We’re Not the Same Under the Skin

Blood can be racially or ethnically specific, and it makes a difference

“We need black blood.” I didn’t know what to say to this, not least because it had been said by the head of donor services at England’s National Health Service Blood and Transplant. The interview was for a book I was writing on blood, and his statement shocked me. Surely we’re all the same under the skin?

I knew the history of race and blood was an ugly one. America’s earliest blood bank, founded in 1937 at Cook County Hospital in Chicago, noted race on donor forms and other blood banks followed suit. During World War II, African-American blood was labeled N for Negro (and some centers refused African-American donors outright) and given only to African-American soldiers. Writing to Eleanor Roosevelt, the chairman of the American Red Cross, Norman H. Davis, admitted that segregating blood was “a matter of tradition and sentiment rather than of science,” but didn’t stop doing it until 1950. Louisiana banned the segregation of blood only in 1972.

But the Red Cross was wrong: While no one is suggesting forced segregation of blood bags, it’s now scientifically established that blood can be racially or ethnically specific.

Most people know about the eight major blood groups: A, B, AB and O, each of which can be positive or negative (the Rh factor). These are determined by genes, and what group you are depends on what combination of proteins and sugars — antigens — are on the outside of your red blood cells. The International Society of Blood Transfusion lists 360 known antigens, but the combinations are infinitely more. Many have no bearing on routine blood transfusion, though all were discovered because they caused a problem with compatibility.

A successful blood transfusion relies on sameness. If incoming blood has an antigen that you lack, your body can react badly to it. In extremely rare cases, the reaction can be fatal; and even if not, it can tax the immune system in people who are already weakened by their condition. Also, you will make an antibody, a sort of immune storm trooper, to better recognize the same antigen next time. Patients who need regular blood transfusions — those who have sickle cell disease, thalassemia or leukemia, for example — may face an ever decreasing pool of suitable blood because they keep creating antibodies.

Wouldn’t it be easier if all our blood was the same? Blame bugs. Much of the variance “has been driven by evolutionary selection by bacteria, malaria and parasites,” says Connie Westhoff, executive scientific director at the National Center for Blood Group Genomics at the New York Blood Center. If malaria finds its way into the bloodstream via a particular antigen, that antigen may change to defend itself, leading to different blood types. Cholera thrives better on intestinal cells derived from O-type stem cells, but O is also more protective against malaria. For many complicated reasons, only 27 percent of Asians have type A, but 40 percent of Caucasians do. Type B is found more commonly in Asia than Europe.

This works not just with blood types. Sickle cell trait is now known to protect against malaria, which is why sickle cell, a painful and debilitating disease caused by malformed blood cells, is found frequently — but not only — in people with African heritage, because malaria thrives in Africa.

This past winter, the case of a little girl named Zainab Mughal in South Florida illustrated all this complexity perfectly. Zainab, who is now 3, has neuroblastoma, an aggressive cancer, and her treatment — chemotherapy and stem cell transplants — means she will need blood.

But she also has rare blood. She belongs to the fewer than 1 percent of the population missing an antigen that makes her blood some of the rarest in the world. She lacks both the antigens Indian B and Big E. Via appeals to the American Rare Donor Program, and then the International Rare Donor Panel in England, Zainab’s local blood banker, One Blood, found five donors with the same extremely rare type.

It was a tall order: The Indian B antigen is lacking in the blood of Iranians, Pakistanis and Indians, so donors had to have both parents from these populations. Two donors live in the United States, two in Britain and one in Australia.

Publicity about Zainab’s case, though it was extreme in its rarity, helped raise awareness.

Yet it is a difficult message: that our blood is different. When it comes to finding stem cells for bone marrow transplants, the search also has to be discriminatory. This time the issue is HLA, the human leukocyte antigens present in white blood cells.

“The reason why ethnicity comes into the picture,” says Dr. Abeer Madbouly, a senior scientist at Be the Match, a program run by the National Marrow Donor Program, the largest stem cell donor registry in the world, “is that HLA encodes the immune system, and the immune system goes through particular conditions based on where you are.” Depending on the threat, each population will develop particular sets of HLA types. In a diverse population like that of the United States, finding a matched donor becomes more challenging.

“Let’s say you have someone with African roots and someone from Asian descent coming together, and then they have an offspring of mixed ethnicities,” Dr. Madbouly says. “You have an African HLA and an HLA type common in Asian areas coming together to form a new type of HLA that is not common in either.” Though Be the Match added nearly two million donors to its registry last year, only 30 percent were what Dr. Madbouly calls “diverse.” That’s not enough.

Zainab’s situation is rare. What concerns blood bankers is a more common condition caused by uncommon blood. Sickle cell disease is predominantly found in African- Americans, and thalassemia among South Asians, and both conditions require precisely matched blood. But there is a shortfall between ethnic minority patients who need blood, and ethnic minority donors. In New York, Caucasians are 35 percent of the population but 58 percent of donors. Twenty-eight percent of New Yorkers are African-American but only 8 percent of donors, and that’s after five years of outreach by the New York Blood Center with its PreciseMatch campaign.

Even so, there was trouble when the Blood Center began in 2009 to offer the option to “self-declare” ethnicity on its donor forms. This was efficient: Without a budget to precisely screen every donation, they could home in on antigens known to be specific to certain populations. At first staff members were upset. “We didn’t educate the staff,” Dr. Westhoff says, “to know that we weren’t segregating the blood just to be segregating. We were doing it to send all the African-American units to the sickle program children because they were doing much better with blood that came from this same ethnic group.”

Disquiet was inevitable given sensitivity about whether race is skin-deep and whether differences should be highlighted. But the startling truth about blood is that acknowledging its differences can tip the balance between life and death for people who need it.

Blood bankers are reluctant to talk about why some communities are keener to donate than others, but read some of the “myths about blood donation” that they regularly publish and a picture emerges: Blood donation doesn’t make you put on weight. Nor does it affect your sex drive (though you shouldn’t do vigorous exercise within 24 hours). It is not against Islamic law or tradition. One of the most common reasons people who don’t donate give is that no one has asked them.

Cases like Zainab’s help reach these populations: Many of the 25,000 people who emailed in wanting to help were first-time donors. But as Susan Forbes of One Blood says, “The goal is for them to make it a habit and come back, and help boost the blood supply wherever they live.”

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Don't knock NATO

Jeff Jacoby

THIS SEASON marks the 20th anniversary of one of the greatest feats of statesmanship since the end of the Cold War: the opening of the North Atlantic Treaty Organization to Eastern Europe and the former Soviet Union. It was in the spring of 1999 that Poland, Hungary, and the Czech Republic became the first of the nations from behind the Iron Curtain to join the Atlantic alliance. Seven more nations joined in 2004, and another three since then.

NATO today comprises 29 countries in Europe and North America. Much has gone wrong in the world over the past two decades. The enlargement of NATO is one hugely important thing that went right.

That is not the received wisdom, however. Elite academics and pundits have been denouncing the expansion of NATO ever since the idea was first broached.

Enlarging the alliance would be "a dreadful, potentially catastrophic idea," the Cato Institute's Ted Galen Carpenter warned at the time, calling it a 1990s "equivalent of the Treaty of Versailles, which sowed the seeds of revenge and an enormously destructive war." The Federation of American Scientists decried NATO expansion as "a Pandora's box" that would needlessly provoke Russia. Foreign-affairs sage George Kennan condemned it as "a fateful error." Opposition to NATO's eastward growth has flourished on the isolationist right and the pro-Russia left. So-called "realist" scholars blame it for Vladimir Putin's aggression against Ukraine. New York Times columnist Thomas Friedman derides the expansion of NATO as "one of the dumbest things we've ever done."

But the naysayers are wrong.

NATO was founded 70 years ago in the turbulent aftermath of World War II. With the Soviet Union ruthlessly imposing totalitarian police states on half the European continent, the new allies were intent on keeping Europe's other half free and at peace. In the famous formulation of its first secretary general, NATO was created to "keep the Russians out, the Americans in, and the Germans down" — and it did. Under America's nuclear umbrella, Western Europe remained safe from Soviet violence throughout the Cold War. Just three years after its birth, NATO began to expand, admitting Greece and Turkey in 1952, West Germany in 1955, and Spain in 1982. With each new accession, the zone of European stability and democratic freedom widened, and Moscow's scope for aggressiveness was reduced.

The end of the Cold War consigned Soviet communism to the ash-heap of history, but it didn't render NATO obsolete — far from it. It was as necessary as ever to "keep the Russians out," and newly liberated Eastern European nations lobbied to join the alliance. Writing in the March issue of Foreign Affairs, historian M. E. Sarotte described how leaders of the fledgling democratic governments in Budapest, Warsaw, and Prague first began talking about NATO membership within months of the end of communist rule in 1989, and how they earnestly pressed the matter with Bill Clinton after he became president in 1993.

"In our values and spirit, we are part of Western Europe," the Czech president (and former political prisoner) Vaclav Havel told Clinton. Lech Walesa, Poland's democratic hero, put the stakes bluntly: "We are all afraid of Russia," he said. "If Russia again adopts an aggressive foreign policy, that aggression will be directed to Ukraine and Poland."

If that was true for former members of the Warsaw Pact, it was even truer for the Baltic countries. Lithuania, Latvia, and Estonia had been forcibly annexed by the Soviet Union in 1940, and desperately feared what Russia might do in the future to reassert its hegemony. When they broke free at last from the Kremlin and knocked on NATO's door, should the allies have turned them away?

Critics routinely claim that Russia was bound to feel endangered by NATO's expansion, but that turns reality on its head. NATO never threatened Russia. It was the threat of Russia's aggression that led most of its former satrapies into the arms of the alliance. Moscow may bristle, but a bigger NATO has kept it at bay. Russia has not dared to attack or invade any NATO member. Contrast that with its violent assaults on Ukraine and Georgia, which are not NATO allies.

After winning the Cold War, America might have pulled out and gone home. But just as NATO expansion continued to "keep the Russians out," it continued to "keep the Americans in," deeply invested in maintaining European peace and stability. Under US leadership, NATO provided the space for a new, post-Soviet normalcy to take hold. Within NATO's borders, peace has reigned for 70 years. Germany, once such a hateful menace, abandoned its murderous, militaristic ways. Liberal democracy has not triumphed everywhere in Europe — Hungary under Viktor Orban and, especially, Turkey under Recep Tayyip Erdogan have grown alarmingly authoritarian. But the day is long past when half the continent could be terrorized, or plunged into war, by totalitarian superpowers.

That would never have happened had it not been for NATO. Seventy years after its creation, the Atlantic alliance remains one of the towering achievements of modern statecraft, with a membership that is bigger, and therefore better, than ever.

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Pence Tells West Point Grads To Expect To See Combat

Vice President Mike Pence told the most diverse graduating class in the history of the U.S. Military Academy on Saturday that the world is “a dangerous place” and they should expect to see combat. “Some of you will join the fight against radical Islamic terrorists in Afghanistan and Iraq,” he said.

Pence congratulated the West Point graduates on behalf of President Donald Trump, and told them, “As you accept the mantle of leadership I promise you, your commander in chief will always have your back. President Donald Trump is the best friend the men and women of our armed forces will ever have.”

More than 980 cadets became US. Army second lieutenants in the ceremony at West Point’s football stadium.

Pence noted that Trump has proposed a $750 billion defense budget for 2020 and said the United States “is once again embracing our role as the leader of the free world.”

“It is a virtual certainty that you will fight on a battlefield for America at some point in your life,” Pence said. “You will lead soldiers in combat. It will happen. Some of you may even be called upon to serve in this hemisphere.”

Pence spoke as the U.S. plans to send another 1,500 troops to the Middle East to counter what the Trump administration describes as threats from Iran; as the longest war in U.S. history churns on in Afghanistan; and as Washington considers its options amid political upheaval in Venezuela. The administration is also depending more heavily on the military to deter migrants from crossing the U.S.-Mexico border.

The class was the most diverse in West Point’s history, and Pence said he wanted to acknowledge “the historic milestones that we’re marking today.”

The 2019 cadets included 34 black women and 223 women, both all-time highs since the first female cadets graduated in 1980. The academy graduated its 5,000th woman Saturday.

The 110 African Americans who graduated were double the number from 2013.

Pence said the graduates also included the academy’s 1,000th Jewish cadet.

Pence did not serve in the military but noted that his late father served with the Army in the Korean War.

“And as I stand before you today here at West Point I can’t help but think that First Lt. Edward J. Pence, looking down from glory, is finally impressed with his third son,” Pence said. “So thank you for the honor.”

The ceremony was Pence’s second visit to West Point and his first as commencement speaker.

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Trump sees 'great progress' in trade negotiations with Japan

President Trump said on Sunday that "great progress" is being made in trade negotiations with Japan.

The president focused on agriculture and beef in a tweet sent during his trip to Japan, adding, however, that "much will wait until after" the nation’s elections in July.

"Numerous Japanese officials told me that the Democrats would rather see the United States fail than see me or the Republican Party succeed - Death Wish!" he added in another post.

Speaking to a reception of Japanese business leaders Saturday evening, Trump said the relationship between the U.S. and Japan "has never been stronger" and called it an "exciting time" for commerce between the two countries.

“You're doing fantastically well. I was looking very closely on the ride over at some of the numbers being produced in Japan, and you're doing great,” he said, according to a White House transcript of the president's remarks.

“I would say that Japan has had a substantial edge for many, many years, but that's OK. Maybe that's why you like us so much. But we'll get it a little bit more fair, I think. I think we'll do that,” he added, noting that Japan is ordering a “great deal” of U.S. military equipment. Trump also mentioned last week’s reopening of Japanese markets to U.S. beef exports.

“We welcome your support in these efforts, and we hope to have several further announcements soon and some very big ones over the next few months,” he said.

Trump's visit to Japan also included a number of ceremonial events, including a round of golf Sunday morning with Japanese Prime Minister Shinzo Abe.

Trump on Sunday also attended a sumo tournament, where he awarded a "United States President’s Cup" trophy to the champion.

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