On January 24th, four days after President Xi Jinping made his first public statement about the coronavirus, The Lancet, a British medical journal that has been printed weekly since 1823, published a clinical account of forty-one patients who had been infected in Wuhan. The seven-page paper, which had twenty-nine co-authors and was funded by the Chinese Academy of Medical Sciences, listed the symptoms of COVID-19 that the world now knows by heart. In clear, urgent terms, the paper described how twelve of the patients developed acute-respiratory-distress syndrome and how thirteen required treatment in intensive care. It spoke of cytokine storms—dangerous overreactions of the immune system—and suggested a worryingly high mortality rate. Six of the patients in the study died.
Richard Horton, who has edited The Lancet since 1995, approached the paper as an excited editor—looking for problems, checking that it made sense. It was only when the article appeared in print that he began to fully assess the public-health implications. (In the late nineteen-eighties, Horton practiced as a doctor.) “I really thought, Oh, my god. A very large proportion of patients are being admitted to I.C.U.,” he told me, earlier this week. “This is coming.” At the time, Horton was also working on several other COVID-19 articles. The Lancet published five papers on the outbreak in the last week of January. In Britain, at least, Horton sensed that the authorities weren’t grasping the gravity of the crisis. On January 25th, he tweeted, “Few countries have the clinical capacity to handle this volume of acutely ill patients. Yet no discussion.”
Since then, Horton, who is fifty-eight, has become one of the sharpest critics of the public-health response to the pandemic in Britain, the United States, and other nations whose governments have failed their populations. The Lancet sounds like—and is—a rather forbidding publication. Unlike other leading scientific journals, it does not produce simplified versions of its articles. “The Lancet is not The Economist,” Horton says. “We don’t spend a great deal of time trying to translate research for public consumption.” But Horton is also a polemicist. His Twitter bio reads, “Welcome to a permanent attack on the present.” He has described Donald Trump’s decision to withdraw funding from the World Health Organization as a crime against humanity. He despairs of Jair Bolsonaro, in Brazil. He has accused Boris Johnson of “misconduct in public office,” a criminal offence that can be punished by life imprisonment, for his handling of Britain’s outbreak, which has killed an estimated sixty thousand people. “If somebody says to me, ‘Why are you so angry?,’ I say, ‘Look at the number of deaths,’ ” Horton told me. “Every single citizen of this country should be furious.”
In a manner that is unusual for the editor of a scientific journal, Horton has leaped into the politics of the pandemic. Watching daily coronavirus briefings from Downing Street, which ended this week, after Johnson signalled the end of Britain’s “hibernation,” Horton kept up an acerbic commentary, impugning ministers and the country’s most senior scientists. “COVID-19 will be a case study in the death of independent scientific advice,” he tweeted on April 13th. “This is a mass delusion. Resist. Resist. Rebel,” he wrote on June 9th. In the past three months, Horton has given scathing evidence to Parliament; been cited by the British government in defense of its actions (a tactic that he regards as disinformation); and written a short, angry book, “The COVID-19 Catastrophe”—all while carrying out his day job at The Lancet and undergoing immunotherapy for advanced melanoma, a treatment course that he expects to complete in July.
I spoke to Horton on Zoom at his home, in Muswell Hill, in North London, where he has been since March 23rd, when Johnson announced Britain’s lockdown. Because of his health, Horton has scarcely left the property. He sat at a garden table, wearing a dark T-shirt, in the shade of a deep-red umbrella. The leaves of a large bush framed an empty summer sky. I asked Horton to describe editing The Lancet during the pandemic. “We’ve been deluged with research papers and communications from all over the world,” he said. Submissions to the journal are currently running at four or five times the usual rate; Horton and the editorial team reject about ninety-five per cent of them. “My constant anxiety is, Have we let something go that could be really important?” he said. “I don’t think I’ve ever been in a situation where so much knowledge has been produced in such a short space of time.” He and the journal have struggled to cope. “I don’t think we’ve had the capacity easily to deal with it, and that has stretched all of us,” Horton said. “Inevitably, in moments like that, you get very, very anxious about mistakes.”
On May 22nd, The Lancet published a striking paper about hydroxychloroquine, the antimalarial drug touted, and taken, by President Trump, as a potential treatment for COVID-19. Unlike other studies, which had merely questioned the drug’s effectiveness, The Lancet article claimed that the use of hydroxychloroquine carried a greater risk of heart arrhythmia and death. The paper’s stark conclusions and huge sample size—it purported to use data from 96,032 patients on six continents—halted hydroxychloroquine trials around the world. But, within days, reporters and public-health experts noticed anomalies in the study’s data set, which was provided by Surgisphere, a small tech company outside Chicago. Surgisphere supplied almost real-time “cloud-based health-care data” from 4,402 COVID-19 patients in Africa, which other researchers found improbable. It overstated the number of deaths from the disease in Australia. Thirteen days after the paper was published, The Lancet retracted it. An hour later, The New England Journal of Medicine, the world’s other preëminent medical journal, also retracted a COVID-19 study that relied on Surgisphere data.
Horton described the episode as “a monumental fraud.” (On June 3rd, Sapan Desai, the chief executive of Surgisphere, told the Guardian that there was “a fundamental misunderstanding about what our system is and how it works.”) Horton said that something like this happens every few years. “In some ways, this is normal science,” he said. “Science is not immune to having bad people. There are bad people in society, and there are bad people in science. Science is very vulnerable to deceit. . . . When somebody submits a paper to The Lancet, the first thing I think is not, Do I need to consider research misconduct?” He acknowledged the political appeal of the hydroxychloroquine study, in light of Trump’s remarks. “It certainly excited our editors and peer reviewers about the possibility of answering that question,” Horton said. “And we all made a collective error, and that collective mistake was to believe what we were being told.”
But Horton rejected the criticism of other Lancet papers that have been peer-reviewed and published at speed during the pandemic. On June 1st, the journal published a review, funded by the W.H.O., of studies looking at the relative effectiveness of face masks and social distancing, which has been criticized for its statistical methods. The paper has been alternately cited and debunked by the opposing sides in Britain’s debate about reopening the economy. “A research article is not an event. It’s part of a process of trying to understand a treatment or a disease,” Horton told me. “This time is different. Every paper we publish is scrutinized and dissected. That has advantages. But it also means that conversations about the nuances of work—it’s very hard to have those.” Horton accused some of the scientists who have questioned the paper of using COVID-19 to grandstand and raise their media profile. “That’s very disappointing behavior,” he said.
