Secrets of the MMR scare

The Lancet’s two days to bury bad news

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c7001 (Published 18 January 2011)
Cite this as: BMJ 2011;342:c7001

Recent rapid responses

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Displaying 1-4 out of 4 published

I hope someone is going to answer the question: why has Richard Horton not been sacked?

Competing interests: None declared

Roger A Fisken, Retired consultant physician

None

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This was Brian Deer's statement to Mr Horton at a Lancet meeting on 18th February 2004:- 'I told them that the paper's first author, Wakefield, was retained by a lawyer and was funded to help sue vaccine manufacturers.' This assertion by Brian Deer formed a major part of the GMC case against Wakefield, Murch and Walker Smith.

To dispel any ambiguity: Dr Wakefield WAS enlisted as an expert witness by MMR medical litigation lawyer Richard Barr. Dr Wakefield was paid by the hour, pro rata, to compile reports and possibly be an 'expert witness' during a court 'proof' hearing. This is normal procedural practice for lawyers compiling evidence to be used in a UK court of law.

I must stress that Dr Wakefield's fees for this work, would have been paid directly to him via Richard Barr, who was responsible for administering the childrens' Legal Aid awards; the money would NOT have been paid directly to Dr Wakefield by the Legal Aid Board. This money was legitimately earned by Dr Wakefield and was therefore his to spend as he wished, apart from a UK tax liability of around 40%. If Dr Wakefield chose to donate any of it to a charitable trust fund, then the tax liability would have been waived under UK tax rules.

I feel that Mr Deer's use of the word 'funded' in his above statement seems to imply that the Legal Aid Board awarded money directly to the Royal Free Hospital for 'research'. Again, this does not happen under UK Legal Aid rules. Richard Barr DID NOT arrange for my Grandson to have ANY paid scopes or scans carried out at the Royal Free Hospital. These had already been carried out as part of my Grandson's initial diagnostic procedures at the Royal Free. The legal reports on him were based on these previous tests and treatments, some of which are still ongoing. I cannot comment on any other children's cases, but if Mr Barr recommended tests to be carried out on any other children, as part of an evidence gathering exercise, this will have been discussed and agreed with the parents beforehand and paid for via Mr Barr, NOT the Legal Aid Board.

There is NOTHING illegal, unusual or 'fraudulent' about ANY of this. It is USUAL PRACTICE in litigation cases to obtain reports and evidence from suitably qualified experts; indeed expert testimony is a necessary part of ALL litigation court proceedings. Many eminent clinicians and scientists regularly act as expert witnesses in court cases.

Competing interests: My autistic Grandson was treated by Professors Walker Smith and Murch at the Royal Free Hospital. He has bowel disease but was not one of the Lancet 12 children. He was one of a large number of child MMR litigation clients of Richard Barr. My Grandson's parents applied for and were awarded UK Legal aid on his behalf. (These awards are granted to individuals on a means tested and merit basis).

Jenny H Allan, retired

none

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Brian Deer, The Sunday Times and Channel Four's Dispatches should be congratulated. The current BMJ editor is right to say that medicine needs more investigative journalism, and to highlight the need for wider vaccination against measles.

But several problems remain. The neutral observer might well ask how the “good” investigative journalism of Mr Deer is to be reliably distinguished from the "bad" of the Daily Mail, The Daily Telegraph and Private Eye. Is it really just the detail, the lengths to which Mr Deer went? I am not convinced that if Melanie Phillips (say) had spent the same amount of time on the story, she would have ended up believing Andrew Wakefield to have been fraudulent, or even deliberately dishonest.

Mr Deer himself seems to recognise the limits of his three BMJ pieces. In a Press Gazette interview last year he indicated that there is no real distinction between scientific journals, newspapers and magazines. He stated in a Guardian Blog (12th January 2011) that the BMJ was part of an "insidious cartel". What difference does it make, then, that his first BMJ piece was "peer reviewed" by the usual anonymous process? Perhaps it would have been more consistent of him to decline it.

The Lancet's Richard Horton is alleged to have acted from entirely "medical establishment" motives. But in my view there are two significant flaws in the Deer/BMJ account. First, it distorts and minimises the history of the "autistic enterocolitis" construct, which developed from a decade or more of speculative but "peer reviewed" research, and not merely Wakefield's undisclosed legal action.

Second, it ignores the whole context in which the worldwide anti- vaccinationist movement has grown. The British Medical Journal and the Lancet have both played an important role in the current debate, following Vioxx and other cases, about "industry" conflicts of interest and the right balances between openness, promotional claims, and business interests.

However, the BMJ has gone much further, even at the height of the MMR scare in the UK, in promoting scepticism about the "inappropriate domination of the Western view of mental health", a process in which "doctors and the pharmaceutical industry" irresponsibly push both "Western cultural ideas" and "a rapid growth in the numbers of children diagnosed with conditions such as attention deficit hyperactivity disorder and autism" (Timimi, BMJ, 2005).

Two days after Brian Deer's second article, a Blog piece entitled "How to stop the medical arms race" by a former BMJ editor revealingly set out the default position of the journal (Smith, BMJ, 13th January 2011): selectively publish evidence that "technology" and "doctors" lead to worse outcomes, not better. That Richard Smith's Blog piece was typically urbane and self- deprecating might suggest that here, not in the Lancet, lie the really established views.

The BMJ has also published many opinion pieces by the "No Free Lunch" campaigner Des Spence which go further. For example: "big pharma use[s] political lobbying to pervert the course of medical justice" (11th March 2009), and "A medicated childhood is blunt, defies reason, and is just bad medicine." (21st July 2010).

Taken together, when some parents, journalists and politicians read these opinions, in the light of their own experience of the indifference by the "medical establishment" to neurodevelopmental disorders, it is not very surprising that they prefer a different version of events: Andrew Wakefield's continued fight against a vaccine industry which scored a temporary victory during the fitness to practise panel's 45 days of deliberating in secret (to use Brian Deer's preferred term, rather than the GMC's euphemistic "in camera"). Today, searching the GMC site for "Wakefield transcript" still turns up no results, despite the Editor's claim two weeks ago that it had been published.

Finally, that an eminent "evidence-based medicine" expert such as Trisha Greenhalgh inflames the situation further by repeating a comparison of the MMR sceptics with "flat-earthers" (rapid response, 18th January), only shows how remote the BMJ is perceived to be from the concerns of ordinary patients, and the "front-line" staff who do not have the luxury of engaging with non-MMR-sceptic families only.

If medical journals are really just newspapers with mystique, perhaps it follows that a way out might be for medicine to become an honest trade rather than a dodgy "profession". No doubt the size of the financial transaction between the BMJ and Brian Deer was small; and it remains open whether the journal's new policy of commercially encouraging "good" investigative journalism at the expense of "bad", will have the desired result in respect of the larger dragons of commercialised medicine, which the BMJ appears to see as its destiny to slay.

Competing interests: I have consulted to The Priory Group within the last three years.

Neil MacFarlane, Independent Consultant in Adult Developmental Psychiatry

17 Wimpole Street, London

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4 February 2011

In the three instalments chronicling his investigation into Wakefield's Lancet paper, Brian Deer gives himself the central role. He it is who begins the Sunday Times investigation of Wakefield, who unmasks discrepancies in the paper, who reveals collusion between the Lancet's editor and the authors and senior managers, and who (last week) uncovers the pharmaceutical enterprise Wakefield, the Royal Free and others planned. So it goes on.

It is not surprising that some have applauded Deer as hero in this seven-year saga of unceasing revelation he so compelling constructs, as he performs the role of investigator, research-analyst, complainant, solver of the crime, and story-teller. On busy days he could be found writing copious notes at the GMC hearing and then later presumably writing up the day's notes, submitting copy for the following weekend's Sunday Times, updating his own website and blogging around the world.

That one person has performed this Herculean task, demands debate on who should be performing these distinct roles and, given the destruction of reputations involved, whether a single journalist should be granted the power to exact such a heavy price from the subjects of his story.

Who should have checked the data and content of the Lancet paper? Its 13 co-authors covering different medical areas of expertise, and the anonymous expert referees, did, corrected it and were then satisfied. But Deer checks and finds it wanting.

Deer offers his findings to the Lancet editor and he checks them with the authors and the Vice-Dean. The editor has some misgivings but the paper stands to Deer's dissatisfaction.

He brings his findings to the GMC and after 7 years the panel of three doctors and two lay persons decides against Wakefield and Walker- Smith having heard testimony from expert witnesses on both sides. But were the panel members academically qualified in the relevant areas of medical expertise to make sense of the expert testimony heard in a case that has no precedent in the GMC's history?

So Deer is vindicated by the GMC. Whether the truth has now been established and the public interest restored by the actions of these two parties are questions that remain. However, the over-riding question is whether the GMC, the news media and BMJ, whatever roles they are entitled to play, are the right tribunals for settling scientific disputes, including serious allegations of rigging results, where the accused are denied judgment by their academic peers but must face the ultimate price of their life-time reputations destroyed.

Competing interests: father of autistic son

Hewitt, retired

London

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