Dr. Neil Blumberg runs the transfusion medical unit at the University of Rochester Strong Hospital. He concedes that the public health impact of transfusion immunomodulation is very difficult to estimate. Then he ventures to do just that—if anyone can do it, it will be someone immersed in the field—and says “that in the United States we can expect that 10 to 50 thousand patients a year may be dying from transfusion immunomodulation related causes.”

He doesn’t mean dying on the operating table. He means dying somewhere down the road through disease transmitted directly by means of a blood transfusion or indirectly due to a compromised immune system later admitting such disease. He might even have had in mind science fiction writer Isaac Asimov, who died in 1992 of AIDS transmitted through a transfusion given nine year previous. Blood transfusions come with severe risks. Those risks have mostly become known only in recent decades, largely through research attempting to meet the needs of Jehovah’s Witnesses.

An October 15, 2012 article in The Telegraph, entitled ‘Killed by a Needless Blood Transfusion,’ quotes Professor of Epidemiology and Public Health at the London School of Hygiene and Tropical Medicine Ian Roberts, as saying: “Like many interventions that have been used for a long time, the necessity for blood transfusion has never been properly tested.” Transfusions are “engrained in medical culture,” he says. “A doctor will assess patients for levels of oxygen in the blood, find it’s low and think: ‘Oh, I’ll raise it.’ It’s a bit like cooking – you make a casserole, you taste it and think it’s not very salty and you add some salt.” Mike Murphy, a professor of blood transfusion medicine at Oxford University, says “Most blood transfusions are non-urgent, used routinely to ‘top up’ patients about to undergo planned surgery.” (The patient “killed by a needless blood transfusion” died afterwards of Creutzfeld-Jakob disease, acquired through the transfusion, though his hip-replacement operation itself was successful.)

It is not easy to find such material. It is drowned out in a flood of promotion as to how safe transfusions are said to be, often advanced by those who have vested interests in preserving the status quo. One suspects that Jehovah’s Witness detractors are chief among them—the status quo they wish to preserve is the perception that anyone who would turn down a “life-saving” blood transfusion is either a lunatic, or, more likely, a victim of a brainwashing cult. “Today at least 80% of the patients would strongly favor not to have blood transfusion” says medical Professor Roland Hetzer. To hear Witness detractors carry on, one would think that they all drop to their knees and beg for one.

Though they might strongly favor not having a blood transfusion, they will not necessarily be given that option. In most places still, blood transfusion is standard fare. Indeed, the hospital that Dr. Blumberg works for has long been uncooperative with Jehovah’s Witnesses wishing to avoid blood transfusions. I know this because I long resided in the general area. An area doctor, who is a Jehovah’s Witness, knows Dr. Blumberg. When I asked him why Blumberg’s expertise and authority—he is in charge of the blood unit, after all—has failed to sway his own hospital, his answer was: “Because he is not political.” Exactly. It’s not enough to be on the cutting edge of science. One must also battle day and night those who want to knock you off that edge. Not everyone is up to it, for it may entail arguing one’s life away. Don’t people have spouses, children, and their own health to consider? One must choose one’s battles.

Hospitals that have added bloodless to their toolbox report favorable outcomes. Such techniques make for cheaper medicine due to reduced recovery times, for everyone knows that blood is a foreign tissue, and everyone knows that the body tries to reject foreign tissue. It is also cheaper in terms of avoiding liability for transfusions gone bad. Overall, there is no negative impact upon mortality. As far back as 1962, heart transplant pioneer Dr. Denton Cooley was known to cooperate with Jehovah’s Witnesses, declaring that their stand could be accommodated with “acceptable risk.” Fifty years later, bloodless has become the gold standard—where it is available.

Up to half of adverse transfusion reactions are due to simple human error. If the transfusion is unnecessary to begin with, any adverse reaction at all is a huge penalty to pay. A 1994 study gave further evidence that many of them are. Known as the Sanquis study, the records of 43 European teaching hospitals and 7000 patients were examined. It was found that transfusion usage varied greatly from hospital to hospital and depended upon preference of the doctor, not the condition of the patient. The same type of surgery that came with standard transfusion use in one hospital came with almost none in another. In the aftermath of such research, some hospitals have halved their use of blood transfusions simply by relaxing the trigger that calls for one—from 10.2 g/dL to 9 or even 8, at no cost whatsoever, and with no impact upon mortality. The 10.2 figure is but an arbitrary figure that dates back to 1942, yet it still holds sway in the popular mind—drop below it, and, for many doctors still, a blood transfusion is indicated.

A storekeeper will the sell the customer, not necessarily what is best for him, but what is on his shelf. A mechanic will choose, not necessarily the best tool, but the one that is in his toolbox. It is the same with bloodless medicine. If the facility is not equipped with it, for all practical purposes, it does not exist, and the doctor may know of it only in the abstract. For now, it is a specialty, and one can hardly expect all doctors to specialize. To the extent possible, Jehovah’s Witnesses lay the groundwork well ahead of time, even choosing specific hospitals, so as not to show up suddenly at one of them and say: “Surprise! No blood!” It is no wonder that some doctors have blown a gasket in such circumstances.

It is not always possible. When I was admitted suddenly for a condition that required prompt surgery, I made clear several times that I would not accept a blood transfusion. ‘Not a problem,’ I was told more than once. ‘We do it all the time. It shouldn’t be indicated for this type of operation, anyway. Here, sign this, initial that, and rest easy.’ Yet, on the verge of going under anesthesia, the anesthesiologist introduced himself and asked if I would prefer to die rather than accept a blood transfusion should one prove necessary. The reason that it is not advisable to do this, as I discussed with the man afterward, is that it introduces to the patient at the last moment the notion that maybe his surgeon is not very skilled after all—perfectly capable of botching an operation that everyone else has said was a piece of cake.

Taken aback, I had responded that if he were to come to a point in which he felt a blood transfusion was necessary, he was to find an anesthesiologist to whom it would not prove necessary—it wasn’t my fault if they couldn’t get their ducks lined up. But it wasn’t his fault, either. The man was just being conscientious. If a fault was to be assigned, it was with hospital management that had not afforded opportunity to settle this ahead of time. Probably the man had received only five minutes training on the subject: “Run with them if you can but run them down if you can’t.”

The account is related in greater detail in my first book, Tom Irregardless and Me, in which I have changed all names and even attributed the experience to someone else. There, I came up with the seemingly cute idea of giving all medical staff names that would suggest drugs or diseases. My nemesis anesthesiologist became Dr. Mike “Ace” Inhibitor, and his trusty assistant, Nurse Hep See. Some of the other characters have not aged well, having been named after drugs that were then advertised heavily on television, which was frequently playing in the background as I wrote, but which have today been replaced by other drugs. I would do things differently today.

In every area of medicine, Jehovah’s Witnesses know less than their doctors, and they never pretend otherwise. But in the area of blood transfusion, sometimes they know more. This is not because they’re smart, but because it is their special cause. “The trouble is,” I told Dr. Inhibitor, that our people are likely to know about the New Scientist article, (see chapter 18) and if you do appear not to, they will panic, even to the point of questioning your qualifications.

Jehovah’s Witnesses are not medical reformers. They don’t tell doctors what to do; they just would like that their consciences be respected. By sheer happenstance they have spurred major advancement in the field of blood transfusion therapy. Some Witnesses will say, however, that it is not sheer happenstance. They will venture the opinion that if the Bible consistently says to not “eat” blood, it cannot be that transfused blood is overall good for you.

It is the underlying principle that counts. If the doctor was to say that absolutely you had to avoid alcohol at all costs because it would cause excruciating pain with your unhealed dental surgery, and you concocted a plan to bypass your mouth and transfuse it directly into a vein instead, well—whatever floats your boat. Go for it. But if the reason is that your liver has taken all the abuse it can take and but one more drop of alcohol will cause it to shut down, then you will pour that alcohol out on the ground as if water. The fact that Christ’s death fulfilled the Law of the Old Testament, yet the requirement to abstain from blood is still carried over into New Testament times, indicates that something more than mere dietary law is at work here.

Among the greatest repositories of bloodless medical research is that found at JW.org in a section entitled ‘Medical Information for Clinicians.’ Not that the Witnesses do any of the research themselves, but they keep track of it for obvious reasons. They have produced two videos in which doctors and academics from around the world inform on the latest developments in bloodless therapy: ‘Transfusion-Alternative Strategies—Safe, Simple, and Effective,’ and ‘Transfusion-Alternative Health Care—Meeting Patient Needs and Rights.’ Several doctors here quoted are taken from this source.

When the first rudimentary blood transfusion experiments were performed centuries ago, Professor of Anatomy at the University of Copenhagen, Thomas Bartholin (1616-80), objected. His concern was not on scientific grounds but on spiritual: “Those who drag in the use of human blood for internal remedies of diseases appear to misuse it and to sin gravely,” he wrote. “Cannibals are condemned. Why do we not abhor those who stain their gullet with human blood? Similar is the receiving of alien blood from a cut vein, either through the mouth or by instruments of transfusion. The authors of this operation are held in terror by the divine law, by which the eating of blood is prohibited.”

The only people I know of who still have regard for this aspect of “divine law” are Jehovah’s Witnesses. If there were others, (and judging from Bartholin’s comment, there must have been) they abandoned it when transfusions were adopted by the medical mainstream. More or less the same thing has occurred with both abortion and embryonic stem cell research.

Science advances. It is now possible to separate blood into the tiniest of fractions. This development occasions the seemingly deliberate misunderstanding on the part of Witness opposers that the Watchtower organization has “flip-flopped”—they now “allow” what they formerly “forbade.” The reality is that Witness HQ simply recognizes that it is for the conscience of each member to decide which of these minuscule components constitutes blood and which does not. Some will reason that any fraction, no matter how tiny, is blood. Others will reason along the lines of: “It’s not a cake until you mix the ingredients.”

Chichester-based Dr. Vipul Patel has stated: “I can foresee in the future that patients will almost expect that any surgery that is necessary is carried out without blood transfusion.” If his vision comes true at all, it will be a long time away, probably, because the forces of inertia favor the status quo. Of the many developed techniques of bloodless medicine, Dr. Aryah Shandler has said: “This is universal, can be practiced in any institution, in any part of the world….This is the best way of treating patients and truly should be a standard of care.”

From the book TrueTom vs the Apostates!