250,000 Jehovah's Witnesses have died refusing blood

by nicolaou 739 Replies latest watchtower medical

• 

  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
• 

  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
• 

  adamah

  Marvin said-

  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?

  Since you don't get it yet, let me repeat what I just said:

  Within the framework of science, remember that the rule is, "an absence of evidence is not evidence of absense".

  Do you understand what that saying actually means? It's saying that in the absense of evidence, it's not fair game to assume. Assumptions don't fly in science.

  Whether you realize it or not, in making a claim you ARE making an implied (unstated) assumption: you ARE claiming that the rates of rejection are the SAME in NZ JW and in JW's Worldwide, and hence YOU bear the burden of proof to PROVE that claim, since YOU make the positive assertion that the assumption is valid.

  I've just presented counter-evidence that it's NOT a valid assumption: NZ has a lowered age of consent which doesn't allow for extrapolation to the rest of the World, and thus I've presented one piece of evidence that challenges your assumption as invalid.

  Marvin said-

  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.

  Marvin, no offense, but you cannot discern when you're offering opinion or making assumptions vs relying on facts. It's an acceptable inability in a lay-person (trust me, there's a downside to thinking as a scientist, as it drives women in my life crazy, LOL!), but it's unacceptable and an undesirable trait in anyone who's trying to add to human knowledge in any meaningful manner.

  (Although, don't take that as discouragement, just helpful constructive criticism from someone who's already been there, done it. Continue with your efforts, but primarily as a personal learning experience.)

  BTW, scientists don't use words like 'prediction' when trying to estimate PAST events.

  Also, the words 'precise' and 'accurate' are not synonyms, but each carries a specific meaning. In this case, using 'accurate' would be proper (even though the actual number IS unknown, your extrapolation attempts to determine the actual number).

  Here's a visual representation that should explain the difference (where 'precision' refers to the tightness of the cluster of data points, whereas 'accurate' refers to how close data points are to the actual figure, i.e. the bulls-eye):

  

  Adam
• 

  Simon

  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.

  Each time you expand the population you are extrapolating the conclusions and confidence weaken. Ultimately, if you extend it to "all people" then it becomes hillarious.

  Aren't all people at risk of becoming JWs and so facing a treatment choice, potentially refusing blood and dying as a result?
• 

  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
• 

  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

  I don't know where you think I've insulted you. I don't think you are too sensitive so have to assume you are trying to create some drama as an excuse to bypass the question I've now asked multiple times.

  I have communicated clearly, you again miss the point completely.

  I have already said that the deaths due to refusing blood are in those other figures. You are trying to alter the issue.

  What you are not answering is why the number you claim die due to refusing blood doesn't match most people's experience.

  Eventually all 100 will die. (Not said sarcastically)

  What a pointless statement! What I actually said was "From your figures, for every KH of 100 people then 3+ of them will die from refusing blood."

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

  Simon

  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).

  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?

  No, we leave that game to the WTS. Well, I thought we did.
• 

  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
• 

  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
• 

  TD

  True, but you're simply pointing out yet another factor that is not accounted for, and only increases the uncertainty in any estimation; that point only undermines the ability to be able to safely say that ANY figure is accurate, much less to claim then that figure as being "conservative".

  I can accept that, but would clarify that this is a statistical uncertaninty in your assertion that, "In the U.S., we don't let 16 yr olds die..." I trust the irony is not lost here, if you've got a sense of humor.