About The Lancet medical journal History

The Lancet's prestigious heritage as one of the world's leading medical journals continues to inspire our authors and editors today as they strive for medical excellence in all that they publish.

When Thomas Wakley founded The Lancet in 1823, he announced "A lancet can be an arched window to let in the light or it can be a sharp surgical instrument to cut out the dross and I intend to use it in both senses". This philosophy remains at the heart of the journal today.

The Lancet first appeared on Oct 5, 1823. From the beginning, Wakley's aim was to entertain, instruct, and reform. Instruction came in the form of transcribed medical lectures from the London teaching establishment; entertainment in the early days of the journal came in the form of theatre reviews and piquant political comment. The Lancet has been, first and foremost, a reformist medical newspaper known for its campaigns, for example, our focus on child survival in recent years. Thomas Wakley and his successors aimed to combine publication of the best medical science in the world with a zeal to counter the forces that undermine the values of medicine, be they political, social, or commercial.

The journal was, and remains, independent, without affiliation to a medical or scientific organisation. More than 180 years later, The Lancet is an independent and authoritative voice in global medicine. We seek to publish high-quality clinical trials that will alter medical practice; our commitment to international health ensures that research and analysis from all regions of the world is widely covered. Critical appraisal of research and reviews is ensured by strong Comment and Correspondence sections; The Lancet's opinion and personality is communicated by three editorials every week; fast dissemination of priority issues is delivered by online first publication through thelancet.com; and the continued success of our monthly specialty titles ensures that The Lancet delivers in-depth knowledge in key medical disciplines Between our first online publication in 1996 and today, 1.8 million users have registered at thelancet.com.

From those few hundred copies in London in 1823, The Lancet's global reach has extended to the point where today it delivers the latest medical news and clinical research to every country in the world.

Whether clinical specialist or student doctor, all health professionals will find something at The Lancet online medical journals of interest to them. No longer just the printed word either: audio medical content is now an increasingly popular feature of all The Lancet medical journals.
The Lancet family of journals

Through the 19th and 20th centuries, The Lancet pursued its mission to grow the evidence base that the world's medical community requires to combat the global burden of disease. Entering the 21st century, The Lancet has launched 3 specialty journals in the fields of oncology, neurology, and infectious diseases to allow it to grow that evidence base of clinical medicine further and faster. All Lancet specialty journals have existed as both print and online medical journals since first published.

Together with its specialty journals, The Lancet today makes a crucial contribution to the medical resources available to physicians and health professionals worldwide.
The Lancet: key milestones 1823 Louis Pasteur was only one year old when Thomas Wakley published the first issue. 1867 Lister's antiseptic principle. 1918 Rivers' insights into shell shock therapy that led to a better understanding of what is now known as Post-Traumatic Stress Disorder. 1940 Florey's announcement on the value of penicillin. 1961 The first published signal that thalidomide was linked to birth defects. 1996 Description of new-variant Creutzfeldt-Jakob disease. 2003 Identification of coronavirus as a possible cause of SARS. Reputation and impact

The Lancet has an impact factor of 28.600. The journal is currently ranked second in the general medicine category (ISI Journal Citation Reports, 2007).
Coverage

The Lancet publishes medical news, original research, and reviews on all aspects of clinical medicine and public health. TheLancet.com will shortly see the launch of Article Collections, collating articles in sub-specialties published across The Lancet journals. Please register on this site and opt in to receive emails to receive notification of the launch of The Lancet Article Collections.
Editorial
781
What is health? The ability to adapt
The Lancet
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Health is not a “state of complete physical, mental, and social well-being”. And nor is it “merely the absence of disease or infirmity”. The first part of this formulation is enshrined in WHO's famous founding constitution, adopted in 1946. It was supposed to provide a transformative vision of “health for all”, one that went beyond the prevailing negative conception of health based on an “absence” of pathology. But neither definition will do in an era marked by new understandings of disease at molecular, individual, and societal levels.
782
The USA's crisis of the uninsured
The Lancet
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Roughly 45·7 million Americans—15% of the country's population—lack health insurance. Both wealthy and poorer states have almost a quarter of residents between the ages of 18 years and 64 years uninsured. The US Congressional Budget Office predicts that, nationwide, the number of uninsured people will rise by 10 million in the next decade. And this in a country where health-care expenditure alone is estimated to exceed US$2·5 trillion this year.
782
Acting responsibly
The Lancet
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Worldwide, celebrities sell. Whether it is Oscar-winning actors appearing in drug advertisements in the USA or Bollywood stars promoting soft drinks in India, celebrities can have considerable sway when it comes to consumers' behaviour. Companies who use celebrities to endorse their products can benefit from healthy profits and celebrities usually receive substantial sums of money for their efforts. But what if the product has an unhealthy effect on consumers? Should celebrities just be allowed to quietly exit stage right when something goes wrong?
Comment
783
Peace and health in the occupied Palestinian territory
Jimmy Carter
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32 years ago, one of my highest priorities as President of the USA was to bring peace to the Middle East. For 13 days, I led intense negotiations between Israel and Egypt, resulting in the Camp David Accords in 1978.1 There were two agreements, ratified by an overwhelming vote of the Israeli Knesset. One was a peace treaty that was signed 6 months later between Egypt and Israel, and which has been meticulously honoured by both sides. The other was a commitment by Israel to withdraw its political and military forces from Palestinian territory and grant the Palestinians full autonomy over their own affairs.
784
The occupied Palestinian territory: peace, justice, and health
Richard Horton
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The distances seem short. From Jerusalem to Ramallah is only a few kilometres; from Gaza City in the north of the Gaza Strip to Rafah in the south, 30 km; from Ramallah to Gaza, 70 km. One can drive the length of the West Bank in just a few hours. Yet for those living outside the occupied Palestinian territory, the distances—to peace and justice—seem impossibly vast. The impression conveyed through western media is of a land in perpetual war, a people drenched in hatred, aggression, and violence.
788
Lancet Steering Group on the occupied Palestinian territory
Iain Chalmers, Jennifer Leaning, Harry S Shannon, Huda Zurayk
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Rita Giacaman (founding director of the Institute of Community and Public Health at Birzeit University, Birzeit, occupied Palestinian territory) and Richard Horton (Editor, The Lancet) invited us early in 2007 to join them in a steering group for a Series of reports1–5 about health and health services in the occupied Palestinian territory. Who are we and what did we do?
790
Rectal cancer: optimum treatment leads to optimum results
Robert D Madoff
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Even though the primary treatment of rectal cancer is surgery, there is now widespread agreement that combined modality therapy is often indicated. Debate, however, continues to rage as to exactly what type of therapy to give, when to give it, and who ought to have it. In The Lancet today, two papers from the combined MRC CR07/NCIC-CTG C016 trial shine light on these questions and highlight ongoing challenges.1,2
792
Salt intake in individuals with metabolic syndrome
Gonghuan Yang
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In The Lancet today, Jing Chen and colleagues (the GenSalt Collaborative Research Group) examine the association between metabolic syndrome and the salt sensitivity of blood pressure.1 The study was done in rural areas of northern China from October, 2003, to July, 2005. Because the researchers did not describe the general demography, prevalence of hypertension in the population, and number of hypertensive patients and family members in the selected community, we cannot judge whether there was selection bias and need to view the study as a selected cohort.
794
Advertising on TheLancet.com
Sarah Ramsay
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At the end of last year, we launched a faster and much improved website. As promised, we are continuing to expand the service offered by TheLancet.com and our users can now set up tailored search alerts. The latter allow a user to be notified of each new instance of Lancet content that matches personally selected keywords.
794
Thank you to all our clinical and statistical peer reviewers!
Sabine Kleinert
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Over 3500 advisers from all over the world have again given up time voluntarily and enthusiastically in 2008 to help us here at The Lancet to choose the most important papers. Peer review is still not recognised enough as a valuable academic activity, and yet many clinicians and researchers rightly regard it as an essential part of their contribution to research. In addition to aiding selection, a constructive review becomes part of the intricate process to achieve the best reporting of a research study or presenting of other material.
World Report
795
Medical missionaries deliver faith and health care in Africa
Samuel Loewenberg
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Missionaries have played a long-running part in the history of African health care but now they are more widespread and diverse than ever before. Samuel Loewenberg reports from Tanzania.Mark Guilzon figured he was “living the American dream”. With his wife and four children, he lived in a comfortable home in upstate New York, where he had worked for 15 years as a physician's assistant in cardiothoracic surgery. But Guilzon and his family decided to give it all up after he had what he says was a divinely inspired vision.
797
“Fat taxes” and the financial crisis
Karen McColl
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Introducing taxes on junk foods and subsidies for healthy foods has been hotly debated in several countries. Could such moves build healthier populations and economies? Karen McColl reports.The Governor of New York has proposed a new “soda tax” as part of measures to balance the state's budget following the shortfall caused by the financial crisis. The potential for so-called “fat taxes” on unhealthy foods—or subsidies on healthier foods—to improve public health has been the subject of much debate.
Perspectives
799
A Palestinian physician's memoir of life in Israel
Emma Williams
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Working with Palestinian patients, as I used to do, gave me lessons in stoicism I will never forget. Two women in particular spring to mind, describing their admissions to hospital. One had to clamber over a massive earth mound put up as a barrier across the only road to her village. The other woman had to endure a nightmarish ambulance ride with bullets and missiles screaming overhead. Both were in labour. Both were simply trying to reach hospital to give birth. They live under occupation, which makes life—moving around, getting to school, or town, or work, or hospital—more difficult than can be imagined.
800
A revolutionary doctor
Talha Burki
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He joined the revolution as a doctor: “the Argentine doctor”. Fleeing a fusillade of enemy bullets at the Alegria de Pio, Cuba, in late 1956, the soldier in front of him dropped a box of ammunition. Next to it sat a box of medical supplies. Together, they were too heavy for one man to carry. “I was faced with choosing between my devotion to medicine and my duty as a revolutionary soldier”, Ernesto “Che” Guevara later recalled. He picked up the ammunition.
801
Rita Giacaman and Rana Khatib: promoting health for Palestinians
Jan McGirk
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Rita Giacaman takes the steps two at a time to her office, at a branch of Birzeit University located in downtown Ramallah, the bustling West Bank city near Jerusalem. The stairwell of the Institute of Community and Public Health is bare except for a single philodendron plant that, against all odds, has flourished and grown around the banister and railings with such strength and tenacity that the vine rises for several storeys. The same vitality is evident in both Giacaman and Rana Khatib, who is Director of the institute.
802
Managed fear
Charles Rosenberg
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We live in a world of ambient risk. Most of us in the developed world are part of ageing populations, characterised by chronic diseases, managed but not banished. When we imagine our futures we are necessarily forced to think about disease: how we will live with it and how we will play the roles dictated by its various narratives. It is hard not to contemplate future illness, especially when we are assailed on television and in newspapers and magazines with warnings about weakened bones, compromised arteries, impaired sexual function, and the ominous presence of “precancerous” lesions.
Obituary
804
Sir George Edward Godber
Geoff Watts
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Celebrated UK Chief Medical Officer. Born in Willington, UK, on Aug 4, 1908, he died in Milton Keynes, UK, on Feb 7, 2009.
Correspondence
805
HIV-1 Step Study
Aaron M White
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As detailed by Susan Buchbinder and colleagues (Nov 29, p 1881),1 the first full-scale trial of a vaccine aimed at evoking cell-mediated immunity to HIV-1 failed to achieve its objectives. This failure is considered by Buchbinder and colleagues to reflect a failure of cell-mediated approaches to HIV-1 prevention. In his Comment on the report, Merlin Robb2 suggests that “An even greater emphasis will be placed on developing a vaccine that yields protective humoral responses.”
805
HIV-1 Step Study
Angus Dalgleish, Justin Stebbing
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Two papers document the failure of an HIV-1 vaccine based on gag, pol, and nef genes in an adenoviral vector.1,2 Two explanations are discussed as to why the vaccine failed: the possibility that T-cell immunity needed to be more broadly reactive or qualitatively different from those elicited by this vaccine, and that T-cell-based vaccines alone would not be sufficient to protect against HIV-1 infection or disease.
805
HIV-1 Step Study
CP Hudson
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Susan Buchbinder and colleagues report the failure of the Merck adenovirus vaccine to prevent HIV-1 infection in the phase IIb Step trial.1 There have been calls for a “back to basic science” agenda since the results were announced in September, 2007. The first of the “explanatory” studies has now been published.2 However, basic science explanations for the Step results do not exclude another factor which might have contributed. The possibility of behavioural disinhibition (risk compensation) was examined by Buchbinder and colleagues in the last paragraph of the Results section.
806
HIV-1 Step Study – Authors' reply
Susan Buchbinder, Ann Duerr, Michael N Robertson
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We agree with Aaron White that cell-mediated immune responses have an important role in the control of HIV, and a successful vaccine might well need to be capable of eliciting these types of response. However, we disagree with the statement that “the vaccine used in the Step Study failed to evoke cell-mediated immunity.”
807
Anaesthetic techniques for carotid surgery
Jaideep J Pandit
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In the GALA trial (Dec 20, p 2132),1 all types of regional anaesthesia were grouped as one: “local anaesthesia”. Yet clinical and anatomical studies confirm important differences between simple subcutaneous infiltration, formal “superficial” cervical plexus block, and a deep block. The last two are clinically equally effective,2 anatomical investigations showing that the so-called deep cervical fascia might not exist as a distinct or impermeable entity as previously supposed.3 Solutions freely enter the deep space:4 local anaesthetic placed relatively superficially in the neck will reach the same anatomical sites as that placed more deeply.
807
Anaesthetic techniques for carotid surgery
Lulong Bo, Keming Zhu
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The trial of general versus local anaesthesia for carotid endarterectomy by the GALA group1 shows no definite difference in outcome between the two techniques. How will this finding affect clinical practice or guide future anaesthetic techniques for carotid endarterectomy?
807
Anaesthetic techniques for carotid surgery
Kosmas I Paraskevas, Dimitri P Mikhailidis
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The General Anaesthesia versus Local Anaesthesia for carotid surgery (GALA) trial1 did not show a difference in rates of postoperative stroke, myocardial infarction, or death between patients undergoing carotid endarterectomy under local anaesthesia and those undergoing general anaesthesia.
807
Anaesthetic techniques for carotid surgery – Authors' reply
Steff Lewis, Mike Gough, Andy Bodenham, Charles Warlow
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Jaideep Pandit suggests that careful subgroup analysis of GALA might help establish which regional anaesthetic technique is safer, but GALA will not reliably answer this question. The trial was designed as a pragmatic trial of a policy of general anaesthesia versus a policy of local anaesthesia, and we allowed individual centres to provide these techniques and surgery in the way they currently practised. Thus any subsidiary analysis of individual local anaesthetic techniques will be non-randomised (and, moreover, selected by the anaesthetist after the randomised treatment was allocated), and will have to be interpreted very carefully indeed.
808
EU target of increasing participation of older workers is not realistic
Wim De Ceukelaire, Thomas Engelbeen
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A study by Carol Jagger and colleagues (Dec 20, p 2124)1 found a large variation in the remaining healthy years in men and women at 50 years of age between the 25 EU countries in 2005. They conclude that, especially in the ten “new” EU countries where people have less healthy life-years, the target of increasing participation of older people into the labour force will be difficult to meet.
808
EU target of increasing participation of older workers is not realistic – Authors' reply
C Jagger, JM Robine, H Van Oyen, for the EHLEIS team
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In our paper, we showed that healthy life-years can be a valuable metric on which to base evidence-based policy discussions, as shown by our example of the EU target of a 50% employment rate for older workers.1 We acknowledge that in several countries there is a social gradient with a reduced healthy life expectancy in less privileged social groups2 and based on different measures of socioeconomic position such as educational attainment, job classification, and income levels. More specifically within Belgium, differences in health-expectancy indicators by socioeconomic groups have been published3 and the contribution of disabling diseases such as arthritis, back complaints, asthma, and chronic obstructive pulmonary disease to the social gap in health expectancy has been estimated.
809
The unitary nature of functional psychoses
Dermot Walsh
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The paper by Paul Lichtenstein and colleagues (Jan 17, p 234)1 shows a common genetic basis to schizophrenia and bipolar disorder, and the accompanying Comment by Michael Owen and Nick Craddock2 suggests a unitary basis for these disorders along a continuum, rather than the traditional Kraepelinian dichotomy.
809
The unitary nature of functional psychoses
Andrew E Czeizel
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The findings of Paul Lichtenstein and colleagues1 in Sweden helped us to achieve consensus on a previous debate in Hungary.I have previously assessed the genealogical background and pathography of 21 great Hungarian poets.2 Of these all-male poets, 16 had bipolar conditions, including nine bipolar disorders, and two committed suicide. These 21 poets had 23 children, of whom three had schizophrenia and were admitted to hospital. In chronological order, these three individuals include the youngest daughter of Mihály Vörösmarty (1800–55; author of Szózat [Proclamation], which is regarded almost as a second national anthem); the youngest daughter of Imre Madách (1823–64; author of the play Az ember tragédiája [Tragedy of man], and hailed as the Hungarian Faust); and the only son of Dezső Kosztolányi (1885–1936, disputably the greatest artist of the Hungarian language).
809
Humanitarian crisis in Vanni, Sri Lanka
Oliver Johnson, Anenta Ratneswaren, Fenella Beynon
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Past tragedies have shown us that it takes a bloody slaughter of civilians before the international community reacts to a systematic genocide. Long before the present crisis, atrocities against Sri Lankan Tamils have been flagged by many experts, including the Genocide Prevention Project.1
810
Medical professionals for sale?
L Thomas
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Much has been written in the medical press about the influence of the pharmaceutical industry within the medical profession. Many of the conclusions drawn, it seems to me, are well meaning but rather nebulous theoretical constructs. The question has been seen solely from the medical profession's sadly limited perspective and the views of concerned members of the general public are either unknown or ignored. Please allow me to tell you how this influence can permeate the profession.
811
Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial
David Sebag-Montefiore, Richard J Stephens, Robert Steele, John Monson, Robert Grieve, Subhash Khanna, Phil Quirke, Jean Couture, Catherine de Metz, Arthur Sun Myint, Eric Bessell, Gareth Griffiths, Lindsay C Thompson, Mahesh Parmar, on behalf of all the trial collaborators
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Taken with results from other randomised trials, our findings provide convincing and consistent evidence that short-course preoperative radiotherapy is an effective treatment for patients with operable rectal cancer.
821
Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial
Phil Quirke, Robert Steele, John Monson, Robert Grieve, Subhash Khanna, Jean Couture, Chris O'Callaghan, Arthur Sun Myint, Eric Bessell, Lindsay C Thompson, Mahesh Parmar, Richard J Stephens, David Sebag-Montefiore, on behalf of the MRC CR07/NCIC-CTG CO16 trial investigators , the NCRI colorectal cancer study group
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In rectal cancer, the plane of surgery achieved is an important prognostic factor for local recurrence. Short-course preoperative radiotherapy reduced the rate of local recurrence for all three plane of surgery groups, almost abolishing local recurrence in short-course preoperative radiotherapy patients who had a resection in the mesorectal plane. The plane of surgery achieved should therefore be assessed and reported routinely.
829
Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study
Jing Chen, Dongfeng Gu, Jianfeng Huang, Dabeeru C Rao, Cashell E Jaquish, James E Hixson, Chung-Shiuan Chen, Jichun Chen, Fanghong Lu, Dongsheng Hu, Treva Rice, Tanika N Kelly, L Lee Hamm, Paul K Whelton, Jiang He, for the GenSalt Collaborative Research Group
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These results suggest that metabolic syndrome enhances blood pressure response to sodium intake. Reduction in sodium intake could be an especially important component in reducing blood pressure in patients with multiple risk factors for metabolic syndrome.
Clinical Picture
836
Chilaiditi's sign
Thomas Tzimas, Gerasimos Baxevanos, Nikolaos Akritidis
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A 79-year-old man presented with symptoms and signs of upper respiratory tract infection; he had a history of permanent pacemaker implantation. An upright postero-anterior chest radiograph showed a raised right hemidiaphragm delineated by subdiaphragmatic air. Unlike free air, which forms an uninterrupted crescent-shaped subdiaphragmatic radiolucency, this radiograph showed a haustral pattern of subdiaphragmatic lucency (figure), overlapping the upper border of the liver shadow. On examination, clinical findings suggesting acute abdomen from rupture of a hollow viscus were absent and there was no recent history of abdominal surgery to account for the presence of subdiaphragmatic air.
Series
837
Health status and health services in the occupied Palestinian territory
Rita Giacaman, Rana Khatib, Luay Shabaneh, Asad Ramlawi, Belgacem Sabri, Guido Sabatinelli, Marwan Khawaja, Tony Laurance
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We describe the demographic characteristics, health status, and health services of the Palestinian population living in Israeli-occupied Palestinian territory, and the way they have been modified by 60 years of continuing war conditions and 40 years of Israeli military occupation. Although health, literacy, and education currently have a higher standard in the Israeli-occupied Palestinian territory than they have in several Arab countries, 52% of families (40% in the West Bank and 74% in the Gaza Strip) were living below the poverty line of US$3·15 per person per day in 2007.
Seminar
850
Barrett's oesophagus
Nicholas J Shaheen, Joel E Richter
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Barrett's oesophagus is a metaplastic change of the lining of the oesophagus, such that the normal squamous epithelium is replaced by specialised or intestinalised columnar epithelium. The disorder seems to be a complication of chronic gastro-oesophageal reflux disease, although asymptomatic individuals might also be affected, and it is a risk factor for the development of oesophageal adenocarcinoma, a cancer with rapidly increasing incidence in developed societies. We review the presentation, epidemiology, and risk factors for this condition.
Department of Ethics
862
Moving from research ethics review to research ethics systems in low-income and middle-income countries
Adnan A Hyder, Liza Dawson, Abdulgafoor M Bachani, James V Lavery
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The challenges associated with research ethics in low-income and middle-income countries are complex. The development of effective programmes for reviewing research and protecting participants in these countries engages wider issues surrounding the general stage of development and democratisation of developing-world societies, and cannot be addressed by regulatory processes alone.1 Despite sustained attention to the challenges of research-capacity building by developing countries, there have been few attempts to describe how a country's stage of development relates to the two challenges central to research ethics—protection of research participants and promotion of ethical conduct in research.
Case Report
866
Can clubbing tell you about ears?
Richard SK Chang, Macy MS Lui, David CL Lam, Raymond TF Cheung, Shu-Leong Ho
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