The American Journal of Public Health has retracted a controversial 2018 paper on the effects of economic austerity in Spain because it contained “inaccurate and misleading” results linking those policies to a massive spike in premature deaths.
The journal also has published a second piece, by a different group of authors, refuting the central claim of the now-retracted paper. Whereas the first article asserted that austerity in Spain during the mid-2000s led to more than 500,000 excess deaths, the new research says deaths in the country slowed during the country’s economic crisis.
The flawed article, “Austerity policies and mortality in Spain after the financial crisis of 2008,” was written by a group of researchers at the Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, on the Canary Islands. The authors claimed that their analysis of the years 2011 to 2015 showed that:
During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain.
The Spanish Civil War, by comparison, claimed an estimated 500,000 lives, as the headline of this skeptical article in El Pais pointed out.
As the retraction notice explains, between acceptance and publication of the Canary Island paper, the journal became aware of problems with the data. Signed by the journal’s editor, Alfredo Morabia, MD, PhD, the retraction notice states:
I have decided to retract this article … because there is clear evidence that the findings are inaccurate and misleading.
After accepting the article in 2018, we invited an editorial by Hernández-Quevedo et al., which suggested that there was a major flaw in the analysis. I then asked Cabrera de León et al. to revise the article on the basis of the editorial. The authors made some changes but did not want to modify their main conclusion: half a million deaths were attributable to the economic crisis and austerity policy of the late 2000s in Spain. The article and the editorial were published in August 2018. I did not retract the article then because it had undergone peer review and I had no evidence of the magnitude of the flaw.
Since then, we have reviewed and accepted an article, published in this July issue, by Regidor et al. (p. 1043) that provides a more accurate analysis and interpretation of the data: overall mortality declined in Spain between 2001 and 2016 even though there was a small uptick during the austerity years that does not have a singular explanation. …
I regret that I have to take this action, but there is no alternative.
The paper has been cited three times, according to Clarivate Analytics’ Web of Science.
Antonio Cabrera de León, the first author of the article, told us by email that he and his colleagues don’t object to the retraction:
but that does not mean that we agree or that we are happy … We would have preferred to have been allowed a letter to the director to clarify the error and correct its magnitude (not the direction of the effect of austerity, only its magnitude).
Our honesty is not questioned nor have we made an error in calculations made by us. We have recognized that there is a mistake in the article because we did not notice that the National Institute of Statistics in Spain changed its standard population in the middle of an economic crisis, just when the application of austerity policies began.
This mistake, our fault, led us to an overvaluation of mortality attributable to population impoverishment policies. But that being said, it is a non-differential bias. That is to say, there was an excess of mortality that we detected, although not as big as the one we thought.
de León said that he would advise other researchers to:
standardize yourself the raw data and do not trust even official institutions data.
And he added that:
public health professionals who defended austerity policies, if they have to accept your figures they will deny the cause; and if they detect a mistake they will discredit your work. Those who denied that there had been an increase in mortality in Spain now accept it but they attribute it to lifestyle changes. But that is a euphemism. Naturally, any population or person subject to austerity policies changes the lifestyle, but it is a consequence of the impoverishment.
This case isn’t the first we’ve covered about austerity economics. In 2013, we wrote about a correction involving an influential article by a pair of researchers which found — incorrectly, as it happened — that countries relying on high levels of debt financing grew more slowly than those with tighter budgeting.
In a guest editorial for the AJPH, Chik Collins, of the School of Media, Culture and Society at the University of the West of Scotland, in Paisley, writes that despite its flaws, the retracted paper deserves consideration:
We should be careful not to meet one fatal suspension of disbelief (in the face of erroneous data) with another one (perhaps stemming from overmodeling data). Policymakers should be helped to understand, on the basis of what we know to be true, that austerity is not only unnecessary, frequently cruel, and not justified by sound economic reason (it is ultimately a form of class war, waged from above) but also has real and significant adverse public health consequences.
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