On Darwinism's two headed coin

Finagling Molecular Clocks to Fit Darwinism
Evolution News & Views

Finagle's Constant is whimsically defined as "that quantity which, when added to, subtracted from, multiplied by, or divided by the answer you got, gives you the answer you should have gotten." One of the best examples in modern science is the so-called "Molecular Clock" hypothesis in evolutionary theory.

In Current Biology, Michael S. Y. Lee and Simon Y. W. Ho teach the uninitiated about the wizardry that goes into molecular clocks. First, a bit of history.

In the 1960s, several groups of scientists, including Emile Zuckerkandl and Linus Pauling, had noted that proteins experience amino acid replacements at a surprisingly consistent rate across very different species. This presumed single, uniform rate of genetic evolution was subsequently described using the term 'molecular clock'. Biologists quickly realised that such a universal pacemaker could be used as a yardstick for measuring the timescale of evolutionary divergences: estimating the rate of amino acid exchanges per unit of time and applying it to protein differences across a range of organisms would allow deduction of the divergence times of their respective lineages.... [Emphasis added]
Remember this: at first, biologists assumed they had discovered a reliable timepiece. Great, they thought; now we can watch Darwin's tree of life unfold over time. This new clock would show the sequence of great transformations: when animals emerged from the sea, when flowering plants blossomed on land, and when the ancestors of great whales began swimming. Unfortunately, as with many things in biology, complications soon set in.

In the 50 years since, leaps in genomic sequencing technology and new computational tools have revealed a more complex and interesting reality: the rates of genetic change vary greatly across the tree of life. The term 'molecular clock' is now used more broadly to refer to a suite of methods and models that assess how rates of genetic evolution vary across the tree of life, and use this information to put an absolute timescale on this tree. Modern molecular clocks are thus critical to inferring evolutionary timescales and understanding the process of genetic change. Analyses of genomic data using clock models that accommodate variation in evolutionary rates have shed new light on the tree of life, as well as the organismal and environmental factors driving genetic change along its branches. However, some major theoretical, empirical and computational challenges remain.
It's not a clock then. It's not reliable. The genetic changes tick at wildly different rates. Ah, but the promise of "shedding light" on evolution was too tempting to let it go. With a few tweaks and new assumptions -- a little finagling -- molecular clocks might still prove useful. We'll just give the variations an impressive-sounding name. How about "rate heterogeneity"?

Modern molecular clocks can handle various forms of evolutionary rate heterogeneity. Rates can vary across different parts of the genome (site effects), across taxa (lineage effects), and across time (here termed 'epoch effects').
Moving along, Ho and Lee engage in some rationalizations for stretching, compressing, and force-fitting wildly different clock rates into Darwin's tree. It's reminiscent of naughty Johnny telling more and more lies to back up the first one.


An extra layer of interest and complexity emerges when two or more sources of rate heterogeneity interact. Site and lineage effects interact when different genes have different patterns of rate variability across taxa (Figure 2D). Mitochondrial DNA has greatly accelerated rates of evolution in snakes and dragon lizards compared with typical lizards, but nuclear DNA shows no such trend. Genomic analyses suggest that such interactions are widespread. Selection might be relaxed on particular genes in particular taxa and thus lead to rapid molecular evolution. For example, the genes coding for tooth enamel are no longer under stabilizing selection in toothless mammals such as anteaters and sloths. Thus, those genes evolve much more rapidly in these lineages, but this pattern is not seen for most other genes. Such complex patterns of rate variation can be accommodated using partitioned clock models, where different portions of the genome are recognized as evolving according to separate clocks or 'pacemakers'.
There is one fixed star that keeps the finaglers on target: the fossil record. It reliably shows the divergence times and patterns over evolutionary history. But wait. Wasn't the molecular clock supposed to be the yardstick for the fossil record? Which clock is calibrating which?

Molecular clocks are vital to reconstructing the detailed timescale and branching pattern of the tree of life, especially in soft-bodied groups that have left few or no fossils. In turn, this can shed light on how major evolutionary events have been influenced by Earth history. However, the use of inappropriate clock models or erroneous calibrations can produce highly misleading estimates of evolutionary timescales. These issues have led to vigorous debates about the timing and drivers of major evolutionary events, including the origins of animal phyla, the ordinal divergences of birds and mammals or the radiation of flowering plants.
The "origins of animal phyla" -- this brings them to the Cambrian explosion. As an example of many spectacular differences between molecular clocks and fossil-record clocks, Ho and Lee point to molecular estimates that put the emergence of animal phyla "a billion years ago -- nearly twice the age of the explosion of animal fossils in Cambrian rocks." Now what to do? Evolutionists tried to compress the rates as far as they could, but it wasn't enough.

These results were at least partly driven by failure to account for lineage effects: genetic change generally occurs more slowly in vertebrates than in invertebrates, but early molecular analyses extrapolated the slow vertebrate evolutionary rate across the entire animal tree. This caused the estimates of animal divergence times to be stretched deep into the Precambrian. Subsequent analyses with better models of rate variation and more carefully chosen calibrations moved the initial radiation of animals to a later time -- into the early Ediacaran period, when the world was gripped by several massive glaciation events ('snowball earth'). Nevertheless, this still precedes the first definitive metazoan fossils by tens of millions of years.
One pattern does emerge; molecular divergence times are generally older than fossil divergence times. But with flexible clocks, how can one know which to rely on? The situation resembles the folk tale about the town crier who set his watch by the church bell, only to find out the bell ringer calibrated his tolling by the town crier's call.

The fixed star on which both methods rely is actually neither one: it is the assumption of Darwin's tree of life. With that in mind, watch this:

One intriguing but largely untested suggestion is that molecular evolution might occur much more rapidly during evolutionary radiations, leading to big genetic divergences in short time intervals. This would be likely to cause current clock models to overestimate divergence ages.... The link between higher rates of evolution and evolutionary success might prove to be more general, and relevant for phenotypic as well as genetic traits.
Mr. slow-and-gradual Darwin might be scandalized by the notion that evolution could be rapid, but he would be gratified to know that finagling a few assumptions can leave his tree intact.

In sum, what we were told would provide empirical evidence for evolution actually has morphed into a set of assumptions and methods to calculate different Finagle's Constants for each part of Darwin's tree, in order to keep the picture from getting falsified. Empiricism must yield to that requirement.

Lee and Ho end by saying, "we can choose to identify and analyse only the genes that display the most desirable of evolutionary timescales." On the other hand, "Instead, more room for improvement might lie in developing better models of rate variation and refining our knowledge and use of calibrations." Each animal, each lineage, each gene, and each epoch are now going to need their own calibration method, based on what is needed to keep the Tree of Life from falling. "For these reasons, molecular clocks will continue to play a key role in shaping our understanding of the evolution of life and the genes that code for it."

For more on problems with the molecular clock hypothesis, see here on the Cambrian explosion, Casey Luskin on placental mammals and biogeography, and Stephen Meyer's analysis of "lightning-fast evolution" to explain the Cambrian enigma.

Descartes should have thought again?

Descartes’s Blunder
Michael Egnor

What is it that we are most sure of? It’s a fundamental question, the object of philosophical analysis for millennia. Our modern answer to this question was provided by René Descartes in the 17th century. Descartes’s answer is the answer most modern men would give. But Descartes got it wrong.

Descartes set out to rethink metaphysics from the ground up. In Meditations on First Philosophy, he asked this question: How do I know what is real? Of what can I be certain? He suggested this scenario: Imagine that his mind is controlled by an evil demon. The demon is of “upmost power and cunning [and] has employed all his energies in order to deceive me.” How, he asked, could he know whether or not this were the case? Descartes doubted the reliability of his senses: they can deceive, he believed. Of what can he really be certain?

He concludes, famously, that he can be certain only of this: that he exists. Cogito ergo sum. Because even to doubt his own existence presupposes his existence.

This metaphysic of radical skepticism forms the basis for much of Descartes’s metaphysics, which we moderns have (largely unconsciously) inherited.

But Descartes is misguided (and not by a demon). Most fundamentally, he is wrong about the thing that we are most sure of.

The foundation of epistemology is not self-awareness. This can be understood by considering Descartes’s maxim, “Cogito ergo sum.” Notice that we cannot conclude that we exist unless we can conclude. That is, we must first know the principle of non-contradiction — that being is not non-being — before we can conclude that “I think therefore I am.”

“Therefore,” not “I think” nor “I am,” is the crux of the most important thing we know. The principle of non-contradiction is prior to self-awareness.

This is a foundation of Thomistic philosophy. St. Thomas notes:

By nature our intellect knows being and the immediate characteristic of being as being, out of which knowledge arises the understanding of first principles, of the principle, say, that affirmation and denial cannot coexist (opposition between being and non-being) …

(Summa Contra Gentiles: II, 83. Cf Ia IIae, q. 94, a.2.)

Aquinas derives his principle from Aristotle’s principle of non-contradiction: a thing cannot be and not be at the same time. It is the most fundamental thing we know, because if we do not know it, even Descartes’s first principle — cogito ergo sum — is not true. If being and not being could coexist, if contradiction were metaphysically possible, then it would be possible for me to think and at the same time not to exist.

The law of non-contradiction, not cogito ergo sum, is the foundation of knowledge.

It’s worth noting that modern atheists and materialists have a particular problem with non-contradiction. Consider a number of atheist and materialist claims in this light.

Materialists and atheists claim that ID is scientifically wrong, and claim that ID is not scientifically testable. But of course, in order to be scientifically wrong, ID must be scientifically testable.

Materialists and atheists believe that our minds evolved by natural selection. But if we evolved wholly by natural selection, we evolved to maximize reproductive success, not to discern truth, and thus we could not trust our belief that we evolved by natural selection.

Materialists and atheists believe that determinism is true and that free will is not real. But if determinism is true and we lack free will, then our opinions are determined by physical processes, which are not propositions and which lack truth value. Chemical reactions are neither true nor false, so a materialist’s opinion that determinism is true and free will is not real has no truth value.

Materialists and atheists believe that the universe spontaneously came from nothing, and they define nothing as the laws of quantum mechanics.

Materialists and atheists believe that the existence of evil disproves the existence of God, yet if there is no ultimate Source of right and wrong, there is no evil and no good; there are merely circumstances we like or dislike. Nietzsche, unlike the New Atheists, understood this.

Again and again, materialists and atheists hold opinions that violate the law of non-contradiction. In this sense, atheism and materialism aren’t even really metaphysical theories. They’re just self-refuting nonsense.

In attempting to explain away molecular motors Darwinists fumble the ball.

Berra’s Blunder in Molecular Motors
Evolution News | @DiscoveryCSC

Whenever we see new articles and papers about cellular motors like ATP synthase and the flagellum, we get excited, thinking that now, finally, someone might make a design inference that questions Darwinism. That’s why this from Imperial College London, “How bacteria turbocharged their motors,” raised our hopes:

Bacteria use molecular motors just tens of nanometres wide to spin a tail (or ‘flagellum’) that pushes them through their habitat. Like human-made motors, the structure of these nanoscale machines determines their power and the bacteria’s swimming ability.

Previously, the team from the Department of Life Sciences at Imperial looked at these motors and discovered a key factor that determined how strongly bacteria could swim. Like human-made motors, bacterial motors have distinct ‘stator’ and ‘rotor’ components that spin against each other. 

“Like human-made motors” – great! They see the light. Our hopes were dashed when we discovered that the goal of their research was to vindicate Darwinism:

The team found that the more stator structures the bacterial motor possessed, the larger its turning force, and the stronger the bacterium swam. Despite these differences, DNA sequence analysis shows that the core motors are ancestrally related. This led scientists to question how structure and swimming diversity evolved from the same core design.

OK. But it’s the way that the reporter, Hayley Dunning, explained evolution that was startling. Don’t evolutionists in 2018 know their own theory?

Ranking: Flagella with 12 stators are labeled “primitive” but those with 17 stators are ranked “sophisticated.” These are arbitrary adjectives.

Lamarckism: The article describes parts of the flagellum “fusing” to allow more stators, and thus graduating to “sophisticated” rank. How mutations did that is not described, nor how the accident became heritable.

Saltation: Darwin stressed that “Natural selection … can never take a great and sudden leap, but must advance by short and sure, though slow steps.” Yet this article alleges that flagella suddenly went from primitive to sophisticated versions in one “quantum leap.”

Berra’s Blunder: The article claims that extra structures attached to the “sophisticated” flagella illustrate evolution, reminiscent of how Tim Berra asserted that you can see evolution in action by watching how Corvettes added parts between 1953 and 1955.

Convergence: Observations show some of the extra structures occurring in unrelated species. She attributes this to the magic wand of convergence: “The extra structures appear to have evolved many times in different species of bacteria, using different building blocks but producing the same functionality.” The writer appeals to convergence in wings and eyes as illustrations.

Inevitability and Creativity: Natural selection is supposed to be blind, random and uncaring, but not here!

We’ll let Dr. Morgan Beeby of Imperial College express these blunders in his own words:

Dr. Beeby said: “Bacterial motors are complex machines, but with studies like this we can see how they have evolved in distinct steps.

“Moreover, the ‘leap’ from 12 stators to 17, while a great innovation, has an aspect of ‘biological inevitability’ in the same way as wings, eyes, or nervous systems in higher animals: the precursors of high torque have evolved multiple times, and one set of them ended up fusing to form the scaffold we describe in our work”.

He added: “Evolution is a creative process, often drawing on variations upon a theme. It is constantly churning out new molecular ideas, many of which fail, but inevitably some get realised multiple times. We have seen this in animals, and now we see this process in the nanoscopic world of molecular evolution too.”

Whatever “evolution” Beeby is talking about is surely not Darwin’s variety, or that of neo-Darwinians, either. He has essentially proposed miracles by another name. Does his paper in Nature Scientific Reports do better? He has Bonnie Chaban and Izaak Coleman as co-authors. Will they correct his blunders? Nope. All three embrace the fake Darwinism wholeheartedly. They see design, but attribute it to a “‘quantum leap’ evolutionary event.” They see the addition of new structures the way Berra saw new parts added to intelligently designed automobiles as an illustration of evolution.

One ray of hope breaks through in the middle of the paper, suggesting that ID has penetrated the conscience of these Darwinians, putting them on the defensive:

How did the Campylobacter-type motor evolve from a simpler ancestral motor? During our previous work, we discovered that each accessory protein is essential, posing a conundrum: how could proteins have been added stepwise to form this (naively “irreducibly complex”) motor?

Of course, they do not provide a reference to Darwin’s Black Box, nor define his term irreducible complexity. They don’t deal with co-option problems, genetic codes, or Scott Minnich’s challenges.

But in this backhanded swipe at Michael Behe, calling him naïve, they reveal an awareness that they are playing defense. “To identify a possible incremental evolutionary pathway, we determined a phylogeny…” etc.  Basically, they arrange flagella from different bacterial species the way Berra arranged Corvettes to prove evolution. Their conclusion, however, seems less bombastic than usual: “our structural and phenotypic results enable us to propose a working model for the incremental evolution of the bacterial flagellar motor.” ID is getting under their skin. The callout quote in the news release affirms Darwinism against ID over the loudspeaker:

Bacterial motors are complex machines, but with studies like this we can see how they have evolved in distinct steps.

ATP Synthase

Meanwhile, the other main rotary engine in cells, ATP synthase, has been examined in greater detail than ever before. That is thanks to a cryo-electron microscopy study reported in Nature Communications.

These reconstructions are of higher resolution than any EM map of intact rotary ATPase reported previously, providing a detailed molecular basis for how the rotary ATPase maintains structural integrity of the peripheral stator apparatus, and confirming the existence of a clear proton translocation path from both sides of the membrane.

What does this paper say about evolution? Not much. The Japanese team basically does a lateral pass to other papers for coverage of motor evolution. “Eukaryotic V-ATPases are likely to have evolved from homologous enzymes found in archea and some eubacteria,” they say, with three references to Darwinian papers. The only other mention doesn’t help Darwinians: it refers to “evolutionary conservation of the rotor structure,” once again tossing the ball to another paper.

There’s no mention of phylogeny, ancestry, mutation, natural selection, or any other Darwinian argument. From these papers we can infer that the design argument is having an impact. For one, if there were clear, unambiguous arguments for evolution, scientists would proudly present the evidence for it. For another, they wouldn’t offer indefensible notions like this one from Morgan Beeby:

“We are used to observing evolution at the scale of animals or plants, such as the giraffe’s neck slowly getting longer over time to reach previously inaccessible food.

“However, the evolution at the molecular scale is much more radical. It’s like a giraffe having children with necks suddenly a metre longer.”

Another hopeful sign is that scientists increasingly toss the ball to others to explain how things evolved, rather than try to describe it themselves in a rigorous way. Instead, they seem to focus on the molecular machines’ complexity and efficiency, without Darwinian gloss.

Finally, the occasional back-handed swipes by Darwinians directed against ID concepts, coupled with exasperated attempts to provide stepwise evolutionary models, suggests that intelligent design has not, in fact, escaped their notice. They know, like aging athletes relying on reputation alone, worrying about declining cheers from the stands, that they are playing defense against a young and vigorous challenger.

On common design v. common descent.

Adam and the Genome and Human-Ape Genetic Similarity
Evolution News | @DiscoveryCSC

In Adam and the Genome, Trinity Western University biologist Dennis Venema covers many other subjects besides what you might expect from the book’s title. We have been reviewing this material by the prominent theistic evolutionist and BioLogos author; find the series so far here.

Thus, Venema cites the high degree of genetic similarities between insulin genes in humans and other mammals as evidence for our common ancestry. He writes:

[W]e can see that there is good evidence to support the hypothesis that these two present-day genes come from a common ancestral population in the distant past … What we observe for this short segment is that the gorilla sequence is identical to that of the human except for one letter; the chimpanzee is identical except for three; and the orangutan is identical except for five. As before, this level of identity far exceeds what is needed for functional insulin, and strongly supports the hypothesis that humans share a common ancestral population with great apes. Indeed, the similarities between these sequences make English and West Frisian look like very distant relatives by comparison.

(Adam and the Genome, p. 30)

The obvious answer to this argument is common design — that humans, gorillas, and orangutans were designed based upon a common blueprint. This would explain genetic similarity between humans and other species quite well.

Venema is aware of this objection, and he doesn’t buy it:

Suppose you decided you wanted to design two languages. Would you design them in such a way that they appear to be closely related to each other, especially if your prowess as a designer is such that you can effortlessly design languages in any way you wish? Furthermore, as a designer, you understand that there are many possible ways to design words, grammar, syntax, and so on. Would you make it appear that your two languages are related to each other, if indeed you wanted to convince others that they were separate, independent creations? (p. 32)

There he goes again, telling God what he can and cannot do. It’s a bit of chutzpah, don’t you think? He’s also telling God what God must intend when he does certain things. In particular, Venema is telling God that if he designs two species to be similar then God must thereby intend to tell us that those species are related through common ancestry. And if those species aren’t really related, then Venema tells God that he is being deceitful.

But what if Venema is putting thoughts into God’s head that aren’t there? What if God could have entirely different purposes for designing two species as similar — purposes that have nothing to do with trying to communicate some message to humans about relatedness or unrelatedness?

The reality is that this is not a theological question. There are good logical reasons why different species may have similar genetic sequences: namely, functional requirements. Those requirements have nothing to do with common ancestry. Engineers know from much experience that there are good ways to design things and bad ways. If you want your design to work a certain way, and you find a good blueprint that accomplishes what you seek, then it’s a good design principle to use that blueprint over and over again. That could easily explain why we see similarities in different species — common design to meet functional requirements.

Even Francis Collins acknowledges the merits of this argument, stating:

Some of that evidence is shown in Table 5.1, where the similarity between the genomes of ourselves and other organisms is displayed. This evidence alone does not, of course, prove a common ancestor; from a creationist perspective, such similarities could simply demonstrate that God used successful design principles over and over again.

(The Language of God, p. 134)

Though Collins of course thinks that common ancestry is a better explanation, his point here is exactly right. Reusing successful designs (like reusing genetic sequences) is a completely valid explanation for why genetic similarities exist between humans and other species.

Like many evolution proponents, Venema is thinking inside an evolutionary box. The similarities he observes may boil down to common design, but he apparently can’t see that. Whether we humans properly interpret or misinterpret the meaning of those similarities need not be God’s concern.

Venema’s points here ultimately seem to be rhetorical, though. He writes: “No matter how you slice it, the human and chimpanzee genomes are nearly identical to one another.” (p. 32) This is supposed to impress the reader, leaving no alternative but to conclude that humans and chimps must be related. Venema admits that by some metrics the human and chimp genomes are only 95 percent similar. Fine. But the exact number really isn’t important. What is the metric for demonstrating common ancestry based upon genetic similarity? There doesn’t seem to be one. Venema’s argument appears arbitrary.

Moreover, others geneticists have argued that human-ape genetic similarity might be significantly lower than 90 percent. See,  “Human/Ape Common Ancestry: Following the Evidence.” See also, “Critically Analyzing the Argument from Human/Chimpanzee Genetic Similarity.” Perhaps the best treatment of the issue of human-chimp genetic similarity, however, is the chapter “Genetic Evidence for Human Uniqueness,” by Ann Gauger, Ola Hössjer, and Colin Reeves in the book Theistic Evolution: A Scientific, Philosophical, and Theological Critique. We recommend it to Dr. Venema.

Yet another own goal by Darwinists?

Two Evolutionists Inadvertently Demolish Evolution
Cornelius Hunter

Yesterday we saw how, in a new paper, evolutionists Warren Allmon and Robert Ross reformulate the argument for evolution from homologous structures. The paper makes several mistakes, but is important because it is a rare case of evolutionists (i) recognizing the religion in evolutionary thinking, and (ii) trying to do something about it.

In this case the religion is in the claim that God would not have created non-optimal homologies (such as vestigial structures). Allmon and Ross attempt to remove the religion by restating the claim as: God did not have to create such homologies. It is good that evolutionists are finally recognizing the religious aspect of their argument, after having been in denial for so many years. But Allmon and Ross’s solution fails on several counts.

The first failure of their solution is that it strips the power of the argument. The traditional religious arguments (i.e., God would not create those structures) at least had the virtue of providing a strong argument for evolution. Granted it was a religious argument, and granted one had to agree with that particular religion. And granted it ignored the problems of process and pattern (more below on that). And granted it turned evolution into, as Elliott Sober hinted, a “Lewis Carroll world in which down is up,” because the argument required evidence that is unlikely on evolution. The more unlikely, the better. Such is the logic of evolution’s religion. But after all those caveats, at least it provided a strong argument for evolution.

With design refuted, evolution had to be true, no matter how many problems it had. But with Allmon and Ross’s reformulation, design is not refuted. Now the advantage for evolution is not that the alternative is false or even highly unlikely, but that the alternative does not specify what we observe whereas evolution does. Allmon and Ross triumphantly conclude that their new formulation is a powerful argument for evolution. They apparently think this reformulation is merely a minor tweak, and that their new argument is just as strong as the traditional argument. It isn’t.

There is no free lunch. What Allmon and Ross fail to understand is that this is a much weaker argument. But it gets worse.

The second failure of Allmon and Ross’s solution is that it never did get rid of the religion as they had hoped. Allmon and Ross naively assume that the claim God may or may not create these homologies is merely an obvious point of fact. This is a deep subject that Allmon and Ross have rushed into, but suffice it to say that it is not at all clear that God can go with either world. Leibniz undoubtedly would disagree. The Lutheran polymath would argue that because of His perfection and other attributes, God cannot just create any old world. The bottom line, about which Allmon and Ross are blissfully naïve, is that like it or not, claims about God are religious.

But it gets worse. Much worse.

Not only did Allmon and Ross utterly misapprehend and expose the homology argument, they have, in fact, now demolished evolutionary theory. Remember, with their reformulation it becomes utterly crucial that evolution predicts what we observe. In other words, evolution must predict the pattern of similarities and differences we observe across the species. This is because their new formulation was that while design can explain a common descent pattern or other patterns, evolution is narrowly restricted to the common descent pattern.

With that the two Harvard-trained Epicureans just inadvertently blew up evolution. This is because what we actually observe is not the common descent pattern.

The actual comparisons between the species have contradicted the common descent pattern over and over. It is, as we have documented so many times, not even close. If evolution predicts the common descent pattern, then by modus tollens, evolution is false.

The Divine Law and bloodXIII:"The Gold Standard" Don't take my word for it

New “Gold Standard” Improves Outcomes for Elective Surgery Patients
larryrondeauwriting business writing


Research carried on for decades in the U.S. and Europe has resulted in a new “gold standard” for elective surgery that significantly improves patient care, lowers costs and saves lives.  It is practiced regularly in leading medical centers across America, including Massachusetts General Hospital, The Johns Hopkins Hospital and The Cleveland Clinic, as well regional teaching hospitals like Hartford Hospital, Rhode Island Hospital, Pennsylvania Hospital and New Jersey’s Englewood Hospital, which pioneered its use.  It has become the official standard of treatment of the U.S. military for elective surgery.[i]

This new “gold standard” is actually an updated and improved version of a nineteenth century practice:  bloodless medicine and surgery.  According to surgeon Nathaniel Usoro, MD:

Kocher, MDVirtually all surgeries prior to the 20th century were essentially ‘bloodless.’ And some were remarkably successful.  Theodore Kocher, for instance, did his first thyroidectomy in 1872, and by the end of his career he had done 5000 thyroidectomies with only 1% mortality.  Kocher never transfused any patient and he won a Nobel Prize.[ii]

Dr. Kocher’s procedures were safe and successful because he meticulously avoided unnecessary bleeding.  The new bloodless surgery does that as well using up to date technology. In addition, it often makes use of the patient’s own blood, which at one time was thrown away during surgery.  It is “bloodless” because it avoids costly transfusions of donated blood that actually produce lower success rates than procedures that salvage the patient’s own blood.  As Dr. Usoro continues, “Many clinicians are surprised to learn that blood transfusion is based on tradition and associated with a poorer outcome (unrelated to infectious hazards) in a wide variety of patients.”[iii]

But isn’t blood “The Gift of Life?”

gift of lifeMarketing campaigns have trained most Americans to believe that “blood is the gift of life.”  And for some patients with massive traumatic blood loss, transfusions of donated blood can indeed prove to be lifesaving.  Around the time of World War I, when medical researchers learned how to safely store blood for weeks and match it correctly to patients, a new era in medicine was born.  Bloodless surgical techniques were set aside as transfusions became an automatic feature of modern surgery.  It appeared to be a genuine improvement.

surgeryBut then physicians conducted studies to compare outcomes of those who underwent what had become traditional surgery including transfusions with those who had the same procedures without blood.  This crucial body of research revealed that bloodless surgery patients experience substantially fewer complications, shorter hospital stays and faster recoveries.

Speaking at a medical conference Dr. Joseph Sweeney, Professor of Pathology and Laboratory Medicine at Brown University and Director, Coagulation and Transfusion Services for the Lifespan hospital group made these important points:

Studies show that patients who are anemic at the time of surgery have poorer outcomes.
Blood transfusions do not improve the prognosis for most anemic patients, as once widely believed.
Research has revealed a previously unknown transfusion risk that bloodless surgical techniques can eliminate. [iv]
capillaryBlood banks have worked hard to reduce the chance of transmitting blood borne infections through transfusions, with varying degrees of success.  But research has uncovered another risk that is hard to avoid without using bloodless surgery.  Dr. Sweeney explained that red blood cells stored for just six days become rigid.  Transfusions can hinder circulation through a patient’s capillaries, the tiny blood vessels that bring oxygenated blood to sustain individual cells.

The Journal of the American Medical Association stated, “Some studies actually indicate no increase in tissue oxygenation with blood transfusion.”[v] Rigid red cells can stop up tiny capillaries, actually starving the cells they were transfused to nourish.

Cleveland ClinicA major research study of patients who underwent heart bypass surgery at The Cleveland Clinic supports this conclusion. Those whose doctors used bloodless surgical methods were much less likely to suffer serious complications than those who had traditional bypass surgery with transfusions of packed red blood cells.  Summing up their detailed findings, researchers wrote:

Our results suggest that transfusions should be avoided to the extent possible.[vi]


It has now become clear that transfusions of donated blood, even carefully screened and washed red cells, increases the risk of serious complications. New surgical methods are needed.  Fortunately, these were developed over the years by innovative surgeons and anesthesiologists.  They were willing to take on the challenge of operating on patients who refused blood transfusions, most notably Jehovah’s Witnesses who were determined to obey the biblical injunction to “abstain from blood.”[vii]

Denton CooleyPatients who steadfastly refused blood transfusions formed a pool of experimental subjects, “human guinea pigs” who permitted doctors to try new procedures so that they could have the surgery they needed without violating their consciences.  One willing surgeon was Dr. Denton Cooley, who performed the world’s first heart transplant in 1968.  He also pioneered bloodless open heart surgery and later wrote:

We became so impressed with the results on the Jehovah’s Witnesses that we started using the procedure on all our heart patients. We’ve had surprisingly good success and used it in our [heart] transplants as well.[viii]

How the new gold standard is carried out

Ired blood cells2n his presentation at the 2009 New England Regional Society for the Advancement of Blood Management Conference, Dr. Sweeney outlined a simple procedure for the new gold standard, bloodless elective surgery.  Since anemia revealed by a low blood count reduces the likelihood of a successful procedure, it’s important to check and, if necessary, build up patients’ blood 4-5 weeks before surgery.

Blood counts can be raised by administering iron supplements, either in pill form or intravenously.  In some cases, patients receive erythropoietin (EPO), a medication that speeds up their natural red blood cell production.  Surgery will be scheduled when blood counts reach the acceptable range.

Cell Saver

During the procedure, doctors will employ equipment that minimizes blood loss.  This includes cell salvage equipment that suctions up blood leaking from the wound, cleans it, and returns it to the patient’s circulation.  Instead of throwing away the patient’s blood, as done for years, the medical staff cleanses and reinfuses it.  There is nothing better for a patient than their own fresh red blood cells, far safer than donated blood (or even the patient’s own stored blood).

If the patient’s blood count is still low, EPO administration will begin to raise it within a few days.

Conclusion

leaving hospitalBloodless medicine and surgery provides many advantages to both patients and the healthcare system.  It significantly improves outcomes, reducing the risk of complications.  It shortens hospital stays and promotes quicker recoveries.  Further, it saves healthcare dollars, an important consideration as baby boomers retire and Medicare membership grows.

Major medical centers, regional teaching hospitals and the U.S. military have all embraced the new gold standard.  If you’re considering elective surgery it might well pay dividends to ask your doctor if it’s appropriate to use bloodless medicine and surgery in your case.

By MICHELLE CASTILLO CBS NEWS July 3, 2012, 3:03 PM

Jehovah's Witnesses who refuse blood transfusions after cardiac surgery at no greater health risk:

CBS News) New research shows that Jehovah's Witnesses who refuse blood transfusions after cardiac surgery are at no greater health risks than people who undergo the procedure.
The study, which was published in the Archives of Internal Medicine on July 2, intended to look at patients who do not undergo blood transfusions after cardiac surgery. Because Jehovah's Witnesses believe on religious grounds that they are not supposed to ingest the blood of another, they made ideal test subjects.

The study looked at 48,986 non-Witnesses who had blood transfusions and 322 Witnesses who refused to have blood transfusions who all underwent cardiac surgery between 1983 to 2011. After matching the patients up by similar cases, researchers found both groups had similar risks for dying at the hospital. However, Witnesses had lower chances of having additional operations for bleeding, renal failure and sepsis compared with non-Witnesses who received transfusions.

"It behooves us to examine more closely some Jehovah Witness processes of care and implement them in our routine surgeries," study author Dr. Colleen Koch, a cardiothoracic anesthesiologist at Cleveland Clinic in Ohio, said to HealthDay.

Witnesses spent less time in the intensive care unit and less time in the hospital than the other group. They also had higher survival rates compared to the people who were non-witnesses at 95 percent and 89 percent respectively. Both groups had close 20-year survival rates (34 percent versus 32 percent).

According to the Mayo Clinic, blood transfusions can cause a number of health complications, including allergic reactions, fevers, lung injury, spread of bloodborne infections and acute immune hemolytic reaction - a rare transfusion reaction in which a person's body attacks the new blood because it's not the proper type. But, HealthDay points out that screening techniques introduced in the 1990s have made it safer than it previously was.

Transfusion is typically ordered because of the risk of anemia - which the National Institutes of Health defines as a condition where the body does not have enough red blood cells. Anemia can cause the person to feel tired or weak, have headaches and shortness of breath, as well as problems concentrating or thinking.

Dr. Victor A. Ferraris, a professor of cardiothoracic surgery at the University of Kentucky, wrote in an accompanying commentary that the study shows that it might do doctors well to look at their own practices.

"The findings of this analysis by Pattakos and colleagues add to the increasing data that suggest that more conservative use of blood transfusions would be in our patients' interest, in both Witnesses and non-Witnesses," he stated.

But, Dr. Gregory Fontana, chair of cardiothoracic surgery at Lenox Hill Hospital in New York City, warns HealthDay that the results don't indicate that we should expand the findings to everyone.

"just because this paper is published, we cannot willy nilly start treating everyone like Jehovah's Witnesses," he told HealthDay. "It does provide further evidence that transfusion with real indication carries a risk that heretofore has been underestimated."

The gold standard(not my say so) II

Bloodless surgeries show cost and care advantages over traditional surgeries

By Diane Anderson, RN 
Clinical Consulting Specialist
HCC Life Insurance Company

During my 20-year career as a nurse and clinical consultant, I have witnessed numerous cutting-edge medical techniques that help plans receive improved patient results while saving money.  Bloodless surgery and medicine, however, has been around for almost five decades, yet it is just now receiving the recognition it warrants. New studies and research have shown that bloodless surgery and medicine is not only cost-effective, but quickly becoming a standard of care because it typically results in fewer complications and post-surgery procedures.

In my current position as a clinical consultant with HCC Life Solutions, HCC Life's Healthcare Risk Management (HCRM) medical management program, I often receive inquiries from our clients about bloodless surgery and how it can lead to both clinical and financial outcomes. To help our clients better understand this proven medical practice, I have developed a set of frequently asked questions and their answers.

Bloodless Surgery and Medicine � What is it? 
The Center for Bloodless Medicine and Surgery at Hartford Hospital in Connecticut defines bloodless surgery as, �� surgical and/or medical treatment without the administration of blood or blood related products.�

Bloodless surgery has been called the "Gold Standard" because of its known advantages over traditional surgery.

When is it done? 
The practice has been incorporated into many areas of care including surgeries for general, cancer, neuro, oral/maxillofacial, orthopedic, pediatric, trauma, organ transplants and vascular. It is also being utilized for services in the areas of HIV/AIDs, cardiology, hematology and neonatology, to name a few.

For example, an Allegheny General Hospital gynecologic surgeon developed a bloodless surgical technique for removing large uterine fibroids, which spares the uterus. This surgical approach even allows for the possibility of future child bearing. Typically the removal of the tumors (myomectomy) results in large amounts of blood loss requiring multiple transfusions, often leading to removal of the uterus (hysterectomy). The bloodless surgical technique involves isolating and clamping off all blood vessels to the reproductive organs to temporarily shut off blood flow to that area. The fibroids are removed and the uterus is then reconstructed using tissue from the abdominal wall to reduce the formation of adhesions that could later cause infection and/or bleeding. Lastly the clamps are removed and the incision is closed.

Why is it done? 
Bloodless medicine and surgery is an approach to health care that began in the 1960�s as a simple avoidance of the use of transfused blood or blood-related products. A variety of infectious agents have been found in the nation�s blood supply including; hepatitis A, B and C, malaria, syphilis, cytomegalovirus, Epstien-Barr virus, Creutzfeldt-Jacob virus (which causes the human form of �mad cow� disease), West Nile Virus, HIV/AIDS and other viral infections. The practice reduces the risk of blood product diseases. Of equal importance, bloodless medical and surgery reduce the potential risk for negative outcomes due to administration errors and adverse reactions.

New research is constantly proving the complexity of blood. Because it is a liquid organ, it does not transplant well. A 2007 news release from the University of Pennsylvania School of Medicine stated that one expert in the area, �likens the weeks-old blood often used for transfusions to �water like a dirty fish tank�. Depleted of most of its oxygen carrying capacity, the stored blood is not maximally beneficial to any patient.�

Donated blood for transfusions is stored and administered on a first-in, first-out basis so the oldest blood is always administered. Current blood bank policies allow blood stored up to 42 days to be used for transfusions. As donor blood ages, it looses critical amounts of the nitric oxide that helps deliver oxygen to the body, therefore potentially causing major harm to the patient. Beginning in the second week of storage, serious hemorrhagic disorders develop, including the decrease of blood cell deformability secondary to shape abnormalities, acidosis and the decrease in blood clotting. Most blood substitutes are experimental and are rarely used, although they can be approved under the compassionate use protocol.

Cost savings can be significant
According to noblood.org, the average cost of a bloodless heart surgery is only $16,345 while the average cost of a heart surgery using blood transfusions is $23,415.  Dr. Patricia A. Ford, medical director of The Center for Bloodless Medicine and Surgery, Pennsylvania Hospital, Philadelphia said in a Feb. 22, 2007 Bottom Line's Daily Health News article, �many hospitals have a $2 million or $3 million budget for blood�even a 10% reduction in blood use can really have a significant impact.�

Where is it done? 
About one year ago, HCC Life Solutions, a department of the HCRM division of HCC Life, received a request for bloodless transplant accommodation. At that time, we could only locate two bloodless transplant facilities. That number has grown by leaps and bounds to more than 200 bloodless surgery centers worldwide, including 100 facilities in the US alone.  Even Australia began supporting bloodless surgeries, as �the Department of Health of the Government of Western Australia recently acknowledged patient blood management as an evidenced-based patient-focused medical and surgical concept, being in full compliance with the Australian Council on Healthcare Standards, and decided to implement it as a standard of care statewide between 2008 and 2012.� (Anesthesiology, 2008).

Who performs it? 
Bloodless surgery techniques involve meticulous study and skill. While  a cooperative surgeon, a surgeon who is agreeable to avoid the use of blood products, will practice blood-conserving techniques, that does not mean he/she is qualified to do a bloodless surgery. Even though more than 100,000 surgeons worldwide, including military surgeons, have been trained in this particular area, more bloodless surgery health practitioners are needed to meet the high demand. Training for surgeons, anesthesiologists, perfusionists and nurses are provided by bloodless surgery and medicine centers and some medical device companies.

How is the practice applied?

Preparation
To ensure optimal success of a bloodless surgery, care begins prior to the surgery. Recommendations given to patients before surgery could include:

Female hormone therapy, especially estrogen which protects cells from damage by allowing them to hold their healthy shape.

A diet high in iron or supplements with ferrous sulphate or ferrous gluconate, vitamin C or folic acid, which help boost oxygenation.

Medications

Medications that raise red or white blood cell counts and hemoglobin levels, such as Erythropoietin, which stimulates production of red blood cells, or oxygen carriers such as perflurocarbons or hemoglobin substitutes.

Aprotinin, amiocaproic acid, desmopressin, vasopressin or vitamin K.

Coconut water, the sterile liquid from young green coconuts/endosperm, can substitute for plasma because it has the same electrolyte balance of blood. Historically it was used during World War ll when the nation�s blood supply was low.

Anesthesia

Anesthesia techniques may include volume expanders such as crystalloids/colloids, hypotensive anesthesia, hypothermia or normovolemic hemodilution and hyperoxic ventilation.

Surgical Methods

A surgical method often used in bloodless surgeries is intraoperative autotransfusion, where the patient's own blood is suctioned directly from the operative site, then washed and replaced directly back into the patient.

A variety of surgical devices, such as ultrasonic scalpels, microwave coagulating scalpels, argon beam coagulators, laser surgery, selective embolization and the new harmonic scalpel, a vibrating laser that cauterizes as it cuts, are common with bloodless surgeries.

Techniques such as platelet gel, fibrin glue, and use of pediatric tubes for limited micro blood sampling are also popular blood conservation techniques.

In Conclusion
The cries about blood shortages are real. The nation's donated blood supply is 100% dependant upon a steady core of altruistic donors, whose numbers are fast declining. Studies show that patients have fewer infections and shorter hospital stays, therefore making bloodless surgery and medicine an excellent approach to address blood shortages. Additionally, there are no barriers to the bloodless medicine, as all of its techniques are FDA-approved and non-experimental. 

Bloodless surgery and medicine is not a fad. It’s healthcare of the future that's been around for decades.

If you have any additional questions about bloodless medicine, or would like to learn about how HCC Life Solutions can help plans maximize effective management of claim dollars and clinical opportunities, contact Diane Anderson at (877) 843-5743.

References:

About the Center for Bloodless Medicine & Surgery. Hartford Hospital. Web
default.aspx?cHT=bloodless surgery>.

Ford, Patricia A. "Bloodless Surgery: Safer, Smarter Surgery Goes Mainstream." Bottom Line's Daily Health News 22 Feb. 2007.

Landis, Lee-Ann. "New Choices for Patients: Transfusion-Free Medicine for Jehovah's Witnesses and Transfusion-Wary." December 5, 2007. Web .

NoBlood, Inc., www.noblood.org.

Society for the Advancement of Blood Management, www.sabm.org.

Spahn, Donat R., Holger Moch, Axel Hofmann, James P. Isbister. "Patient Blood Management: The Pragmatic Solution for the Problems with Blood Transfusions." Anesthesiology 109 (2008): 951-953.

On the Commander in chief:The Watchtower Society's commentary.

JEHOVAH OF ARMIES

This expression, found 285 times, with variations, in the Scriptures, translates the Hebrew Yeho·wahʹ tseva·ʼohthʹ. The prophetic books, particularly Isaiah, Jeremiah, and Zechariah, contain by far the majority of its occurrences. Paul and James, quoting from or alluding to the prophecies, used its equivalent (transliterated into Greek) in their writings.—Ro 9:29; Jas 5:4; compare Isa 1:9.

The Hebrew word tsa·vaʼʹ (singular; plural, tseva·ʼohthʹ) basically means a literal army of soldiers, or combat forces, as at Genesis 21:22; Deuteronomy 20:9, and many other texts. However, the term is also used in a figurative sense as in “the heavens and the earth and all their army,” or “the sun and the moon and the stars, all the army of the heavens.” (Ge 2:1; De 4:19) The plural form (tseva·ʼohthʹ) is employed a number of times as applying to the Israelite forces, as at Exodus 6:26; 7:4; Numbers 33:1; Psalms 44:9; 60:10. Some scholars believe that the “armies” in the expression “Jehovah of armies” include not only the angelic forces but also the Israelite army and the inanimate heavenly bodies. However, it appears that the “armies” signified are primarily, if not exclusively, the angelic forces.

When Joshua saw an angelic visitor near Jericho and asked him if he was for Israel or for the enemy side, the reply was, “No, but I—as prince of the army of Jehovah I have now come.” (Jos 5:13-15) The prophet Micaiah told Kings Ahab and Jehoshaphat, “I certainly see Jehovah sitting upon his throne and all the army of the heavens standing by him, to his right and to his left,” clearly referring to Jehovah’s spirit sons. (1Ki 22:19-21) The use of the plural form in “Jehovah of armies” is appropriate, inasmuch as the angelic forces are described not only in divisions of cherubs, seraphs, and angels (Isa 6:2, 3; Ge 3:24; Re 5:11) but also as forming organized groups, so that Jesus Christ could speak of having “more than twelve legions of angels” available at his call. (Mt 26:53) In Hezekiah’s plea to Jehovah for help he called him “Jehovah of armies, the God of Israel, sitting upon the cherubs,” evidently alluding to the ark of the covenant and the cherub figures on its cover, symbolizing Jehovah’s heavenly throne. (Isa 37:16; compare 1Sa 4:4; 2Sa 6:2.) Elisha’s fearful servant was reassured by a miraculous vision in which he saw the mountains around the besieged city of Elisha’s residence “full of horses and war chariots of fire,” part of Jehovah’s angelic hosts.—2Ki 6:15-17.

The expression “Jehovah of armies” thus conveys the sense of power, the power held by the Sovereign Ruler of the universe, who has at his command vast forces of spirit creatures. (Ps 103:20, 21; 148:1, 2; Isa 1:24; Jer 32:17, 18) It thus commands deep respect and awe, while at the same time being a source of comfort and encouragement to Jehovah’s servants. David, alone and unaided by any earthly military force, challenged the formidable Philistine Goliath in “the name of Jehovah of armies, the God of the battle lines of Israel.” (1Sa 17:45) Not only in times of literal battle but also in all other trialsome situations or occasions of importance God’s people as a whole and as individuals could take courage and hope from recognizing the majesty of Jehovah’s sovereign position, reflected in his control over the mighty forces serving from his heavenly courts. (1Sa 1:9-11; 2Sa 6:18; 7:25-29) The use of the expression “Jehovah of armies” by the prophets supplied yet one more reason for those hearing the prophecies to be certain of their fulfillment.