Letter: Judgements in hindsight of doctor jailed in HIV blood-transfusion case

Sir: Your report and leading article on 'L'Affaire Allain' (26 July) does less than justice to the matters involved.

In January 1985, Professor Allain wrote a letter to the French Blood Transfusion Service urging that they acquire forthwith the technology for heating factor VIII for the treatment of haemophilia. He had come to the conclusion, from studies that he had carried out the previous year and from the results of the Travenol trial that were published in February 1985, that unheated factor VIII was highly likely to be contaminated with the Aids virus and that its use would risk infecting that proportion of French haemophiliacs (probably less than half) that were not yet infected.

In reaching his conclusion he was showing prescience and good judgment since it was by no means obvious in early 1985 that this was the correct course to follow. The relationship between a positive antibody test for HIV and the likelihood of developing Aids was not fully established and it was generally believed that only a proportion of those infected with the virus would go on to become ill. Furthermore, it was not clear whether heat-treated factor VIII would, in fact, be more likely to give rise to antibodies in the haemophiliacs. Formation of antibodies to factor VIII makes haemophiliacs extremely difficult to treat and may cause life-endangering problems much sooner than infection with HIV.

With hindsight, it is clear that Professor Allain was entirely correct and he could reasonably have expected to be applauded for having given the right advice so early and forcefully. It is simply not true that he did not make every effort to convince his professional colleagues and administrative superiors of the correctness of his view. He even gave an interview to Le Matin, which was not published, presumably because there was an insufficient interest in the whole matter in France at that time.

For him now to be held criminally responsible for the fact that his advice was not taken does not merely appear unjust. It seems to his colleagues in the Royal College of Pathologists, who set up a working party to look into the matter in detail, to raise a serious matter of principle if it comes to be held that those who give advice to government or its agencies on the basis of sound professional judgement and in good faith can be held accountable for this advice not being followed. This will leave anyone giving such advice in an impossible situation and must lead to a growing reluctance to give advice at all.

It is amply clear to the Royal College of Pathologists, and I believe to a wide section of professional opinion, both in the UK and in France, that such a development is wholly inimical to high standards of both medical practice and medical research.

Yours faithfully,

P. J. LACHMANN

President

The Royal College of Pathologists

London, SW1

27 July