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Other factors make bloodless surgery increasingly attractive. Transfusions can suppress the immune system, for example, leaving a patient open to infection, slower healing and a longer recovery time. "Also, banked blood, after it's cooled and stored, doesn't have the capability of fresh blood to transport oxygen," says Shander. "We're just beginning to understand what it is we do when we give a transfusion." Finally, there is the cost: at around $500 for each transfusion, plus administrative add-ons, the total bill comes to between $1 billion and $2 billion annually, more than enough incentive to consider alternatives...
...challenged, we extend ourselves," he says. "Some of my colleagues have adopted bloodless medicine purely as a technique. Others have learned that it also has an impact on ethical and humanistic values. I feel that once you become philosophically committed to practicing bloodless surgery, the benefits to patient and physician alike become more and more apparent. Those are my greatest rewards...
...doctors would even have tried to remove the malignant growth, located in her right frontal lobe, that had already taken over one-sixth of her cranium, pushing her brain down and to the left. Leave it alone, and the cancer would keep compressing useful tissue inexorably, robbing the patient of speech, movement, consciousness, life itself--all within months. Try to cut it out, and there would be the risk of taking too little, leaving cancerous tissue to grow again, or taking too much, causing profound and irreparable brain damage...
Schuler's death sentence has been postponed, perhaps for years. By the following day, she will be walking the halls. Not surprisingly, she will feel deep gratitude. This is not uncommon; most of Black's patients exhibit an awe for his skills that borders on worship. "You're God," exclaims another patient on being told his tumor has been removed. "No, I'm not," Black replies, quietly but firmly. He gets such comments frequently, and they make him very uncomfortable. No one is more acutely aware than Black of the perils of the physician-God complex...
Black is also working on an entirely different experiment for treating tumors. Cooperating with molecular biologist Habib Fakhrai, he is trying to enlist the patient's own immune system to attack brain cancers. Tumor cells produce a substance called TGF-beta (transforming growth factor-beta) that both fuels their own growth and tricks the immune system into ignoring their presence. Using genetic engineering, Fakhrai has come up with a genetic "switch," called TGF-beta antisense. When inserted into a tumor cell's genetic machinery, the antisense turns off the cell's ability to produce TGF-beta. Injected into patients, these...