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GMC case against Wakefield’s colleague was “superficial,” says appeal

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1103 (Published 14 February 2012) Cite this as: BMJ 2012;344:e1103
  1. Clare Dyer
  1. 1BMJ

The General Medical Council panel that found Andrew Wakefield’s colleague John Walker-Smith guilty of serious professional misconduct and struck him off the medical register in 2010 was dealing with a task that was “beyond it,” his barrister told the High Court in London this week.

Stephen Miller QC told Mr Justice Mitting at the start of a two week appeal hearing that the panel ignored evidence that paediatric gastroenterologists at the Royal Free Hospital in London, headed by Professor Walker-Smith, were carrying out investigations that were clinically indicated and undertaken for the purposes of diagnosis and treatment and not for a research project.

Professor Walker-Smith, who retired in 2000, was one of the coauthors of the 1998 Lancet paper, of which Dr Wakefield was the lead author, that sparked a worldwide scare over the measles, mumps, and rubella (MMR) vaccine when it seemed to find a link between bowel disorder, autism, and the vaccine in 12 children.

The Lancet eventually withdrew the paper in 2010 (BMJ 2010;340:c696, doi:10.1136/bmj.c696), after Dr Wakefield was found guilty by the GMC of dishonesty and flouting ethics committee approval. He was later struck off, along with Professor Walker-Smith (BMJ 2010;340:c2803, doi:10.1136/bmj.c2803).

The GMC panel found that in 1996 and 1997 children had been subjected to investigations, including colonoscopy, lumbar puncture, and magnetic resonance imaging, that were not clinically indicated and against their best interests. Mr Miller said that in all but one of the cases the gastroenterological team had gone on to treat the children for conditions they had found and that in some cases the treatment went on for years. Letters were written to the children’s GPs setting out the findings and how the children were to be treated.

But the panel had failed to say what its thought processes were in deciding that the exercise was research rather than clinical. “We say the panel did not get to grips with why the investigation was not clinically indicated,” said Mr Miller. It had even looked at the wrong ethical guidelines and failed to spot that the guidelines it took into account “had nothing to do with whether something is clinical medicine or research.”

The panel had ignored what the doctors who were charged and their team said about what they were doing and why they were doing it and what the GPs who gave evidence said about why they were referring. A “superficial” approach permeated the case at all levels, the QC added.

In grounds of appeal filed with the court, Mr Miller argues that Professor Walker-Smith was denied a fair trial because, among other failings, the panel’s reasoning “demonstrates that the task of dealing fairly with the evidence and the issues was beyond it.” He adds: “The complete absence of any sensible analysis of the oral evidence and particularly the expert evidence suggests that the panel had either failed to understand it or had chosen not to remind itself of it from the transcripts.”

The GMC hearing lasted 217 days, beginning in July 2007 and finishing in March 2010, with lengthy adjournments, which meant that the panel “had to rely on the documents, transcripts and (receding) memories of the witnesses to decide the detailed questions raised in a charge sheet which ran, in all, to over 135 pages,” say the grounds of appeal.

Notes

Cite this as: BMJ 2012;344:e1103