[back] Wakefield hearing
by Allison Edwards (italics) & Martin J Walker (regular type)
Getting an innocent London bus from Victoria to Warren Street, on Monday 12th January, I found myself regaled by a robotic female voice that told me whenever the bus reached any notable point on the journey. Although this broke into my solitude and private thoughts I found it more or less acceptable, until we reached a point just past Westminster, when the voice suddenly intoned in a slightly more discursive manner, 'The next bus stop is closed'. As it was raining, my first thought was that this was a good thing, until that is, I realised that 'closed' in this case meant non-functioning. Britain is going through a language crunch just as important as the credit crunch. Very little means anything anymore, especially a high-sounding Fitness to Practice Hearing that actually has more similarities to a corrupted eighteenth century trial for debt.
On Monday the 12th, I showed up at the GMC just before the end of the morning session being at the mercy of Virgin Trains Saver ticket rules, for off-peak travel times; my earliest possible arrival at Euston was midday. The whole excursion, including an overnight stay came in at £112, better than a standard day return fare of £153.00. It’s steep for any parent/carer of an autistic child but a price worth paying, I feel, to show my unstinting support for these three eminent doctors. So, during my son’s four night stay at respite, I travelled to London.
I had bad dreams in the early mornings of the days that followed New Year’s Day. They were all to do with Finlay Scott, the Chief Executive of the GMC, receiving the Commander of the British Empire (CBE) in the New Year’s Honours list. In the dreams, the GMC building remained as it had been, except when I got to the third floor and approached what used to be reception; I found that I was on the Star Ship Enterprise. Captain Kirk's position in the chair was now taken by Finlay Scott. As I came in he was saying quietly and assuredly, to a statuesque black woman 'Warp Three Uhura, let’s break the Wakefield hearing'. Scotty, who seemed tired and emotional, questioned the Commander, 'But Sir I might have to tighten some nuts and bolts on the engine before we can outrun Wakefield's ship'. Finlay Scott gave a questioning frown, 'I'm Commander of this Star Ship Scotty, and don't forget it', 'Yes Commander, of course Commander, it's just that at warp speed 3, our whole strategy will be exposed'. 'Scotty, this isn't the time to argue the toss on this one, the Lord High Commander of the Star Fleet, His Great Master Salisbury, has instructed that we bring this adventure to an end'. With this last statement, the Star Trek theme began, but it seemed different; mainly it had Chinese instruments and Miss Smith's voice-over said something about 'I'm going where no man has boldly gone before.' I always woke up scared and in a terrible sweat.
You can imagine my relief when I did get to the hearing, only to find that none of the staff were wearing the tight, powder-blue uniforms of my dreams, and apart from new ribbon bedecked pictures of Finlay Scott giving a wave, entitled 'Our New Commander' everything was as drab and dreary as usual. The dreams about Finlay's CBE did make me think, however, and not for the first time, about the linguistic dissonance, the grammatical dysfunction, that exists in Britain, and I wasn't really surprised when I found that the Chief Medical Officer, Liam Donaldson was on the committee that gave him this honour. Unfortunately I haven't had the time to research how much influence GSK have in this matter, although I have heard the rumour that in the next New Year’s Honours list, the honour will be called CBDGSK. That's Commander of the British Dominions of GlaxoSmith Kline. This is far more applicable anyway because there no longer exists any Empire to speak of. These acronyms, and the failing of language, brought to mind an acronym in the civil service that I think well fits Finlay's situation, POWG (Paid Off With Garbage).
My parental anger simmers because it was whilst these top-flight pioneers were delving into discovering the 'whys' of regressive autism in some children, that they were confronted with these ridiculous charges. Undoubtedly those who brought the charges were more deserving, themselves, of some sharp questioning about their own motives for this 110 day fandango. How have these people got away with stifling medical and scientific investigations and more crucially the treatment of very poorly, vulnerable children?
And in the newspapers and on the telly, the same old lazy media, denials, disguising any opportunity to shed light on this important topic, constantly churning out the original charge sheet, time and time again, screaming guilty whilst bowing to the political factions hell-bent on putting this WMD type issue to bed. The 'can’t-be-bothereds' who won’t do what we parents do and sit in on and find out the facts of this stitch up job by listening to the defence. Where have all the decent reporters gone, did boredom eventually kill them off? How can the media be so uncaring towards our babies? Hush, hush from the top seems enough for them!
The next three weeks of the hearing is devoted to the defence of Professor Simon Murch. Murch is defended by Mr Adrian Hopkins. I was wondering how I could write about Hopkins without seeming somehow condescending - after all, who am I to critique a barrister of 20 years standing - so I turned to the web site of 3 Serjeant's Inn, to see what the site said about him:
"...'incisive and knowledgeable, with an amazing grasp of detail'..." Legal 500 2008
'The “flawless” Adrian Hopkins QC offers “great attention to detail, combined with the ability to step back and look at the broader issues of a case.” His “low-key, quietly courteous and moderate approach” stands him in good stead with disciplinary tribunals.' Chambers & Partners 2009
'Adrian Hopkins QC heads the set’s medical team and is a perennial favourite with solicitors. “Low-key and deadly,” he boasts “a clear-thinking, analytical approach,” which he deploys in negligence issues of considerable importance.' Chambers & Partners 2009
"Hopkins is very diligent and measured. He is excellent in complicated, high-value cases where he has delivered some impressive results. He really knows how to make the most complex case appear straightforward while showing such good attention to detail." Legal Week article, 8 December 2005
Well, I agree with all of that and these brief reviews come amazingly close to the words I would have used myself. From the very beginning, as Hopkins began leading Professor Murch through his evidence in chief, he showed an intuitive grasp of the case and it's context. He led us into the Royal Free Hospital and gave us a tour of the Department; he described through Professor Murch's eyes, what the team of highly skilled doctors did in the Department. During this tour, he opened all the doors on the muddled prosecution charges, and Simon Murch explained and refuted them from his singular point of view.
Dr Simon Murch and his Counsel, Adrian Hopkins, conducted the defence adeptly. Both are as confident and concise as an Oxford Dictionary. Two or three times or more I felt like bursting into a spontaneous round of applause for the crystal clear explanations of this particular group of children with a novel form of bowel disease and regressive autism. Like partners in a waltz the questions led well to answers in step and in sequence. Dr Murch puts everyone at ease with his manner, particularly empathic he began some answers with, 'If it was my own child this had happened to….'
Questioning highlighted the care and diligent enquiries needed to understand whether the children really were in need of investigation due to their histories. Had they carried out appropriately required colonoscopies? They had. Were the biopsies necessary, where from and how were they done, and for what purpose? For good, proper and accurate diagnosis to help the child and parents and not specifically for research. Meetings were discussed, who was there, what was recommended by whom and why? Much of what was said had been covered by previous defence counsels for Wakefield and Walker-Smith, but we heard again how this was teamwork, carried out by the best of the best, carefully drawing from the wealth of experience they all had in their field. All carried weight in their opinions and the opinions of others connected with the Department.
As far as I could hear, not one of them would have been able to make rash, ill-considered decisions without being noticed. The families were crying out for help. Quality of life was impaired by severe gut pain and brain function deterioration following MMR; they suffered amongst other things from various allergies. The doctors’ aim was ultimately to diagnose and treat. Cause and science are rarely challenged or brought into question here, so why is this not the case when it’s reported. These doctors and their right and proper work, are being junked in the most unforgivable way. Failure to continue with such important research is indeed Britain’s loss.
Hopkins chose the days of a week to describe the work that went on at the Royal Free, and by the end of Monday he and Professor Murch had between them presented an intimate picture of work in the department, of its challenges, its routine and a solid refutation of the bizarre intervention of this much later prosecution.
Most important, it seemed to me in this break down of work at the Royal Free, were the following.
Perhaps the most interesting aspect of Hopkins’ analysis of Professor Murch's work, was the way in which he approached it from a position that was empathetic with both the children and the parents. Hopkins’ trek through Murch's evidence in chief was marvellously post-modern and multi-layered. It spoke eloquently about the role of the doctor in modern society, the needs of parents and children with undiagnosed illnesses, and most of all it created an umbrella of explanation about human concern, and therefore ethics, that surrounded surgeons and researchers.
Professor Murch never ceased to be quietly reasonable, the kind of doctor one might only dream about in the hubbub of modern urban society. His tone was measured and fair, except where he refuted the mainly absurd prosecution allegations, such as those that he examined children and then performed colonoscopies on them for research purposes. These often ludicrous assertions were put with a chilling clarity, delivered by Hopkins in a tone equal to that of the chillingly logical Dr Spock, to be answered by Murch in an alert, definite and even forceful manner.
Perhaps being only day one, all in the room are alert, a perky panel on the right and down at the prosecution end of the room is the same twitching, flappy, hair flicky, and scratchy, as a bad case of nits. Lots of coughing and nose blowing going on too – in the circulating air conditioning all sorts could be blowing about. Let’s hope a clear run at some good evidence is possible throughout the month of January without cases of plague.
Throughout Professor Murch's evidence I was constantly reminded, as I had been during Professor Walker-Smith's case, that both these doctors placed considerable reliance on nutrition. This opens up a whole new area of speculation, because since 1988, the quack-busting groups, now consolidated with Sense About Science and the Science Media Centre, have been attacking nutritionists, especially those that suggest that nutritional treatments can help alleviate cases of serious illness. Most strenuous in the attacks on nutritional medicine are the followers of the pharmaceutically dominated and genetics lobbies, who not only suggest that every condition is genetic in origin but that nutritional approaches to treatment should be banned.
It was odd and rather surprising to hear Professor Murch describe Candida as most noted in the 'grey literature' and then to talk about Professor Jonathan Brostoff as a widely respected allergist. The original quack busting group in Britain - the Campaign Against Health Fraud, now called HealthWatch - spend years campaigning against allergy, saying that anyone who claimed to have it was probably mentally ill. While Professor Murch might be right today in saying that the whole field of allergy has changed and much more credence is now given to claims of it, the exposure of this subject reminds us that as well as the pharmaceutical companies, the processed food industry is also involved in the refutation that nutrition has any bearing on health. While from the perspective of a hospital consultant, appraisals of nutrition might have changed, on the ground, nutritionists are still mercilessly attacked by quackbusting reporters like Ben Goldacre.
At around mid-day on Tuesday, Mr Hopkins leaned on his rostrum and apologised to the panel for what he said he was about to begin; going through the Lancet cases one by one. He was aware, he said, that the panel - and everyone else in the room - had heard this detailed evidence over and over again. However, it was not until Mr Hopkins began down this path that I really understood his need to apologise. Master of detail that Hopkins is, this review of the twelve cases is evidently going to be a tour de force, a kind of War and Peace version of the Lancet paper. One has, at least, to bow to Mr Hopkins’ judgment even if his approach could well be heralded as the new post-industrial equivalent of Chinese Water Torture. He is obviously right to be so descriptive in building up a material picture of all twelve cases, after all it has been the very looseness of the defence case generally that has left the clear ground on which Miss Smith has erected her shibboleths.
* * *
The beginning of the hearing on Monday 12th of January was considered with excitement by those who had closely followed the hearing. The last episode had ended with the vague possibility that Richard Horton might return to the hearing to explain how he had failed to recall that he had known for at least a year before the publication of the Lancet paper; that Dr Wakefield had been promised funding by the Legal Aid Board.
This matter of a conflict of interest is at the very centre of the case against Wakefield and was the core of Horton's evidence to the Panel. His case was that he was suddenly and virginally surprised, almost shocked to find in 2004, following his briefing from Brian Deer, that Wakefield had a conflict of interest. When the defence produced papers, after his evidence, that showed clearly that he should have known about the legal aid money, it was asked if Horton could be recalled. At the end of the last session Miss Smith adroitly presented 'the dog chewed my homework' defence for Horton and most observers saw a full blooded cross examination of Horton drift away.
At 4pm the afternoon session drew to a close, Professor Murch was invited to leave if he so wished and that was when the Horton shenanigans reared its head. A statement was to be read by the panel, who would deliberate after adjournment and give a response as to whether Dr Richard Horton, Editor of The Lancet would be called for further questioning on the 21st of January. If I have rightly understood what I was hearing, Horton, during his evidence, had not been precise with the facts regarding dates and what he knew when. The reality of his knowledge was exposed in a letter discovered in a lost filing cabinet at the Wakefield’s home which now left room for further investigation.
We were all to find out in the morning what the panel’s decision would be in relation to that statement, although it seems discussions between Counsel Smith for the prosecution and Counsel Coonan for the defence had already taken place on whether or not it was necessary, and seemed to be a 'done deal' for the let’s-not-bother-brigade AGAIN with the panel beginning to look weary at the thought of anything that might prolong and interfere with the smooth running timetable of Dr Murch’s defence – it was a hefty consideration! But how come, from the beginning the whole prosecution has been swept along in the prosecutors wake ? And she makes up the most cloying disguises for her true intentions. She gave the impression of WANTING Horton to be summoned back there to be cross-examined harshly – as he so rightly should have been - she said in a fake serious voice, but “ not wanting to run the risk of being the most unpopular person in the room” she would concede. We could all see what she was playing at, creating yet another dread of stretching it into forever, implying it was the others, the defence who didn’t want that to happen, and the panel too, Que Sera Sera! She tried….sigh! Shocking tactics I felt.
On the afternoon of Monday, the hearing was told that Mr Coonan and Miss Smith were, not for the first time, in complete agreement, that there was no need to recall Horton, especially as his diary was so full. Both barristers were sure that a statement from him would be completely sufficient. The Panel were sent into camera to discuss this important agreement and to consider whether they would like to see Horton back at the witness table. Inevitably they endorsed the unanimity of the counsel and it was agreed that Horton's statement should be read on Tuesday morning.
And so, tomorrow….. Tuesday 13th January. Will it be drama or a damp squib? A long lens got me as I came in. Why? Maybe they liked my jacket and scarf combination! Up on the 3rd floor, a little later than the intended 9.15am start, it began. And just like The Magic Roundabout’s Zebedee, Brian Deer arrived, dropped out of nowhere, ready to hear the Horton statement even though he hadn’t been there the day before to hear which act was on next. Curiously, this man seems to get wind. When something goes on, he’s there, then vanishes like Harry Houdini. How come? Is he the Ring Master or merely an entertaining plate spinner? Tiresomely, the rest of us have to sit through the gusty slow flow of this age-old case barely knowing when the circus is next coming to town.
Horton's statement was worse than even I expected. In it's introduction it pointed to papers he had been supplied that hinted at the fact that he had known for years before 2004 about the LAB money. These papers referred to a Dawbarns fact sheet, the agreement between Dr Wakefield and the Legal Aid Board and the letter from Mr Rouse printed in the Lancet. Horton didn't waste words, he simply said that he had considered each of these references and claimed that none of them had forewarned him of any conflict of interest.
Given that Horton's maligned contention - that Wakefield's case review paper in the Lancet was hopelessly compromised because he failed to note funding for other forthcoming work from the Legal Aid Board - is at the very centre of the case against Wakefield, I personally will never be convinced that it wasn't in the interest of the defence to force Horton's second appearance at the GMC. Never was there a better case, in my opinion, for an aggressive cross examination of a major prosecution witness who had failed to give the facts in his evidence in chief.
The problem appears to be that while the prosecution and its agents, from the government down to Brian Deer, have poured venom into the prosecution, the defence, apart from a couple of incidents of intransigence and some exceptions in attitude, have been strolling through the park, smelling the flowers and pretending that the case isn't actually about thousands of vaccine damaged children.