The Walker-Smith Appeal, the British Media and the Boseley Problem
By John Stone
Sarah Boseley (centre in the photo) is the senior Guardian newspaper journalist who wrote on the occasion of the UK General Medical Council’s findings against Dr Andrew Wakefield and his colleagues Prof John Walker-Smith and Prof Simon Murch in January 2010:
"Opinion is divided in the medical establishment on the wisdom of pursuing Wakefield – and particularly his colleagues who played a lesser role in the drama – at the GMC. Some say there was a clear case to answer and that the GMC had no other option but others believe that no good can come of it."
What Boseley omitted to do as a decent journalist and a competent reporter was to tell her readership what the medical establishment was worried about. And what they were worried about may be by now coming back round to haunt both the medical establishment itself and the media, although no doubt damage limitation measures are already being put in a state of readiness. The spectre came in the form of a UK Press Association report of Prof Walker-Smith’s High Court appeal misleadingly entitled ‘MMR row doctor decision was “fair”’ . However, underneath the headline the story begins to hint at the real matter:
“The decision to strike off an eminent doctor over the MMR jab controversy has been defended at the High Court as "just and fair - not wrong".
“The General Medical Council (GMC) admitted to a judge that "inadequate reasons" may have been given by a disciplinary panel that found Professor John Walker-Smith guilty of serious professional misconduct. Those reasons related to conflicts over expert evidence.
“But Joanna Glynn QC, appearing for the GMC, said: "In spite of inadequate reasons it is quite clear on overwhelming evidence that the charges are made out."
“Professor Walker-Smith is asking Mr Justice Mitting at London's High Court to rule that he was denied a fair hearing. On the fourth day of his challenge, the judge said that the case had been "complex and difficult from the start - it greatly troubles me".”
At stake in the hearing are essentially two issues: whether Prof Walker-Smith acted beyond his brief as a clinician in the care of the 12 children in the much disputed Lancet paper, and whether the paper had anything to do – as alleged – with the protocol (identified with Royal Free Hospital ethical approval 172-96) for a Legal Aid Board funded paper, or was just as the paper itself stated an “early report” on 12 children seen and investigated on the basis of clinical need. This problem has been perpetually hinted at but never clearly explained in the British media – we will call it for convenience “the Boseley problem” though it is very much the problem of other journalists too.
Following the allegations by journalist Brian Deer and doctor MP Evan Harris in 2004 that the Wakefield Lancet paper had been commissioned and paid for by the UK Legal Aid Board the first apparent dissent to appear was in an award winning article by Dr Ben Goldacre ‘Don't Dumb Me Down' , the son of a leading government epidemiologist and Oxford University professor, Michael J. Goldacre. Goldacre junior wrote in September 2005:
“Now, even though popular belief in the MMR scare is - perhaps - starting to fade, popular understanding of it remains minimal: people periodically come up to me and say, isn't it funny how that Wakefield MMR paper turned out to be Bad Science after all? And I say: no. The paper always was and still remains a perfectly good small case series report, but it was systematically misrepresented as being more than that, by media that are incapable of interpreting and reporting scientific data.”
This statement refers to neither Deer or Harris, and what it does not tell you is that the issue as to whether the Lancet paper was a really a “fraud” or not hinged on if it was “a perfectly good small case series report” as stated on this occasion by Ben Goldacre or if it was based on the protocol for the Legal Aid Board commission to which it bears little or no resemblance (and which the three doctors at the GMC were later to claim was never executed) as originally argued by Deer and Harris in 2004. At the same time the possibility that medical establishment was trying to hedge its bets against the failure of a flawed GMC prosecution is opened up by the fact that Dr Harris, himself, was on the jury which gave Goldacre his Association of British Science Writer’s award for the article (note that page mistakenly attributes the article to John Gribben) .
Indeed, there was sequence of editorials around the time of that award (which took place in the summer of 2006) doubting the wisdom of prosecuting Andrew Wakefield and his forgotten colleagues, which included pieces in The Independent, the New Scientist, by Dr Michael Fitzpatrick in Spiked Online and a little later by Dr Fiona Godlee in British Medical Journal calling for the prosecution to be called off .
All this led later to particular embarrassment for Ben Goldacre, whose vacillating position on the matter was reported on Age of Autism (Can We Have it Straight?), (Goldacre Challenged on Wakefield) and who as late as November 2010 (and months after he had first welcomed the GMC verdict) was accurately telling Irish Health:
“But you have to remember this paper didn’t actually say MMR causes autism, it didn’t even speculate on that. It was accompanied by an editorial that said by the way people should be very clear that it doesn’t mean that MMR causes autism.
“Also, this was a 12 subject case series report - it was a description of only 12 children’s clinical anecdotes, and while this is not good evidence to say MMR causes autism, it is a perfectly legitimate thing to publish.”
The almost unavoidable conclusion is that large sections of the British media have always known that the “Wakefield” prosecution was based on an imposture, and have been holding their silence in contempt of fair reporting and of the public at large, and that these people are much more concerned about their own backs than they are about our children.
John Stone is UK Editor for Age of Autism.
Fever
To be clear, the judge has gone away to make up his mind ("reserved judgement"). It is still possible that whatever he decides either Prof Walker-Smith or the GMC could appeal again. However, the GMC have ruled out the possibility of referring the matter back to them for a re-trial.
Posted by: John Stone | February 26, 2012 at 04:01 AM
Thank you Jenny Allan
Posted by: Fever | February 25, 2012 at 06:21 AM
Fever asks:-
"Has the High Court said it would not contradict the GMC "judgment" or has it only postponed its own judgment?"
Justice Mitting is still deliberating and has not yet announced his verdict.
The GMC has indicated to the High Court that they will not contest the High Court verdict in the event of Judge Mitting finding in favour of Professor Walker-Smith.
Posted by: Jenny Allan | February 24, 2012 at 07:30 AM
Not being a native english speaking person , I am not sure to fully understand the High Court decision : has the High Court said it would not contradict the GMC "judgment" or has it only postponed its own judgment ?
By the way, how is the procedure initiated by Dr David Lewis going ?
Posted by: Fever | February 24, 2012 at 06:28 AM
Yes John Stone and Elizabeth. Prof Walker-Smith is indeed a "wonderful and humane doctor". The following is one of my growing collection of non published BMJ Rapid Responses, (December 2011):-
"Brian Deer's BMJ articles imply the 12 children in the Wakefield et al 1998 Lancet study were procured purely for the purposes of producing a research paper to discredit the MMR vaccine. Deer insists these children were subjected to unnecessarily invasive procedures without benefit. As the medically unqualified Deer was recorded stating loudly outside the GMC premises in London, 'They didn't have bowel disease.'
In fact the Royal Free Clinic treated dozens of children with very similar bowel conditions. (This clinic did NOT treat or diagnose autism). One of these children was my grandchild. He was not 'procured' but referred by his GP to Professor Walker-Smith in the usual way for investigation and treatment of his bowel problems.
A colonoscopy was a very necessary procedure in order to diagnose my grandson's bowel disorder. My daughter properly gave permission for Dr Wakefield to receive two EXTRA biopsies for research purposes. Dr Wakefield WAS NOT involved at any time with my grandson's treatment which involved prescribed medications, medical interventions and dietary advice.
We cannot praise Professor Walker-Smith and his team enough. They were professional and compassionate and the treatments helped my grandson enormously. The furore surrounding the Wakefield/MMR vaccine issues, resulted in the virtual NHS abandonment of these iatrogenic children. My grandson is now an adult; he has never known what it is like to be free of pain.
COI
My autistic grandson was treated for his bowel problems, under the excellent care of Professor Walker Smith and his team at the Royal Free Hospital clinic 1998-2002."
The BMJ RR 'assessment' person Sharon Davis contacted me, stating she was unhappy with the word 'procured' and asked me to find another one instead. She also wanted a reference for my quoted Deer comment:-
"Dear Ms Davies,
Very pleased to oblige. This is a video recording of Mr Brian Deer outside the GMC premises giving his 'diagnoses' . I was actually present at the demonstration where this unpleasant altercation took place. This is very difficult to witness without revulsion. Please watch the entire video.
http://www.youtube.com/embed/cq5BuVHu4Uw?feature=player_embedded
Brian Deer uses his 'expertise' to diagnose children outside the GMC building.
I suggest another word might be RECRUITED? which would still not alter the sense of what Mr Deer was implying in his BMJ 'Secrets of the MMR scare' articles. I have used the word procured twice, and suggest that the line about my grandson should now start' He was referred by his GP to Professor Walker-Smith', leaving out the word 'procured' altogether.
Regards
Jennifer
Brian Deer's terminology regarding the Lancet 12 childrens' 'recruitment' includes the following:-
"Their misconduct arose out of a fishing expedition."
http://www.bmj.com/content/342/bmj.c5347.full
Secrets of the MMR scare
"At their meeting with Horton, the paediatric gastroenterologists Walker-Smith and Murch also denied impropriety. I had claimed that some children were solicited, rather than spontaneously referred."
http://www.bmj.com/content/342/bmj.c7001.full
The Lancet’s two days to bury bad news
Posted by: Jenny Allan | February 23, 2012 at 04:55 AM
Elizabeth (AussieMum)
And it should not be forgotten that not only is Prof Walker-Smith a wonderful and humane doctor - the benefactor of many British children and the pioneer of the discipline of paediatric gastroentology - he is also an Australian.
John
Posted by: John Stone | February 23, 2012 at 03:41 AM
And so the worm turns...
http://www.youtube.com/watch?v=ppFVmnmpGz8
Posted by: Garbo | February 22, 2012 at 08:32 PM
Thanks John for keeping us updated.
The appeal of Walker-Smith has not reached our shores yet!
Elizabeth Gillespie
Posted by: AussieMum | February 22, 2012 at 08:25 PM
Benedetta: GREAT article! The sharpie is mightier than the needle.
Posted by: Amanda Blinn | February 22, 2012 at 07:16 PM
Big Pharma delenda est.
Posted by: Amanda Blinn | February 22, 2012 at 07:11 PM
This statement by Professor John Walker-Smith can be found on Brian Deer's website, as part of Deer's 'evidence gathering' information. It seems to me to be a very clear, and easily verified statement, about the Lancet 12 childrens' clinical referrals to Professor Walker-Smith's clinical team for investigation and treatment of their bowel problems.
http://briandeer.com/mmr/lancet-walker.htm
From above:-
"This statement, by Professor John Walker-Smith, formerly head of the Royal Free hospital's department of paediatric gastroenterology, was issued through the Lancet on February 20 2004, when the journal's editor, Dr Richard Horton, press-released content from a confidential meeting with Brian Deer for The Sunday Times."
A STATEMENT BY PROFESSOR JOHN WALKER-SMITH
"I deny the allegation that there was systematic bias in the pattern of referral for the children in the 1998 Lancet paper. No children were invited to participate in the study.
Upon review of the Centre for Paediatric Gastroenterology, Royal Free Hospital, work book entitled “Biopsies VI 4/9/95 to 21/7/97”, we confirm that the children who were reported in the Lancet paper of 1998 were the first 12 children consecutively referred to the university department of paediatric gastroenterology with autism and related disorders, who had gastrointestinal symptoms requiring ileo-colonoscopy to exclude chronic bowel inflammation.
These children were referred to me at the university department of paediatric gastroenterology at the Royal Free Hospital from July 25, 1996, to February 24, 1997—one being referred from the island of Jersey and one from the USA. By the time the paper was accepted for publication, as mentioned in an appendix to the Lancet paper, up to January 28, 1998, a further 40 children had been so investigated, 39 with the syndrome reported in the paper. The children were all investigated specifically and exclusively by clinical need to determine whether bowel inflammation was present that could then be appropriately treated.
These children were referred to the Royal Free by their general practitioner (ten cases) or consultant paediatrician (two cases)."
Posted by: Jenny Allan | February 22, 2012 at 06:48 PM
Possibly Deer is a lost cause,I just thought he would take "The Writers' Guild of Great Britain award" at the comedy awards for his outstanding comedy but no....and it`s all his own original work done by himself ,all OFFIT...
just ain`t a fair world these days..
Angus
Posted by: Angus Files | February 22, 2012 at 05:22 PM
I have just discovered that Phil Hammond posted his Private Eye commentary on the GMC findings on his website:
http://drphilhammond.com/blog/2010/02/18/private-eye/dr-phil%E2%80%99s-private-eye-column-issue-1256-february-17-2010/
May be compared with my critique of it last month:
http://www.ageofautism.com/2012/01/in-memoriam-paul-foot-private-eye-in-an-ethical-tangle-over-mmr.html
I would not incidentally do Dr Hammond the injustice of suggesting he is naieve.
I see Private Eye has this very day finally published the shortlist for the Paul Foot Awards 2011 (delayed from early January). No sign of Brian Deer (not surprising after last week).
http://www.private-eye.co.uk/paul_foot.php
Posted by: John Stone | February 22, 2012 at 04:37 PM
You can only see so much from a picture-- though in this case you can basically guess the characters involved. Laurence looks like a euphemist.
Jerry and Jim think Bill's a great guy all along. They mythologize all the more frantically the closer they get to the truth. It might be colder outside the charming embrace of acceptance within the inner circle, but the air is clearer.
Posted by: Adriana | February 22, 2012 at 04:06 PM
Thanks Adriana
Incidentally, it is an interesting photograph: the Medical Journalists Awards 2004 (Medical Journalists Association), and from left to right we have:-
Jeremy Laurance who would most likely written the editorial in the Independent in 2006 calling for GMC prosecution to be called off. More about his views can be deduced from this set-too here:
http://www.bmj.com/content/339/bmj.b5281?tab=responses
(My letters are now reproduced in reverse order)
Jenny Hope, health correspondent of the Daily Mail
Sarah Boseley
Gill Markham, Corporate Affairs Director, Wyeth
Phil Hammond, MD of Private Eye, discussed here:
http://www.ageofautism.com/2012/01/in-memoriam-paul-foot-private-eye-in-an-ethical-tangle-over-mmr.html
John
Posted by: John Stone | February 22, 2012 at 03:28 PM
It's all beginning to remind me of John Le Carre's Tinker, Tailor, Soldier, Spy. In this scenario, John, you are probably the protagonist who is the most akin to Smiley in character and methodical approach, even though you are not a former member of the authoritarian establishment who's been secretly asked back into the fold to help clean up the proverbial toxic internal spill.
On that score-- and I think this is what you're saying in essence-- there don't appear to be any Smiley-parallels left with a remaining foothold within the media and medical establishments from which they might still have some power to rectify-- though maybe they will reveal themselves later at some pivotal moment. I won't hold my breath. The pivotal moments seem to have come and gone and come and gone and real human lives continue to be destroyed. We know the Controls are dead. There are a few Prideauxs, Jerry Westerbys, Ricki Tarrs and Connies in the wreckage who hold separate fragments of the truth but have little power to reveal anything on their own against a whole world full of Tobys and Percy Allelines on the inside and the few key Bills. But no Guillams and no Smileys, which leaves it to those on the outside to fill the gaps.
I think it takes a particular kind of mind to detect the importance of certain stray-seeming details within the bigger fiasco. Obviously one of the reasons Tinker, Tailor has endured, besides "stunningly insightful characterizations," is because of the challenge: the book can be read twenty times and some will still never understand precisely on what basis Smiley unravels the scheme. Though some of us aren't able to quite grasp the import of these "stray" bits which you're bringing into sharper relief, I assume a few key targets of your inquiries understand quite well why these details are so damning and how the stray bits threaten to bring the intrigue closer to collapse.
Obviously there's no Mother Russia or cold war moles in this analogy, though I think time will reveal that at root there is political ideology involved.
Don't stop trying to make us understand, even if we don't always grasp that what happens in England tends to get exported.
Posted by: Adriana | February 22, 2012 at 02:27 PM
More about that 'inadequate' GMC reasoning:-
http://www.theoneclickgroup.co.uk/documents/vaccines/media/GMC%20case%20against%20Wakefield%20colleague%20was%20superficial%20says%20appeal,%20BMJ.pdf
GMC case against Wakefield’s colleague was “superficial,” says appeal: Clare Dyer BMJ
From above:-
"The GMC panel found that in 1996 and 1997 children had been subjected to investigations, including colonoscopy, lumbar puncture, and magnetic resonance imaging, that were not clinically indicated and against their best interests. Mr Miller said that in all but one of the cases the gastroenterological team had gone on to treat the children for conditions they had found and that in some cases the treatment went on for years. Letters were written to the children’s GPs setting out the findings and how the children were to be treated. But the panel had failed to say what its thought processes were in deciding that the exercise was research rather than clinical.
“We say the panel did not get to grips with why the investigation was not clinically indicated,” said Mr Miller. It had even looked at the wrong ethical guidelines and failed to spot that the guidelines it took into account “had nothing to do with whether something is clinical medicine or research.”
The panel had ignored what the doctors who were charged and their team said about what they were doing and why they were doing it and what the GPs who gave evidence said about why they were referring. A “superficial” approach permeated the case at all levels, the QC added."
Posted by: Jenny Allan | February 22, 2012 at 02:10 PM
Haha, go with the pen, Benedetta.
Posted by: Jen | February 22, 2012 at 01:56 PM
Jake
Yes, I suspect that the young lady who wrote it - and who I sat next to that morning - knew very little about it and understood less. She certainly sounds less than on top of the subject matter here:
“The General Medical Council (GMC) admitted to a judge that "inadequate reasons" may have been given by a disciplinary panel that found Professor John Walker-Smith guilty of serious professional misconduct. Those reasons related to conflicts over expert evidence."
On the other hand she obviously knows how to stay on message, so she will probably go far.
Posted by: John Stone | February 22, 2012 at 01:44 PM
They were able to hook the word fraud and clever on to Dr. Wakefield's name - and the ped's offices over here has their little magazines telling how safe vaccines are as they hook fraud and clever in their articles around Dr. Wakefield's name.
All the medical offices this year have a wonderful posture this year in all the doctor's offices with a header called "Flu Shots". The picture on the posture is a older looking man (grandpa) holding a baby. It is in black and white - very stunning.
But best of all: the arm of grandpa in in white - perfect for writing the word Alzheimer's on it and the cute little baby is wrapped in a white blanket and is "perfect" for showing up the word autism. Of course I have to be sneaky, but just for this posture I carry around a sharpie - to show up more -- although an ink pen does well too/ perhaps a pen is better -- the staff may not notice as much as the patients sitting out in the waiting room.
Posted by: Benedetta | February 22, 2012 at 11:50 AM
Media Scholar
Except, of course, in this instance the journalist seems to have been more interested in being "on-message" and politically correct than reporting the real news, which was that the GMC case was in danger of folding. It is interesting to note therefore, that the BMJ -under pressure as they are - recycled the article but with the real news headline. How old-fashioned!
Posted by: John Stone | February 22, 2012 at 11:43 AM
Facts are stubborn things. Included among the grossly obvious is the rush to sensationalize medical findings to sell more fish wrap. In that, so called scientific writers unwittingly found bees frequently come with the honey.
Rather than leave the matter to professionals, a feeble, sadistic, and perverse effort to twist and bend science into something it really isn't was made. More honey, more bees.
Without bees, there is no honey. Without bees, there is no sting. A sting might be harmless to some, and death to others. That's science.
Posted by: Media Scholar | February 22, 2012 at 11:25 AM
Thank you for this excellent article John Stone. I think the UK Press Association behaved abysmally over their reporting of Professor John Walker-Smith's High Court Appeal.
To quote GMC Counsel Joanna Glynn's assertion that the GMC verdict was "just and fair - not wrong" as a HEADLINE gave a completely false impression of the day 4 court proceedings, which actually included a grudging and very damning admission from Ms Glynn that the GMC's verdict had been based on 'inadequate reasons'.
The PA apparently sent one reporter to the court to compile a 'collective' press response which was then repeated verbatim by a large number of news outlets. Something I found particularly reprehensible was the BMJ internet article, authored by Clare Dyer entitled:-
"Reasons for striking off paediatric gastroenterologist may have been “inadequate,” GMC admits"
This article appears to be IDENTICAL to the Press Association's Day 4 press release. It starts the same and presumably ends the same. The only difference seems to be that in the UK access to the WHOLE article costs £20,($30 in the US). This is either blatant plagiarism or deliberate profiteering based on a PA/BMJ collusion. I HOPE no one got duped into paying for an article easily accessed for FREE in a large number of other internet news outlets.
Posted by: Jenny Allan | February 22, 2012 at 07:01 AM