Intrigue and Fatigue Blood feud Almost exactly 2 years ago (Daily Dose, 4/23/04), I wrote to you about the initial, promising tests of a universal blood substitute called Polyheme. To recap, the trials of the new substitute were limited to cases of extreme trauma, when adequate supplies of matching blood were unavailable... In other words, it was used only in life-or-death instances in which there was no other option. The concept of informed consent never enters into these situations. It's do-or-die time. But this fact didn't stop so-called "patient advocates" from voicing concerns at the time about the ethics of injecting an unproven, artificial substance into patients - even those who may have only minutes to live otherwise. Well, this issue's back in the spotlight now. A University of North Carolina bio-ethicist has published an article on the Website of the American Journal of Bioethics condemning a current Polyheme study among a group of 600 hospital-bound trauma and emergency heart surgery patients. Her article maintains that since the study continues administration of the blood substitute (instead of real blood) for a 12-hour period of hospitalization AFTER the initial emergency ambulance injections, it's unethical - because it violates patients' right to informed consent about experimental medical procedures... And as much as I hate to wade into the murky waters of bioethics, I think she may have a valid point. Think about it: It's one thing to administer an experimental blood substitute when the right stuff's not on hand or not available in large enough supplies, but to keep pumping it in for testing purposes once the proper blood is on hand seems over the line to me - especially without express written consent from the patient. I know if it were me, I'd want the real thing as soon as possible after any trauma. Needless to say, the invention of a viable blood substitute that blends with all known blood types would solve a lot of problems inherent to keeping emergency stocks of real blood on hand - things like storage requirements, spoilage (blood doesn't stay usable very long after its drawn), and the transmission of disease. It would also save a lot of lives, eliminating the time it takes to accurately blood type in trauma victims... For this overarching reason, I'll be continuing to follow this story, and will keep you abreast of any developments. Stay tuned. **************************************************** Sensible scents In the essay above, I talked about some things that could happen to you if you're the victim of major trauma. But now, I want to tell you about one of the best ways to AVOID one common kind of trauma... According to a 1997 study, accidents directly attributable to sleepy drivers cost the U.S. $37.9 billion. This equates into tens of thousands of needless deaths (one 1988 study pegged the number at over 24,000), and most certainly 100,000 or more emergency trauma cases in which one or more parties is rushed to the hospital - or given blood or blood substitutes. A huge number of these victims are over 50. This is the time in life when getting a good night's sleep can be an increasing challenge due to hormonal changes, weight gain, back pain, prostate and bladder issues, or any number of other things. One thing that can help folks stay alert while driving, according to some West Virginia research reported in a recent Reuters article, is to regularly sniff peppermint or cinnamon. The study's findings also point to some benefits in driving performance from these two spices, and a reduction in road-related stress. Of course, my favorite solution to the open-road droops is good ol' antioxidant-rich coffee. But if that's not possible, some peppermint or cinnamon flavored gum should help, or at least an air freshener in the same scents... Sure, they're ugly, but so is dying in a ditch - or an ambulance - after falling asleep at the wheel. Never asleep on my job - of bringing you the scoop, William Campbell Douglass II, MD | 
