Showing posts with label Canadian Blood Services. Show all posts
Showing posts with label Canadian Blood Services. Show all posts

Tuesday, March 31, 2020

We are the world (Musings on COVID-19's impact on the world's blood supply)

Stay tuned: Revisions are sure to occur
March's blog derives from the ongoing worldwide shortage of blood due to the coronavirus (COVID-19). Of course, because this is a transfusion medicine blog, I'm preaching to the converted. But I hope it gets wider distribution among all healthcare colleagues and the public beyond. 

Specifically, I ask all transfusion heath professionals to speak to colleagues, family, friends, neighbours about the ongoing need for blood donation, made even more crucial because of the COVID-19 pandemic. 

The blog's title is based on a 1985 song written by Michael Jackson and Lionel Richie for  'USA for Africa.' 

BLOOD SHORTAGES
For TraQ's newsletter, I've collated some of the ongoing blood shortages across the globe (Further Reading). Fact is, the need for blood transfusion is ongoing despite the COVID-19 pandemic. Yet blood donation has dropped off significantly in many nations for numerous reasons explained in the news items in Further Reading. 

TRANSFUSION NEEDS
Despite the ongoing efforts of the Transfusing Wisely initiative (Further Reading), implemented in many nations, regular need for transfusions still exits for many patients. Transfusing Wisely's general goals: Reduce the rate of unnecessary blood transfusions with the goals of lowering the risk of complications for patients and supporting the judicious use of valuable resources. 

For the general public, just some of the ongoing needs for blood transfusion include the following (not all inclusive):

Patients who need blood transfusions
  • Mothers who incur significant bleeding during delivery, including those with placenta previa
  • Gastrointestinal bleeding (if massive can be life threatening) with many causes such as hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn's disease, colonic polyps, or cancer in the colon, stomach or esophagus  
  • Kidney disease, sometimes secondary to type 1 diabetes, that requires dialysis
  • Any surgery that involves significant blood loss
  • Trauma patients including those in car accidents who experience blood loss and victims of knife attacks or gun shot wounds
  • Blood disorders, including
    • Thalassemia major patients need regular red blood cell transfusions to raise their hemoglobin level and deliver oxygen to body tissues
    • Sickle cell disease patients need regular red blood cell transfusions to provide normal red blood cells, lessen anemia and reduce the blood's viscosity, allowing it to flow more freely and ease disease symptoms and prevent complications
    • Leukemia patients who develop thrombocytopenia need platelet transfusions to control bleeding 
The need is real and ongoing. Please encourage colleagues, family, friends, and neighbours to donate blood and save a life. It's one thing folks can do during the pandemic. Further Reading includes questions about donating in Canada and blood systems in all nations have similar information. 

FOR FUN Naturally, I chose We Are The World, originally written for 'USA for Africa' in 1985 by Michael Jackson and Lionel Richie, produced by Quincy Jones and Michael Omartian, and sung by many fabulous American  artists.  
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving...

As always, comments are most welcome and appreciated.
FURTHER READING
Australia: In the face of coronavirus pandemic, Australian Red Cross Lifeblood’s stocks are threatened (24 Mar. 2020)

Canada: Top doc says Canada still needs people to give blood amidst social distancing (17 Mar. 2020)
      Canadian Blood Services: Message by CEO Dr. Graham Sher
      CBS answers COVID-19 blood donation questions

Pakistan: Experts urge volunteers to donate blood as thalassaemia patients face shortage (22 Mar. 2020)

Spain: In COVID-19 emergency blood bank stocks in Costa Del Sol hospitals are alarmingly low (18 Mar. 2020)

UK: Blood donors needed after 15% drop, says NHS (23 Mar. 2020)

USA: Coronavirus fears threaten America's blood supply (12 Mar. 2020)

Transfusing Wisely Canada

Tuesday, October 01, 2019

Both sides now (Musings on humans vs technology in transfusion medicine)

Stay tuned: Revisions are sure to occur

INTRODUCTION
There's much transfusion news these days on artificial intelligence (AI), big data, drones, innovations, new technology, precision medicine. In a way this blog is a follow-up to the prior one, 'Get back' (Musings on transfusion medicine's future).

September's blog (albeit published Oct. 1) was stimulated by a weekly feature ('Workplace column') on a local radio program I heard this morning (Further Reading). Also, because as an oldster I want a record of events I've experienced in the hope they will resonate with some and influence others to do similar. Otherwise when we oldsters croak, they're gone forever.

The blog's title derives from a song by Canada's Joni Mitchell.

As you read the blog, regardless of your health profession, please consider the challenges you faced if you have held a management position and, if not, think about the strengths and weaknesses of managers you have had. Also, consider the impact you as a manager have had on colleagues and the influence your managers have had on you and your career. 

Specifically, the radio column was on moving into management, generally viewed as a promotion with a higher salary. The columnist (@sandbaryeg) gave tips on becoming a manager for the first time. Her tips made me recall when I took a giant leap from a long career as a transfusion educator of medical laboratory technologists/biomedical scientists to become a lab manager at CBS ('assman' as the centre's QA department addressed my mail). True, I'd been lab supervisor in my 13-yr job before teaching, but with none of the responsibility the 'assman' position entailed.

Indeed, as I only learned later, although I managed the patient services lab at the blood centre, the position had been downgraded to 'assistant manager' in order for the centre (and perhaps head office?) to retain more control, especially over salaries. Also, I hadn't realized (bit stunned of me) that the person who had been an assistant to the prior manager and perhaps (just a guess) had applied for the job I was recruited for, and was the acting manager when I came. She was a prior student of mine, in fact in the first Med Lab Sci class that I taught all the way through, who I was and still am exceedingly fond and proud of.

My take on the consultant's 5 tips for new managers. How to
1. Run meetings, something many dread;
2. Give effective feedback;
3. Foster a team environment;
4. Attract & recruit the staff you need vs filling an existing job;
5. Manage your own time effectively.

Promotion: First, I'll note that in my experience (historical, I know, dating from 1960s-2000) often the folks who get promoted in the lab are ace technologists. If all factors are considered more or less equal, seniority may play a role. To me, that's not an effective process, but it's likely the easiest.

How often do fabulous footie players (soccer in NA) or hockey players become great managers? Not many. Why? Because the skills needed are quite different.

Needed skills? More recently, not only med lab techs/scientists but also physicians (perhaps nurses?) tend to get Masters of Business Administration (MBAs) as lab medicine and transfusion have become more and more a business. Presumably these degrees help in a new career as a 'suit' whose prime concern is the bottom line, though patient safety is always touted, given first place in communications.

I'll discuss the 5 tips in various ways based on my experience.

RUNNING MEETINGS
Decades ago as an educator I'd experienced many ineffective meetings, including those run by MDs at the departmental (Lab Med & Path) & Faculty of Medicine levels. Some dept. meetings were info-only unneeded sessions. Few required active participation. And often the minutes were totally useless to anyone not attending.
  • My experiences motivated me to write a resource for TraQ in 2009 on running meetings (Meetings as Time Wasters, Further Reading).
On running meetings in my brief career as 'assman' I was fortunate and smart to designate my prior student to run many meetings. She was experienced in the task and did it much better than I ever could. Only time I ran meetings was when it came to getting staff on board with changing almost all pretransfusion testing methods in the lab. That came easy as it was right up my alley as an educator.

In a similar vein, I was glad I'd insisted on a whiteboard for my 'assman' office as it was well used when meeting with supervisors in the various sections of the patient services lab.

EFFECTIVE FEEDBACK
As an educator I had to give feedback over decades and some was difficult. For example, telling foreign students (English as a second language), whose parents had struggled and worked hard to send them to Canada that they were not going to pass their clinical rotation. For such students it was a total disaster, an incredible loss of face and shame. Frankly, it broke my heart and I know that whatever I said to lesson the blow (e.g., they could have great success in another career) wasn't heard and didn't lesson their reality in any way.

In giving more routine feedback, as a med lab technologist with an MEd, I knew the characteristics of effective feedback. On a personal level I believe that often what shapes us for good and bad in life are 15-60 second interactions with others. For example, I'll never forget the powerful effect of my Dad saying, 'Pat, don't be afraid to be different.'

As a teacher of med lab students I always kept that in mind when giving feedback. Meant I treated struggling students the same as high achievers. And in retrospect I see that many of those who struggled have gone on to be high achievers, leaders in their field. Why? Suspect it's because success depends on many factors, not necessarily getting the highest grades.

A good pal is a standardized patient at the University of Alberta and they have a particular take on feedback, called CORBS (Further Reading):

CLEAR – Give information clearly and concisely
OWNED – Offer feedback as your perception, not the ultimate truth. Talk about how something made you feel. Use terms such as “I find” or “I felt” and not “You are”
REGULAR – Feedback is offered immediately, or as soon as possible after the event
BALANCED – Offer a reasonable balance of negative and positive feedback. DO NOT overload with negative feedback.
SPECIFIC – Feedback should be based on observable behavior and behaviors that can be modified.

TEAM ENVIRONMENT
Not much to say. Health care teams are similar to politicians kissing babies. Everybody does it as it's the reigning orthodoxy, the cliché of how we love to see ourselves. Again, University of Alberta has a course on it. INT D410 - Interprofessional Health Team Development.

Like to think I've been a member of many teams in health care (my transfusion families over the years) but must admit that many who promote it most publicly do not walk the talk.

RECRUITING STAFF
Will only speak to my recruitment to be 'assman' 21 years ago. Fact was the job was not quite as advertised. In retrospect I thought they portrayed part of the job almost as if it was what became hospital liaison specialists. I totally dug the part about the centre being the pilot site for a new information system and found it a worthwhile challenge.Our talented team of med lab professionals did a wonderful job in implementing the new IS.

Similarly, I loved the opportunity to change outdated lab methods, though don't think they hired me for that. It was just my 'value added' to the job I held for all of 9 months. When I tendered resignation I explained why in exit interview. They understood more money wouldn't make a difference and admitted they could not change what I thought needed changing most (head office, though it's more complicated than that).

So did CBS recruit the right person for the job? Yes and no. Yes, because I led the talented patient services lab team successfully through a difficult time of incredible change. No, because after years in academia at a university where dissent and free speech are cherished, I didn't fit in a national organization where adhering to head office directives was paramount. That's what made you a valued team member.

MANAGE YOUR TIME
The radio consultant pointed out that managers need to prioritize their tasks and serve as role models for staff as they cannot work to 10 pm over the long term. I don't have much to say except that you obviously cannot help others if you're exhausted. See it as a Buddhist concept that you need to love yourself, be okay with who you are, in order to love and help others. Over my entire career I was often the first in and last out daily but that's another story.

CONCLUSION
Are AI, big data,new technology, precision medicine all important to health care and more crucial than the qualities of people in leadership positions? Perhaps. But not to me. As a human being on plant earth, I'll always value the human condition over technology. See excerpt from 2001, a Space Odyssey (Further Reading).😁

FOR FUN
Chose this song because I've lived long enough to see transfusion medicine evolve from being people-focused to technology-focused. As  early adopter of technology (not a Luddite), I doubt we're on the right track (Further Reading). Also, admit that I love the songs of Canada's Joni Mitchell.
FURTHER READING


Monday, December 31, 2018

Those were the days (Musings on physicians I've worked with over a lifetime)

Significant updates: 12 Feb. 2022 (See #3 below:In memoriam:Dr. David Ferguson)
December's blog is about eight pathologists, hematopathologists and hematologists, I've had the pleasure to work with over a more than 50-year transfusion career. I cannot do them justice so will offer a series of brief tidbits that symbolize how I see them. Some are what folks call 'real characters,' some not, but they all have strength of character and I'll never forget any of them.

1. John Bowman (Winnipeg, Manitoba)
I've blogged on Jack before when he died in 2005:
Dr. Jack Bowman (In Memoriam)
Many tidbits to show why I respected him.

The rest are from my career in Edmonton, Alberta, Canada.

2. Lynn K. Boshkov (Edmonton)
Lynn is such an unassuming person. Loved her tenure at the UAH transfusion service. She was the Medical Director when this case happened
So respected her when she disclosed and explained what had happened to the patient's family whose loved one had died and supported the staff member involved. Lynn eventually moved to Portland's Oregon Health and Science University.

3. David Ferguson (Edmonton)
As UAH Medical Director David helped me a lot as the clinical instructor to the UAH transfusion service. He eventually moved to BC and later retired. Two tidbits:

The Med Director gave oral exams to all med lab technologist doing their clinical rotation at UAH and I was present to decrease any stress. Once David asked a student which lectin acted like anti-A1. Her reply was Delicious biflorus (not Dolichos biflorus) at which point he started laughing uncontrollably. Poor kid, I tried to salvage the moment, though I had a huge grin on my face.

Second tidbit is David's reaction to feedback we got on a paper submitted to AABB's Transfusion.

Letendre PL, Williams MA, Ferguson DJ. Comparison of a commercial hexadimethrine bromide method and low-ionic-strength solution for antibody detection with special reference to anti-K. Transfusion 1987 Mar-Apr;27(2):138-41.

AABB reviewers thought we needed to change title to add 'with special reference to anti-K'. We did, of course, but I'll never forget David's venting as only he could do. In retrospect I wish all could see him as I did.

In Memoriam - David Ferguson: Recently learned of that David died on January 3, 2022.He'll be sadly missed by all of Canada's transfusion medicine community.

4. Ed Uthman (MEDLAB-L)
When I created the mailing list MEDLAB-L in 1994, Ed was one of the first to subscribe. He soon became a rockstar and motivated many to love the list and join. He contributed many posts and made the list a success.

Now on Twitter Ed still contributes to pathology worldwide: Ed on Twitter

5. Neil Blumberg (MEDLAB-L)
Neil also joined MEDLAB-L early on and was so generous with answering questions completely and in detail. The wealth of knowledge he has is incredible and that he's so willing to take time to share it with others.Wow!
I'll always treasure Neil's contributions and he's still at it: Neil on twitter
6. Ira Shulman (MEDLAB-L)
Ira gave talk at Edmonton conference and I got to know him. Came to my University of Alberta Med Lab Sci office to catch up on e-mail. I erred in ordering wine that was sweet at a local restaurant (horrors!) and especially funny as I prefer very dry wine. We went to the local IMAX theatre as he wasn't into a river valley walk. 


Great guy. Loved California Blood Bank Society (CBBS e-network forum) but it ended.

Once he asked me to present at AABB conference with him, but without financial support as a consultant I couldn't, especially given the US-Canada exchange rate. At ISBT World Congress in Vancouver I enjoyed his OMG comment on all the backup files I had for my Powerpoint presentation.

6. Heather Hume (Ottawa, CBS Head Office)
I worked on contract for CBS under Heather's supervision, along with colleague and friend Kathy Chambers, when Heather was executive medical director, and had the vision that CBS should do more transfusion education. Heather is special.

Together, with input from Dr. Lucinda Whitman, we created a Transfusion Medicine website [screen shot of old site] that has since transmogrified to Professional Education.

At Vancouver at ISBT 2002 Congress when, as a panel member, I noted I'd stayed at University of Alberta Med Lab Sci for 22 years but managed only 9 months at CBS Edmonton as 'Assman,' Heather quipped,~ to 'Pat always wants to end with a laugh.' I'm sure she was thinking much worse, but the classy lady gave me the benefit of the doubt.

7. Gwen Clarke (Edmonton)
I taught Gwen when she was in Med Lab Sci and got to know her better after she became a hematopathologist. In 2006 Gwen and Morris Blajchman edited Clinical Guide to Transfusion, the first to be published online and in print. Believe it or not, I was a co-author (minuscule role) of one of its chapters:
2006 Chamber K, Letendre P, Whitman L. Blood Components. In: Clinical Guide to Transfusion, Clarke G, Blajchman M, eds. Ottawa: Canadian Blood Services, 2006.
Every technologist who works with Gwen respects her. She's a oner. I hope CBS knows how lucky they are to have her on staff.

 8. Susan Nahirniak
I count Susan as one of my Med Lab Sci 'kids'. Despite all my kooky blogs and tweets, Susan never fails to greet me with a warm smile, as here at MLS 2018 reunion. I so appreciate that she forgives me my sins for old time's sake. During our talk her phone kept vibrating because her daughter wanted to be picked up, but Susan kindly ignored the phone.

In summary, I hope you enjoyed these glimpses into encounters I've had with a variety of transfusion physicians over the decades. All are very different, unique, and superb representatives of their profession.

TWEETS
Replies I received on Twitter when I posted this blog. Both have given me permission to post their tweets.
#1 By @shroon7, 1 Jan. 2019
I adored Dr. Boshkov and was @UBB [University of Alberta Blood Bank] as an LAII when she left. Dr. Clarke is also wonderful and I’m glad I still get to talk to her occasionally when she’s on call. RBB’s [Royal Alexandra blood bank] loss was CBS’s gain.Dr. N [Nahirniak] is another fave; more than a few times I’ve been very glad it was her on call. #2 By @shroon7, 1 Jan. 2019
She [Lynn Boshkov] was just so wonderfully “chill” in bone marrows. She had the best ability to keep patients distracted and at-ease during the whole procedure.
#3 By @shroon7 1 Jan. 2019
To sum up: Considering THREE fabulous hemepaths I’ve had the good fortune to work with are three of your top choices after your long career, I’d consider myself very blessed.

#1 By @DoctorCanBob, 1 Jan. 2019
Lynn was trained in McMaster and was also a superb "clotter".
#2 By @DoctorCanBob, 1 Jan. 2019
Lynn is still doing primarily clotting in Portland at OSMU. 

Also see entire thread of these tweets.

FOR FUN
Could choose many songs for this blog but decided on 'Those Were The Days' by Mary Hopkin. Her 1968 version, produced by Paul McCartney, became a number one hit in UK.
As always, feedback is appreciated. See Comments below.

Wednesday, June 20, 2018

The sound of silence (More musings on paid plasma pros & cons)

Updated: 13 August 2022 (Fixed one link)
Wrote first version of this blog a few days ago then pulled it. Why? I wrote it when angry, never a good idea. What got me mad was the following reality:
If there's one thing that gets my goat (or, in the vernacular, pisses me off), it's a campaign that's clearly orchestrated and perhaps indirectly funded by the likes of USA's far-right Koch brothers (Further Reading). I say indirectly because Koch biz is well known as a hidden maze of covert operations. Tracing funding is impossible. Like crime investigators, I don't believe in coincidence as outlined below.
The reality is the many letters to the editors, and so-called opinion pieces/commentary, that support paid plasma have 'coincidentally' flooded many Canadian papers as Health Canada's Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada considered the issue. Interestingly, several op-eds 'coincidentally' cite the same letter written to the Panel by Peter Jaworski (co-author of 'Markets without Limits:  - Further Reading) and 32 ethicists and economists, including two Nobel Prize winners and a recipient of the Order of Canada, as we are ever reminded. Walks, talks, and quacks like coordinated to me. 
I've since cooled off and developed a second thesis for the blog. Advocates on both sides of the paid plasma issue are talking past each other, both sides being certain they are right. Like current USA politics, polarization is extreme and we're all partisans, endlessly pounding home the same points to those who agree with us and to convince the larger public via endless op-ed pieces.

Disappointed that CBS and Health Canada are not more transparent about where Canada is headed on paid plasma. Both HC's Expert Panel (bit of a joke) and CBS have been less than transparent on the issue. CBS's position is understandable, Health Canada's not so much. This is the origin of the blog's title, The Sound of Silence.

So the blog's aim is to outline what I find wrong and weak about both anti-paid plasma and pro-paid plasma advocacy. Yes, my position is clear and I've said similar before over many years. One more time....

ANTI-PAID PLASMA
My view is that anti-paid plasma advocates (I'm one) who sound alarm about safety issues that are iffy at best do not do the cause any good. Yes, some risk exists since zero risk is impossible. Although paid plasma is as safe as volunteer plasma, largely due to the processes that fractionated products like intravenous immune globulin go through, plasma fractionation destroys KNOWN 'deadly' risks (HBV,HCV,HIV) but not necessarily future unknown transfusion-transmitted infectious organisms. But to focus on safety is non-productive. Why?

Because focusing on safety undermines two main legitimate arguments:
1. Paying for body tissues is unethical because it preys on the poor;
2. Culture of paid blood donation will undermine volunteer donations over time.

For more on unethical, see Further Reading (Musings on how paid plasma mirrors Rumpelstiltskin).

FACT: Valid statistics about decreased voluntary donations are hard to come by since no one knows what they would be if (1) paid plasma didn't exist and (2) national blood suppliers like CBS had made concerted efforts over the years to encourage and facilitate plasma donation.

PRO- PAID PLASMA
The pro-side argues as follows, exemplified by Jawarski in 'Markets without Limits':  'If you may do it for free, you may do it for money' meaning selling body tissues and organs is moral because you can do it for free (voluntarily donate). And selling tissues / organs saves lives so must be good, conveniently ignoring or minimizing that it preys on the poor (Further Reading).

Another position pro-plasma advocates pound away at is that anti-paid plasma advocates in Canada and elsewhere are hypocrites. Let's face it, we are all hypocrites in some ways. I'm a vegetarian who wears leather shoes, believes in transitioning to renewable energy yet has flown a lot around the world and taken cruises, which contribute significantly to greenhouse gas missions. 

To me, not wanting to make Canada a paid-plasma haven like the USA, sucking the blood from the needy, is a legitimate ethical view. More legitimate than fear mongering that patients will die if we don't pay for plasma that can be fractionated into life-saving derivatives. Fear mongering conveniently serves the needs of Big Plasma and its billions in annual profits, And means nil will change, we'll be forever captive to the plasma industry, instead of promoting voluntary donation and developing innovative alternative treatments, and reining in off-label uses of products like IVIg. 

Another pro-paid plasma position is that anti-paid plasma advocates are all about unions wanting to save their members' jobs. Seems a knee-jerk reaction to public service unions supporting voluntary donations, often citing the iffy safety rationale. But please answer this: Under what scenario would unionized CBS workers lose their jobs to paid plasma private clinic workers, who presumably would not be unionized and paid much less to maximize profits to shareholders, as well as having poorer working conditions? Beats me.

WHO'S BEHIND PRO PAID PLASMA PROPAGANDA?
In the latest propaganda piece ('Why we should pay Canadian donors for their blood plasma donations,' 13 June 2018), the authors feel compelled to write:
'Neither of us is in any sense funded by 'big plasma' or any other commercial interest. We are professors at universities (one at a Canadian public institution, and one at a private American one). We have no financial stake in this issue. We are merely doing our jobs as philosophers and ethics professors: namely, putting forward what we believe to be the very best argument on a matter of substantial public importance.'
Reminds me of 'the lady doth protest too much, methinks' (Hamlet). Note that Jaworski co-founded the Institute for Liberal Studies (Further Reading) and is an adjunct scholar at the libertarian Cato Institute (Further Reading - Behind the Cato Myth), created by the Charles Koch Foundation. Cato is anti-minimum wage, anti-union, anti-universal healthcare. You get the picture. And it's fair to judge folks by the company they keep, isn't it?

Not all Cato Institute positions are obnoxious to progressives like me, but among other policy positions, Cato is pro-tobacco, pro-private schools, pro-private prisons, in other words, pro-private anything like pro-paid plasma. And, of course, Cato thinks man-made climate change is exaggerated.

All these philosophers writing to papers and volunteering to author op-eds may be sincere advocates that paid plasma is the way to go, and are prepared to put patient needs above the poor who subsidize patient treatment risking their own health. Kinda reminds me of Trump's 'Amerika First'. My needs trump yours.

And pro-paid plasma advocates ignore that Big Plasma makes billions off the blood of the needy because markets rule (Further Reading). Instead they focus on the needs of patients, a legitimate concern, but have closed minds that voluntary plasma donation can significantly help. Until recently, plasma donation has never been promoted by CBS. Volunteers may not be able to supply all the plasma needed but why not try instead of letting paid plasma become the norm?
  • Once paid plasma is part of the culture, why would anyone donate plasma voluntarily?
Just a coincidence that pro-paid plasma philosophers, who seem to know each other via various networks, flood newspapers with pro-paid plasma pieces, just because they're doing their jobs?

Perhaps but clearly a coordinated effort. They may be sincere but do not support a heart of gold. Instead they support Big Biz, earning gold on the backs of the poor. As befits anyone who's part of the Koch-Cato right wing propaganda initiative.

As always comments are most welcome.

FOR FUN
Again I use Simon and Garfunkel's ditty:
FURTHER READING
Over the years I've written many blogs on paid plasma, the last previous to this one on Dec. 29, 2017:

Look what they done to my song (Musings on how paid plasma mirrors Rumpelstiltskin) Note relevant links in Further Reading:
  • Twisted business of donating plasma for money (The Atlantic, 28May 2014)
  • WHO: The state of the international organ trade: a provisional picture based on integration of available information
  • Meeting an organ trafficker who preys on Syrian refugees (BBC, 25 Apr. 2017)
  • The body trade - Reuters series ('The chop shop')
  • Search on Google for organ trafficking(1.3 million hits, 29 Dec. 2017)
A rare look inside the Koch brothers political empire

Those ubiquitous libertarians (2014) - Discusses influence of the Koch Brothers in academia (much of it hidden); wonders about funding of Jaworski's Institute for Liberal Studies (ILS)

Multi-millionaire quietly funds network of right-wing groups active in fight to dismantle Canada’s public healthcare system (2017); Including funding ILS

Behind the Cato Myth (2012)

Why we should pay Canadian donors for their blood plasma donations (13 June 2018)

'Markets without Limits: Moral Virtues and Commercial Interests' (positive review)

BIG PLASMA MAKES BILLIONS

Saturday, July 22, 2017

Both sides now (Musings on where careers take us)

Updated: 2 August 2017

July's blog originated when, after decades of hoarding 'stuff', I finally decided to clean out a file cabinet. In the Medical Laboratory Science (MLS) folder, where I'd taught for 22 years+, I came across a graduation talk I'd given in 1991. The talk got me thinking about preserving (via a blog) some of the history of med lab techs who got caught in the cost constraints of the 1990s and had to work outside Canada. Some eventually decided to transition to other careers. 

The idea for the blog further crystallized when a local radio station used as its 'talking point of the day' 
  • 'How did your education (or lack thereof) play into your career? Are you doing the job you trained for and can people still learn on the job?'
I thought the question's focus was slightly off because it assumed that education for a career was mainly for a particular profession's job-specific tasks and ignored all the transferable skills students learn with a good professional education.

Executive version: What follows is an edited version of the grad talk followed by my musings on what happened to the careers of some graduates in the 1991 class. My thesis is that, if education for a career is sound, graduates come out with the self-confidence and transferable skills to transition to wherever life takes them.

Why read it? The educational issues discussed relate to med lab techs/biomedical scientists everywhere and cover a few of the transferable skills essential to any health professional. As well, the blog may resonate with nurses and physicians who find themselves forced to travel to foreign lands for job opportunities. 

Today where I reside (Edmonton, Alberta, Canada), depending on which provincial political party wins the election in 2019, health professionals could find themselves back in the 1990s when medical laboratory technologist, nursing, and laboratory physician jobs all but dried dried up due to the government's obsession with balanced budgets. 

The blog's title derives from an iconic 1967 song written by Canada's Joni Mitchell. I used it once before for a 2013 blog.

GRADUATION TALK TO MLS CLASS of 1991
What follows is an edited version of the talk. It's a run-of-the-mill talk but makes a few points I think are key to a sound education and still apply 26 years later.
Thanks very much Terry for your generous introduction. I am glad to have this opportunity because there are a few things I still need to cover with this class. First, I thought we would have a spot quiz, because students love them. Be aware that some of the answers will only make sense to the graduates. Let’s begin, starting with a test of your long-term memory.
Q #1: How many 1st-year MLS students does it take to change a light bulb?
  • Five. One to change it and four to set up Kohler illumination.
Q #2: How many 2nd-year students does it take to change a light bulb?
  • None. At least not in my class. You see, they were all asleep during my Powerpoint presentations and the light would only have disturbed them.
Q #3: How many 3rd-year students does it take to change a light bulb? [3rd yr is the clinical rotation yr]
  • The whole class. One student to change it and the rest to complain that their friends in other faculties had all summer off to do it.
Q #4: This one is a test of your short term memory. How many 4th-year students does it take to change a light bulb?
  • Again, the whole class. One to change it and the rest to complain that it should be deleted from Path 401 [a catch-all course, long since dropped].
Q #5: How many MLS instructors does it take to change a light bulb?
  • Ten. One to change it and nine to evaluate whether it was done right.
Now that the spot quiz is over there are a few things that I would like to talk to you about in a more serious vein. 
A few weeks ago I went to the Ambassador Awards at the Convention Centre. It was attended by people from all walks of life who belonged to associations like the CSLT [now CSMLS] that can bring conventions to the city. The organizers gave out awards and asked all of us to act as ambassadors by promoting Edmonton as a convention site. 
The thought occurred to me that in one way or another we all act as ambassadors. For example, when we are tourists in a foreign country, or when we interact with visitors to our city. 
So I would like to talk tonight about the idea that all of you—the MLS graduates of 1991—are going to be ambassadors for MLS whether you realize it or not. No matter what the future holds for each of you, all of the people you will meet will be gaining impressions of MLS through you, your actions, and attitudes. 
Now before you say, “Good grief! I can’t handle the pressure—-MLSers for life”—I want to tell you that I have great faith in each and every one of you. As an MLS instructor I have been privileged to share a part of your life for the past few years. 
Let me explain why I think that you will be great ambassadors. In a way, I feel like the mosquito in a nudist colony. I don't know where to begin.  
First, there are all of the things you have learned while in MLS. And I’m not talking about the knowledge and technical skills you have assimilated, although these are important. You have learned so much that what you have forgotten would fill a library.No—I’m talking about transferable skills that you will find useful all your lives. 
For example, you have learned how to be good listeners. Goodness knows you have had enough practice being listeners during your time here. As you begin your careers, remember the words of a wise person who once said, “good listeners are not only popular everywhere, but after a while they know something.” I have learned much from listening to you over the years.
You have also learned how to communicate clearly, both orally and in writing. Who can ever forget their first teaching assignment? I should explain that our students give at least three oral presentations to classmates and instructors beginning with teaching assignments during 3rd year. 
I’m sure that some of you think that teaching assignments were cruel and unusual punishment—both for the student and the audience. But, boy, do they ever pay off. The progress you made was really shown when you presented your 4th-year research projects. Your instructors and supervisors were impressed. 
This ability for you to make presentations will be a real plus for you in any career. I tell you this because I have listened to many technologists, scientists, and doctors who have not had the advantage that teaching assignments provide—namely to express ideas clearly and concisely. And listening was brutal.
There are many other intellectual skills you have learned. For example:
  • Your grasp of the scientific method and all that entails; 
  • The ability to be skeptical about so-called established knowledge, and yet to be open-minded about complex issues;
  • You know that it is okay to say, “Gee, I  don’t know, but I will find out”;
  • Most important of all, you know how to learn
You will draw on these skills over and over again— especially because medical laboratory science is evolving so rapidly. 
I would like to shift for awhile to some of the ways you have all grown in your personal development. 
Those of you who entered MLS lacking self-confidence have seen your belief in your abilities increase. Self-confidence is essential because no one will believe in you if you don’t believe in yourself. I’m not talking about being over-confident and self-important, but rather about the quiet self-assurance of people who are competent and know it. 
Conversely, if you came with a fair degree of self-confidence—if you were like me at 18 (and trust me, I was 18 once—and thought I pretty much knew everything) —then your experiences in MLS have added to your growth by teaching you humility. 
Your entire 3rd year was an exercise in discovering your strengths and weaknesses, coming to terms with them, and accepting both praise and criticism gracefully. 
It was hard to be evaluated each and every day of your hospital rotation; it was hard to accept feedback that you may or may not have felt was justified. But you all did it, and because of this you will have a big advantage in the workplace, as well as in life.  
Having a positive approach to learning will always serve you well. You know that imperfection is only human. The important thing is that we all try to do better. And keep in mind that misery is optional. 
You have also learned what friendship means. In the years ahead, you will remember your friends very fondly . One definition of a friend is “a friend is one who dislikes the same people that you dislike.” There is a lot of truth in this, but a better way to think of friendship is to realize that the only way to have a friend is to be one. You have all done that during your university days. 
Let me remind you that universities have always stood for the dignity of each human being—for the belief that each individual is to be appreciated for what they uniquely think, do, and feel. I want you to realize that you are important and have had an impact on your friends and teachers in MLS. 
Earlier I said that, whether you realize it or not, you are going to be unofficial ambassadors for MLS. Over the years, you have seen many role models—instructors, professors, nurses, doctors, and technologists. As ambassadors-—-with personalities and styles of their own—they succeeded to varying degrees in creating good-will for their professions. Soon you too will have this responsibility. 
As you leave MLS, remember the people who have influenced you. Think of those who have treated you with dignity and patience, who smiled rather than frowned, who took the time to criticize constructively, who showed you how to solve problems as medical laboratory scientists, who loved their subject, and who challenged you to be your very best. 
These are the people you will want to emulate as you become role models for others. And now, graduates—this is your night. You have struggled and succeeded in a difficult program. We, your instructors, are very proud of you. You have chosen a rewarding and challenging career.  
In conclusion, it's a cliche but always believe in yourself. You are graduates of the most rigorous Medical Laboratory Science program in Canada and one of the best in the world.  And don't be afraid to dream of what you want in life. No matter what the future holds, you have the right stuff to succeed.
MUSINGS
Of the 22 students in the 1991 MLS graduating class, here's what I know 26 years later about their careers. Most, as would be expected, went on to have careers as medical lab technologists/scientists. But the 1990s brought severe healthcare cuts in Alberta and throughout Canada and jobs became scarce. Graduates' careers I'm aware of:
  • Went to NZ to work for New Zealand Blood Service (NZBS) - 2
  • Worked for CBS, Canada's national blood supplier for years - 2
  • Dentist - 1 
  • Lawyer - 1 (after years of working as a med lab tech in Canada and later for NZBS)
  • PhD (microbiology) - 1
  • Gynecologist -1 (who was in Christchurch, NZ on a fellowship learning advanced laparoscopic surgery when the earthquake struck in 2011)
  • Radiologist - 1 (after many years of working as a med lab tech in USA)
To me, this validates that graduates of MLS at the University of Alberta learned many transferable skills and had the self-confidence to believe in themselves and accept challenges, as well as to dream. As one example, the MLS grads who went to NZ to work for NZBS (six in all from several graduating classes) were brave indeed and went through all the government hoops and regulations, requiring incredible stamina and belief that they could do it, no matter what. 

ANECDOTE #1
I'll share correspondence I had with one grad (John) 8 years later (when he was 30 years old) and again, 14 years post-graduation. John, like most MLS grads, had written the USA's ASCP(MT) exams when he graduated from the University of Alberta MLS program. As a result, he could go to the USA under NAFTA with a BSc (MLS) and work in a profession that was deemed needed in the United States. He worked for years as a med lab tech in Montana and also acquired EMS certification and worked part time as a firefighter. 

He wrote me and 3 others in MLS in 1999 because he had obtained his green card and could apply to U.S. medical schools and needed references from his instructors.

Bottom line was that John was accepted into an American medical school in ND, interned in Spokane, Washington, and later got a residency at the coveted Mayo Clinic in 2005, followed by specializing in radiology.He also did a fellowship in Neuroradiology at the Mayo Clinic. 
Mayo Clinic info (1999):"The Mayo residency and fellowship programs are among the most sought-after in the world. Last year, nearly 7,000 people applied for slightly more than 360 positions....Last year, the medical school accepted only 42 new students and only about 5% of those who applied for a residency or a fellowship."
Going back to MLS, in the 3rd year, students rotate through the clinical laboratories in groups of 3 or 4. I distinctly recall John's group because they were so motivated and, more importantly, so much fun to teach. Honestly, everyone should be so lucky to have such students.

John rotated with two female students (Donna and Jennifer), who both went to to work for NZBS in Hamilton, NZ for several years. Jennifer eventually became a lawyer and now works for a law firm in Edmonton where she represents hospitals/health regions and their employees, including AHS . Donna, who prior to NZ had worked for years in a Las Vegas mega-lab where technologists were more like factory workers, later worked for CBS and now works in a local hospital laboratory.

My spouse and I visited NZ for 6 weeks in 1998-99 over Christmas/New Years and touched base with two of the MLS grads, including Donna, who had the courage to go to a foreign country to practice their profession. They had made the best of a bad situation and were loving their foreign adventure.

These grads believed in themselves and were great ambassadors for MLS at the University of Alberta.

ANECDOTE #2
While the MLS grads worked for NZBS, a US software company visited to demonstrate and pitch its blood bank software. Reason I know this is that the software company (Wyndgate Technologies, now Haemonetics Software Solutions) contacted me. 

Specifically, they wanted to know if MLS had more grads like the ones working at NZBS because they were very impressed with them and would love to hire some.

Bottom line: Two MLS grads were brave enough to transition to software testing and moved to Sacramento, California to work for Wyndgate in 2000. One worked for Wyndgate/Haemonetics for 15 years, latterly in a senior management position.

FOR FUN
I chose Joni Mitchell's 1967 song for two reasons. Of note, it has been covered ~600 times by other artists and counting. 

First, I love it. By any standard, Canada's Joni Mitchell is a songwriting genius.

Second, to me it means that life isn't always what you expect it to be. We win some, lose some in the careers we choose but in the end we're left with the illusion of what we hoped it would be. And that's okay providing we acquired the skills to follow our dreams past the illusion. Perhaps too philosophical?
I've looked at life from both sides now 
From win and lose and still somehow 
It's life's illusions I recall 
I really don't know life at all. 

As always, comments are most welcome.

Thursday, May 25, 2017

The sound of silence (Musings on why it's key to criticize TM professionals / organizations)


Updated: 25 May 2017 
(Major revision from the blog initially posted.)

May's blog was stimulated by recent experiences I've had on a transfusion Twitter account. It deals with concerns about professionals speaking their minds versus being silent. As such it's a personal blog but I hope transfusion professionals everywhere will be able to discern the issues involved and how they may relate to their professional lives.

The blog's content is the type of thing folks don't usually discuss except perhaps with their trusted best friends (or in social media speak, their BFF).

Executive version: The blog is about decisions made on Twitter and on transfusion-related blogs like this one, which occasionally make me persona non grata with fellow tweeps and colleagues. The blog's focus is about the need for transfusion professionals to speak out and discuss the things that bug them, instead of remaining silent.

The blog's title comes from a Simon and Garfunkel song, circa 1965.

BACKGROUND
So readers can appreciate the context of where I'm coming from and what has shaped my views, some background.

In brief, I'm a lifelong medical laboratory technologist who began my career as a 'kid' at Canada's then national blood supplier (Canadian Red Cross) in Winnipeg in the pre-AIDS era that blood bankers often call the 'golden age of serology'. CRC is where I grew up professionally and the Canadian Red Cross Blood Transfusion Service (CRC-BTS) staff became my beloved blood banking family. The learning opportunities were abundant because Winnipeg's CRC-BTS was, and remains, the only combined blood supplier-transfusion service in Canada. Many of the staff became lifelong pals.

Later I lucked out by getting a teaching position as a lecturer, then professor, in the MLS program at the University of Alberta in Edmonton and a clinical instructor for the UAH blood bank, positions held for 22 years. I called these positions the best transfusion science teaching job in Canada, maybe the world, before choosing to give up a tenured university position to embark on new adventures.

With this background I've seen many changes, some I judge as good, some as bad, and been a keen observer of our profession for decades. Transfusion medicine remains a lifelong love affair.

It's obvious, but please be aware that what follows is my perspective and, as such, shows my biases.

CRITICIZING A RESPECTED ORGANIZATION
As noted earlier, my TM career began with Canada's blood supplier CRC-BTS, now CBS. After being a med lab tech, lab supervisor, and clinical instructor at CRC-BTS, decades later I was privileged to obtain many consultant jobs with CBS - I loved them all - and briefly served as a lab manager of a CBS patient services lab. It's an organization Canadians can be proud of but, like any large organization, is not perfect.

Over the years I've criticized CBS on Twitter and in blogs for what I perceive as deception, hypocrisy, use of hackneyed business jargon, and more.

Some tweets I've made often occur on the spur of the moment and constitute errors in judgement. Some are because, as a bit of a contrarian, I see things differently than many or choose to reveal my true feelings on issues that others do not for whatever reason.

Reminds me of advice I'd give to Med Lab Science students:

Explaining how feedback is an indispensable tool to help both instructor and learner improve, and modelling appropriate responses such as, "Thanks for telling me that." When MLS students enter their clinical internship year, I'd explain that constructive criticism is their best friend. They can improve only if supervisory staff tell them when they are doing something wrong or doing something that needs to be improved.
That said, does CBS even want feedback from the likes of me, especially when it's often critical of their practices or constitutes a send-up? Perhaps not.

Sad but tweets about CBS could potentially cause folks I respect to unfollow me on Twitter. I know of at least one in the UK who has done so.

The blogs are a different matter. They're not spontaneous but a way to get something that bugs me off my chest. In a way they're therapeutic. I blog about an issue and feel better because I've said my piece and haven't remained silent. Often I wonder how the heck I've had the chutzpah to criticize a respected organization and its leaders.

So the question arises, is it preferable to keep silent or continue to challenge CBS to be even better? Or are blogs and tweets similar to pissing in the wind?

Fact: Most transfusion professionals choose to keep silent and not criticize organizations such as national blood suppliers for several reasons. First and foremost, the organization may be their employer. Or perhaps they interact with the blood supplier as a hospital client and want to maintain a cordial relationship. 

But the result is that the blood supplier often never knows where they need to improve because no one dares to tell them. Certainly rank-and-file employees usually don't. Reality is many employees outside an inner circle at head office, or not in management positions in blood centres, have long since given up offering feedback about policies because it's invariably ignored. At least it seems that way to 'trench workers'.

Directives and self-congratulatory missives emanate from CBS head office that staff in the far flung regions sometimes consider a joke, often so hypocritical that the missive is the exact opposite of reality. I could write a lot more on this from my experiences as a CBS lab manager but won't now.

LEARNING POINTS
Why should we offer honest feedback to TM colleagues and organizations? Because it's the only way they can improve. If we only promote what a great job they do, they will NEVER improve. And I want the organization I grew up in and love to improve.

As to errors in judgement, those mistakes are what I must learn from. If I've inadvertently offended colleagues, I apologize unreservedly. Being passionate about a subject can sometimes push me to say dumb things.

Does any of this resonate with your experiences? Are you deep into the 'sound of silence' as many, perhaps most, transfusion professionals are? Food for thought that I hope is palatable and doesn't cause you to choke.

FOR FUN
This Simon and Garfunkel song fits this blog. TM professionals and organizations who might improve - if only colleagues would speak inconvenient truths - never can improve if the Sound of Silence reigns in the TM community.

Saturday, January 28, 2017

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