Marvin Shilmer

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Posts by Marvin Shilmer

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  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  Adamah,

  I had a colleague make inquiry.

  None of the minors included in Beliaev’s study died for blood refusal.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “The other causes of death are based on the figures for the general population with the same percentages applied to the JW population. If more JWs were dying because of refusing blood transfusions then those would be in addition to those values shown which would be larger to encompass them. I don't think your point is at all relevant as it wouldn't materially change things.”

  Simon,

  You’re operating under a false premise.

  We have mortality figures for the population in general.

  We do not have mortality figures specific to JWs to know if their mortality rate is higher than the general population.

  If we assume JWs would have an identical mortality rate as the general population were it not for their unique blood refusal then the factor of blood refusal would only increase that mortality rate for conditions like, for instance, severe anemia.

  As it stands deaths of JWs due to refusal of blood are distributed throughout that table you showed a few pages back. Because of this it is impossible to compare one with the other without being able to extract one from the other first.

  “Personally, I think a claim that at least 3 out of every 100 JW deaths would be due to refusing blood is laughable.”

  Yes. You’ve made that clear. What you’ve not made clear is that you understand the math showing how well dispersed these figures are to the point of not being able to observe without retrospective statistical analysis. I don't think you understand this at all. But, then, we each are entitled to opinion. Right?

  “I doubt 3 out of every 100 even have "refusing blood" come up as an issue. How many people simply die of old age? Not every death is a dramatic event.”

  You probably won’t understand this, but I’m going to point it out anyway. The “refusing blood” issue arises as a factor every time a JWs presents themselves for medical service. When or if this has an impact on a patient’s survival is often unknown (and maybe unknowable) at the time. It can only be identified after the fact by a statistical analysis of hundreds if not thousands of patient outcomes.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  Adamah,

  For varied reasons you and I hold different views on how much the teens in Beliaev’s study (assuming there were teens in the group) would influence the number I concluded. That aside for a moment, I’m not sure your direct comparison of legality has the effect you think because in service areas like the USA though the law is different I’m not so sure the outcome is different. Let me explain what I mean.

  Doctors in the USA have a duty to provide appropriate care for all patients.

  When an adult patient refuses appropriate care doctors are not allowed to overturn the decision unless the patient is incompetent or does not have a healthcare proxy completed when they were competent.

  When a doctor is confronted with refusal of treatment by a minor or parents/guardians of a minor a legal and ethical challenge arises over what is appropriate care for the patient when alternative treatment exists. Because there is much gray area in medical science as to what is appropriate care under most circumstances doctors in the USA have been compelled to apply alternative medical therapy though it’s not what they think is most appropriate. In effect, they are compelled by peers and this pressure is brought to bear through the conduit of Watchtower’s Hospital Liaison Committee groups.

  In comes practitioners like James Isbister and Aryeh Shander. These men have good credentials and training, and they are influential when called upon for consultation. Both these men (and many more like them with their own ideas of appropriate use of blood product) have made a pretty good living off the patient population of JWs. I’m not suggesting these men have somehow mistreated this patient population or otherwise behaved inappropriately. What I’m suggesting is that when these men speak up about success they’ve had treating JWs without blood it places pressure on local clinicians to approximate the same therapy in order to avoid complications such as legal costs.

  I don’t want to reveal his name, but I know a now-retired cardiologist who was among the very best in the world at treating pediatric heart patients. I was in the room with him several years ago with a JW child under discussion. He flatly refused a particular treatment option saying it was an unethical because there was a safer option that would fix the problem whereas the treatment at issue was only temporary and the safer option would eventually have to be performed. He explained in detail one risk in particular of the temporary fix. He said it would place undo stress on the child’s heart causing it to enlarge, which would place the child at increased risk of death. The local HLC member in the room had prearranged a phone conference with another world-class pediatric cardiologist. This consultant went on and on about how the procedure was completely acceptable and was well within standards risk acceptability. She plied lots of information on how many times she’s performed this procedure with success. The heart surgeon on my end was upset by this consult, but he eventually agreed to perform the temporary fix job. The child died 1-1/2 years later of an enlarged heart at a hospital more than 300 miles away from the cardiologist.

  This thing happened to a near infant. I’ve been in rooms on many occasions where the same thing was done, and more often than most people would expect, the physician lays down and does what he or she’s asked.

  That baby’s cause of death was not filed as “refused blood”. But that’s what caused that child to lose its life.

  This is how things have been structured and to this day we still have children dying as the result.

  Have you read the Watchtower organization’s May 22, 1994 journal issue of Awake? Take a look. You’ll see what I’m talking about.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “Let me be clearer: are you saying that out of every 100, over 3 of them will die as a result of refusing blood? Do you think that number looks reasonable compared to other established figures.”

  Simon,

  There are no "established figures" for how many JWs die the result of refusing blood.

  What you term “established figures” are deaths across a spectrum of causes within which is buried deaths attributable to refusal of blood. You can’t compare against these “established figures” when what you’re comparing against is within the same figures. You have to have a way of extracting the deaths in each case attributable to refusal of blood. This is something the data set from Beliaev offers some insight into.

  That 3 of 100 deaths is attributable to refusing blood transfusion among a group who refuses blood transfusion regardless of disease or condition considering that all 100 will suffer multiple diseases and/or conditions during their lifetime is no shock to my senses.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “I don't know where you think I've insulted you.”

  Simon,

  Respectfully, since you don’t seem to understand it then let me spell it out for you:

  Telling someone they are intentionally ignoring a substantive issue for sake of a preferential view is an insult.

  Any questions about that? Do I need to underline it?

  “So, do you believe that roughly 3+ people out of every KH will die from refusing blood?”

  “From refusing blood” is the tricky part for all the reasons I expressed in this discussion.

  I believe it entirely possible that among a group of people who refuse a medical treatment used across a broad range of presentations and is important to mortality in each case that that group of people will end up suffering the rate you cite. Problem is this is not apparent at the time and it’s only recognizable after the fact when/if someone digs through thousands and thousands of individual patient records to look for a common denominator. In the case of JWs that common denominator is refusal of blood product.

  “No one is questioning the value in very specific circumstances. But you are taking the outcomes of those very specific circumstances and applying it to many others that don't match.

  “In some cases refusing blood will have saved someone's life. We rightly don't take those specific outcomes and try and apply it to all JWs do we?”

  JWs refusing red cell transfusion in the Beliaev study had all manner of Watchtower approved alternative therapy applied. If these alternative treatments saved someone’s life then it showed up in the data set as a non-mortality.

  As for applying specific circumstances to others that don’t match, I’m not doing that at all. What it takes to be a healthy human in New Zealand is no different than what it takes to be a healthy human anywhere else in the world. Humans have similar anatomies, morbidities etc. Hence my treatment of statistics in the Beliaev study does no more than transpose the result onto the total population of JWs in the world by treating them all as equal.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “Whether you realize it or not, you ARE making a claim in your assumption that is implied: you ARE claiming that the rates of rejection are the SAME in NZ JW and in JW's Worldwide, and hence the burden of proof falls on YOU to PROVE that claim, since YOU want to make the positive assertion that this assumption is valid.”

  Adamah,

  I do assume what you say for sake of an extrapolation.

  If someone has reason to doubt that assumption then they will have reason to doubt my extrapolation to the extent they think it a factor.

  To my knowledge no one can quantify the point you raise so I accounted for the factor by assuming the neutral. I'm fine with that, and I'm fine leaving it for each person to make of as they wish. This is why I stated the assumption.

  “Marvin, it comes down to this:

  “Does the sub-population of JWs with anemia who refused blood and who were included in the study have a higher mortality rate than:

  “1.JWs
  2.JWs in NZ
  3.JWs in NZ who face a treatment choice
  4.JWs in NZ who face a treatment choice and refuse blood
  5.JWs in NZ who face a treatment choice and refuse blood and were in the study area
  6.JWs in NZ who face a treatment choice and refuse blood and were in the study area but excluded from it

  “If your answer to those is "yes" then how can you extrapolate the numbers to those populations? Even the last couple would be a stretch, the first ones would be a giant leap.”

  Simon,

  I do not answer yes to those questions because I treat each one on par between the JW population in New Zealand and the rest of the world on average.

  My extrapolation assumes in each case that JWs elsewhere in the world do not on average have a higher mortality rate than the 12,700 annual number of JWs living in New Zealand at the time for all causes and circumstances. My reason for thinking this a safe (conservative) assumption is because of the published longevity and healthcare opportunities available to JWs living in New Zealand compared to the rest of the world on average.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “Marvin is focusing on this particular study because other studies have failed to show increased mortality, at least not in the way this study dos. But this study was one study, in only four hospitals, in one part of one small country. It simply cannot be extrapolated out over the entire JW population, over fifty years. But, as everyone else has said, even one death is too many and we should focus on those individuals and their stories, rather than trying to make this study show something it doesn't and can't.”

  LisaRose,

  That’s rubbish!

  All studies known to me show that risk of mortality increases with decrease in Hb level < 7-8 g dL accompanied by lack of red cell transfusion (whether refusal, neglect or lack of resources).

  This is not what’s unique about the Beliaev study, and I’m not going to keep repeating myself. If you want to know what is unique (in my view) of Beliaev’s study then dig back through this discussion. It’s there multiple time and expressed multiple ways.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “Marvin, just wondering how many JWS have died for not taking a BTs under your own beliefs and estimates?”

  Finkelstein,

  At least 50,000 between the years 1961 and 2011.

  “If you are willing to answer a few more questions from me, how long did the study follow these patients? I know it was a ten year study, but for each patient in the study, how long did they track mortality? For example, if a patient who took a transfusion died six months later of cancer, was that death counted in the mortality statistics?”

  I’d have to go back re-read the article but I think it covered the period of hospitalization.

  “What I am getting at is that the study was to determine the cost benefit of transfusions. If a patient took a transfusion lived, then died later of their condition, there would have been a cost benefit for the short term, and the patient would be glad to have extended their life by those months, but the transfusion would not alter the outcome of their disease in the long run.

  “So if a Jehovah's Witness refused the transfusion, and so died sooner rather than later of their underlying condition, can you really attribute that death to the Watchtower?”

  Based on the above I’d say this is a non-factor. I’ll go back and check the article later.

  “Again, you're missing the point and again I think it's so you can skip what I'm saying. I'm not saying these are "extra" deaths *not* included in the other ones, I'm demonstrating what the NUMBERS equate to and what the likelyhood should be of us all being personally aquainted with someone who dies from refusing blood.”

  Simon,

  Please stop insulting me with insinuation that I’m intentionally ignoring something you’re trying to communicate. I’M NOT!!!

  Has it occurred that maybe you’re doing a poor job communicating to me?

  Now, back to the subject, we have every reason to think the numbers I’m talking about (50,000) are scattered within the causes of death on your chart because that what study after study tells us on select patient presentations. Look up death rates for heart patients with Hb < 5 g dL who refuse blood. The figures are staggering! But when these patients die the cause of death is usually heart disease. Look up death rates for obstetric patients who refuse blood. The figures are staggering. But when these patients die the cause of death is usually listed as obstetric hemorrhage. Look up death rates for cancer patients who refuse blood. The figures are staggering. But when these patients die the cause of death is usually listed as some type of cancer. I can keep on going. Any patient presentation where transfusion of some Watchtower forbidden blood product comprises a substantial treatment modality we find mortality statistics shooting through the roof yet causes of death do not reflect the culprit.

  All these incidents add up, and they add up a lot faster than folks comprehend because of distribution of morbidities and population.

  “From your figures, for every KH of 100 people then 3+ of them will die from refusing blood.”

  Eventually all 100 will die. (Not said sarcastically) The factor we’re talking about is whether refusal of some Watchtower forbidden blood product causes a premature death, and if so how many. In my neck of the woods most of the 100 will die over age 70 and by that time there’ll all have plenty of comorbidities and have suffered many throughout their life. Heart disease. Cancer. You name it. Each of these presents an increased risk factor for JWs somewhere in the world. Each of them, and each time they occur during one person’s life. When we layer this risk factor onto the 100 for each instance of a comorbidity it’s easy to conclude at least 3 of the 100 will suffer premature death due to refusing blood.

  That’s how the number of preventable deaths gets hidden in the math. Statistically we can assign these deaths only by retrospective statistical analysis. But from a purely observational perspective there’s an even bigger reason why it seems counterintuitive to think 3 of the 100 died from refusing blood: because in the world of JWs even with a death is directly attributable to blood refusal its glossed over with a “we can’t say for sure what caused his death” mentality. This does not begin to address deaths that are caused secondarily by refusal of blood. JWs and novices close to JWs don’t see these deaths because they are not readily apparent for what they are and the community dismisses many incidents that are obvious.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “Within the framework of science, remember that the rule is, "an absence of evidence is not evidence of absense", since that is what is called, "making an assumption".”

  Adamah,

  I agree with that statement. Hence I made no assumption of deaths I was unaware of. I don’t see disagreement on this point. I was only stating the obvious.

  “I know that, and assumed you'd know that the "population" you're trying to extrapolate to IS the JW Worldwide population: OF COURSE it's not the entire population of BILLIONS of humans who live on Planet Earth. Odd that you'd think I wouldn't know that, having taken a few years of stats more than you?”

  I can’t read your mind. I can only read what you write. That’s what I responded to, plus more in case you were speaking of only the worldwide population of JWs.

  Given that you were speaking to the worldwide population of JWs (not literally “the entire population Worldwide”), then I fail to see your point and you’ve not clarified as requested.

  1. If as a population JWs have a higher rate of anemia because of the unique factor of refusing red cell transfusion, and

  2. If the sub-population of JWs with anemia have an again higher mortality rate because of refusing red cell transfusion, then…

  Then so long as the population I correlate this with is JWs then I see no reason why those factors are any reason for why the Beliaev study is, as you say, unfit for extrapolation purposes. I have no reason to think JWs in New Zealand refuse red cell transfusion any more or less than JWs anywhere else in the world. Do you?

  “If you want to claim to generate a "conservative" figure, you'd also need account for the sub-population of those JWs under 18 who are included in the total head count (7.4 mil, or whatever it is) to remove them from the calculations, since they are generally protected as minors in most Countries.”

  Though having that information would be useful, I don’t think it absolutely necessary to estimate a minimum level of mortality due to Watchtower’s blood doctrine. Having that information would only help make a prediction of a total number more precise, but it would not necessarily decrease an otherwise conservative estimate of a minimum.

  Among JW patients who died in the Beliaev study odds are the cause of death at the time was probably assigned to something other than lack of red cell transfusion. The finding that lack of red cell transfusion was a predominate factor in so many cases was something discovered after the fact. Hence for teens in the study we shouldn’t presume doctors were doing anything other than what they felt was the most appropriate treatment at the time whether that included red cell transfusion or not. The study by Beliaev does not say these patients died because of severe anemia. And, in many cases of severe anemia the best standard of care in a healthcare service area like New Zealand is not red cell transfusion.

  Marvin Shilmer
• 
  739

  250,000 Jehovah's Witnesses have died refusing blood

  by nicolaou in

  1. watchtower
  2. medical

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

  250,000+ #jehovahswitnesses have died refusing blood.

  stop this #cult!

  1. 
  2. 
  3. 
• 

  Marvin Shilmer

  -

  “And you must acknowledge that one study is less convincing than six that show the basic same thing. And you must also acknowledge that a smaller study has more room for variation than a larger one. If you can agree with that, we can move on.”

  LisaRose,

  More documented information is always more convincing that less documented information. In other words I’ve expressed this several times during this discussion. I haven’t changed my mind.

  Adamah,

  When composing my extrapolation I considered the issue of teens and a higher incidence ratio unrelated to refusal of blood product (e.g., Maori ethnicity).

  Here’s why I opted not to mathematically account for the issue of teen deaths due to red cell transfusion refusal:

  1. I don’t know that there is anything to account for because I don’t know that any of the teens are among the 21 deaths in the 103 JW patients.

  2. I’m familiar with laws and customs related to refusal of treatment of a broad spectrum of healthcare service areas around the world. I disagree with you about the potential for inclusion of teens in Beliaev’s study by comparison for at least the following reasons: 1) In third-world areas refusal of blood transfusion by adults alone would more than offset the potential disparity you cite because these service areas are more dependant on red cell transfusion to treat anemia than in developed service areas. 2) In developed healthcare service areas (e.g., the USA) there is a medical ethics concept known as “mature minor”. Under this ethical legal construct doctors and institutions have allowed themselves to perform high risk procedures on minors who achieved a rather subjective competency threshold value and who refused blood. At the very least this would mitigate the effect you cite. 3) The advent of alternatives to red cell transfusion to treat anemia (particularly in the Hb range of =/<8 g dL to >7 g dL) further mitigates the effect of teen inclusion because the threshold value of Hb =/<8 g dL does not necessarily demand transfusion of red cells when alternative treatment is available. In many instances there is actually a good medical argument not to give red cell transfusion to treat anemia Hb =/>6-7 g dL. Hence had a JW teen with Hb =/>6-7 g dL not been treated with red cells transfusion it could easily be the case the transfusion was avoided because of implementing an alternative therapy that is arguably better and that this was done regardless of patient preference of no red cell transfusion. In other words, in these cases alternative treatment effectivly trumped the question of red cell transfusion or no red cell transfusion.

  3. In addition to the preceding, there are additional deaths due to JWs refusing blood products other than red cells, and the Beliaev study examined outcomes related strictly to red cell transfusion. Alone this single factor would likely (if not surely) outweigh the effect you cite of teen inclusion, should it be real.

  “Not only does the sample population have a higher rate of anemia, but you admit that in the sub-population it has a higher mortality rate if left untreated, and those two factors explain WHY the study is unfit for extrapolation purposes: it's not truly a representative sample of the entire population Worldwide.”

  I do not compare results of the Beliaev study with the entire population worldwide.

  I compare the result of the Beliaev study with the population of JWs worldwide.

  JW make up the “the sample population” you speak of and the “sub-population” you speak of, and it's mortality among the JW population that is at issue.

  If I’ve misunderstood you please feel free to restate yourself or otherwise clarify.

  Marvin Shilmer