Just before Christmas Brian Deer made an unusual appearance in the comment columns of Huffington Post. Why he chose to do so is a bit of a mystery though typically tasteless since the column was about the plight of British doctors driven to suicide while under investigation by the UK General Medical Council. Possibly Deer does not think enough doctors commit suicide but otherwise his intervention was decidedly off subject (besides being a come-down from the London Sunday Times and the British Medical Journal).
Equally pressing reform, in my view, is needed with regard to section 35(a) of the Medical Act 1983. This allows medical practitioners to stand mute in the face of charges, and not to disclose any information.
This unique provision to protect doctors contrasts with the civil law, under which parties in litigation are required under the CPR to disclose evidence and statements of case in good time before a hearing, and the criminal law, under which police are authorised to seize such evidence as they need and those accused are directly warned that to fail to answer questions may count against them at trial.
This unwarranted protection for doctors - slipped in to the act so long ago - almost entirely derailed the Wakefield, Walker-Smith, Murch GMC case in 2010, potentially costing at least five million of doctors' money and nearly causing a substantial part of the case to be reheard.
In that case, two of the three (Walker-Smith and Wakefield) stood mute in face of charges that the practitioners' claims of ethical approval for research on uniquely vulnerable patients was false. After the prosecution closed its case, the practitioners' then announced that they never carried out any research (as they had said they had before being charged) and Walker-Smith proceeded to retrospectively diagnose what he said were clinical indications for each of the patients. This then added about a year to the length of the hearing, and threw the management of the case into chaos.
This is, of course, complete and utter nonsense, and I responded:
There was no question of Walker-Smith or Wakefield remaining mute. The paper was what it said, a review of cases seen on the basis of patient need: it never claimed to be a research paper. That was the defence. I wrote unchallenged in BMJ Rapid Responses immediately after the findings:
"The panel stated in the short version of their findings on fact read out to journalists at the GMC last month :
"“The Panel has heard that ethical approval had been sought and granted for other trials and it has been specifically suggested that Project 172-96 was never undertaken and that in fact, the Lancet 12children’s investigations were clinically indicated and the research partsof those clinically justified investigations were covered by Project 162-95. In the light of all the available evidence, the Panel rejected this proposition.”
"However, it is my understanding that 162-95 was not a "project" in any normal sense but the ethical approval granted Prof Walker-Smith on his arrival at the Royal Free Hospital in September 1995 - as probably the most senior figure in British paediatric gastroenterology - to retain biopsy samples from colonoscopies for research purposes. If this is the case it would seem a basic criticism of the panel, that in reaching their view, they did not explain why this ethical permission did not obtain in this instance. We are also confronted by the oddity that the panel having concluded that the study was in fact project 172-96 then found the three doctors to be in breach of its terms at every twist and turn, instead of drawing the more obvious inference that it wasn't 172-96 at all, but an "early report" as stated."
Two years later Mr Justice Mitting accepted that Walker-Smith was not conducting research and he was exercising his clinical judgment in the best interests of the patients -clearly also Walker-Smith was ultimately responsible for all clinical decisions as well as being senior author of the paper. A more pertinent question is whether Deer when he was denouncing the doctors witheld evidence of 162-95 which he had obtained under FOI.
Unsurprisingly, challenged in this way Deer remained “mute”. In 2010 my comment appeared under an article by Prof Trisha Greenhalgh: it was a direct challenge to Greenhalgh whose mischievous analysis of the Wakefield Lancet paper had appeared on Deer’s website, to Brian Deer himself and to journalist “opinion leader” Dr Ben Goldacre. Unsurprisingly, all three remained “mute”, although patently embarrassed. Five years on Deer is still …”mute”.
Ignoring the manifold other falsehoods of Deer and the GMC – repeated across the mainstream media for more than a decade - this is surely structurally the central one. A day later the LA Times was weedily propounding over an alleged upturn in vaccine acceptance in California:
This is good news for California, where the anti-vaccine movement has thrived over the last decade despite its basis in a thoroughly discredited study and public statements by a few celebrities who are neither scientists nor medical experts.
It could scarcely demonstrate better how thin the defence of the vaccine program has become. Farcical to maintain that the only doubt about the safety of all vaccines could or should hinge on a single study, but if you consider the manner in which the study was “discredited” it poses far more questions about the industries and the governments hiding behind Deer than about the study itself.
John Stone is UK Editor for Age of Autism.