While two centuries would be a solemn milestone for any publication, for The Lancet it’s much more than that. After the turbulence of the Covid pandemic, the journal is not only more celebrated than ever but also more embattled. It faces the fallout of a major Covid retraction and accusations of malfeasance by prominent figures.

Here, however, The Lancet is in its element. The journal’s long-reigning editor-in-chief, Richard Horton, a kind of Anna Wintour figure of science publishing, seems more sanguine than ever as he advances political and even ideological positions in the name of science with his characteristic media savvy and a constant refusal to tone it down — no matter how unruly it gets. While some may claim that this is a departure from the journal’s staid, grey roots, they’d be wrong. For The Lancet was forged by controversy.

Conceived by a fiery Victorian physician and rights campaigner named Thomas Wakley, The Lancet came into the world in a fit of protest. Born in 1795 in Devonshire to a family of yeoman farmers with 11 children, Wakley had in his early twenties married the daughter of a wealthy businessman and hospital governor who set him up with a London medical practice. Ensconced in a 15-room house at 5 Argyll Street, Wakley had every reason to believe his success imminent until one evening in 1820 when an unexpected knock on his door was followed by a brutal assault. The assailants believed (probably baselessly) that Wakley had played a role in the execution of members of the Cato Street Conspiracy, a radical plot to murder the entire cabinet and the prime minister. Wakley survived, but his house and practice were burned to the ground.

Part of the founding myth of The Lancet was that it was born from Wakley’s outrage and desperation. His insurance company refused to cover damages from the fire, leading to Wakley’s first confrontation with institutional injustice. He sued — and won. His practice had been ruined but a new career as a journalist rose from its ashes. The episode thrust Wakley’s name into the limelight and, according to a review of his 500-page 1897 biography, earned him “a reputation as a man who would fight strenuously against an injustice”.

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With The Lancet, Wakley set out to do something different. While the existing journals were the elite products of an elitist medical system, The Lancet was “founded by a marginal medical man with no reputation and a left-of-centre agenda [within] a conservative profession”, according to a 1998 history published in (none other than) The Lancet. But The Lancet was far more than an ideological and class reaction to medical orthodoxy. It was a stylistic mould-breaking experiment driven by a commitment to “entertain, instruct, and reform”. Its early editions featured chess problems, theatre reviews, and even gossip. “Our Columns will not be restricted to Medical Intelligence, but on the contrary, we shall be indefatigable in our exertions to render ‘THE LANCET’ a complete Chronicle of current Literature,” Wakley wrote in the preface to the journal’s inaugural issue.

The literary elements were quickly dropped but a more potent approach was taken up, one that construed medicine itself as an inherently — and even primarily — political endeavour. “It is widely recognised that, from its foundation in 1823, The Lancet functioned as the principal mouthpiece for the disadvantaged medical classes,” historian of medicine Michael Brown wrote in a 2014 academic article. “It is likewise recognised that, as its editor, Thomas Wakley occupied a uniquely powerful position from which to shape the radical medical political agenda.”

For Wakley, medicine was the arena of a Manichean struggle between good and evil. This played out in the pages of The Lancet as a grand melodrama, with Wakley’s pen supplying a slashing lexicon entirely out of character for a journal at that time. It was a rhetoric of “monsters, spies, and villains, of fetid dungeons and the chains of bondage”, the forces of darkness and evil embodied by the British medical establishment — in particular, surgery — that preyed on the snowy innocence of its eternal victims, the poor and disadvantaged.

In an 1828 editorial, Wakley raged with characteristic hyperbole that: “The Hydra of medical corruption is at its last gasp, and one well-directed blow may rid us of a monster, whose noxious influence has retarded the progress of science, disgraced the character of British surgery, and rendered the profession an object of public scorn.” He was talking about the Royal College of Surgeons. Wakley wrote in the same editorial that while the “tyranny” of the medical establishment was strong “we have possession of the field, and THE LANCET IS UNBROKEN”. In this sense, the publication’s name referred not only to an instrument that could pierce infected skin, but also to the pointed spear used by medieval cavalry. Wakley was the self-styled white knight of public health. The Lancet was his weapon.

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Though it was draped in the language of melodrama, Wakley had in hand a remarkably effective formula for success. His target was a corrupt system, but abstractions rarely make for good targets. Wakley, ever the effective polemicist, understood this. He directed his most ferocious attacks on individuals. In the most notorious case, The Lancet covered a lithotomy (the removal of a kidney stone) from a patient by a surgeon who was the untalented nephew of a luminary figure in British medicine. The surgery was a debacle. The procedure (inserting forceps into the male patient’s urethra to remove the stone — with no anaesthesia) should have taken 10 minutes. It took an hour. The patient, who begged the surgeon to stop, died shortly after.

It wasn’t the facts that got the journal into trouble, but the florid, withering tone it employed. Casting the procedure as a literal tragedy, the article theatrically divided the events into “Act I” and “Act II”. Bransby Cooper, the surgeon who performed the botched lithotomy, sued Wakley for libel and won (though the damages granted by the court were considerably less than what he’d claimed). While The Lancet’s coverage of Cooper’s surgery was deemed libellous, the journal had found a template for how to not simply address medical incompetence and corruption, but to catapult itself to further fame as a crusader for justice. As Brown put it: “By deliberately publishing libellous material and thus positively soliciting prosecutions, Wakley was able to locate his specifically medical campaign within the established traditions of democratic political reform.”

One of the many remarkable things about The Lancet is that it has managed to poignantly maintain its character for two centuries. In the past three years, the journal has again and again found itself at the centre of the most heated Covid controversies and scandals. The most prominent began in the first week of June 2020, less than three months after the WHO declared a pandemic, when the journal was forced to retract a paper on hydroxychloroquine — the anti-malarial drug promoted by Trump as a Covid cure — because it was based on fabricated data.

On its own, a retraction by a journal as prestigious as The Lancet would be noteworthy. But this wasn’t just any paper. For the preceding two months, the media had leaned on The Lancet’s paper, authored by a Harvard Medical School cardiologist, to claim that the Trump-touted drug was not just ineffective in treating Covid, but also dangerous. It became a weapon to attack the President, furthering the notion widespread in the media that no matter what Trump said, the opposite was likely true.

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Nevertheless, it was in the context of not just The Lancet’s hydroxychloroquine retraction but no fewer than seven other Covid-related retractions that the journal clinched the top impact factor — science publishing’s measure of influence — in its category last year, doubling its 2021 score. “I think what you saw with The Lancet is they were clearly chasing big splashy papers that would get a lot of attention,” said Ivan Oransky, the co-founder of Retraction Watch and editor of the journal Spectrum. In this, he says, the journal is no outlier. “The Lancet is like a more public version of what happens at every journal. Everybody’s chasing impact factor, everybody’s chasing particular papers.”

In the wake of the retraction, The Lancet’s editor Richard Horton mounted a very different defence. After acknowledging the paper to be a “monumental fraud”, he averred that the peer-review system that forms the backbone of science publishing isn’t equipped to detect this kind of fraud at all. “If you have an author who deliberately tries to mislead, it’s surprisingly easy for them to do so,” he told The New York Times.

This, however, raises the question of what the science journal is there to do. For Horton, the answer isn’t merely to ensure the integrity of scientific papers. Rather, it’s an explicitly political mission that can be traced directly back to his predecessor, Thomas Wakley: using science to accomplish the objectives of radical politics.

Like Wakley, Horton has created a field-defying public profile by standing on a mountain of accumulated controversy. This includes his scathing open letter to Gaza on Israel’s treatment of Palestinians, which brought accusations of antisemitism (followed by an apology); The Lancet labelling women as “bodies with vaginas” (followed by an apology); and Horton channelling the ghost of Wakley by attacking the Royal Society as a “shrill and superficial cheerleader” (followed by a semi-apology). There were also accusations that the journal vastly overestimated the number of deaths caused by the war in Iraq, drawing the ire of Christopher Hitchens, who called the study in question “moral idiocy“. And, more recently, Horton has supported Extinction Rebellion, chiding Britain’s scientific community for doing too little for “the struggle for climate justice”.

Far from being a black mark against the publication, each new episode presents Horton with an opportunity to drive home the institutional ethos that has defined the journal for two centuries — namely, that science is, and ought to be, a vanguard for politics. “Some of the great advances, like the 19th-century sanitary movement and the birth of the NHS, were not technical accomplishments but political struggles,” Horton told the Financial Times. “The idea you can strip out politics from medicine or health is historically ignorant. The medical establishment should be much more politicised, not less, in attacking issues like health inequalities and poor access to care.”

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So successful has this strategy been that it was effective in navigating Horton through the mother of all science publishing scandals — the fraudulent paper published by Andrew Wakefield in The Lancet claiming a link between the MMR vaccine and autism. It took The Lancet an astonishing 12 years to fully retract it. By that point, the damage had been done, and vaccine-related conspiracy theories had taken root.

Horton’s response to the scandal was to publish a “5,000-word avalanche of denials”, according to Brian Deer, the Sunday Times journalist who broke the story. Even more disturbingly, Horton looked to Wakefield and a number of co-authors of the MMR paper to lead the initial investigation into the fraud. “In short,” Deer wrote in the BMJ, “the accused were investigating themselves — an investigation that Horton would say ‘cleared Wakefield’.”

And in the most quintessentially Lancet fashion, the scandal did nothing to damage Horton. Far from it. In the midst of the scandal, he was awarded the Deans Medal by Johns Hopkins University in 2009. A decade later, he received the Roux Prize. Between those two honours, he received another: in 2015, he was the recipient of the “Chinese Government Friendship” award granted by the CCP. To mark the occasion, Horton offered Lancet readers soaring rhetoric on how China’s “emphasis on friendship, and the free flow of critical ideas that such friendship encourages, might offer lessons to other nations about how scientific co-operation can accelerate social and political change”.

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In the years that followed, Horton would be vocal in his defence of China. In 2016, he attended a symposium organised by the Chinese government body that ran the country’s “Thousand Talents” programme, which, according to The New York Times, “lured” Western scientists into collaboration with China using “lavish funds” that sometimes amounted to quadruple a scientist’s official salary.

There is no evidence to suggest that Horton personally took any money from China. Nevertheless, he became one of the most high-profile voices to praise China for its handling of the pandemic — not only in the Western media but in China too. In a May 2020 interview with China Central Television, he said: “I think we have a great deal to thank China for how it has handled the outbreak in Wuhan.”

Horton also claimed during the interview that questions about whether the virus might have originated from a lab in Wuhan amounted to “disinformation” based on “conspiracy theories”. This narrative would go on to form the basis of the first major publication on the question of Covid’s origin. Published in mid-February 2020, “The Lancet Letter” — as it came to be known — made baseless claims that the lab-leak hypothesis was a racially motivated conspiracy theory. It was later revealed that the man who organised the letter, Peter Daszak, funded the lab in Wuhan in question — and that four of the scientists who signed the letter were affiliated with Daszak’s NGO. More astonishingly, according to The Daily Mail, Horton admitted to being aware of the conflict of interest. Nevertheless, The Lancet waited almost a year and a half to formally disclose the conflicts.

None of this would stop, or even put a dent in, The Lancet’s ceaseless march to prestige and power. This likely has to do with the fact that the journal has built its reputation on a foundation of public scandal and melodrama. It was founded not on the principle of scientific rigour — but as a basis for radical political activism. And it remains an activist publication to this day. If he were alive now, Thomas Wakley would likely be proud of Horton, his intellectual heir, who has remained strikingly true to the founder’s vision. While the formula has brought acclaim for Horton and for the journal, the question for the rest of us is this: who really pays the price for The Lancet’s success?

True breakthroughs are rare (the cause of Aids; Dolly the Sheep) and almost none is granted the kind of establishment send-off as the research unveiled that morning. For months, private briefings had teased the press regarding what was coming. The hospital installed answering machines to field the alarm it expected. And both its medical school’s dean and a top professor stepped forward with a mid-rank lab researcher to introduce a “study” that wouldn’t only stalk the nightmares of a generation of young parents, but shovel trenches for a war that has raged ever since.

“The study has identified a possible link between gut disorders in children and autism,” a press release explained, with 21 minutes of video clips to maximise TV pick-up. “In the majority of cases, the onset of symptoms occurred soon after the MMR vaccination.”

Ahh, MMR: the measles, mumps, and rubella shot. What Brit beyond their teens never noticed the fallout that rained from that morning’s event? Over months and years, vaccination rates slumped, and measles returned to kill or maim children as the most agonising health scare since the early years of Aids unleashed outbreaks of fear, guilt, and disease. That night, TV news tracked the Royal Free script:

“Questions were raised today about the safety of the combined mumps, measles, and rubella vaccine…”

“Claims there could be a link between a common childhood vaccine and autism…”

This was February 26, 1998, with the paper datelined to the following Saturday. Beneath a technobabble title, 13 authors were listed. But only one wrote it: Andrew Wakefield. Then aged 41, a bowel surgeon by training, he had a large-chested voice, a patrician manner, and what admirers described as “charisma”. Dressed in a black suit at a blue-clothed table, with the dean stood to his left and the professor sat to his right, he pitched a story to draft a page in medical history. He had gathered data from a series of 12 developmentally challenged kids, anonymised in the paper by number. They had been admitted to the Royal Free for an unprecedented five-day battery of tests he had devised, including needles into their spines, tubes deep into their guts, brain scans, x-rays, and blood work.

His first “finding” would echo down the decades like machine-gun fire in a cathedral. For eight of the 12 (aged from three to nine), the paper said their parents, quizzed by doctors running the tests, recounted a terrifyingly similar experience: a son or daughter was developing normally, received a shot of the three-in-one “live virus” MMR, and showed autistic symptoms within days.

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The paper further claimed discovery of a new medical “syndrome” of both brain and bowel disease in the children. All but one, it reported in text and tables, had developmental issues plus “chronic enterocolitis” — inflammation of both the large and small intestine. “It’s a moral issue for me,” Wakefield told his audience, calling for MMR to be suspended in favour of single shots for measles, mumps, and rubella. “I can’t support the continued use of these three vaccines, given in combination, until this issue has been resolved.” The dean equivocated, but the professor backed Wakefield. And so was born an intractable controversy as the paper was leveraged to launch a crusade: first against this vaccine, then later another… and another… all the way to SARS-CoV-2.

“It’s not a vaccine at all,” Wakefield would rail against the latter at the height of the Covid pandemic. “It’s actually genetic engineering.” Back in 1998, his ground had been firmer, even based on a mere dozen patients. Many medical insights begin with short case series. Autism: 11 kids in the Baltimore area, for example. Aids: five men in Los Angeles. That Thursday, it seemed possible the Royal Free had got lucky: maybe catching the first snapshot of a hidden epidemic of catastrophic injuries to kids. Massive studies around the world, however, found nothing to confirm this, leaving a whale of a riddle rotting on the beach. If parents of two-thirds of 12 children with developmental issues blamed the triple shot for the sudden onset of autism, why weren’t vaccine victims everywhere? Wakefield doubled down, claiming they were. But, while the medical establishment sought refuge in authority, urging the public to trust experts, not a lone-voice maverick, an old-school Sunday Times investigation, run by me, would pepper revelations across more than the next decade, revealing what this doctor had done.

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Our first report splashed in February 2004, almost exactly six years after the press conference. “Revealed: MMR research scandal,” was the front page, igniting a new media firestorm. We had discovered a monstrous conflict of interest that Wakefield kept hidden, then denied. For two years before his “moral issue” surfaced — and before any of the children set foot in the hospital — he had been payrolled by a small-town solicitor named Richard Barr to help lead an attack on MMR. Unlike expert witnesses, who give advice and opinions, the doctor was delegated to arrange the tests, building pressure for a speculative lawsuit.

“I have mentioned to you before,” Barr wrote to Wakefield, six months before the Royal Free event, “the prime objective is to produce unassailable evidence in court so as to convince a court that these vaccines are dangerous.” Barr filed the lawsuit at the Royal Courts of Justice eight months after the breathless press conference. Wakefield claimed fees of £150 an hour (about £254 an hour at late 2022 values), drawn from the government’s legal aid fund. So, as he recruited the children and wrote the paper, he had a financial incentive not only to trigger a client-grabbing furore, but to keep it going for as long as he could.

Those clients poured in — nearly 1,600 families — as journalists were duped to fuel the scare. And by late 2003, when Barr’s lawsuit collapsed, Wakefield had. been handed £435,643 (about £738,000, or nearly US $900,000, at last year’s values), plus expenses, in taxpayers’ money. But as he gazed into the glare of TV lights, his legal deal was only one of his secrets. As he’d made his call for a switch to single vaccines, he forgot to mention that eight months previously he’d filed a confidential claim at the London Patent Office for his own, supposedly safer, single vaccine.

His shot wouldn’t have worked. When I asked experts about it, they laughed. But four days after the Royal Free event, he put it to the medical school that they start a joint company to raise money for this, and other products he’d imagined, which only stood much chance of enticing investors if confidence in MMR was damaged. Yet this doctor wasn’t shy of shady stuff, even hopelessly suing me for what a High Court judge described as “public-relations purposes”. So I carried on digging for years, on-and-off, exposing secrets and lies by the bucket. “If my son really is Patient 11, then the Lancet article is simply an outright fabrication,” complained the father of a California boy brought to London for the tests, after I found the dad and showed him a copy. “I know that paper is not right and fraudulent,” the mother of another boy, from the north of England, emailed me. “I can see that from what was written about my son.”

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Confidential medical records (lawfully checked) confirmed the parents’ right to be angry. Some of the kids said to have symptoms days after MMR, actually had them before or up to nine months later. Some were reported with “autism” without this diagnosis. Tests for bowel disease came back normal. None of Wakefield’s data revealed enterocolitis: the chief gastrointestinal symptom was constipation. Parents blaming the shot, moreover, wasn’t even a “finding” — it was a covert qualification to take part. Records showed that not eight, but 11 of the kids’ families named the vaccine at the hospital (the 12th’s later joined them to file a claim in the lawsuit) — a give-away number, sure to provoke questions, if Wakefield hadn’t airbrushed the figures. The poisonous truth was that all but the American family had links with vaccine activists caught up in Barr’s plans, pointing them to Wakefield’s project. And, surprise, legal aid authorities at the time insisted that, for cases to qualify for public funding, alleged symptoms must follow within days.

Wakefield was finished, but he couldn’t say sorry. And when The Sunday Times ran with “MMR doctor fixed data on autism”, he fought back, denying all error. “The notion that any researcher can cook such data in any fashion that can be slipped past the medical community for his personal benefit is patent nonsense,” he argued, in one of countless lengthy rejoinders. He wasn’t alone in not wishing us well. Much of the medical establishment was aggrieved. “I will now defend the heretic Dr Andrew Wakefield,” sneered, for instance, Bad Science author Dr Ben Goldacre. “The media are fingering the wrong man, and they know who should really take the blame: in MMR, journalists and editors have constructed their greatest hoax.”

But tunes changed abruptly in May 2010, after a hearing longer than the trial of OJ Simpson in which the General Medical Council vindicated what we’d published and scrubbed Wakefield from the doctors’ register. The Lancet, which for 12 years defended the paper, retracted it. And, after opposing the GMC proceedings, the British Medical Journal highlighted the irony. “It has taken the diligent scepticism of one man,” the BMJ said in an editorial, “standing outside medicine and science, to show that the paper was in fact an elaborate fraud”.

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I won’t forget that, and not just for my name-check but because the establishment mobilised to vilify journalists rather than hold a mirror to themselves. How could it be that all the doctors and professors, royal colleges and government experts, steeped in more medicine than I’d know how to spell, failed to spot that the paper was a scam? It was as if they couldn’t accept the ugly truth was even possible. A chap wouldn’t do such a thing. So, in plain view of a dozen co-authors, platformed by a hospital and its medical school, and published after peer review in a most prestigious journal, he’d effortlessly exploited conceits and vulnerabilities that remain below the radar to this day.

Personally, I’d trust The Daily Mail before The Lancet (especially the football and TV data). But, if Wakefield had ploughed a field of less instant public interest — say, psychogeriatrics or kidney surgery — his chances of getting caught were close to zero. He might have published fake findings until the day he retired, and no newspaper reporter could have convinced their editors to pay for what it would take to prove what happened. So, the next time you read of some medical marvel, remember the lesson of the Wakefield scandal. As I put it in The Doctor Who Fooled the World, (published after he’d moved on to trashing Covid vaccines): “If he could do what he did — and I’ll show you what he did — who else is doing what in the hospitals and laboratories that we may one day look to for our lives?”

The single quote on the front cover was stark, “Historically, the anatomy and physiology of bodies with vaginas have been neglected.”

Our new issue is here! On the cover—'Periods on display' and the cultural movement against menstrual shame and #PeriodPoverty.

Plus, @WHO air quality guidelines, low #BackPain management, community-acquired bacterial #meningitis, and more. Read: https://t.co/eP1Lx7D116 pic.twitter.com/DchfiHnYEs

— The Lancet (@TheLancet) September 24, 2021

Not even, “people with vaginas”, though that would have been bad enough. The Lancet has now gone beyond the appalling language — “people who menstruate” — that so upset JK Rowling last year.

The excerpt came from a review of an exhibition on the history of menstruation by Sophia Davis, but my complaint is not with her — she used the words woman and women five times in her piece. My concern is that this specific quote was chosen to be used so provocatively on the cover.

The Lancet — one of the world’s oldest and best-known medical journals — is on a mission. The publication might claim that “improving lives is the only end goal,” but editor Richard Horton has grand plans. His vision, which he laid out in 2016 is political revolution.

“The idea of the Lancet was born at an extraordinary moment in the history of the world in the early 19^th century which was a moment of political revolution and social revolt. We have to capture that idea every single day in what we do… What I think we’re trying to achieve now is to capture that original idea – the essence of who we are, our identity, in these campaigns that we are developing.”

This journal is of course no stranger to controversy. In 1998, it published Andrew Wakefield’s now notorious article that linked the MMR vaccine with chronic enterocolitis and autism. By the time that paper was retracted — 12 years later — children had been harmed. According to Public Health England, “It had an important impact on MMR coverage which dropped to about 80% nationally in the late nineties and early 2000s and took many years to recover. … Measles cases continued to rise and in 2006 endemic transmission became re-established in the UK.”

Horton has strayed over the line from medicine into politics repeatedly, covering for example the invasion of Iraq and the conflict in Gaza. While he has been quick to challenge the UK government over the response to Covid-19, he has been rather more forgiving of the Chinese authorities.

It is perhaps no wonder that he has waded into one of the most charged political debates of our time: the material reality of flesh and blood. Yes, some people struggle with their bodies — for any number of reasons, but we can never be divorced from them.

The egregious quote might lead us to think that Horton believes otherwise. Does he really think that “bodies with vaginas” are as peripheral to humanity as, say, cars with a hatchback: mere perambulating devices that transport our metaphysical essence from place to place?

If so, he would be replacing modern science with Gnosticism, a heresy that stretches back much further than the founding of The Lancet in 1823. So ancient in fact, that it was first refuted by Ignatius of Antioch who died around 110 CE.

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In the early second century, Gnostics separated the spiritual from the material. They held that matter was evil and the spirit good. Their focus was on the person of Jesus Christ — claims were made that he did not have a real body but only an apparent or phantom one — and a hope of salvation that came through esoteric knowledge, or gnosis.

There are strong parallels today in the debate over sex and gender. Adherents of what has become known as “gender ideology” might replace spirit with mind, but the schism between mind and body is much the same. Their entire belief system is constructed on esoteric knowledge.  Even small children are understood to be able to discern their gender identity, a mysterious quality that supposedly trumps mere biology when demarcating men from women.

As Mary Harrington suggested in her recent essay about latter-day “luxury Gnosticism”, when we can spend so much time in cyberspace in whatever form we please, it is seductive to believe that choosing our sex in the real world is as easy as toggling a switch and changing our name.

Gender ideology might not be a religion in the traditional sense but it is certainly a belief system. Gender identity — its principal dogma — is unprovable and unfalsifiable, yet we are expected to believe in it or keep quiet. It has its catechisms — Transwomen are women, transmen are men and non-binary people are valid — and its priestly class. They would be transgender people like me, supposedly with esoteric knowledge about what it means to be trans.

The reality — and I chose that word deliberately — is rather different, of course. Nobody, not even transgender people, can discern what it feels like to be someone else. All we have is our own experience. Are transwomen women, or are we men? Not only that, but men with a psychological disorder that drives us to want to become women? In a battle of ideas divorced from objective reality it is one person’s word against another.

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That benefits nobody, not least transgender people who have been plunged into possibly the most toxic and divisive debate in politics. Campaigns that were once important — for example the resourcing of NHS gender services and the protection against less favourable treatment at work — have been overshadowed by pointless squabbles over pronouns.

Words matter, because if we change the words we use we change the way we think. In many contexts, sex has been replaced with gender and — equally troubling to me — transsexual has been replaced with transgender. In both cases, people are separated from their reproductive biology. That doesn’t help anyone live their life in the real world where sex does matter.

Horton’s chosen quote — bodies with vaginas — both extends and focusses the denial of humans as material beings. Not only does he separate people from their entire biology, he directs the attention at just one sex: women. The Lancet used very different language in a Tweet about men’s health last week, “About 10 million men are currently living with a diagnosis of prostate cancer.”

The complaints appear to be piling up at The Lancet, including objections from the medical profession itself. Professor Dave Curtus, a contributor to The Lancet, tweeted: “Just wrote the Lancet to tell them to take me off their list of statistical reviewers and cancel my subscription and never contact me about anything ever again. Absolutely inexcusable language to refer to women and girls.”

The concerns are far more than mere intellectual or academic protests. This type of language makes women yet more vulnerable. The ideologues might convince themselves that womanhood is somehow separate to femaleness but as Professor Selina Todd explained in The Post last week, “Ignoring sex doesn’t make sex-based discrimination and harassment go away, it just prevents you from dealing with it.”

Bev Jackson, founding member of the Gay Liberation Front in 1970 and more recently a co-founder of the LGB Alliance, went further in her analysis, “Dehumanization is the prelude to violence.”

Moreover, as in the MMR debacle over 20 years ago it is children who are being put at risk of harm. They have no special knowledge about their gender identity — nobody does — but promises are being made to them that can never be delivered: that they can somehow choose to be a boy or a girl. The flip side of course is the implied threat that if they choose incorrectly, they may go through the “wrong” puberty and never find satisfaction in life.

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Now this quasi-religious belief system is being given legitimacy on the front cover of The Lancet. It took the journal 12 years to retract the misinformation over the MMR vaccine. For the sake of the current generation of young people, Horton needs to rectify this current outrage somewhat more quickly.

Gnosticism may be alluring but it is ultimately futile. We are our bodies. It is high time that politicians, policy makers, and even the editor of The Lancet accepts the truth that Ignatius knew by the turn of the second century.

It was around the same time, in 2018, that measles cases across Europe hit a 20-year high. The sharp rise, blamed by the World Health Organization (WHO) on vaccine hesitancy, was heralded by the rapid resurgence of the ‘anti-vaxxer’ movement. Today, the threat anti-vaxxers pose to public health is even more pressing: just this month, measles outbreaks have been reported in areas of Greece, Italy, France, Canada, Ireland, the USA and Japan; the WHO ranks vaccine hesitancy among the top ten threats to public health in 2019.

It is no coincidence that the smiling presence of Andrew Wakefield – a struck-off British doctor, notable for widely discredited research linking the MMR vaccine to autism – had re-entered public consciousness in 2017 after being spotted at one of President Donald Trump’s inauguration balls. In the subsequent months, the British press had covered with interest – and often rising alarm – his exploits in America.

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But none of this was on my mind when, attending the surgery for my blood test, I was offered a free flu vaccination. Nor when I was immediately offered another free vaccine, against pneumonia. Indeed, it rather gave me pause when the friendly medical assistant ran through a remarkable litany of awful things that could happen to mild asthmatics – like me – who contracted pneumonia, including the possibility of ending up in a coma. So I consented. Like the majority of British people, I am a firm believer in the public health benefits of vaccination.

I then headed into work, where I felt completely fine for a couple of hours. Then I lost most of the movement in my left arm. I started to feel alternately boiling hot and freezing. My view of the office started to spin like a slot machine. I held on to the edge of my desk with my good arm, to avoid falling out of my seat.

The next day, I was in agony. I went to A&E, expecting to be given a prescription for codeine and summarily dismissed. Instead, as my arm had swelled to almost the size of my thigh, I was admitted as an inpatient.

Doctors tried various combinations of antibiotics to bring down my speeding heart rate, spiking temperature and grotesquely swollen arm. I’d been under the weather, but no evidence of an underlying condition was found in any of the tests the hospital ran. We were left with one conclusion: getting vaccinated had made me dangerously sick.

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For a while, I was angry that I had been given the second vaccine at all: several doctors at the hospital had remarked that they would never have bothered vaccinating a mildly asthmatic 22-year-old against pneumonia. They told me it had probably been done because the GP surgery received additional funding per vaccinated patient. Suddenly, the medical assistant’s pneumonia horror stories made a lot more sense.

But then, when a diagnosis was finally reached, I realised the stupidity of my annoyance. I had contracted a severe case of cellulitis, a common and usually non-serious condition that can occur after any break in the skin. It can, though rarely, be caused by an injection needle and it can, again rarely, become serious. In short, I had just been really unlucky.

But that isn’t a comforting explanation. When, filled with righteous zeal, I began searching the internet for a reassuring answer to why I had become so ill, the only places offering one were social media communities for anti-vaxxers. For the first time, I understood the draw of these groups – and there are a lot of them out there.

Type ‘vaccination’ into the Facebook search bar and you receive suggestions like VACCINE TRUTH MOVEMENT, Vaccination Re-education and Stop Mandatory Vaccination. The latter group is followed by more than 130,000 accounts and was recently censored by the UK Advertising Standards Agency over a paid-for Facebook post. “Parents,” it read, “not only can any vaccine given at any age kill your child, but if this unthinkable tragedy does occur, doctors will dismiss it as ‘Sudden Infant Death Syndrome’.”

The post also included an image of a baby, eyes closed, with the caption: “Owen Matthew Stokes (Aug 18, 2017 – Oct 25, 2017)… 2 month old dies 48 hours after 8 Vaccines”.

Personal stories like this one feature heavily across online anti-vaxxer communities. Most of them are about babies with congenital health conditions, diagnosed after the child had been vaccinated. But that isn’t how the graphics, videos, and below-the-cut posts tell it.

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There is a persistent belief among anti-vaxxers that ‘too many’ vaccinations at once can overwhelm the immune system, causing illnesses from encephalitis to multiple sclerosis – or, classically, neurodivergence like autism. Debunking this with scientific evidence has proved ineffective; the almost inevitable responses are another sick baby scare-story or a pseudoscientific counter-argument, backed up by the apparent authority of a naturopath.

This month, Pinterest decided that the only tenable solution was a blanket ban on all content relating to vaccines, recognising that their platform had become a hive of misinformation and scare-stories propagated by anti-vaxxers.

What’s striking about these groups, is the range of political viewpoints they can accommodate. Left-populist distrust of profit-motivated healthcare comes up a lot – its an understandable instinct, and one I felt too when I was given reason to wonder if the man who vaccinated me did so out of financial incentive. A lot of people in these communities also have strong libertarian leanings. They are inherently suspicious of government incentives to vaccinate, considering it an affront to bodily autonomy.

Research published just this week by Queen Mary, University of London, indicates that vaccine hesitancy grows in line with support for populist parties across the political spectrum. But while the populism is important, the politics is usually secondary to the appeal of online anti-vaxxer spaces. The biggest draw is having something concrete to blame for sickness and suffering. People can become horrifically ill horrifyingly quickly, and sometimes doctors don’t understand why. We all know this, but it doesn’t help much when it actually happens to us.

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For parents of severely ill or deceased children, a demographic vastly over-represented in these communities, blaming vaccines allows them to believe that they can do something active to protect other children from the suffering their child experienced. It is far more difficult to accept the helplessness of never knowing exactly how or why your child became sick, than it is to accept that their suffering is the fault of something you are able to fight against. Vaccines provide a target.

Where does that leave us? A measles epidemic in Madagascar just killed more than 900 people. To achieve and maintain immunity, we need to reframe the issue for people feeling the lure of the anti-vaxxers. The power of the case against vaccines is largely in its appeal to emotion and agency. It’s this that the pro-vaccine majority needs to address when we make our counter-case.

What happened to me was rare, non-contagious and eminently treatable. None of those things is true for the diseases from which vaccination protects us.