legion of Honour in his lapel has left home under police guard.

Twenty minutes later, he arrives at the Palais de Justice where he is the chief defendant in the trial of four French doctors accused of knowingly allowing the distribution of blood products tainted with the Aids virus to haemophiliacs in 1985, a year when safe products had become available. During the trial, Michel Garretta has changed visibly. He has lost weight and folds of skin recall the full cheeks of a month ago.

Today, the prosecutor is due to sum up and make her plea for sentences against the defendants, who face jail terms of up to five years and heavy fines.

So far, the trial has presented a lamentable picture of doctors obsessed with economic considerations rather than with treating those in need. One defendant after another and one witness after another has tried to point the finger of responsibility elsewhere.

Last Friday, responding to a claim by one defendant, Professor Jacques Roux, 69, the former director-general of health, that politicians had ignored warnings, Laurent Fabius, the prime minister in 1985, and two of his ministers testified. Of the three, only Edmond Herve, the health minister of the time, came across badly.

His testimony, following a hesitant account by his chief technical adviser, pointed to a weak ministry out of touch with the issues. Claude Weisselberg, the adviser, admitted to the court he had not passed on warnings as quickly as he might. 'Forgive me,' he asked.

The conclusion was that, while the ministers knew that blood products were probably contaminated, they had not been advised that there was an alternative.

Mr Fabius said he was aware of the need to screen blood supplies as soon as a test became available, but had not heard of the separate issue of heated blood products which could have saved lives among France's 2,500 haemophiliacs. About half became HIV-positive and more than 250 have died.

'What Fabius said was credible,' a lawyer for the civil plaintiffs - haemophiliacs who have contracted the Aids virus, and their families - said privately. 'This is plainly not anything to do with the politicians. It is an industrial problem, the problem of a dangerous product not being withdrawn by its manufacturer.'

In this case, the manufacturer is Dr Garretta. As director-general of the National Blood Transfusion Centre, he was responsible for producing the concentrated coagulating agents which had revolutionised the treatment of haemophiliacs a few years earlier.

Previously, if a haemophiliac had a cut or a haemorrhage, he - haemophiliacs are almost always men - needed a transfusion. With the arrival of concentrates, he could treat himself by injection to clot the blood and lead a normal life. The concentrates were made from thousands of blood samples mixed together. It only needed one contaminated donation to taint the whole lot.

In May 1983, Travenol, a US firm, told Dr Garretta it was heating all its blood products, a technique known to kill hepatitis but not then proven against Aids. The next year, the US Center for Disease Control recommended that only heated products be used. A senior French health service doctor urged that France take note.

In February 1985, Abbot Laboratories of the United States said it had a screening test available. But, in both the case of the test and the heated products, France waited until it had its own versions. Dr Garretta had warned of the economic consequences of destroying existing stocks.

In June 1985, Dr Garretta wrote: 'The distribution of unheated products remains normal procedure as long as they are in stock.' In July, the health authorities decided to prescribe only heated products from 1 October.

In court, Dr Garretta, who admitted to errors, said he had believed that the US companies were pushing their products for purely commercial reasons, trying to establish a foothold in the French market.

The atmosphere in the courtroom is tense. The civil plaintiffs often shout at witnesses. When a witness spoke of the pain he felt, there were shouts of 'And what about us?' When Dr Weisselberg said, 'I talk about Aids every day', a mother shouted back: 'So do we.' Much of the victims' anger was directed at Jean-Pierre Allain, 43, director of research at the transfusion centre in 1985 and now professor of transfusion medicine at Cambridge. He was one of the doctors most directly in contact with patients.

In private conversation, one defendant said the trial had shown what happened when industrial and commercial decisions took over from medical ethics. One 31- year-old seropositive haemophiliac, quoting Montaigne, told the court: 'Science without conscience is the death of the soul.'

(Photograph omitted)