|Edited by||Richard Horton|
The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest and best-known general medical journals. It was founded in 1823 by Thomas Wakley, an English surgeon who named it after the surgical instrument called a lancet (scalpel).
The journal publishes original research articles, review articles ("seminars" and "reviews"), editorials, book reviews, correspondence, as well as news features and case reports. The Lancet has been owned by Elsevier since 1991, and its editor-in-chief since 1995 is Richard Horton. The journal has editorial offices in London, New York, and Beijing.
According to the Journal Citation Reports, the journal has a 2018 impact factor of 59.102, ranking it second after The New England Journal of Medicine in the category "Medicine, General & Internal".
The Lancet also publishes several specialty journals: The Lancet Neurology (neurology), The Lancet Oncology (oncology), The Lancet Infectious Diseases (infectious diseases), The Lancet Respiratory Medicine (respiratory medicine), The Lancet Psychiatry (psychiatry), The Lancet Diabetes and Endocrinology (endocrinology), and The Lancet Gastroenterology & Hepatology (Gastroenterology) all of which publish original research and reviews. In 2013, The Lancet Global Health (global health) became the group's first fully open access journal. In 2014, The Lancet Haematology (haematology) and The Lancet HIV (infectious diseases) were launched, both as online only research titles. The Lancet Child & Adolescent Health (paediatrics) launched in 2017. The three established speciality journals (The Lancet Neurology, The Lancet Oncology, and The Lancet Infectious Diseases) have built up strong reputations in their medical speciality. According to the Journal Citation Reports, The Lancet Oncology has a 2017 impact factor of 36.421, The Lancet Neurology has 27.144, and The Lancet Infectious Diseases has 25.148. There is also an online website for students entitled The Lancet Student in blog format, launched in 2007.
Prior to 1990, The Lancet had volume numbering that reset every year. Issues in January to June were in volume i, with the rest in volume ii. In 1990, the journal moved to a sequential volume numbering scheme, with two volumes per year. Volumes were retro-actively assigned to the years prior to 1990, with the first issue of 1990 being assigned volume 335, and the last issue of 1989 assigned volume 334. The table of contents listing on ScienceDirect uses this new numbering scheme.
The Lancet has taken a political stand on several important medical and non-medical issues. 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, 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, and a call for an independent investigation into the American bombing of a hospital in Afghanistan in 2015.
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.
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."
The Lancet also published an estimate of the Iraq War's Iraqi death toll--around 100,000--in 2004. In 2006, a follow-up study by the same team suggested that the violent death rate in Iraq was not only consistent with the earlier estimate, but had increased considerably in the intervening period (see Lancet surveys of casualties of the Iraq War). The second survey estimated that there had been 654,965 excess Iraqi deaths as a consequence of the war. The 95% confidence interval was 392,979 to 942,636. 1,849 households that contained 12,801 people were surveyed.
The estimates provided in the second article are much higher than those published in other surveys from the same time. Most notably, the "Iraq Family Health Survey" published in the New England Journal of Medicine surveyed 9,345 households across Iraq and estimated 151,000 deaths due to violence (95% uncertainty range, 104,000 to 223,000) over the same period covered in the second Lancet survey by Burnham et al. The NEJM article stated that the second Lancet survey "considerably overestimated the number of violent deaths" and said the Lancet results were "highly improbable, given the internal and external consistency of the data and the much larger sample size and quality-control measures taken in the implementation of the IFHS."
In August 2014 and during the 2014 Israel-Gaza conflict, The Lancet published an "Open letter for the people of Gaza" in their correspondence section. As reported in The Daily Telegraph, the letter "condemned Israel in the strongest possible terms, but strikingly made no mention of Hamas' atrocities." According to Haaretz, the authors of the letter include doctors who "are apparently sympathetic to the views of David Duke, a white supremacist and former Ku Klux Klan Grand Wizard." One of the doctors responded by saying: "I legitimately use my right of freedom of opinion and do not agree or value the politics of the government of Israel, nor of many others, including Jews in and out of Israel." A second one responded with: "I didn't know who David Duke was, or that he was connected to the Ku Klux Klan. I am concerned that if there is any truth in the video, that Jews control the media, politics and banking, what on earth is going on? I was worried."
The editor of The Lancet, Richard Horton, said: "I have no plans to retract the letter, and I would not retract the letter even if it was found to be substantiated." However, Horton subsequently came to Israel's Rambam Hospital for a visit and said that he "deeply, deeply regret[ted] the completely unnecessary polarization that publication of the letter by Paola Manduca caused."
Mark Pepys, a member of the Jewish Medical Association, wrote: "The failure of the Manduca et al. authors to disclose their extraordinary conflicts of interest... are the most serious, unprofessional and unethical errors. The transparent effort to conceal this vicious and substantially mendacious partisan political diatribe as an innocent humanitarian appeal has no place in any serious publication, let alone a professional medical journal, and would disgrace even the lowest of the gutter press." In addition, Pepys accused Richard Horton personally, saying: "Horton's behavior in this case is consistent with his longstanding and wholly inappropriate use of The Lancet as a vehicle for his own extreme political views. It has greatly detracted from the former high standing of the journal." In response, Horton said: "How can you separate politics and health? The two go hand-in-hand."
On 16 May 2020, the journal published an article on the US Centers for Disease Control (CDC) that, amongst other things, faulted the Trump administration for its July 2019 termination of a CDC programme under which the CDC stationed officers in China, ostensibly to serve as a distant early warning system. The writers opined that CDC director Robert R. Redfield was frightened of Trump and in any case had not "the technical capacity to lead today's complicated effort." The article concluded with a call to the American people to elect someone other than Trump in November 2020.
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. In February 2004, The Lancet published a statement by 10 of the paper's 13 coauthors repudiating the possibility that MMR could cause autism. 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. The journal completely retracted the paper on 2 February 2010, after Wakefield was found to have acted unethically in conducting the research.
The Lancets 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.
In January 2006, it was revealed that data had been fabricated in an article by the Norwegian cancer researcher Jon Sudbø and 13 co-authors published in The Lancet in October 2005. 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.
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; a follow-up study was published in Lancet Psychiatry in 2015. 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. 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". 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."
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.
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". 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.
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.
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. The following day, The Lancet published a corrected version. According to the authors, the corrections did not change the overall findings of no benefit. However, on 2 June 2020, The Lancet published an "Expression of Concern" and began an independent audit commissioned by the authors.
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, and The Lancet published a retraction of the study.
The following persons have been editors-in-chief of the journal:
Miss Nightingale on Theories of Disease, October 1870
On the Antiseptic Principle in the Practice of Surgery by Joseph Lister, September 1867
Advertisement for A.B. brand insulin, May 1923
Were it not for the GMC case, which cost a rumored £6m (EUR7m; $9m), the fraud by which Wakefield concocted fear of MMR would forever have been denied and covered up.