The resurgence of justifiable anger surrounding the devastating impact on so many lives caused by contaminated blood given to NHS patients (Contaminated blood victims urge mass tests to save lives, 30 April) raises questions that go beyond the immediate demands for better screening and increased compensation to victims. In 1970, Richard Titmuss, Britain’s leading commentator on social policy at the time, published the book for which he is best remembered, The Gift Relationship, demonstrating conclusively that the British system of voluntary blood donation was superior to the American paid-for system in two crucial respects. It avoided contamination but it also reaffirmed, on a personal level, the collective duty of care to strangers on which the NHS was founded. The fact that the blood at the centre of the current scandal was brought in from the US, some of it coming from prisoners and drug addicts, vindicates Titmuss’s argument that commercialising blood supply is a medical disaster waiting to happen. But it also raises wider questions about the onwards march of outsourcing and privatisation in the NHS. As Titmuss reminds us, when we offload our responsibilities for the welfare of others to private contractors in pursuit of profits we not only increase the risk of exploitation, malpractice and corner-cutting, we devalue the ethic of altruism as the animating principle of social relations. In the other book for which he was famous in his lifetime, The Theory of Moral Sentiments, Adam Smith, now paraded as the militant champion of free markets, made precisely this point, observing that a society “upheld by mercenary exchange according to an agreed valuation” in which “no man [sic] in it should owe any obligation” will never be in “the most comfortable state”.

Professor Graham Murdock

Loughborough

• Around 1988, I learned of people who were given contaminated factor VIII to treat their haemophilia when I did interviews for my contribution to a photography exhibition intended to bring HIV out of the shadows and open up a debate. When I did my work, I was one of the few people who was prepared to tackle a difficult subject by talking to people directly affected by the virus. Some of my subjects were not willing to be identified because of the stigma attached to having HIV. However, two of them, Henry Tennant and Gerard Healy, were generous with their time and willing to speak openly. Gerard, whom I met at the Terrence Higgins Trust, was trying to highlight this exact issue of contaminated factor VIII and how it had wrecked the lives of the recipients. So, 30 years on, why am I not surprised at the cover-up?

Anna Arnone

Eastbourne, East Sussex

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