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 BMJ calls for GMC to drop Wakefield prosecution
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John Stone

United Kingdom
1254 Posts

Posted - 10/27/2006 :  20:31:55  Show Profile  Reply with Quote
Not receiving any of the publicity of the BMJ's belated exposure of the flu vaccine scam was editor Fiona Godlee's remarkable call for the GMC to drop its proposed prosecution of Andrew Wakefield:

"UK vaccination rates remain below those achieved before Andrew Wakefield published his Lancet paper on MMR in 1998, and efforts to regain lost ground have been only partially successful. In the battle for hearts and minds, the media and anti-vaccine groups have mounted a far more compelling case than the Department of Health.

"In view of this, plans to pursue Wakefield for misconduct through the General Medical Council seem doomed and dangerous. Doomed if the main charge is publishing flawed research because that would set an impossible precedent. So much research is flawed, the GMC would be overwhelmed. Dangerous because, even if successful, the case would refuel the controversy and present Wakefield's supporters with a platform. Part of the problem is the perception that no one in an official position has taken seriously the concerns of families who believe their children have been damaged by the vaccine. The denial that the vaccine has caused the damage, though almost certainly accurate, doesn't sound very sympathetic and leaves Wakefield with a monopoly on taking these concerns seriously."


http://bmj.bmjjournals.com/cgi/content/full/333/7574/0-f

Its a surprising conclusion from this source that the "media and anti-vaccine groups have mounted a far more compelling case than the Department of Health". While she is quite right that we have the better arguments and the stronger evidence (though this is not what she means) few would have said that vaccine safety campaigners have been given much room in the media in the past three years - there is no doubt that pressure from government and the industry have been the predominant feature. The sense of failure on their part is fascinating and stems simply, surely from being wrong.

Equally bizarre is Godlee's statement:

"Part of the problem is the perception that no one in an official position has taken seriously the concerns of families who believe their children have been damaged by the vaccine."

For many of us this is more than a perception. What evidence is there that they have except in terms of denial and social repression? Their only answer has been to tell everyone to shut up, persecute dissenting professionals like Andrew Wakefield, Peter Mansfield, Lisa Blakemore-Brown and Jayne Donegan and close down the litigation before the evidence could be properly assembled. But most people know little enough about this: all they sense is unreasonable pressure, the bullying attitude and arm-twisting which is endemic in the implementation of the programme.

And what's wrong is perfectly illustrated in the flu scam. We have Tom Jefferson of Cochrane declaring the inefficacy of flu vaccine for the enth time: but this time there was an effective press release and it may just work. Yet the truth is that this has always been known - which has not stopped so-called independent government advisers from pushing it (as we know recently targetting pregnant women and infants). The culture which gave you this error gives you all the others too.

The answer to Fiona Godlee is to stop patronising people, and when they tell you something has gone wrong, believe them.




John Stone

United Kingdom
1254 Posts

Posted - 10/27/2006 :  21:07:16  Show Profile  Reply with Quote
BMJ Rapid Responses did not post this response from me:

"Having argued extensively in these columns that there were no grounds for the prosecution of Andrew Wakefield I welcome the editor's statement. The case always looked flawed and fabricated to suit public policy: it looked bad two years ago and it is shameful that threat of prosecution has remained over Wakefield's head all this time, with the GMC and its solicitors Field, Fisher, Waterhouse scratching around for anything substantive that they could bring against him, at the behest of former Health Secretary John Reid.

"Where I disagree with the editor is that not only is there a perception that officialdom have not taken the MMR parents' concerns seriously (except in a malign way), they live it day to day, with lack of medical and education support, while many have also suffered unpleasant fabricated illness allegations. Everything which is dysfunctional about modern government has been visited on these unfortunate families. Moreover, the way these families have been treated undermines scientific objectivity itself. That the present hue and cry should have folllowed one of the flimsiest stories that even a Sunday newspaper has ever produced speaks volumes.

"Another point of disagreement is with the comparison with flu vaccine. While few would doubt that unlike flu vaccine MMR is relatively effective, the unspun Cochrane review of last year surely did anything but endorse its safety. Even the six studies included which bore on the Wakefield thesis were found to have serious defects - in this regard the claim that they had not shown a link with autism and bowel disease ought not to have been considered of the greatest significance."

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Angladrion

New Zealand
153 Posts

Posted - 10/28/2006 :  08:18:49  Show Profile  Reply with Quote
Neither did they publish, from me, this:

quote:
I disagree with Fiona Godlee that the case against Wakefield should be dropped. Her stated editorial position has always been that of an ardent MMR advocate. It seems that by proxy and belief therefore, Wakefield has been inconclusively and irrefutably proven wrong in the eyes of the whole medical profession?

The reason why the case against Wakefield should proceed is that if the pro-vaccine medical literature on MMR is not also flawed, the proponents of MMR have a wonderful platform from which to convince the public that everything since 1998, said by Wakefield is a load of rubbish. Either side should be prepared to put up or shut up, not suggest that cancelling the case is a good idea, because not prosecuting will deprive Wakefield supporters of airtime.

The basis of scientific accuracy and resultant public choice, should be robust debate, not "no debate and maybe the problems will go away."

Fiona Godlee also says that Wakefield's work served as a reminder about flawed medical research, and "as if to prove [that]point" she rolls out Tom Jefferson's article showing lack of evidence of usefulness of the flu vaccine.

Again here, I believe she is wrong. The medical evidence about the uselessness of the influenza vaccines dates from the 60's when the USA DBS (Division of Biologics Standards, now the FDA) attempted to silence their vaccine tester, Dr Anthony J Morris, who for years found that the flu vaccine was consistently useless before he was "shifted sideways".

More recently, a couple of years ago, when Simonsen et al likewise found the same thing,

http://www.fic.nih.gov/news/inthenews/SimonsenArchives.pdf

using data from the point where Dr Morris was shifted sideways to 2004, they were later forced to recant, and pay penance by saying "...but if we vaccinate all the children then Granny won't get it." That didn't go down so well with parents, so it seems that last week, the backroom boys pulled the ultimate emotional blackmail on mothers, on the basis of one supposed study to say

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=412187&in_page_id=1&in_page_id=1&expand=true#StartComments

... that pregnant and lactating women should receive the flu vaccine on the basis that it might prevent a two-fold increase in childhood cancer.

No mention that such a position is based on the erroneous assumption that the vaccine works in the first place. What does it take for the medical profession to drop something that has been pretty much useless since it first hit the market 50 plus years ago...? If Health Departments and governments can't see sense with the flu vaccine, is it any wonder that MMR's halo will be relentlessly protected, no matter what?

I believe the time has come, not to say who may speak, who may not; which case should go forward or which should not; but to root out flawed research, hypocrisy, inflated egos, and lack of transparency and accountability in the medical profession, politicians and medical journals.

If all that is done, then when fall-out has finished, the average person on the street might have a chance to see what the real issues are without the current, constant obfuscation by point-scoring.




"..it does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds.." - Samuel Adams
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Angladrion

New Zealand
153 Posts

Posted - 10/28/2006 :  08:23:20  Show Profile  Reply with Quote
I had to laugh though, when they published this from a doctor:

quote:
It appears Ms Godlee in resisting the temptation to shy away from controversy has shied away from any responsibility to public health or the doctors she supports.

It is important to publish papers such as the Tom Jeffersons(1) paper but to do so in an appropriate way. To do so in the middle of a vaccination campaign risks leaving individuals unprotected. The rise in measles she describes in her first paragraph should have been her warning.

Does she see her role as helping to improve health and helping her readership to do that? or something else? The BMJ certainly achieved something- the headlines “Those flu jabs could be a waste of time, says expert’”– Telegraph (2)

“Flu vaccines 'not worth the bother' says expert” Mail(3)

Was there any consideration for the General Practitioners who are still completing their flu vaccinations and now face questions of its efficacy without time to assess the article? Or even the people who may decide not to have their vaccination having read these headlines? And what of the consequences?

Jeffersons paper supports the Joint Committee on Vaccination and Immunisation (JCVI) policy decisions(2). It shows a decrease in influenza in healthy adults and elderly and a decrease in deaths in the elderly but she makes no reference to this.

The vaccine is safe and effective but the BMJ has helped to promote the opposite message at the most sensitive time.

(1)Jefferson T., Influenza Vaccine: policy versus evidence BMJ 2006;33: 912-5 (2) Telegraph 27/10/06 (3) Mail 27/10/06 (2)CMOs letter, June 2006, Department of Health

Competing interests: None declared


Typical.





The whine fair pulsed off the page.


"..it does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds.." - Samuel Adams
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Angladrion

New Zealand
153 Posts

Posted - 10/28/2006 :  22:01:31  Show Profile  Reply with Quote
Two very interesting responses today: Retired physician:

quote:
5 years ago I asked my GP what the facts were about the pros and cons of ‘flu vaccination, and I was referred to the propaganda hand outs from the Department of Health. These were long on assertion and short on facts. Perhaps unwisely I embarked on a literature search and running correspondence with various civil service mandarins (including Sir Liam Donaldson) with the limited ambition of getting data on what actual tests- of efficacy and safety- were done on current vaccines and with what results. After much evasive action and stalling I was informed that such information was confidential. The Lancet (2001:357:2141) published my scepticism about the extra ordinary claims being made for the ability of ‘flu vaccine to prevent not only the ‘flu but death as well, whatever the cause. Since then there have been a few papers expressing concern about the inconclusive nature of the evidence for its efficacy (1,2). On the other hand, there have been repeated exhortations to the public to “protect themselves.” The enormous expense of this futile exercise doesn’t seem to register- partly, I fear, because of payment inducements offered to GPs. They, perhaps, may claim they believed the recommendations of the DH and carried out the vaccination programs in good faith. This “only carrying out orders” excuse is of doubtful validity. There can be no excuse for the harmful public health decisions and refusal to come clean about what precisely were the reasons for their them. It is too much to hope for repentance and reversal, however. The Faustean contract exemplified in the structure of the Medicines and healthcare products regulatory agency will see to that.

1.van der Wouden et al, Respiratory Medicine (2005) 99,1341-1349. 2. Simonsen L et al, Arch Int Med (2005) 165, 265-272

Competing interests: None declared



and a hospital dermatologist. Note what he asks for:

quote:
Over the past few decades the practice of Medicine has moved from a basis of personal experience and understanding of the disease process and its treatment, towards the application of authorized protocols and guidelines. The body of Medical knowledge is now so great that this has many advantages. Nevertheless, we do recognize the importance of in-depth understanding, both in applying guidelines sensibly, and managing uncommon conditions for which rigorous evidence-based recommendations are not available.

Tom Jefferson's article raises concern about the situation in which an inadequate evidence base has become canonised into established guidelines, Government policy and incentivised practice. It takes a bold man indeed to challenge this set of Emperor's clothes.

Perhaps we need a forum within which such nagging concerns can be raised by lesser mortals in order to build up a sufficient groundswell of opinion to challenge the court tailors.
Competing interests: None declared





Well, there used to be one. BMJ e-responses, until Godlee decided that lay dissent was no longer admissable.

If doctors was to change the standard of honesty, editor are going to have to have more initiative and courage than Godlee has shown.

"..it does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds.." - Samuel Adams
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John Stone

United Kingdom
1254 Posts

Posted - 10/31/2006 :  18:51:14  Show Profile  Reply with Quote
Just to note that they did publish my Rapid Response with 4 days delay though not Angladrion's. They also published this from Bill Welsh:

"DENOUEMENT NEARS 31 October 2006

"Fiona Godlee is quite right in asserting that any plan by the General Medical Council (GMC) to pursue Andrew Wakefield on the grounds of “publishing flawed research” is “doomed”. The reason for the failure of such a scheme would not, however, as she claims, be due to there being a plethora of flawed studies in circulation. It would be because Wakefield’s robust and rigorous research was accurate. It has been replicated. Wakefield was and is correct; many autistic children have a novel form of bowel disease.

"Ms Godlee is also quite right in pointing out that there is a perception that the medical establishment “has not taken seriously the concerns of families who believe their children have been damaged by the vaccine”.

"This point is well illustrated by a Medical Research Council that, in almost eight years of raging debate, has refused to fund the clinical examination of even one of the thousands of children reportedly withdrawing into autism following MMR vaccination. The MRC apparently inhabits an ivory tower, unaware of the public health tragedy unfolding below. One child in a 100 in the UK now has a diagnosis of autism, a previously very rare condition. No plausible explanation for this development is being put forward by medical officialdom. As the denouement nears the GMC aspect looks more and more like a sideshow.

"Bill Welsh
Chairman
Autism Treatment Trust, 26B Great King Street, Edinburgh. EH3 6QH

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