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

-

“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

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

-

“OK, got it. By dataset, you mean the number of JWs in the study who died in excess of the number non JW patients.”

LisaRose,

By “data set” I’m talking about the matched comparison established by Beliaev which included all 103 JWs who refused red cell transfusion in the 4 hospitals between 1998-2007 who experienced Hb =/< 8 grams dL and the matched records at a 1:1 ratio of 103 non-JW patients who did not refuse red cells transfusion in the same hospitals between 1998-2007 who experienced Hb =/< 8 grams dL.

Of these 206 patients 21 of the JW patients died and 2 of the non-JW patients died. The disparity is 19.

“So the 15 % is using that number (per year) by all regions of NZ, the .026% is for only the two regions involved in the study. The reason for that is that you feel that is closer to the true amount, but still conservative, by your calculation?

Presuming you meant to keyboard .015% rather than 15%, essentially what you write is correct.

As I explained earlier in this discussion there are, basically, two ways to align these statistics so that a value obtained from 2 regions aligns with New Zealand population. One way is to treat the 19 deaths as a factor of the 57% of New Zealand’s total population living in the 2 regions, which in the case of JWs would make the rate of annual mortality 0.026% of the JW population. Alternately you can align these numbers by treating the 19 deaths as representing 57% of deaths in the total population of JWs in New Zealand. Both methods achieve the same result of 0.026% annual mortality of the JW population.

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

-

“OK, the .015 percent figure is based on the number of JWs who died due to severe anemia, compared to the total number of Jehovah's Witnesses in that part of NZ?”

No.

The .015% figure is a percentage of JWs in all 4 regions of New Zealand in relation to a data set (the number of JWs who died over and above the norm) extracted from only 2 regions of New Zealand.

This is why my extrapolation goes on to adjust for population distribution in the 4 regions so that the data set is comparable to total population.

“So that percent could be higher, if deaths from other hospitals had been included?”

The percent could be higher and would be higher if there were comparable deaths at any additional hospitals in the same 2 regions as the data set came from.

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, because I asked a yes or no question, and you did not give me a yes or no response.

“It's sounds like from your response, that no, you did not include any JW patients who may have died in hospitals other than the four in the study.

“Please confirm, yes or no.”

LisaRose,

You’ve asked two different questions, each asking for a yes or no. Let me simplify and supply yes and no responses:

No. My extrapolation does not include any JW patients who may have died in hospitals other than the four in the study.

And,

No. My extrapolation does not include any JW patients who may have been treated for anemia in hospitals other than the four in the study.

Why those answers don’t suggest possibility of an inflated conclusion from my extrapolation:

My extrapolation only uses the hard-count of deaths over and above the norm from the 4 institutions against the population of JWs in the 2 regions.

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 the part I have trouble with. The study included four hospitals. There are more than four hospitals in that part of New Zealand. If there were Jehovah's Witnesses in that part of New Zealand being treated for anemia in other hospitals they would not have been included in the statistics. That would mean your statistics are low, which you feel is OK, because it is a more conservative number.

“Yes, or no response please, you can then add an explanation.”

The answer is not a simple yes or no because we’re not dealing strictly with incidents of “severe anemia”. The statistical deaths of “severe anemia” JW patients due to refusing blood is the count used in my extrapolation, and in this case I’ve intentionally based this count on the localized data set for the 2 regions

When we do a patient-to-patient matched comparison between patients in the same institutions with the same comorbidities et al so the sole difference is accepting or rejecting red cell transfusion we end up with a differential based strictly on accepting or rejecting red cell transfusion.

When this patient-to-patient matched comparison is performed across 4 separate medical institutions there is a degree of confidence that institutional variation has been accounted for within the spectrum of like facilities, which in this case is an array of trauma service facilities. Regardless, the matched comparison still gives us a statistical hard-count of units (statistically preventable deaths in this case) for those 4 institutions.

My extrapolation assumes a valid matched comparison and does not include any more deaths other than the ones indicated by the above differential. In other words, my extrapolation only uses the hard-count of deaths over and above the norm from the 4 institutions against the population of JWs in the 2 regions. I assume there are no additional deaths to count in the ratio of deaths per capita of JWs in New Zealand.

If another institution had as many as 10,000 or as little as 1 JW patient with “severe anemia” it would not change the statistical hard-count of deaths found by the differential in Beliaev’s study of patient data from the 4 institutions.

If another institution in the 2 region data set had even 1 death of a JW patient with “severe anemia” and refusing blood this would increase the ratio of deaths per capita of JWs in New Zealand. This is probably the case. But my extrapolation does not assume this. It assumes no more than the hard-count derived from the matched patient comparison in the 4 hospitals for the 2 regions.

Does this answer your question?

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

-

LisaRose,

When I initially published my article on deaths due to Watchtower’s blood doctrine I knew there was a detail of presentation I had spotted in need of rewording, but I got sidetracked and either forgot to make the correction or else was unable to find it. Your questions above helped me find it. Thanks.

I just changed:

“18.45% of 1.43 deaths per 1,000 is 0.26 deaths per 1,000.”

To read:

“18.45% of 1.43 per 1,000 cases of severe anemia is 0.26 deaths per 1,000.”

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

-

“What if the Witnesses in New Zealand did actually suffer anemia at a higher rate?”

LisaRose,

As a point of clarification:

If JWs in New Zealand did actually/statistically suffer anemia at a higher rate compared to JWs in other service areas of the world on average then my treatment of this as an even rate across the total population of JWs would artificially inflate the statistical mortality.

But I’ve made no assumption on this point. That is, I’ve calculated the statistical percentage of incidents based on the information before me and used that figure without assuming it low or high. You could say I’ve assumed the rate is even. But assuming this leaves the information before us to speak for itself rather than presuming something other than what that information says at face value.

Marvin Shilmer