Science writer Douglas Starr

DATE June 18, 2002 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Douglas Starr discusses his book, "Blood: An Epic
History of Medicine and Commerce"
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Even if you're squeamish at the sight of blood, I think you'll find it
fascinating to hear the story of "Blood," including the misconceptions that
doctors had before modern medicine. My guest, Douglas Starr, is the author of
"Blood: An Epic History of Medicine and Commerce." The book is the basis of
the new TV series, "Red Gold: The Epic Story of Blood," which begins Sunday
night on most public television stations. In conjunction with the series, a
new paperback edition of Starr's book has just been published, with a
post-September 11th afterword. Starr is the co-director of The Knight Center
for Science and Medical Journalism at Boston University. I asked him about
some of the early beliefs surrounding blood before anyone understood its
chemical makeup.

Mr. DOUGLAS STARR (Author, "Blood: An Epic History of Medicine and
Commerce"): It's really interesting about blood, because people have always
felt so intensely about it; maybe because if you lose it, you die. But, you
know, as you know, it's in all sorts of religious rituals. It's got national
significance. People attach all sorts of values to it, as did doctors. From
the ancient times, it was thought to be one of the four humors, and that if
you were sick, maybe you needed to balance the humors by draining one of them.
So they would drain blood in an effort to make people better.

Later on when physicians began to understand that maybe blood isn't something
you just remove, they still couldn't get away from mystical associations, so
they adopted a philosophy called vitalism, which meant that maybe blood is a
nutrient. Maybe you don't just have to drain it to make somebody healthy, but
it still carries the characteristics of the creature in which it flows. So
the blood of a lion was thought to be brave, and the blood of a sheep was
thought to be meek and so on.

GROSS: When you say that blood was one of the four humors, what were the
other three?

Mr. STARR: Let's see, it was choler, phlegm, bile and blood. And that was
the Greek system in which the humors of the body were thought to mirror the
elements of the universe that kept everything in balance. But I should say
that bloodletting began even before the Greeks. There's hieroglyphic evidence
that the Egyptians did bloodletting as well. It's just something people
always did. Oddly, there was never any evidence that it did any good.

GROSS: Before we get to bloodletting, what it is in blood?

Mr. STARR: That's a good question. Blood consists of several things.

GROSS: I didn't expect a laugh out of that line.

Mr. STARR: No, well, it's funny. You know, nobody's asked that before. I'm
sorry. Nobody's actually asked that. Blood is a fascinating liquid. There's
red cells, those little red cells that carry hemoglobin, which is the molecule
that carries oxygen. There's plasma, and that's that sort of amber-colored
clear liquid. And if you let a pint of blood sit for a long time, the red
cells settle to the bottom, and then the plasma is like the top 60 percent.
And that's a protein solution with antibodies and other proteins and water and
salts. And then in between is this little buffy coat, and that has platelets,
and those are very sensitive bodies that aid in clotting, and there's also
white cells in that section as well.

GROSS: Here comes another laugh line, just so we have the basics.

Mr. STARR: Sorry.

GROSS: What are the actual functions that blood serves in the body?

Mr. STARR: OK. First of all, blood carries blood and nutrients to all of the
organs and all of the cells. That's probably the most important things it
does. It keeps our tissue alive. And the other thing it does is carry immune
agents and antibodies to fight disease. The other thing it does that a lot of
people don't think about is it's a hydrostatic fluid. And that is if you keep
enough blood and plasma in the veins and arteries, it keeps them full so that
fluids could move around. And one of the things that happen, interestingly
enough, they discovered in World War II, is when people started running out of
blood, they would die from shock, not so much because they lost the red cells
and the oxygen, but just when you didn't have enough of this pressure in the
vessels, they collapsed, and it kind of cut off the circulation to your
organs.

GROSS: Hmm. OK. Well, let's get to bloodletting now. I mean, for
centuries, one of the curative things was believed to be draining the person
of a lot of blood, which goes so against everything that we know now. Why was
that believed to be curative?

Mr. STARR: Nobody really knows how it started. Some people theorize that
seeing women in menstrual cycles, perhaps thought they were relieved by
bleeding. But nobody really knows how it got started. But it did get
started, and people did it for about 2,500 years.

GROSS: That's a very long time.

Mr. STARR: It's a very long time, especially when there was really never any
evidence that it did any good. And one of the interesting things about
doctors before the 19th century is they didn't really keep records. In the
early part of the 19th century, they kept billing records, but they never kept
record saying, `We tried this on this patient, and this was the result,' so
they were very anecdotal about it. And they always interpreted whatever
happened to their benefit. So if they let someone's blood out, and
miraculously, they got better despite the doctor's efforts, they would say,
`Well, it cured him.' If they let blood out until the person died, they'd
say, `It's a shame that they died because we almost cured him.'

GROSS: So was there like a science to bloodletting? Like if you had one
disease, would they take a pint of blood, and another disease, two pints of
blood?

Mr. STARR: Oh, they were...

GROSS: Was it leeches for one disease and incisions for another?

Mr. STARR: They were absolutely fetishistic about the exactitude of
bloodletting. And it's interesting. There was a Greek school of
bloodletting, which--say if you were bleeding from your left nostril; they
would bleed from your left elbow to stop it somehow. But then when the Roman
and Greek empires fell and sort of the seed of learning went to the Arabic
world, they sort of felt the opposite. They called it revulsive bloodletting.
So if you were bleeding from your left nostril, in order to stop it, they'd
bleed you from your right elbow. There were all sorts of calendars and charts
and specificity about how to bleed in case of this or this, when to use
leeches, when to use a lancet.

They had all sorts of wonderful zany devices. One was called a Schnapper(ph),
and it was created by a Viennese inventor, and it was actually a bunch of
little blades, and if you lacked the skill to slice with a lancet, you'd put
this box against a person's arm, sort of pull back the trigger and `schnap'
it, and the blade would slice diagonally across the vein. So it was quite a
science.

GROSS: And, you know, I know the word the `lancet,' and I know there's a
medical journal called The Lancet, but I've never really seen a lancet. How
is that used?

Mr. STARR: A lancet is an exquisite little blade sharpened on two edges, and
it was a real--the French loved it and it was very small. And with a very
deft flick of the fingers, a skilled bloodletter could sort of slice up along
a vein. Now you didn't want to slice across it 'cause you'd sever it. It
took quite a bit of skill. Then they bleed them into exquisitely wrought
bleeding bowls, many of which were made in Venice and became family heirlooms.
Sometimes they would do cupping, in which they would warm a bowl and put it
against your skin, and the warmth would draw a blister, and then they'd flick
that and bleed it. As I say, it was quite a science. It's too bad it didn't
do any good.

GROSS: You know, I just find it amazing to think of how that was made a
science for so long and all it did was hurt people and not help them.

Mr. STARR: Yeah. And it's very interesting. One of the reasons bloodletting
faded in the 19th century was there was a series of typhus epidemics in
Britain. And a lot of the fevers that affect people, like malaria, are
excitatory fevers, so if you bleed someone to the point of fainting and
they've been raving in their delirium before that, you might think the
person's getting better. But typhus is a debilitating fever, and the bleeding
only appeared to make them worse, and that was one of the several elements
that made people realize maybe this isn't the best idea.

GROSS: What else made them realize that bleeding wasn't the best idea?

Mr. STARR: Well, there came the birth of bacteriological science, in which
people began to understand that there was such a thing called germs, people
like Pasteur and Ehrlich. There was the germ theory of disease. That was in
the 19th century. And there was a French doctor named Pierre Shaw Alexander
Louis(ph) who started doing that. He would sort of wander the hospital
corridors of Paris actually talking to patients and writing down what they
said. And at the end of many of these studies he would tabulate what worked
and what didn't, and he conclusively showed that removing blood had no
relation to curing people.

GROSS: If you're just joining us, my guest is Douglas Starr. He's the author
of the book "Blood: An Epic History of Medicine and Commerce." And this book
is the basis of a new PBS series called "Red Gold: The Epic Story of
Blood," which begins on most PBS stations this Sunday.

Let's look at the first blood transfusion, which you write about in your book.
And this was between a calf and a mentally ill man. When did this happen?

Mr. STARR: This was 1667, and there were other experimental transfusions, but
this was the first real one in which I was able to get complete records. You
can still find the laboratory notes. And it was actually done for
psychotherapy.

GROSS: So how were these two paired, the calf and the mentally ill man?

Mr. STARR: Do you mean physically how did they connect?

GROSS: No. No. Why?

Mr. STARR: Or do you mean how...

GROSS: Why were they--why a calf?

Mr. STARR: Well, this was...

GROSS: Why a blood transfusion, in the first place...

Mr. STARR: Well, this was...

GROSS: ...and then why a calf?

Mr. STARR: Right. Right. This was wonderful. And one of the things I did
in the book--I should say there's a very sharp difference between fiction and
non-fiction, and when I was getting into the topic so many of these stories
astounded me and seemed unbelievable on the face of it that I made a personal
rule to go back to primary sources for everything and that every sentence
would be literally true because, as you know from our discussion, a lot of
these things are difficult to believe. So what I'm telling you is literally
true.

But this was a period of time when people weren't sure what was going on with
blood. It was in the 1600s. William Harvey had discovered there was such a
thing as circulation. They realized now there were blood vessels and blood
moves sort of around in a circle through the body. And people began
experimenting, `Well, if it does, maybe we can put something into the
circulatory system and have an effect.' And they began injecting milk into
animals and liquor to see how they behaved. And then they started putting the
blood from one animal into another to see if it could resuscitate them. So
this was kind of scientific.

But at the same time these people believed in this theory of vitalism, this
sort of mystical belief that the blood carried the characteristics of the
creature in which it flowed. So there was a physician in the court of Louis
XIV, Jean-Baptiste Denis, and he was doing some experiments with calves and
dogs, and he put some ram's blood into a horse and he thought maybe this could
be a good thing for people. And he didn't want to put blood from one person
into another because he thought the blood of people was too debauched by
drinking and people's lifestyles, and the thought the blood of animals would
be more innocent.

So there came the night when a nobleman brought in a madman. His name was
Antoine Mauroy, and he was known in the neighborhood. He would have frenzies
in which he would strip naked and run through the neighborhood setting house
fires. So he brought him into Denis' lab and he said, `Maybe you could help
him.' And Denis figured maybe transfusing some blood from the calf into this
madman would transfer some of the calf's gentleness that might calm him down.

GROSS: What did happen?

Mr. STARR: Well, it did calm him down because it almost killed him. You
can't put animal blood into a person. Your allergic system goes wild. You
know, the antibodies attack the cells. The broken bits of the cells hurt your
kidneys. So he injected some blood into the man. He tied him down, tied a
calf down, created some kind of cannula connecting the two. He put in a small
quantity, it's hard to say how much, and the man immediately had an allergic
reaction in which the heat began rising out of his arm and he became very weak
and feverish, which the doctor interpreted as progress because he did seem to
calm down. So a couple of days later he tries it again, and this time, as in
any reaction, the man has a severe antibody allergic reaction, which not only
does he have the heat rising up his arm, he's urinating black, which we now
know is broken red cells, he's vomiting, he has a severe fever, and then he
really becomes quite mild. And for all eyes of the late 17th century, the man
is cured.

GROSS: Did he survive his cure?

Mr. STARR: Well, it gets a little complicated. So Mauroy goes home. Now
meanwhile, I should say, the English, who had been working on this technique,
were absolutely outraged. They felt he stole the idea for them. He didn't
give them credit. So they go their own madman and they transfused him, and
he, after almost dying, appeared briefly to calm down. Meanwhile, the
nobleman of the French court who specialized in all sorts of intrigues,
started attacking Dr. Denis as using--one of them called it a technology from
Satan's boutique. One of them said something very interesting. He said,
`There's no way that this could work. On the other hand, if it does work,
there are not enough animals on the planet Earth to satisfy the demand for
this kind of thing.'

So meanwhile, the madman's wife takes him home and everything's fine, but then
a couple of weeks later she knocks at the door with her husband in tow and
says, `He's having frenzies again. Could the doctor transfuse him?' And the
doctor looks at the man, who's really in bad shape, and declines. Some time
later the wife gets in league with some of the doctor's enemies and says,
`I'll slander you. I'll make it public that you're killing my husband if you
don't transfuse him.' So he tries to transfuse the patient again, but the
patient dies before he could actually get any blood into him.

GROSS: Was the animal killed whose blood was being used for the transfusion?

Mr. STARR: I'm sorry. There's no record of what came of the animal...

GROSS: Right.

Mr. STARR: ...so I can't put that disclaimer on saying, you know, there were
no animals harmed in the course of this experiment.

GROSS: So eventually the doctors figured out that this type of transfusion
from animal to human was going to kill the human and not cure them.

Mr. STARR: Well, it happened rather quickly because after Mr. Mauroy died,
the wife started slandering the doctor saying, `The doctor killed my husband,'
when the doctor full well knew he didn't, and he actually brought a slander
trial against the wife. And I was able to get the records of that trial,
which are tantalizingly almost complete, and the records I found were able to
say that partway through the trial a new piece of evidence came out. You
know, everybody was testifying for both sides, and then a piece of evidence
came out that the wife, tired of the husband's brutality, had been slipping
arsenic into his soup. And they found this out because one day...

GROSS: You're kidding.

Mr. STARR: No, no. One day he put a bowl of it on the floor and then the
family cat drank some and died. So the lieutenant of the court said, `This
court will now inquire into the attempt into the murder of Mr. Mauroy by his
wife,' and unfortunately the record ends there because there was a fire that
destroyed all the records. That said, the court ruled the doctor innocent,
but this created such a brouhaha that the technology was absolutely abandoned
for the next 150 years.

GROSS: What a story.

My guest is science journalist Douglas Starr. He's the author of "Blood: An
Epic History of Medicine and Commerce." We'll talk more after a break. This
is FRESH AIR.

(Soundbite of music)

GROSS: My guest is science journalist Douglas Starr. His book "Blood" is the
basis of the new PBS series called "Red Gold: The Epic Story of Blood." It
begins Sunday night on most public television stations.

You date the first modern blood transfusion in 1908. What made this the first
modern transfusion?

Mr. STARR: Well, there had been some transfusions in the early 1800s, but,
you know, half the people would die. There was nothing--you know, they didn't
have sterile procedure. It was quite primitive. But in 1908, Dr. Alexis
Carrel was working at the Rockefeller Institute in New York, and he was a
famous surgeon from France who'd perfected a technique called anastomosis in
which he could actually stitch a vein to an artery by hand, which it's almost
incomprehensible to us. And he developed this skill, in part, by studying
with a seamstress in Lyon, France. So he was experimenting with animals doing
this. You know, it was sort of the forerunner to microsurgery.

And one night there's a knock at his door in the middle of the night. One of
his colleagues' wife had given birth to a baby girl who was critically anemic,
and said, `Doctor, you must come to my house. I feel that the only thing can
save her is your transfusion technique.' And the doctor said, you know, `How
can I do this? I've only experimented on animals.' And he said, `You must
come.'

So he goes to the house and there's the baby, absolutely white as a sheet, and
there's the mother and the uncle and the father all looking distressed. So
the doctor tries a radical technique. He puts the baby on--binds her to a
board--I think it may have been an ironing board or the table--and he slices
open the father's forearm--and this is without anesthetic--and he teases out
an artery and stitches it to a vein in the baby's thigh. And only using his
finger to regulate the pressure, he actually begins to refill the baby with
her father's blood. Now this was good technique. The only they lacked is
they weren't doing blood types at the time, so it was just dumb luck that the
baby and the father had the same type.

And as the moments passed--the uncle left a diary of the affair--the baby
actually began to refill with blood, and you could see her color change, and
this line of pink started at her thigh and then rose to her stomach and her
chest and her shoulders. And he wrote that when the pink got to the top of
her ear, he said, `Dr. Carrel, you'd better turn it off or she'll burst.' And
he closed the vein, stitched it up, stitched up the artery and everybody
survived fine. And that kind of initiated transfusion as a technique that
people could begin to use.

GROSS: Wow. So other doctors started borrowing this technique afterwards.

Mr. STARR: Others did it, and they used various devices to make it a little
more manageable. There was George Washington Criele(ph), who developed a
little ring that made it work. And this was called direct transfusion, and
this continued well into the 1920s. They got...

GROSS: Direct transfusion being from one person's body directly to the other,
not...

Mr. STARR: Right.

GROSS: There's no blood bank.

Mr. STARR: No bottle, nothing.

GROSS: There's no vial of blood. Right.

Mr. STARR: No.

GROSS: No bag of blood.

Mr. STARR: No. Right. Now they did figure out blood types and did figure
out preservatives, so then you could pass briefly into a bottle and into the
other person via a pump. They started to collect people, and this became
known as donors on the hoof. So their version of the blood bank would be a
bunch of people in the community. You could call them, and at a moment's
notice they'd come and then they'd submit to this rather difficult procedure.

GROSS: So in order to have blood banks and procedures where it's not directly
from one person's veins into another, they had to figure out what clotting was
and how to overcome it temporarily.

Mr. STARR: Right. And that was Richard Lewison who figured out citrate,
'cause they did all sorts of things. You know, they tried coating all the
materials with paraffin and keeping it cold and keeping things moving and
pumping quickly. But, you know, a blood clot is a really powerful thing. So
Richard Lewison figured out a certain solution of sodium citrate that kept it
liquid. Now interestingly, it still didn't occur to anybody to do this for
long-term storage, and that's something that really the credit goes to the
Soviets of the 1930s, who figured out that you could actually use cadaver
blood in a blood bank, and those were the first real blood banks.

GROSS: Douglas Starr is the author of "Blood: An Epic History of Medicine
and Commerce." It's the basis of a new PBS series called "Red Gold." The
series begins Sunday on most public TV stations. Starr is the co-director of
The Knight Center for Science and Medical Journalism at Boston University.
He'll be back in the second half of the show.

I'm Terry Gross, and this is FRESH AIR.

(Announcements)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Douglas Starr, author
of the book "Blood: An Epic History of Medicine and Commerce." It's the
basis of the new PBS series "Red Gold," which begins Sunday night on most
public TV stations. When we left off, we were talking about some of the
innovations in blood science just before World War II.

Now you point out that a lot of this new knowledge about blood, clotting,
transfusions came just in time for World War II, when a lot of blood was
needed.

Mr. STARR: Yeah.

GROSS: What are some of the breakthroughs that happened during World War II?

Mr. STARR: Some of the big things were spinning off the plasma, and this was
something that was developed in this country, and they found that plasma had a
very, very long shelf life, and at the time blood just had a shelf life of a
couple of weeks. It's now over a month, but the time was short. But plasma
had a shelf life for months and months. Then they could freeze dry plasma,
which kept it useful almost indefinitely. Edwin Cohn at Harvard then figured
out that you could break plasma into smaller constituents like albumin and
gamma globulins, so what you had now was blood wasn't just this one resource.
It wasn't like crude oil anymore. But it was like cracking oil. You know,
much as you had gasoline and oil and petrochemicals, now you had, you know,
red cells and plasma and freeze-dried plasma and albumin, and there was a
whole constellation of materials people could use.

GROSS: Meanwhile, while we were understanding more about blood and perfecting
its storage and usage, the Nazis had theories about blood and the purity of
blood that they were using as justification for, you know, genocide.

Mr. STARR: Yes. And the Nazis really crippled themselves. In the years
preceding World War II, one of the sad realities is that the medical
profession embraced Naziism as fast or faster than any other profession. So
they purged themselves of Jewish doctors, many of whom happened to be
prominent people in hematology, and then they dismissed all the Allied
advances in hematology as degenerate foreign practices, and they turned their
attention to looking at blood types as proof of their own racial superiority.
Now it should be said that blood types don't mean anything in particular in
terms of the way you behave or the way you act. It's like eye color or hair
color. It just doesn't mean anything. But they got obsessed with this, and
they assumed that the type A was the Aryan blood and that type B was somehow
Slavic or Semitic blood, and the tests that came out of Nazi Germany were just
unbelievable.

They did studies showing that type A Aryans were more inclined to be scholars
and athletes. Type B were more inclined to be degenerates and shopkeepers.
There was one study that actually alleged that people with type B blood sat on
the toilet longer than type A blood. Then they produced these magnificent
color maps showing how the A blood types were about to swarm over Germany and
creating an island of B blood.

Now what's wrong with this? Number one, it's completely invalid
scientifically. Number two, it wasn't even valid statistically in Berlin.
Berlin didn't even have a majority of A blood types. The other thing was,
instead of doing, you know, what they should have done with blood, using it as
a strategic resource, as we did and the British did and the French did, they
almost dismissed it. So they did mark a few of their soldiers as pure Aryan
and tattooed them with their blood types to have donors on the hoof. But the
other thing was even in Nazi Germany, you didn't have that many pure Aryan
people. So for all intents and purposes, they didn't have transfusion.

I have intelligence reports from American doctors who stumbled upon German
field hospitals and found them absolutely bled white and, out of compassion,
would give them plasma. You know, they couldn't bear to see it. Nobody's
actually done a calculation, but it must have made a difference of thousands
and thousands of lives.

GROSS: Hmm. Well, meanwhile, in the United States, we had some of our own
problems with this issue of blood. Blood in the United States during World
War II was segregated between African-American and white.

Mr. STARR: Mm-hmm. Right.

GROSS: Why?

Mr. STARR: Well, this is not a happy thing. It's interesting. One of the
most famous people in the history of blood is Charles Drew, and he was the one
who figured out how to process plasma in an industrial way so it didn't get
infected. You know, you think of milk as being handled in such a sterile way,
mainly because it's a rich medium. Well, so's plasma. And they were having
terrible problems getting plasma together in large quantities. One of the
first things Drew did was help organize a blood bank in New York that was
sending plasma to London during the blitz. And yet, because Drew was an
African-American, he wasn't allowed to give blood to his own blood bank.

Now there were a couple of reasons for this beyond just lumpen bigotry. One
was that this whole blood bank thing was pretty new, and it had never really
been organized by the military before, and the military, wrongly we now know,
was thinking, `People are so nervous about this, you know, if we mix the
races, that'll just put it over the top.' And they also figure, you know,
what if some kid from the South is bleeding to death on the battlefield and
refuses to take, you know, quote, "colored blood"? You know, if they had just
thought for two minutes longer, they would have thought, `I don't think he's
gonna ask whether the blood is white or colored if he's bleeding to death.'
But they did have this prohibition, and the American Red Cross and others
spoke out against it and then they eased the prohibition, saying that
African-Americans could give blood, but that it would be separately labeled.

GROSS: When did this practice end?

Mr. STARR: This continued in some place into the civil rights period of the
'60s. It ended fairly quickly in the North. In fact, during or after World
War II, a lot of places ended it. And I should say that a lot of Red Cross
people in the blood banks themselves just said, you know, `We're not gonna
listen to this.' But they did separate it in the South until the civil rights
period and now, of course, it doesn't happen anymore.

GROSS: My guest is science journalist Douglas Starr. He's the author of
"Blood: An Epic History of Medicine and Commerce." We'll talk more after a
break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Douglas Starr, and he's the
author of the book "Blood: An Epic History of Medicine and Commerce." This
book is the basis for a new PBS series called "Red Gold," on the history of
our knowledge of blood, and this series begins on most public television
stations this Sunday.

Once some scientists understand how blood can be used for transfusions and how
blood can be stored and preserved before transfusion, then you have blood
banks developing, and then you have more of a commerce in blood developing as
well.

Mr. STARR: Yeah.

GROSS: You write a little bit about the competition between the American
Association of Blood Banks and the American Red Cross. You say this
competition balkanized America into a jumble of territories with incompatible
rules. What were some of the problems?

Mr. STARR: Well, this was something that began in World War II. There were
already some blood banks in hospitals in this country, and the military needed
a national body to coordinate blood collection, so they appointed a disaster
agency, the Red Cross. After World War II, people kind of let it go. They
didn't see the value of this. But then certain visionaries like Leslie
Groves, who helped direct the Manhattan Project, and Edwin Cohn of Blood World
said, you know, `If there's ever a nuclear attack, we're gonna really need a
lot of blood.' So they revived the program, and it should be said that some
of the chief people in the Red Cross saw this as a good way to raise funds,
not so much for selling the substance, but that this would be a good way to
keep the Red Cross in people's minds in between disasters.

So they started spreading blood banks around the country, and a lot of local
associations said, you know, `You're poaching in our territory,' and this
became very confusing for the public. The Red Cross had rules saying, `Look,
everybody could get blood, you know, regardless of whether they've given or
not.' Some blood banks had rules say, if you're gonna get four pints in the
hospital, you should recruit your friends to give four pints. And it became
very acrimonious and confusing for many years. The American Association of
Blood Banks is actually a trade association of blood banks, and it should be
said that the Red Cross now belongs to that association. But even now we
still have a fairly competitive situation among the various groups.

GROSS: Are the various groups a mix of commercial and non-profit companies?

Mr. STARR: Well, blood now is broken into two industries. If you go to the
hospital and you get red cells or plasma, that's completely non-profit.
Somebody gave that, you know, just by going and donating it and it's put in
the blood bank and people aren't making big profits from that. It goes to the
hospital. I mean, it's expensive. The red cells are $180 a unit. But this
is considered the non-profit world.

Now plasma is different. You may remember that we were talking about Edwin
Cohn before World War II figuring out that plasma can be made into different
products. That became the realm of the commercial pharmaceutical industry.
Plasma became made into factor VIII, which helps the blood of hemophiliacs to
clot, gamma globulins, something like--rabies vaccine is made from plasma,
about 20 products in all. And that is a for-profit industry and it's run by
multinational corporations and it spans the globe. And if you donate your
plasma to a center, you're paid for doing that generally.

GROSS: Because there's going to be a profit made on it.

Mr. STARR: There's a profit made, and it's a long and tiresome procedure, you
know. They use something call plasmapheresis, in which the machine takes out
your blood, but then returns the red cells and keeps the plasma, and in that
way you don't get anemic. And then that way, rather than giving, you know, a
few times a year--I think it's six--you could give a hundred times a year
without endangering your health. It's just a different industry.

GROSS: There was a quite scare about our blood bank system after the start of
the AIDS epidemic before the blood was tested for the presence of HIV. How
safe would you say the blood system is now?

Mr. STARR: The blood system then was people had a right to be scared. The
blood system now is incredibly safe. The chance of HIV or hepatitis C in a
unit of blood is one in a million or less. That's because it's so difficult
to give blood now. I mean, you've got to submit to about 33 questions that
are designed to see whether you're a member of a risk group. One of the
questions is something like, `If you're a female and if you've ever had sex
with a man who has ever had sex with another man since 1977 you can't give.'
Even interpreting that question is a job. So you answer all those questions.
And then there are eight or nine tests--some of which detect a nucleic acid of
any virus that might be in the blood. So it's incredibly safe. Not so in the
Third World. But in this country, in fact, the danger that we face at the
moment is not so much the safety of the individual unit, but a lack of supply
that could affect people's health.

GROSS: My guest is Douglas Starr. He is the author of the book "Blood: An
Epic History of Medicine and Commerce." And that book is the basis of the new
PBS series "Red Gold: The Epic Story of Blood," and that series start on most
PBS stations this Sunday.

Since one of the issues you're really examining is blood and global commerce,
I'm wondering if there's any equivalent to, say, fruit and vegetables? In
other words, we have certain standards in the United States for
pesticides--certain pesticides you can't use because they're considered too
toxic. But there are other countries--certain South American countries, for
instance--that use these more toxic pesticides, and when we buy fruits and
vegetables, we might be eating imported ones that use the more toxic
pesticides. Is there a similar issue with blood, where there are different
standards in different countries for protecting the blood supply and where,
you know, in different parts of the world the blood isn't as safe as it is
here?

Mr. STARR: Yeah, it's similar to what you describe with fruit, but reverse.
We are the OPEC of blood products. Our blood now is amazingly safe. What we
do--and we don't export any and nor do we really import much anymore. I'll
get to that in a minute. But traditionally blood is not imported or exported.
But the plasma products travel the globe. And because the US has always had
flexible regulations about plasma collection, we've always had a surplus that
we've exported around the world. So as I say, we are the OPEC of plasma.

There was a period in the '70s that I refer to as the wildcat days in the book
where even we started to run short of a way to fill the demand. So we started
importing from Central American companies. Now those were very clean, they
were actually FDA inspected, but there were terrible political problems with
that. And, in fact, it was a plasma center in Nicaragua and the outrage that
it fostered that led to the Nicaraguan revolution.

In terms of varying standards, what you tend to find is that First World
countries have very high standards and generally very safe blood supplies, and
it's really iffy in Third World countries. You've got countries that don't
have the reagents to test. A WHO team went to Kenya and found that, you know,
at least 45 percent of the people had no access to safe blood. In two weeks
there they couldn't even find an HIV test kit, or you may find a blood bank
that could test for AIDS on Fridays and the rest of the days it's a crap
shoot. So the real disequilibrium in the world now is the fairly safe stuff
in the First World and the really questionable stuff in developing countries.

GROSS: All right. You're the co-director of The Knight Center for Science
and Medical Journalism at Boston University. And I'm wondering, as a science
and medical journalist, if you think there are certain issues now facing your
part of journalism, certain issues unique to science and medical journalism
right now?

Mr. STARR: I think the issues that face us as medical and health journalists
are kind of looking at the systemic problems we might face as a nation--how to
make the stories of national health-care systems interesting. Science is not
as open as it used to be. This is a problem we're facing in our profession.
It used to be that if somebody came out with a piece of science in the
pharmaceutical industry or in universities or in medicine, this was open, this
was in the open literature. But the influence of money and power and the
newly relaxed patent laws are making it more possible for private corporations
to privatize science. And this is a terribly dangerous thing in the way that
some companies are trying to privatize parts of the genome.

There was a recent incident in which a company only published a piece of its
findings in science magazines, said, `Well, the is bought and paid for.' I
mean, this is simply not science anymore. Science has to be open and
available so people could replicate results and so journalists can ask about
it. That's a big issue. We're finding that certain sectors of the
health-care industry are getting more closed than they used to, so we are
having a real challenge with the pharmaceutical industry. Now they have their
own priorities in that they're working on something that they've invested a
huge amount of money on and it's proprietary, and they only want to announce
what they want to announce when they want to announce it. Oftentimes those
announcements are related to stock options as opposed to scientific advances.

And although we willingly accept it as part of our job, it's very difficult
for health policy journalists to say, `OK. What's really going on here? How
important are these trials really? How important is this new drug really?
How important is this biotech development really?' So it's getting a lot more
sophisticated than it used to be. You know, at the same time, news holes are
getting smaller and some people are asking that the information be dumbed
down. So this is the tightrope we're walking. I should say this makes it a
very interesting time and a very exciting time to be a journalist in this
field.

GROSS: Well, Douglas Starr, thank you so much for talking with us.

Mr. STARR: It was a pleasure, Terry.

GROSS: Douglas Starr is the author of "Blood: An Epic History of Medicine
and Commerce." It's the basis of a new PBS series called "Red Gold." The
series begins Sunday on most public television stations. It stars the
co-director of The Knight Center for Science and Medical Journalism at Boston
University.

Here's a passage from Philip Glass' "Dracula." Glass wrote this score to
accompany screenings of the Bela Lugosi film.

(Soundbite from "Dracula")

GROSS: Coming up, TV critic David Bianculli has some DVD alternatives to
summer reruns. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Summer DVD collections of complete seasons of TV shows
TERRY GROSS, host:

TV critic David Bianculli has been watching a lot of TV this summer, but very
little of it new. The rest comes from another source he loves.

DAVID BIANCULLI reporting:

If you want to watch TV right now, about the best thing you can do is watch
sporting events: the US making an unprecedented run in the World Cup, Tiger
Woods winning another major, Shaq and the LA Lakers winning another
championship. And in the sports of fame seeking and national embarrassment,
there's always "American Idol," which has grabbed an instant sizeable audience
on Fox.

Most of television, though, is in reruns. Even on cable, "Sex and the City"
won't start again until next month, and "The Sopranos" doesn't show up until
September. But I've found something to watch, something not only to wile away
the time but to consume it endlessly and giddily. And the irony is, I've
avoided the boredom of watching old TV shows by watching old TV shows. These
shows, however, are on DVD.

There are no commercials and I can watch them when and how often I want. They
come packaged beautifully and massively, a complete season at a time. Most of
them are loaded with extras, from deleted scenes to commentary from producers
and actors. They look great, they sound great and they're simply no better
way to enjoy your TV show.

I've raved before about the DVD format in general, but this time I'm getting
specific. It's clear this new technological format is getting very
sophisticated very quickly, so it's time to keep track of some of the best new
DVD releases as they come out. Some of these compilations are of TV series
still on the air. "Friends," which formerly was out in a pair of best-of
packages, has recently been released with its entire first season in one big
boxed set. Another recent release is the complete third season of "Sex and
the City," which basically catches us up-to-date on that steadily maturing HBO
comedy. There aren't many extras here, but there don't have to be. The
episodes are terrific and habit forming. Slip in the first disk, and I'll bet
you can't watch just one. They're also packaged very sexily in a see-through
plastic case and look great on your video shelf while taking up less space in
the process.

In terms of attractive packaging, though, almost no one beats the folks of
20th Century Fox. Having worked their way through the first four years of
"The X-Files," they've just released the complete fifth season in a gorgeous
set covering six disks and tons of extras--deleted scenes, alternate audio
commentary, the works. And just last week, Fox released a complete second
season, also on six disks, of "Buffy the Vampire Slayer."

"Buffy" is one of my all-time favorite TV shows. And to enjoy it like this
isn't work, it's pure pleasure. There are plenty of brilliant episodes in the
second season, some very playful, others amazingly dark and dramatic. And the
shows are bursting with supporting characters who will pop again in later
seasons or meet untimely ends in this very collection. And series creator
Joss Whedon even shows up this time, providing a very entertaining alternate
audio commentary on "Innocence," one of the best episodes in the entire
"Buffy" canon.

(Soundbite from "Buffy" DVD episode)

Mr. JOSS WHEDON ("Buffy" Creator"): I created "Buffy the Vampire Slayer" as a
movie a long time ago to protect, as I've said before, the blond girl in the
alley who always got killed. One of the distinguishing features of the blond
girl in the alley who always got killed was that she actually had sex. She
always seemed to be punished for it. That bothered me and I thought it wasn't
fair. So "Buffy" was created as a sort of stereotype buster on that level.
However, when we came back to do the series, we knew we had to keep her in
high school for awhile, and we had to bounce her age back to 15, make her a
sophomore instead of a senior. So the issue of sex was one that we were going
to have to deal with eventually in a different and somewhat more serious way
on the series. "Innocence" represents the effort to do that. What we
basically wanted to show was a horror movie version of the idea of `I sleep
with my boyfriend and now he doesn't call me, and also he's killing hookers in
alleys.'

BIANCULLI: For a "Buffy" fan, there is no greater experience and no better
gift.

But there's one other fresh DVD out there that I love just as much, a new BBC
video release of "The Hitchhiker's Guide to the Galaxy," the 1981 TV
miniseries version of Douglas Adams' sci-fi radio comedy. This "Hitchhiker's"
set includes not only the complete miniseries, but enough extras to occupy an
entire second disk. More than 20 years later, though, it's the pure wit of
"Hitchhiker's" that still delights the most. The special effects are tacky
now, but not the ideas.

One of the show's concepts was a universal translator that actually was
nothing more than a particular species of fish stuck into one's ear. Here's
how the computerized "Hitchhiker's Guide" book, whose voice is provided by
Peter Jones, describes that fish and its cosmic and religious implications.

(Soundbite of "Hitchhiker's Guide to the Galaxy" DVD episode)

Mr. PETER JONES (Radio Actor): The babelfish is small, yellow, leechlike and
probably the oddest thing in the universe. It feeds on brain wave energy,
absorbing all unconscious frequencies and then excreting telepathically a
matrix formed from the conscious frequencies and nerve signals picked up from
the speech centers of the brain, the practical upshot of which is if you stick
one in your ear, you'll instantly understand anything said to you in any form
of language. The speech you hear decodes the brain wave matrix. Now it is
such a bizarrely improbable coincidence that anything so mind-bogglingly
useful could evolve purely by chance that many thinkers have chosen to see it
as a final and clinching proof of the non-existence of God.

The argument runs something like this. `I refuse to prove that I exist,' says
God, `for proof denies faith and without faith, I am nothing.' `But,' says
Man, `the babelfish is a dead giveaway, isn't it? It proves you exist, and
so, therefore, you don't. QED.' `Oh, dear,' says God, `I haven't thought of
that,' and promptly vanishes in a puff of logic. `Boom, that was easy,' says
Man. And for an encore, he goes on to prove that black is white and gets
killed on the next zebra crossing.

Most leading theologians claim that this argument is a load of dingo's
kidneys. But this didn't stop Oolan Kaloofi(ph) making a small fortune when
he used it as the central theme for his best-selling book "Well, That About
Wraps It Up for God."(ph)

BIANCULLI: Well, that about wraps it up for me, too, but only for now.
Coming up on the DVD horizon later this summer: the second season of "The
Simpsons," the third season of "The Sopranos," the complete run of "My
So-Called Life" and the best TV drama ever written expressly for television,
Dennis Potter's "The Singing Detective." With all this coming to a DVD player
near you, who needs summer reruns?

GROSS: David Bianculli is TV critic for the New York Daily News.

(Credits)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.