Need to Know Transcript – August 20, 2010

Need to Know

Episode 116

Airdate: August 20, 2010

ALISON STEWART: I’m Alison Stewart.

JON MEACHAM: And I’m Jon Meacham. Here’s what you need to know.

ALISON STEWART: As American troops pull back from combat positions in Iraq, just what sort of Iraq is the U.S. leaving?

JON MEACHAM: Rethinking a common medical practice – when to give blood transfusions…and when not to.

MARIK: There have been a whole host of studies which have actually supported our findings that the older the blood the greater the number of complications and the less effective the blood is in delivering oxygen.

ALISON STEWART: Military checkpoints in New York. War with Venezuela. China as the world’s only superpower. Meet the man who cooked up those story lines …best selling author of “Super Sad True Love Story,” Gary Shteyngart.

GARY SHTEYNGART: Absolutely. Each year I think I lose about six percent of my humanity. That’s what the scientists tell me.

JON MEACHAM: You’re the polar ice cap.

GARY SHTEYNGART: I’m the polar ice cap. Thank you, exactly. I am the polar ice cap of the humanities. And I’m slowly, slowly shrinking.

JON MEACHAM: All that, and Andy Borowitz.

ALISON STEWART: Next on Need to Know.

JON MEACHAM: Thanks for joining us. We begin by focusing on the consequences of war, and the obligations of peace.

ALISON STEWART: On Thursday morning, local time in Iraq, the Fourth Stryker Brigade, Second Infantry Division, crossed into Kuwait…the last U.S. combat brigade to be pulled out of Iraq. The war that began seven years ago with the previous administration’s shock and awe ends now with the current administration’s mission to “advise and assist”. That is how President Obama describes the new role for the 50,000 American troops who will remain there until 2011. You may hear those words, advise and assist, but you’re not likely to hear the word “victory” when officials talk about Iraq these days. Here to help us evaluate what’s been achieved, and what still hangs in the balance in Iraq is Middle East scholar and history professor at the University of Michigan, Juan Cole. He writes the widely-read blog, Informed Comment and is  author of “Engaging the Muslim World.” Welcome Professor Cole. Thanks for coming to New York…

JUAN COLE: Thanks…

ALISON STEWART: …to join us. So this drawdown has been happening slowly for the past 18 months. But the big dramatic pictures we all saw, the big dramatic action was these troops coming across– the brigade coming across and the gate closing two weeks before the scheduled deadline. Tell me your thoughts on the timing and why it was such a fairly closely held secret.

JUAN COLE: Well, I mean, withdrawing from a war zone is– is always dangerous. And there– there was– danger of troops being attacked. I think you’ll– you’ll notice that they came out at night– and that was a security measure. There are still Shiite militias, the Maathi Army (PH) operating in those areas near Kuwait. And then this was an enormous logistical challenge. Logistics means moving things around in military terms. So– you know, a million and a half pieces of equipment had to be taken back out of the country. They were living there. There’s microwaves and– air conditioners and so forth and– and, of course, tanks and– armored vehicles. So getting all of that equipment out in addition to thousands and thousands of men– and women was– was a real logistical challenge. And– it– it’s remarkable that the U.S. military pulled this off on schedule.

ALISON STEWART: 50,000 troops will remain in the country. Let’s talk about what is the role of the military starting right now?

JUAN COLE: Well, for some time now the U.S. military has not been engaged in active war fighting. There are still battles. We lost four guys last week. It was very tragic– that they’re still fighting and losing their lives. But it’s on a far reduced scale to what we saw in the past. And– they’re not doing active– they– they hadn’t been doing active patrols– in the– in the– cities. So now– the– the tasks that remain are to continue to train– the Iraqi military. The U.S. is providing– logistical support to the military. It’s moving around water and ammunition because the Iraqis lack an air force. And it’s giving close air support, if there is a battle and they need something bombed, you know, the U.S. will do that for them. So there– there still is, you know, a role for the U.S. military in the next 18 months.

ALISON STEWART: Obviously the Iraqi military is going to have to step in. Yet we saw earlier this week an attack on a recruitment center that killed 59, wounded 100. Who at this point wants to attack recruits to the Iraqi military?

JUAN COLE: Well, there are still small guerilla groups that are very, very unhappy about the new situation in Iraq. These are mostly Sunni Arabs. And they feel that, you know, Iraq was their country. The U.S. has put Shiites and Kurds in charge of them. There’s been a foreign military intervention. And so they’re still pushing back against this new order. They’re still trying to destabilize it. They’re engaging in terrorism. And it– it’s not effective politically.

ALISON STEWART: Contractors will still be in Iraq. What do you expect their role will be, U.S. contractors?

JUAN COLE: Well, the U.S. contractors are brought in by the U.S– it will be by the State Department and what’s left of the military mission– in a support role. That’s a U.S. decision– and it’s still controversial among– Iraqis, especially the private security groups. And, of course, they banned– the old– Blackwater– or Z Group– from Iraq. But– I think also the civilian contractors’ roles will change. The mission will shift to being more support, development, economic progress, and so forth.

ALISON STEWART: Given what we’ve seen this week, with a little bit of hindsight, was the Bush administration’s 2007 surge successful?

JUAN COLE: Well, I don’t wanna take anything away from the efforts of the U.S. military, which were– important in tamping down violence. But– in my view, the thing that caused the violence to subside in the main was that the Shiites won the civil war. And they ethnically cleansed the capital, Baghdad, of hundreds of thousands of– Sunni Arabs– something that I think in American reporting on Iraq is– is often missed, is that Baghdad– Baghdad is now– a largely Shiite city. That was not the case. It was about 50/50 when the U.S. invaded. A lot of refugees have– have been produced in this process. So that’s not good for stability.

ALISON STEWART: And, also, would obviously cause resentments.

JUAN COLE: Yes.

ALISON STEWART: And how would those resentments play out potentially in the future?

JUAN COLE: Well, at the moment, I perceive the Sunni Arabs to be largely demoralized, except for those guys who are bombing things from time to time. But– most Sunni Arabs seem to have had the fight knocked out of them. So I don’t anticipate a revival of the civil war soon. But certainly over the long term, if you have, you know– a significant number of people, 20 percent of the population– really deeply unhappy with the political– conditions– then the danger of a recrudescence of violence is there.

ALISON STEWART: Let me follow up on that idea of ethnic cleansing of the Sunni Arabs. What was the U.S.’s role, if any, in that? Did we know about it? Did we look away?

JUAN COLE: At the time, you know, the Sunni Arab guerilla groups were doing a lot of damage. And so I think we did kind of look away– at the time in 2006 and ’07. It wasn’t the worst thing in the world that could have happened from our point of view, I– I’m afraid. And– and– but– but the other thing to say is that the U.S. was powerless to do anything about it. This was happening at a micro level. So I think, you know, the– it’s easy to overestimate the power of an occupying force. But 160,000 troops in a country of 30 million really can’t dictate the course of affairs very easily.

ALISON STEWART: Let’s move on to the political situation in Iraq. Last week, negotiations to broker some sort of power sharing deal fell through because the election five months earlier, there was no clear winner between the former prime minister and the current prime minister. So what’s next?

JUAN COLE: Well, it’s a very bad situation obviously. Nouri al-Maliki– who’s been– prime minister since 2006, remains the caretaker prime minister. But, of course, his legitimacy, his scope of action, is constrained. And they haven’t managed to put together– a coalition of parties who did well in the elections and which could together form a majority in parliament.

ALISON STEWART: With Shiites in power, how does this bring Iran into the equation?

JUAN COLE: Well– Iran is extremely influential with the Iraqi Shiites. It– it doesn’t dictate things to them. They’re not obedient to Iran. But they have an alliance with and they have warm relations. So one of the problems with forming a government at the moment is that Iran wants the Shiites to coalesce in a big Shiite coalition and run the government. The United States is backing– former interim prime minister, Ayad Allawi, whose list is more secular and was largely supported by the Sunni Arabs– and which is– tends to be anti-Iranian. So the U.S. would very much like to maneuver– Allawi into at least control of the security apparatus to make sure that Iran doesn’t control– Iraq. And one of the reasons that the Iraqis can’t form a government is that, in a way, the United States and Iran are– are playing politics at the same time as local factions are.

ALISON STEWART: Anthony Shadid of the New York Times has done some interesting reporting. And he’s been writing that the elites in Iraq are extremely disconnected from the people in the street and the people in the street are extremely disenchanted with the way the political process has gone forward. What could this disconnect mean for forming a new government, a new government that actually has is power and can get things done like get the electricity back on and like make life livable for the average Iraqi?

JUAN COLE: Well, you know, Iraq now is– is– in a condition where– things have been engineered in the constitution and in the political process so that there’s a weak government. And this is a reaction against there having been way too strong a government back in the era of Saddam Hussein who, you know, committed genocide and– ruled the country with an iron fist. So everybody’s a little bit afraid of another, you know, strong man emerging. And so they– they mobilized against this. But they’ve over-corrected. So they’ve ended up in a situation where they can’t manage to form a government at all and one that’s formed tends to be weak– and ineffectual and not good at providing services. I think eventually the Iraqis are gonna have to work their way toward– a more functional– federal government. But the danger is that if they don’t do that soon– people will become disenchanted with the whole democratic process, having elections and so forth, that it’s not producing any results.

ALISON STEWART: The world’s biggest embassy is in Iraq and it’s the United States embassy. And the State Department is planning to open up four more offices around the country. With such a big United States diplomatic presence, why hasn’t the United States been able to move this process along in any way? And what does that say that we have not been able to help move this process along?

JUAN COLE: Well, the United States– has, you know, now– has no combat troops in Iraq. So its– its position is much weaker than it used to be. We can’t dictate the situation in Iraq. That big State Department– compound– is not a sign of power. It’s a sign of an aspiration for– the United States to continue to have influence and to have an impact on Iraq of a civilian sort– as the war winds down.

ALISON STEWART: Given Iraq’s history, is a coup a concern?

JUAN COLE: I think a coup is a concern. As the Iraqi military becomes stronger– as it’s maybe the only institution in the country that’s actually functioning– well– you could see a general– or– or– or lieutenant colonel– get ambitious. There’s another possibility which is someone like the current– caretaker prime minister, Nouri al-Maliki– has gotten a lot of the officer corps to report to him personally. And he’s established tribal militias in the south who report to him. What if it gets to the point where people say to Maliki, “Go,” you know, “Step down so we can form a government with somebody else,” and he says, “Make me”?

ALISON STEWART: Let’s talk about the personal toll. Obviously over 4,000 American troops have died. Thousands of Iraqis have died and been wounded. What is life like for Iraqis as the United States pulls out combat troops? Are they safe? Do they have infrastructure they need? What about the refugees?

JUAN COLE: There have been riots in recent weeks over the lack of electricity. A lot of the middle class left because of the extreme violence in the war. And so getting good medical care is difficult. Infrastructure– has been damaged by years and years of sanctions and war. It has been sometimes targeted where it was rebuilt by– the insurgents. So– life is hard. There are an estimated four million refugees– 2.7 million inside the country, the rest outside. Security is not good. People are afraid. There’s enormous dissatisfaction with the condition of life. The– the government still has not been able to pump very much more petroleum than was being pumped– in the days of Saddam and the sanctions regime. And so the government’s income is limited. And so things are not good. And international investment is not coming in because of the bad security situation.

ALISON STEWART: Outside of forming a new functioning permanent government, what is the outstanding issue in Iraq, in your mind, as U.S. combat brigades pull out?

JUAN COLE: One is that the Kurdish ethnic group in the north has conflicts over territory– and prerogatives with the Arab majority. And this has gone to fighting. At some points they fired at each other. That’s a whole ‘nother civil war that could occur. And it could– draw in Iran and Turkey. Could be a big mess. So that needs to be resolved.

ALISON STEWART: Final thoughts. The current administration has said that all troops will be out by the end of 2011, although Defense Secretary Gates has opened the door for that to be till 2012. What needs to happen in Iraq between now and then for that to actually happen, for all the troops to come out?

JUAN COLE: Well, the Obama administration has been pretty steadfast about keeping to a schedule of taking troops out. Having the troops out by the end of 2011 was set by the Status of Forces Agreement– legislated by the Iraqi parliament and agreed to by the Bush administration. So it’s not really in American hands. I think there will be a U.S. presence in Iraq of a military sort– on a small scale for many years to come. I think– Iraq is emerging as an independent country. It– it’s got a very fragile security situation. Its politics are very fractious. But it is going to be standing on its own two feet.

ALISON STEWART: Professor Juan Cole, thanks for joining us on Need to Know.

JUAN COLE: Thanks for having me.

ALISON STEWART: One of the nice things about working with Jon Meacham is that he knows history….really, really knows history. This comes in handy when we want to reach past the heat and noise of a controversy in the news, and get some perspective. This week, there was loud and sometimes overwrought discourse about the proposed cultural center and mosque near the site of the world trade center attacks. Strong opinions were everywhere… politicians, pundits, religious leaders. As for the families of the 9/11 victims, they’re divided about it. So we turn to Mr. Meacham, who reminds us that the struggle over religious freedom has quite a long history in Manhattan, one that’s older than the nation itself.

JON MEACHAM: History can seem abstract, but it always begins in quite concrete, and often small, places. The story of religious liberty in America is such a chapter and it begins right here in lower Manhattan. Walking around here offers us a way to understand the complexities and compromises Americans have always made in negotiating the tensions between faith and politics, church and state, majority and minority.

In fact, those tensions started long ago when New York was a Dutch colony known as New Amsterdam…In the mid 1600s, Peter Stuyvesant walked these streets – or hobbled (he had a peg leg, as you can see) – as the head of the new Amsterdam colony. It was a pretty diverse community even then – Lutherans, Catholics, Quakers and of course Calvinists, of whom Mr. Stuyvesant was one. In fact, he frowned on non-Calvinist Christians and wasn’t above jailing or even flogging them.

But it was only when Jews first arrived in 1654, that Stuyvesant actually tried to kick an entire religious community out of town. “Hateful enemies and blasphemers of the name of Christ,” he called them; anti-Semitism alive and well in the new world 356 years ago.

Stuyvesant was overruled by his superiors in Holland, however, and Jews were given official permission to settle in the area – on the basis of — quote — “reason and equity.” This small community became known as Congregation Shearith Israel.

Yet despite their official recognition, Stuyvesant still wouldn’t let them practice their faith outside their own homes. By 1685, New Amsterdam had passed from Dutch to British hands, but congregation Shearith Israel still couldn’t establish its own place of worship. The governing common council said “publique worship is tolerated…but to those that professe faith in Christ.”

It wasn’t until 1730 when these first Jewish New Yorkers finally secured permission to build what became the very first Jewish synagogue in America here where this parking garage now stands. It was from here – several decades later when revolution was in the air – that a tiny band of Jews, led by Gershom Seixas, the leader of Congregation Shearith Israel, made a bet on the colonial cause.

Seixas would later update a traditional Hebrew prayer to bless the Continental Congress and “…his excellency George Washington, captain general and commander in chief of the federal army of these states.”

Sexias wagered rightly, that Washington, like most of the founders, believed religion a matter best left, as much as possible, to the individual. Liberty of conscience was a keystone of American liberty.

Washington was inaugurated president on April 30, 1789 right here at Federal Hall. Afterward he walked to nearby St. Paul’s Chapel for services. At the time, New York newspapers took care to list the 14 clergymen in the city–and Gershom seixas was among them.

In a letter Washington wrote from New York to the Hebrew congregation at Newport, Rhode Island the following year, he said that the government of the United States should give “to bigotry no sanction, to persecution no assistance” and, quoting the prophet Micah, added that every man should be left free to sit under his own vine and fig tree and none shall make him afraid.

We were fearless in the beginning right here, on the tip of this island–fearless about freedom, and confident enough in the great experiment in liberty that differences were not merely to be tolerated but expected and defended. As it was in that beginning, so it should be now.

ALISON STEWART: We turn now to some information you need to know about for the sake of your health. It’s about blood…specifically, blood transfusions. For decades, blood has been called the gift of life. And while its image was tarnished in the 1980s when HIV and hepatitis contaminated the blood supply, better screening tests have made donated blood the safest it’s ever been. Each year, close to 5 million Americans receive a blood transfusion. For many, that transfusion will be a lifesaver. But for others, a transfusion may do more harm than good, according to some doctors and researchers. For those patients, there may be a better alternative. We asked Need to Know medical correspondent Dr. Emily Senay to report on the potential problems, and ingenious solutions, to the time honored practice of blood transfusions.

VOICEOVER: Donate blood—save a life. It’s been part of our national consciousness since World War II.

ANNOUNCER: The Army and Navy have called upon the Red Cross for an increased quota of 4 million pints of blood in 1943…

VOICEOVER: And Americans heeded the call for blood… between 1941 and 1945 the Red Cross collected 13 million pints headed for wounded soldiers on the field. Transfused blood was miraculous, saving countless numbers of soldiers’ lives.

ANNOUNCER: Today scientific use of blood has emerged as one of the major medical advances of WWII…

VOICEOVER: These days more than 14 million units of whole blood or red blood cells are transfused each year in the United States. The benefits of blood—so it goes—are so obvious as to be beyond question. But are they?

Now a growing number of experts are questioning the value of blood and blood products and are concluding that for many patients the risks of transfusions can outweigh the benefits.

It’s a controversial point of view that is changing medical practice, and potentially saving lives. And you might be surprised to learn that one of the driving forces behind it – has been the Jehovah’s Witnesses.

BETTY MYERS: I want to know when I go in there that they will not use the blood under any circumstances whether I live or die.

VOICEOVER: Jehovah’s Witnesses like Betty Myers see blood as a precious fluid – so precious that being transfused with someone else’s blood means losing the chance for eternal life.

BETTY MYERS: There are several passages in the book of Genesis, the book of Leviticus and the book of Acts that prohibits the taking of blood, because blood is in your body as a life to you.

VOICEOVER: In 1994, a committee of Jehovah’s Witnesses from the world headquarters in Brooklyn, New York made a simple request to hospitals in the area: give us the best medical and surgical care you can…..just do it without the use of blood transfusions. Many facilities turned them down, but Englewood Hospital, in nearby New Jersey, agreed.

DR. ARYEH SHANDER: To be honest with you, we just accepted this as a challenge. We, we thought that someone had to take care of this population. And we were ready to learn.

DR. EMILY SENAY: So you didn’t think they were out of line or suicidal or on the road for trouble pushing this?

DR. ARYEH SHANDER: We, we may have, going back that far, but w e certainly learned very, very quickly that that’s not the case.

VOICEOVER: As chief of anesthesiology and critical care at Englewood, Dr. Aryeh Shander was already questioning conventional wisdom about blood transfusions.

DR. ARYEH SHANDER: Transfusion of blood components seemed to be erratic and I started looking at my own practice to see that the decisions were not really based on anything and that when I did apply some rationale to the decision, the amount of transfusions that I was using clearly was much, much smaller than what was being used around me.

VOICEOVER: Within a year of treating Jehovah’s Witness patients without transfusions, Shander and Englewood noticed something unexpected.

DR. ARYEH SHANDER: Our physicians started seeing Witness patients coming, getting their surgery, getting the medical care without a single drop of blood. Going home, either at the same time as other patients or even going home earlier. No complications. And that’s when we started to recognize that there is something here we needed to investigate more.

VOICEOVER: Dr. Shander wasn’t the only physician questioning the value of blood. At about the same time critical care specialist Dr. Paul Marik was also coming to some surprising conclusions about blood transfusions. In 1993 he published this study suggesting that transfusions weren’t doing the very job they were supposed to do – and that is to deliver oxygen to cells in the body. One reason he speculated was that some donated blood might be sitting too long on the shelf

DR. PAUL MARIK: hat we found was that the older the blood, the less effective it was in…in unloading oxygen in the tissues.

VOICEOVER: By law,donated blood must be used within 42 days…but just like anything else that sits on a shelf, blood degrades… and as it ages, red blood cells become mishappen, making it harder for them to maneuver through tiny capillaries.

DR. PAUL MARIK: Since then there have been a whole host of studies which have actually supported our findings that the older the blood the more the…the greater the number of complications and the less effective the blood is in delivering oxygen.

VOICEOVER: One example: a 2008 Cleveland Clinic study that looked at the records of 6,000 heart surgery patients. It showed that those who received blood more than two weeks old had a significantly higher risk of complications like infection, respiratory problems, kidney failure, and even death.

There is disagreement in the medical community about whether older blood causes problems. But it’s not just the age of blood that might be harming patients. Dozens of studies suggest transfusions are linked to other serious risks including cancer recurrence, organ failure and the significant long term impact blood may be having on the recipient’s immune system.

DR. PAUL MARIK: We know now that transfusion of blood lowers the host’s immune response and ability to fight infection so it predisposes sick people to get infections.

VOICEOVER: Doctor Marik is a harsh critic of the status quo when it comes to blood use in American hospitals. He says doctors use blood transfusions the way they do….because….well…that’s how they’ve always done it. Dr. Shander agrees.

DR. EMILY SENAY: Are there large numbers of Americans who are getting blood probably inappropriately? Or blood products?

DR. ARYEH SHANDER: Yes. I think that the short answer is yes, the question of appropriateness is something which is very ill-defined.

DR. EMILY SENAY: Are they at risk?

DR. ARYEH SHANDER: The recipients?

DR. EMILY SENAY: Yes.

DR. ARYEH SHANDER: Absolutely. If you can’t demonstrate benefit, all you’re offering the patient is risk.

VOICEOVER: Need to Know went to the American Red Cross – which supplies 40 percent of the nation’s blood – to find out what its attitude is towards the new thinking on transfusions.

Dr. Richard Benjamin, chief medical officer of the Red Cross, supports the conservative use of blood, but is wary of much of the research about the potential hazards of donated blood, including older blood.

DR. RICHARD BENJAMIN: There are a number of studies published, they are retrospective analyses, they are generally inconclusive. We really do need randomized control trials to answer this question.

VOICEOVER: Large clinical trials including one sponsored by the national institutes of health are underway now to determine what effect if any the age of blood has on patient outcomes.

The results of that research could have a major effect on how the Red Cross conducts business.

DR. RICHARD BENJAMIN: If indeed it turns out that six week old blood is not as good as three week old blood, we would have to change our whole collection system to supply the appropriate blood for hospital needs.

DR. EMILY SENAY: How would that affect you?

DR. RICHARD BENJAMIN: Well we’ll go out and do it. I mean we will do what is best for patients and is best for hospitals.

VOICEOVER: Dr. Harvey Klein is the head of the department of transfusion medicine at the National Institutes of Health’s clinical center. He supports many of the ways transfusion practices are changing.

But he points out that this shouldn’t lead anyone to believe that blood transfusions are always bad…..in some situations there is simply no substitute…

DR HARVEY KLEIN: If you’re dying on the battlefield, there’s no replacement for human blood. If you’ve been shot in an alley, there’s no replacement for human blood. And in fact if you begin to bleed like crazy in the operating room, only blood will save you.

VOICEOVER: And indeed, Englewood Hospital does transfuse blood when needed.

But since 1995, the hospital has applied its blood conserving standard of care to all patients, cutting transfusions by 40 percent. How do they do it? They use an aggressive approach involving what they call patient blood management and bloodless surgery.

Here’s how it works. First, candidates for surgery are carefully evaluated and treated for problems like anemia. The point is to keep them from needing transfusions in the first place.

And what happens once you get in the operating room? This patient is having a heart valve replaced.

DR. ARYEH SHANDER: We actually take some of your blood out and keep it by your bedside so there’s no storage, at room temperature, so it’s active and it’s whole blood and load your vessels with liquid so that if you’re going to bleed it’s going to be very, very dilute. And then at the end of surgery, we return this blood.

VOICEOVER: Even the blood lost when surgeons open the patient’s chest is collected, cleansed of contaminants and returned. These so-called bloodless surgical techniques — meticulously preserve the patient’s own blood so she won’t need someone else’s.

Dr. Shander says compared to patients who get transfusions, patients without them do better….

DR. ARYEH SHANDER: If you look at the cardiac population for example, compared to other institutions, our risk adjusted mortality is the lowest in the state of New Jersey with probably the lowest transfusion rates in the world.

DR. EMILY SENAY: What are the circumstances where you really absolutely have to transfuse someone? There’s just no question about it?

DR. ARYEH SHANDER: You know for me it’s a very difficult question to ask because there are patients that we have here who have hemoglobin levels of less than 2 grams per deciliter which is considered to be incompatible with survival who have gone home. So…

DR. EMILY SENAY: Without a transfusion.

DR. ARYEH SHANDER: Without a transfusion. We generally, if somebody will accept blood, we would transfuse them when they get to those…those levels. We won’t let them get down to those levels. But we’ve seen people survive with aggressive therapy without receiving blood.

VOICEOVER: The notion that less may be more when it comes to blood is catching on…but slowly. About 100 hospitals across the country offer blood management programs, up from about 25 in the mid 1990s. One is Eastern Maine Medical Center in Bangor, Maine. Dr. Irwin Gross established their program in 2007 and within three years he cut transfusions by 60 percent – saving the hospital almost 1.5 million dollars a year.

DR. IRWIN GROSS: Much of this is not high-tech. And there really are very few aspects of patient blood management that are not accessible to even the smallest of community hospitals. Most of this is just good clinical care of the patient.

ANNOUNCER: This bag saved the driver. This bag saved the passenger.

VOICEOVER: There is no doubt that when necessary – donated blood can save lives. The question the medical community is trying to answer now – is when is it necessary?

ALISON STEWART: Joining us in studio now to answer just a few more questions is Need to Know’s medical correspondent, Dr. Emily Senay. So Emily, I’m a patient, I’m going to the hospital – what kind of questions should I be asking about transfusions?

DR. EMILY SENAY: Well you know, you should ask questions. Everybody should ask questions. If it’s the case of surgery, the first question you wanna ask is “Is this a procedure that requires a blood transfusion?” And depending on the answer you get, you wanna ask your doctor, “Is there anything I can do to reduce my own risk for needing a transfusion?” And these are the blood management techniques talked about in the piece, and these are very simple things. How do I get myself in the best shape possible? How do I reduce anemia and problems like that, so when I get to the O.R. I don’t need a transfusion? Then you should ask, well how do you compare to other doctors who are doing this procedure? Do you use more blood or less blood? Does this institution use more blood or less blood than neighbors or large academic medical centers. Whatever your wishes are in terms of blood transfusions, whether they’re religiously based or not, you wanna make sure that the doctors you’re talking to know what they are.

ALISON STEWART: Let’s talk about the other side of the coin…donations. Does this mean that people should keel back donations?

DR. EMILY SENAY: No, absolutely not. No expert we spoke with would suggest that at all. This is a discussion about how to use a scarce resource. The scarce resource is blood. We need donors. We need donors now, we’re going to need donors into the future. This is really a discussion about how we use what they’re giving us through donations in the best way possible so it’s good for the patients, and we make sure we’re doing it correctly.

ALISON STEWART: And especially if we talk about the age of the blood as being a factor in its effectiveness, I know the NIH did some studies, we saw that in the piece. What other investigations are ongoing?

DR. EMILY SENAY: It’s so interesting, Alison. This is the only developed country that until recently did not have a national adverse event blood transfusion monitoring program, so just this past February the Centers for Disease Control has launched just such a program to give us a snapshot of what we’re seeing nationally. You know, we do know about certain things, like mortality related to certain types of blood transfusions or blood products, but we don’t know much else. So this will allow hospitals to upload their data to the CDC and allow them to analyze them compared to other programs – the first time we’re going to know something about what’s going on in this country – it’s called the National Hemovigilance Program, it’s just launched recently, in February.

ALISON STEWART: This also begs the question about science… what about artificial blood?

DR. EMILY SENAY: Sure, this is the science fiction part, the thing that’s sort of always on the horizon. When are we going to get that chemical that will replace the need for blood transfusions, blood donations. You know, that’s a horizon that’s always moving into the future, unfortunately. Some things came up recently – they were used in clinical trials that were not successful. They’re looking at other things – actually taking some of the molecules inside red blood cells, isolating those – I think one of the coolest science fiction things out there is this blood farming where they’re looking at stem cells and trying to actually grow red blood cells in a “factory” and then using that, but nothing is on the horizon or close to the marketplace anytime soon, so for now, donating blood – it’s going to be the thing that we need to do to help people who are in the hospital, trauma victims, and absolutely in the military.

ALISON STEWART: But blood farms – that’s great sci-fi.

DR. EMILY SENAY: Blood farming, very sci-fi.

ALISON STEWART: Dr. Emily Senay, thanks a lot.

DR. EMILY SENAY: Thanks, Alison.

ALISON STEWART: Commercial shrimping resumed along parts of the Gulf Coast this week, and an area near the Florida Panhandle reopened for fishing on August 10th. The question of course is, will consumers feel okay about eating Gulf seafood?

JANE LUBCHENCO, NOAA: We know that the seafood that is in the market now from the Gulf is in fact safe to eat.

ALISON STEWART: But all those pictures of oil-covered wildlife might still make you wary of a shrimp kebab or grouper sandwich. We did our own research and uncovered 5 Things You Need To Know About Gulf Seafood.

ALISON STEWART: Thing Number One: Which seafood is most likely to be safe?

Some species of seafood are better at clearing oil out of their bodies than others. Fish do it the fastest. In fact, the federal government reopened some Gulf waters for fishing last week.

ALISON STEWART: Thing Number Two: Shellfish take longer to cleanse themselves.

Shrimp, crabs and especially oysters have a harder time processing oil droplets that enter their systems. Shrimpers are back out in coastal state waters this week, but further into the Gulf, federal waters are still closed to them.

ALISON STEWART: Thing Number Three: How is seafood from these reopened areas being tested? You may have heard about the federal government’s sensory test to evaluate Gulf seafood. Specially trained sniffers, yes I said sniffers, actually smell samples of fish and shrimp from the Gulf for evidence of oil or dispersants, as seen here.

It may sound odd, but Calvin Walker of the National Seafood Inspection Lab told us the sniffers can detect petroleum and dispersants down to about one part per million. Meanwhile, the samples are also undergoing chemical analysis for oil.

And here’s something else to consider – most seafood served in the U.S. doesn’t undergo anywhere near this rigorous level of safety testing. The U.S. imports about 80 percent of its seafood and only a small fraction of that undergoes even physical inspection.

ALISON STEWART: Thing Number Four: Laws of supply and demand don’t necessarily apply to seafood pricing. In a normal year, only about two percent of the seafood consumed in the U.S. comes from the Gulf. Steve Hedlund, the editor of a seafood trade publication, told us that your average supermarket probably doesn’t even carry any seafood from the Gulf to begin with. Despite that, because there’s been a perception that shrimp are in short supply, Hedlund says panicky buying has driven prices up by about 10 to 30 percent across the country.

ALISON STEWART: Thing Number Five: What’s the bottom line? Does all this safety testing mean we’re safe? The general consensus seems to be that having a plate of Gulf seafood is safe, but Gina Solomon of the National Resources Defense Council cautioned this week that some people might want to be more careful. Pregnant women, children and people who eat fish as a large part of their diet might be more susceptible to long-term health effects.

She also worries there will be contaminants that may not show up in near-term testing. Oil contains heavy metals like mercury, arsenic and lead that will take some time to accumulate into dangerous levels. The National Oceanic and Atmospheric Administration, NOAA, tells us that while it is not currently testing for heavy metals, it is aware of the concern and that analysis will likely be added to its long-term monitoring efforts.

JON MEACHAM: This week online…We visit Houston to see how a program meant to target and deport illegal immigrants with criminal records might actually be threatening public safety.

MALE VOICE: Everybody that comes through the door, in some way or the other, is interviewed or screened for immigration status.

JON MEACHAM: Contributor Robert Fri debunks some of the hype surrounding natural gas and its potential to solve our energy problems…And if there is a story you think we should be telling… tell us. Visit the new and improved “Pitch Room” on the Need to Know site.

JON MEACHAM: How much of what ails America can be blamed on Facebook? According to best-selling author Gary Shteyngart, quite a lot. Shteyngart’s new satirical novel “Super Sad True Love Story” imagines a world in which the American economy has collapsed, the government is run by the so-called Bipartisan Party, and the media is dominated by Fox Liberty Ultra and the New York Lifestyle Times. It’s also a world in which people no longer read. Books are considered novelty items, and smelly ones at that. People communicate primarily in online slang through smart phones and social networking sites. Genuine human contact has become obsolete.

Shteyngart, who updates his own Facebook page often, was born in 1972 in what was then Leningrad. His family immigrated to the United States when he was a boy. He was named one of the New Yorker’s 20 best writers under 40. And the New York Times, the real one, called his book a, quote, “Super sad, super funny, super affecting performance.” In fact, the book has debuted to great reviews and is a New York Times bestseller. Gary Shteyngart, welcome.

GARY SHTEYNGART: Thank you. Great to be here.

JON MEACHAM: Now, your novel is supposed to be futuristic. It’s supposed to be about people not talking to each other, only communicating through devices, and speaking in a slang that develops out of the technology as opposed to human contact. So is this fiction or are you simply reporting?

GARY SHTEYNGART: Well, any novel that’s set in an illiterate America that’s about to collapse is pretty much set next Tuesday. So that’s about the timeframe I’ve given myself. This is the problem with writing a novel these days. If you’re gonna write about anything technological, it evaporates the next day. We don’t have a present anymore, just a future. Tolstoy, 1862, he was writing about, you know, horse carriages in 1812. They may have evolved a little bit, but he didn’t have to worry about some killer app coming along and destroying his world.

JON MEACHAM: Right. What’s the constant human factor, though? I mean, Tolstoy is presumably writing– was writing about the same sorts of things you’re writing about in terms of humanity. Or do you think something has fundamentally shifted as the Internet has taken over?

GARY SHTEYNGART: It’s a big question. We’re still at the very beginning of the process. You know, people still need to interact. There’s still some interaction. But so much of it is done digitally. There was– I read about a seminar at NYU where—the incoming freshman class had to figure out how to talk to one another without Facebook. And they had them up on a stage. And they said, “Come on, just ask Jimmy where he’s from.” And then he said, “Where you from, Jimmy?” “I’m from Syosset.” “Oh, me, too,” you know? And– and they were shocked that they could communicate without Facebook– or without Twitter or without any other kind of thing. So it– it’s a whole new world. And as a writer, I feel responsible– I’m– I don’t write historical fiction. I’m writing what’s happening right now. And the only way to write about right now is to write about in the future.

JON MEACHAM: Have you always wanted to be a novelist?

GARY SHTEYNGART: Always wanted to be a novelist. I was– four or five years old, my– growing up in Leningrad. And my grandma had me– write a little novel about Lenin, who I adored. There was a big statue of Lenin. Lenin meets a magical goose and they invade Finland and try to create a Socialist revolution there. And then Lenin–

JON MEACHAM: That–

GARY SHTEYNGART: –eats the goose.

JON MEACHAM: –that actually happened, too.

GARY SHTEYNGART: That actually happened. It’s happening as we speak.

JON MEACHAM: There’s a pattern.

GARY SHTEYNGART: There’s a pattern there, yeah. So I’ve always wanted to be a writer.

JON MEACHAM: The– you told The New York Times in 2002, “Look, it’s a heroic act to leave your country. In a way, it’s even more brave when you do it not because you’re a refugee but because you simply demand a better life. But it’s a self-selecting impulse. People who dare to cross borders have a certain personality. And I don’t think I’m one of them.” Are you talking about the difference between your generation in that of your parents’ and grandparents’?

GARY SHTEYNGART: Yes, exactly. I mean, I– I think– I don’t think I would have the gumption to say, “I’m leaving the United–” I– I spend a lot of time in Italy and other countries. I don’t think I have the– the strength to say I’m gonna abandon my culture, abandon my language, abandon all the things that– that– that make my life what it is and just move somewhere just to make a better life for my kids. That requires a kind of selflessness that I wish I would have but I– I frankly don’t. I– I always write– I’ve written about immigrants for quite a while– in my first two books. In this last book, what’s interesting to me is– he’s– Lenny, the hero of the book, is– is native born American. He has Russian parents. But I see him as an immigrant from another– another planet almost, which is the pre-digital planet. He is 15 years older than– than his lover in the book who is completely digitized. And he is basically an immigrant from a whole different way of thinking, an introspective way of thinking that doesn’t exist anymore.

JON MEACHAM: So while we become more self-absorbed, we put all the information we possibly can about ourselves out there. Has that been at the price of introspection?

GARY SHTEYNGART: Absolutely. Each year I think I lose about six percent of my humanity. That’s what the scientists tell me. It’s– it’s a process I can’t reverse.

JON MEACHAM: You’re the polar ice cap.

GARY SHTEYNGART: I’m the polar ice cap. Thank you, exactly. I am the polar ice cap of the humanities. And I’m slowly, slowly shrinking. It– it is a very annoying situation. And I go to upstate New York because– American telegraph and telephone cannot deliver– a phone call up there. I use an iPhone. So that’s my respite from it. And I get so much done there not just in terms of writing but in terms of actually reading and– and– and having my mind enter the consciousness of another human being, which is what reading really is, which is why I’m so scared of it being under threat.

JON MEACHAM: But why, at a moment when we’re evermore connected, at least virtually, do you think that– is that– that is at a price of human connection? Why can’t we have both?

GARY SHTEYNGART: It would be nice to have both. And I– I love technology. I mean– this thing which– tells me where to go, you know, I tell my computer iPhone, I say, you know, I– I want a taco right now. And it says, “Oh, you’re going completely the wrong way.” That’s nice. It’s nice to be led around like that by a small– plastic device. But what I miss is actual connection with human beings. You know, the– the people on Facebook, they’re connected to their friends, but are they really connected? There’s nothing like sitting, you know, having a beer with someone, having a coffee with some– even tactile connection, even, you know, somebody petting me is– is an amazing thing.

JON MEACHAM: But why is it that the more time we spend creating a virtual world do we draw back? Is it– is it a function of time, lower-case “t”?

GARY SHTEYNGART: I think humanity– I think these leaps in technology– as happens in the book, they happen so quickly. And I think it’s– it takes time for us as human beings to process everything that’s happening around us. For now we are so distracted by these very bright lights and these flashing things. You know, I– I spend– a lot of my time in upstate New York. And there’s some towns where they’re second homeowners. And a lot of them are retired and they’re in their 50s and 60s. They’ve already had a career. You would think they would be talking about grandchildren and introspective things, figuring out where they– what their life has been. No, all around me they’re sitting at dining tables talking about the latest app as if it’s the most important thing that’s ever happened to them. “Oh, my god, I just downloaded this new Android. It’s amazing.” You know? It– it– it shocks me how easy we fall for the seduction of this siren song and how easy it is for us to say, you know, these people, this world that we’ve had around us, it’s just not important enough. Let’s leave it behind and move to the digital realm.

JON MEACHAM: What is the, to your mind, next step? Does it continually get worse? Is there a backlash?

GARY SHTEYNGART: You know, there’s a great slow food movement in Italy and other countries. I love it. I love it. You know, we– we’re so busy. We’re running around. We’re eating this garbage, you know?

JON MEACHAM: Yeah.

GARY SHTEYNGART: And finally somebody said enough is enough. We’re– we’re gonna slow it down. The same thing with– with– with literature and– and other things. We have to go back to– we have to spend some time digitally and then move away from it and spend time looking at long-form text like novels. You know, in my book “Super Sad True Love Story,” there’s– it barely exists. There– there’s barely any reading. At one point, Lenny, the protagonist, tries to read—“The Unbearable Lightness of Being” to Eunice, his much younger lover. And she can’t understand what’s coming out of his mouth because she’s never heard it. And she becomes very frightened by it because books are actually– people say, “Oh, this is cutting-edge technology. It’s so avant-garde.” It’s actually quite boring. I find the stuff in books, the raw material, the blood and guts of humanity, I find that to be a lot more avant-garde, a lot more– chilling, thrilling, and also cool.

JON MEACHAM: When you talk about a book, do you mean long-form narrative– in one sequential form? Or do you mean the physical item?

GARY SHTEYNGART: I mean both. I mean, it’s nice to have that four pounds in your hands, you know? I– I don’t have that much problem with the Kindle or the e-book or the iPad. You know, if people read, people read. But it’s very distracting to try to look at something on a screen as opposed to a book. A book also tells you who you are. You know, you’re on the subway. You’re a young man. You’re trying to flirt with a young woman, and you– you take out your James Joyce Ulysses and you say– book– I’m not saying that was my past.

JON MEACHAM: I– I hear the Shteyngart’s very effective on that.

GARY SHTEYNGART: Oh, the Shteyngart is a great accessory book.

JON MEACHAM: Is that right?…You read Mark Twain in Russian.

GARY SHTEYNGART: Yeah, yeah. I grew up– reading Mark Twain with an introduction I think by one of Stalin’s henchmen had– the intro to it: “This racist book betrays America’s racist society.” I love Mark Twain. I think– you know, for me, the books I write, if they don’t entertain a certain group of people then I failed already. If it’s just gonna be a novel of ideas, I don’t care. Shoot me. I– I’m not interested in that. It has to be– it has to have a lot of humor. It has to be, you know, picaresque. And– and it has to really draw you into the lives of these characters. Lenny and Eunice are the first– you know, the last book I had, 325 pound—“Absurdistan” was the novel. 325-pound guy, bad circumcision, not gonna draw in a huge amount of readers. But Lenny and Eunice, for the first time I feel a real closeness to these two characters. The way I read “1984,” I want Julian Winston to survive this horrible society. I want my Lenny and my Eunice to survive the horrible society I’m describing as well.

JON MEACHAM: Now, how many times are you gonna update your Facebook page from today till midnight?

GARY SHTEYNGART: Well, it depends. You know, I do readings. Today I’m doing a reading. And sometimes people bring these adorable wiener dogs. I love dachshunds. They’re my favorite animal. So I’m gonna have to take some pictures of those if they come and then post them immediately on Facebook. It’s very exciting stuff. I mean, these are small furry dogs.

JON MEACHAM: But you don’t– but you– you have no hypocritical twinges about– satirizing a world of which you’re very much a part?

GARY SHTEYNGART: I hate myself very much for doing this.

JON MEACHAM: Well, I think you– I think you’ve managed to– to survive and monetize that.

GARY SHTEYNGART: I– I’ve monetized it. I built a platform and I monetized it. I don’t even know what I’m saying, but it sounds great, right?

JON MEACHAM: Gary Shteyngart, thank you.

GARY SHTEYNGART: Thank you very much.

ALISON STEWART: Coming up on the next edition of Need to Know…

MALE VOICE: We all know what happened to New Orleans on August 29, 2005.

ALISON STEWART: On the 5 year anniversary of Hurricane Katrina, an unusual voice – actor, comedian and long time New Orleans resident Harry Shearer – previews his new documentary about the myths and realities of what caused the disaster.

HARRY SHEARER: This was caused by four decades plus of misfeasances and malfeasances on the part of the federal government.

ALISON STEWART: “The Big Uneasy,” on the next Need to Know.

ALISON STEWART: Before we leave you tonight, we’d be remiss if we didn’t share some wisdom from our prognosticator-in-residence, Andy Borowitz.

JON MEACHAM: This week, Andy joins us with some insight into the costs and benefits of a higher education. Andrew?

ANDY BOROWITZ: Thank you so much, Jon, Alison. Well, next week, I’m driving my daughter up to college. Now, a lot of people are asking, in this economy, is a college education really worth it? Well to answer that question, I’m launching a special Next Week’s News investigation: “In This Economy, Is a College Education Really Worth It?” Helping me out are my two educational pals from PBS, Elmo from Sesame Street and Ken Burns.

Ken Burns goes to college and studies “documentary filmmaking.” Elmo doesn’t go to college. Elmo lives with his parents and becomes a “barista.” After four years of college, Ken Burns discovers that documentary filmmaking is an “unmarketable skill.” After four years at Starbucks, Elmo becomes a “manager.” Ken Burns applies to Elmo for a job as a barista. “Sorry, Ken Burns,” says Elmo. “You’re ‘overqualified.’” Elmo doesn’t have to live with his parents anymore. He gets his own apartment and a “Nintendo Wii.” Ken Burns has to sleep on his parents’ couch. He owes thousands of dollars in college loans and drinks a lot of “malt liquor.” But it’s a happy ending for Elmo. He gets two weeks off for summer vacation on the “Jersey Shore.” So, when I drive my daughter to college next week, I clearly have a lot to think about. Like, how am I going to pay for it all? Well, don’t worry; I’ve already got a plan. Alison, Jon, may I take your order?

ALISON STEWART: Tall, non-fat mocha, extra hot.

ANDY BOROWITZ: How modern.

ALISON STEWART: Thanks Andy. That’s it for this edition of Need to Know on television, but as you know, we’re always posting new stories online.

JON MEACHAM: At the Need to Know website at pbs.org, you’ll find podcasts, blogs, and videos you won’t find anywhere else. Thanks for watching and we’ll see you next time.

 

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