The Lancet is no stranger to controversy. In fact it courts the worst kind of it - Political!

Perhaps its its high impact factor that nudges it and its left-leaning editor into taking up issues such as the Iraq war, but seriously, does it really serve its stated mission?

Advancing medicine, by delivering superior education, reference information and decision support tools to doctors, nurses, health practitioners and students.

Oh yeah.

The Lancet's history of serious wobbling started with its publication of a paper in 1998 which tried to link MMR Vaccine with Autism! The last I heard about it, the controversy is still on. The Jan 2006 scandal of the fabricated 'Non-steroidal anti-inflammatory drugs and the risk of oral cancer: a nested case-control study' was enough for the Vancouver Guidelines to be updated with new guidelines and ethical consideration rules.

The 2004 Controversial estimate of Iraq war's death toll of Iraqis of the Lancet brought it into the mainstream glare of critical 'fact checking' crowd online...
And now, they come up with this:

"About 100,000 Iraqi civilians -- half of them women and children -- have died in Iraq since the invasion, mostly as a result of airstrikes by coalition forces, according to the first reliable study of the death toll from Iraqi and US public health experts. "

The Guadian discusses it and writes:

100,000 Iraqi civilians dead, says study
About 100,000 Iraqi civilians - half of them women and children - have died in Iraq since the invasion, mostly as a result of airstrikes by coalition forces, according to the first reliable study of the death toll from Iraqi and US public health experts.
The study, which was carried out in 33 randomly-chosen neighbourhoods of Iraq representative of the entire population, shows that violence is now the leading cause of death in Iraq. Before the invasion, most people died of heart attacks, stroke and chronic illness. The risk of a violent death is now 58 times higher than it was before the invasion.

Last night the Lancet medical journal fast-tracked the survey to publication on its website after rapid, but extensive peer review and editing because, said Lancet editor Richard Horton, "of its importance to the evolving security situation in Iraq". But the findings raised important questions also for the governments of the United Sates and Britain who, said Dr Horton in a commentary, "must have considered the likely effects of their actions for civilians".

There is a report out today in The Lancet (discussed here in the Guardian) which attempts to measure the number of deaths from coalition actions in Iraq. Here is how it is being reported:

"About 100,000 Iraqi civilians -- half of them women and children -- have died in Iraq since the invasion, mostly as a result of airstrikes by coalition forces, according to the first reliable study of the death toll from Iraqi and US public health experts. "

A major story if true. One does not have to be a partisan Democrat to "question the timing" of an announcement; indeed one does not even have to be a potential voter in the US elections next week to think that there is something a little, um, odd, about the timing of this paper. For, as we are told:

"Last night the Lancet medical journal fast-tracked the survey to publication on its website after rapid, but extensive peer review and editing because, said Lancet editor Richard Horton, "of its importance to the evolving security situation in Iraq". But the findings raised important questions also for the governments of the United Sates and Britain who, said Dr Horton in a commentary, "must have considered the likely effects of their actions for civilians". "

The full justification for the early publication is given by the Editor:

"Roberts and his colleagues submitted their work to us at the beginning of October. Their paper has been extensively peer-reviewed, revised, edited, and fast-tracked to publication because of its importance to the evolving security situation in Iraq. But these findings also raise questions for those far removed from Iraq -- in the governments of the countries responsible for launching a pre-emptive war. In planning this war, the coalition forces -- especially those of the US and UK -- must have considered the likely effects of their actions for civilians. And these consequences presumably influenced deployments of armed forces, provision of supplies, and investments in building a safe and secure physical and human infrastructure in the post-war setting. With the admitted benefit of hindsight and from a purely public health perspective, it is clear that whatever planning did take place was grievously in error. The invasion of Iraq, the displacement of a cruel dictator, and the attempt to impose a liberal democracy by force have, by themselves, been insufficient to bring peace and security to the civilian population. 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."

More than a piece of academic investigation? Really? Are we sure? We don't think that publishing this, in fact fast-tracking it (A more normal "academic" paper would take up to six months to wend its way through the peer-review process and the raw data for this was only collected six and seven weeks ago.) has anything at all to do with an election in the US some four days away? Good grief man, what do you take us for, morons?
At the very least one would have to add The Lancet to that list of mainstream media which are worth 15% (or is it 5% now, the left have never really been any good at numbers) to John Kerry in the polls. What makes it a great deal worse is this, from the findings to the report. In fact, these are the findings in their totality:

"The risk of death was estimated to be 2.5-fold (95% CI 1.6-4.2) higher after the invasion when compared with the preinvasion period. Two-thirds of all violent deaths were reported in one cluster in the city of Falluja. If we exclude the Falluja data, the risk of death is 1.5-fold (1.1-2.3) higher after the invasion. We estimate that 98 000 more deaths than expected (8000-194 000) happened after the invasion outside of Falluja and far more if the outlier Falluja cluster is included. The major causes of death before the invasion were myocardial infarction, cerebrovascular accidents, and other chronic disorders whereas after the invasion violence was the primary cause of death. Violent deaths were widespread, reported in 15 of 33 clusters, and were mainly attributed to coalition forces. Most individuals reportedly killed by coalition forces were women and children. The risk of death from violence in the period after the invasion was 58 times higher (95% CI 8.1-419) than in the period before the war."

Have a look at those confidence levels. Yup, 95%. That is, a one in twenty chance that the effect simply does not exist. Look at the relative risk ratios (leave out Falluja; I don't think anyone is really very surprised to see a higher mortality rate there): 1.1-2.3. It isn't just that it is an absurdly wide one (note, a relative risk ratio of 1 would mean no effect whatsoever) it is that if this paper was written to generally accepted statistical standards it would never have been published. With a 95% confidence level a relative risk ratio of anything less than three is regarded as statistically insignificant. Just to clarify that, by "insignificant" no one is stating that it is not important to those people who undoubtedly have been killed during the War. What is being said is that we don't have enough information to be able to say anything meaningful about it. "Statistically insignificant" means "we don't know".
In effect, what has been found in this paper is nothing. Nada. Zip.
Except of course that one of the two leading medical journals in the world has published a piece of shoddy research four days before the US elections with the obvious motive of influencing them. Sad, that, and my apologies as an Englishman that it should be one of my countrymen who did such a thing.

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The Techcentralstation weighs in:

The once-respectable British medical journal The Lancet has produced a report claiming we're destroying Iraq to save it. It says that about 100,000 Iraqi civilians have been killed by coalition forces since the invasion began, most from airstrikes. The journal even admitted its findings were an October Surprise, pre-released online to sway the election across The Pond. But its conclusion will surely be employed by war opponents and Iraqi insurrectionists long after the November dust settles.

The research, led by Les Roberts of the Johns Hopkins Bloomberg School of Public Health in Baltimore, involved sending teams to interview 998 families in 33 allegedly randomly selected neighborhoods across Iraq. They asked how many people in each household had died and of what, then extrapolated to the nation as a whole. Thence the 100,000 figure, which they claimed was "conservative." But a better word is "worthless." Consider just this: The sample size was so small that the range for deaths was a humongous 8,000 to 194,000. So Roberts and friends just split the difference.

They admitted the sample size was small, but pleaded it was necessary because the surveyors were in constant danger. By that, they no doubt meant F-16s putting them in their crosshairs, as opposed to those jolly terrorists who routinely kidnap civilians and slowly saw off their heads with dull knifes.

More than that, the researchers didn't feel themselves bound by anything official, like death certificates. Interviews were just fine. "In the Iraqi culture it was unlikely for respondents to fabricate deaths," they wrote.

Such faith in the honesty of Iraqis is truly touching. But these are the people who gave us "Baghdad Bob" and are regularly quoted saying that once again a U.S. airstrike killed only innocents. It's as if American had developed a chip for its weapons that zeroes in strictly on women, children, and old men.
Cluster sampling can be valid if it uses reliable data, rather than on inherently unreliable self-reporting. But it can also be easily skewed by picking out hotspots -- like determining how much of a nation's population wears dentures by surveying only nursing homes.

In fact, intentionally or otherwise, that's pretty much what The Lancet did. Most of the clusters had no deaths whatsoever. But here's the real bombshell: "Two-thirds of all violent deaths were reported in one cluster in the city of Falluja," the journal reported. That's it; game over; report worthless.

But why stop there? Consider also that 98,000 deaths during the time in question averages out to over 180 daily. Have you heard anyone claim we killed anywhere near that number on one day, much less every day? Even the insurrectionists wouldn't try to pull that off. They left it to The Lancet.

Consider also that even various self-styled human-rights groups have proclaimed the Lancet numbers outlandish. "The methods that they used are certainly prone to inflation due to overcounting," Marc Garlasco, told the Washington Post. "These numbers seem to be inflated." Garlasco is senior military analyst for Human Rights Watch, which has repeatedly been a thorn in the Pentagon's side during the Iraq war.

The overtly anti-war group www.iraqbodycount.com estimates about 14,000-16,000 deaths since the war began. It cautions that its data rely solely on press reports, but considering how the Iraqis like to pad body counts this means its own figures are certainly too high.

Finally, consider that The Lancet researchers are far from disinterested observers. "I was opposed to the war and I still think that the war was a bad idea," Roberts admitted to the Associated Press. "As an American, I am really, really sorry to be reporting this."

If you think Roberts's Lancet editor Richard Horton might have been a check on sloppy work or outright false propaganda, think again. "Democratic imperialism has led to more deaths not fewer," he told the BBC, proclaiming coalition efforts in Iraq "a failure."

We thus witness the further erosion of the reputation of Britain's former leading medical journal. Recently it's been embarrassed by two other reports. One tied childhood vaccines to autism, but turned out to have been paid for by a trial lawyer representing children in the study. The other combined 14 studies of antioxidant supplements, of which some showed protective effects, some showed no effect, and one showed a negative effect. It thereby concluded antioxidant supplements can kill you.

Now The Lancet has become Al-Jazeera on the Thames.

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