The dangers of death toll reporting

According to a report published by the online edition of the Lancet today, 100,000 Iraqis have died as a result of the war. But it's the publication of the report rather than the report itself that is most interesting.

Researchers at Johns Hopkins and Columbia Universities in the USA, and Al-Mustansiriya University in Baghdad, seem to have seriously attempted to estimate the death toll. Thirty-three clusters of households selected randomly across Iraq were asked about deaths before and after the war. The risk of death appeared to have risen 2.5-fold in this period, although the majority of violent deaths were in one cluster in the city of Fallujah. The researchers excluded this one cluster from their final figure, reducing the increase in risk to 1.5-fold - implying 'excess deaths' of 98,000 since the war started.

The authors of the report themselves admit there are many limitations with their study. Such a method would be problematic in a peaceful country - the additional complications created by the situation in Iraq were numerous. The figure also seems remarkably high compared to previous estimates - for example, it is between three and 10 times higher than the figure reported by the Iraq Body Count project. In fact the actual figure, according to the report's own statistics, may be anywhere between 8,000 and 195,000. So the figure of 100,000 may turn out to be correct, but must be treated with considerable scepticism at present.

However, the stated objective behind the publication of this report is more concerning. The study has been rush-released to coincide with the US presidential election. In an accompanying editorial, Lancet editor Richard Horton states that: '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.' It is perfectly legitimate to be angry at the mess created by the coalition in Iraq, but is that the proper role for a medical journal whose reputation lies in its objectivity? And isn't there a danger of repeating the much-criticised error from Blair's 'dodgy dossier', that the proper caveats that accompany such a report will be forgotten in favour of presenting a Greater Truth?

The war in Iraq: civilian casualties, political responsibilities, Lancet, 29 October 2004

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What is the point of health awareness campaigns?

They generally seem to affect the middle-classes and the young, who are unlikely to be ill, while they are ignored by the poor and the old. They do serve, however, as a point of contact between government and people's personal concerns, driven by fear of illness.

As Alice O'Keeffe notes: "The truth is that screening, and disease awareness in general, serve some rather powerful interests. Health is one of the few issues that continue to engage voters. Getting people to worry about disease and attend health screenings creates a sense that the government is intervening positively in their lives."

"I see it as a two-sided thing," says [Dr Michael] Fitzpatrick. "There's a drive from above, from the government, which wants to make health a central feature of policy, and from the medical establishment, which wants publicity. On the other side, there's a popular resonance. People don't find screening and endless tests intrusive - they want to get involved."

New Statesman - What good the pink ribbon?