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

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“Marvin, your acknowledgement that you simply assumed the incidence of anaemia in New Zealand matched that of other countries shows how simplistic your research endeavors are. New Zealanders have ready access to the health care system for serious medical conditions and - I would venture far readier access than many other countries, including the USA. Besides, it is also highly likely that the incidence of blood disorders from country to country - and even within countries - varies significantly across socioeconomic groups. It is untenable basing hard numbers research findings on the kinds of assumptions you have made. BTW, whether you openly acknowledge your assumptions or not, unsupportable assumptions remain unsupportable.”

Steve2,

First, what you cite is misplaced because my presentation is not based on incidents of anemia but rather a statistically hard mortality number, and that mortality is not related to anemia but, rather, to refusal of blood product.

Second, assuming New Zealanders have comparatively ready access to healthcare makes my assumption of parity with other socioeconomic regions conservative. If anything this assumption of parity makes my extrapolation an understatement rather than an overstatement.

“I have worked in a metropolitan hospital in New Zealand for over ten years and can categorically state that preventable deaths due to blood-transfusion refusal are extremely rare. All hospitals in New Zealand have a statutory obligation to formally report "sentinel events" which includes deaths due to treatment refusals (although the reporting does not include personal identifiers). Again, the numbers stand out as very low. I personally am very angry about the extrapolations Marvin and his supporters are making. These claims detract from the impressive body of reasoning that exposes the Watchtower's blood doctrine as scripturally and medically unsuppprtable.”

“I have worked at…”?

That’s really great. Are you suggesting Beliaev and his co-researchers lied when reporting the 19 statistically preventable deaths among an annual average of 12,700 JWs over 1998-2007?

I’ll take a documented and published finding over your anecdotes every day of the week.

If my work makes you angry then why not take the evidence as it is presented by Beliaev, compare it with the New Zealand population of JWs and extrapolate your own estimate, first of preventable deaths of JWs suffering severe anemia and refusing blood. Then we can discuss how or whether to use this toward the world population of JWs.

In the end, either Beliaev’s presentation offers a means of estimating the ratio of JWs who died during 1998-2007 with severe anemia and refusing blood versus the number of JWs in New Zealand, or it does not. If it does, then what is YOUR estimate? If it does not then what is YOUR reason why Beliaev’s study is not useful for this purpose?

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

-

“No, the sample is 19 out of 103 patients over a decade. That is a small sample.”

Simon,

Not in my use of the information it’s not, and it’s my use of this information at issue. Right?

Of the 19 and 103 values the sample is 103 and the population of that sample is 19. This sample of 103 was used by Beliaev to form a matched comparison group to identify whatever disparities between the two groups, and in particular disparity of costs between the two groups in relation to outcomes.

That was Beliaev’s use of the 19 and 103 values; not mine.

My use was to take Beliaev’s identification of 19 statistically preventable deaths and compare it with the population of JWs in New Zealand.

My use of Beliaev’s identification of 19 statistically preventable deaths among JWs in New Zealand uses the population of JWs in New Zealand as the sample value (=12,700 annually between 1998-2007) against the 19 identified instances of statistically preventable deaths among JWs in New Zealand.

You don’t understand these things. That’s apparent. Moreover, I don’t see any need in repeating these things.

“Your are assuming that there is no other variance than the patient being a JW. It would be incredible if the same hospitals had two sets of 1000 patients and had the exact same outcomes for both - same number of deaths, same reasons etc...”

Where I’ve assumed I’ve done so conservatively so that if I’m wrong I’m wrong in terms of an understatement rather than an overstatement. My extrapolation is based on these conservative inputs. Hence, if anything, the numbers of preventable would be higher rather than lower. As you don’t understand the sample set and population of that sample set, you don’t understand this either. I see no need in repeating this, either.

“Your issue is that you are taking numbers that have a chance of being correct as being absolutely correct.”

My extrapolation is based on a hard number of preventable deaths that is absolutely correct. That number is 19 over a 10-year period documented in a minority of trauma centers in New Zealand.

My extrapolation is based on a hard number value of JWs in New Zealand at the time and uses the same hard number value of JWs worldwide. These numbers are published.

“If your method was in the least bit scientific you would be able to tell us what the confidence and margin of errors were. I don't think you can.”

I could. But I don’t need to. My extrapolation is not presented as a predictor of preventable deaths. It’s presented as a conservative figure of preventable deaths. The former tends to need a confidence factor and margin of error; the latter does not because it’s based on conservative inputs. You don’t understand this either.

“Marvin, this should be a fairly straightforward question which you've danced around:

“How many JWs have died? (using known populations and normal mortality rates)

“What proportion of those deaths are you claiming are due to refusing blood?”

Simon,

What you say above is not only an insult, worse, it’s a boldfaced lie.

I answered both these questions on page 15 of this discussion, and I provided this information in reply to YOU!!!:

http://www.jehovahs-witness.net/watchtower/medical/265357/15/250-000-Jehovahs-Witnesses-have-died-refusing-blood#.UmGw-vMo7IU

Please stop with the insults.

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

-

“That's what this whole discussion has been about. How truly represantative of the ENTIRE JW POPULATION is this SMALL SAMPLE and can you be justified applying it to all JWs.”

Simon,

The sample used to extrapolate mortality among the entire JW population is an annual value of 12,700 over the period of 1998-2007. This is not a small sample.

The population of that sample is whatever it is for statistical purposes. In this case we have a hard number of 19 preventable deaths identified in a minority of trauma centers in New Zealand.

“It's a pre-selected sample of JWs who refuse blood. Not all JWs do. That's one reason why your figures are off. The other is extrapolating from a tiny number of questionable provenance.”

The hard number of preventable deaths is not changed by what you mention above, and the hard number is the basis for my extrapolation. You don’t understand this.

“You have 'hard numbers' for something like 0.000000006% of JWs and think you can work out what they all had for breakfast from it.”

No. I have hard numbers of a sample that’s 0.21% of the larger matching value for JWs worldwide. You don’t understand this, either. You’re percentage claims betrays this.

“Finally, you ignore the maori element which I seem to remember someone saying made up 20% of the people and have a predisposition to anemia - but you want to make out this small group had a lower than average rate so that you can slap a "conservative" label of confidence on it.”

I responded to this much, much earlier in this discussion. The Beliaev study made a regression adjustment for the “Maori element”. I guess you missed this. If you read Beliaev’s article you’d know it. But you haven’t done that either, by the looks of it.

“Your numbers and methodology are not convincing. I'd use the word laughable but you'd do your prima-dona routine and start claiming you'd been insulted again.”

I still don’t understand your insults. That said, my extrapolation is presented and explained and I’m happy for readers to make of it what they will. When it comes to objections to my presentation, I’m more interested in those trained to make such an analysis and who have read the data set it uses. Though I’m happy to respond to other complaints as time and circumstance allows I’m not bothered by these.

In your case, I’ve presented several issues you fail to account for in your complaints, and what I get in return is insult rather than substantive response. I don’t understand that. I’m not here to make friends or enemies. I’m here to share what I’ve learned and learn from others for myself.

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 am happy that you are so convinced but I think you're numbers don't make sense and your attitude and approach to people asking questions reduces confidence still further.”

Simon,

My attitude and approach to people asking questions is to cull through the mire and respond to what appears to me as substantive issues. I don’t waste my time responding to anything else unless someone points to something specific and requests response. I’ll respond to these inquiries as time and circumstance allows. If you or anyone else finds that offensive or somehow putting-off, I’m sorry. But this is how I use my time. If it upsets you then you’re upset. I’m happy for readers to make of this whatever they will.

When someone raises something worth responding to, 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

-

“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