New Delhi: The Lancet, the world’s most renowned peer-reviewed medical journal, last week retracted a key study that linked the anti-malarial drug hydroxychloroquine (HCQ) to increased risk of death and irregularity in heart rhythms in Covid-19 patients.
The study had proved to be highly influential, even prompting the World Health Organization to pause HCQ clinical trials on coronavirus patients.
A second study, claiming that cardiovascular diseases increased chances of in-hospital Covid contraction, conducted by the same researcher as The Lancet study, has also been withdrawn from the New England Journal of Medicine.
The Lancet has published many studies being conducted on the novel coronavirus, from trials to test the efficiency of remdesivir for Covid-19 treatment to proving that the virus doesn’t pass from mother to child in late pregnancy. But the controversy over the study, its publication by The Lancet and the subsequent retraction have raised serious questions about the publication’s rigour, and undermined its credentials as perhaps the world’s most trusted and authoritative professional medical research journal.
ThePrint looks at what The Lancet is and why it is considered to be one of the most credible medical journals.
What is The Lancet?
The Lancet is an independent, international weekly medical journal. It was founded in 1823 by English surgeon Thomas Wakley. According to its website, it states that The Lancet is “committed to applying scientific knowledge to improve health and advance human progress”.
It has published over 10,000 issues and currently ranks second out of 160 journals in the ‘Medicine, General and Internal’ subject category in a 2014 Reuters report for citations from a journal. The Lancet publishes research papers, randomised controlled trials, reviews, seminars and more. All studies published undergo stringent editing and peer-review, according to the journal’s website.
Richard Horton is the Editor-in-Chief of The Lancet, and was elected as a foreign associate of the US Institute of Medicine in 2011. Horton also received the Andrija Stamper Medal from the Association of Schools of Public Health in Europe. In 2017, he was awarded the Edwin Chadwick Medal for his contributions to the betterment of public health.
Most credible medical journal
The Lancet has over 18 lakh registered users worldwide, and is seen as an “authoritative voice in global medicine”. It is a highly selective medical journal, with only 5 per cent of submitted manuscripts accepted for publication.
The Lancet publishes original primary research and reviews articles of the “highest standard”. It is “stringently” edited and each article goes through a peer-reviewing process. It has a vast network of contributors and alerts physicians to issues affecting the practice of medicine through its articles.
It has over 19 specialty journals such as Child and Adolescent Health, Diabetes and Endocrinology, Digital Health, Gastroenterology and Herpetology, Global Health, Haematology, HIV, Infectious Diseases, Microbe, Neurology, Oncology, Planetary Health, Psychiatry, Public Health, Regional Health, Respiratory Medicine, Rheumatology, EBioMedicine and EClinicalMedicine.
Some of The Lancet articles most cited since 2017 include ‘Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China’; ‘Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial’; and ‘Global, regional and national incidence, prevalence, and years lived with disability for 328 disease and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016’.
Who can write for The Lancet?
According to its guidelines for article submission, The Lancet will “consider any original contribution that advances or illuminates medical science or practice, or that educates or entertains the journal’s readers”.
It adds, “Whatever you have written, remember that it is the general reader whom you are trying to reach.”
In case research papers are based on randomised controlled trials, they must be peer-reviewed by the journal’s staff within 72 hours. If accepted, the paper must be published within four weeks of receipt.
There is no fee for the submission of manuscripts at The Lancet. However, the manuscripts must not be published anywhere else previously, and they must not be under consideration of other journal. Potential authors for The Lancet must abide by criteria for authorship set by the International Committee of Medical Journal Editors (ICMJE).
The ICMJE recommends that the authorship for journals be based on four criteria. First, there must be “substantial contributions” to the inception and design of the work, including the analysis and interpretation. Second, the work must be drafted and revised critically “for important intellectual content”. Third, the final approved version of the article must be published. Finally, the author must agree to be held accountable for all aspects of the work and must ensure that any concerns regarding “accuracy or integrity” are appropriately investigated and resolved.
The Lancet states on its website that it is committed to supporting its authors and making their research publicly and freely available. Submissions of research articles associated with funders are offered two options, either the “gold” open access or a “green” open access. To cover the cost of editing and reviewing, the journal charges $5,000 if the research articles that choose the ‘gold’ open access are accepted.
Authors whose funders are located in countries with a low UNDP development index are exempt from the payment.
Politicisation of HCQ
The usage of HCQ in Covid-19 treatment had become highly politicised after US President Donald Trump endorsed it as “valuable”, despite lack of credible data.
A paper written by Oommen C. Kurian, senior fellow and head of the Observer Research Foundation’s health initiative on public health, said: “Ever since HCQ was endorsed by President Trump as an effective weapon to fight coronavirus, a worldwide surge in demand was witnessed. As the largest global producer, this also became a potent tool for India’s health diplomacy efforts. This intermingling of global politics, scientific disagreements and ever sharpening commercial agendas make the debate on HCQ a vexed one.”
Kurian argued that it was also likely that HCQ was being used to “cover up” the failure of governments to provide personal protective equipment to healthcare workers.
He asserted: “The fog of war surrounding Covid-19 and the desperation of the scientific community and practitioners to have evidence-informed medicines and vaccines may give room for large- scale manipulation of studies, like The Lancet controversy proves.”
Moreover, he argued, “commercial interest” meddling with finding the effectiveness of any drug must be punished.
In 2006, The Lancet had reported that the death toll among Iraqis due to the US-led invasion had reached 6,55,000. There were concerns raised around the number because it was different from the figures suggested by the US and UK governments.
Similarly, in 2004, The Lancet had published a study that estimated 1,00,000 Iraqis died due to the war. This figure also proved to be controversial.
The Lancet’s past troubles
The Lancet also found itself in trouble when it published another Surgisphere study, which concluded that ivermectin, an anti-parasitic drug, reduced the mortality in Covid-19 patients.
This paper did not appear in any other journal, nor had it been peer-reviewed. It caused a surge in demand for the drug in Latin America, where it is readily available.
Surgisphere was labelled a “mysterious company” by Science magazine.
But The Lancet’s retraction is not unprecedented. Perhaps, the biggest example was a falsified paper by discredited ex-physician Andrew Wakefield, which suggested that the MMR (measles, mumps and rubella) vaccine causes autism.
This 1998 paper stated that 12 children who took the vaccine showed links to autism development because of the vaccine, but the data was found to be manipulated and the studies funded by anti-vaccine groups.
The children used in the study had parents who had filed anti-vaccination lawsuits, and no other study has ever managed to replicate the findings.
Wakefield’s co-authors withdrew support for the paper, which was ultimately retracted in 2010. But the study had gathered so much attention that until today, it continues to influence strong anti-vaccination sentiment, despite overwhelming scientific evidence that vaccines do not cause autism.