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Last week the medical journal The
Lancetreleased 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 US 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 US 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 October 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. 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, October 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.
Dr. Curren Warf, MD 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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