The only steadfast rule the Lancet provides is that the letter should reach the journal within eight weeks of the publication of the item commented on. As one can see, I did send a reply in the configuration required by the journal. At no time did the Lancet offer the possibility of publishing my letter as a commentary. I may not have come out and specifically stated that I wanted to publish this as a comment letter, but both the intent and form of the letter made it implicitly clear of my desire to request the letter be printed. All rights reserved.
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