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 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

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

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

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

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

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

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

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

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

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

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

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

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

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

250,000+ #jehovahswitnesses have died refusing blood.

stop this #cult!

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

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 just want you to admit that the study could be flawed, as most studies are.”

LisaRose,

I don’t know that a particular presentation of information is flawed until a flaw is demonstrated one way or another.

I don’t know that “most studies are” flawed. That’s a sweeping generalization.

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 wonder if is even possible they matched these patients in enough ways to make the results statistically meaningful. People are all unique individuals. Unless you are comparing identical twins, it's obvious that they are not matching in every thing, maybe not even then. You brush off the criticisms of Ibister as if they are nothing, but he did say they were comparing apples to oranges. I believe you do not want to accept the possibility that he could be right. With only 103 JW patients, it wouldn't be hard to totally throw off the results. That is why the results of only one study are suspect, especially when the control is so small.

“Do you not see the possibility that the study could be wrong or overstated?”

LisaRose,

I’ve not brushed off Isbister’s criticism. I’ve pointed out a demonstrable false premise of his criticism. He overlooked the very thing he complained of. It’s right in the articles for everyone to see.

To borrow a phrase, Do you not see the possibility that Isbister could be wrong?

Otherwise, in a matched comparison the disparity between 2:103 and 21:103 is not likely to be freak happenstance.

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 figures are approximations by applying the cause of death data to the JW population.”

Yes. That is what I said before in other words.

Refusing blood is almost never cited as cause of death. The deaths we’re talking about are buried in the numbers in your chart from one side to the other, sometimes including even suicide believe it or not.

“Now, in 2011 the regular data tells is that 14k would die from Heart disease, 13.5k from Cancer, 1.9k from alzheimers and dementia, 1.6k from influenza and 900 suicides.”

A deceased’s cause of death listed as “heart disease” may well be a result of refusing blood.

Same with cancer.

Etc.

The numbers of those who’ve died prematurely are buried in the statistics you show, only the deaths we’re talking about add to the overall mortality. But, again, they’re buried under “cause of death” that does not identify the active consequent of refusing blood when it would have made a difference.

I don’t have access to the patient records in Beliaev’s data set. But it would not surprise me to learn that “cause of death” was not listed as “refusing blood” in even one instance. Yet the reality is that these deaths were identified by retrospective statistical analysis with a common cause: refusing blood when it would have saved a life.

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

-

“Here's one you've never answered, and the answer COULD vastly inflate the number of your extrapolation:

“How many of those 19 JW's who died by refusing a BT were in the 16-18 y.o. age range?

“No need for an rationalization of how it wouldn't matter or such excuse, Marvin; just a simple number will suffice.”

Adamah,

Beliaev does not document how many 16-18-year olds died in the JW group.

Now tell everyone why this could vastly inflate the number of my extrapolation. Can you please do that?

“Also Marvin, I think you are going off your experience which differs greatly to other people's. Why does your experience count and others don't? You are quick to dismiss other people's experience of *not* coming across many cases of JWs dying because of blood.”

Simon,

No. I can’t use my experience to extrapolate real numbers. I can only extrapolate real numbers with real data before me with a face value.

I have not dismissed anyone else’s experience, either. It’s quite common for JWs to not have firsthand experience/knowledge of a JW who they know for sure died due to blood refusal. What I’ve done is used numbers to show why this experience can be real despite the numbers I’ve extrapolated. In other words, I’ve used numbers to demonstrate why this lack of firsthand knowledge is no refutation of my extrapolation but, rather, consistent with my extrapolation. This is not a dismissal of other people’s experience.

“50,000 deaths by refusing blood would be over twice the number of suicides. Are suicides easier or harder to 'hide' from stats? Do we know those?”

Suicides are easier to identify than mortality due to refusing blood.

Also, the data you’re using appears to come from cause of death data. Refusing blood is not usually cited as cause of death. For instance, cause of death from hemorrhage due to blunt trauma by a patient who refuses red cell transfusion would not be listed as “died due to refusing blood”. This is one of many reasons why these deaths fly under the radar and whose quantity is identified only by retrospective statistical analysis.

The deaths we're discussing are buried in the figures you cite above. They're buried all the way across the board, sometimes even the deaths by suicide believe it or not.

“It's also about the same as would die from Alzheimers or dementia. How many do you know die from those? Any? Many? You need the same number to have died refusing blood. Same for diabetes.”

Same as above.

“Now, for every one you know who's died of influenza or stroke, about 2/3rds of that number died from refusing blood.:

Same.

“And finally, for every 7 or 8 people who die from heart disease or cancer, one is dying from refusing blood.”

Same.

“That's if you take the 50,000 figure. Obviously, the 250,000 gives even wilder outcomes - in fact you're nearly at the 50/50 level of being off'd by blood refusal as by one of the leading causes of death for the general population.”

JWs with severe blood loss have a very good chance of dying if they refuse blood. It’s just no listed as cause of death.

“Whether you find those figures believable or not based on your own experience is up to everyone to decide.”

I see nothing in your chart that surprises me.

“250,000 would mean 15% of JW deaths were due to refusal of blood treatment.

“Sorry, I just don't buy it.”

Close, but not exactly.

If 250,000 JWs died because of refusing blood then it means this would be 250,000 deaths in addition to the standard mortality we would expect.

To put this in perspective, 5x 50,000 deaths over the period of 1961-2011 would translate into about 1 death annually per 11 congregations. Given how these deaths can go unidentified without by retrospective statistical analysis that rate could be happening right in front of our eyes and we’d not realize it.

If we take this figure of 5x 50,000 death over the greater period of 1945-2013 the reality would be even harder to see.

Simon,

It looks like I’m out of posts again. Don’t know when I can reply.

Marvin Shilmer