The Last Day of Andrew Wakefield’s Defence at the General Medical Council
By John Stone
On the last day of his summing up of the defence case for Andrew Wakefield, defence counsel Kieran Coonan at one point remarked about the allegation that Andrew Wakefield had breached medical ethics and the terms of his contract by administering an unusual medication (Transfer Factor) to a patient (patient 10 in the “Lancet Study”) that “this pursuit by the prosecution of Dr Wakefield at all costs was unattractive” (reminding us all also of a certain journalist). Coonan spent the better part of the morning forensically demolishing the prosecutions claims about this matter. By the time the evidence was heard it had transpired that ethical permission for the use of this medication had been sought jointly by Wakefield and John Walker-Smith and received from the Ethics Committee (Dr Lloyd), that Wakefield had obtained the medication and deposited it in the hospital pharmacy (where it would have been issued on prescription), and a prosecution witness had declared the medication to be completely safe: “no more dangerous than drinking goat’s milk” (Dr Lachman).
Coonan emphasised to the hearing that the prosecution never had any evidence that Wakefield had administered the medicine – no documents were produced and no witnesses were called – but in the face of the recovered documents suggesting that everything about the matter was above board, instead of backing down the prosecution was reduced to alleging without evidence that Wakefield had administered the medicine having held some back from the consignment he had deposited in the pharmacy. They had also further tried to muddy the issue by mixing up the safety of this medicine with another type of Transfer Factor (of bovine origin) about which Wakefield made enquiries some time after the event.
Probably, the single matter on which Wakefield is most vulnerable is the issue of the birthday party at which blood samples were taken. There was, of course, such an occasion but it bore little resemblance to that described in his talk to the MIND Institute of California in 1999. Wakefield’s remarks on the occasion of the MIND talk, while originally taken literally by the prosecution, had been intended humorously and were understood as such by the audience, who had laughed. Contrary to the anecdote every care had been taken to handle the matter sensitively. A group of parents (some of whom were medical people) were approached before the party to ask whether their (healthy) children would be happy to give blood to help sick children – no inducement was offered in advance (but five pounds had been slipped into the party bags of the children who had helped out at the end). The samples were taken not by Wakefield, but by someone practiced in taking blood samples from children as they had arrived at the party, and using appropriate equipment. The occasion had been managed according to contemporary advice about taking blood samples from children under relaxed conditions (rather than in a hospital, which might not be so pleasant), and had passed off happily, without incident and without any of the participants ever complaining - indeed, “They were proud to have taken part”.
Evidently, the prosecution had conceded some of this since they had agreed that charges be amended so that it was not stated that Wakefield had taken the blood himself. The prosecution had quoted as evidence the views of witnesses Professor Ian Booth and Sir Michael Rutter about the inappropriateness of the conditions under which the blood had been taken, but this was on the basis of the fanciful MIND narrative, rather than what actually happened, which Rutter had acknowledged. But Coonan also expressed dismay that the prosecution counsel, Sally Smith, should have co-opted the evidence of Simon Murch, who had spoken about the potential for distress to autistic children when blood was taken (a completely different matter).
However, Coonan acknowledged that Dr Wakefield had been forced to concede that he had not known at the time of the party that he should have sought ethical permission for this exercise under National Health Service guidelines. Coonan, nevertheless argued that it was a “low risk” exercise given the care which had been taken. There remained outstanding the charge that Wakefield’s action “had brought the profession into disrepute”, which might have been the case if he had actually done what he told the MIND Institute audience, but was tenuous given that he had not.
Coonan’s concluding remarks were left till after lunch, which was extended by 10 minutes because “the Wakefield team” and “the GMC team” were having “a conflab”.
The underlying theme of this last section, which lasted just over half an hour, was the extent to which the prosecution case had rested on the absence of evidence, which in turn depended on the unavailability of documents, some of which had actively been withheld by the Legal Services Commission, by the prosecution itself, but some of which had been located – as in the case of the Transfer Factor issue – by Professor Walker-Smith’s team. He noted that there were still known missing documents likely to be helpful to the defence, and how unfair it was that in the absence of such material it was left to one person’s memory playing off another’s at a very great distance in time from the actual events, and in the face of actually unsubstantiated allegations. And he returned in particular to the evidence of Dr Horton.
Again, in this instance, it had been documents retrieved at the last moment, which had supported the defence case, and had at the very least shown that the Lancet was institutionally aware of Dr Wakefield’s involvement in the MMR litigation, whatever Dr Horton’s memory. Coonan pointed out that all this could have been avoided if Dr Horton, himself, had instituted a search at the Lancet before making his main allegation in 2004, and again in 2007 before giving evidence to the GMC under oath. He thought it regrettable that even now Dr Horton had not apologised, but what he considered most deplorable was the twist put on the matter by prosecution counsel Sally Smith in her summing up, complaining that Wakefield had sought to defend himself by impugning Dr Horton’s integrity. Apart from anything else Dr Wakefield had been at pains not to do this – had expressly avoided it – while producing the documentary evidence that Horton was substantially mistaken.
Coonan pointed out the complete consistency of Wakefield’s position over 5 years: that with almost none of the documents available to him at the time of the statements he had published in the Lancet in March and April 2004 he had stated a position that was entirely vindicated years later when the documents came to light (though not through the auspices, of course, of the Lancet or Dr Horton).
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
I am by no means a veteran of legal hearings but I would be very surprised if it was normal for one counsel to attack the integrity of another so forthrightly as happened on several occasions on this last day of Andrew Wakefield’s defence: all the more remarkable because Kieran Coonan and Sally Smith share offices (HERE). Coonan cannot have said any of this lightly, and it is, of course, deeply troubling - not least because until now the panel have been so indulgent to the prosecution in allowing it to conduct itself in this way.
We can only conclude that the GMC prosecuting team went on a fishing expedition against Andrew Wakefield and his colleagues at the behest of government minister, aided and abetted by a certain journalist, and that the exercise has been prejudicial both in spirit and execution. It is hard to imagine, though, a case being demolished more thoroughly than it was by Coonan in his final speech. Let us hope that at last fairness and good sense will prevail.
John Stone, based in London, is a Contributing Editor to Age of Autism.
its so great to get news, most of us with ASD children and adults are surviving and often not much more. thankyou for great writing, our thought are with the three doctors, I hope justice at last will prevail and they will be applauded for honesty, am I in lala land.
Posted by: Linda Macleod | May 05, 2009 at 04:00 PM
Autism Grandma
As we know there are great institutional inbalances in the US and yet actually I am sure we are still suffering in the UK from there being ill-defined limits on the state, which can probably be traced back centuries. This is not to say that there were not times in the not so distant past where we had the illusion of living in a liberal democracy, but it turns out to have been somewhat conditional.
A lot of people who are not so concerned about our issues are now extremely concerned about executive abuse in the UK - the real difficulty is communicating to them that our problems are an extension of the general malaise, and that they are vitally important.
Posted by: John Stone | May 03, 2009 at 12:41 PM
The Wakefield Affair in Light of English History
Is History Repeating Itself?
During the past reigns of many English Queens and Kings, including Henry VIII and his daughter Bloody Mary, anyone who dared to speak out against the corruption and criminal behaviors of the King, Pope, or any religious official, was considered a "Heretic" and thus "guilty of treason" and "deserving of death", summarily thrown in the Tower, to await their fate of having their head chopped off, hanged, drawn and quartered, or burned at the stake. They always did everything by legal propriety however in an honest court of law, whereby "witnesses" were tortured until they agreed to "testify" according to the wishes of the King and Cardinals. The only possible way out was to "Recant their beliefs" in favor of losing their heads.
They utilized the most horrific deaths and tortures in public executions to successfully keep the people enslaved in fear. In spite of all this, after Martin Luther abandoned his Catholic priesthood and published his list of grievances and scriptures which supported his renegade viewpoints, Catholics began committing "Treason" by leaving in favor of Protestant teachings, which was a direct result of the Bible finally being translated into English. So in 1536 by order of Cardinal Wolsley, William Tyndale was arrested, tried for heresy and burned at the stake for translating the Latin Vulgate into English. However, a secret underground movement printed and distributed these books in Europe, and they became very popular in England even though it was illegal and dangerous to own this book at that time. Although eventually many of these evil rulers who were behind these executions ended up getting their own heads chopped off, hundreds of thousands died in comparison to the few evil rulers that finally got their own just rewards.
So now we have the "King of England" [Big Pharma and GMC] persecuting Wakefield and his "co-conspirators" who are being legally tried in a court of law for "committing high treason" and "translating the Bible into English" with the intention of "burning them at the stake" in order to preserve the power and rulership of the almighty Vaccine Industry. [Wakefield's previous co-conspirators were able to escape with their heads in tact by "recanting" their support.] It is inevitable that eventually these evil rulers behind this persecution will get their own heads chopped off, but how many more innocent children will end up with autism before this finally happens?
[Note: No offense intended to anyone of the Catholic persuasion, as I was raised as a Catholic myself, and am just providing a bit of historical comparison]
Posted by: Autism Grandma | May 02, 2009 at 07:32 PM
It's my understanding that Transfer Factor has frequently been recommended by one of the top immunologists of our time -- H. Hugh Fudenberg.
He's authored a few papers... at the site below, 851. The Transfer Factor paper is #806.
http://www.nitrf.org/9biblio.html
Posted by: nhokkanen | May 01, 2009 at 10:24 PM
Thanks, John, for this very helpful report - and to defence counsel K Coonan, for his rigorous defence. It would seem clear that this case would never have arisen, or gone this far, except for politics.
Unfortunately the panel may feel it has to come up with SOMETHING to hang Wakefield by, thus grasping at any little thing to do the dirty deed. All we can hope for is for justice - and "good sense" - to prevail.
Posted by: Stan | May 01, 2009 at 03:43 PM
That was a great read John, thanks for all your time and efforts. I would love to have been there but travelling all the way from Scotland is a big task.
My thoughts and encouragement to you and the good doctors.
Posted by: Joan Campbell | May 01, 2009 at 07:40 AM
Thank you John for taking the time to share in detail this day in court. Yes - we can only hope that justice prevails.
Theresa
Posted by: Theresa Cedillo | April 30, 2009 at 11:20 PM
Terrific article. You made some details of the case very clear which had been a bit unclear in the past. It's extraordinary in light of what you report that the case was ever brought forward at all.
Like everyone else, I'm very anxious about the outcome of this trial and concerned that all you can really get out of a kangaroo court is kangaroo justice. The special masters in the US Omnibus case were very indulgent towards the government attorneys throughout the process and this was reflected in the outcome. I do hope that the GMC is constrained in coming out with an illegal verdict. We seem to have little constraints in that regard in the US.
One thing is certain though-- because of honesty and consistency of Drs. Wakefield, Murch and Walker-Smith and because of the brilliant legal work of Kieran Coonan, the transcripts of the GMC trial will tell only one story to anyone bothering to read it-- that the case should never have been brought before the court in the first place, that the panel itself was compromised and the government's case tainted.
Thank you, John, for the work you've done in keeping us up to date on these events.
Posted by: Gatogorra | April 30, 2009 at 10:12 PM
Thank you JS for your help in keeping us abreast of Wakefield's hearing.
My prayers for a positive outcome for Dr Wakefield and his family.
Posted by: kathleen | April 30, 2009 at 09:49 PM