Richard Horton: ‘It’s the biggest science policy failure in a generation’

Richard Horton: ‘It’s the biggest science policy failure in a generation’

When Dr. Richard Horton shows up for our Zoom lunch, I feel a bit of disappointment. I am at home but dressed for a real work meeting: black dress, harmless earrings and a little makeup. The editor of The Lancet, the prestigious British medical journal founded in 1823, “arrives” in a black hoodie. He apparently forgot his light promise to wear a jacket, but he happily remembered that we had dinner together. “Look, I had lunch,” he said proudly, pushing a brown paper bag toward the camera. He offers to wait until mine is delivered.

I am not surprised that our loose dress deal collapsed in front of her to-do list. It was The Lancet which, in January, published for the first time clinical reports mysterious Wuhan pneumonia. Since then, a net of documents on Covid-19 has become a torrent of crucial and freely accessible information helping to shape the public health response in real time.

This gave this 58-year-old man an undoubtedly more important secondary role: chief critic of the British government’s management of the Covid-19 epidemic. Since February, he has accused ministers and their advisers of not having seen the coming storm, facing a barrage of criticism in The Lancet, in newspapers and on television. The British response to the pandemic, he told the BBC on March 26, is a “national scandal”. I get to the heart of the matter: does the government have blood on its hands?

“I’m not going to use these words, but I think lives could have been saved if we had acted sooner,” he said. “If we had used February to increase the capacity for testing and contact tracing, and to start increasing the capacity for using intensive care beds, it is absolutely clear that we would have saved lives and saved the NHS. Even if it was not the extreme lockdown we are seeing now, we should have reduced social mix and slowed down economic activity, such as promoting homework and physical distance, so we started cutting transmission lines. “

We are speaking in the context of an increasingly vindictive debate on the UK’s response. He despaired of the way the science and politics of this pandemic have been handled at every turn: from the lack of testing at the start to what he says is the “masquerade” of daily press conferences and “strategic failure ” of the government. plan adequately. He, along with others, demanded transparency on the opaque epidemiological models that shaped the laissez-faire response originally in the UK, which included the idea of ​​”collective immunity”.

I delegated catering on my side to my 17 year old daughter, Rosa. She settled on an Italian via Just Eat. It rings the doorbell; a few minutes later, she serves me four slices of Hawaiian pizza and greets my interlocutor. Horton and I briefly discuss how troubling the pandemic is for children.

Horton sits in an office with the compulsory library in the background. He unpacks his lunch and tilts his camera to view a carefully organized Mediterranean feast. Its spicy meze platter includes homemade chicken, tzatziki and hummus, baba ganoush and fresh chili sauce. I can’t help but feel a little jealous.

Horton must be one of the oldest British publishers. He joined The Lancet in 1990 and was named editor five years later, at only 33 years old. He does not apologize for being openly political. “Some of the great advances, such as the 19th century health movement and the birth of the NHS, were not technical achievements but political struggles. The idea that you can withdraw politics from medicine or health is historically ignorant. The medical establishment should be much more politicized, not less, to tackle issues such as health inequalities and poor access to care. One of his idols is Michael Marmot, a London-based academic who was a pioneer in studying how social inequality affects health.

It was by studying physiology and medicine at the University of Birmingham that opened Horton’s eyes to the way others lived. “I remember a student entering skyscrapers where the carpets were soaked with urine,” he says. “The bathrooms were completely unsanitary, the kitchens were loaded with unwashed dishes and cutlery, and everywhere there was dirt. I had never seen anything like this before. “

After a bourgeois education, he only discovered in his forties that he had been adopted, that his biological father was Norwegian and that he had five half-brothers and sisters: “It was a shock. I went from an only child to this huge family. Being half English and half Norwegian has changed the center of gravity of who I thought I was and I have had a love affair with Norway ever since. “

Horton has been labeled a left winger by his critics. He rejects the label, saying that he voted for the Conservatives, Labor, Liberal Democrats and the Greens. His philosophy, however, is faithful to the spirit of the founder of the Lancet, Thomas Wakley, surgeon and social reformer, once described as “an honest denouncer of infamous distinctions between rich and poor”. Wakley named the journal after a surgical instrument and a type of window: it was supposed to symbolize piercing corruption and let in light.

As a result, Horton highlighted The Lancet on a range of political causes: he rented the climate protest group Extinction Rebellion, urging healthcare workers to join a non-violent protest; he published an emotional letter in support of the people of Gaza written by a geneticist in Italy later accused of anti-Semitic sympathies; and he conducted a study claiming that the civilian deaths related to the war in Iraq had been underestimated.

No one made him the most popular man in the room. Dr. Michael Fitzpatrick, general practitioner and former Lancet columnist, described Horton to me as “very pleasant and easy to treat, but a bit of a showboater and a pariah in the medical establishment”.

In truth, Horton was never forgiven for publishing a 1998 article by Andrew Wakefield that raised unsubstantiated doubts about the safety of the measles, mumps, and rubella (MMR) vaccine for children. Despite years of controversy, the document was not fully retracted until 2010, after the General Medical Council ruled that Wakefield had been dishonest (he was later struck off). Uncertainty has brought down childhood immunization rates and energized the anti-vaccination movement. The debacle of the MMR has become one of the greatest calamities underway in the field of public health.

“You can’t escape the serious damage that has been done,” Fitzpatrick tells me. “He [Horton] was not sorry enough for what happened. “

Does Horton regret what happened with MMR? “I would be mad not to do it, but I can’t just take out papers that I don’t like. There must be due process [via the GMC tribunal]. “Has he ever been fired?” I don’t know, “he smiles.” You should ask my editors. All good publishers end up being licensed. “

It is time to change the subject. We have a pandemic to discuss.

When we meet, the shortage of personal protective equipment among health workers dominates media coverage. Hospital trusts have threatened whistleblowers with disciplinary action; Horton proposed to act as an intermediary for their dispatches from the pandemic front line: “The workers were intimidated and forced to see patients who clearly or are suspected of having Covid-19 without PPE. When they raise concerns, they are demeaned or threatened. It is horrible to see the lack of concern on the part of some NHS leaders. A doctor told him that war zones are better prepared than the world’s sixth largest economy.

The NHS has been left to catch up, says Horton, because the government has ignored the information or failed to act in a timely fashion. The first one paper suggesting the existence of a new contagious virus that appeared in The Lancet on January 24. Horton now wants to know why this cooling assessment was apparently done in Whitehall. “Why hasn’t this document been read by the Scientific Advisory Group for Emergencies, the New and Emerging Respiratory Virus Threats Advisory Group, or the NHS England, or the chief medical officer or chief scientific adviser?” he asks.

“We had all of these committees and all of these offices and all of these organizations, but somehow they weren’t connected. We have experienced the greatest failure of science policy in a generation. “He rejects the idea that such a devastating epidemic could only have been predicted with hindsight:” How can this be hindsight? He is there in black and white on January 24, written in a newspaper of China, saying to people, “Please act now, this is urgent, there is a crisis.” “

A week later, another Lancet article warned that since the virus was no longer contained in Wuhan, and that “self-sustained epidemics in major cities around the world may become inevitable.” . . Preparedness plans and mitigation interventions need to be prepared for rapid global deployment. “

Blue Kitchen Mediterranean cuisine

177c Priory Road, London N8 8NB

Plate of hot and spicy marinated chicken meze (farm chicken, fresh organic chili sauce, tzatziki, baba ganoush, hummus) £ 9.50

Highland spring water

Wood oven pizza

391 Kilburn High Rd, London NW6 7QE, via Just Eat

Pizza Tropicana € 9.99

Extra black olives 80p

Service charge 50p

Total £ 18.79

Horton’s combative public figure hides a personal struggle: in 2018, he was diagnosed with advanced melanoma. His experience as an NHS patient adds to his sense of outrage at the pressures faced by health workers. “I don’t think I’ve ever been to an institution where people were really nice and thoughtful,” he says. “This is why I am so angry that we did not act sooner. I am angry because I know how good the NHS can be. Politicians, policy makers and scientists have abandoned the NHS and his staff. And that’s unforgivable. “

The government is clearly shaken by such criticism. A Sunday Times article titled “Coronavirus: 38 days when Britain fell asleep in disaster”, published last weekend, drew a long rebuttal from the Ministry of Health and Social Affairs. The rebuttal includes a quote from Horton of January 23 calling for “caution” and accusing the media of “escalating anxiety by speaking of a killer virus” to reject the idea that a scientific consensus around a pandemic to come was built in late January

The quote comes, he said, from a tweet urging caution on heavy cover rather than government policy. In addition, the World Health Organization declared a public health emergency on January 30. “I think it’s a false statement, absolutely,” he says. “Between January 24 and January 31, there was more and more daily evidence and there was concern that it would lead to a pandemic.”

Meanwhile, the scientific community is desperate to guess what the virus will do next. “We are already seeing that the potential is likely to return,” he said, noting China’s rise in some cases. “It is really very worrying, and that is why we need a vaccine as soon as possible.

“But there is still a lot to learn. Why did the outbreak take off so dramatically in Italy but not in Germany? Testing is a possibility, but we are not sure. The tests are absolutely crucial, and if we want to get out of these blockages, we absolutely have to increase our capacity. “

The deaths of Covid-19 have gone from Asia to Europe - and now to the United States. Flow chart and stacked column charts showing regional daily deaths of patients diagnosed with coronavirus

Western countries have been unsuccessful in responding to coronaviruses compared to Asian countries, he thinks, because they have seen the threat through the prism of the flu. China and Hong Kong feared a rerun of Sars, a much more deadly disease, and quickly raged. Cognitive bias, he says, has cost us dearly.

Horton is also worried about complacency once this pandemic has run its course: “It would be very dangerous to say that this is our 1918 [Spanish flu pandemic], and think that these things only happen once in a century. Conditions still exist in countries for zoonoses [which jump the species barrier from animals to humans] develop. We have had five or six in the past 20 to 30 years. It’s the big one at the moment but there could be a bigger one coming. “

Rosa brings a cupcake to the cafe, but we’ve moved on to talking about Horton’s cancer and it seems disrespectful to eat it. It was his 19-year-old daughter Isobel from Horton’s marriage to pediatrician Ingrid Wolfe who urged her father to have a mole checked on his right temple. Since his diagnosis, Horton has undergone three surgeries and is left with scars and an uncertain prognosis. He is now on immunotherapy. Each day is “the drawing of a coin”.

The therapy eased its darkest moments: “I thought I didn’t have a very long time to live, maybe weeks or months. . . It was extremely helpful to be able to sit in a room with someone on your side and be able to say anything. Comfort now comes in the form of books – currently The birth of biopolitics by Michel Foucault, on how governments exercise their power over the lives of their citizens – and a glass of Lagavulin whiskey in the evening.

He is always nervous about touching his face because he is afraid the cancer will come back. But for now, he feels – and seems – strong: “I’m waking up and I think I have to make the most of each day, because I don’t know how much I’ll get.”

He will press for a public inquiry into the coronavirus pandemic and for WHO to be strengthened and not weakened. The inaction that followed the WHO emergency declaration, he said, is attributable to the member states and not to China, to which it says the world should be thankful for its warnings and efforts to confinement.

This attitude may surprise members of the medical profession who have criticized China’s initial response to the epidemic. But the idea that China should pay reparations for the resulting economic losses is, he says, ludicrous, and he calls Donald Trump’s decision to end WHO funding a “crime against humanity” .

He is writing a book explaining why, despite the warning signs, the Covid-19 pandemic took the world by surprise. Meanwhile, this formidable list of tasks does not leave time to respond to its detractors:

“You said earlier that people think I’m an outcast. Maybe in previous years it could have upset me. But now? I really don’t care what people think of me. If I’m not not here in six months or a year … the f ***. Seriously. “

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