Doctors take the gloves off

April 16, 2015
Sarah Benton

In this posting, 1) Hands off the Lancet statement; 2) Letter from Sir Mark Pepys and other ‘Concerned Academics’; 3) Notes and links including an unbalanced interview with Dr. David Nott.

A child in Rafah injured by IDF shelling is carried to hospital, August 2nd 2014. Cause of injuries – nothing to do with politics. Photo by Reuters

Hands off The Lancet

April 15, 2015

In this public response to the smear campaign and personal attacks on Richard Horton, The Lancet Editor-in-Chief, Lancet Complaint to Reed Elsevier, we assert:-

1. Richard Horton is highly regarded as an exceptional leader in global health and as a campaigning Editor of The Lancet in the best traditions of the Journal.

2. Politics is intrinsic to many health issues and a legitimate subject for health commentary and debate, especially in the world’s leading global health journal. Controversy is an inevitable and healthy aspect of public discourse on political issues.

3. The “Open letter to the people of Gaza” addressed an important topical issue, the main points of which have been substantiated by subsequent, independent, reports of what happened in the Gaza Strip in the summer of 2014, of which it is possible that some of the complainants are unaware.

4. To describe the Open letter as ”stereotypical extremist hate propaganda” is inaccurate and unhelpful hyperbole.

5. The Lancet provided equal coverage of views for and against the letter in subsequent published correspondence, reflecting the ratio of letters received by the Journal and allowing a healthy debate to take place.

6. The Lancet Ombudsman’s review of the issue was balanced and fair, highlighting the strengths and weaknesses of the letter and how the controversy was handled, for all to see. She was not persuaded that the letter should be retracted.

7. The Committee on Publication Ethics (COPE) is best placed to judge whether its Code of Conduct and Best Practice Guidelines have been breached. A previous Chair of COPE has written that the Open letter should not be retracted.

8. The heavy-handed attempt to force The Lancet to withdraw the Open letter is the latest in a series of attempts to stifle media coverage of the Israel-Palestine issue and should be resisted.

9. In the light of reports by Physicians for Human Rights-Israel, Amnesty International, Human Rights Watch, the United Nations and others, the “unfinished business” of Operation Protective Edge is to determine whether and by whom, from either side of the conflict, violations of international human rights and humanitarian law were committed.

15 April 2015

Scroll down to read the full response.


Professor Graham Watt MD FRCGP FRSE FMedSci, Professor of General Practice, University of Glasgow, UK

Sir Iain Chalmers DSc FFPH FRCP Edin FRCP FMedSci, Coordinator, James Lind Initiative, Oxford, UK

Professor Rita Giacaman, PharmD, MPhil, Professor of Public Health, Birzeit University, occupied Palestinian territory

Professor Mads Gilbert MD PhD, Professor of Emergency Medicine, University of Tromsø, Norway

Professor John S Yudkin MD FRCP, Emeritus Professor of Medicine, University College London, UK

If you wish to communicate with the Writing Group please email HandsOffTheLancet@Gmail.Com

Supporting Signatories

If you wish to add your name to this list of supporting signatories please use the form here

Professor Emeritus Jarle Aarbakke MD PhD Former President (Rector) UiT The Arctic University of Norway, Tromsø, Norway

Professor Adel Afifi, MD, MS Professor Emeritus, Carver College of Medicine, University of Iowa, US.

Professor Rima Afifi, PhD Faculty of Health Sciences, American University of Beirut, Lebanon.

Dr. Neil Arya, MD, CCFP, FCFP D Litt Assistant Clinical Professor Family Medicine, McMaster University, Adjunct Professor Family Medicine Western University, Adjunct Professor Environment and Resources Studies University of Waterloo, Canada.

Dr. Rajaie Batniji, MD, DPhil Clinical Assistant Professor of Medicine, Stanford University, US

Professor Robert Beaglehole DSc FRS(NZ) ONZM Professor Emeritus, University of Auckland, New Zealand.

Professor Espen Bjertness, PhD Head, Section of Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Norway.

Professor Rolf Busund, MD PhD Professor of Cardiothoracic and Vascular Surgery, UiT The Arctic University of Norway, Tromsø, Norway.

Professor Simon Capewell DSc MD Professor of Clinical Epidemiology, University of Liverpool, UK.

Professor Phil Cotton MD Professor of Learning and Teaching, University of Glasgow, UK.

Professor George Davey Smith MD DSc FMedSci Professor of Clinical Epidemiology, University of Bristol, UK.

Professor John A Davies Emeritus Professor of Paediatrics, University of Cambridge, UK.4

Dr. James Deutsch, MD, PhD, FRCPC Department of Psychiatry, University of Toronto, Canada.

Judith Deutsch, M.S.W. Faculty, Toronto Psychoanalytic Institute, Canada. Former President Science for Peace (2008-2012)

Professor Abbas Elzein, PhD Associate Professor of Environmental Engineering, University of Sydney, Australia.

Sir Terence English KBE FRCS FRCP. Former President of the Royal College of Surgeons, President of the British Medical Association and Master of St Catherine’s College, Cambridge, UK.

Professor Gene Feder MD FRCGP Professor of Primary Health Care, University of Bristol, UK.

Professor Olav Helge Foerde, MD PhD Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.

Professor Per Fugelli, MD Professor of Social Medicine, University of Oslo, Norway.

Dr. Miriam Garfinkle, MD Retired Community Physician, Independent Jewish Voices, Canada.

Dr. Emilio Gianicolo, PhD Researcher of the Italian National Research Council, Italy. Since September 2013, guest researcher at the University of Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics in Mainz, Germany.

Professor Gordon Guyatt, PhD Distinguished Professor of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Canada.

Professor Rima Habib, PhD, MPH, MOHS Faculty of Health Sciences, American University of Beirut, Lebanon.

Professor Gudmund Hernes Norwegian Business School, Oslo; Former Norwegian Minister of Education and Research (1990-95), and of Health (1995-97)

Professor Dennis Hogan,PhD Robert E. Turner Distinguished Professor Emeritus of Population Studies and Sociology, Brown University, US.

Professor Gerd Holmboe-Ottesen, PhD Section of Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Norway.

Professor Anne Husebekk MD PhD Rector of UiT, The Arctic University of Norway, Tromsø, Norway.

Professor Tor Ingebrigtsen MD PhD Hospital Chief Executive/CEO, The University Hospital of North Norway, Tromsø, Norway.

Dr. Lars Jerden, MD, PhD Center for Clinical Research Dalarna, Sweden.

Professor Jak Jervell, PhD Professor Emeritus, Honorary President, International Diabetes Federation, Norway.

Professor Ann Louise Kinmonth CBE FMedSci Emeritus Professor of General Practice, University of Cambridge, UK.

Professor Rebecca Kay PhD Professor of Russian Gender Studies; Co-convenor Glasgow Refugee, Asylum and Migration Network GRAMNET, University of Glasgow, UK

Professor Debbie Lawlor FMedSci Professor of Epidemiology, University of Bristol, UK.

Professor Jennifer Leaning, MD, SMH FXB Professor of Practice of Health and Human Rights, Director, FXB Center for Health and Human Rights, Harvard University, US.

Professor Emeritus Georges Midrè, PhD Department of Sociology, Political Science and Community Planning, The Arctic University of Norway, Tromsø, Norway.

Professor Alan Myers, MD, MPH, FAAP Professor of Paediatrics, Boston University School of Medicine, US.

Professor Kaare Norum, MS, PhD Former president (Rector) University of Oslo, Former Dean of Medical Faculty, University of Oslo, Norway.

Professor Iman Nuwayhid, PhD Dean, Faculty of Health Sciences, American University of Beirut, Lebanon.

Professor Kate O’Donnell PhD Professor of Primary Care Research and Development, University of Glasgow, UK.

Professor Ole Petter Ottersen, MD, PhD Rector of the University of Oslo, Norway.

Professor Alison Phipps, OBE, PHD, FRSE Professor of Languages and Intercultural Studies, University of Glasgow, UK. Co-Convener: Glasgow Refugee, Asylum and Migration Network, UK.

Professor Raija-Leena Punamaki, PhD School of Social Sciences and Humanities, University of Tampere, Finland.

Reem A. Qadir MSW RSW A social worker with extensive work experience in Individual and Family Therapy, Canada.

Dr. Sara Roy, PhD Senior Research Scholar Associate, Center for Middle Eastern Studies, Harvard University, US.

Professor Harry Shannon, PhD Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada

Professor Debbie Sharp PhD FRCGP Professor of Primary Health Care, University of Bristol, UK.

Dr. Angelo Stefanini, MD, MPH Scientific Director, Centre for International Health. Department of Medical and Surgical Sciences, University of Bologna, Italy.

Professor Johanne Sundby, PhD/MD Department of Community Medicine, University of Oslo, Norway.

Dr. George Tawil, MD Clinical Associate Professor, Georgetown University Hospital, Washington DC. Past president of the Medical Staff, Inova Alexandria Hospital, Alexandria, Virginia. Past Chair, Medical Affairs Council, Inova Health Systems, Fairfax, Virginia, US.

Professor Paul Wallace FRCGP FFPHM Emeritus David Cohen Professor of Primary Care, University College London, UK.

Professor Steinar Westin MD PhD Department of Public Health and General Practice, The Norwegian Institute of Science and Technology (NTNU), Trondheim, Norway.

Professor Salim Yusuf, DPhil, FRCPC, FRSC, O.C. Professor of Medicine, McMaster University, Canada

Professor Huda Zurayk, PhD Professor and previous Dean of the Faculty of Health Sciences, American University of Beirut, Lebanon.

It is this boy’s terror, rather than his injuries, than makes this photo July 2014 from Al-Shifa hospital by Ezz al-Zanoun / APA images so striking.


On 31 March 2015, 396 professors and doctors, led by Professor Sir Mark Pepys, submitted a complaint to the Senior Management and Board of Reed Elsevier concerning “egregious editorial misconduct at The Lancet that is unacceptable in general and also gravely violates your own published Editorial Policies”.

The signatories include 5 Nobel laureates, 4 knights and a Lord. 193 (49%) of the signatories are from the US, 95 (24%) from Israel, 33 (8%) from the UK, 26 from France, 19 from Canada, 12 from Australia with smaller numbers from Belgium (3), Brazil (3), Italy (2), Denmark (2), Mexico (1), Panama (1), South Africa (1), Sweden (1) and Switzerland (1).

The complaint makes brief mention of The Lancet’s publication of the paper by Wakefield, linking MMR vaccine to autism, which was shown subsequently to be fraudulent, but is chiefly concerned with The Lancet Editor-in-Chief, Richard Horton, and his alleged “persistent and inappropriate misuse of The Lancet to mount a sustained political vendetta concerning the Israel-Palestinian conflict, to promote his own well known personal political agenda”.

The centre of the complaint concerns “An open letter for the people of Gaza” by Manduca and 23 others, which was published online by The Lancet on 22nd July and in hard copy on 2nd August 2014, 14 days into “Operation Protective Edge”, Israel’s 50 day attack on Gaza.

The complainants consider that this letter, and The Lancet’s handling of the controversy it aroused, breached both the Journal’s own policies and the Code of Conduct and Best Practice Guidelines for Journal Editors issues by the Committee on Publication Ethics (COPE).

The complaint ends by requiring “Reed Elsevier to behave ethically by retracting the Manduca letter, apologizing for its publication and ensuring that any further editorial malpractice at The Lancet is prevented”.

Chronology of events

8 July 2014

Israel began a major military assault on the Gaza Strip, the fourth in eight years. It lasted 50 days and was more devastating than previous offensives. 2,220 Gaza residents were killed, of whom at least 70% were civilians, including over 500 children. More than 17,000 residents were wounded and over 100,000 made homeless (UN OCHAopt, 2014). According to Israeli official accounts, 73 Israelis were killed: 67 soldiers and 6 civilians, including one child and one migrant worker. 469 Israeli soldiers and 255 civilians were wounded (Bachmann et al. 2014).

15-22 July 2014

A report cited by the Sunday Telegraph newspaper records that 125 children were killed during the week 15-22 July 2014, including 59 on 20th July.

22 July 2014

On the 14th day of Israel’s 50-day assault ‘An open letter for the people in Gaza’, co-authored by 24 signatories from Italy, the UK and Norway, was published by the medical journal The Lancet, initially online and subsequently in print (Manduca et al. 2014a). One of the signatories provided eyewitness accounts of the medical consequences for the civilian population, while working clinically at the largest trauma centre in Gaza during the first weeks of the assault. The letter was endorsed online by more than 20,000 signatories.

9 and 16 August 2014

The Lancet published 20 letters in hard copy editions, divided equally between authors criticising and supporting the Open Letter. Some correspondents declared that medicine “should not take sides” and that those who speak out against the consequences of war for civilians incited hate or introduced politics “where there is no place for it” (see, for example, Konikoff et al. 2014). Others described the letter as “anti-Jewish bigotry, pure and simple” (Marmor et al. 2014), although at least one of the authors of the ‘Open Letter’ was Jewish, and the word “Jewish” did not appear in the letter. Similar charges were made in the lay press, both within Israel and elsewhere (see Simons 2014, for example).

One of the letters published in response to the ‘Open Letter’ was co-authored by seven Jewish health professionals in South Africa (London et al. 2014). They suggested that “remaining neutral in the face of injustice is the hallmark of a lack of ethical engagement typical of docile populations under fascism”. They had witnessed and exposed some of the worst excesses of state brutality under apartheid, and had been harassed, victimised or detained for being anti-apartheid activists. They pointed out that they did not have the opportunity to air their views in their national medical journal, which suppressed public statements made by concerned health professionals and labelled such appeals for justice and human rights as ‘political’.

They expressed support for The Lancet’s decision to permit a discussion of the professional, ethical, and human rights implications of the conflict in Gaza, emphasizing that it is appropriate for health professionals to speak out on matters that are core to their professional values.

30 August 2014

After 20 responses to the ‘Open Letter’ had been published, its authors accepted The Lancet’s invitation to reply (Manduca et al. 2014b). They denied any financial conflicts of interests, as had been alleged, and listed the variety of experiences and affiliations that had led to their support for Palestinian society.

They noted that the allegations by the Ministry of Health in Gaza that gas had been used by the Israeli military would need to be tested by an independent Commission of Inquiry set up by the UN Human Rights Council. They ended by recalling the context in which they had written their letter: during the preceding two days one Palestinian child was being killed, on average, every two hours, and the UN had made clear how serious the situation had become:

The huge loss of civilian life, alongside credible reports about civilians or civilian objects (including homes) which have been directly hit by Israeli shelling, in circumstances where there was no rocket fire or armed group activity in the close vicinity, raise concerns about the principles of distinction and proportionality under international law.” (OCHA oPt 2014)

22 September 2014

Some were dissatisfied with The Lancet’s handling of the Open Letter. Two medical academics at University College London registered complaints with The Lancet Ombudsman (Simons 2014). One of them, Professor Sir Mark Pepys, was quoted in The Telegraph as having written that “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.”

Pepys suggested that the behaviour of Dr Horton, editor of The Lancet, was “consistent with his longstanding and wholly inappropriate use of The Lancet as a vehicle for his own extreme political views, which had greatly detracted from the former high standing of the journal.” (quoted in Simons 2014).

The article in The Telegraph also alleged that two of the authors of the Open letter – one of them Chinese – have sympathies with the views of “an American white supremacist” (Simons, 2014), following the mistaken forwarding of emails, for which both individuals subsequently apologised.

When one of the authors of the ‘Open Letter’, the Norwegian doctor Mads Gilbert, who has worked clinically in Gaza during every Israeli assault on the Strip since 2006, was voted “Norwegian Name of the Year” in a national poll in December 2014, Pepys and eight other doctors wrote to the largest Norwegian newspaper, VG, to complain about his silence on the ‘loathsome hatred and racism’ of his co-authors. They asked for his national award to be reconsidered (Cohn et al. 2015).

17 October 2014

The Lancet Ombudsman published her report online on 17 October (Wedzicha, 2014). She said that she had received many emails and letters, some supporting and others opposing the position expressed in the ‘Open Letter’, and that some of them had been inappropriate in tone and of a personal nature. She stated that it was “entirely proper that medical journals and other media should seek to guide and reflect debate on matters relevant to health, including conflicts”.

She was not persuaded by calls for retraction of the ‘Open Letter’, “I do not believe that sufficient grounds for retraction have been established, and this would make other letters referring to the publication in question difficult to interpret”.

The Ombudsman went on to address allegations of bias among the authors of the ‘Open Letter’. “Given the shocking images and statistics reported from Gaza at the time, the use by Manduca and colleagues of emotive language, in description of the ‘massacre in Gaza’ for example, can be understood. Where the letter is less successful is in its portrayal of the armed element of the conflict on the Palestinian side. Given the authors’ close association with the region they will have been aware that several thousand potentially lethal rockets and mortars were fired from Gaza into Israel during the conflict, leading to loss of life.”

The authors were criticised for not having disclosed at the time of submission “any financial or other relationships that could be perceived to affect their work”, and she indicated that she would be asking the journal’s editors to put a policy in place as soon as possible to rectify this. The Ombudsman criticised the authors for not referencing in their original letter the source for their statement about the possible use of gas in Gaza.

The Ombudsman’s most serious criticism of the letter was the “regrettable statement” that, because only 5% of Israeli academics had supported an appeal to the Israeli government to stop the military operation in Gaza (Gur-Arieh 2014), the authors had been “tempted to conclude that…the rest of the Israeli academics [had been] complicit in the massacre and destruction of Gaza”.

“In summary”, the Ombudsman concluded, “the letter by Manduca and co-authors was published at a time of great tension, violence and loss of life. Given these circumstances the letter’s shortcomings can be understood, as a measure of balance has been achieved by the publication of further letters from both sides of the debate.”

3 November 2014

The Ombudsman’s decision to reject calls for the letter to be withdrawn from the public record was supported by Dr Richard Smith, former editor of the British Medical Journal, former chair of COPE and author of COPE’s Code of Conduct for Editors (Smith 2014): The Lancet letter was “passionate, overstated in parts, inflammatory to some, and one sided; and the authors failed to declare competing interests and two of them had acted in an objectionable but not illegal way. But none of these are grounds for retraction.”

He ended his commentary on an historical note: “The Lancet was made the great journal it is by Thomas Wakley, the founder and first editor, publishing articles that were so inflammatory that his critics burnt his house down. That radical tradition has not always shone brightly in the nearly 200 years since, but Horton has restored it strongly, establishing the Lancet as a world leader in global health, speaking truth to power and giving a voice to those who are not heard (like the children of Gaza). It’s against that radical tradition and leadership that the Gaza open letter must be viewed. It should and has been disputed, but it shouldn’t be retracted.

Contrasting views of journal editors

Editors have disagreed on whether political issues should be addressed in scientific journals.

For example, the American Diabetes Association issued a statement, signed by several editors of leading diabetes and endocrine journals, indicating that they “will refrain from publishing articles addressing political issues that are outside of either research funding or health care delivery” (American Diabetes Association 2014).

In response, a commentary signed by the current and two previous editors-in-chief of theEuropean Journal of Public Health, one of whom has longstanding and very extensive collaborations with Israeli colleagues (McKee et al. 2015), voiced strong support for The Lancet, arguing that medical journals cannot ignore the political determinants of health, including those arising from conflicts. They noted, “It seems strange that it was the diabetes community that feels it necessary to take this decision,” noting how the global epidemic of diabetes, fuelled by forcing markets open to energy-dense food, reflects a policy identified primarily with Republicans rather than Democrats in the United States.

Following the Ombudsman’s Report

Soon after Israel’s 2014 assault, Physicians for Human Rights-Israel (PHR-Israel) assembled a medical fact-finding mission (FFM) of 8 international medical experts, unaffiliated with Israeli or Palestinian parties. Four had expertise in the fields of forensic medicine and pathology; four others were experts in emergency medicine, public health, paediatrics and paediatric intensive care, and health and human rights. The FFM made three visits to Gaza between 18 August and November, 2014.

The principal conclusion in the report of the FFM (Bachmann et al. 2014) is as follows: The attacks were characterised by heavy and unpredictable bombardments of civilian neighbourhoods in a manner that failed to discriminate between legitimate targets and protected populations and caused widespread destruction of homes and civilian property. Such indiscriminate attacks, by aircraft, drones, artillery, tanks and gunships, were unlikely to have been the result of decisions made by individual soldiers or commanders; they must have entailed approval from top-level decision-makers in the Israeli military and/or government.

The FFM (pp 98-99) listed many examples “suggestive of several serious violations of human rights and international humanitarian law”, including disproportionality, attacks on medical teams and facilities, and denial of means of escape. They also reported (pp 53-55) evidence which suggested the use of anti-personnel weapons and gas during the conflict.

These accusations have also been made in reports by Amnesty International (Amnesty, 2014), Human Rights Watch (Human Rights Watch, 2014), B’Tselem (B’Tselem – The Israeli Information Centre for Human Rights in the Occupied Territories, 2015) and the United Nations (OCHA, 2014, 2015).

The FFM called on the UN, the EU, the US and other international actors to take steps to ensure that the governments of Israel and Egypt permit and facilitate the entry of investigative teams into Gaza, including experts in international human rights law and arms experts, and noted (in January 2015) that this had still not been done, months after the offensive. Specifically, the UN Commission of Inquiry has been denied entry to Israel, the West Bank and Gaza (See: United Nations Independent Commission of Inquiry on the 2014 Gaza Conflict).

The FFM recommended further urgent and rigorous investigation into the impact of this war, as well as the previous armed conflicts, on public health, mental health and the broader social determinants of health in Gaza, adding that, in its assessment, the implacable effects of the on-going occupation itself would have to be taken into account.

There have been subsequent accusations by Amnesty International of war crimes committed by both sides of the conflict (BBC 2014; Linfield 2015).

Further calls for retraction of the Open Letter

Dissatisfied with the Ombudsman’s report, critics of the Open letter continued to call for it to be withdrawn and for The Lancet editor to apologise for publishing it. In a new development, the authors of the Open letter, and the journal, are being accused of being anti-Semitic. The current complaint to Reed Elsevier now refers to the Open Letter as “stereotypical extremist hate propaganda, under the selective and hypocritical disguise of medical concern”. On 24 February 2015, its lead author Professor Sir Mark Pepys wrote to 58 Israeli academics (Pepys, 2015):

The Lancet under the editorship of Richard Horton has published, for more than the past 10 years, many disgracefully dishonest and unacceptable articles about Israel. Horton has made no secret of the fact that these pieces express his own very strongly held personal views which he has published elsewhere in detail.

Last July, at the height of the Gaza war, The Lancet published a piece by Manduca and others which was at an unprecedentedly low level. It combines outright lies and slanted propaganda viciously attacking Israel with blood libels echoing those used for a thousand years to create anti-Semitic pogroms. It completely omitted the Hamas war crimes which initiated and sustained the conflict. There was no historical or political background. Crucially there was no mention of any conflict of interest among the authors despite the fact that Manduca and all the co-authors have long participated enthusiastically in not just anti-Israel but frankly Jew hating activities. All these individuals are close colleagues and collaborators of Horton.

Many of us have been trying as hard as we can since the Manduca publication to get it retracted, to get an apology for it and to convince Elsevier, the owners of The Lancet to both sanction Horton and to prevent any repetition of such shameful and unacceptable behaviour. So far there has been no satisfactory response. Indeed Horton continues to stand by the Manduca piece and refuses to accept that it is not factual and correct.

The goal of the attached protest to Elsevier document is to get the [‘Open letter’] retracted. I hope that all of you will sign it. Meanwhile colleagues at the Rambam Hospital have, as you know, invited Horton to Israel and shown him the reality of Israeli medicine, as opposed to the vicious anti-Semitic fantasy he has promoted. They have engaged in long discussions with him. Despite his refusal to either retract or apologise for his publications some colleagues are apparently convinced that Horton has reformed. Others, including Professor Peretz Lavie, the President of the Technion, who met with him for one and a half hours, were unconvinced by Horton’s presumed change of heart.

My view is that the Manduca piece was written by dedicated Jew haters, though some choose to mask this by being overtly passionate only about hating Israel. But they all agree that a Zionist/Jewish lobby or power group controls the world and its destiny and must be brought down. The Manduca piece would have made Goebbels proud and Streicher would have published it in Der Stürmer as happily as Horton published it in The Lancet…… anybody who was not a committed anti-Semite would firstly not have published (the Open letter), and secondly would have retracted instantly when the first author’s long track record of blatant anti-Semitism were exposed. In Horton’s case he already knew and liked her and her co-authors well, fully aware of all their vicious anti-Israel and frank, overtly anti-Semitic backgrounds.

Pepys’ text was distributed widely beyond the Israelis to whom the initial text had been sent, including, on 30 March, to over 150 academics with the subject line amended to:

DO NOT CITE The Lancet in your work – Their content includes fraudulent data’ (Lewis 2015).

As a result of this correspondence, 396 people have co-signed the complaint, including the statement “The collaboration of the academic community with Reed Elsevier and its journals is based on trust in their maintaining high ethical and scientific standards. None of us is under any obligation to submit and review material for publication in their journals or to serve on their editorial or advisory boards”.

The long history of pro-Israel suppression of medical freedom of expression

The heavy-handed escalation of the dispute and the use of ad personam charges of anti-Semitism to suppress freedom of expression in medical journals are not new.

In 1981, a short article in World Medicine informed medical readers who were considering attending the ‘medical olympics’ in Israel that the event was going to be held on the site of a massacre ordered by the then prime minister of Israel (Sabbagh 1981). The pro-Israel protest led eventually to the demise of the journal (O’Donnell 2009).

In 2001, pro-Israel objections to the historical background in an article on ‘The origins of Palestinians and their genetic relatedness with other Mediterranean populations’ published in Human Immunology (Arnaiz-Villena et al. 2001) led Elsevier to remove it from the public record.

In 2004, an article entitled ‘Poverty, stress and unmet needs: life with diabetes in the Gaza Strip’ (Tsapogas 2004) published in Diabetes Voice was expunged from the public record and the editor resigned, again because of charges of political bias.

In 2004, there was an outcry from pro-Israel doctors when the British Medical Journalpublished a personal view entitled ‘Palestine: the assault on health and other war crimes’ (Summerfield 2004). The editor received nearly a thousand emails, many of them personally abusive and alleging anti-Semitism (Sabbagh 2009).

In 2009, commenting on several British Medical Journal papers exposing and discussing these issues, a senior British Medical Journal editor concluded that authors, editors, publishers, advertisers, and shareholders should ignore orchestrated email campaigns (Delamothe 2009). Citing another editor he suggested that the best way to blunt the effectiveness of this type of bullying is to expose it to public scrutiny.


The “Open letter to the People of Gaza” was written in deep concern and outrage during a military assault on the Gaza Strip, killing large numbers of civilians, including women and children, on a daily basis. The world was shocked and appalled. The content and tone of the letter were controversial, as shown by subsequent correspondence in The Lancet, for and against.

The Lancet Ombudsman criticised aspects of the letter but neither she nor a former Chair of COPE considered that it should be withdrawn.

The involvement of 396 senior researchers in a mass effort to force Reed Elsevier to withdraw the letter is the latest in a series of heavy-handed interventions to stifle media coverage of the Israel-Palestine issue and should be resisted.

Richard Horton should be supported as an exceptional editor of The Lancet, in the best traditions of the Journal.

The “unfinished business” of Operation Protective Edge is not whether the “Open Letter to the People of Gaza” should be retracted, but in the light of reports by Physicians for Human Rights-Israel, Amnesty International, Human Rights Watch, the United Nations and others, to determine whether and by whom, from either side of the conflict, violations of international human rights and humanitarian law were committed.

Will the 396 signatories of the complaint to Reed Elsevier give their support to that objective?

Writing group

Professor Graham Watt MD FRCGP FRSE FMedSci

Graham Watt has long term academic links with the Institute of Community and Public Health at Birzeit University; has post-doctoral colleagues working at Birzeit University and the University of Hebron; chairs the steering committee of The Lancet-Palestinian Health Alliance* and is a Trustee of the UK charity Medical Aid for Palestinians. He did not sign the Open Letter for the People of Gaza.

Sir Iain Chalmers DSc FFPH FRCP Edin FRCP FMedSci

Iain Chalmers was employed by UNRWA in Gaza in 1969 and 1970, and has returned there (self-funded) at intervals since, most recently to help support the development of Evidence-Based Medicine. He was a member of the steering committee for The Lancet series on Health and Health Services in the occupied Palestinian territory, and serves on the steering committee of The Lancet-Palestinian Health Alliance*. He has supported the Gaza Oxford Brookes University Scholarship scheme financially, and makes regular financial contributions to Physicians for Human Rights–Israel, Jews for Justice for Palestinians, Jewish Voice for Peace, together with other charities supporting human rights. He is a co-author of the Open Letter for the people of Gaza.

Professor Rita Giacaman, PharmD, MPhil

Rita Giacaman is a Palestinian faculty member at the Institute of Community and Public Health, Birzeit University and a member of the steering committee of The Lancet-Palestinian Health Alliance*.

Professor Mads Gilbert MD PhD

Mads Gilbert is a member of the Norwegian Palestine Committee and co-founder of Norwegian Aid Committee (NORWAC); has received funding from the Norwegian Government for medical work in Lebanon occupied Palestine; and has travelled to occupied Palestine, including Gaza, on various medical missions with paid or unpaid leave from the University Hospital of North-Norway for WHO, UNRWA, NORWAC, and the Norwegian Palestine Committee. He has worked as a clinician in Al-Shifa Hospital during recent Israeli incursions (2006, 2009, 2012 and 2014). He is a peer reviewer for conferences and publications of The Lancet-Palestinian Health Alliance*. He delivered testimonies for the Report of the International Commission to enquire into reported violations of international law by Israel during its invasion of Lebanon, to the “Goldstone Commission” and to the current UN Independent Commission of Inquiry on the 2014 Gaza Conflict. He is a co-author of the Open letter for the people of Gaza.

Professor John S Yudkin

John Yudkin is a peer reviewer for conferences and publications of The Lancet-Palestinian Health Alliance* and a member of its steering committee.

*The Lancet-Palestinian Health Alliance (LPHA) is a loose network of Palestinian, regional and international researchers who are committed to the highest scientific standards in describing, analysing and evaluating the health and health care of Palestinians, to contributing to the international scientific literature and to developing local evidence-based policy and practice. The principal activity of the LPHA is an annual scientific conference, selected abstracts from which have been published by The Lancet.

2012 was a good year for Professor Sir Mark Pepys. He was knighted by Queen Elizabeth II at Buckingham Palace and the eminent speaker at the Jewish Medical Association’s Annual Dinner. Photo by Dominic Lipinski, PA.

Richard Horton

Responsibility, honesty and transparency are the essential basis of ethical, medical and scientific publishing.

Letter of complaint to Reed Elsevier from Concerned Academics for Editorial Ethics
March 31, 2015

We, the under signed, vigorously protest:

1) the grossly irresponsible and damaging editorial misuse of The Lancet for
political purposes and

2) the abject failure of the owner/publisher, Reed Elsevier, to enforce
appropriate ethical standards of editorship.

 “An open letter for the people in Gaza” by Manduca et al, published in The Lancet on July 22, 2014 consists of numerous vicious and deliberately inflammatory falsehoods, omissions and abusive dishonesty, which have no place in any responsible publication.

 The Lancet, its editor, Richard Horton, and the owner/publisher, Reed Elsevier, should comprehensively retract the article and formally apologize for their grave breach of editorial ethics. It is inconceivable that such stereotypical extremist hate propaganda, under the selective and hypocritical disguise of medical concern, should remain available on the pages of any reputable journal.

 The collaboration of the academic community with Reed Elsevier and its journals is based on trust in their maintaining high ethical and scientific standards. None of us is under any obligation to submit and review material for publication in their journals or to serve on their editorial or advisory boards.

 We invite all scientists and clinicians who value honesty and ethical conduct in publication to support this complaint by adding your signature at so that we can inform Reed Elsevier about the depth of concern among the professionals on whom they depend for their business.

 The primary role of all professional scientific and medical journals is to publish material which is rigorously and independently peer reviewed. In the case of reviews and opinion pieces it must at least comply with fundamental requirements of honest and fully transparent disclosure of actual or potential conflicts of interest.

 Failure to apply the normal rigorous standards of honesty and transparency to Commentary and Opinion pieces with overtly political content is a particular betrayal.

Publication in a journal which is assumed to have such standards provides a false impression of reliability and a level of recognition which would otherwise not exist.

 The Lancet, owned by Reed Elsevier, is one of the major general medical journals. It has been misused by its editor-in-chief, Dr Richard Horton, as a vehicle for his own eclectic personal and political agenda, at times characterized by flagrantly irresponsible publications. The worst examples of this are the MMR vaccine scare of 1998 and “An open letter for the people in Gaza” by Manduca et al published on July 22, 2014.

 In 1998 Horton published the scientifically fraudulent ‘MMR vaccine causes autism’ scare, authored by Andrew Wakefield. Horton and Wakefield had trained as junior doctors in the same clinical team and been mentored by the same senior physician.

The Lancet’s publication of the Wakefield fraud, which was transparently deeply flawed from the outset, seriously damaged vaccination programs worldwide ( The consequent illness, maiming and death of children continue to this day, for example, there are already over 150 cases in the current measles outbreak linked to Disneyland in California. It took Horton 12 years to retract the paper that caused this disaster although it was clear from the start that its publication was recklessly irresponsible (

 The second example is Horton’s persistent and inappropriate misuse of The Lancet to mount a sustained political vendetta concerning the Israel – Palestinian conflict, to promote his own well known personal political agenda.

 The Lancet publications on this topic flout many of the key ethical requirements of responsible publishing as outlined in the Committee on Publication Ethics (COPE) Code of Conduct.

 COPE issued a Code of Conduct and Best Practice Guidelines for Journal Editors as well as Retraction Guidelines.

1) Horton, editor-in-chief of The Lancet, is an Honorary Member of COPE but also participated in the development of these guidelines.

2) The guidelines’ goals: “COPE aims to define best practice in the ethics of scholarly publishing and to assist editors, editorial board members, owners of journals and publishers to achieve this.”

 The COPE guidelines include:

1) “always be willing to publish corrections, clarifications, retractions and apologies when needed”

2) “ensuring that non-peer-reviewed sections of their journal are clearly identified”

3) “considering developing a transparency policy to encourage maximum disclosure about the provenance of non-research articles”

4) “supporting initiatives designed to reduce research and publication misconduct”

5) “maintain[ing] the integrity of the academic record”

 Deliberate, selective abandonment of these essential industry-wide best practices by a journal editor is recklessly irresponsible. It betrays the scientific process and can cause grave damage to knowledge, scientific and medical progress and the public health.

 Under the direction of Horton, The Lancet has become a vehicle for publication of deliberately false material which deepens polarization between Israelis and
Palestinians, and does nothing to promote either global health or the health of those involved in this conflict.

 The most recent example of such a diatribe, “An open letter for the people in Gaza” by Manduca et al contains false assertions, unverifiable dishonest ‘facts’, many of them libellous, and glaring omissions, while deliberately concealing the grossest possible conflicts of interest of its authors, as acknowledged by The Lancet’s Ombudsman.

Two of the authors (Manduca and Swee Ang) promoted an anti-Semitic video by American white supremacist David Duke. Chalmers, another co-author, has publicly spoken of how “Zionists” have “control in so many different domains.” These blatant anti-Semitic messages and speeches are well documented and readily accessible.

 The Manduca et al publication is thus a disgraceful paradigm of malignant wilful disregard of honest and ethical medical authorship and editorship.

 The ombudsman system of The Lancet has fallen far short in addressing how this atrocious and irresponsibly harmful material was published and clearly is unwilling and/or unable to enforce even remote compliance with the COPE principles.

 Reed Elsevier, which owns The Lancet, has not responded meaningfully in any way to numerous communications from physicians, researchers and scientists protesting these failings, including a petition with over 4,000 signatures ( Indeed we note that Reed Elsevier profited financially from the scandalous Lancet publication of the lethal MMR scare and continues to profit from The Lancet’s current polarizing and overtly political agenda.

 There has been no adequate response from The Lancet to the existing channels for complaint. There has been no response at all from Reed Elsevier to explicit direct complaints by a very wide range of senior medical professionals worldwide.

 We accuse Reed Elsevier of irresponsible and unethical business practice –profiting from the publication of dishonest and malicious material that incites hatred and violence. We demonstrate to them the depth and breadth of disapproval by the profession. We require Reed Elsevier to behave ethically by retracting the Manduca letter, apologizing for its publication and ensuring that any further editorial malpractice at The Lancet is prevented.

1. Professor Sir Mark Pepys Kt MA MD PhD FRCP FRCPath FRS FMedSci
Director, Wolfson Drug Discovery Unit, University College London, Honorary Fellow, Trinity College, Cambridge
2. Dr. Arthur Weinstein MD, FACP, FRCP, MACR
Professor of Medicine, Georgetown University
3. Professor Paul Zimmet AO MD PhD FRACP FRCP FTSE Hon LLD
Director Emeritus, BakerIDI Heart and Diabetes Institute, Mellbourne, Australia
4. Dr Stuart M. Sprague DO, FACP, FASN, FNKF
Clinical Professor of Medicine, University of Chicago Pritzker School of Medicine, Chief, Division of Nephrology, NorthShore University HealthSystem
5. Dr Philip Greenland MD
Harry W. Dingman Professor, Departments of Preventive Medicine and Medicine, Feinberg School of Medicine, Northwestern University Chicago
6. Professor David R Katz MB PhD FRCPath
Emeritus Professor of Immunopathology, University College London
7. Professor David Stone BSc, MB ChB (Edin), MD (Edin), FFPH (UK), FRCP (UK), FFPH (UK)
Emeritus Professor, University of Glasgow, Paediatric Epidemiology, Public health
8. Professor Daniel Drucker
Professor of Medicine and Senior Investigator, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
9. Dr. Steven Kahn MB, ChB
Professor of Medicine, University of Washington
10. Dr. John Buse MD, PhD
Professor of Medicine, University of North Carolina, Endocrinology, Diabetes
11. Professor Sir Aaron Klug OM FMS
Nobel Laureate, Past President of the Royal Society
12. Dr Sydney Brenner CH FRS
Nobel Laureate, Salk Institute, CA
13. Professor Roger Kornberg Nobel Laureate
14. Professor Michael Levitt Nobel Laureate 2013
Professor & Associate Chair, Stanford School of Medicine, Computational Structural Biology
15. Professor Peretz Lavie PhD
President, Technion-Israel Institute of Technology, Haifa, Israel
16. Professor Daniel Zajfman PhD
President, Weizmann Institute of Science, Rehovot, Israel
17. Prof. Rivka Carmi
President, Ben-Gurion University of the Negev, Pediatrics
18. Professor Aviezri S. Fraenkel
The Weizmann Institute of Science, Faculty of Mathematics and Computer Science
19. Professor Lord Robert Winston DSc FRCOG FRCP FRCSEd FSB FCGI FMedSci HonFREng
Professor of Science & Society and Emeritus Professor of Fertility Studies, Imperial College London
20. Professor Sir Marc Feldmann Kt AC MB BS PhD MD (Hon Causa), DMSc (Hon Causa), FRCP FRCPath, FRS FMedSci FAA
Emeritus Professor and Former Director, Kennedy Institute of Rheumatology, University of Oxford
21. Professor Sir George Alberti DPhil FRCP
Senior Research Investigator, Imperial College, London, UK, Medicine, Diabetes
22. Sir Nicholas Wright MA MD PhD DSc FRCS FRCP FRCPath FMedSci
Professor of Pathology, Barts Cancer Institute, Queen Mary University of London, Histopathology, Histipatholoy
23. Dr. Jordan Cohen
President Emeritus, Association of American Medical Colleges, Medicine, Nephrology
24. Dr. Leonard Wartofsky Professor of Medicine
Editor in Chief, Journal of Clinical Endocrinology & Metabolism, Georgetown University School of Medicine, Medicine, Endocrinology
25. Professor Joseph Alpert Editor in Chief, The American Journal of Medicine
Professor of Medicine, University of Arizona College of Medicine, USA, Internal medicine, cardiovascular disease, cardiology
26. Professor Gerald Weissmann Editor-in-chief: The FASEB Journal
Dirctor Biotechnology Study Center, NYU-Langone Medical Center School of Medicine, Immunology/Lipid chemistry, Rheumatology
27. Professor Klaus Olgaard M.D., dr. med.
University of Copenhagen, Rigshospitalet, Department of Nephrology
28. Dr. Lawrence Leiter
Professor of Medicine and Nutritional Sciences, University of Toronto
29. Stephen Hammes
Professor, University of Rochester Medical Center, Endocrinology
30. Prof Alan Chait MD FACP
Head. Division of Metabolism, Endocrinology and Nutrition, University of WAshington, Medicine/Metabolism
and 523 others

Notes and links

Last Christmas Eddie Mair, presenter of BBC Radio 4’s PM news programme interviewed at length Dr. David Nott, a trauma surgeon who takes time to travel to places where people suffer traumatic injuries. In 2014 it was Syria and Nott described in painful detail the lives of Syrians being bombed by President Assad’s forces and the sort of injuries that those hit by barrel bombs had, if they survived. This interview was so transfixing, and stirring, it remains available on various websites. Below, Syria Relief is one.

Dr. David Nott

If any group of medics sent a public letter of complaint about a neutral national broadcasting service publicising a political and one-sided account by a doctor of a Middle East calamity, we have not heard of it.

Trauma surgeon’s harrowing account of working in warzone inspires moving artwork – 13 June 2014, news release from Imperial College NHS Healthcare Trust.

‘Manduca letter’

For full letter to Lancet from Professor Paola Manduca and others, click
These attacks aim to terrorise, wound the soul and the body of the people

Lancet ‘hijacked in anti-Israel campaign’, Telegraph, September 22nd, 2014

Source of information that Drs. Paola Manduca and Ang Swee have circulated links to the racist and antisemitic David Duke website and that they support pro-Palestinian NGOs such as Medical Aid for Palestine.

Concerned Academics for Editorial Ethics

Perhaps Sir Mark Pepys suffers from the complaint hyperbolic verbosity.

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