The case against Dr Andrew Wakefield: Part 2

In my previous post I gave an account of all the other charges against Andrew Wakefield who is currently before the General Medical Council on charges of professional misconduct. The main ones are:

  • that he published inadequately founded research
  • that he failed to obtain ethical committee approval for the work
  • that he obtained funding for it improperly
  • that he subjected children to “unnecessary and invasive investigations”

Source.

In this post I’ll look at the latest allegations.

On 8 February 2009 the Sunday Times printed the third part of an investigation by Brian Deer into the activities of Wakefield. According to Deer, “Wakefield changed and misreported results in his research”. The notorious paper, which was published in the Lancet in 1998, involved twelve children. According to the paper’s Table 1, eleven of these children had chronic non-specific colitis and most of these also had something called reactive ileal lymphoid hyperplasia. Only one of the twelve children had no such problems.

Table 2 shows the neuropsychiatric diagnosis for each child. Eight children have the word ‘autism’ as the only diagnosis. The same table shows that in eight children (including six of those diagnosed as having autism) the first manifestation of behavioural symptoms occurred soon — no more than a fortnight — after they had the MMR vaccine, according to their parents or doctor.  Says Deer:

In most of the 12 cases, the children’s ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.

Wakefield’s right to respond

The first bone of contention, it seems, is whether Wakefield was given sufficient opportunity to respond to these very serious allegations before the Sunday Times went to press. Deer’s main article quotes Wakefield’s lawyers as saying that, because the case is still before the GMC, it would be

inappropriate for Dr Wakefield to give a detailed response to you. He has denied the allegations and gave a detailed response over many days to the GMC panel.

The lawyers’ letter is on Deer’s website here.

Interestingly, Wakefield is now saying something rather different. In spite of his lawyers saying it would be “inappropriate”, Wakefield has since produced a 58-page response to Deer and dressed it up as a complaint to the Press Complaints Commission. On page 2 he claims he was given less than 24 hours to respond and that this was insufficient time to consult his lawyers and get the papers needed to “formulate a proper and thorough response.”

That sounds fair enough — but Wakefield isn’t naive. He knows the Sunday Times is a newspaper not a tribunal and there wasn’t a dog in hell’s chance that it was going to include a “proper and thorough response” in the same issue. The best he could hope for was the inclusion of a couple of quotes from him denying it. We are not told whether Wakefield demanded the right to make a proper and thorough response or, indeed, any kind of response in a subsequent issue of the paper. Did he even write a letter for publication? I’ll hazard a guess that he didn’t because if he had made such a request and it was refused, we would have heard about it. It’s not as if he and his supporters will miss any trick to help maintain his martyr status.

The uselessness of the Press Complaints Commission

A complaint to the Press Complaints Commission sounds all official and important but, as most people in the UK know, it isn’t. The PCC has no legal powers. It has no power to impose financial penalties or award compensation. Complainants have to be satisfied with factual corrections and apologies. I’m not suggesting these aren’t important but, from the newspapers’ perspective, it’s just a slap on the wrist. They don’t lose much, if anything, by it.

According Nick Davies’ Flat Earth News, over the last 10 years, the PCC has received 28,227 complaints from the public. Of these, the PCC refused to consider ruling on 25,457 of these, rejecting just over 90% of them on technical grounds without them ever investigating the substance of the complaint.

Of the ones that were rejected, nearly 1,000 were rejected because they were not made quickly enough, nearly 2,000 were rejected because they were made by third parties and nearly 7,000 were rejected because they didn’t fit within the PCC’s code. Many others were rejected because they were not ‘formalised’ by the complainants.

Only 2,770 were accepted for investigation (less than 10% of those made). Most of these (2,322) were miraculously resolved by the newspapers (by issuing an apology or clarification) when the PCC accepted the complaint. This leaves just 448, 1.6% of the total that the PCC were forced to adjudicate on.

The PCC rejected over half (251) of these, leaving just 197 of the 28,227 complaints made that were upheld by the PCC — that’s 0.69% of the total.

Anyway, it doesn’t take a genius to work out that the PCC need do nothing with Wakefield’s complaint until the GMC have ruled and that won’t be for several months yet. The PCC are not even qualified to consider much of the information in Wakefield’s complaint and he damn well knows this. If they accept the complaint for investigation, they surely will be guided by the GMC. And if the GMC rules in Wakefield’s favour, then Wakefield will be vindicated, regardless of any complaint to the PCC.

That Wakefield has put his complaint on his website for all the world to read is clearly intended to divert attention away from the allegations by smearing the person making them. Rather ironic coming from the martyr himself.

Deer’s ‘conflict of interest

Wakefield and his supporters make much of what Wakefield describes on page 2 of his complaint as Deer’s “undeclared interest” in the outcome of the GMC hearings. This allegation is pathetic and brings to mind what the judge said in Wakefield’s abortive libel action against Deer that I drew attention to in my previous post. Here’s the court report and this is what the judge said,

(Wakefield) chose to issue these proceedings and to use them, as I have described above, as a weapon in his attempts to close down discussion and debate over an important public issue.

Wakefield’s argument, if I understand it correctly, goes like this:

P1. Deer made a complaint about him to the GMC.
P2. Deer wants the GMC to uphold the complaint.
C: Therefore any report Deer makes will be biased.

“Failure to have disclosed this conflict to readers of the Sunday Times is misleading,” whines Wakefield.

A bit like failing to disclose you’re being funded by lawyers or failure to disclose that some children in your study were included because their parents are involved in litigation, right?

This ‘reasoning’ — for want of a better word — is being repeated all over the web by Wakefield’s supporters and was also promulgated in The Spectator by that spectacularly biased and as mad-as-a-box-of-frogs hack, Melanie Phillips.

Unfortunately, this one’s a non-starter as a far as the PCC is concerned. The PCC Code of Ethics upholds the right of journalists to be partisan.

Assuming, for the moment, that Brian Deer did complain directly to the GMC about Wakefield…so what? Why exactly would that then preclude him on reporting any further on this case? Evidently Wakefield’s supporters think that, no matter how well Deer can support his allegations, the public should not be allowed to know about them.

As Deer himself says,

Of course, it’s understandable that he wouldn’t want me to continue. Although journalists supplying their findings to statutory regulators is a conventional occurrence, and could never prevent them from continuing their inquiries, having developed my expertise to be able to penetrate his activities, he would wish I moved on to pastures new [as do I]. For years he had preferred columnists, celebrity chefs and music critics, who, in ignorance, just write what he says.

In my opinion, Brian Deer should have made a formal complaint to the GMC and I think that if I were in his shoes I would have done. If, Deer did make a complaint to the GMC, he did what any responsible citizen in possession of the information he held would do. Then again, as a journalist working for a top newspaper, who’d been able to reach an audience of potentially millions just by writing about what he knew, it wasn’t actually necessary for him to complain to the GMC to bring about Wakefield’s demise and their solicitors have made it pretty clear that, under GMC rules, Deer’s status can only be that of informant.

As stated in Peter Swain’s letter to you dated 16 December 2004, your role in this matter is that of ‘informant’ rather than ‘complainant’. This is due to the fact that the conduct of the practitioners in question has not affected you directly and clearly involves issues of a wider public interest.

A few days ago, Sally Smith QC, told the GMC hearing,

I should remind you that the prosecution has been brought solely on the instructions of the General Medical Council. Mr Deer is not the complainant.

In any event, it is clear that if  Deer hadn’t complained, someone else would have.  As was reported at the time, the then Health Secretary, John Reid, called for an enquiry and Wakefield responded thus:

Health Secretary John Reid has called for a public enquiry. I welcome this since I have already called for a public enquiry that addresses the whole issue in relation vaccines and autism. It has been proposed that my role in this matter should be investigated by the General Medical Council (GMC). I not only welcome this, I insist on it and I will be making contact with the GMC personally, in the forthcoming week.

The libel suit against against Deer, the ST and Channel 4

By the way, on page 2 of Wakefield’s complaint he says,

I was forced to abandon my action for libel, after an interim ruling in the High Court ordered that it had to run concurrently with the GMC case, which my lawyers advised was physically impossible.

Really? So why did he send Brian Deer a cheque and why hasn’t he sued Deer for writing this on his website?

After threatening to sue for libel over Deer’s revelations, Andrew Wakefield was ordered by the High Court in London to put up or shut up. When his legal advisers studied hundreds of vital documents, including children’s medical records, however, Wakefield took the only reasonable course: and shut up. In January 2007, he abandoned his meritless claims against Channel 4, The Sunday Times and this website, and compensated Brian Deer for his personal costs.

Time lag between the MMR and the first symptoms

This is weird. On page 3 of his complaint, Wakefield quotes Deer’s article, the bit where he says,

(The Lancet paper) claimed that the families of eight out of 12 children attending a routine clinic at the hospital had blamed MMR for their autism, and said that problems came on within days of the jab.

Wakefield asserts that this is “factually inaccurate” and refers us to this quote, which appears on page 2 of the Lancet paper.

In eight children, the onset of behavioural problems had been linked, either by the parents or by the child’s physician, with measles, mumps, and rubella vaccination. Five had had an early adverse reaction to immunisation (rash, fever, delirium; and, in three cases, convulsions). In these eight children the average interval from exposure to first behavioural symptoms was 6.3 days (range 1–14).

Um…hello? Can anyone see a difference between what is in the paper and what Deer wrote?

The new syndrome

Similarly, in response to Brian Deer’s comment that,

the team also claimed to have discovered a new inflammatory bowel disease underlying the children’s conditions,

Wakefield counters,

This is also factually inaccurate. Nowhere in the Lancet paper is such a claim made. (see paper)

OK, let’s look at the paper.

We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction.

In what way is this materially different from what Deer wrote? I challenge anyone to put that sentence from the Lancet paper into language that makes it suitable for publication in a newspaper and to do a better job than Deer has done.

The abortive libel suit

In my previous post I drew attention to the fact that Wakefield had tried to sue Deer only to later abandon his claim. According to the court report, the judge said,

(Wakefield) chose to issue these proceedings and to use them, as I have described above, as a weapon in his attempts to close down discussion and debate over an important public issue.

In his complaint, Wakefield claims,

I was forced to abandon my action for libel, after an interim ruling in the High Court ordered that it had to run concurrently with the GMC case, which my lawyers advised was physically impossible.

Frankly, I can’t be bothered with this.

It may be that there is some truth somewhere in the 58-page complaint to the GMC. It may be that Wakefield successfully refutes Deer’s most recent allegations. But judging from the nonsense on the first couple of pages, I’m not holding my breath, much less bothering to plough through the rest of his complaint.

Unlike Wakefield’s supporters, who’d made up their minds before Wakefield even circulated his response, I am content to leave that judgement to the GMC.

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