We can work it out (Musings on transfusion association annual meetings)

Last revised: 2 June 2019  (See ADDENDUM below)

INTRODUCTION
As the CSTM annual conjoint meeting with CBS and Héma-Québec is now on May 29 to June 2, I thought I'd muse on annual meetings in general. As readers of this blog will know, I've had a long career in transfusion starting at the bottom without qualifications but being incredibly fortunate in my employers.

I'm an outlier of sorts with atypical views and being an oldster gives me the freedom to say things that colleagues likely would not. Perhaps many may disagree with me on this blog's points. That's okay too as I'd be concerned if all, even most, agreed with me. Included are tidbits I think contribute to quality presentations at meetings.

Professional associations exist to serve and represent the interests of their members, which applies to the three associations I belonged to during my long career as a medical lab technologist turned educator: AABB, CSMLS (includes IFBLS membership), CSTM. The latter two are Canadian organizations, the first American but AABB has branched out to become international, though its headquarters remains in the USA as does its primary focus.

The blog's title is based on a 1965 Beatles ditty, We Can Work It Out.

LESSONS LEARNED
Over the years I've attended many meetings, aka conventions and congresses. With a few exceptions most of all those attended were held in Canada by CSMLS or CSTM. One memorable one (IFBLS) was held in Oslo in 1996. Why memorable? Most of all it was because I met a Norwegian med lab technologist who worked in transfusion and we've been good pals ever since.

To me, that's Lesson #1 of what's important at annual meetings. It's not so much the scientific presentations you hear and what, if anything, you learn from them (commit to long-term memory). Face it, if you read professional journals you're pretty up-to-date on the latest and greatest. During my career the AABB journal Transfusion and similar were kept in the bathroom as a welcome distraction or read while basking outside in Canada's all too short spring, summer, fall.

Of course, I suspect not many transfusion technologists and nurses in the trenches regularly read journals. Take a peak at the index of Transfusion 2019;59(5). How many articles would you read let alone understand?

Today, keeping current also applies to those on social media platforms like Twitter where journals and associations alert folks to the latest developments. But how many of you use Twitter?

LESSON #1: The most valuable benefits of meetings are the interactions with peers, sharing experiences and knowledge that's not in journals or textbooks, including the friendships made. Often such interchanges are shared during a night-out over a meal or glass of wine/beer. Typically, chitchat involves practical and tacit knowledge only gained from experience.

~~~~~~~~~~~~~~~~

Pretty certain that Lesson #2 will be familiar to medical lab technologists/scientists world-wide, at least those lucky enough to attend meetings:

• So many of the presentations at transfusion association meetings are by physicians and researchers, though it's slowly changing. 

What this means is the information and research presented, though significant, is often not particularly meaningful nor of immediate use to those in the trenches, whether transfusion med lab techs, nurses, physicians without university appointments. And being able to use new meaningful learning right away is important to busy adult learners. In continuing education and professional development courses it's critical because 'adults vote with their feet' as the cliché goes.

Indeed, I wonder in the age of the smart phone how many meeting attendees during presentations  spend most of the time checking e-mail, texting and browsing. Suspect it's far too many. Best take is they're live tweeting but no, that's not it.

Reality is that much transfusion research is esoteric, of interest mainly to those involved in similar, narrow research.  Kudos to CSTM for its full day of workshops relevant to front-line professionals.

LESSON #2: Many presentations at scientific meeting are of minimal value to attendees, especially those who work in the trenches on the front-lines of transfusion, those in the lab and those on the wards. If you're a PhD or MD/PhD researcher and the topic coincides with your interests, the talks are no doubt fascinating.

~~~~~~~~~~~~~~~~

Lesson #3 relates to a sad fact of life for many in the trenches. Years ago funding for CE/CPD was scaled back significantly. The result is fewer and fewer attend national meetings (unless local), let alone international ones. Today the cost of airfare and hotels is increasingly exorbitant.

Who can afford it? My guess includes

• Physicians and researchers who get funding support or earn large salaries, along with those in senior positions. 
• Bench technologists and front-line transfusion nurses not so much. 
• Educators and those in health profession unions who get discretionary funds to use for CE/CPD but the funding wouldn't come close covering travel and hotel costs to attend meetings outside their locale. 
• Some associations fund invited presenters, but not all.
• An association's board of directors, whose members are volunteers and put in much dedicated time and a tiny perk is funding to attend meetings.

Many transfusion associations/organizations now offer local CE/CPD events across the country or provincially, including CSTM's Education Days. And thanks to the Internet, technology makes webcasts and podcasts possible.

LESSON #3: To what extent have annual meetings become a place for the 'elites' to meet and interact?  By elites, I mean those professionals fortunate to have funding or be wealthy enough to attend if the meeting is not in their locale and schmooze with other elites? It's a question to which I do not have an evidence-based answer, yet suspect it may be true.

~~~~~~~~~~~~~~~~

Lesson #4 has been a pet peeve of mine for ages and relates to the quality of presentations at meetings by the biggies, the so-called 'thought leaders' of a profession. My experience is presentation quality is often awful, bordering on pathetic.

It's one reason I'm so glad that Medical Laboratory Science at the University of Alberta has a communications course that includes how to give presentations and gives students opportunities to practice the skills, including presenting their research projects.

Wish all MSc/PhD graduate and medical education programs included such a course. About physicians, my experience is, if a communication course or any professional development program, is not given by a physician, they devalue it. Apparently only physicians can teach physicians.😞

To me the biggest, common presentation failures include NOT doing the following, relevant to physicians, especially. BTW, the points are basic, equivalent to Presentation 101 courses.

• Begin with a personal anecdote to grab audience attention immediately and get them to appreciate your authenticity, that you've 'been there, done that,' and dig their professional realities.
• Explain up-front why the talk is relevant to the audience.
• For gawd sake, don't keep it a secret.
• Briefly outline what the talk is about, perhaps even say, if that's not what you expected, feel free to exit now. 
• Shows you  respect the needs of audience.
• Mention there will be time at the end for questions, if the person who introduced you did not.
• Distribute handouts at the end and say that up front. 
• Include your speaker notes in handouts so the audience has something substantive to take away.
• In the early days of Powerpoint I don't know how many handouts I brought home from meetings, including making notes on each slide myself, that were all but useless and eventually tossed in a trash can.
• Fact: If you distribute handouts at the start of a talk, the audience will concentrate on them, not what you are saying.
• Use mostly graphics in the presentation vs bullet points. It's a way to get folks to listen to what you say.
• If you use a few slides with bullets, do NOT use complete sentences and, regardless, NEVER read the points word for word unless you want to put the audience to sleep.
• Forget about using any busy slides you have where the writing is minuscule and unreadable.
• Just don't, no matter what.
• Saves you the trouble of cynically apologizing for it being busy.
• Because obviously you included the slide anyway, thus disrespecting your audience's intelligence. 
• Throughout the talk refer to the experiences of colleagues and audience members you recognize, and sprinkle the presentation with their work.
• It's not all about you, it's about those who helped you succeed.
• Self-deprecating humour, if sincere, is appreciated by listeners.
• Focus on key points only.
• Though tempting, do not succumb to presenting all your data and conclusions.
• Few viewers are as obsessed with the topic as you are.
• The fewer key learning points, the more they will be remembered because of info overload.
• At talk's end, briefly tell the audience what you told them and reinforce why it's significant and relevant to them. 
• Thank the audience for their attention and thank conference organizers for inviting you.
• With questions at the talk's end, even if you get snarky questions (yep, there are always all-about-me colleagues), try to be gracious, realizing that to most in the audience, the asker is showing themselves in a bad light and you are better than them.
• Taking the high road always wins.

LESSON #4: Physicians and researchers, at least try to learn how to present well. I realize you could care less as you've gotten away with pathetic presentations forever and have zero motivation to change. But please try to be better because it has many rewards, adds to your reputation.

 ~~~~~~~~~~~~~~~

ADDENDUM

First a disclosure. Folks, for most of my career I was one of the fortunate 'elites' I referenced earlier, mainly by virtue of volunteer positions for professional associations, being an invited speaker at conferences where organizers funded travel and hotel costs, or as a perk of being an educator at a university. 

One thing I noticed in those days of yore versus today's national meetings is that now there seem to be fewer young attendees. Perhaps it's my imagination or just that all professions are aging and those in senior positions are older than before. Or maybe not.

While I hesitate to mention this, one reason could be that younger med lab technologists/scientists may not be as keen as we were in what I call the 'golden age of immunohematology.' Perhaps when considering annual fees, younger folks and many older ones too, wonder if it's worth it, questioning the benefits of membership. That is, they first ask 

• What will the association and being a member do for me? vs
• What can I do for my association?
• How can I give back to my profession?

Or it could be that membership for some has become a financial burden. For example, in Canada registration with provincial regulatory colleges is compulsory for med lab techs,e.g. CMLTO annual fees. In contrast, membership in professional associations is voluntary and annual fees are a bargain in my opinion, e.g., CSTM $120 and CSMLS $167. But if you worked in Ontario and belonged to all three, the total would be $671.20. To me, that's just a tiny percentage of annual salaries and the benefits are many. 

Which brings me Julie Hendry's presentation. Julie is this year's recipient of the CSTM's  Buchanan Award, who included this slide at the end of her talk (click to enlarge - Julie's slide was tweeted by Geraldine Walsh and Clare O'Reilly on Twitter): 

Julie's challenge is a great one for CSTM members and members of all professions. We in the health professions are so lucky. 

FOR FUN
I chose this Beatles song because its lyrics fit the blog's content.

• We can work it out

As always, comment are most welcome (and there are some below).

I will remember you (Musings on TM colleagues past)

Updated: 30 April 2017 (Fixed typos)

April's blog focuses on a friend and colleague who recently died. How to write about Kathy Chambers after she so suddenly and unexpectedly died? Celebrate her life with a series of anecdotes on how she affected Canada's transfusion and quality community and beyond and especially those she closely worked with. 

Kathy's was the first blog in the CSTM's 'I will remember you' series (Further Reading). This blog allows me to be more personal and intimate.

For those who didn't know Kathy, I hope the blog has interest and value as a narrative on the complex interpersonal and mentoring relationships that exist in the transfusion workplace, indeed, any workplace. As you read it I encourage you to think of your own colleagues and how you interact.

The blog's title derives from one of Canadian Sarah McLachlan's songs.

ANECDOTE 1
Upon first meeting Kathy when she worked as a senior in the transfusion service of UAH, Edmonton I was struck by how she was so no-BS and down-to-earth, true to her Saskatchewan roots. She told it how it was, without the soft edges of political correctness. 

My gawd, I thought, this is the hard-nosed technologist I must collaborate with to develop the students' blood bank rotation experience? She was confident and a bit intimidating. If intimidating to me, an experienced transfusion professional, how would she appear to the 'kids' (as I call them to this day). 

Well, I needn't have worried. Kathy turned out to be the proverbial 'egg', hard on the outside and soft on the inside. She truly wanted the vulnerable neophytes (students) to have a good experience, to learn and grow during their clinical rotation. Kathy's confident exterior was intimidating, but she was warm and caring too, a trait that became increasingly clear the more I got to know her. 

Someone you could treasure as a lifelong friend no matter where life's divergent paths take you. 

ANECDOTE 2
At the CSTM 2000 conference in Quebec City, 10 years after she'd left Edmonton, Kathy introduced me to the then BC PBCO medical director and put me forth as the webmaster/content coordinator of its TraQ website. The offer came out-of-the-blue, totally unexpected, and was very kind given that we hadn't kept in close touch over the years. 

That conference generated many laughs. Kathy had such joie de vivre, always smiling and sharing an unspoken joke. 

TraQ was a dream job because I'd recently left a tenured position in MLS at the University of Alberta. After 22 years it was time for a new adventure and to give some of the 'kids' I'd taught a chance to transmogrify the job into the 21st C.

On subsequent trips to Vancouver for TraQ, and later on a CBS educational website project, Kathy always picked me up at the Vancouver airport (a chore in itself, given the traffic) and I stayed at her home and got to know her up close and personal.

One tidbit I recall is how we'd sit on her back deck each morning over coffee and she'd laughingly point out the neighbours who were suspected drug dealers.

To my surprise, I learned that Kathy gave me significant credit for something I took as normal. During her time in Edmonton she'd undertaken an ART (Advanced Registered Technologist), no longer offered by the now CSMLS. The ART was a way for Canadian medical technologists without BSc degrees to qualify for supervisory and managerial positions in clinical laboratories. 

Part of the ART requirement, besides a research project and oral examination, was a literature review. Kathy's lit review needed quite a bit of work and, as an experienced instructor, I gently suggested how she might improve it. Goodness knows who had taught her in the past because she inexplicably credited me for being a kind mentor and never forgot it. 

I suspect it formed the basis of her many acts of kindness to me over almost 40 years.

Fits with my experience that what we remember in life is mainly a series of small events (sometimes even seconds long) that strongly affect us positively or negatively and that we recall for the rest of our lives. 

I'm so glad that Kathy saw a small act in a positive light because her resulting kindness made my post-Med Lab Science career.

ANECDOTE 3
In 2000, Kathy and I were approached by Heather Hume, who had a vision to create a CBS educational website, which we did (2000-2003). Still think the site was a vein-to-vein masterpiece but impossible to maintain without considerable resources. Today, it's morphed to CBS's Professional Education site.

We had so much fun creating the original website. And I learned a lot from Kathy. Her breadth of experience was incredible. 

Towards the end of the project, Kathy and I had a parting of the ways, so to speak. The details are not important but, in retrospect, the fault was all mine. Indeed, Kathy went out of her way to rectify the situation and soothe my feelings but I was the stupid, hurt-feelings, hard-headed one. Keep this in mind for what comes next.

ANECDOTE 4
In 2007 I formed a consortium that was eventually hired by Alberta Health & Wellness to develop a Provincial Blood Contingency Plan to deal with severe blood shortages from pandemics and other causes (July 3 - Nov. 30, 2007). Folks I asked to form the Consortium included Penny Chan, Maureen Patterson, Dianne Powell, and Maureen [Webb] Ffoulkes-Jones, and yes, Kathy Chambers. 

As it turned out, Kathy Chambers became the 'de facto' lead under difficult circumstances and led the project to its successful conclusion. Quite an accomplishment and one that showed she had the 'right stuff', which I never doubted for a moment. 

Those of us involved refer to it as the 'project from hell' and Kathy was its saviour.  We can laugh about it now but not then.

ANECDOTE 5
When CSTM asked me to do a series of 'I will remember you' blogs, the first person I thought of was Kathy Chambers. She agreed without hesitating and, as was typical of her, quickly delivered the 'goodies' needed for the blog. 

Kathy was so talented and efficient throughout her entire career. How the heck could she have such focus? Amazing woman! A force of nature, a 'oner'. Like many in Canada and beyond, I'm fortunate to have known and learned from her. 

My best memories are of the many laughs we shared. Cannot see Kathy's face without a smile. I hope readers will recognize themselves and colleagues such as Kathy who have affected their lives for the better. 

FOR FUN
Naturally, I've chosen Sarah McLachlan's song for this blog:

• I will remember you 

I will remember you, will you remember me? 
Don't let your life pass you by 
Weep not for the memories.

FURTHER READING

• CSTM 'I will remember you' blog: Kathy Chambers

Four strong winds (Musings on trends identified by Malcolm Needs' 3rd CSTM blog)

Updated: 29 Jan. 2017

This month I'm going to feed off CSTM blogs on the career of the recently retired UK's Malcolm Needs (Further Reading). 

Typically, in the CSTM 'I will remember you' series of blogs, I offer my musings on what the featured author writes. But for January I've developed comments originally written for Malcolm's third CSTM blog (not yet published) into a stand-alone TM blog. So in a way this blog will foreshadow Malcolm's upcoming blog on regrets, concerns, and challenges, and serve as an advertising 'teaser' for it.

The blog's title comes from a 1963 song by the iconic Canadian duo, Ian and Sylvia. The blog is organized as a take-off on the song's title.

Strong Wind #1: AUTOMATION 
In his upcoming third blog, Malcolm mentions automation in the context of how it has changed the skill mix of staff employed in transfusion hospital laboratories. I've written about automation often including in 2010:

• Goldfinger's filings, a customer's toolkit: Musings on business intelligence (Further Reading)

In the July 23, 2010 filing of its FORM 10-K Immucor (Form 10-K reports, which public companies file with the U.S. Securities and Exchange Commission, offer comprehensive business overviews of a registrant's business, such as history, competitors, risk factors, legal proceedings.) , one maker of blood bank automation (Immucor) writes:

'Our long-term growth drivers revolve around our automation strategy. We believe innovative instrumentation is the key to improving blood bank operations and patient safety, as well as increasing our market share around the world.'[Note they put improvements and patient safety up front, but increasing market share is their prime concern.]

'We believe our customers...benefit from automation. Automation can allow customers to reduce headcount as well as overtime in the blood bank, which can be a benefit given the current shortage of qualified blood bank technologists.' [Reduce headcount is a nice euphemism for get rid of staff and their costly benefits. Diagnostic companies also tout automation as freeing lab technologists/biomedical scientists to do more interesting tasks. And of course, if you can remove the human, you remove most of the error, or so it is said.]

• 'We believe that instrument placements are the most effective way to gain market share ... Because our business operates on a “razor/razorblade” model....' [A razor/ blade model means give them the instruments relatively cheaply, because we can soak them with reagents costs, which continue forever.]

'In the new field of molecular immunohematology, we are currently developing the next generation automated instrument for the DNA typing of blood for the purpose of transfusion, which we believe will be the future of blood bank operations.' [And, by gawd, if a demand doesn't exist, we'll create one. See Strong Wind #4 below] 

Aside on automation: As a long-time transfusion science instructor (1974-99), graduates often told me they chose to work in hospital transfusion service labs because of the hands-on testing, correlating test results with patient diagnosis and history, and problem solving. They didn't choose clinical chemistry, in particular, because that clinical lab was heavily automated. Loading patient specimens on instruments and relying on software to flag abnormal results struck them as not nearly as engaging as transfusion science, or clinical microbiology, for that matter. 

Other grads obviously loved the highly automated clinical labs, and not just because job opportunities were more abundant. Of course, those who went to work for the blood supplier - on the 'dark side' as I affectionately call donor testing, where I enjoyed working in prehistoric days - inadvertently were sucked into the world of automated, mass testing of donor samples. 

Indeed, transfusion service labs whose test volumes warrant it, have moved into automated testing big time, as shown in the 'Goldfinger's filings' blog.

Strong Wind #2: LEAN
In his third blog, Malcolm also mentions LEAN. LEAN is a biggie in NA too, touted as an industry 'saviour', developed in Japan by the American Deming. LEAN expanded into health care ages ago. LEAN is promoted as allowing clinical laboratories and component production facilities to do more with less. 

For example, Canadian Blood Services (CSB) cooperates with Toyota and makes videos about  it. CBS higher level staff sport Master Black Belts in Lean Six Sigma. Jargon (~bafflegab) abounds as LEAN, Kaizen, and Six Sigma run together in a blur. 

Moreover, LEAN consultants make a great living by marketing it to health providers and training staff in-house. 

In 2008 I wrote a blog on automation and LEAN: 'Morning becomes Electra' (Further Reading). Refer to my views on whether automation and LEAN are progress, given that progress generally means improvement or growth, whether for individuals, organizations, societies, or humanity. 

Bottom line: Add automation and robotics to LEAN hospitals and soon we'll have gotten rid of all the non-value-added waste in the health system, as well as most of the health professionals. But is it progress?

Strong Wind #3: STANDARDIZATION
In his upcoming blog 3 Malcolm mentions that, in an effort to streamline how laboratories work, and to standardise (Brit spelling - grin) the work, a 'one size fits all' campaign was instituted in all NHSBT reference laboratories. 

From talking to colleagues in the field, I sense that standardized operating procedures (SOPS) are now 'SOPs on steroids'. Some hospital transfusion service lab SOPs are now so complicated that even long-time transfusion specialists must consult them often as they perform routine procedures they've done 100s of times. Do 'busy' SOPs increase patient safety? To me it's likely staff lose focus on patients due to the extreme emphasis on paperwork. 

Whenever a national blood supplier in any country tries to standardize work across laboratories or regions, my initial reaction is Beware! In his blog Malcolm explains the ways in which standardization doesn't always fit. My guess is that frontline staff aren't consulted enough initially and the head office folks writing the SOPs don't have the experience to realize it's a no-go from the get-go. 

Later the organization may ask for feedback on the SOPs that have been rolled out but seldom acts on it. Staff may even stop offering feedback because they've learned it's useless. 

I saw staff giving up firsthand in my brief stint as 'assman' at CBS (1999/2000). Staff tolerated nonsensical inaction from head office, because their feedback was met with a brick wall of silence and un-returned e-mails. Perhaps more senior people on-site knew little, too, because they were never told. Frankly, I shook my head in bewilderment at how dedicated, talented staff had come to accept the unacceptable. But, being naive, I went up the chain at head office until I found someone with real authority, who, when told what was occurring, fixed it immediately. 

About nation-wide SOPs:

• Sometimes it seems as if they've been written by folks who have never performed the procedure, at least not currently;
• Or maybe the writers know one lab's methods and don't understand that it won't fit others, a version of the cliché, 'a little knowledge is a dangerous thing';
• Or perhaps standardization is a significant someone's current hobby horse;
• Or, and here's the crux of the matter, standardization will save money in writing and revising. Never mind that they won't work operationally for every laboratory.

What's going on with SOPs in hospital transfusion service labs is a mystery. But I suspect it relates to government regulation and inspections by Health Canada (HC). 

HC regulators presumably gather input from all the stakeholders before new standards / regulations are instituted. But how much medical lab technologists / scientists play a role is debatable. 

My sense is that HC inspectors of transfusion labs have little, if any, first-hand knowledge of working transfusion medicine. Their concern focuses on documentation that processes have been validated and paperwork exists, regardless if it adds to patient safety, or even if they don't truly understand what it means. 

Strong Wind #4: MOLECULAR RBC GENOTYPING
Also in his third blog, Malcolm welcomes blood group genotyping as long overdue in immunohematology labs. 

As with any new technology, many constraints to widespread adoption exist, including staff expertise and cost. In the USA an added roadblock has been convincing government to pay for special DNA blood grouping when some of it is hard to justify with evidence. Naturally, patients with the money can get it. 

Again, see my 2010 blog, 'Snip, snip, the party's over?' for an overview of the issues (Further Reading). I see genotyping as a great innovation, but decry the increasing move to expand its uses beyond what can be justified clinically as a return on investment (ROI) in the technology. 

Moreover, I understand why, given that some folks have built their careers on it, and also dig the seductive lure of 'personalized medicine' (typical, over-the-top Rah!Rah! snake oil).  

For interest, see the UK's 'Red Book' (incredible resource) on 'Clinical applications of blood group molecular typing'.

LEARNING POINTS
In his upcoming third blog, Malcolm identifies concerns and challenges and shows hope for the future of TM labs. The issues he identifies are significant forces. Automation, LEAN, standardization, and molecular blood grouping are 'four strong winds' currently shaping transfusion medicine laboratories worldwide. At their heart, I see these 'winds' as deriving from 

• Vested commercial interests;
• Cost constraints and the need to do more with less;
• Government regulation gone amok.

FOR FUN
Given Malcolm's four topics, I decided the 1963 song by Canadian icons Ian and Sylvia was too good to resist. Of interest, in 2005 this song was voted the top Canadian song of all time, quite an honour given that Canadians have written many great songs. 

The song is a reflection on a failed romance, but the phrase, 'if the good times are all gone' resonates with me. Of course, even the earth's seas and mountains change over time, nothing is forever. Also, as an Alberta resident for ~40 years, I can attest there is plenty to do here all year round. 

Not sure, however, just who all these TM changes/trends benefit. As always, I hope the blog is 'food for thought' for readers. Watch for Malcolm's multiple blogs at CSTM. His second will be published this weekend (Jan. 28-29) and third in Feb. 2017.

• Four strong winds (Ian and Sylvia 1986 reunion concert)
• At end see Murray McLauchlan, Judy Collins, Gordon Lightfoot, Emmylou Harris (left to right) join them on stage.

Four strong winds that blow lonely, seven seas that run high,
All those things that don't change, come what may.
If the good times are all gone, and I'm bound for moving on,
I'll look for you if I'm ever back this way.

Comments are most welcome.
FURTHER READING

• Malcolm Needs blogs at CSTM:
• Blog #3: Coming in Feb.
• Blog #2: Any day now....
• Blog #1
• LEAN thinking in the medical laboratory (2014)
• My earlier blogs: 
• Mourning becomes Electra (July 2, 2008)
• Snip, snip, the party's over? -Musings on the seductive rise of DNA typing of blood groups (Dec. 20, 2010)
• Goldfinger's filings, a customer's toolkit -Musings on business intelligence)  (Aug.26, 2010)

Islands in the Stream (Musings on how love of transfusion medicine unites us)

Updated: 20 Dec. 2015

December's blog is based on a request from CSTM to 'put my money where my mouth is' and follow up on a statement from a March 2015 blog:

• I will remember you (Musing on retiring TM professionals & their patients)

'Just a thought. Perhaps the CSTM would consider celebrating some of these wonderful transfusion professionals on its website as an ongoing feature?'

As a longtime CSTM member and active blogger, guess it was natural to ask me and I was happy to oblige. Of course, blogs on individual careers cannot be written without the help of their subjects. So I asked, and they've kindly complied with only a little arm twisting.

As a value added benefit, blogs about lifelong transfusion medicine professionals document not only their contributions but also their experiences. Having remembrances in writing creates a historical record. And the only way to document this type of history is by asking questions of those who lived it.

This blog consists of 'teasers' about blog subjects to be featured on the CSTM website. 

They're all Canadians and mainly medical laboratory technologists / scientists. I encourage TM workers around the globe, whether med lab technologists, nurses, or physicians, to see themselves and their careers in these portraits and snippets of what transfusion medicine was like in the 20th C.

In some ways the blogs document the 'best of times and worst of times' to use one of the most famous opening lines ever in a novel, Dickens' opener to 'A Tale of Two Cities':

'It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope ... in short, the period was so far like the present period....'

The blog's title derives from a Bee Gees ditty whose title was taken from a Hemingway novel. Sung by Rogers and Parton, it became one of the best country duets of all time. 

CSTM BLOG SUBJECTS

In no particular order, a small sampling of blogs to come. This med lab professional...

1. Began his career in the UK where he met R.R. Coombs of Cambridge University, emigrated to Canada to work in Winnipeg's Rh Institute with the likes of Dr. John Bowman and Marion Lewis (awarded AABB's most prestigious Karl Landsteiner Award in 2001 and 1971, respectively) and ended his distinguished career in southern Alberta. 

2. Worked for Canada's blood suppliers (Red Cross/CBS) in multiple roles and several hospitals where in the 1990s she experienced the Alberta government's deep cuts to laboratory medicine funding, resulting in lab restructuring in which up to 40% of med lab techs in Edmonton lost their jobs and were faced with a career change.

3. Began her career as a PhD immunologist with research and academic experience in clinical microbiology, cancer research and immunology in several countries and later earned a masters in Health Admin. In 1994 she began working for Justice Krever on the Commission of Inquiry on the Blood System in Canada, eventually becoming executive coordinator and scientific advisor. Since then she has worked around the globe for the WHO on many blood-related projects in Third World countries.

4. Born in Hong Kong, began his career with BS in Med Tech from the University of Hawaii. Obtained ART certification (CSLT/CSMLS ) in Immunohematology, worked for Canada's blood supplier and several hospital transfusion services. Later he became business manager / technical education specialist for a diagnostic company, providing many educational workshops at TM conferences and beyond.

Many more transfusion professionals have agreed to be featured in CSTM blogs. If you want to suggest candidates, please do. 

Musings on History
I'll end with a few quotations on history. Perhaps the most famous is attributed to Santayana:

• 'Those who do not remember the past are condemned to repeat it.'

Churchill's is also a beauty:

• 'History will be kind to me for I intend to write it.' 

Who could omit this true witticism by George Bernard Shaw?

• 'We learn from history that we learn nothing from history.'

On a more serious note, one I particularly like by M. Scott Peck:

• 'The whole course of human history may depend on a change of heart in one solitary and even humble individual - for it is in the solitary mind and soul of the individual that the battle between good and evil is waged and ultimately won or lost.'

Then there's this:

When the blogs become available on CSTM's site, they will be referenced in TraQ's monthly newsletter. I'm hoping they will both inform and entertain, snippets of transfusion medicine history as experienced by those who lived it.

As always, comments are most welcome. 

FOR FUN
To me 'Islands in the Stream' means that, although as transfusion professionals we have separate careers that are different (like islands in the stream), our love for transfusion medicine unites us. Enjoy this 'tour de force' duet:

• Islands in the Stream (Kenny Rogers, Dolly Parton)

As always, comments are most welcome.

Look what they've done to my song, Ma (Musings on misuse of Twitter)

Updated: 16 Nov. 2015

November's blog was motivated by monitoring the AABB's twitter account during and after the 2015 Annual Meeting in October. 

The blog's title derives from a 1970 ditty by Melanie Safka, known professionally as Melanie. 

As an AABB member since 1975 (40 years), and being an early adopter of social media (mailing lists as of 1994 and Twitter since 2011), I'm naturally interested in how professional associations use social media. [FYI: Tried Facebook and hated it.] 

Be aware that you can follow Twitter accounts without being on Twitter. It's a good way to keep current on the latest transfusion news. Just bookmark (favorite) an account and visit daily, weekly, whatever suits your needs.

Why read the blog? Maybe to see what Twitter's all about? Or  how you as an individual or member of a transfusion-related professional association may want to use it to benefit the profession? To read the blog takes 5-10 minutes out of a 1440 minute 24 hours (maximum of ~0.7%).

AABB BACKGROUND
For interest, the AABB is one of the largest transfusion medicine related professional associations in the world, if not the largest, at least in the West. A few statistics from AABB's 2014 Annual Report:

AABB has more than 5000 members:

• 5,420 Health Care Professionals
• 1,294 Physicians
• 149 Residents
• 29 e-Members
• 298 Emeritus Members

I'd guess non-physician AABB individual members are mostly medical laboratory technologists/scientists.

AABB's Transfusion had almost 500,000 articles downloaded. That's impressive and I'm curious who's doing all the downloads.

AABB revenue ($US) from 

• Dues: $3,084,744
• Annual meeting: $3,956,264
• Print sales: $2,577,601
• Education: $5,065,813

Let's agree that AABB is a huge professional association. If you read the annual report, you will see that expenses are also large.

AABB MEETING/POST-MEETING TWEETS
With that as background, let's examine recent @AABB activity. Tweets during the annual meeting, Oct. 24-27, 2015, are summarized as follows. Non -substantive tweets are those that are 'me too' or thanks.

Day (Date): Number of tweets (n,% non-substantive)
Day 1 (Oct. 24): 47 (7, 15%)
Day 2 (Oct. 25): 48 (9, 19%)
Day 3 (Oct. 26): 29 (3, 10%)
Day 4 (Oct. 27): 30 (7, 23%)
Total = 154

Average tweets each day = 38.5. Non-substantive tweets over 4 days: ~17%

Post-meeting (28 Oct. - 14 Nov)
17 days of tweets: 32 tweets with 11 thanks 

Average tweets each day = 1.8. Non-substantive tweets over 17 days: ~34% 

See @AABB 2015 Annual Meeting tweets  (Non-substantive tweets in pale green)

NOTE: You can access tweets that include https:// as follows:

• Highlight the URL, e.g., https://t.co/WAox1aGgm8 in the first tweet 
• Don't include the "
• Right click highlighted text
• Select 'Go to https://t.co/WAox1aGgm8'

So what do AABB's tweets reveal about how health-related professional associations use Twitter?

MUSINGS
Twitter's Background
First, be aware that Twitter  - founded in 2006 - is a relative Johnny-come-lately to social media. Twitter didn't take off until years later and Twitter's 500 million users pale compared to Facebook's claimed 1 billion+ users. 

Twitter is popular, even indispensable in crises, because you discover what's happening before it's on live news channels. Indeed, news media now identify what's happening via Twitter. During the latest Paris terrorist attacks, I saw breaking news on Twitter before it appeared on CBC, BBC, CNN. 

Yet, many health professionals do not use Twitter at all. They learned Facebook and are unwilling to endure Twitter's learning curve. Plus many see Twitter's 140 character limit as meaning it's mickey mouse, only about tweeting what you had for breakfast, as if anyone cares.

Indeed, many professional associations do not know how to use Twitter to maximum advantage, likely because they see it of minimal value, albeit something they need to do if they want to be considered 'with it'. 

AABB vs Other Associations
As a large organization, AABB has a relatively active Twitter account compared to much smaller transfusion medicine associations, those with fewer resources, such as BBTS  and CSTM, both of which tend to post more substantive tweets. To my knowledge, ANZSBT isn't on Twitter.

Designated Person Tweeting
I know from one of my Twitter accounts, @transfusionnews, that tweeting substantive news to interest others requires time, effort, and discernment. It definitely helps to have the time and motivation to share significant 'goodies' but especially to have a transfusion background.

Would love to know who tweets for AABB. A paid staff member? Transfusion background required? What guidelines, if any, are provided regarding suitable content and frequency?

Bottom Lines
AABB is to be commended for maintaining an active Twitter account. That many tweets thank folks is also commendable and creates goodwill. 

But...and there's always a 'but' in my blogs...If I were tweeting for AABB, I'd include many more substantive tweets. Many of the @AABB tweets that I did not categorize as 'me too' and 'thanks' were not particularly substantive. 

What do I mean by 'substantive'? Tweets that are significant and meaningful to users and useful in their professional lives. Information and resources they didn't otherwise know about and are grateful for.

Because that's the beauty of Twitter. Despite it's 140 character limit, it's a wonderful medium for disseminating useful information quickly to many users. Yes, it should be fun and foster goodwill but mostly distribute information to those interested. That's one of Twitter's key strengths. 

Another is Twitter's ability to provide feedback and opinions. Yet few professional organizations use it for that. For example, I've never seen a professional organization use a poll or ask followers important questions. 

Yes, AABB's tweets during its annual meeting and thereafter were touch-feely but disappointed. From a huge organization I expect more. 

As Napolean said, 'If you're going to take Vienna, take Vienna'. Similarly, if you're on twitter, use it wisely to good advantage.

FOR FUN
This song written and recorded by Melanie Safka for her 1970 'Candles in the Rain' album fits the blog because it expresses how I feel about professional associations that misuse Twitter. 

Not abuse, just misuse. The blog is meant to be food for thought for how we can all improve our tweets so that busy professionals find them more useful.

Need I mention that I love this song for its clever lyrics?

• Look what they've done to my song, Ma (Melanie Safka)

Or try this fun duet: 

• Look what they've done to my song, Ma (Miley Cyrus and Melanie)

Look what they done to my song, ma.
Look what they done to my song.
Well it's the only thing
That I could do half right
And it's turning out all wrong, ma.
Look what they done to my song.

As always, comments are most welcome.

SUGGESTED READING

• @AABB 2015 Annual Meeting tweets

C'est si bon (Musings on TM news that is so good and not so good)

Updated: 29 May 2014

May's blog is a take-off on cartoonist Gary Clement's weekly feature, 'Week in Review' in Canada's National Post, e.g, Week of Apr. 20-26, 2014. I love them because they capture the week's news with a smile.
The blog's title derives from an old ditty by Eartha Kitt, C'est si bon (It's so good).

The topics include an eclectic selection of news items in TraQ's newsletter in the first quarter of 2014. C'est si bon is an attempt to write shorter blogs. I'd love your feedback. Shorter is so good or not so good? Keep returning because I'll add the odd 'So...' periodically.

A version of the blog (without some of the Comments below) is available on the BBTS website.

1. So creepy

• Vet accused of secretly keeping family's pet alive for blood transfusions

You take your dog to a vet and are told that the pet needs to be euthanized within 24 hours. Six months later you get a call from a former employee of the veterinary clinic who tells you that your pet was still alive and being bled for plasma to transfuse to other dogs. Say what?

2. So deserving

• Canadian Society of Transfusion Medicine 2014 award winners

The CSTM promotes excellence in TM for Canadians. The 2014 CSTM award recipients are, indeed, deserving. I'm fortunate to know them all. 

• Wendy Owens
• Dr. Lucinda Whitman
• Ann Wilson
• Crystal Oko

3. So nerdy (added 11 May 2014)

• How to make fake blood cuts 

Clever and simple, this is the type of chemistry trick we used to love in school. The kid in us still smiles, especially if we're nerds at heart.

4. So overdue

• Big pharma's relationship with your doctor needs some U.S.-style sunshine

By the end of 2014, the USA's Physician Payment Sunshine Act will require drug companies to report every transfer of value (as little as $10) to doctors and academic hospitals on a public website. Canada needs to do the same.

Think it's overkill? Think again. See CMA President Dr. Louis Hugo Francescutti's take on doctors and drugs. Big Pharma's influence on docs has stunk for a long time.

5. So predictable

• CBS CEO Graham Sher: Purchased plasma safe,essential 
• The article is in response to Payment for plasma bad policy 

Dr. Sher's key points (my analysis):

• After the tainted blood scandals of the 1980s and '90s, Canada created a safe and secure system that is the envy of the world and did it using science, evidence- and risk-based decision making.
• Drs. Ryan Meili and Monica Dutt, the authors of Payment for plasma bad policy, may not understand that blood donation and plasma donation are distinctly different, so Dr. Sher will clarify.
• Whether to allow paid plasma donation is a legitimate public policy debate about Canada's societal values and norms but is not an issue of product safety due to today's system and technologies.

So to all you 'worry warts' out there, don't sweat about whether paid plasma is safe. It definitely is. To Canada's elite evidence-based TM scientists, it's only about whether our values can embrace paying for plasma donations. Oh, by the way, without paid plasma patients will die.

As to the Ontario government's attempt to ban paid plasma, as predicted, the minority government has fallen and with it, all legislation.

Added 29 May, 2014: 'Must read' on paid plasma: 

• Twisted business of donating plasma for money (The Atlantic, 28 May 2014)

6. So sad

• Passing of George Garratty, March 17, 2014

The January 2014 issue of the AABB journal Transfusion reported that George Garratty, PhD, retired as associate editor of the Immunohematology section of Transfusion after 31 years of service promoting papers on red blood cell serology.

George was an icon to TM medical technologists. We will miss him dearly. 

• See 2012 interview

IN REPLY to Anonymous (11 May 2014)

Anonymous finds CBS CEO Dr. Graham Sher's public pronouncements on paid plasma in Canada both confusing and unreliable. Me too.

CEO Sher says that he doesn't want paid plasma clinics to open in Canada but, at the same time, he contends that paid plasma is needed to meet current demands for plasma derivatives in Canada and globally. Canada can only meet 30% of its needs. Moreover, he suggests that, without paid plasma, patients would die.

Dr. Sher's key learning point: Like it or not, patients in Canada and the world need paid plasma.

The flaw in that argument is that Canada has never truly promoted plasma donation. Indeed, CBS closed a plasma collection facility because it was cheaper to buy plasma from the USA and (sadly and stupidly) obfuscated its reasons for the closure.

Dr. Sher also contends that today paid plasma is safe because of 'donor screening and testing, plasma quarantine, and technology that inactivates viruses, and several purification steps.' He's right, as far as it goes.

But this reasoning assumes that no emerging infectious disease agents will appear that may escape the detection, inactivation, and purification steps involved in producing plasma derivatives. It also assumes that manufacturing errors will never occur.  And that, with today's system,  a disaster like hepatitis C contaminating Rh immune globulin can never again occur.

Perhaps CEO Sher suffers from cognitive dissonance, i.e., discomfort from holding conflicting beliefs. He contends that paid plasma is safe, and patients need paid plasma derivatives, but he doesn't want paid plasma clinics in Canada because CBS's voluntary donation system works well. Huh?

Cognitive dissonance aside, Dr. Sher is a clever man and has CBS spin doctors (communication specialists) advising him. He knows what he's doing. Any obfuscation is covered by emphasizing evidence-based decisions.

Just like Canadian Red Cross medical experts did when rejecting surrogate tests for non-A, non-B hepatitis (now hepatitis C), which resulted in tens of thousands of Canadians being infected with HCV.

Who can argue against evidence and science? Anyone who questions the safety of paid plasma is automatically and conveniently designated as non-scientific.

In reply to Unknown (12 May 2014)

Unknown asked, 'Is there something in it for CBS and Dr Sher in supporting American paid plasma?'

Great question. What follows are possibilities. First, I believe CBS CEO Graham Sher to be an honorable man who mostly believes what he says or, paternalistically, believes he's doing the right thing for Canada by protecting our TM system from non-scientific types.

But it's not that simple. As AABB President it's possible he's drunk the Kool-Aid of American-style transfusion medicine, given the schmoozing he's no doubt done with Big Pharma and the laboratory diagnostic firms who support AABB, as well as with so-called not-for-profit transfusion labs that operate as businesses.

Or maybe he's into Real Politik, focussing on practical rather than ethical issues.

What's in it for CBS to support paid plasma? It prevents CBS from spending money to promote free plasma donation and to build and maintain plasma collection facilities. Both earn brownie points with CBS's provincial paymasters.

What's in it for Graham Sher to support paid plasma? It's about the money, stupid. Money CBS can save by NOT maintaining collection facilities and staff, as above.

IN REPLY to Anonymous (13 May 2014)

Thanks to Anonymous, who supplied a link to yet another lobby group to promote paid plasma in Canada and noted that Canadian Plasma Resources has deep pockets: 

• Ontario Plasma Coalition (press release 13 May 2014)

The press release is classic PR spin (emphasis is mine):

Made up of deeply concerned Ontarians, the Ontario Plasma Coalition was launched to address the provincial government's irresponsible handling of Ontario's plasma supply and its attempts at banning compensated donations with Bill 178. In partnership with Canadian Plasma Resources, the Coalition was formed following thousands of responses received through PlasmaForOntario.ca.

Who knew that 1000s of deeply concerned Ontario citizens were practically marching in the streets to protest its irresponsible government's move to ban paid plasma?

Sheesh, you'd think the world would come to an end if Canadian Plasma Resources (CPR) didn't operate its paid plasma collection facility next to a homeless shelter and a centre for addiction and mental health. 

CPR built its facilities without Health Canada's approval, at least without its official approval. Who knows what went on behind close doors, including possible collusion by CBS (as in, 'Would you object?' Answer: 'No'). 

To me, CPR should shove its PR campaign where the sun don't shine. Just kidding!

IN REPLY to Anonymous (26 May 2014)

Thanks to Anonymous who commented, 

"So sad" - that it has come to this - money and big pharma. Blood was one of the last vestiges of old fashioned medicine....

With the ability to manufacture fractionated plasma products, blood became big biz for Big Pharma more than 70 years ago. A few facts and figures (hope eyes don't glaze over):

According to CBS's 2012-13 Annual Report (Management Analysis) in Canada demand for plasma protein products (PPP), such as immunoglobulin (paraphrased):

• Has grown exponentially, with annual growth averaging 8% 
• Ig utilization represents ~43% of the total cost of the PPP program
• Softening of Ig utilization is driven by the provinces and territories taking measures to manage escalating Ig demand 
• For example, in British Columbia, all requests for Ig use are screened to make sure that Ig is used in accordance with provincial guidelines
• [See BC PBCO 'Intravenous immune globulin', including order forms]
• Total Plasma Protein Products program expenses increased to $469.5 million in 2012/2013 
• [See trends and usage information by provinces on CBS site]

Since immunoglobulins represent 43% of the PPP program cost, that's ~$201.9 million of Canadian taxpayer money going to Big Pharma for this one product alone. That's small potatoes to the Big Pharma companies who supply CBS, who then supplies it free of charge to hospitals (and their patients). But Canada is but one of many customer countries who purchase products like intravenous immune globulin (IVIG).

Big Pharma pours mega-bucks into funding research aimed at increasing its use (and then convincing physicians to use their products). For example:

• Phase 3 trial of IVIG to treat Alzheimer's Disease

As noted, blood became big biz with the ability to fractionate plasma proteins:

• Beginning in the 1940s with Cohn fractionation to produce albumin
• Factor VIII concentrate to treat hemophilia in the 1960s (and we know the tragic consequences of that)
• Business really took off in the 1980s with the ability to produce IVIG
• See History of Plasma Fractionation

IN REPLY to Anonymous (26 May 2014)
Anonymous asked who AABB's corporate members were. I suspect Anonymous means commercial entities, as opposed to non-profit institutional members like  transfusion services and blood centres. See

• List of current corporate affiliates
• Benefits of corporate affiliate program

FOR FUN
To follow-up on the 'so' theme, enjoy these renditions of a popular jazz ditty from long, long ago:

• C'est si bon (Eartha Kitt's French version)
• C'est si bon (Louis Armstrong's English version)

As always, comments are most welcome.