If Shander, 49, an Israeli-born physician who majored in Asian languages as an undergraduate, is passionate about anything, it is blood. Not only because it is, as Goethe observed, "a very special juice," the fluid pumped by our hearts through arteries, veins and capillaries, and without which the body's cells would be starved of oxygen and nutrients; nor only because he knows blood transfusions save lives; nor simply because 70% of those transfusions are administered by anesthesiologists.

What concerns Shander most is how blood has become a convenient tool for his fellow anesthesiologists, and how it is sometimes used cavalierly when it need not be given at all. According to some estimates, 25% of U.S. transfusions are unnecessary. There are also indications that patients cannot tolerate levels of hemoglobin as high as previously thought and that young people especially have a built-in reserve of blood. These findings, Shander believes, support the need for a more sparing use of blood products. As one of the directors of the Englewood institute, he is convinced that withholding blood is a viable and preferable choice for most patients. It not only benefits many patients but also forces surgeons to pay closer attention to technique and tests their willingness to depart from tradition.