Politics, medical journals, the medical profession and the Israel lobbyBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2377 (Published 12 May 2015) Cite this as: BMJ 2015;350:h2377
- 1University College London, London, UK
- 2François-Xavier Bagnoud Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, USA
- Correspondence to: J S Yudkin
In April, Reed Elsevier, publishers of the Lancet, received a complaint written by Professor Mark Pepys and signed by 396 physicians and scientists, including five Nobel Laureates.1 They protested that the Lancet was being used for political purposes and for “publication of deliberately false material which deepens polarization between Israelis and Palestinians.”
The most recent example of what was termed this “political vendetta” was the July publication, during the latest Israeli assault on Gaza, of an “Open letter for the people in Gaza.”2 They wrote that the letter “contains false assertions and unverifiable dishonest ‘facts,’ many of them libellous,” and that its authors had failed to declare possible conflicts of interest. The complaint insisted that the July letter be retracted (disagreeing with the Lancet ombudsman’s decision3) and that it contravened the code of the Committee on Publication Ethics (disagreeing with a former chair of the committee4). It asked for the support of all scientists and clinicians “on whom they [Reed Elsevier] depend for their business,” adding “none of us is under any obligation to submit and review material for publication in their journals or to serve on their editorial or advisory boards.”
An email chain soliciting support for this complaint was more explicit.5 In it Pepys accused the July letter of “viciously attacking Israel with blood libels echoing those used for a thousand years to create anti-Semitic pogroms” and being “written by dedicated Jew haters.” He suggested that the letter “would have made Goebbels proud” and that “anybody who was not a committed anti-Semite would firstly not have published Manduca [lead author of the July letter] and secondly would have retracted instantly when her long track record of blatant anti-Semitism were [sic] exposed.” Two days before the complaint, the title of the email chain was modified to read “DO NOT CITE The Lancet in your work—Their content includes fraudulent data.”6
The July letter included a UN estimate of the number of Gazan children killed up to that date during the Israeli bombardment,7 which the Pepys email implied was exaggerated. The UN Office for the Coordination of Humanitarian Affairs (OCHA) has estimated the cumulative number of Palestinian children killed during the conflict as 5518; the estimate of Defence for Children International Palestine is 547, around two thirds of whom were aged 12 years or younger.9 A report cited by the Telegraph recorded that 137 children were killed during 15-22 July 2014, including 59 on 20 July, two days before the letter was published.10 Reports on the conflict from OCHA,7 Physicians for Human Rights—Israel,11 B’Tselem,12 and Amnesty International13 all concur that the July letter’s allegations of disproportionality in civilian deaths and injuries and of targeting residential areas, schools, power and water treatment plants, and medical facilities and staff were probably not overstated. None of these humanitarian or human rights organisations imputes a motive regarding these findings. Certainly the outcomes raise issues of adherence to principles of international law and norms of humanity.
Medicine cannot avoid politics
These events raise two issues. The first is the appropriateness of medical journals discussing political issues that have bearing on health, including civilian mortality and morbidity. The Gaza letter in the Lancet provoked a statement from senior editors and presidents of diabetes and endocrinology associations saying that their “journals will refrain from publishing articles addressing political issues that are outside of either research funding or health care delivery.”14 In response, an editorial in the European Journal of Public Health referred to the upstream determinants of patterns of nutrition and physical activity that are driving the diabetes epidemic, quoting Virchow, who taught that “Medicine is a social science and politics is nothing else but medicine on a large scale.”15 The Lancet’s editor, Richard Horton, has transformed it into the leading journal in global health, with politics being intrinsic to many issues that the journal covers. If medical journals are fearful of entering the debate where medicine, politics, and ethics intersect, it is hardly surprising that professional associations are even more reluctant to do so.16 Yet to avoid such debate is to remain obdurately silent in the face of important trends and events that impact negatively on the wellbeing of individuals and groups. Inevitably, controversy will ensue, but this is a healthy aspect of public discourse on political matters.
The second issue is the similarity between this complaint’s attempt to stifle coverage of the conflict in Gaza and previous examples of writing campaigns provoked by articles in medical journals critical of Israeli policies, including allegations of hyperbole, accusations of antisemitism, and threats of boycott.17 18 Criticism of Israel, or more specifically of Israeli government policy, is not ipso facto antisemitic, and to label it as such is a tactic to stifle debate. It is possible to be a non-Jew or Jew (or in the case of one of the authors, Jew-ish19) and to oppose Israeli actions or policies without being antisemitic. One former medical journal editor who has been subjected to such a campaign believes that “the best way to blunt the effectiveness of this type of bullying is to expose it to public scrutiny.”18 This is the purpose of this editorial.
The reports published by the UN and others all point to the need for an independent investigation into the conflict by international teams of humanitarian, arms, and legal experts to determine whether and by whom—from either side of the conflict—violations of international human rights and humanitarian law were committed. The effect of this war on civilian mental health, morale, and assets is magnified by the cumulative burden of still destroyed houses and livelihoods dating from previous conflicts. As a deputy editor of The BMJ has pointed out, “Future generations will judge the journal harshly if we avert our gaze from the medical consequences of what is happening to the occupants of the Palestinian territories and to the Israelis next door.”20
Cite this as: BMJ 2015;350:h2377
Competing interests: We have read and understood BMJ policy on declaration of interests and declare JSY is a member of the steering group of the Lancet Palestine Health Alliance and a signatory of Jews for Justice for Palestinians. He was formerly the director of UCL’s International Health and Medical Education Centre, which was supported by the Lancet and its editor with sponsorship of an annual IHMEC-Lancet lecture and for an annual Lancet essay prize. JL is a collaborator of the Lancet Palestine Health Alliance and was a member of the steering group for the 2009 Lancet series on the health status and health services in the cooupied Palestinian Territory. She has visited Israel and Palestine several times during the past 30 years to explore the effect of the conflict and participate in human rights investigations sponsored by Physicians for Human Rights—USA, an organisation she cofounded. She was a member of the independent fact finding mission into Operation Protective Edge coordinated by Physicians for Human Rights—Israel.
A response to the complaint to Reed Elsevier, written by five clinicians and scientists including one of the authors, can be viewed at http://handsoffthelancet.com.
Provenance and peer review: Commissioned; not externally peer reviewed.