New Research at AJWRB
To characterize what we have published as self professed "gospel" is at the very least a gross mischaracterization that hardly deserves a response. Check the meaning of the word. We have been careful to state that it is only an estimate, and that there are both known and unknown factors that would alter the estimate.
The single greatest limitation of this analysis is that it likely grossly underestimates the actual number of fatalities. Bear in mind, we didn't count as much as one death for the entire period of 1945-1961. A period when "non-blood" alternative therapies did not exist for all practical purposes.
As previously said, please feel free to take a look at what is out there and make your own attempt to use existing studies to estimate the impact. Let's see what you come up with.
Lee Elder you stated:
We have been careful to state that it is only an estimate, and that there are both known and unknown factors that would alter the estimate.
Please, point to where you talked about the unknown factors for this estimate. I can see small sections in your report where you speak of some limitations but these are fleeting thoughts at best and does not go in depth with what they are or how you attempted to overcome those unknown factors.
Even two of the three studies that you make references too, in their conclusions they go into deep discussion of what the limitations are.
You also have said twice now for those that disagree with your methodology to go do our own estimate. I will contend with you on this again. No one who disagrees with how you came to that methodology has claimed to make an estimate nor have they claimed to put this in a research article, which you yourself calls the article. You have claimed that you have presented this estimate to a conference also you have said that you have a leading expert in this field who has helped to come up with this estimate.
So the pressure is on you to defend your numbers. Scientists don't submit articles to the peer reviewed journals, and when someone disagrees with them, they say well go off and do your own study and prove me wrong. It is up to the person who has presented the article to prove their facts. If you think you have proven your estimate by use of facts then you should be able to defend them legitimately.
Read the article, read the references, read the thread. We haven't made any attempt to do anything other than present a conservative estimate. Not sure what else you'd like me to say. The numbers are what they are. The fact that you find them disturbing probably says more about you then it does about the estimate. Technically, the only thing I have personally done is bring these estimates current through 2016 using the method the original investigators used. Your issue is really with them I think. You'd like to see an estimate that breaks down risk for every type of surgery or illness, year by year, country by country, etc, etc, etc. Wouldn't that be lovely? Of course its impossible to do that, so therefore we should just give the Watchtower Society a pass? Well that is not going to happen. They clearly have thousands upon thousands of deaths they are directly responsible for. We might not be able to come up with an exact figure for how many died in the Civil War, World Wars, Holocaust, etc, etc, etc. We still do our best with the data we have. I think you have to accept that John. Its not a perfect world. We have enough to know that there is a huge problem.
Lee Elder I have read the article, I have read the references, I have read the thread. I don't have a problem with the numbers I have a problem with your methodology. You say that I should have a problem with the people who created the estimating methodology, but that is your organization. When you speak of a Medical Adviser and a Science Adviser when they create these numbers they are representing you and your organization.
Again you never once speak of the limitations of the methodology that was used. It is one thing if you are just saying that this is what you think but you yourself have called this a research project. You are trying to give it more credibility by saying it is research done by an organization that has a Medical Adviser and a Science Adviser. I am not even bringing up that nowhere do you speak of either adviser's credential. If you want to say it is your opinion then you should say that in your article.
The methodology is sound and credible. We'll just have to agree to disagree.
Here is an email I received today from an interested reader:If we have a given population (JWs) with a unique attribute that is suspected to have a certain effect compared to the general population (non-JWs) that does not have that unique attribute then we need to find a means of measuring the suspected effect within a defined population that represents both the given and general populations.
The article published by Beliaev and company in the July 2012 issue of VoxSanguinis is useful because it gives a matched set of patients with one set of patients representing the unique population (JWs) and the other set of patients representing the general population (non-JWs). The sole difference between these two patient sets was that one refused transfusion of red cells to treat severe anemia and the other set did not.
Beliaev and company found that in the region from which their medical data came there were 19 deaths over a 10-year period over and beyond what the matched set of patients experienced in the general population. Keep in mind this is a hard number. 19 deaths were due to refusing transfusion of red cells to treat severe anemia. More than 19 deaths were suffered within the set of JW patients. But 19 of them were found to be due to the unique attribute of the JW population to refuse transfusion of red cells to treat severe anemia. If we divide these 19 deaths by 10 (the number of years the study gathered data for) it results in 1.9 deaths per year due solely to refusing transfusion of red cells to treat severe anemia.
The region from which this data was gathered represents 57 percent of the total population of New Zealand. The JW population in New Zealand for the 10-year period averaged 12,700 per year (this is the number of “publishers” not the total number of all persons associated with the religion; infants, bible studies, etc.). 57 percent of 12,700 is 7,239. Hence, compared to the general population the JW population suffered 1.9 deaths per 7,239 of its published number of “publishers” due to refusing transfusion of red cells to treat severe anemia.
The ratio of 1.9 deaths per 7,239 publishers is not an estimate. These are hard numbers. 1.9 is the actual average annual number of deaths known to have occurred solely due to refusing transfusion of red cells to treat severe anemia. The 7,239 is the actual published average number of JWs per year for the same period and population from which the deaths occurred.
From here it’s basic math to calculate an estimate of deaths suffered by the great population of JWs for refusing transfusion of red cells to treat severe anemia. The numbers are staggering, and they’re hidden in plain sight.
What makes an estimate based on these hard numbers conservative? Several things. For one, the average life span for the general population from which the data was collected is very high (very good), which means the numbers are not skewed in an upward direction due to poor healthcare or living conditions found in other population regions of the world. Also, the 1.9 value assumes there was not even a single death among JWs suffered in the given population during the same 10-year period at any of the other scores of hospitals in the same population region from which the data came, each of which treats patients with severe anemia, hence using the 1.9 value does, if anything, skew the estimate downward. Another thing this estimate ignores is even a single death in the same region due to refusing products rendered from blood to treat diseases other than severe anemia. Again, if anything this tamps any estimate downward rather than upward.
the problem is that the poster and you Lee elder are not addressing why this study was done and why it appears in later journals. the study was done in order to know and manage risks amongst JW patients who become anaemic to improve outcomes and this is one of the things which you are not allowing for in your so called conservative estimates and it is this that makes your estimates sensationalist. for example
Mortality risk stratification in severely anaemic Jehovah's Witness patients.
Beliaev AM1, Marshall RJ, Smith W, Windsor JA.Author information
The aim of this retrospective cohort study was to identify early risk factors of mortality and develop a mortality risk stratification instrument for severely anaemic Jehovah's Witness patients.
ANZ J Surg. 2013 Mar;83(3):161-4. doi: 10.1111/j.1445-2197.2012.06228.x. Epub 2012 Sep 17.Beliaev AM1, Marshall RJ, Smith W, Windsor JA.
The Hamilton AMRS allows treatment monitoring of anaemic JW patients and adjustment of their risk of mortality.
Treatment monitoring and mortality risk adjustment in anaemic Jehovah's Witnesses.
The study aims to develop an anaemia-related mortality risk prediction instrument...
then here again from 2013, one of the authors of your study, Beliaev from above, argues for JW patients to be closely monitored in ICU and given EPO every other day, iron and B12 even low AMRS scores can reduce mortality in some cases.
High-risk anaemic Jehovah’s Witness patients should be managed in the intensive care unit
When weights of individual statistically significant anaemia-related risk factors of mortality were combined and a composite mortality risk score, the Hamilton Anaemia Mortality Risk Score (Hamilton AMRS), was calculated, it was shown that JW patients with Hamilton AMRS of 0 to 2 had 4% mortality, Hamilton AMRS of 3 to 4, 29%, Hamilton AMRS of 5, 40%, and Hamilton AMRS of ≥6, 67%.
On admission to hospital the trauma patient described by Lorentzen et al.6 had an Auckland AMRS of 3 (age, acute admission and Hb ≤80 g/L on admission to hospital) and a Hamilton AMRS of 6 (shock, ischaemic bowel perforation and the nadir Hb concentration ≤70 g/L) that estimated the patient’s mortality risk exceeding 70%. The patient underwent an open bowel resection and was managed in an intensive care unit (ICU) with physiologic parameters monitoring, ventilatory support, fluid resuscitation and an administration of vasopressors. The patient’s infective complications were treated with broad spectrum intravenous antibiotics, collection drainage, and wounds debridement and washout. Also the patient was treated with intravenous iron, B12 supplementation and subcutaneous administration of erythropoetin (EPO) in the dose of 10,000 units every second day.
JW patients accept EPO, which is an erythropoiesis stimulating agent, as an alternative to blood transfusion. EPO is a 165 amino-acid glycoprotein, which is mainly produced by renal peritubular capillary endothelial cells in response to hypoxia7. As a haematopoietic cytokine, EPO promotes proliferation, differentiation and survival of erythroid progenitor cells8. In addition, EPO exerts a potent protective effect against hypoxia through its anti-apoptotic action9. After binding to its receptor on the cell surface, EPO initiates a JAK2 signalling cascade leading to NF-kB- and STAT5-dependent transcription of anti-apoptotic genes, including Bcl-xL, Bcl-210. Furthermore, EPO exerts a potent vascular protection and induces neoangiogenesis11–13.
Beliaev's work crops up again here in 1914 to save another JW life (pls see link below. you know what after all this research I could write a great article for you guys that would highlight the work you have done Lee Elder, the work Muramoto has done and yet still manage to highlight controversies to do with lack of patient autonomy, ostracism and the desire to part of a community as it is these latter things that need to stand out nowadays. whats more my article would be good for your cause and for any JWs, xjws and any in between who are undecided about blood transfusion or simply want another pov.
Successful Treatment of Severe Anemia using Erythropoietin in a Jehovah Witness with Non-Hodgkin Lymphoma
2. Beliaev AM. High-risk anaemic Jehovah's Witness patients should be managed in the intensive care unit. Blood Transfus 2013;11:330-2. [PMC free article] [PubMed]
3. Beliaev AM1, Marshall RJ, Smith W, Windsor JA. Treatment monitoring and mortality risk adjustment in anaemic Jehovah’s Witnesses. ANZ J 2013;83:161-4. [PubMed]
4. Beliaev AM1, Marshall RJ, Smith W, Windsor JA. Mortality risk stratification in severely anemic Jehovah’s Witness patients. Intern Med J 2012;42:e1-3. [PubMed]
Ruby 456. You wrote:
"the problem is that the poster and you Lee elder are not addressing why this study was done and why it appears in later journals. the study was done in order to know and manage risks amongst JW patients who become anaemic to improve outcomes and this is one of the things which you are not allowing for in your so called conservative estimates and it is this that makes your estimates sensationalist".
This is patently false. You have either not read the original research by Beliaev in July 2012 VoxSanginis, or you are being intentionally dishonest. The research was undertaken to assess the clinical beneﬁt and cost-effectiveness of ARBC transfusion in severe anemia. In order to do this the researchers did the only thing they could do, compare costs and outcomes with patients who accept ARBC transfusion with costs and outcomes with a matched set of patients who refuse ARBC transfusion.
Beliaev et als research demonstrated that ARBC transfusion in anaemic patients is clinically beneficial and cost-effective. On this point the outcome of JW patients suffering severe anemia who refused ARBC transfusion, compared to patients who were treated with ARBC transfusion resoundingly demonstrated that ARBC transfusion to treat patients with severe anemia is extremely effective, not to mention its cost effectiveness.
I have attached a scan of the front page of the article. It is not available for free online, only the abstract.
Please move your mind to another subject. I am too busy with important work to continually have to correct your mistakes..
I cannot believe that you got permission to use this article the way you are using it. https://www.ncbi.nlm.nih.gov/pubmed/22150804
Please provide evidence that you do have t his permission. If you do not have permission you need to stop using it in this way and take it down off of your site. the way you are using it is misleading and unethical