Straight to the point

by Dr David Bell

The Lancet was once a medical journal

There is supposed to be a clear line between medical publishing and propaganda. No less so than in the pages of the Lancet, previously been considered a relative bastion of integrity in publishing. Honesty in medical publishing, meaning publication on the basis of transparent rigorous review and impartiality, is of particular importance to medicine and public health. The outcomes of such publications contribute to saving or killing people.

In 2020 Lancet published an apparently fraudulent study discrediting the use of hydroxychloroquine in the management of COVID-19. While this was later withdrawn, it should not have passed first glance of a serious editor as the data published by a previously unknown institution could not credibly have been collated in the timeframe concerned.

A Lancet ‘commission’ to investigate the origins of SARS-CoV-2 included people who had direct conflict of interest as they would potentially be culpable if its findings revealed a lab-based origin. This followed the publication of a letter stating that a lab-release origin of SARS-CoV-2 was a ‘conspiracy theory’ and ‘misinformation’, despite the first cases being reported within a few miles of the Wuhan Institute of Virology where research on SARS-like viruses was being performed, hundreds of miles from the habitat of the putative zoonotic hosts. Lancet again apparently missed the obvious conflict of interest in this letter’s authorship until forced to confront it.

Together with Lancet’s unquestioning acceptance of mass-vaccination in countries with very low mortality and high competing priorities, and its pushing of ‘zero-Covid’ in the context of a global spread with no transmission-blocking interventions, the journal’s poor history on COVID-19 does suggest an intentional bias.

Modelling fantasy for profit

Last week, Lancet published a modelling study by Oliver Watson and others from Imperial College, funded by, among others, the Bill and Melinda Gates Foundation. This predictive model from Imperial College suggests that COVID-19 vaccination introduced at the end of 2020 saved 14.4 to 19.8 million lives in the subsequent 12 months. A summary is provided here. The Imperial College modelling team previously massively overstated anticipated COVID-19 deaths in 2020.

Models should pass basic credibility criteria to be published, based on plausibility. Any lack of coherence with real-world data or known biology should be stated and discussed. For reasons upon which one can only speculate, Lancet again seems not to have actually assessed the credibility of the paper prior to publication. This matters, as others who lack an apparent basic understanding of scientific process, such as The Economist and various commentators on social media, then disseminate the model’s predictions as fact. People can die when public health is twisted in this way.

Vaccination against SARS-CoV-2 commenced late 2020, and significant vaccination rates were not achieved in most populations until at least a few months into 2021). In a respiratory virus outbreak the most vulnerable, most likely to die, are likely to be over-represented in mortality in year one. However, this first year did not produce anything like the mortality claimed to have been ‘saved’ by the vaccines in 2021. Lockdowns and other non-pharmaceutical interventions don’t account for this.

Post-infection immunity is effective in mitigating COVID-19, and more so than vaccination alone. Serological surveys indicate most people gained post-infection immunity by mid- to late-2021. As infection rates are higher than vaccination rates for much of the world’s population, post-infection immunity would be expected to play a larger role than vaccination in reducing subsequent mortality. The African continent, with the lowest vaccination rate, has the lowest mortality rate – a multi-factorial relationship but one that should have given Lancet, The Economist, and any thinking person pause for thought.

One could argue that vaccination was more targeted to the highly vulnerable and so disproportionately impactful – but this would run against the Lancet paper’s claim that higher vaccination rates would save even more people. The vaccine is not transmission-blocking, so the vulnerable minority account for nearly all possible vaccine impact.

The suggestion by Watson et al. that all-cause mortality can be used as a proxy for COVID-19 also runs foul of the evidence in two areas:

• Firstly, randomized controlled trials of the mRNA COVID-19 vaccines show a small excess all-cause mortality in the vaccinated group over the placebo. This alone makes a substantial reduction in overall mortality through vaccination unlikely, with adverse events possibly promoting non-COVID-19 mortality.
• Secondly, a large increase in all-cause mortality is associated with, and expected from, lockdown measures. This is evidenced by rising malaria and tuberculosis, reduced childhood vaccination, and over 75 million added people in extreme poverty. Poverty raises mortality, killing infants in particular. UNICEF estimated 228,000 child lockdown deaths in the 6 countries of South Asia in 2020 alone, and when extrapolated across sub-Saharan Africa and through 2021 this is a lot of dead children. So lockdown deaths, which are not from COVID-19, comprise a large part of excess mortality.

Modeling or reporting COVID-19 ‘mortality’ or ‘lives saved’ raises a further issue that Lancet and the wider media have consistently overlooked. COVID-19 deaths are concentrated in the elderly (age >75 years) with multiple co-morbidities. This is the population sub-group most likely to die in the next months or year. A child saved from malaria is likely to gain 70 years of life, while a person saved from COVID-19 is likely to gain a year or less. While that year is important, relatively few would equate it to their grandchild’s potential loss. It also means the term ‘saved’ requires considerable nuance, as those that Watson et al. claim were ‘saved’ by the vaccines in the first half of 2021 are likely to have died by now from something else.

This is why metrics incorporating life-years lost or disabled were standard up to 2020, including in Lancet’s lucrative partnership with IHME on the Global Burden of Disease assessments funded by the Bill and Melinda Gates Foundation. To abandon these metrics when a pandemic appears that overwhelmingly targets those with the shortest life expectancy is extraordinary. 

Weighing lives and profit

Tens of billions of dollars are being generated for large pharmaceutical companies and their investors through mass vaccination for COVID-19. The Lancet is a business, and as such is dependent on pleasing these dominant influencers of medical research. As diversion of resources from diseases of higher burden to mass-vaccination of young immune populations in low-income countries is demonstrably harmful to overall health through resource diversion and general impoverishment, this presents difficulties for Lancet.

Killing children en-masse is a bad look for a medical journal, but the evidence indicates that this is what this resource diversion will do, and Lancet clearly feels inclined to support it. When a major Lancet partner faces significant income loss if the mass-vaccination paradigm is questioned, standing on principle and ethics would have taken courage and incurred risk.

This is the ethical dilemma that the high level of private investment in public health has brought. Pharma investors sponsor ‘global health’ schools, research, modelling and the public health institutions, including the WHO, that use their outputs. For-profit publishing houses must be aligned with these funding sources to thrive.

The losers in all this are the populations who have commodity (i.e. vaccine) ‘equity’ forced on them at the expense of health equity and the freedom to choose.  As malaria, malnutrition, and other diseases of poverty increase, public health and its medical journals must focus elsewhere on areas profitable to their funders.

Succumbing to conflicts of interest is hardly new in human society, and humans are excellent at justifying it. This is why we need external oversight in areas where such conflicts can cause great harm. New rules on conflict of interest and transparency are needed in medical publishing, including reforms to ensure transparent peer-review and open access to rebuttals of published papers. For-profit institutions cannot be the main arbiter in determining what health information reaches the public.

For now, though, it is difficult to see a path to improvement unless the publishers themselves value integrity, and the journalists interpreting them value truth. We have allowed vested interests to dominate public health discourse because we value their money more than the printed word. This matters because honesty in medical publishing determines the quality of life, and likelihood of death, of people. It is not an abstract problem.