For months Mr Komatsu (not his real name) had been injecting himself with daily doses of clotting agent. Sometime between 1983 and 1985, his doctor informed him, one of these bottles had been infected with the HIV virus. At the age of 35, he was facing a death sentence.
Eleven years on, Mr Komatsu shows no symptoms of full-blown Aids, but his immunity is declining by the month and he knows time is not on his side. Two out of every five haemophiliacs in Japan - some 1,800 people - are infected with the virus; every five days, somewhere in the country, one of them dies of Aids-related diseases. It is a story of institutionalised greed and betrayal - by the Japanese government, by drug companies and by individual doctors.
The facts of the case are simple enough. In March 1983, the US Centres for Disease Control in Atlanta officially announced what had been suspected for months: that supplies of clotting agents, each dose blended from the blood of as many as 25,000 American donors, were infected with HIV. In the same year, it licensed the sale of blood plasma that had undergone a heat-treatment to eliminate the virus.
Rumours spread to Japan, whose own supplies of coagulant were blended by domestic pharmaceutical companies from American blood. In 1982, as head of the Tokyo Haemophiliacs Association, Mr Komatsu attended a meeting addressed by Japanese blood specialists.
"One of our members asked a doctor if it was possible to get Aids from blood products," he remembers. "He told us Aids was a disease of homosexuals, and had nothing to do with haemophiliacs whatsoever.''Also at the meeting was Takeshi Abe, a 79-year-old professor, who has become the chief villain in the piece. Dr Abe was the chief adviser to the Health and Welfare Ministry and to him fell the task of assessing the risks of imported blood. And, to patients, doctors and ministry employers, he insisted repeatedly that the blood products presented no risk. It was not until August 1985 that heat-treated blood was approved in Japan, 28 months after the US decision.
It was during this period that the haemophiliacs were infected. Similar tragedies occurred all over the world. But in Japan, a characteristic combination of arrogance, bureaucratic inertia and conspiratorial secrecy made the situation much worse. For a start, many of those who tested positive were not informed. Mr Komatsu believes his wife was put at risk for two years while his doctors mustered the courage to tell him of his condition. She remains uninfected, but others were not so lucky: three out of a group of 218 haemophiliacs suing the government in Tokyo passed the virus to their spouses.
As an expert in the field, it seems inconceivable that Dr Abe learnt of the risks so much later than the American doctors, but the official line was that the Health Ministry did all it could based on the information it had at the time. But as early as 1984, it has now been revealed, Dr Abe found that half of his 48 haemophilia patients were HIV-positive; tapes of meetings, leaked to journalists, record officials blithely discussing the likelihood of infected blood in Japan even while publicly denying its existence.
This month, the Health Minister, Naoto Kan, finally came clean. "The ministry and the government are responsible for everything," he told a group of haemophiliacs and their lawyers. "I apologise for inflicting serious damage to people who have no reason to suffer.''
But how did such a scandal come about? Much of it has to do with the culture of medicine in Japan, where doctors are regarded as sensei,"masters" whose authority is seldom called into question. Further, sufferers of infectious diseases, particularly one with the associations of Aids, often experience discrimination. But there are more mundane explanations. As well as prescribing them, doctors sell drugs to their patients, at a profit.
At the time that other countries were switching to heated blood, the process had not been mastered by Japanese companies. As a result, not only was the safe blood more expensive, but it was only available from foreign suppliers. To have licensed its use before domestic firms had set up production would have significantly affected market share. One drug company, Green Cross, was a major donor to a foundation headed by Dr Abe. Five of its senior executives are former ministry bureaucrats.
Only one group had anything to gain from a quick decision to switch to the safe blood - the patients. Five hundred have died; the rest face months or years of wrangling over settlements. But one thing has been established: they were in the right, the establishment was in the wrong. "I didn't cry when the doctor told me," says Mr Komatsu. "I have never cried in court. But when the Health Minister apologised, for the first time tears came out of my eyes.''Reuse content