British Medical Journal Remains Ethically Challenged Over Brian Deer’s Journalism
By John Stone
Once again BMJ and its editor Fiona Godlee have demonstrated their high-handedness and double standards by refusing to allow full discussion of their non-disclosure of affiliations in the Wakefield affair. At least two letters responding to Godlee’s belated disclosure (HERE) have not been posted in the on-line edition, one of which documents undisclosed hospitality received by author Brian Deer a few weeks before publication of the articles attacking Wakefield. While BMJ have posted limited comments, they are evidently hiding from others by Dr Mark Struthers and myself which put their activities further under scrutiny. Even they have been forced to face the fact that as supposedly leading experts on Conflict of Interest they have been caught with their trousers down. Godlee and Marcovitch are both former chairs of COPE (Committee on Publication Ethics) (HERE ) so any claims at naivety fail. Marcovitch had even in an earlier article remarked on the double standards of the Journal of the American Medical Association, even if it is not quite the paradox that he claimed: "It is a paradox that the professional medical association that owns JAMA was less than open and transparent with Lundh and colleagues about potential financial conflicts (such as their income from industry sources) as they expect their authors to be." (HERE ).
Here are the missing letters.
From myself:
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"Re: In response to John Stone"
Thank you for responding [1]. Unfortunately, as we know from the history of religion pious sentiments are not always accompanied by pious deeds: there can be no assurance from the finest words that the culture of a journal is not altered by its business associations. Moreover, we can base very little on the fact, bearing in mind the sequence of events, that BMJ discussed Vioxx in 2007 or Rosiglitazone in 2010 (a little after the horse had bolted in both cases?).
I wonder what we can deduce from the judgement that serial publication of Brian Deer's articles, full of familiar allegations for which many challenges exist [2], were of "high global importance" [1]? As it is, to my certain knowledge, several substantive letters questioning Deer's interpretations and findings have been blocked, and outside the traditions of academic and scientific publications the defence of them has been legalistic, technical and incomplete [3,4,5]. Most noticeably, Deer has never been required to return to BMJ's columns to meet any of the criticisms.
Further, I note with concern that while Harvey Marcovitch as a signatory of the editorial 'Wakefield's article linking MMR vaccine and autism was fraudulent' [6] and associate editor of BMJ may not have a problem with his role as head of GMC panels, he should as head of GMC panels have a problem with signing that article. He has also in that role failed to investigate or discipline the chair of the 'Wakefield hearing', Surendra Kumar, who failed to disclose that he sat on two licensing authority committees, owned shares in GSK [7], and after the hearing called for MMR to be made compulsory at the BMA [8] all in clear breach of the Nolan rules on standards in public life [9], although it may not have occured to him.
It also looks like it 'didn't occur' to Brian Deer when he accepted an invitation to address the American College of Toxicology in Baltimore last November [10] that the event was heavily endowed by the pharmaceutical companies, including GSK [11]. And I recommend to him the seminal article on the subject by Ben Goldacre, 'Jounalists, anything to declare?' [12].
I trust that 'it didn't occur to us' will at least not be the resort of journal editors ever again after this misadventure.
[1] Fiona Godlee, 'In response to John Stone' BMJ Rapid Responses HERE
[2] Kimberly R Stagliano 'Re:BMJ response to emails from readers of Age of Autism', HERE
[3] Guardian UK
[4] Age of Autism Fiona Godlee Reponds
[5] Fiona Godlee 'BMJ response to emails from readers of Age of Autism', HERE
[6] Fiona Godlee, Jane Smith, Harvey Marcovitch, 'Wakefield's article linking MMR vaccine and autism was fraudulent', HERE
[7] John Stone 'Re: Financial conflicts -shock horror', HERE
[8] Lyndsay Moss'Doctors reject calls for compulsory pre-school immunisation' Scotsman 2 July 2010, HERE
[9] Summary of the Nolan Committee, HERE
[10] BrianDeer.com
[11] actox.org/AnnualMeeting/MeetingSponsors
[12] Ben Goldacre,'Journalists, anything to declare?', HERE
Competing interests: None declared
From Mark Struthers:
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"Re:What about BMJ, Merck and GSK (and Andrew Wakefield)?"
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Andrew Wakefield was accused and ultimately found guilty of serious professional misconduct for not disclosing in 'The Lancet' paper of February 1998 that he was a medical expert involved in assessing the merits of litigation against the manufacturers of MMR on behalf of children possibly damaged by the vaccine. However, the matter of litigation had no bearing on 'The Lancet' paper and Dr Wakefield had followed the 'subjective' Lancet disclosure rules in place in 1997 when the paper was submitted. [1]
In his report to the GMC of May 2007, Professor Sir Michael Rutter FRS, expert witness for the prosecution, declared that failure to disclose in 'The Lancet' was "quite unsatisfactory." At the subsequent GMC hearing, Professor Sir Michael, expert witness on behalf of the vaccine industry in the UK MMR litigation, confirmed that a researcher had an objective duty to disclose conflicting interests. The entirely laudable reason for the disclosure obligation was so that ...
... "the reader of the published research could judge for himself whether the quality of the reported science outweighs the potential for the conflict to bias the interpretation."
Of course, the disclosure rules for 'The Lancet' and other medical and scientific journals had changed in the intervening decade - but Sir Michael, an expert in conflicts disclosure, did not seem to feel the need to clarify the matter before the GMC.
It seems that the BMJ reader was not given the opportunity to judge the potential for the BMJ's conflicting interests to bias the editorial interpretation of Brian Deer's published research. The failure to disclose could quite justifiably be interpreted as "unsatisfactory".
[1] 'Callous Disregard: Autism and Vaccines - the Truth behind a Tragedy' by Andrew Wakefield 2010. Chapter Eleven: Disclosure.
John Stone is UK Editor for Age of Autism.
I stopped paying for a BBC licence nearly 3 years ago ,dont pay it only encourages them...
Great work John
Angus Files
Posted by: Angus Files | March 27, 2011 at 04:53 PM
Jenny Allan https://www.bbc.co.uk/complaints/forms/
Please complain to the BBC about this blatantly biased programme. There's plenty to complain about regarding the 'utterings' of both Deer and Godlee on the programme!!
I also 'mentioned' the 'non occurring' of Godlee et al and the exponential rise in autism and other 'morbidities' in children post MMR.
Go for it folks!!!
http://www.bbc.co.uk/programmes/b00znb98
Posted by: Jenny Allan | March 26, 2011 at 07:09 AM
http://www.bbc.co.uk/programmes/b00znb98
John posted this url in response to me(below).
I have listened and am APPALLED!! It's 30 minutes of Wakefield annihilation. They are all there Godlee, Deer and AJW. Only Wakefield gets the 'awkward' questions of course. The Deer BMJ articles are the source for the programme and they are 'the bible' in terms of being sacrosanct!!
Amongst others, Deer rants on about the childrens' developmental records (red books), used by the research team when compiling the children's medical histories; (the researchers also used hospital records and on occasions contacted GPs and paediatricians for additional information). It is not normal practice for hospital clinicians to use GP records when taking fresh medical histories.
Deer quote (as near as I remember it):-
" They used BABY BOOKS for the medical histories!! I ask you, BABY BOOKS. Only an INCOMPETENT DOCTOR would use BABY BOOKS for research. BABY BOOKS never mention autism or anything. They should have sent for the GP's notes. That's wot I used. They are the 'proper' records!!'
Deer omits to mention that he was ILLEGALLY given all of the children's medical records for HIS Sunday Times investigation. Isabella Thomas, (Mother of two of the Lancet 12) has actually NAMED the doctor who handed over the GP records to Deer on Facebook. Dr Wakefield, in his book states that " strictly confidential medical records of disabled children had been provided to him apparently by the North London Special Health Authority".
In the UK, a doctor can be 'struck off' by the GMC for breaking confidentiality rules, but the GMC seems to operate under 'multiple' ethical and safety standards these days!!
Fiona Godlee, BMJ Editor on the programme, pointed out correctly that the GMC did not find any 'fraud' in the Wakefield et al Lancet paper, nor did the GMC dispute any of the paper's findings or hypotheses. The BMJ's Deer articles show how the 'fraud' was perpetrated. Godlee also referred to the GMC doctors as 'clinicians', failing to point out that Dr Wakefield was employed by the Royal Free as a RESEARCH SCIENTIST who had NO CLINICAL INVOLVEMENT with the child patients.
Dr Mark Rutherford, accepted all of Deer's and Godlee's assertions like they were written 'on tablets of stone', but questioned EVERYTHING Andrew Wakefield said!!
The BBC is funded by licences which we ALL pay in the UK. I am going to complain about this blatant establishment propaganda exercise. The BBC is SUPPOSED to be independent of political and establishment pressures.
Posted by: Jenny Allan | March 26, 2011 at 04:04 AM
John, you consistently amaze me. This non-disclosure should constitute fraud, but I have my doubts.
Thank you.
Posted by: Kevin | March 25, 2011 at 10:58 AM
Apart from Dr Wakefield and Professors Murch and Walker Smith, who were tried by the GMC, the other Royal Free Hospital key personnel, in place during the Wakefield et al research and subsequent furore, have been remarkably media silent for the last 13 years. The Royal 'never explain' mantra seems to have been the collective 'stance' for these persons. That is until the BMJ decided to 'commission' the latest series of Brian Deer articles, 'Secrets of the MMR scare'.
In his third article ‘The Lancet’s three days to bury bad news”, Deer reports on Lancet Editor Horton’s GMC evidence:-
“We went to the vice-dean of the Royal Free, laid out the nature of the problem, and asked him to investigate and come back to us, as best he could, with his own judgment of the veracity or not of the allegations”……….... “We asked the institution where the work was conducted—the Royal Free hospital—to complete an investigation,” he (Horton) submitted in a written statement to the journalists’ magazine Press Gazette. “They did, and they cleared Wakefield of wrongdoing.”
Deer goes on:-
“But documents, emails, and replies obtained under the Freedom of Information Act reveal no formal investigation. What emerges is merely a scramble to discredit my claims during the 48 hours after I disclosed the information. They show the journal’s editor, the paper’s senior authors, and the Royal Free medical school, frantically mobilising against me. Were it not for the GMC case, which cost a rumoured £6m (€7m; $9m), the fraud by which Wakefield concocted fear of MMR would forever have been denied and covered up.”
In his book ‘Callous Disregard’, Andrew Wakefield presents an altogether different version of events at the Royal Free. According to AJW, the then Dean of the Medical School, Professor Arie Zuckerman, had already been approached in September 1996, by Professor Sir David Hull and another person from the Department of Health. Professor Hull was the then chairman of the Joint Committee on Vaccination and Immunisation in the UK.
At that time AJW was unaware that the 1000+ children involved in the Barr MMR vaccine damage litigation would have to sue the UK Department of Health because the MMR vaccine manufacturers had already been granted full Government indemnity against litigation. Neither AJW, nor the lawyers acting for the children, were aware of this at that time. If they had known, it is doubtful whether the lawyers would have proceeded with the litigation.
According to Dr Wakefield, Professor Zuckerman was under intense Government pressure to stop the Wakefield et al research. Chief Medical Officer Sir Kenneth Calman, heavily involved with implementing the DOH vaccine policies in the UK, wrote to Professor Zuckerman to say he was “very concerned about the unwelcome controversy surrounding the work on Crohn’s disease which is carried out at this School by Dr Andrew Wakefield and his group.” Professor Zuckerman also gave evidence to the GMC trial panel. AJW describes his evidence as ‘fickle’.
Brian Deer’s allegations of a Royal Free medical ‘cover up’ seem to be at variance with what actually happened, subsequent to Deer’s Sunday Times article 2004, and his complaint to the GMC, which resulted in the GMC ‘show trial’ of Dr Wakefield and his two colleagues, Professor’s Murch and Walker Smith. To those of us who support them, these three excellent doctors were actually ‘hung out to dry’ by both Royal Free Hospital and Government personnel.
As Professor Murch said to my daughter at a clinic appointment for my Grandson back in the year 2000:-
‘It feels like a public flogging!!’
By the end of 2001, new clinicians were brought into the Royal Free to ‘deal with’ these unfortunate children. One of them told my daughter “Your son will grow out of this in 6 month’s time”; (we wish!!). Another wrote “In view of the increasing burden of providing this service, we are now no longer able to offer more than the initial assessment of autistic children with bowel problems. Thereafter we will be able to advise local paediatricians and GPs in the long term management.”
Since then, the only treatment my Grandson ever gets is laxatives and more laxatives. He is ‘passed round’ the clinicians at his ‘gastro’ clinic. They are all too terrified to prescribe any other treatment. He looks at me with pleading eyes, “I don’t feel well Grandma.” His life is one of constant pain and discomfort. I cannot help him.
In his book Dr Wakefield says:-
“January 28, 2010 may go down as the day that clinical care died.” This was the day the GMC made those pronouncements against him.”
Alas, the 'public flogging' of Wakefield et al goes on as does the iatrogenic neglect of the children. Shame on them!!
Posted by: Jenny Allan | March 25, 2011 at 08:15 AM
Jenny
It is troubling at according to a BBC programme last night
http://www.bbc.co.uk/programmes/b00znb98
the investigation seems to be taking place under the auspices of Prof Mark Pepys who was so closely involved in events, and is known to have disagreed with AW - indeed was talking about the matter from his side on the programme. Pepys is also closely involved with MMR manufacturer GSK, and has been dubbed "a superstar" by them:
http://uclb.com/ucl-professor-mark-pepys-hailed-as-an-academic-superstar-by-glaxosmithklineucl-professor-mark-pepys-hailed-as-an-academic-superstar-by-glaxosmithkline
This is, of course, not a conflict of interest (!!!), and did not need to be mentioned by Adam Rutherford the programme's presenter.
Posted by: John Stone | March 25, 2011 at 03:51 AM
Just to enlarge on Jen's post regarding UCL:-
http://www.bmj.com/content/342/bmj.c7452.full/reply#bmj_el_247716
Replies to BMJ Editorial 'Wakefield's Lancet article linking MMR vaccine and autism was fraudulent'
Professor Sir John Tooke, Vice-Provost (Health)
Professor David Price, Vice-Provost (Research)
"UCL takes any allegation of research misconduct very seriously, and we will certainly investigate those raised in the BMJ. At this point, however, we have not been given the opportunity to view all of the articles to be published in the BMJ relating to this issue. We are therefore currently able to give only a general institutional response to the issues so far raised.
At the time the research relating to February 1998's Lancet paper was conducted the Royal Free Medical School was not part of UCL. The Royal Free and University College Medical School was formed via a merger of the two schools in August 1998 and has been known as UCL Medical School since October 2008."
Posted by: Jenny Allan | March 25, 2011 at 02:51 AM
Australia
Thank-you John and thank goodness for the Internet or else I would be kept in the dark.
From down under.
Posted by: AussieMum | March 24, 2011 at 08:55 PM
Thank you so much, John, for continuing to fight for the truth!!!
Posted by: Twyla | March 24, 2011 at 08:16 PM
Jersey Joe
Thanks for your encouragement. It seems presently beyond the realms of possibility that a mainstream journal is going to allow discussion of this (apart perhaps from BMJ on a slightly involuntary basis), though they certainly ought. As an Englishman I don't know a lot about Columbia Journalism Review, but will look into it.
I note that 'The Scientist' put up a blog about it yesterday which now seems to have been removed.
John
Posted by: John Stone | March 24, 2011 at 07:04 PM
John, I greatly admire your work on this complicated matter. I wonder if there is a possibility of your submitting it as an op-ed piece to the New York Times or to the Columbia Journalism Review. It is a fascinating study of what "research" means these days. It seems like everybody has an ax to grind and a few skeletons in the closet. Deer still hasn't explained how he got access to those kids medical records. Anyway, I just wanted to say that there may be some publication in this crazy world that would publish your work as an investigative piece. Rolling Stone?... I think even people not involved in the autism issue per se would find the whole affaire interesting.
Posted by: Jersey Joe | March 24, 2011 at 06:12 PM
UCL have apparently started their own internal investigation of Deer's claims of scientific fraud... they're gonna be digging up old slides and stuff. All because Brian Deer said so. unbelievable.
Posted by: Jen | March 24, 2011 at 06:07 PM