250,000 Jehovah's Witnesses have died refusing blood

by nicolaou 739 Replies latest watchtower medical

  • Marvin Shilmer
    Marvin Shilmer

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    “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

  • LisaRose
    LisaRose

    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?

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

  • Marvin Shilmer
    Marvin Shilmer

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    “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

  • LisaRose
    LisaRose

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

    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?

  • Marvin Shilmer
    Marvin Shilmer

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    “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

  • Marvin Shilmer
    Marvin Shilmer

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    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

  • LisaRose
    LisaRose

    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.

    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.

    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.

  • Marvin Shilmer
    Marvin Shilmer

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    “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

  • TD
    TD

    Statistics is not my field and I freely admit that, so I can't comment on Marvin's data and methods.

    However as someone who has researched this subject for 20+ years, and worked in a med lab, several issues stand out as items Marvin can't possibly account for which would make his figures conservative. In no particular order, they are:

    Primary vs. Contributory causes of death

    This is a distinction that Jehovah's Witnesses take advantage of and which Dr. Aryeh Shander briefly explains in the video, No Blood: Medicine Meets The Challenge. When a patient with leukemia dies, they die from their disease. Period. End of story. Transfusion is not thearpy for leukemia, or any of the related and/or similar illnesses. Transfusion is administered to counteract the effects of intense chemo and/or radiation treatment, or in the event of a bone marrow transplant, to keep the patient alive while the grafted marrow 'takes.'

    When blood products are not an option, these treatments are often simply unavailable and alternative treatments are employed. Why induce severe anemia as a side effect in an attempt to treat a disease that might or might not work when you know in advance that you can't administer blood to counteract it?

    Yet contributory causes of death are still important. To dismiss them out of hand, because they can't rightly be included in a statistical study is to distort the issue. The survival rate of Witnesses leukemia patients is so bad that The Oncologist ran an article in 2002 entitled "Faith Identity And Leukemia: When Blood Products Are Not An Option" to help medical professionals deal with the feelings of guilt, frustration and anger over the loss of Witness patients.

    As a nurse who had witnessed the death of a female JW patient put it, "She wanted everything done, but would not consent to the one essential thing that would save her life."

    Red Cells are only one component

    Blood does a lot of things in the body and most of them are vital for life. My youngest child was hospitalized when a common perscription medication attacked the platelets in her blood. Her count was so low that the ER physicians hands were shaking when he showed me the lab report. Acute thrombocytopenia is every bit as dangerous as acute anemia, if not more so. A sneeze can set off a fatal brain hemorrhage and the patient will be dead in seconds.

    Obviously then, there are other transfusion types besides the tradtional red cell transfusion. Whole plasma is often administered when physicans are not entirely sure what exactly is wrong, but do know that it is a plasma function, as in atypical bleeding, cases involving liver impairment and other plasma specific disfunctions. Platelets are administered in cases like I mentioned above with my child. Witnesses are not supposed to accept any of this stuff.

    Differering standards of care

    I've already quoted a letter from BMJ on this thread which (IMHO) poignantly shows the plight of a JW patient when bloodless medicine is either unavailable or too expensive. Even today, this is still the case in many parts of the word.

    Evolution of the doctrine

    The JW parent organization has made many adjustments over the years to blunt the sheer human cost of adherence to this doctrine. Nobody thinks twice about accepting gamma globulin today. It's the basis of most post-exposure vaccines. It's the basis for antivenins for snake and other poisonous bites. It's used to treat acyte thrombocytopenic purpura, Kawasaki's syndrome, etc. Yet there was a time when JW's were not supposed to accept gamma globulin.

    Similar observations could be made about albumin, factor specific concentrates for bleeding disorders, Anti-D, (Which despite being a gamma family globulin was treated differently by the JW parent organization for some strange reason.) Transfusion of gamma globulin (Which again was treated differently than simple injection by the JW parent organizaiton for some strange reason.) etc. All of these were forbidden at one time. If we're talking about the human cost since the inception of the doctrine, these things are relevant, because they all represent potential (I would actually say probable) areas where JW patients experienced higher mortality in decades past than they do today.

    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.

  • LisaRose
    LisaRose

    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 thegroup in service areas whose standard does not exceed that of the original, which in this case is New Zealand.

    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?

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