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Lancet

The Lancet is a weekly peer-reviewed general founded in 1823 by English surgeon and reformer Thomas Wakley as an independent platform to expose medical abuses and advance clinical knowledge. Published by since 1991, it covers original research, reviews, commentaries, and policy analyses in clinical medicine, , and , maintaining a high of 88.5 that ranks it first among general medical journals. With continuous publication since its inception, The Lancet has influenced medical practice through seminal contributions, such as early advocacy for sanitary reforms and evidence-based interventions, though its editorial stance has occasionally drawn criticism for prioritizing institutional consensus over dissenting empirical . Notable controversies include the 2020 retraction of a study that temporarily halted global trials due to unverifiable from Surgisphere Corporation, eroding public trust amid the , and the 2010 full retraction of Andrew Wakefield's 1998 paper falsely linking the to , which originated from unethical research practices.31324-6/fulltext) These events underscore challenges in and at high-profile outlets, where rapid publication pressures during crises have amplified scrutiny of and potential biases in .

The Lancet (Medical Journal)

Founding and Early History

The Lancet was founded in on October 5, 1823, by Thomas Wakley (1795–1862), a qualified and who had become disillusioned with the medical profession's entrenched corruption and restrictive practices. Wakley's motivations stemmed from personal and professional grievances, including a in 1822—likely orchestrated by rivals—that involved being shot, stabbed, and having his home set ablaze, leaving him with permanent disabilities and fueling his radical reformist zeal. The journal's title referenced , a precise surgical blade used for incisions, as a for cutting away professional abuses, while also alluding to a lancet arch window designed to illuminate obscurity. From its inception, prioritized exposing the secrecy of by publishing unauthorized verbatim transcripts of lectures from elite institutions like and , which had barred public reporting to safeguard guild privileges and incompetent instructors. The first issue included a prospectus decrying the "" of , alongside reports of surgical procedures, clinical observations, and critiques of prevailing doctrines such as excessive . Wakley, operating from modest premises with limited resources, sold the weekly at a low price of 1 to reach practitioners and students excluded from establishment circles, rapidly building a circulation that challenged rivals like The Medical and Chirurgical Review. Early editions embodied Wakley's combative ethos through editorials lambasting in bodies like the Royal College of Surgeons and advocating empirical scrutiny over dogmatic authority, often provoking libel trials that Wakley won by proving the truth of his accusations against figures such as Sir Astley Cooper. These legal battles, numbering over 30 in the first decade, underscored the journal's role in eroding barriers to medical progress, including pushes for unregulated access to cadavers that influenced the , which legalized to curb illegal grave-robbing while enabling dissection for training. By 1830, had established itself as a vanguard for merit-based reform, prioritizing clinical evidence and accessibility over elite consensus.

Editorial Evolution and Scope

The Lancet was founded on October 5, 1823, by , a and reformer, with an initial editorial focus on exposing within the medical establishment, advocating for ethical reforms, and providing public access to surgical lectures and clinical reports that were previously restricted to elite institutions. Wakley, who served as editor from 1823 to 1862, positioned the journal as a "" against professional abuses, emphasizing transparency in and practice while publishing detailed accounts of hospital procedures to democratize knowledge. His sons, James Wakley (1862–1886) and grandson Thomas Wakley Jr. (1886–1908), continued this familial oversight for 85 years, maintaining a blend of clinical reporting, commentary on issues, and crusading that prioritized over purely academic pursuits. In the 20th century, editorial leadership transitioned to non-family appointees, marking a shift toward professionalization and greater emphasis on scientific rigor, though the journal retained its reformist ethos. Samuel Squire Sprigge (1909–1937) introduced a more literary style, while subsequent editors like Theodore Fox (1944–1964) advocated for expanded health services and David Wilson (1964–1976) resisted formal peer review in favor of editorial judgment. By the late 20th century, under editors such as Ian Munro (1976–1988) and Robin Fox (1990–1995), The Lancet increasingly incorporated statistical analysis and evidence-based content, evolving from a primarily British clinical periodical to an international platform; Richard Horton, editor since 1995, further broadened its scope by launching specialized Lancet family journals and commissioning reports on global challenges like climate-health intersections starting in 2009. This evolution reflected adaptations to scientific advancements, including gradual adoption of peer review processes despite early resistance, and a pivot from localized reform to addressing systemic inequities in global health. The Lancet's contemporary scope encompasses all domains of medicine, including , , and , inviting original contributions that advance or illuminate medical science and practice through formats such as randomized controlled trials, meta-analyses, systematic reviews, seminars, and health analyses. It publishes weekly issues prioritizing high-impact, evidence-based work from diverse global contributors, with a mission to apply scientific knowledge for societal transformation, including series on access, , and environmental determinants of . Editorial policies emphasize ethical standards, in conflicts of interest, and a commitment to , while commissioning targeted reports to influence and without restricting submissions to specific subfields.

Impact Factor and Influence

The Lancet's 2024 Journal (JIF), as calculated by Clarivate Analytics and released in June 2025, is 88.5, positioning it as the top-ranked journal in the categories of general and (out of 172 journals) and , general & internal (out of 332 journals). This figure represents the average citations in 2024 to citable items published in the journal during and 2023, down from a peak of 202.7 in the 2022 JCR amid extensive COVID-19-related publications, but still indicative of elite status compared to peers like The New England Journal of Medicine (JIF 97.7). Its 5-year JIF of 104.8 further measures citations to articles from the prior five years, highlighting enduring relevance beyond short-term spikes. Complementary metrics reinforce this standing: a of 87.6 (average citations over four years to 2023 publications), an (SJR) of 12.113 (prestige-weighted citations, quartile in ), and an of 936 (936 papers cited at least 936 times each). In 2024, its articles garnered approximately 347,563 citations, reflecting broad dissemination across clinical, , and domains. These indicators, while imperfect—susceptible to self-citation inflation and field-specific biases—position The Lancet as a primary outlet for transformative , with global readership exceeding 1 million unique monthly visitors to its online platform. Beyond quantitative measures, The Lancet's influence manifests in shaping evidence-based guidelines, such as those from the on epidemics and non-communicable diseases, where its peer-reviewed syntheses have informed interventions reaching billions. High-profile series on climate-health linkages and have spurred legislative actions, though critics note that editorial selection may amplify certain narratives over others, potentially skewing perceived impact. Overall, its metrics and policy penetration affirm a commanding role in advancing medical discourse, albeit one tempered by the need for rigorous scrutiny of underlying methodologies.

Major Controversies and Retractions

One of the most significant controversies involved a 1998 paper by Andrew Wakefield and colleagues, which reported on 12 children and suggested a possible link between the measles, mumps, and rubella (MMR) vaccine and autism or bowel disease.11096-0/fulltext) The study was later found to be fraudulent, with Wakefield having undisclosed financial conflicts of interest, including funding from lawyers suing vaccine manufacturers, and data manipulation such as altering patient histories to fit the hypothesis. The paper was partially retracted in 2004 regarding its interpretation of a vaccine-autism link, but fully retracted on February 2, 2010, after the General Medical Council ruled Wakefield guilty of serious professional misconduct, including unethical treatment of vulnerable children.60175-4/fulltext) This publication contributed to widespread vaccine hesitancy, resulting in measles outbreaks across multiple countries; for instance, MMR vaccination rates in the UK dropped from 92% to 80% post-publication, correlating with over 1,000 cases annually by 2008. In May 2020, amid the , published a study by Mandeep Mehra and others analyzing data from Surgisphere Corporation, claiming or use—alone or with macrolides—increased mortality and ventricular arrhythmias in over 96,000 hospitalized patients across six continents.31180-6/fulltext) The findings prompted the and multiple national agencies to suspend clinical trials of these drugs for treatment. However, independent verification failed due to Surgisphere's refusal to share , client contracts, or reports, revealing inconsistencies such as implausibly low case numbers in hospitals and mismatched demographic data.31324-6/fulltext) Three authors retracted the paper on June 4, 2020, citing inability to confirm , while the fourth, Surgisphere's CEO Sapan , dissented; subsequent investigations highlighted Surgisphere's small team and lack of verifiable database infrastructure. This incident exposed vulnerabilities in rapid during emergencies, leading to implement stricter data-sharing requirements for all submissions.31958-9/fulltext) Other notable retractions include papers tied to Macchiarini's tracheobronchial transplantation research, retracted in 2023 for ethical violations and falsified claims of success in regenerating airways, which had influenced clinical practices despite lacking rigorous evidence. These cases underscore recurring issues with data and author accountability, though The Lancet's overall retraction rate remains low compared to peers, at approximately 0.1% of publications from 1997–2017 per broader analyses of medical journals.

Criticisms of Bias and Methodological Rigor

The Lancet has faced significant criticism for lapses in methodological rigor, particularly highlighted by high-profile retractions during the . In a prominent case, a May 22, 2020, published in the journal analyzed data purportedly from Surgisphere Corporation, claiming that or treatments for patients were associated with higher mortality and ventricular risks across 671 hospitals in six continents.31180-6/fulltext) The study, involving over 96,000 patients, prompted the to pause global trials on May 25, 2020, due to safety concerns. However, independent verification revealed unverifiable and inconsistent data, including mismatches with from countries like , leading to the paper's retraction on June 4, 2020, after authors could not provide raw data for audit.31324-6/fulltext) Critics, including statisticians and clinicians, argued that the rapid peer-review process—completed in days amid pressures—bypassed standard , exposing systemic vulnerabilities in high-impact journals' handling of urgent research. The incident eroded trust in The Lancet's editorial safeguards, as the journal's editors acknowledged failing to secure verifiable data before publication, prompting new policies requiring data-sharing statements for all submissions.31958-9/fulltext) Subsequent analyses showed that retracted papers like this one continued to be cited positively in later works, amplifying despite retraction notices. Allegations of have centered on The Lancet's content and choices, with detractors pointing to a pattern of politically charged interventions that prioritize over neutrality. A June 6, 2020, Lancet questioned the Surgisphere study's before its retraction, coinciding with hydroxychloroquine's promotion by figures like then-U.S. President , raising suspicions of ideologically motivated scrutiny rather than purely scientific doubt. The journal's history includes editorials framing medical issues through lenses of and global inequities, such as critiques of Western policy in climate health or inequities, which some analysts describe as transforming into platforms for radical advocacy. For instance, coverage of conflicts like the Israeli-Palestinian issue has drawn accusations of selective outrage, with publications emphasizing alleged Israeli aggressions while downplaying contextual claims, potentially reflecting institutional leanings in . These criticisms underscore broader concerns about in elite journals, where left-leaning biases prevalent in may influence topic selection and framing, as evidenced by uneven of politically sensitive treatments during crises. Despite The Lancet's defenses emphasizing its to evidence-based , such episodes have fueled demands for greater transparency in and to mitigate risks of or rushed conclusions.

Surgical Instrument

Historical Development and Bloodletting

The lancet originated as a specialized for , a practice documented as early as 1550 BCE in the , where initial tools included sharp stones or basic blades for venesection to alleviate ailments by purportedly balancing bodily humors. In , by the era of around 400 BCE, a precursor known as the phlebotome—a simple lancet-like blade—was used for precise incisions into veins, reflecting early efforts to standardize the procedure beyond crude methods. By the , the thumb lancet marked a significant advancement, consisting of a double-edged iron or blade adjustable in depth and secured between two hinged, often ornate covers for manual operation; this design improved control during , allowing surgeons to incise superficial veins with minimal tissue damage compared to earlier knives. These instruments proliferated in amid humoral theory's dominance, with applied to conditions from headaches to plagues, often extracting up to a or more of blood per session. The introduced the spring lancet, a pivotal innovation featuring a trigger-activated, spring-loaded that deployed rapidly for depth-controlled incisions without pressing the device directly against the skin, thereby enhancing speed, sterility, and safety for the operator while minimizing patient trauma. This mechanism, sometimes called a "Schnapper," became standard in surgical kits, with manufacturers producing variants adjustable via screws for depth, reflecting growing of medical tools amid bloodletting's peak usage by barbers-surgeons and physicians. Bloodletting's reliance on lancets persisted into the early , but empirical observations—such as higher mortality in bled patients during epidemics—prompted scrutiny, culminating in its sharp decline by the 1870s as antisepsis, germ theory, and controlled trials exposed the practice's causal harms over benefits, shifting lancets toward diagnostic sampling. Despite this, lancet designs informed later sterile, disposable variants for blood glucose testing, underscoring the instrument's evolution from therapeutic excess to precise utility.

Design Features

The surgical lancet is characterized by a compact, double-edged blade crafted from iron or , optimized for making precise, shallow incisions in procedures such as or minor . This blade design allows for minimal tissue trauma while facilitating controlled blood flow, with the edges honed to a fine point for penetration. In thumb lancets, the dominant form from the 15th to 19th centuries, the blade measures typically 1 to 3 inches in length and is adjustable in exposure for varying incision depths. The blade is housed between two protective scales or shields, commonly constructed from durable, non-conductive materials like , tortoise , or occasionally metal, which serve to shield the edges during storage and transport while enabling quick deployment via thumb pressure. These scales are riveted together at the proximal end, forming an ergonomic handle that fits the practitioner's for , ensuring stability during use without requiring additional tools. Variations in scale materials reflect both functionality and status, with finer tortoise denoting higher-quality instruments for professional surgeons. Later innovations, such as the spring lancet introduced in the late , incorporated a mechanical spring mechanism within a or silver body to propel the blade forward upon trigger release, achieving consistent penetration depths of approximately 2-5 mm independent of user strength. These featured a detachable handle for portability and often included a loading to retract and tension the blade, with the overall encased for hygiene and compactness during house calls. Blade shapes evolved to include curved or profiles for venous access, enhancing efficacy in by aligning with vessel contours.00108-7/fulltext)

Modern Medical Applications

In contemporary , lancets serve primarily as disposable tools for sampling, most notably in for . These devices feature a fine, sterile blade or needle that creates a small puncture to obtain a drop of for , minimizing patient discomfort and tissue damage compared to larger incisions. Lancets differ from scalpels in their specialized design for shallow, precise pricks rather than deep cutting, with common sizes ranging from 28 to 33 , where higher gauges correspond to thinner needles that further reduce pain. They are integrated into adjustable lancing devices, such as the OneTouch Delica Plus or Accu-Chek FastClix, which control (typically 0.5 to 2.0 mm) and incorporate ejection mechanisms for safe lancet disposal, thereby lowering risks of needlestick injuries and cross-contamination. Single-use lancets are pre-sterilized and often color-coded by for ease of selection, supporting frequent self-testing—up to multiple times daily for insulin-dependent patients—to maintain glycemic control and avert complications like or . Beyond , lancets facilitate other diagnostic applications, including neonatal heel sticks for screening metabolic disorders and heel or finger pricks in clinical settings for or assays, where minimal suffices. Safety-engineered variants, compliant with regulatory standards like those from the FDA, include retractable needles or shielding to prevent reuse and transmission, reflecting advancements in device reclassification for general and contexts. While occasional use persists in minor procedures for precise, small incisions, such as in or , the tool's dominance lies in non-invasive diagnostics rather than therapeutic , which has been largely supplanted by evidence-based alternatives.

Architectural Feature

Definition and Characteristics

A lancet in refers to a tall, narrow or arched opening terminated by a sharply pointed , evoking the slender blade of a medieval or surgical lancet . This form emphasizes verticality, with the height typically far exceeding the width, creating a slender profile that directs the viewer's gaze upward. The defining characteristic of the lancet arch is its acute , formed by two intersecting curves where each arc's surpasses the of the opening, producing an angle narrower than a standard semicircular arch and often less than 90 degrees. Unlike broader pointed arches, the lancet prioritizes elongation and minimal width, frequently appearing without decorative in its simplest iterations, though later variations may incorporate subtle moldings or hoods. This geometric restraint enhances structural efficiency by distributing weight along tapered lines, a principle rooted in load-bearing considerations for stone . Lancets are commonly deployed singly or in paired or triple groupings under a unifying dripmold or platband, fostering rhythmic facades while admitting light through minimal glazing areas. Their proportions—ratios of height to width often approximating 3:1 or greater—contribute to an aesthetic of aspiration and lightness, distinguishing them from the rounded arches of preceding Romanesque styles.

Origins in

The and arch emerged in the early Gothic period of the , marking a key innovation in the transition from Romanesque architecture's rounded forms to pointed arches that better distributed structural loads and permitted taller, more luminous interiors. This form, characterized by its narrow, sharply pointed profile—where the arch's radius exceeds its width, evoking a tip—facilitated vertical emphasis and increased glazing, aligning with Gothic aspirations for symbolic height and divine light. The pointed arch's adoption, first evident around 1140 in , addressed Romanesque limitations in vaulting and wall thickness, enabling slender columns and expansive areas without compromising stability. In , early lancet elements appeared in cathedrals like (begun c. 1130), where pointed arches began supplanting rounded ones amid broader structural experiments with ribbed vaults and early flying buttresses. By the mid-12th century, this evolved into the "Lancet style" or Early Gothic phase (c. 1140–1200), prioritizing austere, untraceried lancet windows to maximize height and minimize ornament, as seen in subsequent French examples that prioritized light over mass. The style reflected influences from late Romanesque precedents and possibly Islamic pointed arches encountered via , though its causal driver was pragmatic: redirecting thrust downward for thinner walls and larger apertures. The lancet form spread to by the late 12th century, maturing in the Early English Gothic (c. 1190–1250), where it defined austere window designs without , as in Cathedral's extensions (c. 1174–1184). Here, lancets grouped in tiers emphasized elongation, influencing later developments like the triple lancet motifs at (construction begun 1220). This evolution underscored Gothic architecture's empirical progression toward efficiency, with the lancet's simplicity yielding to more complex in phases, yet retaining its foundational role in enabling the era's luminous cathedrals.

Notable Examples and Variations

One prominent example of lancet windows is found in , , constructed between 1220 and 1258 in the Early English Gothic style, where the west facade features a large central lancet flanked by two narrower ones, topped by a smaller lancet and , emphasizing verticality and light penetration. The cathedral's aisles and transepts also incorporate multiple lancet openings with original 13th-century glass, highlighting the form's role in early plate tracery development. Lincoln Cathedral provides another key instance, with its early 13th-century clerestory featuring stepped triplets of lancet windows per , paired with lancet arches to enhance interior illumination and structural rhythm. The west front includes blind lancet arcades and openings framing sculptural elements, dating from phases around 1235–1250, which integrate the motif into decorative screens. Similarly, Abbey's north employs sets of three lancet windows above porches, constructed in the mid-13th century, often filled with later but retaining the original sharp-pointed profiles. Variations of lancet forms include single narrow windows with acutely pointed arches, typically spanning 4–12 feet (1.2–3.7 meters) and rising 4.4–13.3 feet (1.3–4 meters), used for minimalistic emphasis in austere settings. Double or triple lancets, as in early Gothic examples like those at the Museum's preserved panels (circa 1245–1280), combine identical pointed units under a shared or , allowing grouped lighting without complex bar . Stepped arrangements, seen in transepts like Cathedral's east end (with five upper and three lower lancets from the 12th–13th centuries), create hierarchical compositions for facades or apses. lancets in arcades, devoid of glazing, serve ornamental purposes, as in Lincoln's galleries, evolving from structural to aesthetic roles in later medieval designs. These adaptations distinguish lancets from equilateral or obtuse pointed arches by their elongated radius exceeding the span width, prioritizing slender verticality over symmetry.

Other Uses

Surname and Etymology

The surname Lancet is rare, with global incidence estimated at fewer than 100 bearers as of recent genealogical surveys, predominantly in (49% of occurrences) and Anglo-North American regions. Historical census data record the name in the United States, , , and between 1841 and 1920, with the largest number of families (five) appearing in the U.S. by 1880. Etymologically, Lancet is an English surname of medieval origin, derived from an unrecorded or personal name *Lancet, a or pet form of the Continental Lanzo. Lanzo itself stems from ancient Germanic elements, often interpreted as relating to "" (from Proto-Germanic *landą) in compound names, with pet forms evolving into surnames like and through influence post-1066 . Variant spellings such as Lancett, Lanceter, and Lancetor appear in records, reflecting phonetic adaptations in English parish registers from the 16th century onward. Alternative derivations link the name to Old French lancette ("little lance"), a diminutive of lance (spear), potentially indicating an occupational origin for a surgeon using lancets or a spear-maker, though this interpretation lacks direct attestation in primary surname records and may conflate the tool's semantics with onomastic evidence. Genealogical sources prioritize the personal name hypothesis due to patterns in related surnames and medieval naming conventions.

Miscellaneous References

The Lancet is a weekly peer-reviewed general established on 5 1823 by Thomas Wakley in , . It publishes original research, reviews, and commentaries across clinical medicine, , and , with an emphasis on advancing scientific knowledge to improve human health. The journal's name derives from the surgical lancet, evoking the idea of incisive critique to expose flaws in medical practice and illuminate obscured truths in the field. As of 2023, it holds an of 88.5, ranking first among 332 general medical journals, reflecting its influence in disseminating high-quality evidence-based findings. Published by , it maintains while committing to rigorous , though it has faced scrutiny over retractions of high-profile papers, such as a 2020 study on efficacy that was withdrawn due to unverifiable data concerns.31180-6/fulltext) In biology, "lancet" refers to Dicrocoelium dendriticum, a trematode parasite known as the lancet liver fluke for its slender, leaf-shaped (lancet-like) body measuring 6–10 mm in length and 1.5–2.5 mm in width. Primarily infecting the bile ducts of ruminants such as sheep, , and , it causes dicrocoeliasis, leading to symptoms like , , and liver damage in heavy infestations, though infections are often subclinical. The fluke's involves terrestrial s as first intermediate hosts, where infective metacercariae develop in slime balls consumed by , which serve as second intermediate hosts; grazing mammals ingest infected s to acquire adults. Human infections are rare accidental occurrences via contaminated vegetation or water, typically resulting in mild or asymptomatic cases treatable with . This parasite is distributed worldwide, particularly in temperate regions with suitable and habitats, and control relies on reducing populations and pasture management rather than routine due to its zoonotic infrequency.

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