The Lancet’s Cutting Edge

Should medical journals enter the political realm?

Image by Richard James Mendoza/NurPhoto via AP

In late May, The Lancet, a leading British medical journal, published a study raising urgent red flags about the use of hydroxychloroquine, an antimalarial drug, to treat covid-19.

At the time, the drug had been in the news for several weeks. President Trump had begun touting it as a covid cure after its proponents—including a skull-ring-wearing French microbiologist, a cryptocurrency investor, and the Fox News host Laura Ingraham—helped put it on his radar. In mid-May, Trump claimed that he, personally, was taking “the hydroxy,” despite not then having covid (or, as far as we know, malaria). Already, he was going against the guidance of his own Food and Drug Administration, which cautioned, in April, that hydroxychloroquine may cause heart-rhythm problems in covid patients and should not be administered outside of a clinical setting. The Lancet study further raised the stakes. Drawing on data that was furnished by a little-known company named Surgisphere—and that purported to cover nearly a hundred thousand patients in hundreds of hospitals across six continents—it reported that hydroxychloroquine increases covid patients’ risk of death.

Given Trump’s hype act, the study attracted instant media and scientific attention. The World Health Organization and researchers in various countries suspended hydroxychloroquine trials. But the study quickly came under an uncomfortable spotlight. Soon after it was published, nearly two hundred prominent scientists from research institutions around the world signed an open letter excoriating its methodology and raising strong doubts as to the plausibility of the data. 

Then, in early June, The Guardian published a bombshell investigation of Surgisphere. Reporters found, among other odd details, that several of the company’s staffers lacked scientific credentials (one appeared to be a sci-fi writer; another, an “adult content” model); that the company as a whole had no real presence online (a contact form on its website linked to a WordPress template for a cryptocurrency site); and that Sapan Desai—Surgisphere’s CEO, who, along with three scientists including a respected Harvard professor, was listed as an author on the Lancet study—had repeatedly been named in medical-malpractice lawsuits. (He has called these suits “unfounded.”

The day after the Guardian story came out, The Lancet retracted the study. The journal said that it had asked to see Surgisphere’s data, and that Surgisphere failed to comply; editors now call the study “a monumental fraud.” Many medical experts questioned how it was published in the first place, given its obvious flaws. Tracey Brown, the director of Sense About Science, a British group that challenges scientific misrepresentation, told me that, among other things, Surgisphere’s claims to have access to a worldwide repository of patient data were questionable on their face. “It really surprises me that alarm bells didn’t ring,” Brown said. “Like, how?

The Lancet wasn’t the only journal that published work based on data from Surgisphere: a leading rival, the New England Journal of Medicine, did so, too, and also had to retract a study. The episode shone a light, albeit fleetingly, on the world of scientific publishing—an industry that tends to get pigeonholed as fusty and academic but has always been more important than that, never more so than right now. It’s a world—upstream of mainstream media and social media, with their simplifications, obsessions, and conspiracies—that’s been rocked, time and again, by scandal and lively debate about the building blocks of scientific knowledge. Who gets to handle them, and with what safeguards? How involved should the public be in the process? Is new knowledge best advanced cautiously, or amid flaming, boundary-pushing controversy?

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Perhaps more than with any other journal, such debates are baked into The Lancet’s DNA: it was founded, in nineteenth-century London, in a bid to broaden the circle of medical knowledge—to chuck grenades at the ossified, conservative surgical establishment. In more recent times, it’s rarely been far from outrage. Surgisphere is only the latest example. 

“People love to have a go at The Lancet because they have made some big boo-boos. But they’ve also had some fantastic successes,” Nicholas White, an Oxford University professor of tropical medicine who serves on The Lancet’s international advisory board, said. The decision to publish the Surgisphere study deserves “a little bit of criticism, yes. But let’s not throw the baby out with the bathwater.”

White had reason to be annoyed at The Lancet: the Surgisphere study had hampered a clinical trial that he was working on. Nonetheless, he said, “I want The Lancet to take risks. I want there to be opinionated, prominent…” He paused. “I don’t want a gray, boring background to medical journalism.”

 

The world of scientific publishing has never been more important than right now.

 

Richard Horton, who has been The Lancet’s top editor since 1995, has been called many things, but never boring. “One of the failings of the scientific community has been to be doing its work almost in the abstract,” he told me when we spoke on Zoom in July. He was sitting under a tentlike structure in the garden of his London home, in a black shirt and tortoiseshell glasses. (He reminded me of the actor Richard E. Grant, but with spikier hair.) “I feel very strongly that we should be using The Lancet as a platform for advocacy,” he said. “There’s not much point in publishing science unless you do something with it.”  

The pandemic has lent journals like The Lancet a greater measure of mainstream relevance than they have enjoyed in years, handing Horton and his colleagues an opportunity to do something vital with their science, albeit under draining, fast-moving circumstances. (Beyond the many uncertainties of pandemic life, Horton has been receiving treatment for melanoma, a form of cancer.) “I think the burden on our staff has been really tough, I’ll be very honest,” he told me. “But in other ways I think we feel a greater sense of solidarity than we’ve ever felt.… Because we felt in a kind of epicenter of knowledge for the pandemic, that’s given us a sense of mission.” 

In addition to overseeing cutting-edge research—itself a high-stakes enterprise, as the Surgisphere study proved—Horton has energetically thrown his and his journal’s weight behind scalding attacks on the British medical and political establishments. He’s written columns for The Guardian and been an active, often caustic presence on Twitter, where he’s slammed British health officials (“#YouAreSimplyNoLongerBelievable”), criticized media coverage of the pandemic, and named “Isolation,” by Joy Division, as his quintessential coronavirus song. 

He cast Trump’s decision to withdraw US funding from the WHO as “a crime against humanity” and called on Anthony Fauci and Deborah Birx to resign from Trump’s coronavirus task force rather than continue to lend it their expert credibility. The Lancet even wrote, in an unusual, unsigned editorial in May, that Americans should kick Trump out of office in November. “Sovereignty is dead,” Horton told Britain’s Sunday Times, by way of justification. “The people of Britain have a legitimate interest in who is leading the United States.” (Ironically, the governments of Boris Johnson, in the UK, and Trump, in the US, have both cited statements by Horton and The Lancet to justify stances they’ve taken during the pandemic. Horton has called both citations misleading.)

In June, Horton published The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again—a zippy book in which he argues that many Western nations’ response to the pandemic represents “the greatest science policy failure for a generation,” and that the world will forever be changed by it. 

The argument draws as much from social science as from medical science; among others, it quotes the utilitarian philosopher Jeremy Bentham, the French theorist Michel Foucault, and Slavoj Žižek, a leftist thinker Horton credits with “perhaps the first serious response” to the social implications of covid. (“The responses of governments have made us all communists now,” Horton writes, summarizing Žižek’s argument.)

In the book, Horton extols the British doctors on the front lines of the crisis, and contrasts their heroism with the cowardly, cronyistic behavior of the country’s top medical experts—denizens of what he calls a “broken system of obsequious politico-scientific complicity.” He accuses elite medical societies and think tanks of “a grubby betrayal” of patients and healthcare workers, and sage, the council of scientific experts that advises the British government, of “luxuriating in elite insouciance.” By contrast, he sings the praises of the so-called “Indie sage: an unofficial expert panel, founded in response to the perceived failures of the official sage, that has committed to greater transparency, including by streaming meetings on YouTube.

Horton has his admirers. “I think you have to say that Horton has been one of the top medical-journal editors…a little quirky, but so are most full-time editors,” Jerome Kassirer, a former editor in chief of the New England Journal of Medicine, told me. He applauded Horton’s fierce criticism of Trump and others, and believes that American journal editors should be similarly bullish. “Unfortunately, that aspect of using the bully pulpit of a major journal has just about disappeared,” Kassirer said. 

Horton has his detractors, too, especially on the right. Since the pandemic began, critics including the libertarian blogger Brendan O’Neill, Ron Paul, and the Wall Street Journal editorial board have resurfaced well-worn criticisms of Horton’s approach—that he is a grandstander, and that The Lancet should stick to science. Horton sees that as impossible, because medicine, in his view, is inherently political. 

In 2004 and 2006, The Lancet published research that estimated many more Iraqi deaths as a result of the US invasion—more than 650,000, as of 2006—than official figures and other independent estimates had ventured. World leaders, including President George W. Bush, pushed back, and some academics questioned the reliability of the researchers’ methodology, which entailed going from house to house in Iraq asking questions and examining death certificates. Writing in Slate, Christopher Hitchens argued that The Lancet appeared to be courting a reputation “for conjuring bloodbaths and then reviewing them through a slitlike aperture”—apt, Hitchens wrote, since a lancet is both a surgical tool and a type of window.

At times, the ferocity of the blowback has taken The Lancet by surprise. In 2014, during a period of intense conflict between Israel and Hamas members in Gaza, The Lancet published an open letter in which twenty-four doctors and scientists denounced Israeli aggression and cast 95 percent of Israeli academics as “complicit in the massacre and destruction of Gaza.” It subsequently emerged that two leading signatories on the letter had previously shared anti-Semitic content online. 

Horton initially dismissed criticism of the letter as a “smear campaign,” but he changed his perspective after a doctor in Israel invited him to visit the country and learn more about its healthcare institutions. “This schism helped no one and I certainly regret that result,” Horton wrote afterward. “I have seen for myself that what was written in the…letter does not describe the full reality.”

 

‘Every generation of editors at The Lancet needs to reinvent that idea of using knowledge for social progress, and for holding accountable those with power, to make sure that the promise of knowledge for social progress is delivered.’

 

Arguably, The Lancet’s overtly political controversies have been the straightforward ones. Messier and more consequential controversies regularly beset the journal. In 2011, it published a study, known as the pace trial, about chronic fatigue syndrome, now known as ME/CFS. The study concluded that cognitive behavioral therapy and exercise can be effective treatments for the condition. Many patients reacted furiously to that claim, which they found stigmatizing, and to the study’s recommendations, which they say do not reflect their experience with the illness; meanwhile, David Tuller, a journalist who teaches at the University of California, Berkeley, reported concerns about the pace trial’s methodology. (The US Centers for Disease Control and Prevention, whose guidance reflected the recommendations set forth in the pace study, revised it in 2017.)

Opponents of the pace trial say they found Horton to be dismissive when they raised concerns. (He didn’t provide an answer to a follow-up email about it.) “When you get pushback, even if it’s coming from people without big credentials, I think that needs to be taken seriously,” says Julie Rehmeyer, a science journalist and ME/CFS patient who has written about the pace trial. “A journal like The Lancet really needs to be aware of the power that they hold.”

In 1998, three years after Horton became editor, The Lancet published a study led by Andrew Wakefield, a doctor and researcher at a London hospital where Horton had previously worked. Wakefield sought to establish a link between the triple-shot measles, mumps, and rubella (MMR) vaccine and bowel disease and autism in children. The language of the study itself made clear that its findings were speculative and inconclusive, but at a post-publication press conference, Wakefield told reporters that the vaccine should be withdrawn from use. His remarks sparked a firestorm that shows no signs, more than twenty years later, of burning out. 

The Lancet did not participate in the briefing, and took steps to add caveats to the study—editors placed an “early report” label on each page and commissioned an independent evaluation by two CDC vaccine experts, who eviscerated Wakefield’s work. As Seth Mnookin, a science writer and professor at the Massachusetts Institute of Technology, put it in his 2011 book, The Panic Virus, the experts found that the study “wasn’t built on a house of cards,” because “there weren’t any cards to begin with.” 

In September 2003, Brian Deer, then a reporter with the Sunday Times, started investigating the study, and alleged that Wakefield was ensnared in a web of conflicts of interest and potential research fraud. Over the course of several years, Deer would allege that Wakefield had been paid by a lawyer who was planning to sue vaccine manufacturers on behalf of an anti-vax group, and who helped Wakefield recruit children into his study; that Wakefield performed invasive, unethical procedures on the children, whose medical histories did not always align with claims in the study; and that he had patented an alternative measles vaccine. (Deer has written a book, The Doctor Who Fooled the World, that came out in September.)

In early 2004, Deer took his initial findings to Horton and other senior staff at The Lancet’s offices. “I turned up with a cart with all my files on—a great stack of lever arch files, which is how we kept documents in those days—and talked to them for five hours,” Deer recalls. When he wrapped up, Deer expected Horton to offer a response to what he’d just heard, “but he didn’t. Instead, he told me Wakefield was on his way to his office, and he asked me to hide in the boardroom. And I had to hide while Andrew Wakefield came into the building.” 

Deer alleges—based, in part, on records he obtained under Britain’s Freedom of Information Act—that Horton subsequently worked with the study’s lead authors, including Wakefield, to do damage control. (Soon after Deer’s story appeared, ten of the thirteen researchers who contributed to the study distanced themselves from it.) Wakefield acknowledged that he’d been retained by an attorney, but said that he did not stand to benefit personally; in fact, according to Deer, Wakefield pocketed more than $500,000 from the arrangement. Shortly before Deer’s story was set to drop, Horton issued a statement to the press in which he acknowledged that Wakefield had a “fatal conflict of interest” and said that, if he’d known about it at the time, he wouldn’t have published the study. Horton added, however, that “professionally,” he didn’t regret publishing it, because “The Lancet must raise new ideas.” 

The Lancet finally retracted the Wakefield study in 2010, after Britain’s General Medical Council ruled, following a two-and-a-half-year inquiry, that Wakefield had committed misconduct. Later that year, Wakefield lost his license to practice medicine in the UK. Horton has since said that he would have liked to retract the study sooner but felt that Wakefield deserved due process. Horton told me that he has no desire to rewrite his personal history. “I think these are all learning moments,” he said.

Wakefield, for his part, consistently cast himself as the victim of a conspiracy perpetrated by the medical establishment and the elite media. He moved to the US, where he remains a darling of anti-vaxxers. “I think without any question he was the person who helped launch the modern-day anti-vax movement,” Mnookin, the author of The Panic Virus, which explores the history of the movement, told me recently. Mnookin argues that Wakefield’s presser did more than the Lancet study to stoke MMR hysteria, and that the media—in particular, Britain’s tabloid press—must take much of the blame for burnishing Wakefield’s credibility. Still, Mnookin says, The Lancet lent its prestigious imprimatur to deeply harmful science. “It was such a bad study that I think it was really beneath The Lancet to publish it initially,” he says.

The Wakefield episode has shadowed Horton’s reputation ever since. Earlier this year, when the Financial Times interviewed Horton, it put to him the criticism that he is something of a “pariah” among the British medical establishment. “Maybe in previous years that might have upset me. But now? I really don’t care what people think of me,” he said. “If I’m not here in six months or a year…fuck them.”

 

Though Horton tends to be regarded as an unusually iconoclastic figure in the medical publishing field, he sees himself as the guardian of a long tradition going back to The Lancet’s founding editor.

In the summer of 1820, a young London surgeon named Thomas Wakley had to abandon his home after members of a mob burned it down. (They were most likely political radicals who mistook Wakley for someone else, historians believe.) Wakley eventually relocated to premises near the heart of London’s publishing world, where reformist journalists including William Cobbett, a radical pamphleteer and future member of Parliament, inspired him, in 1823, to found The Lancet—which would, in its own words, hurl medical elites, who Wakley saw as self-dealing snobs, “upon the pedestal” of public opinion. 

“It was designed for everybody,” Sally Shuttleworth, a professor of English literature at Oxford University, says. “It wasn’t just for the medical profession. It was the notion that people should be empowered to actually know about medicine.”

It was not the only medical journal in print at the time, but it was cheaper and, as a weekly, more frequent than its competitors. It pushed for transparency and championed doctors and their interests, including unionization, while aggressively holding their supposed superiors to account. As the historian Michael Brown has written, Wakley actively tried to get sued for libel. In 1828, The Lancet recounted how a botched surgery conducted by a man named Bransby Cooper, the nephew of a prominent surgeon, led to a man’s death. (The story took the form of a stage play—part of a broader literary style that, as the researcher Brittany Pladek has written, also encompassed satire, gossip, and theater reviews.) Cooper sued. He won—but Wakley used the trial to rail against the nepotism and corruption in the hospital system. When Wakley left the courtroom, he was greeted by a cheering crowd.

When I noted the parallels between Horton’s outlook and that of Wakley, Horton told me the resemblance was deliberate. “Every generation of editors at The Lancet needs to reinvent that idea of using knowledge for social progress, and for holding accountable those with power, to make sure that the promise of knowledge for social progress is delivered.”

By the end of the 1800s, however, The Lancet had become a fixture of the British medical publishing landscape and lost some of its radical edge. This continued through the twentieth century. Since 1991, The Lancet has been owned by Elsevier, an academic-publishing behemoth based in the Netherlands; it now oversees a family of around twenty specialist publications and is considered to be one of the top medical journals in the world. It derives revenue from subscriptions, other types of fees, and also from pharmaceutical companies that fund drug trials and publish their findings in The Lancet’s pages. (The Lancet has been criticized, including by some of its competitors, for not keeping a sufficiently critical distance from Big Pharma; Horton insists that publishing world-leading research necessitates some engagement with drug companies, but acknowledges that such work can be sensitive.)

Scientific researchers sometimes complain that The Lancet, like many of the most prestigious publications, seeks sensation before substance. Academic journals, many researchers feel, are obsessed with their “impact factor,” a measure of how often a journal’s work is cited externally, and are thus incentivized to publish research that’s likely to make a splash. By contrast, studies that fail to prove their hypothesis often get shelved—even though they’re often just as useful scientifically as studies that yield a new finding.

Such complaints can normally be boiled down to a central concern: that many journals are currently hardwired to compete, when science works better as a collaborative process. More radical critics argue that the journal-publishing system should be abolished altogether, and replaced with new, less bounded models of knowledge-sharing. 

Alexandra Freeman, who used to make documentaries for the BBC and is now a researcher at Cambridge University, is developing a new system, called Octopus, that she hopes will facilitate open collaboration. She doesn’t want to abolish journals, but thinks that they should focus less on technical work and more “on what they were initially set up to do,” which is “to carry editorialized, well-written content to their readers.” Science “is not an entertainment medium,” Freeman says. “Yet the entire way researchers are being judged on their work is through their outputs, and their outputs are being judged on how readable they are and not how good the science is.”

 

The Surgisphere study added grist to perennial concerns that journals lack adequate editorial safeguards and will continue to publish bad research until they change their protocols.

 

In late January—while many of us were still fretting about impeachment, Iowa, Brexit, and Megxit—The Lancet published a study, funded in part by China’s science and technology ministry, that noted the “pandemic potential” of the “2019 novel coronavirus in Wuhan, China.” The study tracked the symptoms, treatment, and outcomes of forty-one patients in Wuhan, six of whom died. Before January was out, The Lancet had run four further papers on the emerging threat. Since then, it has published reams of useful work on the pandemic—much of which has been eagerly amplified by the world’s media—and has received five times its usual rate of submissions. 

There was also, however, the hydroxychloroquine furor. Some observers have argued that the incident showed science working as it should—a new hypothesis was floated, and independent experts quickly reviewed it and found it wanting. But at this moment, in particular, such experts have many urgent demands on their time and attention. “It tied a lot of people in knots for a long time—I lost two days on this paper, trying to prove on the back end that there was something horribly wrong with it,” James Heathers, a research scientist at Northeastern University, who weighed in on the paper, including in a column for The Guardian, says. “I think it would be much more efficient for me to have my time back.”

Many other observers expressed fears that top journals’ rush to publish during the pandemic had overburdened their editorial processes, allowing big mistakes to slip through. Ruanne Barnabas, an associate professor of global health and medicine at the University of Washington, has been working on a hydroxychloroquine trial, and saw weekly enrollment drop by around three-quarters due to the safety warnings in the Lancet study and the breathless media coverage they attracted. “The retraction unfortunately did not receive as much attention, and enrollment has not recovered to the level that it was,” Barnabas told me, in mid-June. She called the episode a “serious failure” that undermined public trust in science.

On June 4, the day The Lancet retracted the study, Horton was especially active on Twitter, trading barbs with his critics. When one user tweeted that The Lancet had been revealed as a “political magazine,” not a scientific journal, Horton replied, “Thomas Wakley might disagree with you.” When another user called The Lancet a “political action rag,” Horton wrote, “We appreciate the compliment. Thank you.”

He has also, however, been self-critical. When we spoke, he acknowledged the difficulties of finding the proper balance between speed and rigor at a time when both are essential and mistakes can be costly. Even though Horton has long seen The Lancet’s work as political, it’s unusual for Politics (with a capital P) to intrude on The Lancet’s work to the extent that Trump’s hydroxychloroquine boosterism did in the case of the Surgisphere study. Sometimes, Horton said, it can be “a little bit frightening, to be honest. Because we’re just not used to that kind of political scrutiny.” 

While it took The Lancet more than a decade to retract Wakefield’s MMR study, the Surgisphere retraction came less than two weeks after the paper was published. Past critics of Horton’s, including Fiona Godlee, the editor in chief of the rival British Medical Journal, said afterward that Horton appeared to have learned the lessons of the Wakefield scandal. (In 2011, the BMJ ran a series of articles by Deer about Wakefield; Godlee concluded, in an accompanying editorial, that The Lancet had committed “institutional and editorial misconduct.”)

Still, the Surgisphere study added grist to perennial concerns that journals lack adequate editorial safeguards and will continue to publish bad research until they change their protocols. Experts including Heathers and Ivan Oransky, the cofounder of Retraction Watch, a site that tracks retractions in medical publishing, told me that the current system of peer review—under which (usually unpaid) researchers assess a given study before publication—isn’t good at spotting data that’s been spun from whole cloth. Andrew Gelman, a statistician at Columbia, perhaps put it best when he wrote, in 2016, that “the current system of science publication and publicity is like someone who has a high fence around his property but then keeps the doors of his house unlocked. Any burglar who manages to get inside the estate then has free run of the house.”

Horton told me that The Lancet takes submissions, in large part, on trust. Going forward, he said, he will ask editors and reviewers to consider whether the data in a study may have been fabricated. (In September, The Lancet announced several reforms to its publication process, under the headline “Learning from a retraction”: henceforth, multiple authors will have to attest to having verified the data underpinning a study; authors will have to outline if, when, and how they plan to share their data; and studies purporting to be based on large, “real world” data sets will face more rigorous statistical peer review.)

But having to take extra precautions clearly doesn’t sit well with Horton. He sees science as a messy process of trial and error that necessarily involves risk. Throughout his career, he’s said consistently that scientists must be allowed to make mistakes, and shouldn’t overcorrect when they do.

I asked Horton if he feels, sometimes, that The Lancet’s prestige is an impediment to his bold, risk-taking view of scientific progress. He seemed surprised by the question, and appreciative of it. “It would be lovely to be able to fly kites—wild new ideas in medicine and science—and to see where those new ideas went, to see how they evolve,” he said. “But we can’t do that. There is a limit. Of course there’s a limit, because of the exact reason that you point out: that if we publish something that’s so wild, and it ends up on the front page of the New York Times, then that could be very damaging.” 

 

If a vaccine candidate trialed in The Lancet makes it through to widespread usage—and even if it doesn’t—The Lancet will have done its job: accelerating the advance of medical knowledge for the greater good. Yet it will also, indelibly, have played a role in many people’s distrust of that knowledge.

 

At one point in our conversation, which took place in early July, Horton offered me an example of how The Lancet was then trying to balance speed and accuracy in its work on the coronavirus. “An author writes to me about a vaccine study and says, We’re gonna submit this paper to you on a Wednesday, and we really need it published next week, because the UK government wants to make a statement about this vaccine, and it’s really got the potential to have a high impact,” he said. “I absolutely understand that. But in an era when there is this mobilizing anti-vaccine movement, and any mistake—any tiny, tiny error on a vaccine study—will be used as an instrument to mobilize the anti-vax movement, we have to be super cautious about how we review and publish any vaccine paper.”

Ten days after we spoke, Horton tweeted a short teaser: “Tomorrow. Vaccines. Just saying.” The next day, The Lancet published a study, written by researchers at Oxford in conjunction with the pharmaceutical giant AstraZeneca, showing positive results from early human trials of an experimental covid vaccine. The Lancet summarized the study in a tweet from its official account: “UK’s #COVID19 vaccine is safe and induces an immune reaction, according to preliminary results.” The world’s media pounced on the news. (In early September, the media pounced again after AstraZeneca suspended trials when a participant suffered a potentially unexplained illness. The company resumed its UK-based trial shortly afterward; its US-based trial remained on pause.)

The same day that it published the Oxford trial results, The Lancet also published a study of a Chinese vaccine candidate that was said to show modestly positive results. Then, in early September, it published a study on Sputnik V, the controversial Russian vaccine that many international observers feared was being rushed into use. The results, again, were broadly positive, though some scientists questioned the underlying data. Horton, appearing on CNN, cautioned that the study was “tiny,” compared to the Oxford one, and rebuked Russian officials for wielding it as a chest-beating challenge to Western science. It would be “highly premature,” he said, to conclude that the world now has a working vaccine.

There remains, of course, a very long way to go until we reach that point. Still, in recent weeks—and particularly amid widespread concern that Trump will seek to politicize vaccination to boost his reelection prospects—attention has started to turn to the challenges we might face after a vaccine is ready for market. What will be the logistics of mass-producing and distributing it? Will poorer countries be able to get it? And, perhaps most crucially, will people actually want to take it? 

Recently, a poll conducted by Axios and Ipsos, in the US, found that 60 percent of respondents are “not very” or “not at all” likely to get a covid vaccine as soon as one becomes available. Other surveys have returned similarly skeptical results. “If you think you have someone in mind who you think is the archetype of someone who opposes vaccines, you absolutely do not,” Jan Hoffman, a health reporter at the New York Times, told the paper’s Daily podcast, in July. “It crosses racial lines. It crosses socioeconomic backgrounds, educational backgrounds. It crosses political affiliation.”

Hoffman noted that the anti-vax movement has very deep roots; in the US, it stretches all the way back to Benjamin Franklin. She also, however, name-checked Wakefield’s MMR study in The Lancet as being “most prominent in the modern memory” of vaccine skepticism. Michael Barbaro, the host of The Daily, said that his recollection of the anti-vax movement had been “that it starts with questions around autism.”

Barbaro is far from alone in that impression. If a vaccine candidate trialed in The Lancet makes it through to widespread usage—and even if it doesn’t—The Lancet will have done its job: accelerating the advance of medical knowledge for the greater good. Yet it will also, indelibly, have played a role in many people’s distrust of that knowledge. When I spoke with Mnookin in June, the Oxford results were still a few weeks in the future. I asked him instead whether he saw any parallel between The Lancet’s retracted MMR study and the hydroxychloroquine study. While the two studies were qualitatively very different—and the former, in the long view of history, will prove much more harmful than the latter—Mnookin told me he did, indeed, see a link.

“It validates the opinions of people who actually are anti-science,” he said, of the decisions to publish both studies. “All of these things kind of contribute to an environment and an atmosphere where science becomes just another thing to fight over in the public realm—like political opinions or sports teams or whatever. And I think that’s really dangerous.”

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Jon Allsop is a freelance journalist. He writes CJR’s newsletter The Media Today. Find him on Twitter @Jon_Allsop.