Sadly The Lancet, one of the most prestigious medical journals in the world, founded in 1823 and its owner Elsevier both stand to lose much of their lustre if a serious controversy is not resolved very soon over publication of an objectionable unscientific open letter.

Under the bold headline “Lancet Hijacked in anti-Israel campaign” the British Telegraph reported that senior medical figures say the well-respected journal is being used as a platform by alleged conspiracy theorists. It is not surprising that publication of an unscientific emotional one-sided political opinion letter by authors, with dubious credentials relating to the subject of the letter, has reflected so adversely on the journal.

Five principal authors of the offending letter misleadingly declared they had no competing interests, egregiously failing to disclose that they actively promote the Palestinian cause and that two of them, Dr Paola Manduca and Dr Swee Ang who are members of pro-Palestine NGOs, distributed a video containing an extended anti-Semitic rant by the notorious white supremacist and former Ku Klux Klan Grand Wizard David Duke, who has been described as “a neo-Nazi”.  Moreover. Dr Manduca is known to have forwarded an email message alleging that the Boston marathon bombings were carried out by Jews.

Because appeals to retract the Manduca letter have fallen on deaf ears, a large and increasing number of senior physicians and scientists have resigned from Lancet committees and are calling for a boycott of all Elsevier scientific publications.  This boycott includes refusing to subscribe to Elsevier publications, refusing to submit manuscripts to Elsevier publications, refusing to cite articles that appear in Elsevier publications and withdrawing chapters from Elsevier textbooks.

A sidelight to this sorry episode is eloquently detailed in a letter by Professor Eric Hassall, Emeritus Professor of Pediatrics at the University of British Columbia to Professor David Sanders, Emeritus Professor at the School of Public Health, University of the Western Cape [Footnote 1]

On a positive note, Lancet editor Dr. Horton accepted an invitation to visit the Rambam Medical Center in Haifa after which he declared that he had revised his opinion in the light of what he learned during the three day visit as described in more detail in a letter I submitted to the Lancet, copied below. It remains to be seen whether the Lancet will publish it.


The offending Gaza letter and Dr. Horton’s visit to Israel

By Maurice Ostroff M.Sc (eng.), FIAC

The controversial “Open letter for the people in Gaza” published online on July 23, 2014 that caused wide adverse publicity for the Lancet contained over 1,500 words and as an Israeli citizen directly wounded by that letter I trust the Lancet will afford me space to exercise my right of reply.

Firstly I refer to the visit by Lancet editor, Dr. Horton to Rambam Medical Center and I commend him on his courage in revising his opinion in the light of new information.  He deserves admiration for choosing honesty above personal considerations.  As  Kathryn Schulz, author of “Being Wrong –  Adventures in the Margin of Error” wrote,

 “when you are open to the idea of being wrong, when you truly believe that another path might be better and are not cowed by it, you will be a more creative and innovative person”.

As Dr. Horton wrote in his People to People letter

 “At Rambam I saw an inspiring model of partnership between Jews and Arabs in a part of Israel where 40% of the population is Arab. I saw Rambam offering an open hand, gladly grasped by families from Gaza, the West Bank, and Syria, who were living with life-threatening health-care needs. I saw Rambam as one example of a vision for a peaceful and productive future between peoples, which I learned exists throughout Israel’s hospitals”.

Most significantly he pointed to a better way. He wrote

 “What is the opportunity? First, we have to make a conscious choice. Either one can let residual anger prevail and entrench existing divisions still further – a position that has too often scarred relations in the Middle East. Or one can use this moment to nurture something positive and long lasting, which I firmly intend to do”

And in his speech at Rambam, Horton said

 “I need, very honestly, to set the record straight with you. First, I deeply regret the completely unnecessary polarization that publication of the letter by Paola Manduca caused… Second…I was personally horrified at the offensive video that was forwarded by two of the authors of that letter. The world view expressed in that video is abhorrent and must be condemned, and I condemn it.”

During his visit, Dr. Horton expressed his clear opposition to boycotts in general and to BDS in particular.  He also expressed the desire to receive manuscripts from Israel, and to promote collaboration between Rambam and The Lancet to further the cause of health care at all levels of society for all peoples worldwide.

The Ombudsman’s report

As the ombudsman states that she has not found sufficient grounds for retraction of the offending letter, I offer with respect the following compelling reasons:

1. The letter should have been disqualified ab initio for failing to meet the Lancet’s minimum criteria that “Authors should say how they assessed the quality of evidence, ie, how they selected and how they combined the evidence”.

2. The authors’ claim that they “witnessed” the events they described is misleading. Equally egregious is their claim that they were presenting facts whereas they were expressing their opinions.

3. The ombudsman’s report states that shocking images and statistics reported from Gaza justify the use of emotive language. To the contrary, there is absolutely no justification for the unscientific emotional false accusations in that letter which completely avoid the context that is essential to enable a reader to understand matter under discussion. As omission of relevant information is as deceptive as providing false information it is unacceptable in intellectually honest journalism and even more so in a scientific journal.

4. Before the letter was published in print on August 2, 2014, a great deal of information was already available indicating that extreme caution was necessary in evaluating press reports from Gaza and apportioning blame.

For example on July 21 the WSJ’s Middle East correspondent posted a photo on Twitter of a Hamas leader giving an interview from a room in Gaza’s Shifa hospital confirming Israel’s claim that the medical facility was being used as a “de facto headquarters for Hamas leaders” along with other civilian institutions such as mosques, schools and private homes.

Similarly, the correspondent for Radio Popolare Milano reported that Hamas rockets, not IDF strikes, hit the UN Shati refugee camp, killing nine children.

5. Intellectual honesty demands that no person who purports to express an informed opinion on the Gaza conflict in general, or Manduca’s allegations in particular, can ignore readily available important and relevant information. For example the following articles throw some light on the credibility of reports from Gaza [footnote 2].

6. The extremely prejudiced outlook of the authors of the letter was confirmed by Dr Horton who was horrified to discover that two co-authors of the Manduca letter had forwarded a vile and offensive video that is “abhorrent and deserves universal condemnation”.  Publishing unscientific emotional letters by such extremely openly biased authors degrades the prestige of the Lancet,

7. Since the outcome of the offending letter was extreme polarization Dr. Horton proposed that editors should always pause, reflect and consult before publishing any manuscript that might unnecessarily polarize, or foster or worsen political division.

Contrary to this recommendation, the offending letter was not reviewed.

8. The report states that some letters received were unacceptable in scholarly or political debate being inappropriate in tone. By the same standard the entire tone of the Manduca letter is even more inappropriate, couched as it is in unverifiable assumptions and accusations which have no place in responsible media let alone a scientific journal

9. Although readers should be able to rely on the validity of information contained in scientific journals this does not apply to the Manduca letter since Dr. Horton said he saw for himself that the letter does not describe the full reality.

10. Retraction is intended to ensure the integrity of a journal by warning readers when it is discovered that material containing unreliable or inappropriate content has been unjustifiably published and it is obvious that the Lancet’s high reputation will be seriously tarnished if this offending letter is not retracted.

The seriousness of the matter is emphasized by the resignation of several distinguished professors from the editorial boards of specialized Lancet publications and their decisions to avoid submitting further contributions until this matter is resolved.


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