New Article on Bloodless Medicine

by Lee Elder 15 Replies latest watchtower medical

  • Lee Elder
    Lee Elder

    Here is a good article on bloodless medicine. I have weighed in with my thoughts, and encourage others to do the same:

  • LV101

    Interesting -- thanks and appreciate your opinion/reply.

  • smiddy3

    An interesting article Lee and I agree with your observation/comment and it is my belief that the patient is under pressure to involve the liasion committee in any decision they make.

    In other words they are co-erced to follow WT/JW beliefs in the matter

  • Fisherman

    Thank you for the link.

  • steve2

    Perhaps a shade too bland about the limits and the risks of bloodless surgery. I notice it skirts around the dangers of child birth in more complicated cases where blood is critical.

    Moreover, OrphanCrow would have something to say about the claimed survival rates of JWs in the study cited. Little wonder the survival rates were high because the bloodless procedures were for elective surgery where preparation is paramount .

    No comment about the increased risk of death when massive blood loss occurs and blood refusal continues. The dice against JWs occurs most tellingly in Emergency Medicine. Sure the article was not looking at this aspect but needed to include at least footnoted references about a less favorable outcome in the area of Accident and Emergency.

  • OrphanCrow

    Yes, Lee, this does seem to have the appearance of being a "good article".

    I spent some time trying to track down the authors and trying to figure out why the article was written in the first place.

    A couple things seem a bit "off" to me.

    First, the little plug at the end of the article says this:

    This study, Treatment of individuals who cannot receive blood products for religious or other reasons was recently published by Carlton D. Scharman, Joseph J. Shatzel, Thomas G. DeLoughery in the American Journal of Hematology.

    The medical doctors who are purported to have authored this article, would and should know that this article is not a study, isn't even close to being a study, and it doesn't even follow proper referencing and sourcing for the material that they have presented. A doctor that is worth even a tiny bit of their salt should and would use good references. These authors didn't. They didn't reference one single tiny little bit of information that they so readily put out there for the public to lap up and consume.

    I am going to bet money on this (if anybody wants to take me up on it and if they are okay with a tiny little bet just cause I am poor) and I am going to take a "shot in the dark" and say that this is a fluff piece generated by Jehovah's Witnesses themselves who have a special interest in the world of "bloodless medicine". JWs are notorious, especially in the world of blood, for soliciting the propaganda surrounding their medical investments

    Moreover, OrphanCrow would have something to say about the claimed survival rates of JWs in the study cited. Little wonder the survival rates were high because the bloodless procedures were for elective surgery where preparation is paramount .

    Okay, Steve, I will say something. What I can say about the "study cited" is that the study isn't cited at all. Not one citation in the whole article. What I can say about the "study cited" is absolutely nothing at all. The "doctors" who wrote this article didn't bother to cite anything - they just threw stuff out there and expected the reader to accept whatever they are writing. Good writing that offers solid information does not take that approach.

    You are correct in that so-called "bloodless surgeries" conducted on JWs are done on patients who are in better health than those who undergo conventional surgery. That is a known fact.

    Here is something else that is a red-flag to me when reading this article. Not once do the authors talk about any of the risks or side effects of so-called "bloodless medicine"

    And another thing (this is actually the biggest 'thing' that gets my attention...)

    Does anyone remember that court case a few months back where the court was unconvinced that "bloodless medicine" and/or "bloodless surgery" even existed? In fact, the court decided that the use of those terms was meaningless and that the field of "bloodless medicine" didn't even exist.

    That last point is the final straw that makes me take the position that this article has been generated by JWs who have a special interest in keeping the bloodless myth alive when it is actually dead in the water

  • OrphanCrow

    (Sheesh, I always feel bad after being critical of others' writings)

    I will offer a couple counterpoints to what I critiqued in my previous post.

    The authors of the article in the OP say this about low HB levels:

    Although the minimum hemoglobin level required to sustain life is unclear, a study of Jehovah’s Witnesses who declined blood products after surgery showed that some patients were able to survive with the lowest hemoglobin of 2.1–3.0 grams per deciliter, which is approximately 15-25% of normal. This suggests that even in the setting of profound blood loss, transfusions are not the only option for survival.

    Note that no citation was offered for the profound "suggestion" that they offered. None. No citation. Just a "suggestion" based on a study that they didn't cite.

    Then there is this which comes from an interview with Kaaron Benson, a doctor who has treated JWs with cancer:

    Other groups of researchers have looked at larger patient populations. One study, which was reported in 2002 in Transfusion, looked at more than 2000 surgical patients with postoperative hemoglobin levels of 8 g/dL or lower who had declined red blood cell transfusions for religious reasons. This study found that as the hemoglobin level fell to 7 g/dL or lower, the adjusted risk increased 2.5-fold for every 1 g/dL decrease. When the hemoglobin level fell to 3 g/dL or lower, the in-hospital mortality at 1 month was 64%. This study did not find any immediate adverse effects as long as the patients’ hemoglobin level was greater than 7 g/dL.

    and then, at the end of the article, we find the citation for the above quote:

    Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion. 2002;42(7):812-818.

    Now, let's take a quick look at what the authors of the OP article have to say about JWs with cancer:

    Although not associated with overt blood loss, patients with cancer can also benefit significantly from bloodless medicine. Modern-day chemotherapy can have impressive cure rates in some cancers if treated aggressively. However, this often results in chemotherapy-related side effects as well as severe anemia and low platelets, from which patients may require significant transfusions in order to survive their treatment.
    This poses a challenge in those who can potentially be cured but decline blood products, because modifications to chemotherapy (such as dose reduction), while more tolerable, may compromise the ability to attain cure; the management of these patients is extremely complex and should be considered on a case-by-case basis. In patients for whom the goal of treatment is not curative (ie, a “palliative” strategy), we recommend adjusting the chemotherapy in such a way so as to not require transfusions. Notably, small studies and case reports of Jehovah’s Witness cancer patients have reported favorable response to treatment when supplemented with aggressive supportive measures and shear tolerance of significant anemia.

    Then, let's read what a cancer specialist, Dr. Kaaron Benson, has to say about cancer treatment for JWs:

    These patients are at increased risk for morbidity and mortality caused by severe anemia and thrombocytopenia. Years ago, our hospital did a retrospective study of the 58 Jehovah’s Witness oncology patients we had seen at our hospital from October 1986 through February 1994. Of the 15 patients who had transfusion requirements, 9 refused blood. One older woman had a postoperative stroke and a young woman died, likely because of the combination of severe anemia and thrombocytopenia. Long-term prognosis also may have been affected. We did find that younger patients were more likely than older ones to accept transfusion, and parents were more likely to accept transfusion for their children than for themselves.
    We found that 10 of the 58 patients we evaluated had their treatment limited because of their refusal of blood. For example, surgery was restricted or not performed, chemotherapy was withheld or the dose was lowered, or radiation therapy was withheld because the physician did not want to create a situation in which the patient would need a blood transfusion.

  • betterdaze

    The authors are current employees of OHSU, Oregon Health & Science University, which of course has a Bloodless Surgery and Medicine program.

    Debora Burger, M.S.N, R.N. is the Patient Blood Management Program Manager. She coordinates the care of patients requesting bloodless surgery or medicine.

    Debbie Burger, R.N.

    Patient Blood Management Coordinator

    Phone: 503 494-5024

    [email protected]

    Scharman’s email: [email protected]

    Shatzel goes by @Clotmaster on Twitter.

    DeLoughery goes by @Bloodman.

  • steve2

    Thanks OrphanCrow - you add compelling substance to my comments. I see what you mean: No actual studies were cited. It does appear to be a fluff piece that is probably written by pro-JW organization interests and/or will be added to JW organization's loaded arsenal of "research" (cough, splutter) against conventional medicine.

    One final point I could make concerns the costs of bloodless procedures:

    They are extremely costly compared to blood-based procedures. Of course, cost is not at all the most salient argument "against" bloodless surgery - but it needs to be elevated for consideration, especially when those who oppose transfusions at times expect nonblood procedures to be available. Fair enough, but who pays?

    In medicine, cost crucially matters - and, in my view, if a patient's religious beliefs are a barrier to more conventional procedures (whose costs are comparatively lower), then who bears the additional costs of the treatment the patient elects to have? An ethical and philosophical question I won't attempt to address here.

  • Fisherman

    What I have seen across the US is no blood treatment advocacy by major hospitals. Just recently, I visited a major hospital and flashing on the computer screens of some of the doctors I noticed: No blood treatment flashing and it said something about making it the standard of care.

Share this