Posted by Neil Munro has had another go at the Lancet studies. This time he has gone on right-wing talk shows to attack Riyadh Lafta.
On Glenn Beck he claimed
This study — the guys in this study have not shown the forms and the date and the sheets collected by the surveyors who worked for an Iraqi without U.S. supervision. This particular Iraqi was once employed by Saddam Hussein, where he produced crummy scientific papers as part of Saddam`s effort to lift economic sanctions in the 1990s.
On Mike McConnell he elaborated (search for “neil munro” at the link):
The strange thing is that the entire study depends on the data delivered by the Iraqi research team. There were no Americans on this study in Iraq, none at all. …
The person they hired used to do propaganda journals for Saddam back in the 1990s when Saddam was trying to break the sanctions. He was sending his flacks and minions out to the United Nations and American universities saying “Hundreds of thousands of children are starving to death etc”. He would get his Iraqi researchers to do studies that backed up this claim. And one of the guys who was doing it for Saddam was a fellow named Dr Riyadh Lafta. …
When they hired this Iraqi researcher they never went back and read his 1990s articles about “times are terrible, let Saddam have his sanctions lifted”. I called the two chief guys running the study and one told me “I never read those articles” and the other said “I don’t have copies of those articles”. Would you buy a car for your daughter from a guy and not test drive it? They hired this guy in Iraq without actually trying to find out much about him. …
I asked the guys: “Why did you not look into the background of this fellow? Did you not do your due diligence? When you buy a house, you check for termites. When you buy a researcher do you not check for Saddam?” And they said to me: “He’s a researcher, that’s good enough for me”.
The two articles that Munro described as “crummy” and “propaganda” are on child malnutrition rates and on risk factors for child deaths. You can read the papers yourself, but neither one seemed to me to be “crummy” or to be propaganda.
But then, I’m not an expert, so I asked Richard Garfield, who is an expert on the effects of the sanctions on Iraqi children.
He replied:
Thanks for asking about this. I knew Riyadh’s boss some years before
the invasion and he had introduced me to his assistant (Riyadh) as
well. I got to know Riyadh in the days following the invasion, when I
worked closely with his department chair and I am the one who
initially linked him up with Les.I did not read or know of authorship for any papers prior to the
invasion, but there is no surprise there (in contrast to the
condemning statements by Munro). These were in Iraqi journals, that
were essentially ‘publishing’ without paper. I saw about a dozen of
papers like the one (there is only 1 on your website), but I was aware
that there were many more that I could not put my hands on as
libraries were closed and even WHO and UNICEF in Iraq had been able to
acquire only a few in the years of the embargo, not including this one
as I had pored through any I could put my hands on for a review of 46
nutrition assessments done in Iraq during those years (reference
Garfield R. Changes in malnutrition levels in Iraq, 1990 1999.
Nutrition Reviews 2000; 58(9); 269-77.)Reading this paper now, my conclusion is quite the opposite to Munro’s
about its political bent. Many of those that I did read prior to 2003
were laced with political comments, making the separation of primary
data and interpretation nearly impossible. This, by the way, is not
uncommon in countries even without dictatorships where peer review and
a tradition of scientific inquiry is weak. But this paper by Lafta is
almost completely devoid of such political commentary, including only
a few words about the social and political situation of the country
among a substantive report on the weights and heights of children
attending one clinic. This paper, among the ones that I read in Iraq
prior to 2003, would stand out as an apolitical report, one that might
even get the author in trouble for its lack of repetitive politicized
language commonly used then in Iraq. I would have read this and
assumed that the author was not supportive of the regime, just the
opposite conclusion that some of the critics, who knew nothing of the
times and context for such work, seem to have made.
Note that Munro was in contact with Garfield but failed to ask him about Lafta’s papers. I asked Munro if he had consulted with any experts at all before claiming that the papers were “propaganda”. His reply:
I’d love to know if I missed any
sections in the papers that showed how sanctions-era death rates were
higher than pre-sanctions-era death rates, that provided independent
data to back up those claims, or that provided evidence that sanctions -
which were prompted by Saddam’s refusal to open up his police-state to
outside inspection – were the cause of the increased death rate. Also,
I’d like to know of any other papers that reconcile Lafta’s 2000 claim
of a high Saddam-era death rate with Lafta’s 2004 discovery of a low
pre-war death rate.
So not only did Munro not consult with experts, he doesn’t even understand what the papers were about. Munro seems to have confused malnutrition rates with death rates.
I also got comments from Gilbert Burnham:
Riyadh has worked with a number of international researchers, and we
checked his work out with them first. All found him to be a diligent and
responsible researcher who understood the scientific and ethical basis
of research involving human subjects. When WHO wanted to investigate an
possible polio outbreak in the Iraq, Riyadh was their choice to head the
investigation.As far as the papers go, I did look at the 1997 Nutritional survey (the
second NJ link never worked for me–but send me the pdf file if you have
it), and this is a perfectly respectable nutrition survey. At the time
of the sanctions many people were concerned at the impact of sanctions
on the children of Iraq. UNICEF mounted several very large nutrition
surveys to this effect. To document the impact of political events on
children of a country is an important safeguard. Sanctions are supposed
to protect the vulnerable in the process of creating political change.
If the vulnerable are suffering almost everyone would agree that the
sanctions are off target. I am not arguing the right or wrong of
political sanctions, but if malnutrition is a problem or is increasing
among the children of the affected populations, then something is wrong
with the implementation of the sanctions. I think all would agree that
Saddam manipulated the sanctions to his own benefit, and this itself may
have increased malnutrition among children. This is exactly the thing
that repressive governments often do. But documenting the nutritional
effects of sanctions is nothing that would cast doubt on someone’s
integrity.As far as the survey forms, we have all the original field survey forms.
Immediately following the study we met up with Riyadh (in this very
hotel I am now in) and Shannon, Riyadh and I went through the data his
team had computer entered, and verified each entry line-by-line against
the original paper forms from the field. We rechecked each data item,
and went through the whole survey process cluster-by-cluster. We
considered each death, and what the circumstances were and how to
classify it. Back in Baltimore as we were in the analysis we checked
with Riyadh over any questions that came up subsequently. We have the
details on the surveys carried at each of the clusters. We do not have
the unique identifiers as we made it clear this information was not to
be part of the database for ethical reasons to protect the participants
and the interviewers.I have tried to point out that Riyadh Lafta is part of the university
system (Ministry of Higher Education) not the Ministry of Health. He was
one of the very few doctors who refused to join the Baath Party under
Saddam. This meant that he had limited career prospects in the in the
Ministry of Health. But this information seems a bit to complex and
unsupportive for the critics of the study.Virtually all international research relies on
team work. No one person can be everywhere at any time, and many times
it is unsafe to do so–both to the interviewers as well as members of
the international team. The data on decreased infant and child mortality
in Afghanistan, which both Munro, President Bush and President Karzai
have cited as examples of success in Afghanistan, were collected in
exactly the same way, by ‘local’ teams working in communities where any
foreigner would be at very high risk of a quick death. (I am the PI on
this work). This is not unique to Afghanistan or Iraq, but is true in
the Congo (from where IRC recently published mortality data), Darfur,
Chad, and certainly during the Balkan wars. On a survey team not
everyone can do everything and be everywhere–it is very much a team
effort. Having a solid team with trust and respect that works closely
together is what makes sound research.For the 2004 survey Les went to Baghdad, in safer days, and worked with
Lafta directly on the design of the study, the training of the
interviewers and actually physically oversaw a quarter of the clusters.
He was satisfied with the methods, understanding, and the quality of his
work. Based on that work, and the day-to-day work with Riyadh and his
team in Iraq that we decided to go ahead with him in 2006. Before the
survey we first worked out the study design with Riyadh by e mail. Then
we went met up in Jordan and spent several days carefully going through
each part from consent forms to the interview and interviewer training,
to the selection of clusters, to alternative plans for insecurity, to
the classification and recording of data. For the 2006 survey we had
many of the same interviewers that Les had worked with in 2004, but
because of security we could not again participate with them in the
field (same as with Afghanistan when we did our first surveys in
2002-2004 sleeping and eating with the field teams in the provinces).
Les Roberts added:
Note that the malnutrition rates shown in the 1996 Lafta study are I believe
a little below the UNICEF estimates of the time?I would add to Gil’s comments below that I could monitor the houses with
deaths in the 2004 survey without the interviewers knowing. By watching
from the car, I could see where people went at the end of the interview to
collect a death certificate. I never saw a dataform with a reported death
before I had seen the person go to fetch the certificate. This is not
perfect confirmation in these clusters, but it is better than can usually
be done. Those 8 clusters I visited had almost an identical CMR as the
other clusters when the Kurdish north (lower) and Falluja(higher) were set
aside. Thus, I have very high confidence that the 2004 data were valid. I
suspect that it is rare that a mortality or nutritional survey article of
this sort is published in a top flight journal where the PI went to 1/4th
of the sampling sites as occurred in 2004.
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