TCS Daily

The Lancet: A Casualty of Politics

By Tim Worstall - October 29, 2004 12:00 AM

Editor's note: Prior to publication, the author realized a critical error in his article. See explanatory note at the end of the following link.

There is a report out today in The Lancet (discussed here in the Guardian) which attempts to measure the number of deaths from coalition actions in Iraq. Here is how it is being reported:

"About 100,000 Iraqi civilians -- half of them women and children -- have died in Iraq since the invasion, mostly as a result of airstrikes by coalition forces, according to the first reliable study of the death toll from Iraqi and US public health experts. "

A major story if true. One does not have to be a partisan Democrat to "question the timing" of an announcement; indeed one does not even have to be a potential voter in the US elections next week to think that there is something a little, um, odd, about the timing of this paper. For, as we are told:

"Last night the Lancet medical journal fast-tracked the survey to publication on its website after rapid, but extensive peer review and editing because, said Lancet editor Richard Horton, "of its importance to the evolving security situation in Iraq". But the findings raised important questions also for the governments of the United Sates and Britain who, said Dr Horton in a commentary, "must have considered the likely effects of their actions for civilians". "

The full justification for the early publication is given by the Editor:

"Roberts and his colleagues submitted their work to us at the beginning of October. Their paper has been extensively peer-reviewed, revised, edited, and fast-tracked to publication because of its importance to the evolving security situation in Iraq. But these findings also raise questions for those far removed from Iraq -- in the governments of the countries responsible for launching a pre-emptive war. In planning this war, the coalition forces -- especially those of the US and UK -- must have considered the likely effects of their actions for civilians. And these consequences presumably influenced deployments of armed forces, provision of supplies, and investments in building a safe and secure physical and human infrastructure in the post-war setting. With the admitted benefit of hindsight and from a purely public health perspective, it is clear that whatever planning did take place was grievously in error. The invasion of Iraq, the displacement of a cruel dictator, and the attempt to impose a liberal democracy by force have, by themselves, been insufficient to bring peace and security to the civilian population. Democratic imperialism has led to more deaths not fewer.

"This political and military failure continues to cause scores of casualties among non-combatants. It is a failure that deserves to be a serious subject for research. But this report is more than a piece of academic investigation."

More than a piece of academic investigation? Really? Are we sure? We don't think that publishing this, in fact fast-tracking it (A more normal "academic" paper would take up to six months to wend its way through the peer-review process and the raw data for this was only collected six and seven weeks ago.) has anything at all to do with an election in the US some four days away? Good grief man, what do you take us for, morons?

At the very least one would have to add The Lancet to that list of mainstream media which are worth 15% (or is it 5% now, the left have never really been any good at numbers) to John Kerry in the polls. What makes it a great deal worse is this, from the findings to the report. In fact, these are the findings in their totality:

"The risk of death was estimated to be 2.5-fold (95% CI 1.6-4.2) higher after the invasion when compared with the preinvasion period. Two-thirds of all violent deaths were reported in one cluster in the city of Falluja. If we exclude the Falluja data, the risk of death is 1.5-fold (1.1-2.3) higher after the invasion. We estimate that 98 000 more deaths than expected (8000-194 000) happened after the invasion outside of Falluja and far more if the outlier Falluja cluster is included. The major causes of death before the invasion were myocardial infarction, cerebrovascular accidents, and other chronic disorders whereas after the invasion violence was the primary cause of death. Violent deaths were widespread, reported in 15 of 33 clusters, and were mainly attributed to coalition forces. Most individuals reportedly killed by coalition forces were women and children. The risk of death from violence in the period after the invasion was 58 times higher (95% CI 8.1-419) than in the period before the war."

Have a look at those confidence levels. Yup, 95%. That is, a one in twenty chance that the effect simply does not exist. Look at the relative risk ratios (leave out Falluja; I don't think anyone is really very surprised to see a higher mortality rate there): 1.1-2.3. It isn't just that it is an absurdly wide one (note, a relative risk ratio of 1 would mean no effect whatsoever) it is that if this paper was written to generally accepted statistical standards it would never have been published. With a 95% confidence level a relative risk ratio of anything less than three is regarded as statistically insignificant. Just to clarify that, by "insignificant" no one is stating that it is not important to those people who undoubtedly have been killed during the War. What is being said is that we don't have enough information to be able to say anything meaningful about it. "Statistically insignificant" means "we don't know".

In effect, what has been found in this paper is nothing. Nada. Zip.

Except of course that one of the two leading medical journals in the world has published a piece of shoddy research four days before the US elections with the obvious motive of influencing them. Sad, that, and my apologies as an Englishman that it should be one of my countrymen who did such a thing.

Time Worstall is a TCS contributor. Find more of his writing here.

Editor's note: See Sydney Smith's article on the politicized Lancet here.


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