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Lancet surveys of mortality before and after the 2003 invasion of Iraq
From Wikipedia, the free encyclopedia
The medical journal, The Lancet, published two peer-reviewed studies on the effect of the 2003 invasion of Iraq and subsequent occupation on Iraqi mortality, the first in 2004, the second (by many of the same authors) in 2006. The studies estimate the number of excess deaths caused by the occupation, both direct (combatants plus non-combatants) and indirect (due to increased lawlessness, degraded infrastructure, poor healthcare, etc.).
The first survey[1] published on 29 October 2004, estimated 98,000 excess Iraqi deaths (with a range of 8,000 to 194,000, using a 95% confidence interval (CI)) from the 2003 invasion and subsequent occupation of Iraq to that time, or about 50% higher than the death rate prior to the invasion. The authors described this as a conservative estimate, because it excluded the extreme statistical outlier data from Falluja. If the Falluja cluster were included, the mortality estimate would increase 2.5 fold (95% CI: 1.6 to 4.2).
The second survey[2][3][4] published on 11 October 2006, estimated 654,965 excess deaths related to the war, or 2.5% of the population, through the end of June 2006. The new study applied similar methods and involved surveys between May 20 and July 10, 2006.[4] More households were surveyed, allowing for a 95% confidence interval of 392,979 to 942,636 excess Iraqi deaths. 601,027 deaths (range of 426,369 to 793,663 using a 95% confidence interval) were due to violence. 31% of those were attributed to the Coalition, 24% to others, 46% unknown. The causes of violent deaths were gunshot (56%), car bomb (13%), other explosion/ordnance (14%), air strike (13%), accident (2%), unknown (2%).
The Lancet surveys are controversial largely because their mortality figures are much higher than those in other (non peer-reviewed) reports that used different methodologies, including those of the Iraq Body Count project, the United Nations, and the Iraqi Ministry of Health. The Lancet surveys were supported by many epidemiologists and statisticians. However, they were criticized by the US and Iraqi governments, the Iraq Body Count project, epidemiologists, demographers, Iraq-war journalists and others. See the sections below on "criticisms".
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http://en.wikipedia.org/wiki/Lancet_...vasion_of_Iraq
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Criticism
Some skeptics criticized the relatively broad 95% confidence intervals (CI95) due to the relatively small number of clusters.
For instance, Fred Kaplan in an article on Slate.com described the confidence interval: "the authors are 95 percent confident that the war-caused deaths totaled some number between 8,000 and 194,000. (The number cited in plain language—98,000—is roughly at the halfway point in this absurdly vast range.) This isn't an estimate. It's a dart board."[11]
 
normal distribution
The authors responded by claiming that the phrase in parentheses in the above represents a poor understanding of the meaning of a statistical confidence interval because the central estimate of 98,000 was not chosen solely because it is "roughly at the halfway point". The probability distribution follows the normal distribution, with numbers near the central point estimate more likely to be accurate than numbers closer to either extreme. Roberts said, "this normal distribution indicates that we are 97.5% confident that more than 8,000 died, 90% confident more than 44,000 died and that the most likely death toll would be around 98,000,";[12] he said that many well-accepted statistics, such as the number killed under Saddam’s regime or the number dead from the 2005 tsunami, have a similarly broad CI due to small but statistically adequate sample sizes." He also questioned Kaplan's motives and accused him of altering quoted text and for focusing on one aspect of the report.
Lila Guterman, after writing a long article[13] in January 2005 in The Chronicle of Higher Education, wrote a short article in the Columbia Journalism Review that stated: "I called about ten biostatisticians and mortality experts. Not one of them took issue with the study’s methods or its conclusions. If anything, the scientists told me, the authors had been cautious in their estimates. With a quick call to a statistician, reporters would have found that the probability forms a bell curve — the likelihood is very small that the number of deaths fell at either extreme of the range. It was very likely to fall near the middle."[14]
A Ministerial Statement written 17 November 2004, by the UK government stated "the Government does not accept its [the study's] central conclusion", because they were apparently inconsistent with figures published by the Iraq Ministry of Health, based on figures collected by hospitals, which said that "between 5 April 2004 and 5 October 2004, 3,853 civilians were killed and 15,517 were injured" .[15]
Some critics have said that The Lancet study authors were unable to visit certain randomly selected sample areas. In an interview on the radio program "This American Life" however, the authors of the study say that they never substituted different, more accessible, areas, and that every place that was randomly selected at the beginning of the study was surveyed in full, despite the risk of death to the surveyors.
Critics of the Lancet study have pointed out other difficulties in obtaining accurate statistics in a war zone. The authors of the study readily acknowledge this point and note the problems in the paper; for example they state that "there can be a dramatic clustering of deaths in wars where many die from bombings". They also said that the data their projections were based on were of "limited precision" because the quality of the information depended on the accuracy of the household interviews used for the study.[16][17]
Fred Kaplan argued in Slate that the study's prewar mortality rate estimate of 5 deaths per 1000 is erroneously low because Iraq's mortality rate in the period from 1980-1991 were all higher, ranging from 6.8 to 8.1, so that the study's conclusions were overstated because of this discrepancy.[18] Kaplan's pre-war mortality estimates were based on the findings of Beth DaPonte, whose 1980-1990 numbers came from United Nations figures; most of Daponte's estimates of Iraqi casualties from Desert Storm and its aftermath are higher than those of other researchers[19]
The results of the study were politically sensitive, since a heavy death toll could raise questions regarding the humanitarian justifications on the eve of a contested US presidential election. Critics objected to the timing of the report, claiming it was hastily prepared and published despite what they perceived as its poor quality in order to sway the U.S. electorate. On this topic, Les Roberts stated "I emailed it in on Sept. 30 under the condition that it came out before the election. My motive in doing that was not to skew the election. My motive was that if this came out during the campaign, both candidates would be forced to pledge to protect civilian lives in Iraq. I was opposed to the war and I still think that the war was a bad idea, but I think that our science has transcended our perspectives."[20][17] He replied to criticisms by Professor John Allen Paulos of the Temple University Math Department of "an expedient rush to publish" with
Dear Dr. Paulos, I read your note below with some sadness. FYI, there was a rush to publish as I have said in every major interview I have given. A) I have done over 20 mortality surveys in recent years and have never taken more than a week to produce and release a report (because people dying is important) until this article. Thus, this was the least rushed mortality result I have ever produced. B) We finished the survey on the 20 Sept. If this had not come out until mid-Nov. or later, in the politicized lens of Baghdad (where the chief of police does not allow his name to be made public and where all the newly trained Iraqi soldiers I saw had bandannas to hide their faces to avoid their families being murdered…) this would have been seen as the researchers covering up for the Bush White House until after the election and I am convinced my Iraqi co-investigators would have been killed. Given that Kerry and Bush had the same attitude about invading and similar plans for how to proceed, I never thought it would influence the election and the investigators never discussed it with each other or briefed any political player. C) if you have information about how and why people in New Orleans were dying today, would you rush to release it? The Falluja downfall happened just one week after the study came out and whether you believe the 500 or the 1600 or the 3600 estimates of associated Iraqi deaths, that alone was probably more than will occur from this moment on due to Katrina. So, we rushed to get it out, I do not understand why the ‘study's scientific neutrality’ is influenced or the likelihood that the sample was valid, the analysis fair… What does neutrality mean? Do people who publish about malaria deaths need to be neutral about malaria? Yours in confusion and disgust, Les Roberts[21] On the contrary, Roberts views critics of his study as motivated more by politics than by science; "It is odd that the logic of epidemiology embraced by the press every day regarding new drugs or health risks somehow changes when the mechanism of death is their armed forces."[22]
[edit] Lancet publications related to criticisms- November 20, 2004. Criticism and suggestions by peer reviewer Sheila M Bird, MRC Biostatistics Unit, Cambridge CB2 2SR, UK, chair of the Royal Statistical Society's Working Party on Performance Monitoring in the Public Services. Calls scientific method "generally well described and readily repeatable", but says "[p]articular attention is needed to the methodology for randomly selecting the location(s) of cluster(s) within governorates. Roberts and colleagues describe this rather too succinctly". Suggests additional information be included so that more precise multipliers (to obtain the final estimate) can be applied. Discusses an example hypothetical circumstance incorporating said information, regarding airstrike deaths and collateral damage, under which over-counting could occur due to population density variances among cluster representations.[23]
- March 26, 2005. Criticism by Stephen Apfelroth, Department of Pathology, Albert Einstein College of Medicine. Criticizes "several questionable sampling techniques that should have been more thoroughly examined before publication" and lists several flaws, including a "fatal" one, that "In such a situation, multiple random sample points are required within each geographic region, not one per 739000 individuals."[24]
- March 26, 2005. Response by L Roberts et al to Apfelroth. Acknowledges flaws, but says "the key public-health findings of this study are robust despite this imprecision. These findings include: a higher death rate after the invasion; a 58-fold increase in death from violence, making it the main cause of death; and most violent deaths being caused by air-strikes from Coalition Forces. Whether the true death toll is 90000 or 150000, these three findings give ample guidance towards understanding what must happen to reduce civilian deaths. ...Before publication, the article was critically reviewed by many leading authorities in statistics and public health and their suggestions were incorporated into the paper. The death toll estimated by our study is indeed imprecise, and those interested in international law and historical records should not be content with our study. We encourage Apfelroth and others to improve on our efforts. In the interim, we feel this study, as well as the only other published sample survey we know of on the subject, point to violence from the Coalition Forces as the main cause of death and remind us that the number of Iraqi deaths is certainly many times higher than reported by passive surveillance methods or in press accounts."[25]
[edit] Other responses to criticism
The Chronicle of Higher Education also wrote an article discussing the differences in the survey's reception in the popular press over how it was received in the scientific community.[13]
Epidemiologist Klim McPherson writes in the March 12, 2005 British Medical Journal:[26] "The government rejected this survey and its estimates as unreliable; in part absurdly because statistical extrapolation from samples was thought invalid. Imprecise they are, but to a known extent. These are unique estimates from a dispassionate survey conducted in the most dangerous of epidemiological conditions. Hence the estimates, as far as they can go, are unlikely to be biased, even allowing for the reinstatement of Falluja. To confuse imprecision with bias is unjustified."
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Criticisms
An October 12, 2006 San Francisco Chronicle article[28] reported:
"Six hundred thousand or whatever they guessed at is just, it's not credible," Bush said, and he dismissed the methodology as "pretty well discredited." In December [2005], Bush estimated that 30,000 Iraqis had died in the war. Asked at the news conference what he thinks the number is now, Bush said: "I stand by the figure a lot of innocent people have lost their life." At a separate Pentagon briefing, Gen. George Casey, the top U.S. commander in Iraq, said that the figure "seems way, way beyond any number that I have seen. I've not seen a number higher than 50,000. And so I don't give it that much credibility at all." The UK government, too, rejected the researchers' conclusions. In doing so, it did not mention the advice of the Ministry of Defence's Chief Scientific Adviser, Sir Roy Anderson, who had called the study "robust" and its claimed methods "close to 'best practice' in this area, given the difficulties of data collection and verification in the present circumstances in Iraq", in an internal memo on the day the study was published, dated 13 October, 2006.[29][30]
The Iraq Body Count project (IBC), who compiles a database of reported civilian deaths, has criticised the Lancet's estimate of 601,000 violent deaths[31] out of the Lancet estimate of 654,965 total excess deaths related to the war. The IBC argues that the Lancet estimate is suspect "because of a very different conclusion reached by another random household survey, the Iraq Living Conditions Survey 2004 (ILCS), using a comparable method but a considerably better-distributed and much larger sample." IBC also enumerates several "shocking implications" which would be true if the Lancet report were accurate, e.g. "Half a million death certificates were received by families which were never officially recorded as having been issued" and claims that these "extreme and improbable implications" and "utter failure of local or external agencies to notice and respond to a decimation of the adult male population in key urban areas" are some of several reasons why they doubt the study's estimates. IBC states that these consequences would constitute "extreme notions".[32]
Jon Pedersen of the Fafo Institute[33] and research director for the ILCS survey, which estimated approximately 24,000 (95% CI 18,000-29,000) war-related deaths in Iraq up to April 2004, expressed reservations about the low pre-war mortality rate used in the Lancet study and about the ability of its authors to oversee the interviews properly as they were conducted throughout Iraq. Petersen has been quoted saying he thinks the Lancet numbers are "high, and probably way too high. I would accept something in the vicinity of 100,000 but 600,000 is too much."[34]
Debarati Guha-Sapir, director of the Centre for Research on the Epidemiology of Disasters in Brussels, was quoted in an interview for Nature.com saying that Burnham's team have published "inflated" numbers that "discredit" the process of estimating death counts. "Why are they doing this?" she asks. "It's because of the elections."[35]. However, another interviewer a week later paints a more measured picture of her criticisms: "She has some methodological concerns about the paper, including the use of local people — who might have opposed the occupation — as interviewers. She also points out that the result does not fit with any she has recorded in 15 years of studying conflict zones. Even in Darfur, where armed groups have wiped out whole villages, she says that researchers have not recorded the 500 predominately violent deaths per day that the Johns Hopkins team estimates are occurring in Iraq. But overall Guha-Sapir says the paper contains the best data yet on the mortality rate in Iraq."[36]
Fred Kaplan of Slate criticized the first Lancet study and has again raised concerns about the second.[37][38] Kaplan argues that the second study has made some improvements over the first, such as "a larger sample, more fastidious attention to data-gathering procedures, a narrower range of uncertainty", and writes that "this methodology is entirely proper if the sample was truly representative of the entire population—i.e., as long as those households were really randomly selected." He cites the low pre-war mortality estimate and the "main street bias" critique as two reasons for doubting that the sample in this study was truly random. And he concludes saying that the question of the war's human toll is "a question that the Lancet study doesn't really answer".
Madelyn Hicks, a psychiatrist and public health researcher at King's College London in the U.K., says she "simply cannot believe" the paper's claim that 40 consecutive houses were surveyed in a single day. "There is simply not enough time in the day," she says, "so I have to conclude that something else is going on for at least some of these interviews." Households may have been "prepared by someone, made ready for rapid reporting," she says, which "raises the issue of bias being introduced."[39]
Dr. Hicks published a thorough account and clarification of these concerns, which concluded that, "In view of the significant questions that remain unanswered about the feasibility of their study’s methods as practiced at the level of field interviews,it is necessary that Burnham and his co-authors provide detailed, data-based evidence that all reported interviews were indeed carried out, and how this was done in a valid manner. In addition, they need to explain and to demonstrate to what degree their published methodology was adhered to or departed from across interviews, and to demonstrate convincingly that interviews were done in accordance with the standards of ethical research."[40]
Borzou Daragahi Iraq correspondent for the Los Angeles Times, in an interview with PBS, questioned the study based on their earlier research in Iraq, saying, "Well, we think -- the Los Angeles Times thinks these numbers are too large, depending on the extensive research we've done. Earlier this year, around June, the report was published at least in June, but the reporting was done over weeks earlier. We went to morgues, cemeteries, hospitals, health officials, and we gathered as many statistics as we could on the actual dead bodies, and the number we came up with around June was about at least 50,000. And that kind of jibed with some of the news report that were out there, the accumulation of news reports, in terms of the numbers killed. The U.N. says that there's about 3,000 a month being killed; that also fits in with our numbers and with morgue numbers. This number of 600,000 or more killed since the beginning of the war, it's way off our charts."[41][42]
The Lancet estimate also drew criticism from the Iraqi government. Government spokesman Ali Debbagh said, "This figure, which in reality has no basis, is exaggerated".[43] And Iraq's Health Minister Ali al-Shemari gave a similar view a month later, "Since three and a half years, since the change of the Saddam regime, some people say we have 600,000" killed, he said. "This is an exaggerated number."[44]
Steven E. Moore, who conducted survey research in Iraq for the Coalition Provisional Authority and was an advisor to Paul Bremer for the International Republican Institute, also ridiculed the Lancet study in an editorial in the Wall Street Journal. In a piece entitled, "655,000 War Dead? A bogus study on Iraq casualties", Moore wrote, "I wouldn't survey a junior high school, no less an entire country, using only 47 cluster points. Neither would anyone else..."[45].
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Originally Posted by engfant
To say I TOLD YOU SO is an UNDERSTATEMENT.
To say that these above numbers are NOT A DISASTER would be ignorant and HIGHLY ANTI AMERICAN.
These above numbers ARE NOT DISPUTED. THEY ARE NOT EXAGGERATED. THEY ARE FOR REAL.
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Last edited by Ezliving_Jim; 08-08-2007 at 11:42 AM.
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08-08-2007, 11:30 AM
If I can put my two cents, I say USA should have not got involved with Irak just like Canada should have not got involved with Afghanistan. It is a waste of time, waste of money and waste of people.
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