Dr Priyad Ariyaratnam

Is the Lancet becoming too political?

The Lancet's editor, Richard Horton, on Question Time

Doctors have always been political. Medical school is often a cradle of social activism, driven by a syllabus underlining health inequalities and the cultural aspects of disease. Some medics inevitably take up politics: Che Guevara, Salvador Allende and Bashar al-Assad are just a few (notorious) examples. But there are plenty of others, and this crossover between medicine and politics highlights how the study of medicine can easily influence ideology. A different challenge posed, however, is when ideology begins to influence medical policy, corrupting medical decisions. This can be particularly problematic in the field of medical publishing.

Medicine relies on the integrity of up-to-date published scientific evidence to find the right treatment for a particular disease. Research that is published in medical journals is differentiated from unpublished research by the process of peer-review. Peer-review involves assessing the quality and validity of the research by experts in the field prior to acceptance or rejection for publication. The danger of relying on research that is not peer-reviewed was recently demonstrated in our Government’s embrace of the Imperial College model to navigate towards lockdown, a model that many experts feel, in retrospect, had serious shortcomings.

From my experience both publishing in, and reviewing for, medical journals, the peer-review process is generally both fair and robust. However, there are instances in which papers based on erroneous data analysis or unethical research practices have slipped through the net. Prompt retraction of such published material usually follows.

Last month, the Lancet, one of the world’s oldest and most prestigious medical journals was forced to retract a study criticising the drug hydroxychloroquine, a drug famously endorsed by president Trump. The data the authors used to draw their conclusions was not subject to the scrutiny a reputed journal would exercise for such an important and contentious topic.

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