It does not delve as deeply into the evidence behind some of these blood substitutes as we would have liked. Nor does it always identify conflicts of interest where appropriate. Overall, though, it is a balanced and thoughtful look at the topic.
As the story notes, blood shortages can magnify the effects of a disaster like the tsunami and volcano eruption in Indonesia this month. A recent study in Prehospital & Disaster Medicine found that if there were a major earthquake to hit Tehran — one of the largest cities in the world — "a shortage of blood was estimated to surge the capacity of all blood transfusion posts around the country within first three days". Researchers estimated that the demands for blood could outpace supply by as much as eight times. If a successful blood substitute were found it could have a huge impact on emergency medicine and in other areas. That’s why the topic needs the kind of attention to detail that this story brought to the descriptions of blood and its substitutes with some additional critical analysis of the evidence.
This is a big omission in the story. Given the ongoing shortages of blood, the costs to healthcare delivery systems continue to escalate. A readily available alternative to what is in reality an organ transplant would be welcome especially if the costs of the product were competitive with blood. Especially in a low-resource setting, like Haiti or Indonesia, blood substitutes would need to make good financial sense to even be considered an option. Certainly these companies have some rough estimates on what a final product might cost. Given the stage of development, it is not likely that an exact market price could be identified, but some range of possible costs would have been importnat information to include.
No benefits were quantifed in the story, which was disappointing given all the great descriptions of the way blood works and the way these products interact with the body. Instead phrases were used such as, "The hemoglobin substitute appeared to do a better job of delivering oxygen, and there were no worrisome side effects, O’Callaghan says." That’s not good enough for readers to understand whether these products truly have value and a future.
The story does quantify some of the harms for some of the blood products discussed, but not all of them. For example, it says "But 3% of the people treated with PolyHeme had heart attacks — three times as many as in the control group — and the Food and Drug Administration concluded that all hemoglobin-based carriers are dangerous." When discussing PHER-O2, though, it only says "breathing in too much oxygen can prompt the release of dangerous free radicals, which can damage cells throughout the body." But, again, we appreciate how difficult it is to cover all of this for four different products, so we lean toward a satisfactory score on this criterion.
The story notes that most of the studies that have examined blood substitutes are company-sponsored and small in scale. It also notes the drawbacks of each approach. We wish the story would have provided more details about the studies’ designs. Discussion of limitations are sparse. This is a tough task in a story that is trying to draw together four different products: PolyHeme, HemoTech, MP40X, and PHER-O2. A sidebar just breaking down the benefits and drawbacks of each might have been helpful. Nonethless, we lean toward a satisfactory score for the reasons we first listed.
The story does a great job setting up the reasons for new options in blood transfusions without unduly scaring people — no small feat when a story is all about blood. The story says, "Every year, 4.5 million Americans receive lifesaving transfusions, according to the New York Blood Center, and 1 in 3 people will need blood at some point in their lifetime. But real blood has many inconveniences. It requires refrigeration, which means ambulances can’t stock it and medics can’t administer it on the battlefield. It goes bad after 42 days. Donor blood must be compatible with the patient’s blood type. And some people refuse transfusions — Jehovah’s Witnesses, for instance, believe the Bible forbids them." It also makes the critical point that the blood supply is mostly safe in the US but not everywhere else.
The story leans a little too heavily on sources who either work for the companies involved or ran studies funded by the companies, and it does not always identify conflicts of interest. It does, though, make it clear which company is backing which product and when someone from a company is being quoted. It only quotes one completely independent outside expert: Dr. Ross Herron, chief medical officer of the Western Division of the American Red Cross in Pomona. We’ll give it the benefit of the doubt.
The story does a great job of taking people inside the body to show them how exactly blood works and how these blood substitutes work. Some of the best parts of the story are where the reporter uses descriptive language to bring people right down to the cellular level. "Red blood cells are basically little dimpled bags full of hemoglobin, the molecule that collects and releases oxygen. So researchers have attempted to build oxygen carriers out of hemoglobin itself. … But outside its little bag, pure hemoglobin is toxic. It tightens blood vessels, leading to high blood pressure and heart attacks. It also causes inflammation, including swelling and fevers."
The story makes it clear that all of these products are under development.
All of the blood substitutes are described in a way that makes it clear that they are different from blood itself and from each other.
This story goes far beyond any news release.