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.

Aspartame And Our Health

equal-frontAspartame is a pervasive ingredient that is used as a low-calorie sweetener in a wide range of food and beverages. I got into a discussion about it recently because I was drinking a Diet Mountain Dew, which is sweetened using aspartame, and was informed that instead of being helpful as a way to watch Calories it would actually make me gain weight and that it causes all kinds of other health problems. I’ve heard many of these claims before and, being the skeptic that I am, was is the antithesis of scientific skepticism.  So I decided to look into what the side-effects of aspartame might be.

Janet HullDoing a Google search, one of the first websites I came across was hosted by Janet Starr Hull who is the creator of the Aspartame Detox program. This page reinforced my skepticism because, while I know very little about Hull, her homepage begins by hawking her book, then immediately follows with a link to submit your case of how aspartame negatively affected you. In the next paragraph she tells a vivid, yet completely unverifiable tale about how she was misdiagnosed with Graves disease in the early 1990s but restored her health with her own detox program. This is all very reminiscent of the tactics used by Dudley LeBlanc to hawk Hadacol in the 1940s and by Super-Charlatan Kevin Trudeau in all of his bogus blatherings. Furthermore, Hull refers to herself as Dr. Hull but is vague about her professional credentials, her website states that she has a doctorate in nutrition but she does not say from where, which sets off my skeptic alarms even further:  One can purchase a Ph.D based on life experience for $849.  I am not accusing Hull of purchasing her doctorate but since she is not forthcoming on her website about where she received it we can’t easily tell. After a little digging I found that she got a Ph.D in holistic nutrition from the Clayton College of Natural Health, which, before it closed was an unaccredited institution, that specialized in “alternative” medicine.  Finally, she promotes other things on her website that are definitely bogus. For example you can link to her online hair analysis program with the assurance that if you send in a hair sample it will help you detect any toxic chemicals in your system as well as nutrient and vitamin deficiencies. Hull’s credibility is definitely suspect but whether this because she is a charlatan or just overly-credulous I do not know for certain. I do, however, know that she is not an authoritative source and that I don’t trust her for objective information. The problem is that she has been cited in at least one research article as the source of claims about the ill-effects of aspartame. So, credible or not, she is evidently affecting public opinion about aspartame.

Aspartame chemical structureIt is with this in mind that I decided to look at some of the actual research on aspartame to see if there is any real concern to be had. Aspartame was discovered in 1965, and unlike other artificial sweeteners it is the only one that is completely broken down by the body into its constituent components: amino acids, aspartic acid, phenylalanine, and methanol.  All of these components are present in other foods and are used by the body the same way whether they come from aspartame or other sources.

With regard to potential side-effects, there was a study done in 2005 that did find that people who regularly drank diet sodas had a 41% increase in the chance of being overweight for every can or bottle of diet soft drink he or she consumed. This, however, says absolutely nothing about the role of aspartame in the process. Even the study’s authors concluded that soda is not the root of obesity and conclude that it may be something that is correlated with diet soda drinking that causes the weight gain. There are other concerns with aspartame, though. It has been speculated that aspartame may cause increased allergic reactions based on anecdotal reports of increased headache and other allergic signs and symptoms. However a study out of Duke University found no difference between placebo and aspartame groups in allergic signs. Other studies have confirmed that aspartame is no more likely than a placebo to cause allergic sensitivity.

One real potential problem with aspartame is that one of the constituent components is methanol. Methanol breaks down into formaldehyde, which then breaks down into Formic acid. These can be toxic to humans at high enough levels. However it has been shown that we break down and excrete formic acid faster than we accumulate it through consumption of aspartame.

There is more to this controversy but the fact is that Aspartame is one of the most studied and tested food additives ever approved by the U.S. Food and Drug Administration. It has been shown repeatedly that aspartame is safe for most people (there is a notable exception for those individuals with a condition called Phenylketonuria). So relax and enjoy your low calorie yogurt and your diet soda, just consume them in moderate amounts and you’ll be fine.

The Current Fear of Vaccines: Fraudulent science and the identifiable victim effect

Tetanus Painting by Sir Charles Bell, 1809.Last week a story circulated about a seven year old New Zealand boy named Alijah whose parents opted against vaccinating him and his siblings. They made this decision based on what they believed was solid evidence in favor of forgoing vaccination. Unfortunately Alijah got a small cut on the bottom of his foot in December of 2012 and contracted tetanus, an excruciating condition which ultimately led to the need to put him in an induced coma to stop his agony; agony that could have been entirely avoided if he’d received the tetanus vaccine. Alijah was in this coma for three weeks then had to learn to walk and to eat again once he came out of it.

Alijah’s parent were not bad people, they, like most parents, want the best for their children and made what they thought was the better decision regarding vaccinations. Further, and this is important to remember, they went public about their error so that others might avoid making the same mistake. That is not an easy mistake to admit as a parent so they deserve a lot of credit for their candor.

The question of whether vaccines might be linked to harmful side-effects is not new; there have been religious arguments against vaccination since the process began. In 1798 an Anti-vaccination Society was formed by physicians and clergymen, who called on the people of Boston to suppress vaccination, as “bidding defiance to Heaven itself, even to the will of God.” There are indeed still those who object to vaccinations for superstitious reasons but the current Andrew Wakefieldcontroversy is not religious, as least in an obvious sense. Rather it began with a paper that was published in the Lancet (a well-respected journal of repute!) by Andrew Wakefield in 1998. In his paper he concluded that there is an association between the MMR vaccine and the appearance of autism and bowel disease. This study was the impetus for the anti-vaccine movement and has led to a cultural shift regarding vaccines. The most salient fact, however, about this study, is that it was proven fraudulent and ultimately retracted by the journal and by 10 of the paper’s 13 authors.  In addition to the study being retracted, Wakefield’s license to practice medicine in the United Kingdom has been revoked by the British General Medical Council (GMC), for professional misconduct.  Nonetheless, the damage done by Wakefield continues; Last year in Britain there were 2,000 reported cases of measles, and this year there has already had been more than 1,200 reported. The group that is most affected by this disease is adolescents who were never vaccinated.  

 

Lancet retracted article

The fear of vaccines is not isolated to the United Kingdom or to New Zealand. In the United States, Jenny McCarthy has been an outspoken activist against the use of them for several years now. She has repeatedly made the claim that her son’s autism was caused by vaccinations. Unfortunately because of all of the above claims many people are now assuming that vaccines are harmful and opting out of vaccinating their kids. This is resulting in cases of otherwise preventable diseases being on the rise once again in the U.S.

jmcvaccinesThe problem with taking the advice of someone like Jenny McCarthy is that she is an entertainer and a public figure.  There is absolutely nothing wrong with that but being a public entertainer does not mean she has any expertise in public health or the biological sciences. So why do we give her opinions on autism and vaccines any consideration? Actually there is a very good, albeit unscientific, reason that her opinion carries so much weight. It is the result of something called the identifiable victim effect. This occurs when there is a victim of some ailment or event, in this case it is McCarthy whose son suffered from autism, who we can identify and empathize with. When McCarthy talks about her son in the public forum most of us, especially if we are parents ourselves, feel sympathy toward her plight as a struggling parent.  When she blames vaccines for her son’s autism and ultimately her struggles, it is hard not to want to boycott all vaccines.  

Among the myriad of problems with this line of reasoning are, as mentioned above, the fact that the only study showing an association between vaccines and autism has been proven fraudulent, and the fact that the identifiable victim in this case is Jenny McCarthy, who is not the actual victim of autism.  In reality there is not a single scientifically documented case of a vaccine causing autism, therefore many more people are harmed by avoiding the vaccines. These people are no more than statistics to most of us though so their plight is not nearly as vivid as McCarthy’s strife.

I hold no ill will towards Ms. McCarthy but her misguided rhetoric blaming vaccines—which are, in fact, one of the greatest achievements of scientific medicine—for the rise in autism is sadly misguided and is causing harm.