by Martin J Walker
"Reading the accounts (of the GMC hearing) whilst in my private prison keeps me riveted, and in part wishing I only had to suffer a year’s tedium and it would all be over - my son would be fine."
A couple of weeks ago I commented on ‘abuse of process’ and pointed out how the prosecution could manipulate both the information of the case and its outcome by delaying or dragging out the hearing. I don’t usually quote my own writing but I have done it here because I have seen my words recently become reality. In my fourth piece on the hearings I wrote:
"Having begun the hearing in July 2007, the prosecution now intends to suspend the hearing until March 2008. It could be argued that having presented the prosecution case, this six month period is likely to consolidate this case in the minds of the Panel. Because there is no sub judicae rules which affect the publication of general and specific information about the charges brought against Dr Wakefield, it could be argued that the medical establishment, the government and the pharmaceutical companies, have now six months during which time they might publicly build on the prosecution case and even move forward with the programme of multiple vaccines."
On Tuesday 28th of August, the prosecution and the defence organised another schedule which entails ending the hearings on August 29th 2008. On the 30th August, those ranged behind the prosecution, by which I mean those linked to the government, the medical establishment, the GMC and the pharmaceutical companies, began a massive out-of-hearing campaign specifically in support of the measles component of MMR. This flurry of amplified campaign material reached the media at exactly the time that Dr Wakefield’s defence was supposed to have begun in the first time-table of the hearing.
One can almost see the cerebrally bloated Professor Salisbury, hunching back into his office, his pride fatally wounded by the defence unwillingness to ask him a single question, picking up the phone, calling the Health Protection Agency and barking out an order for them to produce propaganda. The Health Protection agency organises all the scare stories about vaccination and such things as bird flu as well as all the un-scare stories about other public health matters from mobile phone masts to toxic chemicals in the water supply.
The statement issued by the HPA on August 30th went to all the media and was massively reported by Sky and The Times, both outlets belonging to Rupert Murdoch who over the last decade has worked hand in glove with Tony Blair and New Labour.
On the front page of The Times, a story headed ‘Vaccine warning as measles cases triple’, which included a scientifically educative five and a half inch square picture of a child with a measles rash over his face and shoulders, had a tucked away paragraph about Dr Wakefield.
"The triple vaccine has proved highly controversial in recent years over unfounded concerns that it may be linked to autism. The study that first sparked fears about its (MMR’s) safety is currently being scrutinised in a hearing by the General Medical Council, the medical watchdog. Andrew Wakefield and two co-authors of his research are currently appearing before the GMC on charges of serious professional misconduct."
Apart from the obvious issues raised by this paragraph, especially ‘over unfounded concerns’, and ‘the study … being scrutinised’, when the reality is that three doctors are on trial, it is interesting to note the semantic twist when David Rose talks about the GMC hearing. Andrew Wakefield ceases to be a doctor and the treatment of 12 children, carried out by a whole team at the Royal Free becomes ‘his’ (i.e. Wakefield’s) research.
Dr Michael Fitzpartrick took up the story and ran with it in the Guardian, a paper which is becoming well known as a major outlet for pharmaceutical company propaganda.
"While discussions with privileged parents about the utterly discredited claims of a link between MMR and autism continue in our baby clinics …….."
"Now that the anti-MMR campaign is history …"
Having dedicated a large part of his life to the maniacal Revolutionary Communist Party (RCP) it is inevitable that Fitzpatrick can’t help but draw attention to what he considers class issues; even if in a very superficial manner. His writing is always rhetorical and so founded on personal assumptions that it rarely makes sense when closely examined.
At the end of the 1990’s some 2,000 parents had spoken to lawyers over serious illnesses which had occurred in their children coincident with their receiving MMR or MR. It goes without saying that all of these parents initially believed in vaccination (can you grasp that Fitzpatrick?), they all had their children vaccinated! Obviously they came from across class boundaries. That they believed that their children were damaged by a vaccine and that they then protested but were ignored, says nothing whatsoever about class. To suggest that it is only ‘privileged’ parents who are involved in the arguments about MMR and that working class parents have not fought their corner shows exactly the same contempt for the working class that the RCP showed during its short life as a ‘political party’; amongst ‘privileged’ university students and lecturers.(The Revolutionary Communist Party, were the only left grouping, to side with the State at the start of the miner’s strike, when pressure was put on the NUM to hold a ballot of members so as to get a ‘democratic mandate’ from the workforce to go ahead with a strike. Although there is nothing wrong with this view from a communist perspective – over the last century, communists have always suggested working within democratic frameworks until they reach a point where they are able to seize power – when the NUM failed to do what the RCP thought correct, the RCP withdrew from any comment, analysis or involvement in the strike. This was not of course a proper political strategy, more like a child taking his ball from a football match after a disputed gaol. What it made me think was that the RCP leadership were inevitably more concerned with ideology than the day to day lives of the working class from whom they contemptuously withdrew their support.)
The situation of the parents whose children may have been adversely affected by MMR, while it has nothing to do with class, has a great deal to do with the power of the State, and what has often been termed the medical-industrial complex. If we approach the situation of vaccination and adverse reactions from a political perspective, it has everything to do with the power of the state to override the wishes of the individual. Such discourses might well leave a nasty taste of libertarianism in Fitzpatrick’s mouth. But surely he knows that his oppressive ideas about state power place him, in the eyes of many, within a collectivist tyranny. A tyranny whereby state power - in congregation with multinational commercial cartels, inimical to individual liberty, demonstrate a complete lack of care for the citizens whose safety it compromises.
The real poverty of Fitzpatrick’s politics and that of his crowd, is shown by the fact that this whole matter could have been resolved along the lines of good ethical and moral principles. Had the government instructed doctors much more carefully on the application of the vaccine and avoided giving it to children who showed the slightest signs of vulnerability. Had they accepted, as they have in the past, that some children are inevitably damaged by vaccination and pledged itself to care for those who were damaged. Had they at the same time kept a high level of pharmaco-vigilance and consistently updated research that might have had a bearing on these adverse reactions, then the whole political complex of the problem could have been quite different. Anyone who thinks that the policy outlined above is subversive of democracy obviously doesn’t deserve to be working with vulnerable people in the public sector.
In his Guardian article, Fitzpatrick makes a point of saying that a measles epidemic has recently been underway in Hackney in East London, and that there have so far been 150 cases in the borough in the last three months. The Times, using emotive statistic-scattered prose, suggests that ‘hundreds of thousands of children returning to school as early as next week may cause the highly infectious disease to spread’. In fact the tripling surge which the Times is referring to seems to have taken place only in Hackney, one of the poorest and most disadvantaged of London boroughs.
Nevertheless, the Health Protection Agency (HPA), Fitzpatrick and The Times, all suggest that the 480 cases so far this year are ‘well on the way’ to being greater than the total annual 736 measles cases reported in 2006. This assertion, however, doesn’t really stand up. An estimate based on figures already disclosed for the first 8 months of 2007, would bring the years cases to around 732, actually less than the total cases in 2006.
While we’re on the subject of statistics, perhaps someone could explain the meaning of the figures in the table for Measles Notification: England and Wales, By Age Groups, 1989-2006, that appears on the Health Protection Agency web-site. This table shows the number of measles cases notified (excluding ones at Port Authorities, to exclude the bias of people bringing measles into the country from abroad) for 2006 as 3,739. Why is this figure almost 3,000 more than the figure quoted by the HPA and repeated in the articles of Fitzpartick and others?Given that the battle over the attempts of parents to gain acknowledgement, treatment and care, for children who they believe to have been damaged by MMR, is still insistently proliferated outside the hearing room of the GMC, it is worth looking at the effect such recent propaganda might have on justice for the three defendants. What does accepting the elasticity of the new GMC time-table for the hearing really mean in terms of justice?
Perhaps more important than the fact that the Panel could well be swayed by the constant reference in the media to the guilt and criminality of Dr Wakefield, it now occurs to me that this prolonged delay could actually ‘bury’ both the importance of the initial conflict, the subsequent hearings, and the final verdict - whatever that may be.
There can be absolutely no doubt that while the three defendants are easily winning the ineptly prosecuted legal case, the scientific and public health high-ground will always appear to be held by the government, the NHS and the spinners at the HPA. Even if the three doctors are found not guilty on all counts, a slothful press, bent scientists, pharmaceutical company executives, New Labour aparachiks and a rag bag of Liberals, sceptics and ex-communists will have had plenty of time to convince the general public that the doctors were always guilty.
The possibility of the three defendants being found not guilty, does, however, raises a multitude of questions that the GMC would need to answer about their faux legal processes. It would seem absurd, for instance, were the defendants to be found not guilty, that there was no process available by which the defendants could obtain compensation for the suspension of their lives and their public criminalisation over a period of four and a half years. It would also appear quite wrong that the GMC could get away with this immense charade, involving biased evidence and witnesses who don’t tell the whole story without their being some form of public enquiry into the conduct of this case.
As Miss Smith marches the prosecution, lemming-like, to the edge of the cliff, it is becoming more apparent that their case has always been in confusion. When the prosecution began, especially as it was under the auspices of the General Medical Council it was taken for granted that the three doctors on trial were being accused of being bad doctors.
As the trial has dragged on, however, and more especially with the general reluctance of the GMC to bring children or parents to give evidence, it has become more than apparent that none of these doctors have, in any way whatsoever, adversely affected the welfare of their patients. Even the most prejudicial witnesses have been unable to claim this under oath and early suggestions that the doctors put their patients at risk by administering dangerous investigative procedures has been frequently discounted by experienced witnesses called by the prosecution.
Now, after almost two months of the hearing, the ‘butterfly’ case brought by the GMC has alighted on the idea that, actually, science has been the subject of the prosecution all along. The three doctors - and particularly Dr Wakefield - are clearly being accused of bad scientific method. If we look at this situation carefully, we can see that it is as utterly untenable as the prosecution’s first hypothesis.
The pharmaceutical companies and the organisations of corporate science have been looking for ways of disciplining medical scientists who either carry out research in ways that they don’t like or who are ‘alternative’ in their approach to subjects of study. The easiest point of entry for corporate science into the patchy regulatory framework for medical science in Britain, is a politically compromised GMC. The fact that the GMC has eagerly taken up this role on behalf of the government and the pharmaceutical companies, has nothing to do with the suitability or the correctness of it. The regulation of science and scientific enquiry should be conducted by scientists and such regulation should be planned and co-ordinated by a body which is utterly free of vested interests.
With the hearing at the GMC, we face the same question that has always been asked about science and the law; is the court of law a proper venue for deciding scientific matters? Let’s face it, no one on the prosecution side or even those in their train, know anything about science, nor would you expect them to, their number is made up of doctors, lawyers and a journalist.
Still, Miss Smith, whom sometimes you have to feel for, has had the same lack of good fortune in getting her witnesses to say bad things about the scientific abilities of the defendants as she did when she was accusing them of harming their patients. As the case spluttered out last week, and before the next sitting in late September and October, when the re-briefed expert witnesses for the prosecution appear, the Ms Smith called a couple of witnesses who were meant to decry the underlying scientific method of the Lancet paper.
I was away from London on Monday 27, Tuesday 28, Wednesday 29 and Thursday 30 August. There was no hearing on Friday 31 August. Two of the days that I missed were covered by Susan and Olivia Hamlyn and I have included edited versions of their reports below. I have added any of my own comments in italics and labelled them MW. In the first report from Susan Hamlyn, written originally for the campaign internal email list, the mother of ‘child 12’ was named. I cannot do this in my more public account. Doing so would invite criticism from the GMC on the grounds that revealing the name of the child would make him or her vulnerable to prejudicial or damaging enquiries. Of course, as those presently campaigning against the Family Courts will tell you, this secrecy, with threat, immensely aids the prosecution. However, this account is not the place to challenge such usurpation of parental authority by the state and legal profession. I have continued the rule of the GMC hearing in referring to the child as ‘child 12’ and therefore the child’s parent as mother 12.
Susan Hamlyn writes
Mother 12 and I last met when our sons were in adjoining beds in the Royal Free way back in Jan 1997 - a crucial time and the one to which most attention was paid today.
I was, of course, surprised that Mother 12 was being called as a prosecution witness. She made it clear to me afterwards that when she was first contacted by the GMC, and even when they visited her to take away documentary material, it was never made clear that she was to be called for the prosecution. She was anxious not to damage the three doctors in any way. She made it clear in her evidence that she had no complaint about any of them and that she and her son were always well-treated at the Royal Free.
MW: Actually bringing a defence witness in the hope that they will give prosecution evidence is even more audacious than Miss Smith’s previous corruption of the prosecution process whereby prosecution inclined witnesses have been allowed to give evidence-in-chief which simply helped the defence.
The day was, in fact, another extraordinarily damp squib. I spent it sitting with Dr Wakefield’s mother who had not been before and who was amazed at how dry, tedious and seemingly pointless it all was.
Miss Smith, began by asking Mother 12 a series of questions to elicit details of her child’s medical history. She established that Mother 12 first heard about AW's work at the Royal Free from another mother at a parent-toddler group. This mother recognized the symptoms - behavioural and gastroenterological - that Child 12 was displaying. About the assumption she made regarding the role of MMR in her son’s case, she had the following to say:
- ‘I had a perfectly normal child who suddenly wasn't normal any more’.
- ‘it (MMR vaccination) was the one thing that had happened to him that could have caused such a change.’
Miss Smith established that Mother 12 had contacted Dr Wakefield directly and not via her GP. She seemed to be hinting at a conspiracy of money-hungry mums who had banded together to get money out of the NHS. She wanted to know how Mother 12 had made contact with Dawbarns and was asked what she had understood the solicitors were doing. Mother 12 answered - 'to stop the MMR - to stop children being damaged by it.'.
Miss Smith then dragged through endless letters between Mother 12, and the Royal Free and between Mother 12 and Richard Barr. Together with these she read out extracts from the Dawbarns newsletters.
It looked throughout as if Miss Smith would have liked to prove skulduggerous links between Dr Wakefield and Dawbarns, in relation to the Lancet paper cases, but everything she read out seemed to demonstrate exactly the opposite - meticulous and scrupulous dealings with everyone from both the Royal Free and Dawbarns.
Miss Smith moved vaguely, as she is always tempted to do, in the direction of suggesting that Mother 12 submitted her son for tests to help with research when they weren't strictly indicated by his conditions. However, Mother 12 defused that insinuation. She said that although she was clearly wanting to support research which might help other children, she hoped that something therapeutic would come out of it for her son.
One potential hiccup was when, apparently, during a ward round a note was made by one of the doctors that child 12 should not have an MRI or a Lumbar Puncture, however, for some reason, both procedures were carried out although no consent form was found for these procedures. Mother 12 did, though, sit with her son throughout both procedures.
Two mildly farcical moments came when, first, Miss Smith noted darkly that one of Mother 12’s letters to AW began "Dear Andy". ‘When’, Miss Smith wanted to know, with all the zeal of a jealous lover, ‘had that mode of address been agreed on?’
The second farcical moment was when Miss Smith quoted an umpteenth newsletter from Dawbarns referring to the fact that they were still waiting for Dr Wakefield to 'deliver the goods' – i.e. come up with a full scientific report. Miss Smith made ‘the goods’ sound like something in a plain brown packet slipped from one hand to another at midnight on Clapham Common.
Much time was spent on a press release which coincided with the Lancet paper and which came from Dawbarns. If Miss Smith was attaching real significance to this, it was yet another point that was never actually brought to fruition.
When Miss Smith suddenly stopped asking questions of this reluctant witness, she had not pushed home any of the points that she had seemingly been moving in on. Superficially at least to the untrained eye, it appeared that absolutely nothing had been achieved by the prosecution.
Mr Miller, for Professor Walker-Smith made a few points in cross examination. He went over the fact that Child 12 was developing normally until his MMR and that, after that, he actually regressed.
He re-established that child 12’s first diagnosis of Autism Spectrum Disorder was made before any contact with the Royal Free and that Mother 12 had taken her child to the hospital in the hope of helping him get better and not to assist with research.
Questions from the panel mainly went back over the same ground covered in cross examination, although one panel member wanted to know whether Mother 12 had applied for legal aid before she had taken her son to the Royal Free for his first appointment. Mother 12 answered that it was 'about the same time'.
The tenor of all the panel’s questions was, again, to establish the research/clinical treatment balance and ultimately, none of them seemed to find it hard to grasp that a parent could desperately want her son to be helped while also being keen to aid research for children in general.
We were told that the witness the following day would be child 8's GP. Unfortunately neither Olivia nor I can attend.
Olivia Hamlyn writes
This brief and boring day began with the prosecution reading out the witness statement of Deborah Davis, PA to the chief executive of the Royal Free. It had been decided that there was no need to call her to give oral evidence.
The statement dealt with Dr Wakefield’s appointment as honorary consultant in experimental gastroenterology and the terms and conditions on which he was first appointed. However, the exact terms and conditions which were applicable in 1994 had actually been destroyed so the prosecution had to rely on the current terms which, we were told, were very similar. ‘Very similar’ has always been good enough for Miss Smith.
The terms and conditions established that Dr Wakefield would mainly be involved with research and not as a consultant gastroenterologist, he would not see patients in or out of the hospital and he would be exclusively involved in lab-based research.
This evidence having been tendered, Miss Smith asked the panel to rise, so that the counsel could argue over the terms of the next witness's evidence. An hour later, at 11.30am when we re entered the room, we saw Sarah Alwyn sworn in. Alwyn had been a legal advisor to the Legal Services Commission, which she had joined in 1998 when it was still the Legal Aid Board (LAB).
Miss Smith went over the background and procedure for dealing with an application for legal aid and discussed the meaning of a multi-party action, the term used for the MMR case. They went over the criteria for awarding legal aid which included that the cause must have good prospects of success. They then discussed the authorization of use of the money and the things it could be used for, e.g., to facilitate the setting up of Dr Wakefield’s study and to fund a preliminary report from Dr Wakefield.
It was established that the solicitors in the LAB offices had no medical qualifications and relied on the experts found by the law firm when considering whether to award money in this area. Alwyn told the panel that it wasn't the responsibility of the regional LAB offices to look behind the information given by these experts.
The prosecution then went through several letters, which inevitably had been shuffled and placed out of sequence, between Dr Wakefield, Richard Barr and a Miss Cowie of LAB. This sequence of letters ended in 1996, when the first installment of legal aid money was arranged. Miss Smith went on to deal with the second installment.
The prosecution then moved on to 2003 when the legal aid funding was withdrawn. The reason given was that the criteria for payments to the defence case no longer met legal aid requirements, i.e. that the case was no longer considered to have a good prospect of success. Then, the unsuccessful appeal to the High Court Judge. This had been the first time that medical research had been funded by the LAB and it was decided that the Medical Research Council would have been the more appropriate funding body.
MW: This of course is pure nonsense for while it might appear odd for the LAB to fund medical research, it is at least independent of government and not prone to take sides in legal conflicts; they facilitate independent searches for the truth. Moreover they do fund all kinds of independent investigations, from private detectives who search for ‘unknown’ but suspected evidence, to vehicle mechanic experts who research the causes of accidents. The Medical Research Council, on the other hand, has nothing to do with legal cases. It stands four square behind the pharmaceutical companies and the government on vaccination and is incapable of conducting an independent investigation, or grant aiding anyone who might.
There followed some discussion of the names of the children involved and what appeared on their legal aid certificates. It was clear that much data in relation to this matter had been destroyed or lost.
Little interest was shown in the witness either by defence counsel or by the Panel.
Martin Walker Writes
There was no hearing on Friday 31st of August and it resumed on Monday 3rd of September, by which time I had returned.
On Monday, and then on Tuesday, the prosecution brought what might have been in any other prosecution some heavy-duty witnesses However, as has become the norm in this case, both witnesses turned out to be more Airsoft guns than heavy artillery.
Mr Tarhan was the Finance officer at the Royal Free Medical School during the relevant period in the 1990’s and Dr Susan Davies the Consultant Histopathologist at the Royal Free during the 1990s.
Mr Tarhan’s name had cropped up on occasions during the hearing, in relation to the cheque from the legal aid board. He turned out to be a very solid and professional witness, although this was not to the credit of the prosecution.
As the Deputy finance officer and then the finance officer at the Royal Free throughout the 1990s, Mr Tarhan had ended up as the Managing Director of the business arm of University College London. In the 1990s, many universities, charities and patient organizations which were involved in research, tried to enter the market and capitalize on the findings of their researchers.
In his capacity as MD of the new business set up by UCL, at that time called Medical Marketing International, Mr Tarhan was able to speak about the patent which was taken out by Dr Wakefield on measles transfer factor. The prosecution line on this was, as always, cloudy; perhaps because they failed to look independently at the matter and as in much else, went down the deer-track.
The deer-track on this matter was simple; Dr Wakefield was accused of being a capitalist. As a research doctor, hell bent on making private profit, he had developed ‘a vaccine’ apparently for measles, in forceful competition to the major multinational drug companies. Had this fiction stopped there, it might just have appeared plausible – if a little comical. However, Deer’s contention was that Wakefield’s vested interest and the development of his own vaccine was one of the main reasons for his so called ‘anti-vaccine’ stance. Of course at the end of the day, Deer’s narrative involved more plot turns than the Bourne conspiracy and though, like the films it was initially exciting it turned out to be utterly implausible; not too bad for a film but pretty defeating for a legal case.
In both the matter of transfer factor and the LAB cheque, Tarhan gave evidence which reflected entirely on his professionalism rather than on Dr Wakefield’s supposed criminality. Tarhan came across as a steady, wide shouldered and responsible accountant, he cast Dr Wakefield, from what he had heard, as a good doctor and research worker with a youthfully impatient and slightly anarchic approach to financial systems and accounting. Although Tarhan seemed to look quite fondly on his working relationship with Dr Wakefield, he was obviously disturbed by what he saw as his gung-ho approach to finance.
As for the assertion that Dr Wakefield tried to make a personal profit from manufacturing a vaccine in competition to the multinational drug companies, it became clear during Mr Tahan’s evidence - and that of previous witnesses - that firstly, this was not a vaccine against measles, but a therapy that might ameliorate the adverse effects caused by measles vaccine; that Dr Wakefield had actually sought partnership with pharmaceutical companies to develop the therapy and finally that all profits from the patent, had it become a viable product, would actually have gone to the Royal Free Medical School.
In the event, Mr Tarhan told the panel that the business arm of the Royal Free was not happy with the product, because it had not been proven to work and was too risky to back until it had been. It also appeared to be contentious and therefore a poor business risk.
In relation to the cheque from the legal aid board, the worst that Mr Tarhan seemed to say about Dr Wakefield was that he had failed to send to the finance department any pro forma or note which detailed the nature of the project that the money was intended to cover. This might have appeared lax, though not criminal, had it not been for the fact that Mr Coonan (counsel for the defence) produced a letter from Dr Wakefield to Dave Wilson, Mr Tarhan’s senior. The letter informed Mr Wilson of the account that the cheque was to be paid into, provided other details, and ended by asking him to get in touch if he needed any further information about the cheque and the use to which it should be put.
Apart from this, Tarhan also suggested that it had irked him when he discovered that Dr Wakefield had failed to fill out a receipt for the money, using the receipt book held in the finance department. Well, you know what they say about accountants…? When I put this point to Dr Wakefield in a conversation, he said with the evident bemusement of a research scientist, ‘How was I to know there was a receipt book in the finance department? I did send Richard Barr a receipt but it was just a straightforward written one on headed note paper.’
When Miss Smith took Tarhan through his evidence-in-chief, she clearly wanted to make it appear that Wakefield had taken out the patents on transfer factor, in order to make profit for himself. With the most reliable air, Tarhan disputed this. In fact although Dr Wakefield, exasperated with the time it might take, had moved to take out two patents himself, Tarhan was quick to point out that they were taken out either in the name of Free Medic as the UCL business venture was then known, or the Royal Free Medical School.
At his most vehement, Mr Tahan insisted that while this was not illegal or illegitimate in any way, he did wish, like all administrators, that Dr Wakefield had kept him in the loop. He knew that Dr Wakefield and Professor Roy Pounder had both incurred personal expenses in employing lawyers to lodge the patents; that neither of them stood to gain from the patents and that any revenue that they generated would go to a charity.
Ghengis Tarhan acquitted himself well as a witness, the way that he distanced himself from the prosecution while remaining slightly critical in his own lights of Dr Wakefield, gave his evidence considerable integrity.
Dr Susan Davies, was, from the beginning, a difficult witness for the prosecution to handle. She had been the Consultant Histopathologist at the Royal Free between 1992 and 2002 and was now working at Addenbrookes Hospital, Cambridge.
Unlike so many of the male witnesses who seemed to be wearing work-a-day suits, and slightly down-at-heel shoes, Dr Davies verged on glamorous. I was particularly struck by her three-quarter length frock-coat made out of a shiny metallic material which gave her the look of an eighteenth century man-about-town. On the two days that she gave evidence, she wore this coat over a very large- print full skirt decorated with a bold pattern in red and black.
In the event, Dr Davies was to need all the security and reassurance she could get from the ‘performance’ clothes that she seemed to have picked after some consideration. She appeared as a witness for two days and some of her exchanges with Miss Smith, showed the rather brittle nature of Miss Smith’s ritualistic courteous legal manner. It wasn’t that Dr Davies was obviously unhelpful in answering Miss Smith’s questions, but apparently frightened of giving the wrong response to Miss Smith’s sometimes confusing questions, she often replied with multiple choice answers, ensuring that she covered all the bases; and more.
It was easy to see why Miss Smith came close to losing it on a number of occasions, though difficult to have much sympathy for her as she tried to drag the very professional Dr Davies into a mire of incriminating allegations, which would have had Dr Wakefield ‘fixing’ his research results.
As the consultant histopathologist in the paediatric gastrointestinal department, Dr Davies was responsible for preparing and presenting all the samples which were taken from the ‘Lancet paper children’ (and many other children treated at the Royal Free in the gastroenterology unit) during the clinical investigations that determined their diagnosis and treatment.
In one of those incredibly boring reviews of all 11 Lancet children, Miss Smith dragged Dr Davies through each case in some detail. This time however, we were no longer concerned with where the children came from or from whom they were referred, instead we followed each one through their histology reports presented by Dr Davies in the Friday meetings.
For a whole day we remained utterly oblivious, as it appeared did Miss Smith, to where Miss Smith was taking the witness. Apart from the occasional emphasis on cases which did not appear to fully fit the criteria for the Lancet paper, each case passed by embedded in the most baroque detail but without any apparent fault attached to it.
On the second day of Dr Davies’s evidence-in-chief, everything became as clear as Miss Smith is able to get, which is, on reflection still pretty opaque. Despite the fact that there were showers of sparks that briefly illuminated unnecessary investigative procedures etc., the prosecution had two planks to its case. First, it was suggested that between first provisional diagnosis and later writing up in the Lancet, some of the diagnostic pictures had been changed to fit more exactly the conclusions of the paper. Reflecting upon this, one can see it as the closest the prosecution gets to the charge of ‘research fraud’; a charge which the GMC would no doubt have loved to bring against Dr Wakefield.
Second, the prosecution suggested that Professor Murch and Dr Davies had been so concerned about the recorded diagnostic outcome of the Lancet cases they had instigated a review of the cases (of Dr Wakefields work) which was carried out by Dr Davies.
As always appears to be the case with Miss Smith’s assertions, both these propositions came to naught as they were disassembled during Mr Miller’s cross examination. The explanation of the first matter of the ‘shifting’ diagnosis, gave us a rare insight not just into the mechanics of clinical research but into the way in which imagination and intellectual problem-solving lie at the heart of this creative process.
When Dr Davies and the defense council explored this area, one began to see clearly why it is important not just for the defendants, but for the future of medicine, creativity and culture that we understand what separates the constipated word-crunchers such as Deer and the mercenary legal pedants like Miss Smith, from a medical researcher of Andrew Wakefield’s caliber.
An erudite and intellectual explanation for the metamorphosing diagnosis which changed between the initial base line crude report and the more detailed consensual diagnostic picture which emerged at the end of the histology process was explained by Dr Davies. When the children arrived at the Royal Free they carried with them the diagnostic notes from a local GP or consultant, this was a base line diagnosis from someone who was not necessarily a specialist in the child’s condition, and who had little comparative material by which to contextualize them.
Following the child’s stay at the Royal Free, a number of more complex investigations and case history explorations, the diagnosis became more complex and specific. In the last analysis, the complex diagnosis written up in the ‘case review’ was produced after all the cases had been reviewed together looking for common themes and ‘brainstorming’ or leaping between cases and seizing on common threads and connected factors that might join one to another.
There are of course many ‘scientists’ with petrified brains who might feel that this process is quite criminal and amounts to sorcery rather than science. However, it is in this imaginative area, that real developments tend to be made in science.
The Murch-Davies review was conducted, according to Miss Smith (and initially Dr Davies!) because both doctors felt concerned about the results of the Lancet cases. The matter was resolved relatively speedily in cross examination. Explained correctly, it exposed yet another howler that Miss Smith had presented, having trustingly been led up the deer-track.
After some perceptive cross examination by Mr Miller, who in another life must have been adept at prising stones from horses shoes, it was agreed by the witness and council that the review which Dr Davies had carried out, was not of the Lancet cases at all, but of another group of cases for a quite different paper!
Once again, we did not have to await the evidence of the defendants before the paucity and nakedness of the prosecution case was revealed. I think that the only real worry of all the defendants, should now be that when it comes to the presentation of the defence case, council for the defence dizzy at hearing defence evidence consistently given by prosecution, forget themselves and present the prosecution.
The last day of the prosecution case, before the three week break organized by the GMC so that the prosecution can re-tutor its expert witnesses, was Wednesday September 6. The prosecution used the morning of the 6th to show an incredibly poor quality video of Dr Wakefield brightening up a lecture on IBD by telling a few jokes about how he gained control-group blood samples from children at his son’s birthday party.
What strikes me about this final charge on the prosecution calendar, is that it strikes at the very heart of professional, medical and legal culture. Both lawyers and doctors have always told interesting and funny stories about their experiences and their patients. There is of course a reason for this, the everyday experience of both doctors and lawyers, brings them into contact with death and disease, murder and mayhem, these abscesses on the human soul have to be balmed and soothed, this is done with humour, strange tales and surreal stories.
What of course does bring medicine into disrepute is the marketing and prescription of drugs like Vioxx which kill 30,000 people or the shameful and continuous prescription of HRT which results in breast cancer and heart disease. Even more so than these examples, is this present GMC hearing which is blatantly trying to censor original scientific research at the behest of the government and pharmaceutical corporations. This hearing isn’t bringing only medicine into disrepute but democracy and government … yes I know it’s difficult to imagine that anyone could do the latter.
But then perhaps this particular charge says more about the GMC and the politics of medicine than all the other charges put together. The GMC obviously intends that we live in a world not just free of choice over vaccination but where it is a crime to make fun of doctors, scientists and medical apparachiks. Just like the industrial bourgeois of the nineteenth century the humour-challenged plutocrats of science hate anyone reminding them of their unregulated history in quackery and illegal experimentation; and god forbid you joke about medicine.
The case brought against Jayne Donegan by the GMC was a calculated attack on the right of defendants to bring independent expert evidence to court. Like the Wakefield, Murch and Walker-Smith case, the case illustrates the GMC acting well beyond it’s remit in attempting to stifle independent scientific thinking. Where the GMC picked up this prevailing idea that as the regulatory body for doctors, they have the expertise and authority to arbitrate on matters of science, God - or Dawkins - only knows.
One thing is certain however. These contemporary cases show that the GMC, in the face of very serious criticism over the years, is now hell-bent on taking the lead in the regulation of scientific and medical method. This bid for power and authority well beyond their competence will not be stopped until the scientific community intervenes and takes these bourgeoning powers out of their hands.
Apart from anything else, the legal form which the GMC has hijacked is utterly unsuitable for resolving arguments about scientific method. But as with all other interventions in this field, the interests behind the GMC are the multinational pharmaceutical companies and other corporate interests that have been trying over the last twenty years to bend the regulation of science away from qualitative approaches and towards quantitative methodology. Towards the laboratory and away from the person.
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A journalist I was speaking to the other day, suggested that the Sunday Times was about to send Brian on a social skills course. I must say that he does have a funny way about him. On the last day of this part of the hearing, we were shown the video of Dr Wakefield speaking at a conference. Predictably the large screen suspended from the ceiling over the heads of the public and press was not working. Being appraised of this I settled myself down next to a tiny monitor in the corner of the press section of the public gallery, meant I think for GMC staff to keep an eye on the hearing.
Brian, who on many days is my constant and only companion in the hearing room, came in a little later while Miss Smith was introducing the video. I must say I find this closeness can be quite disturbing it’s as if we were participants on a Big Brother set. I am always fearful that, banged up in such a small space together, I might develop some variety of Stockholm syndrome and feel a desire to engage in serious conversation with him.
When Brian came in and saw that I was in the press section where he had thought of sitting, he seemed to snort and veer off, sitting instead below the large suspended defunct video screen. I thought that he was probably anticipating that it would come to life when the video began. Not wanting him to miss his big moment, I tried to attract his attention by quietly calling his name. On the third call, he turned his lugubrious but stony face slowly in my direction without actually looking at me. It was as if his attention had been drawn to something on his shoe which smelt. I whispered, to the inattentive side of his face, ‘That screen isn’t working’, at which he turned his face slowly back to Miss Smith as if I was invisible and unheard. When Miss Smith began running the video and it dawned on Brian that it wasn’t showing on the screen above him, he jumped out of his seat and ran headlong out of the hearing room for the Press Room.
I was surprised at Brian’s reaction to me. Why is he so distrustful? Not at all the ‘hail fellow well met’ approach that has been common amongst most journalists and writers in past times.
Supporters of Dr Wakefield, Professor Walker-Smith and Professor Murch, were happy to hear of the result of another case brought by the GMC against Dr Jayne Donegan in mid-August. Dr Donegan had found herself dragged into the vaccine debate and then attacked by the government and the medical establishment when she gave expert evidence in a court case. The problem was that she gave expert evidence which was independent of government dictate and in contemporary England you are likely to be put on trial, or in a ducking stool, for doing this. Aubrey Blumsohn has posted a very clear piece about Dr Donegan’s case on his web site ( www.scientific-misconduct.blogspot.com Aubrey Blumsohn 8/31/2007 12:50:00 AM). I have summarized the main content of it below.
Dr Donegan MBBS DRCOG DCH DFFP MRCGP is a medical doctor and family practitioner. She also has some interest in homeopathy. She graduated as a medical doctor at St Mary's Hospital Medical School (London) in 1983. It is reported that she is an excellent doctor. Donegan is however one of several medical doctors in the United Kingdom who holds views about science that have led to selective disciplinary/"fitness to practice" procedures (FTP) by the General Medical Council.
Dr Donegan's ‘sin’ was precisely to do with the science of conventional medicine. She testified in an important court case in which mothers and fathers differed in their views over whether their children should be vaccinated. Two witnesses for the fathers provided a view that would have pleased the Department of Health. Donegan provided testimony for the mothers. She provided a detailed scientific report which concluded that a perfectly rational parent making a decision about vaccination for their own child might well have some valid fears about the integrity and strength of the underlying science. For her sins, Jayne was subjected to a lengthy Fitness to Practice Procedure.
The stated charge was that she had written a medical report about the underlying science for the court that:
... and having done so, Dr Jayne Donegan was charged with serious professional misconduct, and with bringing the profession into disrepute.
Unfortunately for the GMC Donegan presented overwhelming evidence to back up the science she had presented to the court, leaving the distinct impression that all three opposing experts should actually have been placed in her position. The GMC had no choice but to clear her of all charges. 24 August 2007).
The case appeared to have been brought by the GMC itself, and as far as I am aware there was no complainant. Her report was challenged by "GMC expert, Dr Elliman" who produced a supposedly objective evidence-based report on Donegan's report. Donegan's report had in turn challenged expert reports produced for the fathers.