[back] Wakefield GMC Hearing 2007
"You think any of this makes sense when you stand back from it? You think God made an ordered universe? That's the laugh with the law. We like to pretend it makes life more reasonable. Hardly."
The central character,
a lawyer in Scott Turow's Personal Injuries
Counsel for Professor Walker-Smith, Mr Miller has spent the last week tracing the referral, condition and treatment procedures used in each case of the 12 children who came to be cited in the case-review paper published in the Lancet in 1998. Because we have heard this evidence in developing form on three previous occasions, I don't feel the need to repeat it again. Instead, after a very brief resume of it, I want to look at aspects of the case that have been much on my mind recently, including, the absence from the beginning of a proper prosecution process.
Each time that one of the counsel goes through the cases of the twelve children cited in the Lancet case review paper, it raises the fundamental misinformation that is at the heart of the prosecution.
It is through a strategy to discredit this paper that we end up with a trial based upon it. In order to discredit three of the authors of the paper the prosecution chose to advance upon the basis of 'research misconduct' developing charges against the three doctors that grew directly from the way in which the prosecution say that the research for the paper was carried out. While actually, it is the content of the paper that the government and the drug companies would want to censure, they have approached this by attacking the ethics of the 'research' cited in the paper.
We all know why this trial is taking place, it's a win-win situation for the government and the pharmaceutical companies, a guilty verdict will discredit the three doctors and the premise that they made public, however tenuously, that there was a link between MMR, Inflammatory Bowel Disease and regressive autism. Even if the defendants are found not guilty on every count, their names have now been so sullied that they will find professional life in Britain difficult. And anyway the two years of the hearing have given the government massive space in which to move forward with its vaccine policy.
The problem from the beginning, however, for those wanting to bring the prosecution, was that there was nothing substantially wrong with the paper, the information within it, or its construction or publication. That there is no factual evidence to discredit the case-review paper, has not of course stood in the way of the vaccine manufacturers, the New Labour government or the minions of these agencies. Either by design or ignorance, it has always been hard to tell which. Brian Deer, Medico Legal Investigations and then the General Medical Council constructed their prosecution upon the false premise that the case review paper published in the Lancet was not a 'case review' paper but one that recorded the results of a full blown study that had received considerable funding, that had needed and requested ethics committee approval, parental consent, and such things as a declaration of conflict of interests by its authors.
It was possible to see from the very beginning how the government, the NHS and the science lobby groups would try to metamorphose the 'case review', into a full blown study. One of the first criticisms raised in the media was that 'the sample was too small and there was no control group'. In a case review study, of course, you are not dealing with a 'sample', you are looking only at a number of cases referred to a doctor, a hospital or observed in public through some other institution. And this group does not need a 'control group', any study of this group describes what happens clinically to this small group or sub-set, not what doesn't happen to any larger or similar group under different circumstances.
Having decided that the case review was actually a full blown study and not just a review of 12 children that had been seen at the Royal Free Hospital on the basis of clinical need, the pharma -lobby began by finding fault with the way in which the illusory ‘study' had been organised, coming up with the following basic accusations:
Perhaps the most substantial factor missing from the 'reasoning' lying behind the prosecution case, is that of motive. The prosecution expects the panel and the public to believe that one doctor and two professors, with almost a hundred years collective experience, suddenly acted out of character breaking all the rules of their so far unblemished clinical careers. The matter of motive is crucial in this case because what the prosecution is proposing is so preposterous.
The prosecution seem to be suggesting that Dr Wakefield and others set out to destroy the government vaccine policy and line their pockets in the process. Not only this, but being characters similar to The Joker in Batman, having limitless criminal resources, they also set out to bankrupt the worlds leading pharmaceutical companies. Oh, and we shouldn't forget that at the same time, they wanted to exacerbate any public health crisis, provoking the deaths of an untold number of children and adults from measles, mumps and rubella.
Had it, in fact, been the case that the twelve children in the Lancet case-review paper were used at the whim of a group of doctors, experimented upon with the intention of glorifying the doctors concerned, many parents would have been thankful for the intervention of Brian Deer, the complainant and the GMC itself. If there had been such a case, the prosecution would have paraded these parents as symbols of the accessibility of the prosecution process. Parents whose children had been seriously wronged, helped by the GMC, would have been clamouring to give evidence against the men who had damaged their children. This is patently not the case and in fact, all the parents support the three doctors, while finding incomprehensible the perverse actions of the GMC which in essence constitute yet another hidden attack on the parents. The parents of vaccine damaged children, will not, however, be moved and have stayed committed to the few doctors who have helped and supported their children.
And it is within this contradiction that another very serious and corrupted aspect to this prosecution raises it's head. The GMC has ignored the parents and refused them a venue to voice their complaint against the NHS or the pharmaceutical companies for damaging their children with MMR and has refused to recognise their vaccine damage. We are therefore forced to view the prosecution in the context of the State paternalism that is poisoning the contemporary legal protection of children in Britain. Nothing comes across more insidiously than the fact that the GMC considers that it knows better than the parents concerned, the nature and origins of their children's illnesses.
It is surely not just coincidence that the Association of British Pharmaceutical Industry (ABPI) is resident in Whitehall within spitting distance of Downing Street. Nor is it possible to overestimate the power and influence of the pharmaceutical industry in Britain, especially under New Labour. In post industrial society, general doctors are more or less irrelevant, most of them acting simply as drugs industry 'runners'.
How is it possible to bring a legal prosecution against three well established and honourable doctors, on evidence that is lacking in continuity, is ill-founded, cannot be proven and is clearly carrying the considerable weight of vested interests? The State prosecutors in Britain are called the Crown Prosecution Service and they have a rule of thumb when deciding whether to proceed with cases; 'Does the case stand better than a 52% chance of ending in a conviction'. It is clearly necessary for any prosecutors to have such a rule of thumb, so that it doesn't invite cases of wrongful arrest, wrongful conviction or waste the time of prosecutors or defendants in drawn-out fruitless trials.
The pharmaceutical industry has ferreted it's way into the medical-legal system in a way that no other industry could have managed. The regulatory body for the drugs industry, the MHRA (previously known by the massive euphemism as the Medicines Control Agency), which is meant to be a department of government within the Department of Health and answerable to the Minister for Health, is actually a trading organisation wholly funded by the pharmaceutical industry. In common with the Atomic Energy Authority and the British railway network, it has it's own police force, and is able to bring charges of the most serious nature against individuals; it takes people to court and the court can send them to prison. However none of the charges prepared and brought by the MHRA pass through the offices of the Crown Prosecution Service (CPS). None of the charges are overseen by any kind of independent body that measures the quality or even the quantity of the evidence.
At the General Medical Council, we see exactly the same process. Let's put to the side those cases in which patients are complainants. In all probability, a case of assault against a female patient could actually be dealt with in a better way when dealt with by the GMC, than if the patient made a complaint to the police, in just the same way that wrongful dismissal will probably get a better hearing in an employment tribunal than it would in civil court. But if we look at other cases, not brought by patients, but brought apparently in the interests of research ethics, a completely different picture is revealed.
In these cases, Medico Legal Investigations (MLI), the private enquiry agency wholly funded by the pharmaceutical industry acts as a police investigations force for the GMC, and with the GMC this agency puts together prosecutions that involve infringements of research practice and medical ethics involving doctors. Here again employees of the pharmaceutical industry, in a huddle with barristers at the General Medical Council, formulate complex prosecutions and charges of the most serious nature, that are never assessed by an independent body such as the Crown Prosecution Service.
Perhaps this kind of prosecution is actually more insidious than those taken by the MHRA; at least in these latter cases, the prosecutors have to come into public view and perform in front of judges. Prosecutions assembled by the pharmaceutical industry and the GMC are heard inside the GMC building in front of a paid professional panel, itself chosen by the GMC. The absence of a judge in the final proceedings means that procedurally the prosecution can get away with murder. In the over-ground system, judges are the last people able, if they wish, to review the prosecution case and even if they do nothing until the end of the trial, they can in their summing up analyse the prosecution evidence in such a way as to disrobe it of it's most obvious failings and contradictions.
It is this lack of judgement in relation to the prosecution case that most seriously concerns me about the GMC hearing. Almost everyone except the residents of Britain's cemeteries and Miss Smith and her juniors, now know that Dr Andrew Wakefield, Professors Walker-Smith and Murch , did not embark upon an experimental trial without parental or ethical committee approval. In as much as Miss Smith continues to state that this was the case, she is plainly accusing the three doctors of concocting a false defence and lying under oath to the hearing. In no uncertain terms she is accusing them of being organised criminals.
On the simplest level, however, the prosecution case doesn't hold together. Even if we were sympathetic to their perspective, the case itself is hopelessly mixed up and has no clear line of evidence. For instance, in order to make her case that Dr Wakefield had failed to make a statement of conflicting interests in the Lancet paper, during her cross examination of Wakefield, Miss Smith forcefully made the point that the ‘study' it was agreed should be funded by the Legal Aid Board (LAB), involving 5 children with Crohn's disease and 5 children with IBD, was actually the ‘study' written up in the Lancet. Yet anyone who wasn't unconscious could see that the case review paper did not include ten children categorised in this way.
While Miss Smith is allowed to run this argument if she wants, one wonders whether the panel will grasp the fact that for the whole of the rest of her presentation, she has claimed that the paper written up in the Lancet represents not the LAB study but a trial labelled 172/96. One gets the feeling that had there been a proper overview of the prosecution by a body similar to the Crown Prosecution Service, Miss Smith would not have been able to pull tricks of this kind.
Of course one is continually concerned about who in this hearing will pick up on Miss Smith's duplicities. It seems unlikely for instance that the legal assessor will make much noise because he seems only called upon when a legal question arises which relates to the ongoing hearing. It would not appear to be the role of the Chairman either. Whatever the outcome of this case, it is unlikely that in the near future anyone with any authority will be able to right the most serious injustice; that the three doctors have been wrongfully and maliciously prosecuted by an institution that is, at least in this case, clearly under the influence of other interests.
Apart from a finding of 'not guilty' on all the charges brought against the defendants, the best and most important outcome in this case would be an enquiry into the GMC that had the power to take away from it, it's right to prosecute without the oversight of an independent body such as the CPS. Perhaps not in all cases, but certainly in those as important as this one and definitely in any case which is of even peripheral interest to the pharmaceutical industry.
Sitting through the GMC hearing, one not only learns about the work of dedicated doctors in a large hospital and the legal machinations of prosecuting bodies, but equally about the swirl of undercurrents and arguments that have supported the attack on the three doctors.
While it cannot be suggested that Dr Wakefield, Professor Walker-Smith and Professor Murch have been involved in alternative medicine in any sense, and in fact, aspects of Dr Wakefield's work right up to 1995 were funded by companies such as GlaxoSmithKline, there is one aspect of their work that hasn't had much of an airing inside or outside the GMC. Because all three doctors were researching the digestive system, their ongoing research and some of their conclusions veered heavily towards considerations of nutritional medicine. Nothing brings out the tree-swinging medical reactionaries more readily than mention of nutrition.
The other element destined to stir up a terrible reaction from the drug companies, is research into adverse reactions. Mainstream medical research has languished over the last twenty years, in relation to adverse drug reactions. Although they have been admitted in an off-hand manner by pharmaceutical companies, there has been no attempt to train general doctors or physicians in their consequences. The new science lobby groups, such as the Science Media Centre and Sense About Science, and specifically the moribund cadre of the Revolutionary Communist Party, have since 1998, added a whole new perspective on adverse reactions.
In the face of the growing adverse effects of environmental toxins and triggers for human illness, the RCP began in the nineteen nineties - even then toeing an industry line - to theorise about too much emphasis being placed upon risk in contemporary society. Growing out of this debate came a whole new generation of science based ' quackbusters ' who ridiculed the idea of environmental illness or environmental triggers to conditions while asking us to put our faith in developing technology and multinational corporations. This movement met up with the anti-environmental illness movement founded in Britain and America in the late 1980s.
Their message, however, was greatly expanded and while the earlier versions had suggested that environmental illness might exist in some forms and that adverse reactions to pharmaceutical products were sometimes possible, the new contemporary version of these campaigns, especially in Britain, claimed that there could be absolutely no adverse reactions from either modern drugs or environmental pollutants such as mobile phones, phone masts or such things as pesticides. Mike Fitzpatrick for instance has argued, like Professor Simon Wessley , an early Campaign Against Health Fraud member, not only that ME and Chronic Fatigue Syndrome do not exist but those who suggest that they do are suffering from mental health problems (see my books, SKEWED and Brave New World of Zero Risk, available from www.slingshot.com).
The fundamental intellectual problem with the new generation of quackbusters is that if the base of your theoretic position is that modern technology and modern medicine are incapable of producing adverse reactions, there is nowhere else for the argument to go. And in fact this is the purpose of such a dogmatic argument; admit to one adverse reaction to drugs and of course you have to admit to the possibility of others.
There is no possibility, of productively discussing science with people who insist that medicine or new technology has no adverse risks. In fact such arguments signal the end of science and the beginning of an authoritarian Orwellian world, in which dissent and opposition has to be continually censured by those in charge of the official dogma. This is yet another reason why the GMC hearings are an ongoing fiasco, the pharmaceutical companies, the science lobby groups and New Labour inhabit a world of total denial, in which from the very beginning they have decided that there are no adverse reactions to vaccination and they will use any argument to prove this, including the idea that the present three GMC defendants are criminals.
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I am really pleased that people enjoyed my last report from the GMC and I am seriously encouraged by the number of readers who have told me that they have placed orders for ripe bananas to arrive some time at the end of April next year. I don't want to be crude about this, but if everyone does what they say they will do, we could, next year, have a kind of 'Vomitfest', perhaps in one of the GMC lifts taking the prosecution team up to the 3rd floor. All participants will be expected to wear sou'westers , high wellington boots and waterproof capes. This could be Alan Golding's chance to become the new medical Tarantino, with his film about the hearing opening with a scene of multiple projectile vomiting that leaves the prosecution team prostrate and strewn across the floor of the lift.