A Serious Medical Journal Just Went Totally Clinical

Liam Hoare

Liam Hoare

Freelance writer based in the United Kingdom

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~ Also in this issue ~

~ Also by Liam Hoare ~

From the Blog

Why did one of the world’s most widely respected medical journals publish anti-Israel conspiracy theories?

It was once the case that The Lancet, one of the oldest and most prestigious peer-reviewed medical journals in the United Kingdom, was merely a forum for publishing suspect and unreliable research. Its infamous 1998 paper that linked the MMR vaccine to autism, for example, was subsequently disowned and apologized for by the journal’s editor, Richard Horton, although not before anti-vaccination hysteria gripped the world to the point that vaccination rates in the richest suburbs of Los Angeles are now as low as third-world nations such as Chad and South Sudan.

Today, The Lancet is embroiled in controversy once more. On July 23, the journal published “An open letter for the people of Gaza” in its correspondence section. Authored by medical professionals on behalf of 24 signatories, most of them from Italy and the UK, the letter denounced “what we witness in the aggression of Gaza by Israel.”

We challenge the perversity of a propaganda that justifies the creation of an emergency to masquerade a massacre, a so-called “defensive aggression.” In reality, it is a ruthless assault of unlimited duration, extent, and intensity. We wish to report the facts as we see them and their implications on the lives of the people. … We are appalled by the military onslaught on civilians in Gaza under the guise of punishing terrorists.

Published at the zenith of Operation Protective Edge, the letter went on legitimize Hamas’ aggression, speculated that Israel might be responsible for war crimes, called for the “cessation of any trade and collaborative agreements” with the Jewish state, and suggested that Israeli academics who failed to denounce the military operation should be boycotted. Clearly, the letter went far beyond the role of correspondence suitable for a peer-reviewed medical journal.

Indeed, its publication and the subsequent fallout suggest that, due to the failure to adequately scrutinize the letter and those who authored it, The Lancet allowed itself to be used as a forum for the dissemination of pure and unfettered anti-Israelism. Moreover, subsequent editorials and statements by Horton have indicated a persistent failure to grasp what may be an even more serious problem: The authors of the letter appear to have been motivated, not by “the survival, health, and wellbeing of Gaza’s and Israel’s civilian residents,” but by views that indulge in conspiracy theory and flirt with anti-Semitism.

There is no doubt that Operative Protective Edge was a tragedy. Over 2,000 Palestinians were killed, and it appears that somewhere between 50-70 percent were civilians. 66 Israeli soldiers and six civilians died. Over 4,500 rockets were launched from Gaza at Israeli civilian areas. 875 of those fell inside the Strip. But The Lancet’s “open letter for the people of Gaza” was not a sincere lamentation on this tragedy. Instead, it was a document of concealments, half-truths, and distortions that revealed the biases of its authors and signatories. And it was, above all, incredulous. It was a document that never asked why.

First, the authors bought into the Hamas narrative of resistance, that “people in Gaza are resisting this aggression because they want a better and normal life.” While it is true that Gazans reside in impoverished conditions, with many of them cramped together in refugee camps, the connection between the betterment of conditions in Gaza and the firing of rockets and mortars on Israeli population centers during Protective Edge is quite spurious. Indeed, before the operation began, 450 rockets had been fired at Israel in 2014 alone.

The letter’s authors also cited the blockade of Gaza—a frequent refrain from Hamas apologists—asserting that “building materials have been blockaded so that schools, homes, and institutions cannot be properly rebuilt.” This is not the case. Restrictions on the import of construction items and materials such as concrete, cement, and steel exist in order to prevent their misappropriation for the building of a terrorist infrastructure, including bunkers, fortifications, and tunnels. This fear of misuse was not unjustified, given that during Operative Protective Edge, a shocking number of tunnels were uncovered by the Israel Defense Forces, some of which were used during the war to launch attacks on Israel itself.

Dr. Richard Horton, Editor in Chief of The Lancet. Photo: Russavia / Wikimedia

Dr. Richard Horton, Editor in Chief of The Lancet. Photo: Russavia / Wikimedia

The letter also cited accusations of the use of poison gas by Israel, and the question of whether Israel “unequivocally” committed a “war crime” is raised. In doing so, the authors presented absolutely no evidence of such a crime, and apparently want to try Israel for an offence before any has been discovered. Indeed, the accusation was based solely on a statement made by Ashraf al-Qudra, the spokesperson for Hamas’ Health Ministry in Gaza, who said that Palestinians had inhaled “white poisonous gas emanating from shells fired by the Israeli artillery on the northern and southern Gaza Strip.” Needless to say, Hamas’ credibility in regard to such accusations is essentially nil.

“War crime” was not the only example of inflammatory language in the letter. Much of the rhetoric borders on outright incitement. Israel’s part in the war was repeatedly deemed an “aggression” and its actions in Gaza referred to as a “massacre.” “Israel’s behavior has insulted our humanity, intelligence, and dignity,” the authors wrote. They went on to engage in the ugly charge of guilt by association, saying that Israeli academics who did not sign “an appeal to their government to stop the military operation” are “complicit in the massacre and destruction of Gaza.”

Not once, however, did the authors discuss the causes of the conflict between Israel and Hamas, such as rocket fire and terror tunnels; or what might explain the scale of the damage in Gaza, namely, Hamas’ deliberate placement of rocket launchers in densely populated civilian areas. Moreover, given that the authors are medical professionals, it is surprising that they showed no concern for the use of hospitals as military facilities. These included Shifa Hospital in Gaza City, which, according to a report in The Washington Post, became the “de facto headquarters for Hamas leaders, who can be seen in the hallways and offices.” This use of hospitals for military purposes, incidentally, is a genuine war crime, with which the authors of the letter seem oddly unconcerned.

Their open letter, therefore, was telling as much for what it didn’t included as what it did: Completely and, one is forced to suspect, deliberately absent was both Palestinian agency and Israeli legitimacy.

It was not simply the content of the letter that revealed serious failings in The Lancet’s editorial process. The authors themselves have proved to be a highly dubious bunch. In the same issue of The Lancet, a partner letter written by five authors on behalf of 1,234 Canadian physicians appeared, stating,
We too are doctors and scientists who are deeply saddened by the loss of life and human suffering occurring in Gaza and Israel. We are concerned with an apparent oversight in the process leading to the publication of this open letter in The Lancet. Some of its leading authors have important conflicts of interest that are not consistent with their declaration of no competing interests.

The counter-letter went on to say, “the authors’ participation in highly political non-governmental organizations dependent on fundraising constitutes both an ideological and financial conflict of interest requiring disclosure.”

Specifically, the counter-letter cited Swee Ang, a consultant orthopedic surgeon based in London, who is a founding trustee of Medical Aid for Palestinians. Also cited was Mads Gilbert, Professor and Clinical Head of the Clinic of Emergency Medicine at the University Hospital of North Norway, who is a representative of the pro-Palestinian Norwegian Aid Committee. “Both organizations,” the counter-letter asserted, “are hostile to Israel.”

It got a great deal worse than this. It was subsequently discovered that more than one of the authors were connected to writings with a decided anti-Israel bias, as well as conspiracy theories, support for terrorism in general, and racist, anti-Semitic, and white supremacist figures.

Gilbert, who became infamous as the “Norwegian doctor” who provided dispatches from Gaza during Operation Protective Edge, has in the past expressed sympathy with those who commit terror attacks against the United States. In an interview with the Norwegian newspaper Dagbladet just days after 9/11, Gilbert said, “The attack on New York did not come as a surprise after the policy that the West has led during the last decades. … The oppressed also have a moral right to attack the USA with any weapon they can come up with.” He was directly asked, “Do you support a terror attack against the USA?” Gilbert replied, “Terror is a bad weapon, but the answer is ‘yes’ within the context that I have mentioned.”

Dr. Mads Gilbert, a signatory to the letter in The Lancet, has compared Israel to the Nazis and has expressed sympathy for the 9/11 terrorists. Photo: Annelis / Wikimedia

Dr. Mads Gilbert, a signatory to the letter in The Lancet, has compared Israel to the Nazis and has expressed sympathy for the 9/11 terrorists. Photo: Annelis / Wikimedia

Gilbert has also used rhetoric that meets the U.S. State Department’s definition of anti-Semitism. During Operation Protective Edge, he made a speech that drew direct parallels between contemporary Israeli policies and the Nazis. On July 31, one week after the publication of the Lancet letter, he said, “In 1938, the Nazis called the Jews untermenschen, subhuman. Today, Palestinians in the West Bank, in Gaza, in the Diaspora are treated as untermensch, as subhumans who can be bombed, killed, slaughtered by their thousands, without any of those in power reacting.”

The principal author of the letter was Dr. Paola Manduca, Professor of Genetics at the University of Genoa in Italy. Manduca is a member of the Google group “Sempre Contro la Guerra.” Last month, the Israeli watchdog organization NGO Monitor revealed in an extensive report that Manduca posted an email to the group from Swee Ang that contained a link to a video made by the infamous American white supremacist David Duke.

In her original email, the subject line of which was “Fw: CNN Goldman Sachs & the Zio Matrix,” Swee Ang wrote, “This is shocking video please watch. This is not about Palestine—it is about all of us!” Underneath her note, the email continued, “SEE THIS VIDEO BEFORE IT IS REMOVED FROM CIRCULATION – Please do pass on to others who you think would be interested and would pass on>>>The whole world needs to know.”

The video, per the description, contains an utterly demented anti-Semitic conspiracy theory. It claims to reveal “how the Zionist Matrix of Power controls Media, Politics and Banking and how each Part of this Tribalist matrix supports and protects each other! The documentary shows how the media is biased for Zionist interests in Palestine and over the world.” The video itself labels the Federal Reserve as “the Zio Club FED,” calls NBC News anchor Brian Williams a “good Shabbos goy Zioscript reader,” identifies U.S. Supreme Court Justice Elena Kagan as a “Zio tribalist” (presumably because she is Jewish), and states that “Zios invaded and took over Walt Disney Corp. just as they invaded and took over Palestine” (again, presumably because some of its executives are Jewish).

Dr. Swee Ang, a signatory to the letter published in The Lancet, favorably passed along a video made by the white supremacist David Duke. Photo: LudVan70 / YouTube

Dr. Swee Ang, a signatory to the letter published in The Lancet, favorably passed along a video made by the white supremacist David Duke. Photo: LudVan70 / YouTube

Manduca has apparently posted numerous articles and videos with anti-Semitic content to “Sempre Contro la Guerra.” On September 9, 2014, for example, she posted an article by Paul Larudee. Playing on the old anti-Semitic stereotype of Jews as parasites, it read in part,

Israel has thus constructed a strangler fig network of roots and vines that is feeding itself from the resources of world’s most powerful nation while gradually starving that nation. … If a strangler fig is allowed to thrive, its host will wither and die, and only its form will remain as an empty shell for as long as the parasite continues to survive.

Manduca also posted an email, dated May 1, that described Judaism as a “‘blood determined’ religious group with ethnic and racist background and imperialist and genocidal in the context of Palestine.” She shared an article by the notoriously anti-Semitic basement dweller and jazz saxophonist Gilad Atzmon, in which he states, “I have come to believe that resistance to Jewish politics and power is the only thing that can save world peace as well as the Jews.” Another email she posted on April 16, 2013, related to the Boston Marathon bombings, read, “Let us hope that someone in the FBI is smart enough to look more carefully at the clues in Boston and find the real culprits behind these bombings instead of buying the Zionist spin.” And so on and so on.

Even more troubling, perhaps, was a fundraising appeal for an organization called Interpal that Manduca shared with the group, dated July 10, 2014. A BBC Panorama investigation in 2006 found that “funds from Interpal ‘had helped build up Hamas into what it is today’ by most of them being sent to Islamic (partner) charities in Gaza and the West Bank, a number of which promoted Hamas’ ideology.”

The BBC also showed that, at the time of the investigation, Interpal was “was at the heart of a global coalition of 56 Islamic charities called the Union for Good, chaired by the spiritual leader of the worldwide Muslim Brotherhood Movement, Dr. Yusuf Qaradawi.” In August 2003, the United States designated Interpal as Specially Designated Global Terrorists (SDGTs), freezing the group’s American assets and prohibiting transactions with American nationals.

That someone with the background of Dr. Paola Manduca could be the dominant author of and signatory to an open letter related to the Israeli-Palestinian conflict published by a reputable journal constitutes a gross editorial failure on the part of The Lancet and Richard Horton in particular. Critics of the journal, however, have gone further, arguing that Horton has often allowed The Lancet to be used as a sink for anti-Israel views.

“For many years, The Lancet has been consistently using its reputation to attack Israel,” Professor David Katz of the Division of Infection and Immunity at University College London told The Daily Telegraph’s Jake Wallis Simons. “The Lancet is supposed to be a politically neutral medical journal. The fact that they have given proven anti-Semites a platform and not rescinded it, even when confronted with the evidence, is appalling. They have allowed their hatred of Israel to blind them to the norms of medical science and the pursuit of reason.”

Wallis Simons further reported that on August 29, Professor Sir Mark Pepys, director of the Wolfson Drug Discovery Unit at UCL, authored a public letter along with Professor Katz and some other senior medical figures in the United Kingdom to register their feelings officially. It read in part,

The failure of the Menduca 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.
Horton’s behavior in this case is consistent with his longstanding and wholly inappropriate use of The Lancet as a vehicle for his own extreme political views. It has greatly detracted from the former high standing of the journal.

Certainly, prior to the publication of documents revealing the links between the authors of the letter and the anti-Zionist, anti-Semitic ramblings of David Duke, Horton declined to disown the letter. On August 4, The Lancet published an editorial on the subject of Operation Protective Edge. “In the conflict taking place in Gaza, our position is very clear,” it said. “We do not support any side whose actions lead to civilian casualties.” Referring to the open letter, its conclusion stated,

Their letter has led to a debate about the appropriateness of a medical journal giving space to opinions about an issue that lies at the intersection between health and politics. But here is a war that is having far-reaching effects on the survival, health, and wellbeing of Gaza’s and Israel’s civilian residents. It is surely the duty of doctors to have informed views, even strong views, about these matters; to give a voice to those who have no voice; and to invite society to address the actions and injustices that have led to this conflict. Our responsibility is to promote an open and diverse discussion about the effects of this war on civilian health.

Precisely how publishing a letter by known anti-Semites and apologists for terrorism promotes invites society to address “actions and injustices,” or civilian health, for that matter, remains unknown.

Two months after the publication of the Lancet letter, Richard Horton arrived in Israel to visit the Rambam Health Care Campus in Haifa, the largest hospital in the north of the country. In recent weeks, Rambam has treated a 14-year-old boy from Gaza who urgently needed a kidney transplant, as well as a 5-year-old boy from southern Syria who, while out for a walk with his father, was hit by a stray bullet that entered his face through the cheek and continued through his neck.

The purpose of Horton’s visit, Rambam said in a statement at the time, was to

provide a venue for academic discussions and meetings in Israel’s multicultural medical institutions that have strong medical cooperation agreements with the Palestinian Authority to treat people from the West Bank and Gaza. Some of the lectures and discussions will also examine the limits and appropriateness of freedom of political opinion in scientific journals, and openly consider and discuss the unilateralism of which The Lancet has been accused.

At the conclusion of his three-day visit to Rambam, Horton expressed “deep regret” for “the completely unnecessary polarization that publication of the letter by Paola Manduca caused.” He went on to say, “I was personally horrified at the offensive video that was forwarded by two of the authors of that letter. The worldview expressed in that video is abhorrent and must be condemned, and I condemn it.”

Writing subsequently in The Lancet, Horton added, “At a moment of unbearable human destruction in Gaza, the unintended outcome of the Manduca et al letter was an extreme polarization of already divided positions. This schism helped no one and I certainly regret that result. I have seen for myself that what was written in the Manduca et al letter does not describe the full reality.” He also said of Rambam hospital,

I saw an inspiring model of partnership between Jews and Arabs in a part of Israel where 40 percent 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.

In a subsequent interview with The Times of Israel, Horton said, “While the letter was well intentioned, because it was this cry of anguish, it did not convey the level of complexity that is the reality in Israel, and it’s that level of complexity which I saw last week; which, having seen it, I want to build something from so that we never publish a letter like that again.” Nonetheless, he would not apologize for publishing it in the first place.

The conclusion of this saga, for the time being at least, is a report from The Lancet’s ombudsman, Wisia Wedzicha, Professor of Respiratory Medicine at Imperial College London. Wedzicha reviewed the original letter from Manduca and her co-authors, a follow-up letter dated August 20, and 20 other letters penned by various contributors subsequently published in the journal, either in support of the original letter or in opposition to it.

Wedzicha rebuked the authors of the letter for certain falsehoods and false accusations. “Its portrayal of the armed element of the conflict on the Palestinian side,” she concluded, was lacking. “The authors should have been aware of the need to disclose, at submission, any financial or other relationships that could be perceived to affect their work.” They did not provide a source for the accusation that Israel had committed war crimes by using poison gas. And “it is clearly in poor taste to accuse anyone of complicity in the loss of human life simply because they have not signed a petition.”

But in terms of the bloody language of the letter, Wedzicha saw nothing ill in it. Indeed, she said, “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.” Her conclusions on “An open letter for the people of Gaza” were as follows,

I firmly believe that the debate about the conflict in Gaza would be the poorer if Manduca and co-authors’ letter were to be withdrawn, and note that it has spurred a forthright debate in The Lancet and elsewhere about issues related to the conflict. The calls for retraction of Manduca and co-authors’ letter are not persuasive. …
In summary, the letter by Manduca and co-authors was published in a time of great tension, violence, and loss of life. Given these circumstances, the letter’s shortcomings can be understood, and a measure of balance has been achieved by the publication of further letters from both sides of the debate.

Wedzicha went on to state, “I now consider this matter closed.” It seems, then, that while some of the substantive criticisms of the letter have been heard and at least partially addressed, other fundamental issues have not and apparently will not.

To this extent, The Lancet’s reaction to the controversy has been a whitewash. In particular, the publication has simply refused to address the role played by racism and anti-Semitism in the writing of the letter, not to mention some of the authors’ apparent support for terrorism. Instead, it appears to minimize such issues by saying they “can be understood” in the context of the Gaza conflict. To say that this is deeply troubling would be something of an understatement.

In particular, it does not bode well for the future. Are we to conclude that The Lancet, in spite of what has been unearthed about Dr Paola Manduca’s connections to anti-Semitism, white supremacism, and junk conspiracy theories, will continue to publish her political screeds? If there is another Israeli-Palestinian war, will it be permissible to accuse Israel of committing war crimes and massacres, since such language can apparently be “understood”? And, in spite of what Richard Horton has purported to have learnt, are there any mechanisms in place to assure readers that The Lancet will never again be hijacked for the dissemination of such blatant, unfiltered, and defamatory anti-Israelism?

Banner Photo: Abed Rahim Khatib / Flash90