In the latest dramatic twist in the Wakefield affair the senior histopathologist co-author of the controversial Lancet paper, Dr Amar Dhillon, has defended his contribution to the study. His intervention further knocks on the head allegations from journalist Brian Deer and the editor of the British Medical Journal, Fiona Godlee, that Wakefield had manipulated the data. In a statement to the journal has Dr Dhillon has explained his contribution to the study and set it in the context of regular clinical practice. Hidden from British Medical Journal readers the case against Wakefield has been unravelling since last week when in answer to criticism from microbiologist Dr David Lewis one of the experts hired by BMJ to review the data, Prof Ingvar Bjarnason admitted to Nature.com that “the forms don't clearly support charges that Wakefield deliberately misinterpreted the records. "The data are subjective. It's different to say it's deliberate falsification," he says," he says”. Bjarnason’s admission was particularly telling given his public hostility to Wakefield and his research.
Dr Dhillon notes:
“The reappearance (BMJ Nov 2011 online: http://www.bmj.com/highwire/filestream/536428/field_highwire_adjunct_fil... ) of some of my histology grading sheets for the Lancet 1998 study (Wakefield AJ et al. Ileal lymphoid nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children. Lancet 1998;351:637-41) is interesting. I have not seen the grading sheets since 1997-98 when I gave them to Andy Wakefield. Following the interest shown in the grading sheets in the November 12 2011 BMJ Feature “Pathology reports solve “new bowel disease” riddle” (BMJ 2011;343:bmj.d6823), accompanying articles and editorial it is evident that there are a number of misunderstandings. Many of these are a result of a lack of understanding of the essential difference between the systematic documentation of specific microscopical features in a grading sheet by a “blinded” (ie in the absence of any clinical, or other information) pathologist on the one hand; and on the other hand concluding an overall clinicopathological diagnosis by integration of clinical information with diverse lines of investigation (including information in the grading sheet). The difference between the two activities should be understood better…
“At the time of submission of the Lancet 1998 publication I had the clinical, laboratory, endoscopic and histology information presented to me in summary tabular form, and aggregated descriptive text only.
-My grading sheets were with Andy Wakefield and my general recollection of my impression of my slide review was that some biopsies were a bit inflamed, and others were not: I did not know which case was represented by which set of slides, and which sets of slides were “normal” controls. As far as I recall, the changes were not severe in any of the slides, but it is not unusual for gut mucosal biopsies to show little abnormality even in clinically well defined cases of gastrointestinal disease, particularly in children
-My clinical colleagues had collated all of the available information, including my microscopical grading sheet observations in the context of their knowledge of each patient’s condition and concluded a final diagnosis of colitis when this was considered by them to be appropriate
-Thus, at the time of submission of the Lancet 1998 publication, with the limited supplementary information available to me (which I had been prevented deliberately from knowing during the study); and in the context of a comprehensive clinicopathological review by trusted clinical colleagues, the designated diagnosis of colitis seemed to me to be plausible.”
The statement does not hint at anything resembling research impropriety.
With this in view I have written to Dr Godlee through BMJ Rapid Responses suggesting it is time to call it a day:
‘Dear Dr Godlee,
How can this folly go on? It is now perfectly clear that Andrew Wakefield acted as part of a team and the clinical analysis was conducted with the highest of motives, and expertise.
You have had your answer - please can we now have an apology. It would be appalling if you took any action now but to back down.
Godlee has been calling for a further inquiry into the Wakefield affair – it is almost as if having dug herself a pit, she is calling for someone else to pull her out.
John Stone is UK Editor for Age of Autism.