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Counsel continued with their presentation about the Newcastle Haemophilia Centre. In Dr Jones’s testimony to the Lindsay Inquiry, in regards to treatment used, Cryoprecipitate was considered safest and the NHS product was considered the next safest, due to population pool.

Dr Jones said his policy adopted in the 1970s and remained even after 1983 was for young children to be treated with Cryoprecipitate, this would be changed to Concentrate for severe hemophiliacs at 6 years old. The youngest child to become infected in Newcastle was 7. Counsel suggested this could suggest the result of transferring from Cryoprecipitate at around this age. The Newcastle experience seemed to be that those on Cryoprecipitate did not develop AIDS.

In Dr Jones’s statement to the Inquiry on product decisions, he noted this would be decided at a meeting with the Co-Director, a member of nursing staff, pharmacy staff and a patient representative. They would choose products taking regard to safety, efficacy, availability and price. Evidence to the Inquiry does not show any policy of sticking to one brand of concentrate, a range of commercial concentrates were received by patients.

In a 1974 book by Dr Jones he mentioned the risk of Serum Hepatitis. The cause of Jaundice was mentioned with reference to Hepatitis B. In 1975, Newcastle had 16 cases of Jaundice over the previous 18 months in haemophiliacs. It was said by Dr Jones that the benefits of treatment outweighed risk of infection. Dr Jones wrote an article for the Haemophilia Society Northumbria Newsletter in 1976 regarding concern from the World in Action documentary. He claimed the documentary dramatised the actual danger of Hepatitis. In testimony for Lindsay, when asked what information he would give patients in 1983, he said he would give relevant information; he said everyone was aware of Hepatitis, patients were aware of side effects and he referred to the World in Action programme. Sir Brian noted that here he is regarding the programme as a source of information, whereas in his article he seemed to be saying not to listen to the media.

In 1979 for the World Congregation in Haemophilia in Tel Aviv, Dr Jones spoke on whether chronic hepatic damage was an expected side effect from haemophilia treatment. He said risks in all multitransfused haemophiliacs must be followed closely. However, there had not been an increase in death rate from liver failure, and although the answer may only become clearer in time, the risks seem to be outweighed by the need to treat patients. Counsel suggested this raises an ethical question of whose decision this should be. At a 1998 Seminar, Dr Jones said from the beginning with concentrates they knew they were transferring disease. They knew of Hepatitis B and later of the Non-a  Non-b Hepatitis (Hepatitis C), but did not think it would result in a devastating disease that would kill more than a few people. He said they did not know about HIV or AIDS for years. In a witness statement to the Inquiry, Dr Jones said his knowledge of Hepatitis C and the risks grew over time. Dr Hamilton said in his statement, in 1978, there was a small change of Hepatitis B transmission. Non-a, Non-b transmission did occur, but was understood to not have significant side effects. Sister Fierns said in her statement that she first became aware of Hepatitis C in the 1970s and did not think at first it was life threatening. She also said information on the boxes of treatment would state the size of the donor pool, the pool was larger for commercial products. She later realised in hindsight that the greater the pool, the greater the risk of infection. Counsel questioned that if a nurse specialist did not realise this link, would patients?

In the 1998 seminar, Dr Jones said they realised they may have a problem with HIV when the first description of cases became available in 1981. He thought 1 in 1000 haemophiliacs may develop AIDS, he put this aside in favour of treatment. Dr Jones or Dr Hamilton attended Reference Centres and Haemophilia Centre meetings where issues related to AIDS were discussed between 1982 and 1984. Dr Jones wrote a complaint to the Press Council about an article in The Mail, “Hospitals using Killer Blood ” for sensationalising the issue with a lack of proof. In a December 1983 BMJ article, Dr Jones wrote of the risk of AIDS and Hepatitis for hemophiliacs. In the article, he also regarded the dramatic increase of life expectancy for haemophiliacs which he claimed to be entirely due to Factor VIII. However, Counsel noted as shown in evidence from yesterday, he once made a similar claim about Cryoprecipitate. In the Penrose Inquiry evidence Dr Boulton spoke of Dr Jones, saying he believed Dr Jones and others were reluctant in drawing too much of a conclusion about AIDS that would significantly reduce the amount of therapy they could give to their patients.

In Dr Jones’s statement to the Inquiry on what action was done to reduce risk of HIV to patients, he said heat treatment was used when it became available. He also reserved Cryoprecipitate for children and claimed they cut off non-urgent surgery for a time. Dr Jones claimed that patients were always told exactly what the state of knowledge was at the time of their consultation. This is not in line with evidence that has been given in witness statements from patients who claim they were not given such information.

The introduction of heat-treated products was sought by Dr Jones for Newcastle as evidenced in correspondence in November 1984. The three pharmaceutical companies agreed to take back the non-heat treated products as well as sending the treated products. However, in a meeting with patients in December, it was advised to use up the products they had at home, despite the recall. A letter to Centre Directors on December 13th showed Dr Jones’s concern of contamination of NHS products due to cases in Edinburgh and evidence of at least two batches of Elstree concentrate being contaminated. Dr Jones’s statement for the Lindsay tribunal said testing for HTLV III began at the end of 1984. The results by May showed that of 143 multitransfused patients, 99 were positive. When asked how patients were told, Dr Jones said it depended on the patient, the maximum time would be at their next routine visit in 3 months.

Counsel also discussed how in 1986 Dr Jones raised concerns about heat-treated Armour products. A memo between Dr Smithers and Dr Harris in February referred to Dr Jones being reprimanded by the Chief Medical Officer for raising his concern at a conference causing public fear. Dr Jones wrote to the Committee of Medicines on multiple occasions about his concerns. Dr Jones’s concerns were proved correct as it was confirmed heat-treated Armour products had transmitted HIV.

Counsel stated they still had more they wished to present about the Newcastle Haemophilia Centre and it was agreed that the Newcastle presentation will continue on Tuesday 9th February at 2.15pm.

 

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