New Scientist - "Blood doesn't always save lives"

by Zico 7 Replies latest watchtower medical

  • Zico

    I got sent a .pdf copy via e-mail today about blood transfusions that's causing a lot of excitement among local JWs. It was one of those 'Look, Scientists say we're right' e-mails. It was in the April 2008 issue of New Scientist magazine. I think this might end up doing the rounds in the JW community, and I can also see it being quoted in a Watchtower, so I thought I'd post it here. If anyone wants the original .pdf, if you PM me your e-mail, I can send it to you.

    Here's what New Scientist have to say:

    An act of faith in the operating room

    BLOOD transfusions have been a constant of medicine for almost a century. They are used to treat not only patients who have lost a lot of blood in a traumatic accident, but also those who are critically ill or undergoing major surgery. So it is a shock to learn that the technique frequently does more harm than good. A series of studies suggest it may increase the risk of death in all but the most serious cases of anaemia and people suffering a catastrophic loss of blood (see page 8). It appears this damage is done not by infectious agents in the transfused blood but by the blood itself - possibly because of chemical changes that have a deleterious effect on the recipient's immune system. The precise mechanism is still unclear, and every effort should be made to uncover it so that surgeons can be made aware of all the risks involved. At first glance it seems astonishing that a technique used so widely for so long could be doing such harm. Yet many surgeons have proved reluctant to submit their methods to systematic study. They have tended to put their trust in the fact that their procedures have been practised for years and appear to work. The lesson is clear. Surgeons must bring science to bear to ensure their techniques really are having the desired effect. The revelations about the dangers of blood transfusions are a stark reminder that in medicine there is no substitute for evidence.

    Blood doesn't always save lives
    Transfusions can be a lifeline, but concerns are growing that they can sometimes be harmful too


    "FOR the life of the flesh is in the blood. No soul of you shall eat blood." So says the Bible's book of Leviticus, and it is for this reason that Jehovah's Witnesses shun blood transfusions. They do not, however, shun surgery. As long as surgeons use special techniques, Jehovah's Witnesses can have surgery - including operations with the greatest potential for blood loss, such as open-heart surgery - without ever receiving a drop of someone else's blood.
    Now some surgeons and anaesthetists are questioning whether every patient shouldn't get the same treatment. Over the past decade a number of studies have found that, far from saving lives, blood transfusions can actually harm many patients.
    The problem is not the muchpublicised risk of blood-borne infectious agents, such as HIV, but the blood itself. Study after study has shown that transfusions, particularly those containing redblood cells, are linked to higher death rates in patients who have had a heart attack, undergone heart surgery, or who are in critical care. The exact nature of the link is uncertain, but it seems likely that chemical changes in ageing blood, their impact on the immune system, and the blood's ability to deliver oxygen are key.
    In fact, most experts now agree that the risk posed by the transfused blood itself is far greater than that of a blood-borne infection. "Probably 40 to 60 percent of blood transfusions are not good for the patients," says Bruce Spiess, a cardiac anaesihesiologist at Virginia Commonwealth University in Richmond.
    Such claims have led this week to the US National Institutes of Health issuing a call for proposals to study the problem Also this week, the Joint Commission in Chicago, which accredits US hospitals, is holding the first of several meetings to look for ways to reduce the risks. It is expected to at least conclude that hospitals should be more selective in the use of transfusions.
    Blood transfusion became a mainstay of medicine during the two world wars, where it was used as a last resort to save soldiers who had suffered massive blood loss. But now, far from being restricted to catastrophic bleeding, transfusions are routinely used as an optional treatment, most commonly for patients in intensive care or undergoing major surgery. In these situations, mostly small volumes of red cells are transfused, usually after they have beer stored at 4 °C for anything up to 42 days.
    The rationale behind such blood transfusions seems incontrovertible. Red cells deliver vital oxygen to tissues, and seriously ill patients who are also anaemic fare less well, so a transfusion should help. Those assumptions went untested for the better part of a century.
    Things started to change in 1999 with a randomised controlled trial on 838 critical care patients in Canada that used haemoglobin levels to determine when a blood transfusion was given. Normal levels of haemoglobin, the oxygen-carrying protein in red cells, range from 120 to 170 grams per litre. A normal haematocrit - the proportion of red cells in the blood - ranges from 36 to 50 percent. Doctors decide whether to give a transfusion based on a number of factors, including haemoglobin levels and haematocrit, and the patient's overall robustness. Many guidelines exist, and practice varies from one hospital or doctor to another, but it is common for patients to receive transfusions when their haemoglobin dips to between 70 and 100 g/1 or their haematocrit to 21 to 30 per cent.
    But the Canadian study found significantly fewer patients died in hospital, 22 versus 28 per cent, if they received transfusions only when their haemoglobin fell below 70 g/1 rather than when it fell below 100 g/1.
    A more recent study has found that in heart attack patients withhacmatocrits of over 25 per cent, a transfusion is associated with more than three times the risk of death or a second heart attack within 30 days compared with not having a transfusion (Journal of the American Medical Association, vol 292, p 1555).
    For almost 9000 patients who had heart surgery in the UK between 1996 and 2003, receiving a red cell transfusion was associated with three limes the risk of dying in the following year and an almost sixfold risk of dying within 30 days of surgery compared with not receiving one. Transfusions were also associated with more infections and higher incidences of stroke, heart attack and kidney failure-complications usually linked to a lack of oxygen in body tissues (Circulation, vol 116, p 2544).
    "There is virtually no high quality study in surgery, or intensive or acule care - outside of when you are bleeding to death - that shows that blood transfusion is beneficial, and many that show it is bad for you," says Gavin Murphy, a cardiac surgeon at the Bristol Heart Instiiuie, who ran the UK study.
    Organisations such as the American Society of Anaesthesiologiscs have started recommending that doctors be more conservative about ordering transfusions. But many experts worry that the recommendations are being ignored, and don't go far enough. Transfusion, they say, should only be used as a last resort, and far greater effort should go into preventing blood loss in the first place and ensuring patients are not anaemic before surgery (see "Bloodless surgery').
    "Usually when there is any clinical uncertainty about a treatment you don't give it, but with transfusions we do," says James Isbister of the Royal North Shore Hospital in Sydney, who is an adviser to the Australian Red Cross Blood Service.
    A priority is to find out how transfusions can be harmful. One possibility is that they affect the patient's immune system. Blood transfusions are typically teeming with cytokines - chemicals that modify immune cells - and both the cytokines and white blood cells in donated blood have been shown 10 affect the action of "recipient" immune cells in the lab. Before modern immunosuppressant drugs were developed, blood transfusions were sometimes used to achieve immunosuppression during kidney transplants.
    Several of the recent studies have found an association between contracting infections in hospital and transfusions, which seems to support the theory. "The more units of blood patients receive, the more likely they are to get infections," says Mary Rogers at the University of Michigan in Ann Arbor, who has studied transfusions in US heart surgery patients.
    Infections are not the whole story, however. Within hours of being collected, red cells become stiff, making them less able to squeeze into narrow capillaries - essential if they are to deliver oxygen to organs. The changes are triggered in part by white cells, although it is not known how they might do this. Blood banks in the UK routinely filter blood to remove any white cells, something which is not done everywhere in the US or Australia. Chemical changes also take place that limit the ability of red cells to deliver oxygen to the tissues. For example, levels of nitric oxide (NO), which signals blood vessels to open, drop dramatically within a day of collection. "We are now working on the best way to put NO back into blood on a large scale," says Jonathan Stamler of Duke University in North Carolina.
    Another study, published last month, suggescs the longer red cells are stored, the poorer their quality (The New England Journal of Medicine, vol 358, p 1229). It found patients who received blood more than two weeks old were almost 70 per cent more likely to die within a year than those who got newer blood.
    "If all blood had to be used within two weeks, it would cause a major inventory problem," says Isbister, adding that the finding highlights the need to look for better ways to store blood. Just as important is the need for clinical trials to work out who benefits from transfusions and who doesn't. "We need 60 or 70 randomised clinical trials right now," says Spiess.
    But people should not stop donating blood, stress experts. "Transfusion is critical in several situations such as severe haemorrhage. We also need blood for essential products such as antibodies and clotting factors for people with haemophilia," says Isbister.


    "Reduce, reuse, recycle" is usually a mantra for the environment, but it applies to "bloodless surgery" too.
    It was originally developed to enable Jehovah's Witnesses, who shun transfusions, to undergo major surgery. But as safety concerns have spread so has its use. It may involve little more than treating any anaemia prior to surgery, reducing the blood taken for tests, and meticulous surgery. "Most general surgery patients who receive a transfusion get one or two units of blood. With careful surgery you can avoid losing that amount in the first place," says Nicolas iabbour at the Baptist Medical Center in Oklahoma City.
    Special techniques can also be used. For example, at the New Jersey Institute for the Advancement of Bloodless Medicine and Surgery at Engiewood Hospital, patients who have lost a lot of blood may spend time in a hyperbaric chamber after surgery in an attempt to load their remaining red cells with oxygen. More commonly, during or after surgery, spilt blood is collected, cleaned and reinfused. The process has the disadvantage that it removes proteins that stimulate clotting and is also unacceptable to some Jehovah's Witnesses. An alternative is to remove some blood before surgery and replace it with saline or another fluid. After surgery, the patient's blood is returned.
    Bloodless surgery works, suggests a 2006 study comparing 49 Jehovah's Witnesses and 196 non-Jehovah's Witnesses undergoing cardiac surgery, which found comparable death rates during surgery [The American Journal of Cardiology, vol 98, p 1223).

  • 10p

    I subscrive to the mag, just got mine in the mail yesterday

    I really hope this sort of evidence keeps coming and makes transfusions a thing of the past in most instances.

    For all the obvious reasons, blood transfusions are not an ideal treatment for anything other than major blood loss. Use of blood components would probably still continue for a long time, but its still better to find a cure for haemophilia.

    On a JW level too ... it would be good to have this whole issue reduced to a minor thing. Lets face it, those who died from not having a transfusion still died. They might have not fared as well as someone who didn't have a xfusion who LIVED, but when you've died, you're just as badly off as anyone else who died! On the other hand, there are certainly cases of witnesses who didn't have blood who might otherwise have, who DID fare better than their counterparts.

    Of course, JWs refuse to store their own blood prior to surgery, which would help in a lot of cases, and they dont donate blood whilst using the general bloody supply for 'fractions'. They're still immoral.

    So as far as blood goes, the JWs have been about 80% correct. I've always felt this way anyway - the science has always pointed this way, just surgeons have been slow to follow science. I find it remarkable that there was an item on the news the other night about how there is this big trial going on in New Zealand to use a checklist in surgery. WTF? I thought that would have been the case 100 years ago!!! HEll, they use a checklist to check my car for road worthiness every 6 months - how come they haven't been using a checklist in surgery? I think its time for surgeons to realise they are not gods, and to get their god-complex deflated a little. OF course, there are some nice surgeons out there. I haven't met one yet.

  • glenster

    Most important uses of blood/blood fractions have long been matters outside
    the operating room, and the JWs leaders' have long played prophet badly in re-
    quiring agreement with their scriptural stance.

    What I have on it is on pp.12-42 of GTJ Brooklyn:

  • Elsewhere

    Articles like that tend to kill more people than they save and promote opinions based more on personal opinion and ignorance than hard facts and science.

    • Antibiotics don't always work and can breed super-bugs... shall we abandon them too?
    • X-Rays do not always allow a Dr. to diagnose and expose people to cancer causing radiation... shall we abandon that too?
    • Chemotherapy causes severe illness, even death... shall we abandon that too?
    • Flu shots don't always work and actually kill about 1 in a million people... shall we abandon that too?
    • Ambulances can crash and kill people... shall we abandon them too?
  • Warlock
    Articles like that tend to kill more people than they save and promote opinions based more on personal opinion and ignorance than hard facts and science.

    According to who?


  • skeeter1

    I think the Watchtower had a hand in seeing that this story is written.

    The Watchtower is trying desparately to undue the damage caused by the media stories of JW's losing their lives. The Watcthower also has several key cases in court (including one at the Canadian Supreme Court), and they are trying desparately to make their position look reasonable.

    The fact is that the Watchtower's "no blood" is not good medicine. In the Sextuplet case, the Watchtower could only get two experts to testify that these kids did not need blood. Guess what? Both experts were "friendly" with their local Kingdom Halls, even attending Memorial serivces. The Watchtower could not get a Harvard scientist to back its claim.

    In the Irish case of the woman who was transfused against her wishes, the Watchtower just lost. There, the Watchtower got 3 experts to testify about the woman's medical condition. Guess what? All 3 experts said that it was medically necessary for the woman to get the transfusions & would have given her the blood transfusions if she was not a JW. The reason was that she could easily start bleeding again, and she was already too low on blood. In her case, she lost anywhere between 50-75% of her blood and was down to a 5.1 in her blood level (normal is 12.0 - 15.0).

    Now, I will address the article above.

    I take issue with the New Scientise. It is all "pie in the sky". The article says that doctors are too quick to order blood, and should wait until a patient has a lower blood number. The article fails to tell the reader what the current transfusion guidelines are and what the author of New Scientist thinks they should be. The article does not say at what blood level a blood transfusion should be given to a healthy patient, versus an elderly patient, versus a newbornd. What are the chances a health person with a 5.1 hemoglobin will survive? Is it 10%? The New Scientist is very "unscientific" as it does not give set values. To a JW, this is a death "roll of the dice" as to how low to go.

    Further, the New Scientist gives no hard number on AIDS/HIV, hepatitus, etc. What are the exact risks? AIDS is 1 in several million according to the Red Cross. This article makes blood look scarier than it is.

    The article is also adrift on infections. Since there are infections that can occur, what about giving antibiotics to treat the infections? What is the success rate once antibiotics are given to the patient?

    The New Scientist article is very similar to the "How Can Blood Save Your Life?" booklet by the Watchtower Society. Apostate attorney Kerry Louderback-Wood purblished a legal paper that beat up on this booklet's medical misinformation.

    Courts realize that JWs are operating under medical misinformation. In the Irish courtcase, the dying woman wanted tomatoes and Coca-Cola as a blood substitue. On the stand, a JW testified that other JWs realize the health benefits of tomatoes and Coca-Cola for building up one's blood. In part, the Irish High Court stated that the JW could not give consent, as she could not process information as to her dire situation. In other words, she refused to see that she would eaily die without a blood transfusion. Becuase her mind was so colored (proven by the crazy tomatoe request), the court said she did not give "informed consent".

    In Bethany Hughes, Bethany was given arsenic instead of blood.

    Enough said.


  • BluesBrother

    I have read enough conflicting opinion among medical "experts" to make me want to decline blood treatment in all but an imminantly life threatening situation

  • 10p
    I have read enough conflicting opinion among medical "experts" to make me want to decline blood treatment in all but an imminantly life threatening situation


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