The city of Fallujah in Iraq suffered through intense fighting during 2004, and US troops bombarded the city heavily. The US military has admitted to the use of white phosphorous, which is quite toxic though not necessarily cancerogenic. Whether depleted uranium (DU) weapons were used or not is still an open question, there is a number of statements in both directions from many different sources.
During the last few years there have been news reports about an alarming number of children born with deformities, and other serious health effects among the Fallujah population. In July 2010 a study by Chris Busby and coworkers was published in the International Journal on Environmental Research and Public health (here). The title of the article is the rather alarming Cancer, Infant Mortality and Birth Sex-Ratio in Fallujah, Iraq 2005–2009, and it reports on the results of a survey done in Fallujah that reveals drastic increases in various forms of cancer and birth defects.
The details of the study can be found directly in the paper (here), or from Busby's presentation about it in Stockholm in August 2010 that is available on Youtube (here). A transcript of what he says in the presentation and the discussion after is given here.
There are many things that can be said about the survey and the quality of it. Considering the difficulties of performing the survey, and the limitations of this kind of survey (knocking on doors and asking about the health status of the people living there), one has to be very careful and consider all the weaknesses before drawing any conclusions. Busby and coworkers cover much of these concerns in section 2.3 of the article; Strength and Weaknesses. It says, among other things:
One weaknesses of this type of study is population leakage due to migration. Although ten years is used on the questionnaire, from analysis in earlier studies of this kind  it has become clear that there is leakage of cases (due to deaths and subsequent population movements) and so the recent five year period is employed.
In other words, if the survey gives the result that 100 people in a population of 1000 suffer from a certain disease, giving a rate of 10%, it means that the actual rate can be different due to the fact that some of the people suffering from the disease may have died or moved away before the survey was done. This makes sense, but then there is a strange passage:
However, as a consequence of such a population leakage it is clear that the result will show the minimum cancer rates existing in the study group. In earlier studies this effect was especially found for lung cancer which has a high mortality to incidence ratio.
This part is not so obvious. Of course, if the people who died or moved away suffered from the same disease, the rate would be higher if they had still been alive and had participated in the survey. But it could also be the opposite, the people who died or moved away did not suffer from the same disease, and if they were still alive and participated in the survey the rate would be lower. So, if the disease we are looking at has a high mortality rate, as in the case with lung cancer, then the assumption may be reasonable, depending on how many people that have moved away or died of other causes. Clear it is certainly not.
Another interesting thing is that, while Busby and co-authors in the article are very careful about not stating that uranium is the cause of the health effects, Busby has no qualms about laying out the words in other places. For instance, in the Green Audit report where he claimed that 10 tonnes of enriched uranium had leaked from the Hinkley Point nuclear power plant, he puts them together without further explanation:
Most recently, alarming increases in breast cancer, leukaemia, childhood cancer and congenital malformation/infant mortality increases were found in Fallujah, Iraq, a city where uranium weapons were employed and uranium particles will have been inhaled (Busby et al 2010).
So even though the original paper does not show any connection between uranium and the health effects, he makes it sound like there is an obvious connection when he refers to the paper in other works.
Well, let's move on. In section 2.5 of the article the sex ratio is defined in one line as:
The population data in 5-year age groups was used to examine the sex ratio in 5-year birth cohorts.
In section 3, which covers the results of the survey, we read the following regarding the sex ratio:
The responses show that there is an anomalous sex ratio in the 0–4 age group. There are 860 males to 1000 females, a significant 18% reduction in the male births from the normal expected valueof 1,055 (267 boys expected, 234 observed; p < 0.01)
860 boys to 1000 girls after the 2004 battle, this does indeed sounds serious if the normal ratio is 1055. To use Busby's own words from the BSRRW meeting:
"It is absolutely standard, and very rarely diverse at all, that number, unless there is some problem."
But what possible reasons could there be for it? Section 3 of the paper continues:
Perturbation of the sex ratio is a well known consequence of exposure of mutagenic stress and results from the sensitivity of the male sex chromosome complement to damage (the females have two X chromosomes whereas the males have only one).
So according to Busby and co-authors, mutagenic stress is the cause of why less boys than girls are born. The text continues with an explanation of what can cause mutagenic stress (emphasis is mine):
A number have studies have examined sex-ratio and radiation exposure of mothers and fathers. Of relevance is the study of Muller et al.  of the offspring of 716 exposed fathers who were Uranium miners. There was a significant reduction in the birth sex ratio (fewer boys). Lejeune et al. (1960) [11,12] examined the offspring of fathers who had been treated with pelvic irradiation; at high doses there was an increase in the sex-ratio, but this reversed in the low doses (around 200 mSv). Schull et al. 1966  found a reduction in the sex ratio in A-Bomb survivor fathers (mothers “unexposed”) for children born 1956–1962 a reversal of an earlier finding by Schulland Neel 1958  of a positive effect in the 1948–1955 births. It should be noted that there were external and internal irradiation effects in these groups, with the internal effects predominating in the later years. Yoshimoto et al. 1991  found an overall reduction in the sex ratio for A-Bomb survivors for children born 1946–1984. Thus the evidence suggests that exposure to ionising radiation at low doses and specifically exposure to Uranium may cause a reduction in the sex ratio.
The quoted references deal with uranium miners, medical radiation treatment, and radiation from the Hiroshima bomb. So, exposure to radioactivity among the parents may cause mutagenic stress, which leads to a reduction in the number of boys born. At least there were scientific reports about it during the 1950's and 1960's, five of the six references are quite old. One would expect that such a world famous radiation expert as Chris Busby should be able to back his reasoning with references that covers the development of the field until present instead of what happened more than 45 years ago. There is nothing wrong with referring to old articles, but if you only do it and ignore later developments (if they exist) then your line of reasoning may be very weak.
Regarding the low sex ratio in the case of Fallujah, could there be other reasons than uranium-based weapons? Please note that Busby and co-authors do not mention any of the studies that show a connection between deviating sex ratio and exposure to chemicals, heavy metals, smoking and other environmental effects (see for instance the Wikipedia entry on sex ratio). Busby does not even acknowledge the chemical toxicity of uranium, instead it has to be the radioactivity of uranium, if it is the cause. The authors mention depleted uranium several times, but are very cautious about drawing any conclusion regarding what is the reason. That is a wise approach considering all the uncertainties related to a study like this, and the fact that there are a number of other possible causes.
It is less wise, however, to emphasize uranium as a likely cause, or to claim that the 18% reduction of the sex ratio is significant when you are not even sure about what you have measured. During the talk at the BSRRW meeting in Stockholm in August 2010, a person in the audience, Dr. Eckerman, wanted to have a clarification of what the data really showed. After some confusion it turned out to be that the sex ratio was not derived from the number of born children, but from the number of children available at the time of the survey.
So, to repeat the quote from Busby's presentation again:
"It is absolutely standard, and very rarely diverse at all, that number, unless there is some problem."
As it turned out during the BSRRW meeting, there was indeed a problem. Not only did Busby ignore the earlier so cautious approach when he claimed that the deviation was significant, he also based the sex ratio on the wrong assumptions about the group of children.
You may wonder what's the big fuss about? Well, if the sex ratio is to be trusted it has to be derived from the number of born children in the study group. If you instead only have data on the number of living children at the time you make the survey, then you are missing the children who may have died or moved away. Busby disqualified the method himself when I asked about the age group 5-9 years old, which seem to deviate in sex ratio in the opposite direction, i.e. there are significantly (13%) more boys than expected. To be fair to Busby, for the age group 5-9 there are more children that may have died or moved away (or moved to the city) than for the age group 0-4 years, there have been 5 more years when things can happen. But even with that in mind, it is very irresponsible of Busby to claim that it is such a significant finding, when he ignores all the weak points in his reasoning.
So all the time Busby has known that the reported sex ratio is based not on the number of born children, but instead on the number of children available at the time of the survey. The message from Dr. Eckerman is quite clear; to speculate about the causes of the deviating sex ratio should not be done without keeping the limitations of the study in mind. And if you are honest in your approach, you make a clear statement about this the next time you present the study. In spite of this, when Busby a few weeks later has a presentation about his study at the Human Rights Council in Geneva (22 September 2010) he repeats the same thing without any caveats. In fact he says:
Then most important, we found the sex ratio... [...] This is the most important result that we had here.
It seems as if he has forgotten Eckerman's objections. To be fair, he does say that there are some structural problems with the study, and that those concerns are brought up in the paper. But he gives no details about these structural problems during the talk. Instead he goes on with all sorts of explanations about the causes (including some ludicrous speculation about cold fusion based weapons!), as if they were clearly established facts. A year later all concerns about weaknesses in the study seem to be forgotten. The new article about Fallujah (Alaani et al., Conflict and Health 5:15 (2011)) starts off with the following statement in the second sentence (emphasis is mine):
In addition to the increased cancer and rates and infant deaths, the epidemiological study  showed that there was a sudden significant drop in the sex ratio (an indicator of genetic stress) in the cohort born in 2005, one year after the battles which occurred in the city, suggesting that the cause of all these effectsis related to the time of the US led invasion of the city in 2004.
I could buy the argument if it was phrased something like "the epidemiological study  gave an indication, although with large uncertainties, of a reduction in the sex ratio..." But as we have seen before it is not in the interest of Chris Busby to be clear about the details, at least not when the details make the case weaker. Instead he never misses a chance to bring it up, for instance in the RT interview from 26 October:
or in the LLRC press release:
Busby has to push the line that there has been a significant change in the sex ratio, and without stating it clearly he and his co-authors do everything but saying it straight out that it must be due to uranium.
So we now have seen how Busby in writing is very careful with stating too clearly that there is a clear connection between the deviating sex ratio and some sort of uranium based weapons. In talks and interviews however, he clearly gives a different message. And he consistently ignores all other possible explanations, just as if they wouldn't even exist.
Now the question is, is the deviating sex ratio in Fallujah even relevant? We will look at this issue in part 2. Stay tuned.
Mattias Lantz - member of the independent network Nuclear Power Yes Please
Related blog posts: