Posted - 07/21/2007 : 11:47:10
| Well done to everyone last monday,we made our point and were broadcast
around the world,amazing support from the public: fire engines buses and many many cars all using sirens and using their horns!rock on,regards mike.
Posted - 07/21/2007 : 18:19:35
| I know it was just amazing to meet up with people who I have been in contact with over the Jabs forum as well as the MMR10. I especially delighted to meet right at the end of the day the parents of Georgie who sadly died from the MMR. It was a good turn out. I attended the hearing at was disgusted at the charges against the good doctors. I made contact with Carmel the wife of Dr Wakefield and Professor's Murches wife, such down to earth people. As for Brian Deer i was sitting behind him at one point but never once did I give him eyecontact. I kept my ears open in the lobby of the hearing when reporters were speaking on their mobiles. Some were downright smug arrogant and rude to say the least. I never let them know who I was.
Posted - 07/24/2007 : 13:46:29
| Daily Mail Letters - July 23 2007
Dr Wakefield can help our suffering son
Building a new house in our front garden and selling our old house is the only way we can keep supporting our son James, in his on-going medical treatment in America.
We believe James was terribly injured by the MMR vaccination, diagnosed severely autistic when he was three. He's now on the waiting list at Thoughtful House, Texas, to see Dr Arthur Krigsman, one of Dr Andrew Wakefield's collegues. They are the only doctors in the world with the knowledge to help him.
How despicable that Dr Wakefield stands on trial for trying to identify the stomach and bowel disease that we beieve was triggered by the vaccine.
James is nine and, like his sister, Alex, is a joy. I'm humbled by his sunny nature and determination.He's a talented artist and enjoys writing magazines and stories.
At 19 months, he had a terrible reaction to the MMR jab. His leg swelled and he slept fitfully with fevers for days. He developed a raging thirst and temperatures.
Ten days after the jab he developed a measles-like rash and was very ill. Within weeks, he lost all eye contact, descended into full-blown autism and lost all skills and language.
He also developed severe bowel problems, would scream for hours and lost all desire to communicate. It was a nightmare for all of us.
By researching on the internet, we've brought him back from severe autism to a child who still has difficulties but not as you'd know, apart from a speech delay and being a slow learner at school.
He still has horrendous bowel and stomach pain, can't digest food and has allergies.
How has the Government managed to get away with removing thiomerosol (the mercury preservative) from DTP vaccinations? We believe the three shots of mercury our son received in the triple DTP as a baby affected his developing immune system so much that when he had the MMR, it was in no fit state to mount an effective response.
Sue Lawson, Bedale, North Yorks.
Posted by JABS
Posted - 07/31/2007 : 16:59:15
On the 16th July 2007 Professor Simon Murch, Professor John Walker-Smith and Dr. Andrew Wakefield began a 16 week hearing into allegations of professional misconduct. The initial allegations were made not by any patient but by an investigative ‘journalist’. On Monday, the first day of the hearing, the autism community worldwide showed its support of the doctors. Those who could make the journey gathered in front to of the GMC Building in London. The many thousands of children who could not be there on the day were represented by a floral display comprising flowers from petitioners all over the world. Check the cryshame.com site for more information and pictures about the GMC Rally...
CryShame and others– including JABS, Treating Autism and the Autism Treatment Trust - joined in showing support for these courageous men who did nothing more than put our children before the interests of global pharmaceutical profit. The GMC hearing is providing the world's press with a window on the world of deceit that underlies a catastrophic global increase in rates of autism spectrum disorders.
The Hearing Opens
By Martin J Walker
Inside the Hearing: Dr Wakefield, Professor Walker-Smith and Professor Simon Murch on Trial
Inevitably the atmosphere inside the building was quite different from that outside. Inside the glass shell, there was a feeling of being in an underwater bubble. Anyone entering was greeted by an almost entirely black security personnel, attractively dressed young women with fixed smiles and confident young men in casual dress. On the third floor, through two sets of glass doors past a lounge area and the doors to the rooms provided for the press, off a corridor on the right is the entrance to the hearing room. All attendees in the public gallery and members of the press are searched before entering the long room.
About 60 foot long and 40 feet wide, the room is flanked by glass panels down one of its long walls. The atmosphere is one of quiet efficiency. There are between 30 and 40 participants in the hearing. The defendants and the adjudicators sit facing each other, the doctors with their legal teams are down the left hand side and the panel and GMC clerks down the right hand side.
It is difficult to imagine that this long mainly white room, with an oblong of tables in its centre, will be the daily place of work for the three doctor defendants in this case. For the next three months these highly trained doctors will have to defend many of the professional decisions which they have made over the last decade. Things that ‘just happened’ and that carried no particular importance at the time could now, in the light of this room, spell the end to their medical careers.
The room is not really like a court room, there is no central point of authority, although the principal prosecutor for the GMC, Miss Smith, sits at one end of the rectangular tables, she is not sitting higher than anyone else and is sometimes hardly noticeable amidst the books, boxes and reading rests that surround her. Nor are the ‘accused’ sitting together in a dock of any kind but dispersed amongst their lawyers.
Almost everyone in the room, outside the public area, is wearing black, its deadness only interrupted by the silver hair and white shirts of the men and on some women brief touches of ochre or translucent white of arms and legs. There is a round and almost classic clock on the wall at the far end of the room, on its face time passes very slowly.
The first days of any juridical hearings, whether they be at the Old Bailey or the General Medical Council (GMC) are always the worst for defendants. It is in these first days that the complainants or the prosecutors make their case, and knowing that they have a free hand in tarring the accused, prosecutors always over-egg the pudding.
Consequently, defendants find themselves powerlessly listening to an endless litany of their dishonesties and their dishonest nature. Amongst many unfairnesses introduced into the judicial process by the GMC on this first day, was an evidently unrestricted number of charges – Wakefield was faced with some 40 heads each broken down into two or three separate accusations, while Professor Walker-Smith and Professor Simon Murch faced counts in their twenties and thirties. Anyone who has ever had any experience of juries or tribunals knows full well that with so many charges the the adjudicators are inevitably faced with a quandary. As the mud is thrown at the wall some will inevitably stick. ‘Well’, they will say ‘We have found for the defendant on some of the charges, we have to find against them on some’.
Dr Andrew Wakefield, Professor Simon Murch and Professor Walker-Smith, the three accused, faced a formidable number of charges. In fact, they faced so many charges that one might imagine that the GMC had purposely covered every bit of green beige on the roulette table to ensure a victory, if not on the red or the black, then at least on number 38, para 1 (i) small a.
All three defendants, listened throughout the whole of Monday to a reading of the accusations first from the GMC and then from defence council and finally again, ‘just checking’ from the panel chairman. Like demonstrating a Chinese water torture, it would seem impossible for any member of the panel not to have been hypnotised into believing that the defendants were definitely guilty in triplicate. This strategy is perhaps equal in unfairness to the bizarre three year delay in formulating the charges; a delay that would probably not be tolerated in most third world regimes or still surviving Stalinist enclaves.
Of course, in a fairer system, the admissions and mutual agreements over some parts of the charges; those factual aspects which hold no legal or ethical value judgements, would all have been sorted out well away from the panel or the public, at a much earlier time.
Lawyers, however, enjoy this kind of legal accountancy, perhaps more than actually fighting cases or defending their clients. The hearing room echoed with bold legal statements such as:
18 (i), little 3 and little 5, is admitted as is 18 small k.
Each barrister seemed to revel in this soliloquy of small letters and numbers. And of course such terminally boring speeches, gave opportunity for the pearls of legal language to be dredged up from the deep.
‘Yes’ one barrister said to the Panel chair, ‘Sir, you are right and I am wrong’.
Brian Deer also faced his persecutors inside the building. During the morning break, two parents objected to sitting in the same public gallery space and indeed breathing the same air as him. There was nothing that the GMC could do about the air problem but ever eager to show fairness, security personnel roped off the section of the public gallery which contained Deer and the other embedded journalists.
Then at a break in the afternoon a security guard, checking under seats with the ‘wand’, thought he had found a bug under the seat next to that used by Deer. It turned out to be a fault in the machine and no device was found.
The sense of utter tedium, however, masks a very serious operation which is intent on stopping Dr Andrew Wakefield from ever again acting as a doctor in England and perhaps more exactly ensuring that he never appears as an expert witness in any cases of vaccine damaged children.
Posted - 08/08/2007 : 15:57:04
The Hearing Trundles On
17 to 20 July and 23 to 26 July
Martin J Walker
Legal cases, whether they be seen from the perspective of the prosecuting or defending counsel, are dependant upon narrative; the telling of a story. Unfortunately for Miss Smith, the GMC have provided her with an already threadbare narrative which because it is all she has, she proceeds to bang on about as if it were the dead parrot in the famous Monty Python sketch. Watching Miss Smith try to construct a believable story out of her information is heartbreaking for anyone who enjoys the legal process.
But what is even the best lawyer to do without a story? You could hum and haw your way through the whole production - making it up on the hoof so to speak - or you could take the strategy for which Miss Smith has opted.
This strategy involves hurling chunks of disconnected information at the defence in the hope that at the end of the hearing some damage will have resulted. Because her case contains few specifics and very little fact, each plank of Miss Smith’s prosecution is shaped in global terms.
In hearings of this kind, the nature of the defence is inevitably structured by the prosecution. So while it is clearly Miss Smith’s intention to filibuster her way through the case, the defence has to respond with a careful, exact and specifically detailed revision of the local facts. Because the prosecution is based on partial information and a threadbare story, the defence has to bring to light the facts which make the story whole.
They have done this with great dexterity in the first two weeks of the hearing. Defence counsel’s cross examination of the prosecution witnesses brought so far has been exemplary. They proceed quietly and with an erudite commitment to prizing out the truth. What is really exciting to watch is the way that defence counsel shape and place the bricks of their case with such smoothness that even the most professional of witnesses are unlikely to see the denouement.
Most of my experience of law is with criminal cases, where one is rarely dealing with complex arguments. The defendant knows not to say that he carried out the crime while the police have spent hours in the canteen checking their notes to ensure consensus about exactly what time the defendant went for a pee the day before the robbery. In the GMC case, however, the arguments are subtle and the whole craft of cross examination might be observed at its most intricate.
The Prosecution Case
On Tuesday 17 July, after a morning to discuss legal issues, particularly that of the confidential nature of children’s medical records, Miss Smith spent the afternoon giving a broad description of the prosecution case. She began with the words:
‘It boils down to simple allegations against a research project to do with a new syndrome’.
If other members of the public and the press were thinking that this broad description under a number of heads was the opening of the prosecution case, to be followed by witnesses, they were to be sadly disappointed.
On that Tuesday afternoon and for all day on Wednesday, Miss Smith presented almost every detail of the prosecution case. This presentation inevitably made one wonder why the GMC were bothering to call witnesses to the hearing, as Miss Smith appeared to have given much of the evidence herself.
At one point on Wednesday afternoon, during an analysis of the route by which the children were introduced to what the prosecution call ‘the research’, a problem associated with this style of presentation obviously occurred to the leading defence council. He stood, to ask why Miss Smith, while appearing to introduce the whole case in detail, had missed out large chunks of the narrative that did not support their case.
The idea of the defence asking the prosecution to include defence material in their opening remarks left me momentarily bewildered. And in fact Miss Smith slid easily from beneath the guillotine, explaining that it was not up to her to introduce facts which helped the defence case. The defence, she said, would have ample opportunity to bring these matters to the attention of the panel, during cross examination or during the presentation of the defence case.
When, defence council must have been thinking, would it be possible to correct this view that children had arrived at the ‘research’ in an unorthodox and unethical manner. If each child’s circumstances was not to be specifically presented as evidence, how was the defence to give a detailed map of each child’s route to the research?
In fact, although each child’s route to the Lancet case series is vital to the prosecution case, the children and parents have been left out of the hearing, obviously because they are all sympathetic to the defendants and furious about their prosecution. It is rather as if in a case of serious assault at the Old Bailey, the prosecution fail to bring the victim to give evidence because he insists that he was never assaulted.
When viewed from the perspective of the parents and children, the GMC hearing brings up other serious questions besides such things as research regulation and the power of pharmaceutical lobby groups. The hearing throws into our vision, the whole question of the individual’s right to choose medical interventions and the doctor and research workers’ right of freedom to prescribe and research in areas where policy is guided by corporations or governments.
The Case for the Prosecution
The prosecution has broken down the case against the three doctors under a number of heads, these are.
The Children: By presenting the GP’s of each child whose case was reported in the Lancet paper, the prosecution hope to show that Dr Wakefield, Professor Walker-Smith and Professor Simon Murch touted for children whom they had no intention of assessing, or treating, but to whom they wanted access for the sole purpose of research. The prosecution case is also that some of the children did not meet the criteria for ‘the study’; that some children did not present with symptoms which made them part of what the prosecution insist on calling the ‘disintegrative disorder’ group and that the defendants carried out unjustified, invasive, frightening and risky procedures on the children.
Ethical matters: The prosecution will try to show that from the beginning of the application to the ethical committee, Wakefield and others confused, if not lied about, their intentions. That after approval with reservations, the doctors went their own way. They will try to show that, amongst other things, the doctors broke ethical guidelines by enrolling children in research outside the time frame of the ethical approval; confused the GP’s about how the ‘research’ was being funded and failed to include details of ‘research’ procedures in the patients’ notes.
The Lancet paper: Under this head, the prosecution will try to show that Wakefield and others completely misled the editor of the journal, especially in that they were well aware of the serious nature of their conclusions and the damage which it might do to the nation’s public health. Part of the case against the paper is that Wakefield had failed to make a declaration of conflicting interests.
The Birthday Party: As the prosecution made the case, the taking of blood at a children’s party and the ‘inducement’ of £5 to each child was made far worse a crime after Wakefield told a story about it during a lecture in America. This telling of a humorous story was considered, ‘so inappropriate as to bring the medical profession into disrepute’. Of course, considering that the anecdote has always been the mainstay of both the medical and the legal profession, this is a culturally, if not legally, astounding position.
The actual case for the prosecution
Miss Smith went through the background to each of the children reported in the 1998 Lancet paper. She did her best to distance the children from any perceived vaccine-related event. She failed to mention that hundreds of other children had undergone the same procedures for clinically indicated reasons. She also failed radically to introduce the parents into the story. Had she done this, it would have become clear that, at the time and to this day, the parents were more than happy to have someone take an interest in their child’s illness and to share with them the terrible ordeal of having a damaged child without any real hope being held out to them.
The prosecution reported the cases of these children in the context of a health care system which is without fault. A health care system in which GP’s, for instance, always give parents the right advice and quickly reach correct diagnostic conclusions. In fact the reality is almost the opposite. All the GP’s who gave evidence followed the advice of parents that they wanted their children referred to the Royal Free specifically because no one else was able to offer a diagnosis.
The prosecution called a majority of the GP’s who initially dealt with the children whose cases were reported in the Lancet paper. There was some reluctance amongst a number of them to appear. This was summed up by one GP who responded acerbically to one question: ‘I have been drawn into something which is bigger than me and I would rather be back at my practice seeing patients’.
The clearest impression garnered while the GP’s were giving evidence is that the prosecution is doing everything they can to avoid bringing the children, the plight of the parents, vaccination or MMR into court.
As Miss Smith took the hearing through each of these cases, the children and their illnesses were all carefully distanced from their vaccinations or the possible adverse effect of these. Equally, the parents were very cleverly painted out of the picture, so that to all intents and purposes it appeared that they had been put into a terrible dilemma by a rogue doctor wanting to experiment on their children.
Just so that I could clear my mind on this matter, I asked one of the parents – of a child who was not actually included in the case series – whether she and her husband had been disturbed by the offer of tests given by the Royal Free team. ‘I think that my boy would have died if he hadn’t had the tests which were proposed’. ‘It was the logical step to take, we had absolutely no doubt at all about the tests’. She thought for a moment: ‘ I don’t know any parent who had any doubts about the tests’.
Listening to Miss Smith, one lost count of the number of times she said, ‘Neither the GP nor the Consultant mentioned that there were any gastrointestinal problems in this case’. To which one is bound to answer, ‘Well they wouldn’t would they, this is the reason they ended up with Dr Wakefield, who outlined a NEW syndrome’. This of course is the nature of serious scientific research, that medical research workers find solutions by looking at a numbers of cases, where GP’s remain confused by the experience of individual cases.
I have always thought that it would be the parents who will win this case and for that matter the campaign. From the beginning the ‘lobbyists’ have sent out a clear message that Wakefield is on his own; a ‘lone maverick’. Only the parents could save him from this description, by coming forward for the case and the campaign and making it clear that he has their full support.
However, when it comes to working with children and parents, lawyers have an approach similar to that which WC Fields had towards children and animals. They seem to be considered by lawyers as loose cannons. It is for this reason almost entirely that the real story will not come out of this hearing. What the hearing has done is refocus the matter entirely on Dr Wakefield, and to a smaller extent the other doctors, at the expense of the parents and children. It puts all the power into the hands of doctors at various levels of authority and takes away from the parents their experiential evidence of their children’s damage. In this, the defence is playing a similar game to the prosecution. Neither team wants the hearings to leak out beyond the professional domain and into the public.
Dr Pegg the Anaesthetist
On Tuesday July 25 Miss Smith began to address one of the main planks of the prosecution case; Dr Andrew Wakefield’s alleged failure to abide by ethical rules governing the practice of research. A lawyer with a good story might have started by leading the first witness through their evidence in chief, asking them to describe the role of ethics committees before moving on to tired old lines such as,
‘Was there a time in 1996 when Dr Andrew Wakefield approached the Royal Free ethical committee with a research project.’
If the answer is ‘yes’ then the project can be investigated.
Aware of her lack of story, Miss Smith began by reading what seemed like every pertinent document, word for word, which addresses ethics and research on human subjects. Having dealt with the historical and global, little of which had anything at all to do with anyone in the hearing, she then moved directly to the witness.
When, however, she asked Dr Pegg, Consultant Anaesthetist at he RFH and Chair of the hospital’s Ethics Committee, to agree the history of ethics in the developed world since the second world war, Dr Pegg immediately responded, ‘Yes but you have missed out the most important reference, The Declaration of Helsinki’. Miss Smith immediately hunkered down to read this document word for word as well.
Personally, I felt that Miss Smith missed a good opportunity when she failed to read out the Nuremburg Codes, which would quickly have tarred Dr Wakefield and his co-defendants as Nazi’s as well as mavericks.
In leading Pegg through his evidence-in-chief, Miss Smith kept her creature on a very short leash. But because she had hopelessly overcrowded the evidence with irrelevant detail, the shape of her narrative was lost, certainly on me and perhaps on the panel. Prosecuting with a witness such as Pegg, one needs to coax from him clear and simple ways in which the defendants had acted unethically. But Pegg was almost apologetic, and like the GP’s, of course, keen to watch his own back;
‘Don’t forget, these were the guidelines which we used 11 years ago’ and
‘Yes that was probably my secretary (referring to a wrongly dated letter) she was overworked’.
Oddly enough, Pegg, who clearly came across as having something simple to say about the defendants ignoring ethical guidelines, found himself guided by Miss Smith into byways of obfuscation. That, and the fact that in this complex case pages in evidence folders appeared frequently to rearrange themselves, provoking endless speculation about page numbering, inevitably drew attention to the weakness of the prosecution case.
When Pegg had been led through his evidence in chief, it looked as if the prosecution might have dug up a couple of sharp points about the doctors’ behaviour. Had the defendants not, for example, enrolled children in the ‘research’, before the start date granted by the ethics committee? Had they continued to give lumber punctures in some cases even though the ethics committee had warned them against this.
However, when Mr Miller rose to cross examine, holding a sheaf of papers which turned out to be letters, sequentially important in the actions of the RFH group, even these issues were well on the way to being resolved. When Miss Smith said with muted complaint,
‘I just want to make clear to the panel that we have not seen these letters’,
one was tempted to ask ‘Why not?’ was she saying that after three years of assembling the prosecution case, she had based her case on an incomplete exchange that had gone on between the defendants and the ethics committee?
Three quarters through the cross examination of Dr Pegg, the whole matter of documentation became even murkier. Looking for the rest of any exchange which might help his client Mr Miller asked Pegg:
‘Do you have any ethics committee records at the Royal Free?’
‘No there is no paper work. Everything is shredded after three years’.
The matter appeared to have been dropped but then an hour later, Miller approached it again.
‘You have no record of these letters?’
‘No we have no record, everything is shredded after three years’.
‘That seems a very short time to keep records’.
‘No everything has been digitised, after it has been digitised all the paper records are shredded’.
When Miller appeared surprised at the deception that had apparently been practiced on the defence. Pegg added scathingly.
‘If you want something, you can go and search through all the discs if you want’.
This in a tone of voice which suggested that what he meant by their being no records had been clear all along.
This was, amongst other of Pegg’s acerbic asides, an indication of his general attitude to the defence. Throughout his cross examination, his manner was unhelpful and truculent. At one point having answered a string of carefully framed questions from Mr Miller, with breath short stunted ‘yeses’, he answered the final one with:
‘Well I’ve answered all the others with yes, I might as well answer this with Yes as well’.
In a proper court, like so much else, this childishness would have earned Dr Pegg a rebuke, if not a warning, but in the court of Miss Smith, Dr Pegg, a creature of the prosecution was allowed to bring the tribunal into disrepute. Nor was Dr Pegg able to stop himself from openly insulting Mr Miller, suggesting in a hardly veiled manner that he was ‘stupid’ and perhaps illiterate.
The evidence of Dr Pegg must have left a bad taste in the mouths of many people in the hearing room. It was evidence which only the defence barristers walked away from with some kind of honour. Watching Miller, Koonan and Hopkins hold their tempers while revealing Pegg’s bolshi nature to the panel was an object lesson in how to cross examine a difficult and rude witness.
Just as the prosecution had, at the end of the day, been utterly unable to depend upon the general practitioner witnesses to state clearly that Dr Wakefield and his colleagues had trawled the country for children to experiment upon and then had failed to treat these children, so Dr Pegg failed to aid the prosecution in simplifying how Wakefield had broken the guidelines of the ethical committee.
The prosecution needed Dr Pegg to be able to make simple and obvious statements about how Dr Wakefield had acted unethically. However, because like the GP’s, Pegg also had to watch his own back, he seemed unable to accuse Wakefield in a straightforward manner.
Did Dr Wakefield or any member of his team write back and discuss the changes that the EC had asked for? Pegg wasn’t sure and had no records.
Was it just Dr Wakefield involved in this project? Pegg couldn’t really remember who was involved. When the signatures of around ten clinicians and technicians on the submitted forms were brought to his attention he seemed surprised.
But by far the biggest failure of Dr Pegg’s evidence came when he was asked about the requirement for applicants to declare sources of finance. He had to admit that, because of the routine way in which all funding had been handled by the RFH trustees, there was no requirement for a declaration of original sources of finance on Dr Wakefield’s (or anyone’s) part when completing the relevant ethics form. Given that such specific information about financial sources was not required in the financial section, it was unclear where one might make mention of it. The best Dr Pegg could do was to suggest that Dr Wakefield might at least have declared legal aid funding under ‘objectives of the study’, which seems rather odd to say the least.
The defence was clearly preparing the path for the argument which will inevitably take place around the authors’ failure to state any conflict of interest relating to the Lancet paper. On this matter Pegg was immensely helpful to the defence claiming that such matters were ‘…not even on the radar in 1996.’
A second key matter on which the defence was eager for commitment from Dr Pegg was whether a ‘case study’ - that is a clinical report of one or more similar cases – did or did not need ethical committee approval. On this matter, Pegg was hardly helpful to anyone. If the doctor concerned knew from the beginning of a case that he was going to write it up, then he needed ethical approval. If he did not initially intend writing up the case but did anyway, then he didn’t. This was a ridiculous explanation and one suspects it was made up on the hoof. What he probably meant to say, was that if individual children were examined for the sake of a scientific study then the doctor concerned needed ethical committee approval. If, however, all the children were seen on the basis of clinical need and at some point a number of the cases were written up, no ethical committee approval was needed.
On the evidence so far, after almost two weeks of the hearing, the defendants appear to be in very good shape. However, it will not be clear up until the last breath of the hearing what value the panel members will place on the evidence. With a case such as this, which has been in the public domain for over three years and which panel members have probably read about extensively, it would seem almost impossible that they do not have pre- conceived notions about the three defendants.
Transcripts were freely available through week one, when allegations were being read out without rebuttal. After cross examination began it was decided not to make them available any more.
* * *
GUS THE FUSS
Posted - 08/09/2007 : 17:38:12
| Not forgetting George Reid labour health minister, who instigated the enquiry at the request of Blair who still hasnt vaccintated Leo ..
Posted - 08/09/2007 : 23:51:28
| He hasn't vaccinated Leo at all? Not even singles?
GUS THE FUSS
Posted - 08/10/2007 : 13:32:24
| No nothing ...but its all right for the masses..
Dr Wakefield's 'crime' was to open an important debate that remains
unresolved. Eight years on, he is by no means alone among doctors in
believing that he may have been on to something. The trouble is we just
Even Tony Blair, though publicly committed to the triple vaccine, seems to
have private doubts. What else would explain why he has refused to tell MPs
if his son Leo has been given it?
After all, he has never been above dragging his family into the spotlight,
when it suits his political purposes.
Posted - 08/13/2007 : 17:54:38
| At Last I have got around to posting a letter of support of Dr Wakefield, Murch and Walker Smith to Claire Henesy
Dear Claire Henesy
I am writing to you because I feel it is important that you should know that I am in no doubt as to my support of Dr Wakefield, Professor Murch and Professor Walker-Smith. My name is Joan Campbell and my husband and I attended the first day of the GMC hearing of the three doctors listed above.
I have had the pleasure of communicating and meeting Dr Wakefield and Dr Murch as he was known then back at Dr Murch’s clinic at the Royal Free Hospital from the year 2001-2003.
I can not stress how disappointed I was at the allegations of Dr Wakefield, Professor Murch and Professor Walker-Smith at the first day of trial as they are innocent and my son was treated with the utmost respect when he attended Dr Murch’s clinic.
I object to the false allegations made by Brian Deer and I have enclosed a letter I wrote to Dr Wakefield back in 2000 plus a statement I have read out in court to Justice Keith at the Royal Courts of Justice in 2004 regarding my son’s vaccine damage. Sadly to say because of legal aid being withdrawn I have had to discontinue my claim against Merck and Co Inc.
I was lucky to become a part of the MMR10 because one of the parents Jennifer Horne-Roberts who is a barrister is one of the 9 families who formed the MMR10, she took our case to the European Court of Human Rights last year. I have enclosed a statement that was lodged at the ECHR.
I am hoping you can find the time to read my son’s story and how Dr Wakefield has helped my son when no one else could be bothered.
I would be grateful if you could please acknowledge my letter.
Posted - 08/13/2007 : 19:17:08
Prosecuting For The Defence
Written by Martin J Walker
The GMC Hearing July 30th to August 6th
Despite having chosen to sit directly beneath the air conditioning vents in the hearing room, I occasionally nod off. On Wednesday of last week I had a very disconcerting experience, I nodded off during the evidence of Dr Berelowitz, a psychiatrist who was one of the co-authors of the Lancet paper and who acted at that time as a psychiatric-paediatric liaison worker.
I must have only dozed for a moment but it was long enough for me to become caught up in a disturbing dream which I now can’t remember. I can, however, remember just before I woke, my head was full of the sound of stampeding people, running and shouting as if they were trying to escape a natural disaster. I could see the front runners as they scrambled over everything in their path, amongst them I recognised Dr Berelowitz and realised that the deserting crowd were mainly witnesses fighting to get out through the door of the GMC hearing room. Behind them was Andrew Wakefield sitting completely alone apart from some vague ghosts of friends and his defence counsel.
I woke with a start and tuned back in to Berelowitz’s evidence. He was saying that he had been happy to be a part of the research which led to the Lancet paper. He was happy with the ethical position of the research team, yes, he was also happy with the investigative tests which were carried out on the children. As far as he was concerned such tests were common in the diagnosis of bowel disorders.
However, Berelowitz went on, he had been upset and disconcerted about what had happened at the press conference. As far as he was concerned, the Lancet paper should naturally have called an end to the rather spurious tenet of the research into any link between MMR and autism. The paper clearly stated that no link had been proven and Berelowitz, for some reason apparent only to himself, had taken this to mean that no link could ever be proven. On the basis of this fundamental and rather startling misunderstanding he had expected any future research to take a completely new direction. This, naturally, had proved not to be the case and Dr Berelowitz seemed unsure of who was to blame. Was it the media? Was it Andrew Wakefield?
He suggested that his relationship with Wakefield, and his association with the research, had utterly collapsed after the press conference. Berelowitz recounted the story of how a journalist friend, present at the press conference, had got up to interview Wakefield, who had just opined that perhaps use of the triple injection should be suspended until research definitively answered the question of a link between MMR and regressive autism. Berelowitz had apparently said to his friend, 'The story is here in the paper, it shows that there is no connection between MMR and autism', his friend had answered, 'No, the story is over there with Wakefield'.
So, as far as Berelowitz was concerned, he had opted out of the research either because Wakefield was intent on pursuing the MMR theory or because the media seemed determined to pursue it. Both these reasons gave Berelowitz a way out, a way of setting himself free from his association with Wakefield and his 'crimes'.
Dr Berelowitz would, he said, have nothing to do with Wakefield after the press conference. So vehement was he on this matter, that it occurred to me for a second that he was going to say that Wakefield had forged his signature on the protocol form for subsequent research in which he had clearly been involved. In the event, however, Berelowitz claimed that he was tentatively involved in the research in name only and after a time had not gone through with any involvement. His parting shot on this matter was the simple logic that Paul Shattock was involved in the research and he, Dr Berelovitz would never be involved in anything in which Shattock was involved because his research methodology had been found wanting.
In many ways Dr Berolovitz was hoist by the same petard as all the other prosecution witnesses. He had willingly taken part in the research for a period of time, and he, as those before him, now had to somehow cast that involvement in an innocent light, while appearing happy to endorse the prosecution against Wakefield.
This situation is perhaps the worst in which any prosecutor could find themselves, calling upon a gaggle of reluctant witnesses who should, if the defendants are in fact guilty, all be with them in the dock. This predicament further accounts for the manner in which Miss Smith and Owain Thomas, the prosecutors, often appear to all intents and purposes to be presenting the case for the defence when leading their witnesses through their evidence-in-chief.
Take the matter of Dr Berelowitz and lumbar punctures. The GMC prosecution have presented these as highly invasive, risky procedures which should on no account be used on children; they were portrayed as arcane and evil experimental methods. But how could Dr Berelowitz agree with the prosecution on this matter? If he did, he too would surely be admitting guilty involvement. So, on this, as on a number of other matters, Berelowitz, witness for the prosecution, essentially gave evidence for the defence.
He had, he told the hearing, done his own research into lumbar punctures and children, just to assure himself that he was not involved in anything unethical. His quick perusal of the literature had led him to believe that lumbar punctures were commonly used in a whole series of clinical situations involving children and were used in research by some of the most authoritative institutions in Britain and America.
Dr Berelowitz had to make a similar defence on the issue of ethical approval, another of the main planks of the prosecution case. On this he maintained very clearly, as others have done before him, and as others will no doubt do after him, that the writing up of a case-series does not require ethical approval.
It has been apparent from the first day of the hearings that the prosecution is leaking like a stricken boat trying to get to harbour in a storm. Not only has Miss Smith presented portions of the defence case, but the GMC is having to depend upon, in the main, entirely reluctant witnesses who are busy watching their own backs.
The last week has been a week of extremes. It began with the pleasant and clear minded evidence of Mrs Cowie, a solicitor who worked for what was at the time the Legal Aid Board (LAB). Richard Barr, the solicitor who by 1994 had been approached by a number of parents of potentially vaccine damaged children, had applied to the LAB for money to fund research which might, or equally might not, turn out to be of use to these claimants.
That this money had apparently been used by Dr Wakefield for his research and then not declared in his Lancet paper was a main plank of the prosecution evidence. Cowie was a generous witness who seemed completely in control of her independent position. Under cross examination she was happy to tell the panel that the money which had originally been sent to Dawbarns Solicitors, had later been paid to the Royal Free Hospital’s School of Medicine.
Instead of insisting, as the prosecution might have wanted her to, that the money was ring-fenced for an exact and explicit purpose, she informed Mr Koonan, counsel for Dr Wakefield, that the money was intended for generic work in the area. The money and the research were, she said, 'like a melting pot', it was to cover 'what was going on', and could happily be moved from one head, or research project, to another.
The Last Two GPs
During the week, two more GPs of the anonymous children written up in the Lancet paper, were called. Although admittedly, calling the GP’s was better for the prosecution than calling the parents, on the whole the prosecution gained next to nothing from bringing them to court.
Both GPs gave evidence and were cross examined on the matter of their having let the patients out of their grasp and, as it were, allowing them to be self-referred by their mothers to the Royal Free. Both GPs were of a similar mind; that the cases were complex and their symptoms presented a condition with which they were by no means familiar. This inadvertent lack of knowledge had led to a series of referrals in both cases, which might be considered in hindsight to have been ‘casting around’ for a solution.
Both GPs refused to fall in line behind the prosecution supposition that in referring the children to the Royal Free the doctors had given up their patients to the devil. Both declared with ringing common sense that they had done what was best for their patients and their parents. What is more, both felt that their actions had been thoroughly vindicated when they received the discharge summary from the Royal Free and when later it became apparent that the two patients had been offered a believable diagnosis and treatment which had in differing degrees helped their condition.
The second of the GPs was an ebullient man who despite being called for the prosecution, determinedly spoke for the defence. His evidence was packed with common sense and a humble acceptance that there were people in the profession who might know more than he did.
At one point during his cross examination this doctor put succinctly into words the thoughts that had been on the minds of most of the other doctors. Explaining that he had reached a stage where he was not concerned about the child attending the Royal Free or being subjected to investigations he said; 'I was pleased that the child was being dealt with and was glad that the mother was behind the referrals. Anything was worth a try'.
By the time that this GP appeared at the end of the week, it was apparent that the prosecution had slightly changed direction. Whereas the previous group of GPs had all been tarred with the brush of sending child patients on an illegitimate caravan to be experimented upon by Dr Wakefield, the two later doctors were charged with having helped Wakefield with his obviously nonsensical research. Research which claimed that MMR caused autism.
In fact it didn’t matter, because all the GPs appeared worthy, conscientious and sensible in the face of the rather haphazard prosecution. Apart from one unfortunate remark by a doctor who suggested a patient’s mother was searching too hard for a cause and a viable treatment, when she should perhaps learn to live with her son’s condition, most of the GPs gave credence to the parent’s feelings.
The fact that these worthy doctors had been brought to London in order to give evidence against three other doctors and, in a sense, against their patients and their parents made one wonder at the GMC's political turpitude.
In an odd way, the presentation of evidence by all the GPs gave one new faith in the average doctor. All seemed unaffected by the ideological blandishments of the Department of Health and unwilling to carelessly throw in their lot with their own regulatory body. They were independent and happy to admit that they had acted in the interests of the patient and the patient’s family. All of them expressed their empathy for the terrible circumstances which had befallen the parents and in comparison with the apparently unfeeling approaches of Miss Smith and Owain Thomas, they came across as intellectually engaging and sympathetic to both the parents and the children.
The end of facts
It might almost be true to suggest that the facts of the case against Wakefield, Walker-Smith and Murch have, with the general practitioners and the expert on ethics, almost been exhausted and what we might expect from this point onwards are ideologically versed witnesses.
On Thursday August 2nd, a Dr Kirrage gave evidence and one was forced to wonder yet again about the sense of the prosecutors bringing forward lower tier apparatchik’s to make their case. Kirrage came to the GMC hearing from that very heart of darkness, perfidy and spin which is the contemporary Health Protection Agency. In 1997 he had been a consultant working for Worcestershire Health Authority, it was his job to assess Extra Contractual Referrals (ECR) from Worcestershire Health Authority to others which provide specialised services.
A mother had approached her Consultant Paediatrician, with her son’s case. The consultant appears to have taken a jaundiced view of both the mother and the child. Despite having no real idea himself of how a diagnosis might be reached, he had bridled at the suggestion that the child be referred to the Royal Free, saying that he could not see how the child might benefit.
To get support for this decision, based upon ignorance, he communicated the details of the case to Dr Kirrage. Kirrage in turn had immediately sought advice from a friend in high places, Dr Elizabeth Miller. Miller had told him that Andrew Wakefield’s theories and research were now discredited and that there was no link between MMR and autism. In her opinion it was best not to refer the child to the Royal Free.
Using a pro-vaccine propaganda leaflet sent him by Miller, that he copied into an apparently personal letter, Kirrage wrote back to his consultant friend. He suggested that the consultant send a copy of this letter to the parents, at the same time informing the child’s mother he could not see that either the child or the family would gain anything from travelling to the Royal Free in London.
What made this apparently ideologically motivated decision even more hurtful was the fact that neither the consultant nor Kirrage appeared to have the faintest notion of how they might get a proper diagnosis or specialised treatment for the child in their own Health Authority area. They were, as the mother wrote in a heart wringing letter to the consultant, dooming her son to incarceration in an institution where he would be drugged to keep him manageable.
By the end of the hearing’s third week, most of those parents, and others associated with the Wakefield camp, had a more or less clear picture of the pressure which had been brought to bear on Dr Wakefield as he began treatment of the cases which were to be reported in the Lancet paper published in February 1998.
If anyone wanted confirmation of the very personal feud which had begun against Dr Wakefield inside the Royal Free medical school, they need have looked no further than the evidence of Professor Zuckerman, who had at that time been the Dean of the school. The strategy in bringing forth Professor Zuckerman was resoundingly clear from the start of his evidence.
Professor Zuckerman was a wholehearted supporter of vaccination and immunisations. He was an advisor to the World Health Organisation, he had been an adviser over many years to the Department of Health and was a contributor to over 1,000 journal papers and articles. He had experience in epidemiology and in the safety and development of vaccines.
Professor Zuckerman did not stop, throughout his evidence, making the point that while the whole world agreed with his views about the safety of MMR, only one person in the world, Dr Wakefield, offered the contrary view. Opinion is divided, one might say.
Professor Zuckerman’s evidence was threaded through with campaigning strategies aimed solely at Dr Wakefield. The first matter at issue was that Dr Wakefield had received money from the Legal Aid Board to carry out research. As far as Zuckerman was concerned this was funding from the devil given to further the argument that Hell was a pleasant place. It was funding which led straight into a conflict of interest, possible legal confrontation with the government and a public health debacle waiting to happen.
Professor Zuckerman made the point on a number of occasions that in 45 years, he had never come across funding for research which entailed 'lawyers directing the research'. He didn’t have to explain this in any depth and defence council never put to him the endless evidence that in much research into workplace illness, in for example, the chemical industry, not only is the funding supplied by associate industrial interests but the work is carried out in industry funded establishments with data provided entirely by the industry in question.
Professor Zuckerman was only getting warmed up with these arguments. Later as he got deeper into defence counsel’s cross examination his evidence seemed to have less and less to do with real academic issues and more to do with an implacable abhorrence that gripped him in relation to Dr Wakefield.
Professor Zuckerman returned again and again to what appeared to be his most central concern, that unproven research results of this kind could only damage public health and on these grounds entirely they must not be allowed publication. Anyone paying attention to Zuckerman’s arguments couldn’t fail to conclude that he would rail against any and all research which postulated adverse reactions to vaccination on the same grounds.
At the end of the first day when Zuckerman was still being led through his evidence-in-chief, a serious matter occurred which threw into contrast the different approaches of the defence and the prosecution.
Miss Smith was almost finished taking Professor Zuckerman through his evidence, when Dr Wakefield’s counsel rose. He told the panel that Miss Smith had allowed Professor Zuckerman to give evidence which was not in the statement which had been served on the defence. Sometimes, a witness might do this on a matter which is non-contentious and which the defence does not need warning of in order to conduct their cross examination. This particular matter, however, was particularly value laden – whether or not Dr Wakefield had refused to send his research to another independent laboratory to seek replication.
Clearly, if Dr Wakefield’s counsel was to cross examine on these new allegations, he would have to go through the matter in detail with his client. In the circumstances he asked simply that the days hearing be brought to an end (it was, anyway, almost over) and be resumed again tomorrow after he had taken the opportunity of talking the new evidence through with Dr Wakefield.
It is as if such professional and real demands push buttons for Miss Smith, for she responded as she had done previously; acerbically. She pantomimed the suggestion that Mr Koonan was always doing this, suggested that it wasn’t an important piece of evidence and accused him of time-wasting. If we were to keep going over the planned time, she said, we would never get the case finished. Mr Koonan argued that we were talking about a matter of justice and not a matter of administration.
Both the legal advisor to the Panel and the Panel Chairman came to Mr Koonan’s aid and told the hearing that Professor Zuckerman’s evidence would be continued in the morning. On his dismissal for the day, Zuckerman could not help but make a special plea on his own behalf, to the Panel. They had to realise he said, just how difficult and painful this situation was for him.
Professor Zuckerman finished his evidence the following day, during which time it became clear beyond any doubt at all that he was The First True Prosecution Witness. As Mr Koonan was later to suggest, he argued a case throughout his evidence, and the foundations of that case stood out like burning charcoal thrown into the snow.
Zuckerman clearly detested Wakefield. He poured sugary flattery on both Professor Murch and Professor Walker-Smith. Answering cross examination from Dr Wakefield’s counsel, he was completely defensive. Obviously feeling trapped and threatened, he was always on the brink of leaving his chair and the hearing.
However, much of what Zuckerman said made little sense. While he claimed to have been at odds with Wakefield from the start, he thought the Lancet paper was a very good piece of work. While he sought evidence from sources outside the University about Wakefield’s work he failed to discuss his doubts with Dr Wakefield himself. He continually quoted all the august bodies of which he was a part, yet failed to answer the simple question of what you might do if research did point out a serious public health problem with adverse reactions to vaccination. Zuckerman seemed to take it for granted that any reports of adverse reactions to vaccines could not be based on good science.
But the most intriguing question of all related to the press briefing shortly before the publication of the Lancet paper. Zuckerman had helped organise the ‘conference’ and he seemed happy to chair it. He had a preview of its structure and the questions it would address. However, when a journalist at the end of the briefing, asked what approach parents should now have to the MMR combination vaccine, Zuckerman directed the question to Dr Wakefield. This was despite the fact that he knew Wakefield to have had concerns about the polyvalent vaccine for many years. Despite the fact Zuckerman was at that time in receipt of a letter from Dr Wakefield in which it was explicitly stated that, if asked at the press briefing, Wakefield would make clear those concerns.
As soon as Dr Wakefield had made the statement which apparently ended his career at the Royal Free, suggesting that it might be better to suspend use of MMR until research had proved its safety or otherwise, Zuckerman re-directed the question to Professor Murch. Murch quickly expressed his complete support for the vaccine. Why, one might ask, had Zuckerman directed the question to Wakefield?
Although Zuckerman had begun the morning at 9.35 in a seemingly reconciliatory mood, by 10.00am he was showing all the truculence of the previous day. Instead of answering simply ‘no’ to questions with which he disagreed, his returns to Mr Koonan were always qualified; ‘certainly not’ and ‘absolutely not’ he kept repeating. This showed defensiveness beyond any provocation offered by the defence.
As time slipped by, Professor Zuckerman quickly found himself distractedly hissing and booing his answers. It soon got to the point where Mr Koonan had to put it to Zuckerman that far from giving objective evidence, he was ‘arguing a case’; not that the case he was arguing was rational.
Eventually, the two protagonists, as they had gradually become, drifted rudderless into a head on confrontation. Zuckerman began to rise to every question as if it were a personal insult. Mr Koonan closed in, forcing Zuckerman into a corner. By 10.15, Koonan had arrived again at the extra evidence about replication of research results which had been offered by Zuckerman on the previous Friday.
Slowly with steady articulation, Mr Koonan put it to Professor Zuckerman that he had alleged Dr Wakefield was implacably opposed to any attempts at replication of his work, although, in fact, replication did take place. 'It’s as simple as that', Mr Koonan blandly ended the statement. There were signs, then, that Zuckerman was about to lose it.
Koonan’s next set of questions dealt with the press briefing. He suggested to Professor Zuckerman that Zuckerman was not displeased to have the paper published by Dr Wakefield and other researchers from the Royal Free. That he thought the work reflected well on the medical school. He was even, Mr Koonan suggested, pleased to chair the briefing.
At this, Professor Zuckerman lost his footing and began to slide down the cliff face, his terse venomous responses coming almost automatically. 'I absolutely reject this. I absolutely reject this. I absolutely reject this' he said in triplicate at one point.
And then, as if caught up in a shouting match with a mortal enemy he began to interrupt Mr Koonan’s well phrased questions.
The Chairman asked Professor Zuckerman to let Mr Koonan finish his questions.
Zuckerman all but left his seat, saying that he would have to get his own legal adviser to sit with him, if this kind of questioning did not stop.
Miss Smith intervened to draw upon some secret set of rules, about cross examination. 'Mr Koonan is not entitled to phrase his questions as statements'. This was news to the Panel Chairman who said that he had heard both the prosecution and the defence ask questions in this way; using the words 'I put it to you that ...'
The panel broke-up at that time, perhaps in the hope that Professor Zuckerman would regain control of himself. Oddly, in all the following exchanges, the last questions from Mr Koonan and some very polite exchanges with counsel for Professor Walker-Smith and Professor Murch Zuckerman kept himself under perfect, even polite control.
At the end of Zuckerman’s evidence one was left with the impression that he had performed cleverly, expressing his personal detestation of Dr Wakefield, defending his professional interests and managing to avoid answering the most damaging exchanges with Mr Koonan by utilising a display of histrionics.
I have been interested to hear the Chairman of the panel refer to the proceedings on a number of occasions as an ‘enquiry’. By no stretch of the legal imagination could this be the case. The proceedings are adversarial and at their heart is a hard brought and fought prosecution.
The prosecuting authority is the General Medical Council, which is acting in concert with government public health policy and pharmaceutical company marketing strategies. The ultimate point of the prosecution is, from the prosecutor’s perspective, to defend the regulatory tenets of industrial scientific and medical research, isolate Dr Andrew Wakefield, and cast him out beyond the pale of informed medical opinion.
Were this an ‘enquiry’, an independent GMC would, from the beginning, have produced evidence of process, which would cast light on the motives of the sole complainant in the case, Brian Deer. Had it been an enquiry, many hours would have been spent recording the evidence of all the parents who had cajoled, fought and pushed their way to the Royal Free in order to get their children the best medical attention available in Britain.
This hearing is to all intents and purposes, a ‘trial’. As such, it is remarkable in contemporary society for not questioning, in any degree whatsoever, issues arising from the power of the pharmaceutical companies, their vested interests and their marketing strategies. The word ‘kangaroo’ became associated with the word ‘court’ presumably on account of that animal’s capacity to jump over great swathes of ground.
Posted - 08/15/2007 : 20:11:48
| I have heard this evening that the hearing is to be suspended for three weeks in September because witnesses cannot attend, and because it is not going to be possible to finish on time in October it will be further suspended and not resumed until spring 2008 (who knows on previous form whether it even will then?). There is a general feeling that so far the hearing has gone extremely well for Andy and the prosecution is in disarray.
Just to elaborate slightly, if the hearing had been going according to plan AW would be appearing presently at the witness desk. The new schedule entails stringing the prosecution case out till the end of the third week in October - 9 weeks hence - with the defence case not beginning till April. All this is very odd.
Another fascinating aspect is that after nearly five weeks - and this is not something I would usually complain of - we have barely heard a peep from Mr Brian Deer. It looks like he is finally lost for words.
Edited by - John Stone on 08/16/2007 22:59:15
Posted - 08/17/2007 : 19:37:31
| Tuesday 14th August GMC hearing
Here is an account of what happened today at the hearing...
By Olivia Hamlyn (daughter of Susan, sister of Francis)
I arrived at about 11.15am and so missed the prosecution cross-examining Dr Revell. He was the Head of Histopathology at the RFH at the time the Lancet paper came out etc.
Miller [defence counsel] was the main cross-examiner and most of his cross-examination as far as I could see was spent 1. establishing the relationship between Revell and his department and those carrying out the clinical work and research work and 2. The difference between clinical work and retrospective research work.
Revell made it clear that where investigations were taking place, i.e., here involving slides taken from colonoscopies, there was much discussion between clinicians and pathologists in weekly meetings. He didn't attend the meetings and therefore couldn't say what went on in them exactly, but their purpose was to reach a consensus about what had been found and about the care and treatment of patients and so that departments would be in communication with each other. These meetings were mainly in Dr Sue Davis' (later witness) hands. He made it clear though, in summary, that all processes used for the care etc. of patients were professional and contained nothing to raise concern.
Miller then established that should the interpretation of the slides change after later examination for research purposes, then treatment of the patient would not change. Furthermore, that in order to conduct retrospective research now, the patient's consent would be needed. This was a result of the Human Tissue Act (2004), which hadn't been around when this research was being carried out. Revell did regard it as a retrospective study, he said and added that Dr Davis and Dr Dillon did their own retrospective review of the same slides in order to verify the description in the article. He assumed this review was the same as that referred to in the Lancet paper.
In relation to the Lancet paper, he said that what had been found were interesting observations and would need a larger study.
In response to panel questions, he thought there had been nothing unusual about the biopsies except that one was for an autistic child. He had concerns about this so investigated as part of his job to check that the NHS was being used appropriately. He was obviously satisfied. It was unusual for a child with autism to be biopsied but then again, he wasn't a gastroenterologist. When pressed about the necessity for ethical approval he said in 1998 one wouldn't have necessarily needed ethical approval for writing retrospective case studies but couldn't remember when it changed.
Next up was Professor David Candy who is a paediatric gastroenterologist and was a peer-reviewer to the Lancet paper. Smith [prosecuting counsel] took him through the process by which one becomes peer-reviewer and the background to his being asked to peer-review the Lancet paper. Briefly, one can be nominated by the authors of the paper or chosen by the editor (there are probably other ways too). This was his first peer-review for the Lancet although he had experience doing it for other journals. He received two papers: the first one being the clinical paper (the one which was published) and the second one being a basic science paper (which was actually rejected) and a letter from John Bignall of the Lancet asking him for a swift review of both warning him of the implications of publishing these papers and requiring him to make sure the findings were absolutely watertight.
Several clear points came out in his cross-examination which can't have done the prosecution much good.
Firstly that he knew the papers would be excellent because he knew and admired Professor John Walker Smith. He needed to make no major amendments and would have been surprised if he had had to, he said. He said that the second paper especially led to his endorsement of the pair.
Secondly, the major criticism of the Lancet paper both in the editorial that accompanied it and from other sources was that there was a lack of virological evidence/virus infection to support/explain the claims made in it. He said, however, that the these criticisms would have been met if only the second scientific paper has been published too, along with the first paper. The first paper implicated the measles component of MMR because the authors knew what the second paper said, i.e. The presence of the measles protein in the gut had been identified. He also noted that it was puzzling that the editorial should contain such harsh criticism of a paper which had been accepted for publication!
Thirdly, he talked about the research techniques used to detect the measles virus such as PCR and these were techniques which he had faith in and had experience of. He gave both papers positive reviews and doesn't know why the second paper was rejected. He conceded however, that because the peer-review process was not transparent then and he didn't know who the other reviewers were, then it could have been negatively reviewed by someone with more expertise. But then again, we won't find out for sure why the second paper was rejected because the no one seems to know what happened... However, he made it clear that he was not happy that only the first paper was published without, as he put it, "the missing piece of the puzzle" and felt that it would have been better to publish nothing, rather than just the clinical paper. He described the two papers as "indivisible" and said that the observations in the first paper were strengthened and confirmed by the second paper. Koonan [defence counsel] suggested that the publication of the first paper without the second looked like an error and Candy replied that it had definitely been an error not to consult the peer-reviewers on this matter. He felt that if there had been a disagreement among the peer-reviewers then the authors should have been asked to comment and it should have been resolved that way. Apparently this is Horton's usual method, as he stated last week, but evidently it didn't happen...
Fourthly, he felt that taken together, the findings of the two papers were watertight and both were well-written and excellent research. He also said that the existence of measles viral infection in the bowel was a revolutionary finding. He said he was aware of what measles virus could do to the brain and that it was not implausible that the measles virus could damage the bowel and brain.
He made it clear too that he was annoyed at the criticism insinuating that the peer-review process had failed and because he was unable to answer due to the need to remain confidential. He said the concern expressed by third parties could have been avoided with the publication of the second paper and the level of adverse comment could have been lower.
Finally, in response to panel questions, he reiterated his confidence in the findings of the paper because of the quality of the authors and the reputation of the institution.
Apparently tomorrow there's just going to be wrangling between the two sides over whether the witness statement of Dr Clifford Spratt is admissible as he is too ill to attend. There is no hearing on Thursday and Friday [16th and 17th August].
Apparently too, David Salisbury will be called to witness at the start of next week.
Posted - 08/24/2007 : 15:36:10
An Ongoing Account of the General Medical Council Prosecution for Professional Misconduct Against Dr Andrew Wakefield, Professor Simon Murch and Professor Walker Smith
By Martin J Walker
A Massive Abuse of Process
August 6th – August 15th
The last week of the GMC hearing leading up to Wednesday August 15th saw the virtual collapse of the badly presented GMC prosecution against Dr Andrew Wakefield, Professor Simon Murch and Professor Walker-Smith. On Wednesday 15th after long administrative discussions between counsel, which was followedup on Thursday August 23rd, the following appears to have been agreed: that the prosecution will continue the present leg of the hearings until 6th of September. There will then be a break for three weeks until September 26th when the hearing will recommence and continue until the prosecution has presented its case in full – estimated at some time in late October. The hearing would then shut down and the defence case will not be presented until the end of January 2008. No, that’s not a typo, January 2008.
The prosecution appear to be claiming that, as the first half of their prosecution over-ran, few of the expert witnesses were able to attend at their original pencilled-in dates. On the basis of this they have asked for the 3 week break between September 6th to 26th. To anyone who has been watching the case wend its tawdry way through the last month, this excuse will be easily recognised as the grown up legal equivalent of ‘the dog chewed my homework’, and it must be clear to almost everyone, including Brian Deer, that the prosecution has waded from the shallow end of the pool to the deep end, where it now realises that it is drowning.
At best the case has been mismanaged. At worst the prosecution has been involved in a considerable abuse of process. To my mind the prosecuting counsel, the GMC and Brian Deer should be given no quarter. However, I can see that the defence would not be happy gaining a stay of the prosecution on the grounds of delay, it would mean in effect that Dr Wakefield won on a technicality and didn’t actually clear his name.
The kind of delay which the GMC prosecution has subjected the three defendants to is clearly an ‘abuse of process’ and I discuss this legal concept at the end of this account of the ten days of the hearing August 6th – August 15th.
A Prosecution in Decline
Unfortunately I had to miss the 8th, 9th and 10th of the hearing. I have made a note in the text of the witnesses therefore missing from my account. Someone else did take notes which I had intended to write up, but when I came to read the notes they made little sense to me and confirmed my feeling that, unless you are there in the hearing, listening to the evidence with all its nuances, it is actually very difficult to understand what is happening.
This led me to consider the media and the way in which they have represented this case. On the whole Dr Wakefield has been badly served by the press and their coverage of the hearing has been pitiful. A crusading press has all but disappeared in Britain, and in the mud at the bottom of the gradually draining pond we are left with only the Brian Deers of the world who, instead of challenging powerful interests, not only speak for them but appear to campaign on their behalf.
Perhaps even more upsetting is the fact that in the name of public health, New Labour has been determinedly in the driving seat, defending the collective vaccine policy against the individuals claiming damaged from adverse reactions. That New Labour has been able to control and muzzle the media, lends a lie to the idea that British society is democratic. With such powerful media outlets, acting entirely on behalf of the government, it would not be too absurd to call the GMC hearing a ‘show trial’.
* * *
I suppose I should have known as soon as I saw Dr Richard Horton on the list of prosecution witnesses, that he was a good guy who supported the defence case; the timing of Dr Horton’s appearance might also have confirmed this, after all, Miss Smith was just beginning to call her best witnesses for the defence.
It isn’t always easy to understand why we take a dislike to people, never having met them or spoken to them. If I didn’t actually dislike Horton, I suppose my feelings towards him were luke-warm. I had an idea that he had actually been persuaded by Brian Deer or at least was on good terms with him, or perhaps even frightened by him. This impression, and the sneaky suspicion that he was some kind of science nerd who verged on being a Quackbuster, persisted in my mind right up until I watched him giving evidence for the prosecution at the GMC. After his evidence, the only thing which I might have held against him, had I been inclined, was his very Englishness in appearing to want to please people.
Horton turned out to be tall and athletic looking. Wearing a casual but well-cut black suit, his whole demeanour exuded pleasantness and the kind of collegiate personability that the English are good at. He took the seat at the hearing recently vacated by Professor Zuckerman, and no one would have blamed him if he had repeated President Chavez’s words as he stood at the UN podium the day after Bush had addressed the gathering; putting his hand to his nose Chavez claimed ‘I can still smell burning’.
But Horton was, from the beginning, utterly cool. He exuded the kind of confident presence that only well educated Brits can. Of course it probably helped that Miss Smith was not in the slightest bit hostile to him; her questions flirting with him as if with a new lover. She slid through his evidence-in-chief as if she couldn’t have agreed more with everything he said in favour of the three defendants.
Miss Smith is, in some odd, camp way, turning into the heroine of the tableaux being unveiled at the GMC. Every witness she calls aids the defence; either they are so stricken with bile that they must make a bad impression on the Panel, or they are so much in favour of the defence that the Panel must go into camera scratching its collective head.
A glimmer of why she behaves in this manner was nicely revealed in Horton’s evidence which added to the very strong impression that Ms Smith has been briefed to believe wholeheartedly in the tall tales of Brian Deer. Consequently, before she had actually heard anyone attempt to present evidence, everything must have made a perverse sort of sense. Conversely, for those who fail to succumb to Deer logic, for those who are free from the rotting hand of pharmaceutical and government propaganda, Deer’s tales have always appeared threadbare. One can only conclude that Ms Smith now finds herself in something of a dilemma.
The point at which my ignorant dislike of Horton unravelled was when he described, how, on addressing Deer’s complaints against Wakefield, presented at the Lancet, he immediate said, ‘this has to be investigated’, and began to plan evidence gathering trips to the Royal Free to question Wakefield and his colleagues. According to Horton, Deer collapsed in the face of proper investigation and pleaded with him not to pursue this approach. Not long after this, Horton told the hearing, ‘I fell out with Mr Deer’.
According to Horton, his enquiry into Deer’s allegations left him sure that at least one of the most serious was completely fictitious. From that point onwards, in real life and in the hearing, Horton gave impeccable evidence for the defence. In fact he rose to a level of praise for Dr Wakefield the like of which I have only previously heard from parents.
When Horton moved to talking about the paper published in the Lancet, it became clear that he had the highest regard for the method which the ‘case series’ used and the way in which it was presented. If the prosecution was expecting him to say that the paper was full of poor science, they must have been surprised when he said the absolute opposite.
Horton said that the Lancet paper was an excellent example of a ‘case series’. That this was a standard and entirely reputable way of reporting on a possible new syndrome. He likened it to how the first cases of HIV/AIDS were reported in the early 80s and how the new variant CJD issue broke more recently. He said unequivocally that the science reported in the 1998 Lancet paper ‘still stands’ and that he 'wished, wished, wished' that the clock could be turned back and the paper be considered in the light it was first presented, without everything that followed.
Defence council spent a considerable time cross examining Horton about the declaration of ‘conflict of interest’ issue. Over the years this has become one of the most important issues associated with the Lancet paper. At the end of a long session, the worst that Horton could adduce was that Dr Wakefield was genuinely surprised that there was the need for him to reveal funding from the Legal Aid Board, which anyway hadn’t been used in this case-series, or at all at that point.
Horton was happy to say that Dr Wakefield had been honest throughout his dealings with the Lancet and that he had not declared any conflict of interest because he genuinely believed (and believes still) that there was no conflict to be declared. While Horton personally disagreed with Dr Wakefield’s interpretation of this, as did Professor Simon Murch and Professor Walker-Smith, he acknowledged clearly that it could be seen as a matter of opinion and not a reflection on Dr Wakefield’s honesty.
The Bogy Man
From the beginning of the hearing, Sir David Hull’s name cropped up frequently; principally in relation to a letter which he sent to Professor Zuckerman, stating his concerns about Dr Wakefield’s work. Hull who was Chair of the JCVI between 1995 and 1999 and President of the British Paediatric Association between 1991 and 1994, was portrayed by the prosecution as the ‘wise man’ who had intervened.
Hull’s letter of concern, in turn, appeared to have concerned Zuckerman so much, that he immediately sent off a missive to the BMA, asking for their independent position on Dr Wakefield’s research, possible conflict of interest and invasive investigative procedures used for research purposes. The BMA replied with a well considered appraisal of the questions, saying nothing critical of the clinical methods which Dr Wakefield’s team had been employing. Nor did they appear concerned about the conflict of interest issue.
Despite his ‘concern’ in 1998, regarding issues important to the prosecution in 2007, Hull, like so many other witnesses before him, refused to be drawn into the case entirely as a creature of the prosecution.
Hull’s areas of critical interest in the case seemed to be in the same areas as Zuckerman’s, although he expressed his view with less vehemence. He was, he said, concerned that the record of MMR had been damaged. This he compared to the ‘inaccurate’ reports of damage resulting from use of the pertussis (whooping cough) vaccine in the 1970’s. In referring to this he reduced the real adverse reaction damage caused by petrussis to a chimorous ‘scare’.
Hull was also worried about the involvement of the Legal Aid Board in the funding of research. He was troubled by the use of invasive procedures in the examination and diagnosis of children with autism, although he admitted that he himself had no experience of autistic children or the clinical and diagnostic work which was necessary; he thought that these matters should be left to clinicians.
It became clear half way through Hull’s evidence-in-chief that although he would have made a plausible prosecution witness he seemed disinclined to give Miss Smith what she wanted. His evidence was measured, discursive, sometimes humorous and clearly he felt far less determined than he might have been ten years ago when the engineered ‘scandal’ was at its height.
On August 9th the prosecution called Martin Else, Chief Executive of the Royal Free Hospital and a special trustee. The special trustees managed funds and endowments which came to the hospital, separate from the day to day running of the NHS Trust. It was to this group that the cheque from the Legal Aid Board was sent pending a decision being made about its use. The cheque had originally been forwarded to the Royal Free by Richard Barr, solicitor for the MMR claimants.
Else’s evidence was followed by that of Dr Mills, a GP, who volunteered himself to the GMC hearing in order to give evidence that referral of children to the Royal Free from outside the London area was not in the best interests of the children themselves. It did not become clear during this witnesses evidence, who had advised him to volunteer his evidence to the prosecution, although it is suspected that he is another witness who might have discussed his situation with Professor Salisbury.
The Amnesiac Witness
I came back to the hearing just in time to see the prosecution reach new heights of absurdity on Monday August 13th , when they called Dr Lloyd Evans, a consultant in paediatric neuro disability, as a witness.
The witness did manage to remember his name and address, but little else about anything much, and almost nothing about his contact with Dr Wakefield at the Royal Free. Dr Evans happily chatted with Miss Smith about the generality of his work at the Royal Free and what he did in the London Borough of Camden. Had he been asked, no doubt he would have talked happily about his tastes in music and the sexual mores of his neighbours but asked specifically about any contact he had with Andrew Wakefield, he suffered acute amnesia.
Dr Lloyd Evans repeated the words ‘I can’t remember’, so many times, that half way through his evidence I got the feeling that I had strayed into a 1950s B Movie, entitled something like ‘The Man Who Forgot Who He Was’. Then it occurred to me that perhaps Miss Smith had called him to the wrong hearing and that he was actually some kind of exhibition witness in a University lecture she was giving on amnesia; thoughts of Miss Smith in a professorial gown, mortar board and pointer stick floated through my mind. On the other hand, observers with more vivid imaginations who had seen the Manchurian Candidate might have conjured up a scenario where Lloyd Evans had been hypnotised on the phone by one of the defence council, to respond with the words ‘I can’t remember’ whenever he heard the words ‘Dr Wakefield’.
Miss Smith spent her time between Dr Lloyd Evan’s repetitions, desperately thinking of how she might phrase a question which would gain a positive response. However she phrased her questions though, the witness remained memoryless. Miss Smith persisted asking him in detail, even with the help of contemporary records, how he had found the three children, nos. 8, 6 and 7, each of whom he had apparently been asked by Dr Wakefield to asses. ‘Do you remember the children’ Miss Smith asked earnestly, ‘No, not at all’, responded Dr Lloyd Evans. ‘Did you assess them?’ she persisted, ‘I can’t remember’ he responded.
Having steered him through the rocks on matters of fact relating to the defendants work, and having elucidated nothing from him by way of fact about the case before her, Miss Smith decided to have a chat with him about his work and other things of interest. In this, Dr Lloyd Evans, acquitted himself well. Did he know what ‘regressive autism’ was, asked Miss Smith. ‘Yes’, replied Lloyd Evans, who went on to describe regressive autism and despite putting his own interpretation on it’s diagnosis and it’s prognosis, made real the very syndrome which Dr Wakefield had reported; although of course adding nothing about its gastroenterological aspects.
Suddenly Dr Lloyd Evans was speaking for himself, as if freed from hypnosis. In cases of regressive autism you would need to carry out many tests and investigations. Definitely you would need lumber puncture to test for biochemical and viral elements in fluids. Miss Smith balked at this revelation, and it took her a good quarter of an hour to discipline Dr Lloyd Evans and to get him, as they say, ‘singing from the same hymn sheet’. At the end of the day, however, all he would say in recompense for this further gift to the defence was, that in cases of more straightforward autism you didn’t need all those investigations.
Dr Lloyd Evan’s evidenceless and memory free evidence, left little fertile ground for defence cross examination and when the defence rested at 11.45, Miss Smith had to admit that she did not have another witness in waiting. At her most imperious, she joked that, as it was impossible to tell how long the defence would take in cross examination, she had been unable to bring her next witness. It is difficult to imagine what kind of cross-examination of the amnesiac witness Miss Smith thought was possible. As Dr Lloyd Evans was a specialist in neuro-disability, perhaps a question such as; ‘Could you tell me why you can’t remember anything?’ might have been appropriate.
In Britain and America the law is radically changing. The older pattern of set and dependable rules is being quietly eroded by a prosecution based legal system that is increasingly said to face greater and greater threats from law breakers, mainly ‘terrorists’, embedded but unseen in the community.
The area of law which is changing most is that of the ‘process’ by which law is enacted. The body of law related to process has grown up over hundreds of years, usually by virtue of common law. Until fairly recently, most of this law was quite specific. The contemporary anti-democratic changes have been so many that it is impossible to address them in this text but they include things like the diminishing of pre-emptory challenges to jurors and the right of judges to give non specific sentences, left to be determined by the prison authorities.
A simple idea of changing process can be seen in relation to the police and suspects. Prior to the 1930’s, police (representatives of the State) were not allowed to talk to suspects they had arrested before they were brought before an ‘independent’ magistrate or judge. Today the police organise the whole case against the suspect talking to them and interrogating them for long periods before they appear in court to be belatedly ‘examined’ by the magistrate.
In America, it is now common practice for suspects to be ‘detained’ i.e. held in custody without being arrested or charged with a specific offence. While politicians would like us to believe that this Guantanamo law is only reserved for serious terrorist suspects, this is far from the truth. The main body of law relating today to ‘abuse of process’, is meant to defend the ‘rights’ of the accused from arbitrary powers and oppression by his or her accusers.
A major part of the ‘abuse of process’ relates to temporal matters; how long a person is held without charge, how long a defendant must wait for the trial while being held in custody and how long trials themselves take. In turn these temporal or ‘delaying’ matters can be judged as more or less serious when publicity about cases, which might affect defendants, is also taken into account. Although ‘abuse of process’ mainly relates to criminal cases and courts, I have no doubt that it could be brought to bear on a professional regulatory process such as the GMC fitness to practice panel hearing.
Looking at Dr Wakefield as a defendant, rather than a research doctor, I would draw attention to a number of matters.
First Abuse of Process
The GMC has taken over the complaint made against Dr Wakefield by a single lay complainant - Brian Deer. It is one of the most basic tenets of the British, and other juridical systems, that the accused should be able to face his or her accuser and question them about their motives, vested interests and of course whether they have worked with, been instructed by or aided in making the complaint by any other party. It is essential that the defendant has the right to divine the motive of the complainant and so make this motive known to the body which will decide on his or her guilt or innocence.
In not citing Brian Deer as the sole complainant and not bringing him forward as their principle prosecution witness, the GMC has deprived the defence of the opportunity to cross examine him on a large number of matters which reflect upon his motive for bringing the complaint.
Another matter which runs parallel to this is the fact that our judicial system makes clear the separation between the complainant, the body which is prosecuting and the ‘jury’ that body which determines guilt or innocence, whilst the process as a whole is meant to be separate from government and any political parties.
In this hearing, there is a continuous vein of sympathy between all the bodies involved in the process of the prosecution. Brian Deer in fact wrote up almost the whole of the prosecution in the Sunday Times and then, at the behest of the then Minister of Health who was quoted in that article, he became the chief and sole complainant to the GMC, and the GMC is now shielding him from being questioned by those he has complained against. We do not know whether he worked with any other organisation or received any funding from any interested organisations in formulating this complaint to the GMC. We do know that the GMC took the complaint from him and proceeded with it without calling him as a witness. We also know that this complaint is being heard by a Panel chosen by the GMC. In other words, the complaint, the prosecution and any judgement that is made, are all being pursued by bodies which appear to have a common identity of interest.
Second Abuse of Process
It is another basic tenet of British and other Europe juridical systems that any accused person should be brought to trial as quickly as possible, while obviously taking into account the organisation and administration of the prosecution case.
From the time of Brian Deer’s Sunday Times article in February 2004 and the instruction quoted in that article by the Minister of Health, that a complaint should be made to the GMC, almost three and a half years passed before the charges were ready to be put to the defendant in the present hearing, which began in July 2007.
During the time the accused doctors waited to answer the charges, a massive quantity of information appeared in newspapers, on Brian Deer’s website and in other media, most of which was insistent that Dr Wakefield, in particular, was guilty.
Having begun the hearing in July, the prosecution now intends to suspend the hearing until February 2008. It could be argued that having presented the prosecution case, this six month period is likely to consolidate the case in the minds of the Panel. Because there is no sub judicae rules which affect the publication of general and specific information about the charges brought against the doctors, it could be argued that the medical establishment, the government and the pharmaceutical companies, have now six months during which time they might publicly build on the prosecution case.
A clear example of this biased influence being voiced beyond the hearing, could be seen on Monday 20th August, when Channel 4 aired the second episode of Richard Dawkins programme, The Enemies of Reason. In this episode which should have been titled Friends of Ignorance, Dawkin’s pointed to the MMR controversy, in which he claimed an inoculation against disease has been suggested as a cause of autism, ‘without the slightest shred of proof’.
While it might just be possible to depend upon the panel not to be influenced by this free flow of information, it could, obviously have a considerable effect on the climate in which the hearings resume in January/February of 2008.
ABUSE OF PROCESS
In this box, I have brought together a number of simple unreferenced statements about ‘abuse of process’. I am not presenting this as legal research but as a simple aid to understanding how far away from proper legal and juridical conventions the GMC has moved.
* * *
Abuse of process is a wrong committed during the course of litigation. It is a perversion of lawfully issued process and is different from malicious prosecution, which is a lawsuit started without any reasonable cause
* * *
Abuse of process has been defined as ‘something so unfair and wrong that the court should not allow a prosecutor to proceed with what is in all other respect a regular proceeding’.
* * *
The elements of a valid cause of action for abuse of process in most common law jurisdictions are as follows: it is the malicious and deliberate misuse or perversion of regularly issued court process (civil or criminal) not justified by the underlying legal action. "Process" in this context is used in the same sense as in "service of process," where "process" refers to an official summons or other notice issued from a court. The person who abuses process is interested only in accomplishing some improper purpose that is collateral to the proper object of the process and that offends justice, such as an unjustified arrest or an unfounded criminal prosecution.
* * *
Where there has been a serious abuse or misuse of power by the investigators, the court may decide that there has been an abuse of process. This is to protect the integrity of the criminal justice system. The judge/magistrates must decide whether the abuse of power is so serious that it amounts to an affront to public conscience.
To establish abuse of process based on delay, the defendant will need to prove that, because of the delay, s/he will suffer such serious prejudice that a fair trial cannot be held.
* * *
It may be an abuse of process if either: the prosecution have manipulated or misused the process of the court so as to deprive the defendant of a protection provided by law or to take unfair advantage of a technicality; or the defendant has been, or will be, prejudiced in the preparation or conduct of his defence by delay on the part of the prosecution.
* * *
The European Court of Human Rights (ECHR) gives the defendant the right to be tried ‘within a reasonable time’. This right flows from the time that a person is formally charged or served with a summons. In HSE prosecutions, this will usually be the time when the summons is served. When a court considers whether there has been a breach of the right to a trial within a reasonable time, they will consider:
the length of the delay; the reason for the delay; whether the right was asserted (i.e. whether there were complaints about the delay);
whether there has been any prejudice to the defendant.
* * *
The House of Lords has confirmed that the court has a general and inherent power to prevent abuse of process. This power includes a power to safeguard an accused person from oppression or prejudice.
* * *
Both the Crown Courts and magistrates' courts have discretion to protect the process of the court from abuse. This includes protecting the accused person from oppression or prejudice.
* * *
There are broadly 2 sets of circumstances in which a court has discretion to stay proceedings as an abuse of process.
The first set of circumstances are where it would be impossible to hold a fair trial. Where it would amount to a misuse of process to start or continue a prosecution because it offends the court's sense of justice and propriety to be asked to try a defendant in the circumstances of the particular case
Examples of the first set of circumstances will include non- disclosure, delay, inability to examine evidence, inability to call evidence, inability to question prosecution witnesses and adverse media publicity.
Examples of the second set of circumstances will include dereliction of duty by the prosecutor, improper substitution of a charge, disregard of extradition procedures, improper motive, oppressive investigative techniques, avoidance/manipulation of statutory time limits, prosecutorial misconduct and proceedings commenced or continued in breach of a promise not to prosecute.
* * *
Article 6 (1) of the European Convention on Human Rights confers on any defendant the right to trial within a reasonable time. The House of Lords concluded in the 2001 reference that time ran for the purpose of this right from the earliest time when the defendant was officially alerted to the likelihood of criminal proceedings being taken against him, which would normally be when he was charged or served with a summons.
* * *
The principles directly applicable to cases of delay pre charge/official notification are governed by the common law. In practical terms they mirror the tests set out by the House of Lords in the 2001 reference and can be summarised as follows;
In cases of delay there should be no stay unless the defendant shows on the balance of probability that, owing to the delay, he will suffer prejudice to the extent that no fair trial can be held.
Anyone wanting to read about the reality of the damage caused by Pertussis vaccine should read Harrison Coulter’s brilliant book, written with Barbara Loe Fisher, A Shot in the Dark, and Helen’s Story by Rosemary Fox, the woman who, on the basis of her own vaccine damaged daughter, campaigned to bring the Vaccine Damage Payment Unit into being.
Through the late Eighties into the early Nineties, Martin J. Walker worked as an investigator for lawyers in criminal and civil cases and with many defendants in criminal and civil trials - with and without lawyers. In the late 1980s he co-founded Hackney Community Defence Association (HCDA), an anti-racist group which worked on the defence of people assaulted, fitted up and wrongfully arrested by the police in north east London. In 1990, he began investigating and writing about the ‘health fraud’ movement and the vested interests of science and medicine. His fifth book in 1993 - Dirty Medicine: Science, big business and the assault on natural healthcare, was described by Christopher Bird, author of 'The Secret Life of Plants', as "a masterpiece of investigative journalism and attentive scholarship, elegantly written". Since then he has published further titles including ‘The Brave New World of Zero Risk: Covert strategies in British science policy’ and ‘HRT: Licensed to kill and maim’. For the past five years he has also been one of the legal advisors on the BBC 1 drama series ‘Judge John Deed’.
More on Martin J. Walker at www.slingshotpublications.com
Posted - 09/12/2007 : 12:26:04
An Ongoing Account of the General Medical Council Prosecution for Professional Misconduct Against Dr Andrew Wakefield, Professor Simon Murch and Professor Walker Smith
By Martin J Walker
The Utter Irrelevance of Professor Salisbury
Monday 13 August – Thursday 24 August
The inability of prosecution witnesses to attend the hearing through illness or some other cause can be a difficult matter for the defence. This is partly because witnesses who have anything contentious to say should be required to make their accusation directly to the defendants and should be available in person for cross examination.
In the case of the witness whose statement was read on the afternoon of Monday August 13, Mr Koonan, while not objecting to the statement being read, had to say that it was not accepted by the defence and the details of it would be disputed when the defence presented its case.
Miss Smith then proceeded to read the statement of Russ Phips into the record. Phips was an Assistant Director of Finance from 1991 – 2006 and the financial administrator of the Special Trustees at the Royal Free. The statement bore witness to the fact that the money which had arrived at the Royal Free from Dawbarns solicitors had been initially lodged with the Special Trustees and then paid out to Dr Wakefield, so creating the conflict of interest which they are so keen on proving.
This of course seems to be a good point for the prosecution and they have pursued it throughout the hearing. However, like much of the prosecution case, the point has now proved to be wrong. The money sent on from the Legal Aid Board and deposited with the Special Trustees was, in fact, paid out immediately to Ros Sim a Medical Laboratory Scientific Officer concerned with viral detection at the Royal Free.
It was difficult to understand exactly what Mr Phips was saying about the money which originated from the Legal Aid Board. To put it in common parlance it seemed, very much, as if he was suggesting that there was an attempt to ‘launder’ the money through the Special Trustees before paying it into Dr Wakefield’s general research funds.
The next morning Professor Ravel gave evidence. To a great extent, Professor Ravel was a typical prosecution witness; short on facts which might incriminate the three defendants and obviously unsure of what was expected of him. This circumstance was illustrated by the Professor when he was being led through his evidence by Miss Smith. At one point, his flow on an important matter was interrupted, he thought for a moment and then said:
'I've forgotten what I was going to say'
To which Miss Smith blithely responded, ‘Don’t worry’ and passed on to the next issue.
Miss Smith’s continued in her attempt to assert, this time through Ravel, that Dr Wakefield was somehow experimenting, without permission and unethically, on children. This previously ill-fated line of attack took another turn when she tried to insinuate into the evidence the idea that Dr Wakefield’s unit might be illegally and unethically taking biopsy samples from children and then using these for research.
Professor Ravel, however, had nothing bad to say about the clinical methods of the gastroenterology team. He gave evidence about the histology group, which came together to scrutinise clinical cases, and to look at biopsies and samples taken during internal examination. This evidence succeeded simply in shedding further light on how a dedicated group of doctors worked with considerable commitment in a collegiate atmosphere to come to the best conclusions on behalf of their patients.
Having spent many wasted Saturday evenings watching programmes like Casualty, the evidence which began to blossom about the histology meetings ran completely contrary to my received opinion of how doctors in large hospitals work. It would never have occurred to me that, in a profession which is always portrayed as being full of egotists, collective discussions about diagnosis and the outcome of various procedures might be profitably held.
One of Professor Ravel’s tasks as Joint Head of the Department of Histopathology, was to police the taking of biopsy and other samples which might be snipped from patients bodies during this or that procedure. My mind was filled with cartoons of hospital administrators, acting as the docks’ police did before and just after the second world-war. Every worker was searched for stolen goods as he left for home through the dock gates. ‘So what ‘ave we ‘ere chummy, a little bit of bowel. OK, over ‘ere, empty your pockets, drop your pants and lets have a look in your orifices.’
Oddly enough although Ravel’s task had led him to ask questions about the biopsy material taken from the children, these samples had all turned out to be ethically accounted for. Further than this, he made the point that often when doctors do try to slip human material out of the operating theatre, it turns out usually to be at the behest of pharmaceutical company trials for which patients permission has not been sought.
It turned out that Professor Ravel had been the person who was asked to assess at least two of Dr Wakefield’s project proposals. In both cases he was happy to give approval to these studies. About one of them he said, as if taking it for granted, It was ‘a well prepared document; a good example of that kind of study’.
A Second Lancet Paper
The unlikely named Professor Candy is a consultant paediatric gastroenterologist and a highly qualified peer reviewer of 20 years standing for the Lancet. Whilst Richard Horton had already alluded to it in passing, it was only when the professor gave his evidence that a ‘partner paper’ came into focus. This paper, explaining the science behind claims of a link between Inflammatory Bowel Disease (IBD), persistent measles virus and regressive autism/CDD, had been handed to the Lancet at the same time as the now infamous 12 child ‘case-series’ paper.
For the uninitiated, a frightening picture now emerged of the prosecution presenting for the first time robust evidence that Dr Wakefield’s science left a lot to be desired. Professor Candy, however, turned out to be a real sweetie and yet again a great patron of the defence.
Apparently, Dr Wakefield and other signatories had expected both papers to be published in the same issue of the Lancet. In the event, the scientific model underpinning the ‘case series’ paper was turned down by two peer reviewers but supported by Professor Candy; not just supported, we heard, but supported in glowing terms.
Candy’s evidence was an eye opener for those who had often wondered about how peer reviewers work. He told an interesting story of a field which had become gradually more open over the last twenty years.
Professor Candy’s first comment about the ‘partner’ paper was that it was well written. This was stated as a throw-away line, and he followed with a barely surprised comment that this was only to be expected. ‘Professor Walker-Smith’ Candy said, ‘has written text books which are very lucid’. This was not the first, not would it be the last praise for Professor Walker-Smith’s reputation and his considerable body of work, which included a number of text books.
On Professor Walker-Smith, when I see him at the hearing, my thoughts are thrown back to the pompous, angry and defensive Professor Zuckerman, who insisted on saying that giving evidence against his colleagues was painful. Although I have no reason to assume Professor Walker-Smith, now retired for 5 years, is not holding up as stoically as the other defendants, his general demeanour exudes a world weariness which is sad to observe.
Although the emphasis throughout this whole affair has been on the injustice done to Dr Wakefield, we should always be mindful of what Brian Deer’s complaints to the GMC are doing to Professor Walker Smith. To end an entirely meritorious career in medicine with this smear of a trial is a calamity almost unbearable for a person of such obvious integrity.
The position of Professor Walker-Smith is testimony to the lengths that politicians and the medical establishment will go to keep faith with the pharmaceutical industry; to break an exceptional physician on the rack of cynicism and profitability. In all such matters I am guided almost entirely by the parents with whom I have spoken. To witness the warmth and respect that they show to Professor Walker-Smith gladdens the heart. I hope that he is aware of the affection in which he is held and that in turn this provides strength and solace.
Professor Candy’s remarks about Professor Walker-Smith were immediately followed by very flattering statements about Professor Simon Murch and Dr Thompson, whom Professor Candy informed the Panel were the two best endoscopists in the country.
Professor Candy, a learned looking man with white hair and glasses had begun giving his evidence at 12.15 and by 12.40 any fears that the prosecution had called a good witness for their case had evaporated. In fact Professor Candy got quite carried away, falling into the vernacular, with his enthusiasm for the second unpublished paper.
The second paper demonstrated measles virus protein in the gut of some of the children whose cases were reviewed in the published paper. ‘It was like a double-whammy’, he said ‘clinical observation backed up by good science.’
Professor Candy said that he was upset and surprised when the Lancet published the first paper without the second, and even more surprised when the publication of the first paper was accompanied by an editorial which suggested that there was no evidence presented for the strength of the measles virus in the gut of the children cited. This information was in the second paper, he said, and it was his opinion that both papers should have been published together; that the first paper was supported by the second. In Candy’s opinion the two papers were ‘indivisible’.
When Mr Koonan began his cross examination of Professor Candy he had little difficulty in consolidating the points which had already been brought out in his evidence-in-chief. Both papers, he said, ‘were well written and needed no significant criticism from him.’ He said that ‘the findings of measles antigen in the bowel of the treated children, some years after exposure, seemed to me to be revolutionary’.
The whole peculiar incident of this paediatrician’s evidence reminded me of the rule, doggedly adhered to by quackbusters and sceptics across the globe. While such people moan and keen over the subject of junk science, when faced with the genuine article they simply refuse to discuss it. While claiming that only science matters, in the majority these people show themselves to be ignorant of human motivation, honest purpose and most of all science in the public interest.
In fact both Mr Koonan and Mr Miller were able to make major consolidation over the work of the team who authored both Lancet papers. Almost at the end of his cross examination at 2.25, Professor Candy made the statement which all three defendants will be able to look back upon with pride.
‘The findings of the papers’ he said, in his opinion ‘were watertight’.
A Spratt to Catch a Mackerel
As the evidence continued to pile up for the defence and after an awful morning of waiting and false starts while the inner circle sat round negotiating agendas and doing what they like to call ‘housekeeping’, we were forced to listen to another statement of another absent witness, read into the hearing record by Miss Smith.
This witness, Dr Clifford Spratt, whose name bore an uncanny similarity to that of Lancelot Spratt the pompous and egotistic consultant played by James Robertson Justice in the ‘Doctor’ films, was a resident of Jersey, where he had treated child 9. However, Spratt, the victim of a heart condition and therefore not robust enough to travel through central London, let alone be taken through his paces by Koonan & co., was far from a shrinking violet when it came to criticising the clinical or research views of Dr Wakefield.
When he found that the mother of child 9 was insistent that the damage done to her son had been caused by MMR, Dr Spratt swam straight to the phone and called his friend Dr (now Professor) Salisbury. Asked to make additions to his statement, at a date near to the hearing, Dr Spratt told the GMC; that he didn’t think that child 9 had any kind of bowel disorder; that he didn’t think that there was any link between MMR and this child’s autism; and that in his opinion the child’s autism was of unknown cause.
Mr Koonan, was quick to point out to Miss Smith that while Spratt’s evidence was admissible, if read to the panel, the defence did not agree with it and the panel should be advised upon its lack of weight while it stood uncontested.
Two Days of Excruciating Boredom
When I was 15 and at secondary school, President Kennedy suggested that his US marines could easily route-march 50 miles. I can’t imagine how, but this inanity became a bye-word throughout Britain for fitness amongst teenage school children. All kids of my age, at schools like mine got shoed into a similar walk. I can remember thinking when I was thirty miles out of Manchester, with my feet blistering and my brain deadened in the half-light of night, that this is what Hell must be like.
The next two days of the hearing were just like that, as pure boredom dragged my feet and my hands alternatively between sleep and jerky autonomous movements. Fortunately, it was during the evidence of Dr David Howard Casson, now of the Royal Liverpool Children’s Hospital that the most exciting, and hilarious incident of the hearings occurred, when Miss Smith showed a previously un-revealed talent for clowning in the best tradition of Chaplin and Keaton.
Dr Casson was giving evidence for the prosecution because he had been responsible as a Registrar, for ‘clerking in’, to the Royal Free the majority of children who made up the ‘case-series’ reviewed in the Lancet.
Dr Casson was in the main a reluctant witness, perhaps because, just like other witnesses, had he agreed with Miss Smith that Dr Wakefield was involved in hole-in-the-wall research conspiracies, he would inevitably have implicated himself in the prosecution case. Because Dr Casson appeared to know next to nothing about the case-series or about any other research which went on in his department, Miss Smith concentrated on the endoscopies. In between the silent responses of much unrecalled information, Miss Smith managed to prise out the details of each endoscopy and the details of any other procedure to which each child had been subjected.
Miss Smith tried her hardest to present the clinical work with the children as a kind of conspiracy of satanic abuse. Because of this, she inevitably appeared lost in a maze, not tall enough to see over the hedges to know where her questions were taking her. Her questions yet again seemed only to endorse the fact that with each child the tests were necessary for a correct diagnosis and thereafter for proper treatment.
Dr Casson was mainly responsible for seeing each case through the hospital, from referral, during a week’s in-patient treatment, through investigative procedures usually on Mondays and then into histology discussion, usually on Fridays, before finally writing the discharge notes to the child’s GPs.
Had it been the case that Dr Casson’s evidence had revealed a dark conspiracy at the heart of the Royal Free Hospital; doctors abusing the trust of patients and failing to get parental or ethical consent for invasive investigations; discernable trauma and physical damage to the health of children; if the doctors had clearly been working for profit and personal aggrandisement, at war with parents; had any of this been the case Dr Casson’s report would have been anything but boring. However the doctors were simply doing what doctors do. Until, that is, Brian Deer and associates decided that they should be struck off for it.
It was not just the fact that each child’s case was discussed in detail which made the exchanges between Miss Smith and Dr Casson exceptionally boring. In fact one real joy of the hearing to a lay person has been that the description of the workings of a department within a large hospital has been a revelation. No, it was how Miss Smith disassembled the evidence of work. It was as if Miss Smith took some printed stanza’s from Shakespeare, cut them up with scissors, reassembled them and then began a literary analysis of their meaning. Miss Smith seemed to be examining the arms and legs of a cadaver without understanding they were joined to a body.
Stoic as always, she tried to glean as much from the evidence as possible, Ms Smith dragged Dr Casson through a detailed clinical and administrative review of the 12 children associated with the Lancet paper. None of the cases provided a single dramatic moment, not once did Casson respond to Miss Smith’s fishing expeditions, which attempted to show that the clinical investigations were unnecessary and that some of the children had no bowel problems at all. Casson, despite remaining a reluctant witness, despite tinting his evidence with a few distancing remarks which ensured that he was not seen as a ‘friend’ of Dr Wakefield, gave nothing to the prosecution.
Yet again one was left to wonder why, despite her best efforts, Miss Smith was actually consolidating the case for the defence. For the public gallery, however, the stultifying boredom of the continuously repeated questions wiped away all thought of motive or continuity in the case, numbing the mind to sleep.
When Mr Miller, counsel for Professor Walker-Smith, stood to begin his cross examination after a break at 3.15, it was difficult to see how this could be any less boring than the evidence already elicited by Miss Smith.
While Miller took Casson through the details of his CV and his work at the Royal Free, I found myself studying Miss Smith. I wrote in my notes that she always carries her largish handbag with her, grasping her arm in front of her. This pose, I realised suddenly, was reminiscent of Mrs Thatcher. I began to wonder whether this was a class thing. For the next hour and a half Mr Miller sketched in some of the more general salient points about Casson’s evidence, without discussing the detailed circumstances of the 12 children. He made it clear that he needed a day’s continuous time to address these circumstances.
When Mr Miller began his cross examination at 9.30 on the morning of Tuesday 22nd he went straight into a review of medical process, beginning with the general parameters such as consent forms for invasive procedures and then focusing on the specifics in the case of child 2.
Mr Miller’s detailed portrait of 2’s medical and administrative treatment during his week at the Royal Free hospital was masterly. To compare it to any of Miss Smith’s process narratives of yesterday would be like comparing Michelangelo’s work in the Sistine Chapel with a Jackson Pollock. For the first time since the hearings began, we saw the hospital and the department of paediatric gastroenterology within it, as a living organism. Mr Miller, like a good sociologist, articulated a structure of diagnosis and care which has been built up and perfected by physicians over a long period.
When he had finished with child 2, Mr Miller had convinced me at least, that custom and practice together with the skills of the specialists involved, made the Royal Free at the time in question the safest place to send ones child. If, that is, your child is suffering from an undiagnosed condition following vaccination. With that first patient presentation, the already chimerical prosecution case suffers yet another serious blow.
Mr Miller’s review of the other 11 children consolidated this impression. It added to the general picture of an efficient department, working in an orderly and well regulated manner and it took us a jet journey away from the portrayal of Dr Wakefield as a lone maverick. The hospital described by Mr Miller, with the help of Dr Casson, was one where a large number of doctors worked co operatively and professionally.
By 4pm Mr Miller had finished the section of his cross examination of Dr Casson where it related to the 12 children in the Lancet paper. He moved on, then, to address some broader questions before he ended for the day.
Dr Casson had a hard time, in the ‘witness box’ over two days. His reluctance made more determined by the fact that he must have had only a blurred idea of where the questions were going and whose case his answers were helping or hindering.
Miss Smith acquaints herself with the Carpet
It was at this time, just as Mr Miller was beginning to wind up his cross examination that Miss Smith moved to add immense levity and some concern to the proceedings.
Just to remind readers of the lay out of the hearing. The prosecution all sit at one table which stretches across the width of the room. Miss Smith sits in the centre of the table in relatively cramped conditions, with files stacked high behind her and books, papers and files littering the table around a box which doubles as a lectern in front of her. At the table with her, to her left as she looks down the long room, are her two male junior counsel. Facing her about 50 feet away is the witness. Down the left wing of the room, the panel and GMC administrators. Down the right wing the defendants, their counsel and solicitors. The circumstances of the hearing are relatively formal and the black clothes common to legal proceedings make for a quiet reverential process.
Miss Smith cuts a very singular figure partly because all the other leading counsel are men and partly because her appearance is distinctive; she has presence. Her silvery blond hair is cut short around the nape of her neck and while she dresses in black her white face has the sharp angularity of a Walt Disney cartoon character.
At four o’clock, while Mr Miller was still cross examining Dr Casson, Miss Smith, always working, always digging out papers to help her cause, rose from the table and turned to face the bank of ‘evidence’ files which ran behind her across the room. She took a couple of steps along the wall of files, then without falter fell, pole axed, to the floor. This appeared to be no untidy trip, no stumble or faint, but a full-blooded head-first dive into the carpet. Miss Smith lay still but definitely conscious. In fact, listening carefully one might have heard the constant question circulating in her mind as she tried to decide how to deal with her new, incredibly embarrassing position on the carpet.
As she partially disappeared from view and hit the floor, a Mexican wave swept round the hearing room tables and almost everyone was on their feet. Some moved quicker than others to go to the aid of Miss Smith, her junior counsel moved not a muscle, nor did Dr Wakefield, the nearest doctor to her (Could be grounds for a professional misconduct hearing some time in the future?). Only the witness, Dr Casson, the furthest person from Miss Smith, actually moved paces closer to her as he started off like a sprinter out of the starting blocks, round the tables.
Having come to a lonely decision about how she might stand and face her audience, Miss Smith rose from the floor and with her back to the hearing stared at the wall of file boxes before her. Watching her trying to recover herself, I was reminded of an occasion, when looking down from the window of my high rise East London flat, I saw a young guy kick a lamp post after he had run his car into the back of another parked car. I wondered if Miss Smith was contemplating a swift kick or head-butt to the boxed files, instead she turned with considerable composure, a wry self-deprecating smile on her face, and sat back in her seat.
The Panel chairman at his most ministerial, suggested it might be time for a break, but his usually strong voice trailed off as Miss Smith shooed the idea away with her hand and aggressively told him to carry on. Within minutes of Mr Miller’s cross examination beginning again, it was as if Miss Smith had never been prostrate on the GMC’s utility carpeting. As if everything was as it should be.
The afternoon session finished at 4.30 and the Chairman announced that the hearing would convene earlier the next morning, so that Miss Smith might carry out her re-examination and finish with time enough to call the next witness Professor Salisbury.
Professor Salisbury Gives a Lecture
Professor David Maxwell Salisbury, director of immunisation at the Department of Health barrelled into the GMC hearing like a man about to retrieve his car from a garage but wanting to haggle over the cost of the work. Miss Smith took him too slowly through his career awards, so he grabbed the declaration from her and set off at a brisk trot evidencing every WHO committee, virtual and real, upon which he had ever sat.
This was, in fact to be his style throughout his ‘evidence’. He took each question as an opportunity to give a short lecture on the history, effect and efficacy of vaccination policy. But then in Mandy Rice Davies’s oft quoted words, ‘He would say that wouldn’t he’. Those people who later expressed shock, or at least surprise that Salisbury had maintained that the MMR vaccine worked efficiently, clearly misunderstood the whole point of the prosecution calling him in the first place.
Professor Salisbury should never have been a witness in this hearing and his presence there only confirmed the surreal nature of the charges against the defendants. Salisbury had nothing to say which was relevant to the charges. He was brought by the prosecution to muddy the waters, to make the panel believe that Wakefield et al were charged with spreading alarum and despondency about the government vaccine programme. Although the GMC would no doubt have liked to have brought charges which echoed this Orwellian idea, unless it was framed as a charge of conspiracy this was never possible under British law.
They brought him, thinking that arriving late and with ground prepared, he could administer the coup de grace. Sadly, this was not to be. Salisbury could say nothing of evidential value about the specific charges and while he was not an expert witness of any kind, he ended up giving evidence on the theoretical and conceptual implausibility of the ideas which Dr Wakefield and others had put forward linking MMR to regressive autism.
Counsel for the defence were determined not to give Salisbury any more space than he himself grabbed from the hearing, and chose not ask him any questions in cross examination. The embarrassed silence which followed this collective denial of opportunity was amusing; there can be no doubt that Salisbury had settled into his chair anticipating a limitless opportunity to sound off about his own and the government’s greatness. In the event he quickly metamorphosed from a preening cock to a deflated balloon.
The refusal to cross examine might appear risky, in that it seemed to let Salisbury off the hook with respect to important and simple questions such as: ‘Why did it take you two years to respond to Dr Wakefield’s first communication with you, which warned the DoH of a public health crisis over MMR?’ and ‘Why did it take six years for you to organise a meeting with Dr Wakefield to discuss his ground breaking research?’ and finally, ‘Did you intend to suggest in your evidence that Dr Wakefield was trying to blackmail the Department, by suggesting he would precipitate a public health crisis unless you gave him money for research?’
All the facts relevant to the charges against Dr Wakefield, Professor Murch and Professor Walker Smith will of course be given in evidence by the defendants themselves. If they remain accused. Dr Wakefield, in particular, will be able to inform the panel about the considerable evasion indulged in by Professor Salisbury and the Department of Health from the time that they were first informed of the epidemic of adverse reaction to MMR.
A few issues raised by Salisbury’s evidence are worth commenting on here. Without eliciting a tsunami of self congratulation it might have been worth asking Salisbury how, exactly, he came by the Professorship bestowed on him only weeks, it seems, before the GMC hearing.
More important is the matter of how much Salisbury actually knew about the press briefing given before the publication of the Lancet paper. In cross examination, the defence had previously put it to Professor Zuckerman that he had co-operated with the media committee, and with Dr Wakefield, in their plan to make clear their view of MMR and regressive autism. Professor Zuckerman, who had chaired the media committee which organised the press briefing had, it turned out, been appraised of the intention to propose a return to the single vaccine.
In evidence, Zuckerman had denied this. A letter from him to Dr Wakefield produced in evidence, however, twice stated that in the event of a question being asked, he hoped that Wakefield would push the use of monovalent (single) vaccine. When asked about this letter in cross examination, Zuckerman had said that the twice used word ‘monovalent’ was on both occasions a typing error, and it should, of course, have read that they should push the ‘polyvalent’ (triple) vaccine. This was almost plausible, but if it was not true it hinted at a much deeper conspiracy on the part of the establishment than even I had imagined.
As Miss Smith, heroine of the defence, led Salisbury through his evidence, she presented him with a letter written by Roy Pounder head of Wakefield’s department, to the Department of Health. A letter which Salisbury had seen. The letter, according to the twisted narrative of the prosecution, was supposed to be an example of how the Royal Free research team had constantly tried to blackmail the DoH. In the letter, Pounder had notified the Department of their intention to recommend at the press conference that parents ask for the ‘monovalent’ vaccine. He wrote, Pounder said, making this clear because he did not want the NHS to be caught short when requests for the single vaccine were made. ‘Did they have sufficient stocks?’ he asked. Now, unless monovalent was also a typing error in this letter, a nightmare picture of conspiracy and deceit is beginning to unravel in the GMC hearing.
The other considerable matter which Salisbury onanistically droned on about was his department’s determination to understand public perception of the various vaccinations. He introduced this matter by suggesting that no one else (no other government) in the world was able to track the take-up and public perception of vaccines in the way that the British government could. The data on public perception of vaccine was massive, he said. The survey methods were infinitely sensitive, the government even knew what newspapers respondents read. In all, Salisbury and his colleagues had carried out 30 surveys into the public outlook on vaccination, costing millions of pounds.
Listening only lethargically to this ‘evidence’, one might be moved by it. ‘The government really is interested in the public experience of vaccination’, an observer might think. Of course nothing could be further from the truth. All this data, all these surveys, all these millions of pounds have been spent in order to advance the marketing of vaccines and to plan public relations strategies which will ensure that the public accept the vaccine programme without question. This is nothing to do with science, this is jury rigging.
At this point in Salisbury’s evidence I came near to shouting out - ‘How much has the department spent and how many surveys have they carried out on the study of adverse reactions?’ Actually, this would have been a stupid question because, despite the fact that Salisbury would have responded by describing the yellow card system, I actually know that millions of pounds worth of research is carried out into adverse reactions, not by the government but by large private research companies.
These multinational companies work directly for the pharmaceutical cartels, which, after all, have very good reason to monitor adverse reactions. These companies conduct the most detailed research, by contacting general practitioners and getting lists of those prescribed drugs or given vaccines. The doctors, nurses and patients are all intensively interviewed about the effects of prescribed medications. It is on the basis of this information that pharmaceutical companies change drugs or withdraw them from the market, with as little publicity as possible.
Does the DoH conduct similar research or fund these research companies to carry it out? No, of course not. Is there an obligation on pharmaceutical companies to provide such data to the Department of Health? No, of course not. In all the much vaunted PR research conducted by Salisbury’s department, it is not public health which is leading the research, but public perception of government and the defence of pharmaceutical profitability.
Unfortunately, however, the present hearing will furnish us with no answers to important questions about the working of government and pharmaceutical companies. The defence has a specific objective to realise in the hearing and that is to prove beyond doubt that the defendants are not guilty of the charges. This limited objective can best be achieved without giving people like Salisbury the chance to ‘run off at the mouth’.
*nbsp; * *
Since the virtual collapse of the prosecution case two weeks ago, we have seen Miss Smith increasingly making objections to cross examination questions put to witnesses by Mr Koonan and Mr Miller. I’m sorry that Miss Smith doesn’t seem to understand how demeaning and petty these objections appear. One can only assume, as she has been overruled by either the Chair or legal assessor of the panel on almost all occasions, that she is making them in order to break the flow of the defence argument implicit in the questioning.
When I think how the defence sat quietly while Miss Smith asked the General Practitioners fruitless questions which fell a million yards from the tree of evidence-rules, I find it hard to stomach. Because it didn’t suit the prosecution to bring parents to give evidence at the hearing, Miss Smith tried to prise parent information from the practitioners. This resulted in questions of this kind: ‘What do you think the mother was thinking when she suggested you referred child x to the Royal Free?’ and ‘Where did the mother get the information from about the work of Dr Wakefield?’ and ‘How had the mother decided that MMR caused the damage to her child?’
I was also concerned last week, by a reference Miss Smith made to the fact that the hearing ‘does have an enquiry aspect’. Is Miss Smith reading our site?
Posted - 09/12/2007 : 13:17:17
| http://www.cryshame.co.uk//index.php option=com_content&task=view&id=69&Itemid=85
An Ongoing Account of the General Medical Council Prosecution for Professional Misconduct Against Dr Andrew Wakefield, Professor Simon Murch and Professor Walker Smith
By Martin J Walker
Dealers in Second Hand Words
Monday September 3rd - Thursday September 6th
"Reading the accounts (of the GMC hearing) whilst in my private prison keeps me riveted, and in part wishing I only had to suffer a year’s tedium and it would all be over - my son would be fine." A parent
A couple of weeks ago I commented on ‘abuse of process’ and pointed out how the prosecution could manipulate both the information of the case and its outcome by delaying or dragging out the hearing. I don’t usually quote my own writing but I have done it here because I have seen my words recently become reality. In my fourth piece on the hearings I wrote:
"Having begun the hearing in July 2007, the prosecution now intends to suspend the hearing until March 2008. It could be argued that having presented the prosecution case, this six month period is likely to consolidate this case in the minds of the Panel. Because there is no sub judicae rules which affect the publication of general and specific information about the charges brought against Dr Wakefield, it could be argued that the medical establishment, the government and the pharmaceutical companies, have now six months during which time they might publicly build on the prosecution case and even move forward with the programme of multiple vaccines."
On Tuesday 28th of August, the prosecution and the defence organised another schedule which entails ending the hearings on August 29th 2008. On the 30th August, those ranged behind the prosecution, by which I mean those linked to the government, the medical establishment, the GMC and the pharmaceutical companies, began a massive out-of-hearing campaign specifically in support of the measles component of MMR. This flurry of amplified campaign material reached the media at exactly the time that Dr Wakefield’s defence was supposed to have begun in the first time-table of the hearing.
One can almost see the cerebrally bloated Professor Salisbury, hunching back into his office, his pride fatally wounded by the defence unwillingness to ask him a single question, picking up the phone, calling the Health Protection Agency and barking out an order for them to produce propaganda. The Health Protection agency organises all the scare stories about vaccination and such things as bird flu as well as all the un-scare stories about other public health matters from mobile phone masts to toxic chemicals in the water supply.
The statement issued by the HPA on August 30th went to all the media and was massively reported by Sky and The Times, both outlets belonging to Rupert Murdoch who over the last decade has worked hand in glove with Tony Blair and New Labour.
On the front page of The Times, a story headed ‘Vaccine warning as measles cases triple’, which included a scientifically educative five and a half inch square picture of a child with a measles rash over his face and shoulders, had a tucked away paragraph about Dr Wakefield.
"The triple vaccine has proved highly controversial in recent years over unfounded concerns that it may be linked to autism. The study that first sparked fears about its (MMR’s) safety is currently being scrutinised in a hearing by the General Medical Council, the medical watchdog. Andrew Wakefield and two co-authors of his research are currently appearing before the GMC on charges of serious professional misconduct."
Apart from the obvious issues raised by this paragraph, especially ‘over unfounded concerns’, and ‘the study … being scrutinised’, when the reality is that three doctors are on trial, it is interesting to note the semantic twist when David Rose talks about the GMC hearing. Andrew Wakefield ceases to be a doctor and the treatment of 12 children, carried out by a whole team at the Royal Free becomes ‘his’ (i.e. Wakefield’s) research.
Dr Michael Fitzpartrick took up the story and ran with it in the Guardian, a paper which is becoming well known as a major outlet for pharmaceutical company propaganda.
"While discussions with privileged parents about the utterly discredited claims of a link between MMR and autism continue in our baby clinics …….."
"Now that the anti-MMR campaign is history …"
Having dedicated a large part of his life to the maniacal Revolutionary Communist Party (RCP) it is inevitable that Fitzpatrick can’t help but draw attention to what he considers class issues; even if in a very superficial manner. His writing is always rhetorical and so founded on personal assumptions that it rarely makes sense when closely examined.
At the end of the 1990’s some 2,000 parents had spoken to lawyers over serious illnesses which had occurred in their children coincident with their receiving MMR or MR. It goes without saying that all of these parents initially believed in vaccination (can you grasp that Fitzpatrick?), they all had their children vaccinated! Obviously they came from across class boundaries. That they believed that their children were damaged by a vaccine and that they then protested but were ignored, says nothing whatsoever about class. To suggest that it is only ‘privileged’ parents who are involved in the arguments about MMR and that working class parents have not fought their corner shows exactly the same contempt for the working class that the RCP showed during its short life as a ‘political party’; amongst ‘privileged’ university students and lecturers.
(The Revolutionary Communist Party, were the only left grouping, to side with the State at the start of the miner’s strike, when pressure was put on the NUM to hold a ballot of members so as to get a ‘democratic mandate’ from the workforce to go ahead with a strike. Although there is nothing wrong with this view from a communist perspective – over the last century, communists have always suggested working within democratic frameworks until they reach a point where they are able to seize power – when the NUM failed to do what the RCP thought correct, the RCP withdrew from any comment, analysis or involvement in the strike. This was not of course a proper political strategy, more like a child taking his ball from a football match after a disputed gaol. What it made me think was that the RCP leadership were inevitably more concerned with ideology than the day to day lives of the working class from whom they contemptuously withdrew their support.)
The situation of the parents whose children may have been adversely affected by MMR, while it has nothing to do with class, has a great deal to do with the power of the State, and what has often been termed the medical-industrial complex. If we approach the situation of vaccination and adverse reactions from a political perspective, it has everything to do with the power of the state to override the wishes of the individual. Such discourses might well leave a nasty taste of libertarianism in Fitzpatrick’s mouth. But surely he knows that his oppressive ideas about state power place him, in the eyes of many, within a collectivist tyranny. A tyranny whereby state power - in congregation with multinational commercial cartels, inimical to individual liberty, demonstrate a complete lack of care for the citizens whose safety it compromises.
The real poverty of Fitzpatrick’s politics and that of his crowd, is shown by the fact that this whole matter could have been resolved along the lines of good ethical and moral principles. Had the government instructed doctors much more carefully on the application of the vaccine and avoided giving it to children who showed the slightest signs of vulnerability. Had they accepted, as they have in the past, that some children are inevitably damaged by vaccination and pledged itself to care for those who were damaged. Had they at the same time kept a high level of pharmaco-vigilance and consistently updated research that might have had a bearing on these adverse reactions, then the whole political complex of the problem could have been quite different. Anyone who thinks that the policy outlined above is subversive of democracy obviously doesn’t deserve to be working with vulnerable people in the public sector.
In his Guardian article, Fitzpatrick makes a point of saying that a measles epidemic has recently been underway in Hackney in East London, and that there have so far been 150 cases in the borough in the last three months. The Times, using emotive statistic-scattered prose, suggests that ‘hundreds of thousands of children returning to school as early as next week may cause the highly infectious disease to spread’. In fact the tripling surge which the Times is referring to seems to have taken place only in Hackney, one of the poorest and most disadvantaged of London boroughs.
Nevertheless, the Health Protection Agency (HPA), Fitzpatrick and The Times, all suggest that the 480 cases so far this year are ‘well on the way’ to being greater than the total annual 736 measles cases reported in 2006. This assertion, however, doesn’t really stand up. An estimate based on figures already disclosed for the first 8 months of 2007, would bring the years cases to around 732, actually less than the total cases in 2006.
While we’re on the subject of statistics, perhaps someone could explain the meaning of the figures in the table for Measles Notification: England and Wales, By Age Groups, 1989-2006, that appears on the Health Protection Agency web-site. This table shows the number of measles cases notified (excluding ones at Port Authorities, to exclude the bias of people bringing measles into the country from abroad) for 2006 as 3,739. Why is this figure almost 3,000 more than the figure quoted by the HPA and repeated in the articles of Fitzpartick and others?
* * *
Given that the battle over the attempts of parents to gain acknowledgement, treatment and care, for children who they believe to have been damaged by MMR, is still insistently proliferated outside the hearing room of the GMC, it is worth looking at the effect such recent propaganda might have on justice for the three defendants. What does accepting the elasticity of the new GMC time-table for the hearing really mean in terms of justice?
Perhaps more important than the fact that the Panel could well be swayed by the constant reference in the media to the guilt and criminality of Dr Wakefield, it now occurs to me that this prolonged delay could actually ‘bury’ both the importance of the initial conflict, the subsequent hearings, and the final verdict - whatever that may be.
There can be absolutely no doubt that while the three defendants are easily winning the ineptly prosecuted legal case, the scientific and public health high-ground will always appear to be held by the government, the NHS and the spinners at the HPA. Even if the three doctors are found not guilty on all counts, a slothful press, bent scientists, pharmaceutical company executives, New Labour aparachiks and a rag bag of Liberals, sceptics and ex-communists will have had plenty of time to convince the general public that the doctors were always guilty.
The possibility of the three defendants being found not guilty, does, however, raises a multitude of questions that the GMC would need to answer about their faux legal processes. It would seem absurd, for instance, were the defendants to be found not guilty, that there was no process available by which the defendants could obtain compensation for the suspension of their lives and their public criminalisation over a period of four and a half years. It would also appear quite wrong that the GMC could get away with this immense charade, involving biased evidence and witnesses who don’t tell the whole story without their being some form of public enquiry into the conduct of this case.
The Death Throws of a Prosecution
As Miss Smith marches the prosecution, lemming-like, to the edge of the cliff, it is becoming more apparent that their case has always been in confusion. When the prosecution began, especially as it was under the auspices of the General Medical Council it was taken for granted that the three doctors on trial were being accused of being bad doctors.
As the trial has dragged on, however, and more especially with the general reluctance of the GMC to bring children or parents to give evidence, it has become more than apparent that none of these doctors have, in any way whatsoever, adversely affected the welfare of their patients. Even the most prejudicial witnesses have been unable to claim this under oath and early suggestions that the doctors put their patients at risk by administering dangerous investigative procedures has been frequently discounted by experienced witnesses called by the prosecution.
Now, after almost two months of the hearing, the ‘butterfly’ case brought by the GMC has alighted on the idea that, actually, science has been the subject of the prosecution all along. The three doctors - and particularly Dr Wakefield - are clearly being accused of bad scientific method. If we look at this situation carefully, we can see that it is as utterly untenable as the prosecution’s first hypothesis.
The pharmaceutical companies and the organisations of corporate science have been looking for ways of disciplining medical scientists who either carry out research in ways that they don’t like or who are ‘alternative’ in their approach to subjects of study. The easiest point of entry for corporate science into the patchy regulatory framework for medical science in Britain, is a politically compromised GMC. The fact that the GMC has eagerly taken up this role on behalf of the government and the pharmaceutical companies, has nothing to do with the suitability or the correctness of it. The regulation of science and scientific enquiry should be conducted by scientists and such regulation should be planned and co-ordinated by a body which is utterly free of vested interests.
With the hearing at the GMC, we face the same question that has always been asked about science and the law; is the court of law a proper venue for deciding scientific matters? Let’s face it, no one on the prosecution side or even those in their train, know anything about science, nor would you expect them to, their number is made up of doctors, lawyers and a journalist.
Still, Miss Smith, whom sometimes you have to feel for, has had the same lack of good fortune in getting her witnesses to say bad things about the scientific abilities of the defendants as she did when she was accusing them of harming their patients. As the case spluttered out last week, and before the next sitting in late September and October, when the re-briefed expert witnesses for the prosecution appear, the Ms Smith called a couple of witnesses who were meant to decry the underlying scientific method of the Lancet paper.
I was away from London on Monday 27, Tuesday 28, Wednesday 29 and Thursday 30 August. There was no hearing on Friday 31 August. Two of the days that I missed were covered by Susan and Olivia Hamlyn and I have included edited versions of their reports below. I have added any of my own comments in italics and labelled them MW. In the first report from Susan Hamlyn, written originally for the campaign internal email list, the mother of ‘child 12’ was named. I cannot do this in my more public account. Doing so would invite criticism from the GMC on the grounds that revealing the name of the child would make him or her vulnerable to prejudicial or damaging enquiries. Of course, as those presently campaigning against the Family Courts will tell you, this secrecy, with threat, immensely aids the prosecution. However, this account is not the place to challenge such usurpation of parental authority by the state and legal profession. I have continued the rule of the GMC hearing in referring to the child as ‘child 12’ and therefore the child’s parent as mother 12.
Mother 12 : August 28
Susan Hamlyn writes
Mother 12 and I last met when our sons were in adjoining beds in the Royal Free way back in Jan 1997 - a crucial time and the one to which most attention was paid today.
I was, of course, surprised that Mother 12 was being called as a prosecution witness. She made it clear to me afterwards that when she was first contacted by the GMC, and even when they visited her to take away documentary material, it was never made clear that she was to be called for the prosecution. She was anxious not to damage the three doctors in any way. She made it clear in her evidence that she had no complaint about any of them and that she and her son were always well-treated at the Royal Free.
MW: Actually bringing a defence witness in the hope that they will give prosecution evidence is even more audacious than Miss Smith’s previous corruption of the prosecution process whereby prosecution inclined witnesses have been allowed to give evidence-in-chief which simply helped the defence.
The day was, in fact, another extraordinarily damp squib. I spent it sitting with Dr Wakefield’s mother who had not been before and who was amazed at how dry, tedious and seemingly pointless it all was.
Miss Smith, began by asking Mother 12 a series of questions to elicit details of her child’s medical history. She established that Mother 12 first heard about AW's work at the Royal Free from another mother at a parent-toddler group. This mother recognized the symptoms - behavioural and gastroenterological - that Child 12 was displaying. About the assumption she made regarding the role of MMR in her son’s case, she had the following to say:
- ‘I had a perfectly normal child who suddenly wasn't normal any more’.
- ‘it (MMR vaccination) was the one thing that had happened to him that could have caused such a change.’
Miss Smith established that Mother 12 had contacted Dr Wakefield directly and not via her GP. She seemed to be hinting at a conspiracy of money-hungry mums who had banded together to get money out of the NHS. She wanted to know how Mother 12 had made contact with Dawbarns and was asked what she had understood the solicitors were doing. Mother 12 answered - 'to stop the MMR - to stop children being damaged by it.'.
Miss Smith then dragged through endless letters between Mother 12, and the Royal Free and between Mother 12 and Richard Barr. Together with these she read out extracts from the Dawbarns newsletters.
It looked throughout as if Miss Smith would have liked to prove skulduggerous links between Dr Wakefield and Dawbarns, in relation to the Lancet paper cases, but everything she read out seemed to demonstrate exactly the opposite - meticulous and scrupulous dealings with everyone from both the Royal Free and Dawbarns.
Miss Smith moved vaguely, as she is always tempted to do, in the direction of suggesting that Mother 12 submitted her son for tests to help with research when they weren't strictly indicated by his conditions. However, Mother 12 defused that insinuation. She said that although she was clearly wanting to support research which might help other children, she hoped that something therapeutic would come out of it for her son.
One potential hiccup was when, apparently, during a ward round a note was made by one of the doctors that child 12 should not have an MRI or a Lumbar Puncture, however, for some reason, both procedures were carried out although no consent form was found for these procedures. Mother 12 did, though, sit with her son throughout both procedures.
Two mildly farcical moments came when, first, Miss Smith noted darkly that one of Mother 12’s letters to AW began "Dear Andy". ‘When’, Miss Smith wanted to know, with all the zeal of a jealous lover, ‘had that mode of address been agreed on?’
The second farcical moment was when Miss Smith quoted an umpteenth newsletter from Dawbarns referring to the fact that they were still waiting for Dr Wakefield to 'deliver the goods' – i.e. come up with a full scientific report. Miss Smith made ‘the goods’ sound like something in a plain brown packet slipped from one hand to another at midnight on Clapham Common.
Much time was spent on a press release which coincided with the Lancet paper and which came from Dawbarns. If Miss Smith was attaching real significance to this, it was yet another point that was never actually brought to fruition.
When Miss Smith suddenly stopped asking questions of this reluctant witness, she had not pushed home any of the points that she had seemingly been moving in on. Superficially at least to the untrained eye, it appeared that absolutely nothing had been achieved by the prosecution.
Mr Miller, for Professor Walker-Smith made a few points in cross examination. He went over the fact that Child 12 was developing normally until his MMR and that, after that, he actually regressed.
He re-established that child 12’s first diagnosis of Autism Spectrum Disorder was made before any contact with the Royal Free and that Mother 12 had taken her child to the hospital in the hope of helping him get better and not to assist with research.
Questions from the panel mainly went back over the same ground covered in cross examination, although one panel member wanted to know whether Mother 12 had applied for legal aid before she had taken her son to the Royal Free for his first appointment. Mother 12 answered that it was 'about the same time'.
The tenor of all the panel’s questions was, again, to establish the research/clinical treatment balance and ultimately, none of them seemed to find it hard to grasp that a parent could desperately want her son to be helped while also being keen to aid research for children in general.
We were told that the witness the following day would be child 8's GP. Unfortunately neither Olivia nor I can attend.
The Funding of Law: August 30th
Olivia Hamlyn writes
This brief and boring day began with the prosecution reading out the witness statement of Deborah Davis, PA to the chief executive of the Royal Free. It had been decided that there was no need to call her to give oral evidence.
The statement dealt with Dr Wakefield’s appointment as honorary consultant in experimental gastroenterology and the terms and conditions on which he was first appointed. However, the exact terms and conditions which were applicable in 1994 had actually been destroyed so the prosecution had to rely on the current terms which, we were told, were very similar. ‘Very similar’ has always been good enough for Miss Smith.
The terms and conditions established that Dr Wakefield would mainly be involved with research and not as a consultant gastroenterologist, he would not see patients in or out of the hospital and he would be exclusively involved in lab-based research.
This evidence having been tendered, Miss Smith asked the panel to rise, so that the counsel could argue over the terms of the next witness's evidence. An hour later, at 11.30am when we re entered the room, we saw Sarah Alwyn sworn in. Alwyn had been a legal advisor to the Legal Services Commission, which she had joined in 1998 when it was still the Legal Aid Board (LAB).
Miss Smith went over the background and procedure for dealing with an application for legal aid and discussed the meaning of a multi-party action, the term used for the MMR case. They went over the criteria for awarding legal aid which included that the cause must have good prospects of success. They then discussed the authorization of use of the money and the things it could be used for, e.g., to facilitate the setting up of Dr Wakefield’s study and to fund a preliminary report from Dr Wakefield.
It was established that the solicitors in the LAB offices had no medical qualifications and relied on the experts found by the law firm when considering whether to award money in this area. Alwyn told the panel that it wasn't the responsibility of the regional LAB offices to look behind the information given by these experts.
The prosecution then went through several letters, which inevitably had been shuffled and placed out of sequence, between Dr Wakefield, Richard Barr and a Miss Cowie of LAB. This sequence of letters ended in 1996, when the first installment of legal aid money was arranged. Miss Smith went on to deal with the second installment.
The prosecution then moved on to 2003 when the legal aid funding was withdrawn. The reason given was that the criteria for payments to the defence case no longer met legal aid requirements, i.e. that the case was no longer considered to have a good prospect of success. Then, the unsuccessful appeal to the High Court Judge. This had been the first time that medical research had been funded by the LAB and it was decided that the Medical Research Council would have been the more appropriate funding body.
MW: This of course is pure nonsense for while it might appear odd for the LAB to fund medical research, it is at least independent of government and not prone to take sides in legal conflicts; they facilitate independent searches for the truth. Moreover they do fund all kinds of independent investigations, from private detectives who search for ‘unknown’ but suspected evidence, to vehicle mechanic experts who research the causes of accidents. The Medical Research Council, on the other hand, has nothing to do with legal cases. It stands four square behind the pharmaceutical companies and the government on vaccination and is incapable of conducting an independent investigation, or grant aiding anyone who might.
There followed some discussion of the names of the children involved and what appeared on their legal aid certificates. It was clear that much data in relation to this matter had been destroyed or lost.
Little interest was shown in the witness either by defence counsel or by the Panel.
Two steady and reliable witnesses
Martin Walker Writes
There was no hearing on Friday 31st of August and it resumed on Monday 3rd of September, by which time I had returned.
On Monday, and then on Tuesday, the prosecution brought what might have been in any other prosecution some heavy-duty witnesses However, as has become the norm in this case, both witnesses turned out to be more Airsoft guns than heavy artillery.
Mr Tarhan was the Finance officer at the Royal Free Medical School during the relevant period in the 1990’s and Dr Susan Davies the Consultant Histopathologist at the Royal Free during the 1990s.
Mr Tarhan’s name had cropped up on occasions during the hearing, in relation to the cheque from the legal aid board. He turned out to be a very solid and professional witness, although this was not to the credit of the prosecution.
As the Deputy finance officer and then the finance officer at the Royal Free throughout the 1990s, Mr Tarhan had ended up as the Managing Director of the business arm of University College London. In the 1990s, many universities, charities and patient organizations which were involved in research, tried to enter the market and capitalize on the findings of their researchers.
In his capacity as MD of the new business set up by UCL, at that time called Medical Marketing International, Mr Tarhan was able to speak about the patent which was taken out by Dr Wakefield on measles transfer factor. The prosecution line on this was, as always, cloudy; perhaps because they failed to look independently at the matter and as in much else, went down the deer-track.
The deer-track on this matter was simple; Dr Wakefield was accused of being a capitalist. As a research doctor, hell bent on making private profit, he had developed ‘a vaccine’ apparently for measles, in forceful competition to the major multinational drug companies. Had this fiction stopped there, it might just have appeared plausible – if a little comical. However, Deer’s contention was that Wakefield’s vested interest and the development of his own vaccine was one of the main reasons for his so called ‘anti-vaccine’ stance. Of course at the end of the day, Deer’s narrative involved more plot turns than the Bourne conspiracy and though, like the films it was initially exciting it turned out to be utterly implausible; not too bad for a film but pretty defeating for a legal case.
In both the matter of transfer factor and the LAB cheque, Tarhan gave evidence which reflected entirely on his professionalism rather than on Dr Wakefield’s supposed criminality. Tarhan came across as a steady, wide shouldered and responsible accountant, he cast Dr Wakefield, from what he had heard, as a good doctor and research worker with a youthfully impatient and slightly anarchic approach to financial systems and accounting. Although Tarhan seemed to look quite fondly on his working relationship with Dr Wakefield, he was obviously disturbed by what he saw as his gung-ho approach to finance.
As for the assertion that Dr Wakefield tried to make a personal profit from manufacturing a vaccine in competition to the multinational drug companies, it became clear during Mr Tahan’s evidence - and that of previous witnesses - that firstly, this was not a vaccine against measles, but a therapy that might ameliorate the adverse effects caused by measles vaccine; that Dr Wakefield had actually sought partnership with pharmaceutical companies to develop the therapy and finally that all profits from the patent, had it become a viable product, would actually have gone to the Royal Free Medical School.
In the event, Mr Tarhan told the panel that the business arm of the Royal Free was not happy with the product, because it had not been proven to work and was too risky to back until it had been. It also appeared to be contentious and therefore a poor business risk.
In relation to the cheque from the legal aid board, the worst that Mr Tarhan seemed to say about Dr Wakefield was that he had failed to send to the finance department any pro forma or note which detailed the nature of the project that the money was intended to cover. This might have appeared lax, though not criminal, had it not been for the fact that Mr Coonan (counsel for the defence) produced a letter from Dr Wakefield to Dave Wilson, Mr Tarhan’s senior. The letter informed Mr Wilson of the account that the cheque was to be paid into, provided other details, and ended by asking him to get in touch if he needed any further information about the cheque and the use to which it should be put.
Apart from this, Tarhan also suggested that it had irked him when he discovered that Dr Wakefield had failed to fill out a receipt for the money, using the receipt book held in the finance department. Well, you know what they say about accountants…? When I put this point to Dr Wakefield in a conversation, he said with the evident bemusement of a research scientist, ‘How was I to know there was a receipt book in the finance department? I did send Richard Barr a receipt but it was just a straightforward written one on headed note paper.’
When Miss Smith took Tarhan through his evidence-in-chief, she clearly wanted to make it appear that Wakefield had taken out the patents on transfer factor, in order to make profit for himself. With the most reliable air, Tarhan disputed this. In fact although Dr Wakefield, exasperated with the time it might take, had moved to take out two patents himself, Tarhan was quick to point out that they were taken out either in the name of Free Medic as the UCL business venture was then known, or the Royal Free Medical School.
At his most vehement, Mr Tahan insisted that while this was not illegal or illegitimate in any way, he did wish, like all administrators, that Dr Wakefield had kept him in the loop. He knew that Dr Wakefield and Professor Roy Pounder had both incurred personal expenses in employing lawyers to lodge the patents; that neither of them stood to gain from the patents and that any revenue that they generated would go to a charity.
Ghengis Tarhan acquitted himself well as a witness, the way that he distanced himself from the prosecution while remaining slightly critical in his own lights of Dr Wakefield, gave his evidence considerable integrity.
Dr Susan Davies and the Syntax of Honest Evasion
Dr Susan Davies, was, from the beginning, a difficult witness for the prosecution to handle. She had been the Consultant Histopathologist at the Royal Free between 1992 and 2002 and was now working at Addenbrookes Hospital, Cambridge.
Unlike so many of the male witnesses who seemed to be wearing work-a-day suits, and slightly down-at-heel shoes, Dr Davies verged on glamorous. I was particularly struck by her three-quarter length frock-coat made out of a shiny metallic material which gave her the look of an eighteenth century man-about-town. On the two days that she gave evidence, she wore this coat over a very large- print full skirt decorated with a bold pattern in red and black.
In the event, Dr Davies was to need all the security and reassurance she could get from the ‘performance’ clothes that she seemed to have picked after some consideration. She appeared as a witness for two days and some of her exchanges with Miss Smith, showed the rather brittle nature of Miss Smith’s ritualistic courteous legal manner. It wasn’t that Dr Davies was obviously unhelpful in answering Miss Smith’s questions, but apparently frightened of giving the wrong response to Miss Smith’s sometimes confusing questions, she often replied with multiple choice answers, ensuring that she covered all the bases; and more.
It was easy to see why Miss Smith came close to losing it on a number of occasions, though difficult to have much sympathy for her as she tried to drag the very professional Dr Davies into a mire of incriminating allegations, which would have had Dr Wakefield ‘fixing’ his research results.
As the consultant histopathologist in the paediatric gastrointestinal department, Dr Davies was responsible for preparing and presenting all the samples which were taken from the ‘Lancet paper children’ (and many other children treated at the Royal Free in the gastroenterology unit) during the clinical investigations that determined their diagnosis and treatment.
In one of those incredibly boring reviews of all 11 Lancet children, Miss Smith dragged Dr Davies through each case in some detail. This time however, we were no longer concerned with where the children came from or from whom they were referred, instead we followed each one through their histology reports presented by Dr Davies in the Friday meetings.
For a whole day we remained utterly oblivious, as it appeared did Miss Smith, to where Miss Smith was taking the witness. Apart from the occasional emphasis on cases which did not appear to fully fit the criteria for the Lancet paper, each case passed by embedded in the most baroque detail but without any apparent fault attached to it.
On the second day of Dr Davies’s evidence-in-chief, everything became as clear as Miss Smith is able to get, which is, on reflection still pretty opaque. Despite the fact that there were showers of sparks that briefly illuminated unnecessary investigative procedures etc., the prosecution had two planks to its case. First, it was suggested that between first provisional diagnosis and later writing up in the Lancet, some of the diagnostic pictures had been changed to fit more exactly the conclusions of the paper. Reflecting upon this, one can see it as the closest the prosecution gets to the charge of ‘research fraud’; a charge which the GMC would no doubt have loved to bring against Dr Wakefield.
Second, the prosecution suggested that Professor Murch and Dr Davies had been so concerned about the recorded diagnostic outcome of the Lancet cases they had instigated a review of the cases (of Dr Wakefields work) which was carried out by Dr Davies.
As always appears to be the case with Miss Smith’s assertions, both these propositions came to naught as they were disassembled during Mr Miller’s cross examination. The explanation of the first matter of the ‘shifting’ diagnosis, gave us a rare insight not just into the mechanics of clinical research but into the way in which imagination and intellectual problem-solving lie at the heart of this creative process.
When Dr Davies and the defense council explored this area, one began to see clearly why it is important not just for the defendants, but for the future of medicine, creativity and culture that we understand what separates the constipated word-crunchers such as Deer and the mercenary legal pedants like Miss Smith, from a medical researcher of Andrew Wakefield’s caliber.
An erudite and intellectual explanation for the metamorphosing diagnosis which changed between the initial base line crude report and the more detailed consensual diagnostic picture which emerged at the end of the histology process was explained by Dr Davies. When the children arrived at the Royal Free they carried with them the diagnostic notes from a local GP or consultant, this was a base line diagnosis from someone who was not necessarily a specialist in the child’s condition, and who had little comparative material by which to contextualize them.
Following the child’s stay at the Royal Free, a number of more complex investigations and case history explorations, the diagnosis became more complex and specific. In the last analysis, the complex diagnosis written up in the ‘case review’ was produced after all the cases had been reviewed together looking for common themes and ‘brainstorming’ or leaping between cases and seizing on common threads and connected factors that might join one to another.
There are of course many ‘scientists’ with petrified brains who might feel that this process is quite criminal and amounts to sorcery rather than science. However, it is in this imaginative area, that real developments tend to be made in science.
The Murch-Davies review was conducted, according to Miss Smith (and initially Dr Davies!) because both doctors felt concerned about the results of the Lancet cases. The matter was resolved relatively speedily in cross examination. Explained correctly, it exposed yet another howler that Miss Smith had presented, having trustingly been led up the deer-track.
After some perceptive cross examination by Mr Miller, who in another life must have been adept at prising stones from horses shoes, it was agreed by the witness and council that the review which Dr Davies had carried out, was not of the Lancet cases at all, but of another group of cases for a quite different paper!
Once again, we did not have to await the evidence of the defendants before the paucity and nakedness of the prosecution case was revealed. I think that the only real worry of all the defendants, should now be that when it comes to the presentation of the defence case, council for the defence dizzy at hearing defence evidence consistently given by prosecution, forget themselves and present the prosecution.
Bringing Medicine into Disrepute or the ‘I Should Coco’ charge
The last day of the prosecution case, before the three week break organized by the GMC so that the prosecution can re-tutor its expert witnesses, was Wednesday September 6. The prosecution used the morning of the 6th to show an incredibly poor quality video of Dr Wakefield brightening up a lecture on IBD by telling a few jokes about how he gained control-group blood samples from children at his son’s birthday party.
What strikes me about this final charge on the prosecution calendar, is that it strikes at the very heart of professional, medical and legal culture. Both lawyers and doctors have always told interesting and funny stories about their experiences and their patients. There is of course a reason for this, the everyday experience of both doctors and lawyers, brings them into contact with death and disease, murder and mayhem, these abscesses on the human soul have to be balmed and soothed, this is done with humour, strange tales and surreal stories.
What of course does bring medicine into disrepute is the marketing and prescription of drugs like Vioxx which kill 30,000 people or the shameful and continuous prescription of HRT which results in breast cancer and heart disease. Even more so than these examples, is this present GMC hearing which is blatantly trying to censor original scientific research at the behest of the government and pharmaceutical corporations. This hearing isn’t bringing only medicine into disrepute but democracy and government … yes I know it’s difficult to imagine that anyone could do the latter.
But then perhaps this particular charge says more about the GMC and the politics of medicine than all the other charges put together. The GMC obviously intends that we live in a world not just free of choice over vaccination but where it is a crime to make fun of doctors, scientists and medical apparachiks. Just like the industrial bourgeois of the nineteenth century the humour-challenged plutocrats of science hate anyone reminding them of their unregulated history in quackery and illegal experimentation; and god forbid you joke about medicine.
Fundamental Attacks on the Independence of Science
The case brought against Jayne Donegan by the GMC was a calculated attack on the right of defendants to bring independent expert evidence to court. Like the Wakefield, Murch and Walker-Smith case, the case illustrates the GMC acting well beyond it’s remit in attempting to stifle independent scientific thinking. Where the GMC picked up this prevailing idea that as the regulatory body for doctors, they have the expertise and authority to arbitrate on matters of science, God - or Dawkins - only knows.
One thing is certain however. These contemporary cases show that the GMC, in the face of very serious criticism over the years, is now hell-bent on taking the lead in the regulation of scientific and medical method. This bid for power and authority well beyond their competence will not be stopped until the scientific community intervenes and takes these bourgeoning powers out of their hands.
Apart from anything else, the legal form which the GMC has hijacked is utterly unsuitable for resolving arguments about scientific method. But as with all other interventions in this field, the interests behind the GMC are the multinational pharmaceutical companies and other corporate interests that have been trying over the last twenty years to bend the regulation of science away from qualitative approaches and towards quantitative methodology. Towards the laboratory and away from the person.
* * *
A journalist I was speaking to the other day, suggested that the Sunday Times was about to send Brian on a social skills course. I must say that he does have a funny way about him. On the last day of this part of the hearing, we were shown the video of Dr Wakefield speaking at a conference. Predictably the large screen suspended from the ceiling over the heads of the public and press was not working. Being appraised of this I settled myself down next to a tiny monitor in the corner of the press section of the public gallery, meant I think for GMC staff to keep an eye on the hearing.
Brian, who on many days is my constant and only companion in the hearing room, came in a little later while Miss Smith was introducing the video. I must say I find this closeness can be quite disturbing it’s as if we were participants on a Big Brother set. I am always fearful that, banged up in such a small space together, I might develop some variety of Stockholm syndrome and feel a desire to engage in serious conversation with him.
When Brian came in and saw that I was in the press section where he had thought of sitting, he seemed to snort and veer off, sitting instead below the large suspended defunct video screen. I thought that he was probably anticipating that it would come to life when the video began. Not wanting him to miss his big moment, I tried to attract his attention by quietly calling his name. On the third call, he turned his lugubrious but stony face slowly in my direction without actually looking at me. It was as if his attention had been drawn to something on his shoe which smelt. I whispered, to the inattentive side of his face, ‘That screen isn’t working’, at which he turned his face slowly back to Miss Smith as if I was invisible and unheard. When Miss Smith began running the video and it dawned on Brian that it wasn’t showing on the screen above him, he jumped out of his seat and ran headlong out of the hearing room for the Press Room.
I was surprised at Brian’s reaction to me. Why is he so distrustful? Not at all the ‘hail fellow well met’ approach that has been common amongst most journalists and writers in past times.
The Case of Dr Jayne Donegan; Abused by the GMC
Supporters of Dr Wakefield, Professor Walker-Smith and Professor Murch, were happy to hear of the result of another case brought by the GMC against Dr Jayne Donegan in mid-August. Dr Donegan had found herself dragged into the vaccine debate and then attacked by the government and the medical establishment when she gave expert evidence in a court case. The problem was that she gave expert evidence which was independent of government dictate and in contemporary England you are likely to be put on trial, or in a ducking stool, for doing this. Aubrey Blumsohn has posted a very clear piece about Dr Donegan’s case on his web site (www. scientific-misconduct.blogspot.com Aubrey Blumsohn 8/31/2007 12:50:00 AM). I have summarized the main content of it below.
Dr Donegan MBBS DRCOG DCH DFFP MRCGP is a medical doctor and family practitioner. She also has some interest in homeopathy. She graduated as a medical doctor at St Mary's Hospital Medical School (London) in 1983. It is reported that she is an excellent doctor. Donegan is however one of several medical doctors in the United Kingdom who holds views about science that have led to selective disciplinary/"fitness to practice" procedures (FTP) by the General Medical Council.
Dr Donegan's ‘sin’ was precisely to do with the science of conventional medicine. She testified in an important court case in which mothers and fathers differed in their views over whether their children should be vaccinated. Two witnesses for the fathers provided a view that would have pleased the Department of Health. Donegan provided testimony for the mothers. She provided a detailed scientific report which concluded that a perfectly rational parent making a decision about vaccination for their own child might well have some valid fears about the integrity and strength of the underlying science. For her sins, Jayne was subjected to a lengthy Fitness to Practice Procedure.
The stated charge was that she had written a medical report about the underlying science for the court that:
Gave false and/or misleading impressions of the research which you relied upon.
Quoted selectively from research, reports and publications and omitted relevant information.
Allowed your deeply held views on the subject of immunisation to overrule your duty to the court
Failed to present an objective, independent and unbiased view.
... and having done so, Dr Jayne Donegan was charged with serious professional misconduct, and with bringing the profession into disrepute.
Unfortunately for the GMC Donegan presented overwhelming evidence to back up the science she had presented to the court, leaving the distinct impression that all three opposing experts should actually have been placed in her position. The GMC had no choice but to clear her of all charges. 24 August 2007).
The case appeared to have been brought by the GMC itself, and as far as I am aware there was no complainant. Her report was challenged by "GMC expert, Dr Elliman" who produced a supposedly objective evidence-based report on Donegan's report. Donegan's report had in turn challenged expert reports produced for the fathers.
Posted - 10/11/2007 : 14:52:08
An Ongoing Account of the General Medical Council Prosecution for Professional Misconduct Against Dr Andrew Wakefield, Professor Simon Murch and Professor Walker Smith
By Martin J Walker
Expert in What?
The First Expert Witness for the Prosecution
September 27th to October 3rd
The social network beyond the hearing - the medical establishment, the government and the pharmaceutical corporation - used the two week suspension to good effect, taking the opportunity to make a number of statements about the guilt of Dr Wakefield. It sometimes crossed my mind to wonder why the medical establishment and the government don’t simply announce the guilt of the three doctors, without all this legal palaver; after all, everyone in the country knows that Dr Wakefield is guilty, even if they can’t quite remember what of.
During the recess, the JCVI took the opportunity to announce their decision to look at the possibility of adding chickenpox vaccine to MMR. This announcement was not only a great opportunity to enforce the obvious point that multiple vaccines were perfectly safe but also to rubbish Dr Wakefield and his ‘discredited’ idea that MMR is solely responsible for every case of autism in the known world (authors sarcasm).
The idea of the inclusion of chickenpox vaccine was floated on the usual raft of the numbers of deaths caused by this viral illness. No illness is too insubstantial to be called into the service of the vaccination programme. One hopes that when, some time in the near future, Big Pharma introduces its vaccination for male pattern baldness, with the argument that this disfiguring illness kills thousands of men and women annually, the British public might wake from its somnambulist trance. As one of the papers remarked:
"Chickenpox is a highly contagious virus. It is effects are usually mild in children. However, it is more serious for adults and can sometimes be fatal. It causes about 20 adult deaths in England and Wales each year."
One of the major concerns, according to the media, was that the vaccine could cause shingles later in life when the body's naturally immunity weakens. It was also suggested that certain groups have already argued that children are at risk of being 'over-vaccinated' and that their immune system can be overwhelmed. Anonymous ‘doctors’, however, speaking through the media ‘reassured patients that this is almost impossible’; which is a bit like almost being a safe pedestrian but being knocked down and killed by a car.
Even the most ardent critic of conspiracy theory might have been set thinking by the comments offered on the Radio 4 ‘Today’ programme by Sir David King, the Chief Scientific Adviser to the government. After talking about the vaccination programme and the possibility of joining a fourth viral strain to MMR, King injudiciously made the point that Dr Wakefield’s ideas have been discredited and that he was guilty of research misconduct.
Inevitably there was no mention of King’s conflicts of interest, or of his various connections. King is a member of the Science Advisory Group of the Science and Media Centre, the organisation set up by the rabid rationalists Dr. Michael Fitzpatrick (ex-revolutionary communist) and Lord Dick Tavern (the pharmaceutical company lobbyist, insurance sales-man and ‘political’ buddy of millionaire Lord Sainsbury (New Labour benefactor and ex-science Tzar). The Science Advisory Group is directly funded by, amongst other sources, the Association of British Pharmaceutical Industries (ABPI). King is also closely linked to the Royal Society, which despite its fabulous historical reputation has been completely overtaken by mercenary commercial interests which have made science in contemporary British society resemble a flea market run by the Russian Mafia.
These are the same people who destroyed the professional life of Dr Arpad Pusztai the Rowett Institute researcher, whose research concluded that genetically modified potatoes damaged the health of mice fed on them. A full scale campaign of lies distortion and planted stories was run by Royal Society members, guided by staff under the instruction of Lord Sainsbury at that time head of science policy and a major figure in the bio-genetic industry who had tried to introduce Monsanto’s genetically engineered crops into Britain without any public discussion.
During his interview on the ‘Today’ programme, King suggested not only that Dr Wakefield was guilty, but that the Royal Society had long had a code of ethics for scientists which covered the declaration of conflicting or vested interests.
What King did not make clear, was that this code of ethics had only been launched in 2007, a good ten years after the events presently being mulled over by the GMC. Nor did he explain the aetiology of this code, which was actually helped on its way by those with commercial and ideological interests at the Royal Society.
The Royal Society has, over the last decade, been keen to adopt new regulatory codes in relation to science, such as the code of practice drawn up to stop non-scientists commenting on science in the media. This little gem attempts to ban personal stories about illnesses, therapies or medicines and rules that medicine and health might only be discussed in terms of double-blind, placebo-controlled trials and written up by scientists, or science journalists. If you have ever wondered why, in 1996, 1997 and 1998, British newspapers were full of the personal stories of adverse reactions to MMR while now, ten years on, it is almost impossible to draw attention to the condition of the MMR children, you need think no further than this regulatory code (See Brave New World of Zero Risk).
The idea for developing such a universal ethical code of conduct for scientists came out of a 2004 Carnegie meeting - a regular informal meeting of science ministers and advisers from G8 countries - and was moved forward in Britain by Sir David King and the Council for Science and Technology (CST), the UK Government's advisory body on science and technology policy issues. Discussion at the Royal Society resulted in their report ‘Rigour, respect and responsibility: a universal ethical code for scientists’, and in January 2006, the CST published the findings of its consultation. The Code was officially unveiled at National Science Week in March in 2006.
The idea that this code of conduct is universal and will apply to pharmaceutical companies, should be used as one of the main jokes in the next red nose day. Especially as this charity raises money for Africa, a continent very close to the hearts of many pharmaceutical companies.
Headlines announcing the code trumpeted, ‘Code Sets Out to Regulate Science’. It called, news reports said, for rigour, honesty and integrity among scientists, who should take steps to prevent corrupt practices and professional misconduct and declare conflicts of interest. Scientists should ensure that their work is lawful and justified, and they should ‘minimise and justify any adverse effect’ their work may have on people, animals and the natural environment. Which, when you think about it, is a load of bunkum.
Not only do pharmaceutical and chemical companies kill, maim and torture millions of animals in toxicity trials, but it is generally recognised that pharmaceutical drugs are still going through extended experimentation when they are prescribed to the public. On top of this, pharmaceutical companies are entitled to keep secret their trial documentation in order to safeguard the competitive profitability of their products. And what does the code say about giving legal protection and financial rewards to whistle blowers in industry?
On 13 March 2007, ‘following a successful pilot among Government scientists’, Sir David King issued a challenge to the rest of Government and the wider scientific community to adopt the Code
Approaching the GMC building on Thursday 27th September, the day the hearing began again, Anthony Gormley’s nude male statue which stares into the GMC building and is mirrored by the same figure on the inside looking out, reminded me of my age and the fact that human beings get rusty as time passes.
Returning from the recess was a little like returning to school after the holidays. The fact that everyone is in the same place as they were before we went home, that the same faces are apparent, lent the proceedings an air of surreal intractability. I got the sense that perhaps these people had been here while we were away, in a frozen tableau.
Arguing against this idea was the fact that Miss Smith seemed to have had her hair done - although I couldn’t put my finger on exactly what she had had done - and Dr Wakefield was not present. Dr Wakefield had decided that the fourteen month-long trial was interfering with his work in America, where he is still working with other doctors helping children with serious IBD and autistic conditions.
Arriving just on time on the Thursday morning, an apparently new and insistently officious young man behind the GMC reception refused to open the doors to the hearing for me until I signed in. Not wanting to miss any of the proceedings, I said that I would do it at lunch time, but he still refused. This increased the feeling that I was returning to school after the holidays.
Inside the hearing room, a cold sun streamed through the glass walls. The first submission of Thursday morning was an apology for the absence of Dr Wakefield. Following this, like a music box gradually turning to the right speed, everything returned to normal, the first witness was introduced and Miss Smith began again her indefatigable and relentless repetition of the prosecution case. This time she was getting Professor Sir Michael Rutter to agree with her various concerns about the way that the children had been treated, or the way in which the three doctors had lapsed into research when they were supposed to have been dealing with the children clinically.
Professor Rutter is a tall, thin man with broad shoulders and white hair which surrounds his balding pate, like the gaseous circle round Mars, but curling up at the back. As time goes by - for Rutter is to be in the witness chair for almost a week - he begins to drape himself over the witness chair, his sharp knees almost touching the underside of the table and his arms on occasion dangling down the side. Also, as time goes by, he proves to be an affable man, not at all officious as might befit his place in the academic and clinical hierarchy. He is also seemingly fit and full of energy. He presents himself as likeable and fair minded.
Professor Sir Michael Rutter, qualified in medicine ultimately specialising in autism, with a particular focus on the nature of the psychological aspects characterising children with autism. He is a psychiatrist who has spent some 20 years on the ethics committee at the Maudsley Hospital. Miss Smith makes a point of revealing that he was primed as an expert witness for Merck in the claim for compensation taken by the parents against the MMR manufacturers. Rutter in turn makes the point, quite strongly, that the case never actually got to court. Why he feels this makes his conflict of interest in this case any less potent he doesn’t tell us.
At the end of his evidence, when it is suggested by the Chairman of the Panel that he ‘acted for’ the pharmaceutical company in the compensation case, he bridles at the term, telling the Panel that he was an independent expert. One presumes that experts for the claimants might equally lay claim to such independence?
With the possible exception of Professor Zuckerman, Rutter will turn out to be the first real witness for the prosecution. He is an ideological witness, one who is not giving evidence to fact, but rather, agreeing with the prosecution critique of the behaviour, the methods, the language and the professionalism of the three doctors being tried.
In fact the use of Professor Sir Michael Rutter as an expert witness in this case does lead one to speculate about the nature of expert witnesses. While it cannot be denied that Professor Rutter is an expert on the psychological aspects of autism, this is not the subject of his evidence. He was to end up giving expert evidence, with a broad brush, on the work of the whole gastrointestinal department at the Royal Free. This, despite admitting at least three times during his evidence, that he knows nothing about gastrointestinal medicine. Perhaps even more oddly, at the end of his evidence, he assures the Panel of one thing; he cannot criticise the gastrointestinal work carried out in the department and his view in sum, is simply that the neuro-psychiatric aspect of the ‘work up’ on the children was lacking.
This is not something that the defence would wish to argue about. In the main, the majority of the children had already been diagnosed with a disorder on the autistic spectrum before they arrived at the Royal Free. The authors of the Lancet paper, despite title changes, were quite definite about what they were writing about; a new syndrome which linked inflammatory bowel disease (IBD) to various behavioural disorders, the onset of which appeared, anecdotally to coincide with their children’s MMR or MR vaccination.
Any hope that Miss Smith has spent the two week break practising her courtroom manner in front of the mirror, or her husband, are dashed when she begins taking Professor Rutter through his evidence-in-chief. Unlike those expensive automobiles advertised as going from 0 to 60 mph in 10 seconds, Miss Smith does the opposite; slowing almost to a stop after her first few words have reached the back of the room.
Through Thursday, Friday and the whole of Monday, Miss Smith presented, for the third time, the whole of the prosecution case; turning from her reading every ten minutes or so to let the Professor reassuringly nod his acquiescence. Rutter was equally uncreative in the presentation of his evidence. It was as if Miss Smith and he were in a three-legged race, both completely of one mind. Rather than elaborate on the various pillars of the case, Professor Sir M simply agreed wholeheartedly, and sometimes enthusiastically, with the propositions put by Miss Smith.
‘It was odd’, he agreed, to this and that. ‘It certainly wasn’t the way he would have done it’, he shook his head, to that or this. Miss Smith segued into a repeat trawl through the cases reported in the Lancet paper, and those who had been present throughout the whole hearing looked fearful of the boredom which was about to descend. After discussing ethics committee approval, Miss Smith picked up each case one at a time and travelled through referral, hospital induction, invasive procedures - particularly in respect of lumbar puncture - lack of consent for, and lack of notes with respect to, involvement in research.
Miss Smith bore witness to the howlers, sins, crimes and simple gaffes of Dr Wakefield, in the measured voice of a teacher explaining advanced calculus. I don’t know how Brian felt but I have to admit that by Friday mid-day I was tinkering with the idea of becoming an alcoholic. It was on Friday, while I was being mesmerised by the boredom of Miss Smith’s presentation, that the Kama Sutra came into my mind. As my thoughts languidly turned over, I tried to envisage Miss Smith presenting this text and others. I concluded quite quickly that any text would suffer the same fate, its juicy, sensual resonance sucked out of it and replaced by dry spiritless air.
I should not perhaps be so critical of Miss Smith, her brief is hopelessly lacking in substance and she must be hard pressed to turn her instructions into poetry or to exhibit her so far well-hidden legal skills. Even on some of the more purple charges, such as the illegitimate use of lumbar puncture as a diagnostic aid, Miss Smith found it difficult to make her point with a flourish. This was mainly because on the whole, even those witnesses most ardent to please, like Professor Rutter, could not agree that it was entirely wrong to use lumbar puncture as an aid to diagnosis on some children whose illnesses fell within the autistic spectrum.
In some senses, I also felt sorry for Professor Rutter as he was frog-marched through the prosecution case. This expert witness was not really being used as an ‘expert’. Rather he was being asked simply to add his weight to the prosecution. Perhaps the panel and others might have gained considerably from hearing Professor Rutter talk about autism, rather than see him perform like a nodding dog in the back of Miss Smith’s almost empty charabanc.
Miss Smith’s overview of the prosecution case which Professor Rutter gave his affirmation to, consisted of a wide range of issues, which I will list here as well as I am able:
Was the consideration given by the local research ethical committee thorough enough when it passed ‘the protocol’ for ‘the study’?
(I have put ‘the study’ and ‘the protocol’ in inverted commas because as we shall see later there is a conflict over whether ‘the study’ that is given ethical approval, is actually the Lancet case series review.)
Did the children fit the pattern determined by ‘the protocol’ passed by the ethical committee?
How many of these children actually had regressive autism or childhood disintegrative disorder?
Had the Royal Free correctly determined regressive autism or childhood disintegrative disorder?
Did all the children actually have autism?
How many of these children have bowel problems?
How many were in or out of time for the study?
Were the children seen in order to follow a research protocol or were they seen for clinical treatment on the basis of clinical need?
Were the invasive investigations justified? Or more simply, because Rutter was unable to talk about endoscopy, were lumbar punctures justified?
If the children were being clinically investigated, why were some conditions, such as the high lead levels in three of them, not followed up; or not followed up as far as Rutter was able to determine, with the select papers he had been given?
Most specifically, should lumbar puncture be used in clinical or research investigations on children with autism?
Were the children properly referred from GPs to the Royal Free, or had Dr Wakefield intervened in this process and ‘cherry picked’ the subjects? Why had Dr Wakefield been involved in obtaining referrals anyway?
Why was it repeatedly mentioned by parents and then, even though unproven, repeated later, that many of the children had apparently become ill coincidently with their MMR? Nothing, in Rutter’s view, disclosed the unscientific nature of Wakefield’s work more than this constant anecdotal reference to MMR.
Was there ethical approval for biopsies and samples taken from the children during the investigations?
Was Dr Wakefield guilty of making clinical decisions, which his contract with the RF specifically forbade?
Why was there such a substantial lack of psychological investigation?
Did Dr Wakefield have a conflict of interest, which should have been disclosed in the Lancet paper when acting as an expert for the claim against the MMR manufacturers?
Was it right to give one child a treatment which was at that time untried and not tested (This refers to the use of Transfer Factor)?
Finally, was it unethical to give children £5 for blood samples and was it unethical to take these samples at a children’s birthday party?
Rather than comment in any depth on each aspect of the prosecution case above, I would like to address a number of more general points which were important in Rutter’s evidence.
Certain matters are not deemed worthy of comment by the prosecution. One such matter is the real, rather than prosecution-sanitised, condition of the children and the crisis of coping and caring which the parents were, and still are, faced with daily. An understanding of the severity of the children’s condition is absolutely essential to a realistic understanding of the work of Dr Wakefield in the mid 1990s. We have not however, been given any indication of the real condition of the children by the prosecution.
Equally, at every turn, any mention of MMR or adverse reactions to vaccination is reduced to anecdote and the correctness of scientific scrutiny is juxtaposed with parents’ apparently hysterical stories about the agony of their children after vaccination.
In fact, the corporate scientific establishment has been working hard for a decade, to expunge from the public culture the experiential narrative of people who suffer either environmental illness or adverse reactions to medical procedures or pharmaceutical drugs. The replacement of personal observation, human experience and subjective narrative, with the collective, rational narrative of scientific study is a complex phenomenon. One which I am not equipped to even begin discussing here. It is a subject that has, however, begun to dominate descriptions of illness in post-industrial society.
What it means for the subject is that the personal voice is no longer recorded or listened to. Taking this to its logical extreme, it might appear that, in the future, it will not be just the subjective discussion of illness which will be censured, but all matters of personal feeling. While the conflict taking place, between the feelings about our bodies and the rationale of science, has been rolling along since the end of the eighteenth century, its contemporary manifestations can be disturbing. This is why anyone who has experience of an autistic or regressively autistic child, who they believe to have been affected by vaccination, must make the most of presenting their subjective and experiential view of that child and their dealings with him or her.
The denial of subjective experience in environmental illness, or adverse drug reaction, began in the mid-eighties when individuals suffering from environmental illnesses were made the butt of jokes and ridiculed when they described how their bodies were responding to modern toxins. The early ‘quackbuster’ organisations consistently disputed the reality of such things as food allergy, saying that it was a mental aberration. Now twenty years on, we find that British society has some of the highest recorded rates of food allergy in the world. The same can be said of chemical sensitivity, now recognised by some of the leading medical authorities. Corporate medicine has consistently denied the environmental aetiologies of illnesses caused by chemicals for the last twenty years.
Perhaps the most central case, which is raised consistently in my mind during the GMC hearing, is that of Myalgic Encephalomyelitis (ME) or chronic fatigue syndrome (CFS). Quackbusting groups have singled this illness out for the last two decades, denying any organic aetiology and arguing that subjective recognition of it is due to mental disorder rather than an organic or biological condition.
In order to prize ME from the hands of the psychiatrists and psychologists, activists have argued for years that each patient needs a thorough bio-medical work-up which will throw light on the medical nature of the illness. Perhaps the most interesting matter brought to light by Rutter’s evidence, which reflects on this social, medical and political conundrum, is the fact that we see at the end of his evidence that he is really opposed to the idea of biomedical work-ups for children with autism - an idea woven into Wakefield’s approach. When Rutter disputes the biomedical basis of regressive autism he is defending a neuro-psychiatric position which some would say has stymied progress in medical research for the last half-century.
The third point I would like to make about Rutter’s evidence relates to the fact that it has become clear to me during the hearing, that the prosecution is utterly unwilling to take into account the weaknesses and difficulties that beset NHS general practitioners (GPs). Rutter made the point consistently, that referral letters from GPs to the Royal Free Hospital were often inadequate in their descriptions of the presenting child’s symptoms and conditions. There are clear reasons for this, the first being that GPs are general practitioners and most of them found themselves overwhelmed by reports of specific gastrointestinal symptoms about which they had absolutely no expertise.
Perhaps more pertinent, it must be said that Dr Wakefield and the gastrointestinal team at the RF cannot realistically be held responsible for the general inefficiencies of the NHS. GPs rarely have sufficient time to analyse complex medical conditions. If this manifest lack of time is conjoined with a lack of knowledge of the problem under review and a lack of consultants in the immediate geographic area, it is more than understandable that, under pressure from parents, they quickly passed the children to those who were deeply involved in this particular problem at the Royal Free.
My final comment is intimately linked to all those above. Miss Smith has persistently presented this case against the three doctors as if it were an academic exercise in which all parties had the money, the time and the knowledge to progress steadily with an examination of the cases. Underlying the assumptions of the whole hearing is a devastating critique of the three doctors on trial. The prosecution is saying that had it not been for personal and mercenary motives of the three, this public health blip would never have occurred; that it wasn’t real but generated by a small group of people who knew nothing about autism, its causes or its origins.
It is as if the prosecution is accusing the doctors of being soldiers involved in a small incident during a major battle. While the majority of the military were concentrating on trying to gain ground and push forward against considerable opposition, these three combatants had turned on their own troops, killing a number of them with friendly fire. The truth of course is massively different. To use the same analogy, the whole of the forward moving army was actually at rest, apparently happy with the job that they were doing, while one unit, at an advanced post, was fighting a desperate battle with the enemy that threatened to over-run it.
While the whole of the prosecution case has settled on the children reported in the Lancet paper, no one has made mention of the fact that in the five years between 1993 and 1998 hundreds of parents made their way to the gastrointestinal unit at the Royal Free. They went there often with their own determination, because this was the only collection of doctors in the whole of the UK who were dealing with the public health crisis which had occurred following the introduction of the various MMR or MR products after 1988.
All these points, I am sure, will come out during the presentation of the defence case. I feel a need to introduce them now because they were seriously omitted from the prosecution case and the evidence of Professor Sir Michael Rutter. The central matter of the denial of the experience of both parents and children, is perhaps the most upsetting aspect of this case and I feel that there will never be enough space or time to bring this tragedy to the surface.
The Deconstruction of Professor Rutter
The repetition of the whole of the prosecution case, together with Rutter’s pleasant, discursive and sometimes jokey presentation made me feel profoundly despondent during Thursday, Friday and the following Monday of the resumed hearing. It wasn’t that the prosecution case appeared any stronger than it had previously; it was just that, like a Chinese water torture, the constant drip, drip, drip, of repeated allegations made the defence look vulnerable. And of course, there was the matter of feeling isolated and vulnerable myself, when for those three days the only other person in the public ‘enclosure’ was Brian.
Never, however, has the saying, ‘every cloud has a silver lining’ been more apt. By the end of Tuesday October 2nd, I was feeling privileged to have observed one of the best cross- examinations it has been my fortune to see. During the 1970s when I was attending court cases regularly in different capacities, I had the honour of working on a number of occasions with Michael Mansfield now a QC. Some of his cross examinations of Robbery Squad detectives linger still in my mind, as no doubt will Mr Hopkins’ cross examination of Professor Sir Michael Rutter.
There is a sense of utter finality, even at the beginning of good cross-examination. The cross-examination itself is not just a hunt, but more dramatically, the denouement represents the last spring of the chase which fixes the opposition to the ground. The art of cross examination is not just apparent in the measured contesting of the damaging points made by the witness, but in the ability of counsel to ‘shut the witness down’; to hold the witness in an immobile position.
Mr Hopkins, acting on behalf of Professor Simon Murch, did just this, and with sublime competence. Whenever Professor Rutter tried to wander off into muck-spreading arguments, Hopkins descended on him with an ‘I think you have misunderstood the intention of my question’ or a quietly spoken but forceful ‘That’s not the point I was making’. From 9.45am, when Hopkins rose to begin his cross-examination, until 1.00pm when he finished, he completely controlled the witness. Quietly but with a focused intent, he tied Rutter up and de-experted him.
In terms of argument, what Hopkins was able to do was to make it clear to the panel that much of what Professor Rutter claimed during his evidence-in-chief was little more than personal opinion. Perhaps even more exactly, it was personal opinion heavily biased towards the neuro-psychiatric axis of the arguments around autism.
He began his cross examination by rescuing Dr Wakefield from the isolated corner into which Professor Rutter and Miss Smith had painted him. Hopkins made it clear that there were actually four hospital departments involved in the clinical work of caring for the children who attended the Royal Free. That there were a number of ‘responsible consultants’ making decisions from day to day about treatment and investigations.
In effect, Hopkins re-introduced the earlier evidence given by prosecution witnesses which had aided the defence. For almost two months we had listened to evidence which constructed the collective work of general practitioners, consultants and finally whole hospital departments. Listening to the description of this construct, and understanding the work in its social and professional context, it became increasingly difficult to imagine that Dr Wakefield, Professor Murch or Professor Walker Smith could have been acting at all improperly, let alone as a small isolated immoral conspiracy.
Although Hopkins laid siege to each strand of Rutter’s evidence, his strategy was most pronounced when dealing with the matter of lumbar punctures. From the beginning the prosecution has made the case that the use of lumbar puncture, as a diagnostic aid on children, especially children with any kind of autistic disorder, is an abomination akin to torture. Rutter, however, when speaking on lumbar punctures, was at best a reluctant witness. At his most transparent, he was happy to admit that in cases of disintegrative disorder or regressive autism lumbar puncture was necessary in order that encephalopathy could be confirmed or disregarded.
It was apparent that Rutter was concerned at having made this admission and he tried to lessen its force and its use to the defence by claiming that next to none of the cases in the Lancet paper could be shown to have a disintegrative disorder and in other cases lumbar punctures should not be used as a general investigation.
Very gradually, Hopkins introduced papers to the tribunal from Professor Chris Gilberg who has carried out clinical research in Sweden. Hopkins described him as having been an expert in autism for 33 years and pointed out that in the mid 1990s Gilberg was considered a leading authority. But unlike Rutter, Gilberg was in favour of using lumbar puncture.
Hopkins took Rutter through a series of Gilberg’s papers all of which advocated the use of investigations including lumbar puncture. Rutter began contesting Gilberg’s work, suggesting that he had made a number of mistakes in his career, having evinced arguments which had proved to be wrong or fallacious. This defence came across as the expression of professional jealousy and not as scientific evidence.
Hopkins turned the ratchet up a notch with each paper which he put to Rutter. As the papers mounted, so did their authority and so did the number of authors who favoured the use of lumbar puncture as a primary biomedical investigation. Besieged, Rutter was thrown back on the odd argument that while this might be the case in the rest of the world, in Britain it was not considered an acceptable practice.
Gradually, Hopkins began to develop a more important argument relating to the legitimising of bio-medical investigations. By introducing the idea of the medical work-up in cases of autism, he made it apparent that there was, is and historically always had been a serious conflict between two schools of thought on the diagnosis and description of autism. These two schools are on the one hand those who believe in an almost entirely psychiatric approach and those who believe that a whole battery of biomedical investigation should be carried out in an attempt to find a medical explanation of autism. While neither of these schools of thought was exclusive, the psychiatric partisans had held sway almost without argument for the last thirty years. This school was, in fact, only now beginning to accept that there might be environmental factors involved in autism. But while Gilberg cited the supposition that one in three cases were based upon a ‘medical’ condition, Rutter would agree only to a possible one in ten ratio.
Some individuals who support the non-medical paradigm for autism, however, still argue vehemently that there are no environmental factors involved, first amongst these people are those who support the pharmaceutical and vaccine industry, such as those in Sense About Science, like Michael Fitzpatrick.
One of the biggest problems for the biomedical school, is that, because pharmaceutical drugs and vaccines count as environmental factors, the school faces an apparently unlinked but powerful opposition. There are similarities here again with ME. The biomedical school, which advocates a wide range of biomedical tests for those presenting with ME, face major opposition, not just from the psychiatric school, but also from the chemical companies whose toxic environmental products and processes might be a contributory factor in some cases.
While presenting Gilberg’s papers, Hopkins drew attention to one of Gilberg’s primary suggestions, that there was a serious lack of comprehensive biomedical work-up in autistic cases. The gap between Gilberg and Rutter, and therefore between the Royal Free team and an entrenched psychiatric view of autism, was obviously considerable.
Following the Gilberg papers, Hopkins moved on to deal with a few more of Professor Rutter’s expert views, such as his half-hearted support for the inclusion of bowel pathology in diagnosing cases, and more simple things, such as his views on the patient consent form used by the Royal Free team.
At the end of Mr Hopkins’ cross examination, it was difficult to imagine that the panel had not received the message that Professor Rutter was far from independent in his view of Dr Wakefield’s research. I personally felt like clapping. It seemed then that whatever matters Miss Smith brought up, it would be extremely difficult for her to resuscitate her expert witness. It was also difficult to envisage what further damage Mr Miller, acting for Professor Walker-Smith, might do to Rutter when he cross-examined him.
At 2.00 pm on the same day, Mr Miller got to his feet. Of the three barristers, Mr Miller appears on the surface to be the most chatty and sympathetic. However, having seen him in action it is easy to understand that his introductory bonhomie is simply a distraction. It was never more so than in his dealing with Professor Rutter. After the exchange of a few pleasantries, Mr Miller plunges straight into the heart of his cross examination. This plunge was like the descent of a cage taking miners down the pit. His voice took on an edge which the tribunal has not previously heard.
Mr Miller puts it to Professor Rutter that the case-series reported in the Lancet is not the study ‘172/96’, which he and Miss Smith have made the core of the prosecution case. As the argument developed, with Mr Miller putting it to Professor Rutter that the children in the Lancet paper had clearly been treated on the basis of clinical need and not as research subjects, for the first time Rutter’s response became uncertain. He said, ‘My impression is that this is research’.
Mr Miller was positively cruel in his repost, ‘This is the danger of poring over the documents!’ This comment struck at the very heart of the shaky prosecution case and revealed what appeared to be a massive schism in both the prosecution reasoning and the paper work. Miss Smith, who has been placidly reviewing notes, and Mr Owen, her junior, suddenly re-engage with the hearing, both looking slightly stunned.
Mr Miller drove his point home. In answer to Rutter’s assertion that the children do not represent a homogeneous group, like good research subjects, Mr Miller replies, ‘No one ever went out to look for these specific types of children’.
And on the matter of the research consent forms which Professor Rutter and the prosecution have been adamant are missing from the patient notes, Mr Miller was again scathing. ‘You also say that there are no research forms in the children’s notes; was this because there was no research?’
When Professor Rutter realised what had happened, I would not have been surprised if he had addressed Miss Smith with the words, ‘This is another fine mess you’ve got me into’. To his credit, however, Professor Rutter seemed to suffer the cross-examination in good heart, he continued to protect the prosecution case while sounding almost as if he recognised that, for the moment at least, he was on the losing side.
Keiran Coonan did not cross examine Professor Rutter and it seemed at the end of the day almost as if Dr Wakefield’s work was not at issue. By Professor Murch and Professor Walker-Smith sharing responsibility for the whole department, the defence had reinforced their point that the programme for the treatment of children at the Royal Free had been undertaken by a wide variety of individuals and specialists.
So there we had it. Research project 172/96 was actually a quite different project from the clinical work that had generated a review of 12 consecutively referred initial cases. Cases seen at the Royal Free on the basis of clinical need. Once this had been exposed, one could not help wondering how Miss Smith could continue with a large part of her prosecution. One also had to wonder what the defence had left to throw at Professor Rutter on the next day’s cross-examination. Professor Rutter now appeared to be an expertless expert. He had been softened up by Mr Hopkins and then knocked out by Mr Miller. All the counsel on the defence table seemed to finish their day with eyes averted from prosecution counsel and the expert witness as if embarrassed by the enormity of the prosecution’s mistake.
The Day After the Debacle
If anyone thought that Tuesday’s revelations would radically affect the prosecution case, they were seriously disappointed on the Wednesday. The hearing continued as if what had been said yesterday was just another point to argue.
During Wednesday morning Mr Miller effectively mopped up those issues which had been left open after Mr Hopkins’ cross-examination on the previous day. He spent some time going over each of the cases, disproving the prosecution case that the majority of the children reported in the Lancet paper had been referred to the Royal Free without mention having been made of them having any kind of bowel disorder. It turned out that only in two cases was there what I referred to in my notes as a ‘slightly lacking reference’ to bowel disorder. Like many of the other prosecution points, under scrutiny, this conflict turned to steam and hot air, once placed.
At the end of cross-examination by the defence, Rutter’s entire case lay in tatters on the floor, and he was left repeating an earlier criticism that ‘the investigations were done without consulting with the other specialists (the psychiatrists and neurological specialists)’. Making the point even more specifically, he said, nearing the end of his cross examination, ‘follow-up is lacking on the neurological, psychiatric side. My criticisms are on the brain side and not on the gut side’.
With this final criticism it appeared, to me at least, that the whole case for bringing Professor Rutter as an expert witness was brought into question. To hear Rutter say that he had no criticisms of the gastrointestinal side of the work, but only the lack of psychiatric and neurological aspects of research or patient care, was to invoke the words of Mandy Rice Davies in the trial of Stephen Ward, ‘Well, he would say that wouldn’t he’. There can be little doubt, however, that this personal and professional bias is very far away from anything even vaguely resembling damning, or even ‘expert’ evidence.
For almost the first time during the hearing, I felt privileged to be present and grateful for seeing the legal art practised as completely and as exquisitely as one always hopes is possible.
During her re-examination, Miss Smith did her best to put the deconstructed Professor Rutter back together again, but one sensed an almost tired reluctance on Rutter’s part to be paraded round the stadium a second time. Even Miss Smith was unwilling to go through every argument which was necessary to push the case back into project 172/96 and so reserved her re-examination on this matter to a couple of perfunctory questions. This conveyed the impression of someone carrying on a rearguard action to defend a bridge that had already been blown up and fallen into the ravine, leaving the defender with no escape route.
Within a quarter of an hour of Miss Smith beginning her re-examination I was falling asleep again. Her voice came to me from a considerable distance, out of my hearing, like white noise in the background. In fact, I had heard what she was saying so many times before that, like a hypnotic auto-suggestion, as soon as she repeated the words, my eyelids began to fall and my head dropped to one side.
Next week, beginning slightly later than usual, the prosecution’s second expert witness, Professor Booth gives evidence. It appears that he might be more robust than Professor Rutter because he is an expert in gastroenterology. Following Booth, there will be a quick appearance of another expert - an immunologist - before the prosecution finishes its case. The hearing will resume again in the New Year.
* * *
On Monday October 1st, a cockroach was observed strutting around the base of the tea and coffee dispenser at the GMC. I wasn’t there for the aftermath of the discovery, but I have been told that after it was found, a cluster of lawyers and doctors from the hearing went into a huddle. After a long and sometimes heated discussion it was decided by all concerned not to report this public health threat. The doctors were concerned about being struck off following a four year wait for a fitness to practice hearing. The lawyers feared being taken before the bar council on the grounds that they had brought the GMC into disrepute by spreading alarum and despondency.