GMC Fitness to Practice Hearings: Deeper into the Shallows.

I am here to tell you that this case is not that complicated. What the prosecution's case amounts to is a labyrinth of smoke and mirrors. And when we blow away the smoke and get through the labyrinth, you will understand that. You will find that there is no fire, that there is no case against the defendant. That there is more than reasonable doubt here, that there is outrage that this case was ever brought in the first place.

Defence lawyer, Michael Haller introducing his opening
remarks to the jury in Michael Connelly's, The Brass Verdict [Orion 2008] 

By Martin J. Walker

All aesthetic judgements are based on two factors, form and content, this is just as true of a barristers closing speech as it is of a sculpture. Perhaps in the case of a barristers closing speech there is the added factor that the barrister is, as well as presenting a case in measured and creative terms also trying to convince a jury, a judge or in the case of the GMC a panel of professional jurors, of the correctness of the clients case. This being so, it is sometimes tempting to respond quietly to oneself, aside from either form or content, 'well he would say that wouldn't he'.

Taking this into account, Mr Miller's closing speech seems to me to have been so far, close to perfect in relation to form and content; a consummate synthesis. As for selling anything to the panel, this hardly seems necessary as his goods tumble off the barrow of their own accord pressing themselves on to the buyer. Of course the casual observer with a butterfly mind, such as a journalist, might be tempted to comment that Mr Miller's critique of the prosecution evidence is over the top or laced with depreciating comments that belittle the witnesses, but then they didn't sit through the evidence and would not see that if anything Mr Miller is politely downplaying, as is his style, the bare stupidity of much of the evidence.

Admittedly Mr Miller has an easier task than Mr Coonan who had to make a closing speech referring to evidence of phenomena that actually had nothing to do with his client. There is, of course always the chance that in arguing against something which hasn't happened, you make it more positive in the minds of observers. In concentrating on the areas of evidence he is, Mr Miller has been able to do that almost impossible thing in this case, make his closing speech interesting and alive. Believe me, I know, I have sat through one hundred and twenty odd days of evidence that on occasions have put me to sleep with greater efficacy than any prescription medicine.

In this report as in the last one, I have chosen to highlight only what I consider to be the most serious areas of contention. In order to suggest that non of the children were ill with gastrointestinal problems, the prosecution had to climb the wall in distorting and manipulating the evidence given or written by GP's and consultants, they had to not call parents, and they had to call expert witnesses who were practiced enough to avoid giving expert evidence in this area.

Dealing with the evidence of GP's and the letters sent with children who attended at the Royal Free, Mr Miller said that while the prosecution claimed that non of the children had IBD or any other novel gastrointestinal problem, the evidence from GPs and others did in fact point to some kind of gastrointestinal problems in the majority of the children. Of course it is not the GP's position to diagnose IG problems, this is better done in hospital with a battery of quite advanced procedures.

Once he got into his stride on Monday 15th June, Mr Miller homed in again and again on the issue of 172/96. So clear was it that 172/96 did not happen, that one marvels at Miss Smith's skill, and the GMC's audacity in hoaxing the whole hearing over two years - eventually perhaps even three - into believing that the trial was about the research ethics of this non existent study. If Miss Smith ever steps down from the bar, which one hopes she might have the grace to do soon, she could always work the Soho fringe venues as a magician.

Mr Miller often appeared to be adopting an ironic tone when he addressed the matter of 172/96, this is not to say that he was actually being ironic, just that the things he said in all honesty inevitably rang of irony. He detailed 9 main aspect of defence evidence that argued 172/96 had not actually occurred.

• All three defendants had given evidence that the Lancet children were not seen under the protocol for 172/96. Miss Smith can only suggest that the defendants are lying.

• The defendants say that all the children were seen on the basis of clinical need. Miss Smith can only suggest that the defendants are lying.

• All procedures were clinically indicated by everyone who saw the children. Miss Smith can only say that her expert witnesses who did not see the children suggest that there was no basis for these clinical decisions.

• Professor Walker-Smith wrote to Dr Pegg who chaired the Research Ethics Committee, that all the procedures took place on clinical grounds, whether or not 172/96 had been agreed.

• That where histology samples had been taken, a common occurrence during IG procedures, previous ethical committee approval was held for the taking of these samples.

• Why, said Mr Miller, in a question voiced by many people, would Professor Walker-Smith have wanted to deceive the research ethics committee at this point in his meritorious career. Miss Smith can only suggest that Walker-Smith, 75 years old and without a blemish on his career and one of the greatest European paediatricians is lying when he defends himself against these accusations.

• Other doctors and staff at the Royal Free Hospital all agreed that tests and procedures were carried out for clinical purposes. Miss Smith failed to call any of these doctors, nurse or other staff.

• The team that dealt with the clinical management of the children did so in a big hospital under the aegis of NHS care. Mr Miller asked how did the doctors on trial deal with other doctors involved while looking after these children did they dupe them while carrying out unauthorised research on them? Miss Smith seems determined that the whole hospital is lying and involved in a conspiracy.

• Mr Miller posed two alternatives, either there was a major conspiracy inside the hospital or Professor Walker-Smith was telling the truth and the children were seen on the basis of clinical need. Miss Smith is determined that there was a conspiracy.

In fact, following the run down on these points, Mr Miller pointed clearly to the paranoia present in the prosecution case when he suggested that the prosecution had intimated that the defendants had forged one document in order to make it appear that studies were clinically rather than research based!

From around 11.00 am on Monday, having explained the above points, Mr Miller embarked upon an analysis of the clinical presentations made by the children and analysed the procedures that they were used to try and diagnose their conditions. For the first time in a long time, the hearing became interesting and alive. I think that this was because Mr Miller did not, nor did he appear to want to dodge the very personal issues especially relating to Professor Booths evidence. It is undoubtedly when we begin to look at the personal dimension of the prosecution narrative that the hearing suddenly lights up.

Read the full report, "Deeper into the Shallows" HERE.

Martin J Walker is an investigative writer who has written four books about aspects of the medical industrial complex. He started focusing on conflict of interest, intervention by pharmaceutical companies in government and patient groups in 1993. Over the last three years he has been a campaign writer for the parents of MMR vaccine damaged children covering every day of the now two year hearing of the General Medical Council that is trying Dr Wakefield and two other doctors. His GMC accounts can be found at www.cryshame.com, and his own website is, www.slingshotpublications.com .

Comments

[Mike]

Thank you so much for your posts. As a parent of a beautiful little girl with severe autism, you could not have explained my feelings any better than when you used the analogy of a wet cloth over a chalkboard. If the result of this fiasco is a decision against the good Doctors the level of disappointment and dispair that I will feel will be overwhelming.

[Benedetta Stilwell]

In a free society this is what is suppose to happen. Both sides are presented, hopefully the judges are fair, and hopefully right wins out. However, this does not keep it from being gut wrenching to good people, esp when right does not win out, and perhaps people doing the ruling could be bias?

[Gatogorra]

I believe Occam's razor is usually put this way: all things being equal, the explanation which presents the least number of postulates is most likely to be true.

So let me get this straight-- our choices here are:

A) the Royal Free was in the grips of some cultish GI sect which ritualistically performed secret, unnecessary scopes on perfectly thriving children to appease some weird digestive God and then coerced or brainwashed everyone down to nurses' aides, subjects' parents and other doctors into silence.

Or

B) Drs. Murch, Walker-Smith and Wakefield performed clinically necessary tests on sick children at the request of the children's parents and are telling the truth.

I'm thinking, hmm, selection B.

[Jake Crosby]

That was a great analysis of the hearing. How the prosecution can claim that there was no clinical need to examine these childrens' conditions is appalling. Luckily, I think that pharma has really shot itself in the foot by putting these doctors and scientists on trial, regardless of the outcome. But I still hope Dr. Wakefield and Professors Murch and Walker-Smith are cleared, and that Miss Smith, Professors Booth and Rutter and Brian Deer all get theirs.