"Basics of Blood Management" by Dr. Petra Seeber and Dr. Aryeh Shander - Inaccuracies and Myth
Hi OrphanCrow, were you aware of the following newspaper article from Western Australia, May 2014?
The article is lengthy, but here is a cut-n-paste of the start:
How two Jehovah’s Witnesses were paid millions to restrict WA blood transfusions
THE WA Department of Health has paid almost $4 million to two Jehovah’s Witnesses, neither of whom is a medical doctor, to roll out a statewide program to cut blood transfusions to thousands of patients being treated in public hospitals.
The Sunday Times can reveal the two men, Axel Hofmann and Shannon Farmer – whose religion is vehemently opposed to blood transfusions – won the lucrative five-year contract in 2008, with an American associate, without having to bid for the job...
Sherdless, yes, Shannon Farmer and Axel Hofmann (both JWs who are affiliated with the HLC) were instrumental in establishing PBM as the standard of care in Australia.
A Canadian blood bank educator had a response to that article:
News about Shannon Farmer has been really quiet since the Australian story broke. But, from what I can tell from the little that is out there online, he is still hanging on the coat tails of Axel Hofmann, who is actively involved in Austria's blood management program.
Australia's National Blood Authority (NBA), a well respected government organization that does much valuable work, appointed Shannon Farmer, a Jehovah's Witness, as the key consumer representative on a government panel developing new transfusion guidelines for Australia's hospitals. Nil inappropriate about that except Mr. Farmer didn't declare
- Formally, or otherwise it seems, that he was a Jehovah's Witness.
- His consultancy work since 2007 to an Austrian business involved in commercial tendering for patient blood management projects around the world.
- Receiving fees for consulting and lecturing from multinational pharmaceutical companies,e.g., J and J.
When informed, the NBA said it would review the details. Whether or not possible conflicting interests are of "sufficient conflict" is a moot point.
Fact is they were not declared and at the time of his appointment Farmer was described as "consumer" and "independent consumer advocate". An NBA spokesperson is quoted as saying, "The NBA believes any potential conflict of interest, real or perceived, should be declared."
So far as I can tell Shannon Farmer is not a physician nor a PhD researcher, yet:
- He's an Adjunct Research Fellow, School of Surgery, at the University of Western Australia, where he's listed as an author on multi-authored papers about blood.
- LinkedIn shows he's an Adjunct Senior Research Fellow Centre for Population Health Research, Curtin University.
- He's lectured extensively on bloodless surgery and blood conservation.
- He's apparently an expert on transfusion medicine.
Yet it's hard to discover which degrees he has, where he went to school, or any of the normal qualifications of someone who's an author, lecturer, and expert on TM, with university appointments.
And none of the above profiles even hint that he's consulted for years to Austria's 'Medicine and Economics' business involved in commercial patient blood management projects globally.
How can you not know that someone you appoint to panels developing national blood transfusion guidelines is a member of a religion that forbids transfusion and earns big bucks implementing blood management programs internationally? How can you say, when information comes to light, 'These aren't sufficient conflicts'?
Isn't this equivalent to someone being appointed to a government panel on the future of private laboratories in Alberta (Canada, UK, you name it)
- Who is a member of a political party whose policies are pro-private medicine (pro-private everything)?
- Who consults for (perhaps partially owns) a private laboratory consortium bidding for government contracts?
Sorry, the non-physician Jehovah's Witness as TM expert and global blood management consultant who advises on transfusion guidelines, didn't declare potential conflicts, makes millions off blood management, and was initially listed as a consumer and consumer advocate doesn't meet the sniff test.
Or...he's a fine fellow, does good work, and the NBA thinks it's okay that he didn't declare potential conflicts, despite their policies, because the conflicts are not serious ones?
The Australian journalists who wrote the original article that exposed Farmer and Hoffman received an award for their work:
Cathy Saunders and Martin Saxon won the award for Best Print/Text News Report for their Sunday Times story “Blood & Money”
....here information that what I hope fits to the overall image, it originates from a polish article "Surgery in J.W. our experiences" and after a long extensive discussion (read & click on the link) concludes that
"We found that abdominal surgeries in our small group of Jehovah's Witnesses patients were safe. However, two of our female patients agreed to blood transfusion in a “life or death” situation after serious discussion with them. The first woman was a middle-aged mother and the second older female patient underwent major abdominal surgery and developed postoperative complications.
In the section "Discussion" following is stated about the mentioned reports:
In 1977, Ott and Cooley reported on 542 cardiovascular operations ...
= report: https://www.ncbi.nlm.nih.gov/pubmed/302345 (link added by me)
performed on Jehovah's Witnesses without blood transfusion and concluded that this procedure could be done “with acceptably low risk”. He (who?) also did a statistical review of 1,026 operations (REVIEW not REPORT is this relevant?) and determined that the risk of surgery in patients of the Jehovah's Witness group was not substantially higher than for others [6, 13]. Similarly, DeBakey communicated that in the vast majority of situations involving Witnesses, the risk of operation without the use of blood transfusions was no greater than in those patients on whom he used blood transfusions . Jassar et al. developed a comprehensive multimodality programme for Jehovah's Witness patients and obtained excellent results in cardiac surgery. Based on their 10-year experience, they reported that bloodless cardiac surgery in Jehovah's Witness patients could be performed with excellent outcomes in both elective and urgent situations. Major complication rates were not significantly different between the elective group and the urgent group . Similarly, Vaislic et al. reported their 21-year experience in cardiac surgery based on 500 Jehovah's Witness patients and concluded that cardiac surgery without transfusion in high-risk Jehovah's Witnesses patients could be carried out with results equivalent to those of low-risk patients thanks to recent advances in surgical techniques and blood conservation protocols .
Just a quick comment about this quote in the Polish article:
He (who?) also did a statistical review of 1,026 operations (REVIEW not REPORT is this relevant?) and determined that the risk of surgery in patients of the Jehovah's Witness group was not substantially higher than for others [6, 13]
"Who" refers to Dr. Cooley in this context. The reference is to the Dixon/Smalley article and does not cite the Colley 'review' itself:
6. Dixon JL, Smalley MG. Jehovah's Witnesses the surgical/ethical challenge. JAMA. 1981;246:2471–2.
The next quote in the Polish article also cites the Dixon/Smalley article:
Similarly, DeBakey communicated that in the vast majority of situations involving Witnesses, the risk of operation without the use of blood transfusions was no greater than in those patients on whom he used blood transfusions .
This is what theDixon/Smalley article actually said:
Similarly, Michael E. DeBakey, MD,
communicated "that in the great
majority of situations [involving Wit
nesses] the risk of operation without
the use of blood transfusions is no
greater than in those patients on
whom we use blood transfusions"
(personal communication, March
So here we have evidence that this 'evidence based' article really doesn't have evidence at all - all it has is the word of two WT men who claim that the reviews/reports said what they say the report/reviews said. That is all. Hearsay evidence.
Constructed 'evidence'. Not backed up by evidence simply because the evidence isn't accessible. We have no way whatsoever of testing those claims. We have no way of knowing what those report/reviews left out.
What is really weird about all this is that these citations have been accepted by peer reviewed journals. Nobody has challenged the Dixon/Smalley claims. Nobody has demanded proper citation and reference to original reports/reviews themselves.
I want to see those 2 reports. I want to read them for myself. I want to know the context of the conclusions and what the reports actually said. I want to see the statistical analysis. Scientific investigation demands that. Without those reports being produced, the interpretations of the WT men do not stand the rigors of scientific investigation.
Wonderofyou, I will have to spend some time reading the entire article...and chasing down the citations. Thank you for posting it.
Wonderof you....I read the study.
It has little scientific value. It is rather meaningless.
All it really said is - we operated on 16 JWs using PBM methods and 2 of them needed blood transfusions or they would have likely died. Which the patients agreed to. They got blood transfusions.
I don't get what the thrust of the study was meant for other than to say...hey, look! 14 JWs didn't need blood after these procedures.
So what? Personally, I have had seven surgical procedures and have only had a blood transfusion once. Surviving surgery without blood isn't a miracle...it happens more often than not when using conventional methods.
I don't think that this study is all that valuable. Lots of patients go through surgery using conventional methods and they don't require blood transfusions. And, they don't require their blood being drained out, stored, re-infused and diluted. Or, their blood being salvaged and run through a processor and then re-infused.
This study is simply a promotional piece for PBM with little scientific value. The only thing it really demonstrates is that PBM doesn't reduce the need for blood transfusions - two of the patients would have died without blood.
OrphanCrow - "It is a f**king gold mine..."
Seems to me that from what you've been reporting, the mine's starting to run dry.
Or am I understanding it wrong?
vidiot: Seems to me that from what you've been reporting, the mine's starting to run dry.
Or am I understanding it wrong?
Well. That depends.
BM and PBM is being adopted in various parts of the world. It has become a global enterprise with tentacles that reach into Asia, South America, Australia, Canada, the US....the list goes on and on. Not to mention the bloodless tourism industry to India - not sure how that is doing.
There has been setbacks. Various failures in the world of artificial blood. But there is a new one on the horizon that will be very interesting to watch - the new artificial blood made from stem cells. I am curious to see if the WT comes up with a spin on that one.
The biotech investment world is volatile. There is that side of it.
There is another crack showing in the PBM world. The Netherlands has been trying to de-implement PBM strategies for their orthopedic surgery for the past few years. After several years of having PBM strategies used in ortho surgery, a study was done and it was determined that there was little to no advantage to using those methods. The only strategy that appeared to have a benefit was far too costly to use. And, they found that PBM did not reduce the need for blood transfusions.*
However, if you look to countries like Austria (where Hofmann hangs out) there is a big push to put PBM into place.
So, I don't know. Time will tell...I am watching. There will always be another research project that can utilize a particular risk group. The no blood cult mentality has permeated almost every aspect of medical care around the world. The bloodless cult has long tentacles.
*there is a Dutch study online that evaluates the benefits/disadvantages of PBM in ortho surgery
What disappoints (and alarms) me about this Blood Management and Patient Blood Management is that it clearly states, in the textbook that Aryeh Shander, the PBM guru, has authored, that the principles that BM rests upon, comes from Holy Scripture.
I don't understand how something so clearly religious in nature could be adopted by the World Health Organization, an arm of the United Nations, as "the golden standard of care". For the world.
Why is a medical practice that is driven by religious beliefs being considered the best for everybody in the world?
Yes, and besides the above mentioend "basic principles" mentioned in chapter 20 "law ethics, religion and BM" of the textbook "Basics of Blood Management" there is a distinct chapter called "Jehovah's witnesses" included, simply the quote "J.W. love and cherish life", shows that this was a part written by J.W. HLC members, nobody else would write such a text.
It is therefore evidently that these parts of the scientic textbook were written mainly with the group of patients in mind which is mostly concerned - j.w. It shall be a helpf for doctors and nurses to better information about Jehovas witnesses. (?) These chapters are therefore of informational character. The inaccuracies could be inaccidently because nobody would be interested in awkward embarrasing details anyway, perhaps even neither HLC nor the authors were informed about those details about these persons you mention and they were not historians, or the HLC didnt support the two authors with accurate informations.
Concering Prof. Shander, I watched some videos with him he is a man who believes in a mission, he is a fighter against big resistance, he believes that he has a mission and that truth will vindicate in the end. (I will write later more about). It looks even like he was a J.W., how he talks and how he acts, the HLC may have influenced him and supported him in his mission, so he is now in an oneway of "missionary" combat.
I dont think that the WHO is accountable for the context of these books are has even read the content.
some pages missing
So the work is unmistakeable for J.W. promotional in the resp. chapters, but it is also the first basic frame for building up a professional system on which later other researcher can build up, and is certainly partly historically inaccurate because of ommission. But the positive effect is that the group of patients that is at present mostly concerned and daily has to cope with these procedures are for the first time explicitley addressed and have medical support.