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, you say the patients were matched, but how closely? 103 patients is a very small sample. The paper that critiqued the study did mention they were comparing apples and oranges, as far as ages, and other criteria. it makes me wonder if it really is a valid comparison. I guess that is enough for the purposes of the study to say that, yes, taking blood results in less mortality, but is it enough to extrapolate from a sample with any degree of accuracy?There has to be a level of error in that study, and that level of error could result a huge difference, even if you are conservative on other areas.”

LisaRose,

The article “Comparing Apples with Oranges” by Isbister is based on a false premise that deviations such as age were not responsibly corrected for. Don’t ask me how Isbister overlooked this. But he did. You can see the corrections made in the tables, and it’s even pointed out in a footnote for those who didn’t take time to analyze the tables.

If we assume an extreme error (say, 50%) it would not begin to offset all the conservative inputs I assumed for sake of my extrapolation. I used an input value of 19 deaths. There are way more than just the 19 deaths due to refusing red cell transfusion. On top of this are additional deaths due to refusing platelets transfusion. On top of this are yet more deaths to add to the input due to refusing plasma exchange transfusion. Then we have the previous years’ greater dependency on blood transfusion prior to alternative techniques, methods and medicines we have today. This previous increased dependency on blood transfusion would add yet again to the input value.

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

-

“Given that you admit that the changes would have an impact on thedeath rate, isn't it a little disingenuous to suggest that the figure produced by a formula that ignores these changes is accurate and conservative?”

Simon,

Of course the figure produced by my extrapolation is not disingenuous because my extrapolation is as stated: Since 1961 we can conservatively estimate that at least 50,000 of Jehovah's Witnesses have died due to Watchtower's blood doctrine. What does "at least" mean to you, Simon?

Whether my extrapolation is conservative in order to establish a minimum value is for critics to examine. So far I’ve been offered no evidence showing my value is anything other than minimal.

“Again, you are so convinced that you are 'conservative' that you are not even willing to even consider any ways that you may not be. The 19 dead in the study could be a large cluster for all you know and not indicative of results elsewhere or even there for the following or preceeding time periods.”

The 19 deaths are still 19 deaths. Right? Guess what? The 19 deaths is not an understatement because we know they occurred, and that is the baseline input used in my extrapolation.

Mortality resulting from refusal of red cell transfusion in years previous to 1998 would only inflate the value of my extrapolation because in previous years patients were more dependant on red cell transfusion than today.

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: You keep with the assumption that things could only ever increase your value and seem blind to anything that could possibly decrease it.”

Simon,

Then name something that would tend to inflate my value that I have engaged in.

“When extrapolating very small numbers to very large ones the slightest change can have a dramatic effect on the final figure.

“It's for this reason that I think your conclusions, while well intentioned, are possibly incorrect and misleading.”

Let’s talk about how small numbers and their influence.

My input number of 19 deaths comes from 4 hospitals with trauma services out of 14 hospitals with trauma services in the same region. Do you think there were ANY additional like deaths at any of the other 10 hospitals with trauma services? How about the scores of other hospitals in the same region that don’t offer trauma services but do have emergency rooms and treat bleeding patients? Do you really think my input value of 19 is POSSIBLY inflated based on this?

If so, please tell me how. I’d really love to know.

My input number of 19 deaths DOES NOT include any deaths resulting from JW refusing a blood product other than red cells. Do you know how many other blood products prevent premature death everyday of the week by their administration by transfusion? Were I to account for any of these additional deaths it would only increase my input value of 19. Right? So, do you really think my input value of 19 is POSSIBLY inflated based on this?

If so, please tell me how. I’d really love to know.

Oh, and I could keep going with a pretty long list. Need I?

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 just asking the questions at this point. I understand the study excluded patients in palliative care. But they could have had cancer that was still being treated, no?”

LisaRose,

Yes. There were many comorbidities other than severe anemia. But, again, this was a matched comparison study so these comorbidities existed in each group; hence the differential in mortality was solely due to lack of red cell transfusion. When it comes to cancer, the study shows the non-JW group included nearly twice as many with this comorbidity/history. Despite this the non-JW group had a mortality rate that was in the basement compared to the JW 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

-

“This is why anything that's based on a simple calculation is fundamentally flawed.”

That’s false.

A calculation’s level of complexity (less or more) is no indicator of correctness.

“A true model is needed taking into account the different factors of both WatchTower doctrine AND medical treatments available as well as the number of JWs around and the likelihood that they would refuse blood treatment and die as a result of it as each period of time (whether per year or per decade).”

That’s false.

We do not need to account for all different factors if we want to extrapolate based on conservative inputs. My calculation was done intentionally with the use of conservative inputs at every turn in order to establish what amounts to a minimum value. So 1) when it comes to Watchtower doctrine the conservative approach is to use statistics influenced by changes that were formally issued in year 2000. The data collection of Beliaev has this statistical influence because most of the data was accrued from year 2000 onward. And 2) when it comes to medical treatments available the conservative approach is to use statistics based on current medical technology rather than outdated medical technology. The Beliaev study fits this bill, too.

“Simple logic: if the period the study covered was the worst period for JWs dying then you can't apply the results to ALL periods. Does anyone truly believe that the risk has been constant and that changes in doctrine and treatment have no effect?”

In answer, no. More importantly, my extrapolated value opts for inputs that are least likely to inflate the outcome and most likely to deflate the outcome. This is a strength of the approach I took to answering the question of how many JWs have died due to Watchtower’s blood doctrine. My extrapolation is 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

-

“The things I mentioned can't possibly be included in Marvin's calculation.”

TD,

Exactly, and they are not.

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 don't know how Marvin (Or anybody else) could statistically account for these types of things, but if they could be accounted for, they would inflate rather than deflate his numbers.”

TD,

As you say, each of the factors you present would only increase my extrapolated value if they could be accounted for, and there are many others. Take, for instance, TTP (thrombotic thrombocytopenic purpura) patients. The outcome for these patients is dire without plasma exchange, but with plasma exchange therapy the outcome is greatly improved.

Prior to year 2000 JWs with this condition had to refuse this therapy and opt for a less effective alternative with greatly reduced efficacy. Since 2000 Watchtower doctrine allows JWs to accept transfusion of a plasma product known as cryosupernatant, which can be and is used effectively for plasma exchange therapy. This therapy has saved lives that otherwise would have ended prematurely.

But no deaths attributable to refusing plasma exchange therapy are counted toward my extrapolation. Were we to include these then my extrapolated number could only increase.

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

-

“Now I understand a little better how you got your numbers. I have some questions about the study itself. For the Jehovah's Witnesses who died, do you know if any of them had an underlying condition that would have been fatal eventually, even if they had accepted a transfusion? For example, cancer, or some other serious illness?”

LisaRose,

The JW patients in palliative care were excluded from Beliaev’s study.

Don’t forget that the Beliaev study was a matched comparison. This means patient profiles and comorbidities were accounted for. So, for instance, in the 103 JW patient pool there were 8 with cancer and in the non-JW pool there were 15 patients with cancer. But regardless of condition, if treatment options were exhausted so a patient was in palliative care they were not included in the study because inclusion would skew the result.

Accordingly, the factor you raise is not one that would inflate my extrapolated value.

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 think I understand what you did, that is a start. I think your calculations are unorthodox, to say the least. You are simply comparing the number of JWs who died in the study over and above the rate that non JWs died in the study (annualized), then dividing it by the number of JWs in that part of New Zealand to obtain a percentage. You realize that there might have been other deaths in the other hospitals in that area, but you are simply using the numbers you know for sure to have died, because they were in the study. Thus, it is a conservative number, actual numbers were probably higher.

“You then apply this percentage to the number of Jehovah's Witnesses throughout the world, per year, since the blood doctrine has been in place.”

LisaRose,

We can characterize it however we want, but having a direct ratio of attributable deaths among a captured population of JWs goes a long way toward grasping the extent of the issue. One thing that makes the New Zealand population of JWs very helpful in this regard is the standard of healthcare and accessibility we have there. If anyone can survive severe anemia it's patients in a service region like New Zealand, which for purpose of my extrapolation makes the mortality numbers more conservative.

Yes, I fully realize in all likelihood there were additional deaths among JWs in the same 2 regions of the data set for the same reason identified by Beliaev. There are a variety of mathematical models we could employ based on this probability but for sake of keeping my extrapolation as conservative as possible I refrained from publishing these values, though I did speak of one of these additional extrapolations much earlier in this discussion.

To clarify one item you mention, my extrapolation does not include mortality values for years 1945-1960 because a very substantive change occurred in year 1961 in relation to Watchtower’s blood doctrine. 1961 was the year JWs were made subject to disfellowshipping for accepting blood products like red cell transfusion. Hence my extrapolation is only for the 50-year period of 1961-2011.

“If I have it right, then we can move forward. I appreciate you being patient in answering my questions, but I want to make sure I understand your methodology.”

In the end my methodology boils down to using what in all likelihood is a fraction of mortalities as though that fraction represents all mortalities among a quantifiable population of JWs in the same service area. This yields a ratio that we can then use as a conservative indicator to estimate mortality in the same group in service areas whose standard does not exceed that of the original, which in this case is New Zealand.

Please feel free to move forward with whatever you need to ask.

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

-

To add a little insight into this whole discussion there is a dynamic at work I’m not sure is understood (or accounted for) among critics. It’s this:

1. Anemia is a largely treatable condition. This means that incident of anemia (in this case Hb =/< 8 grams dL) does not translate into a mortality statistic at a 1:1 ratio.

2. A primary therapy for treating severe anemia (Hb =/< 8 grams dL) is red cell transfusion. Study after study demonstrates red cell transfusion of patients with Hb =/< 8 grams dL results in lower mortality. The lower the Hb level the more dramatic the mortality without red cell transfusion.

There has been much bantered around in this discussion about whether New Zealanders have a higher rate of anemia (in this case Hb =/< 8 grams dL). This criticism boils down to: If New Zealanders have a higher rate of anemia compared to the rest of the world on average, this could mean my extrapolation at issue is inflated.

Here’s what wrong with that notion: There is a difference between rate of anemia and rate of mortality due to anemia, and there is a gargantuan difference between rate of anemia and rate of mortality due to refusing blood with anemia.

Because anemia is a largely treatable condition then rate of anemia is not so much a determinant of mortality due to anemia. What counts in my extrapolation is not rate of anemia (or severe anemia) but, rather, known deaths attributed solely to lack of red cell transfusion in patients suffering severe anemia. Rate of anemia does not change this mortality statistic against the population.

What this means is that if we assume New Zealanders have a higher incidence of anemia this does not mean New Zealanders have a higher mortality due to anemia. Yet, again, regardless of either statistic the number of known deaths attributed solely to lack of red cell transfusion in patients suffering anemia does not change. The study by Beliaev shows that 2 regions of New Zealand’s population had 19 deaths of patients with severe anemia attributed to lack of red cell transfusion.

Marvin Shilmer