Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
A good start
- John Stone (29 October 2004)
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Untoward inferences: stay on message
- John Stone (29 October 2004)
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Elliman and Bedford - a bad and unbalanced review
- Johanna Carl (29 October 2004)
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Re: Elliman and Bedford - a bad and unbalanced review
- Mark Struthers (29 October 2004)
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Re: Re: Elliman and Bedford - a bad and unbalanced review
- John Stone (30 October 2004)
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Science Fiction as fact
- John P Heptonstall (31 October 2004)
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MMR - What I know.
- Ruth E Acaster (31 October 2004)
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Editors choosing is not censorship; junk science
- Adrian K Midgley (31 October 2004)
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To spell out the problem
- John Stone (31 October 2004)
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Reviews of books on MMR
- Mary J. Whalley, Martin Underwood, Director Analysis Associates Ltd. (1 November 2004)
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In defence of Jayne Donegan: a "damning" judgement, or just gratuitously damaging.
- John Stone (1 November 2004)
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Richard Horton must withdraw his complaint against Andrew Wakefield
- John Stone (1 November 2004)
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Re: In defence of Jayne Donegan: a "damning" judgement, or just gratuitously damaging.
- Dr John Rumbold (1 November 2004)
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Re: a "damning" judgement, not gratuitous.
- Adrian K Midgley (1 November 2004)
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Chasing Dr Donegan's tail
- Adrian K Midgley (2 November 2004)
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"The confusion": Richard Horton - a remarkably frank passage
- John Stone (2 November 2004)
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Re: Re: a "damning" judgement, not gratuitous.
- John P Heptonstall (2 November 2004)
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Jayne Donegan: the High Court; HiB
- John Stone (3 November 2004)
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Re: Re: Re: a "damning" judgement, not gratuitous.
- Adrian K Midgley (3 November 2004)
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Richard Horton and the safety of MMR: the IOM report
- John Stone (4 November 2004)
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Re: Jayne Donegan: the High Court
- Adrian K Midgley (4 November 2004)
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Junk justice and Dr Donegan
- Mark Struthers (5 November 2004)
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The real question
- John Stone (5 November 2004)
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Re: Re: Re: Re: a "damning" judgement, not gratuitous.
- John P Heptonstall (9 November 2004)
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Re: Junk justice and Dr Donegan
- Ruth E Acaster (10 November 2004)
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trolling or obfuscation
- Adrian K Midgley (10 November 2004)
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Re: trolling or obfuscation
- John P. Heptonstall (10 November 2004)
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Re: Re: trolling or obfuscation
- Adrian K Midgley (15 November 2004)
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Re: Re: Re: trolling or obfuscation
- John Stone (16 November 2004)
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Re: Re: Re: trolling or obfuscation
- John P Heptonstall (17 November 2004)
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Re: Re: Re: Re: trolling or obfuscation
- Dr John Rumbold (17 November 2004)
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Allegations against Andrew Wakefield
- John Stone (17 November 2004)
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Re: Allegations against Andrew Wakefield
- Dr John Rumbold (20 November 2004)
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Re: Re: Re: Re: trolling or obfuscation
- Adrian K Midgley (20 November 2004)
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Making money from vaccines.
- Richard G Fiddian-Green (25 December 2004)
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Re: Editors choosing is not censorship; junk science
- Deborah Kahn (19 September 2007)
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John Stone, none London N22
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It is pleasing to note that Helen Bedford and David Elliman are extremely careful to give accurate information about the controversial 1998 paper, unlike so many others -at least since the events surrounding publication of Brian Deer's Sunday Times article on 22 February 2004. Let us hope that others will take their cue from this example in future. Nevertheless, it is rather conjectural to lay the blame for the decline in uptake of MMR entirely at Andrew Wakefield's door[1]: uptake was already in decline before his inervention at the celebrated news conference. The fact that there was a news conference undermines Bedford and Elliman's assertion that the paper was not news. Subsequently, as we know the Department of Health compounded mistrust by withdrawing the alternative of having the three vaccines administered separately. Meanwhile the Prime Minister has persistently failed to confirm that he had his infant son Leo vaccinated, although it is scarcely an intimate matter. And, of course, there are other issues like the proliferation of autism in the last decade which now begins to impinge at least perpherally on most people's lives, and the DoH's complete failure to address or explain it. And there is the brutal disregard of parents who report adverse reactions to vaccine, and the circular parading of statistics which take no account of such reports, thus proving that the incidents do not happen. And there is the persecution of Andrew Wakefield. If the DoH and the medical establishment had been confident of the safety of the product would it not have reassured everyone to have allowed Andrew Wakefield to pursue his research unimpeded. As it is, nearly seven years later, the basic clinical research is still incomplete. And then there are the sick children... [1] See F.Edward Yazbak 'Dr Andrew Wakefield is being blamed for the decline measles, mumps and rubella vaccination in the UK, Dec 22, 2003: http://www.redflagsweekly.com/Yazbak.html Competing interests: Parent of an autistic child |
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John Stone, none London N22
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"However, to concentrate on financial conflicts so much is probably too simplistic as for most researchers this is probably a minor consideration". The question is, how could it be? The price for drawing an untoward inference, or for having an aberrant thought is very great. You could not only lose your funding, you could lose your job, and even end up in a disciplinary hearing before the General Medical Council, like Andrew Wakefield or Jayne Donegan. Competing interests: Parent of an autistic child |
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Johanna Carl, Teacher and parent 14 The Galleries, High Wycombe, Bucks HP13 5HR
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In asserting that Richard Horton deserves some of the blame for the current situation regarding the MMR vaccine in Britain, Elliman and Bedford neglect to consider the consequences had the Editor of The Lancet chosen to censor an early report that had been successfully peer reviewed and was published with a commentary urging caution. This demonstrates a rather worrying lack of understanding of the nature of the process of scientific enquiry; namely that an hypothesis is put forward, often as a case report or series, and further work is done to support or refute the proposition. Given that the authors of this book review hold positions as academic child health professionals working in prestigious institutions, the implied support of censorship, and lack of insight into the scientific process is surprising and disappointing. In the case of MMR, an hypothesis was proposed, and in due course, subsequent work refuted it. Science has fulfilled its purpose; to further knowledge by the process of asking questions, and devising experiments to test hypotheses. A thought experiment: imagine if the MMR – autism link had been proven correct. Imagine the implications of a perceived cover-up along the lines of the BSE scandal in the UK. We live in a tinderbox of public mistrust of science, medicine, and Government. Censorship only stokes the fires of public suspicion. Elliman and Bedford claim that conflict of interest is a minor consideration – “for most researchers”. Surely it is not for the researchers, but those who are directly affected by the research – the patients and families - to judge? Especially, if like the authors of this review, those researchers are funded by multinational vaccine manufacturers. Horton’s book refreshingly engages with conflict of interest and other important issues of public confidence. Not by shouting the same message more loudly – as is the well-worn practice of this country’s unimaginative public health community, but by thinking up new ideas of how truly to address issues of public doubt. And crucially, in his well- balanced and fascinating book, Horton takes on the issue of global measles – an enormous cause of childhood morbidity and mortality - ignored in this book review. Measles worldwide represents a much graver problem than the failure of British medical professionals to meet their remuneration-linked vaccine take-up targets. Moreover Horton provides an enlightened discussion of autism, and rather nobly donates royalties from his book to the Autism Intervention Research Trust. Competing interests: None declared |
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Mark Struthers, GP Bedfordshire. mark.struthers@which.net
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What a good review of a bad one. I couldn’t agree more with Johanna Carl. I too enjoyed Richard Horton’s thought provoking book. Competing interests: None declared |
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John Stone, none London N22
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With regard to Mark Struthers' remark that Richard Horton's book was thought provoking it would perhaps not be unreasonable to cite my six posts which were provoked by the book ""MMR - SCIENCE AND FICTION": the Richard Horton story I-VI" [1]. Perhaps this was the reason that David Elliman and Helen Bedford ultimately found Richard Horton's narrative in relation to the Wakefield affair unsustainable. And, indeed, nobody in the past five weeks has challenged any of the six posts. If all of the book had been of the same quality as the chapter "The Dawn of McScience" then I might have shared the enthusiasm. The term "junk science" (of which I take it "McScience" is a variant) has come into widespread use of late but unfortunately more often on behalf of the Big Pharma than against it, and most notoriously by Lord Justice Sedley against expert witness Jayne Donegan (who had argued in a dispute between parents that vaccines were not necessarily as safe or effective as Government science would have us believe). In the context of the book the chapter stands apparently as surety of Horton's integrity, although it is hard to set the larger narrative in the context of the picture he paints here. It is all to obvious that even on mistaken grounds challenging the Pharma is a heroic and professionally selfless thing to do, and the mystery remains why - when the chips were down - Horton chose to go along with journalist Brian Deer and Dr Evan Harris MP, when every ground existed to resist, even if Wakefield's science was wrong (which is still more than debatable). In fact, as described on pages 11 and 12 of the book Horton actually had to search for technical grounds to take action against Wakefield - they were not readily to hand. These events are too bizarre and inexplicable for words: indeed, more bizarre and inexplicable in the light of Horton's narrative than before. [1] MMR - SCIENCE AND FICTION: "the Richard Horton story" http://bmj.bmjournals.com/cgi/eletters/28/7438/528#75516 Competing interests: Parent of an autistic child |
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John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG
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Sir Why do I suspect that the 'book review' by Bedford and Elliman has little to do with reviewing two books and more to do with attempting damage limitation for the vaccine industry against Horton's well- considered and timely request for two authoritative bodies with scientific and legal integrity and professionalism to oversee the 'vaccination' scenario? Horton is correct to require, and Bedford and Elliman (whose 'competing interests' perhaps disclose why they do) are wrong to deny, the need for a 'NASH' and a 'Council for Research Integrity' to move foreward with 'vaccine science' which at the moment is little more than science fiction parading as fact. Regards John H. Competing interests: None declared |
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Ruth E Acaster, Full-time mother Worthing, west Sussex
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I was fascinated to discover another article about MMR. I haven't read either of the books mentioned in the above review, presumably they will be available freely to parents? (I assume they have been published with a view to attempt to reassure people that the MMR vaccine is 'safe'?) I am not sure that Michael Fitzpatricks book would be my first choice of reading material, although I expect it would be 'entertaining'! I have read articles by Mr Fitzpatrick where he jubilantly dismisses alternative medicine, 'crackpot theories', 'cranks' and 'quack healers', I find his attitude a little short-sighted. Doctors, Drug Companies, Scientific disciples such as Mr Fitzpatrick can try to assure the informed members of the public that MMR is completely safe. They are dismissing parents and children however, whom experience life changing reactions following administration of the MMR vaccine. Thankfully I ignored my very persistent Health Visitor, who I must add had NO knowledge about vaccines, and studied the subject myself. The only decision I could make, after reading numerous books with information extracted from 'Scientific papers', was to not vaccinate my daughter at all. Competing interests: None declared |
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Adrian K Midgley, GP Exeter EX1 2QS
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Editors may choose the papers they publish on several grounds, but the ones they do not publish are not, at least not by that alone, censored.
They are just not published. Horton got his editing wrong, interesting though the question posed in the paper was, it was not developed enough to be worth publishing in a general journal. Spiked is quite good on this[0] As to Jayne Donegan, the judgement[1] is damning, but polite, and that isn't censorship either. "…..this is an independent medico-legal report based on my opinion, knowledge and research on the diseases, their vaccines and taking into account the particular cases of the children involved. I understand that the court will use it in coming to a decision as to what is in the best interests of the children involved. I have indicated my sources extensively. The facts and opinions expressed in this report are true and accurate to the best of my knowledge. I confirm that any fees are independent of the outcome of the case." 45. I regret that Dr Donegan has not fulfilled that declaration. Mr Cohen submits that she has not understood nor complied with her duty to the court. I am satisfied that his submission is well founded. Had I heard her evidence alone, I might have been mislead and could well have reached a decision not supported by the research upon which she largely relied. ... 53. Dr Conway considered Dr Donegan's first paper in a response of over 60 pages with which Professor Kroll entirely agreed. I am satisfied he was not over critical. But at various places he points to Dr Donegan being confused in her thinking, lacking logic, minimising the duration of a disease, making statements lacking valid facts, ignoring the facts, ignoring the conclusion of papers, making implications without any scientific validation, giving a superficial impression of a paper, not presenting the counter argument, quoting selectively from papers, and of providing in one instance no data and no facts to support her claim. " In the appeal case[2], the point of appeal was not the science, but reasonably enough the Court considered it and recorded:- 37 In opposition to this material the judge had the evidence of two knowledgeable clinical scientists, both respectful of parental anxieties. They concurred in the conclusion that, while you can never prove a negative, there was strong scientific evidence that the risks of not immunising children were real and in many instances serious – tetanus, meningitis C, mumps, measles and rubella presenting what Professor Kroll characterised as 'a plausible risk of severe illness and death'; that the effectiveness of the vaccines was high; and that their known side-effects were rare and not life-threatening. 38 It is especially worth highlighting why autism was not an issue in this case: not even Dr Donegan suggested that there was a scientific case for linking it to the MMR vaccine. I appreciate that outside the confines of the present case there is an ongoing dispute about autism and the MMR vaccine; but this much at least deserves to be known. " [0] http://www.spiked-online.com/articles/0000000CA6F2.htm [1] http://www.bailii.org/ew/cases/EWHC/Fam/2003/1376.html [2] http://www.bailii.org/ew/cases/EWCA/Civ/2003/1148.html
Competing interests: None declared |
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John Stone, none London N22
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1) The claim (a) that Andrew Wakefield had failed to diclose an interest is predicated on the claim (b) that the 1998 paper presented a hypothesis that the children's condition had been caused by MMR: "Did this behaviour amount to scientific misconduct? It was hard to tell. But certainly it invalidated Wakefield's central claim - namely that the link between the MMR vaccine and autism was a serious independently arrived at hypothesis that needed to be investigated urgently" (Horton p.10). 2) Richard Horton does not cite any passage in the 1998 paper in which such a hypothesis is formulated. What is recorded very embarrassingly in the paper is the fact that in eight out of the twelve cases symptoms had first manifested themselves following violent local reactions to MMR vaccine. And as Horton states: "Their clinical histories were not disputed" (p. 11). David Elliman and Helen Bedford (above) apparently agree that no such hypothesis was formulated in the paper. 3) The statement of the ten authors who signed up to a partial retraction of the paper refers not to a "hypothesis" but to an "interpretation" (Horton p.12). So it was actually not something that was articulated in the paper, but something you are not allowed to even think. Which is odd enough, but quite a different matter. 4) On top of this Richard Horton does not report that Andrew Wakefield had disclosed his involvement in the case in a letter published in The Lancet on 2 May 1998, so that this could not possibly have been a revelation to Horton, John Walker-Smith or Simon Murch at the meeting in the Lancet offices of 18 February 2004: "Simon Murch and John Walker-Smith were visibly shocked by his (Deer's) revelation" (Horton p.5). Once again David Elliman and Helen Bedford (above) agree that this earlier disclosure ought to have disposed of any ethical issue on that account. 5) There is also the issue of whether acting as an expert witness for the courts constitutes a competing interest at all. 6) Horton has been less than rigorous over other cases of non- disclosure in The Lancet I have cited - notably that the proprietor of The Lancet, Crispin Davis, had recently been made a director of MMR defendants GlaxoSmithKline (July 2003). * * * Looked at this way, both on the merits of the case that Deer had presented, and on the basis of ordinary practice concerning disclosure of competing interest, there was no basis for Richard Horton to pursue any action against Andrew Wakefield. In order to take action he apparently had to stretch many points. Why, then, did he do it? Docummentation: http://bmj.bmjjournals.com/cgi/eletters/328/7438/528#75516 and following. Competing interests: Parent of an autistic child |
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Mary J. Whalley, Consultant Psychiatrist, Queen Elizabeth Hospital, Kings Lynn, Norfolk PE30 4ET, Martin Underwood, Director Analysis Associates Ltd.
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Editor Given the controversy over MMR vaccine was it appropriate to ask Drs. Bedford and Elliman to review Richard Horton's and Michael Fitzpatrick's books ? 1. Is it impossible to find a reviewer who has not been financially supported by the pharmaceutical industry ? 1. Elliman and Bedford Reviews BMJ 2004 7473:1049 Competing interests: Most academic meetings Mary Whalley attends are sponsored by the pharmaceutical industry. |
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John Stone, none London N22
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It strikes me as an extremely dubious proposition that the expert witness on the losing side in a court case is not only subjected to adverse personal comments by the judge(as well the equally gratuitous favourable personal comments about the the expert witnesses on the winning side), but also gets denounced to the General Medical Council for gross professional misconduct for their trouble. In a hostile court environment good and honourable witnesses can fumble, but they are not usually expected to pay this kind of penalty. If Jayne Donegan believes there are greater uncertainties about the efficacy and safety of vaccine products than official science would have us believe she is probably on firmer ground than official science, which bases so much its evidence on statistics: it is a territory in which there are huge confounders and where the real mechanisms are largely unknown or unresearched. I do not know what happened in court, but Jayne Donegan is plainly under less heighteneted conditions an eloquent and convincing exponent of her views. I note her majestic note on McVernon et al's survey of HiB vaccine in Rapid Responses, 23 September 2004, "Dogs chasing tails" [1], which so far no one has cared to dispute. Perhaps Dr Midgley rubs his hands with glee at what has befallen Dr Donegan. I wish to express my utter disgust. [1] http://bmj.bmjjournals.com/cgi/eletters/329/7467/655#75417 Competing interests: Parent of an autistic child |
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John Stone, none London N22
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The formula used by the ten co-authors of the 1998 paper "we should together formally retract the interpretation placed upon the findings in the paper" (Horton p.12) makes it clear that there was no hypothesis to retract, and Horton himself states: "The twelve children did exist. Their clinical histories were not disputed" (Horton p.11). The ten signatories may say they no longer think something but this cannot be allowed to distract from the fact that no theoretical claim was ever made in the paper and therefore cannot have been misleading. The paper does not articulate what Andrew Wakefield believed on this matter (or still believes) and there is no ethical question for him to answer in relation to it. There is surely, however, one for Richard Horton. Competing interests: Parent of an autistic child |
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Dr John Rumbold, n/a West Midlands
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When an expert witness is asked for his or her opinion that is one matter; when an expert witness (was Dr Donegan defined as an expert witness and on what grounds?) is backing up a report with research he/she has a duty to quote sources appropriately. There has been much examination of medical expert witnesses in the area of child protection so this case is not an exception by any means. The judge clearly felt the report was trying to "bamboozle" him and was ideologically driven rather than scientifically. Competing interests: None declared |
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Adrian K Midgley, GP Exeter EX2 1QS
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Mr Stone has demonstrated that he is impervious to pretty much anything, but makes some assertions.
In a judge's summing up, it is not gratuitous to remark on the expert witnesses. If they are good then their evidence is reasonably taken into account. If their evidence is rejected as rubbish, then an explanation must be given why. And in this case is. In the absence of this being done properly, any barrister appealing the case will be able to criticise the process. The case was appealed. Such criticism was not the basis of appeal. Mr Stone asserts that elsewhere - I take him to mean where critical supervision is absent - Dr Donegan was eloquent. however she held herself out, for a fee, as an expert witness and signally failed to come up to proof. Mr Stone may not appreciate that an expert witness has several duties, some of which are to the Court. Reading and understanding the straightforward and measured English of the judgement makes this perfectly clear, and makes it clear that this judge found this doctor to have failed to a degree which might reasonably be thought negligent to perform those duties. If Dr Donegan has not learned anything from that case then the GMC is likely to regard her with disfavour. It really is made very clear in the judgement, anyone rational reading it would be hard put to misunderstand, and it is not necessary to go to the transcript - unless someone is asserting that the judge is simply lying about who said what ... ? Competing interests: None declared |
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Adrian K Midgley, GP Exeter EX1 2QS
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"... Jayne Donegan is plainly under less heighteneted conditions ... her majestic note on McVernon et al's survey of HiB vaccine in Rapid Responses, 23 September 2004, "Dogs chasing tails" [1], which so far no one has cared to dispute. "
I suspect they looked at it and were repelled by the badness of the first paragraph. It is hard to pick a point to start, and only criticising part of it will be taken by several posters here as agreement with the rest. (actually, expressing total disagreement with every aspect of it is likely to be represented here and elsewhere as agreement, which is one of the obvious problems.)
Feinman, a very clever physicist, used to have alleged proofs of mathematical theorems, designs for perpetual motion machines and similar oddities sent to him by people convinced they were even cleverer. First paragraphs, even in a brawl like this, are generally reckoned to be worth a second look before one releases them. If the first paragraph is rubbish - as that one is - then the reader may reasonably wait for the second draft before reading the second and subsequent paragraphs. However glancing onward, the quality of argument does not improve. I have not critically read the references that Dr Donegan presents as supporting her assertions, so i do not kno whether they offer any support. What is clear is that she presented a considerable number of references in the court case, claiming that they supported her arguments, and then admitted when cross-examined on many of them that in fact they did not, or were contrary to her argument, or irrelevant. This harms her credibility in letters written to the Journal of an Association established one and ahalf centuries ago with several aims, two of them to support scientific medicine, and to oppose quackery. Competing interests: None declared |
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John Stone, none London N22
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Confusion: "Indeed, the GMC seemed non-plussed by Reid's [John Reid, the Health Secretary] intervention. The best their spokeswoman could say was: 'We are concerned by these allegations and will be looking at what action, if any, may be necessary.' In truth, they had not a clue where to begin. At a dinner I attended on 23 February [the day after Brian Deer's Sunday Times article], one medical regulator and I discussed the Wakefield case. He seemed unsure of how the Council could play a useful part in resolving the confusion." (Horton p.7) However: "As we talked over coffee while the other dinner guests were departing, he scribbled down some possible lines of investigation, and passed me his card, suggesting that I contact him directly if anything sprang to mind. He seemed keen to pursue Wakefield, especially given ministerial interest. Here, was professionally led regulation of doctors in action - notes exchanged over liqueurs in a beautifully pannelled room of one of medicine's most venerable institutions [Horton does not say which]." (Horton p.7-8) Can anyone say whether this is a proper way to conduct science, justice, or government? Competing interests: Parent of an autistic child |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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Sir I agree that expert witnesses should make expert judgements based on solid evidence; but would query whether those judgements should be criticised by a judge unless the judge is suitably qualified in that area of expertise, or relays criticism from other experts who have appeared in that court who have shown scientifically that the 'expert' evidence is definitely flawed. Was that the case here? Regards John H. Competing interests: None declared |
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John Stone, none London N22
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The High Court: It was obviously quite extraordinary to expect the High Court to rule against medical orthodoxy, and bizarre to send out as an expert witness someone who had no experience in this legal territory. The judgement of all sorts of people who ought to have known better should be in question as well as that of Dr Donegan, who apparently had to endure a day and a half of hostile questioning. She, alone, seems to have had all the opprobrium heaped on her. And if anyone says this is not the way to resolve scientific (or legal) questions, they are most certainly right. What is appalling is the shear intolerance of the medical profession which will not allow the ambiguity of the evidence to be discussed in a civilised way. The lack of tolerance damages the profession and endangers public safety. Dr Midgley and Dr Rumbold standing on their dignity all the time portrays the profession in a particularly absurd light. HiB: From 'Harrison's Textbook of Internal Medicine' 11th Ed. (1987) p.602: "The incidence of systemic H Influenza b diseases has increased fourfold during the past 3-4 and a half decades, and more adults are being affected. The basis for this increase is not understood, but improved diagnostic laboratories and diminution in the prevalence of type-specific immunity due to excessive use of antibiotics have been suggested as possible mechanisms." Competing interests: Parent of an autistic child |
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Adrian K Midgley, GP Exeter EX1 2QS
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Do query it. Read it. The reference is provided so that people who want to make up their mind from knowledge can conveniently acquire it. To say the answer is "yes" is rather an understatement. Competing interests: None declared |
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John Stone, none London N22
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I have not previously touched on Richard Horton's account of the science, and the reasons may be evident to regular followers of BMJ Rapid Responses: simply because there are so many compelling arguments against the official line it is very hard to know where to begin. But in Horton's narrative the clinching and definitive moment is presented as the Institute of Medicine report on vaccine safety in May of this year. "But Wakefield's position received a further blow in May 2004, when the Institute of Medicine, America's lead agency for providing scientific advice on matters of health and medicine, published its final report on vaccines and autism. The Institute's eleven-member committee had the benefit of reviewing the events leading up to the retraction of the interpretation [sic] in the Lancet...The report had particular value because the members of the panel selected by the Institute of Medicine to review the evidence were chosen according to strict criteria - namely, that they had neither links to vaccine manufacturers nor any association with ongoing vaccine litigation. Their conclusions were as unbiased as one was ever likely to get." For a British readership, particularly, who do not know how controversial the IOM report was (since it was kept completely out of the media) this is hugely misleading. Contrast the words of Republican congressman Dr Dave Weldon just a few days after the publication of the report at the Autism One Conference in Chicago(29 May 2004): "As with thimerosal, the IOM relied almost exclusively on epidemiology. They made there decision as to whether measles may be related to Autism in children, by reviewing 13 statistical studies in which many of the authors had conflicts of interest. Some of these authors have been openly hostile in their assessments which calls in question their objectivity. Also, remember it is the epidemiology that reigns supreme in this review - even if the studies are flawed in their design. "The IOM still cannot answer the question as to why measles is in the intestines of some autistic children. Why is it there? What is it doing? How did it get there? Is it contributing to autism? The IOM attempts to explain this issue away by say it is likely that the presence of measles is just a co-morbidity with autism. This cavalier attitude of the IOM, the CDC, and others in the public health community is unacceptable etc." [1] From Horton we learn nothing about such criticisms, and we hear nothing about the controversy: he can in fact more or less bank on the fact no one except a few exceptionally informed people know anything about it in this country. But surely as a good medical jounalism this is quite unacceptable. He may sincerely believe that MMR is safe or does not cause autism or bowel disease, but he also fails to report or acknowledge the contrary arguments. [1] http://www.gov/weldon/news/Speeches/AutismOne-Speech.pdf Competing interests: Parent of an autsitic child |
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Adrian K Midgley, GP Exeter EX1 2QS
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Mr Stone adds little but incomprehension and insult in a reply about the status and behaviour of a doctor presenting herself as an expert witness in a case relating to Measles, Mumps and Rubella immunisation. Expert witnesses have a duty to the Court, not to one side in a case, which must require some detachment and care by them when they are paid by one side to be there. I see no reason to think that a barrister and the rest of the legal team going in to that case would not select the best witness they could find - the most credible and best prepared. And their witness failed to come up to proof, admitting that various of her references when actually read offered conclusions opposite to the conclusions she offered them in support of. Witnesses can avoid an awkward time in Court by not claiming to be expert unless they are; if their opinion is based on personal experience and theorising rather than on experimental evidence or observation simply saying so, and carefully avoiding doing anything that looks as though it might be misleading the judge. The performance as described by the judge and accepted by the mothers' laywers in appealing only on other grounds appears to be very far below the standard for anything that a doctor should put themselves forward to become involved in. Competing interests: None declared |
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Mark Struthers, GP Bedfordshire, UK. mark.struthers@which.net
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There is something distinctly distasteful in the savage way Dr Donegan has been treated by the medico-judicial system in this country. Cogent scientific evidence lay on both sides of the argument over the immunisation of two little girls. Their lordships had a decision to make in the best interests of the children. For good or ill, they made that decision, as was their duty. However, their Lordship's decision to belittle, disparage and refer Dr Donegan to the GMC was unnecessary, unwarranted - gratuitous indeed. Their Lordship's vindictive over-reaction to the perceived threat posed by Dr Jayne Donegan was revealing. Rather than the care of the individual child, the concerns of justice were in the protection of the herd and the security of vested interest. The judiciary might care to recall how trust in British justice has been squandered in recent years. Their Lordships would do well to look at the precedent set by the trials of Sally Clark, and Angela Cannings. They need to remember how they have been bamboozled by the expert paediatrician and the dreadful consequence thereof. It was on these occasions that the judiciary were apparently misled and chose to believe the junk science of eminence. They must recognise the catastrophic injustice that these cases represent and the disgraceful, abysmal failure to protect children that is the result. I wonder if their Lordships have learned the lessons of this dismal partiality and have honestly sought to restore an element of credibility to our system of justice. This country, like the US, is a land of junk justice. May I politely suggest that Dr Adrian Midgley is deluded, very much the dupe - like the average American on Election Day, behind and beyond. Competing interests: damned by the illusion of four more years of justice and the dream chosen by the American nightmare. I am a severe sufferer of BvDS ? Bush- victory depression syndrome. |
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John Stone, none London N22
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Perhaps if Dr Midgley was examined on his core scientific beliefs by a clever point scoring legal team for a day and a half he might test to destruction. I should have thought given the great gaps in actual knowledge, scepticism is far wiser than certainty in this field. Dogma will destroy science, and it will destroy people. I notice no one has said anything much about Richard Horton. Competing interests: Parent of an autistic child |
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John P Heptonstall, Director of the Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG
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Sir I reach a rather different conclusion to Midgley on the part played by Dr Donegan, and the criticisms levelled against her. I sympathise that she found herself in an adversarial position against two experienced paediatricians, Conway and Kroll, some of whose opinions seem, on inspection, highly questionable. It would appear that where Dr Donegan opined without showing supportive data, or against the conclusion of authors of papers from which she cited data, she was criticised for doing that. Surely an ‘expert’ scientific witness must use that expertise to interpret all available evidence that arises from the complex of 'published alleged facts', personal knowledge and understanding of the subject? Summaries of case and appeal suggest that unless an ‘expert’ could quote scientific chapter and verse, as can be done in arguments over statute, from publications in relatively uncritical fashion (despite it being acknowledged that many research papers are published for the wrong reasons with little integrity) the ‘expert’ is criticised. Scientific opinion cannot be constrained by published data or views of the authors alone as the very nature of science ensures that data is likely to be superseded by future scientific argument. I would be concerned about scientific opinion that is based on the uncritical acceptance of any research as published - but do not detect similar concern from the learned judges. I was surprised at the appointment of Prof. Kroll for the two girls. 'Competing interests’, despite the rules for ‘expert’ witness, could potentially place him in the unenviable position of having to criticise, and for the children refuse, practices he is likely to have supported and developed for many years. I prefer to see an expert for children unencumbered by ‘competing interests’ past or present of any persuasion. I am sure Kroll did his best under the circumstances. It is disappointing that Dr Donegan was criticised as providing ‘junk science’ after she produced good scientific argument where available, and honest opinion based on her ‘expertise’ otherwise. She advanced supportive data where available, and when existing data failed to completely support her own beliefs she admitted this and, by reading between the lines in certain research papers, had reached her own opinion. Alas she was attacked for not accepting the opinions of authors, which were not necessarily scientific fact, yet which appear to have been projected as such by the other two experts. Dr BJ Ward in the Bulletin of the WHO, “Vaccine ADRs in the new millennium: is there reason for concern”, 2000, 78:2; 205-25 states that “relatively little is known about the immunopathogenesis of even the best characterised vaccine adverse events...and vaccine use is being justified in terms of societal and parental ‘costs’ rather than in straight forward morbidity and mortality costs....the available epidemiological and laboratory tools to address the issue outlined above are somewhat limited...”. Nowhere can I find evidence that Kroll or Conway conveyed such an opinion to the learned judge, yet the spirit of this opinion was conveyed to the Judge by Dr Donegan, and the mothers of the two children, in their own way. Prof. Kroll (from the Health Handbook “Immunisation against infectious diseases”) referred to “before 1988 more than half the acute measles deaths occurred in previously healthy children who had not been immunised”. This was drawn from “Deaths from measles in England and Wales 1970-832 by Miller CJ, BMJ, 1985; 443-4; it says that almost half the people who died from measles between 1970-83 (270) had pre-existing conditions (eg Cerebral Palsy (24), leukaemia (19), etc.) but provides no direct evidence supporting the assumption that the remainder were ‘healthy’. It also states that “no attempt was made to establish vaccination status”. Was Kroll’s opinion, as accepted by the court against Dr Donegan's opinion, based on unreliable data which could easily be refuted by reading the original article? Conway opined, and it was accepted by the court against Dr Donegan's opinion, that “it is unlikely that whooping cough outbreaks would start and spread against a well vaccinated population”. He appears unaware that an epidemic swept through Holland despite a vaccination rate as high as 96%, “with no clustering in areas of low vaccination” (BMJ 1998: 316; 92). Did expert Kroll not intervene to avoid Conway misleading the court? I was concerned with the courts acceptance of the two ‘experts’ opinion that mercury in vaccines is not a high dosage. The US Environmental Protection Agency (EPA) recommends a maximum daily exposure level for mercury of 0.1ug/kg. Every dose of DTP or DT contains 25ug of mercury –so one needs to weigh 250kg (about 39 stones) to achieve minimum safety status for that amount of mercury. The 4 and 10 years old children are unlikely to weigh more than about 40 to 60kg so according to the EPA, they would be at a risk of receiving some 4 to 6 times (400 to 600%) the maximum acceptable recommended levels of mercury - directly into their bloodstreams - cited by the US EPA. The court appears to accept the injection into the two girls of levels of mercury far in excess of the EPA maximum daily exposure level, for that neuro and nephro toxin, favouring the opinions of Conway and Kroll. I think that in scientific argument there are few truths and numerous viable opinions, unlike many other forms of argument; science by its nature evolves and must correct itself along the way, vaccine science is no different. One must become aware of as much data, facts, and arguments as possible. A scientific ‘expert’ is not one who can quote the most publications accurately, but one who applies utmost scientific method and scrutiny without fear or favour, who is capable of separating fact from fiction, and who remains objective throughout. Midgley’s regurgitation of court summaries is premature, inconsiderate of Dr Donegan’s position, and of the part she played admirably for the mothers. She entered the lions’ den to represent a position that flies in the face not of science or fact but of medical and political dogma as we are all aware with the ongoing debate on accuracy and adequacy of scientific evidence, the apparent lack of proper reporting of adverse events, and the trend for data production that is driven by desired conclusion not objectivity. This created a no-win situation for the mothers, and therefore their children, for whom there could have been no balanced opinion of ‘experts’ no matter how hard the court tried to navigate towards the truth - there is no truth and so the verdict seems to rely on opinions of paediatricians whose lives are spent striving to vaccinate every child with every vaccine government edict supports. The two experts seem to have provided opinions which do not stand up to scientific, therefore legal, scrutiny yet unlike Dr Donegan they escape admonishment. Is that justice? Regards John H Competing interests: None declared |
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Ruth E Acaster, Full-time Mother Worthing, West Sussex
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I am assuming that the Judge in this case had no previous knowledge about Vaccination, possibly apart from the general ill-informed view that it has been our saviour! Surely it would have been beneficial to all concerned to have a Judge that had better understanding of this highly immotive subject. I think it is outrageous that an honest and very knowledgable GP; Dr Donegan has been referred to the GMC. There are allegedly some quite suspect Doctors still in practice. Does the GMC really have the nations health and safety as their primary concern? I don't think so. Competing interests: None declared |
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Adrian K Midgley, GP Exeter EX1 2QS
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If someone holding themselves out as an expert witness says that a paper supports a conclusion, then the judge does not expect on reading it to find that it in fact supports the opposite conclusion. This is the situation the judge remarked on, adversely, and which has resulted in further investigation. The long reply above from Mr Heptonstall starts off by not acknowledging this and then veers thorugh fantasy, irrelevance and insult. But nowhere does it add information. Competing interests: None declared |
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John P. Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre. TCM Practitioner LS27 8EG
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Sir I would very much welcome Midgley's explanation, with sufficient factual evidence, to show how he arrives at the opinion shown by his statement:- "If someone holding themselves out as an expert witness says that a paper supports a conclusion, then the judge does not expect on reading it to find that it in fact supports the opposite conclusion. This is the situation the judge remarked on, adversely, and which has resulted in further investigation". I am of the opinion that the problems Dr Donegan faced in that court were far more complex, and my own response alludes to that fact, than Midgley would have us believe through his oversimplifications. Regards John H. Competing interests: None declared |
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Adrian K Midgley, GP Exeter EX1 2QS
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No you wouldn't. http://bmj.bmjjournals.com/cgi/eletters/329/7473/1049#83016 Above, and to which something posing as a reply has been posted. Two of the three references given contain exactly the information you need to decide what the judge objected to. Unless you care to state that the judge lied in his summing up? Its trolling. Competing interests: None declared |
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John Stone, none London N22
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Hitherto I have been unfamiliar with the term "trolling" but understand it means "being offensive". I am sure that John Heptonstall did not mean to be offensive, and I am equally certain that Adrian Midgley intended to be rude about him (without presenting any arguments which I can see). I do not think that it is the necessary consequence of what John was arguing that the judge was lying, only that the judge was mistaken. Competing interests: Parent of an autistic child |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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Sir As must be clear already from my last response to Midgley, I am not interested in what the judge/s decided, having read the transcripts of the summaries of case and appeal courts from which my opinions were formed for my last response to Midgley, I am interested in the evidence Midgley can provide to support his statement "if someone holding themselves out as an expert witness says that a paper supports a conclusion, then the judge does not expect on reading it to find that it in fact supports the opposite conclusion. This is the situation the judge remarked on, adversely, and which has resulted in further investigation". The only reference Midgley gives, contrary to his submission that 2 out of 3 references 'contain the information I need to decide what the judge objected to', that might come close to supporting his statement is 36 but that leaves much to be desired...it says that "Dr Donegan's report was based on no independent research, and most of the published papers cited by her in support of her views turned out to either support the contrary position or at least to give no support to her own...". It does not state "supports the opposite conclusion" - it speaks of position, not conclusions, which is a situation or circumstance one arrives at after assessing all facts available (if necessary despite any conclusions an author may reach). Midgley accuses Dr Donegan of stating that a paper supports a conclusion that it does not. Nowhere can I find that accusation being made of Dr Donegan by the court in the references Midgley cites. So I ask again What evidence does Midgley have that any paper cited by Dr Donegan "supported a conclusion that the judge, on reading it, found that it in fact supported the opposite conclusion"? I can only read into 36 that she reached positions from particular papers that were not reached by either the authors or the judge/s who read those papers. She was an expert witness, employed for opinion born of experience, not a regurgitator of scientific papers which are on their own notoriously inadequate if one wishes to form an opinion on a complex subject. Presumably the judge/s did not have sufficient scientific expertise in those areas, unlike Dr Donegan, to be capable of reading into those papers anything other than the positions adopted by the authors? I note that in Andrews et al 2004, the paper on Thimerosal in DTP/DT recently published, the authors cite several times that there is an apparent protective effect of thimerosal against certain neurological problems in children - the authors reached that 'position'. I questioned them on Pediatrics Journal Rapid Responses on that position, and received a reply from Andrews saying they do not 'conclude' that thimerosal has a protective effect against certain neurological problems on children. Someone less versed in science might accept the 5 references in Andrews et al to the 'apparent protective effect of thimerosal' as a position which could be seen as a conclusion - according to the authors it is not. I note how Midgley 'damns' Dr Donegan with "As to Jayne Donegan, the judgement (1)is damning, but polite, and that isn't censorship either" and, together with his assertion (yet to be justified by him with references and fact) that she said that papers supported conclusions when they did not. I think a retraction is in order from Midgley. Regards John H Competing interests: None declared |
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Dr John Rumbold, n/a West Midlands
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There will be a programme about the deceptions behind the MMR scare on Thursday night by Brian Deer, the journalist behind previous revelations about Andrew Wakefield. (Dispatches, Channel 4, 9pm) Competing interests: None declared |
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John Stone, none London N22
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In all fairness I have posted many times on this site to correct unfounded allegations against Andrew Wakefield, notably above under the present topic, but also under Joanna Lyall, 'Editor in the Eye of the Storm': http://bmj.bmjjournals.com/cgi/eletters/328/7438/528. To date no one has found any grounds to take issue with me on any of the relevant posts. It may also be of interest that in response to the new allegations a website will be opening tomorrow: http://www.mmrthequestions.com. The immediate brief of the site will be to address the new allegations although it is hoped that it will broaden its focus in the near future. Competing interests: Parent of an autistic child |
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Dr John Rumbold, n/a West Midlands
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I am intrigued by the link between the religious right in the US and the anti-vaccination movement. I browsed the site Good News Doctor (www.gnd.org) mentioned in last night's Dispatches programme and I am genuinely interested in finding out how much of the anti-vaccination movement is this strange mix of religion and fringe science? I have tried posting on anti-vaccination websites with no reply so I wonder if Mr Stone could answer my query? I had an interesting experience recently of a minister telling me about a secret cancer cure developed by a Christian doctor, which has parallels with the Good News Doctor website message. Competing interests: None declared |
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Adrian K Midgley, GP Exeter EX1 2QS
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The definition of Trolling offered above is incorrect. An accurate definition is easily found with the most minimal research. Heptonstall says: - " "Dr Donegan's report was based on no independent research, and most of the published papers cited by her in support of her views turned out to either support the contrary position or at least to give no support to her own...". It does not state "supports the opposite conclusion" - it speaks of position, not conclusions, which is a situation or circumstance one arrives at after assessing all facts available (if necessary despite any conclusions an author may reach)." For most of us, in a situation where someting is one or the other thing, contrary is the same as opposite. Heptonstall is either trolling here, or genuinely has an inability to understand something quite simple. Either way, he will be fed no longer by me. Competing interests: None declared |
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Richard G Fiddian-Green, FRCS, FACS c/o Sanders, Temple Gdns, Moor Park.
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I was interested to read in the press today that the GP gaoled for fraud had been able to earn £70,000.00 a month by giving single injections rather than MMR. Short terms financial gains of this magnitude are not in anyone's interest except the GP. In an earlier eLetter I raised the possibility of staggering reimbursemnts for operations performed delaying some 50% to further increments 2, 5 and even 10 years later. How might this system of reimbursement be successfully applied to physicians and GPs? By rewarding GPs for reducing the number of times a patient seeks retreatment for any given condition such as back pan? By adjusting their reimbusements for detecting cancers for the stage at which the disease is detected? By rewarding them for detecting vascular diseases before aneurysms are excessively large and/or before organ dysfunction or damage occurs? What of vaccines? By rewarding GPs for preventing diseases and deferring reimbursements for 5, 10 or even 15 years. Deferred reimbursements might be especially successful in preventing obesity and its sequelae and in achieving and maintaining weight reducion in the morbidly obese. In raising the potential for profits from innovations loans could be obtained and outside investors even attracted without any risk of unacceptable conflicts of interest. The beauty about this proposal is that it would not only address governmental and patient needs it would also address the costs of failed treatments and GP/physician pensions. In such a system savings would be effectivly enforced and a GP or physician might even be able to afford to retire long before a surgeon with a busy private practice. Most importantly effort and clinical excellence would be rewarded. The system would not, however, work unless patients had private insurance. The gaoled GP is highly unlikely to have committed fraud in such a system. Competing interests: None declared |
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Deborah Kahn, librarian Warren Public Library 05674
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Since Dr. Donegan has now been totally cleared of all charges, perhaps the label of "junk" could be removed from her science? Just as a matter of courtesy? The news blackout on the successful outcome of her case has been quite interesting... Competing interests: None declared |
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