By John Stone
The GMC hearing against Andrew Wakefield, John Walker-Smith and Simon Murch has finished hearing evidence. All that remains are for panel to hear final summaries next month, and to give its final adjudication sometime in the early summer. It is apparently not possible to address representations to the panel so this letter is addressed to GMC president, Sir Graeme Catto.
Dear Sir Graeme,
I write at this late stage of the GMC hearing against Andrew Wakefield, John Walker-Smith and Simon Murch to draw your further attention to procedural failings in the conduct of the case by the GMC, that the GMC has been politically manipulated, and the central charges are “trumped-up” fabrications which should never have been brought. I would particularly like to highlight the horrific manipulation of the truth, which has a vile ideological tinge to it - redolent of the theories of Dr Meadow and Dr Southall - that the three doctors were engaged in the invention of symptoms of the patients, and instigating uncalled-for interventions. But I would also like to re-visit the political circumstances in which this prosecution was brought.
The claim that such procedures on autistic children were inherently inappropriate recently received a blow with the publication of the NIH study, Hornig et al, ‘Lack of Association Between Measles Virus Vaccine and Autism with Enteropathy: a case control study’. While the results of the study were much more indeterminate than its formal conclusion the study itself was testimony to the fact that in many cases colonoscopy is an appropriate procedure for children with bowel complaints, irrespective of whether they are autistic or not. To believe the prosecution at this hearing Profs Walker-Smith and Murch were responsible for ordering investigative procedures when there was no physical reason, although the association between autism and bowel disease is actually well attested. This was in fact stated by the National Autistic Society ahead of the hearing. I quote their statement:
‘The National Autistic Society (NAS) is keenly aware of the concerns of parents surrounding suggested links between autism and the MMR vaccine. The charity is concerned that the GMC hearing, and surrounding media coverage, will create further confusion and make it even more difficult for parents to access appropriate medical advice for their children.
‘It is particularly important that this case is not allowed to increase the lack of sympathy that some parents of children with autism have encountered from health professionals, particularly on suspected gut and bowel problems. Parents have reported to the NAS that in some cases their concerns have been dismissed as hysteria following previous publicity around the MMR vaccine. It is crucial that health professionals listen to parents' concerns and respect their views as the experts on their individual children.
‘There is an urgent need for further, authoritative research into the causes of autism, to improve our understanding of the condition, to respond to parents' concerns and to enable us to ensure that there are appropriate services and support in place to meet people's needs.’
The statement reflects the tragic predicament of autistic children with bowel disease in this country as result of this unfortunate prosecution, and it will simply not do to blame these three doctors for the continuing cruelty and neglect inflicted on these children by the medical establishment , as evidenced by the National Autistic Society statement. Even if there was no particular association between autism and bowel disease, there would be no grounds for this discriminatory medical practice against those autistic children with GI symptoms which needed investigating and treating.
I was also perplexed to see that the journalist who originally brought these accusations against the three doctors , Brian Deer, place the Hornig study on his website. He perhaps also ought to have noticed the statement in the paper’s discussion which places its own conclusions in an anomalous light:
‘Our results differ with reports noting MV RNA in ileal biopsies of 75% of ASD vs. 6% of control children ... Discrepancies are unlikely to represent differences in experimental technique because similar primer and probe sequences, cycling conditions and instruments were employed in this and earlier reports; furthermore, one of the three laboratories participating in this study performed the assays described in earlier reports. Other factors to consider include differences in patient age, sex, origin (Europe vs. North America), GI disease, recency of MMR vaccine administration at time of biopsy, and methods for confirming neuropsychiatric status in cases and controls.’
So, at this late stage the results of this study, based on patients from the Royal Free Hospital, stands. Moreover, the Hornig paper lends support to the persistent ileal measles hypothesis, by detecting measles RNA in two cases (one of them without autism but both having gut pathology and being vaccinated with MMR) confirmed across three leading laboratories. And on its own testimony the difference in results between the two studies is the difference of selection not of methodology, with a case selection process in the Hornig study which is both opaque and evidently designed to avoid too many positive results. But even if this was not the case, the Hornig study would still testify to the appropriateness and ethicality of the use of these investigative procedures in a sub-group of autistic children.
This bears on the issue of the good sense and fairness of this prosecution. How could it be that two senior paediatric gastroenterologists – without any of the alleged competing interests of the third defending doctor – would order tests on children where there was no clinical necessity, when in fact there are many such children for whom there is? The prosecution has been forced to maintain outrageously throughout that there was nothing clinically wrong with the children - in effect making Meadow style allegations against the doctors of fabricating their patients’ illnesses. Not only is this a repulsive accusation but as both the prosecution and defense cases illustrated, many other experienced clinicians were also involved in these decisions. The GMC has apparently no ethical qualms in making its members answer the most absurd and fanciful accusations, and this is troubling because if such accusations can be made in the first place, can we even rely on the good sense and independence of the panel in rejecting them?
It is essential to raise this issue because at no stage, so far, in the history of this affair have any of the traditional lines of due process been observed, and I note the peculiarly political inception of the prosecution , which began with the editor of the Lancet, Richard Horton, making an allegation and the Secretary of State for Health, John Reid, calling for an investigation – all of which took place on the eve of a hearing into the Legal Services Commission decision to remove funding from the MMR case before a judge – Sir Nigel Davis - who turned out to be the brother of Crispin Davis, who was chief executive of the parent company of the Lancet, Reed Elsevier, and thus Horton’s employer, but also for some months at the time of these events a director of MMR defendant company GlaxoSmithKline . On his own testimony, Horton, was within three days talking with a senior regulator (GMC official) about how a prosecution might be brought against Wakefield, despite his key role as a witness, if such a case was brought (which, of course, it was). I quote from his book MMR Science and Fiction: Exploring the Vaccine Crisis (August 2004):
‘In truth, they (the GMC) had not a clue where to begin. At a dinner I attended on 23 February (2004), one medical regulator and I discussed the Wakefield case. He seemed unsure of how the Council could play a useful part in resolving the confusion. As we talked over coffee while the other dinner guests were departing, he scribbled down some possible lines of investigation, and passed me his card, suggesting that I contact him directly if anything sprang to mind. He seemed keen to pursue Wakefield, especially given ministerial interest. Here was professionally led regulation of doctors in action - notes exchanged over liqueurs in a beautifully panelled room of one of medicine's most venerable institutions’ (p7-8)
When I recently drew this matter to your attention you did not respond but passed the matter on to Nell Marshall, assistant director, Adjudication, Fitness to Practice Directorate’ who wrote back:
‘In short, I can assure you that the instigation of our investigations has absolutely nothing to do with any conversations which ‘medical regulators’ may have had with Dr Horton at the dinner described in his book. If such conversations took place, they were not reported back in to our investigations team who were looking at the case at the time. This being the case, the content of any such discussions had absolutely no impact at all on any of the decisions made about whether to proceed to investigate the case or, indeed, how such investigations should be carried forward.’
But actually this simply makes the point that they did not investigate the case properly, did not look at issues which were in the public domain and bore on the impartiality of both their investigation and their witness – and remained unconcerned when they had it pointed out to them.
Nor, it seems did they probe Horton’s claim against Wakefield adequately. I, myself, was present in August 2007 when Horton told the hearing that he was under the misapprehension that Wakefield’s disclosure of his involvement in the MMR litigation referred only to the period after the publication of the controversial study (28 February 1998). To be sure, Wakefield’s letter was not published in the Lancet till nine weeks after on 2 May 1998, but the letter from Andrew Rouse to which Wakefield was responding - which referred to material already published on the web – was dated 4 March 1998. Now this is quite extraordinary for someone who is not only supposed to be a mentally competent person but is also the editor of a great scientific journal. Horton did not apparently check this out when he made his original allegation against Wakefield in the BBC evening news on 20 February 2004, did not check it out when the Independent newspaper pointed out the existence of the letter on 27 February 2004, did not check it out before writing his book (where the matter is not mentioned), and did not check it out before giving his evidence under oath before the GMC. I believe the GMC have been negligent and incompetent in allowing this to happen.
I also believe that the GMC has been too willing to be at the government’s beck and call. John Reid asked for the GMC to investigate Horton’s allegation on 21 February 2004. On the 23 February 2004 the Chief Medical Officer, Sir Liam Donaldson, told the BBC:
"Now a darker side of this work has shown through, with the ethical conduct of the research and this is something that has to be looked at".
And the then Prime Minister, Tony Blair, told ITN:
"There's absolutely no evidence to support this link between MMR and autism...I hope now that people see that the situation is somewhat different to what they were led to believe, they will have the triple jab because it is important to do it."
So, there was not only a willingness and desire for them to involve themselves, but also to pre-judge the issue. And the GMC has further compromised itself, first of all by appointing Prof Denis McDevitt, who sat on the government sub-committee that passed MMR Pluserix vaccine as safe for use in 1988, as chair of the hearing panel, but also when he was forced to withdraw, appointing in his stead Surendra Kumar, who sits on two medicine licensing authority (MHRA) committees, and has at least until recently owned shares in GSK – be it noted that the MHRA describes itself as a Department of Health agency. However independently Kumar acts, the GMC’s indifference to ordinary perceptions of conflict on the establishment side is remarkable.
John Stone is a member of Cryshame, has an autistic son and lives in London.
Secret British MMR Files Forced Open By Legal Action (HERE)