The Lancet

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The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest and best-known general medical journals.[1][2] It was founded in 1823 by Thomas Wakley, an English surgeon who named it after the surgical instrument called a lancet (scalpel).[3]

Political controversies, retracted papers and scientific controversies[edit]

The Lancet has taken a political stand on several important medical and non-medical issues.[4] Recent examples include criticism of the World Health Organization (WHO), rejection of the WHO's claims of the efficacy of homoeopathy as a therapeutic option,[5] disapproval during the time Reed Exhibitions (a division of Reed Elsevier) hosted arms industry fairs, a call in 2003 for tobacco to be made illegal,[6] and a call for an independent investigation into the American bombing of a hospital in Afghanistan in 2015.[7]

Tobacco ban proposal (2003)[edit]

A December 2003 editorial by the journal, titled "How do you sleep at night, Mr Blair?", called for tobacco use to be completely banned in the UK. The Royal College of Physicians rejected their argument. John Britton, chairman of the college's tobacco advisory group, praised the journal for discussing the health problem, but he concluded that a "ban on tobacco would be a nightmare." Amanda Sandford, spokesperson for the anti-tobacco group Action on Smoking and Health, stated that criminalising a behaviour 26% of the population commit "is ludicrous." She also said: "We can't turn the clock back. If tobacco were banned we would have 13 million people desperately craving a drug that they would not be able to get." The deputy editor of The Lancet responded to the criticism by arguing that no other measures besides a total ban would likely be able to reduce tobacco use.[8]

The smokers rights group FOREST stated that the editorial gave them "amusement and disbelief". Director Simon Clark called the journal "fascist" and argued that it is hypocritical to ban tobacco while allowing unhealthy junk foods, alcohol consumption, and participation in extreme sports. Health Secretary John Reid reiterated that his government was committed to helping people give up smoking. He added: "Despite the fact that this is a serious problem, it is a little bit extreme for us in Britain to start locking people up because they have an ounce of tobacco somewhere."[9]

Andrew Wakefield and the MMR vaccine (1998)[edit]

The Lancet was criticised after it published a paper in 1998 in which the authors suggested a link between the MMR vaccine and autism spectrum disorder.[10] In February 2004, The Lancet published a statement by 10 of the paper's 13 coauthors repudiating the possibility that MMR could cause autism.[11] The editor-in-chief, Richard Horton, went on the record to say the paper had "fatal conflicts of interest" because the study's lead author, Andrew Wakefield, had a serious conflict of interest that he had not declared to The Lancet.[12] The journal completely retracted the paper on 2 February 2010, after Wakefield was found to have acted unethically in conducting the research.[13]

The Lancet's six editors, including the editor-in-chief, were also criticised in 2011 because they had "covered up" the "Wakefield concocted fear of MMR" with an "avalanche of denials" in 2004.[14]

Fabricated article withdrawn (2006)[edit]

In January 2006, it was revealed that data had been fabricated in an article[15] by the Norwegian cancer researcher Jon Sudbø and 13 co-authors published in The Lancet in October 2005.[16][17] Several articles in other scientific journals were withdrawn following the withdrawal in The Lancet. Within a week, The New England Journal of Medicine published an expression of editorial concern regarding its published research papers by the same author, and in November 2006, the journal withdrew two oral cancer studies led by the Norwegian researcher.[18]

PACE study (2011)[edit]

In 2011, The Lancet published a study by the UK-based "PACE trial management group", which reported success with graded exercise therapy and cognitive behavioural therapy for chronic fatigue syndrome;[19] a follow-up study was published in Lancet Psychiatry in 2015.[20] The studies attracted criticism from some patients and researchers, especially with regard to data analysis that was different from that described in the original protocol.[21] In a 2015 Slate article, biostatistician Bruce Levin of Columbia University was quoted saying "The Lancet needs to stop circling the wagons and be open", and that "one of the tenets of good science is transparency"; while Ronald Davis of Stanford University said: "the Lancet should step up to the plate and pull that paper".[21] Horton defended The Lancet's publication of the trial and called the critics: "a fairly small, but highly organized, very vocal and very damaging group of individuals who have, I would say, actually hijacked this agenda and distorted the debate so that it actually harms the overwhelming majority of patients."[21]

Starting in 2011, critics of the studies filed Freedom of Information Act requests to get access to the authors' primary data, in order to learn what the trial's results would have been under the original protocol. In 2016, some of the data was released, which allowed calculation of results based on the original protocol and found that additional treatment led to no significant improvement in recovery rates over the control condition.[22][23]

Health impact of alcohol (2010)[edit]

A December 2010 article determined that alcohol had the worst medical and social effects compared to other recreational substances such as heroin and crack cocaine. The drugs marijuana, ecstasy, and LSD scored far lower in terms of related harms. The authors did not advocate alcohol prohibition, but they suggested that the government raise the price of alcohol until it was no longer widely available.[24] Gavin Partington of the Wine and Spirit Trade Association, responded to the report by saying that alcohol abuse affects "a minority" needing "education, treatment and enforcement". He also remarked that millions of British citizens enjoy alcohol as "a regular and enjoyable social drink".[25]


Study on hydroxychloroquine (2020)[edit]

On 22 May 2020, The Lancet published an article by Mehra et al., "Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis".[26] This study, based on retrospective observational review of 96,032 patients from 671 hospitals between 20 December 2019 and 14 April 2020, had an immediate impact; the WHO decided to stop all the clinical trials on hydroxychloroquine.[27]

On 26 May 2020, Australian researchers found an error: only 67 deaths from COVID-19 had been recorded in Australia by 21 April, where the study claims 73. The Lancet told Guardian Australia, "We have asked the authors for clarifications, we know that they are investigating urgently, and we await their reply." Surgisphere's Sapan Desai said a hospital from Asia had accidentally been included in the Australian data.[28]

On 28 May some 180 researchers and doctors from various countries published An open letter to Richard Horton, editor of The Lancet, regarding Mehra et al.[29] The following day, The Lancet published a corrected version.[30] According to the authors, the corrections did not change the overall findings of no benefit.[31] However, on 2 June 2020, The Lancet published an "Expression of Concern" and began an independent audit commissioned by the authors.[32]

On 3 June 2020, the WHO announced that clinical trials of hydroxychloroquine or chloroquine will be discontinued. The following day, three of the four authors retracted the paper,[33] and The Lancet published a retraction of the study.[34][35]

WHO-funded Coronavirus study on 2-metre distancing (2020)[edit]

In June 2020 a WHO-funded study claimed a reduction from 2 metres to 1 metre social distancing would raise infection risk from 1.3% to 2.6%.[36] Prof Ben Cowling of the WHO Collaborating Centre for Infectious Disease Epidemiology and Control at the University of Hong Kong was critical of the study because it looked only at distance and not how long a person was exposed for. The UK Governments paper, Environmental influence on transmission of COVID-19, 28 April 2020,[37] takes into account how long people are together, ventilation and room size. The WHO-funded research was carried out by a team at McMaster University in Ontario. The McMaster team pooled data from previously published studies to estimate the risk of becoming infected with coronavirus at different distances. Kevin McConway, emeritus professor of applied statistics at the Open University said, “The method of comparing the different distances in the paper is inappropriate for telling you exactly how the risk at 2-metre minimum distance compares to a 1 metre minimum distance. It does not support, and should not be used in, arguments about how much greater the risk is with a 1 metre limit versus a 2-metre limit.” Other critics of the report include David Spiegelhalter, Winton Professor of the Public Understanding of Risk at Cambridge University, and member of the UK government’s Scientific Advisory Group for Emergencies. The WHO responded by saying, "The evidence used to inform this guidance was based on a systematic review of all available, relevant observational studies concerning protective measures to prevent transmission of the coronaviruses that cause Sars, Mers and Covid-19. After checking for relevance, 44 comparative studies done in health-care and non-health-care settings were included."[38] The Lancet report was published as Boris Johnson, the UK Prime Minister, launched a review into the 2m social distancing rule.[39] UK government scientific advisers report that being 1m apart carries up to 10 times the risk of being 2m apart.[40]

Controversies about R. Horton, editor-in-chief[edit]

Peer review[edit]

The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability — not the validity — of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish, and frequently wrong.[41]

HIV/AIDS[edit]

Regarding the role of HIV in AIDS, Horton wrote in the New York Review of Books that "The central role of HIV in the development of immunodeficiency is, in my view, established by the force of epidemiological and laboratory evidence. On this key issue, Duesberg is, I believe, in error," but "Duesberg has predicted, correctly, that the virus alone is not enough to explain all aspects of the immunodeficiency process."[42][43]

Royal Society[edit]

In the May 11, 2005 The Lancet, Dr. Horton criticized the ancient British scientific group, the Royal Society, under Lord Rees for its neglect of medicine.[44] Professor Mark Pepys and thirty other society members responded. A few years earlier the society and the journal had taken different positions in a scientific reporting debate known as the Pusztai affair involving research on genetically modified potatoes.

Professor Sir Roy Meadow[edit]

Horton published an article in 2005 supporting Professor Sir Roy Meadow who had been charged with serious professional misconduct by the GMC for giving erroneous and seriously misleading evidence in the Sally Clark trial. This was especially controversial as the article appeared whilst the GMC proceedings were still under away and was published on the first day of Meadow's defence. The article 'incensed" Clark, a solicitor who had been the victim of a serious miscarriage of justice. With the support of erroneous statistical (and other) evidence from Meadow the prosecution wrongly convicted her of murder and she spent over three years in prison before her successful second appeal.[45][46]

Her husband wrote a rebuttal letter to The Lancet in order to correct Horton's 'many inaccuracies and one-sided opinions' and to prevent them prejudicing independent observers. Dr James Le Fanu, medical practitioner and writer, also wrote to The Lancet in the same issue and described Horton's words as 'mischief'.[47] The Clark family issued a statement addressing and countering with established fact each of the points making up Horton's biased support of Meadow.[48]

"Much of the scientific literature, perhaps half, may simply be untrue"[edit]

Dr. Horton recently published a statement declaring that a lot of published research is in fact unreliable at best, if not completely false.

   “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”[49]

John Ioannidis made a similar statement in 2005 ("Why Most Published Research Findings Are False").[50]

References[edit]

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See also[edit]

External links[edit]