A prominent medical journal published pseudo-scientific attacks on Israel for years—until it took the demonization one step too far. What accounts for its unprecedented turnaround?

The British publication The Lancet is one of the most influential medical journals in the world, and for many years, was used as a major platform for anti-Israeli demonization campaigns under the façade of science and medicine. Between 2001 and 2014, 264 articles on Palestinian and Israeli issues were published, a majority consisting of political opinion or commentary with little medical content.[1] Many included distorted or unsupported claims that Israel was responsible for premature births, deaths of Palestinians at checkpoints, cancer deaths, psychological disorders, and more.[2] In addition, The Lancet’s editor Richard Horton repeatedly condemned Israel, repeating the false allegations, for example, that “Tens of documented deaths, including of children, have been attributed to checkpoint delays.”[3]

These statements and publications were, and continue to be, used as sources in anti-Israel campaigns, particularly in the health field. For example, a resolution introduced at the 2013 meeting of the American Public Health Association, referring to “apartheid-type policies in the occupied lands of Palestine,” included 16 references to The Lancet.[4]

However, in September 2014, these attacks abruptly ended. Horton accepted an invitation from doctors at Haifa’s Rambam Hospital to visit Israel, and in public appearances and media interviews, expressed regret. He announced a new project that would portray Israel in a positive light, and in 2017, The Lancet published a special volume on Israeli contributions to medicine. This remarkable reversal is unparalleled among major platforms used in anti-Israel demonization campaigns.

As described in detail below, the immediate trigger for the unprecedented turnaround in 2014 was a exposé published in the “Health News” supplement of The Telegraph under the headline “Lancet ‘hijacked in anti-Israel campaign': Senior British medical figures say the well-respected journal is being used as a platform by alleged conspiracy theorists.” The article, based on NGO Monitor’s research, highlighted the activities of two frequent contributors and co-authors of a virulent anti-Israel “open letter for the people of Gaza” published in The Lancet. These authors promoted “the views of David Duke, a white supremacist and former Ku Klux Klan Grand Wizard,” including pushing a video entitled “CNN Goldman Sachs & the Zio Matrix.” The video features an anti-Semitic rant by Duke on how “the Zionist Matrix of Power controls Media, Politics and Banking” and Jewish “racism and tribalism to advance their supremacist agenda.”

The Lancet’s remarkable reversal is unparalleled among major platforms used in anti-Israel demonization campaigns.

The article, coming amidst wide criticism in the medical community over the Gaza letter, forced Horton to defend his position and his carefully cultivated public image. By his own admission, he was deeply troubled by the association with racism and anti-Semitism. Moving very quickly, within one week after the Telegraph article, Horton made his appearance on the stage at Rambam hospital, and abruptly ended the use of The Lancet for political attacks on Israel.

The following analysis takes a close look at the history of The Lancet’s anti-Israel narrative, the role of Horton and other key players, and the processes and factors by which this role was brought to an end. On this basis, I will ask the question of what lessons can be learned from this case regarding the use of various platforms for anti-Israel campaigns, particularly among academic and scientific frameworks.

The Lancet‘s central role in anti-Israel demonization began in parallel to the wider political war launched in late 2000, at a time of violent clashes between Palestinians and Israelis. The scenes of the alleged death of a Palestinian child Mohammad al Dura broadcasted repeatedly around the world, followed by mass terror attacks and Israeli responses, and the chorus of condemnations of Israel for “deliberate killing of Palestinians,” created the conditions for efforts to demonize Israel. In this context, the NGO Forum of the UN Durban Conference in September 2001 launched a campaign aimed explicitly at the “complete international isolation of Israel as an apartheid state,” including through the use of boycott campaigns.

It was during this period that The Lancet began publishing numerous articles advancing this poisonous political agenda, through allegations of medical and health related abuse of Palestinians. This activity took place under the aegis of Richard Horton, who has held the position of Editor in Chief since 1995[5] and who frequently generates controversy by using the journal to gain visibility for his pronouncements on major social and political issues associated with progressive liberal agendas. In this context, Horton joined the Palestinian cause, reinforced through close association with highly politicized non-governmental organizations (NGOs) such as Medical Aid for Palestinians (MAP) and Physicians for Human Rights Israel (PHR-I).[6] Under Horton’s direction, The Lancet and MAP co-sponsored The Lancet-Palestinian Health Alliance (LPHA), generating a steady flow of pseudo-scientific papers, and, in turn, providing Horton with political support and visibility.

One of Horton’s closest supporters, and a contributor of several articles to The Lancet, was Sir Iain Chalmers – an accomplished medical researcher and consistent pro-Palestinian advocate who frequently attacks “the Zionists” and the “many different domains that they control.”[7] In December 2013, at an LPHA event, Chalmers made a presentation that featured numerous attacks on “Zionists”, including highly offensive cartoons. In response to a question from an audience member, he declared, “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.”[8]

Similarly, Dr. Derek Summerfield is credited as being the catalyst that encouraged Horton “to take an interest in the Palestinian territory.”[9] In a 2008 interview[10] with Egypt’s Al-Ahram Weekly, Summerfield acknowledged that he has “always been angry at Israel,” and declared that, “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).[11]

Dr. Swee Ang Chai, co-founder of MAP, was another central figure in The Lancet campaign and a frequent contributor to anti-Israel demonization, and the introduction from her book From Beirut to Jerusalem was posted on The Lancet’s “Global Health Network” website. The article, which included no citations and advanced no medical claims, was removed 28 days later following widespread criticism of “factual inaccuracies.” Another piece by Swee Ang cited testimonies of unnamed “eyewitnesses” to make war crimes allegations related to the 2009 Gaza conflict.[12] In addition, she participated in an internet group that promoted David Duke’s racism and anti-Semitism, including promoting a video titled “CNN, Goldman Sachs, and the Zio Matrix” in which Duke accuses Jewish banking, media and political figures of conspiring to create “an unholy tribal alliance.”[13] As detailed below, it was this facet of Swee Ang’s activity that was exposed by NGO Monitor in 2014, triggering the “naming and shaming” that forced Horton to abandon the Palestinian cause and the demonization of Israel.

These and other authors published the 264 articles and abstracts on Palestinian and Israeli issues in The Lancet between 2001 and 2014, the majority of which bashed Israel and largely erased Palestinian terror attacks, including the thousands of rockets from Gaza aimed at Israeli civilians. Many used medical issues as a thin façade for ideological attacks, such as a 2011 piece by Ruchama Marton, founder of the highly politicized PHR-I, that promoted the Palestinian statehood campaign at the United Nations.[14]

The Lancet published 264 articles and abstracts on Palestinian and Israeli issues between 2001 and 2014, the majority of which bashed Israel and largely erased Palestinian terror attacks.

When there was some mention of health, Israeli policy was always guilty. The Lancet published a number of articles pushing the bogus theory that the sonic booms caused by Israeli planes flying over Gaza (with no reason, apparently) caused health and mental health implications for pregnant women and children.[15] (According to a University of California study unrelated to the Middle East, “no convincing evidence was found to prove or disprove the existence of adverse health effects due to exposure to sonic boom.”[16]) Likewise, Horton gave a platform to Eyad El-Sarraj, founder of the Gaza Community Mental Health Programme (GCMHP) and an accomplished political advocate, thanking him for assistance with series on “The Occupied Palestinian Territory: Peace, Justice, and Health.”[17] In February 2014, The Lancet published an obituary praising Sarraj as a “pillar” whose career was a “mixture of medicine and activism,”[18] and describing GCMHP as an organization with an “ethos of respect for justice and human rights,” with its major target groups being “children….and victims of organized violence and torture.”[19]

In parallel, the dysfunctional Palestinian health infrastructure, internal violence (including between Hamas and Fatah), mismanagement, and corruption were off-limits under Horton.[20] An article entitled “Emergency preparedness and response of the Palestinian health system to an Israeli assault on the Gaza Strip, occupied Palestinian territory, in 2012: a qualitative assessment” simply blamed “Israeli violence.” Two of the authors, Ghassan Zaqout and Aed Yaghi, were affiliated with the Palestinian Medical Relief Society (PMRS), a political NGO that alleges Israeli methods of “collective punishment,”[21] the supposed use of “non-conventional weapons against civilians,” and plans to “oust the Palestinians…[and move them] into densely populated enclaves fully controlled by Israel and geographically separate.”[22]

Horton did not limit himself to selecting and publishing these pieces, and also authored articles alleging Israeli wrongdoing, including a 2007 New York Review of Books (NYRB) screed titled “The Palestinians: The Crisis in Medical Care.”[23] He described his meetings in Gaza with Palestinian doctors and with several Israeli NGO activists, repeating allegations that “Tens of documented deaths, including of children, have been attributed to checkpoint delays. Most Western citizens and perhaps many Israelis are unaware of the living conditions endured by ordinary Palestinians.” He also extensively quoted Rita Giacaman, from Ramallah’s Birzeit University and another frequent contributor to anti-Israel campaigns. As demonstrated in a detailed critique by Dr. Elihu Richter from Jerusalem’s Hadassah hospital, Horton’s piece consisted primarily of myths and “did not have one single reference to the 2774 rockets, missiles and mortars that have been targeted at the civilian population in Sderot…”^[24]

Horton’s anti-Israel advocacy also included public events, such a 2012 MAP event, “Pitching for Palestine,”[25] where he passionately (and falsely) alleged that because of Israel, Palestinians have no access to health care:

“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 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. ….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.”

In December 2013, at an LPHA event, Horton repeated Summerfield’s attack on the Israel Medical Association (IMA)[26] and in April 2014, he signed MAP’s call for an “end to Israel’s demolition of Palestinian homes.”[27] In parallel, the impact of The Lancet and its editor as seemingly unimpeachable scientific sources for demonization of Israel, and particularly for BDS (boycott, divestment, and sanctions) campaigns, continued to grow.

On July 23, 2014, in the midst of the 50-day Gaza war, The Lancet took a further step in anti-Israel campaigning, in the form of the high profile “Open Letter for the People of Gaza,”[28] alleging massive “war crimes.” The letter referred to accusations of the use of poison gas, stating that “should the use of gas be further confirmed, this is unequivocally a war crime for which, before anything else, high sanctions will have to be taken immediately on Israel with cessation of any trade and collaborative agreements with Europe.” For readers, it was clear that The Lancet was comparing Israel to Nazi Germany and its response to Palestinian terror to the Holocaust.

Following the now standard pattern, the letter also ignored Hamas’ crimes of rocket attacks and terror tunnels from Gaza into Israeli territory. Instead, the five principle authors and the 24 co-signatories accused Israel of carrying out a propaganda campaign that “justifies the creation of an emergency to masquerade a massacre.”[29] In addition, The Lancet also solicited and collected more than 20,000 email signatures to “support the letter.”[30]

As discussed above, the main authors, including Chalmers, Summerfield, and Swee Ang had long records of anti-Israel campaigning and anti-Semitism. The first listed author, Paola Manduca, had also published attacks in The Lancet, including a co-authored paper on alleged increased birth defects in Gaza, in which the author acknowledged funding from Interpal (designated as a terrorist entity by the United States)[31] and cooperation with “the Ministry of Health, Gaza Strip,” an arm of Hamas.[32] Manduca is also a leader of the New Weapons Committee (NWC), a radical fringe group. Another co-author – Mads Gilbert from Norway – frequently promoted the Hamas line from Shifa hospital in Gaza, which reportedly housed the terror leadership during the wars. Gilbert also expressed understanding for the September 11 terrorist attacks.[33]

The virulence of these allegations triggered massive denunciation of Horton and The Lancet, particularly among leading medical professionals. A letter was published on behalf of 1,234 Canadian physicians condemning “an apparent oversight in the process leading to the publication…” and noting that the “authors have important conflicts of interest that are not consistent with their declaration of no competing interests.”[34]

In parallel, NGO Monitor, which had written a detailed study of The Lancet‘s role in anti-Israel demonization through medical and health allegations,[35] published evidence that two frequent Lancet contributors and authors of the “Open Letter” – Manduca and Swee Ang – promoted a virulently anti-Semitic video made by the American white supremacist David Duke.[36] This blatant link between The Lancet letter and crude anti-Semitism was the critical evidence that changed the equation.

On September 22, 2014, Jake Wallis Simons published a detailed article in the prestigious “Health News” supplement of The Telegraph (UK) headlined “Lancet ‘hijacked in anti-Israel campaign’: Senior British medical figures say the well-respected journal is being used as a platform by alleged conspiracy theorists.” The article quoted a number of top medical figures, including Professor David Katz, one of the UK’s most accomplished doctors. According to Katz:

“For many years, The Lancet has been consistently using its reputation to attack Israel…The Lancet is supposed to be a politically neutral medical journal. The fact that they have given proven anti-Semites a platform and not rescinded it, even when confronted with the evidence, is appalling. They have allowed their hatred of Israel to blind them to the norms of medical science and the pursuit of reason.”

In addition, Wallis Simons cited a public letter to The Lancet from senior medical professionals noting:

“The failure of the Menduca et al authors to disclose their extraordinary conflicts of interest…are the most serious, unprofessional, and unethical errors. The transparent effort to conceal this vicious and substantially mendacious partisan political diatribe as an innocent humanitarian appeal has no place in any serious publication, let alone a professional medical journal, and would disgrace even the lowest of the gutter press. Horton’s behavior in this case is consistent with his longstanding and wholly inappropriate use of The Lancet as a vehicle for his own extreme political views. It has greatly detracted from the former high standing of the journal.”

This article in the mainstream British media, which featured a large photograph of David Duke, suddenly put Horton and The Lancet on the defensive. Initially, Horton told The Telegraph that the NGO Monitor revelation was “…utterly irrelevant. It’s a smear campaign,” adding that, “I don’t honestly see what all this has to do with the Gaza letter. I have no plans to retract the letter, and I would not retract the letter even if it was found to be substantiated.”[37]

But the pressure on Horton and calls for his resignation, including correspondence with the publisher, Reed Elsevier, increased. Critics wrote that “due to the failure to adequately scrutinize the letter and those who authored it, The Lancet allowed itself to be used as a forum for the dissemination of pure and unfettered anti-Israelism.” They referred to the authors of the Gaza letter as “motivated, not by ‘the survival, health, and wellbeing of Gaza’s and Israel’s civilian residents,’ but by views that indulge in conspiracy theory and flirt with anti-Semitism.”[38]

Over the next few months, over 4,000 medical professionals signed “A call to action to institute guidelines governing ethical publishing of science and medicine free of divisive political opinion” and demanded a change in “the corporate behavior of Elsevier.”[39] Another group known as the Concerned Academics Group called for the retraction of the letter, a public apology, and steps to ensure that “any future malpractice at The Lancet is prevented.”[40] Leading researchers from prestigious institutions sent letters to Reed Elsevier announcing that they would not contribute, serve as referees or on the editorial boards of related journals.

In response, Chalmers and Summerfield created a counter group, called “Hands off the Lancet,” which garnered 1,303 signatures.[41] The group claimed that “The heavy-handed attempt to force The Lancet to withdraw the Open letter is the latest in a series of attempts to stifle media coverage of the Israel-Palestine issue and should be resisted.”[42] Horton also published letters defending the Gaza letter, but these did not blunt nor offset the growing criticism.[43]

A week after the article in The Telegraph appeared, Horton accepted (or initiated, according to some reports) an invitation from a group or prominent Israeli doctors led by Prof. Karl Skorecki and Dr. Mark Clarfield to immediately visit the Rambam Hospital in Israel. After numerous visits and conferences involving Palestinians, this would be his first public visit to Israel. In response, a number of public figures and medical professionals criticized the invitation as whitewashing Horton’s moral transgressions and providing impunity.

On October 2, after three days of “seminars and meetings with senior researchers and physicians,” Horton addressed the hospital’s weekly grand rounds before a packed auditorium of Israeli medical professionals and journalists.[44] His speech was also posted on YouTube.

In a marked contrast to his earlier comments and rejection of any criticism, particularly in The Telegraph, Horton now claimed to “deeply, deeply regret the completely unnecessary polarization that publication of the letter” caused.[45] He also said he was “personally horrified at the offensive video…The world view expressed in that video is abhorrent and must be condemned, and I condemn it.”[46] In media interviews and a subsequent essay in The Lancet,[47] Horton sought to soften the impact by referring to the letter as “well intentioned, because it was this cry of anguish,” but “it did not convey the level of complexity that is the reality in Israel.”[48] He furthered acknowledged that the letter referred to the “extreme polarization of already divided positions” as “an unintended outcome,” adding “this schism helped no one and I certainly regret that result. I have seen for myself that what was written in the Manduca et al letter does not describe the full reality.”

Nonetheless, under questioning in Israel and later, he refused to explicitly apologize for publishing the letter or to retract it and the previous anti-Israel articles.[49] Horton did not accept responsibility for the failure, admit any wrong-doing, and at times, even portrayed himself as a victim. In his statements on the issue, he limited his comments to the Manduca et al Gaza letter, referring to this as “the unfortunate episode.”

Substantively, as part of his damage limitation strategy, Horton immediately stopped publishing the anti-Israel articles, including from the authors affiliated with MAP, PHR-I, and other politicized NGOs. Between August 2014 and June 2016, no such articles were published, and although the LPHA conferences continued, the abstracts and papers were no longer published in the pages of The Lancet. Horton was keenly aware of the ongoing criticism, including pressure on Reed Elsevier and follow-up articles months later in the UK mainstream media.

As Horton had announced during his October 2014 visit, the process of publishing a Lancet series on Israeli medical contributions began. Submissions were solicited, and in May 2017, the special issue focusing on health in Israel, edited by Dr. Mark Clarfield, was published in English, Hebrew, and Arabic.[50] Horton wrote that he “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.”[51]

Together with halting the role of The Lancet as a major platform for demonization of Israel, the events marked an important defeat for BDS and related campaigns. However, considerable damage was done, and in the absence of a retraction, the numerous pseudo-scientific articles continue to be cited.

Given the important roles played by Horton and The Lancet in legitimizing BDS campaigns through medical and scientific claims, it is worthwhile to step back and examine the broader lessons that can be learned, particularly in the sharp reversal that took place. Can this experience be applied to other academics and professionals who have joined the anti-Israel campaigns, and who might be persuaded to reverse course?

Horton’s behavior in a wide sense is complex, and his motivations for promoting the anti-Israel agenda are subject to debate. Was he initially misled by anti-Israel (and anti-Semitic) friends and colleagues, as well as overwhelmed by the media reports of Palestinian suffering, while failing to understand the impact of decisions that he had made repeatedly, as he (partially) claimed following the storm engendered by the Gaza letter? Was he a conscious participant in the Israel-bashing who knowingly and cynically published articles based on invented or false allegations and who suddenly underwent a fundamental change of heart and allegiance? Or is he a clever self-promoter and accomplished orator who pandered to the proponents of the Palestinian cause when it benefited his career, and stopped when the costs exceeded the benefits, threatening his public image and position?

The explanation that invokes anti-Semitism is based on the vitriol that Horton used in vilifying Israel. In 2008, Dr. Elihu Richter wrote that Horton’s profile fits that of “an upscale variant of classical anti-Semitism” – a pattern common among British elites, and reflected in the behavior of some of his colleagues, including the co-authors of the Gaza letter.[52] In rejecting the anti-Semitism charge, Horton complained that “my daughter goes to a school where there’s a strong Jewish community. We had parents coming into our house…and shouting at my wife, accusing her of being anti-Semitic because of me. My daughter would come home from school saying to me, ‘Dad, why do you hate Jews?’ …The irony is that my wife’s father is Jewish, and his mother escaped from Russia during the pogroms to Ellis Island.”[53]

Self-serving rhetoric aside, the details and rapid reversal that began in late September 2014 do not fit the profile of theological or ideological anti-Semitism, and other explanations are more convincing. From the beginning of his tenure as editor, Horton courted and created medical as well as political controversy in order to promote himself and The Lancet. In these cases, Horton was quick to dispense with blind peer review and fact-checking requirements normally expected from scientific publications, declaring the processes “biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish, and frequently wrong.”[54]

For example, in 2006, Horton ran an article claiming to assess civilian deaths in the Iraq War (Burhman et al, 2006),[55] which was criticized as a gross over-estimation possibly based on unethical and fabricated research methods.[56] His actions and the debate that followed, however, gave him increased visibility, leading to invitations for speaking engagements around the world and enhancing his personal brand.

The most visible example and greatest controversy resulted from Horton’s 1998 decision to publish an article spuriously linking childhood vaccinations to autism. In 2010, after more than a decade of angry exchanges refuting the scientific validity of the claims and accusing Horton of professional failure, The Lancet officially retracted the article and UK medical authorities revoked the author’s license.[57] Horton’s adoption of Palestinian victimization and demonization of Israel, and the publication of the 2014 Gaza letter are consistent with these and other examples of courting publicity and visibility in order to enhance his standing.

However, the publication of the Gaza letter and the criticism of the crudely anti-Semitic dimensions made the systematic demonization of Israel and support for the Palestinian cause were too costly. The effort led by major medical and scientific figures to convince Reed Elsevier, The Lancet’s publisher, to remove Horton as editor was a tangible threat that has continued for a number of years.[58] The attempts by his old allies to counter this pressure were insufficient, and Horton apparently realized that to maintain his position, he had to reverse course.

Thus, Horton expressed regret for the Gaza letter, but never apologized, nor did he retract the numerous articles promoting Palestinian propaganda. He acted as if some hidden hand led to the sudden appearance of the Gaza letter on the pages of The Lancet – ex machina – in a manner that he could not control. In his October 2014 comments, he quickly moved the discussion to the future, stating the goal of seeking “use this moment to nurture something positive and long lasting, which I firmly intend to do.”[59]

In looking beyond Horton to other cases in which scientific and medical professionals abuse their positions for antisemitism and to promote false allegations to demonize Israel, “naming and shaming” can play a central role when there is sufficient leverage. Horton’s public reputation was important to him, and as soon as he saw that this reputation was endangered, he moved to limit the damage. In contrast, Stephen Rose – a British professor of biology and a leader of the anti-Israeli academic boycott – embraced his radical reputation, including demonization of Israel. There was no source of leverage on Rose – he could not be forced out of his position over political actions. Horton, in contrast, as editor of The Lancet, occupies what is essentially a commercial position, where a loss of reputation can be costly.

While naming and shaming worked in this case, particularly because of Horton’s lack of due diligence in vetting crudely antisemitic authors like Manduca and Swee Ang, it is difficult to extend the same approach to other examples. The case of Horton and The Lancet are important for understanding political warfare, but at the same time, the ability to apply the relevant tactics and strategy is limited.