Article contributed by S. Sparrow

January 8th 2000 Awake! Magazine

January 8th 2000 Awake! Magazine

The January 2000 issue of the Awake! magazine, published by the Watchtower Society Bible and Tract Society of New York and distributed worldwide, featured articles endorsing bloodless surgery and promoting bloodless medicine as a safe alternative to allogeneic blood transfusions.1

Several physicians are featured in this special issue of the Awake! magazine and it is apparent that these doctors would have been included in the “cooperative doctors” list that is compiled and maintained by the Hospital Information Services of the Watchtower Society.

In  November 2002, less than two years after the publication of this particular Awake! magazine, the Watchtower Society claimed to have a database of over 100,000 physicians that would use bloodless methods on Jehovah’s Witness patients:

Hospital Information Services, or HIS, is the arm of Jehovah’s Witnesses headquarters staff that coordinates communication between over 110,000 physicians worldwide. Some 1,600 subgroups termed Hospital Liaison Committees, or HLCs, facilitate this communication on a local level. 2

The article The Growing Demand For Bloodless Medicine and Surgery, opens with a quote from Dr. Boldt, a professor from Germany, who undoubtedly would have been on the Hospital Information Services list of WT approved physicians:

All those dealing with blood and caring for surgical patients have to consider bloodless surgery. – Dr. Joachim Boldt, professor of anesthesiology, Ludwigshafen, Germany.

Dr. Joachim Boldt

The article also features this quote from the same doctor:

“Bloodless surgery is not only for Jehovah’s Witnesses but for all patients. I think that every doctor should be engaged in it.”  – Dr. Joachim Boldt, professor of anesthesiology, Ludwigshafen, Germany.

At the time that Dr. Joachim Boldt was being featured in a Jehovah’s Witness publication, his research was being used by the medical community to validate the use of hydroxyethyl starch solution as a volume expander to replace a patient’s blood, thereby avoiding the use of, or reducing, allogenic blood transfusions. Boldt’s research, comparing the efficacy of different colloids to albumin, used hydroxyethyl starch suspended in an electrolyte solution instead of the usual saline that had been in use by the medical community since the 1970s.

Volume expanders are essential to surgical procedures that drain and store the patient’s blood during surgery and hydroxyethyl starch had been one of the mainstays of surgical procedures for over two decades.3 

In 2002, hydroxyethyl starch suspended in saline (hespan), was facing investigation by the FDA and the FDA was considering putting a black box warning on hespan.4  Eventually, after several FDA hearings and workshops, hespan received a black box warning that alerted medical professionals to an increased risk of bleeding in some patients when using the product.5 

However, Hextend, the hydroxyethyl starch solution that Boldt employed in his research, managed to avoid the black box warning during the FDA hearings in the early 2000s, based on the presumption that Hextend’s carrier solution and smaller molecular size could avoid the problems that hespan was facing. This later proved to be false and Hextend as well, now carries an FDA warning stating that increased bleeding and renal failure may occur with its use.6 

In 2010, the research that Joachim Boldt had published in favor of hydroxyethyl starch suspended in electrolyte solution was revealed to contain falsified data and/or the research had inadequate ethics approval.7 8 9 The studies that have been retracted for Joachim Boldt now number 96 and according to Retraction Watch, a website that tracks retractions in the scientific community, this number places Boldt as second on the leaderboard for number of studies retracted.10 

Over the course of the past four decades, hydroxyethyl starch has been used for the Jehovah’s Witness population, including the newest formula on the market – Voluven.11 This has happened in spite of the known risk of increased bleeding in some patients.12 Increased red cell blood transfusions have been noted in studies that have been conducted into the safety and efficacy of hydroxyethyl starch.13

It is clear that the use of hydroxethyl starch adds extra risk to the patient,14 15 16 and that this added risk was known for many years:

“Research by Dr Gill Schierhout and Dr Ian Roberts of University College London found in 1998 that the use of colloids during surgery increased the risk of death by four percentage points – equivalent to four extra deaths in every 100 patients. A review published 10 years later by Konrad Reinhart and Christiane Hartog of Friedrich Schiller University in Jena, Germany cited two large-scale clinical trials which found that HES could prevent the blood from clotting, which can cause heavy bleeding. Other studies have shown that some colloids can result in complications including heart and kidney failure, fluid entering the lungs and anaphylactic shock.”17 

The Hospital Information Services of the Watchtower Society has been irresponsible in promoting a medical procedure that places an at-risk population in a position of further risk. The JW population does not have the safety net of a blood transfusion to compensate for the risk of increased bleeding when hydroxethyl starches are used and yet the Watchtower fails to alert the JWs to this added risk.

Not only has the Watchtower Society advocated for the use of a blood alternative that has added risk, they have also endorsed Dr. Joachim Boldt, a questionable medical researcher in the field of bloodless medicine. Dr. Boldt, the physician featured in the Awake! magazine, conducted medical research on patients without ethical approval, and then falsified the data in order to promote an alternative to blood transfusions.

Promoting notorious medical pretenders is not something new for the Watchtower Society. Dr. Joachim Boldt’s name will go down in Watchtower history alongside other notable quack doctors that the WTS has endorsed over the years such as Albert Abrams, George Starr White, Charles Betts and Bernarr McFadden.18  

FOOTNOTES

1.  Awake!, January 8, 2000. Watchtower and Bible and Tract Society of New York.

2.  https://web.archive.org/web/20091120230915/http://www.jw-media.org/gbl/20021118.htm – SABM award recognized the Watchtower Society’s contribution to the field of Blood management.

3. Hydroxyethyl Starch: Here Today, Gone Tomorrow. J. P. Nolan; M. G. Mythen. Br J Anaesth. 2013;111(3):321-324.

4. https://www.fda.gov/OHRMS/DOCKETS/ac/02/transcripts/3867T1.rtf

5. http://www.who.int/medicines/publications/NewsletterNo4_2013EC.pdf

6. https://www.drugs.com/pro/hextend.html

7. Joachim Boldt profile: a glittering career built on charisma and charm. Heidi Blake. http://www.telegraph.co.uk/news/health/news/8360678/Joachim-Boldt-profile-a-glittering-career-built-on-charisma-and-charm.html

8. https://en.wikipedia.org/wiki/Joachim_Boldt

9. http://intensivecarenetwork.com/148-scandal-and-reputation/

10. When you have 94 retractions, what’s two more? Retraction Watch. http://retractionwatch.com/2017/03/01/94-retractions-whats-two/

11. Normovolemic hemodilution using hydroxyethyl starch 130/0.4 (Voluven) in a Jehovah’s Witness child requiring cardiopulmonary bypass for ventricular septal defect repair. Bryan D. Laliberte, , Dilip S. Nath, , John P. Costello, , Mark Nuszkowski, , Richard F. Kaplan. Journal of Clinical Anesthesia, Volume 26, Issue 5, August 2014, Pages 402-406

12. A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah’s Witness. D.N.J. Lockwood, C. Bullen, S.J. Machin. Anaesthesia, 1988, Volume 43, pages 391-393.

13. Effect of intraoperative HES 6% 130/0.4 on the need for blood transfusion after major oncologic surgery: a propensity-matched analysis. Fernando Godinho Zampieri, Otavio T Ranzani, Priscila Fernanda Morato, Pedro Paulo Campos, and Pedro Caruso. Clinics (Sao Paulo). 2013 Apr; 68(4): 501–509.

14. http://pulmccm.org/main/2013/randomized-controlled-trials/hydroxyethyl-starch-fries-kidneys-in-another-large-trial-rct-nejm/ CHEST trial – NZ and Australia.

15. http://clincalc.com/blog/2013/04/fresenius-kabi-its-time-to-pull-the-plug-on-voluven-hydroxyethyl-starch-1300-4/. Fresenius Kabi: It’s Time to Pull the Plug on Voluven (hydroxyethyl starch 130/0.4)

16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234780/#ref9 Hydroxyethyl starch: Controversies revisited. Rashmi Datta, Rajeev Nair, Anil Pandey, Nitish Kumar, and Tapan Sahoo.

17. http://www.telegraph.co.uk/news/health/8360667/Millions-of-surgery-patients-at-risk-in-drug-research-fraud-scandal.html

18. The Watchtower Society and Medical Quackery, Kenneth G. Raines. http://www.freeminds.org/history/quackery.htm

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