Conflicts of Integrity

by Martin Walker MA1

A look at the views of Dr Richard Horton, editor of the Lancet his defence of Sir Richard Doll and his part in the downfall of Dr Andrew Wakefield

Richard Horton’s long review of Devra Davis’s book, The Secret History of the War on Cancer in The New York Review of Books, March 6, 2008, held few surprises. He seemed to agree completely with Davis’s founding arguments, but was incapable of laying blame on industry and industrially biased-researchers for the growing toll that environmental pollutants are taking on the public health of developed nations.

1. A part of this essay, principally about Dr Richard Horton, editor of the Lancet, was originally written as an article (Hardell and Walker 2008) for the New York Review of Books (NYRB) as a rebuttal of Horton's review of Devra Davis's book The Secret History of the War on Cancer (Davis 2007). However, despite Dr Hardell's stature as an epidemiologist a cancer clinician and researcher, the NYRB managed to avoid any communication with the authors on the three occasions that they wrote submitting it for publication. The rebuttal is here considerably extended to include more information that is germane to Horton's approach to dissent and dissenters in the matter of public and environmental health. Because Lennart Hardell's contribution to the earliest version was not substantial and because he is not familiar with the material in the second half of this new version he suggested that his name was withdrawn; instead his contributions throughout are footnoted.

For those not fortunate enough to have read Davis's book, it is possible to summarise its message. Since the 1930s, industry has disguised the detrimental effects of its processes and products on public 1 health. Arguing that its hands are clean, it has backed up its propaganda with forests of scientific studies, armies of academic research workers, and a series of institutes and shell organisations dedicated to PR. These organisations, individuals and their strategies, often hidden or undeclared, have been used to deny the industry aetiology of cancer, and have thereby insured that the ‘war on cancer’ has mainly been a fraud.

Rates of cancer in the developed world have continued to grow, and statistics now suggest that one third of the developed world’s population will have cancer at some point in their lives. Despite the culture of denial engineered by industry, these statistics stretch massively beyond those representing the possible consequences of genetic and hereditary vulnerabilities, and well beyond cases caused by obvious carcinogens such as cigarettes. Industry-orientated cancer researchers have argued that it is too difficult to dig out environmental causes of cancer from the plethora of suspected factors, and have alighted instead on easily-identifiable lifestyle causes. Davis's book, one of the first in this field, attempts to construct a map of how corporate industrial interests have come to dominate this area.

The first half of Horton’s review reiterates the historical evaluation of business relations between organisations such as the US Food and Drug Administration (FDA), the National Cancer Institute (NCI), the American Cancer Society (ACS), and industry generally. Such vested interests as those reported by Davis and acknowledged by Horton, have increasingly been reported since the 1950s, (Epstein 1978) (Epstein 1998) and they would appear to have played a considerable part in undermining and delaying the recognition of chemical carcinogens, which has in turn contributed to the worldwide cancer epidemic we are now facing.

However, having agreed with Davis about the foundations of the problem, when he comes to conclusions about the book, he gets so many things wrong that it would be hard to discuss his review without a much longer reply. Horton draws in his critique, upon a review by Peter Boyle of the same book published by Horton in the Lancet. (Boyle 2007). Until very recently, Boyle was the director of the International Agency for Research on Cancer (IARC). He had held this position since 2004, and in this capacity he has had to defend the agency against increasing criticism that it is losing its independence to industry infiltration. In fact, Horton’s review in the NYRB could be said to be an extension of Boyle’s, which, from the outset, with its title ‘Conspiracy Theories of Cancer’, trashes all the important aspects of Davis’s book. It is worth looking at Boyle’s review before moving on to Horton's, because in so doing one can observe their parallel thinking.

Boyle’s review begins with an insulting dismissal of Davis as a conspiracy theorist:

Devotees of conspiracy theories and aficionados of gossip and innuendo will be drawn towards this book like wasps to a juicy piece of meat. It has many of the necessary ingredients: Big Industry cover-ups, hidden consultancies, secret documents exposed, tittle-tattle, and accusations about the conduct of famous names. It only lacks the steamy sex section, but perhaps this is being held back for a further volume.

It's difficult to understand the use of the term 'tittle-tattle', the second reference to 'gossip' in the paragraph above. What is Boyle trying to say here; these things are all only the subjects of gossip, or that accusations of such things as 'big industry cover ups and hidden consultancies' are without any foundation. One thing is for sure, being clearly unconcerned about descending to personal insult, and therefore a bit of a tosser, Boyle would be amongst the first to queue for the second 'steamy sex' volume were it to be published.

The review ends with a description of Davis as a third-rate investigative journalist (‘Accuracy with the facts is a sine qua non in investigative journalism’), while labeling her again as a purveyor of ‘gossip and tittle-tattle’. Readers of the Lancet might have been forgiven for thinking that Boyle was referring to another Davis, an investigative journalist, and not this particular highly regarded academic in the field of cancer epidemiology.

There is more than a hint of misogyny in Boyle’s remarks, and out of the corner of one's eye, one can see him flexing his macho scientific muscles while he disputes Davis’s subjective style of writing. In fact, Davis writes beautifully, and like many other female academics, manages to make her highly-crafted text passionate, pleasing and personally involving.

Boyle cannot help himself but defend the late Sir Richard Doll from the balanced and timely criticism in Davis’s book. Doll has emerged in the past thirty years as a 20th century icon of corporate scientific comment.

His elevation to the sainthood of epidemiology is, however, like many sainthoods somewhat mystical. When his position is challenged, the world and its dog, who know next to nothing about his work, rally to stop his statue from being pulled down. Boyle distorts Davis’s references to Doll with the intelligence of an exemplary propagandist:

Davis is repeatedly critical of Sir Richard Doll, one of the key figures in cancer epidemiology and prevention. One could imagine that Doll’s lifetime work on tobacco and the risk it posed to cancer would have alienated him from the tobacco industry. But Davis subtly argues that if you believe that tobacco smoking is a major cause of cancer then ipso facto industrial and environmental exposures are not. The premise that enemies of tobacco are friends of the chemical industry seems naive and over-simplistic.

Apart from the transparent inaccuracy in stating that Doll was a key figure in ‘cancer prevention’, when nothing could be further from the truth, this paragraph is a complete corruption of what Davis believes and suggests.  The assumption of those who criticise Doll is quite straightforward: after he had done so much damage to the tobacco industry, the chemical industry fostered his talents and feted him, lest he turn these talents upon them. They need not have worried: Doll devoted the rest of his working life after his survey of smoking doctors, to arguing in passive favour of other man-made environmental or occupational carcinogens of consequence (Walker 1998).

Boyle’s most belittling paragraph is about Davis’s reflection on Doll’s consultancy fees from Monsanto (Walker 2003):

Davis suggests that Doll could have received US$1,500 dollars per day from Monsanto since 1979, leaving the reader with the impression that he could have received the (absurd) total of more than $12 million dollars. Davis apparently “knew” of this consulting for some time and it begs the question as to why she waited until Doll was dead to make this charge in an open forum.

For someone who has headed one of the most important cancer research agencies in Europe, Boyle appears remarkably ignorant of the ways of industry. Quite obviously, Davis was referring to a consultancy fee that was paid whenever Doll freelanced for Monsanto and not a monthly salary payment; Doll was, in the crudest sense an epidemiologist for hire.

It is completely absurd to suggest, as Boyle does, that Davis purposefully waited until Doll was dead before raising the issue of Doll's money on-the-side. Equally, Boyle’s idea that information about the secret links between industry and academics should not be referred to outside their contemporary incidence, is a kind of anti-culturalism that is drummed into industry-orientated scientists.

* * *

Unlike Boyle, Horton begins his review by noting the alarming number of deaths from cancer in both men and women, in Europe and North America. This figure, he says, presently stands at ‘one in three in women and one in two in men’. He follows this with a competent analysis of Davis’s account of the failed ‘war on cancer’.

However, with that part of the review out of the way, and with the need fast approaching to apportion blame, or at least to make value judgements, Horton flunks it completely. He lets all the likely suspects off the hook, and then does exactly what Doll and his industry-oriented buddies have done for the past half-century, which is to place the blame squarely on the shoulders of the individual; smokers and those who eat too much of the wrong food and fail to exercise; these silly people who keep giving themselves cancer!

Although Davis does not actually spend that much text on Doll, Horton, like Boyle, feels the galvanising need to rise to the dead man’s defence. Yet there are many reasons why the late Sir Richard Doll should become the subject of considerable controversy in relation to cancer and industry-funded research. Principal among these is that his work consistently exonerated industry from blame for causing cancer in workers (Hardell et al 2007). Any reason for this remained obscure until his payments from Monsanto were revealed in 2003 (Walker 2003). This $1,500 a day was not earned by carrying out independent research projects, but was an account to be drawn on whenever Doll answered the call of Monsanto to write or speak in their defence. His account at Monsanto was handled by Bill Gaffey, an epidemiologist who had been brought into Monsanto the company specifically to clean up the public perception and scientific record of the highly-toxic dioxins. (Montague 1996).

Perhaps the most spectacular example of Doll’s PR work for Monsanto was his intervention in the aftermath of the Australian Royal Commission on Agent Orange (Royal Commission 1985), when Doll wrote, apparently without reason or rational, congratulating Judge Evatt, who had adjudicated on the last part of the commission, for finding in favour of Monsanto and against veterans and others affected this potent herbicide and defoliant (Hardell et al 1998). Doll’s letter was quite specific in its meaning and its intent: he told the judge, in a letter reproduced as a half-page advertisement in many of Europe's leading newspapers by Monsanto (Allen 2004), that he thought the evidence of Lennart Hardell and, in fact, all of Hardell’s work on pesticides, dioxins and cancer risks, should be struck from the academic record.

Hardell and his colleague Olav Axelson were the first to report, at the end of the 1970s and early 1980s an association between phenoxy herbicides, chlorophenols, contaminating dioxins and cancer (Hardell 1977, 1979, Hardell, Sandström 1979, Hardell et al 1981). It was only much later that the public was informed of the fact that these studies were of crucial importance in the banning of 2,4,5-T and Silvex in USA, and the regulation of certain pesticides in Sweden (Hardell 1981). These herbicides included the same chemicals as those in Agent Orange, and the Swedish findings were of vital importance in the Agent Orange settlement that awarded compensation to Vietnam veterans with certain types of cancer.

Although he did not give evidence to the Commission, Doll was keen to rebut these findings and to support the industry views expressed by Monsanto lawyers and Justice Everett on the conclusion of the Royal Commission (Hardell et al 1998).

The consequence, in real terms, of Doll’s industry-funded approach to science, was that thousands of Australian Vietnam veterans got no compensation for the debilitating and sometimes fatal illnesses they had contracted after contact with one of the most toxic chemicals produced by industry; to say nothing of the nightmare effects, still suffered to this day, by generations of Vietnamese people who have not actually died from exposure.2

Unfortunately, in today’s blizzard of information manipulation, the finer points of justifiable criticisms levelled at Doll and other ‘bought’ scientists is increasingly lost to history. The fact that Horton speaks lovingly about Doll as if he were a grand pater of science, who spoke with wisdom, says much more about Horton than it does about Doll. First and foremost it tells us that Horton has not read the literature, or if he has, he has chosen to ignore it.

We need to look no further than Horton’s inelegant defence of Doll, to seek the proving of the message in Davis’s book. Horton says about Davis’s appraisal of Doll’s work: ‘But Davis paints Doll in the most unforgiving light. And, while her accumulated arguments do hurt Doll's scientific legacy, such a partial view seems unbalanced and unjust.’

2 Lennart Hardell made a contribution to the 5 paragraphs above this.

It doesn't appear to have occurred to either Horton or Boyle, that Davis is seriously disturbed by the spectre of dead workers and citizens in a way that these two specific male scientific minds has difficulty in comprehending. By criticising Davis’ comments about Doll in such transparently personal terms, Horton again shows clearly, that he has not even approached - or turned away from - the literature and has no knowledge of any comparison between Doll’s exaggerated statements in defence of known carcinogens, and the actual damage suffered by workers in production, their families or citizens living close to factories.

Just to give one example, Davis says in her book that Doll 'systematically underestimated the dangers of the workplace', in relation to asbestos. It is because of this that Doll was asked on a number of occasions to act as an expert witness in defence of corporations and against claiming workers. It is also why he ended up advising the UK’s leading asbestos manufacturer, Turner and Newall, on the subject of workers claims.

However, the view expressed by Davis and criticized by Horton, barely scratches the surface of Doll’s compromised ignorance in relation to the real proportion of the asbestos crime. Asbestos exposure has caused and continues to cause cancer deaths worldwide. While Doll’s work played down the risk to workers, it completely dismissed any health risks of asbestos beyond the factory. Even today, family victims subject to secondary asbestos exposure from fibres carried on worker’s clothes etc, are not always compensated. Meanwhile the toll of damage done by asbestos in public places and by its removal, such as was suggested by Selikoff (Selikoff 1975, 1976, 1978, 2007), is considered by industry defenders to be, like secondary smoking, an unrelated and unscientific matter.

Doll’s almost benign view of asbestos in the community should be contrasted with the opening remarks in Geoffrey Tweedale’s book Magic Mineral to Killer Dust (Tweedale 2000) thst quotes one source as saying that the annual death toll from mesothelioma (a rare and virulent cancer, one of three asbestos-related diseases) among males in the UK, could reach 3,300 by 2020. Add to this a proportionate number of asbestos-induced lung cancer, and that toll could reach between 5,000 and 10,000 annually.3

3 Contemporary figures supplied by Geoffrey Tweedale estimate an actual figure of 5,000 a year.

These deaths relate negligibly to the industrial production of asbestos in factories such as Turner & Newall, compared with secondary exposure in the building and engineering trades, and from routine maintenance tasks. Doll was not only sceptical of the asbestos hazard in these occupations, but at the end of his life even argued that asbestos could continue safely to be used.

While accusing Davis of being unjust to Doll, Horton unbelievably takes up Boyle’s argument that it seems wrong to criticise a dead man who cannot answer for himself. This sentiment could bring to an end almost overnight the discipline of literary criticism - perhaps not such a bad thing - but it would also cease the flow of all those political biographies of demented politicians and dictators, letting them off the historical hook. Of course it is an utterly spurious argument, and were it adopted universally would it lead to a knee jerk defence of all dead people.

Those arguing the contrary case, again have Horton’s sad lack of familiarity - or dismissal - of the literature to thank for his shabby intellectual reasoning that Doll is just now being criticised because he's dead. Many people wrote critically about Doll when he was alive including both Walker and Hardell (Walker 2005) (Hardell et al 1998) as did Dr Olav Axelson (Axelson 1998), Robert Allen (Allen 2004), Professor Gayle Greene (Greene 1999), Professor Samuel Epstein (Epstein 1979 and 1998), Dr Barry Castleman (Castleman 1995 and 2001), Professor Christopher Busby (Busby 2002 and 2006), and, of course, a small army of activists involved in different struggles, as well as a raft of lawyers representing claimants against corporate interests.

The reason why we have spent so much time discussing Doll in the paragraphs above, is that he remains the most potent symbol of the idea that it is somehow 'all right' for epidemiologists and other public health scientists to work directly for the industries suspected of causing public health damage, and even to work with the figures and statistics provided by those industries. Davis makes clear in her book that until we receive a clear picture of these scientists, and understand their psychology and their everyday political views, we cannot approach their work with any kind of objectivity.

* * *

In an age when even the most established medical journals, such as the British Medical Journal (BMJ) and the New England Journal of Medicine (NEJM) appear to be cracking down on conflict of interests in any form, Dr Horton presides over a journal the parent company of which, Reed Elsevier, is chaired by Sir Crispin Davis, a non-executive member of the board of the biggest pharmaceutical company in the world, GlaxoSmithKline (GSK), one of the producers of the MMR vaccine. 4,5

It might, of course, be tempting to think that in relation to the editor of the Lancet, the chair of the board of Reed Elsevier is a relatively distant figure. Horton throws some light on this matter however, in his book MMR Science and Fiction: Exploring the vaccine crisis (Horton 2004), There he describes an occasion when the House of Commons Science and Technology Committee (STC), a rabid, pro-corporate science cabal closely related to Sense About Science6 and the Science Media

4 I didn't know when I wrote this that it had been revealed that the editor of the NEJM had been shown to have ties to GlaxoSmithKlein.
'A recent case, discussed in the February 4, 2008 report of Integrity in Science Watch, with the title "NEJM Reviewer with Conflicts Leaked Damaging Study to Drug Firm," seems particularly significant. According to this report, New England Journal of Medicine (NEJM, a prestigious scholarly journal owned by the Massachusetts Medical Society), received a manuscript, submitted for publication by Steven Nissen, which was, in effect, a negative discussion of the drug Avandia, made by GlaxoSmithKline. The manuscript was sent to Steven M. Haffner for peer review. Haffner had strong financial ties to GlaxoSmithKline, “receiving at least 75,000 dollars in fees since 1999 [...]”. Haffner sent a copy of the manuscript to a scientist at GlaxoSmithKline, Alexander Cobitz, “giving GlaxoSmithKline time to prepare a public response”.

It turns out that the NEJM editor-in-chief, Jeffrey Drazen, has, according to the Integrity in Science database, financial ties with many drug companies, including GlaxoSmithKline as well. This situation has an ironic twist. Krimsky [2003] lauds and commends NEJM as the scientific journal taking the lead in dealing with conflict of interest situations. He states that it had been “at the vanguard of setting ethical standards in publication [...]” (p. 172) Authors of manuscripts submitted for publication in NEJM are supposed to reveal conflicts of interest related to the contents of the manuscript. But, based on the contents of “NEJM Reviewer with Conflicts Leaked Damaging Study to Drug Firm”, it does not seem that similar revelations of conflicts of interest are demanded of the journal's secret peer review referees. Nor of their editors, for that matter.' (Gordon Moran, Editorial Conflicts of Interest and Problems Relating to the Correction of Scholarly Error. Posted: April 29, 2008 Scienza e Democrazia/Science and Democracy )

5 Davis, had been with Reed Elsevier since 1999, and had been appointed a nonexecutive director of GSK in July 2003.

6 Sense about Science. was set up by Lord Dick Taverne and is registered as a charity, some of it's personnel comes from ex-Revolutionary Communist Party members. It is funded by a number of different corporations, including a number of pharmaceutical companies, including GlaxoSmithKlien. It has influential individuals on its boards, including politicians, academics and industry bosses. It campaigns and lobbies on behalf of corporate science.

Centre,7 put questions to the Reed CoE Crispin Davis about Horton's role in the publication of the contested paper authored by Dr Andrew Wakefield and eleven other authors (Wakefield 1998 see below). When the pro-science lobby group MPs asked Davis if he believed Horton had behaved properly in relation to the Wakefield case review paper, he replied that he did not hold 'our' editor to blame. 8,9

Of course it is possible to argue, as Sir Richard Doll did all his life, that financial investment in and control of projects of any kind, and even behind-the-scenes long-term ties to industry with payments of millions of pounds, need have absolutely no effect upon the output of

7 The Science Media Centre, was set up by ex-Revolutionary Communist Party Members with an input from Lord Sainsbury when he was head of the the Department of Trade and Industry and head of Science for New Labour. It grew from a unit inside the Royal Society that lobbied on behalf of GM crop producing corporations. It was primarily responsible for new guidelines on health and science which it constructed for the media. Although many commentators, like Horton, pretend that these guidelines are inneffective, the guidelines and the SMC, because of their close relationship with New Labour and due to their heavy handed campaigning that includes sending groups to the offices of editors when papers produced articles with which they disagree, have actually managed to shut down the public debate on some issues, like MMR.

8 Most interesting in this situation is the fact that the committee put on a great circus when Davis answered that he thought Horton had done the best thing in demanding a partial retraction from the paper's authors. Vehement committee members refused to accept this and bayed for Horton's blood, saying that the whole of the paper should have been retracted and Horton's mistake in publishing it made public. The truth is that the difference between Horton and the science lobby groups is a hairline and GSK, having won the most substantial victory against Wakefield over the six preceding years and having protected their damaging vaccine, was quite happy to let the rednecks of the STC and the more hapless Horton, dragged into the dispute not by force of conviction but by career protectionism, fight the matter out in a public brawl.

9 In relation to conflict of interest, Davis, a director of the world's largest pharmaceutical company, said about their journal, The Lancet, 'In all fairness, I do not hold our editor to blame in that (this) instance. I think it was regrettable but I do not think that he or the Lancet were at fault at all. We were in our opinion badly misled.' It would take an expert in post modern textural deconstruction to evaluate the words 'we' and 'our' in the last sentence. Was Davis referring to the medical journal the Lancet or the corporation, GlaxoSmithKlein, and where exactly was Davis placing himself and Horton in relation to these. (MMR Science and Fiction pp 50/51)

research workers, writers and intellectuals who benefit from this backing -after all, were we not all on the same side? It does, however, seem questionable that the next online manager for the editor of the Lancet should be a director of the biggest drug company in the world.10

Dr Horton must have been under some pressure during the second half of 2007, even perhaps during the writing of his review of Devra Davis's book. In October 2007 he gave evidence for the prosecution against Dr Andrew Wakefield and two other defendants at a GMC 'fitness-to-practice' tribunal that took four years to prepare, has been going on now for almost a year, and is not due to finish until April of 2009. A look at Horton's involvement in Dr Wakefield's case provides us with a brief glimpse of how close contact with the world's biggest drug company might make life difficult for the editor of one of the world's most prestigious medical journals.

In 1992, Dr Wakefield, a well accredited gastroenterological research physician responsible for leading work on Crohn's disease, began to try to call the government's attention to the fact that he and his colleagues at The Royal Free Hospital in London were concerned about the rise in Crohn’s disease and its possible relation to measles virus.

The government paid no heed to Wakefield's letters and phone calls; in fact it took six years to award him the meeting for which he had asked in his early letters. In 1997, Wakefield presented a case review paper to the Lancet involving 12 children whose condition illustrated a new syndrome. He suggested at an accompanying press briefing arranged

10 When Brian Deer attacked JABS and John Stone for making this information public, he accused the campaigning group of being cruel to Davis, who after all Deer suggested was just a hapless member of Britain's small and intimate ruling class.

by his university department when the Lancet published the paper in 1998,11 that the NHS might consider returning to the prescription of single vaccines until the cause of these apparent adverse reactions to MMR was properly researched.

Although initially, following the publication of the paper, Dr Wakefield and the gastroenterological unit at the Royal Free Hospital were rewarded with considerable interest in their research, within a short time a reaction had set in that defended MMR and denied all vaccine damage. By the end of 2001 Wakefield left the Royal Free Hospital his position there having become untenable.

A clearly recognisable group of individuals and organisations came out against Wakefield and his work. These included science lobby groups funded by pharmaceutical companies, certain politicians who might or might not have had some connection with pharmaceutical companies, embedded journalists and media commentators who had connections with pharmaceutical companies, members of the medical community and research workers funded by pharmaceutical and government agencies.

Dr Wakefield, vilified at every turn by orthodox opinion, and seeing his research possibilities in Britain quickly disappearing, left the country for America, where he set up a research establishment that could help children with regressive autism and support his research into vaccine damage.

11 A J Wakefield, S H Murch, A Anthony, J Linnell, D M Casson, M Malik, M Berelowitz, A P Dhillon, M A Thomson, P Harvey, A Valentine, S E Davies, J A Walker-Smith. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, Volume 351, Number 9103 28 February 1998.

Despite wholesale changes at the Royal Free Hospital and Wakefield's departure for the States, there remained an interest in the MMR debate, reflected by stories in the papers and the occasional television programme, together with any interest that the parents of affected children created.12 Of course the problems of vaccine-damaged children and their parents didn't disappear, and in 2004 the campaign against the critics of MMR came to a head. The Lord Chancellor's department withdrew legal aid funding from those claimants who had been pursuing a case against three vaccine manufacturers for almost ten years.

The judge who presided over the appeal of parents to get the legal aid reinstated, was Sir Nigel Davis, brother of Sir Crispin, Richard Horton's on-line manager at the Lancet. In a closed hearing in February 2004 Judge Davis rejected appeals of 2,000 parents acting on behalf of their children against loss of court funding for their claims. Making this judgment he failed to declare his connection with Sir Crispin Davis or his brothers place on the board of the worlds largest pharmaceutical company.13

12 One campaigning organisation JABS (Justice, Awareness and Basic Support) was set up in 1994 and has campaigned for parents and Dr Wakefield and his colleagues since that time. (  /) See, Silenced Witnesses (ed) M. Walker. The Parents Story: The denial of vaccine damage by government, corporations and the media. Written by the parents. Slingshot Publications. London 2008.

13 John Stone, writing for JABS (Justice Awareness and Basic Support - for vaccine damaged children) MMR Judge Faces Enquiry Over Vaccine Firm Links Parents Demand Answers. When this conflict of interest involving the judge was later pointed out by campaigners it was said by the judge that he was unaware of his brother's involvement in the biggest drug company in the world, one of the MMR producing companies and one of the defendants in the court case before him.

This devastating blow to the parents who had chosen the legal route, was followed up by a lengthy all-out attack on Wakefield by a pro-MMR journalist, Brian Deer, in the Sunday Times.14

On the point of publishing his article, Deer descended on the offices of the Lancet and, with the bizarre and diminutive Dr Evan Harris MP in tow, confronted Horton with the apparent findings of his investigation. This investigation had in fact been aided by Medico-Legal Investigations, a private inquiry agency working almost solely for the Association of the British Pharmaceutical Industry (ABPI).15 Over a 48 hour period Horton caromed around London speaking to senior authors on the 1998 paper and other witnesses and generally behaving is if it was his sole responsibility to investigate and adjudicate on the questions raised by Deer.

Within days of its publication, the bullet points of Deer's Sunday Times the article were lodged with the General Medical Council (GMC) as a sorry excuse for a complaint against Dr Wakefield, on the suggestion of the then New Labour Minister of Health, John Reid.

Having published Dr Wakefield's paper six years before, Horton became inextricably drawn into the controversy that erupted again around Wakefield and the issue of MMR. Faced with Brian Deer's accusation - and whoever else was bending his ear at this point - Horton seemed to approach Wakefield's paper with a new perspective, but only slightly new. If Horton, however much he might have been pressured to join the lynch mob that chased after Wakefield, had denied the science of the paper six years after its peer-reviewed publication, his editorship of the Lancet would clearly be on the line.

14 Revealed: MMR rsearch scandal, Brian Deer, The Sunday Times (London) February 22. 2004
15 Martin Walker,The Complainant published on the internet February 2008.

Although Horton claims to have fallen out with Deer soon after he finished his investigation, it might be better to understand this fallingout as a 'difference in degrees of sophistication'. While Deer produced his allegations in Monday's fish and chip wrapping, Horton produced his more subtle undermining of Wakefield in his book for Granta on the 'science and fiction' of MMR and the vaccine crisis (Horton 2004). The book, was, like Deer's Sunday Times article, a decisive aspect of the onslaught on Wakefield and the parents who reported adverse reactions to the MMR vaccination.

Any rational person following Horton's nimble feet on the stepping stones across this river in flood, would be bound to ask, why it was that he felt impelled to fall for Deer's ramshackled attack on Wakefield. In fact, immediately the accusations were in the public domain, Horton took control of the final assault upon Wakefield as if he had been awaiting his moment. The taking over of Deer's allegations, and the translation of them into the much more rational language of science and academic accountability, was essential to the government and the pharmaceutical companies, who had to get the accusations away from the shifting sands that Deer inhabited and onto apparently firmer scientific ground. Having conducted his private investigation, Horton even saw fit to discuss Wakefield's case with a high-ranking member of the GMC, who sought his advice about how the GMC might proceed with the prosecution ordered by the Minister of Health.16

16 Page 7, Horton R. MMR Science & Fiction: Exploring the vaccine crisis. Granta. 2004

* * *

There was a four-year wait before the GMC managed to turn Deer's scarcely coherent 'evidence' into a GMC fitness-to-practice prosecution that would ensure Wakefield gave no expert witness evidence anywhere to anyone, and that he became a pariah to the world's media. Horton's evidence against Wakefield was crucial to the GMC prosecution. When he had published the case review paper, he had apparently given the medical establishment seal of approval to a statement that linked the MMR vaccine to regressive autism. However, like most of the other prosecution witnesses, as well as giving evidence against Wakefield, Horton had to ensure that he emerged from the hearing with his integrity ostensibly intact.

Masquerading as a typically English gentleman in the Doll mould, Horton gave his evidence with a clear desire to please all parties. But it was not possible for him to keep a smile consistently on his face, and his evidence saw him, like a German holidaymaker at a southern Spanish resort, wanting to be liked but equally determined to claim a place for his beach towel at the pool's edge. The odd sharp dig with the elbow, the disguised push, the occasional spat to the right and obscenity to the left, with a casual but apparently mistaken kick in the ankle or sideswipe with the hand were all covered with a smile of even teeth and a polite apology.

In Horton's evidence for the prosecution in October 2007, he had to make it appear that he was a responsible and intellectually acute editor who had been duped on a single issue by a clever and manipulative researcher. So where might he turn for evidence against Wakefield?

Horton stood by the science of Wakefield's paper, extolling its virtues in splendid terms. He alighted, though, on two subjects that he must have judged enough to scupper Wakefield while leaving his own reputation undamaged: He seized, then, upon Wakefield's non-disclosure of his legal aid money, which, according to Deer was used for the research drawn on in the paper, and upon the fact that Wakefield provided no evidence of any kind for assertions by parents who identified the onset of their children's illness with their having received the MMR vaccination.

When Horton had completed his investigation in 2004, he had determined that many of Deer's accusations did not hold water. But at the time of the investigation, on the basis of the anecdotal evidence of the link between MMR and IBD, (Inflammatory Bowel Disease) he had engineered a 'retraction' that 10 of the 13 authors of the paper were persuaded to sign. The retraction was of one small aspect of the case review paper, and not a part of the scientific evidence, yet it led to the apparent wholesale desertion of the battlefield of nine of the paper's twelve authors.

All Wakefield and the other authors had said in the paper about the anecdotal material included in the paper, was that despite its anecdotal nature, it was a possibility that should be researched and evaluated. It was raised, solely because the parents were so insistent and given previous work that Wakefield had published on the effect of the measles virus and Crohn's disease, it would have been irresponsible not to mention the parents concerns about the matter. The information was, in effect, a key to potentially important areas of new research.

In the GMC hearing, in response to cross examination, Wakefield said that he was still of the same mind, that it was not possible to retract 'a possibility'. It was, however, the retraction by nine ten of his less robust co-authors, overblown and enlarged by Wakefield's enemies, that was used to claim that the science of his research had been repudiated even by its own authors.

Further, it was this apparent repudiation of the core content of the paper that led to the constant repetition that 'Wakefield's research has now been thoroughly discredited'. In fact, perhaps rather strangely given the terrible furore which could be stirred up by Wakefield's enemies, Horton stuck doggedly to his opinion of Wakefield's science - but, then, he would, wouldn't he? The case review paper, Horton insisted, was one of the best analyses of a new syndrome that he had seen, and its science was faultless.

In relation to legal aid and the conflict of interest issue, Horton claimed that he had not found out about Wakefield's relationship with the lawyer Richard Barr, and the funding he had been granted by the Legal Aid Board, until after he had published the paper. Near to the GMC hearing he had said publicly, that had he known about this 'conflict of interest', he would not have published the paper.

Dr Wakefield argued a number of very practical points in his defence on the conflict of interest issue. He said on oath that at the time he wrote the case review paper, he had not received any money from the Legal Aid Board. He testified that, at the time that the children 'written-up' in the case review paper received clinical appraisal at the Royal Free Hospital, (a process in which he was not involved),17 he had no

knowledge of any of them receiving legal aid for their claim against the drug companies. Finally, he argued that the case review had nothing to do with any work that he had agreed to do for the Legal Aid Board.

In his evidence, Horton and the prosecuting council, moved the discussion about conflict of interest away from the rubric that was in place in 1997/1998 when the paper was published, to a new rule that had replaced it. How the prosecution managed to conjure this into their case is a mystery,18 but Horton and the prosecution both argued that in 1998, Dr Wakefield should have been aware of a much wider understanding of 'conflict of interest', which went beyond the one used by the Lancet at the time. At the time the statement on conflict of interest supplied by the Lancet was very thin, suggesting only that authors should consider matters in relation to their papers that might cause them embarrassment at some future date.

Dr Wakefield was able to argue that, firstly, it was common public knowledge that he had been awarded legal aid money to do research; second, that he had complied with the conflict of interest rules given to him by the Lancet; and, finally, that within a month of the paper being published, he had written to the Lancet on another matter, mentioning in no-uncertain terms his arrangement with the legal aid board.

* * *

17 It has been a continually reiterated accusation of the GMC prosecution that Wakefield, while only employed as a researcher at the Royal Free had overstepped his contract and frequently become involved in clinical work. This was denied time and again and in fact the prosecution presented no credible evidence that it had every happened.
18 I was there, observing the case and like magic the prosecution were suddenly talking about a new set of rules that had been brought in after 1998 and Dr Wakefiel was having to answer theoretical questions about compliance with these rules.

There are a couple of slightly odd emphases in Horton's book. He makes a passing reference to the use and then withdrawal of two of the three MMR brands that were introduced in 1988. These brands were taken off the market in Britain, because it had been found in Japan and Canada that the Urabe strain of mumps virus used in them created encephalitis, a serious adverse reaction, in a number of children. To be fair to Horton, he also says that many government-biased commentators do not mention this early failure. However, this prime example of iatrogenic illness in vulnerable children, precipitated by unsafe vaccines, appears not to sway Horton in his view that the one remaining MMR vaccine is safe; which one might consider a singularly unscientific assertion.

Horton also lauds the science lobby groups, suggesting that they represent discussion groups that might popularise issues at the heart of contemporary science. Although he does refer to the fact that Sense About Science is part-funded by vaccine manufacturers, he gives Lord Dick Taverne, the founder of this 'charity', a very easy ride. Taverne has been at the forefront of objections to awards for legal aid to claimants against pharmaceutical companies. Horton says that Taverne trained as a barrister, and this in turn suggests that he therefore has a learned and independent point of view. He says nothing, however, about Taverne's background as an executive in important PR companies that interfaced between the New Labour government and the pharmaceutical industry in the late 1990s, nor about his linking up with science-mad members of the ex-Revolutionary Communist Party, nor his attendance at the highly secretive Bilderberg conferences19 nor his loony but vitriolic attacks on any kind of alternative or complementary medicine.20

19 Bilderberg is the economic order in waiting for a global one world government, set up by Rockefeller in the 1954 (

20 Judging by the anti-homeopathic articles and dubious research that Horton has run in the Lancet, he is perfectly at ease with Taverne's major ignorances. The Lancet, Volume 351, Issue 9099, 31 January 1998. The Lancet, Volume 366, Issue 9503, Pages 2083- 208517 December 2005-6 January 2006. The Lancet Volume 370, Issue 9600, Pages 1665-1736.17 November 2007-23 November 2007

* * *

I would like to think that the above analysis of Horton's approach to Wakefield and the GMC prosecution casts significant light on his identity. Despite his complete support for Wakefield's science, in the light of which he must have had to put up with pressure from some quarters, he still chose to cast his stone at Wakefield. Although the stone did not carry much weight, it added to the others that have rained down on Wakefield.

The real remaining unanswered question, after Horton's evidence to the hearing, and in light of his mistaken recollection that he did not know of Wakefield's relationship with Barr or his legal aid money at the time he published Wakefield's paper is, whether Horton played his part in this government and drug-company-inspired attack on Wakefield out of ideological commitment or was simply blown into a corner by the prevailing winds. One difficulty in answering this question comes when we realise that defence of themselves was a priority for most of the witnesses called by the prosecution, who only shards of responsibility at Dr Wakefield.

Many questions that explore the nature of prosecution witnesses in civil matters cut to the heart of concepts about totalitarian power and corruption. State prosecutions instil fear in people, often leading them to give corrupt evidence. It was probably this way with the witnesses for the Catholic Inquisition against Galileo for daring to utter the heresy that the sun was at the centre of the universe, and it was definitely this way with the McCarthy witch hunts.. Few people can face threats to their identity, and their professional livelihood, without losing bits of their integrity along the way. In this sense, and not only in this sense, Andrew Wakefield is an exceptional man.

What a corrupt prosecution does, as in the Soviet show trials of the 1920's and 1930s, is to disguise the corporate or State influence while making it appear that individuals are giving evidence entirely out of individual principle. Everything seems to boil down to the individual. Instead of drama, with its umbra of meaning, we are fed the chiaroscuro of melodrama, with white hats facing black hats. The GMC prosecution of Dr Wakefield, Professor Murch and Professor Walker Smith, is exactly this kind of trial: everyone within its aura is threatened by the powerful forces that lie behind it. Prosecution witnesses scurry like rats for a bolthole. The truth is that the hearing is not really about the defendants but about a much bigger matter - whether or not the pharmaceutical corporations are able to control medical research so that it comes up with only those results that aid the marketing of its drugs .

Horton proved in the GMC hearing that he could nimbly defend himself, deflecting personal blame and any obvious suggestion of collateral lack of scruples, while at the same time showing continuing support for Wakefield's science that he had published.

Whatever conclusions we come to about Horton's role in the Wakefield affair, the similarities that exist between his role and his review of Devra Davis's book are clear. As a doctor with a native integrity, Horton felt bound in both cases to state the truth as he knew it at the start of his analysis, he began his review with the rarely repeated figures for the incidence of cancer in the developed world. He agreed with Davis in her absolute concern about the growing pandemic. However, facing up to the hard facts that somewhere behind these figures there lurked a human hand with a traceable social history, was too much for him, and he sought solace in Doll's frequently used tactic of blaming the patient for their illness.

In the Wakefield hearings, Horton stuck so doggedly to a defence of Wakefield's science, one feels, not just because his good name depended upon it, but because it was the right thing to do. However, when the chips were down, he dealt a scare card in order to please the more powerful individuals in his world. While in essence Horton supported Wakefield in his scientific battle, by arguing the apparent issues of conflict of interests and the matter of anecdotal evidence he shifted the responsibility for Wakefield's apparent wrongdoing away from the political forces that engineered it, and back on to Wakefield himself.

Horton, in his review of Davis's book, presents no proof at all for his statement that the great majority of cancer is caused by cigarette smoking and obesity, nor does he break this sweeping statement down into any component parts, but, rather he rounds upon Devra Davis, accusing her of coming to ill-judged, unfair and - reading between the lines - slightly paranoid conclusions.

In doing so Horton purposefully avoids the whole essential and very strong point of Davis’s book, that those within the chemical companies and the pharmaceutical companies who are responsible for producing carcinogens and are then doubly responsible for skewing research results on environmental factors and cancer, should be brought to account for their crimes in a public setting. Because people like Boyle and Horton insist that any attempt to unmask these disguised agencies and causes is unwarranted, they are driven to dismiss as conspiracy theorists, anyone who does not want to expose them.

Since Davis and Horton agree that cancer is today an epidemic disease, the fundamental issue between them is that of who, or what, is to blame. The answer? Primarily those government and regulatory agencies that refuse to adhere to the precautionary principle and the cancer funds that refuse to grant-aid studies on prevention. The balance has for decades been in favour of microbiology and new expensive molecular targeted drugs, with prevention being utterly neglected, apart from the usual exhortation to stay slim, stop smoking and avoid risk enhancing life styles. As any of the parents presently involved in the defence of Andrew Wakefield would tell you, autism spectrum disorders are also developing into an epidemic. Those responsible for this, if one follows Wakefield's scientific arguments, are also those who neglect proper safety trials, those who refuse to adhere to the precautionary principle, and the autism fundamentalists who refuse to credit research that proposes environmental factors as triggers to autistic states.

Medical researchers with hidden agendas and secret ties who do not disclose conflicts of interests should shoulder the blame for fast developing and clearly environmentally triggered illnesses. If we are to start winning the war against cancer or autism, we cannot afford to be politely forgiving of epidemiologists such as the late Sir Richard Doll, whose vested interests in industry and the cancer research establishment cast doubts on cancer risks while simultaneously being secretly funded by cancer creating industries.21 Nor can we stand by and watch those, often

21 The seven lines above are credited to Lennart Hardell

with secret ties, who would wish to stick the knife into sincere research scientists, such as Dr Wakefield, while hiding darker designs. The only way that scientists can preserve their integrity is by cutting themselves free of all vested interests.

The conundrum of Horton's evidence for a prosecuting GMC casts some light on his review of Devra Davis's book. Horton is clearly a man who wants to retain his self-image of decency and to be liked, but he also has to scramble up the greasy pole. He is almost Shakespearian in his ability to retain apparently personability, while discharging his responsibilities to those who hold his future in their hands. How bizarre it is that Horton chose to focus his undermining of Wakefield on the matter of conflict of interests, when his immediate online manager is a director of the GlaxoSmithKline, the manufacturer of the MMR vaccine that Wakefield has cited as causing adverse reactions in children!

In the case of Horton's criticism of Devra Davis's book, one gets the feeling that it was her criticisms of Doll that really spoilt the book for him. Such censure of a mentor, such intervention in the real world, despite having a solid basis in truth, were not at all in the collegiate tradition of a profession that had helped him get where he now is, and which will undoubtedly help him to climb higher. As with giving evidence in the GMC hearing against Dr Wakefield, Horton found the message he had to take in with on reading Devra Davis's book just too painful, so rather than siding with her and wading into his own profession like a genuine seeker after truth, he prepared to repel boarders.

Davis's book is, however, one of the most honest appraisals, by a recognised and committed academic, of the role played by industry, industry-orientated academics and doctors, in the denial of environmental and industrial carcinogens. In the conclusion to his review, Horton hints vaguely at Davis’s over-emotional approach to the subject and perhaps her too-easily-held views on conspiracy. And yet, in today's world, with it's networks of the powerful working well beyond the boundaries of democratic institutions, all those except the powerful are left in the dark, and can only guess at the truth.


Busby, C, (2002) paper commenting on 1992 Nordic Study: Darby, S. C., Olsen, J. H., Doll, R., Thakrar, B., de Nully Brown, P., Storm, H. H., Barlow, L., Langmark, F., Teppo, L., and Tulinius, H. (1992), `Trends in Childhood Leukemia in the Nordic Countries in Relation to Fallout from Nuclear Weapons Testing', British Medical Journal, 304: 1005-9. 1992. presented to (CERRIE) Committee examining Radiation Risks of Internal Emitters. 2002 [ ].

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