Goldblatt on Lancet study

Mark Goldblatt mounts an attack on the Lancet study:

The JHBSPH study attempts to calculate the number of civilian deaths "above what would have occurred without conflict." I wonder, therefore, if the survey group was taking into account the effects of United Nations sanctions on Iraq prior the invasion -- which, if the conflict hadn't occurred, would logically still be in place. According to U.N. studies using similar methodologies to those utilized by JHBSPH, roughly 150,000 civilians, more than half of them children, were dying every year as a direct result of U.N. sanctions. Since the sanctions ended in May 2003 after the fall of Saddam Hussein's regime, that means that in the 3.5 years since then, roughly 525,000 lives were spared. If we compare that number with the JHBSPH's estimate of 600,000 lives lost as a result of the conflict, we're led to conclude that George W. Bush's decision to oust Saddam has cost roughly 75,000 Iraqi civilian lives. But the JHBSPH researchers acknowledge a huge margin for error; their low end estimate is 426,369. That means Bush's decision to invade may actually have saved almost 100,000 lives.

Well, no. The survey group did take into account the effect of lifting the sanctions. The 650,000 excess deaths is the net effect and includes any decrease that resulted from lifting the sanctions. Nor did UN studies blame the sanctions for 150,000 deaths a year. They found an extra 60,000 deaths per year, which wasn't just the effect of sanctions, but also war and Saddam's failure to invest in health care. In any case, the oil-for-food program ended the harmful effect of sanctions on Iraqi health.

Goldblatt continues:

Skeptical American military commanders point out that the U.N. numbers are based on combined reporting from the Iraqi health ministry, which is controlled by supporters of anti-American Shiite cleric Moqtada al-Sadr, and Baghdad's central morgue, which apparently designates every unidentified corpse as a victim of the war. Indeed, the U.N. numbers feel inflated since 3,000 killings per month averages out to over a 100 every day -- a total that far exceeds daily media accounts. By contrast, Reuters reports the civilian toll in August at 769, down from 1065 in July. (In the interest of fairness, it should be noted that Reuters reports the body count in September as 1,089, a sharp rise in fatalities from August.) The Reuters figures are derived from combined data provided by the Iraqi ministries of health, interior, and defense -- dubious sources, to be sure -- but not data from the Baghdad morgue.

So Goldblatt says that the numbers that others use to attack the Lancet study are unreliable.

Update: Luca Trevisan was here first.

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The pre invasion figure of 5.5 per 1,000 per year used by Lancet was lifted from the CIA fact book and is very conservative, about half the death rate in developed countries.

Pre invasion deaths were high, figures of 500,000 children under the age of 5 dead from the effects of UN sanctions were offered and not disputed. Hans von Sponeck resigned from the UN saying that mortality rates had doubled.

It is doubtful if the figure of 5.5/1,000 is a true representation of life in Iraq at any time.

I have a feeling of deja vu: the very same arguments were also lobbed against the first Lancet study.

Wasn't it the case that the food for oil programme was working in the timeframe the lancet studies take into account, which greatly migated the effects of the UN sanctions?

rog: The 5.5 / 1000 figure was not 'lifted from the CIA fact book' -- it was calculated from the data in the same way as the post-invasion mortality rate. Would it be too much to ask that you read the study before opening your mouth?

Indeed, that's a point worth remembering whenever anyone starts talking about the civilian body count in Iraq. Agendas abound. On the political Left, peace activists and opportunistic Democratic politicians invariably cite high-end statistics in order to justify their attacks on the Bush administration.

Indeed. Compare the Lancet study to the estimate from the official coalition forces survey the number of excess deaths as a result of the invasion...

...oh, it seems that despite laying into the Lancet last time around, they still haven't done one.

There are some curious anomalies in The Lancet's latest report on the death toll in Iraq since the American-led coalition's invasion in 2003.

The most striking is the claim that the pre-invasion mortality rate per 1000 of the Iraqi population was only 5.5. This would place Iraq with close to the world's lowest mortality rate, lower even than Australia's, which was 6.8 in 1998 (ABS, Yearbook Australia 2001, p.149, oh dear I forgot that was the year of Iraq's invasion which led to mass slaughter on Sydney's beaches).

Reality check: the World Bank's World Development Indicators 2000, i.e. before Paul Wolfowitz was able to fix the stats, showed the crude mortality rate in Iraq at 10 per 1,000, not quite as good as Australia's 7, so perhaps that bombing raid on Bondi never happened after all, and was actually directed at Tony Blair's Blackpool, as the UK's crude mortality rate in the same year was 11, worse than Iraq's, luckily Saddam had missed Florida, so the USA's rate in 1998 was only 9 per 1,000).

The Lancet/Johns Hopkins study arrives at its estimate of 655,000 "excess deaths" in Iraq since 2003 SOLELY on the basis of its dishonest statement that the mortality rate in Iraq before 2003 was only 5.5 (nearly the LOWEST IN THE WORLD according to the World Bank data for every other country despite all the enhanced infant mortality previously reported by The Lancet because of the pre-2003 sanctions).

In truth the rise in mortality in Iraq since 2003 is from 10 per 1,000 to 13.3 per 1,000. That means the excess was not 655,000 as claimed by Lancet/Johns Hopkins, but only around 220,000. Of those at least half were due to secticide, although the PC Lancet/Johns Hopkins team never mention the words Sunni or Shia, thereby implying that ALL the excess deaths were due to the Coalition.

Finally, the John Hopkins team (instigated as they admit by Les Roberts) claim that they had NO conflict of interest. So is it true that not Roberts nor the rest ever voted Democrat? Pigs have wings.

Egypt's death rate is 5.23/1000
Jordan's death rate is 2.65/1000
Syria's death rate is 4.81/1000

All "lifted" from the CIA factbook for 2006.

Australia's is 9.76/1000.

Why? Because the median ages of the Middle Eastern countries are very young (20-23 years old). Australia's is 40 years. More old people=more deaths.

Hey, tim- is it true that many of the people disputing the Lancet study have voted for the Republicans?

Tim, you hate it that the Australian or US death-rate is higher than that of ME-countries? Don't let your people become so old. Bring down the median age and change the demographic make-up of the Australian and US population. When people are getting too old, shoot them on the spot so that in the end children between 0-14 make up some 40% of the population and people over 65 some 2-3%. That will bring your death rate down.

By Willem van Oranje (not verified) on 15 Oct 2006 #permalink

Shorter Tim Curtin:
a) The study got its pre-war death rate from an almanac.
b) A low crude death rate for Iraq is implausible on its face.

Let's score that comment for originality and accuracy. Negative numbers not permitted.

I tried to score it, but my brain got sad halfway through his third sentence.

Can we give "incomplete"?

Here's the denialist drill:

Study: calculated the death rate from all causes before the invasion and then after it, and here's the difference.

Denialist: how about cause A before the invasion?

Study: that's obviously included in "from all causes".

Denialist: how about cause B before the invasion?

Study: that's obviously included in "from all causes".

Denialist: how about cause C before the invasion?

Study: that's obviously included in "from all causes".

Denialist: how about cause D before the invasion?

Study: that's obviously included in "from all causes".

and so on... when you run out of letters, use numbers, and never stop.

I don't know whether anyone else has attempted, but I requested Dr. Burnham's data, protocols, statistical programs and log files. He responded promptly but cited a tight schedule and security concerns in refusing. I'll try again in a few months' time. Others may want to consider the factors he cited in making their own requests.

I don't believe this has any bearing on the credibility of his findings, but I'm disappointed I can't give a few items a closer look.

Funny how the 5.5/1000 death rate is persisting as a talking point against the study, in spite of the fact that it's been explained, repeatedly, all over the place.

Even funnier how it's essentially just another application of the argument from implausibility.

I requested the data and code (from Roberts and Garfield) from the 2004 study and got nowhere. Some summary data was released, but nothing that would allow anyone to replicate or reality-check the results. I also e-mailed Burnham this time around and didn't even get a reply.

Last time, I was quite suspicious because the result barely excluded 0 from the confidence interval. This time, the result is so large that it is hard to imagine any modelling issues having much of an effect.

Did Burnham simply refuse or did he imply that, once he had more time, he would make the data available?

By David Kane (not verified) on 15 Oct 2006 #permalink

He didn't simply refuse. He responded within an hour or so, and very politely. He cited a lack of time and concerns over the security of surveyors and responding neighborhoods in releasing the data "quite yet." As for "GPS readings, photocopying death certificates, and detailed probing of deaths," no such study records were maintained.

There does seem to be a pervasive misunderstanding about what a conflict of interest is. Summed up, it's what a local councillor would go to jail for, and translating things into local government terms may help to clarify it. The situation as described here -
"Finally, the John Hopkins team claim that they had NO conflict of interest. So is it true that not Roberts nor the rest ever voted Democrat? Pigs have wings."
- simply doesn't hack it. If a council employee produced a survey of poverty in the district that supported the claims of the party he or she voted for, that doesn't constitute an offence under the act. If they produce a survey that recommends the council buy their house to build a soup kitchen, that's/i> a conflict of interest.
If people vote in the way their evidence points, that's the way democracy is supposed to work.

David Kane wrote:

Some summary data was released, but nothing that would allow anyone to replicate or reality-check the results.

Hmmm. I disagree. I believe "sufficient information exists with which to understand, evaluate, and build upon a prior work."

Last time, I was quite suspicious because the result barely excluded 0 from the confidence interval.

That's an odd reason to have been suspicious. The 2004 paper plainly stated that the sample size was chosen to be able to do that.

Chris: Ok, but meantime I find it hilarious that the CIA, authors of WMD and failure to act on reports of Saudi flying trainees skipping the landing lessons, was the source for the Johns Hopkins pre-war mortality base line. The World Bank data should have been used as well, relying on a single source was not professional, and as the choice of baseline is critical to the findings, this omission certainly suggests bias if not conflict of interest. It is not evident that the study derived a separate baseline from its sample, but if it did and that differs from the World Bank's, then it casts doubt on the sampling method. But in all scenarios there are too many deaths, but the sooner the secticides stop the sooner will the coalition depart.

"I find it hilarious that the CIA, authors of WMD and failure to act on reports of Saudi flying trainees skipping the landing lessons, was the source for the Johns Hopkins pre-war mortality base line."

It wasn't. Could you read the article before commenting further, please?

Total: read p.6 and cited footnotes 18 and 19, 18 refers to CIA; World Bank not cited. The CIA at 18 and Bureau of Census at ref 19 are likely the same source but I have not been able to access the latter to check this.

By Tim Curtin (not verified) on 15 Oct 2006 #permalink

Tim,

5.5/1000/year was calculated by the survey. The reference you site says this:

Our estimate of the pre-invasion crude or all-cause mortality rate is in close agreement with other sources.

They are simply comparing their value to others. Perhaps they should have included other estimates; but the CIA was clearly not the "source" of their baseline.

By Eric Wallace (not verified) on 15 Oct 2006 #permalink

Tim C,

I agree with Eric. From my reading, they calculated their own estimate and then said that this was close to other estimates ie the CIA. I also think that you should acknowledge that it's logical to compare the mortality rate with other countries of a similar demographic profile rather than countires such as Australia that have an aging population.

A similar argument was made here by another cs prof.

Tim,

They derived the 5.5 per thousand pre-war figure from their own survey THEN they validated it against the CIA figure.

By Ian Gould (not verified) on 15 Oct 2006 #permalink

From my reading, they calculated their own estimate and then said that this was close to other estimates ie the CIA.

I don't really think they should have bothered comparing it to the CIA World Factbook, because, if you look at the latest factbook - here - you'll see that their 2006 estimate for Iraq's crude death rate is 5.37/1000. i.e. even less than the pre-war estimate, which, if taken at face value, would imply that, erm, lives have actually been saved by the invasion. Now, it's probably the case, as has been suggested elsewhere, that the CIA has just been putting out these figures without bothering to update them. But if that's so, then, I would humbly suggest, it casts a little doubt on the credibility of its 2002 figures.

Tim Curtin:

Of those at least half were due to secticide, although the PC Lancet/Johns Hopkins team never mention the words Sunni or Shia, thereby implying that ALL the excess deaths were due to the Coalition

As has been pointed out before, to cause a civil war is nothing to be proud of.

By Meyrick Kirby (not verified) on 16 Oct 2006 #permalink

Tim Curtin said
"Chris: Ok,"
and for a moment I thought he was referring to some of the key counterarguments made here, for instance that the pre-war death rate was independently estimated (and not copied from a reference), or that it's natural to have a low mortality rate in a country when the population is mostly made up of children and young adults?

Can you OK those, Tim Curtin? Just for the record?

Harald: I agreed with Chris re conflicts of interest. For the record, the CIA as noted elsewhere here shows a declining crude mortality rate since the invasion to 5 or less. The Economist (Pocket World in Figures 2000) cites a rate of 8.5 before the invasion. But let's be reasonable, the JH/Lancet study asked people to be very precise about dating family deaths before 2003. Anybody doing this kind of survey in 2006 would suspect precision of dates cited as long as 4 years ago. When did your Aunt Agatha actually die, was it 2000, 2001, or 2002?

Anybody doing this kind of survey in 2006 would suspect precision of dates cited as long as 4 years ago. When did your Aunt Agatha actually die, was it 2000, 2001, or 2002?

Well, if it says 2002 on the death certificate I'd go with that.

By Kevin Donoghue (not verified) on 16 Oct 2006 #permalink

It seems to me that Tim C requires one to be either a vestal virgin or a rabid rightwinger in order to be "(scare quotes disinterested".

To quote Coby Beck , as you say "we should do something", you are a policy advocate and as soon as you pick up a phone to tell a friend about your research you are politicizing your science."

In the comments Andrew Dessler points out that for some, "if you have been breathing air you are an advocate."

The point of denialism is diversion, it does so by not only
diverting the discussion to minutia, but also by casting everyone as an "advocate".

Not only is the denialist's bench weak, but they have a limited bag of tricks that they apply to every problem.

Of those at least half were due to secticide, although the PC Lancet/Johns Hopkins team never mention the words Sunni or Shia, thereby implying that ALL the excess deaths were due to the Coalition.

Tim: This is completely wrong. If you'd actually read the study, you would have seen this: "Deaths attributable to the coalition accounted for 31% (95% CI 26-37) of post-invasion
violent deaths." The thing is only seven pages long, you know, and a lot of that is pictures. Why not give it a try?

By Victor Freeh (not verified) on 16 Oct 2006 #permalink

Not only is the denialist's bench weak, but they have a limited bag of tricks that they apply to every problem.

Not only that, but they are too stingy to sand the bench. And I don't expect too many of this crew to be handy with power tools or sandpaper.

Combine this with the benchwarmers being, er, soft of posterior and the folk that occupy the bench get grumpy from splinters in their rears, rendering their judgements unreliable.

Best,

D

Anybody know of a response to the IBC's response: http://www.iraqbodycount.org/press/pr14.php It's basically along the lines of "it can't be true", but would be interested in seeing a thought-through analysis of the IBC's rejection of the Lancet study.

Two more denialists:

Morgan claims that there were conscious or unconscious biases in the sample selection.

johnjayray claims that the results could have been simply made up, because no one re-interviewed the households.

I certainly don't have the chops to deconstruct these claims, but I'd be interested in seeing any analysis that Tim or other commenters here would care to make.

Tim Curtin, you dodged by question. Do you agree that

1. The average age in Iraq is very low compared to western democracies, so a low crude mortality rate compared to us isn't suprising?

2. The recent study did not get its crude mortality estimate from a reference, they only compared it to one?

I'm not asking you to give up on Lancet denial entirely, I'm just asking you to give us these two points. Feel free to add "howevers" and "buts".
I'm asking this because these arguments are recycled again and again, it shouldn't take you too much to admit that they are too simple.

Thanks Lopakhin - I wasn't suggesting that the IBC rebuttal lacked substance, btw. We are, as I suspected, faced with two apparently irreconcilable views. The Lancet statistical analysis can't be faulted, yet comes up with numbers that seem hard to credit. The arguments will go on for the next couple of decades, I should think. The key will be to assess locally-held death certificates (at hospitals and morgues), rather than central ones - should they survive the war.

One concern I have over the Lancet study is that it assumes a constant population distribution, I think? Yet the civil war has created a large number of refugees (I read somewhere a million plus). Some of these are emigrees, but most are internally displaced. How will this affect the statistics? The population of violent regions is probably lower than estimated (meaning the extrapolation of deaths is too high), while the converse applies in less violent regions. Also, is there a possibility of double counting (i.e. somoeone dies, the household moves and is divided among relatives, then the death is reported by both new households).

Harald K:
1. But was Iraq's mortality rate really low in 2002? crude mortality acording to both the World Bank (10 per 1000) and The Economist (8.5)was evidently around 9 at turn of century, despite the age-structure. These rates are not surprisingly high, despite that age structure, not least because of the two major wars and subsequent sanctions that afflicted Iraq between 1980 and 2000, unlike other Arab countries such as Egypt with similar age structures and corresponding lower crude mortality rates (duly reported by WB and The Economist, the latter shows 6.8 for Egypt in 2000, against Johns Hopkins' 5.5 for Iraq.

When I was a graduate student about a millennia ago we were expected to acknowledge all relevant data and at least explain a preference for one source over another. Academics with their own poltical agenda will of course cherry pick the source that best suits their thesis.

John Hopkins deployed two other tricks to boost their headline stat to 654 965 "excess deaths" since 2002.
Trick #1: The Study states at p.4 that the population at the start of the "recall period" (January 1, 2002) was 11956. All deaths up to the invasion amounted to 82; that
produces a crude annualised mortality rate of 5.9, not 5.5; in this game such differences can be material, as here.
Trick #2

The Study uses a total population in Iraq in mid-2004 of 27,135,384, well above the World Bank's projection for that year of 25.11 million. Of course it improves the headline figure (by over 10%) to use the higher figure when multiplying up from the study's excess mortality rates. (Note that the study glides effortlessly from rates over 13 or 14 months, no professional demographer would dream of citing other than annual mortality rates, to annual rates (sometimes).

2. The study cherry-picked a reference that suited their case (actually the CIA figure is about 10% above the study baseline so of course they did not use it)

Harald, I once worked in Scandinavia and never encountered your rudeness, try reading Bjorn Lomborg for some civilised discourse.

Tim Curtin:

When I was a graduate student about a millennia ago we were expected to acknowledge all relevant data and at least explain a preference for one source over another.

Therefore, why do you prefer the World Bank to other sources? Also, when are you going to admit that the CIA World Fact Book was not the source?

Trick #1: The Study states at p.4 that the population at the start of the "recall period" (January 1, 2002) was 11956. All deaths up to the invasion amounted to 82; that produces a crude annualised mortality rate of 5.9, not 5.5; in this game such differences can be material, as here.

Since the increase in the non-violent death rate of 5.4 to 6.0 is not significant (material), the difference between 5.5 & 5.9 won't be either. (Hint: 5.9 is in the 95% CI)

Trick #2: The Study uses a total population in Iraq in mid-2004 of 27,135,384, well above the World Bank's projection for that year of 25.11 million.

Again, what is your justification of the World Bank numbers to the UNDP/Iraqi Ministry of Planning?

Lastly Tim, your obtuse remarks are well known around here, so try not accusing other people of rudeness ... it's mightily hypocritical!

By Meyrick Kirby (not verified) on 17 Oct 2006 #permalink

Tim Curtin wrote:

Trick #1: The Study states at p.4 that the population at the start of the "recall period" (January 1, 2002) was 11956. All deaths up to the invasion amounted to 82; that produces a crude annualised mortality rate of 5.9, not 5.5

The population grew over the period of the study so using the starting population for the denominator of the crude death rate calculation makes the rate too high; demographers adjust for the person-years (or person-months) of exposure to risk of an event for exactly this reason.

Note that the study glides effortlessly from rates over 13 or 14 months, no professional demographer would dream of citing other than annual mortality rates, to annual rates

They glide effortlessly from them because the basic calculations (at least, in the 2004 article) were done with person-months/12. The rates that are quoted are annualized rates.