A new front in the war on freedom of expression has emerged from the pages of the international medical journal, The Lancet. A letter critical of Israel, published in July in the online edition, and subsequently republished in the August 2 issue, provoked the usual hasbara sequence of events: vociferous expressions of outrage and hurt, attacks on the character of the letter writers, insinuations that the Lancet editor is anti-Semitic, and demands for a retraction.
After calling on its ombudsman to conduct a review, The Lancet stood its ground and refused to retract. But the letter’s publication continues to generate heat, even after The Lancet conceded that its letter-publishing policy was deficient and offered conciliatory gestures. Through several strategic moves, the letter’s critics succeeded in diverting the discussion away from the topic at hand: the responsibility of Israel for the dire public health crisis in Gaza. We have seen this sequence before: to name two recent parallels, the University of Illinois’ decision to rescind its offer of a tenured faculty position to Steven Salaita and Barnard University’s removal of a Students for Justice in Palestine banner. In all such cases, the Zionist objective is to stop criticism of Israel by squelching speech and pummeling the institutions that would accommodate debate.
The current outcry started when, just 14 days into Operation Protective Edge, The Lancet published and “open letter for the people in Gaza,” signed by Paola Manduca and others on behalf of 24 signatories who identified themselves as doctors and scientists with first-hand experience in Gaza. “On the basis of our ethics and practice,” the letter writers proclaimed, “we are denouncing what we witness in the aggression of Gaza by Israel”:
We ask our colleagues, old and young professionals, to denounce this Israeli aggression. 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.
The letter then detailed the effects of Israel’s previous two bombardments on Gaza, the blockade, and the indiscriminate nature of the current assault that was killing and injuring civilians, including many children, as well as medical personnel, and that was poisoning the environment. “We as scientists and doctors cannot keep silent while this crime against humanity continues. We urge readers not to be silent too.”
The opportunity to cosign was taken up by 20,000-plus readers of The Lancet; due to threats against signatories published on social media, The Lancet did not publish their names.
Over the course of several issues, The Lancet published a total of 20 responding letters, some supportive, some critical, and some asserting that political topics have no business in the medical journal. The lead-off response was signed “on behalf of 1234 Canadian physicians” and expressed concern about the “oversight” that allowed the original letter to be published without the authors declaring their obvious conflicts of interest. For example:
Swee Ang is founding trustee of Medical Aid for Palestinians and Mads Gilbert is a representative of the pro-Palestinian Norwegian Aid Committee, both organisations are hostile to Israel.
In its August 9 issue, The Lancet published an editorial recapping the situation. It noted that Gaza is:
[a] land that no-one can escape from. A crowded land in which children are the largest single group of the population. These are the conditions in which attacks on Gaza combatants are taking place. One does not have to be a military expert or a scholar of International Humanitarian Law to realise the extreme risk to civilians in Gaza if conflict does not follow very strictly the [International Humanitarian Law] Principles of Distinction, Precaution, and Proportionality.
The editorial concluded:
[H]ere 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.
An opportunity for peace and justice surely beckons. For the health and wellbeing of civilians in both Gaza and Israel, we encourage both parties to have the courage to seize this moment.
In its August 30 edition The Lancet’s editors wrote, “To conclude this exchange, as we usually do, we have given the authors of the original letter an opportunity to reply.” This reply responded to the critics’ charge that the signatories had not declared their competing interests. They appended a list of relevant professional experiences and affiliations, while noting that none had a financial conflict of interest. Further, the authors acknowledged that they had suggested without verification that Israel might have used poison gas, but acknowledged that such claims will be tested by an independent Commission of Inquiry set up by the UN Human Rights Council. Then they wrote, “it is worth recalling the context in which we wrote our strongly worded letter.” Adding new details about the devastation that had occurred through Operation Protective Edge since the original letter was published, they concluded:
What we were seeing was an urgent and escalating health and humanitarian crisis. The events that followed have shown that our concerns were justified.
We may respectfully disagree with correspondents on many issues regarding this conflict. But we believe our critics and supporters would all agree that the best way of advancing health, human security, peace, and justice for Palestinians and Israelis alike is through adherence to international law and a positive commitment to negotiation and political solutions to remove what we see as the major causes of this conflict—occupation and blockade.
Although The Lancet had intended this letter to “conclude the exchange,” it did not do that. By September, signatures were being gathered for a petition to demand Horton’s resignation (whether the petition succeeded in collecting many signatures has not yet been revealed). The website MedPage ran a poll: “Should medical journals venture into what many consider political territory?” Of 2,574 votes, 77.5 percent said no. Then on September 22 The Daily Telegraph entered the fray with an article headlined, Lancet ‘hijacked in anti-Israel campaign.’ The article repeated allegations first reported in the Zionist pub NGO Monitor that purported to link two of the letter’s authors with a David Duke video and anti-Semitic statements.
In the October 11 issue, The Lancet’s editor, Richard Horton, published a column entitled “People to People,” in which he revealed that, at the invitation of a letter writer, he had just returned from a visit to the Rambam Health Care Campus in Haifa. Horton wrote:
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. I also met Israel’s Minister of Health, Yael German, who not only endorsed this visit but also welcomed future collaboration. Out of this exchange has emerged an extraordinary opportunity.
In that same piece Horton announced that ill-guided haste might have allowed the letter to be published, and so The Lancet is reconsidering its letters policy. He provided the wording of the proposed new guidance:
Editors will, from time to time, be faced with submissions that lie at the difficult intersection of medicine and politics. Health and health care do have political determinants and editors should not shy away from those. But politics, by its very nature, can be disruptive and divisive, with many different points-of-view held. While taking strong editorial positions on issues of relevance to health is sometimes necessary, editors should always pause, reflect, and consult before publishing any manuscript that might unnecessarily polarise, or foster or worsen political division.
Pause, reflect, consult: consult who? Unnecessarily polarize: sounds much like the “civility” cover the University of Illinois used to justify Salaita’s unhiring. How the “open letter” sequence might have been better, had the above policy been in place, is open to conjecture.
Meanwhile, on October 3, Ha’aretz had published the scoop that Horton, while visiting Rambam, had said he regretted the letter and would be issuing a retraction. No retraction came, although in his October 11 column Horton did express some level of regret: “At a moment of unbearable human destruction in Gaza, the unintended outcome of the Manduca et al letter was an extreme polarisation of already divided positions. This schism helped no-one and I certainly regret that result.” Horton also announced plans for The Lancet to publish a series on “Israel’s health and medical research system, its strengths and challenges, and prospects for its future.”
For a more fully detailed accounting of the campaign to bring The Lancet into line, read the Middle East Monitor’s Lobbying the Lancet: how Israel’s apologists smeared ‘doctors for terrorism.’ That article was published October 15—but the story continued.
On October 25, The Lancet’s ombudsman, Wisia Wedzicha, published her report. While taking both the original letter writers and some of the respondents to task for various failures, she concluded
… the letter by Manduca and coauthors 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. The Lancet’s editor-in-chief, Richard Horton, has recently visited Israel to debate the issues raised by Manduca and coauthors’ letter, and has written of a desire to adopt a more consensual position on the Gaza conflict, its consequences for health, and the commendable Israeli contribution to health care in the region.
I now consider this matter closed, and look forward to constructive engagement by all parties towards achieving a long-lasting peaceful situation in Gaza.
But no surprise—the matter is still not closed. The Zionist pub NGO Monitor is keeping the story alive, with a November 4 piece of reporting, “The Strange Story of the Lancet Editor and Israel.” This is yellow journalism at its best: “Perhaps Horton’s role in the unethical war against Israel does not reflect inherent anti-Semitism, but rather overriding ambition and the influence of his social and intellectual milieu.”
And that the controversy still festers is evidenced by the fact that Richard Smith, a former editor at The BMJ (formerly the British Medical Journal) felt compelled to write an opinion piece in defense of his professional colleague. “No Case for Retracting Lancet’s Gaza Letter,” published at the BMJ Blog on November 3, is the best writing in the whole saga. On the conflict-of-interest sideshow, he writes:
I’ve long believed that it’s best to declare every possible competing interest, which is why I declared the death of my pet rabbit when writing an editorial on animal research and why some of my competing interests have become Proustian: if you do a lot of stuff you have a lot of competing interests. There’s no shame in having them, and having them does not mean that what you say is invalid.
On the issue of retraction:
I am passionately in favour of free speech. When editor of The BMJ, I believed strongly that we should post every rapid response to an article that wasn’t obscene, libellous, or incomprehensible. One consequence was that we published many rapid responses from people who thought that HIV was not the cause of AIDS. Nature took me to task for publishing such nonsense, and many other people, including my employers, accused me being “tabloid” and publishing rubbish…. The disappearance of the idea that AIDS is not caused by HIV is an example of truth not being put to the worse in a free and open encounter.
What is to be concluded from this ongoing imbroglio? One can applaud The Lancet for resisting the calls to retract. But one can only be saddened when a call to hold the political leaders of Israel to account for their deliberately ruthless bombing campaign—for their occupation, blockade, and defiance of international law—when all that gets shoved aside in the noise over whether a letter should have been published. It’s a loss when the debate is resolved by The Lancet promising to be more cautious next time and to avoid “polarization,” while moving on to obsequious feel-good stories about cross-cultural medical-humanitarian partnerships. But it’s a win if these events can help people who believe in free speech recognize the sequence, so that they can more effectively combat it when it plays out again. And it will. Remember, it goes like this: cries of offense, attacks on character, threats to punish, demands for retraction/renunciation, calls for change of speech policy, and—most importantly—continuous pressure on the offending party until it squeals like a pig.