In the summer of 2014, hostilities again raged in the Middle East, precipitated by thousands of missiles from Gaza targeting civilian centres in Israel, including schools, daycare centres, and heavily populated areas. Israel launched a fierce response, with the goal of eradicating rocket fire greatly complicated by the embedding of rocket launchers within civilian areas of Gaza. In July of 2014, the Lancet published an “Open Letter for the People in Gaza”, no doubt inspired by the anguish of civilian casualties. Surprisingly, for a peer-reviewed scientific journal, the letter was highly biased, with multiple questionable assertions, accusations, and unsupported allegations, that provided a uniquely one-sided narrative, directly at odds with multiple established facts. The Lancet Editorial office piled on, simultaneously establishing an online petition to “Support the Letter”. Not surprisingly, many of the signatories of the letter had a long history of anti-Israel, pro-Palestinian activism, and several signatories, including Paola Manduca herself, were subsequently found openly flaunting their racist, anti-semitic views, eagerly circulating David Duke conspiracy videos to like-minded colleagues. The publication of the letter prompted a series of vigorous responses, including letters to the Editor, calls and letters to Elsevier head office, complaints to the Elsevier ombudsman, and varying levels of disengagement with Lancet and Elsevier journals, books, and sponsored meetings. There are no clear winners in war; innocent people suffer, and tragedy is ubiquitous. Sadly, the Manduca narrative published by the Lancet reminded us yet again that “the first casualty of war is truth”. Our Petition called on the publisher, Elsevier, to “institute guidelines governing ethical publishing of science and medicine free of divisive political opinion.” Although hundreds of colleagues tried to meaningfully engage Elsevier, our entreaties were waved off, dismissed, or ignored, under the rubric of “editorial independence”. To paraphrase Abba Eban, Elsevier seems to (profitably) coast from one controversy to another, “never missing the opportunity to miss an opportunity”. Hence, at a time when libraries and institutions are revolting against mandatory bundled journal costs, and when innovations in open access publishing, supported by charitable trusts and foundations, stand to further disrupt and transform the publishing industry, Elsevier refused to constructively engage with a sizeable scientific constituency, including authors, reviewers and editors. The consequences of inaction for Elsevier are likely to continue for some time, and the loss of goodwill and erosion of reputation, is unlikely to be easily reversed. A debt of gratitude is owed to the thousands of thoughtful individuals for taking a stand, and reappraising their relationships with a publisher oblivious to its moral and ethical responsibilities. The actions of the Lancet Editor-in-Chief, Richard Horton, a long-time supporter of the Lancet Palestinian Health Alliance, have been more constructive. While initially resisting meaningful corrections, retraction, or a measured mea culpa, Dr. Horton accepted an invitation to visit Israel, and engage with its medical leadership. Visiting medical clinics and hospitals, where a large number of Palestinians and Arab citizens receive health care free of charge, provided a different perspective, perhaps one that had remained invisible to an individual who had never before visited Israel. On a series of subsequent visits, Dr. Horton learned a great deal more about the Israeli scientific and medical community, including interactions with emergency health care first response units, and Israelis skilled in the art of minimizing civilian casualties. With the support of senior Israeli medical and government leadership, The Lancet commissioned a series of articles to highlight contemporary themes in Israeli medicine and medical science, a country neglected by the Lancet until now, despite Israel’s Nobel Prize-winning accomplishments in science, biotechnology and medicine. Today Dr. Horton launches the Lancet Israel series, with a series of conferences in key cities across Israel. The series of articles, published in both English, Hebrew and Arabic, highlights emerging themes, innovation, education and leadership in Israeli health, medicine and science,, http://www.thelancet.com/series/health-in-israel As noted by Horton and Skorecki, Israel can lead to leverage the universally accepted principles of health, as a sanctuary against conflict and inequity, to achieve a brighter future for a deeply troubled region of the world” What have we learned from the Manduca-Lancet affair? First, it is worth restating that bias, false accusations, and hatred, have no place in a learned medical journal, irrespective of its focus on global health. Second, credibility and reputational excellence is earned over time, and not easily regained if rules and standards are selectively twisted or discarded. Third, resolution of any conflict, including that engendered by the Lancet-Elsevier-Manduca imbroglio, requires dialogue and mutual understanding. Parties that refuse to engage with each other will find it nearly impossible to reconcile differences and move forward. Credit is due to the Israelis, led by Karl Skorecki, who reached out to Dr. Horton with an invitation to provide him with a perspective of Israel that had previously been lacking. Equal credit is due to Dr. Horton, for accepting the invitation, repeatedly visiting Israel, and ultimately commissioning the Lancet-Israel series that is published this week in the Lancet. In a tumultuous world riddled with recurring human misery and conflict, medicine and science must remain endeavors that work to instill hope for a better future, independent of challenging political realities. We must never abandon our responsibility to maintain the highest ethical standards, in all of our professional activities. Let us remain dedicated to our science, and the health of our patients. “Primum non nocere” challenges us to exercise our responsibility in a thoughtful, respectful, manner. It is our universal obligation that should never be neglected or forgotten.