How the Lancet lost our trust

Right from its first issue in 1823, the Lancet was more than just an ordinary medical journal. Its founding editor, the dyspeptic surgeon and coroner Thomas Wakley, purposefully gave the journal the name of a sharp scalpel that could cut away useless, diseased tissue: he used it as a campaigning organ, to push back against injustice, bad ideas and bad practice.

What bothered Wakley most was the establishment. Not only did the Royal College of Surgeons care little about quacks and snake-oil salesmen, but its members were also engaged in corruption and nepotism, ensuring that their cronies got the best positions and filling their pockets with lecture fees. Wakley wrote in 1838 of the ‘mercenary, goose-brained monopolists and charlatans’ who won privileges that should have been due to merit. This system was ‘the canker-worm which eats into the heart of the medical body’.

Different times, different canker-worms. The Lancet is still going strong, but it exists in a very different system of academic journals than that of the 19th century. It certainly has a strong radical stance as regards politics, with regular editorials railing against the government of the day’s handling of healthcare and related matters. But as regards medical science, things are quite different: the journal is now very much a part of the system, with all the problems that entails. L’éstabliment, c’est la Lancette. And because the Lancet has such remarkable reach and such strong cultural cachet, when it makes a mistake, it really matters.

The journal’s role as the mouthpiece of the medical establishment couldn’t have been clearer in February last year, when it published a group letter organised by the zoologist Peter Daszak on the origins of the Sars-CoV-2 coronavirus. As well as ‘strongly condemn[ing] conspiracy theories’ that the virus did not have a natural origin, the letter expressed ‘solidarity’ with all scientists and health workers in China, ending with some oddly Soviet-era phrasing: ‘Stand with our colleagues on the front line! We speak in one voice.’