Note: Enduring Memories, Prof. Walker-Smith's memoir, is now available in the UK at The Village Bookshop.
By John Stone
‘Looking back I am astonished that I was able to study as many as 116 child autopsies during the period 10 October 1967 to 11 August 1969. That so many children should have died in a children’s hospital during this period of one year ten months shows how much we have advanced during the following thirty years. During my last five years at the Royal Free not one child died of a gastroenterological cause.’ [John Walker-Smith, Enduring Memories, 2nd edition 2012, p. 113]
The corollary of this arresting statement was not only did John Walker-Smith live through those years he was at the very centre of the developments that enabled so many lives to be saved. It is an even more remarkable achievement when you consider that during those last five years Walker-Smith’s department was a place of tertiary referral and that many of the most intractable cases in the country would have been referred on to his department. As we know, in one of the most shameful episodes in modern British history (the nearest comparison being the mysterious death of David Kelly), and with the connivance of the medical and political establishment, within four years of his retirement the department dismembered, his name publicly tarnished while a journalist with no medical qualifications – and a political agenda - made accusations in a national newspaper, meanwhile accessing children’s private medical records with state connivance.
As an Anglophile Australian, growing up in Sydney, perhaps no early experience could have prepared Walker-Smith for this better than taking part in a school production of Gilbert and Sullivan’s HMS Pinafore, with its time-serving, politically correct politician Sir Joseph Porter KCB (‘I polished that handle so carefullee/ That now I am the ruler of the Queen’s Navee’), of which a delightful photograph - one of many – appears in this memoir. This is a deep book which tells you a great deal about places and times, by someone who thinks penetratingly about things – many things, not only medicine but religion, art, literature, international affairs. But Walker-Smith is also someone for who the care of children was always of paramount importance, for who the churning accompaniment of political machinations, and in-fighting were never welcome. It was this that led him to leave Australia in 1972 and to move his department across London fatefully – as it turned out – in 1995 from the administratively blighted St Bartholomew’s Hospital in West Smithfield to the Royal Free Hospital in Hampstead. Inevitably, and in spite of the importance of the rest of this history it is this episode on which the most curiosity will focus.
And it is, of course, the point where the clash between science and medicine, and politics becomes most acute. It is hard to summarise all the issues here, but what is fascinating is the question why, from an early stage, were the politicians and the UK Department of Health not only keen to dismiss any connection between MMR and autism but also to dismiss any between autism and bowel disease, stepping well beyond you might think their competence or normal brief (what, we might ask, did they know?). Walker-Smith quotes his letter to the Chief Medical Officer of the time, Sir Kenneth Calman:
“I was personally very dismayed by your letter of 27 March 1998, especially after our cordial meeting with the Minister at Richmond House. I was not surprised by your robust defence of MMR vaccination but I was very concerned not only by your attempt to completely discredit our reported association between ileal lymphoid nodular hyperplasia, non-specific colitis and autism but your targeting of me personally on page 5 of your letter. It almost seems as if someone in your department has looked through my publications seeking to discover inconsistencies and so undermine my personal credibility as the senior clinician in the Lancet letter
“There are many factual errors…(p217)”
Why, we may ask, was it necessary to attack the gut autism hypothesis in order to defend the vaccine programme?
About this Walker-Smith is in the end deliberately non-committal, but some clues lie in his reflection on the O’Leary findings:
“Since the work has been published, criticism of a technical nature has been made. Such a situation poses a difficulty for a clinician where one does not have personal technical expertise, one has to make a human judgement based upon the quality of the person doing the work and his reputation. For me I have complete faith in the integrity of his findings and the quality of the work coming from John O’Leary’s laboratory. However his findings are merely a beginning. Scientific rigour demands these must be confirmed independently in another laboratory.
“O’Leary’s work was completed and ready for publication in March 2000 but was only published after an agonizingly long wait in the journal Molecular Pathology , in 2002, long after I had retired. The finding of measles genome in tissue from our children with autism in this publication does not prove anything, but mean there was for the first time hard evidence concerning measles virus in children with autism who have bowel inflammation. There was now a case to answer concerning the possible role of measles in the gut inflammation of children with regressive autism. Yet there was no evidence whatever to link the measles virus or MMR directly to autism itself.”
But of course dismayingly the path has been blocked, and even by O’Leary himself. In 2008 the paper by Hornig paper, of which O’Leary was signatory, confirmed the findings:
“Our results differ with reports noting MV RNA in ileal biopsies of 75% of ASD vs. 6% of control children…Discrepancies are unlikely to represent differences in experimental technique because similar primer and probe sequences, cycling conditions and instruments were employed in this and earlier reports; furthermore, one of the three laboratories participating in this study performed the assays described in earlier reports. Other factors to consider include differences in patient age, sex, origin (Europe vs. North America), GI disease, recency of MMR vaccine administration at time of biopsy, and methods for confirming neuropsychiatric status in cases and controls.”
The Hornig paper (which was a very small study) had one instance of measles RNA in an autism case, and one in a control (but all cases had bowel problems and had received MMR) confirmed in three laboratories, including O’Leary’s. This reflected the findings of the earlier paper which also found some positive results among controls, but what is beyond comprehension is why this paper rejected further investigation: surely the presence of measles RNA in the cases where it was discovered remained of potential significance at least for those cases, and the reasons for not continuing the investigation nonsensical. The lesson of course is that if as a doctor or medical researcher you pay attention to parents’ reports of adverse vaccine effects you do so at your professional peril: normal ethical or scientific criteria simply cease to obtain. While Walker-Smith may deplore Andrew Wakefield’s preparedness to take part in the dean Zuckerman’s legendary press conference who could seriously doubt that wheels of retribution would still have gone into motion.
Retribution, of course, finally came in the form of a certain journalist and consumed eight years of Walker-Smith’s retirement. He was placed in the firing line surely simply because as lead clinician in the Wakefield Lancet paper the accusations had to be placed at his door as well as Wakefield’s in order to bring Wakefield down. And now, of course, that he has been completely exonerated in the English High Court many of the findings which were shown to be false still stand anomalously against his colleagues Wakefield and Prof Simon Murch with no attempt by the GMC to rectify the matter.
At the hearing Walker-Smith spent no less than 27 days on the witness stand. He reflects on the GMC “courtroom”:
“I found this “chamber” to be a deeply deceptive room. I regarded the absence of traditional symbols of justice to be highly significant. There were no visual assurances that justice would be done in this room. It seemed to me that the purpose of this room was to deceive the defendants into thinking that this was a room where normal “business” meetings would be held. The implication was that the Hearing was a normal business meeting. This was far, far from the reality, as all the lawyers and panellists knew from long experience. I saw it as a dishonest room where a defendant might be lulled into a false sense of normality. Thereby entrapment by the prosecution might occur. The chairs and the tables had stainless steel fittings. These came to symbolize instruments of torture in my mind. Indeed by the end of cross-examination I came to regard the room as a “Torture Chamber”.” (p.226)
Those of us who sometimes attended can recognise this room but it was relentless questioning of the prosecuting attorney that was even more tortuous than the chairs, relatively and sometimes inexplicably unprotested by the defence lawyers. Walker-Smith writes under the sub-heading ‘The Central Mystery:
“The central issue for me over all the years from the time of the first complaint had been made to the GMC by the journalist, was the following. Who or what was behind the decision ab initio to take his complaint against me so very, very seriously? Other related questions remained unanswered, for example: Why was I pursued in such a zealous way by the GMC/prosecution? Was there a department or organisation behind these decisions? I could not understand why I had been forced to give evidence, especially in cross-examination, for such a long time. I asked myself were the charges against me so heinous that they demanded so great a time and such intense cross-examination? Once again I pondered the central mystery of the Hearing for me. Was there another influence behind the GMC, an invisible Deus ex machina?” (p232-3)
But was it ever a mystery? When Brian Deer’s original allegations were unveiled in the Sunday Times in February 2004 they came supported by none other than the then Prime Minister, Tony Blair, who remarked to ITV "I hope now that people see the situation is somewhat different from what they were led to believe", and the Chief Medical Officer (by that time Sir Liam Donaldson) who went on the BBC and said "Now a darker side of this work has shown through, with the ethical conduct of the research and this is something that has to be looked at".
As Cherie Blair’s style guru, Carole Caplin (who whatever her eccentricities and failings lived close to the centre of power in the early Blair years), wrote a few days later:
“Ever since concerns about a possible link between the MMR vaccine and autism first surfaced more than seven years ago, it's been crystal clear that extremely powerful forces would like nothing better than to suppress public debate about the issue and discredit anyone questioning MMR.
“These forces consist of very senior Government health bureaucrats, who advise our politicians, and leading figures in the British medical establishment, who advise the bureaucrats.
“Senior civil servants and doctors are people who do not like their authority challenged in any way.”
"None the less, it is beginning to look as if, as Neurologist Peter Harvey points out in the same issue [Lancet 14 February], there is now "a step-by-step cascade of evidence" linking the MMR vaccine to some cases of autism.
"This could explain the assault on Dr Wakefield's integrity. The validity of his original findings, it is claimed, may have been compromised by a conflict of interest involving research funds that he failed to disclose. This might be relevant if it were true, but it is not, as anyone can check for themselves: Dr Wakefield acknowledged the source of his funding in 1998. It would seem that neither the Government nor the medical establishment can afford for Dr Wakefield to be vindicated – and they are getting pretty desperate."
And it may be added that Harvey, who sadly died a few days ago, never recanted.
Two years further on a former chief scientist at the Department of Health, Peter Fletcher, spoke up in a Mail on Sunday report:
“A former Government medical officer responsible for deciding whether medicines are safe has accused the Government of "utterly inexplicable complacency" over the MMR triple vaccine for children.
“Dr Peter Fletcher, who was Chief Scientific Officer at the Department of Health, said if it is proven that the jab causes autism, "the refusal by governments to evaluate the risks properly will make this one of the greatest scandals in medical history".
“He added that after agreeing to be an expert witness on drug-safety trials for parents' lawyers, he had received and studied thousands of documents relating to the case which he believed the public had a right to see.
“He said he has seen a "steady accumulation of evidence" from scientists worldwide that the measles, mumps and rubella jab is causing brain damage in certain children.
“But he added: "There are very powerful people in positions of great authority in Britain and elsewhere who have staked their reputations and careers on the safety of MMR and they are willing to do almost anything to protect themselves."”
For them the destruction of the reputation of John Walker-Smith – a man who only achieved good for countless children with his methodical and humane work - was an insignificant price in their alleged war on disease: they could walk away from the children without inspecting the damage, and they took punitive action against anyone who did not follow their example. The powerful message was there for entire profession, perhaps even more menacing to those who could see that it was cruelly unjust.
In 2002, two years after his retirement, and two years before Deer unleashed his allegations Walker-Smith wrote to the Lancet:
“Am I too naïve to ask all people of goodwill on both sides of this debate to speedily agree on an independent research agenda that will finally resolve this matter? Such an agenda must involve non-epidemiological research focusing on the bowels of these children. It is self evident that this whole question is going on far too long and is causing so much heart-ache in parents.” (p.219)
He certainly was too naïve: a decade on there is still no agreement and many children have grown to adulthood in constant pain, the ignored collateral damage of public policy. But this is a fascinating book.