Risky requests for unvaccinated blood on the rise

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Hello, welcome to Health Check from the BBC. I'm Claudia Hammond. Today from the US why a minority of patients needing blood transfusions are requesting blood from people who haven't been vaccinated. In a moment we'll hear why this could put them or their children at risk. And from Vietnam attempts to ban seven million motorbikes from the centre of Hanoi to protect people from the damaging health effects of air pollution.

To help me today, joining us from Ghana, I have genito urinary consultant and HIV expert Vanessa up here. How are you? I'm very well, thank you. How are you? Good thanks. Now what do you have for us today? A few things?

So yeah, so we're gonna be talking about a condition that's really quietly becoming one of the biggest liver disease stories, metabolic liver disease, and the numbers are quite staggering. And then we're also gonna be thinking about something that may surprise a lot of people, but the fact that simply living with someone might be reshaping the bacteria in your gut.

Really interesting. And we'll have a new review of tools to give up smoking that reveals that the best studies show that vaping is more effective than other methods. Now, if you're in hospital and you need a blood transfusion, then doctors will make sure that you get blood of the right type which has been tested for a range of diseases.

But a minority of patients in the US are requesting that they or their children are only given blood which has been donated by people who haven't been vaccinated. New research just published in the takes one hospital as a case study to explore the consequences and risks for those asking for unvaccinated blood. So, Vanessa, when did these requests begin coming into hospitals?

So these really emerged in the post COVID era. And for many of us, I have to say it felt familiar because we saw something quite similar in the early days of HIV when You know, you had frightened families that began making requests about where their blood came from. But what's particularly notable is that similarly to HIV, many of the requests are coming on behalf of children. And where was the hospital in this study and how how did this come about?

So it was conducted at Vanderbilt University Medical Center, which is in Nashville, Tennessee, and It really arose because lawmakers in five US states had attempted to pass legislation that was giving patients the right to request blood from unvaccinated donors. So they looked in this one hospital, and how common was it for people to ask for unvaccinated blood?

So firstly, they note that the numbers that they have are probably an underestimate. But what they saw, it was about 0.03%, so 48 episodes. But they do note that more people had raised the question initially. but then changed their minds before it was formally recorded. So the numbers are based on blood products actually delivered. And as I said, this is mostly to children.

So it's a small percentage of people, but did it have an impact on how quickly those patients could get the care that they need if they've asked for a particular sort of blood? Definitely. Um so when families refuse the kind of standard blood product that really created quite a logistical problem and the system wasn't set up to solve it quickly. So then that meant that there were delays for some people and direct consequences um for their care.

And also see in a couple of patients there are some clinical outcomes that were affected as well. And the key thing here is that, you know, blood transfusions are often time sensitive. So is there any evidence to say that unvaccinated blood is in some way safer than vaccinated blood? It's really important here to emphasise that no, there is no evidence whatsoever. There's vaccines that actually s are in circulation, they don't persist in donated blood in any clinically, you know, meaningful way.

And this isn't a matter of scientific debate. So the belief that vaccinated blood poses a risk isn't supported by any credible data, and we can say that clearly and without equivocation. So some patients have been asking for direct donations instead. What are these? Um so these are um because when patients can't get the assurance through standard supply.

that um someone has not been vaccinated. They've generally identified a specific unvaccinated individual, which typically tends to be a family member, and then requested blood from that person to be reserved for them. So you can see the appeal and it you know, it feels like you've got some element of control, but um the paper's really clear that this perception of safety is quite, you know, illusionary really.

Yeah, I thought that was really interesting. They were saying the direct donations could actually be riskier. Why would that be? Yes, because a number of reasons, but directed donations are actually more likely to contain potentially harmful pathogens because the general blood supply that goes through donations is screened. through a really rigorous population level system, it filters out many risks and so a directed donor, you know, bypasses um some of that and that underpins that system.

And what's really interesting is that they highlight, you know, a well documented phenomenon called pressure donation. So relatives and friends who are asked directly, they may not feel able to refuse. And so that may result in them not fully disclosing relevant medical or behavioural history that would otherwise disqualify them. And we know that honest disclosure is really key to blood safety.

So what can hospitals do to allay patients' concerns if they've got people coming and saying they're worried about this? So I think it's really about um emphasizing the data that's there. And the paper gives some really good examples. You know, some hospitals have had success with structured conversations at the point of request.

And really taking the concern seriously and not just dismissing it, which is so important, and emphasizing the science really clearly. Others have used patient liaison teams. And I think the key thing here is having proactive conversation and supporting people so that they've got their autonomy, but it's really exercised, you know, on that the basis of accurate information. What do you make of all this?

I think it's a really important paper because that's what good medicine should do, shouldn't it? It should notice something early and then interrogate it. And as I said, you know, having worked in HIV. It feels very reminiscent of the early days. And so it just highlights that it's important to recognize that these fears are there and then create a system that responds to those concerns.

Thanks so much for that, Vanessa, and do stay with us. Now anyone who's tried to give up smoking knows it's not easy. There are tools to help, such as vapes or e-cigarettes, and nicotine gum and patches, as well as counselling and supportive apps.

But which of these methods is the most effective? A new overview of the best evidence from around the world has come out, and the author is Dr Angela Wu from the Centre for Evidence Based Medicine and the Oxford Tobacco Addiction Group at the University of Oxford in the UK. She told me why they wanted to look at this.

Originally, the goal of our research was really to take a look and see why is it that still it is being said that the evidence is mixed when it comes to the effectiveness of nicotine e-cigarettes to help people quit smoking. And what we did was a systematic review and all that does is it tries using the strictest methods

to avoid cherry picking, to find research. And what we then did was an overview, this bird-eye view of these existing reviews of evidence and pulled that all together to see what we could find. And what we found actually is the evidence isn't all that mixed and it's actually quite clear that nicotine e-cigarettes are effective and helpful for helping people to stop smoking.

And are you able to quantify I don't know how much better e cigarettes are at helping people to stop smoking than some of the alternatives like patches or chewing gum or other things? So Within our overview of reviews, we are not exactly able to give quite a the precise number, but what we can say is about you're more likely by twenty to forty percent able to stop smoking if you use an e-cigarette versus your typical patch or gum.

So that is quite a difference, isn't it, if what people really want to do is to have the best chance of being able to give up cigarettes. Absolutely. And it's really another opportunity of when there are tools out there that sometimes one tool might not work so well for you that, you know, you're now able to try something that is perhaps more behaviourally, something more familiar.

So you're going through the routine of holding something within your hand and able to breathe into that, that is kind of more similar to what you're used to when you're smoking. When people talk about vaping, it's often discussed as something that's problematic and I mean Singapore, for example, has banned vaping altogether with with quite serious penalties if people are caught. How much do you find that attitudes towards e cigarettes vary around the world?

Yes, so policy decisions in different countries very much are differed by their values, cultural contexts, and public health priorities. So for example, if a country does not have a high smoking rate, it might not make sense. To be promoting um e-cigarettes, a nicotine substance, as a harm reduction tool if smoking isn't a key concern for them, versus for other countries like within the UK, where we have gone into quite a harm reduction strategy.

it makes a little bit more sense to be offering something that is significantly less harmful to help people stop smoking. So should we worry about people taking up vaping e cigarettes? I mean, uh especially people worry about younger people doing this.

I think that's a really good question and something that shouldn't be automatically dismissed. Although within the context of our research, what we're able to show is that e-cigarettes really help people stop smoking. And beyond this own research that we've done. We are seeing that there might be a link between vaping and leisure smoking, but it's actually not clear what that link is and whether it's the reason is because of the vaping.

And at the same time, we're also seeing that youth smoking rates have generally gone down as e-cigarettes have become more common. But I think it's really important for listeners to remember is that the harm within tobacco cigarettes is the burning of tobacco. And it is not nicotine itself. So nicotine is the addictive substance, but the substance that is causing you harm is the tobacco, which is only in that cigarette.

So my research is only looking at e-cigarettes use for people who are smoking and not necessarily e-cigarette use for people who aren't smoking. So something that might be beneficial for someone who is smoking doesn't mean it's necessarily beneficial for someone who isn't. Do we know enough yet about the long-term impact? E cigarette. Yeah.

Yeah, so that's a really good question. And I think it's something that we've noticed within our evidence and gap map, our research roadmap, is that we don't yet have enough information on the long-term serious risk. But the comparison that matches is really comparing versus smoking versus the comparing of with nothing. So we're not comparing against clean air, we're not comparing against no support, we're comparing against smoking, which is so uniquely dangerous.

that almost anything you do to stop smoking will be helpful. Now you're based in the UK, but is your data that you've been looking at from all around the world? Yes, so within this overview of reviews, we've included data that predominantly does come from the UK, US and Europe. And that is something that we are lacking, is getting more information from low and middle-income countries as well to see how these findings might translate globally.

How easy or difficult do you find it to get across the message that e cigarettes are an effective way of trying to give up smoking? I feel constantly, personally as a researcher, that we are fighting a losing battle. Right now within the UK, people of um living with more financial stress are actually more likely to believe that e-cigarettes are more dangerous than cigarettes. And that for me as a health researcher is my biggest concern. Doctor Angela Wu on her study in the journal Addiction.

Live BBC Radio is now available on BBC.com and the BBC app. Get global perspectives, rich conversation, and immediate reaction to breaking news stories wherever you are. Listen to the BBC World Service and BBC Radio Four Stations twenty four seven. Visit BBC dot com slash audio or download the BBC app to start listening.

You are listening to Health Check from the BBC. I'm Claudia Hammond and my guest, Dr. Vanessa Appier, is still with me on the line from Ghana. Now Vanessa, you have some new research for us on metabolic liver disease, predicting that by twenty fifty it could affect Nearly one point eight billion people in the world. Now that sounds like a staggering number, but what is metabolic liver disease? It used to be called non alcoholic fatty liver disease, didn't it?

It did, yes. So it's metabolic dysfunction associated stoatoic liver disease. So essentially as you say, it used to be called non alcoholic fatty liver disease. And it really changed a number of years ago to change the stigma. um from fatty and to really reflect what's driving it, which is metabolic dysfunction.

So it's when fat accumulates in the liver in people that have underlying metabolic risk factors like obesity, type two diabetes, high blood pressure or abnormal cholesterol. So nothing to do with alcohol. So have you encountered patients with it?

Absolutely. And I see it in my work in sexual health and HIV, where metabolic complications are common in patients that are on long-term treatment. But more broadly, it's something that cuts across almost every specialty because of the metabolic factors that are driving it. So one point eight billion people could be affected by it in twenty fifty, but how many people are affected by it right now?

So the study found that it's actually one point three billion people that were um living with the liver dysfunction in twenty twenty three. And this is a 143% increase since nineteen ninety. So this is quite a staggering figure. So why are the numbers rising so much? The drivers are really tied to the global rise in obesity and type two diabetes. And those themselves are linked to changes in how we eat, how sedentary our lifestyles have become.

And you know, the urbanisation as well. And so as populations grow, as these lifestyle related conditions become more common, liver dysfunction follows as well. Yeah, it's a spectrum across the disease. So it can run from really simple fat accumulation in the liver, which in itself um causes no harm. mewn gwirionedd yn ymwneudol ac ymwneudol ac ymwneudol ac ymwneudol.

And the concern is that from there it can progress to fibrosis, which is scarring and then cirrhosis um and in some cases liver cancer. So It's really important to know that it doesn't also just affect the liver. Patients with the liver dysfunction are increased risk of cardiovascular concerns as well. But it's interesting that this increase hasn't led to more people dying. Yes, indeed. And I I think that the data that we're seeing is somewhat reassuring on one level because

The number is rising sharply, but the overall health burden, so what we quote as, you know, the number of years of life lost to illness or death, has remained relatively stable. So I think that tells us that the improvements in treatment and earlier detection are helping people live longer with the condition without it progressing to end stage disease. But I have to say it doesn't mean that we should be complacent.

Thanks so much for that, Vanessa. Let me ask you something. Do you ever ride a motorbike or a moped? And well yeah, I I have in the past but I I I get a bit nervous. So do I. But Hanoi in Vietnam actually has seven million motorbikes and and mopeds, but it also has very high levels of air pollution and so Like many cities around the world, in order to protect people's health, Hanoi is about to introduce new rules on polluting vehicles.

Diesel and petrol motorbikes will be banned in the central areas, including the old quarter and the French quarter. It's all starting in July. It was supposed to be a total ban, but just last week the government decided on a pilot instead. to test out the plan. Well someone who'll be able to see for herself how well it works is BBC World Service reporter Sen Ungwian. When I spoke to her, she told me how serious the air pollution is in Hanoi.

It's quite visible. Whenever I visit home it's quite smoky. And I can feel it and see it around me. I when I hear a lot of coughing, especially my nieces and my nephew, which bother me is quite a bit. But when it comes to scientific evidence that we've got Steve Ying, who is a professor from Nanyang Technological University, have made a very clear association between PM two point five, which is a particular matter with a particular type of lung cancer.

So one of the key findings from our research is the very strong association between black carbon exposure and one type of lung cancer, which we call it as a lung adinocarcinoma. Black carbon PM two point five, which is particle with the diameter with two point five or smaller micrometer. So this kind of particles is small but very harmful to our respiratory system.

But then when it comes to addressing this issue, Steve also mentioned that one of the biggest challenges is that they are doing this w without enough data. We do not have the very good long term and uh high quality health data. So that's why our research now every day is fighting very hard that we try to understand this kind of knowledge gap in our region such that

governments would have uh references or scientific based evidence to support their policy making. Air pollution is definitely one of the very key problems in our region. So you said that you can see the air pollution, that it's visible, but is it something that residents worry about? There used to be a time where looking up air quality monitor, the website that we usually use, IQ Air, wasn't even a practice.

But now is it's quite common and people can feel it, right? And especially for women who do a lot of skincare, you see a lot of dust on your cotton pad. So it's definitely a concern. Wearing a mask has been such a big part of Vietnam anyway, so it's never a a question of debate and it's mostly the children that make adults quite worried.

Because Hanoi or just Vietnamese street life in general is bikes. Like we go on out on bikes and when you go on bikes you are exposed to air pollution a lot more than people who ride in cars. And of course air pollution can come from lots of different sources. Do we know that this pollution is created by the motorbikes? Hanoi government saying well traffic causes more than sixty percent of air pollution and that is

motorbikes and and cars. But then the environment ministry kinda disagree. They're saying, well, it's actually the exhorts that coming from the bikes and the vehicles is only at twelve percent. with much of the rest coming from dust, a construction, farming practices like burning rice straw, even the wear and tear of the tires on your vehicles.

So officials say cutting pollution from transport, officially the millions of of motorbikes is still essential regardless because it is a big source of roadside pollution. But now I think what is also important here to to mention is that EVs are not necessarily clean. If your electricity is generated by renewable energy, that might be the case. But in the case of Vietnam, about half of electricity production comes from coal fired power plants.

In that context is EVs really the way to go? And something that Steve from Nanyang Technology University also mentioned, he said that when you look at EVs, you're not supposed to look at it as one piece. You have to look at it in different parts. One of the very major source of the particles from DV is from the tire and braid. One of the reasons is because EV can accelerate and decelerate very fast.

That is compared with transitional vehicles that are very different. That definitely would be a very major source of the particles or even microplastics from the tire endware. And motorbikes really are a big part of daily life, aren't they, in cities like Hanoi. I've not been to Hanoi, but I've been to Ho Chi Minh City and and I can remember millions it must have been thousands, but it felt like millions.

Yeah, I mean you you're not wrong there when you say there are millions. Um the data I've got, like by the end of June twenty twenty five, there were more than And nine point seven million vehicles on the road in Ho Chi Minh City alone and eight point six of that is bikes. The ability to ride a a motorbike

scooter usually but at least for me, that's your rite of passage as V least. Um and it's it's such a big thing. It's it's what you what you see the first thing when you go on the street is the honking. The honking is also terrible it but it's part of of our urban life. Um, and my dad was ahead of the curve. Two thousand seventeen ish. He bought a E V b before even consulting me when it was even a thing.

He's now at this very moment. He I just talked to him last week. He told me that he's giving people advice on which bike to to buy. And he said that he should be he should be getting commission for this but obviously nobody's gonna pay him. Um but yeah. Ha ha. Other than your dad, what do residents think in general about the change to e bikes and how easy is it for them to swap?

Yeah, switching millions of bikes running on fossil fuel isn't going to be simple, right? Um I mean it's going to affect people's livelihood, especially those who rely on bikes. In the long run, yes, there's a lot of statistics that show the electric bikes actually pays out because you don't have to pay for petrol, but the upfront investment that might not be possible for everyone.

I've talked to a few people and one Hanoi resident, his name is Kwang Gung, he actually listed some of the very practical reason why he's considering switching to EVs. Interestingly enough, we talked while the impact of the war in Iran is still very much here. I mean it's we're still feeling it now. As for me, I see the EVs have a lot of benefits, like the fashionable.

Secondly, they are also lighter than luxury cars and they are more environmentally friendly. Recently, gas prices increased and it had a big impact. That is also a factor but it wasn't the deciding factor for me to switch from gas vehicle to electric one. Are the increased fuel prices around the world having any impact on the transition to e bike? I think it's definitely on people's mind. Like like what Gullen just said, when fuel prices are increasing, of course we're going going to

steer to that. But then they also have been cutting down taxes on fuel. So hopefully a lot of people going to see fuel wise not going all over the roof in Vietnam, but anything can happen. So these changes in the bikes are due to come in in July. Are people gonna be ready by then? So Hanoi w was very confident that they going to have a total bend

But now actually on on April seventh they just said w hold on a minute. We're just going to do a pilot program to keep an eye on exhaust levels and see how it goes. So I think maybe they're listening to people, they can see that m not everyone is ready. I mean even authorities might not be ready to implement this policy. But eventually the key question is, will this reduce air pollution? We wait and see.

Sen Ungwian reporting and have a very happy birthday today, Sen. Now if you live with a group of friends, there's a lot you share the kitchen, the shower, your food perhaps. But how about your gut bacteria? Research from the University of East Anglia on a colony of tiny birds in the Seychelles has revealed that the birds share more of their gut bacteria with the other birds they spend the most time with.

And the team say that the same principle almost certainly applies to humans too. So I wonder, does this make sense to you, Vanessa? I mean why might living with friends alter your gut bacteria? It does make sense because the gut microbiome is really dynamic. So it's shaped by you know the environment that we're in, what we eat.

eat who we're in contact with and the microbes that we're exposed to daily. So it makes sense that when you live in close proximity to people that and when you share surfaces, air and food and even skin contact that the microbes can transfer across these routes. So it does make sense that, you know, sharing a living space would start to bring together our microbial profiles, et cetera.

And this study was done in Seychelles Warblers. But there have been studies, haven't they, looking at people, looking at newborn babies arriving in houses and and partners and looking at their microbiome? Yes, very much so. The birth study's lovely because it's uh you know colony but it's quite tightly controlled. But we have seen evidence in humans already in which

we've um seen this. And, you know, the example are cohabiting couples that share more gut bacteria than non cohabiting pairs. It seems that it's not just the shared diet, it's part of the story, but not the whole story. And the Closeness itself matters, but This is taking me back to my student days now and sharing a it was a house full of would be psychologists, actually, and it makes me wonder how much we were sharing. Does that ring bells for you?

Very much so. I lived in a house with uh five other girls. We shared a lot of things and a lot of our life became very much in sync. yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw, yw. Well, thank you so much, Vanessa Appear, for joining us for Health Chet today, and thanks to the producers Jonathan Blackwell and Hannah Robbins, and our studio engineers today, Searle Whitney and Never Mazerian.

Do contact us with your health questions at healthcheck at bbc.co.uk. I'm Claudia Hammond. Do join me at the same time next week. Bye for now. Live BBC Radio is now available on BBC.com and the BBC app. Get global perspectives, rich conversation, and immediate reaction to breaking news stories wherever you are. Listen to the BBC World Service and BBC Radio Four Stations twenty four seven. Visit BBC.com slash audio or download the BBC app to start listening.