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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“I had mentioned that I worked at a metropolitan hospital only to show I hear firsthand when JWs die from blood refusals (again, the numbers are very low).”

Steve2,

If, as you say, you have carefully considered what I’ve presented then you’d realize hearing reports from colleagues at a hospital of JWs who died over blood refusal would be a relatively rare event.

New Zealand has more than 80 hospitals. The adjusted rate of 3.3 deaths per year my article speaks of in the New Zealand healthcare service area means that any given hospital could go many years, perhaps decades, without a single instance of this preventable mortality. Hence what you share as your personal experience is what I’d expect, which makes me wonder why you think your experience is somehow at odds with that I’ve presented.

Furthermore, many of these deaths are not identified at the time for what they represent. Only after reviewing mortality over a period does frequency become apparent. The data set studied by Beliaev and his peers provide such a review. Again, without this retrospective the incidents would appear relatively rare. But these deaths add up over time. The only question is, how many have died due to Watchtower’s blood doctrine.

I maintain the numbers supplied by Beliaev et al are sufficient to extrapolate a minimum value based on certain assumptions. Assumptions such as 1) JWs around the world tend to accept/reject blood similar to JWs in New Zealand, 2) the frequency of JWs worldwide suffering severe anemia is similar to JWs in New Zealand (adjusted for Maori ethnicity), 3) New Zealand’s healthcare is not less than the rest of the world on average, and a few others spoken of throughout this discussion.

Scott77,

I think the value you’re looking for is P < 0.05.

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

-

“Well, I am not going to argue with you any more, you just keep repeating the same things, and dismissing any other concerns. I don't have confidence in your numbers, but you won't or can't imagine you are not 100% correct, so there is no point in discussing it further.”

LisaRose,

I am unaware of any concerns raised that I have dismissed. In each case I’ve examined the concern and responded with content tailored to that concern. The idea that I “just keep repeating the same things” is a product of what’s presented to me as concerns. That is, similar concerns are expressed over and over again in this discussion using different language. I respond accordingly.

I’ve taken much time to address questions and concerns in this discussion. I think if readers spent a comparative pittance of time researching this subject as I have this one they’d hold a very different conclusion. I’d also advise readers who’re unfamiliar with the various means and methods to consult someone who is familiar with it in order to get some help on the subject.

It’s not my aim to convince anyone here of anything. My aim is to research and share what I find. If I’m wrong I want to know. I’m not interested in asserting bogus information or conclusions. I got my fill of that from Watchtower and want nothing to do with the practice.

Furthermore, I agree with sentiments of many here who find fault with spectacular assertions that cannot be supported. Spectacular claims must have support. Otherwise they have a counterproductive affect. In this case my extrapolation of deaths due to Watchtower’s blood doctrine does have support, and that support is only made stronger given the conservative approach. Those who disagree are free to say so, and have done so. What’s important is what we can support.

Any 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

-

“That is what makes me uncomfortable, it's hard to believe the US rates of Anemia are that much different than NZ, so again, are the numbers from the study useful in determining mortality in the US?”

LisaRose,

I have no reason to think mortality statistics related to severe anemia is much different between the United States and New Zealand, and you have not provided anything suggesting this.

You offered some numbers from the CDC. I asked for bibliographic information to consult these numbers to see if they can be directly compared with the statistics we’ve been discussing from the New Zealand study. You didn’t offer it so I could make no analysis.

I did look up the CDC records for year 2010 for deaths attributed to anemia. Those statistics are not based on the same criterion used in the New Zealand study. Hence we cannot responsibly compare one with the other.

The numbers we find in the New Zealand study are useful against populations in the United States assuming JWs in the United States accept or refuse blood transfusion at a rate similar to 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

-

“LISA You say you are not asumming anything, but there you go. What if there were patients in the other hospitals that refused blood, but didn't die at the same rate? What if they didn't die by a higher ratio than the ones selected in the study? The purpose of the study was to get cost/benefit ratios, not determine mortality rates, so it may not be big enough to do that. I think that is what is making every one suspicious. Of course, I am not a statistician, so it's hard for me to say.”

LisaRose,

In the Beliaev study we have hard numbers from 4 large facilities and there is a mix of trauma services (advanced, district and basic).

From this mix of trauma centers we have over 3,000 patient records to populate the control group.

It’s hard to believe this is not representative of minimal mortality among JWs with severe anemia refusing blood.

Both groups had the same facilities and characteristics, with the sole exception that of refusing blood. We would not expect the comparative mortality statistics at other New Zealand facilities to be different than these because within each institution the healthcare capacity is equal for both those who accept and those who reject blood. If anything the institutional rate of mortality would worsen at lesser equipped hospitals among patients refusing blood because though most would have an ability to transfusion blood equal to larger facilities most would not have an ability to equally offer more exotic responses to anemia needed for patients who refuse blood transfusion.

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

-

“In other words, a combination of lifting the ban on some prior treatment methodologies, as well as advancements in medical science, seems to be working.”

The study conducted by Beliaev was mostly of years since “lifting the ban on some prior treatment methodologies” hence to apply the resulting ratio of deaths per capita to historical numbers of JWs (prior to lifting the ban on some prior treatment methodologies) is to keep the extrapolation 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

-

“Obvious guy asks an obvious question (and sorry if this has been asked before and answered, i.e. not ignored), but aren't your calculations used for extrapolation Worldwide assuming that ALL JWs with severe anemia will refuse blood transfusion?”

No.

My extrapolation assumes JWs in the rest of the world refuse or accept blood transfusion as frequently or infrequently as do JWs in New Zealand.

We know all JWs do not refuse blood transfusion. But this is beside the point when it comes to learning a ratio of deaths per capita based on Beliaev’s data set. To determine a minimum amount of deaths due to refusing blood we need only assume Beliaev’s data set represents all deaths of JWs in the 2 regions of New Zealand from which his data set was extracted.

Once we have a minimum amount of deaths we need only compare that number with the number of JWs in the same region. Then we have a ratio of deaths against a known number of JWs.

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 think, it might have been done to eliminate researchers' bias. By using random selection, reseachers would claim that every segregaed subject in that group had a chance to be selected without bias.”

Scott77,

That’s correct. Once the authors had identified all patient records of treating severe anemia, and once they’d segregated for the issue of study (red cell transfusion treatment or not) then in order to achieve a matched comparison they had no choice but to segregate the red cell transfusion group into subsets to match characteristics of the control group (the JWs) and then randomly select on this basis. But the last step to achieving the 1-to-1 ratio with the control group had to be randomized in order to reduce bias and otherwise satisfy statistical rigor.

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

-

“Why would they 'randomly' select patients from the segregated groups?”

Simon,

To achieve a 1-to-1 ratio for a matched comparison study.

“If they were dealing with such low numbers why not include them all?”

They included all they could and have and maintain a matched comparison.

“All this does is increase the chance that if you repeated the study you'd get very different results.”

Not at all for purposes of gaining a ratio of deaths per capita of JWs in New Zealand. Death’s per capita means only how many deaths for how many in a given population.

In this case the study by Beliaev established a minimum value (number) of deaths among JWs for refusing blood during years 1998 to 2007.

We have published statistics of JWs for New Zealand over the same period hence calculating the ratio of deaths due to refusing blood becomes simple arithmetic.

The sole liberty I took in my presentation was to prorate the number of deaths based on population distribution compared with the sources Beliaev got his data.

For purposes of learning the number of JWs who died for refusing blood during years 1998-2007 it would not matter whether Beliaev cherry-picked his comparison group because this would not change the number of deaths in the JW group for refusing blood, and it’s the number of deaths in the JW group used in my extrapolation.

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 sorry, but this is still confusing to me. That mortality percentage above is from the patients who died in the study, against the general population in that part of the country. But didn't you say there were other hospitals in that part of the country? If there are eighty hospitals, there must be more than four in the part of the country that has 57% of the population. So then might not the other hospitals have anemia deaths too?”

LisaRose,

There are loads of hospitals in the same 2 regions as the 4 whose patient records are part of this study. We’d be naïve to think none of these other hospitals in the same 2 regions had JW patients with severe anemia refusing blood who died as a result. But to keep my extrapolation conservative, for statistical purposes I assumed no such deaths at any of these many other facilities in the 2 regions.

When I was constructing the per capita deaths of JWs in New Zealand due to refusing blood I assumed the only deaths in the 2 regions were the ones reported by Beliaev.

Does that answer your question?

Oh, and by the way, I’m still not sure what your earlier statistic speaks to in terms of “severe anemia” but I did find the CDC report for deaths attributed to anemia in the United States and for year 2010 the adjusted number is 4,631 of a population of 308,745,538. This represents an annual mortality of 0.0014999%, which, based on the proration I used in my presentation is more than the annual mortality among New Zealanders by a factor of 170x. This makes my extrapolation conservative by comparison.

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

-

“Does he say what the outcomes for the 3,000 patients were? How 'increased' was the risk to JWs when they were taken into account? Aren't you talking about 19 out of 3,000 and not 103?”

Simon,

Outcomes for the 3,000? He does not give this because his study was of and only of outcomes and costs in relation to treating patients suffering severe anemia.

Increased risk when the 3,000 are taken into account? What does that have to do with our discussion? We are talking about increased incident (not rate) of mortality of patients with severe anemia refusing blood.

We can talk about rate or rates of mortality until the cows come home and it won’t change the number (the incident) of statistical deaths among JWs in New Zealand with severe anemia refusing blood for the years of 1998-2007.

“It sounds like his model was perfectly designed to give the answer he was looking for which is basically that patients with severe anemia that are urgently in need of a transfusion are better off having a transfusion.”

The authors were looking for a means and method to compare outcomes and cost between treating severe anemia patients with red cell transfusion versus not treating them with red cell transfusion. The only means and method available was to dig into patient records for individuals with severe anemia who refused blood transfusion. There was no way to conduct a controlled trial because it would pose an unethical threat to patients. This left JWs.

Hence the authors scoured patient records from 4 trauma centers and extracted all incidents where patients suffered severe anemia and then separated these into 2 categories. 1 group that accepted red cell transfusion and 1 group that refused red cell transfusion. Will call this Group A and Group B respectively.

Then they examined Group B (the group that refused transfusion) and used it as a model to segregate patients in Group A based on things like general characteristics (i.e., gender, ethnicity, comorbidities, hospital admission type and treatment type). Once this segregation was made the authors randomly selected from the segregated patients of Group A to achieve a matched comparison to Group B so that both groups were very close in all comparisons accept one, and that one comparison was whether the patient accepted or rejected blood.

From that point forward it was only a matter of math, including making adjustment for things like Maori ethnicity given severe anemia was the subject.

The thing about math is that it speaks for itself.

This is what the authors did.

Marvin Shilmer