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James Reynolds: The Film Maker Who Preferred the Less Traveled Way

ames Reynolds, All Lights Film magazine

 

First Do No Harm’ the documentary film directed by James Reynolds explores the story behind the controversial and paternalistic history of blood transfusions. The documentary has caught the attention of a large mass across the globe.

Here you can read a small interview with the film maker and we think that it will help you to get an insight to the documentary film and hence a more logical reading of the film could be possible.

1. ‘First do no Harm’ is a documentary on the controversial and paternalistic history of blood transfusions. The documentary portrays a different dimension of the topic. Why is it so?

Having a historical perspective provides understanding of the why's and how's of any given subject. Blood transfusion has never undergone randomized clinical trials to the level at which a new drug would have to go through the FDA. It’s never been done. Most blood transfusions are administered using stored blood. Blood stored for any length of time cannot deliver oxygen to the oxygen-deprived tissue. This makes giving a blood transfusion counterproductive when tissue oxygenation is required. A unit of stored red blood cells, causes tissue delivery of oxygen to critical organs to actually drop. It becomes worse rather than better. What is it about a packed red cell transfusion that saves peoples' lives? It's perhaps one of the best volume expanders available; however, there are many other things that also serve as volume expanders. For those who have cancer surgery, the recurrence rate is anywhere from two to three times more recurring cancer if one receives blood. That’s a very frightening situation! Scientists looked at patients that were transfused for orthopedic surgery, so they had no other core morbidities, and those transfused for these particular surgeries ten years later, had an increased incidence of lymphoprolific disease. People need to realize that there are side effects that may come along much later. The simplicity of taking liquid from one individual and entering it into another is clearly not that straightforward. The acceptance of radical new ideas is very slow and it’s clearly a radical new idea to say; let’s practice blood management instead of just reaching for a transfusion.

2. Blood transfusion is not just a matter of medical relevance or it is not just a medical process alone. It has got a humanitarian and ethical importance. Presenting a view which is anti conventional certainly needs a bold determination. What was the base for your determination?

Historically, we've been taught that blood transfusion is benenficial.
Many clinicians think of blood and blood components as a drug to treat specific conditions that patients have. Blood is a very complex organ and is transfused, as a means of transplantation.

Tradition and empiricism; we just started trying it out to see where we could use it and what were the consequences. In obvious areas such as traumatic injuries, where it’s obvious that blood is coming out, then practitioners began to put blood back in, thinking, if that’s what’s coming out, that’s what we need to put back in again. And all of this was done without anybody really saying, shouldn’t we study this to see what are the right circumstances for this to be used? How much do you need to give? When should it be given? This mindset has persisted till today.

Max Perutz, discovered the structure of hemoglobin and he said "science is truth". There is a lot of evidence in medical literature to suggest that physicians should be very cautious about transfusing patients and only use it -- if it's really lifesaving. Evidence based medicine fueled our determination to see this project through and the maxim: Doctors advise -- patients decide.

3. How is the response from the spectators?

The Society for the Advancement of Blood Management just completed a scientific review of the documentary interviewee transcript. Rounding-off the film are the high production values, and a gripping storyline. These too, have drawn corresponding commendation.

At the Cannes Film Festival the documentary created a groundswell of interest. I was interviewed by several media organizations from around the globe.

4. What inspired you to take a documentary on this particular subject?

It's only human nature to feel like you understand something and then dogmatically believe in it, this happens all the time. The Semmelweis principle is the knee-jerk rejection of anything new because it challenges the norms. Credible experts are challenging transfusion norms and we seized the opportunity to produce: Primum Non Nocere - First Do No Harm.

5. Next projects???

We're keeping tight lipped, about our next project.