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Partha Kar: Applying aviation safety to healthcare—are we missing the fundamental?

BMJ 2019; 364 doi: (Published 18 February 2019) Cite this as: BMJ 2019;364:l735

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The term “patient safety” occurs twice in the first two sentences of Partha Kar’s excellent article [1]. Aviation Safety was used to highlight a “missing fundamental” in health care systems so may I be excused, particularly this week, in using Aviation Safety to highlight an equally fundamental fact that is often missing in health education and practice? Which is this: Media Patient-Safety Propaganda based on Biased Scientific Information in reputable Journals. If biased scientific publication is misinformation, what is sometimes presented in the Media, Facebook especially, becomes disinformation (deliberate misinformation).


Burial of Dr Lt-Col Frank Djabanor (July 1938-January 2019] in Ghana reminds Ghanaians of the remarkable work that he (who trained at Guy’s) and his brother-in-law Dr Lt-Col Reggie Addae (who trained at The London) did some 47 years ago when they unmasked a false publication in the world’s leading medical journal and went on to prove through Aviation Chamber procedures in Italy that the Sickle Cell Trait [AS] performed as perfectly well at much reduced cabin pressures as those with 2 Normal beta-globin genes [AA].


Drs Reggie Addae and Frank Djabanor discovered that a publication in the world’s leading medical journal describing a Ghanaian nurse flying the 45 minutes from Kumasi to Accra and developing acute abdominal pain requiring surgery to remove infarcted section of her intestines included the false statement “Haemoglobin studies later showed she was a sickle cell trait carrier”. Confronted, the authors were forced to retract the Case Report which had included this statement “If on certain African routes, a Negro traveller must take an unpressurised aircraft it would be wise to ascertain the sickling status before departure”. Meanwhile, London Times Science Report “Sickle Cell Disease and flying” December 9 1971 said (wrongly) that “sickle cell disease is now found in a fifth of West Africans and a tenth of West Indians and American Negroes”. The Science Report continued: “Clearly all flight crew with the sickle cell trait should be removed from flying duties” [2]. Some pilots and air crew were promptly grounded in the USA. The Ghanaian medical establishment exploded. We sent informed comments to the Journal in which the false scientific assertion appeared. The comments of Dr Djabanor [3] deserved framing:

“What the authors do not seem to know is that not only Negroes have the sickle cell gene. In some parts of Greece, the prevalence of the sickle cell trait is 30% (Delayinnis and Tavrayakis, 1955) [4]; more than twice the prevalence in Northern Ghana. The forebears and descendants of these non-Negro possessors of the sickle cell gene are doubtlessly scattered over America and Europe today. How can we identify them from their external features, to thrust upon them the ‘benefits’ of this advice? Surely the authors would not advocate that we deny some section of the world community the benefits of their suggestion” [3].


Doctors in Ghana where 1 in 5 of us possess the Sickle gene knew that our Sickle Cell Trait [AS] siblings could never be told apart health-wise and performance-wise from those without Sickle Trait [AA], so to prove whether intra-flight cabin pressure would affect the phenotypes differently Drs Reggie Addae and Frank Djabanor took two Ghanaian Air Force pilots – one with Sickle Cell Trait [AS] and the other without [AA] into an AVIATION Chamber in Italy for observation under sudden cabin pressure variations while physiological parameters were observed and blood films examined for intravascular sickling of erythrocytes. The Sickle Cell Trait military pilot was as robust as the non-sickle cell trait. Not one sickled cell seen! The results were exhibited at the ICAO [International Civil Aviation Organisation] which promptly reinstated the African-American air crew including pilots.


When I was invited by The Martin Luther King Jr Foundation to give their First Award Dinner Lecture on May 31st 1972 in the presence of Professor Linus Pauling discoverer of the molecular pathology of the sickle cell gene and other Award winners on the topic “The Vital Difference Between Sickle Cell Trait and Sickle Cell Disease”, and because the Organisers knew I was going to reveal that the confusion between the terms “sickle cell trait” and “sickle cell disease” was deliberate for financial gain, I was given 4 body-guards in Philadelphia. Read the account in the British Medical Journal [5].


Right now, Facebook is full of articles describing Sickle Cell Trait without laboratory evidence. A pilot was said to have developed Rhabdomyolysis (muscle rot) because of Sickle Cell Trait [6] without any laboratory evidence in the scientific journal from which Facebook got its information. Another extraordinary misinformation is that “Renal medullary carcinoma is a rare and aggressive tumour that is seen almost exclusively in young patients with sickle cell trait” [7], and a medical journal in the USA has been devoted exclusively to “Sickle Cell Trait”.


Mention his name and Dr Reggie Addae’s, and doctors in Ghana immediately think of their diligence in unearthing dodgy scientific publications. These two Ghanaian Physicians have brought to light what Lord Solly Zuckerman FRS the most respected Physician-Epidemiologist in the UK in the last Century said in a remarkable 9-page article entitled “Pride and Prejudice in Science” which every serious scientist must read. [8] I learnt from that article that Lying Scientists or Scientific Liars did/do exist. Support of Cambridge University’s Professor Hermann Lehmann was greatly welcomed when he described existence of white Sickle Cell Traits and how suggestions of screening Negro travellers “have caused widespread confusion and distress, and indeed resentment.” [9]

The most glaring example not too long ago of Prejudice in Science was when Professor James Watson of “Crick and Watson DNA Nobel Prizes” fame announced that the current Global Gene Sequencing exercise would reveal that Africans had inferior intelligence, and then allowed himself to be genome sequenced only to be found to be African [10], making me comment thus: “Watson, still alive today in the USA, was thus brutally reminded not only that there is but one human race, but also that African genes contributed to the Nobel Prize in ‘Physiology or Medicine’ which he jointly won with Francis Crick and Maurice Wilkins in 1962 on the DNA Double Helix” [11]. Would he, I wonder, care to submit himself for Haemoglobin Electrophoresis test? Beware of Sickle Cell Trait in publications! [12 13 14].

Competing Interest: Abnormal Haemoglobin Trait parents AS x AC, with 11 children sharing 4 different phenotypes SC (3) AS(2) AC(2) AA(4).

Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL. Website: Twitter@profkonoteyahul


1 Kar Partha. Applying aviation safety to healthcare - are we missing the fundamental? BMJ 2019; 364:1735. (18 February 2019).

2 The Times, London. Medicine: Sickle cell disease and flying. December 9 1971.

3 Djabanor FFT. Sickle Cell Trait and Altitude. BMJ 1972; 1: 113.

4 Deliyannis GA, Tavlarakis N. Compatability of sickling with malaria. BMJ 1955; 2: 301-303.

5 Konotey-Ahulu FID. Four body guards or

6 Google “Here is what's possible if you are a carrier of Sickle Cell Trait” and see what Facebook is placarding. Whiskey Delta Charlie September 22 at 4:21pm ·September is Sickle Cell Awareness Month. Awareness to Sickle Cell Trait the gene responsible for creating Warriors who live with Sickle Cell. Here is what's possible if you are a carrier of Sickle Cell Trait #sicklecellawarenessmonth #sicklecelltrait #exertion #Rhabdomyolysis
Lancet Volume 298 Number 7736 page 1255.

7 Konotey-Ahulu FID. Dangerously flawed diagnosis of sickle cell trait in compartment syndrome rhabdomyolysis. Blog

8 Zuckerman Solly. Pride and Prejudice in Science. First published in Aerospace Medicine 1974 Volume 45 pages 638 to 647, the article was so remarkable that I begged Professor Zuckermann (the then Sir Solly) to allow re-publication in Ghana Medical Journal to which he kindly agreed – see Ghana Medical Journal 1975, Volume 14, Number 1, pages 52 to 60.

9 Lehmann Hermann. Sickle Cell and flying. The Times (London), 4th January 1972.

10 Verkaik Robert. Revealed: Scientist who sparked racism row has black genes. The Independent. December 10 2007.

11 Konotey-Ahulu FID. There is but one human race. New African. No. 490. December 2009.

12 Konotey-Ahulu FID. Sickle Cell Trait Confusion: Is it Deliberate Or Is This Ignorance? August 11 2017. Blog

13 Konotey-Ahulu FID. Sickle Cell Trait Misinformation and Disinformation. Blog

14 Konotey-Ahulu FID. Further Communication on Sickle Cell Trait Misinformation and Disinformation and Sickle Cell Trait Terminology: Disease or Disorder? Blog

Competing interests: No competing interests

01 March 2019
Felix ID Konotey-Ahulu
Kwegyir Aggrey Distinguished Profesor of Human Genetics University of Cape Coast, Ghana
Former Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies Kole Bu Teachin Hospital Ghana and Phoenix Hosp[ital Group, 9 Harley Street, London W1G 1AA
Hemel Hempstead