Lancet editorial 'lacks' scientific robustness in calling India's Covid data untrustworthy

Dr Amitav Banerjee, MD*  
The editorial, "India's ascendency: leadership demands integrity," published in Lancet, Vol 401, May 6, 2023 is a half baked political commentary more in the nature of an armchair exercise missing the finer nuances of the political situation on the ground. Regrettably, the editorial also alleges that the Covid-19 data from India is untrustworthy. These are sweeping statements which are speculative on the political issues and bad science as well as the estimates of Covid-19 deaths by World Health Organization (WHO) are inferred from dubious mathematical models rather than hard population level data. Before elaborating how the editorial is wide off the mark on both politics and science it would be relevant to discuss whether political commentaries should find a place in medical journals.
The association between politics and pandemics was first emphasized by Rudolf Virchow in 1848. His observations while investigating the pandemic of typhus in Europe in the nineteenth century drove a paradigm shift in understanding human disease at the population level. 

Beyond the narrow concept of pathogen as the sole cause of pandemics, Virchow stressed the importance of social and economic conditions such as poverty, poor civil services, ignorance, illiteracy, and other socioeconomic factors. These observations, all of which called for political action made him sum up with the famous words, "Medicine is a social science, and politics is nothing but medicine on a large scale.”
Against this background it may be relevant for political commentaries to find a place in medical journals. Having said this, it is important to consider who is competent to write these in an objective and unbiased manner. Even in scientific papers, Richard Horton, the editor of Lancet had conceded that the choice of papers in Western medical journals has a racist bias, giving the diseases of poverty a lower preference. This renders the contents, both scientific and political, of the Lancet highly unrepresentative and biased. They tend to be amateurish with shallow insights ignoring different perspectives.
What is more dismaying is that the editorial lacks scientific robustness in calling the Covid-19 data "wholly untrustworthy." It states that the official government figures place deaths at 530000 while WHO excess death estimates are near 4.7 million. It conveniently overlooks that the WHO figures are based on dubious mathematical models rather than ground level robust data.
For example, estimates of number of deaths in India from Covid-19 based on serosurvey data from the field reassures us that the Indian government figures are authentic. Ioannides, early in the pandemic, based on population level serosurveys inferred that the infection fatality rate (IFR), for persons below 70 years was in the range of 0.03% to 0.04%. Majority of the Indian population, over 97% are below 70 years of age. 

Estimates of number of deaths from Covid-19 based on serosurvey data from the field reassures us that Indian government figures are authentic

As a rule of thumb if we apply the 0.04% IFR and extrapolate the rate to the total Indian population (around 1400000000), the total estimated deaths is 560000, very near to the official Indian figure of 530000 mentioned in the Lancet editorial. In fact, deaths in India may be still lower due to its much lower obesity rates compared to Western populations.

It is evident that the Lancet and other leading journals from the West need a course correction by encouraging diverse views on complex political situations, the nuances of which will be missed by Western authors. Surprisingly, it is getting the science wrong too, as illustrated by the Covid-19 inflated death rates in its commentary. Such lapses call for more diligent homework on the part of leading medical journals before being judgmental and using derogatory terms like “wholly untrustworthy."

A more balanced view, in case the Lancet wanted to discuss politics in relation to health would have been to stress the negative influence of politics & corruption in suppressing science leading to huge collateral harms and economic setbacks. A BMJ editorial poignantly states that when good science is suppressed by politics and corruption, people die. Draconian measures which were adopted in Western countries killed people in poor countries due to the immense collateral harm. 

The papers published in leading Western medical journals, under the influence of politics and corruption, misguided the world in adopting the same measures in their own countries with different epidemiology. The biggest price was paid by the poor in all countries. 

The Lancet itself has been responsible for the biggest publishing scam in recent history when it published a paper based on fake data to tarnish the image of a cheap drug like hydroxychloroquine in early treatment of Covid-19. Later the paper had to be retracted. Now, who is “wholly untrustworthy?”

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*Post doctoral in epidemiology who was a field epidemiologist for over two decades in the Indian Armed Forces. He also led the mobile epidemic investigation team at the Armed Forces Medical College, Pune, India from 2000 to 2004. During this period he investigated a number of outbreaks in different parts of the country. He was awarded for his work on Tribal Malaria and Viral Hepatitis E. He presently is a Professor in a Medical College in Pune