News this Week

Science  11 Mar 2011:
Vol. 331, Issue 6022, pp. 1246
  1. Around the World

    1 - London, U.K.
    New Long-Term Study of a Generation Announced
    2 - Beijing, China
    China Beefs Up Space Program
    3 - Vandenberg Air Force Base, California
    Sic Transit Glory
    4 - London, U.K. 4
    Funding Bodies Decide Weight of Research ‘Impact’
    5 - Brasília, Brazil
    Panel to Reassess R&D
    6 - Washington, D.C.
    Bioethics Panel Examines Global Clinical Trials
    7 - Cocos Island, Costa Rica
    More Room to Swim

    London, U.K.

    New Long-Term Study Of a Generation Announced

    From their 25th week in the womb to their 21st birthday, 90,000 children born in the United Kingdom in 2012 will be tracked in a multimillion-pound longitudinal study, the U.K. government announced last week. Like the country's 1946 National Survey of Health and Development, which followed just over 5000 people, the study aims to investigate how environmental and genetic factors during pregnancy and early infancy influence a child's future. Parents of the 2012 cohort will provide blood samples and fill in questionnaires during pregnancy, and later bring in their new family members to be weighed and assessed at 4 and 12 months. Monitoring will then continue through childhood and adolescence.

    Beijing, China

    China Beefs Up Space Program

    In a speech to the annual National People's Congress (NPC) last weekend, Premier Wen Jiabao hailed crewed space missions and lunar exploration as two major Chinese accomplishments over the past 5 years (see p. 1251). Now the country's space ambitions are set on new heights. In an announcement timed with NPC, Ma Xingrui, general manager of China Aerospace Science and Technology Corp. (CASC)—the prime contractor for the country's space program—revealed to Chinese media aggressive R&D spending plans for the next 5 years.

    China's leaders tout the country's space program as a shining example of indigenous innovation because it has developed much of the technology on its own. CASC says it will increase R&D spending to further boost ownership of core space technology. Toward that end, a CASC subsidiary, the China Academy of Launch Vehicle Technology, is developing a launch vehicle capable of carrying 130 tons, equivalent in capacity to NASA's retired Saturn V rocket, which launched the Skylab space station into low Earth orbit. Meanwhile, CASC has planned some 20 launches this year, including that of its first orbiting “space lab,” Tiangong-1, in the second half of 2011. Tiangong-1 will orbit Earth for 2 years—ample time for Chinese spacecraft to practice docking maneuvers in anticipation of a future, full-fledged space station.

    Vandenberg Air Force Base, California

    Sic Transit Glory

    A rocket failure on 4 March sent NASA's Earth-observing Glory satellite plunging into the South Pacific. The loss of the satellite—launched to monitor subtle variations in the sun's brightness and identify small particles called aerosols in Earth's atmosphere—deprives climate scientists of key data needed to estimate future global warming.

    Problems arose about 3 minutes into the flight, when a protective shroud called a fairing failed to peel away from the Taurus XL rocket as planned. Its weight dragged the rocket downward into the sea. An identical Taurus mishap doomed NASA's Orbiting Carbon Observatory in February 2009, but engineers thought a new separation mechanism had solved the problem.

    The failure means Glory will miss out on continuing observations into the next 11-year sunspot cycle. “It's a terrible loss,” says Glory team member Judith Lean, a solar physicist at the U.S. Naval Research Laboratory in Washington, D.C. “You don't have many solar cycles in your lifetime.”

    Glory

    CREDIT: NASA

    The satellite also would have taken sophisticated readings of sunlight that aerosols in Earth's atmosphere scatter back toward space. The information would have enabled scientists to identify the particles and gauge how much they offset global warming. http://scim.ag/glory-fail

    London, U.K.

    Funding Bodies Decide Weight Of Research ‘Impact’

    Last week, the United Kingdom's higher education funding bodies revealed how much weight the country's next nationwide assessment of science in its universities would give to the economic and social impact of research. Such impacts, which have not been part of previous assessments, will make up 20% of the overall scores in the U.K.'s 2014 Research Excellence Framework, which will determine how a large portion of the nation's research funding is distributed. That weighting is less than the 25% the funding bodies originally proposed—they plan to ramp up the percentage in future assessments—but it's still more than what was desired by critics who argue that the economic and social impacts of basic research can't be meaningfully measured.

    Brasília, Brazil

    Panel to Reassess R&D

    Brazil is putting the brakes on its rapidly growing budget for research and development while launching a broad review of its research priorities. Neuroscientist Miguel Nicolelis of Duke University in Durham, North Carolina, has been tapped to lead the “Commission of the Future,” a panel that will study the direction of Brazilian science. The group's formation follows a $577 million reduction (a cut of about 11%) in the budget of the Ministry of Science and Technology this year. The nation's research program was expanding until the fall (Science, 3 December 2010, p. 1306). But the new president, Dilma Rousseff, has ordered across-the-board government spending cuts in response to concerns about inflation. The 21-member R&D review group includes several U.S. and European scientists along with Brazilians. http://scim.ag/brazil-RD

    Washington, D.C.

    Bioethics Panel Examines Global Clinical Trials

    Bioethics advisers to President Barack Obama have begun to assess whether U.S. rules adequately protect volunteers in global clinical trials.

    The review was prompted by the revelation last fall that from 1946 to 1948, a U.S. federal researcher deliberately infected Guatemalan patients with syphilis to study treatments. In response, President Obama asked his Presidential Commission for the Study of Bioethical Issues to appoint an international panel to determine if “current rules for research participants protect people from harm or unethical treatment, domestically as well as internationally.”

    At a meeting last week, commission chair and University of Pennsylvania President Amy Gutmann announced the inter national panel: four experts from the bioethics commission and 10 others from outside the United States. The commission also heard from experts about how the number of trials abroad has burgeoned in the past decade as companies seek to cut costs. And as part of a fact-finding investigation requested by the president, commission staffers have begun digging through 477 boxes of documents on the Guatemala studies.

    The commission will report to the president by the end of the year. http://scim.ag/bio-ethics

    Cocos Island, Costa Rica

    More Room to Swim

    CREDIT: ALEXANDER SAFONOV/GETTY IMAGES

    Costa Rica has expanded a national park in the Pacific Ocean to nearly 1 million hectares, larger than Yellowstone National Park. Centered around Cocos Island, 550 kilometers from mainland Costa Rica, the new Seamounts Marine Management Area teems with endangered leatherback turtles and scalloped hammerhead sharks, as well as whitetip reef sharks, whale sharks, yellowfin tuna, and numerous endemic species—all now fully protected in the new nonfishing zone. It's good news for Costa Rica's population of leatherback turtles, which dropped 40% in the past 8 years owing to locals' taste for leatherback eggs. The numbers of scalloped hammerhead sharks are also plummeting because of overfishing; they are prized for their large fins, the key ingredient in shark fin soup. The larger area should help protect the region's unique underwater mountains and marine ecosystem, said biologist Marco Quesada of Conservation International, which helped Costa Rica create the park.

  2. Random Sample

    Noted

    >In 1959, when computers were room-sized behemoths with names like UNIVAC, the U.S. government launched a crash project to give them a common language. The result, COBOL, is now the subject of an exhibition opening 17 March at the Smithsonian National Museum of American History in Washington, D.C.

    They Said It

    “ I now know why you won the Nobel Prize. When they asked you a question, by God, you answered it.”

    —Representative Ralph Hall (R–TX), chair of the U.S. House of Representatives science committee, to Energy Secretary Steven Chu after one of many detailed and lengthy answers from Chu to questions posed by committee members at last week's hearing on his department's 2012 budget request.

    By the Numbers

    $8600, $6200, $1000 — The scores of Representative Rush Holt (D–NJ), IBM's supercomputer Watson, and Representative Bill Cassidy (R–LA) in an informal round of Jeopardy! played last week on Capitol Hill. Holt is a former physicist; Cassidy, a hepatologist.

    281 — February sales of General Motors's new, electric Chevy Volt. That's down from 321 in January. Meanwhile, Nissan moved just 67 units of its electric car, the Leaf; it sold 87 in January.

    $263 billion — The cost of identifying Earth's estimated 5.4 million undiscovered animal species, according to a study in Trends in Ecology and Evolution. That's far more than the $5 billion price tag famed ant biologist Edward O. Wilson placed on identifying all life forms in 2000.

    Mixology Meets Materials Science

    CREDIT: JAMES SOTIRAKIS/THINKSTOCK

    Mixing business and pleasure, materials scientists in Japan say they can make the compound iron tellurium sulfide (FeTeS) conduct electricity without resistance if they first soak the stuff in booze. Such superconductivity turns on when FeTeS is cooled below 8 K, but to achieve it Yoshihiko Takano of the National Institute for Materials Science in Tsukuba and his team usually expose a newly formed sample to air, water, or oxygen. Now they've found that a dip in warm wine, beer, or sake works just as well.

    “I enjoy the taste of wine, beer, and so on,” Takano says. Apparently, FeTeS does, too. Takano's team made FeTeS samples consisting of many tiny crystalline grains, and the drinks induced superconductivity in more grains than did a tasteless mixture of water and ethanol, the team reports this week in Superconductor Science and Technology. So something else in the drinks may act on FeTeS, perhaps to catalyze reactions with oxygen, Takano says.

    Not everybody buys it. Single crystals of FeTeS are superconductive right out of the oven, which shows that intrinsically the compound requires no further processing, says physicist Cedomir Petrovic of Brookhaven National Laboratory in Upton, New York. Still, physicist Paul Canfield of Ames Laboratory in Iowa says the preprint of the paper created a stir as scientists contemplated follow-up experiments: “A lot of people were thinking that they could score a lot of good hooch off their grants.”

  3. Newsmakers

    Three Q's

    CREDIT: AMEL PAIN/EPA/LANDOV

    Zahi Hawass made headlines last week when he announced that he intended to resign his post as minister of Egypt's antiquities in the wake of the country's revolution.

    Hawass is arguably the world's most well-known archaeologist, uncovering tombs on television and ruling Egypt's ancient treasures with a firm hand. He had been a strong supporter of Egypt's former president, Hosni Mubarak, and cited the lack of police control over archaeological sites during the past 6 weeks as the reason behind his planned departure. When he announced his intent to resign, Hawass acknowledged extensive looting at Saqqara, Giza, and other important ancient sites.

    Q:Why haven't you actually resigned?

    I did not submit an official resignation because I have not been asked for one. I have announced my reasons and at the moment, I do not want to be part of the new government.

    Q:Would you consider staying on if asked?

    For me to come back, the government has to give me full guarantees that the police will guard every site across Egypt and give me the funding to continue the work I have been doing for the last 8 years. There are 70 great projects that we currently have no money for, such as site-management plans; restoration and protection projects for pharaonic, Islamic, Coptic, and Jewish monuments; education programs for Egyptians; and training projects for young Egyptian archaeologists.

    Q:What are your plans for the future?

    I will continue to write books, give lectures, and watch over Egyptian antiquities. I will report anything bad I hear about on my Web site and take a stand against anyone who threatens antiquities in the near future.

    Hungarian Trio Shares €1 Million Prize

    A new €1 million award from a Danish nonprofit organization honors three Hungarian-born scientists for their contributions to European neuroscience. The inaugural prize from the Grete Lundbeck European Brain Research Foundation goes to Péter Somogyi of the University of Oxford in the United Kingdom, Tamás Freund of the Hungarian Academy of Sciences in Budapest, and Györgi Buzsáki of Rutgers University in Newark, New Jersey. The chair of the selection committee, Oxford neuroscientist Colin Blakemore, praised the men for “their wide-ranging, technically and conceptually brilliant research on the functional organization of neuronal circuits.”

    All three have focused largely on the hippocampus, a brain region central to memory formation. Somogyi has pioneered techniques for identifying different types of neurons and has applied them to map out circuits in that area, whereas Freund, his former student, has made important discoveries about the roles of inhibitory neurons there. Buzsáki, meanwhile, has specialized in recording neural activity in the hippocampus, often in freely moving animals, to investigate how neural circuits in this brain region contribute to memory and other cognitive functions.

  4. The War in Afghanistan

    Counting the Dead in Afghanistan

    1. John Bohannon

    A military data set of civilian casualties, provided exclusively to Science, indicates that the war has become more lethal to the Afghan population, largely because of indiscriminate insurgent attacks.

    Dangerous protectors.

    As the conflict in Afghanistan drags on, civilian casualties are increasing.

    CREDIT: AFP/GETTY IMAGES

    KANDAHAR, AFGHANISTAN—By day, you don't see the war. The wind throws up a red haze that obscures everything. Bearded Afghan men in colorful vests whip their donkeys, lugging vegetables and firewood. Unless you spot an armored convoy picking its way across the rugged landscape or hear a fighter jet scream overhead, you couldn't even guess the century. But once night falls, a brilliant cluster of lights appears, as if a new city has sprouted in the valley several kilometers south of the provincial capital. This is Kandahar Airfield. What used to be a derelict airport littered with debris from the Soviet era has grown into a massive base for the International Security Assistance Force (ISAF).

    Inside its outer maze of concrete walls and machine gun nests is a world of surreal contrasts. Thousands of ISAF soldiers clog the streets, some hurrying to dinner at the end of a grueling workday, others just starting their night shifts. The conversations are in English, French, German, Dutch, and other languages from the 48 nations that have contributed troops to the ISAF coalition. There is no safety beyond the walls, so all recreation must happen here. The Americans brought in a string of restaurants, including T.G.I. Friday's. The Canadians built a full-sized, open-air hockey rink—the floor is concrete rather than ice—and they play in full gear under the glare of stadium lighting. Tonight, men and women in uniform amble along a wooden promenade, licking ice cream cones and watching a volleyball game.

    The spell is broken as sirens blare and everyone dives for the ground. Once per day on average, insurgents manage to send small rockets flying over the walls. The Canadians in the hockey rink famously play through these attacks, each team refusing to flinch. But newcomers on the base can't help but flinch constantly—every jet overhead sounds like an incoming rocket. It turns out to be a drill this time. But an hour later, a dozen missiles erupt from the base's launchers, breaking the speed of sound in seconds and fading over the horizon like cigarette embers. Somewhere to the west people are dying.

    What began as an invasion to capture Osama bin Laden in 2001 has become a full-blown occupation and counterinsurgency. As the war in Afghanistan grinds toward the decade mark—the longest in U.S. history—public support is waning. When he testifies before the U.S. Congress next week, ISAF Commander Gen. David Petraeus will face some difficult questions. Most contentious is the issue of civilian casualties. Media reports of surging violence give the impression of a country slipping out of control, but ISAF has reported steady progress. “There is so much rhetoric flying around and none of it can be tested,” says Neil Johnson, a physicist at the University of Miami in Florida who studies the dynamics of warfare. “What we need is hard, reliable data.”

    A deluge of data arrived last year from WikiLeaks, the organization that has made public thousands of classified documents. It includes the raw observation of casualties by soldiers on the ground in Afghanistan, but the many unknowns surrounding those reports have left researchers puzzled about how to interpret them. A few independent organizations, including the United Nations, have published their own reports on civilian casualties in Afghanistan, but only for illustrating broad trends. The data underlying their reports have never been released.

    Data Visualization

    Visualization

    See an interactive visualization of the casualty data, created by G. M. Brower. (Requires Google Chrome 9, Safari 10.6 or Firefox 4 browser.)

    For the first time, those data are now publicly available. In January, ISAF provided Science with a database of civilian casualties called CIVCAS. It is the military's internal record of the death and injury of Afghan civilians, broken down by month, region, weaponry, and perpetrator. By its reckoning, 2537 civilians were killed and 5594 were wounded over the past 2 years, with 12% of those casualties attributed to ISAF forces and the rest to insurgents. The death toll is 93% identical to that in the WikiLeaks data, revealing those raw field observations to be far more reliable than researchers had suspected.

    In February, after learning that the military was releasing these data, both the UN and an Afghan human rights organization agreed to release versions of their own civilian casualty data to Science. They show twice as many civilians killed over the same period, including 393 deaths by air strikes that were not counted in the military database. ISAF officials acknowledge the gap. “The civilian casualties reported by the UN have always been higher than those reported by ISAF,” says U.S. Navy Rear Adm. Gregory Smith, the director of communications for NATO based in Kabul. “But the trends have been very consistent.”

    Science assembled a team of experts to analyze the released data sets. They conclude that while the war has grown deadlier for Afghan civilians over the past 2 years—up to 20% more civilians were killed in 2010 compared with the year before—ISAF has become a safer fighting force. The majority of deaths, and nearly all of the recent increase, are attributed to indiscriminate attacks by insurgents rather than ISAF soldiers. In spite of a troop surge and the launch of new operations against the Taliban last year, the data provided by the UN show a 26% drop in civilian deaths caused by military forces. And both the UN and ISAF data sets show a drop in deaths due to air strikes last year, by 50% and 10%, respectively.

    All of these data, as well as other information never before released, are now online at http://scim.ag/afghandata. Taken together, they provide the clearest picture yet of the human cost of the war.

    Counting bodies

    Millions of people have died in modern wars, but the exact number is anyone's guess. Historians estimate that at least 10 million people were killed in World War I and at least 50 million in World War II. Although records exist for the number of soldiers who went to war and never came home, most civilian deaths went uncounted. The military did not systematically track casualties beyond their own troops.

    That changed in the late 1960s, when Americans opened their newspapers to find an official count of the people dying in the Vietnam War. Each week, the U.S. military released those numbers to the media, dividing the weekly casualties between U.S. soldiers, U.S. allies, and “Communists killed.” One of the readers was Michael Sutherland, then a statistics Ph.D. student at Harvard University. “The military had a goal of achieving a 10-to-1 kill ratio,” he says. “The idea was that if we were killing 10 of their guys for every one of ours, we were winning.” Sutherland, who was eligible for the draft and had friends already serving in Vietnam, started collecting and analyzing those weekly numbers.

    The kill ratio was indeed approaching 10-to-1, but he discovered other patterns. It was clear that at least some of the data were fabricated. The frequency of the numbers' last digits was skewed, with far too few zeros and fives compared with chance. The reason? “If you're making up numbers, you never say that 150 Communists were killed,” Sutherland says. “Instead, you use 147 or 152.” By comparing the trends in deaths, he also found that U.S. soldiers were clearly the ones fighting the battles rather than the South Vietnamese allies. “We were told that we were over there only as advisers,” he says. Even the official number of troops deployed to Vietnam looked fishy. “We were being manipulated by the government through the media,” says Sutherland, now a statistician at the University of Massachusetts, Amherst.

    Forty years later, with wars raging in Iraq and Afghanistan, the military has become far more cautious with casualty statistics. The new approach was described by U.S. Army Gen. Tommy Franks. “We don't do body counts,” he told reporters in Afghanistan in 2002. Although the deaths of coalition soldiers in Iraq and Afghanistan are available—for example, at www.icasualties.org—an “information vacuum” has surrounded civilian casualties, says Michael Spagat, an economist at Royal Holloway, University of London. So researchers trying to measure the human cost of the wars have had to turn to other data sources.

    One source is the media. The Iraq Body Count (IBC) Web site has tallied Iraqi civilian casualties—over 100,000 and counting—from media reports since the U.S.-led invasion in March 2003. However, this method can provide only a lower limit to the true number.

    Another source is the civilian population itself. Several research teams have used household surveys to estimate casualties in Iraq. A 2006 survey published in The Lancet claiming a civilian death toll of 600,000 has been widely criticized (Science, 6 March 2009, p. 1278). A larger survey in Iraq led by the World Health Organization came to a figure close to 150,000 for the same period.

    But in Afghanistan, these methods may be impossible. The country's size and population are close to those of Iraq—both have 30 million people in an area comparable to the size of France—but that is where the similarities end. Whereas Iraq is a flat country with a well-educated and mostly urban population, Afghanistan is a nightmare for field research. Most Afghans live in small villages nestled within rugged and poorly connected river valleys. Their inaccessibility thwarts surveys, and a lack of journalists on the ground makes rigorous media-based casualty counts “extremely difficult,” says John Sloboda, the director of IBC based in London.

    These difficulties have not stopped some organizations from publishing estimates of the death toll in Afghanistan. The Red Cross has monitored the flow of casualties into hospitals, for example, and the UN has collected statistics through its regional offices. Although these organizations have published estimates periodically, none has given researchers access to their data to make an independent assessment.

    Of course, the organization in the best position to directly record civilian casualties is the military itself, with nearly 150,000 observers on the ground witnessing the violence every day. But it seemed that the military kept no record of those observations—that is, until last year when WikiLeaks showed otherwise.

    From WikiLeaks to CIVCAS release

    Starting in July 2010, the largest leak of secret military information in history went public. WikiLeaks gave media outlets 92,000 internal military documents related to the war in Afghanistan and 400,000 from Iraq, allegedly provided by a low-ranking U.S. soldier who is now in custody. The documents include the raw operational reports from troops on the ground between January 2004 and December 2009. In Iraq over that period, soldiers reported a total of 79,000 civilian deaths, 15,000 of which the media missed (Science, 29 October 2010, p. 575). Afghanistan has been spared Iraq's sectarian violence. Over the same 6-year period, the leaked documents note 4024 Afghan civilian deaths.

    The information vacuum was breached, but researchers have been wary of using the data. The military's raw operational reporting was not intended for research, so any errors, biases, and inconsistencies they might contain are unknown. Did investigations confirm those casualties? How many bodies identified as “combatants” later turned out to be civilians, and how many of the wounded subsequently died from their injuries? Without those answers, the data do little to dispel the fog of uncertainty.

    Late last summer, a confidential source within ISAF informed me that the military was curating a database of civilian casualties. He described a dedicated military team that investigates civilian casualties and analyzes trends in the final tally to help ISAF reduce the number. In a series of e-mail exchanges with Science, ISAF officials confirmed that such a tracking system does exist and that its output is an internal database of civilian casualties called CIVCAS.

    In October 2010, ISAF hosted me in Kabul and Kandahar as an embedded reporter. I was given access to military personnel at every level of the civilian casualty–tracking system, from the collection and quality-checking of CIVCAS data to the analysis that leads to new combat directives. I was also able to tour medical facilities and interview medical personnel (see p. 1261). What I was not allowed to do was take the data with me. ISAF officials were concerned that sensitive information associated with civilian casualty data—such as the tactics and movements of troops—could be revealed. But after 3 months of negotiation, ISAF agreed to give the entire CIVCAS database to Science for public release.

    “Our database is 100% transparent,” says Smith. “Ultimately, this is a war being fought here in Afghanistan on behalf of the Afghan people.” Along with the death rate of soldiers, he says, this is “the most significant data set in identifying whether or not you're making progress.”

    In a series of confidential meetings over the past year, ISAF has provided the UN and some human rights organizations full access to CIVCAS. “The other organizations will share their compiled data but not their raw data,” says Smith. “That's really to protect their own access, freedom, and independence, which is certainly something we recognize and respect.”

    After learning that ISAF was releasing CIVCAS, some of those organizations provided Science with data as well. The United Nations Assistance Mission in Afghanistan (UNAMA) provided 3 years of their monthly casualty statistics, including a detailed accounting of deaths by air strikes since January 2009. The Kabul-based organization Afghanistan Rights Monitor (ARM) provided Science with the highest-resolution data of all, describing individual incidents during the first half of 2010. “Providing these data is a great public service,” says Sutherland, who is undertaking the first statistical analysis.

    Science is making all these available at http://scim.ag/afghandata. ISAF has released additional sets of information to help researchers analyze the casualty data, including precise monthly troop deployment numbers over the past 3 years. Perhaps the most important is a document describing the standard operating procedures of ISAF's civilian casualty–tracking system. “This is crucial,” says Johnson. “It's not enough to see the numbers; you need to know how they are collected.”

    From deaths to data

    Nestled deep inside Kandahar Airfield is an inner bastion, like the nucleus of a cell. Stacked white trailers have been converted into a village of temporary offices. At the center is the Combined Joint Operations Center. Dozens of officers sit in an auditorium facing a wall of giant screens. Some show maps of the combat space, and others show live video feeds from unmanned drones. Since operations were launched last year to push the Taliban out of their original homeland around Kandahar, this has become the nerve center of the war.

    “We have a casualty,” says an Australian officer sitting in the top row. (She requested that her name not be used because she is not an authorized ISAF spokesperson.) On her computer is a window of spooling text called JChat—it looks like an Internet chat session—providing a real-time view of the events of the war. One line of text is red, indicating a request for medical evacuation. It is one of many in this region, with about a dozen evacuations requested per day.

    “It's an Afghan girl wounded by shrapnel,” she says, deciphering the string of acronyms in JChat. The officer is not concerned about who caused the injury. Her job is to save the girl's life by identifying the most efficient path to a doctor. She plots the grid references on a map, and a series of overlapping circles appear around the nearest helicopters. The path is computed and the orders are given. Help is on the way.

    Meanwhile, a parallel stream of data has already started to flow. “This is the start of a process that we call Consequence Management,” says Col. Martin Bricknell, a senior U.K. military doctor and the medical director for southern Afghanistan. The soldiers on the ground with the injured girl have already radioed in a First Impression Report, describing the deaths and injuries that occurred. Once they return to base, they will give their commander a more detailed account. Within 9 days, ISAF Headquarters is expecting a CIVCAS assessment report. Besides reviewing the known facts of the case, the purpose is to improve future operations, Bricknell says. “Is there anything that we can learn from that so we can reduce casualties next time?”

    At that point, the ISAF leadership will decide whether to investigate further. “We are absolutely determined to [track] the consequences of the conflict to the civilian population,” Bricknell says. “Therefore we take every allegation of a civilian casualty very seriously.” If local government officials give a different account of the event, for example, an incident assessment team will be assembled and sent into the field. For the most serious incidents, officials from the UN or other organizations join the team.

    Casualties in time and space.

    The seasonal rhythms and shifting battlefields of the war emerge in this view of the 8131 Afghan civilians killed or injured over the past 2 years, recorded in a military database called CIVCAS. (No data were available for the first 5 months of 2010 in the Southwest region.)

    CREDIT: GEORGE MICHAEL BROWER

    The CIVCAS database tracks all of these deaths and injuries. Between January 2009 and December 2010, it logged a total of 2537 civilians killed and 5594 wounded. About 80% of the deaths and injuries are attributed to insurgents. (The CIVCAS data go back to January 2008, but insurgent-caused casualties were not tracked until 2009.)

    Throughout the war, critics have accused ISAF of undercounting civilian casualties, particularly those caused by their own soldiers. Just last month, a battle in Kunar province on Afghanistan's eastern border with Pakistan generated conflicting accounts. According to villagers, ISAF killed 65 civilians, including 50 women and children. According to ISAF, only insurgents were killed.

    The data provided by UNAMA do show far more casualties than those from ISAF. For 2009 and 2010, its data include 5191 civilian deaths, over 70% of them caused by “antigovernment elements,” 20% by “pro-government forces,” and the rest undetermined. Compared with CIVCAS, they attribute nearly three times the number of civilian deaths caused by military forces, only a small portion of which are Afghan national rather than ISAF forces. One of the most significant discrepancies comes from the 529 civilians that UNAMA claims were killed by “air attacks” in 2009 and 2010. CIVCAS shows only 136 civilians killed by jets and helicopters over that period.

    Asked whether casualty reporting by soldiers might be biased, British Army Lt. Col. George Wilson, who oversees ISAF Consequence Management, demurs. “No, I think the converse,” he says. “I genuinely think we get honest reporting from the ground.” According to Wilson and other ISAF sources, the cause of the disparity in body counts is methodology.

    “Raw numbers will never be the same, and there's a good reason for that,” Smith says. “We do not have a presence in all 34 provinces,” he says, and therefore CIVCAS does not track all casualties. “We only count that which we see.” In some cases, such as alleged casualties from air strikes, “we can do a tremendous amount of forensics, … [but] seldom do we see the actual bodies. Sometimes we have access to someone who was wounded, but not always,” he says. “You can do overflights of cemeteries to determine any fresh grave sites and confirm or deny the numbers involved.” He adds that other organizations trying to track civilian casualties face the same challenges.

    Smith does not question the accuracy of UNAMA's body count. “The UN has a much broader mandate” to track civilian casualties, he says, “and the resources to do that.” Rather than creating a definitive record for history, the purpose of CIVCAS, he says, is “marking progress.”

    A safer force

    Over the past month, Sutherland, Spagat, Johnson, and other experts have analyzed CIVCAS and the other civilian casualty data sets at Science's request. We have also built a timeline of the past 2 years of the war that compares those data with the casualties reported in the media, available at http://scim.ag/afghandata.

    By all accounts, the war has grown deadlier for Afghan civilians. The CIVCAS data show a 19% increase in the total number of civilians killed in 2010 compared with the year before, and the UN data show a 15% jump. But at the same time, there are signs that ISAF has become a safer fighting force, treading more lightly on local populations.

    Although the overall death toll in Afghanistan has risen, the increase was not wrought by soldiers. Over 90% of last year's spike in CIVCAS, and the entirety of that in the UN data, is attributed to insurgents. IED explosions have continued to cause the majority of civilian deaths. By contrast, 2010 saw a 26% drop in the number of civilians killed by soldiers in the UN data. In their own data, ISAF admitted to killing 12% more civilians compared with the year before, while wounding 20% fewer. This happened in the context of the largest military offensive in years and a surge that doubled the number of troops in Afghanistan to 140,000 last year. The lack of a corresponding spike in military-caused casualties is surprising.

    This is especially true of air strikes, by far the most dangerous military activity for civilians. In the data provided by the UN, air strikes killed 171 civilians in 2010, half as many as in 2009. CIVCAS, which separately defines casualties caused by jets and helicopters, shows 11% fewer deaths. There are also subtler signs of progress in the data.

    In April last year, ISAF units received a new directive concerning “escalation of force”: the shooting of civilians due to communication breakdowns. Most of these incidents occur at the hundreds of checkpoints that ISAF operates across the country. In the course of analyzing their casualty data, ISAF commanders noticed a trend. “What became very clear to me is that all the [civilian] fatalities occurred between the 100-meter point and the 0-meter point” approaching a checkpoint, Wilson says. Beyond that range, a flare usually suffices to warn drivers to slow down. But if a vehicle has not slowed down yet, Wilson says, “this is where as a soldier you suddenly think, ‘I'm about to die because this vehicle is going to drive in here and detonate.’” The problem, he says, is that soldiers in that situation had no nonlethal options.

    The new directive gave soldiers more options for warning drivers at a distance, Wilson says. These include laser dazzlers, paint ball guns, and even chalk bullets. “If you fire them at a vehicle,” he says, “they will ping off and make such a loud noise that, if they're a genuinely innocent person, they'll get the message.” The CIVCAS data put numbers to that narrative. Deaths due to escalation of force dropped by 50% in the 8 months after the April 2010 directive went out, compared with the same 8 months in 2009.

    While they applaud the release of these data sets, researchers are grappling with their limitations. “One problem is that organizations are all using different definitions in their data,” Johnson says. For example, whereas the UN data have separate categories for casualties caused by “mortar and rocket fire” and “shooting,” ISAF pools all ground-based battle casualties into “direct fire” and “indirect fire.” The different organizations also divide the country along slightly different lines for coding the location of casualties. “They should be trading notes,” Johnson says, “at least so their data can be easily compared.”

    Such limitations would be solved if all data for civilian casualties were released at the level of individual events rather than aggregated monthly. “Ultimately, that is the only way you can verify them,” says IBC's Sloboda. The data provided to Science by ARM come closest to this level of resolution, but so far, they only cover the first half of last year.

    “Counting seems like such a simple thing,” Sutherland says. “But it is the only way to see the actual effect of the war.”

  5. The War in Afghanistan

    War as a Laboratory For Trauma Research

    1. John Bohannon

    The military is sending scientists onto the battlefield to find ways to improve emergency medicine, but the research faces a practical and ethical minefield.

    From soldier to subject.

    Researchers are collecting data from casualties like this one in Afghanistan.

    CREDIT: AP

    KANDAHAR AIRFIELD, AFGHANISTAN—Easing back into a borrowed chair in a tiny trailer office here on the base, Cmdr. Lisa Osborne should be enjoying a moment of calm. But all she can talk about is work. “I saw a guy show up here in trauma. You wouldn't believe the condition he was in,” she says, recalling the victim of an improvised explosive device (IED). The extent of the injuries was shocking, even to the hardened medics working here in Afghanistan. “He was missing both legs and his whole backside. But he was alive, breathing on his own.”

    For most people, a scene like that would fill them with nothing but horror. But for Osborne, a U.S. Navy anesthesiologist and medical researcher, it was a reminder of hard-earned progress. “Years ago, that kind of patient would be dead,” she says. “No question.” What saved him was a series of extremely rapid interventions, including new techniques for applying tourniquets, drugs, and blood products. Those insights came from medical research conducted in Iraq and Afghanistan, orchestrated through a U.S. military program called the Joint Combat Casualty Research Team (JC2RT). As its deputy director, Osborne runs the show.

    In many ways, war is the perfect laboratory for trauma medicine research. On any given day, dozens or even hundreds of casualties arrive by helicopter to military hospitals across Afghanistan. IEDs are the number one risk, often combining burns, deep lacerations from shrapnel, and brain trauma from blast waves. Injuries like these are too rare to study in peacetime. And because all the patients in these studies are military personnel, they come with exhaustive data relating to preinjury health and postinjury outcome. Many of the insights gained from battlefield studies have found their way into civilian emergency medicine. But war is also the most chaotic and stressful environment imaginable for doing science. “Someone has to take down all this data,” Osborne says. “I saw this poor girl trying to turn this blood-smeared page, trying to get data off of it. … That's the reality. Until you've lived that, you don't realize how difficult it is.”

    Adding to the difficulty, controversy has dogged JC2RT projects, including charges by journalists that researchers rushed experimental treatments onto the battlefield without proper ethical review or sufficient safety testing, needlessly risking the lives of soldiers. Science investigated these issues with the help of two bioethicists and several sources from both civilian and military trauma medicine.

    Exploring the golden hour

    From the moment a bullet or piece of shrapnel hits the body, the clock is ticking. Trauma medics call it the “golden hour,” the small window of time in which the patient's life can be saved. Death can come in a matter of minutes, hours, or days, but the most crucial interventions must be made immediately. War has been “an amazing learning environment,” says Osborne, with each conflict pushing trauma medicine forward. New motorized ambulances in World War I saved wounded soldiers by getting them from the front lines to the hospitals quickly. World War II saw the first large-scale use of antibiotics. Medics in the Korean War pioneered repair and grafting techniques for vascular surgery. In the Vietnam War, portable radiology equipment and ventilators were tested in the field.

    With the wars in Afghanistan and Iraq, combat medicine has faced a new problem. “The difficulty for the current generation is getting approval for research,” says Col. Martin Bricknell, a senior doctor in the U.K. Royal Army Medical Corps who hosted this reporter's visit to military facilities in Kandahar (see p. 1256). “It is considerably more rigorous than it used to be, and therefore the lag between good idea to outcomes is much greater.” JC2RT was created in 2006 to streamline that process.

    “We're a team of eight,” says Osborne, a petite, blonde 42-year-old in the middle of her 6-month tour of duty in Afghanistan. When she is not at war, Osborne is the director of anesthesiology research at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. “Most of us have Ph.D.s,” she says, “but we're not data collectors.” Instead, JC2RT is a gatekeeper and overseer. Ideas for projects are put forward by researchers from all branches of the U.S. military, often with university-based scientific partners. As the proposals roll in, Osborne says, “I'm the one who has to give people the bad news that their research project isn't going to work.”

    A typical problem is feasibility. “The people who are writing these [proposals] are just coming into theater,” Osborne says. “They don't realize that there's no way they're going to be able to do it.” As an example, she describes a project that would have required infrared photography of injured soldiers' limbs. “You often have a whole sea of people working on the patient. You can't tell them, ‘Okay, everybody step back. I'm going to snap some photos.’”

    Another fatal flaw is the use of experimental medical devices. “It's a deal-breaker,” Osborne says, because of U.S. federal regulations. “If you use them, you must have informed consent from the patient. Period.” Most wounded soldiers plucked from the battlefield are in no state to grant consent for a new device, even if they are conscious.

    Whole blood.

    These empty transfusion bags from a single patient in Afghanistan show the 1-to-1 ratio of blood products now used.

    CREDITS: ISAF

    Once a research project passes this prescreening, it must be approved by an independent U.S. Army institutional review board (IRB) based at Fort Detrick, Maryland. That review process is identical to those at any research institution, Osborne says, sourcing outside experts as needed. Osborne and her colleagues identify issues likely to cause problems with reviewers, giving researchers a chance to address them early “so that when [the proposal] goes to IRB it has a chance,” Osborne says. At least one of the investigators must be present to undertake the study in the field. “Most of these folks, they're only here for a short amount of time. If their stuff gets held up in IRB for 6 months, they miss the boat. We try to prevent that from happening. But it does happen.”

    To date, about 100 projects have made it through this gauntlet and into the field, so far producing dozens of peer-reviewed research papers (see table on p. 1263). All of them take advantage of data from the U.S. military's Joint Theater Trauma Registry (JTTR), a continuously updated record of trauma cases in Iraq and Afghanistan. JTTR currently contains the case histories of 40,000 patients, including medical observations, treatments, and outcomes in minute detail. Most of the research has yielded incremental improvements to existing treatments. But some have overturned paradigms of trauma care, says Osborne. One example is blood transfusion.

    Some battlefield injuries are so severe that patients require massive transfusions, sometimes as much as five times the volume of blood in the body. The standard transfusion practice begins with concentrated red blood cells in a saline solution, with the other blood components—plasma containing platelets and clotting factors—added sparingly later. “What we realized,” says Osborne, “is that if you wait on those clotting factors, then you're always behind. You can keep putting in red blood cells and they just keep pouring right out [of the wounds].” The transfusion protocol for severe injuries has now been revamped based on JC2RT research. For injuries that require massive transfusions, the equivalent of whole blood is now given immediately, including a full complement of clotting factors. The researchers found that it reduced mortality rates in these patients from 65% to 17%.

    Another dramatic change from JC2RT research is how “damage control” surgery is performed. “We found that it's critical that we not close some injuries when they come in here,” Osborne says, “because the outcomes are massive infections and sepsis.” Instead, blood vessels are tied off and the wound is left open, sometimes for several days, vigorously cleaning it with saline. “We used to close that wound 7 years ago,” she says.

    Other problems have yet to be solved. One of the most urgent is compartment syndrome, the accumulation of fluid between tissue layers that can result in amputation or even death if the pressure cuts off blood to organs. One JC2RT project is testing whether the pressure in an injured limb can be diagnosed earlier by detecting a drop in oxygen in the tissue. Another unsolved problem explored by JC2RT projects is how to diagnose brain trauma, for example, using ultrasound to measure the blood pressure of vessels within the eye.

    Because of the streamlined process, insights from those projects will move quickly onto the battlefield. In medical research, says Osborne, “you normally have a 10-year pipeline” between the first experiment and a new treatment for patients. “For us, it can be half a year,” she says.

    The speedy turnaround has doubtless saved lives. But at the same time, it has invited intense scrutiny.

    Serious charges

    Wartime medical research has a troubled history. The most notorious examples are the experiments performed on prisoners by German and Japanese doctors during World War II. As a 2002 directive by the U.S. Department of Defense states, “The involvement of prisoners of war as human subjects of research is prohibited.” So even harmless experiments on detainees are forbidden by JC2RT, says Osborne. Nonetheless, its research projects have attracted their share of controversy.

    SOURCE: JC2RT

    A 2009 investigative report by The Baltimore Sun, which has been widely circulated among civilian and military doctors, alleged that researchers sidestepped standard ethical practices in Iraq and Afghanistan. “The military exposed hundreds of soldiers and Marines to the risks of unproven treatments that were unlikely to do much good,” the report claims. U.S. Air Force Lt. Col. Todd Rasmussen, deputy commander of the U.S. Army Institute of Surgical Research in San Antonio, Texas, who oversees JC2RT, declined to comment, saying only that the article reflected “vigorous but appropriate academic deliberations” within the medical research community.

    Science asked two bioethicists, Daniel Wikler of Harvard Medical School in Boston and Norman Fost of the University of Wisconsin, Madison, to assess the issues raised by the article and, more generally, JC2RT's procedures for ensuring that battlefield research is carried out ethically. Fost, who is the architect of the current standard ethical procedures for trauma medicine research, pulled in several other experts. “I talked at length with four experienced surgeons, three of whom specialize in trauma and have military experience, two of whom have served multiple tours in Iraq and/or Afghanistan,” he says. He also reviewed numerous articles in peer-reviewed journals and U.S. Food and Drug Administration documents. Both bioethicists posed questions about JC2RT research directly to Osborne through a series of e-mail exchanges.

    Fost's conclusion: None of the examples of unethical research held up under scrutiny. But the criticism is not surprising. “There is scarcely a disease or treatment in the world without strong disagreement among knowledgeable people about the best approach,” Fost says. As for the charge of lax ethical review, Fost found the opposite to be true. “There was a continuous dedication to evaluating practices in a way that many civilian medical centers would envy,” he says. Beyond the standard IRB approval process, new treatments are evaluated in real time with weekly “morbidity and mortality conferences” that include military physicians from around the world. They are part of a “serious quality-improvement program,” Fost says, which is “beyond anything I'm familiar with in civilian medicine.”

    Wikler agrees that there is no clear evidence of wrongdoing but adds that the extra scrutiny is justified. “There is a long tradition of using soldiers as guinea pigs for research,” he says. “And trauma medicine research in general has the problem of a lack of consent from unconscious patients,” which raises the bar on what types of experiments are permissible. JC2RT research “falls into this double shadow,” Wikler says. “But that doesn't mean it was wrong.”

    “The moral of this story is that continuous research is not only desirable but ought to be seen as obligatory, barring insuperable ethical barriers,” Wikler says. “All of us hope that if we are injured in a traffic accident and are brought to a hospital, the ER docs won't be using primitive medical techniques because research on banged-up patients was forbidden.”

    This is also the view of Peggy Knudson, a trauma surgeon and researcher at the University of California, San Francisco, who has trained U.S. military doctors in Iraq and has advised the military on JC2RT research. Knudson says some of the treatments tested in Iraq and Afghanistan are already being applied in civilian hospitals in the United States. “I copied the military burn protocol and brought it back to my [hospital],” she says. She was also impressed by the new methods for applying tourniquets and temporarily shunting blood vessels. “I use them both.” She says that the military's massive blood-transfusion protocol is being tested at 11 civilian trauma centers across the United States.

    Here in Afghanistan, Osborne has to get back to work supervising the research projects. “I can't wait for tomorrow,” she says. Once per week, she stops being a scientist and becomes a doctor, waiting for the injured to arrive from all directions.

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