MMR - SCIENCE AND FICTION": the Richard Horton story 25 September 2004
Response to
Re; Richard Horton, editor of the Lancet -new book

John Stone,
London N22
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Re: "MMR - SCIENCE AND FICTION": the Richard Horton story

 Richard Horton's new book is evidently an attempt to set the record
straight for a wide readership: I found a stack of copies at our local
bookshop so there are evidently thousands of people out there hanging on
his words.

The book begins with the meeting on 18 February 2004 in the Lancet offices
in which Sunday Times journalist Brian Deer challenges the Lancet, Andrew
Wakefield, and members of the original Royal Free team John Walker- Smith
and Simon Murch with a series of allegations most of which are quickly
shown to be unfounded. The one remaining allegation which was left hovering
above Wakefield and was to prove the basis of the media trial which ensued
in the following days, was that he had failed to disclose a potentially
embarrassing conflict of interest. It is strange in this context that
Horton does not mention the letter that Andrew Wakefield wrote to the
Lancet (published 2 May 1998) in which Wakefield first dealt with the
matter publicly:

"A Rouse suggests that litigation bias might exist by virtue of information
he has downloaded from the internet: from the Society for the Autistically
Handicapped. Only one author (AJW) has agreed to help evaluate a small
number of these children on behalf of the Legal Aid Board. These childen
have all been seen expressly on the basis that they were referred through
normal channels (eg, from general practitioner, child psychiatrist, or
community paediatrician) on the merits of their symptoms. AJW has never
heard of the Society for the Autistically Handicapped and no fact sheet has
been provided by them to distribute to interested parties. The only fact
sheet we have produced is for general practitioners, which describes the
background and protocol for the investigation of children with autism and
gastrointestinal symptoms. Finally all those children referred to us
(including the 53 who have been investigated already and those on the
waiting list that extends into 1999) have come through the formal channels
described above. No conflict of interest exist."

So, what Horton does not tell us here is that this matter had been made
public and had been known by him since May 1998 and had not hitherto - in
nearly six years - been considered embarrassing. It remains extraodinary
that there is no mention that I can see of this letter in Horton's book
until p. 50, where it appears rather incidentally in Horton's account of an
exchange between Dr Evan Harris MP and the proprietor of the Lancet Crispin
Davis at the Commons Science and Technology Committee on 1 March 2004.
Davis tells Harris:

"You can imagine that it is virtually impossible for every editor to
research every single author in terms of conflict of interest, and in this
one Dr Wakefield said there was no conflict of interest, and in fact three
months later in written form repeated that there was no conflict of
interest. In all fairness, I do not hold our editor to blame...",

and again Davis is quoted on p.51 reiterating:

"It actually says: 'There is no conflict of interest'. Should the editor

Without going into the full context of what Davis is claiming it seems
extraordinary, at least, for Horton to quote Andrew Wakefield's statement
that "there is no conflict of interest" so completely out of context.

The other critical point to be made here was that Andrew Wakefield was
legally correct in stating that there was no conflict of interest. In
defending herself against a parellel claim made in Private Eye (19 March
2004), Professor Elizabeth Miller - presumably with the best legal advice -

"there can be no conflict of interest when acting as an expert for the
courts, because the duty to the courts overrides any other obligation,
including to the person from whom the expert receives the innstruction or
by whom they are paid".

Interestingly, Horton quotes from this very same letter p. 56, but not this
bit of the letter. This legal view was also given by barrister Robert
Hantusch in a letter to the Times of 24 February 2004:

"But the courts do not consider that the engagement of someone to act as an
expert witness in litigation has the effect that that person is then
biased. Indeed, if this were the legal position, no paid professional could
ever at any time give evidence to a court"

There are therefore two key points here which Horton's book would seem to
disguise: (a) that Andrew Wakefield's involvement in the court case had be
known by him and not considered embarrassing for nearly six years and (b)
that engagement as an expert witness is not generally regarded as
constituting a conflict of interest. To disclose such an involvement may be
sensible but to disclose it as "a conflict of interest" might suggest that
you were compromised in court.

I note that Richard Horton has not been so super-sensitive to other cases
of non-disclosure which I have recently documented on these boards
concerning the Lancet, Eric Fombonne [1] and Michael Pichichero [2].

[1] Prof Fombonne, Dr Horton and the Lancet: double standards on competing
interests , 12
September 2004

[2] Thimerosal - a case of non-disclosure in the Lancet ,20 August 2004.

Competing interests: Parent of an autistic child

"MMR - SCIENCE AND FICTION": the Richard Horton story II 27 September 2004
John Stone,
London N22
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Re: "MMR - SCIENCE AND FICTION": the Richard Horton story II

 In his account of the meeting at the Lancet offices of 18 February 2004
Richard Horton recounts (p.5):

"There the concensus ended. Wakefield admitted that he had been
commissioned by the Legal Aid Board to conduct a pilot study on behalf of
parents of allegedly MMR-vaccine-damaged children. Some of his colleagues
claimed that he had not disclosed this fact to them. Simon Murch and John
Walker-Smith were visibly shocked by this revelation."

The only colleagues present according to Horton's earlier narrative (p.3)
were Walker-Smith, Murch and Peter Harvey. You might think that however
embarrassed Murch and Walker-Smith were - given the present professional
pressures - they could scarcely have been shocked by the revelation of
information which had been in the public domain since 2 May 1998 (see my
previous post of 25 September 2004). In his statement to the Lancet, 6
March 2004 Walker-Smith states:

"None of the children at the time of the referral was known by the team of
paediatric gastoenterologists who cared for and investigated these children
to be involved in a pilot project commisioned by the Legal Aid Board. At
the time of the consultation, I was aware that some of the parents were
engaged in legal proceedings."

Interestingly, neither Walker-Smith or the ten contributors to the original
1998 report (including Walker-Smith) in their joint statement also in the
Lancet of 6 March 2004 makes the claim that Andrew Wakefield witheld
information from them. If there was any disagreement after Wakefield's
letter of 2 May 1998, it has also never come to light.

Perhaps, what is most significant is the apparent extreme motivation to
find irregularities after the event. Thus Horton writes (p.4-5):

"It was true, however, that the referral of some of these children had been
unusual. They had not simply turned up at the Royal Free by chance. Some of
the parents knew of Wakefield's interests and his prior view that measles
was somehow linked to bowel disease."

What would have been odd is if they had all been referred to a chiropodist.
This is surely a skewed narrative.

Competing interests: As above
"MMR - SCIENCE AND FICTION": the Richard Horton story III 30 September 2004
John Stone,
London N22
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Re: "MMR - SCIENCE AND FICTION": the Richard Horton story III

 Richard Horton tells us little about Sir Crispin Davis, Chief Executive of
Reed Elsevier plc, publishers of the Lancet, except to give an account of
his evidence to the Commons Science and Technology Committee (1 March
2004). It may be of some interest that Sir Crispin was appointed as a
non-executive director to the board of GlaxoSmithKline - defendants in the
MMR litigation - in July of last year.

Sir Crispin's knighthood was announced in the birthday honours, June 2004.

Competing interests: As above
"MMR - SCIENCE AND FICTION": the Richard Horton story IV 1 October 2004
John Stone,
London N22
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Re: "MMR - SCIENCE AND FICTION": the Richard Horton story IV

 Richard Horton writes rather disparagingly about the pharma/bio-tech lobby
organisation, chaired by Lord Taverne [1], Sense about Science remarking

"Unfortunately, Sense about Science has allowed itself to become an easy
target for attack. Its financial donors include GlaxoSmithKline, one of the
manufacturers of MMR vaccine and a defendant in the litigation brought by
claimant families. Among the forty-five people who make up Sense about
Science's board of trustees and advisory council, there are Lords (five),
Knights (seven), Professors (fifteen), luminous Fellows (fourteen),
distinguished doctors (twelve), a Baroness and a Dame."

Richard Horton does not mention that among the "distinguished doctors" is
Michael Fitzpatrick [2], a regular columnist in the Lancet. In the issue of
the Lancet of 21 February 2004 - the very weekend that Richard Horton
decided to throw Andrew Wakefield to the wolves - Michael Fitzpatrick wrote
a polemical piece on the Government's promotion of choice in healthcare:

"Nor is the continuing promotion of choice going to be much help in the
ongoing struggle to improve uptake of the measles, mumps and rubella (MMR)
vaccine, given the government's - entireley legitimate - refusal to allow
parents the choice of separate vaccines." [3]

At no time in all this controversy has Michael Fitzpatrick declared the
Sense about Science-GSK link as a competing interest, he did not on this
occasion, and Richard Horton has taken no public action against him.


[1] See Rapid Responses to Dick Taverne 'The legal aid folly that damages
us all' (24 July):

[2] See also Rapid Responses to Michael
Fitzpatrick 'George and Sam'(26 June 2004):

[3] 'Choice',The Lancet, 21 February 2004, vol.363 no 9409.

Competing interests: As above
The New Science Fiction best seller! 1 October 2004
Carol Johnston,
Carshalton, surrey
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Re: The New Science Fiction best seller!

 Reading John Stone's comments on Mr Horton's book. One wonders just how
far can "poetic licence" be applied to stretch the truth. Indeed it seems
by reading Mr Stone's version of events this book surely belongs in the
category of "Science Fiction".

Perhaps Richard Horton would like to reply regarding Mr Stone's version of
events and explain the anomolies with the versions in his book?

I for one would be very interested to hear what Mr Horton has to say.

Also reading Brian Deer's response I would like to query his choice of
words in referring to the MMR litigants as "highly-motivated" in their
allegations about MMR. Of course they were highly motivated, their children
became severely disabled following MMR. What parent would not be "highly
motivated"? I wonder what thoughts were crossing Mr Deer's mind whilst he
was sitting at the back of the Case Management Hearing in July, listening
to the harrowing and emotional accounts of each parent as they each
recalled their own personal set of circumstances. Does he really believe
that the parents are pursuing this purely for financial gain? The most
pressing reason why the parents are pursuing the litigation case is for
research to be re-instated which will provide answers as to just what
happened to these children and indeed children like mine who have regressed
after having MMR. My children regressed in 2000 and 2001 and indeed, is
still happening.

How does Mr Deer and Mr Horton account for the presence of the measles
virus in the guts and brain stem of these children, the onset of symptoms
such as mutiple seizures, autistic behaviours, loss of previously acquired
skills and bowel disease following MMR.

Does Mr Deer honestly believe that because the UK MMR litigants were
referred to Dr Wakefield as part of the trial, are sufficient grounds for
dismissal of his clinical findings?

Incidentally, Dr Wakefield has my greatest respect not only as a doctor and
a scientist but as a person who believes in his work.

I reckon, if Dr Wakefield were to publicly retract his findings he would be
richly rewarded and welcomed back into the UK medical/scientific/political
fold like a long lost prodigal son. If he was a lesser man he would indeed
retract his findings like many others have already, but perhaps he belives
in something that alot of the scientific community seemed to have
overlooked in the bid to prove that the MMR is safe. That is "TRUTH".

Something has happened to these children, so far in all the furore over the
smearing of Dr Wakefield's the medical community have neglected to look at
these children to offer a valid reason as to why these children and
thousands of others like them have regressed and become severely disabled
following MMR.

If the supporters of MMR are so sure that the MMR is innocent of a role in
these children's illnesses then why have they not examined these children?
Why do they not prove Dr Wakefield wrong with solid clinical science, not
with epidemology, spin, character assassinations and smear campaigns.

I have never had the pleasure of meeting Dr Andrew Wakefield but I would
like to thank him for the personal sacrifices both he and his family have
made in the pursuit of the truth.

Rather than being above all this, it seems that Mr Horton is stuck- fast in
the boggy mire of half-truths, untruths and finger pointing, but everytime
he tries to extricate himself, he sinks a little deeper.

Does Mr Horton agree that these children and their parents deserve an
explanation as to what has happened to them?

Because of the political implications of the MMR debate many vaccine
damaged children continue to suffer in silence because doctors are afraid
to recognise the underlying cause of their conditions.

As a parent of two such children it makes my blood boil when I see people
like Richard Horton ignoring the fate of these children.

My little boy suffers chronic stomach pains, is frequently violently sick
and suffers chronic dirroeah. He cannot speak he is conveniently overlooked
by the likes of Richard Horton.

Has Richard Horton ever attempted to address the parents of the children
who were damaged by the MMR.

This is what people like Richard Horton forget that at the centre of all
this are sick children. The biggest mistake Andrew Wakfield made was that
he cared enough to listen to these parents.

When the truth is finally revealed I sincerely hope that the likes of
Richard Horton, Brian Deer, Elizabeth Miller et al have the decency to
publicly apologise to Dr Wakefield.

Competing interests: 2 ASD kids following MMR
"MMR - SCIENCE AND FICTION": the Richard Horton story V 1 October 2004
John Stone,
London N22
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Re: "MMR - SCIENCE AND FICTION": the Richard Horton story V

 The Lancet today publishes a letter from Dr Mark Geier relating to
non-disclosure of interest by Prof Pichichero (2 October 2004 Vol 364 No
9441), as mentioned in my letter above of 25 September 2004 (""MMR -
SCIENCE AND FICTION": the Richard Horton story"). I have electronic copies
of correspondence which show that Dr Geier first wrote to the Lancet on
this matter on 29 April of this year. After much toing and froing the
Lancet agreed to publish a letter from Dr Geier providing it did not draw
parallels with the Andrew Wakefield affair, and Prof Pichichero was given
the opportunity to defend himself (letter of 1 July 2004).

Notwithstanding this, it seems to have taken a further three months for the
Lancet to produce Dr Geier's letter, perhaps embarrassed by my post. If as
they claimed in the correspondence Prof Pichichero had a sound defence it
is hard to understand why they were not anxious to clear the air.

Where, we might ask, are the transparent upholders of the public good?

(Documents provided)

Competing interests: As above
"MMR - SCIENCE AND FICTION": the Richard Horton story VI 4 October 2004
John Stone,
London N22
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Re: "MMR - SCIENCE AND FICTION": the Richard Horton story VI

 On page 10 Richard Horton writes:

"On this occasion, we had discovered an error of judgement, an important
error of judgement to be sure: a failure to disclose a perceived conflict
of interest that would almost certainly altered peer reviewers' and
editors' view about a preliminary and controversial finding. Did this
behaviour amount to scientific misconduct? It was hard to tell. But it
certainly invalidated Wakefield's central claim - namely that the link
between MMR vaccine and autism was a serious independently arrived-at
scientific hypothesis that needed to be investigated urgently."

The question might conceivably arise whether professional misconduct was
involved if in fact the paper contained such a hypothesis, but there is no
such passage and Horton does not (cannot) cite it.

Horton goes on (p.10-11):

"We needed a partial retraction, erasing as far as one reasonably could the
interpretation concerning the vaccine and the autism. None of the factual
material in the 1998 paper was in doubt. Twelve children did exist. Their
clinical histories were not disputed..."

But Horton does not tell the reader what is contained in their clinical

"In eight children, the onset of behavioural problems had been linked,
either by the parents or the child's physician with measles, mumps and
rubella vaccination. Five had had an early adverse reaction to
immunisatisation (rash, fever, delirium, and in three cases, convulsions).
in these eight children the average interval from first exposure to the
onset of behavioural symptoms was 6.3 days (range 1-14). Parents were less
clear about the onset of abdominal symptoms because children were not
toilet trained at the time or because behavioural features made children
unable to communicate symptoms..." [1]

But where we have to ask was the claim made which related to Andrew
Wakefield's alleged conflict of interest. The reason for Wakefield's
concern is evident, but the claim that his interest somehow distorted the
paper cannot be substantiated. It would not have been proper to omit such
information. And again Horton does not tell the reader what they need to

[1] Wakefield et al: 'Ileal-lymphoid-nodular hyperplasia, non- specific
colitis, and pervasive developmental disorder in children', The Lancet Vol
351, No 9103, 28 February 1998.

Competing interests: As above
Re: "MMR - SCIENCE AND FICTION": the Richard Horton story IV 4 October 2004
susanne mccabe,
cf 24 3pf
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Re: Re: "MMR - SCIENCE AND FICTION": the Richard Horton story IV

 What is a 'luminous fellow'?! Does he glow in the dark?

If readers are interested in reading the views of Michael Fitzpatrick,
'distinguished doctor' - they are as often published on
'spiked-online/health' as in the Lancet. They may be read less often there
by health workers but he makes no secret of his opinions; see 'The Sickness
at the Heart of Medicine' (Spiked on-line 27th September 2004). In this
article Michael Fitpatrick reviews two interesting books 'Hippocratic
Oaths:Medicine and it's Discontents',by Raymond Tallis and 'NHS plc: The
Privatisation of Our Health Care' by Allsion Pollock ,whilst using them to
expound his own critical views on the modernisation of health care in UK.

In the light of the latest scandal involving Glaxo-Smith Clyne and the
licensing of a drug known to cause tragic deaths and extremely harmful
effects - SEROXAT - it would be sensible for anybody, such as members of
Sense About Science, to declare any kind of involvement with the company.

Just as Peter Tyrer, Editor of Journal of Psychiatry, and Mike Shooter,
President of College of Psychiatrists, who both took part in the TV Panoram
documentary last night,which exposed the horror story of SEROXAT, might
have declared why the college continued to advertise the drug in the
Journal after it became known as a 'dirty drug'. David Healey,
psychiatrist, Bangor N. WAles, has been speaking out for years with liitle
support from colleagues. Peter Tyrer stated that he has noticed that people
with certain personalities may have serious adverse effects from taking
SEROXAT but went on to suggest that work needs to be done to indentify
these personalities. It is impossible to monitor such a drug in this way.
Yet again pussy footing around puts real people with real lives to lose at
risk. IS the advertsing money worth it? Ssurely the company should be
boycotted and medical journals should be seeking cleaner ways of funding
their publications.

I have no involvement with individuals or campaigning groups which raise
issues/lobby through the BMJ. My own work is a more braodly based concern
with ethical issues.

Competing interests: None declared