250,000 Jehovah's Witnesses have died refusing blood

by nicolaou 739 Replies latest watchtower medical

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  Marvin Shilmer

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  “He got a percentage, he did the math, he doesn't see why any one would question it.”

  LisaRose,

  That’s false.

  To the contrary, not only do I see why folks would question my extrapolation, I think they should question it and I hope they’ll do so. These are my sentiments for reasons I think probably you don’t get. But that’s another story.

  I don’t have problems with questions. When presented with questions of my work I’m happy to oblige by responding. But as it is with my propositions it is with others. Each assertion carries a burden of proof. When folks in this discussion have raised various factors that would influence my conclusion I’ve responded by testing the veracity of the criticism. Nearly all these factors (if not all) have been raised to suggest my conclusion might be artificially inflated. The implication of artificial inflation is an assertion. All assertions carry a burden of proof. Hence when these factors have been raised I’ve essentially asked in response how could I have assumed more conservatively than I did in order to remove any unintended inflation. You know what answer I get to the many ways I’ve asked this question? Nothing. That’s the answer I’m met with over and over again and it’s throughout this discussion. I’ve practically begged critics to tell me how I could have framed a more conservative estimate than I did by making necessary assumptions more conservative than I did. I get silence.

  One thing that stands out to me in this discussion is the relative few instances here of firsthand experience knowing of JWs who died for opting to abide by Watchtower’s blood doctrine. I understand why this lack of firsthand knowledge. If for no other reason, the math showing distribution tells us why. There is also the insidious red herring given by Watchtower and parroted by JWs suggesting “we don’t really know that John/Jane died because she refused blood.”

  Those of us who do have firsthand experience have more than intimate knowledge. As humans we’re left with a choice. Either do something about what we know or do little if anything about what we know. I choose to do something. My style it not to bemoan critics. I’m a critic myself. But legitimate critics are willing to answer for what they criticism intimates. The latter is what I see missing around here.

  Let readers make of it what they will.

  Marvin Shilmer
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  Finkelstein

  Marvin says ..... That whole objection coming from you and others is no more than one gigantic strawman.

  And you my friend have created nothing more than an misleading objective red herring .

  Must be some JWism still lingering somewhere inside, right Marvin ?
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  steve2

  Marvin, I acknowledge your latest response to my thread. As the good old cliche intones, "We may just have to agree to disagree". The important thing is we both have in common a concern about the blood ban - all else is detail.

  My own sense of decency impels me to say I do see where you're coming from and wish you well.
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  LisaRose

  Marvin :The implication of artificial inflation is an assertion. All assertions carry a burden of proof. Hence when these factors have been raised I’ve essentially asked in response how could I have assumed more conservatively than I did in order to remove any unintended inflation. You know what answer I get to the many ways I’ve asked this question? Nothing. That’s the answer I’m met with over and over again and it’s throughout this discussion. I’ve practically begged critics to tell me how I could have framed a more conservative estimate than I did by making necessary assumptions more conservative than I did. I get silence.

  Marvin, it has nothing to do with the conservative assumptions. Honestly, I do not want to be seen as attacking you. I respect that you spent time to do this, and your intentions are good. As I have said, I am no statistician, nor do I have medical knowledge. But I am willing to give it a try and see if we can get more clarity. How about we start fresh, and take it point by point. I wlll try a few questions and see if we can get anywhere. If that works we will continue.

  First of all, from your blog.

  Statistical frequency of severe anemia suffered annually among Jehovah’s Witnesses in New Zealand is assumed as not greater than the same group worldwide.

  You are making an assumption here. What if the Witnesses in New Zealand did actually suffer anemia at a higher rate? The study counter opinion mentioned including the Maori population, who have higher rates of Anemia. Just a few of them, in this small study would throw everything off. So this is not a conservative assumption, quite the opposite.

  Also, where did you get the statistics for New Zealand of 1.46 per thousand, and how do you know that statistic is severe anemia equal to the severe anemia as selected for inclusion in the study? What is the definition of " severe anemia" as opposed to mild anemia?
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  Marvin Shilmer

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  “I wlll try a few questions and see if we can get anywhere. If that works we will continue.”

  LisaRose,

  Sure.

  “First of all, from your blog.

  Statistical frequency of severe anemia suffered annually among Jehovah’s Witnesses in New Zealand is assumed as not greater than the same group worldwide.

  “You are making an assumption here. What if the Witnesses in New Zealand did actually suffer anemia at a higher rate? The study counter opinion mentioned including the Maori population, who have higher rates of Anemia. Just a few of them, in this small study would throw everything off. So this is not a conservative assumption, quite the opposite.

  “Also, where did you get the statistics for New Zealand of 1.46 per thousand, and how do you know that statistic is severe anemia equal to the severe anemia as selected for inclusion in the study? What is the definition of " severe anemia" as opposed to mild anemia?”

  In the same order…

  Higher rate of anemia in New Zealand?:

  Other than the Maori factor (see below) I was unable to find any reason to think rates of anemia would be higher in New Zealand compared to all other nations on average. Hence I did not assume it higher in New Zealand, or anywhere else.

  Otherwise, and particularly when we look at how Beliaev defined “severe anemia” (see below) and then when we layer the JW blood refusal factor onto that definition something significant emerges.

  Hg =/< 8 grams dL has many causes. When it comes to JWs, they are at a higher risk versus the rest of the population because of the adherents’ unique refusal of red cells transfusion.

  This creates a vicious cycle unique to JWs. Refusing red cell transfusion puts a patient at greater risk of experiencing Hg =/< 8 grams dL. Hg =/< 8 grams dL puts a patient at greater risk of mortality. Refusing red cell transfusion puts a patient with Hg =/< 8 grams dL at an even greater risk of mortality.

  This unique risk of JWs experiencing Hg =/< 8 grams dL drives the incidence of JWs suffering “severe anemia” and the incidence of JWs suffering mortality the result of "severe mortality". I don’t assume a higher incident of “severe anemia” among JWs in New Zealand or anywhere else in the world. But given this unique driver it stands to reason that, if anything, incidence of “severe anemia” among JWs would be higher than the general population in any given service area of the world.

  Maori factor:

  If by “The study counter opinion” you mean the published criticisms of Isibister and Shander, these authors did not raise the Maori factor specifically though both made casual reference to “ethnicity”.

  If by “The study counter opinion” you mean critics in this discussion, one or two did raise this specifically.

  The original presentation by Beliaev et al adjusted for the Maori factor by logistic regression.

  The Maori factor was effectively mitigated (if not completely removed) by the original authors.

  1.46 per thousand:

  I think you mean my figure of 1.43.

  This figure represents the calculated per 1000 of JWs in New Zealand during the period of 1998-2007 who would have fit the profile of “severe anemia” presented by Beliaev based on published population distribution of 57% in the 2 regions from which his data was gathered. This 1.43 per thousand assumes the 103 JW patients documented in Beliaev’s study were the only JW patients in the 2 regions who suffered “severe anemia”.

  In the 2 regions from which the data set was retrieved it would be naïve to think these 103 JWs were the only ones who met the criteria of “severe anemia” applied by Beliaev. Hence using these 103 JWs (as 57% of the total sum) represents a conservative assumption.

  Severe anemia:

  Beliaev and colleagues made no analysis of “mild anemia”. Hence any statistical mortality associated with this condition suffered by JWs is not included in my extrapolation.

  Beliaev and colleagues used a simple benchmark to measure severe anemia versus not severe anemia. The threshold value was: Hg =/< 8 grams dL.

  Regardless of underlying cause or condition, if a JW patient was recorded with a blood hemoglobin of =/< 8 grams dL then the patient met the threshold value of “severe anemia”.

  Does this answer your questions?

  Marvin Shilmer
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  Marvin Shilmer

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  “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
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  Marvin Shilmer

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  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
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  LisaRose

  This figure represents the calculated per 1000 of JWs in New Zealand during the period of 1998-2007 who would have fit the profile of “severe anemia” presented by Beliaev based on published population distribution of 57% in the 2 regions from which his data was gathered. This 1.43 per thousand assumes the 103 JW patients documented in Beliaev’s study were the only JW patients in the 2 regions who suffered “severe anemia”.

  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.
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  Marvin Shilmer

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  “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
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  LisaRose

  Never mind, I was making a comment, but I realized what you were getting at, so I withdraw that question