Surprise ruling won't wash with the victims

Contrary to widespread expectations, the Tokyo District Court on Wednesday acquitted Takeshi Abe, former vice president of Teikyo University in Tokyo, of professional negligence resulting in the death of one of his patients.

It is believed the court strictly abided by the rules of the criminal justice system — if there is even a slight doubt about guilt, the accused should not be convicted.

However, some medical experts voiced concerns that the ruling will work against efforts to change a long practice in this country of not holding individual professionals accountable.

Extensive knowledge, strong influence and leadership exerted by leading professionals such as Abe should be accompanied by a sense of responsibility, they said.

Dr. Rokuro Hama, an Osaka-based specialist who has worked for years on ways to reduce drug-induced disasters, said of the ruling, “If the current law cannot charge science researchers with injustice, we need new legislation for that.”

In the 1980s, Abe failed to pass on crucial information to his patients — including the fact that some had contracted HIV — depriving them of the chance to delay the onset of AIDS or to prevent them from infecting their spouses.

In his four-year trial, Abe also failed to offer detailed explanations of his actions or what he knew at the time, acting as if he were unaccountable.

Wednesday’s ruling has been interpreted as a defense not only of Abe, but also of other doctors without accountability, increasing the risk that another drug-induced disaster will occur, Hama said.

The main focus of the trial was whether Abe had acknowledged the high risk of unheated blood products when they were injected into the patient in May and June 1985 by a subordinate.

Kiyohiko Katahira, an associate professor of pharmacology at Tokyo Medical and Dental University, said Abe knew of the risk by summer 1983 but his basic stance on the agents remained unchanged, judging from theses Abe released and remarks he made.

Abe voiced strong concerns over the possible risk of infection as early as June 1983. In taped comments made at a meeting of the then Health and Welfare Ministry’s panel on AIDS, Abe said, “I inject (the medicine) every day thinking there is toxic substance in it.”

But he also said on other occasions that being infected with HIV did not necessarily mean a person would develop AIDS, claiming only a small number of those with the infection would develop the immunodeficiency syndrome.

Katahira, another leading researcher on drug-induced disasters who has written a number of books on the issue, said that even if Abe had thought only a tiny segment of those infected would develop AIDS, he should have tried to minimize the disaster.

“Abe had knowledge and was the head of the AIDS panel,” Katahira said. “He was in a position to minimize (the disaster) by proposing the use of (the safer alternative) cryoprecipitate to replace the dangerous drugs.”

Cryoprecipitate, which was used before unheated blood products were developed, was made from domestically donated blood, and thus considered a safer alternative but with some inconvenience.

However, it is a matter of debate whether Teikyo’s policy to use unheated blood products in treatment was thoughtless and irresponsible when compared with the practices of other medical institutions both in Japan and abroad at the time.

Unheated blood products were considered dream drugs when they were developed and were enthusiastically welcomed by doctors and patients. The drugs were used by most industrialized countries where people or governments were rich enough to buy them.

Consequently, a large number of hemophiliacs in those countries, with the exception of a few nations, including Norway and Belgium, were infected with the virus.

Prosecutors said Abe was aware of the risk of unheated blood products by autumn 1984 because Robert Gallo, a researcher on HIV at the U.S. National Institute of Health, had informed him in September 1984 that 23 of 48 hemophiliacs given such products at Teikyo University Hospital had tested positive for the AIDS-causing virus. In other words, they had antibodies.

In hindsight, current knowledge of HIV infection and AIDS shows the results of the test were a portent of serious consequences.

But in light of AIDS-related knowledge at the time, it is not clear that the consequences of the test results could be properly gauged in the mid-1980s.

Given that antibodies are developed to defend against viruses in cases of vaccinations, it would not be appropriate to assert that Abe allowed his subordinate to use unheated blood products even though he was aware of the fatal consequences they posed to his patients.

It was also learned at a later stage of Abe’s trial that prosecutors hid important accounts made by Gallo, who was a world-leading scholar on the AIDS-causing virus at the time.

According to Abe’s lawyer, Gallo told prosecutors that there was confusion among American public health experts about what it meant when a person tested positive for HIV. Other world experts made similar remarks.

It had been widely anticipated that the court would find Abe guilty in light of the surge of public anger toward him. The sentiment prompted a number of media organs, including major newspapers, to cast him as a murderer who killed some 500 hemophiliacs who died of AIDS.

It is understandable that relatives of the deceased and HIV-infected hemophiliacs are greatly disappointed with the ruling. And it is obvious that Abe bears huge moral and social responsibility for the HIV disaster. But it may not mean that criminal punishment is appropriate.