The Lancet has rejected a letter criticising the PACE trial that it invited from a large group of scientists. This decision was made after its editor discussed the matter with the study’s authors.

Professor Vincent Racaniello, who led the letter, described the behaviour of Dr. Richard Horton, editor of The Lancet, as “unprofessional”.

Racaniello, with five other signatories, wrote an open letter to The Lancet in November, pointing out “indefensible” flaws in PACE that, the letter said, “have no place in published research”. The letter was ignored and Racaniello reposted it in February, with 36 additional signatures. This time, Dr. Horton responded immediately and replied, “In the interests of transparency, I would like to invite you to submit a letter for publication — please keep your letter to around 500 words. We will then invite the authors of the study to reply to your very serious allegations.”

Racaniello submitted a 43-signatory letter in March. He said, “After several months with no response, we learned only recently by checking the online editorial system that The Lancet had flatly rejected the letter, with no explanation. No one contacted me to explain the decision or why we were asked to spend time creating a letter that The Lancet clearly had no intention of publishing.

“I wrote back to Dr. Horton, pointing out that his behavior was highly unprofessional and requesting an explanation for the rejection. I also asked him if he was in the habit of soliciting letters from busy scientists and researchers that his journal had no actual interest in publishing…. Dr. Horton did not himself apologize or even deign to respond. Instead, Audrey Ceschia, the Lancet’s correspondence editor, replied, explaining that the Lancet editorial staff decided, after discussing the matter with the PACE authors, that the letter did not add anything substantially new to the discussion.”

Dr. Racaniello describes the reasons given for the rejection as “clearly specious” and said, “It is certainly surprising that The Lancet appears to have given the PACE authors some power to determine what letters appear in the journal itself.”

He said that, due to “the urgency of the issue”, he had now posted the letter on PubMed Commons, where it is visible to anyone who accesses the Lancet paper via PubMed, the US National Library of Medicine’s gateway to the scientific literature. He said, “That way readers can judge for themselves whether it adds anything to the current debate.”

Tom Kindlon, a patient who has published criticism of PACE in the medical literature, said, “I find it disgraceful that the PACE Trial investigators were given any sort of say on what would or would not be published. The points raised in the letter were valid and it would be in the interests of science and progress in the field for them to be published. This follows on from various establishment figures, such as members of the House of Lords, defending the PACE Trial. This trial and the investigators who ran it seem to get special treatment and protection from criticism: I don’t believe this is in the interests of patients or indeed medical professionals who depend on well-run and properly reported randomised controlled trials to inform their clinical practice.”

Professor Racianello’s blog can be read in full here.