The practice of medicine has changed dramatically in the last two centuries. Whilst the early 19th century was marked by accomplishment in the field of arts and culture, healthcare didn’t enjoy such quantum leaps; surgery was literally butchery without anaesthetics, and infections, though ubiquitous, were neither understood nor treated effectively. It was in this era that Thomas Wakley, a young surgeon born 1795 and working in London, conspired to launch a new medical newspaper. In his words, “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“.
Today, The Lancet is one of the most prestigious medical journals in existence, having transformed the practice of medicine with the first reports of chloroform, antiseptic practices in surgery and penicillin. The era of evidence-based practice is upon us, elevating peer-reviewed medical journals from professional newspapers to something much more sacrosanct — a resource (indeed, the only primary resource) for clinical workers to model their own practice. A resource to guide the provision of healthcare. This is a responsibility not taken lightly by the publishing journal. History has taught us that biased (or blatantly fraudulent) medical research published by a prestigious journal can do enormous harm, given the results not only guide clinicians, but are trusted by society. As such, the editorial process at The Lancet is painstaking and of over 100 manuscripts submitted to them each week, only three such are likely to make it to print.
As a student of public health, seeing this process as an editorial intern was fantastic. Editors would meet daily to discuss contentious manuscripts, and ultimately decide their fate: to be peer reviewed, published, or let go. However, what impressed me most about the workings of The Lancet was how true it has stayed to the vision and reformist zeal of its founder, to remain a beacon of light, as well as, at times, a sharp instrument to “cut out the dross”. The Lancet remains a campaigning weekly with a strong journalistic side. Each edition, three editorials summarise an issue on clinical medicine, public health and global society, reflecting an understanding of upstream social, political and environmental determinants of our health and prosperity.
I learned the power and value of leadership. A reformist like his predecessor Thomas Wakley, the current editor spends his time on the information circuit; he has a passion for all things human, an interest in international development and a determination to allow The Lancet to be the critical link between scientific research and policy. Because, as intuitive as it may seem, scientists and policymakers often don’t see eye to eye, and operate on completely different incentives; the former ‘publishing or perishing’, whilst the latter often voted in on three to four year cycles.
A major modern example of this disparity between science and policy in global health lies in the wicked problem of anthropogenic climate change. Unfortunately, there is a vast disparity between the scientific consensus on the physical basis of climate change, what responsible greenhouse gas emission mitigation targets should be, and the actual commitments made by our national government to take to the Paris Climate Summit later this year. Determined to help translate sound science into effective policy, The Lancet collaborated with experts from the University College London to launch their second commission on ‘Climate Change and Health’ — summarising the science, highlighting the significant public health opportunities that might come from a decarbonised economy and paving a policy pathway that would allow for such a ‘win-win’ post-carbon transition.
In my one month at The Lancet there were no fewer than four such commissions launched. The other three were aimed at policy makers on the topics of ‘Defeating AIDS’, ‘Global Surgery’ and ‘Women in Health’. The Lancet takes its responsibility to help translate science into action seriously. But, palpably, it also takes pride in it — in the face of deadlines and the added pressure that these additional publications brought, I saw all members of The Lancet staff, from editors to the production team to marketers, rise to the challenge.
The role of a medical journal in promoting public health is indeed sacrosanct; however, the example of The Lancet demonstrates how through organisations with visionary leadership, a bent for advocacy and a way with words, that message might be conveyed all the more clearly. After all, as editor Andrea Cornwall puts it, “words are worlds”, and I’m sure we’d all stand to benefit if good science was advocated for with good words more often.
The Lancet recently published its ten-thousandth issue. See an infographic on some of the research highlights of The Lancet’s 196 years here.