Posts by Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“Marvin: The only hard number is 19. Stop trying to make out you have more facts than you do.

“All you have is a very small sample from a very small corner of the world by people looking for that outcome.”

Simon,

Respectfully, you don’t know the difference between a sample size and a population of that sample. It’s apparent by what you write above in concise terms.

Yes. The hard number is 19. But this is only 19 deaths among a minority of trauma centers in New Zealand. This is something you fail to account for, and so far even talk about in terms of how it impacts the discussion.

When someone raises something worth responding to I'll do so. Otherwise I think I’m done here.

Any specific questions?

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“All maths and extrapolations and assumptions aside, the implications of the 50k and 250k number don't make sense.

“Marvins 'conservative' 50k implies 30 JW's a year bleeding to death in UK hospitals - 250k implies...well you can do the maths.”

besty,

No. Not necessarily bleeding to death.

There is a difference between severe anemia and bleeding to death. One could lead to the other but one is not necessarily related to the other. Apparently you don’t know the difference.

When it comes to recognition of the number of JWs who suffer premature death due to refusing blood it is often difficult then-and-there to say the reason was refusal of blood product. This realization is something that emerges after analyzing data and making matched comparison. Hence not only is the statistical number of deaths diluted to a point of about 1 per year per 60 congregations, but this 1 per year may be unrecognizable until (if ever!) an overall matched comparison is made. Again, this is something you don’t seem to understand.

“Marvins numbers implies that for every JW death that makes the national and local news there are another 30 or so deaths that go unreported....”

Yes. Because of what I write above. The lion’s share of this mortality goes unreported because it’s only recognizable in hindsight and then only when/if someone conducts a matched comparison as Beliaev did in New Zealand.

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“Marvin, kindly show me the actual finding that shows "there is no reason to think mortality due to severe anemia patients (for all causes) refusing blood was more prevalent in New Zealand than any other nation".

“Your statement looks suspiciously like an assumption and not a finding at all. Or do you use the words "finding" and "assumption" interchangeably. Your responses do not inspire confidence I'm afraid.”

For statistical purpose I did assume an equal prevalence of severe anemia between New Zealand and the rest of the world and have said so numerous times in this very discussion. I looked for reasons why we should treat the New Zealand incidents of severe mortality as either larger or smaller. What I found is that, particularly in the case of JWs, the evidence points to higher incidents on average outside New Zealand because by comparison the healthcare system in New Zealand prevents patients suffering anemia from getting the point of severity of patients in the Beliaev study. But for JWs this is not the case among those who refuse transfusion of red cells. Hence my assumption for purpose of statistical extrapolation.

“Furthermore, your statement assumes (1) you have supportive data that shows the numbers of JWs with serious blood disorders (requiring transfusions) in other countries around the world is on a par with New Zealand JWs and (2) that the availability of Western medical treatment (especially blood transfusions) is uniformly equally available elsewhere in all other countries where there are Witnesses.”

My extrapolation is not of New Zealand versus Western nations, though I don’t see how that would change anything given a general parity of healthcare. My extrapolation is of New Zealand versus all other nations, and in this comparison, if anything, we should expect incidents in New Zealand to be less because of the state of healthcare in that nation.

“You unknowingly pile assumption upon assumption upon assumption which bodes poorly for your conclusions - and you appear genuinely baffled by the robust criticism.”

Assumptions I’ve made for statistical purposes are either implicitly or explicitly stated on my blog. In this discussion I’ve shared them in explicit terms and repeatedly. The primary assumption affecting my extrapolation is my proration of incidents from 19 to 33 over the 10-year period. But for reasons given in this discussion not only do I see this proration as reasonable I see it as conservative.

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“erm, but it's OK for you to transpose this risk to 7.5 million people?!?!?”

The 7.5 million match the sample set of JWs in New Zealand. The 10x multiplier is not presented of all patients with anemia. In other words, if we look at the 10x as a “sample set” it does not align (match) with all patients with anemia. It only aligns with patients with conditions that align with the matched comparison groups.

“Anyway, the questions I've asked are easy to find. I thought you'd be able to find them by clicking on the page numbers but obviously not. I know you're trying to bait for insults so you can storm off but I'd like to thrash this out until you see your own error.”

I’ve failed to address several questions and comment in this discussion because they didn’t have any merit worth answering for. I said this already.

“How come your numbers don't change if the rate of deaths does? If there are 1000 JWs instead of just the 103 who refused treatment ... the rate is the same as regular people (1.9%) but your method comes up with 50,000 "extra" deaths. Are you claiming that *no* JW ever accepts blood?”

My numbers are tied to hard data and not rates. The number of preventable deaths is hard. The number of JWs in New Zealand is hard. Various mortality rates will not change these hard numbers. These hard numbers present a fixed ratio.

“Your mistake through all this is to treat "JWs who chose to refuse blood" as synonymous with the entire population of JWs. Any stats to do with deaths from refusal to accept blood is already based on a smaller and more specific sample which is NOT representative of JWs in general. In fact, all JWs who do not refuse to accept blood are in the stats for, well, everyone else.”

The data set from Beliaev includes JWs who accepted blood product forbidden under Watchtower doctrine. Hence the issue you raise is present and accounted for.

Regardless, we still have a hard number of preventable deaths and we still have a hard number of JWs in New Zealand. Also, the data set at issue is specifically about red cells transfusion. Those who died over and above the norm refused red cell transfusion. If there were JWs in New Zealand suffering severe anemia who accepted red blood cell transfusion all that means is those JWs are not in the data set and whether they lived of died does not affect the ratio mentioned above because the ratio is not of JWs who die and those who do not die based on accepting red cells transfusion but, rather, the actual number of preventable deaths versus the JW New Zealand population.

“It's why your numbers don't tally with simple sanity checks and experience / observation.”

The number of 50,000 over a 50-year period is imperceptible unless a person has figures before them to do the math.

“If he'd had more patients in the study but the same mortality rate, then what would the extra deaths do to your numbers? What effect would fewer numbers (but the same rate) have?”

My extrapolation is based on hard numbers and not a rate. However, if more patients died and the rate of mortality remained the same among the JW patients compared with the matched group then nothing would have changed in terms of JWs at risk for premature mortality.

“If your method was based on the rate it wouldn't change ... but it does. Almost as though it has nothing to do with the mortality rate.”

Again, look at the hard numbers. The mortality rate in the Beliaev study is not stated in a way to apply it to a larger sample that does not align with the matched group. But the hard numbers are stated in a way to apply it to a larger group.

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

From page 4:

“The risk multiplier is where this debate hinges. The NZ study indicates 10.74x. And yet the implication of Marvins' interpolation of the JW death rate being 0.26/1,000 (not per 100,000 as is more commonly used) is a 130x risk multiplier.”

Besty,

If you’re speaking of the risk fact of 10x mentioned by Beliaev then you’re wrong.

If you’re speaking of some other risk factor (“the risk multiplier” you cite) then I don’t know what you’re talking about. The only risk “multiplier” I know at issue in this discussion is that mentioned by Beliaev of 10x.

The reason you’d be wrong regarding the 10x risk by Beliaev is because his 10x statistic was not in relation to mortality statistics of anemia but, rather, strictly in relation to the match comparison of severe anemia patients in his study. To transpose this 10x risk onto any other patient populations is comparing relevantly dissimilar patient populations. One has nothing to do with the other.

On the other hand, we have a hard number of 19 JW patients who died who, according to a matched comparison, should not have died. This mortality occurred over the 10-year period of 1998-2007. Please note this is a hard number and not a rate. We also have a hard number to compare this to of JWs in New Zealand. The number of 19 can only go up because the 19 is of patients treated in a minority of trauma centers in New Zealand. On the other hand, the number of JWs in New Zealand is finite.

When this number 19 goes up the ratio of preventable mortality to JWs goes up.

I prorated the 19 documented deaths by correlating these to population density in the 2 regions of the 4 hospitals used in Beliaev’s study. I did this very conservatively by assuming none of the other trauma centers in these 2 regions experienced a single mortality that would increase the value of 19.

Do you find my method of prorating somehow misguided? If so, how so?

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“Please just stick to the point and answer the questions.”

Simon,

I don’t know which question you think I’ve ignored because I can’t answer it.

I just invited you to present one of these questions, and you didn’t.

So again I request of you:

If there is some question you think I’ve skipped because I can’t answer it then please spell one out here and now, and I'll respond.

Is this really so hard for you to do?

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“The JW's and the control group were selected after the fact by Beliaev.”

Besty,

That does not change the fact that 19 JWs are documented to have died who shouldn’t have died for one reason and one reason only: refusing blood according to Watchtower doctrine.

Tell me something, what happens when this number of 19 moves upward in relation to the finite population of JWs in New Zealand?

Do you seriously think that the review of records from 4 hospitals in New Zealand contains all of such deaths among JWs in New Zealand?

Think about this given the finite number of JWs in New Zealand.

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“I just love how Marvin always skips the questions he can't answer however many times they're asked.”

Simon,

Why are you hurling insult at me?

I’ve not skipped anything I can’t answer for. I’ve answered issues raised that have to me some semblance of relevance to the issue I’m answering for, which is my presentation of deaths due to Watchtower’s blood doctrine.

If there is some question you think I’ve skipped because I can’t answer it then please spell one out here and now and I'll respond.

Otherwise please be civil and stop with the needless insult. And, you might try responding to the substance of what I’ve presented. Or, should I think you’re ignoring what you can’t answer for?

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“eg - average number of JW's 12,700 - did you account for unbaptized publishers under the age of 15 being in the official JW figures, but which the Beliaev study would exclude, for example.”

No. Because it would not matter to the mathematical conclusion. The only thing you’d accomplish by adding to the number of JWs in New Zealand (over and beyond the published number) is to increase the sample size - to - deaths ratio. But this would not change the mathematical conclusion because the increased ratio would be applied to a much larger number (the world population of JWs adjusted upward on the same basis you’d adjust upward the number of JWs in New Zealand).

“I'm not saying your maths is wrong, or that your assumptions are not possible. Just that when I take a different approach I get a different answer, and there is a 13x difference in outcomes between our approaches.”

The approach you take is untenable because it attempts to use relevantly dissimilar information as inputs. I explained this already and you ignored it.

Keep pushing! That’s how we all learn.

Marvin Shilmer

739

250,000 Jehovah's Witnesses have died refusing blood

by nicolaou in

80+ branch davidian cult members died in waco, texas.

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

Marvin Shilmer

-

“Such a project is doomed because we do not know whether the numbers of JWs with blood disorders even in similar countries (e.g., Australia) are the same, let alone in very different countries (e.g., Ghana). Given the huge variability in health indicators even across similar countries there is absolutely no justification for extrapolating from a single study in one specific country to make worldwide estimates. It just smacks of research "gaming" that would be laughed out of peer-reviewed research "findings. It's a frank embarrassment akin to the knock-up research by Jerry Bergman - a worthy topic is treated with shocking superficiality.

“How the hell can you responsibly report your extrapolated results based on this single New Zealand study without making it very, very clear that it rests on an uncertain foundation?”

How? You can responsibly share this information by explaining how the extrapolation is made. Then let educated readers make of it what they will. That’s how.

The issue you cite of not knowing whether the numbers of JWs with blood disorders even in similar countries (e.g., Australia) are the same, let alone in very different countries (e.g., Ghana) is a factor to consider, and I did consider this in my assessment. My finding was that there is no reason to think mortality due to severe anemia patients (for all causes) refusing blood was more prevalent in New Zealand than any other nation. Hence to use these New Zealand values is not to overstate what we should expect overall (the world). For this reason my extrapolation is conservative.

On the other hand there is lots of data telling us that severe anemia can be and is successfully treated with blood transfusion therapy, and refusal of this therapy was the sole difference in the otherwise matched comparison study by Beliaev.

Besides the above, when we consider the 19 deaths at issue in the Beliaev study come from only 2 of 5 advanced trauma service hospitals, only 1 of 16 district trauma service hospitals and 1 of 8 hospitals with basic trauma services it should be apparent that these 19 deaths are not at all of the preventable deaths in the category of severe anemia patients refusing blood in New Zealand. Prorating this number to 33 based strictly on regional population is, again, conservative. If we assumed each of hospital with equal facilities had similar outcomes we’d end up with a much, much higher number.

In the end, the issue you cite is no flaw because my number of 50,000 is not predicting how many needless deaths have occurred due to Watchtower’s blood doctrine over the 50-years of 1961 to 2011 but, rather, to say the numbers suggest this is a conservative estimate of how many have needlessly died due to Watchtower's blood doctrine, and that based on well documented information (the Beliaev study).

Marvin Shilmer