The decision of the BBC's Editorial Standards Committee - whose six members are also Corporation trustees - fails to take account of emerging facts, and hides behind Brian Deer's flawed and logically untenable account of events. We publish UK Editor John Stone's final submission to the committee.
I am responding to the document from Part 4... It is important to note that Mr Deer’s claims have unravelled very substantially in the past 5 weeks as the result of a report on Nature News, and further correspondence in BMJ Rapid Responses including statements made by the BBC’s expert advisor on this complaint, Prof Ingvar Bjarnason, by BMJ editor Fiona Godlee, by Brian Deer himself and by Dr Amar P Dhillon, the senior histopathologist co-author of the Lancet paper. These events demonstrate beyond reasonable doubt the original recklessness and unfairness of the programme in March.
I note that progress with the University College London Inquiry stalled after the programme, a source of frustration to the editor of the BMJ at least, who complained to the House of Commons Science and Technology Committee .
The ESC’s attitude to Conflict of Interest is dangerously whimsical: it leaves the BBC free to waive concern about people it likes and crucify people it does not. Unless they decide on objective, citable consistent criteria they will make arbitrary decisions. Anything else is touchy-feely, self-referential nonsense.
I also note that the committee failed to take account of evidence I provided that Andrew Wakefield had embarked in the documentable shape of published papers on “a wider study to replicate findings in the Lancet paper” so it is quite hard to know what Prof Pepys was complaining about. Some people want these papers withdrawn, but they are quite certainly there and their existence factually contradicts Prof Pepys’s claim in its present form.
I refer to my previous comment in relation to CoI.
Once again this is an arbitrary judgement. It is saying that Mr Deer is such a fine person and dedicated journalist that normal ethical constraints do not apply in his case. But it has already been conceded that his unusual arrangement with the GMC was not explained in the programme (which also reflects on the ethics of the GMC). I note that the Committee now cite his current disclosure in BMJ, which also does not explicitly describe the arrangement, but it is also inconsistent on the part of the ESC because it is argued elsewhere in the document that what may have been said in the BMJ is no direct concern of the BBC. Indeed, it is evidently the BBC’s choice not to disclose this embarrassing matter. There is, nevertheless, a serious inconsistency running throughout the response that one minute the BBC is leaning on BMJ, the next saying that programmes claims stand on their own (though they plainly don’t).
A discussion is obviously not fair in the context of a programme which persistently gives more weight to one person than another (and by the way fails to get to the bottom of what is being discussed). I note the ESC’s concluding remarks:
“The committee said that it was clear that it was the reliance of Mr Wakefield (Dr??) on the red books as of evidence of “the child’s prior normality” which Mr Deer was criticising. Accordingly, the Committee did not uphold the complaint on this point.”
This is both a false alternative and an historically unfounded insinuation: as well as the red books Dr Wakefield was reliant on GP correspondence, the medical histories taken by Prof Walker-Smith, and the parent consultations with the neurologist Dr Harvey and the psychiatrist Dr Berelowitz. While this may be Mr Deer’s opinion it shows no respect for factual accuracy. It is not correct and it is not fair comment.
“The Committee noted for the most part, allegations made in the programme had been challenged in the course of the GMC tribunal”.
This is a false statement. These allegations first saw the light of day in a Sunday Times article by Mr Deer in February 2009, and were repeated in BMJ in January 2011. The defence at the GMC hearing which began in 2007 never had to address these allegations.
“The committee note that the tribunal has the same standing as a court of law: and its findings on fact were entitled to be relied upon by the producers of the programme.”
However, all the findings that were remotely relevant to the programme are still under appeal by Prof Walker-Smith, and this was not said, and the absence of any warning regarding this is surely a serious lapse of procedure on the part of the Corporation.
With regard to the evidence of Susan Davies, it is evident that what she is saying is the results of the biopsies were both consistent with significant inflammation and with normality. I note that after the recent intervention of Dr David Lewis as reported in Nature News Prof Bjarnason, Dr Godlee and even Mr Deer had to retreat substantially :
“But he (Bjarnason) says 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.
“Deer notes that he never accused Wakefield of fraud over his interpretation of pathology records…
“Fiona Godlee, the editor of the BMJ, says that the journal's conclusion of fraud was not based on the pathology but on a number of discrepancies between the children's records and the claims in the Lancet paper…”
Although Godlee had previously stated under pressure from Age of Autism readers in February :
“The case we presented against Andrew Wakefield that the 1998 Lancet paper was intended to mislead was not critically reliant on GP records”
I note that Prof Bjarnason’s admission came after new evidence and after his advice on this complaint, and suggests that he had been jumping the gun before.
Further to this Dr Dhillon, the senior pathologist in the paper has also now made a lengthy statement which gives the clinical context in which the interpretation of the biopsy results were modified and which gives the lie to the suggestion that Wakefield was acting on his own and/or fabricating something :
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. The online grading sheets represent an incomplete record of my observations of the slides of gut mucosal biopsies from patients who were included in the Lancet 1998 study, and there were “normal control” biopsies as well; however:
-Of those grading sheets attributed to me not all are mine (grading sheets on p38-47 and p55-64 inclusive of the BMJ Nov 2011 online document belong to someone else: NB the handwriting is different to mine)
-The boxes with assigned patient “case numbers” on the grading sheets have been put onto the grading sheets by someone else (ie “child 1”, “child 2” etc): this information was not available to me at time either of the slide review or Lancet 1998 publication
-Neither the clinical details per case, nor the original diagnostic histopathology reports were available to me at the time of my review of slides
-At the time of my review I had been told that slides of study cases were mixed with “normal” controls: which slides were of study cases and which were controls was unknown to me. My research review of the slides in 1998 has important differences with the routine diagnostic histopathology process:
-Routine diagnostic histopathology is done with knowledge of individual patient’s clinical details as far as they are available at the time of diagnostic reporting, and so the rendering of a diagnostic histopathological opinion in this situation is usual and appropriate (in direct contrast to the situation that pertains in a blinded research review)
-Then there is a joint review by clinicians and pathologists to evaluate the significance of the microscopic observations in the light of additional clinical, endoscopic, radiologic, and laboratory data that has been obtained after the “diagnostic” biopsy has been reported
-It is not unusual for the clinical significance of microscopic observations to be reinterpreted and altered by this process, and it could be that the histological diagnostic interpretation subsequently has to be corrected. Thus the purpose of my grading sheet observations in 1998 was not, could not have been, nor was it intended to conclude the final diagnostic assignment of colitis (which has to be made in the light of full clinical/endoscopic/radiologic/ laboratory data; and response to treatment)
-Therefore on the grading sheets “nonspecific” means: “this microscopical appearance doesn’t remind me of any particular disease entity”, and this is why in none of my grading sheet observations have I stated “colitis”. Bowel disease is not diagnosed by gut mucosal histopathology in isolation:
-I am of the opinion that the histological interpretation should never (or not very often) replace clinical judgement
-“A final diagnosis can only be made with the full clinical information and a biopsy specimen should be reported as diagnostic only if full supportive clinical information is available.” (Jenkins D et al. Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Initiative. J Clin Pathol 50,93-105;1997). In 1998 there was no paediatric gastrointestinal pathology literature to refer to for guidance regarding ileal and colonic mucosal biopsy microscopical appearances and their interpretation or significance in autistic children. In 1998 the series of cases in the Lancet paper was unusual, if not unique, and it was one of the aims of the study to explore the significance or otherwise of the subtle histological changes in autistic children with gastrointestinal symptoms. Prejudgment of the significance or otherwise of the histological changes in isolation in the 1998 study cases would have been inappropriate previously, and remains so now.
-Several expert gastrointestinal pathologists and gastroenterologists have commented on the grading sheets (BMJ Nov 12 2011) and they have stated that the findings cannot be colitis; however:
-It is a mistake to apply uncritically adult gastrointestinal biopsy histopathological thresholds of normality vs abnormality to children
-The expert gastrointestinal pathologist and gastroenterologist commentators have tried to assess the diagnostic implications of data represented in histopathological grading sheets alone
-This is a fundamental mistake: the significance of the histopathological component of any diagnostic equation depends on consideration of the histopathology within the complete clinical context
- The current opinions of the experts regarding the significance of the histology grading sheets are subject to retrospective bias by knowledge of events since 1998. 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.
Corroborating this is the sworn testimony of Prof Simon Murch at the General Medical Council relating to the meeting which took place to address Davies’s initial concerns 
Counsel Q Was there any meeting about the histology section?
Murch A Yes, I recall a meeting. I suspect that I may not be alone with that, but I do have a very good recollection of the meeting. I think the reason was initially that Dr Davies had seen the draft of the paper and just wondered whether the description of the histology perhaps oversold it. In other words, was the description in the paper something that was rather more florid than the lesion she remembered and thus my recollection is that she arranged a lunchtime meeting – I believe it was Friday, that is possibly irrelevant – in the manner of our normal histology meeting in the same place, in the histology seminar room, where the various pathologists who had seen the tissues attended at the same time and so this would be from the paper Dr Anthony —
Q I want to run through a list of names and then if I miss out anyone then of course add them in. Let us start off with Dr Davies; was she present at that meeting?
A She was indeed.
Q Professor Walker-Smith?
Q Dr Thomson?
Q Obviously yourself.
Q Dr Andrew Anthony?
Q Dr Dhillon?
Q Dr Heuschkel?
A I believe that Dr Heuschkel was present, yes. I am less certain about that, but that is my recollection from that meeting.
Q Dr Casson?
A I believe so, yes.
Q Dr Malik?
A I also believe so, yes.
Q Dr Wakefield?
Q Are there any others you remember being present at that meeting?
A I think Dr Alan Phillips may have been there as well but I cannot recall with certainty.
Q Were the original histology slides that had gone to Dr Davies’ lab looked at at that meeting?
A They were.
Q What was the outcome of that meeting about the description of the histology?
A That all the pathologists present when the slides were reviewed case by case agreed that the wording in the paper – we had a table of the histological findings, which I believe will be as seen in the paper here – they all agreed that the wording was reasonable. So I think that Dr Davies was then satisfied that the paper could go forward for publication without change in the histological description.”
Against this background it would be very unwise for the ESC to give precedence to Dr Davies’s initial impression or to assume that they know what is in the GMC transcript on the basis of Mr Deer’s somewhat selective account. Was anyone told by Mr Deer of Dr Davies’s Friday meeting in which between 9 and 11 doctors present came to a concensus about the paper’s histological findings in the GMC transcript? I note that Prof Murch was re-instated by the GMC and has not been accused of dishonesty. And I note the continued silence of Prof Bjarnason after Dr Dhillon’s intervention, in which he explicitly challenged his critics over interpreting grading sheets in the absence of the other clinical data, of using the same criteria for grading in the case of children as for adults.
It is clear that programme gave a false and misleading impression about the significance of the pathology results. The point that Dr Davies initial readings did not detect significant findings is in no way anomalous in relation to clinical practice or the historical circumstances. This is taking a random detail out of context and making a meal of it to give a false impression. Dr Davies (who unlike Prof Bjarnason was there) pronounced herself satisfied and it was a group of 9 or possibly 11 experts who agreed the text of paper on this matter, including herself. The BBC cannot afford to indulge in unfounded innuendo over this matter.
The Committee noted that the majority of allegations made in the programme have been found proven by the GMC tribunal and that the only other specific allegations in the programme are made by Brian Deer, sourced to Brian Deer and clarified in the script where necessary as allegations rather than proven fact.
It is hard to corroborate this claim in detail, but once again the programme failed to state that the matters relevant to the programme’s claim were still under appeal by Prof Walker-Smith and this surely must be an error of procedure.
The Committee noted that subsequent verification by the editorial adviser of relevant sections of the GMC tribunal transcripts supports the programme's confidence in their sources.
This is just citing an unidentified source as corroboration of unspecified claims. It is impossible either to dispute or sustain.
I have commented before on the BBC’s surreal concept of fairness: inviting someone to contribute to a programme in which they have been told effectively that their character will be assassinated does not make it fair.
The Committee noted that the opening of the programme, about which the complainant is particularly concerned, listed only those charges which had already been found proven by the GMC.
This is a misrepresentation. I do not believe that I have ever commented on that passage, I objected to the hyperbolae afterwards, where I pointing out that nothing in this case compared as a modern medical scandal with Harold Shipman or Vioxx (and I might have added Thalidomide, contaminated blood for haemophiliacs, Paroxetene, the cover up of the Camelford water disaster or Joseph Mengele - who is actually still in living memory). It was patently a preposterous claim that it was the worst medical scandal in living memory, and unfair comment.
The committee also failed to take account of the extent to which the association between autism and gut pathology is by now widely – if not universally - accepted in mainstream medicine, for which I provided good evidence, including a very recent US National Institutes of Health paper which gave honourable citations to both Wakefield and Prof Walker-Smith. For this reason the strictures of Prof Jones which the committee invoked, and which I also do not agree with, were still not relevant at least in respect to gut pathology in autistic people. I find it troubling that my documentary evidence on this matter was not only disregarded but also not even reported, thus giving an entirely false impression of mainstream science in this field.
 Eugenie Samuel Reich, ‘Fresh dispute about MMR ‘fraud’, Nature News http://www.nature.com/news/2011/111109/full/479157a.html?s=news_rss
 Fiona Godlee,’BMJ response to emails from readers of Age of Autism, 7 February 2011 http://www.bmj.com/content/342/bmj.c7452?page=1&tab=responses
 Amar P Dhillon, ‘Re: Pathology reports solve “new bowel disease” riddle’, 17 November 2011 http://www.bmj.com/content/343/bmj.d6823?tab=responses
 GMC hearing against – Day 113 Friday 16 January 2008 Pages 43/44 .
John Stone is UK Editor for Age of Autism.