Click here for Appendices.

Click here for the article in The Jerusalem Post, “NGO Monitor Claims Anti-Israel Bias at UK Medical Journal ‘Lancet'”.

Table of Contents

Summary
Introduction and Background
Methodology
Research and Analysis
Findings
NGO Involvement: Medical Aid for Palestinians and the Lancet-Palestinian Health Alliance
Dr. Richard Horton: the LPHA and MAP
Dr. Swee Ang Chai, MAP founder
Dr. Paola Manduca
Sir Iain Chalmers
Dr. Derek Summerfield
Conclusion and Recommendations
Tables

Summary

This NGO Monitor study focuses on The Lancet medical journal and its treatment of Palestinian public health and related issues in 2001-2014, and the comparison of the scientific and political emphasis in different frameworks.  The study’s research and analysis were divided into two periods: 2001-2008 (prior to the founding of the Lancet-Palestinian Health Alliance – LPHA) and 2009-2014 (following the founding of LPHA).

As a scientific medical journal, The Lancet is in a unique position to play a constructive and positive role in not only improving the healthcare of Palestinians in the West Bank and Gaza, but also contributing to the prospects of peace by building bridges between the Israeli and Palestinian medical communities. In contrast, by taking a highly politicized course in the Israeli-Palestinian conflict, The Lancet has ostracized, and to a large extent, demonized Israel and the Israeli medical community.

Key Findings

• In 2001-2014, The Lancet published an aggregate total of 264 items on Palestinian and Israeli health care and related issues. Of these, 58.3% could be defined as political opinion or commentary and 41.7% as medical, an annual average of 11 political opinion or commentary and 7.9 medical. (Table 1)
  • During this period (2001-2014) Palestinian health care items published by The Lancet were 64.7% political opinion or commentary while 35.3% were medical. During the same period The Lancet published a total of 43 items on Israeli health care and related issues. Of these, 25.6% were political opinion or commentary and 74.4% were medical.
  • This disparity indicates a highly politicized agenda in the presentation of Palestinian health care issues. (Table 7)
• In the period 2001 to 2008 (pre-LPHA), The Lancet published 33 items of which 88% were political opinion or commentary and 12% were medical, an annual average of 3.6 political opinion or commentary and 0.5 medical. (Table 2 and Appendix A)
• In the period 2009-2014 (after the LPHA launch), The Lancet published an aggregate of 231 items of which 54% were political opinion or commentary and 46% were medical, an annual average of 20.8 political opinion or commentary and 17.6 medical. (Table 3)
• This indicates that the creation of the LPHA was a likely causative factor resulting in a nearly six fold increase in the average annual number of political opinion or commentary items (20.8/year vs. 3.6/year) published in The Lancet.
• In the period 2009-2013, The Lancet published 122 items as part of the LPHA series, of which 41% were political opinion or commentary and 59% were medical, an annual average of 10 political opinion or commentary and 14.4 medical. (Table 4 and Appendix B)
• During the period 2009-2014, The Lancet published outside of the LPHA framework 66 items on Palestinian health care and related issues of which 97% were political opinion or commentary and 3% were medical, an average of 10.6 political opinion or commentary and 0.33 medical items per year. (Table 5a)

Thematic patterns

• In many items, the discussions of violence are framed primarily through the lens of Israeli military actions. Very little is written about the causes, such as Palestinian attacks on Israeli civilians. (In the 2014 conflict, 4,563 rockets and missiles were launched from Gaza towards Israeli civilian targets – every instance constituting a war crime.)
• Israeli policy towards the West Bank and Gaza is consistently assigned causality for Palestinian health deficiencies and presented as the most critical issue to be examined.
• There is limited discussion of the dysfunctional Palestinian health infrastructure, as well as the impact of Palestinian factional disputes, mismanagement, and corruption.

Dr. Richard Horton, the Lancet-Palestinian Health Alliance, and Medical Aid for Palestinians

• Under Horton’s editorship, The Lancet has become a recurrent platform for advocates of the Palestinian national cause. He also steered The Lancet toward partnering with a number of politicized pro-Palestinian NGOs, particularly the UK-based Medical Aid for Palestinians (MAP). Horton was also a key player in the formation of the highly politicized Lancet-Palestinian Health Alliance (LPHA), of which MAP is also a key participant.
• The most recent example of this politicization was in July 2014, during the Gaza conflict, when The Lancet published an “Open Letter for the People in Gaza.” Emails circulated by two of the letter’s main authors promoted a virulently antisemitic neo-Nazi video that purportedly “reveals how the Zionist Matrix of Power controls Media, Politics and Banking…”
• At a public event, and in Horton’s presence, Dr. Iain Chalmers, another author of the Gaza letter, decried how “Zionists” have “control in so many different domains” and that The Lancet is one publication “they cannot suppress.” Chalmers also mused over the “interesting figure” of “six million” in relation to the number of non-Jews “whose lives” the “Jewish state… controls.”
• In public statements, Horton has attacked Israel and Israeli institutions, defamed the Israel Medical Association, and called for a global “uprising” against Israel.

Recommendations

The Gaza “open letter” triggered a storm in the medical community and in Israel.  That two of the letter’s authors promoted a neo-Nazi video and a third made antisemitic comments in Horton’s presence, underscores the urgent need to address the problems at The Lancet.  To date, Horton has not apologized for the publishing of this letter, and has refused to retract it from The Lancet’s web site.

The failure of Richard Horton and The Lancet’s publisher Reed Elsevier to retract the Gaza letter from The Lancet’s website and apologize for its publication exacerbates the situation. This refusal contradicts the “Code of Conduct and Best Practices Guidelines for Journal Editors,” of the Committee on Publication Ethics’ (of which Horton is an Honorary Member) which states: “Editors should be accountable for everything published in their journals” and should “always be willing to publish corrections, clarifications, retractions and apologies when needed.” COPE’s Retraction Guidelines call on journal editors to “consider retracting a publication if they have clear evidence that the findings are unreliable, either as a result of misconduct (e.g. data fabrication) or honest error (e.g. miscalculations or experimental error).”

In the interest of bringing this issue to a rapid and positive close, NGO Monitor recommends that The Lancet and its publisher Reed Elsevier take the following steps:

• Reform and re-vision the LPHA to remove its politically polarizing consequences.
• Disassociate itself from the NGO Medical Aid for Palestinians and end MAP’s role within the LPHA framework.
• Apologize for, retract, and publicly remove the “Open Letter for the People of Gaza” where it is still available on the home page of The Lancet’s website; Further, Dr. Horton should personally apologize for and retract his own hostile comments against Israel and the Israeli medical community.
• Establish and implement long-overdue professional processes to review articles on complex political issues including on the Arab-Israeli conflict and their appropriateness to The Lancet;
• Initiate an open review of articles related to Israel published since 1 January 2001 to determine whether and which articles fail to meet established scientific standards, and to issue retractions where appropriate.

Introduction and Background

In 2013, NGO Monitor published NGO Malpractice: The Political Abuse of Medicine, Morality, and Science. The medical community, broadly defined, is morally committed to the highest standards of professionalism and universality, treating all those in need irrespective of any other factor. In contrast, and in violation of these moral principles, a number of highly influential non-governmental organizations (NGOs), claiming medical mandates and active in the framework of the Arab-Israeli conflict have politicized medicine, using it as a means to demonize Israel and discriminate against Israelis.

The monograph demonstrates that renowned UK medical journal The Lancet, in particular, publishes and often gives prominence to officials of these NGOs or to articles based on their reports, providing a scientific veneer to NGO political claims and biases. Under the editorship of Dr. Richard Horton, The Lancet frequently advocates for the Palestinian national cause, partnering with a number of pro-Palestinian NGOs and promoting the highly politicized Lancet-Palestinian Health Alliance (LPHA), “a loose network of health researchers committed to illuminating the conditions under which Palestinians live today.”¹.

The LPHA was launched in 2009 as a partnership between The Lancet, the Institute of Community and Public Health at Birzeit University, and the NGO “Medical Aid for Palestinians” (MAP).  The LPHA series has been published annually in The Lancet since 2009 and has served as the main mechanism for the promotion of NGO political agendas in the pages of The Lancet.

The 2009 launch of the LPHA series marked a clear shift at The Lancet, where political advocacy against Israel intensified and the political agenda was consolidated. For instance, prior to the LPHA, there was no uniform stylistic designation for the territories commonly referred to as the West Bank and Gaza Strip. Different authors used various labels, such as “West Bank” or “Palestinian Authority” or “occupied territory.” From 2009 onward, however, the West Bank and Gaza Strip has been referred to almost exclusively with the political term “occupied Palestinian territory” in virtually all articles – even those primarily medical in focus. (See Findings below.)

The primary political role of the LPHA in demonizing Israel was highlighted in July 2014, during the Gaza conflict. The Lancet published a highly politicized, very biased, and disparaging piece under the headline, “Open Letter for the People in Gaza.” The authors’ claims included calling the IDF’s response to Hamas rocket attacks on Israeli populations centers “the creation of an emergency to masquerade a massacre.” The letter text also attacked the entire Israeli medical community by “register[ing] with dismay that only 5% of our Israeli academic colleagues signed an appeal to their government to stop the military operation against Gaza” and assumed with unsubstantiated speculation that “we are tempted to conclude that with the exception of this 5%, the rest of the Israeli academics are complicit in the massacre and destruction of Gaza.”

NGO Monitor researchers’ subsequently uncovered emails circulated by two of the Gaza letter’s main authors (Drs. Paola Manduca and Swee Ang Chai) promoting a virulent antisemitic video by American neo-Nazi David Duke. Major mainstream media coverage, beginning in Britain, followed.

Long before the Gaza letter, these authors had been published in the Lancet, thereby also promoting the agendas of the political NGOs with which they are associated. Paula Manduca, for example, is prominent in the New Weapons Committee.  This NGO has made entirely fictitious claims that Israel “experimented” with new weapons in Gaza and Lebanon.  And Swee Ang Chai is a founder of Medical Aid for Palestinians (MAP), which is very active in promoting the Palestinian political cause and advancing campaigns targeting Israel.

As documented by NGO Monitor, the media in general, including professional journals, acts as a force multiplier and facilitator for medical NGOs and their agendas.  Beyond simply providing this service, The Lancet has also presented numerous articles involving Israeli-Palestinian issues that are given the facade of scientific credibility in an editorial procedure that is not transparent and may or may not include standard blind peer review and evaluation processes.  This study examines in detail the publishing history of The Lancet as it relates to coverage of Palestinian and Israeli health care and related issues.  We begin by outlining our methodology, including the identification of key words used to systematically categorize the articles.

Methodology

NGO Monitor researchers examined and evaluated all available items (articles, editorials, and correspondence) published by The Lancet covering Palestinian health care and related issues during the period January 1, 2001 to the present.² A keyword search used the following: “Palestine,” “Palestinian,” West Bank,” and “Gaza” through the “abstract title, abstract or keyword” search function of The Lancet’s web site.

NGO Monitor researchers also examined and evaluated all available items during the same period (2001-2014) that focused solely on Israeli health care and related issues. The items were chosen by searching the keywords “Israel” and “Israeli” through the “abstract title, abstract or keyword” search function of The Lancet’s website.

The research and analysis were divided into two periods:

1) 2001-2008, prior to the founding of LPHA

2) 2009-2014, following the founding of LPHA

Terminology

1. For purposes of this study the word “item” refers to articles, editorials, and correspondence.

2. Factors considered in determining if an item was “political opinion or commentary” include:

a. Political commentary or news containing no scientific research.

b. Content that was clearly and overwhelmingly political in focus, leading to conclusions heavily influenced by political considerations and premises.

c. Causal claims (such as Israel policies) for health deficiencies faced by Palestinians without examining or considering other publicly available evidence of other potential causes.

d. Politically charged terms, such as accusations of “war crimes,” “apartheid,” “aggression,” and “massacres,” which go beyond the purview of medical analysis.

3. An item was defined as being “medical” if the exclusive or primary focus was a report on medical and/or scientific research.

Research and Analysis

As noted, NGO Monitor evaluated all available items published by The Lancet covering Palestinian health care and related issues during the period January 1, 2001 to the present.  The findings are directly below, and detailed results are found in the tables beginning on page 13.

Findings

• For the period studied (2001-2014), The Lancet published an aggregate total of 264 items on Palestinian and Israeli health care and related issues.  Of these, 154 (58.3%) were political opinion or commentary and 110 (41.7%) were medical. The total aggregate per year average was 11 political opinion or commentary and 7.9 medical items. (Table 1)
• In 2001 to 2008 (pre-LPHA), The Lancet published 33 items of which 29 (88%) were political opinion or commentary and 4 (12%) were medical.  This was an average of 3.6 political opinion or commentary and 0.5 medical items per year. (Table 2 and Appendix A)
• In 2009-2014 (from launch of LPHA to present), The Lancet published an aggregate total of 231 items of which 125 (54%) are political opinion or commentary and 106 (46%) are medical, an annual average of 20.8 political opinion or commentary and 17.6 medical.
  • This indicates that the creation of the LPHA was a likely causative factor resulting in a nearly six fold increase in the average annual number of items (20.8/year vs. 3.6/year) that are political opinion or commentary published in The Lancet. (Table 3 and Appendix C)
• In the period 2009-2013³ (after the LPHA’s launch in 2009), The Lancet published 122 items as part of the LPHA series, of which 50 (41%) were political opinion or commentary and 72 (59%) were medical.  This is an average of 10.6 political opinion or commentary and 14.4 medical per year. (Table 4 and Appendix B)
• In 2009-2014, 66 items on Palestinian health care and related issues were published outside of the LPHA framework, of which 64 (97%) were political opinion or commentary and 2 (3%) were medical, an average of 10.6 political opinion or commentary and 0.33 medical items per year. (Table 5 and Appendix C)
• 20 of these 66 items reference the LPHA, but are not part of the LPHA Series. All 20 are political.  (Table 5a)
• The “Open Letter for the People in Gaza” and all related correspondences that followed (between July 23 to August 30, 2014) accounted for 23 (all political) of the 66 items published in this period. (Table 5b)
• In the period 2001-2014 The Lancet published a total of 43 items on Israeli health care and related issues.  Of these, 11 (25.6%) were political opinion or commentary and 32 (74.4%) were medical. (See Table 6)
• By comparison, on Palestinian health care The Lancet published 143 political opinion or commentary items (64.7%) while 78 items (35.3%) were medical. This indicates a highly politicized agenda in the presentation of Palestinian health care issues in the pages of The Lancet. (See Table 7)
• The 2009 launch of the LPHA series marked a clear shift at The Lancet, where political advocacy against Israel intensified and the political agenda was consolidated. For instance, prior to the LPHA, there was no uniform stylistic designation for the territories commonly referred to as the West Bank and Gaza Strip.  Different authors used various labels, such as “West Bank” or “Palestinian Authority” or “occupied territory.” Different authors used various labels for these territories such as “West Bank” or “Palestinian Authority” or “occupied territory.” For example, an October 2007 article was titled “Health in the West Bank,” and another article from December 2006 was titled “War and health in the West Bank and Gaza.” (For a complete list of articles, see Appendix A.)
• From 2009 onward, however, the West Bank and Gaza Strip has been referred to almost exclusively with the political (as opposed to legal) term “occupied Palestinian territory” in virtually all articles – even those primarily medical in focus. For instance, articles in the 2009 series contained titles as follows:
  • “The occupied Palestinian territory: peace, justice, and health” (by Richard Horton)
  • “Peace and health in the occupied Palestinian territory” (by Jimmy Carter)
  • “Lancet Steering Group on the occupied Palestinian territory”
  • “Teaching child health in the occupied Palestinian territory”
  • “Palestinian refugees outside the occupied Palestinian territory”

NGO Involvement: Medical Aid for Palestinians and the Lancet-Palestinian Health Alliance

Background

• Medical Aid For Palestinians (MAP) is a major UK-based NGO that operates medical clinics in the Palestinian Authority, Gaza, and Lebanon. A number of senior British public figures serve on its board. MAP promotes a politicized, divisive, anti-Israel narrative through its lobbying of the British Parliament and has repeatedly joined with other political advocacy NGOs to lobby the European Union and other international actors to sanction Israel. (For details, see the NGO Monitor website).
• MAP was a partner with The Lancet in building the LPHA.  MAP has been a consistent organizational contributor to the LPHA since its onset in 2009 and remained a funding partner in 2010, 2011, 2012 and 2013.
• MAP also has been linked to terror groups.  For instance, according to Harvard academic, Sara Roy, MAP made payments to the Al-Ihsan Charitable Society,⁴ which was designated by the U.S. Treasury Department in 2005 as a “charitable front for the Palestinian Islamic Jihad … [Al-Ihsan] masquerades as a charity, while actually helping to finance Palestinian Islamic Jihad’s acts of terror against the Israeli people and other innocents.”
• In 2002, MAP accepted the proceeds of a book, After the Terror, which argues that “those Palestinians who have resorted to violence have been right to try to free their people, and those who have killed themselves in the cause of their people have indeed sanctified themselves.”
• At a fundraiser for MAP at the Silver Bullet in London in October 2014, a Palestinian-British activist said, “The resistance is not fighting today for Gaza but for the West Bank as well.  And the ’48 territories, which is still under Israeli occupation… So boycott Israel and isolate it on the international community.  Israel is not a country.  It’s a colony and a fascist organization that was established by the Haganah gangs and it cannot continue.”
• MAP government donors include the EU, UK, Ireland (via Irish Aid and Trocaire), Australia (AusAid), UNICEF, and others.

Dr. Richard Horton: the LPHA and MAP

• Under Richard Horton’s editorship, The Lancet has become a recurrent platform for advocates of the Palestinian national cause.  He also steered The Lancet toward partnering with a number of pro-Palestinian NGOs, particularly the UK-based Medical Aid for Palestinians (MAP).  Horton was also a key player in the formation of the highly politicized Lancet-Palestinian Health Alliance (LPHA), of which MAP is also a key participant.
• Horton’s personal philosophy is that medicine and politics are intertwined. He has said, “Science is political… I want to use science as a political instrument to promote social justice.”  During a “Live Twitter Chat” on November 27, 2014 Horton repeated his conviction in “explicitly using science for advocacy.”
• This use of science as a “political instrument” was apparent in July 2014, during the Gaza conflict, when The Lancet published a highly controversial correspondence under the headline, “Open Letter for the People in Gaza.”  This piece generated scores of positive and negative responses by Israeli and non-Israeli physicians. Further, two of the Gaza letter’s main authors – Drs. Swee Ang Chai and Paola Manduca – promoted a virulently antisemitic video by American neo-Nazi David Duke. The video purportedly “reveals how the Zionist Matrix of Power controls Media, Politics and Banking…”
• In an audio recording surfaced⁵, Gaza letter co-author and Horton confidant Sir Iain Chalmers made a comment that echoes the antisemitism of the Duke video. At a MAP event that took place at the Royal College of Paediatrics and Child Health on December 5, 2013 to launch “crucial new research by the LPHA,” Chalmers decried how “Zionists” have “control in so many different domains” and how The Lancet is one publication “they [Zionists] cannot suppress.”  (See below under the header “Sir Iain Chalmers” for full quote.)
• At the same event, Horton said, “We could not have done it without everybody, including Medical Aid for Palestinians, who have given unstinting support for the last five years.”
• Horton also attacked the Israel Medical Association, falsely accusing one of the IMA officers as having “called Palestinians animals” at a 2007 closed-door meeting in Israel.  Horton claimed that this made him realize he could not find common ground with the Israeli medical establishment.
• While speaking at a 2012 MAP event, “Pitching for Palestine,” Horton described an invented situation in which Palestinians have no access to health care whatsoever, blamed Israel, and called for a global “uprising” against Israel:

And this is what you’ll see if you have 24-hour cameras in a Palestinian village, you will see when a child falls ill with pneumonia the mother will not be able to get access to antibiotics.  You will see when a man injures himself, perhaps fractures an arm or a leg, he will not have access to trauma care.  You will see when a young family, a young couple gets married, they will not be able to build a house because they will have to get a permit to build a house which will be denied them.  You will see that a village that wants to build a clinic or a school will be denied the possibility of building a clinic or a school.  You will see a woman who is pregnant unable to get access to maternity care.  You will see all of these things.  And when the world sees the reality of Palestinian society, right now, today, this second, there will be an uprising.  And there will be shame and horribles (sic) on Israel.

• MAP officials individually have contributed numerous articles to The Lancet, some purely medical, many others political in nature. Andrea Becker, MAP’s one-time “head of advocacy,” has been a significant presence in The Lancet, although her qualifications to write about medical issues are unknown.  Becker promoted the LPHA stating “… any current assessment of the health of Palestinians is dominated by the consequences of Israel’s siege, bombardment, and invasion of the Gaza Strip…This Series illustrates the many ways in which the Palestinian right to health is compromised by the current extraordinary circumstances of occupation, siege, and invasion.”
• Horton describes MAP trustee Prof. Graham Watt as a central element to the LPHA. Watt was published seven times in the framework of the LPHA series. One such article asserts that “a very powerful determinant of Palestinian health is the State of Israel, whose economic, political, and military superiority continue to be applied, not only to the blockade and recent bombardment and invasion of Gaza, but also to the territorial project within the West Bank.”
• In a MAP lecture series, Watt made statements such as, “What is it that maintains that mentality in which power has to be used excessively… one of the things that keep that mentality alive is the thought system or a pattern of ideas which sustains it and it is kind of a cartoon of reality in which Palestinians are portrayed as terrorists…”
• Richard Horton has additionally partnered with MAP on non-medical issues. Horton was 1 of 50 signatories on MAP’s petition to “end to Israel’s demolition of Palestinian homes.”

Dr. Swee Ang Chai, MAP founder

• Dr. Swee Ang Chai is the founder of Medical Aid for Palestinians (MAP); her current position is “honorary Patron.” She remains active in MAP, including participating in MAP panels (2012), profiles in MAP’s newsletter (2014) and briefing reports (2012), and MAP campaigns (2014). In the 2014 Gaza war, Ang “responded to the call for surgeons to go to Gaza to help treat the wounded on behalf of a MAP initiative,” but was denied entry into Israel. Swee Ang discussed her denial of entry in an interview with Global Research, an anti-globalization NGO.
• Swee Ang and Paola Manduca promoted an antisemitic video made by American white supremacist David Duke. The video “reveals how the Zionist Matrix of Power controls Media, Politics and Banking…” (See NGO Monitor factsheet Authors of Anti-Israel Letter in The Lancet Promote Antisemitic Video by White Supremacist David Duke.)
• In 2014, Swee Ang spoke at Israeli Apartheid Week 2014-UCL on “Medicine & Apartheid in Palestine.”
• The Lancet published Swee Ang’s introduction from her book, From Beirut to Jerusalem, on its “Global Health Network” website. The article remained posted for 28 days until it was removed due to gross factual inaccuracies regarding two alleged incidents during the 1956 and 1967 Arab-Israeli wars, whose historical veracity are the subject of much scholarly debate.  Apparently, Swee Ang arrived at her casualty figures by taking an UNWRA report, which claimed “a large number of civilians were killed,” and inflating the number by a factor of twenty. The article, which had no footnotes or references, was filled with unverifiable anecdotes advancing the author’s anti-Israel stance. (The inaccurate and exaggerated facts are discussed in depth in NGO Monitor’s Medical Malpractice Monograph.)
• Swee Ang was a co-author of the July 23, 2014 “Open Letter for the People in Gaza,” published in The Lancet. Other primary signatories included Manduca, Iain Chalmers, Derek Summerfield, and Mads Gilbert.  Each has made extreme anti-Israel statements and, in some cases, made overtly antisemitic ones or promoted antisemitic materials.

Dr. Paola Manduca

• In its 2013 annual report MAP thanked Manduca for being a partner and/or supporter. In 2014 Manduca publically raised funds for MAP.
• “The LPHA series has published three articles co-authored by Manduca, two of which detail studies listed as having been funded by Interpal, an organization that is designated as a terrorist entity by the United States.⁶
• Manduca is a signatory to the “Appeal for the removal of Hamas from the EU terror list.”
• Manduca presented at the 2012, 2013, and 2014 LPHA meetings. Her papers focused on attributing Palestinian birth defects to Israel’s actions in Gaza. For example, she states, “There is an increase of birth defects (BD) starting in 2005, possibly associated with military attacks during the second Intifada.” [emphasis added]
• Manduca posted a number of antisemitic emails to the Italian Google group Sempre Contro la Guerra. She posted an article by Paul Larudee with the subject “israel and parassites” (sic). The article’s main theme is that Israel, through the American Jewish community, is a “parasite” feeding off the host/victim nation – the United States – by controlling key U.S. institutions.  This “Jew as parasite” theme was prominent in Nazi and other antisemitic ideology.
• Manduca also posted an email on May 1, 2014 titled “Egyptian ruler General Abd al-Fattah al-Sisi is a Jew.” In it, Manduca describes Judaism as a “‘blood determined’ religious group with ethnic and racist background and imperialist and genocidal in the context of Palestine.” (sic)
• On April 16, 2013, Manduca forwarded an email to Sempre Contro la Guerra that provided a conspiracy theory behind the 2013 Boston Marathon bombing: “There is no mention of billions made by investors with inside knowledge; no mainstream media tried to investigate the short selling and the US stock market collapse that happened hours BEFORE the bombings (who profited?)… 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.”
• On August 24, 2014, Manduca also posted an article by Gilad Atzmon, who is described by the Anti-Defamation League as an “anti-Semite.” In the article uploaded by Manduca, Atzmon wrote, “America is not the first or second super power to be brought down by Jewish power.”

Sir Iain Chalmers

• Sir Iain Chalmers was a co-signer of the Gaza “Open Letter.” He is co-founder of the Cochrane Collaboration headquartered at Oxford University.
• On December 5, 2013, MAP hosted an event at the Royal College of Paediatrics and Child Health to launch what was billed as “crucial new research by the LPHA.” As noted above, Richard Horton was in attendance. Speaking at this event was Chalmers who made a comment echoing the Duke video promoted by Swee Ang and Manduca:

What pleases me, really pleases me, is that the word ‘Palestinian’ is in there [The Lancet]. And it’s one way in which the Zionists have failed. They have not stopped the use of the word ‘Palestine’ or ‘Palestinian.’ And on the front of The Lancet we have an example. And they have control in so many different domains, that this is one that they cannot suppress.  And so I am very grateful to Richard for being such a staunch supporter of work that keeps on mentioning the word ‘Palestinian.’ (emphasis added)

• At the same program, in responding to a question from an audience member, Chalmers said:

I was asked to write a commentary for The Lancet after the Cast Lead attack.  I ended it by saying a self-defined Jewish state, Jewish state, now controls the lives of almost as many non-Jews as it does of Jews. What will that Jewish state, do with the six million, it’s an interesting figure, the six million, non-Jews whose lives it controls.

• The Lancet has published three of Chalmers’ articles in connection with the LPHA in 2009 and 2012 and several other articles on Palestinian issues. Chalmers also presented research at the 2013 LPHA publication release hosted by MAP.

ReDr. Derek Summerfield

• Derek Summerfield was a co-signer of the Gaza “Open Letter.”
• In the online LPHA series, as well as at the 2013 LPHA research publication launch sponsored by MAP, Horton describes Summerfield as being the catalyst for the LPHA. Horton said the LPHA “started off with Derek Summerfield… [who] encouraged me over the course of many years to take an interest in the Palestinian territory.” Horton further describes how Summerfield coordinated a meeting between Horton and Prof. Rita Giacaman at Birzeit University, which led to the founding of the LPHA. Giacaman is a member of the LPHA steering committee and since 2009 has co-authored 21 articles in the Lancet, 17 of which pertain to the LPHA.
• Summerfield spoke at a September 2014 MAP event in the wake of the conflict between Israel and Hamas.
• In a 2008 interview with Al-Ahram Weekly, which describes him as having “always been angry at Israel,” Summerfield called the Holocaust a “story” that Israel “plays” to stifle criticism: “Support for Israel is embedded in Western systems without doubt. The US and the UK regard Israel as a European country. Israel continues to play the Holocaust story and anti-Semitism as a way of blocking the truth.”
• In 2009 Summerfield “was the co-ordinator” of an international campaign to remove Dr. Yoram Blachar from his position as president of the World Medical Association (WMA).  The campaign baselessly alleged that Blachar, in his role as President of the Israel Medical Association, “turned a blind eye to the involvement of medical staff in torture.”

Horton Changes Course

• In October 2014, in response to growing protests, Horton accespted an invitation to Rambam Hospital in Israel where he spoke to a gathering of Israeli physicians.  He “deeply, deeply regret[ted] the completely unnecessary polarization that publication of the letter” caused. While he strongly condemned Swee Ang’s promotion of the Duke video, he nonetheless refused to apologize for publishing the letter or remove the anti-Israel material and articles from The Lancet website, as demanded by many medical professionals.
• In both his Rambam presentation and a subsequent Lancet editorial Horton promised to institute a “series on Israel’s health and medical research system, its strengths and challenges, and prospects for its future.”  In the same editorial he also proposed new guidelines to govern how “political determinants of health” are reported.  He wrote, “there are reasons to be vigilant about how these are discussed… 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.”
• In May 2017, a special issue of The Lancet was published about health in Israel. Horton wrote that they “wanted to turn the unfortunate episode into a constructive and positive lever that will lead to recognition of Israel’s advantages for global health.” In addition, Horton criticized BDS campaigns, stating that “Boycotting academics and Israeli professionals, as led by the BDS movement, is inefficient and will never be effective in helping shape public and political opinion that will promote a solution, on the contrary, it will harm these goals.”

Conclusion and Recommendations

As a scientific medical journal, The Lancet is in a unique position to play a constructive and positive role in not only improving the healthcare of Palestinians in the West Bank and Gaza, but also contributing to the prospects of peace by building bridges between the Israeli and Palestinian medical communities. In contrast, by taking a highly politicized course in the Israeli-Palestinian conflict, The Lancet has ostracized, and to a large extent, demonized Israel and the Israeli medical community.

Horton’s observation on the need for editorial vigilance regarding how potentially divisive political issues are discussed is a good foundation to begin a reform of the LPHA. Its highly politicized nature, mostly blaming Israel alone for Palestinian health care problems, could lead researchers into making wrong conclusions based on the exigencies of political whims. Epidemiologic and public health studies should avoid basing conclusions on inaccurate, incomplete or politically tainted data, and it is the responsibility of medical journal’s editor to ensure the presentation of such studies is as free from a political agenda as possible. This is underscored all the more when that political agenda is that of one side in a longstanding conflict between two national movements. The danger becomes acute when a medical/scientific journal is recruited into acting as a mouthpiece for a given nationalist cause.  This is what appears to have happened with The Lancet and the LPHA.

Horton’s promise to institute a partnership with Israeli medical professionals to produce a series on the Israeli health and medical research system could become an important first step toward moving the LPHA from its politically polarizing fallouts. Conversely, if the Lancet-Israeli partnership proposal fails to take these factors into consideration, it will be seen as an attempt to put a bandage on the situation by offering a balance to the LPHA. That would not solve the current controversy, and worse it could negatively impact health care for both Palestinians and Israelis alike.

It would be far more beneficial to both Palestinians and Israelis for The Lancet to serve as a truly open bridge between the Israeli and Palestinian medical communities.  In its current form the LPHA prevents this from happening.

The refusal by Horton and The Lancet’s parent company Reed Elsevier, to fully repudiate the Gaza open letter, retract the letter from The Lancet’s website, and apologize for its publication contributes to the ongoing atmosphere of distrust between the Israeli medical community and The Lancet.

Further, this situation has contributed to the alienation from The Lancet by physicians internationally.  Due to The Lancet’s position, a number of prominent doctors have refused invitations from The Lancet to review or submit papers. The resignation by a senior Israeli scientist from an advisory board of The Lancet is another casualty of the ongoing situation.  This breakdown in trust and communications within the world medical community harms the advance of medicine.

In the interest of bringing this situation to a rapid and positive close, and preventing it from worsening, and on the basis of the detailed analysis provided in this report, NGO Monitor urges The Lancet to review its editorial policies. Specifically, NGO Monitor counsels The Lancet and its publisher Reed Elsevier to take the following steps:

• Reform and re-vision the LPHA to remove its politically polarizing consequences.
• A major first step to reforming the LPHA would be for The Lancet to disassociate itself from Medical Aid for Palestinians and end MAP’s role within the LPHA framework.
• Apologize for, retract, and publicly remove the “Open Letter for the People in Gaza” from its website. Further, Dr. Horton should personally apologize for and retract his own hostile comments against Israel such as calling for a global “uprising” and “shame and horribles” against Israel, and the unfounded allegations he made against the Israel Medical Association.
• Establish and implement long-overdue professional processes to review articles on complex political issues, including on the Arab-Israeli conflict and their appropriateness to The Lancet;
• Initiate an open review of The Lancet articles related to Israel published since 1 January 2001 to determine whether and which articles fail to meet established scientific standards, and to issue retractions where appropriate.

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