A Rational Animal

A caveat:  This is not the first in a series of "year in review" posts.  You’re not bloody likely ever to see a roundup of "Best This" or "Worst That" or "Top 10 [X]" here at A Rational Animal.  I don’t do end-of-year reviews.  I find them navel-gazing and masturbatory at best.

However . . . . 

Every once in a while a story comes along that deserves to be shouted from the rooftops - that deserves to be OJ’d to death on every network and every front page and every blog in the nation.   And that gets zip for coverage. 

This is one of those stories.  A couple of months ago, I stumbled over it via Google News headlines; it appeared in SFGate, apparently reprinted from a piece in the Baltimore Sun.  And after that . . . [crickets].  No network news.  No MSM print media.  No bloggers.  [now, I’m not saying that there were no bloggers who covered it; there probably were.  But my daily reading is fairly wide-ranging, and I’ve seen nothing about it.  So if you posted on it, good for you, but don’t bother slamming me for not noticing.  My criticism is reserved for the major outlets, who have a fucking duty to report stories like this.]

Here’s the headline:

"Military use of hemophilia drug raises questions:  It stops bleeding, but it may cause strokes, even death."

Sounds like a major story, right?  Apparently not.  But it should have been:

American military doctors here have injected more than 1,000 of the war’s wounded troops with a potent, and largely experimental, blood-coagulating drug despite mounting medical evidence linking it to deadly blood clots that lodge in the lungs, heart and brain.

[. . .]

In a warning last December, the Food and Drug Administration said that giving it to patients with normal blood could cause strokes and heart attacks. Its researchers published a study in January blaming 43 deaths on clots that developed after injections of Factor VII.

With a lead like that, wouldn’t you have expected a little coverage?  So would I.   Apparently, I would’ve been wrong.

In a nutshell, a Danish pharma firm called NovoNordisk, which specializes in the treatment of hormone research, diabetes, and blood-related disorders like hemophilia, has created a drug called Recombinant Activated Factor VII, a high-end clotting agent designed specifically for hemophilia patients.  And our military, in its infinite quest to get injured cannon fodder back out there on the streets of Baghdad, so that W wouldn’t have to increase troops before the elections, has been shooting up non-hemophiliac injured soldiers with it.  Read on:

The U.S. Army medical command considers Factor VII to be a medical breakthrough in the war, giving frontline physicians a powerful new means of controlling bleeding that can be treated otherwise only with surgery and transfusions. They have posted guidelines at military field hospitals encouraging its liberal use in all casualties with severe bleeding, and doctors in Iraq routinely inject it into patients upon the mere anticipation of deadly bleeding [emphasis added].

[. . .]

Yet the Army’s faith in the $6,000-a-dose drug is based almost entirely on anecdotal evidence and persists despite public warnings and published research suggesting that Factor VII is not as effective or as safe as military officials say.

Doctors and researchers at civilian hospitals, including Johns Hopkins in Baltimore and Massachusetts General in Boston, have rejected it as a standard treatment for trauma patients. Other hospitals say they are cautious about administering it because of clots found in their patients, including some that have caused deaths.

Doctors at military hospitals in Germany and the United States have reported unusual and sometimes fatal blood clots in soldiers evacuated from Iraq, including unexplained strokes, heart attacks and pulmonary embolisms, or blood clots in the lungs. Some have begun to suspect Factor VII.

At Walter Reed Army Medical Center in Washington, doctors said they tried to determine last year whether a high incidence of blood clots in their patients was related to Factor VII use in Iraq, but they discovered that the Army was not collecting sufficient information about the drug to draw any conclusions.

[. . .]

During one 24-hour period in May, at the 10th Combat Support Hospital in Baghdad, three U.S. soldiers arrived in the emergency room with traumatic injuries and all of them were injected with Factor VII. Two died, not from battlefield injuries but from complications related to blood clots, according to medical records and interviews with doctors [emphasis added].

Of course, our military doctors insist that it’s not only safe, but "one of the most useful new tools we have."  Never mind the fact that "the drug has never been subjected to a large-scale clinical trial to verify that it is safe for patients without hemophilia" [emphasis added].  And never mind what civilian medical professionals who are true experts in this area of medicine believe:

"It’s a completely irresponsible and inappropriate use of a very, very dangerous drug," said Dr. Jawed Fareed, director of the hemostasis and thrombosis research program at Loyola University in Chicago and a specialist in blood-clotting and blood-thinning medications.

"It’s insane, using it that way. Absolutely insane," said Dr. Rodger Bick, a University of Texas hematologist and editor of the Journal of Clinical and Applied Thrombosis/Hemostasis.

Army trauma specialists say that clots in severely injured patients could have a variety of causes and that using Factor VII is worth the risk, considering reports from military doctors in Iraq describing its success at controlling severe bleeding.

But some civilian doctors who have worked with the drug say its clotting capabilities are so profound that they have to assume it is responsible for deaths among the military casualties who have received it.

"Of course some of them are dying from it," said Dr. Louis Aledort, a professor of hematology at Mount Sinai School of Medicine in New York, who has studied Factor VII safety. "If you give people this kind of dangerous coagulating product, some of them are going to have (blood clots)."

Yet he and other civilian specialists were less troubled by the dangers — which they said might be justified given the injuries in Iraq — than by the lack of scientific evidence that war casualties are getting any benefit for taking the risk.

"If you don’t have that," Aledort said, "then you’re just experimenting on people with a dangerous drug" [emphasis added].

Yeah, but this [mal]administration is the one that cares about the troops.  Right?  Right? 

Read those last two grafs again.

Sweet jumping Jeebus on a trampoline.