How Richard Horton balances science and politics.Photograph by Antonio Olmos / Guardian / eyevine / Redux

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欧洲杯投注软件—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 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, “”—all while carrying out his day job at The Lancet欧洲杯投注软件 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 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, . An hour later, The New England Journal of Medicine, the world’s other preëminent medical journal, also that relied on Surgisphere data.

Horton described the episode as “a monumental fraud.” (On June 3rd, Sapan Desai, the chief executive of Surgisphere, 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欧洲杯投注软件-19 to grandstand and raise their media profile. “That’s very disappointing behavior,” he said.

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Horton’s critics wonder why he still has a job. In February, 1998, a little more than two years into his editorship, The Lancet published a paper by Andrew Wakefield, a gastroenterologist at the Royal Free Hospital, in London, positing a possible link between autism and the M.M.R. vaccine (for measles, mumps, and rubella) in a study of twelve children. Although the paper was measured, Wakefield gave a news conference opposing the use of the vaccine. The imprimatur of The Lancet did terrible harm. Wakefield took his findings to the U.S., addressed autism conferences, and appeared on “60 Minutes.” In 2001, Tony Blair declined to say whether his youngest son, Leo, had been given the shot. Within a few years, the M.M.R.-vaccination rate among British children had fallen by ten per cent. But, even though Wakefield’s work was largely discredited in 2004, The Lancet did not rescind the study for another six years. “I can’t simply retract papers I don’t like,” Horton told Newsweek, in 2009.

The Wakefield scandal gave Horton a reputation for being stubborn, thin-skinned, and too quick to fall for a big story. Horton and Wakefield had been colleagues at the Royal Free Hospital, and, after the study appeared, Horton expressed no regrets about publishing it. “Progress in medicine depends on the free expression of new ideas,” he wrote in a book about medical decision-making, in 2003. “Nobody wanted to believe the existence of the first few cases of AIDS in the early 1980s.” Over the years, Horton’s politics have come to be expressed in studies that The Lancet欧洲杯投注软件 has chosen to publish. He told me that he chose to make “reparations” for the Wakefield paper with a focus on child and adolescent health. Last year, Horton received the Roux Prize, an award that comes with a hundred thousand dollars, for his contributions to population health.

But there have been plenty of scrapes. In 2006, three weeks before the U.S. midterm elections, The Lancet published a claiming that there had been six hundred and fifty thousand excess deaths as a result of the invasion of Iraq, a much higher figure than most estimates. Horton has been a severe critic of Israel. In 2014, he “An Open Letter for the People of Gaza,” signed by twenty-nine Palestinian doctors and scientists, which was widely seen as simplistic and one-sided. Horton backs the environmental movement Extinction Rebellion, which stages acts of civil disobedience around the world. In February, quoting extensively from President Trump’s State of the Union address, Horton launched , a project to improve the health of migrants and oppose the rise of populism, “which is fuelling racism, xenophobia, and hate.” There can be an all-encompassing quality to Horton’s activism. He questions the business of scientific publishing itself, including the all-important “impact factor,” which preserves the dominance of journals such as his own. “We aid and abet the worst behaviours,” Horton in a Lancet editorial, in 2015. “Our love of ‘significance’ pollutes the literature with many a statistical fairy-tale. We reject important confirmations.”

During the pandemic, Horton has sought to merge almost entirely the scientific mission of The Lancet with a political purpose, while allowing each side to proceed by a different method. “One part of that story, we’re trying to deal with it in as objective a way as possible, and make judgments only about the science,” he told me. “But, at the same time, we’re trying to constantly assess and arrive at some preliminary conclusion or verdict about the political response. And that is obviously not objective. That is clearly political and requires a subjective and often deeply emotional response.”

The risk is that errors—and overreach—on one side of the journal can undermine good work on the other. In our conversation, Horton acknowledged that it was “a very difficult encounter to manage.” Nonetheless, the line between the science of COVID欧洲杯投注软件-19 and its politics is the one he has chosen to patrol, attacking others for their missteps in the process. Some of his most pointed criticisms have been of Britain’s chief medical officer, Chris Whitty, and the government’s chief scientific adviser, Patrick Vallance, and their deputies, for endorsing Johnson’s botched response to the pandemic. “We’ve seen this very bizarre collusion between the scientists and the politicians, in a way that discredits both,” Horton told me. “I know Chris and I know Patrick, and they’re both very good people. But something in the system or their voice in government went catastrophically wrong. They will deny this, but that’s what needs to be overhauled.”

Earlier this month, Sally Davies, Britain’s former chief medical officer, the Observer that she thought Horton’s vehemence during the pandemic arose, in part, from a sense of guilt over the M.M.R. affair. “I think with Covid . . . he’s repaying his debts,” she said. Horton disagreed. “I definitely felt a responsibility for that. But that was in 1998,” he said. “The reason why I’m speaking out, I would say, is because of those five papers we published in the last week of January. But, secondly, it’s my health situation.” Horton has undergone surgery three times for his melanoma, which started as a mole on his temple. Last spring, he spent time at the Royal Free Hospital, where he and Wakefield had worked. “I basically owe my life to the N.H.S.,” he said. In March, Horton started to receive texts and messages from doctors and nurses who were struggling to source P.P.E. and contend with the surge of COVID欧洲杯投注软件-19 patients. Two pages of his book are taken up with their appeals: “We need protection”; “Total carnage”; “Humanitarian crisis.” Horton’s cancer treatment was interrupted by the pandemic. “It’s very important to remind people that health workers did an incredible job,” he said. “But the N.H.S., over all, did not cope, despite their incredible work, and that was because we were inadequately prepared.”

It has been hot in Britain this week. The day after I spoke to Horton, Johnson announced that most of the country’s coronavirus restrictions—including the shutting of hotels, restaurants, and hair salons—would be eased, beginning on July 4th. We held a birthday party for my daughter in the park. In the days that followed, huge numbers of people headed for beaches on the south coast, prompting the police to declare an emergency. Everyone was so eager for this to be over, to think of other things. Like many people who have spent this year operating at the intersection of the disease and our many flawed responses, Horton is fascinated by the Spanish flu pandemic of 1918. “There was no memory of it imprinted in our culture,” he said. “And nobody fully understands why that was. Maybe people just wanted desperately to look forward and not back. And that’s very understandable. You actually just want to move on into a different time, and there is a risk . . .” Horton’s voice trailed off just for a moment, as he searched for the next phrase that might cut through. “COVID欧洲杯投注软件-19 is a moral provocation,” Horton said. “It’s not just a health emergency.”


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