An Immeasurable Crisis? A Criticism of the Millennium Development Goals and Why They Cannot Be Measured
- Publication Date
- September 13, 2005
- Journal
- PLOS Medicine
- Author
- Amir Attaran
- Volume
- 2
- Issue
- 10
- Pages
- e318
- DOI
- https://dx.plos.org/10.1371/journal.pmed.0020318
- Publisher URL
- http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.0020318
- PubMed
- http://www.ncbi.nlm.nih.gov/pubmed/16156696
- PubMed Central
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201695
- Europe PMC
- http://europepmc.org/abstract/MED/16156696
- Web of Science
- 000233182500010
- Scopus
- 27644572990
- Mendeley
- http://www.mendeley.com/research/immeasurable-crisis-criticism-millennium-development-goals-cannot-measured
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Mendeley | Further Information
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Scopus | Further Information
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Journal Comments | Further Information
- {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/748dc583-3a51-438b-985f-26a8799a5709", "title"=>"Response to Amir Attaran", "body"=>"Author: Jeffrey D. Sachs\nPosition: UN Millennium Project\nInstitution: No affiliation was given\nE-mail: sfreeman@ei.columbia.edu\nAdditional Authors: John McArthurand Guido Schmidt-Traub\nSubmitted Date: September 15, 2005\nPublished Date: September 15, 2005\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nAmir Attaran's article raises important points on the poor quality of data for some indicators used to measure progress on the Millennium Development Goals (MDGs) but, sadly, uses these findings to draw the wrong conclusions. The evidence he presents on a small number of indicators is partial and does not justify his conclusion that the MDGs might become a liability and are doomed to fail. Quite the opposite is the case.\n\nOf course the data on the world's extremely poor people are weak, as is just about every other aspect of efforts vis-a-vis the poor. The rich countries dramatically under-invest in helping to save the poor from dying of malaria and TB. It is therefore no surprise that developing countries and the international system lack the resources to measure malaria and TB well. Attaran's criticisms in this regard are justified and have been made by many others before him, including many professionals working for the UN system.\n\nThe MDGs are a political commitment made by the 189 countries represented at the 2000 Millennium Summit to halve poverty in its many forms by 2015. The author ignores that such broad outcome goals adopted by world leaders are distinct from the technical question of how to define and measure corresponding indicators, which the UN has been asked to help answer. It is therefore inaccurate to blame the UN system for setting goals that are difficult to measure. Goal setting is the prerogative of world leaders, and they have correctly reaffirmed their commitment to the MDGs many times since 2000.\n\nIn response, the UN system has set up an active process to review indicators and data on progress towards achieving the MDGs, which involves many UN organizations as well as the World Bank and IMF. In recent years, this interagency process has already revised several MDG indicators and issued guidance notes on how data collection can be improved. The author's assertion that the UN shows a profound disrespect for the scientific process is wrong and misleading. The UN leadership has rightly decided that the heads of state and government convening at the 2005 World Summit should focus their attention on the high-level political decisions needed to strengthen the international framework for security, development and human rights. On the development side, the greatest priority has been to cement the MDGs as operational rather than simply rhetorical targets. The world leaders will not delve into the technical issues of measurement and indicators, but this important work will continue to be addressed by UN statisticians and independent experts. Such experts have indeed been scrutinizing the definition and measurement of these indicators for some time - as did, for example, several of the UN Millennium Project Task Forces.\n\nMr. Attaran's paper generalizes incorrectly across the MDGs. It describes some of the toughest measurement challenges (e.g. maternal mortality and malaria), and uses them to paint all MDGs with the same brush. In addition to the example of child mortality rates cited in the paper, several other MDG indicators can be measured quite well. These include anthropometric measures of malnutrition, primary school enrolment, gender parity in education, and access to basic infrastructure services.\n\nAn implication of the paper is that there should be no goals when measurement is imperfect, as is the case in many countries with indicators for maternal mortality. Should world leaders therefore not set time-bound goals for reducing maternal mortality? This would be wrongheaded for three clear reasons. First, even with incomplete or missing data, dramatic and verifiable improvements in womens health can be achieved by investing in emergency obstetric care and other known practical interventions to build and sustain primary health systems. The MDGs provide a major political and operational framework for doing this. Second, the MDGs are already promoting strengthened health systems in low-income settings, and those improved systems are key to ensuring the vital registrations that the author rightly recommends for improving the measurement of maternal mortality. Third, the very adoption of the maternal mortality goal (and others) is provoking greatly increased attention to improvements in data collection, from the WHO, the Gates Foundation, the World Bank, academia and others. The MDGs are not a static, one-off process.\n\nMr. Attaran misleads the reader when he argues that the MDGs have become all-encompassing catch-alls for tenuously related interventions. To say that roads and electricity are falsely linked to achieving the MDGs is incorrect and suggests a lack of understanding of the integrated nature of development processes. Roads and electricity play a critical role in poverty reduction, access to essential health services, reductions of maternal and child mortality, and a host of other channels directly related to success in achieving the MDGs. Therefore any strategy to achieve the MDGs needs to include these interventions as well. The UN Millennium Project described these linkages in the most detailed series of studies on practical approaches to achieving the MDGs that has ever been produced.\n\nWe hope that Mr. Attaran's key message on improved data collection and interpretation is heard. More and better data are certainly needed on the conditions of the world's poorest and most vulnerable people. However, even in countries with poor data systems, enough is known today to start making the practical investments in education, health, basic infrastructure, and improved environmental management that are vitally needed to cut, and eventually to end, extreme poverty. Crucially, the MDGs provide the unique framework for prompting the international cooperation that is indispensable to helping poor countries escape the poverty trap, and to benchmarking progress en route. No discussion about indicators and measurement no matter how justified it is should deflect from the overarching global commitment to the poorest of the poor that world leaders struck at the Millennium Summit in 2000 and will reconfirm at the World Summit in 2005.", "isRemoved"=>false, "created"=>"2009-03-30T23:46:10Z", "lastModified"=>"2009-03-30T23:46:10Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0020318", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:46:10Z", "replies"=>[]}
- {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/645ae7b4-e27d-4f5c-8a88-a35f81b3f076", "title"=>"Reply", "body"=>"Author: Amir Attaran\nPosition: Associate Professor and Canada Research Chair\nInstitution: Law, Population Health, and Global Development Policy, University of Ottawa, Ottawa, Ontario, Canada, and Associate Fellow, Chatham House, London, United Kingdom\nE-mail: aattaran@uottawa.ca\nSubmitted Date: October 06, 2005\nPublished Date: October 28, 2005\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nI am grateful for the reply of Jeff Sachs, John McArthur and Guido Schmidt-Traub to my paper. Their reply, written on behalf of the UN Millennium Project, shows that even the leading thinkers of that organization possess beliefs about the MDGs that contradict the factual evidence.\n\nOn one issue Sachs and colleagues agree with me: that progress on the MDGs is sometimes not well measured, such that it is impossible to know if the goals are on track to being fulfilled by their 2015 deadline.\n\nBut even on this issue, we disagree on the extent of the problem. Sachs and colleagues write that because my analysis was limited to only the public health MDGs, I based my conclusions on only \"the toughest measurement challenges\", and \"generalize[d] incorrectly across the MDGs\". In their view, if one leaves the difficult health MDGs aside, then \"several other MDG indicators can be measured quite well\".\n\nTo determine whether this assertion is correct, I accessed the UN's own \"Data Availability Analysis\" for 2005, which takes into account every one of the 48 UN-designated MDG indicators (really 65 indicators in 48 categories).1 For each indicator, the UN???s analysis summarizes the percentage of countries possessing measurements taken in two benchmark years: one year near the starting point of the MDGs (usually 1990) and another year nearer to the present (after 1999). Naturally, it is the difference of this pair of benchmark measurements, taken years apart, that proves whether progress is or is not being achieved for a particular MDG indicator.\n\nThe disappointing result of the UN's Data Availability Analysis is that, more often than not, the requisite pair of benchmark measurements doesn't exist, such that no factual conclusion about progress can be made. In the best case scenario, there are 2 indicators having paired benchmark measurements in 98% of countries. In the worst case scenario, there are 26 indicators - 13 times as many - having paired benchmark measurements in 0% of countries. Even the median MDG indicator, which is the one indicator most typical of the bunch, has paired benchmark measurements in just 5% of countries - meaning that the UN does not possess those data for 95% of countries.\n\nIn that context, definitely Sachs and colleagues are wrong to believe that, the health indicators aside, the MDGs \"can be measured quite well\". The UN's comprehensive analysis of all MDG indicators shows that, for whatever reason, most are not measured well, not even so rarely as twice a decade.\n\nWhy is measurement of the MDGs so generally poor? According to Sachs and colleagues, it is money. They write that \"developing countries and the international system\", which presumably includes the UN, \"lack the resources to measure\" the MDGs.\n\nHowever, this belief too contradicts the evidence. Concerning the health MDGs, my paper recommended to expand the network of Demographic Surveillance Sites (DSS) as the single most efficient way to obtain timely, accurate measurements. According to a recent study of DSS in Tanzania, this costs $0.01 per person, per year.2 Thus to institute DSS and good quality MDG measurements for the 4 billion poorest people worldwide would cost perhaps $40 million annually.\n\nIn that context, for Sachs and colleagues to argue that the \"international system lacks the resources\" to effectively measure the health MDGs is without credibility. The sum of $40 million is under 0.1% of the global foreign aid budget.3\n\nWithout such steps to measure progress on achieving the MDGs, any claims made for them are necessarily conjectural, rather than objectively known. Sachs and colleagues write that even without measurement, the MDGs are already promoting strengthened health systems in low-income countriesbut regrettably they omit to furnish evidence of this. They also write that the very adoption of the maternal mortality goal is provoking greatly increased attention to improvements in data collection. What they fail to mention is that the UN adopted that goal in 1990, and despite 15 years of provoking increased attention, elsewhere Sachs and colleagues have called the data unreliable.4\n\nI could dispute other unsupported assertions in the reply of Sachs and colleagues, but choose not to do so because it would distract from this fundamental point: whether to honor the health of the worlds poorest or sickest people, or to restore the earths most vulnerable natural environments, or to secure human rights for children and women, the UN must demonstrate much greater responsibility than it has in measuring the status of the MDGs. Sachs and colleagues urge to cement the MDGs as operational rather than simply rhetorical targets. I agree this is desirable, and actually, to place rhetoric ahead of evidence is unethical.\n\nThat is why measurement to provenot just to speculateon the MDGs operational progress cannot continue to be neglected, and also why the leading intellectuals of the UN Millennium Project err awfully in their judgment when justifying the neglect to date.\n\n1. Data Availability Analysis, 20 January 2005. Available at http://unstats.un.org/unsd/mi/techgroup/January2005/Series%20update%20status%20query_FC.xls, accessed 26 September 2005.\n2. Rommelmann V, Setel PW, Hemed Y, Angeles G, Mponezya H, Whiting D, Boerma T. Cost and results of information systems for health and poverty indicators in the United Republic of Tanzania. Bull WHO 2005;83:569-77.\n3. OECD DAC\n4. UN Millennium Project. 2005. Investing in Development: A Practical Plan to Achieve the Millennium Development Goals. Earthscan, New York.", "isRemoved"=>false, "created"=>"2009-03-30T23:47:22Z", "lastModified"=>"2009-03-30T23:47:22Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>true, "body"=>"AA has held small contracts or been paid per diem by the World Bank, United Nations Development Program, and the Roll Back Malaria Partnership in the last five years. None of these agencies was consulted in the development of this manuscript. Research funding was provided exclusively by the Canada Research Chairs program."}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0020318", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:47:22Z", "replies"=>[]}
- {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/cd2c10e9-b66d-48dc-ba1a-39c488922934", "title"=>"UNESCO education (millenium) goals have measurement problems also", "body"=>"Author: Harvey Goldstein\nPosition: Professor of Social Statistics\nInstitution: University of Bristol\nE-mail: h.goldstein@bristol.ac.uk\nSubmitted Date: April 13, 2007\nPublished Date: April 16, 2007\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nAssociated with the Millennium goals is UNESCO's Education For All (EFA) programme that also has specific targets for the year 2015 with monitoring of each country's progress. Similar measurement issues to those raised by Attaran arise. In a 2004 paper (Comparative Education, Vol. 40, No.1 February. pp. 7-14.) I argue that this ambitious programme could be seriously undermined by its reliance upon the achievement of numerical ‘targets’. Evidence from existing attempts by countries to impose educational targets reveals undesirable side-effects and distortions of educational systems. The paper explores some of the possible consequences of UNESCO’s adherence to such targets and the involvement of agencies such as the World Bank.\n\nThe paper can be downloaded from my website\nhttp://www.cmm.bristol.ac.uk/team/HG_Personal", "isRemoved"=>false, "created"=>"2009-03-31T00:07:20Z", "lastModified"=>"2009-03-31T00:07:20Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>true, "body"=>"I declare I have no competing interests"}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0020318", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-31T00:07:20Z", "replies"=>[]}
- {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/2dc5f7e5-5d41-4f94-80a5-cc290a330824", "title"=>"\"Classic Global Health Debate\"", "body"=>"Readers may be interested in the blog write-up by Andrew Harmer, “Classic global health debates: Attaran vs Sachs – Is the world better off without the MDGs?”\n\nhttp://www.globalhealthpolicy.net/?p=258", "isRemoved"=>false, "created"=>"2010-10-11T17:17:06Z", "lastModified"=>"2010-10-11T17:17:06Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0020318", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2010-10-11T17:17:06Z", "replies"=>[]}
- {"id"=>"221705667575156736", "text"=>"@NeilCodd Interesting article with the notion that the MDGs are 'exhortatory discriminates against the world's poorest' http://t.co/NksXpqKk", "created_at"=>"2012-07-07T20:42:04Z", "user"=>"SusyPK", "user_name"=>"Susy Pyzer-Knapp", "user_profile_image"=>"http://a0.twimg.com/profile_images/2083827117/West_20Somerset-20120405-00052_normal.jpg"}
- {"id"=>"248766845832798208", "text"=>".@harryrutter @WHO Possibly trying to avoid tricky measurement challenges of some key MDGs (MMR, malaria/TB incidence): http://t.co/leD6bnLR", "created_at"=>"2012-09-20T12:53:32Z", "user"=>"CameronNutt", "user_name"=>"Cameron Taylor Nutt", "user_profile_image"=>"http://a0.twimg.com/profile_images/1785813929/Screen_shot_2012-01-28_at_12.29.43_AM_normal.png"}
- {"id"=>"256725439660318720", "text"=>"Fascinating 2005 analysis by Amir Attaran in @PLOSMedicine: \"An Immeasurable Crisis? Why Health MDGs Can't Be Measured\" http://t.co/PD0s83Kn", "created_at"=>"2012-10-12T11:58:09Z", "user"=>"CameronNutt", "user_name"=>"Cameron Taylor Nutt", "user_profile_image"=>"http://a0.twimg.com/profile_images/1785813929/Screen_shot_2012-01-28_at_12.29.43_AM_normal.png"}
- {"id"=>"256727173208088579", "text"=>"RT @CameronNutt: Fascinating 2005 analysis by Amir Attaran in @PLOSMedicine: \"An Immeasurable Crisis? Why Health MDGs Can't Be Measured\" ...", "created_at"=>"2012-10-12T12:05:02Z", "user"=>"jocalynclark", "user_name"=>"Jocalyn Clark", "user_profile_image"=>"http://a0.twimg.com/profile_images/1428019322/00_077_normal.jpg"}
- {"id"=>"310950529717125121", "text"=>"An Immeasurable Crisis? A Criticism of the Millennium Development Goals and Why They Cannot Be Measured http://t.co/4WtqjCbYsN", "created_at"=>"2013-03-11T03:09:18Z", "user"=>"tanavalos", "user_name"=>"Tania Avalos", "user_profile_image"=>"http://a0.twimg.com/profile_images/2668382547/376508d01fc9baacb7081f03b52f5314_normal.png"}
- {"id"=>"441138514881568769", "text"=>"Provides some good info! :) http://t.co/ApKnupuVMm", "created_at"=>"2014-03-05T09:09:52Z", "user"=>"Nimmos2", "user_name"=>"Shannon Nimmo", "user_profile_image"=>"http://pbs.twimg.com/profile_images/434333910135083008/LKx3B5wS_normal.jpeg"}
- {"id"=>"640440802121003008", "text"=>"Well-known PLOS Medicine article on MDGs makes fundamental error that Declaration did not set more ambitious targets\n\nhttp://t.co/4GOv096tr5", "created_at"=>"2015-09-06T08:26:00Z", "user"=>"MDGScandal", "user_name"=>"MDG Scandal", "user_profile_image"=>"http://pbs.twimg.com/profile_images/635724478664810496/JPKGNqti_normal.png"}
- {"id"=>"640454942642335744", "text"=>"RT @MDGScandal: Well-known PLOS Medicine article on MDGs makes fundamental error that Declaration did not set more ambitious targets\n\nhttp:…", "created_at"=>"2015-09-06T09:22:12Z", "user"=>"poorscience", "user_name"=>"Poor Science", "user_profile_image"=>"http://pbs.twimg.com/profile_images/635619095870898176/GyXm5phO_normal.png"}
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- {"month"=>"12", "year"=>"2018", "pdf_views"=>"261", "xml_views"=>"0", "html_views"=>"93"}
- {"month"=>"1", "year"=>"2019", "pdf_views"=>"319", "xml_views"=>"0", "html_views"=>"87"}
- {"month"=>"2", "year"=>"2019", "pdf_views"=>"414", "xml_views"=>"3", "html_views"=>"97"}
- {"month"=>"3", "year"=>"2019", "pdf_views"=>"393", "xml_views"=>"1", "html_views"=>"209"}
- {"month"=>"4", "year"=>"2019", "pdf_views"=>"378", "xml_views"=>"0", "html_views"=>"116"}
- {"month"=>"5", "year"=>"2019", "pdf_views"=>"341", "xml_views"=>"2", "html_views"=>"123"}
- {"month"=>"6", "year"=>"2019", "pdf_views"=>"228", "xml_views"=>"1", "html_views"=>"104"}
- {"month"=>"7", "year"=>"2019", "pdf_views"=>"194", "xml_views"=>"3", "html_views"=>"49"}
- {"month"=>"8", "year"=>"2019", "pdf_views"=>"242", "xml_views"=>"3", "html_views"=>"42"}
- {"month"=>"9", "year"=>"2019", "pdf_views"=>"127", "xml_views"=>"0", "html_views"=>"60"}
- {"month"=>"10", "year"=>"2019", "pdf_views"=>"173", "xml_views"=>"0", "html_views"=>"123"}
- {"month"=>"11", "year"=>"2019", "pdf_views"=>"204", "xml_views"=>"1", "html_views"=>"82"}
- {"month"=>"12", "year"=>"2019", "pdf_views"=>"348", "xml_views"=>"0", "html_views"=>"102"}
- {"month"=>"1", "year"=>"2020", "pdf_views"=>"381", "xml_views"=>"1", "html_views"=>"75"}
- {"month"=>"2", "year"=>"2020", "pdf_views"=>"494", "xml_views"=>"1", "html_views"=>"19"}
- {"month"=>"3", "year"=>"2020", "pdf_views"=>"462", "xml_views"=>"1", "html_views"=>"14"}
- {"month"=>"4", "year"=>"2020", "pdf_views"=>"542", "xml_views"=>"0", "html_views"=>"32"}
- {"month"=>"5", "year"=>"2020", "pdf_views"=>"400", "xml_views"=>"2", "html_views"=>"17"}
- {"month"=>"6", "year"=>"2020", "pdf_views"=>"255", "xml_views"=>"4", "html_views"=>"40"}
- {"month"=>"7", "year"=>"2020", "pdf_views"=>"181", "xml_views"=>"4", "html_views"=>"60"}
- {"month"=>"8", "year"=>"2020", "pdf_views"=>"182", "xml_views"=>"0", "html_views"=>"55"}
- {"month"=>"9", "year"=>"2020", "pdf_views"=>"245", "xml_views"=>"1", "html_views"=>"39"}
- {"month"=>"10", "year"=>"2020", "pdf_views"=>"282", "xml_views"=>"0", "html_views"=>"103"}
- {"month"=>"11", "year"=>"2020", "pdf_views"=>"275", "xml_views"=>"0", "html_views"=>"94"}
- {"month"=>"12", "year"=>"2020", "pdf_views"=>"149", "xml_views"=>"2", "html_views"=>"91"}
- {"month"=>"1", "year"=>"2021", "pdf_views"=>"139", "xml_views"=>"0", "html_views"=>"137"}
PMC Usage Stats | Further Information
- {"scanned-page-browse"=>"0", "month"=>"1", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"196", "unique-ip"=>"156", "pdf"=>"27", "year"=>"2010", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
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- {"scanned-page-browse"=>"0", "month"=>"3", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"268", "unique-ip"=>"214", "pdf"=>"60", "year"=>"2010", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"4", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"358", "year"=>"2010", "pdf"=>"75", "unique-ip"=>"297", "figure"=>"3", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"5", "cited-by"=>"2", "abstract"=>"0", "full-text"=>"338", "unique-ip"=>"268", "pdf"=>"42", "year"=>"2010", "figure"=>"5", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"6", "scanned-page-browse"=>"0", "cited-by"=>"2", "abstract"=>"0", "full-text"=>"255", "year"=>"2010", "pdf"=>"27", "unique-ip"=>"170", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"7", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"138", "unique-ip"=>"113", "pdf"=>"21", "year"=>"2010", "figure"=>"5", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"8", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"187", "year"=>"2010", "pdf"=>"28", "unique-ip"=>"152", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"9", "cited-by"=>"1", "abstract"=>"3", "full-text"=>"425", "unique-ip"=>"285", "pdf"=>"47", "year"=>"2010", "figure"=>"5", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"10", "scanned-page-browse"=>"0", "cited-by"=>"2", "abstract"=>"4", "full-text"=>"254", "year"=>"2010", "pdf"=>"38", "unique-ip"=>"213", "figure"=>"4", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"11", "cited-by"=>"2", "abstract"=>"0", "full-text"=>"270", "unique-ip"=>"208", "pdf"=>"36", "year"=>"2010", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"12", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"94", "year"=>"2010", "pdf"=>"11", "unique-ip"=>"80", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"1", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"128", "unique-ip"=>"109", "pdf"=>"20", "year"=>"2011", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"2", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"169", "year"=>"2011", "pdf"=>"22", "unique-ip"=>"147", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"3", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"323", "unique-ip"=>"296", "pdf"=>"74", "year"=>"2011", "figure"=>"3", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"4", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"261", "year"=>"2011", "pdf"=>"28", "unique-ip"=>"216", "figure"=>"5", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"5", "cited-by"=>"0", "abstract"=>"8", "full-text"=>"208", "unique-ip"=>"174", "pdf"=>"20", "year"=>"2011", "figure"=>"2", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"6", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"159", "year"=>"2011", "pdf"=>"14", "unique-ip"=>"132", "figure"=>"2", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"7", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"79", "unique-ip"=>"63", "pdf"=>"10", "year"=>"2011", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"8", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"108", "year"=>"2011", "pdf"=>"6", "unique-ip"=>"93", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"9", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"143", "unique-ip"=>"127", "pdf"=>"9", "year"=>"2011", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"10", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"275", "year"=>"2011", "pdf"=>"22", "unique-ip"=>"218", "figure"=>"3", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"11", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"188", "unique-ip"=>"153", "pdf"=>"7", "year"=>"2011", "figure"=>"7", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"12", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"127", "year"=>"2011", "pdf"=>"12", "unique-ip"=>"100", "figure"=>"3", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"1", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"76", "year"=>"2012", "pdf"=>"11", "unique-ip"=>"67", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"2", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"139", "unique-ip"=>"117", "pdf"=>"7", "year"=>"2012", "figure"=>"2", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"3", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"3", "full-text"=>"206", "year"=>"2012", "pdf"=>"42", "unique-ip"=>"193", "figure"=>"2", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"4", "cited-by"=>"4", "abstract"=>"6", "full-text"=>"224", "unique-ip"=>"191", "pdf"=>"44", "year"=>"2012", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"5", "scanned-page-browse"=>"0", "cited-by"=>"2", "abstract"=>"6", "full-text"=>"158", "year"=>"2012", "pdf"=>"31", "unique-ip"=>"140", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"8", "month"=>"10", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2005", "figure"=>"47", "scanned-summary"=>"39", "supp-data"=>"30"}
- {"month"=>"11", "scanned-page-browse"=>"16", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2005", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"53", "scanned-summary"=>"37", "supp-data"=>"34"}
- {"scanned-page-browse"=>"7", "month"=>"12", "cited-by"=>"0", "abstract"=>"1", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2005", "figure"=>"40", "scanned-summary"=>"32", "supp-data"=>"25"}
- {"month"=>"1", "scanned-page-browse"=>"13", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2006", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"43", "scanned-summary"=>"30", "supp-data"=>"30"}
- {"scanned-page-browse"=>"6", "month"=>"2", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"1", "pdf"=>"0", "year"=>"2006", "figure"=>"32", "scanned-summary"=>"25", "supp-data"=>"24"}
- {"month"=>"3", "scanned-page-browse"=>"9", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"2", "year"=>"2006", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"33", "scanned-summary"=>"22", "supp-data"=>"25"}
- {"scanned-page-browse"=>"14", "month"=>"4", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2006", "figure"=>"53", "scanned-summary"=>"39", "supp-data"=>"36"}
- {"month"=>"5", "scanned-page-browse"=>"5", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2006", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"23", "scanned-summary"=>"18", "supp-data"=>"21"}
- {"scanned-page-browse"=>"4", "month"=>"6", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2006", "figure"=>"25", "scanned-summary"=>"21", "supp-data"=>"21"}
- {"month"=>"7", "scanned-page-browse"=>"4", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2006", "pdf"=>"0", "unique-ip"=>"1", "figure"=>"23", "scanned-summary"=>"18", "supp-data"=>"18"}
- {"scanned-page-browse"=>"7", "month"=>"8", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2006", "figure"=>"25", "scanned-summary"=>"18", "supp-data"=>"19"}
- {"month"=>"9", "scanned-page-browse"=>"1", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2006", "pdf"=>"0", "unique-ip"=>"1", "figure"=>"16", "scanned-summary"=>"14", "supp-data"=>"14"}
- {"scanned-page-browse"=>"7", "month"=>"10", "cited-by"=>"6", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"2", "pdf"=>"0", "year"=>"2006", "figure"=>"72", "scanned-summary"=>"63", "supp-data"=>"49"}
- {"month"=>"11", "scanned-page-browse"=>"13", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2006", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"68", "scanned-summary"=>"55", "supp-data"=>"49"}
- {"scanned-page-browse"=>"11", "month"=>"12", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2006", "figure"=>"40", "scanned-summary"=>"29", "supp-data"=>"31"}
- {"month"=>"1", "scanned-page-browse"=>"11", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2007", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"44", "scanned-summary"=>"33", "supp-data"=>"30"}
- {"scanned-page-browse"=>"19", "month"=>"2", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2007", "figure"=>"75", "scanned-summary"=>"56", "supp-data"=>"44"}
- {"month"=>"3", "scanned-page-browse"=>"5", "cited-by"=>"0", "abstract"=>"1", "full-text"=>"0", "year"=>"2007", "pdf"=>"0", "unique-ip"=>"2", "figure"=>"48", "scanned-summary"=>"40", "supp-data"=>"38"}
- {"scanned-page-browse"=>"6", "month"=>"4", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"1", "pdf"=>"0", "year"=>"2007", "figure"=>"45", "scanned-summary"=>"38", "supp-data"=>"38"}
- {"month"=>"5", "scanned-page-browse"=>"10", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2007", "pdf"=>"0", "unique-ip"=>"1", "figure"=>"41", "scanned-summary"=>"30", "supp-data"=>"26"}
- {"scanned-page-browse"=>"7", "month"=>"6", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2007", "figure"=>"31", "scanned-summary"=>"24", "supp-data"=>"22"}
- {"month"=>"7", "scanned-page-browse"=>"2", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"0", "year"=>"2007", "pdf"=>"0", "unique-ip"=>"1", "figure"=>"24", "scanned-summary"=>"21", "supp-data"=>"17"}
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- {"month"=>"9", "scanned-page-browse"=>"8", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"0", "year"=>"2007", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"84", "scanned-summary"=>"76", "supp-data"=>"59"}
- {"scanned-page-browse"=>"13", "month"=>"10", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2007", "figure"=>"113", "scanned-summary"=>"100", "supp-data"=>"83"}
- {"month"=>"11", "scanned-page-browse"=>"14", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2007", "pdf"=>"0", "unique-ip"=>"2", "figure"=>"105", "scanned-summary"=>"89", "supp-data"=>"75"}
- {"scanned-page-browse"=>"15", "month"=>"12", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"2", "pdf"=>"0", "year"=>"2007", "figure"=>"110", "scanned-summary"=>"93", "supp-data"=>"70"}
- {"month"=>"1", "scanned-page-browse"=>"22", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"0", "year"=>"2008", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"78", "scanned-summary"=>"56", "supp-data"=>"45"}
- {"scanned-page-browse"=>"22", "month"=>"2", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"1", "pdf"=>"0", "year"=>"2008", "figure"=>"114", "scanned-summary"=>"91", "supp-data"=>"78"}
- {"month"=>"3", "scanned-page-browse"=>"53", "cited-by"=>"2", "abstract"=>"1", "full-text"=>"0", "year"=>"2008", "pdf"=>"0", "unique-ip"=>"1", "figure"=>"213", "scanned-summary"=>"158", "supp-data"=>"138"}
- {"scanned-page-browse"=>"41", "month"=>"4", "cited-by"=>"5", "abstract"=>"6", "full-text"=>"0", "unique-ip"=>"5", "pdf"=>"0", "year"=>"2008", "figure"=>"248", "scanned-summary"=>"196", "supp-data"=>"145"}
- {"month"=>"5", "scanned-page-browse"=>"28", "cited-by"=>"2", "abstract"=>"0", "full-text"=>"0", "year"=>"2008", "pdf"=>"0", "unique-ip"=>"1", "figure"=>"183", "scanned-summary"=>"154", "supp-data"=>"122"}
- {"scanned-page-browse"=>"3", "month"=>"6", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2008", "figure"=>"46", "scanned-summary"=>"43", "supp-data"=>"38"}
- {"month"=>"7", "scanned-page-browse"=>"10", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2008", "pdf"=>"0", "unique-ip"=>"1", "figure"=>"53", "scanned-summary"=>"42", "supp-data"=>"33"}
- {"scanned-page-browse"=>"6", "month"=>"8", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"1", "unique-ip"=>"0", "pdf"=>"0", "year"=>"2008", "figure"=>"53", "scanned-summary"=>"46", "supp-data"=>"37"}
- {"month"=>"9", "scanned-page-browse"=>"18", "cited-by"=>"0", "abstract"=>"1", "full-text"=>"1", "year"=>"2008", "pdf"=>"0", "unique-ip"=>"2", "figure"=>"103", "scanned-summary"=>"81", "supp-data"=>"67"}
- {"scanned-page-browse"=>"0", "month"=>"10", "cited-by"=>"2", "abstract"=>"0", "full-text"=>"164", "unique-ip"=>"140", "pdf"=>"28", "year"=>"2008", "figure"=>"3", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"month"=>"11", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"125", "year"=>"2008", "pdf"=>"23", "unique-ip"=>"106", "figure"=>"3", "scanned-summary"=>"0", "supp-data"=>"0"}
- {"scanned-page-browse"=>"0", "month"=>"12", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"96", "unique-ip"=>"78", "pdf"=>"19", "year"=>"2008", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
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Relative Metric
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