By John Stone
“The case we presented against Andrew Wakefield that the 1998 Lancet paper was intended to mislead is not critically reliant on GP records.” So wrote Fiona Godlee (Editor-in-Chief, BMJ) in February, in effect conceding that Brian Deer’s scrutiny of GP notes which had apparently formed the main s basis of his and BMJ’s fraud allegations could not be used to support such a claim.
Back in February Age of Autism and its readers scored a great victory with it letter writing campaign, forcing editor-in-chief of British Medical Journal, Fiona Godlee, to respond to our criticisms both in our columns (HERE) and in the on-line columns of BMJ itself (HERE ). Remarkable though this was we have perhaps not analysed carefully enough how desperate the defence she presented was.
In both versions of her response we find the sentence:
“The case we presented against Andrew Wakefield that the 1998 Lancet paper was intended to mislead is not critically reliant on GP records.”
So, in fact she conceded then and there that a fraud claim could not be based on GP notes, as originally pointed out by ChildHealthSafety (HERE ) as Andrew Wakefield and the other authors of the paper simply did not have access to them. While, we continue to contend that the data in the notes is entirely reconcilable with data in the paper (as Martin Hewitt began demonstrating yesterday HERE ) it was simply not possible for anyone to alter data from material they could not see.
As we have seen Deer responded with seething contempt on the BBC radio programme ‘Science Betrayed’, broadcast in late March, to the cogent explanation that the records referred to in the paper were the Personal Child Health Records of the children (or so-called red books) (HERE ), but by that stage Godlee – who also had a cameo appearance on the programme - had already admitted as much.
Meanwhile, BMJ have ducked out of publishing my recent letter which bore on several relevant issues including the shifting opinions of doctor-journalist Ben Goldacre, the anomalous and unexplained fusion by Deer and the GMC of the Lancet paper with a protocol for a Legal Aid Board funded study, and the offensive misrepresentation of myself and this matter by Brian Deer in a comment on Orac’s ‘Respectful Insolence’ blog, which I append for interest:
Mark Struthers raises an interesting question. In November 2010 Goldacre was still telling IrishHealth.com :
"With respect to The Lancet, he said he believed it was a "slightly silly paper" for the journal to have published.
""But you have to remember this paper didn't actually say MMR causes autism, it didn't even speculate on that. It was accompanied by an editorial that said by the way people should be very clear that it doesn't mean that MMR causes autism.
""Also, this was a 12 subject case series report - it was a description of only 12 children's clinical anecdotes, and while this is not good evidence to say MMR causes autism, it is a perfectly legitimate thing to publish.""
Both these statements and the Guardian article cited by Struthers are at variance with the GMC finding that the "Lancet paper" was a poorly executed version of the Legal Aid Board protocol . I note that when I posted on this anomaly in Rapid Responses in February 2010 no one came to set me straight: not Ben Goldacre and not Brian Deer (who did indeed contribute a response to the same thread).
Citing the panel finding:
"The Panel has heard that ethical approval had been sought and granted for other trials and it has been specifically suggested that Project 172-96 was never undertaken and that in fact, the Lancet 12 children's investigations were clinically indicated and the research parts of those clinically justified investigations were covered by Project 162-95. In the light of all the available evidence, the Panel rejected this proposition."
“However, it is my understanding that 162-95 was not a "project" in any normal sense but the ethical approval granted Prof Walker-Smith on his arrival at the Royal Free Hospital in September 1995 - as probably the most senior figure in British paediatric gastroenterology - to retain biopsy samples from colonoscopies for research purposes. If this is the case it would seem a basic criticism of the panel, that in reaching their view, they did not explain why this ethical permission did not obtain in this instance. We are also confronted by the oddity that the panel having concluded that the study was in fact project 172-96 then found the three doctors to be in breach of its terms at every twist and turn, instead of drawing the more obvious inference that it wasn't 172-96 at all, but an"early report" as stated. (And this, incidentally, is why several of us think that Ben Goldacre had it right in the first place.)"
On the other hand, in an atrocious personal attack on me (of which this is just an extract) in the 'Respectful Insolence' blog Deer wrote:
"The upside of this clown's cavortings was a hilarious incident where he turned up to the conclusion of Wakefield's GMC hearing, and when the chairman read out a paragraph, Mr Stone - literally - ran from the room, screaming "wrong study, wrong study", as though five panel members, five QCs and all their teams had been sitting there for two years and failed to realize they were looking at the wrong document. It was so monstrously stupid that it came round again as hugely value-for-money."
However, it should be pointed out that ridicule (or even "insolence") is not the same as argument, and that three of the QCs had presented just these points in defence evidence. It goes beyond speculation on Mr Deer's part if he thinks that they immediately changed their mind in the light of the panel's findings.
As to my hurry to get out, I didn't wish to be man-handled by the GMC staff.
 Niall Hunter 'Sorting the Wheat from the Chaff' 22 Novenber 2010, http://www.irishhealth.com/article.html?id=18246
 John Stone 'The unexplained puzzle of the GMC verdict (and reponses to Peter Flegg), http://www.bmj.com/content/340/bmj.c644.full/reply#bmj_el_231147
John Stone is UK Editor for Age of Autism.