Blood and Bad Policies

blood_driveYesterday we had a blood drive at work that was hosted by the American Red Cross. Donating blood is something everyone should consider doing because the need for donated blood is immense. According to the American Red Cross (ARC) there is a need for 44,000 blood donations each day and, in the U.S., there is someone in need of a donation every two seconds.

It is with this in mind that I headed down to the donation drive yesterday to do my part. When I got there I was, unfortunately, turned away because I currently have a pretty bad cough and the ARC requires you to be free of those symptoms before donating blood. This is to help minimize the potential transmission of any blood borne pathogens to those who receive transfusions. I understand the reasoning behind this and told them I’d try again in six months when they return.

When I left the donation area I stopped at the registration table to let them know that I had been deferred as a donor when another fellow who was registering to donate looked up and abruptly asked me “Why can’t you donate? Are you gay?” This question literally left me flummoxed. One, I didn’t know this guy, and two, even if I had known him, why would he ask if I was gay because I got deferred from donating blood. I engaged this guy in discussion just long enough to learn that he believed that homosexuality was immoral and to realize that I would not want to spend any serious time in conversation with him. He was, shall we say, an under-informed, over-opinionated individual with a very caustic way about him.

After this exchange I did go back to my office and do a little bit of research and it turns out that in 1983 the Food and Drug Administration (FDA) placed a ban on male blood donors who have had sexual contact with another male (MSM donors). This was in response to the Acquired Immune Deficiency Syndrome (AIDS) outbreak that began around that time when we didn’t know much about the Human Immunodeficiency Virus (HIV) or how to test for it but it was observed that there was a higher prevalence in the population of homosexual males.

ARC and three logosThe policy was a reaction to the incomplete information available at the time. We now have a much better understanding of the virus and all blood is tested for HIV before it is administered to anyone.  The fact is that with the number of donations needed to meet the demand it is silly to systematically exclude an entire group of individuals as donors. It makes far more sense to evaluate individual donors based their own risk profile. In fact the ARC, the American Association of Blood Banks (AABB), and America’s Blood Centers (ABC) are in agreement with me on this. In 2010 they presented a joint statement to the FDA in which they stated the following:

“ AABB, America’s Blood Centers (ABC) and the American Red Cross strongly support the use of rational, scientifically-based deferral periods that are applied fairly and consistently among blood donors who engage in similar risk activities.  Therefore, since 2006 our organizations have recommended a change in the Food and Drug Administration’s (FDA)  deferral criteria for prospective male blood donors who have had sexual contact with another male (MSM)… After reviewing the data and publications available since the above mentioned 2006 BPAC meeting, our organizations, which represent the blood banking and transfusion medicine community, maintain our recommendation that FDA amend the indefinite deferral currently in place for a male who has had sex with another male since 1977 to a 12-month deferral.  This change in policy would conform the deferral period for MSM with the deferrals for other similar high-risk sexual behavior.  For example, the current deferral period for individuals who have had sexual contact with an individual with HIV or viral hepatitis is 12 months.  In each of these cases, the vast majority of donors with prevalent infections will be positive by both antibody tests and nucleic acid amplification testing (NAT).  This remains true even with increased numbers of HIV-infected MSM, as recently reported by the Centers for Disease Control and Prevention.”

This sentiment was further echoed by the American Medical Association in a 2011 statement. So far the FDA has refused to change their policy despite the fact that three major scientific organizations who understand blood borne pathogens and the risk levels for transmission of these pathogens all recommend them doing so.  There is always the potential that a blood borne pathogen from any donor can be transmitted through a blood transfusion. Its all about managing that risk and the evidence shows that we are able to do so.

Finally, to those, like the fellow I spoke to yesterday, who think homosexuality is immoral, I am not here to argue your beliefs with you, however if you decline a necessary blood transfusion because it may have come from a gay man then any negative consequences are your own fault. Medical science cannot prevent injury that results from misguided obstinance. It is not possible to eliminate all risk from the transfusion process but transfusions have saved millions of lives. Furthermore to discriminate against an entire population is truly unscientific and more importantly it is unethical.

Modern versus traditional medicine

Last Tuesday (just shy of a week ago) I had surgery on my knee to address a torn meniscus, an injury I got because I went on a run after having spent the previous 15 years getting older.  I write about it here because I mentioned that I was having surgery to a guy who works at my gym. This guy is a proponent of traditional Chinese medicine and told me that I was doing myself a disservice by using conventional medicine because traditional Chinese medicine is superior. This, he said, was because traditional medicine has been around for thousands of years, whereas modern medicine has only been around for a few hundred.

Meniscus 1

My poor presurgical knee with its torn meniscus.

The procedure I had is properly referred to as a partial meniscectomy with a joint debridement. Basically that means that they used a scope to go in to my knee capsule and remove the flap of torn meniscus tissue then clean the area up. 

As serious as it sounds, the whole procedure only lasted about 30 minutes. I arrived at the hospital at 7:30 am and was back at home walking around by 11:30.

My post-surgical knee looking almost as good as new.

My post-surgical knee looking almost as good as new.

Prior to surgery it felt as though there was a homunculus with a jackhammer dwelling inside my knee and doing his best to destroy it. Now, a week after surgery, the only pain I feel is from the swelling caused by the procedure itself and that has diminished consistently each day.

The little jackhammering fellow that I imagined causing all the pain.

The little jackhammering fellow that I imagined causing all the pain.

It would be very easy to take this procedure for granted as a minor one but if you stop and think about it, they went into my knee, an area that is usually closed to the outside world, removed bad tissue, and then cleaned the area up all while I felt no pain.  This did not ever happen during the heyday of ancient “traditional” medicine, it happened because in the 19th century practitioners began to use a more systematic and scientific analysis of patient symptoms in the diagnosis of disease and pathology.

It’s true that ancient chinese medicine has been around for at least 2500 years. Chinese medicine encompasses things like Massage and acupuncture, which have been shown to be quite effective in pain management, and other procedures that do nothing beyond the placebo effect. The evidence that massage is effective for pain management is robust enough to suggest that it is a worthwhile adjunct to scientific medicine. This is not controversial though, because massage is often a regular part of the post-operative physical therapy regimen. It was prescribed to me as part of mine.  What’s important to remember is that despite its efficacy for pain management, massage is not doing anything to treat disease or pathology; it helps control the pain. It is the all-natural version of ibuprofen. Certainly worthy of taking seriously but not the end-all-be-all of medicine.

Had I opted to forego surgery and use “traditional” medicine I would still have excruciating pain in my knee and would need to manage it using massage or acupuncture. The pain relief would only last until the effects wore off then I would need to go back and do it again. A 45-minute massage at my local wellness center is $49 and that is not covered by my insurance if I just go on my own without real medical advice. You can see that this would be great for the person charging me for the massage but not really for me. I’d have to keep going back to get the benefit. The surgery I had means that they fixed the problem. I don’t need to go have surgery every week to keep the pain down.

I guess I see the appeal of the ancient therapy argument however I can’t escape the observation that up until very recent times people died of things like influenza by the hundreds of thousands and, with regard to surgery, even very minor surgical procedures would have been torturous.  Ancient therapies aren’t better simply because they are older, they have to work if we want to call them better. I don’t have anything against traditional practices or Chinese medicine if they work but, for my money, I am going to bet on the side that uses science.