The Lancet

• 1. Introduction

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  The Lancet was named after a surgeon's blade. Thomas Wakley, an English surgeon who founded the journal in 1823, chose the name deliberately. A lancet is a small, sharp scalpel used to cut through tissue. Wakley wanted his journal to do the same thing to the medical establishment of his day. He saw corruption, nepotism, and incompetence in London's academic medicine, and he intended to expose it. From its very first issue, the journal carried what its own history describes as a "radical slant". Two years in, more than 4,000 people were reading it. Seven years in, that number had doubled to over 8,000. What began as one man's quarrel with the medical elite became the most cited general medical journal in the world. But prominence and controversy have always traveled together in The Lancet's story. What does it mean when the institution charged with scrutinising medicine becomes itself the subject of scrutiny?

• 2. A Surgeon's Quarrel

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  Wakley launched the journal with a specific grievance: the lectures at United Hospitals cost £15 to attend, and Wakley began reprinting them in The Lancet for free. The professors whose lectures he published had not given permission. Lawsuits followed, brought by multiple parties, charging copyright infringement and defamation. The journal won every single one of those cases. Each victory added to its reputation rather than diminishing it. The pamphleteer William Cobbett was among those who began writing for The Lancet in its early years, giving the journal a voice that extended well beyond medicine. By 1840, the journal had grown large enough that it was said to dominate medical news across the United Kingdom. Members of the Wakley family held the editorship until 1908, making the journal a family institution for more than eight decades before it passed into other hands.

• 3. Early Articles That Changed Medicine

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  During its first decades, The Lancet published accounts that would shape medical history. The journal ran an article about the first blood transfusion ever performed, carried out by the physician James Blundell. In 1867, surgeon Joseph Lister used the journal's pages to explain how antiseptic treatment could be applied to abscesses, a contribution that would transform surgical practice. The journal's scope in its earliest years stretched beyond medicine: until 1825, it published celebrity gossip, political news, and literary correspondence. That broader reach eventually narrowed. In 1915, physician Charles Samuel published the first article on shell shock in the journal's pages. In 1918, psychiatrist William Rivers followed with another article on the same condition. In late 2020, German doctors who treated Alexei Navalny after he was poisoned by the FSB published their account in The Lancet, detailing their use of a cholinesterase inhibitor to save him. The Press Secretary of the Russian presidency, Dmitry Peskov, responded to the article with the statement: "We do not read medical publications."

• 4. How the Journal Works

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  The Lancet accepts only 5% of the articles submitted to it. Every submission is reviewed by staff within 72 hours. Articles that pass that initial review are published within four weeks and then go through an extensive peer review process. The journal's published guidelines say it considers any article that "advances or illuminates medical science or practice, or that educates or entertains the journal's readers". All prospective authors must follow authorship rules set by the International Committee of Medical Journal Editors. Submitting an article costs nothing, but accepted authors are offered the option to have their work sponsored for a fee of $5,000. The journal has published over 10,000 articles in total and counts 1.8 million active users. Its editorial offices sit in London, New York City, and Beijing. Richard Horton has served as editor-in-chief since 1995, and under his direction the journal has pursued what he calls "health equity", devoting more coverage to problems facing low and middle-income countries than other medical journals typically do.

• 5. The MMR Controversy

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  In 1998, The Lancet published a paper suggesting a link between the MMR vaccine and autism spectrum disorder. The paper's lead author was Andrew Wakefield. In February 2004, ten of the paper's thirteen coauthors published a statement in the journal repudiating the idea that MMR could cause autism. Richard Horton stated publicly that the paper had "fatal conflicts of interest" that Wakefield had not disclosed. On the 2nd of February 2010, The Lancet fully retracted the paper, after Wakefield was found to have acted unethically in conducting the research. In 2011, the journal's six editors, including Horton, faced separate criticism. Critics argued that in 2004, rather than acting decisively, the editors had covered up the problem with an "avalanche of denials." The damage from the original paper has been lasting: the suggestion of a vaccine-autism link contributed to declining vaccination rates in multiple countries, a public health consequence that extended far beyond the journal's retraction.

• 6. War, Death Counts, and Data

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  The Lancet entered overtly political terrain with two major studies on casualties in Iraq. In 2004, the journal published an estimate placing the Iraqi death toll from the war at around 100,000. In 2006, a follow-up study by the same research team concluded that the violent death rate had increased substantially. That second survey estimated 654,965 excess Iraqi deaths as a result of the war, with a 95% confidence interval running from 392,979 to 942,636. The survey was based on 1,849 households containing 12,801 people. The 2024 Gaza letter followed a different method: the authors multiplied reported deaths by five to estimate total conflict-related deaths, drawing on patterns from other conflicts where indirect deaths were three to fifteen times higher than direct deaths. The resulting figure of up to 186,000 was widely circulated in media. Three days after publication, one of the authors, Martin McKee, clarified on social media that the number "has been greatly misquoted and misinterpreted" and was "purely illustrative." Critics including Michael Spagat of the "Every Casualty Counts" network called the estimate lacking in solid foundation.

• 7. Scientific Retractions

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  In May 2020, The Lancet published an observational study by Mandeep R. Mehra of Harvard Medical School and Sapan S. Desai of Surgisphere Corporation. The study concluded that hydroxychloroquine and chloroquine did not improve outcomes for COVID-19 patients and may have harmed some of them. Concerns quickly emerged in the scientific community and in media about the reliability of the underlying data. The Lancet launched an independent investigation of Surgisphere and the study. When the independent reviewers found that Surgisphere would not provide the requested data and documentation, the study's authors asked the journal to retract the article. The retraction was carried out on the 3rd of June 2020. The Lancet Group announced revisions to its editorial policy in a comment published on the 22nd of September 2020, titled "Learning from a retraction." In October 2023, The Lancet also retracted two papers from 2008 and 2014 by surgeon Paolo Macchiarini, concerning the first tissue-engineered trachea transplant. An investigation by the Swedish National Board for Assessment of Research Misconduct had found the papers contained fabricated information. Eight years before that retraction, in September 2015, The Lancet had published an editorial stating that Macchiarini "is not guilty of scientific misconduct."

• 8. Editorial Controversies

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  A December 2003 editorial in The Lancet, titled "How do you sleep at night, Mr Blair?", called for a complete ban on tobacco use in the United Kingdom. Amanda Sandford of the anti-tobacco group Action on Smoking and Health argued that criminalising a behaviour practiced by 26% of the population "is ludicrous," and pointed out that 13 million people would be "desperately craving a drug that they would not be able to get." Simon Clark, director of the smokers' rights group FOREST, called the journal "fascist". In August 2014, during the Israel-Gaza conflict, The Lancet published an open letter in its correspondence section that, as described by The Daily Telegraph, condemned Israel without mentioning Hamas. One of the letter's authors, Paola Manduca, was later identified by Haaretz as apparently sympathetic to the views of white supremacist David Duke. Horton said he had no plans to retract the letter, but after visiting Israel's Rambam Hospital he stated that he "deeply, deeply regretted" the polarisation the letter caused. On the 19th of February 2020, the journal published a letter signed by 27 scientists calling theories of a non-natural COVID-19 origin "conspiracy theories." Emails later obtained through Freedom of Information Act requests revealed that those involved in producing the letter had concealed their involvement to create what critics described as a false impression of scientific unanimity. The journal reversed course in September 2021, publishing a letter from 16 specialists stating that research-related hypotheses about COVID-19's origins "are not misinformation or conjecture." The Times of India described the publication as a "u-turn."