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Counting the Dead

The Lancet says that invading Iraq cost the lives of 100,000 Iraqi civilians. See how anti-Bush political hackery has invaded even respected medical journals.

6:25 PM, Oct 31, 2004 • By GERARD ALEXANDER
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JUST IN CASE you were worried that not enough supposedly neutral institutions and publications were gunning for George W. Bush, part of the international public health establishment just risked its reputation to join the fight. On Friday, the New York Times reported a new study in the British medical magazine Lancet claiming the U.S.-led invasion caused 100,000 Iraqi civilian deaths, a civilian mortality rate more than double that of the 14 months before troops went in. The subtext is clear: the overthrow of Saddam Hussein hasn't made life safer even for Iraqis. The Lancet's editors were even clearer: they "fast-tracked" the article for publication because they thought it ought to affect judgments about "the governments . . . responsible for launching a pre-emptive war," including, presumably, governments up for reelection five days after the study's release. And the Times wasn't exactly bashful either. They authoritatively state that the "study is scientific" and don't quote a single expert skeptical of the finding.

Nor does the politics seem to stop at the article's edge. There are at least three major reasons to be skeptical of the study's findings. Here's how the study worked. A team headed by a public health professor at Johns Hopkins asked a small sample of Iraqis about deaths in their households, and then extrapolated a national mortality rate from there. The first grounds for skepticism is a very unpersuasive methodology. Slate's Fred Kaplan points out that the study's method only supports a 95 percent confidence in the conclusion that the war caused somewhere between 8,000 and 194,000 deaths, an extremely wide range. In other words, even taken at face value, the study says that the mortality rate may have gone up quite a bit but also may hardly have risen at all, or may have landed anywhere in between. But the study doesn't explain this, its authors haven't highlighted it in press statements, and the Times never mentions it at all. Now, conditions in Iraq probably permitted at most a very small sample, which compromises the validity of findings. But researchers know that going in, and this team chose to press ahead anyway with a study whose results would almost inevitably be so imprecise as to practically invite being overblown and overhyped.

Second, there's a very good chance the study underestimates Iraq's pre-invasion mortality rate. For one thing, to establish this rate the study focuses on a very unrepresentative period: the last year of Saddam's rule, when his tastes for genocide and war were constrained by the threat of the very invasion these researchers now lament. Even so, the pre-invasion mortality rate reported in the study is curiously low given previous estimates. The study's methodology may explain this too. For example, the Iraqis who were surveyed reported virtually no violent deaths in the last 14 months of Saddam's rule. But as a rule, most Iraqis remain uncertain about the fate of loved ones who fell into the jaws of Saddam's killing machine. Even more problematic is the estimated pre-invasion mortality rate among youngsters. The rate reported in this study is credible, the authors say, because it is "similar to estimates from neighbouring countries." But that means it is three or four times lower than earlier estimates, so low that the researchers wondered if their respondents had under-reported pre-invasion deaths of infants and children.

They should wonder. Throughout the 1990s, a slew of public health studies insisted that international sanctions were causing infant and child mortality rates in Iraq dramatically higher than those in neighboring countries, resulting in hundreds of thousands of deaths. The new study does not repudiate those earlier findings and does not explain the stark disparity. This is especially curious because some of the most prominent of those earlier studies appeared in . . . the Lancet. This leaves the uncomfortable impression that when high infant mortality rates under Saddam made U.S. policy (sanctions) look bad, the Lancet published high rates; and when low rates under Saddam make U.S. policy (invasion) look bad, the Lancet publishes low rates.