Psyche, Science, and Society

Statistical tools help guide responses to human rights crises

Science News discusses the complexities of using statistics to guide humanitarian responses, using the issue of estimating Iraq mortality as an example:

Humanitarian Statistics
Statistical tools help guide responses to human rights crises

Julie J. Rehmeyer

In late 2006, a statistical study of deaths that occurred after the invasion of Iraq ignited a storm of controversy. This Lancet study estimated that more than 650,000 additional Iraqis died during the invasion than would have at pre-invasion death rates, a vastly higher estimate than any previous. But in January, a World Health Organization study placed the number at about 150,000.

The conflicting findings highlight just how difficult it is to gather reliable information in a war zone. But they also show the increasing involvement of statisticians in informing responses to humanitarian crises. In addition to the work in Iraq, statisticians have gathered evidence that has aided in the prosecution of Slobodan Milosevic, guided reparations for the civil war in Sierra Leone, and helped determine the needs of Katrina survivors, among many other projects.

“You can go to a congressional hearing or an international war crimes tribunal and you can hear the stories,” says Lynn Lawry of the International Medical Corps. “But how many are we talking about? How many people are at risk? How many people are affected?”

Statisticians are well-suited to answer these questions because they have the tools to put together partial information into a global picture. For example, even if complete records can’t be gathered, a statistician can survey a small number of randomly chosen people affected by a crisis and infer from their experiences the likely impact on the population as a whole. For example, Jana Asher of Carnegie Mellon University in Pittsburgh, Pa., developed an estimate of the rates of rape across Sierra Leone by determining how many women from a national sample had been raped.

But humanitarian crises pose huge challenges. Little information may be available—even from before a crisis—about how many people live where. Even if a previous census was taken, the high birth and death rates in developing countries tend to quickly make censuses outdated. Areas within continuing war zones can be unsafe for survey workers.

“When you have a displaced population that has been forced to flee their homes, all the traditional census methods really break down very badly,” says David Banks, a statistician at Duke University in Durham, N.C. “The refugees don’t have addresses. They’re wandering from one camp to another. Communication is poor.”

These challenges have to be met with very carefully designed protocols. For example, the Lancet study of Iraq, with the shockingly high mortality rates, was initially criticized for not surveying people who lived in back alleys because the areas were too dangerous for surveyors. Les Roberts, who was at Johns Hopkins University in Baltimore at the time but is now at Columbia University, and his collaborators on the study argued that the critics had misunderstood their randomization technique.

Random surveys are not the only useful statistical method. To tally the number of deaths related to the conflict in Timor-Leste, Romesh Silva and Patrick Ball of the Human Rights Data Analysis Group combined incomplete datasets to generate a broader picture of events. The Indonesian military claimed that its occupation of Timor-Leste had caused no deaths. Many stories had been told of killings and famine, but Silva and Ball wanted solid evidence.

Along with gathering about 8,000 personal accounts conveyed to the Commission for Reception, Truth and Reconciliation, Silva and Ball conducted a census of public graveyards including 319,000 gravestones and a survey of a random sample of 1,400 households about displacements and deaths. The researchers found that the different lines of evidence corroborated one another strongly, adding to the strength of each approach. In addition, Silva and Ball could observe how often names recurred across the different databases and get a much better estimate of the total number of deaths across the country.

They found that Indonesian occupation of Timor-Leste from 1974 to 1999 led to more than 100,000 deaths beyond what would have been expected in peacetime, through a combination of direct killings, famine, and illness.

The conflicting studies in Iraq show just how tricky it is to apply these methods in messy real-life situations. About the Lancet study, Asher says, “I don’t think there was anything obvious in what they did that someone can point to and say this method is flawed. But the WHO study used appropriate methodology too.”

The most suspect part of the Lancet study, Asher says, is that the researchers didn’t supervise the survey workers closely. On the other hand, the World Health Organization relied on government workers to administer the questionnaires. People can be intimidated by government workers and be less inclined to say much, a phenomenon that is particularly common in unstable countries. The only way to resolve the conflict, Asher says, is to do yet another study, with an even more careful design.

If you would like to comment on this article, please see the blog version.

References:

Asher, J., D. Banks, and F.J. Scheuren, eds. 2008. Statistical Methods for Human Rights. New York: Springer. See www.springer.com/statistics/social/book/
978-0-387-72836-0.

Iraq Family Health Survey Study Group. 2008. Violence-related mortality in Iraq from 2002 to 2006. New England Journal of Medicine 358(Jan. 31):484-493. Available at http://content.nejm.org/cgi/content/full/358/5/484.

Burnham, G. . . . and L. Roberts. 2006. Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey. Lancet 368(Oct. 21):1421-1428. Abstract available at http://dx.doi.org/10.1016/S0140-6736(06)69491-9.

Silva, R., and P. Ball. 2006. The Profile of Human Rights Violations in Timor-Leste, 1974–1999. A report by the Benetech Human Rights Data Analysis Group to the Commission on Reception, Truth and Reconciliation of Timor-Leste. Available at www.hrdag.org/resources/timor_chapter_graphs/
timor_chapter_page_01.shtml.

Add comment March 31st, 2008

NPR downplays Iraqi dead

FAIR has issued an Action Alert: NPR Underreports Iraq Deaths, dealing with an NPR report by Scott Simon in which he stated:

“This coming Wednesday marks the fifth anniversary of the start of the war in Iraq. So far 3,975 U.S. service men and women have died. Estimates on the number of Iraqis killed range from 47,000 to 151,000, depending on the source.”

These numbers are, of course, silly. The 151,000 presumably comes from the recent World Health Organization/Iraqi Ministry of Health study recently reported in NEJM. FAIR speculates that th 47,000 is from Iraq Body Count, but it is their estimate of those killed as of June 2006 [In the email below I erred and said August] and is considerably higher now, around 85,000. And other studies from the Lancet and the British polling firm ORB yield far higher estimates of around one million [extrapolating the Lancet study]. Thus, the number of dead from violence is almost certainly at least 250,000 and most likely higher, perhaps far higher. NPR miserably failed its listeners, the Iraqi people, and the truth in this instance. Alas, this is far from the only time that NPR has been a vessel for propaganda supporting the war.

FAIR calls upon concerned listeners to write the NPR ombudsman and ask for an investigation. Here is my email:

I hope that you will look into the very misleading figures in the March 15 braodcast in which Scott Simon described estimates of Iraqis killed since the war began as from 47,000 to 151,000. As a researcher, I have followed this area closely. I can imagine no credible source for the 47,000 figure as Iraq Body Count (IBC, which counts those dead reported in the Western media, puts the current figure of such reported deaths as over 80,000.  IBC is certainly a radical undercount given the exigencies of reporting in a war-torn country where over 100 reporters have been killed and many others kidnapped or arrested.

Further, the 151,000 figure, from the World Health Organization and Iraqi Ministry of Health, was as of August 2006, before the most intense violence.

Further, several additional studies from Johns Hopkins epidemiologists (published in the Lancet) and from the British ORB polling organization have arrived at far higher figures. Johns Hopkins estimated around 600,000 victims of violence by summer 2006 and the ORB estimated around 1,000,000 by the end of 2007.

Surely NPR listeners, as they weigh the five years of war deserve accurate information on the current state of knowledge on the true costs of that war.This Ameriacan Life has reported on the Lancet studies. Surely over reporters should as well. Much as I love Scott Simon, in this case, his report was grossly deceptive at best. The purpose of NPR is to create an informed citizenry. In this instance you failed your mission.

Please investigate and make sure that such an egregious error does not recur.

Thank you very much.

Post your email here.

Add comment March 26th, 2008

Palast: God Damn America — Especially Pennsylvania

Greg Palast, in his inimitable way, illuminated Pastor Wright’s relevance to Pennsylvania whites:

God Damn America — Especially Pennsylvania
by Greg Palast

[Sunday, March 23, 2008, Forest City, PA ]

The kids were snoozing so I drove along the back roads skirting the Lackawanna River on a dawn hunt for black coffee and a newspaper.

I think even Norman Rockwell would have found this place too sticky sweet, too postcard: the weathered barns, the fallow fields perfectly snow-frosted; red, white and blue flags already up on the clapboard farmhouses and the white-washed church in the valley already full for Easter prayers.

At a gas station, I scored the paper and coffee, spilled some on the front page – the closest thing I’ve got to a religious ritual – then parked in front of a row of insanely pretty salt-box houses shining like mad teeth on the river bank. One was missing a pick-up in the driveway; its screen door was left half-open, and there was a letter taped to the window. The Sheriff’s Notice of eviction. Another foreclosure.

God damn America.

I know that’s what Obama’s spiritual guide would say.

But why? It seems likes He’s already done a pretty good job of damning these United States.

And He seems to have really taken it out on this corner of Pennsylvania.

The gargantuan Bethlehem steel works have dwindled to a few robot-operated mills controlled from Mumbai, India. The only remainders of nearby Carbondale’s mining industry are in display cases at the ageing Coal Inn. But you could still get out by selling your home to ski tourists from New York – until this year when mortgage markets turned cancerous.

That leaves Forest City’s one industry, lumbering – which we can kiss goodbye since a recent ruling by the NAFTA board which allows the import of cheap Canadian wood.

Some local kid has made the paper having been thrown, helmet first, into the volcano called Iraq. The Scranton Times-Tribune, two pages after the photo of a priest blessing a bowl of who knows what, noted that three soldiers killed in yesterday’s bombing are, “pushing the death toll in the five-year conflict to nearly 4,000” – which is true if you don’t count Iraqi dead. But Someone must be counting them. (From way up in heaven, I wonder if we look like a nation of Christians – or an empire of Romans.)

Phil Ochs, before he killed himself, wrote,

“This is a land full of power and glory,
Beauty that words cannot recall.
But her power shall rest on the strength of her freedom.
Her glory shall rest on us all.”

Whatever. It’s a difficult place to be an atheist, in this America, surfeited as it is on every vista with signs of His overwhelming grace and His exasperated wrath. It’s as if the Lord Himself is just as confused and frustrated and disappointed as the rest of us by blessings so abused.

There’s one consolation. He has apparently granted Pennsylvanians the privilege, come April 22, of choosing which Democrat will lose in November.

Which may not mean much to Sandy Ryder on whom the spirit of Easter has landed like a ton of bricks. Sandy, says the flyer tacked up at the Bingham diner, was, “Recently diagnosed with Inflammatory Breast Cancer.” She’s a, “Single mother of two – Tony and Brandon – and Grandmother of one – Jason.”

And there they were in a photocopied portrait, the earnest elder son and little Jason to her right, the young slacker (Tony? Brandon?) slouched to her left. The town’s hawking a benefit for Sandy, $10 at the door, “including Food and Beverage” and a “Chinese auction.”

(I’ll bet Al Qaeda could pick up some recruits here – if Osama would offer health insurance.)

Whatever. This is, after all, Holy Week, which marks the anniversary of the grounding of the Exxon Valdez, the day the giant oil corporation soaked 1,200 miles of Alaska’s coast with crude sludge. March 24 marks 19 years since the grounding and 19 years since Exxon’s promise to compensate the ruined fishermen. You should watch the 19-year-old video-tape of Exxon’s man in Alaska. I especially like the part where he tells the fishermen, “You have had some good luck – and you don’t realize it.”

I know some of the fishermen on the TV footage, like the Anderson family, Eyak Natives. I can tell you, the Eyak don’t feel so lucky, still waiting for the Supreme Court to act on Exxon’s latest stall on payment. They’ve seen plenty of Sheriff’s Notices these past 19 years.

So Happy Easter.

George Bush tells us he’s, “feeling just fine.” And we should be glad for him, I suppose.

Bush ends his most belligerent speeches by saying, “God bless America.”

So, why hasn’t He?

Maybe you can tell us, Mr. President: Why hasn’t He?

***************
Greg Palast is the author of the NY Times best-selling books Armed Madhouse and Best Democracy Money Can Buy. Read his reports at www.GregPalast.com and sign up for the audio podcasts RSS here.

Add comment March 24th, 2008

PBS series on health disparities: Unatural Causes

Apropos the New York Times article I posted earlier today o increasing health disparities between rich and poor in the US, a friend has just sent this notice of a related upcoming PBS series, Unnatural Causes, which asks “is inequality making us sick?” that starts this week. Here is the series summary that she sent:

UNNATURAL CAUSES sheds light on mounting evidence that demonstrates how work, wealth, neighborhood conditions and lack of access to power and resources can actually get under the skin and disrupt human biology as surely as germs and viruses. But it’s not just the poor who are sick—so are the middle classes. At each descending rung of the socio-economic ladder, people tend to be sicker and die sooner. What’s more, at every level, many communities of color are worse off than their white counterparts. Compelling personal stories—spanning the country—demonstrate how social conditions are as vital to our health as diet, smoking and exercise.  As Harvard epidemiologist David Williams points out, investing in our schools, improving housing, integrating neighborhoods, better jobs and wages, giving people more control over their work, these are as much health strategies as smoking diet and exercise. And these are the stories that UNNATURAL CAUSES tells.

HOUR ONE: In Sickness and In Wealth (56 mins) What are the connections between healthy bodies and healthy bank accounts? In Louisville, Kentucky, the issues faced by a CEO, a lab supervisor, a janitor, and a welfare mother bring into sharp relief how socio-economic status shapes opportunities to lead healthy lives.  People of color face an additional burden. Solutions, public health officials believe, lie not in more pills but in better social policies.

HOUR TWO: When the Bough Breaks (28 mins) and Becoming American (28 min)
Why do African American infant mortality rates remain more than twice as high as white Americans? Researchers are circling in on a provocative hypothesis:  the chronic stress of racism can become embedded in African American mothers’ bodies and take a toll on their children even before they leave the womb.

In contrast, recent Mexican immigrants, though often poorer, tend to be healthier than the average American. But the longer they live here, the worse their relative health becomes. What’s protective about new immigrant communities that we can all learn from? And what erodes this shield over time?

HOUR THREE: Bad Sugar (28 min) and Place Matters (28 min) The O’odham Indians of Arizona suffer one of the highest rates of Type 2 diabetes in the world. But is this due to their genes, or is it part of the body’s response to decades of poverty, oppression and historical trauma? A new approach rooted in the community re-gaining control over its destiny offers hope where medical-only interventions have failed.

Why is your street address such a good predictor of your health? How can your surrounding built and social environment get inside your body like smog and toxic waste? As recent immigrants move into long-neglected African American urban neighborhoods, their health is beginning to deteriorate too. What can be done to create healthy communities?

HOUR FOUR:  Collateral Damage (28 min) and Not Just a Paycheck (28 min)

Globalization and the U.S. military have disrupted the lives of Marshall Islanders. Many have ended up in the unlikely place of Springdale, Arkansas where a legacy of poverty and powerlessness continues to take a toll on their bodies.

In western Michigan, a factory closure undermines the lives and health of a white, working class community. But the same company shut down their Swedish plant with hardly a ripple thanks to very different social policies.

http://www.unnaturalcauses.org/

Add comment March 23rd, 2008

May 3: Torture and the American Psyche

For those in the Boston area, here’s an announcement of a forum that I am both helping to organize and speaking at. A flyer, suitable for printing and posting, is available here:

Torture and the American Psyche:
Blurring the Boundaries Between Healers and Interrogators
Saturday, May 3, 2008,
9:30 am – 12:30 pm

First Parish Unitarian Church,
382 Walnut Street,
Brookline, MA
http://www.firstparishinbrookline.org

admission is free

DESCRIPTION:

Every day the news brings further details about our country’s recent use of torture and other detainee abuse in national security, and of the debates among our leaders and citizens of practical, legal, and ethical implications of this use. We invite concerned citizens and members of the mental health professions to join together in an open discussion of the far reaching human and moral implications of our nation’s use of torture.

We will discuss the emotional and ethical consequences of being members of a society that sanctions torture and that uses psychologists to make sure abuse is medically and “ethically” conducted. We will have three speakers, followed by a discussion among the panelists and with the members of the audience on the diverse aspects of this topic. Our aim is to facilitate a discussion which will include the emotional, ethical and spiritual dimensions of this topic and allow room for all to participate.

We understand that the topic will give pause to all who consider attending and care will be taken to ensure that the discussion will not devolve into a political diatribe or an immersion into a graphic depiction of torture. We hope that some perspective on feasible actions may emerge from the discussion.

SPEAKERS:

Eric Fair currently a divinity student at Princeton will speak from his experience as a civilian contract interrogator in Baghdad, Fallujah, and Abu Ghraib in early 2004. He will lend his first person account to our conversation.

Leonard Rubenstein, J.D. President of Physicians for Human Rights, a Nobel Prize winning organization, is an attorney and veteran of many human rights struggles. He will speak of the role of torture in our contemporary political culture.

David Sloan-Rossiter, Ph.D. will bring his long standing interest in using a psych oana¬lytic perspective to aid communities to the role of moderator of the program. He is co-chair of the Curriculum Committee at Boston Institute for Psychotherapy and Massachusetts Institute for Psychoanalysis.

Stephen Soldz, Ph.D. a local psychoanalyst, social activist and Professor at the Boston Graduate School of Psychoanalysis, is one of the nation’s leaders in opposing psycholo¬gist participation in torture and abuse. He will speak to the history of that struggle in the context of the broader struggle for human rights.

SPONSORS:

Boston Graduate School of Psychoanalysis, Institute for the Study of Violence
Boston Institute for Psychotherapy
Boston Psychoanalytic Society and Institute
Brookline PeaceWorks
Coalition for an Ethical Psychology
First Parish of Brookline
Massachusetts Association for Psychoanalytic Psychology
Massachusetts Institute for Psychoanalysis
Physicians for Human Rights
Psychoanalytic Institute of New England
Psychologists for Social Responsibility–End Torture Action Committee

Registration is not required but would help us anticipate attendance. If you are interested in attending this program, please email MLoug23@aol.com by Monday, April 28, 2008.

Download flyer here.

CONTINUING EDUCATION

The Massachusetts Institute for Psychoanalysis (MIP) offers Continu¬ing Education for psychologists and social workers. MIP is approved by the American Psychological Association to sponsor continuing education for psychologists. MIP maintains responsibility for this program and its content.
For further information, please contact Mary Loughlin at (978) 692-4790.

Learning Objectives
1. Participants will gain a greater understanding of the way that torture affects all members of a society not just the tortured.
2. Participants will have deeper appreciation of how psychologists’ presence at Guantanamo endorses the United States government stance that torture is morally acceptable.
3 Participants will appreciate the importance of engaging political issues from multiple perspectives including ethical, emotional, spiritual and psychological.

Suggested Readings:
Fair, E. (2007, February 9). An Iraq Interrogator’s Nightmare.
Horton, S., & Rejali, D. (2008, February 13). Six Questions for Darius Rejali, Author of ‘Torture and Democracy’.
Physicians for Human Rights, & Human Rights First. (2007, August). Leave No Marks: Enhanced Interrogation Techniques and the Risk of Criminality.
Soldz, S. (2007, April 13). Aid and Comfort for Torturers: Psychology and Coercive Interrogations in Historical Perspective.

5 comments March 23rd, 2008

Do “free markets” increase life expectancy disparities?

The New York Times today documents that the gap between rich and poor in the US involves not just income, but a growing disparity in life expectancy. Before people start complaining about Bush, not that the main data they present concerns the increase from 1980-1982, the beginning of the Reagan administration, to 1998-2000, the end of the Clinton administration. Presumably, Clinton’s free market ideology and policies contributed to the widening disparities.

Gap in Life Expectancy Widens for the Nation

by Robert Pear

New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.

Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.

One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.

The gaps have been increasing despite efforts by the federal government to reduce them. One of the top goals of “Healthy People 2010,” an official statement of national health objectives issued in 2000, is to “eliminate health disparities among different segments of the population,” including higher- and lower-income groups and people of different racial and ethnic background.

Dr. Singh said last week that federal officials had found “widening socioeconomic inequalities in life expectancy” at birth and at every age level.

He and another researcher, Mohammad Siahpush, a professor at the University of Nebraska Medical Center in Omaha, developed an index to measure social and economic conditions in every county, using census data on education, income, poverty, housing and other factors. Counties were then classified into 10 groups of equal population size.

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

The Democratic candidates for president, Senators Hillary Rodham Clinton of New York and Barack Obama of Illinois, have championed legislation to reduce such disparities, as have some Republicans, like Senator Thad Cochran of Mississippi.

Peter R. Orszag, director of the Congressional Budget Office, said: “We have heard a lot about growing income inequality. There has been much less attention paid to growing inequality in life expectancy, which is really quite dramatic.”

Life expectancy is the average number of years of life remaining for people who have attained a given age.

While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:

¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.

¶Smoking has declined more rapidly among people with greater education and income.

¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.

¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.

Even among people who have insurance, many studies have documented racial disparities.

In a recent report, the Department of Veterans Affairs found that black patients “tend to receive less aggressive medical care than whites” at its hospitals and clinics, in part because doctors provide them with less information and see them as “less appropriate candidates” for some types of surgery.

Some health economists contend that the disparities between rich and poor inevitably widen as doctors make gains in treating the major causes of death.

Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.

“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”

The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.

Robert E. Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said one reason for the growing disparities might be “a very significant gap in health literacy” - what people know about diet, exercise and healthy lifestyles. Middle-class and upper-income people have greater access to the huge amounts of health information on the Internet, Mr. Moffit said.

Thomas P. Miller, a health economist at the American Enterprise Institute, agreed.

“People with more education tend to have a longer time horizon,” Mr. Miller said. “They are more likely to look at the long-term consequences of their health behavior. They are more assertive in seeking out treatments and more likely to adhere to treatment advice from physicians.”

A recent study by Ellen R. Meara, a health economist at Harvard Medical School, found that in the 1980s and 1990s, “virtually all gains in life expectancy occurred among highly educated groups.”

Trends in smoking explain a large part of the widening gap, she said in an article this month in the journal Health Affairs.

Under federal law, officials must publish an annual report tracking health disparities. In the fifth annual report, issued this month, the Bush administration said, “Over all, disparities in quality and access for minority groups and poor populations have not been reduced” since the first report, in 2003.

The rate of new AIDS cases is still 10 times as high among blacks as among whites, it said, and the proportion of black children hospitalized for asthma is almost four times the rate for white children.

The Centers for Disease Control and Prevention reported last month that heart attack survivors with higher levels of education and income were much more likely to receive cardiac rehabilitation care, which lowers the risk of future heart problems. Likewise, it said, the odds of receiving tests for colon cancer increase with a person’s education and income.

1 comment March 23rd, 2008

The “monster” comment and the monstrous administration

Today, Obama adviser Samantha Powers resigned after calling Hillary Clinton a “monster,” and failing in her take-back. Marc Cooper reminds us who Samantha Powers is, and of her intimate knowledge of the amoral nature of the Bill Clinton administration that did nothing but carefully avoid the word “genocide” when confronted with the death of over 800,000 in Rwanda. As Cooper also reminds us, Bill Clinton got to have another of those carefully orchestrated Clinton tearful moments mouthing “I’m sorr” years later:

Clinton, Genocide and a Campaign Gaffe

by Marc Cooper

The Barack Obama campaign is about to pay a very high price for the inopportune words of one of its most distinguished foreign policy advisors. The dazzlingly brilliant journalist, Pulitzer-prize winning author, and Harvard professor, Samantha Power, has been forced to resign from the campaign after she recklessly told a reporter that Hillary Clinton is a “monster.”

In the pungently hypocritical game of American politics, this is just something outside the rules. Whether it’s true, or not, matters little. Nor does it matter that the object of Power’s derision has just finished spending millions on TV ads implying that Obama would be responsible for the countless deaths of millions of American children sleeping at 3 a.m. Tut, tut. Nothing monstrous about that.

Power was rightfully awarded the Pulitzer for her finely written and downright horrifying book “A Problem From Hell” which, in macabre detail, describes the calculated indifference of the Clinton administration when 800,000 Rwandans were being systematically butchered. The red phone rang and rang and rang again. I don’t know where Hillary was then. But her husband and his entire experienced foreign policy team - from the brass in the Pentagon to the congenitally feckless Secretary of State Warren Christopher - just let it ring.

And as more than one researcher has amply documented the case, the bloody paralysis of the Clinton administration in the face of the Rwandan genocide owed not at all to a lack of information, but rather to a lack of will. A reviewer of Power’s book for The New York Times, perhaps summed it up best, saying that the picture of Clinton that emerges from this reading is that of an “amoral narcissist.”

Former Canadian General Romeo Dallaire, who commanded the UN forces in Rwanda at the time of the genocide, tells us a similar story in his own memoir. General Dallaire recounts how, at the height of the Rwandan holocaust, he got a phone call from a Clinton administration staffer who wanted to know how many Rwandans had already died, how many were refugees and how many were internally displaced. Writes Dallaire: “He told me that his estimates indicated that it would take the deaths of 85,000 Rwandans to justify the risking of the life of one American soldier.” Eventually, ten times that many would die. And our response? A handful of years later, at a photo-op stopover in Kigali airport, Bill Clinton bit his lip and said he was sorry.

Therein resides the richest and saddest irony of all. Samantha Power has actually lived the sort of life that Hillary Clinton’s campaign staff has, for public consumption, invented for its candidate. Though not quite 40 years old, Power has spent no time on any Wal-Mart boards but has rather dedicated her entire adult life rather tirelessly to championing humanitarian causes. She has spoken up when others were silent. She took great personal risks during the Balkan wars to witness and record and denounce the carnage (She reported that Bill Clinton intervened against the Serbs only when he felt he was losing personal credibility as a result of his inaction. “I’m getting creamed,” Power quoted the then-President saying as he fretted over global consternation over his own hesitation to act).

We gave Power the Pulitzer for exposing the, well, monstrous indifference of the Clinton administration as it stared unblinkingly and immobile into the face of massive horror. But we give her a kick in the backside and throw her out the door when she has the temerity to publicly restate all that in one impolite word. Monstrous, indeed.

1 comment March 7th, 2008

Guardian article contrasts IRB protections with APA moral vacuousness on torture

A column in today’s Guardian Comment is Free by Ben Goldacre relates the federal Office for Human Research Protections [OHRP] ridiculous actions interfering with life saving I’d blogged about on New Years Day to the complete lack of any ethical concern by the America Psychological Association for the ethical lapses of psychologists designing Bush’s torture regime. Goldacre points out that OHRP stopped a study in a New York Intensive Care Unit which was using a simple checklist to remind people to follow simple safety protocols. Seems, if it’s research you can’t check the boxes without time-consuming Institutional Review Board [IRB] approval. Of course, if they don’t call it “research,” hospitals can do almost anything they want. The only difference is that in the “research” case, they are actually collecting data to find out if the checklist works. The basic idea, is you can do anything you want without onerous review, as long as you don’t bother to try and find out if it’s helpful.

Goldacre contraststs this silliness, leading potentially to many dead patients, with the ethical blindness that has guided the American Psychological Association [APA] for years when faced with the horrifying roles played by psychologists in the U.S. regime of abusive interrogations. The APAhad its ridiculous silliness as well. They were so concerned about unethical interrogations that they appointed a task force composed mainly of those psychologists most likely involved in unethical interrogations to formulate ethics policy for the association. Makes sese that one would appoint those accused of abuses to formulate your ethics policy, doesn’t it? After all, it wasn’t “research,” so stringent protections weren’t needed.

Here is Goldacre’s article (taken from his Bad Science blog rather than the Guardian because the blog version has many links, including several to this site). Make sure to read the last three paragraphs which discuss the APA madness:

Where’s your ethics committee now, science boy?

by Ben Goldacre

The Guardian,

Saturday February 23 2008

People have done some terrible things, over the years, with science, and with their science skills. I’m talking about Zyklon B, electrocuting gay people straight, torturing people in concentration camps, leaving syphillis untreated in large numbers of black men for an experiment (without telling them, in the US, until the 1970s), and more. Stuff where it’s hard to find any humour.

This is why we have research ethics committees, codes of practise, professional bodies, and regulators like the The US Office for Human Research Protections. Sometimes these organisations can cock up quite badly. Let me tell you about two stories which have been unfolding over the past few months.

In New York, a fiendishly clever trial in ITU departments has looked at one of the simplest interventions imaginable: a ticklist for giving IV lines, a helpful little reminder to wash your hands, wear gloves, and so on. Can something as simple as “using a ticklist”, to check if people are doing the right thing, reduce infections and save lives?

This is the bread and butter of medical academic research, which is usually not about pills, or placeboes, or molecules, but about looking pragmatically at whether one thing works better than another. You will remember that homeopaths and various other quacks are philosophically opposed to this process.

The results were spectacular: in 3 months, the incidence of blood infections from these IV lines fell by two-thirds, and over 18 months, the program saved 1,500 lives and an estimated $200 million. Then someone complained to the OHRP, because this was a research study, and they did not have ethics committee clearance. The project was shut down. This week, the OHRP grandly lifted their ban, explaining that now – since it turns out the research bit is over, and the hospitals are just putting the ticklist into practise – they may tick away unhindered.

This is what we might call the “ethical paradox”. You can do something as part of a treatment program, entirely on a whim, and nobody will interfere, as long as it’s not potty (and even then you’ll probably be alright). But the moment you do the exact same thing as part of a research program, trying to see if it actually works or not, adding to the sum total of human knowledge, and helping to save the lives of people you’ll never meet, suddenly a whole bunch of people want to stuck their beaks in.

Hilary Hearnshaw did an elegant study where she pretended to apply to do a medical research project in the Israel, the UK, and 11 other countries in Europe. She said she wanted to do a trial on a leaflet – contain your excitement - which was designed to help older patients get more engaged with their GP.

Only three countries required the project to go through a process of ethical approval, and in the UK, this was more arduous than in any other country. Getting ethical clearance took ten weeks, required two submissions (because they demanded changes), and five full days of administration, during which the proposal had to be reviewed by full committees, some of which required multiple copies of the application paperwork.

This is just the tip of the iceberg (and I would always welcome more examples by email). For one multicentre clinical trial, each of 125 local research ethics committees required between 1 and 21 copies of a protocol. Ethics approval for another trial, involving 51 centres, required over 25 000 pieces of paper, 62 hours of photocopying, and an average of 3.3 hours of investigator time for each centre. You feel like you’re dying when administrators drag their heels. In the case of medical research, when you delay research findings, and deter researchers from even bothering, people really are dying. This wider harm seems to be a blindspot for the ethics committees, captivated by their own mission creep.

But it’s not the only ethical blindspot. These regulations have their roots in the Nuremburg Code. But while the world of clinicians and academics splits ethical hairs, with our eye off the ball, an elephant has walked into the room.

February has seen another string of prominent psychologists resigning from their membership of the American Psychological Association, in disgust at its failure to take a stand on “abusive interrogation techniques”, cruel, inhuman and degrading treatment, and other activities which you might consider to be torture.

Psychologists are key to these interrogations and other activities, both in designing and enacting what I would rather not call “protocols”, out of compassion for the people on whom they are grimly enacted, in places cameras do not go.

APA members, trained, clinical professionals on their register, who have signed up to their codes of practise, now participate in these activities. The APA’s response has been to specifically bend the codes of conduct to permit their actions, and to obfuscate. Where’s your ethics committee now, science boy?

Bits:

Ken Pope, prominent member of the American Psychological Association (and a former chair of its Ethics Committee), resigned his membership on February 6. He’s the latest of a growing number of professional psychologists who have quit APA in protest of its position on the use of psychologists in government interrogations in the “War on Terror.”

Lots more on the APA and torture at Mindhacks.

Add comment February 24th, 2008

Drug company Pfizer attcks integrity of journal review process

Anyone who’s published in a peer-reviewed scientific journal knows that the peer review process has many flaws. But one of them is not that a drug company can use reviews to undermine research questioning its products. According to an article by the Editor-In-Chief in the new Science, drug company Phizer is attempting a body blow against the integrity of the peer review process by subpoenaing journal reviews to aid its defense in lawsuits. Evidently they hope to use the reviews to discredit certain studies.

Here is the Science article:

Confidential Review–or Not?

by Donald Kennedy

At Science, We editors love our reviewers and know that our editorial colleagues elsewhere do too. After all, the process of scientific publication depends on the volunteer services of thousands of experts all over the world who willingly provide, without compensation, confidential and candid evaluations of the work of others. Because all of us in scientific publishing depend on reviewers, we’d better try to keep them at it, happy, and secure. But the following case, involving a lawsuit, a drug company, and the company’s assault on the confidential files of a journal, is a bad news story.

The drug company Pfizer is being sued in various jurisdictions on product liability grounds. Plaintiffs are claiming that its products Celebrex and Bextra cause cardiovascular and other injuries. Pfizer asserts that in some cases plaintiffs are making use of published papers from the New England Journal of Medicine (NEJM). So it wants to dig though the confidential reviews of those papers in search of something to strengthen its defense. The company served NEJM with a series of subpoenas to which the journal replied, claiming several privileges in support of its refusal to comply.

Now Pfizer’s lawyers have filed a motion to compel NEJMto produce the files, which will be heard by a U.S. District Court in Massachusetts. (Full disclosure: I have filed an affidavit with the court supporting NEJM.) The motion is interesting in terms of its revelations about what Pfizer knows about the process of scientific publication and what it regards as the “public interest.” For example, the motion states: “The public has no interest in protecting the editorial process of a scientific journal …” Say what? Doesn’t the public want access to credible biomedical science? If not, what was the open-access movement all about? Do medical advocacy groups really have no use for knowledge that might help their members?

Does confidentiality count for anything to the scientists who serve the journal? Well, if confidentiality is compromised, Pfizer’s attorneys state with breezy assurance, that won’t be a problem for authors: “It is unreasonable to conclude,” they say in their motion to compel, “that scientists and academics will stop submitting manuscripts to NEJM if it complies with this subpoena.” Perhaps. But what about reviewers, who are explicitly promised confidentiality? And what about other journals? If this motion succeeds, what journal will not then become an attractive target for a similar assault?

Viewed in the larger context, this is really a conflict between competing interests. One is the public’s interest in a fair system of evaluating and publishing scientific work–one that offers high confidence in, though not an absolute guarantee of, the quality of the product. Pfizer dismisses this with a wave of the hand, a strangely inconsistent position given the enthusiasm with which it and other drug companies seek to have their own research validated by the very system of scientific publication that Pfizer’s motion decries and would undermine. On the other side, there is a private interest in gaining information that might protect a corporate defendant against a plaintiff’s attack. Without questioning the legitimacy of the latter, it is surely fair to ask whether fulfilling that need should trump the public interest.

An approach often taken in such cases would examine the prospective weight of what defendant Pfizer hopes to find; in other words, is it worth it? What Pfizer’s motion says on that score is: “Scientific journals such as NEJM may have received manuscripts that contain exonerating data for Celebrex and Bextra which would be relevant for Pfizer’s causation defense.” That’s a pretty frank admission that this is a fishing expedition in which Pfizer hopes it “may” find something to help its defense by exposing a reviewer’s comment. Is that an adequate basis for justifying prospective damage to the public interest? We don’t think so, and we suspect our prospective reviewers won’t think so, either. But if efforts of this kind were to succeed, the sad day might come when Science would have to add a firm caveat emptor to its instructions for peer reviewers.

2 comments February 21st, 2008

Reuters covers new ORB Iraq mortality survey

Reuters covers new ORB survey:

Iraq conflict has killed a million Iraqis: survey

LONDON (Reuters) - More than one million Iraqis have died as a result of the conflict in their country since the U.S.-led invasion in 2003, according to research conducted by one of Britain’s leading polling groups.

The survey, conducted by Opinion Research Business (ORB) with 2,414 adults in face-to-face interviews, found that 20 percent of people had had at least one death in their household as a result of the conflict, rather than natural causes.

The last complete census in Iraq conducted in 1997 found 4.05 million households in the country, a figure ORB used to calculate that approximately 1.03 million people had died as a result of the war, the researchers found.

The margin of error in the survey, conducted in August and September 2007, was 1.7 percent, giving a range of deaths of 946,258 to 1.12 million.

ORB originally found that 1.2 million people had died, but decided to go back and conduct more research in rural areas to make the survey as comprehensive as possible and then came up with the revised figure.

The research covered 15 of Iraq’s 18 provinces. Those that not covered included two of Iraq’s more volatile regions — Kerbala and Anbar — and the northern province of Arbil, where local authorities refused them a permit to work.

Estimates of deaths in Iraq have been highly controversial in the past.

Medical journal The Lancet published a peer-reviewed report in 2004 stating that there had been 100,000 more deaths than would normally be expected since the March 2003 invasion, kicking off a storm of protest.

The widely watched Web site Iraq Body Count currently estimates that between 80,699 and 88,126 people have died in the conflict, although its methodology and figures have also been questioned by U.S. authorities and others.

ORB, a non-government-funded group founded in 1994, conducts research for the private, public and voluntary sectors.

The director of the group, Allan Hyde, said it had no objective other than to record as accurately as possible the number of deaths among the Iraqi population as a result of the invasion and ensuing conflict.

Add comment January 30th, 2008