“…science has taken a turn towards darkness” Richard Horton, editor of the Lancet
The latest PACE controversy started with a simple invitation from Richard Horton, the editor of The Lancet – to 42 signers of a letter requesting that an independent analysis of the PACE trial be done.
Horton’s history with the PACE trial had seemed one-sided to many in the ME/CFS camp. Horton could have simply dismissed the criticisms of the trial but he went a step further characterizing the critics complaints as “vexatious”, and characterizing them as
“a fairly small, but highly organized, very vocal and very damaging group of individuals who have, I would say, actually hijacked this agenda and distorted the debate so that it actually harms the overwhelming majority of patients.”
Vexatious complaints are simply attended to annoy; they indicate that no real grounds for the complaint exist.
Horton appeared to listen when 43 professionals submitted a letter to Lancet but then mysteriously disappeared again.
When forty-two researchers, academics and clinicians signed off on a letter stating they believed that the flaws in the PACE trial “have no place in published research” Horton couldn’t ignore them. So he did what a good editor should do: he promised to give them space in the journal to air their concerns. He replied to their email:
“Many thanks for your email. In the interests of transparency, I would like to invite you to submit a letter for publication–please keep your letter to around 500 words. We will then invite the authors of the study to reply to your very serious allegations.”
His reply suggested that the letter would be published with a response from the authors of the trial, but then Horton shelved the letter.. Months later, after some digging, the authors learned that The Lancet had rejected the new letter without explanation. Since contents of the new letter closely followed the contents of the original letter; i.e. Horton knew exactly what he was going to get – they were thoroughly confused.
The Lancet’s latest reply came not from Horton but from Audrey Ceschia, the Lancet’s correspondence editor. She explained “that the Lancet editorial staff decided, after discussing the matter with the PACE authors, that the letter did not add anything substantially new to the discussion.”
The fact that Horton had used the same authors who’d publicly stated that they believed the continuing controversy put their careers in risk to rule on the letter’s veracity seemed not to bother Ceschia or Horton at all.
Lancet appears to be either so blind to the issues of journalistic integrity that they don’t realize how crazy this looks, or they simply don’t care..
Racaniello was shocked by Horton’s “unprofessional” behavior
Horton’s attempted burial of the letter prompted Vincent Racaniello, the researcher running the Virology blog website, to take off the gloves. Racaniello flatly accused The Lancet’s chief editor of “highly unprofessional” behavior and trying to bury the issue. He asserted that Lancet simply could not be trusted to act in an objective manner anymore.
“The reasons given for the rejection are clearly specious. The letter for publication reflected the matters addressed in the open letter that prompted Dr. Horton’s invitation in the first place, and closely adhered to his directive to outline our “serious allegations”. If outlining these allegations was not considered publication-worthy by The Lancet, it is incomprehensible to us why Dr. Horton solicited the letter in the first place. Racaniello
The sequence of events suggested that Horton had initially been persuaded by the letter; he did, after all, ask the 42 authors for another letter but something – probably his conversations with the PACE trial authors – persuaded him to attempt to bury the matter.
The Pretender
One might be inclined to lump The Lancet into the buddy-buddy basket of medical journalism except for two things. The Lancet is genuinely thought of as one of the top medical journals in the world, and Lancet’s editor, Richard Horton, has portrayed himself as a kind of white knight of journalistic integrity. Last year he penned a startling op ed suggesting that perhaps half of the published scientific literature is simply wrong.
The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. As one participant put it, “poor methods get results”.
Horton also slammed the peer review system as “biased, unjust, unaccountable…occasionally fooling and frequently wrong”.
Yet, Horton apparently took the “peer” out of the peer review by giving the PACE researchers a say in whether a letter raising concerns about the validity of their own research should be published. The Lancet at this point is looking more like the Keystone Kops than a serious medical journal.
If Horton believes that perhaps half the scientific literature – ninety-nine percent of which is published without controversy – is untrue, where does that leave the PACE trial? How unlikely is it that the PACE trial, which has generated enormous controversy amongst both researchers and patients, doesn’t have a serious problem?
The Lancet’s Slippery Slope
Horton is clearly invested emotionally in the issue. He surely exaggerated when he told Australian radio that the Lancet paper, which he had fast-tracked and published within four weeks of being submitted, had gone through “endless rounds of peer review”. Horton also probably exaggerated when he reported that FOIA requests concerning the PACE trial had cost the British taxpayers over a million dollars (U.S.)
It’s not clear how much of a hit to Lancet’s reputation Horton is willing to take, or Lancet is willing to take on behalf of him. The Lancet has been described as one of the most prestigious medical journals in the world. Wikipedia. Andrew Gelman pointed that The Lancet’s impact factor was recently ranked second among general medical journals.
Two months ago, though, a presentation at an international statisticians conference asserted that the PACE data was so “highly flawed” as to be “uninterpretable.” The American Statistical Association actually urged its delegates to attend the talk to hear how “how bad statistics harm patients and our profession”.Bruce Levin, a biostatistician at Columbia University, told Julie Rehmeyer that “The Lancet needs to stop circling the wagons and be open. One of the tenets of good science is transparency.”
In a piece titled “PACE study and the Lancet: Journal reputation is a two-way street”, statistician Andrew Gelman pointed to past journals which lost their reputations because of similar situations. He suggested that The Lancet could be playing with fire. He imagined a conversation like this occurring:
Scientist A: My new paper was published in the Lancet!
Scientist B: The Lancet, eh? Isn’t that the journal that published the discredited Iraq survey, the Andrew Wakefield paper, and that weird PACE study?
A: Ummm, yeah, but my article isn’t one of those Lancet papers. It’s published in the serious, non-politicized section of the magazine.
B: Oh, I get it: The Lancet is like the Wall Street Journal—trust the articles, not the opinion pages?
A: Not quite like that, but, yeah: If you read between the lines, you can figure out which Lancet papers are worth reading.
B: Ahhh, I get it.
For now The Lancet has the upper hand. Getting published on The Lancet is so sought after that researchers create their submissions solely based on how they think The Lancet will view them. Given that kind of influence, who, outside of the chronic fatigue syndrome community, wouldn’t give The Lancet the benefit of the doubt against the much maligned ME/CFS community?
A reputation can be a slippery slope – gained with difficulty and easily lost.
The Lancet probably doesn’t feel it needs to play fair with under-served disorders like ME/CFS, but a reputation is more easily lost than won. It’s often in these seemingly small, David vs Goliath type battles where the arrogance endemic in an institution (or an editor) gets fully exposed, that institutions can take their biggest hits.
Horton nixed his chance to get ahead of the curve for once, and acknowledge the PACE study might have some problems. After a judge ruled in favor of an ME/ CFS patient the raw data from the PACE trial data is being independently assessed. We’ll see what happens, but if the data suggests that changes to the trial’s protocols benefited the researchers, the PACE trial will take a big hit – and so will Horton.
Horton should probably note what happened to Queen Mary University of London in its efforts to suppress the PACE data. It floundered about so much it was made to look ridiculous. The Tribunal ruling on the case called some of the QMUL’s arguments “wild speculation” and accused one its defendants of lacking the objectivity demanded by his profession. It asserted that he was unable to distinguish “legitimate ethical and political disagreement”, and that his reports of hostile activist behavior were “grossly exaggerated”. It basically accused one of the QMUL’s main witnesses of an over-reach unbecoming of academia.
In the Dr. Seuss story “Horton Hears a Who” Horton can hear a world that no one else can see. Right now Richard Horton seems to be living in a world of his own – a world where it’s OK to castigate critics and play waiting games instead of responding to inquiries, and allow the plaintiffs to play judge, etc.
He and The Lancet may be in for a surprise.
Horton’s history with the PACE trial had seemed one-sided to many in the ME/CFS camp. Horton could have simply dismissed the criticisms of the trail…
I think that should be trial, not trail. Though the PACE trial did lead down a long rabbit trail. (:
Thanks 🙂
Truth in the medical field, as well as in all fields of inquiry, will out — sooner, during these quickly accelerating evolutionary times, rather than later. Coverups never really expected to be publicly disclosed will widely see the light of day. Horton indeed hears a Who, and the Emperor/s of this medical-industrial power game are seen as they are, more butt-naked by the day. Chronic illness experiencers are waking up exponentially and will act, speak out, educate with much greater results. This is just the beginning of justice for the worldwide neuroendocrine immune/CIR disease communities.
This is not the only subject on which I have heard The Lancet accused of non-objective bias. I like the satirical suggestion about “the opinion pages”, The Lancet certainly seems to be infested with politically correct, progressively left-liberal views just as a lot of “media” are – but bias in actual medical research as it affects the suffering victims of a condition, is a more serious issue.
Hmmm…blaming the victims rather than taking responsibility? I’ve never heard of such a thing.
WINK!
Is there something in the British water supply that causes the doctors over there to be so insufferably stupid? I think I’d rather have ME than be as smug, idiotic, backward, and obtuse as most of them appear to be.
Racist comments like this do not help our cause.
Racist? That is labeling and maybe name-calling, not racist.
I won’t be back to read your reply but if you feel you need to go ahead.
But what Rick stated is NOT RACIST! Just saying “British water supply” is not a racist remark.
“British” is not a race…
I suspect you maybe meant “Xenophobic comments like this do not help our cause”, and I agree.
Morgan and PamJ Consider this definition: “Racism is an ideology that gives expression to myths about other racial and ethnic groups, that devalues and renders inferior those groups, that reflects and is perpetuated by deeply rooted historical, social, cultural and power inequalities in society.” Unfortunately, it does not define race but there are various definitions around, one of the simplest being a group of people sharing history, nationality and/or geographic distribution. Under this definition “British” is a race. To suggest that British doctors in general are “insufferably stupid” and that most of them appear to be “smug, idiotic, backward, and obtuse” most certainly constitute unwarranted and demeaning assertions. By the way I left the grossly politicized British health service in 1982 to work as a doctor in Australia. It was more the system that was the problem and little seems to have changed.
I’m British and so far as the PACE trial goes I agree with you wholeheartedly. Most of our doctors are very dedicated and do their level best, but have to follow national guidelines … which PACE essentially hijacked and distorted. Really hoping that will change in due course now. Maybe something trumps the PACE stupidity.
Doctors tried to bully my proudly ill daughter into GET and CBT because the evidence saying it helped was published in The Lancet.
It appears extremely negligent of Richard Horton to allow the reputation of The Lancet, to be used as a shield to protect Peter White, Trudy Chalder et al….
Gelman suggests that Horton is using the Lancet’s and his reputation as a sort of shield to stop further inquiry. My guess is that Horton feels he can do this because he feels that ME/CFS is kind of weak opponent that he can bully with success. I think he’s going to be wrong and he and Lancet will come out of this looking really bad.
I’m having trouble wrapping my mind around what his motivation might be, especially after his OpEd on rampant fauly scientific literature. Was he saying that the literature is faulty everywhere else, but NOT at the Lancet? Then, what is his connection to the PACE researchers that would give them so much sway, and why would he backtrack as you talked about?
Hmmm. I may be going to far out on a limb with this one, but I’ll say it anyway. I ask myself, who has the most to lose if the Lancet allows for the PACE trials to be fully deligitimized by giving critics such a “well-respected” forum? Who could get Horton to change his position, and put him in a tough enough spot where he would shut down any futher conversation by resorting to name calling and deflection? Surely, it can’t really be the PACE researchers?
I hate to sound like a conspiracy theorist, but I wonder if the British government is somehow involved? Maybe the health ministry has its own agenda when it comes to all this. There’s a lot of money tied up in benefits and services given to ME/CFS patients. Budgets are tight these days.
Then, maybe there are people in charge there who still buy in to the faulty belief that ME/CFS is a psychological problem, and we somehow must be protected from ourselves. Whether the study is accurate or not, we’d have to BELIEVE the methods work, or else we’ll never recover. Blame the victim sort of stuff.
I don’t live in the UK, so I don’t know all the ins and outs, but I suspect there are bigger fish involved somehow.
Great questions. In fact Horton, believe it or not, has called for more researchers to release their raw data!
Horton has been so over the top on the PACE study that I suspect he must have some connections to the researchers. After all, he fast-tracked the study. Why fast-track a CBT study (dozens have been done) which had really moderate results? One would think that fast tracked studies would be of real import – provide information that it was important for researchers or the public to quickly hear but this was not a ground-breaking study in any way….
Horton appears to have a stick up his you know what regarding CGT/GET and ME/CFS.
The PACE study was co-funded by the DWP (Department of Work and Pensions). They have NEVER done this before. They are currently cutting benefits (especially in the disability sector) quite ruthlessly. This whole affair strikes me as being politically motivated.
Ah, now it makes much more sense, Lidia. Is that common knowledge in the UK? Has anyone written anything in the news media making that connection?
When do we stop using the PACE definition of normal range and recovery when NOBODY recovered or obtained normal range?
If we don’t call it as it is who will?
I agree. At least put in something in parenthesis (Recovery nor normal range was ever obtained). Just something. We have to use their original definitions just to point the reader in the right direction but some sort of challenge to that definition should be made right next to their definition.
“The Lancet” – not “Lancet”. Extremely distracting omission.
Great article Cort – you’re doing an awesome job covering all this!
Why did Horton fast-track the paper? If he was induced to do so in some shady way then I imagine he’s keen not to have light shone on that.
BTW – Very good article.
If Horton believes that the problem is “Much ado about nothing”, why is HE being so vexatious? I think that Horton must be the meat in a much bigger sandwich than we are as yet to recognise.
It is amazing to see to what lengths Horton is willing to go to protect his brotherhood in arms (and presumably other characters in this Shakespearean Drama). He is willing to even sacrifice the pride of one of the once most prestigious British medical journals to cover up an even bigger picture. What else lurks?
This is not the kind of sacrifice that Winston Churchill was talking about.
The end result is that we now see the Lancet as no longer a Journal but a magazine!
Horton Fears the Poo
Wasn’t the PACE trial government funded? And isn’t The Lancet first and foremost a British publication? And wouldn’t it cost the government a lot more money if ME/CFS was looked upon as a disease of physiology (not psychology)? I don’t know what if any behind-the-scenes connection Horton has to the PACE study authors, but I do know that most editors are loath to admit they’ve made a big mistake. I’m thinking the only way The Lancet will print a retraction is if many other publications cover this story, showing the PACE results for what they were, practically nil.
Saw this on yahoo…
http://www.businessinsider.com/flawed-lancet-study-me-cfs-chronic-fatigue-2016-9?ref=yfp