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Time To Revisit Deer's Claims That Wakefield Fabricated His Findings

CherryPickEdit

by  Martin Hewitt

Three months after Brian Deer's first BMJ article (HERE) claiming Dr Andrew Wakefield fabricated the findings of the Lancet paper ('Ileal-lymphoid-nodular hyperplasia', Lancet, 1998; p.351), it is now time to revisit the claims and test them against the record, in particular the UK General Medical Council transcripts of the fitness to practice panel against Dr Andrew Wakefield and Professors John Walker-Smith and Simon Murch. We can then judge the accuracy, selectivity and interpretive license Deer applies to his evidence against Wakefield.

This is the first of a series of articles examining the sources Deer uses to back his claims. We start by examining Deer’s evidence for claiming that three of the nine children (child 6, 7 and 12) reported with regressive autism did not have an autism diagnosis. Future articles will examine the evidence for what is said about the other eight children.

The BMJ editors who commissioned Deer’s article continue to support the accuracy of his allegations. Do the editors consider that the GMC judgement of Wakefield means he now has no case to answer? If so, we should remember that Deer uses transcript evidence for a charge the GMC did not lay against Wakefield, namely that he fabricated his research findings.

What Deer says about each of the three children is examined. Each of Deer's claims followed by references word for word is placed are quoted. The claims are followed by other extracts from the transcripts and other sources underneath, together with an explanation of their significance. All emphases below are added to the original.

First, a general point about Deer’s evidence. As you see below, Deer uses testimony and documentation from local GPs and consultants that were not in most cases available to the Royal Free team when the Lancet paper was written. In the UK GP referral letters summarise the patient's cases without including documentation. Of  the Lancet 11 (the twelfth was from the US and not included in the GMC case), only GPs for child 1 and 8 enclosed some documentation and child 2’s GP enclosed one letter from a child psychiatrist with the referral letter.

CHILD 6 (born April 1992; MMR 15 June 1993; Royal Free admission: 27 October 1996)

 Deer claims that three – including child 6 – of the nine children described in the Lancet paper as having regressive autism were neither autistic nor regressive.

“But only one—child 2—clearly had regressive autism.(41)  Three of nine so described clearly did not. None of these three (children 6, 7 & 12) even had autism diagnoses, either at admission or on discharge from the Royal Free….Both [brothers 6 & 7] had histories of fits and bowel problems(42)  recorded before their MMR vaccinations.”(43)   (44)

41. Michael Rutter. Evidence to the panel. Day 37. Day 39

42. Dr N. GP records. Day 6.

43. Dr N. GP note. 18 March 1993. Day 6. The record says child 6 received MMR on 15 June 1993.

44. John Trounce. Report. June 1995. Day 6. Child 7 received MMR on 24 November 1995.

 

Only child two had regressive autism, claims Deer, citing Professor Rutter in footnote 41? Look again at what Rutter said to the hearing: “In some cases there is some evidence of regression.  In Child 2’s case it is quite marked and repeated” (Prosecution Counsel examination of Professor Rutter, Day 37, p.34).

As for fits and bowel problems before the MMR vac – to disprove any claim that autism followed MMR – the GP’s notes referenced in (43) say “18 March 1993. Admitted overnight. Febrile convulsion.” Then underneath “rash raw - florid measles” (Day 6, p.3). The GP’s notes were read to the hearing, showing routine childhood measles. Contrary to what Deer claims, this is not evidence that these symptoms were involved in the onset of autism prior to MMR, that the symptoms were beyond a question of doubt not related to MMR, or that child 6 did not have regressive autism. Rather the GP notes identify the convulsion and rash with measles pure and simple.

Deer claims Asperger’s syndrome is distinct from autism

 

Deer writes: “Child 6 aged 4 years at admission, had Asperger’s syndrome,(45)  which is distinct from autism under DSM-IV, is not regressive,(46)  and was confirmed on discharge.”(47)

45. John Walker-Smith. Letter to Andrew Wakefield. 4 October 1996. Day 41.

46 Filipek PA. Autistic Spectrum Disorders. In Swaiman KF, Ashwal S. Pediatric neurology:. 3rd ed. Mosby, 1999.

47. Panel findings of fact. p.25

Deer, with no medical qualifications to his name, contends that autism and Asperger’s are distinct, relying on the 1994 Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) where the two conditions are given separate entries in the section on pervasive developmental disorders.

DSM-IV describes differences between Asperger’s and autism in one of the triad of autistic features, namely language acquisition, but similarities in the other two, in abnormal social interaction and restricted activities and interests. Overlapping features for impaired social interaction in autism and Asperger’s are marked by the use of almost identical paragraphs in the two entries in DSM-IV (pages 70 & 80). It adds that “Differentiation of the two conditions can be problematic in some cases” (p.83). So no clear differentiation of Asperger’s from autism. But Deer treats the two conditions as unquestionably distinct.

Deer also supports his claim by referring to a source published after the 1998 Lancet paper, and so not available to the authors, namely the chapter referenced in (46) above. The more recent 2006 version of this chapter clearly refers to an overlap – not difference – in the criteria for autism and Asperger’s: "The diagnostic term [Asperger's] was included for the first time in DSM-IV (1994), and the criteria for the qualitative impairments in social interaction and restrictive and repetitive patterns of behaviours and activities are identical to those for autistic disorder....The validity of Asperger's disorder as a definitive diagnostic entity separate from higher-functioning (verbal) children with autism remains controversial" (p.909 in Hirtz DG, Wagner A & Filipek PA, 'Autistic spectrum disorders', in KF Swaiman, S Ashwal & DM Ferriero (2006) Pediatric Neurology: principles and practice, 4th ed., Philadelphia: Mosby).

As for Asperger’s being non-regressive, the 2006 chapter does not mention non-regression in relation to Asperger’s. DSM-IV states that there are no delays in early language acquisition and cognitive development (two of the triad features) in the Asperger's child. However, evidence of developmental delay is not the same as regression following normal development.

CHILD 7 (born February 1994; MMR November 1995; admitted Royal Free 2 September 1996)

Deer writes: ["But only one—child 2—clearly had regressive autism.(41)  Three of nine so described clearly did not. None of these three (child 6, 7 & 12) even had autism diagnoses, either at admission or on discharge from the Royal Free….] Child 7 was admitted at nearly 3 years of age without a diagnosis,(48)  and a post-discharge letter from senior paediatric registrar and Lancet coauthor David Casson(49)  summarised: “He is not thought to have features of autism.”(50)

48. Panel findings of fact. p 93. “On 15 January 1997 Child 7 attended an outpatient consultation with you [Walker-Smith] during which you elicited a history of intermittent episodes of passage of blood associated with constipation and alternating diarrhoea with mucous. You did not undertake an abdominal x-ray to confirm whether or not constipation was the primary cause of Child 7’s symptoms.”

49. Repeated, multiple comparisons between Casson’s documentation shows an exceptional degree of concordance with clinical records generated by consultants.

50. David Casson. Letter to Sian Bennett. May 1997. Day 102


Deer claims, as though problematic, that child 7 was admitted to the Royal Free without a diagnosis. But the reasons for the referral to Walker-Smith, or any other expert consultant, would be because the GP was unable to diagnosis the symptoms and sought expert advice on diagnosis and treatment. Interestingly the panel’s view in (48) that Walker-Smith should have X-rayed the child, ignored, without giving a reason, the evidence of Professor Walker-Smith’s expert witness on paediatric gastroenterology, Dr Miller. He said. ‘I do not think that x-ray is mandatory in that sort of situation (Day102, p.46).

Again the transcripts show that at admission to RFH, the GP says that "[child 7] himself probably does not have autism although this is not certain at present but he does have convulsions which I believe may make him eligible for your study. He also suffers with bowel problems similar to his brother who is autistic" (GP's letter to Walker-Smith, December 96, Day 105, p.46).

Further uncertainties about child 7’s behaviour prior to admission are seen in the following exchange between the prosecuting counsel and the GP: “Q Was it your view at the time – and I do appreciate you are talking as a general practitioner – that he was autistic? A  I think ‘autism’ is probably too strong a word.  I felt he had a social disorder of some sort, yes” (Day 6, p.16).
 
On discharge, Dr Casson’s letter, May 1997, to Dr Bennett, the consultant community paediatrician who saw child 7 (see footnote 50), says, “He is not thought to have features of autism.... It was decided in view of the findings in his brother, to investigate [child 7] further.” (Day 102, p. 50). In other words, a sufficient reason for admission was the possibility that he had similar conditions to his brother, child 6.

During 1997 child 7 continued to see the psychiatrist member of the Royal Free team. The GP’s referral letter, September 1997, to Dr Gillian Baird, developmental neuropaediatrician, Guys’ Hospital, recalls that "[Mrs 7] has also been seen by the Psychiatrist up there [Royal Free] who tells her that [Child 7] is autistic" (Day 6, p.21). Dr Baird’s report, September 1998, read to the hearing, said, “As has been previously suggested, this pattern is that of an autistic disability...his problems are best described as being due to a Pervasive Developmental Disorder in the Autistic Spectrum" (Day 6, p.23).

CHILD 12  (born December 1990 ; MMR 6 March 1992; Admitted to Royal Free 18 July 1996 and 5 January 1997)

Deer writes: “[None of these three (child 6, 7 & 12) even had autism diagnoses, either at admission or on discharge from the Royal Free …] [Child 12] was aged 6 at admission and had previously been assessed for possible Asperger’s syndrome at Guy’s Hospital, London, by a renowned developmental paediatrician.”(52)  (53)

52. Andrew Wakefield. Letter to Mrs 12. 19 July 1996. Day 28

53. Gillian Baird, at the Newcomen Centre, Guy’s hospital. September 1996. Day 36

At admission, child 12 had an Asperger’s diagnosis, as Deer says. However, Deer’s view is that Asperger’s is ‘distinct from autism’ and is not part of the autism spectrum (see above). 

But looking at the record Deer doesn’t quote, we see that on 6 January 1997 the admission record says, “Admitted for investigation of autism and bowel problems” (Day 36, p.58).

On discharge, Dr Berelowitz's report was, according to Professor Rutter’s evidence, “in keeping with the Newcomen Centre's much fuller appraisal.” He added, “Asperger's Syndrome, as we have discussed, is a milder variety on the autism spectrum” (Day 36, p.63). Rutter was the prosecution expert witness on autism.

The implications of checking the original sources are that the 1998 Lancet research was justified in including Asperger's children in the case series of 12 autistic children. Deer fails to produce definitive evidence that the three children did not have a form of regressive autism. There is nothing in the evidence we have seen so far that warrants the charge that Wakefield fabricated this finding in relation to the three children given in the Lancet paper.

We see clearly how Deer works. First he selects extracts from the transcripts to build up his case, ignoring other extracts that might cast doubt on his case such as the above extracts. Secondly he applies his reasoning rigidly to the evidence as though medical diagnosis is about 100% certainty, for example that there is a clear indisputable difference between autism and Asperger’s. On this basis no doctor’s practice would survive this standard of certainty. Deer targets Wakefield.  But were any other doctors’ or scientist’s practice to be subjected to this standard, it would fare as unjustly as Wakefield’s. This is not only a travesty of how medicine works in reality; it is a disservice to medical science and clinical practice. Medicine is not an exact science or an exact clinical practice. 

The question remains as to why the editors of the internationally renowned BMJ commissioned, peer reviewed and published Deer’s article. They continue to support its accuracy.

We will leave the final word to Dr Victor Miller, Professor Walker-Smith’s expert witness, when asked by Walker-Smith’s counsel: are you allowed to have hunches? His reply: “I think medicine is often about serendipity” (102, p.15). Deer, the BMJ editors and the GMC should take this to heart.

Comments

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Birgit Calhoun;
I am so very sorry for you a loving mother left behind and your seweet son is gone. Parents are not suppose to bury their children. And it sounds like he suffered not inspite of the medical society but because of it. Was the bone problems caused by the kidney problems? They now have medicine for bones that only kills people faster. I am truly sorry -.

I am a truthful person, but because of peds and docs I have learned how to lie, twist the truth to get what my son needs.

I am a slow learner and this took a long time to my regret. It took me 17 years to get my son treatment for his seizures, and not untill I learned to play the game. Now I know what I need to know and my son has treatment (I was lucky and ther is a treatment and he is responding to treatment)- NOW when I go into a docs--- I teach when I can. Medical people after all were always good students, so really if I can throw good information rapidally since they are getting paid by the minute--- Bad when you are paying to teach them-- they should owe me - oh what a life!

Birgit, There was little you could have done - it takes time for us to learn to talk to docs, it takes time to find a doc willing to actually try to earn their money, it takes time since we did not go to medical school to read and piece together what we need to know- that is the hardest part. ANd then on top of that we need to get the medical records which I found were slow to come by - they resisted handing over medical records to private people. The only way I got my son's medical records because we were moving way off- three states away, with no doc yet to send them too. I finally walked out of the office with them - something I had tried to get ahold of for the last decade.

I wish I could make you feel better - try writting a letter to each one of these docs and tell them how you feel. It might help them? It might not, but at least you have done something.

Benedetta

Benedetta! When I took Erik to the doctor, it was quite unusual for the doctor to greet Erik. The doctor, male or female, never asked to take Erik's clothes off. It was unlikely that he/she would redo the blood pressure when the nurse had not been able to get a reading. Usually the first words were: “What can I do for you, pointedly averting his/her eyes from my son who was whimpering because he was afraid someone would stick him with a needle. Doctors generally didn't want to know any details. I had to hurry to get in a few words edgewise.

The most common theme, though, was, that those "nincompoops", that's what I think they are, told me that they were not interested in Erik's medical history. I told them, nevertheless, that I needed to know why Erik had had Kawasaki's syndrome and Legg-Perthes disease and tetany and a hundred broken bones, and I thought they should be interested because they were a research hospital. I then told them that I was really interested. But all they did was come back with a question, not just once: “Why do you want to know all that?”

I, too, was naive once. Surely my experience with doctors is not isolated. But knowing what I know would help Brian Deer--bless his soul--immensely in realizing how poorly medical records are kept and how doctors invent things that never existed in order to gloss over the real facts. Or did he in fact learn from my son's doctor's fictional diagnosis.

My son, who was 40 when he died of kidney failure around Christmas last year, has never talked. So he couldn't explain his hurts and pains. But the x-rays and MRIs existed. The orthopedic surgeon ignored the kidney failure that was visible on ultrasound because he preferred bones.

After several operations Erik wound up in a wheelchair permanently. (Erik had learned to walk at age 4, and he participated in running events at Special Olympics. He had ribbons to prove it.) At that point suddenly the doctor's report read that Erik (then about 28 years old) had always had cerebral palsy. And in addition he claimed that Erik had never walked. I wanted to show him video tapes to prove he was wrong. He couldn't be bothered to watch.

It was bizarre how this man was able, with just a few strokes of his typewriter, could invent a condition that had never existed before. He was not trained in diagnosing cerebral palsy. He only "knew bones". But following that diagnosis, in spite of my numerous letters of objection, every one of the doctors Erik saw after that wrote in his report: "This unfortunate young man with cerebral palsy..." They had apparently been in touch with that surgeon and taken his word over mine.

Meanwhile the kidney disease that killed him 12 years later was not given a written diagnosis until he died 12 years later.

Brain Deer has investigated drug companies,and a vaccine against HIV.
http://briandeer.com/vaxgen-aidsvax.htm
Maybe that's when he was recruited by Big Pharma.

Media Scholar

If Deer were "to investigate the vaccine manufacturing drug compainies" he wouldn't have to make anything up, but he also wouldn't get paid.

Brian Deer should investigate the vaccine manufacturing drug companies.

He should tell the public that after one particular vaccine caused a wave of Sudden Infant Death Syndrome which killed lots of American children the vaccine manufacturing drug company decided to bust up the lots making detection of adverse reactions impossible.

http://www.ageofautism.com/files/wyeth79.pdf

That's the same company that won over enough supreme court justices to foil civil claims against vaccines.

Dear Benedetta and everyone:- you all have permission to 'mail' my stuff anywhere where you feel it might help our cause!!

Jenny Allen: Would you mind if I just print your response here and mail it to Dr. Carmel. Seems a waste not to use such a good one?

Great Martin I very,very much hope that some day the whole shady lot of them get the comeuppance they deserve.

Dr Wakefield should have at least a Nobel prize but even that corrupted these days.

http://www.timesonline.co.uk/tol/news/world/europe/article5367941.ece

Thanks Martin spot on .

Angus Files


I took my son to the neurologist this morning. No heatlh insurance, but they were very kind and only charged me 75 dollars. As for medicine well we still have three or four months left from when we did have insurance. But they said they could help us with that????!!!!!

Anyway they had in their office; like all the medical offices --a copy of the "The Health Wellness Magazine" Vol.8 Issue 8, April 2011 and the article is "Understanding Immunizations"
By Jamie Lober, Staff Writer.

It says on page 9 second paragraph down:
"There has been a great deal of hysteria and overreaction about any association with the MMR vaccine and autism over the last 10 to 12 years but the person who did that research and reported it has now been totally discredited by the British Medical Journal that published the article," said Dr. Carmel Wallace, division chief for general academic pediatrics at the University of Kentucky --- Chandler Hospital.

It goes on to say that "pediatricians are happy to discuss any questions and concerns about immunizations which are unusally done at the time of checkups. There is a standard schedule set forth by the Center for Diseaease Control and Prevention but the pediatrician will ask questions to be sure that yoru chld is a safe candidate."

Gee, if only the pediatrician knew what to look for, or cared which they do not. THat was why I was in the neurologist's office with my son because they did not know or care about the signs even if it bite them on the arse.

Somebody give me a good response to mail to this Dr. Carmal - I suppose I could begin with the name of Dr. Wakefield and Dr. Carmel is not fit to lick his boots.

And I suppose I need to write the magazine too - if I can find the address.

Jenny

I am afraid I don't imagine that our UK academic institutions which have to do anything or everything for money these days are so fastidious. Iam sure there have been a few such events.

John

The fact that Deer has no medical training is painfully obvious: the fact that those medically trained monkeys at the BMJ have published Deer's rubbish is an absolute disgrace.

Excellent comments from Martin Hewitt - and Jenny Allen! Hopefully people are starting to look at the bigger picture as to what really was going on here - and why.

http://parenting.blogs.nytimes.com/2011/04/21/autisms-unrepentant-guru/

Irrespective of Dr Wakefields work , how can a journalist of Mr Deer,s apparent magnitude be qualified in medical matters he has so many facts wrong , why did the panel not go through Mr Deer,s pieces with a fine tooth comb , which they so obviously did not , Mr Deer appears to be a puppet but who is working the strings

LilaMae

Actually, an even better word would have been: "Tough!".

LilaMae

It's called checking the facts. When BMJ/Deer published their claims in January they did it in the certain knowledge that there was a 6 million word transcript and though it would be possible to criticise them in broad times it would take months to check the finer detail. Now, you don't like the new narrative, and I have one word to say to you: "Good!"

This was said privately by a friend and colleague of Professor Walker Smith:-

"A recent series of articles in the British Medical Journal has made it clear that the whole GMC exercise was really about Dr Wakefield's stance versus MMR vaccine, but because he did not deal with the children directly it was necessary to involve those who did, and make a convoluted case against them."

Andrew Wakefield has been vilified and hounded out of his profession and country of birth NOT because of THAT 1998 Lancet article, which was a perfectly sound and properly conducted and reported small clinical study, but because of the PUBLIC REACTION to the publicity about it, which resulted in a drop in MMR vaccination levels due to parental concerns!!

This was not helped by the UK government's decision to withdraw the parental choice of single jabs shortly afterwards. I think this decision will turn out to be one of the most damaging to children's health in UK history. Parents DID trust the single measles vaccination, already in use for more than 20 years prior to the 1998 Lancet article, and pre pubescent girls were given the rubella vaccine, again with few problems.

Prior to 1998, single mumps vaccinations were not part of the UK child vaccination programme, but again the passage of time seems show some very serious problems which did not exist prior to the introduction of MMR. Firstly, those children born before 1987 did not receive MMR vaccine. This resulted in mumps outbreaks in young men exposed to this virus in universities and colleges, where it spread like wildfire. Mumps is FAR MORE serious in adults and can cause sterility in males. More recently, in Oban, Scotland a large cohort of fully MMR vaccinated teenagers contracted mumps. This has also happened with measles and whooping cough (pertussis). Who forgot that viruses evolve to 'get round' vaccinations and that vaccine acquired immunity does not last forever?!!

My Grandson got the dreaded MMR jab in 1993, 5 years before the Lancet article and 5 years AFTER the UK MMR vaccine introduction in 1988. Believe me, at that time a groundswell of parents, including Jackie Fletcher founder of JABS, were ALREADY questioning the MMR vaccine's safety. The Daily Mail publicised my grandson's and Robert Fletcher's cases, again long before 1998. (Robert finally got compensation for MMR damage in 2010. It took our government 18 years and inflation meant the award was derisory).

The bankrupt argument 'thrown at' both Dr Wakefield and parents who refuse vaccinations is that they 'cause' measles outbreaks and even kill children!! I beg your pardon Mr Gates, Mr Cooper, Mr Gupta, Dr Jones and Dr Offit et al!! The VIRUSES cause the infections, and viruses appear to be cleverer than SOME humans. My own measles vaccinated daughter, caught the wild measles at age three. It was a nasty dose causing permanent damage; I was told by a medical friend at the time that the wild measles had evolved into a more serious form as a result of the vaccination programme.

The GMC is as morally bankrupt as the arguments used in the case against Wakefield, Murch and Walker Smith. A groundswell of public concerns about both the GMC and the NMC, (nursing and midwifery council), are resulting in reform-we HOPE!! I took part in the GMC public consultation process. Both of these quasi judicial organisations are SUPPOSED to be about protecting PATIENTS from unsafe doctors. The GMC's recent verdicts include allowing a doctor who killed several patients with overdoses to keep her licence to practise medicine!! Dr Wakefield was NO threat to patients. He was a research scientist!!

The callous disregard he was accused of for taking control blood samples at a kid's party, with the full permission of both kids and parents, was technically none of the GMC's business....UNLESS the GMC would like to take an interest in some other, perfectly legitimate, things that are happening in the UK, parents taking babies for ear and body piercings, older children getting tattooed and even receiving botox, nose jobs and breast augmentations from GMC registered doctors in private clinics. All of these procedures are potentially more harmful than a properly qualified doctor taking a few blood samples!!

What concerns me most is WHY, after all this time, did the vaccine manufacturers GSK and Merck sponsored BMJ decide to 'commission' those three 'Secrets of the MMR scare' articles from medically unqualified Brian Deer?? Why 'pick over' the bones of the Lancet 1998 Wakefield et al article more than 13 years later?? After all, a completely new generation of potential parents have probably never even heard of Andrew Wakefield and the MMR issues. The publicity generated by this could cause these parents to question issues they were not previously aware of. Isn't this exactly the same criticism previously levelled at Wakefield?

In the UK, MMR vaccination rates were actually recovering.

This is about far, far more than autism. The unchallenged attack on Dr. Wakefield is a test case in the corporate media of how to use character assassination in an attempt to destroy those with the audacity to speak truth to power. And those who put the needs of the weak before profits and politics.

If finding mold on bread had somehow offended a corporate model somewhere, we would not have penicillin.

If they get away with this model here, where will they try it next? If I were a doctor or a scientist of any kind, I would unite with other doctors to defend Dr. Wakefield--even if I disagreed with his hypotheses--because they were correctly drawn and discussed. I would defend him for many reasons, including one of self-preservation: because if I happen to have discover something profound that upsets the powers that be, they might attack me --instead of discussing the validity of my ideas--next. Wake up Scientists!

What i want to know is how on earth an 'investigative journalist' ended up with enough clout to be able to accuse Dr Wakefield of fraud and write in the BMJ. Whose back pockets are his hands in? Why is the world listening to a non medically qualified self employed journalist rather than someone who has actually been to school for the subject he is so passionately preaching??? Summat doesn't add up.

Wowzers. Talk about pedantry. See the trees for the forest much?

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