image from Wikipedia by Vincent de Groot.

In the context of the last post about the WHO and the assessment of health problems due to radioactivity I wonder about one citation in the BBC report Falluja doctors report rise in birth defects. The BBC report was linked to from the Guardians WHO critique which I had mentioned in the last post.

According to the BBC report the citation was by “British-based Iraqi researcher Malik Hamdan:”

Ms Hamdan said that based on data from January this year, the rate of congenital heart defects was 95 per 1,000 births – 13 times the rate found in Europe.

Malik is a male name, so I guess this is a misprint and who is probably meant is Malak Hamdan.

Why did I wonder about that citation?

I had recently a party conversation with a physician who mentioned that by talking to a cardiologist he learned that there are apparently a lot of untreated early childhood heart problems among elder refugee kids here in Berlin. He mentioned this fact in the context of cost and work pressure, but I was thinking again about what he had said when preparing the last post. I asked him now, wether he knows if there were heart defects, which are genetically formed and in particular which might occur more likely in high radioactivity regions, but he didn’t know and he had not talked about that with the cardiologist. But among others he sent me references to Busby, who was also mentioned in the Guardian article. One the article by Busby, which I looked at lists a coauthor with the name Malak Hamdan who had at the time when the article was written apparently an affiliation at a private limited company called “The Children’s Health Foundation”. So probably the “British-based Iraqi researcher Malik Hamdan” has this Twitter account.

As it seems the study by Alaani, Al-Fallouji, Busby and Hamdan can not be found via her reasearch gate entry (at least but what I get without logging in) but it can be downloaded from the Journal of the Islamic Medical Association of North America.

So anyways. If I understand the article, with Mrs. Hamdan as coauthor correctly then there were 113 babies with Congenital Anomalies in the Cardiovascular system or counting multiplicities 136 occurences with Congenital Anomalies in the Cardiovascular system in Fallujah General Hospital, November 1, 2009 to September 30, 2010 out of 6049 babies.

But 113/6049= 0.017 or 136/6049=0.022 and not 95/1000= 0.095.

So I don’t know were this number 0.095 comes from.

This gives me an uneasy feeling about the BBC report and a bit also about the Guardian article since it seems the above quote was picked up there as a fact. From the Guardian:

In Fallujah, doctors are witnessing a “massive unprecedented number” of heart defects, and an increase in the number of nervous system defects. Analysis of pre-2003 data compared to now showed that “the rate of congenital heart defects was 95 per 1,000 births – 13 times the rate found in Europe.”

That is the Guardian speaks again about 95 per 1000 births = 0.095, as in the BBC report from 2010 but that this was found out “now” (2013).

So lets compare this with other data in order to get some glimpse into what might have happened in Fallujah.

A more or less randomly picked US statistics says that nearly 1% of births display congenital heart defects. So the Fallujah hospital rates 0.017 and 0.022 are still about double as the US average - but not 13 times.

The actual numbers seem to be higher due to underreporting (the article writes “the clinic sees approximately one third of the referrals from the delivery room”) but usually one takes fact based numbers as a reference and even multiplying by 3 is still 6 times more and not 13 times. But maybe Malak Hamdan (if it was her) had more and different data when talking to the BBC.

But lets keep looking at the Fallujah data. A certain rather common heart defect namely the Ventricular septal defect (VSD), which displayed – together with the Secundum atrial septal defect (SASD) – already elevated levels in the study about Chernobyl fallout afflicted areas in Bavaria (Fig. 5) appears to be quite high in Fallujah – even when taking measurement bias into account. In the study about the measurement bias it is reported in the abstract that:

In a population-based study in children born alive during the 10-year period from 1982 to 1991 (n= 22 810), ventricular septal defects (VSDs) were diagnosed in 127 cases, an incidence of 5.6 per 1000.

The ratio in Fallujah lists 50 out of 6049 VSD cases that is a rate of “8 per 1000″=0.008, which is distinctly more than 0.0056 = “5.6 per 1000″ (about ten years later, but in a former war area with probably less good equipment).

The occurences of SASD where 47 out of 6049 which is 0.0077. Both together give the ratio 97/6049=0.016.
The bavarian study showed a proportion of roughly about 0.016 for VSD plus SASD for less afflicted areas (by looking at the diagramm…) and around 0.055 for stronger Chernobyl-fallout afflicted areas.

So taken all this together the heart defect rate in Fallujah (as given by this hospital data) seems distinctly elevated, but it seems rather clearly not as bad as e.g. high afflicted areas in Bavaria during Chernobyl.

But maybe heart defects are not such a good indicator altogether and one should look more at the other malformations. The bavarian researcher write:

A class of malformations that seems to be strongly depen-
dent on the Chernobyl fallout are the deformities of the skull,
face, jawbone, neck, spinal column, hip joint, long bones of
the legs, and feet (ICD7540, ICD7541, ICD7542, ICD7543,
ICD7544, ICD7546, ICD7547, ICD7548, ICD7565, n =
3,686).

and

If the disclosed relation is in fact a causal one, we provisionally estimated that the Chernobyl accident entailed congenital malformations in the range of 1,000 to 3,000 more cases in Bavaria from October 1986 to December 1991 (Fig. 7).

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