Umbertoecho: The fact that they made a few million for their knowledge, a knowledge that does not include any true medical training........is/was a source of out rage to some. Because these men were so able to argue against blood and promote an unproven alternative, has caused many to wonder how safe this is.
And well they should wonder. Journalists from the Sunday Times asked the WA Health Department to provide data to back up the claims that blood management improved patient outcomes:
The Patient Blood Management (PBM) program has resulted in improved patient outcomes such as fewer complications, reduced length of stay, fewer infections and reduced usage of red cell blood products, the WA Health Department claims.
The Sunday Times asked the Health Department on March 28 to provide the results of patient outcomes from more than five years of PBM initiatives in WA.
The department of health provided some data:
More than five weeks later, the department provided four graphs on superficial (skin) infection rates and hospital length of stay.
There was no rationale provided to show how superficial infection rates might be caused by blood transfusions.
According to the US Centers for Disease Control and Prevention and other medical establishments, superficial infections involve the skin only.
The four graphs showed data from 2008/9 to 2012/13 in selected patients.
And what did the data actually show? Was it useful data and did it support the claims of PBM that blood management improved patient outcome? And how could that data apply when there is no causation effect from blood transfusion???
Lets' look at how the blood transfusion rate correlates to superficial infections that have nothing to do with blood transfusions:
Two graphs showed the superficial infection rates along with red cell transfusion rates in hip and knee replacement patients.
The graphs showed superficial infection rates generally went down as transfusion rates went down.
But both graphs showed superficial infection rates in one year went up as the red cell transfusion rate came down. In another year, superficial infection rates in knee replacements went down as transfusion rates went up.
And what about the length of stay on the hospital? Did that change with blood management?
The two other graphs supplied showed changes in length of stay in hip or knee replacement and heart surgery patients.
The graphs show that the length of stay was higher in patients who had a blood transfusion.
There were no data to show how blood transfusions directly affect length of stay, including whether patients who had a blood transfusion had a longer length of stay because they were sicker.
In all graphs, no actual patient numbers were given, only percentages, so it is unknown how many patients in these select groups were included in the statistics.
The department did not produce any results for “fewer complications” apart from the superficial infection rates.
The data provided is not useful - it has been correlated in ways that are inaccurate and misleading and the data is incomplete.
The “reduced usage of red cell blood products” is not a patient outcome.
The department also did not provide any data on whether patients who were refused a blood transfusion or received a restricted amount of blood under the PBM program suffered any adverse effects or were readmitted to hospital.
The main outcome reported was that there was a decreased number of blood transfusions.
There were no reported results on whether patients’ health benefited or was adversely affected by not being given a blood transfusion, or by being restricted to a single unit of blood at a time.
The article’s conclusion was that the PBM program “likely improved outcomes” by reducing patient exposure to donated blood transfusions.
Well, the claim that a patient reduces exposure to risks associated with blood transfusions is somewhat misleading. What isn't considered in that equation is the increased risks that a patient who refuses, or reduces, blood is faced with that they wouldn't have if they had simply had a blood transfusion.
The risks of not having blood transfusions are never mentioned - what about the side effects of the drug cocktails that are given to patients to build up blood to reduce the amount of blood given; what about the risks of using blood substitutes that exceed the risks of using 'real' blood'. And never forget the biggest risk of all: death.
It is obvious that the WA Health Department is considering the bottom line - the dollar. And the reduction in blood use is a measurable outcome that can be seen as dollar signs. However, what needs to be considered in the whole big equation, is not that the hospitals have a few days here and there that save money, but the many factors that are not addressed in the economic impact of using less blood.
What about the cost of the alternative drug cocktails, what about the cost of all that blood management equipment and the technicians to run the equipment? Bloodless medicine, and blood management relies on technology.
Think of it this way - with very little equipment, a blood transfusion can save a life - just a bit of tubing and a couple of hollow needles, and not much else, I can administer my own blood to somebody dying...and save their life. That was done over and over again on the battlefields before the days of blood banking. "Blood on the hoof" was cost effective. Even though it was low technology, it saved lives and the procedure still can.
Modern bloodless surgery and blood management, however, relies on technology - without the cell savers and technicians, 'bloodless' surgery does not exist except as an old, outdated, procedure practiced by chiropractors and masseuses.
It is the bloodless technology that transformed the notion of "bloodless surgery" being a non-invasive procedure to a procedure that is invasive to the extreme.
