In Defence Of Bloodletting

December 6, 2009 at 9:37 pm (Alternative Medicine, Chiropractic, Good Science, Homeopathy) (, , , , , , )

Bloodletting is sometimes used as an example of a medical treatment that we once thought plausible, but now view as ridiculous. It is compared with chiropractic, homeopathy, and other “Alternative Medicine” disciplines in order to ridicule them. However, we might have been unfair. It appears that bloodletting may actually be more valuable than the Alt Med treatments it is compared to.

Bloodletting is actually still used now. And for good reason. It is used as a regular treatment for the iron storage disorder ‘haemochromatosis’.

The Haemochromatosis Society has pages describing the disorder, the symptoms, how it is inherited, the tests for haemochromatosis, and recommendations regarding diet. I will quote from some of their pages here, but please note that for more information you should visit their site.

Diet

It is not possible to treat GH with a low iron diet. A nutritional natural diet is recommended […] We make the following recommendations:

Avoid vitamin supplements or tonics containing iron, and breakfast cereals heavily fortified with iron. Large doses of vitamin C should also be avoided, as it makes the process of depositing iron in some organs easier and enhances the absorption of iron from the diet. [Note: I wonder if food supplement companies and nutritionists ask their customers about haemochromatosis prior to making recommendations about supplementation.]

Reduce intake of offal (liver, kidney etc.) and red meat. The rate of iron absorption from red meat is 20 to 30% whereas vegetables and grains have less iron and a 1 to 20% rate of absorption.

Minimise alcohol intake, particularly with meals, as it may increase iron absorption and it can also cause liver disease. Tea and all milk products taken with a meal reduce the amount of iron absorbed.

Treatment

The simple and effective treatment consists of regular removal of blood. Known as venesection therapy or phlebotomy, the procedure is the same as for blood donors. Every pint of blood removed contains a quarter of a gram of iron. […] Venesection will usually be performed once a week, depending on the degree of iron overload. Treatment may need to be continued at this frequency for up to 2 years, occasionally longer.

This is not the end of the story. Excess iron will continue to be absorbed so the individual will need occasional venesections (maintenance therapy), on average every 3 to 4 months, for the rest of his or her life. Monitoring of transferrin saturation and serum ferritin is used to assess whether venesection is required more or less often. The transferrin saturation should be maintained below 50% and the serum ferritin below 50µg/l.

Venesection treatment will cause tissue iron to be mobilised and iron stores will return to normal. However, it will not cure some serious clinical conditions such as diabetes or cirrhosis if they are already present at the time treatment is started. This emphasises the need for early diagnosis.

With regard to the mention of diabetes, there is a page here on the American Diabetes Association website that provides information on haemochromatosis:

  • Hemochromatosis is a single-gene disease that causes iron accumulation in the tissues of the body.
  • Diabetes is a primary complication if hemochromatosis, sometimes referred to as “bronze diabetes,” goes untreated.
  • It’s fairly common, but often goes undiagnosed and untreated.
  • It’s treated effectively with frequent phlebotomy (blood letting).

Hereditary hemochromatosis is the most common single-gene disease in Western populations, affecting 1 out of every 200-300 people. Yet it is almost unheard of by the general public, and many health professionals are insufficiently aware of it. Because the disorder can cause diabetes via damage to the pancreas, it is something that deserves greater recognition in the American Diabetes Association community.

It appears that bloodletting has been unfairly maligned as a treatment where it has been compared with, for example, homeopathy.

Bloodletting is an effective treatment for haemochromatosis, the effects can be monitored by testing transferrin saturation and serum ferritin, and the treatment can help to prevent serious complications of the disorder if diagnosed in a timely fashion.

Homeopathy (particularly as advocated by those in favour of high dilutions), on the other hand, is utterly implausible, cannot be justified on the basis of the available evidence, and would seem to be unjustifiably promoted by some homeopaths.

[There is also concern regarding the possibility that reckless promotion of homeopathic remedies could potentially endanger patients who fail to seek proper medical attention. I should stress that I am not sure that such reckless promotion of homeopathy is widespread, but it is something that I feel homeopaths should guard against.]

Disclaimer

This blog post should not be construed as providing medical advice. The appropriate person to ask about diabetes or haemochromatosis would probably be your doctor, rather than some random bloke from the internet.

Hat-tip

Credit is due to Jo Brodie for reminding me that bloodletting has its uses. I thank you.

10 Comments

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  2. Jo Brodie said,

    I hadn’t heard of this condition until just a few years ago when someone rang me at work saying they’d been diagnosed with it and needed to find out more. Probably I’ve spoken to or heard of fewer than five people with haem. and diabetes although I believe it is commoner than that. Of course not everyone will ring my office for scientific info!

    When I realised that it involved bloodletting I was quite surprised as that’s always been used as an example, by both ‘sides’, of things that aren’t done anymore in medicine. So thanks for this post – I hope it gets widely read as it’s both interesting and sets the record straight :D

  3. Chris said,

    I first heard of it when I went to donate blood. One gentleman who was hooked up was explaining to the lady in the next donation chair that the reason the staff at the blood center knew him so well was that he came in on a regular basis not out of the goodness of his heart, but because he had this condition.

    It has always made me wonder if the the blood they collected from him would be worthy of donation (providing he did not have the various conditions that prohibit donating blood).

    The author of the book Survival of the Sickest, Dr. Sharon Moalem, explained it in the first chapter. One of his uncles had it, and apparently he does also.

  4. David Colquhoun said,

    And don’t forget Polycythaemia vera.

    Not that they are any excuse for the centuries for which physicians killed their patients by bloodletting.

  5. draust said,

    Yes, HH (hereditary haemochromatosis) is an interesting genetic disease. Partly because, although the main mutation (HFE C282Y, for techies) is quite common in Caucasians, not all homozygotes (people with two copies of the disease mutation) seem to get the disease – it has “incomplete penetrance”, as the jargon is (see Wiki page here which also talk a bit about HH). Contrast, e.g. sickle cell where if you have two copies of the sickle haemoglobin (HbS) gene then you always have the disease. There is a big argument still raging about precisely what % of people homozygous for HFE C282Y get clinically dangerous iron overload.

    As I remember my medical friends telling it, the blood collected from the HH patients was not “banked” but was just thrown away. There is certainly no obvious reason it couldn’t be used (the mutation, obviously, is not transmissible), though the collection procedure is probably different.

    I often use HH as an example in the way you have here, as “they still use blood-letting for this”.

    Re the old term “bronze diabetes” that you mentioned above. Some of the HH patients have skin colouration (presumably due to iron deposition in the skin) that makes them look perma-tanned – hence “bronze”. The reason for the diabetes is probably that the pancreatic Beta-cell which produce insulin are quite susceptible to damage by iron deposition and consequent oxidant attack. Other “targets” of iron overload are the liver (which is the a major controller of body iron levels) and the heart.

  6. uberVU - social comments said,

    Social comments and analytics for this post…

    This post was mentioned on Twitter by jdc325: In Defence Of Bloodletting: Bloodletting is sometimes used as an example of a medical treatment that we once though… http://bit.ly/6X2GCM

  7. _Arthur said,

    Both bloodletting and leeches, and, yes, purges too, have a medical effect that can be useful in specific cases. For 1700-1800 practitioners, these were the ONLY tools of the trade, and they were used at large, and badly.

  8. Chris said,

    Thank you, Dr. Aust. The gentleman with HH who was getting his blood taken was at a blood donation site, and it looked like the same procedure as the rest of us. This is a permanent facility that does is run the local blood bank, not the blood donor vans they use around town (where I go to now because I can walk there, and not drive… which is better for my blood pressure).

  9. The Treatment of Alternatives at the Science Museum « captain [...] elaboration said,

    […] than good for the patient. [Interestingly, it seems that bloodletting has gone the other way, see this site for […]

  10. Homeopathy: there’s nothing in it. Part 2 said,

    […] for nearly 2000 years right up to the late 19th century — it is now used only for a couple of specific conditions.  People used bloodletting for the same reason as people use homeopathy — because they genuinely […]

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