Unnatural selection

A saviour from human ills or the means to a new super-genetic over-class? Karen Kissane reports from the biotech frontline.
The recipe for a longed-for baby used to be a man, a woman and a touch of stardust. But that was before some kinds of baby-making moved into the laboratory; before the warm surrender to fate was chilled by the cool reckoning of science; before new technologies for making humans began to raise fears of a “post-human” world.

It was before the creation of children moved from a private affair between individuals to a public issue debated in committees and classrooms. In this history and philosophy of science tutorial at Melbourne University, there are few stars in the eyes of students talking about reproductive options.

They are told to imagine a child, Sarah, dying of leukaemia. Is it right to clone her so that her life can be saved by cells obtained from the cloned 12-week-old foetus, even if this risks miscarriage of the clone?
Two young women think the cloning is OK but suggest the cloned foetus should be aborted at 12 weeks, after the cells are obtained, because the siblings would face emotional problems growing up as genetic twins who are years apart in age.
But Patrick, another student in the class, is uneasy that this cloning would conceive new life purely to service an existing one. He thinks this principle could justify “a laboratory somewhere where they just make body parts from people and take what they need and they’re not humans any more; they’re just there for our purposes”.

This is the central issue in the growing international debate about reproductive technologies: what is human dignity, and how should it be upheld?

In 1992, the US Supreme Court declared that “at the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life”.

Does this mean that respecting human dignity requires allowing people freedom to choose according to their own moral framework, leaving bio-ethics decisions to the parents who must live with their consequences? Or is there something greater that must be protected, and that justifies the community setting legislative boundaries?

Organised religion is languishing, and with it the belief that humans are precious because they are made in the image of God. So what now justifies the erection of a safety fence around “humanness”? And what will happen if we yield to the very human temptation to tinker with it?

The sci-fi scenarios floated after the birth of the first IVF baby, Louise Brown, in 1978 are now on our doorstep. Technology is close to breakthroughs that some would argue are not so much life-enhancing as death-denying. Bio-ethicist Professor Julian Savulescu, who works at the Murdoch Children’s Research Institute, knows of a Melbourne couple who has already asked if their child, who died soon after birth, could be cloned. (The answer, on both technical and ethical grounds, was no.)
At least two Victorian women have medically retrieved sperm from the bodies of their recently dead husbands, hoping to conceive children post-mortem (in Britain, where one woman has conceived two children this way, the tabloids call it the “sperm widow” phenomenon). In the US, grieving parents of an adult daughter who died leaving frozen embryos behind paid a surrogate to bear their grandchild for them.

Medicine has always been about cheating nature, but now it is doing so in ways that challenge our sense of what is “normal”. A 63-year-old in Italy has become a mother; in Melbourne, IVF specialist Professor Carl Wood has helped a post-menopausal woman of 52 conceive a child using a donor egg.

We do not have to wait for cloning to see the way new technology can produce strange kinks in kinship. Some infertile men now ask their fathers, brothers or cousins to donate semen for artificial insemination. Older women in several countries have acted as surrogates for their daughters’ babies, giving birth to their own grandchildren.

For some, the right to choose is now extending to the right to choose what others see as a disability. A Melbourne IVF specialist, Dr John McBain, has reported that a deaf couple applied to use embryo selection to conceive a deaf child.

It is possible to imagine a world in which sex and procreation are separated. In Japan, researchers have gestated goats in an artificial womb, conjuring visions of foetal organ banks, or of human hatcheries like those in the sci-fi movie The Matrix. If that arouses anxieties about women being made redundant, the gender balance is weirdly restored by other researchers who have grown a rat embryo from the fusion of two female eggs, without any sperm.
While the inhuman possibilities are chilling, most current concern swirls around the prospect of superhumans. People might end up being bred like animals, argues social philosopher Francis Fukuyama, professor of international political economy at Johns Hopkins University, in his new book Our Post-human Future: Consequences of the Biotechnology Revolution.

He writes, “Geneticist Lee Silver paints a future scenario in which a woman produces a hundred or so embryos, has them automatically analysed for a ‘genetic profile’, and then with a few clicks of the mouse selects the one that not only lacks ¤ single-gene disorders like cystic fibrosis, but also has enhanced characteristics such as height, hair colour and intelligence.”

A Melbourne couple approached Wood about genetic selection to help them avoid a child with low intelligence (but not retardation), a problem that ran in one side of their family. If Wood had been able to help them, would he have been right to do so?

Silver is also quoted in the new book Redesigning Humans: Choosing Our Children’s Genes, by Gregory Stock, director of the Program on Medicine, Technology and Society at the school of Medicine at UCLA.

He writes, “Silver, a molecular biologist at Princeton University ¤ imagines we may eventually expand our senses by replicating special adaptations found in other animals: ultraviolet and infrared vision (from spiders and snakes); the detection of magnetism (birds); sonar (bats) and acute smell (dogs).” If you find cross-species enhancement repugnant, consider this: what if a monkey gene were found that could, without harm, protect humans against AIDS?

Stock does not think such scenarios are threatening: “Re-making ourselves is the ultimate expression of our humanity.” Fukuyama, on the other hand, believes humanity is in danger of losing itself. He argues for international laws limiting how we use reproductive technologies in order to protect human nature, human dignity and the principle of universal human rights, which he sees as based on the idea of a humanity we all share.
Students in the class at Melbourne University believe it is difficult to deny parents any kind of selection because of principles that are well established with regard to abortion. Discussing the question of whether a deaf couple should be allowed to abort a hearing foetus, Jenny points out, “People can just abort a healthy foetus day-to-day for any other purpose.”

Says Courtney, “If you’re going to give people the right to pick and choose children based on their genetic factors, then I don’t think you can (dictate) what they choose from. If they want to abort a child because it doesn’t have blue eyes, you have to give them that right.” Agrees Thao, “Separate to the issue of whether abortion is right, if you are enabling selection, then you can’t draw lines around how it is used ¤ Someone might want a boy, someone might want someone who’s intelligent.”

Catholics and many other Christians view the creation of life – conception through to birth – as sacred and untouchable because it is “peculiarly under the hand of God”, says Jesuit priest and ethicist Father Bill Uren. But it sounds like God might have to move over.

Parental narcissism has always made sly mockery of another Judeo-Christian idea, the notion of the child as a gift from God, to be treasured in his or her own right. Parents who want children to mirror themselves, or to achieve what they have not, have long shoehorned gentle kids into footy, sporty kids into violin lessons, shy kids into dance class. Is it that much bigger a step to allow parents to choose an embryo that will have a gene for athleticism or musicality – or deafness or dwarfism?

Savulescu believes current selection is too narrowly focused on avoiding problems such as cystic fibrosis. He says future parents should be allowed to choose positive characteristics to maximise their children’s chances in life.

“I believe our essential humanness is our rationality, our ability to reason and make judgments about what’s best for us, and not just be handed whatever fate dishes up to us,” he says. “The story of humanity is one of struggling to change the world for the better and ourselves for the better.”

Parents should be allowed to select a deaf or dwarf embryo, even though it is not what Savulescu would choose. “We do better to allow them to express their humanness to think, to evaluate, to choose and to act.”

But Uren is critical of shopping for a custom fit. He says: “It’s not a contractual relationship we’re entering into when we have a child; it’s not a trade relationship. It’s a gifting, and we don’t put conditions upon this sort of gift.”

As well as being a priest, Uren is an ethicist at Brisbane’s Mater Hospital for Women and Children and a member of the Australian Health Ethics Committee with the National Health and Medical Research council. He says it would be wrong to use genetic selection in ways that subordinate the interests of the prospective child to the desires of the parents.

A philosopher at the Australian Catholic University, Peter Coghlan, fears children would be burdened by unrealistic parental expectations as the notion of unconditional love was undermined.

There are many ways in which new technologies might re-draw the ways relatives are linked to each other. Fukuyama, though, is most concerned about their impact on society.

He argues that the complex, evolved natures of humans should be protected against self-modification. “We do not want to disrupt either the unity or continuity of human nature, and thereby the human rights that are based on it,” he says.

Fukuyama argues that biotechnology “advances” would involve unpalatable trade-offs. A mouse that had its intelligence genetically boosted also seemed to experience greater pain. “We can cure this disease, or make this child more tractable, at the expense of some ineffable human quality like genius, or ambition, or sheer diversity.”

Would mathematician John Nash’s “beautiful mind” have lost its comet-streak of brilliance if he had been modified to avoid schizophrenia?

Fukuyama and Stock concur on one point; as genetic enchancements become available, people will want to use them. Fukuyama believes people want to “medicalise” as much of their behaviour as possible, reducing responsibility for their actions, and that they will be encouraged to do this by powerful economic interests such as biotech companies. He cites the increasing use of drugs such as Ritalin to treat children with attention disorders as evidence.

Stock predicts the motive will be evolutionary competition. “As long as people compete with each other for money, status and mates, as long as they look for ways to display their worth and uniqueness, they will look for an edge for themselves and their children.”

But genetic selection might sneak into the public’s comfort zone because of its health benefits. The Melbourne University lecturer of the ethics class, Rosemary Robins, is also on the federal gene technology ethics committee that regulates modification of plants and animals.

She says: “Health is a very important issue for our society. We value it highly, partly because we’re not too comfortable with death. That then creates the window of acceptability for these new technologies to proceed, and then slowly they become normalised.”

Genetic manipulation to avoid fatal or debilitating disease is already normalised. One opinion poll of eight countries by a Japanese ethics institute found that many people would use safe genetic interventions to enhance the physical or mental attributes of their children. Israelis were the least accepting (22 per cent) and Thais the most attracted (83 per cent). Americans fell in the middle (43 per cent).

Between 62 and 91 per cent of people surveyed would use gene therapy to keep a child of theirs from inheriting a disease like diabetes, and even more (80 to 96 per cent) would use it to prevent fatal diseases.

Compassion softens resistance even to ideas that at first sound macabre. The news of England’s first “sperm widow”, Diane Blood, caused a public outcry until Blood went public. When ordinary Britons saw this pleasant, grieving widow arguing an emotional case in the face of her huge loss, they swung behind her. Opposition to early IVF eased as headlines about “babies in freezers” gave way to newspaper happy-snaps of real babies in arms.

Today, ethicists have raised concerns that new techniques breach the ancient taboo against bestiality. How do you feel about the idea of infertile men’s sperm being “cooked” in rat’s testicles? IVF specialist McBain sees it as a triumph. “We’re trying to cook female eggs in mouse kidneys. I won an international prize for this work. It’s brilliant.”

Ikky? Would you ban it? Then you have just blocked an avenue of hope for young women made infertile by life-saving cancer treatment. McBain is trying to work out how to remove ovarian tissue and grow eggs from it so that such women can still have their own babies.

The final frontier is meant to be reproductive cloning. It has been banned by the Council of Europe, condemned by Unesco and the US president, and is regarded with repugnance by most IVF practitioners.

McBain says “I think that our work is to parallel the normal but failed reproductive process, where a new and unique person can be conceived and given the chance for growth,” he says. “I think cloning, which repeats the DNA of someone who has already lived a life, is wrong for that reason.”

But compassion, in the end, will drive public acceptance even of cloning, Robins predicts. She says students become sympathetic when asked to consider the case of the couple who want to clone their dead or dying only child. “Feeling for the loss of that family is the thing that will allow the decision to go through an ethics committee, say. After all, most of these decisions get made on a case-by-case basis.”

A Melbourne expert in IVF issues, who does not wish to be named, predicts reproductive cloning will largely be driven by infertile men who want offspring who share their genes. “Many men whose partners use donor sperm have (psychological) difficulties with it afterwards. If women use donor eggs, they are still an intimate part of the process, but for men, donor sperm is a very different experience.”

Savulescu says he sees no justification for cloning but he does not think cloning should be banned. “Who is harmed by it? How would it be bad for the child? This blanket revulsion for cloning is based on stereotypes like The Boys from Brazil . . . It might be very valuable to have a parent who has done a trial run of your life, who has some idea of your diseases, your talents and your weaknesses.”

Where, then, will it all end?

God might know but people certainly don’t. In a modern, pluralistic society there is no consensus even on where it should end. Nor is there clarity about what processes society should employ in dealing with these questions – moral education, or legislation? – or which aspects of decision-making should be private and which communal.

Not only are there differences in the views between people, there are contradictions within individuals. Arlette Schweitzer, America’s first grandmother surrogate, is a committed Catholic deeply troubled by commercial surrogacy, which she says is “borrowing the actual makings of a baby from other people”. But, writes Stock, she sees what she did for her daughter as different. “I didn’t even consider myself a surrogate. I was just a mother helping her daughter.”

Then there is the US senator who was a vocal opponent of abortion but an early supporter of embryo research – his daughter had juvenile diabetes. It seems the pop song is right: love changes everything.

But there are problems with leaving decisions in the hands of those who have an emotional investment in the outcome. Sometimes informed choices are made for deformed reasons, and if enough people make them, individual choices grow into a social norm.

In India, where boys are valued over girls, a Bombay survey of pregnancy terminations following ultrasound found 7997 out of 8000 aborted foetuses were female. (Australia has a weaker preference in the other direction; sex selection is permitted in New South Wales and, at Sydney IVF, 63 per cent of couples choose females.)

With “germ cell” genetic enhancement, genetic changes to DNA also affect the ova or sperm of the animal. This means the changes will be passed on to future offspring. Fukuyama warns this could embed the social preferences of one generation in future generations, “like a tattoo that (they) can never subsequently remove”.

Robins believes society is “muddling through” issues raised by biotechnology, and that we need to develop a secular humanist ethic to grapple with them. “People making decisions about their reproductive choices find it very hard to do it on their own. They want some help . . . Even in genetic counselling sessions, where the aim is to be non-directive, people often ask, `But what would you do?’ ”

The law is a clumsy tool for dealing with ethical issues, but is it the only way to slow down the biotech revolution while the rest of the community catches up with its implications?
It has been argued that decisions should not be left in the hands of doctors and scientists because of their vested interests in careers and budgets. And science has always had its boundary riders, so fascinated by possibility that they are oblivious to potential harm.

Fukuyama cites a researcher who said it would be scientifically important to produce an ape-human cross, and others who suggested using women as “hosts” for the embryos of chimpanzees or gorillas. One biotechnology company put human DNA into a cow’s egg and grew it into a blastocyst before destroying it. “Chimera”, the lion-goat-dragon creature of Homer’s imagination, may not stay a byword for a wild, unrealistic fancy.

If we fail to set limits on the biotech revolution, Fukuyama envisages two ugly political scenarios.

One is war on the streets as a genetic underclass resists the embedded advantage of genetic aristocrats who could afford to pay for enhancement. The other is state-sponsored eugenics programs to improve the intelligence of strugglers.

Christopher Newell, an ethicist and member of the National Caucus of Disability Consumer Organisations, envisages a third possibility: a world in which imperfection is not tolerated. While biotechnology offers great hope of genetic cures, at present it is mostly used to screen out embryos or foetuses with disabilities, he says.

“The implications are to be found in legal decisions around the world which are starting to talk about notions of `wrongful birth’,” he says.

People are saying, ‘How did you slip through the net and not get aborted?’. . . The notion that certain things are so overwhelming they strip you of inherent worth as a human being is an enormously dangerous, insidious philosophy.”

The one scenario impossible to imagine is that of everyone taking an absolute stand against genetic enhancement. As Stock says: “Most of us would rather be among the first to live an extended lifespan than among the last to live a `natural’ one.”
He believes humanity is looking at the birth of a new age of growth and achievement. “Will we suddenly lose our nerve because of the realisation that life will change forever, and because we can scarcely guess the character of this child of our creation? I hope not.”

He likens human daring with genetic experimentation to Prometheus’ stealing of fire from the gods, an act he calls “characteristically human”. But he fails to mention that Prometheus’ theft was punished by Zeus, who unleashed Pandora’s box of evils upon the world.

Should we brace ourselves?

First published in The Age.

When life becomes a game of chance

Doctors know that a completely safe blood supply is a fantasy.But some, like those who get bad transfusions, discover this the hard way. KAREN KISSANE reports.

DOCTORS have a name for illnesses caused by medical treatment: they call them “iatrogenic”, from the Greek for “beginning with the physician”. Tracey McCullagh, lying in hospital after the birth of her second child in 1990, didn’t know that word. But she knew the concept.

When a doctor armed with a consent form raced in to tell her that her day-old son needed a blood transfusion, she looked back at him questioningly. Was the blood safe? “He said, `Don’t worry. It’s been checked’.”
McCullagh, already frantic with anxiety over the child she had been allowed to hold only once, the child born orange with jaundice because his blood was not compatible with hers, the child now at risk of permanent brain damage, signed the form.

They nearly lost Corey several times in the next few days but he recovered. As a toddler he was a bit sickly – on antibiotics every month for minor infections – but McCullagh thought nothing of that. And when he cut himself she thought nothing of sucking the blood from the wound. “We didn’t know,” she says helplessly.

He was two-and-a-half before she was told that the blood that had given Corey life could have given him a chronic and potentially lethal disease, hepatitis C, and that his blood could infect others.

Bad blood. It wasn’t supposed to happen again, McCullagh had thought; things had tightened up since the AIDS tragedies of the ’80s and the blood supply was safe, wasn’t it? It certainly seems safe from HIV; there has been no recorded case of an Australian blood recipient catching that virus for 10 years.

But medical authorities estimate that up to 30,000 of the 130,000 Australians who have hepatitis C (HCV) allegedly caught it from blood transfusions or other blood products. According to the Haemophilia Foundation of Australia, 90 per cent of adult haemophiliacs have hepatitis C, allegedly caught from contaminated clotting agents used before HCV testing of blood donors began in 1990. People with haemophilia need clotting agents made from concentrates of donated blood to stop them bleeding uncontrollably.

The question of whether anyone is to blame for the spread of post-transfusion HCV will come before the courts next year in the first of dozens of legal suits against the Australian Red Cross. Corey McCullagh is among those seeking compensation, although he doesn’t know it yet. He doesn’t even know about his illness: “How do you tell a five-year-old?” his mother asks.

For people with haemophilia, who have seen 245 members of their community catch HIV from blood products, the hepatitis C epidemic confirms that they are the canaries in the mineshaft; problems in the blood supply that could endanger everybody hit them first and hardest. They, along with medical authorities, readily acknowledge what the rest of us have yet to understand: that the blood supply will never be completely safe, and that it was a fantasy to have imagined it ever could be.

The use of blood donations is only one concern. In this age of chronic blood-borne infections, everyone – doctors, dentists, athletes and people wielding home first-aid kits – must re-think how they deal with the blood of others.

Hepatitis is inflammation of the liver, and the different hepatitis viruses have little in common other than their result, which is liver damage. The most serious cases end in liver failure or cancer. Hepatitis C is often a silent infection and most carriers don’t know they have it, which explains how they could have continued to donate blood in the days before the blood bank was able to test for the virus.

The story of hepatitis C and the blood supply is confirmation that the blood banke nightmare – the undetectable spread of a serious illness through donations – remains all too possible.

The hepatitis C bug has been with us for millennia but it was not until it was cloned that a test could be developed to detect its presence in blood. Normally, no one could be accused of negligence for not screening for a virus before a specific test became available for it. With hepatitis C, the issue is not so clear. The law firm Slater and Gordon is acting for more than 300 potential litigants and has filed suits against the Australian Red Cross on behalf of 20 in Victoria and another 20 in New South Wales. Many of the cases involve women who received transfusions when they haemorrhaged after childbirth. Cases are also proceeding with other law firms.

A Slater and Gordon partner, Andrew Grech, says it is alleged that Australian blood banks were negligent for not introducing indirect or “surrogate” testing for hepatitis C before the specific test became available. Surrogate tests of donors’ blood looked for irregularities in liver enzymes, which it was thought might be linked to hepatitis viruses.

“In the United States, some blood banks had implemented surrogate testing in 1982,” Grech says. “Australia introduced the first generation of hepatitis C tests in February 1990.

We allege that surrogate testing here could have prevented well over half of the infections among recipients of blood in the 1980s.”
The chairman of the national blood transfusion committee, Dr Richard Kimber, declined on legal advice to comment on how Australian authorities came to their decisions. He said: “I firmly believe that what the Australian system did . .

. (was) totally correct at the time.”
Dr Katrina Watson, head of the liver clinic at St Vincent’s Hospital, was not privy to their discussions. But she points out that: “At the time that surrogate testing was being done in some parts of the world and not in others, it wasn’t clear whether surrogate testing was offering an advantage. People didn’t really know whether it was detecting a virus or whether it was just detecting the fact that those people had a slightly different liver function profile. The studies that have confirmed the value of doing surrogate testing have been done in retrospect.

” Overseas, some blood bankers have said that they did not use surrogate testing partly because it had a high rate of “false positives”; many people would have been eliminated from donating who did not have hepatitis, which might have caused blood

In public health, decisions like this must often be made by weighing up conflicting interests rather than on the basis of clear right and wrong. This is the case even now with screening blood donations for hepatitis C. Dr Nick Crofts, the head of epidemiology and social research at the Macfarlane Burnet Centre, says: “You have got a window period for hepatitis C, when the virus can be transmitted despite the blood being screened.

“There is a test, PCR, that can detect a proportion of those cases, which looks for the viral genome rather than the antibody. Why aren’t we doing that? Because it’s $60 a throw, because it takes a couple of days, because it would just make the blood transfusion system unworkably expensive.

” There are alternatives to donated blood but Australian authorities have been criticised for being slow to respond to the need for them. “Autologous” donation allows elective surgery patients to donate their own blood, either ahead of time or in theatre just before an operation. And there are machines that can recycle a patient’s own blood during surgery. But neither practice is common in Australia.

“In America, nearly one million people donated units of their own blood last year, and in Europe, countries like Germany use blood salvaging far more than we do,” says Dr Richard Davis, a South Australian anaesthetist who has been lobbying for such
measures for years.

He says that, from senior doctors down, Australians have relied on the Red Cross for so long that there is a reluctance to change. “Red Cross donors are decreasing and for the first time ever, serious blood shortages are occurring.”
In some countries, being offered the chance to donate one’s own blood for elective surgery is becoming the new “reasonable standard of care”, with some American states making it a legal requirement, says Dr Katherine McGrath, associate professor of
pathology at the University of Newcastle and former director of haematology at the Royal Melbourne Hospital.

McGrath argues that authorities must decide what kinds of surgery merit autologous donation – at present it is available ad hoc, and is easier to get if you live near a big hospital or have private health insurance. He says it would cost less if it did not have to have the same stringent testing as donated blood. After all, it is destined only for the same veins from which it came.

Peter moves stiffly, a legacy of the bleeds that have broken down his joints. His already limited life – no action sports, hours each month spent in home treatment of bleeds – contracted further when he felt the first symptoms of HCV a decade ago.

“I spent my weekends in bed, recharging my batteries, so that I could go in to work on Monday; on weeknights I was in bed by half-past seven and I couldn’t understand why.”
HE can rarely plan to go out socially because he never knows when he will have a good or a bad day. Liver tests show he has serious damage but he must live with the uncertainty of not knowing how bad the illness will get; doctors cannot predict which cases will develop into liver failure or cancer.

While haemophiliacs have suffered most from contaminated blood products, they will also be among the first to benefit from its new man-made alternatives. Science is a long way from being able to create artificial whole blood, a complex fluid with many cells that perform different functions, but there is now a genetically engineered form of the clotting agent Factor 8.

And, in America, companies are testing on humans a synthetic plasma volume expander that also contains haemoglobin, the protein that carries oxygen around the body, says Dr Peter Schiff, the clinical services manager of the bioplasma division at CSL,
the former Commonwealth Serum Laboratories. (Plasma is the straw-colored liquid that holds the blood cells).

“There are two approaches,” Dr Schiff says. “Some companies are just using ordinary red blood cells taken from blood that has been collected, and they can be stored for four or five weeks. After that the plasma is still useful, but the red cells can’t function any more as red cells, and the haemoglobin is extracted from them. Other companies are inserting the haemoglobin gene into cells that can be grown in the laboratory.

” Artificial products can be sterilised but Schiff is reluctant to pronounce them completely safe. He predicts that they will be increasingly used but that human blood will still be needed for at least the next 20 years. But, even in a brave new world with synthetic alternatives to all blood products, the risk of catching viruses through everyday contact will remain.

As more is learnt about how this can happen, doctors and dentists have revolutionised the way they work to try to limit exposure to nicks. Hospitals are increasingly challenged about the way they save money by re-using “single-use” equipment, which might increase the risk of patient-to-patient transmission of viruses. Such equipment is chemically sterilised between patients but is too fragile to survive autoclaving, the most efficient form of sterilisation.

Even sports authorities have changed their health policies, with the AFL now insisting all players be vaccinated against hepatitis B, and that injured players, whose bleeding cannot be stemmed, leave the field.

It is taking longer for the message about treating blood with caution to reach the wider public. A disturbing 25 per cent of people with hepatitis C cannot trace how they caught it; some might have become infected by sharing razors or toothbrushes with carriers. Body-piercing and tattooing remain popular despite their links with hepatitis. And then there are drugs: about 100,000 current and former intravenous drug users are estimated to carry the virus and up to 8000 more catch it every year. Nick Crofts sees the most urgent step in stopping the spread of disease among drug users is to legalise heroin and improving education campaigns and needle- exchange programs. Katrina Watson would like to take it a step further: “To me the single most important prevention is the education of the at-risk population, which is children.

“The kids who are at a party when someone says, `Try this’, are not going to go down to the local needle exchange for the first time and say, `I’m thinking of trying this’. They’re going to do it in the back yard at a party, in the dark. I see it as a matter of urgency to tell all kids, in all Australian schools, many times.”
The British writer Richard Titmuss described blood donation as modern society’s ultimate form of altruism – a transcendental selflessness.

It still is. Blood donations continue to keep Peter alive; for him, as with most of the people who allegedly caught hepatitis C from the blood supply, the gift of blood that infected them also helped save their lives.

Australia continues to have one of the world’s safest blood supplies, due to rigorous screening and testing of donations.

It has had no scandals such as those in Germany, France and Japan, where bureaucrats and businesspeople knowingly allowed contaminated material to reach patients, killing hundreds with HIV.

But, Dr Kimber, the chairman of the blood transfusion committee, says that any treatment carries risk and the blood supply is only as safe as modern technology can make it. It is not known what else might be out there, from an alphabet of hepatitises to other disease-bearing organisms. The Canadian Red Cross last year made the largest recall of blood products in its history after two donors were diagnosed with Creutzfeldt-Jakob Disease (CJD), which might be linked to mad cow disease.

Kimber says there is no evidence that CJD can be transmitted through blood, and that the Canadians were being excessively cautious. But it was some time after the arrival of AIDS that it was realised it could be transmitted by blood.

Either way, Peter and the other canaries in the mineshaft will continue to watch and wait for what they and the medical journals call “TNV”: The Next Virus.

First published in The Age.