I couldn’t believe it. Yet there it was on Leftbrain/Rightbrain – news that Fiona Godlee would be giving a talk at the NIH entitled “Lessons from the MMR Scare.” When I clicked the link to the event on the NIH website, it confirmed that LBRB was actually right about something: Fiona Godlee, editor-in-chief of the British Medical Journal, was coming to the U.S. (Thanks Matt!)
So on September 6th, I took the Metro out to Bethesda, Maryland to participate in Dr. Godlee’s discussion, co-sponsored by The Fogarty International Center and the National Library of Medicine: two component organizations within NIH.
The person who introduced Fiona Godlee was Dr. Roger Glass, director of the Fogarty International Center. I was interested to learn that this was not the first time Dr. Godlee had been at the NIH, seeing photos of her with Dr. Glass from her last visit five years earlier.
During his introduction, Dr. Glass described his own work on rotavirus, which spanned, as he put it, “much of my career.” Indeed, he had helped work on rotavirus vaccine development with millionaire vaccine industrialist Dr. Paul Offit. Yet, Dr. Glass said he was not interested in vaccine adverse events until the first Rotavirus vaccine was “crippled” by intussusception, as if the vaccine was the victim and not the children it harmed. It was at that point that he “realized there was a huge anti-vaccine movement outside” – more like the intestines of children turning inside out – including those of the infant son of my former professor, Michael Willrich.
When Dr. Fiona Godlee stepped up to the front of the room, almost everyone applauded. I couldn’t bring myself to clap for her, so I didn’t.
Her talk was hardly anything new – mostly just a regurgitation of practically every smear that’s ever been made against Dr. Andrew Wakefield within the last eight years. She did, however, make one startling admission when stating her three feeble excuses for failing to disclose her journal’s pharmaceutical connections.
First she argued that it “did not occur to me” to disclose because she did not see Brian Deer’s articles as “pro-vaccine” but “anti-fraud.” This, however, is directly contradicted by the accompanying BMJ editorial she cosigned with deputy editor Dr. Jane Smith and associate editor Dr. Harvey Marcovitch – and in fact was the lead author of – which concluded (boldface mine):
The Lancet paper has of course been retracted, but for far narrower misconduct than is now apparent…leaving the door open for those who want to continue to believe that the science…still stands. We hope that declaring the paper a fraud will close that door for good.
That doesn’t sound “anti-fraud,” it sounds anti-Lancet paper.
Dr. Godlee’s next excuse was a complete oxymoron. She said did not see the pharmaceutical connections as conflicting because the Merck-Univadis partnership was with BMJ Learning and the pharmaceutical funding was for the BMJ Group Awards, claiming neither was part of BMJ.
I simply don’t follow her logic at all. Anything that’s part of the BMJ Group revolves around and would therefore be a part of the BMJ, hence the name.
Finally, the last excuse she gave for her failure to disclose her journal’s competing interests with Merck and GlaxoSmithKline (GSK) earlier this year was:
“And the third which I didn’t say at the time because I was afraid it would make me look stupid is I didn’t know that MMR was made by GSK or Merck; I just didn’t happen to know that.”
Well, she certainly looks “stupid” now! How could the BMJ editor-in-chief who had defended the MMR vaccine for at least seven years not have known who made it?
At the end of her talk, Dr. Godlee concluded by hijacking a quote from Albert Einstein:
“The right to search for the truth implies also a duty; one must not conceal any part of what one has recognized to be the truth.”
I couldn’t have said it better myself.
Needless to say, my arms remained crossed when others clapped.
Throughout the question and answer session, I patiently waited my turn, until finally called on by Dr. Glass (you can view the exchange on the 54:00 of the NIH Videocast):
“Yeah? Introduce yourself?”
“Hi, my name is Jacob Crosby with GW School of Public Health and Health Services. I just want to…you made a number of statements here regarding Andy Wakefield who is not here to defend himself against them, but…there are a couple problems that I…that I saw with Brian Deer’s claims. He claimed that three children weren’t autistic because the have Asperger Syndrome, children 6, 7 and 12, but Asperger Syndrome is a form of autism. He said that the bowel pathology results were fraudulent because they don’t match up with the routine pathology results, which is only the first step in the tertiary diagnostic process. The end result from the routine pathologist’s report…is not accused of fraud, to my knowledge…matches up with what was in the paper. And…furthermore, all the five children – or five to six children – that he claimed did not really regress or have some sort of deterioration after the MMR vaccines…those five children…were all developmentally normal except for one kid who had developmental problems due to an unrelated preexisting condition. And…(people in the background started to mumble)…they all faced developmental regression after the vaccine. So…
At that point – about a minute and a half into my question - I was interrupted by Dr. Glass:
“Give us your question!”
I continued undeterred:
…I’m just curious because-I’m curious, why…you’re talking about - there needs to be oversight, in fraud - but it seems like, Brian Deer here, committed fraud.”
For about five seconds, the room was dead silent. An awkward grin was left on the face of Fiona Godlee, nervously nodding her head. However, what she said was the usual:
“Okay, a lot of the things that you’re…itemizing have been raised on web comments and Brian, I think, has responded to them. I mean, I can give you my response…”
“No, he hasn’t,” I said. Brian Deer has never responded in the BMJ to the allegations, and blogs like Leftbrain/Rightbrain and Respectful Insolence hardly count, if those are what Dr. Godlee was referring to.
“Well, I think you’ll find he has,” she replied.
She continued, “The three…three children with Asperger’s Syndrome…he makes the point that the paper is about regressive developmental delay…so these children were being represented as people with regressive autism and Asperger’s…”
“Right and they did have, they did regress, the two children – children 6 and 7 – they, they did have seizures before MMR vaccine, the paper was only talking about their developmental progress, which regressed.”
She didn’t have a response:
“Okay, I don’t know…I’d be happy to talk after about that case, we can discuss that after…”
Why not now? I wanted to point out that Brian Deer’s allegations of regression don’t match up, either:
“Okay fine, but I’m just saying…”
But she was moving on.
Then she backed up one of Brian Deer’s most egregious and verifiably false allegations of fraud:
“…I just want to talk about briefly…the…pathology. I think what’s really important to recognize is that what was reported in the methodology of the paper was that this was a planned protocol approach…with these four pathologists looking at it but that wasn’t in fact the case. What happened was that the…hospital pathologist looked at them…at the pathology slides and found almost no evidence of any…”
I corrected her:
“Oh, no, that was, that was the routine pathologist. When it was followed up with Amar Dhillon, that was, there was…he’s an expert in that field, there–that’s when they found evidence.”
“The Lancet paper did not report it in that way, and I can explain that later…”
She has all the answers “later…” I wasn’t going to let her get away with obfuscating the pathology results, either:
“…Yes, it did.”
At that point, Dr. Glass pulled Dr. Godlee out of the fire:
“L-Let’s go on. Let me move on and we can continue this afterwards if you want.”
“Afterwards” – as in – out of earshot of the audience and the NIH recording devices.
He then quickly changed the subject, asking Dr. Bruce Gellin – head of the National Vaccine Program Office – who sits on NVAC with Dr. Marie McCormick about the “consequences” of the Wakefield paper. Dr. Gellin, looking surprised, played along, asking a two-minute long (uninterrupted) question.
Later, a UK medical student named Marcus stepped up to the microphone, and asked another two-minute long question - also completely uninterrupted - unlike mine – which included the following comment:
“You mentioned the whole idea of one man toppling the entire institution. It’s actually, clearly, Mr.-Dr. Wakefield was really very skilled in this aspect of communication. Indeed, he was able to sell a lie to everyone else – and – everyone else was not skilled, was not able to defend that lie, or, or defeat that lie.”
Dr. Godlee agreed: “He’s a clever man.”
I just shook my head when I heard that. It’s certainly much easier for folks like Dr. Godlee to propose the medical mind control theory about Dr. Wakefield than to examine the evidence before them and consider that he may actually be right. It is almost as if they are trying to scare people into dismissing Wakefield for fear he’ll somehow brainwash them. This was pretty much the whole premise behind a New York Times article written earlier this year by Susan Dominus - friend of Seth Mnookin's Uncle Bob.
After the discussion, I walked over to Dr. Godlee and waited for her to finish speaking with the other attendees. While I was waiting, I was approached by Dr. Glass, who asked in a friendly manner:
“Are you a student at GW School of Public Health?”
“Great, so what do you study?”
“Epidemiology,” I replied.
“Are you in the MPH Program?”
“Who is the head of the epidemiology program?”
“The program or do you mean the whole department?”
“The whole department.”
I said the person’s name and then I later realized Dr. Glass was probably testing me to see if I really was connected to the GW School of Public Health and Health Services as opposed to just wearing a t-shirt with the school’s name on it.
As I was waiting for Dr. Godlee to finish, I checked the time on my cell phone. Probably aware she had been taking awhile, she turned to me and said:
“Don’t go away.”
Finally, she turned and shook my hand, and that’s when our debate continued.
I told her she contradicted herself in the lecture, having told me during Q/A that Deer merely said the children diagnosed with Asperger Syndrome did not have regressive forms of autism, when in fact – as Dr. Godlee read out loud during her lecture – he argued the three children did not have autism diagnoses at all.
She then invented a new claim that they did not have Aspergers diagnoses by the time the paper had been published.
I replied that they did.
So she changed her argument yet again, instead claiming that Asperger Syndrome was not classified as an autism spectrum disorder at that time.
Asperger Syndrome was always part of the autism spectrum! When I made this clear to her and that in 1994 – four years before the publication of the Lancet paper – Asperger Syndrome was included as an autism spectrum disorder in both the Diagnostic Statistical Manual and the International Classification of Disease; she had nothing left to say.
She also did not further explain her claim that the methodology behind the expert pathologist’s report was not properly explained in The Lancet, as she said she could.
Having told her I write for Age of Autism, she said:
“I think Age of Autism is mostly pseudoscience.”
I replied, “I think your defense of MMR is mostly tobacco science.”
“Oh, okay,” she said in embarrassed laughter, “I haven't heard that one before!”
I responded, “Like the Kaye et al. article you cited at the beginning of your lecture, your colleague Tom Jefferson threw it out in the Cochrane Review. It was also funded by pharma and never took into account the age at which children were vaccinated, which according to another study from California decreased progressively during that same period.”
At that point, if there were crickets in the room, I think you’d be able to hear them go: *chirp*chirp*
On the topic of disclosure, she was equally erroneous, but at least somewhat flexible.
Me: You disclosed your awards sponsorship from Merck and GSK but not your journal's Univadis-Merck tie.
Her: Oh yes, we disclosed all of them; we disclosed our income from Merck and GlaxoSmithKline.
Me: But an endless educational grant from Merck's information arm isn't really the same as general income.
Her: The Merck connection we disclosed was for Univadis and the GSK connection we disclosed was for the award.
Me: But Merck also funds an award! I think you should clarify this so that readers will know you aren't just acknowledging your Merck award-sponsorship as a conflict of interest, but also your partnership with Univadis.
Her: You're right; we will post a clarification.
I also backed her into a corner over why she didn't publish John Stone’s letters to the BMJ’s rapid response section, she replied:
"We post A LOT of things from John Stone."
“Not everything," I responded.
Her: "Well, we don't post disrespectful letters.
Me: “John Stone is very polite.”
Her: “John Stone is usually polite but not always.”
Me: “I’ve never seen any rudeness from him.”
She never provided any examples of John Stone being rude in his unpublished BMJ letters. I certainly saw no evidence of rudeness in any of his BMJ-censored letters published on Age of Autism.
On disclosing the BMJ-pharma links under Deer's articles, she wasn't as up front:
“It's my conflict of interest, not Deer's” - she told me.
“The BMJ commissioned him,” I replied.
“Yes, but it's my responsibility as the editor.”
“The fish rots from the head.”
“Oh, wonderful…” she said in more embarrassed laughter.
“It's a Russian proverb,” I clarified to her.
“Well, if we would publish an article by you - we wouldn't - but if we did, I as the editor would be responsible for my journal's connections, not you.”
So, because she would supposedly hold me to the same standard as Brian Deer if I published anything in the journal - even though the journal wouldn't publish it - therefore Brian Deer should get away with no COIs disclosed under his articles, even though he was commissioned by the journal to write them.
I delved further into how he was the original complainant. Dr. Godlee argued he wasn’t, claiming the GMC sent a letter that proved otherwise. To quote Matthew Lohn, the GMC partner who wrote the letter to Brian Deer:
My understanding is that…you were approached by GMC case officer Tim Cox-Brown, who asked you to supply the GMC with further information regarding this matter.
I told her that that letter was from a year later. In contrast, the letter Deer wrote in his email to Cox-Brown at the time said:
I write to ask your permission…
“Oh, those words don’t make him the complainant!” – Dr. Godlee said. Yet she insisted that a ridiculously transparent letter sent by the GMC to Brian Deer to cover his tracks more than a year after the fact, absolved him.
“Oh really? Even the judge who sided with Deer – Justice Eady – said he was the complainant!”
She had nothing to say to that.
I also said Deer was already conflicted when he entered the story.
She denied he was.
I said he was still conflicted because of his ties to the pharma front group, MedicoLegal Investigations and the associations of the editor who put him on the story, Paul Nuki, whose father sat on a sub-committee that approved the first MMR vaccine the UK, later banned for causing meningitis. The manufacturers of these vaccines were indemnified from liability by the UK government.
I further alleged that because Deer was the complainant, he shouldn’t have continued to cover the story for a mainstream media publication such as The Sunday Times, as he was essentially reporting on the story he created.
“I disagree with that,” she replied, without telling me why.
As I was trying to inform her of the latest discovery of fraud that Brian Deer committed – altering content of an article he had originally written for The Sunday Times on his own website - I noticed she was flanked by Drs. Roger Glass and Bruce Gellin. Glaring at my GW Public Health t-shirt, Dr. Gellin cut me off to ask, and not in a friendly manner:
“So what is good for public health?”
I responded it would be a vaccine adequately tested for safety. Otherwise it would just become a new public health threat in place of the disease it was supposed to prevent.
Dr. Gellin answered:
“And in this case, the science is conclusive!”
To which I then put Fiona Godlee on the spot, “No, no, no – her colleague Tom Jefferson said the safety data for the MMR vaccine is largely inadequate.”
Dr. Godlee gave a nervous smile but didn’t say anything.
I told her about Ben Goldacre and how he said the Lancet paper was a good case series.
Dr. Godlee replied, “He used to say that. If you asked him now, he would agree with Brian Deer.”
Perhaps, but I told her that it was only after Brian Deer wrote a blog that was critical of Goldacre’s pro-Lancet stance in the Guardian, Goldacre’s turf, that Goldacre then showed up in the comments section to flatter Deer.
“Oh, well, that’s just Ad Hominem,” she dismissed.
Yet only two months prior to that, Goldacre told irishhealth.com that Wakefield’s case series was “a perfectly legitimate thing to publish.”
As our discussion was winding down, she invited me to write letters to the BMJ’s rapid response column. I then told her that I had already submitted a letter to the BMJ about Ben Goldacre's About-Face on the issue of Wakefield.
Asking eagerly: “Did we publish it?”
“Yes,” I answered.
“Oh, very good,” she replied, as if that somehow vindicated her for not publishing a number of John Stone’s letters. But I decided to humor her:
“100% publication rate so far,” I said jokingly.
“In the BMJ?”
“Yep,” of course, I had only submitted one letter to BMJ.
I said goodbye to her at that point – leaving the room with the thought that we wouldn’t run into each other again.
However, as I was getting on the elevator, I noticed Drs. Glass, Gellin and Godlee all walking down the hall – presumably to also get on the elevator. Not wanting to be rude, I quickly held the door open for them, which on the flip side, could be misinterpreted as cornering her for further debate. They eventually got on, but were in no rush.
I told Dr. Godlee, “Thanks again for promising to post a clarification; John Stone will be pleased.”
“It’s not a problem,” she replied.
As we stepped out, I told her again about how Brian Deer altered the original version of an article he had written, to erase any mention of vaccine injury – and then lied in the later article he wrote about DTP vaccine injury that she cited in her lecture – claiming that he never followed the story before.
She replied, “Well, if the original article is available online, why does it matter?
“Because Brian Deer is representing on his website an article that was altered from how it originally ran in The Sunday Times!” Furthermore, I made clear to her that the original article is not publicly available online – only through limited access with the intelligence engine, Factiva.
She dismissed my answer, “Oh, that’s just Ad Hom!”
“But you referenced Deer’s earlier article on DTP in the lecture, which formed the basis for how he would approach the MMR controversy.”
I couldn’t make out what she said next – it was a barely audible, tired-sounding response that trailed off.
So I said, “I hope I haven’t been wearing you down.”
Her confused response was, “Oh no, I haven’t been wearing you down…”
Clearly, she was too worn down to use the right pronouns.
She almost sounded disillusioned, as if she was somehow feeling forced to confront the fact that her journal made an enormous blunder. Nonetheless, I was glad that she still spent a considerable amount of time talking to me – even though she really had no good answers to anything I said, other than admitting that her journal had still not completely disclosed its pharmaceutical ties.
Before parting ways with Drs. Godlee, Glass, and Gellin as they were about to enter the NIH cafeteria, I shook her hand once more and thanked her for talking to me. Roger Glass waved goodbye, but Bruce Gellin walked right past me without batting an eye.
Jake Crosby has Asperger Syndrome and is a contributing editor to Age of Autism. He is a 2011 graduate of Brandeis University with a BA in both History and Health: Science, Society and Policy. He currently attends The George Washington University School of Public Health and Health Services where he is studying for an MPH in epidemiology.