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Editorials
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Iraq Deaths: Politics vs.
Science By Curren
Warf
October 18, 2006 |
Editor's Note: The cost of
the Iraq War in blood and money keeps rising. Grisly killings are
reported daily across Iraq and casualty reports for U.S. soldiers
continue to surge. Still, perhaps the most shocking recent news was the
study by medical experts estimating that the war has caused the deaths
of more than 600,000 Iraqis.
In this guest essay, Dr. Curren Warf, a professor of pediatric
medicine and a board member of the Physicians for Social Responsibility,
examines the science behind the study and the political attacks against
the numbers:
Last
week, the medical journal
The Lancet released an
epidemiological study concluding that 655,000 Iraqis died from
war-related injury and disease from March 2003 to July 2006. This
shockingly high figure has drawn attacks from the Bush administration
and right-wing pundits.
Speaking as a medical doctor, I
wish to set the record straight. The Lancet study is superb
science. The study followed a strict, widely accepted methodology to
arrive at its sobering conclusion. The study is being attacked not on
scientific grounds, but for ideological reasons.
People may not realize that The Lancet is the world’s most
prestigious medical journal. Prior to publication, the Iraq study was
subjected to a thorough peer-review by specialists in the field of
epidemiology.
Three of the
study's authors, Gil Burnham, Shannon Doocy, and Les Roberts, are
doctors at
Johns
Hopkins University
Bloomberg
School
of
Public
Health.
The fourth author, Riyadh Lafta, is on the faculty of Al Mustansiriya
University in Baghdad. Under dangerous conditions, researchers
conducted a cross-sectional cluster sample survey involving a total of
1849 Iraqi households. The survey documented a four-fold increase in
the crude mortality rate from the pre-invasion to the post-invasion
periods and, in addition, characterized the causes of death.
The investigators followed the same methodology in Iraq that has had
been used in estimating death and disease in other conflicts such as
the Congo -- where the Bush administration uncritically accepted their
results. The public health tool they employed -- cluster surveys --
has been demonstrated time and again to be the best method of
estimating rates of death in areas where vital statistics are not
scrupulously maintained. Such bureaucratic vigilance is not the case
in present day Iraq.
In a war-ravaged country, an estimate of war-related deaths based on
the method of counting bodies will radically underestimate the number
of people who have died. In Iraq today, there have been numerous
reports of mass graves and of bodies dumped in fields, beside roads,
or in the Tigris River.
These
deaths are, by and large, not reported to authorities, as some of
these deaths may be linked to police forces.
One
must also consider the Muslim practice of burial where internment is
swift -- often on the same day. Therefore, relying on media reports of
the number killed, morgue logs, or Iraq Ministry or U.S. military
counts will not provide an accurate estimate of the death toll. We
must also not discount the possibility of bias by government
officials; the U.S. and Iraq have much to gain by minimizing civilian
deaths.
Since the media has been unable to find a scientist critical of the
study, they've turned to policy wonks with literally no expertise in
the health sciences . Danielle Pletka of the American Enterprise
Foundation derides the study, but her advanced degree is in
international studies. Nor does Anthony Cordesman of the Center for
Strategic and International Studies nor Michael E. O'Hanlon of
Brookings have a health background.
At
his Oct. 11 press conference President Bush asserted "No, I don't call
it a credible report." He said he asked the generals and the generals
told him it was wrong. When asked to give a precise number of Iraqi
war-related deaths the President demurred, saying " I do know that a
lot of innocent people have died."
Despite the scientific rigor of the Hopkins study, there is a danger
that the unsubstantiated criticism by administration will color the
public's perceptions. In this age, where fact shares equal time with
conjecture, critics have attempted to discredit the Hopkins study
without specifically addressing the science whatsoever.
If
the administration believes the Hopkins study to be flawed, the
federal government should fund its own study of Iraqi mortality, and
submit the methodology and results to a medical journal subject to
independent peer review. After all the Hopkins study was funded in
large part by a $50,000 grant from MIT; surely the federal government
could afford such a study.
I belong to the Nobel Peace Prize-winning organization,
Physicians
for Social Responsibility.
We care about the “
Medical Consequences of the War in Iraq.”
In fact, that's the title of our
upcoming conference
to be held at UCLA this Saturday, Oct. 21. The conference is
co-sponsored by the UCLA School of Public Health and UCLA Extension.
Dr. David Rush, past president of the Society of Epidemiologic
Research, will discuss the Lancet Iraq study. You can register
at
www.uclaextension.edu,
registration number S3972U.
As physicians, we realize the horrible human cost and needless
suffering the American invasion has brought on the people of Iraq. The
war has also terribly harmed our own American soldiers, 2,765 of whom
have been killed and 20,000 of whom have suffered disabling injuries.
At his recent press conference, President Bush brushed aside a
question to quantify the human toll of the Iraq War with the comment
that “a lot of innocent people” have died. 655,000 is not a guess. It
is the best estimate that we have to date of the human tragedy in
Iraq.
Curren Warf is Associate Professor of
Clinical Pediatrics at the Keck-USC School of Medicine. Dr. Warf sits on
the National Board of Physicians for Social Responsibility.
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