RESPONSE TO "BLOOD
TRANFUSIONS" (#124)
(Investigator
127, 2009 July.
One paragraph is here revised.)
INTRODUCTION
Blood
Transfusions
(#124)
contains, despite being written in 1973,
better statistical comparisons of surgery survival rates with and
without blood transfusion than anything published by the Watchtower
Society (WTS).
BLOOD
Fourteen
millions units of
blood are dispensed to 4,800,000 patients in
the USA every year. (Motluk 2007)
Collected
blood is
centrifuged into layers. The top layer is yellow
plasma, rich in platelet-cells important in clotting. The bottom layer
is red cells which carry oxygen. The layers are packaged separately
because patients require different blood components and because optimal
storage temperatures and safe storage times differ for different
components.
Focus
magazine says:
A
healthy adult
has between 3.8 and 5.6 litres of blood. You can lose
up to 15 per cent of your total volume rapidly without any immediate
effects… At around 40 per cent loss, your blood pressure is too low to
refill the heart chambers and the heart goes into ventricular
tachycardia (a fast rhythm that can be fatal). (2008 March, p32)
Blood loss of 50%
is
survivable if quickly replaced with blood
alternatives (such as Ringer's Lactate mentioned in the 1973 article).
Blood alternatives don't carry oxygen; greater than 50% blood loss
leaves the body with insufficient haemoglobin to maintain life.
1960s/1970s
technology
included hyperbaric oxygen therapy. After
infusion of a blood alternative the patient was placed in a pressurized
oxygen chamber. This enhanced the gas exchange between blood and
tissues. Several JWs survived near 70% blood-loss by this method.
Some
patients, however,
lose more than 70% of their blood and require
large transfusions to survive. Westphal (2005) lists:
| Cancer |
Up
to 8 pints per week |
| Hip
replacement surgery |
Up
to 5 pints |
| Brain
surgery |
Up
to 10 pints |
| Heart
surgery |
Up
to 25 pints |
| Car
crash / gunshot injury |
Up
to 50 pints
|
Liver
Transplant
|
Up
to 100 pints |
RISKS
JWs
emphasize the "risks"
of blood transfusions. Everything, however,
has risks — even eating food since the eater may choke, suffer allergic
reaction, or be poisoned. If we try to save lives by banning food, we'd
all die from starvation! Therefore "risks" are not sufficient reason
for avoiding something. Rather, we need to consider the consequences of
various actions and estimate comparative risks.
Transfusion-transmitted
hepatitis infected hundreds of thousands in the
1970s. But those numbers have gone way down. Also in the 1970s-1980s
4670 British haemophiliacs got hepatitis-C from infected blood (1243 of
these also got HIV). By 2009 about 2000 had died. However, safeguards
against hepatitis-C and HIV were subsequently set up. The Advertiser
reported on a two-year enquiry and said: "Steps to safeguard blood
products against HIV and hepatitis C have been in place since 1985."
(2009, February 25, p10)
Westphal
(2005) lists
current risks in the USA:
| POSSIBLE
EVENT |
RISK |
| HIV
or Hepatitis C infection |
1 in
5,000,000
transfusions |
| Death
from bacterial infection or getting the wrong
blood |
1 in
700,000
" |
| Hepatitis
B infection |
1 in
100,000
" |
| Bacterial
contamination |
1 in
10,000
" |
| Breathing
problems due to immune reaction |
1 in
5,000
" |
| Mistakes
such as receiving the wrong blood |
1
in
400
" |
There's
also a small risk
of catching several other diseases —
researchers are now working on methods of stripping all viruses,
parasites and bacteria out of donated blood in one swoop.
Small
risks are acceptable
if the alternative is bleeding to death.
Westphal says: "Theoretical risks aside, blood is one of the safest
medical products around…"
ARTIFICIAL BLOOD
Artificial
blood or "blood
substitutes" carry oxygen and carbon dioxide
and in that way "substitute" for blood.
An
artificial blood called
Fluosol-DA was used on patients in 1980.
(Awake! 1980 8/8) In 1985 clinical trials stopped because Fluosol-DA:
"didn't carry enough oxygen to vital organs and didn't stay in a
person's system long enough to keep him alive until natural production
replenished red blood cells." (The Watchtower 1985 4/15)
Although
artificial blood
saved some JWs, others died. The British
newspaper The Guardian (1993, March 12) reported that Yvonne
Leighton
bled to death after childbirth although blood substitutes approved by
JWs were administered. The report quoted Dr. Arun Choudry, "I am
positive her life would have been saved if she had accepted blood."
Carlton
Johnson, 25, was
struck by a car. The Dallas Morning News
(1993, July) quoted Dr. Robert Simonson that with a blood transfusion:
"his chances of survival were pretty good…" A blood substitute was
infused but lacked the clotting factors that could stop the bleeding.
Dr. Simonson has seen 20 JWs refuse blood during his 11 years of
emergency-room service: "In most cases the patient died."
New
Scientist
reported:
Charles
Natanson of the National Institutes of Health in Bethesda,
Maryland, analysed trials of the five main blood substitutes used when
real blood was not available. He found that patients were 30 per cent
more likely to die if they received the substitutes instead of a salt
or starch solution, and nearly three times as likely to have a heart
attack… (2008, May 3, pp 6-7)
The New
Scientist
report is based on an analysis (by Natanson et al
2008) of 16 clinical trials, involving 2700 patients, on the safety of
hemoglobin-based blood substitutes. Hemoglobin-based blood substitutes
are: "infusible oxygen-carrying liquids that have long shelf lives
[and] no need for refrigeration or cross-matching."
NEWLY RECOGNIZED RISKS
In the
past, blood
transfusions killed more people than was recognized
because delayed consequences were not attributed to the transfusions.
Motluk (2007) reported:
But
while blood
transfusions undoubtedly save many lives, over the past
five years, several studies have found that patients who received
transfusions were also more likely to suffer heart attack, heart
failure, stroke and death.
Red blood cells
sense the
level of oxygen in their surroundings and,
when levels are low, release nitric oxide to open up blood vessels and
allow more oxygenated blood to flow through. Banked blood, however,
loses much of its nitric oxide within hours — and yet may be stored up
to 42 days! Thus a major purpose for blood transfusion, to supply
oxygen to tissues, is partly frustrated — the tissues are starved of
oxygen instead.
Motluk
says the problem
would be solved if blood banks added nitric
oxide to red blood cells and suggests this be made a standard procedure.
Nowak
(2008) says, "Blood
doesn't always save lives" and "transfusions
can actually harm many patients." She explains that transfusions
involving red blood 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 risk
increases the
longer the blood is stored. Stored blood
undergoes chemical changes: nitric oxide levels drop; red blood cells
become stiff and less able to move through capillaries; transfused
blood may weaken the patient's immune system:
For
almost 9000 patients
who had heart surgery in the UK between 1996
and 2003, receiving a red cell transfusion was associated with three
times the risk of dying in the following year and an almost sixfold
risk of dying within 30 days of surgery.
ADDITIONAL COMMENT
The 1973
article had
inadequate referencing. The River of Life is
quoted without author or date.
A claim
of 99 survivors
out of 100 heart surgeries gives Awake! (August 8, 1970) as the
reference. Looking it up we find that Awake! quotes The
Sentry News (Slidell,
Louisiana), where Dr Pearce says: "We recently used this technique in
100 consecutive open heart surgeries for congenital heart defects…and
there was only one mortality." The American Journal of
Cardiology reference for 39 survivors our of 42 heart surgeries
lacked date and page but has been found — February 1972, pp
186-189.
The
statistics for heart
surgery survivors (in the 1973 article) are
interesting but inconclusive. A scientific approach — which can't be
done for ethical reasons — would match pairs of patients according to
health, age and type-surgery and employ blood transfusion for one of
each pair and alternative treatment for the other.
Besides
rejecting blood
transfusions JWs don't eat meat if the animal
was not "properly drained of blood", or eat "blood pudding", or feed
such products to pets, or use medicinal leeches. Leech therapy is used
when circulation is poor after major surgery. (Recently Australian
surgeons reattached the hand of a surfer mauled by a shark, and used
leeches to maintain blood circulation:- The Australian
2009,
February 25, p3)
Coghlan
(2008) reported:
Blood
transfusions may one day be a thing of the past thanks to the
creation of the first functional red blood cells grown in the lab. The
cells were grown from human embryonic stem cells (ESCs)… The breakthrough raises
the
prospect of mass-producing supplies of the "universal donor" blood type
O-negative, which…can be safely transfused
into any patient…
JWs reject
storing their
own blood for re-infusion. Therefore their
Hierarchy would probably also rule against infusing blood produced from
stem-cells.
BLOOD OR NO BLOOD?
Investigator
#12
estimated that 2,800 Jehovah's Witnesses had died
needlessly since 1944 when the anti-blood doctrine began.
This
estimate was based on
four JW deaths in South Australia and
multiplying 4 x 700 for a worldwide estimate (since 1/700 of all JWs
worldwide lived in SA). In #75 I suggested the South Australian count
might have reached six, giving a new world estimate of 6 x 700 = 4200
The
sample of four (or six)
is too small for a valid calculation. But
it's better than nothing. A similar calculation using New Zealand
estimated 800 JW deaths worldwide. In both cases it's uncertain whether
every JW death from blood loss is included.
Some
commentators claim the
doctrine kills thousands every year. Most
Internet lists of JW deaths, however, are short. My list in #75 is
longer than most, but had only about 150 individuals.
JW
congregations report to
headquarters monthly and also post copies of
pertinent media reports. The WTS therefore knows of all JWs who died
from blood loss — but has never published the data.
The
Watchtower
1993, October 15 says: "Any medical risk of refusing
blood is probably less than the risks involved in accepting blood
transfusions." The article quotes a doctor who claims that side-effects
make blood transfusions not worth it. The doctor also said that
forgoing blood transfusions adds "0.5% to 1.5% mortality to the
operative risk." Since millions of JWs have medical operations, the
added mortality implies many deaths!
Let's
use the 4200-estimate
to calculate whether blood or no-blood is
safer. Blood-transfusions sometimes kill, therefore some of those
estimated 4200 who died from blood-loss would have died from their
transfusion had they accepted. But how many?
The best
anti-blood case,
the best pro-JW case, using the highest
injury-from-transfusion estimates cited in the 1973 article, is that
blood transfusions injured 10% of recipients and killed 1%.
If the
estimated 4200 JWs
who died from rejecting blood had accepted
blood, then the risks for taking blood would apply. In that case 1% of
those 4200 or a total of 42 would have died. And about 10%, or 420
persons, would have gotten a disease and recovered.
Thus the
best anti-blood
case, using the highest estimates for death
and injury from blood transfusions, refutes JWs.
COMMITTEES
In 1979
the WTS introduced
"Hospital Liaison Committees" consisting of
JW elders who intervene in hospitals and courts on JW patients' behalf.
The Committees are armed with a loose-leaf handbook titled Family Care
and Medical Management for Jehovah's Witnesses which constantly gets
updated.
The
Committees:
•
Exert pressure on wavering JW patients;
•
Coach
JW patients and families on what to say;
•
Hinder doctors from seeking court orders and judges
from declaring JW child-patients wards of the state.
The
Committees have phone
access to "Hospital Information Services" at
the New York headquarters which maintains a medical data base and can
fax new information within hours.
In 1993
about 850
committees composed of 4500 elders existed in 65
lands. (Awake! 1993, 11/22)
CONCLUSION:
Blood
transfusions come
with risks. Therefore transfusions of only one
pint to improve wound healing or improve patients' color — often done
50 years ago — might now constitute malpractice.
The JW stance however,
that given today's technology no blood transfusions are necessary, is
even sillier. A reasonable claim is: "at least 25 per cent of blood
transfusions that are done could be avoided…" (Hoffman 2007)
I've
ignored the
theological comment of the 1973 brochure. However, the
history of the anti-blood doctrine, including theology, was discussed
in #10 and #12.
(BS)
REFERENCES:
Coghlan,
A. New Scientist
2008, August 23, p10
Hoffman,
L. The Weekend
Australian Health, 2007, June 16-17, p18.
Motluk,
A. New Scientist
2007, October 13, p18
Natanson,
C.; Kern, S.J.;
Lurie, P.; Banks, S.M.; Wolfe, S.M. JAMA
299 (19)
May 21, 2008: 2304-2312
Nowak,
R. New Scientist
2008, April 26, pp 8-9
The Advertiser, 2009,
February 25, p. 10
Westphal,
S.P. New Scientist
2005, July 23, pp 33-36.
The history of
Jehovah's Witnesses and their "Bible truth" examined on this website: