The Lancet

The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest, most prestigious, and best known general medical journals.

The journal was founded in 1823 by Thomas Wakley, an English surgeon who named it after the surgical instrument called a lancet, as well as after the architectural term "lancet arch", a window with a sharp pointed arch, to indicate the "light of wisdom" or "to let in light".

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. Since 1995, the editor-in-chief is Richard Horton. The journal has editorial offices in London, New York, and Beijing.

Impact
According to the Journal Citation Reports, the journal has a 2017 impact factor of 53.254, ranking it 2nd after The New England Journal of Medicine in the category "Medicine, General".

Specialty journals
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. In 2017, The Lancet Child & Adolescent Health (paediatrics) will launch. The three established specialty journals (The Lancet Neurology, The Lancet Oncology, and The Lancet Infectious Diseases) have built up strong reputations in their medical specialty. According to the Journal Citation Reports, the 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.

Volume renumbering
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.

Controversies
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.

Autism and vaccine controversy (1998)
The Lancet was criticized after it published a paper in 1998 in which the authors suggested a link between the MMR vaccine and autism. 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 Lancet's six editors, including the editor-in-chief, were also criticized in 2011 because they had "covered up" the "Wakefield concocted fear of MMR" with an "avalanche of denials" in 2004.

Tobacco control (2003)
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 criminalizing 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 is 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."

Iraq War death toll controversy (2004)
The Lancet also published a controversial 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."

Fabricated articles withdrawn (2006)
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.

India and superbugs (2010)
In August 2010, The Lancet Infectious Diseases published an article about an enzyme conferring multi-drug-resistance properties in bacteria, which had previously been named New Delhi metallo-beta-lactamase or NDM-1 based on the assumed origin of the mechanism. The article reported 44 clinical isolates of bacteria positive for NDM-1 from Chennai, 26 from Haryana, 37 (from 29 patients) from the UK, and 73 from other sites in India, Pakistan, and Bangladesh. Of the 29 UK patients, 17 had a history of travel to India or Pakistan within 1 year, and 14 had been admitted to hospital in these countries. The authors of the article cited medical tourism to India for the spread of bacteria carrying NDM-1, which the Indian government denied.

Health impact of alcohol (2010)
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. Gavin Partington, spokesman 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".

PACE study (2011)
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 that "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.

Open Letter for the People of Gaza (2014)
In August 2014, 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." 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 regrets" publishing the letter.

Mark Pepys 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 accuses Horton personally, saying that "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."

List of editors
The following persons have been editors-in-chief of the journal: • 1823: Thomas Wakley

• 1862: James Wakley

• 1886: T. H. Wakley and Thomas Wakley (junior)

• 1907: Thomas Wakley (junior)

• 1909: Samuel Squire Sprigge

• 1937: Egbert Morland

• 1944: Theodore Fox

• 1965: Ian Douglas-Wilson

• 1976: Ian Munro

• 1988: Gordon Reeves

• 1990: Robin Fox

• 1995: Richard Horton