Tag Archives: health

“A failure by the British state”

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Reading The Poison Line by Cara McGoogan for the Telegraph, 17 September 2023

Mayor Treloar College, founded in 1907 for the education and care of physically disabled children, was more than just a school for Ade Goodyear. The teaching and medical staff were more like an extended family. Dr Anthony Aronstam, director of the Treloar’s haemophilia centre, used to invite Ade and his schoolfriends over to his house where they drank lemonade and swam in the pool.

One afternoon in the summer of 1984 Ade found Aronstam bent over his desk, trembling. “‘We’ve fucked up,’ Aronstam said. ‘We’ve messed up, boys. I’ve messed up. It’s all gone wrong.’”

In the face of a gathering global calamity, Aronstam had been assessing Ade, without his knowledge, for signs of AIDS. Two of Ade’s schoolfriends were already diagnosed. One, Richard Campbell, had already died. By 1986 Aronstam had forty­-three patients who were HIV positive. He wrote in a report, “”There are gloomier predictions about, which suggest that up to 100 per cent of the infected haemo­philiac population will eventually succumb to the virus.”

The Poison Line is the first book by journalist Cara McGoogan. It began life as a couple of features written for this paper in the opening week of the Infected Blood Inquiry in 2019.
It may seem thin praise to single out the way McGoogan has arranged her material here, but truly the effort has been superhuman. This is the story of a global medical scandal, implicating health services, pharmaceutical companies and whole governments, and unfolding slowly enough, and meeting obstacles enough, that many of its victims died before they ever saw justice, never mind compensation. It is told, for the most part, through the recollections of the victims, their families, their doctors, their legal and political representatives. That so many individual stories here burn their way into the reader’s skull is testament to the strength of the source material, of course, but there were so many plates McGoogan could have dropped here and didn’t, so many stories to leave hanging and implications to leave unexplored, that there ought to be some sort of award for literary juggling established in her name.

Treloar College is just the most familiar domestic emblem of a crisis that played out across the US, UK, mainland Europe, and south-east Asia. It began when a new, much quicker, more convenient and more comfortable way was found of administering blood clotting factors to haemophiliacs. Factor VIII, a freeze-dried powder derived from blood, was infected with hepatitis B, but since this infection was common among haemophiliacs anyway, and went away in time, the issue was ignored. Consequently, other agents infecting Factor VIII went undetected, including HIV and hepatitis C.

Institution after institution doubled down on their original error in allowing and promoting a tainted product. In the UK, ministers themselves come out of this account surprisingly well, as McGoogan traces their appalled investigations into decades of deliberate cover-up. It was left to Jeremy Hunt, “the epitome of the establishment politician”, to sum up the disaster as “a failure by the British state. I don’t think there’s any other way to describe it.

The second half of Poison Line, about the victims’ courtroom battles, reveals the economic drivers of the scandal. By the 1990s plasma was more valuable than gold and oil. Most Factor VIII was produced in the US, and American blood bankers, who are allowed to pay donors for plasma, were gathering blood from wherever they could: outside nightclubs, from inside prisons, and from a centre in Nicaragua nicknamed the ‘House of Vampires’, which collected plasma from up to a thousand people a day. The there was the way Factor VIII was made: any one injection could contain the blood of twenty-​­five thousand people.

As McGoogan’s account gathers pace and scale, the more existential the issues become. At what point does a corporation countenance the death of its customers? In what institutional setting will a doctor think it reasonable to tell an AIDS-infected mother that “Women like you should be sterilized”? What level of conformism does it take for the mother of a seventeen year old, infected with HIV from a haemophilia treatment, to tell him that he’s brought shame on her, and throw him out the house?

By the closing pages, we seem to have left the news pages behind entirely, and be wrestling with something that looks very like the tragedy of the human condition.

Bacon is grey

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Reading Who Poisoned Your Bacon Sandwich? by Guillaume Coudray and Hooked: How processed food became addictive by Michael Moss for the Financial Times, 21 April 2021

The story of how food arrives on our plate is a living, breathing sci-fi epic. Fertiliser produced by sucking nitrogen out of the air now sustains about half the global population. Farmers worldwide depend on the data spewing from 160 or so environmental satellite missions in low-earth orbit, not to mention literally thousands of weather satellites of various kinds.

That such a complex system is precarious hardly needs saying. It only takes one innovative product, or cheeky short-cut, to transform the health, appearance and behaviour of nations. What gastronomic historian, 50 years ago, would have ptedicted that China would grow fat, or that four and out five French cafés would shut up shop in a single generation?

To write about the food supply is to wrestle with problems of scale, as two new books on the subject demonstrate. To explain how we turned the green revolution of the 1960s into a global obesity pandemic in less than half a century, Michael Moss must reach beyond history entirely, and into the contested territories of evolutionary biology. Guillaume Coudray, Paris-based investigative journalist, prefers a narrower argument, focusing on the historical accidents, and subsequent cover-ups that even now add cancer-causing compounds to our processed meat. The industry attitudes and tactics he reveals strongly resemble those of the tobacco industry in the 1970s and 1980s.

Ably translated as Who Poisoned Your Bacon Sandwich?, Coudray’s 2017 expose tells the story of the common additives used to cure — and, crucially, colour — processed meats. Until 1820, saltpetre (potassium nitrate; a constituent of gunpowder) was our curing agent of choice — most likely because hunters in the 16th century discovered that game birds shot with their newfangled muskets kept for longer. Then sodium nitrate appeared, and — in the mid 1920s — sodium nitrite. All three give meats a convincing colour in a fraction of the time traditional salting requires. Also, their disinfectant properties allow unscrupulous producers to operate in unsanitary conditions.

Follow basic rules of hygiene, and you can easily cure meat using ordinary table salt. But traditional meats often take upwards of a year to mature; no wonder that the 90-day hams pouring out of Chicago’s meatpacking district at the turn of the 20th century conquered the world market. Parma ham producers still use salt; most everyone else has resorted to nitrate and nitrates just to survive.

It wasn’t until the 1970s that researchers found a link between these staple curing agents and cancer. This was, significantly, also the moment industry lobbyists began to rewrite food history. The claim that we’ve been preserving meat with saltpetre for over 5,000 years is particularly inventive: back then it was used to preserve Egyptian mummies, not cure hams. Along with the massaged history came obfuscation – for instance arguments that nitrates and nitrites are not carcinogenic in themselves, even if they give rise to carcinogenic agents during processing, cooking or, um, digestion.

And when, in 2015, experts of the International Agency for Research on Cancer classified all processed meats in “group 1: carcinogenic to humans” (they can cause colorectal cancer, the second most deadly cancer we face) the doubt-mongers redoubled their efforts — in particular the baseless claim that nitrates and nitrites are our only defence against certain kinds of food poisoning.

There are alternatives. If it’s a disinfectant-cum-curing agent you’re after, organic water-soluble salts called sorbates work just fine.

Crucially, though, sorbates have no colourant effect, while nitrates and nitrites give cured meat that rosy glow. Their use is so widespread, we have clean forgotten that the natural colour of ham, pate, weiner sausages and bacon is (deal with it) grey.

That the food industry wants to make food as attractive as possible, so that it can sell as much as possible is, of itself, hardly news.

And in Hooked (a rather different beast to his 2013 exposé Sugar Salt Fat), American journalist Michael Moss finds that — beyond the accusations and litigations around different foodstuffs — there’s something systemically wrong with our relationship to food. US consumers now fill three-quarters of their shopping carts with processed food. Snacking now accounts for around a quarter of our daily calorie intake. Pointing the finger at Coca-Cola or McDonalds is not going to solve the bigger problem, which Moss takes to be changes in the biology of our ancestors which have made it extremely difficult to recoup healthy eating habits once they’ve run out of control.

Moss argument is cogent, but not simple. We have to get to grips, first, with the latest thinking on addiction, which has more or less dispensed with the idea that substances are mind-altering. Rather, they are mind-engaging, and the speed of their effect has quite as much, if not more to do with their strength than their pharmacology.

By this measure, food is an incredibly powerful drug (A taste of sugar hits the brain 20 times faster than a lungful of tobacco smoke). But does it make any sense to say we’re all addicted to food?

Moss says it does — only we need to dip our toes in evolutionary biology to understand why. As primates, we have lost a long bone, called the transverse lamina, that used to separate the mouth from the nose. Consequently, we can smell food as we taste it.

No one can really explain why an enhanced appreciation of flavour gave us such a huge evolutionary advantage, but the biology is ungainsayable: we are an animal obsessed with gustatory variety. In medieval France, this inspired hundreds of different sauces. Today, in my local supermarket, it markets 50-odd different varieties of potato chip.

The problem, Moss says, is not that food manufacturers are trying to addict us. It is that they have learned how to exploit an addiction baked into our biology.

So what’s the solution? Stop drinking anything with calories? Avoid distractions when we eat? Favour foods we have to chew? All of the above, of course — though it’s hard to see how good advice on its own could ever persuade us all to act against our own appetites.

Hooked works, in a rambunctious, shorthand sort of way. Ultimately, though, it may prove be a transitional book for an author who is edging towards a much deeper reappraisal of the relationship between food, convenience (time, in other words), and money.

Neither Moss nor Coudray demands we take to the barricades just yet. But the pale, unappetisingly grey storm clouds of a food revolution are gathering.