New Research at AJWRB
Also, Lee Elder, I don't think that study was trying to say what you wanted it to say. In that study, it shows that there is a 20% complication rate for blood transfusions and that those 1404 inadvertently avoided that complication by not accepting a blood transfusion. Whether that is true or not, the use of this study by the group's Medical Adviser may not have been the best study to use for the point that you were trying to make.
john davis let me ask you something
do you agree that the end justifies the means? I have seen the society use this line quite often.
Ruby, what means are you referring too? and what end do you refer too?
their ends are that they are alleviating the sorrows and difficulties of people who are suffering therefore what harm does it do if they use material dishonestly? spiritual warfare strategy for example.
Dr Muramoto also questions the ethics of the watchtower society
I never said that Watchtower doesn't do the same thing. I just said that it may not have been the best article to make your point with. Probably could have found another article to make the same point.
Ruby & John.As both of you seem to be realize, Kitchen's article was extremely limited in scope inasmuch as it dealt only with the administration of RBC's in scheduled surgery.
This is by far the most favorable scenario for the JW patient, because in scheduled surgery, "bloodless" procedures and techniques can be taken advantage of to the full.
But that is not always possible. Kitchen's article did not cover scenarios far less less favorable to JW patients, like pregnancy and surgical complications, industrial accidents, trauma and emergency surgery, Neither did it cover pathological conditions where other blood products are often indicated, including but limited to leukemia & lymphoma in all their various forms, atypical bleeding disorders, liver dysfunction, bone marrow transplant, etc.
The death of Witness leukemia patients has been so common in the past that in 2002 an article appeared in The Oncologist entitled Faith, Identity and Leukemia: When Blood Products Are Not An Option which was intended to help medical practitioners deal with the feelings of guilt, frustration and anger over the routine loss of JW patients.
By confining himself to the one facet most favorable to JW patients, Lee Elder is being unbelievably conservative.
TD I completely agree with you that the original study did not include emergency situations or forms of cancer or rarer blood disorders. But that doesn't mean that Lee Elder's methodology isn't flawed. To have come up with a true estimate he would have had to consider a number of other factors, just a few of them:
Percentage of use of blood transfusions in the following scenarios:
Uses within Oncology diagnosis
Uses within haematology diagnosis
Then you would have to look at how common these diseases and forms of blood cancer are. Is it 1 in 1000 or 1 in 10,000
What is the rate of emergency care that hospital protocol would initiate a blood transfusion? For instance, in a 5 person car accident would it be necessary for all 5 people to receive a blood transfusion or 1 of them or none of them.
These are just 3 examples of questions that would need to be answered for a real estimate.
It is certainly a noble goal to come up with an estimate but what Lee Elder did was a very basic calculation without looking at all of the different variables that are necessary to make an educated estimate of the numbers.
there aren,t many studies of jw patients and this is probably the reason that Muramoto uses this research to discuss the lack of ethics that Jehovah's witnesses have in disallowing patient autonomy. So different context here. Lee elder does not mention that this is the context in which MUramoto uses the research.
also my issue re lee elder is the incorrect way he uses these figures and then jwfacts takes them as gospel and repeats them. And he certainly isn,t underestimating - pls explain how u reach that conclusion. The study spans 7 years lee elder takes them as spanning one year. Then he does not say that the deaths were in the cardiovascular surgery group either.
Both lee elder and jwfacts can make up whatever figures they want to use but to suggest that they are backed up by this research and by dr Muramoto isn,t any different from what the wts is criticised for doing when it misquotes scientists. Dr Muramoto has also questioned the ethics of dissidents and writing in 1999 he thought that this was down to the new medium of the Internet and that this phase would pass - but 17 years on it is still alive and well. Sad and disappointing.
lee elder,s bible research is marvellous and it made me think critically as I,m sure it has many others. He does not need to stoop to this, nor does jwfacts
You seem to be familiar with some of the backstory, but a few details are missing.
Sixteen years ago, Dr. Muramoto wrote an article for the BMJ on the bioethics of the policy change made in the year 2000 by the JW parent organization.
In the discussion that ensued in the Rapid Response section, JW apologist, Rolf Furuli trotted out Kitchen's article in an attempt to claim that the risks of transfusion are greater than the benefits.
Dr. Muramoto pointed out, quite correctly that Furuli was wrong; that Kitchens had greatly overestimated morbidity and mortality associated with transfusion and that when compared against companion studies done by Sazama and others the benefits far outweighed the risks.
When Furuli raised some the the same objections that you and John have raised, about Kitchen's article (Which was odd, considering he was the one who brought it up in the first place..) Dr. Muramoto pointed out, again quite correctly, that coverage of the subject in peer reviewed journals is scarce; that we will never have true double-blind comparisons with human patients because they are unethical in the extreme and that when attempting to calculate the human cost, we have to do the best we can with what we have.
You've asked why I think the estimate is probably still low. I've already explained that. A diagnosis of AML or Hodgkin's disease is virtually a death sentence for a JW. They are very poor candidates for organ transplant. A number of studies suggest that the mortality rate of JW women in childbirth is substantially higher than the general population. For the love of Pete, a JW girl in California fell off her skateboard, and died from the blood loss of a broken femur! -None of that is factored into the 1% estimate and I honestly don't know how it can be.
Another thing to consider is that bloodless alternatives and procedures are still unavailable in many parts of the world. As the medical director for a hospital in Uganda put it years ago:
"The choice is easy here in Uganda. When a child who has severe anaemia from malaria with hookworm infestation and undernutrition comes in the choice is simple: he or she has a transfusion or dies."You've also stated that Dr. Muramoto "...has also questioned the ethics of dissidents..." I'm thinking that is probably a typo (?) Why would he do that?
Ruby456, et al: I have heavy demands of my time, and declining health. I am going to assume your comments are made in good faith, and do my best to briefly address them. This will, however, be a necessary final attempt.
The references to 150 deaths per year in the U.S. are in fact Dr. Muramoto's. Here is the original estimate that he prepared. In the second paragraph from the bottom, on the right, you will find the numbers in question.
This estimate was prepared by Dr. Muramoto specifically for 2001 annual meeting of the American Society of Anesthesiologists in San Francisco. I was present along with about a dozen other members of AJWRB. I continue to be in contact with Dr. Muramoto even though he has retired, and he stands by his estimate, as does AJWRB for a multitude of reasons.
If you feel the need to dig deeper to convince yourself, that is understandable. Here is some additional material that addresses many of these issues related to Kitchens study:
Bear in mind, you are reviewing the work of one of the best experts in this entire field. An author who has been published more times in peer reviewed medical journals than anyone else on this matter. Dr. Muramoto has produced a very, very conservative estimate which is precisely why we use it. It completely ignores all deaths related to the three primary causes of morbidity in JW's related to the blood issue. (Chronic blood disorders, trauma, and child birth). The estimate is certainly on the low side, and the fact that it is reasonable is born out by the study done by Beliaev almost 20 years later. This is actually a much better study for our purpose since it is based strictly on outcome related to anemia.
Clinical benefits and cost-effectiveness of allogeneic red-blood-cell transfusion in severe symptomatic anemia. Beliaev et al. VoxSanguinis 2012 July 103(1):18-24. https://www.ncbi.nlm.nih.gov/pubmed/22150804
A separate analysis and extrapolation performed independently by AJWRB Science Adviser Marvin Shilmer produced the identical mortality factor derived by Dr. Muramoto, namely 0.015% annually. The studies independently validate one another - you can take that to the bank.
As for any notion that Kitchens may have had about mortality and morbidity related to blood, he frankly admits he didn't know. That is not the case now. Its approximately 100:1 - not enough to materially impact our number in any significant way. The following quote in this regard is from Dr. Muramoto's rapid response in the BMJ listed above:
"The risk of blood transfusion was again extensively reviewed in the "Medical Progress" review in the New England Journal of Medicine in 1999. In this progress review, the overall number of deaths from blood transfusion is estimated between 23 and 44 deaths per million units of blood. These numbers include every complication from blood transfusion, not just short-term mortality as in Sazama's report. The short-term mortality which corresponds to Kitchens' estimate should be smaller than these numbers. Thus, a typical blood transfusion of two units carry the risk of 46 to 88 overall deaths per million patients, or 0.0046 to 0.0084%. If a larger amount of blood is transfused, this risk will increase further, to 0.01 to 0.03%.
The accurate number itself is not as important as the magnitude of the risk. Available data indicates that the mortality of refusing blood is close to one hundred times greater than the mortality of being transfused. In the United States alone, about 1.5% of population has conditions requiring blood transfusion each year according to the statistics of the American Association of Blood Banks. That means about 15,000 of Witnesses in the United States will face such conditions each year. Not all of them need transfusion for major surgeries, but suppose half of them had major surgeries, about 7,500 Witnesses have about 1% of additional mortality according to Kitchens. To put this in perspective, 75 Witnesses are dying each year in the United States alone due to refusal of blood transfusion, whereas only about 0.01% of mortality, or life of less than one Witness, is spared by refusing blood transfusion and avoiding transfusion-related death. We never know the exact number of life lost and life saved by refusing blood transfusion. However we can estimate the magnitude of mortality from this practice with reasonable certainty. If we accumulate the above number over the past thirty years and extend to other countries, "hundreds and thousands of deaths from the blood refusal policy" is not at all an exaggeration."