PREMUM NON NOCERE: FIRST DO NO HARM
CONSENSUS V THE EVIDENCE
Australian filmmaker and founder of Asia Geographic #, James Reynolds, outlines the background to his disturbing documentary about the dangers of blood transfusion, which are being ignored by the ‘consensus’ of medical practitioners – against clear evidence – an attitude that isn’t unique.
A knee-jerk rejection of new knowledge because of entrenched norms and perceptions has become known as the Semmelweis Reflex”. Ignaz Semmelweis (1818 - 1865), a Hungarian obstetrician living in Austria observed that physicians at the University of Vienna Hospital were routinely delivering babies without cleaning their hands after performing autopsies. This resulted in the deaths of hundreds of mothers and their babies to puerperal “child bed” fever. Semmelweis deduced that the simple act of sanitizing hands prior to examination and delivery would save many lives.
However, his simple evidence-based suggestion was soundly rejected by the scientific community of his day. It took decades for hand sanitization to become routine practice for doctors.
Blood transfusions enabled surgeons to routinely perform lifesaving procedures unimaginable prior to World War II and, “in the context of relatively limited resuscitation options available ... it undoubtedly saved many lives.”
"a wealth of evidence"
However, “what is frequently overlooked is the fact that, in light of a wealth of evidence as well as other management options, a therapy deemed suitable yesterday may no longer be the first choice today.” (International Society of Blood Transfusion, ISBT Science Series (2009) 4, 423–435).
Since the last century, the assumption has been that the oxygen-carrying capacity of stored blood is conclusive; however, this theory is untested. New insights reveal that during storage, numerous changes occur in red cells and their biological function is altered. This condition is referred to as the storage lesion and may explain the reasons for transfusion-associated heart attacks and death within 30 days.
According to researchers at John Hopkins University, patients having transfusion during surgery for their cancer are 42 per cent more likely to develop cancer again (Anaesthesiology, 2012).
James Reynolds developed a documentary concept: Beijing Goes Bloodless. It chronicled the efforts of remarkable doctors from mainland China who are forging new standards for health care. The film proposed following the development of China’s first bloodless surgical programs in collaboration with the Center for Bloodless Medicine and Surgery, Pennsylvania Hospital.
Following the short-listing of the concept at Mipdoc, Superpitch, 2008 and the favourable response by the Australian Film Finance Corporation, the international significance of the story was realized.
Funding (from Yanki Regan, Malaysia and Noel May, Ireland) was needed to shoot the film and was secured in April 2010 and production commenced immediately. During the making of the documentary, elements of discovery continually surfaced. Many world renowned medical experts are following the evidence and advocating: “The best transfusion - is the transfusion never given”.
Aryeh Shander, MD, is Professor at Mount Sinai School of Medicine and Chief of Department of Anaesthesiology, Critical Care and Hyperbaric Medicine at Englewood Hospital and Medical Center, New Jersey, USA and President of the Society for the Advancement of Blood Management (SABM). Dr. Shander was awarded Time Magazine: Hero of Medicine in 1997.
Pierre Tibi, MD, is Medical Director of Cardiothoracic Surgery Yavapai Regional Medical Center Prescott, Arizona, USA.
Jonathan H. Waters, MD, is Professor with the Department of Anaesthesiology in the University of Pittsburgh School of Medicine, Pittsburgh, USA.
Dame Marcela Contreras, MD, is Professor of transfusion medicine at the Royal Free Hospital Medical School, London, United Kingdom. She retired as the National Director for Diagnostics, Development and Research for the National Blood Service, in 2007.
Bruce D. Spiess, MD, is Professor of Anaesthesiology and Emergency Medicine and Director, Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES) and Director of Cardiothoracic Anaesthesiology, Virginia Commonwealth University Medical Center, Virginia, USA.
Jonathan S. Stamler, MD, is Professor of Medicine and of Biochemistry and Director, of the Institute for Transformative Molecular Medicine, Case Western Reserve University Cardiovascular Center Cleveland, Ohio, USA.
Alice Maniatis, MD, is Professor of Haematology Department of Internal Medicine, University of Greece, Athens, Greece and former President of the Network for Advancement of Transfusion Alternatives (NATA).
Konrad Messmer, MD, is Professor and Chairman of the Institute for Surgical Research at the University of Munich, Germany.
Colonel John Holcomb, MD, is Vice Chair and Professor of Surgery and Director, Center for Translational Injury Research, University of Texas Health Science Center of Houston, Houston, Texas, USA.
Kathleen Sazama, MD, JD, is Medical Officer, LifeSouth Community Blood Centers, Gainesville, Florida, USA and Immediate Past President, The Society for the Advancement of Blood Management (SABM).
David Gozzard, MD, is Associate Medical Director at Mersey Internal Audit Agency, North Wales, United Kingdom.
Sherri Ozawa, RN, is Clinical Director Institute for Patient Blood Management and Bloodless Medicine and Surgery Englewood Hospital and Medical Center Englewood, New Jersey, USA.
Scott A. Scheinin, MD, Medical Director of Blood Conservation and Management Services and Surgical Director of Lung Transplantation at Methodist DeBakey Heart and Vascular Center, and the Methodist J.C. Walter Jr. Transplant Center, Houston, Texas, USA.
Simon Towler, MD, is currently the Chief Medical Officer, Department of Health, Western Australia, Australia.
Vitaly Slepushkin, MD, is Professor and Chief of Anaesthesiology and Intensive Care, Medical Academy and Clinic, Vladikavkaz, Russia.
Nathaniel I. Usoro, MD, is Consultant General Surgeon and Director of the Bloodless Medicine and Surgery Group at University of Calabar Teaching Hospital Calabar, Nigeria.
Richard Daniel Barrister at Law, Bar of England, Wales and Ireland, United Kingdom.
Ken Kipnis, Ph.D., is Professor of Philosophy at University of Hawaii at Manoa, USA and serves as the Executive Director of the International Association for Philosophy of Law and Social Philosophy (AMINTAPHIL).
Danilo Kuizon, MD, Director, Heart Institute, St. Luke's Medical Center, Quezon City,Program Director, Bloodless Medicine and Surgery, East Avenue Medical Center, Philippines. Fellow of the American College of Cardiology.
Gonzalo Cardemil Herrera, MD, is Professor Department of Surgery, Hospital Clinico Universidad de Chile, Chile.
Deb Tabert, RN, CCRN, is Clinical Coordinator, Pediatric Blood Avoidance Service, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.
Shunji Kawamoto, MD, Director of Surgery, Fukuoka Tokushukai, Medical Center, Japan.
Sundar Sankaran, M, Director and Chief Nephrologist of the Karnataka Nephrology and Transplant Institute with the Columbia Asia Hospitals in Bangalore, India.
# Asia Geographic is a niche entertainment company with a diversified presence in documentary production and distribution. The company has built international partnerships with award-winning professionals and over the years has collaborated with an array of businesses, including National Geographic, Beyond Distribution (Australia), TV3 Malaysia and the Australian Broadcasting Corporation.
Published April 4, 2013
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Aryeh Shander MD, is Professor at Mount Sinai School of Medicine
Kathleen Sazama MD, JD, is Medical Officer, LifeSouth Community Blood Centers, Gainesville, Florida
Bruce D. Spiess MD, Professor of Anaesthesiology, Virginia Commonwealth University Medical Center