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Rapid response to:


Does autistic enterocolitis exist?

BMJ 2010; 340 doi: (Published 15 April 2010) Cite this as: BMJ 2010;340:c1807

Rapid Response:

Does autistic enterocolitis exist?

Professor Wright is no stranger to controversy when it comes to scientific integrity1, but he is sailing precariously close to the cliff in what I think is his spirited defense of his once next-door neighbour Andrew Wakefield.

In his Editorial, addressing the shortcomings of the transparency of handling of the histopathology process in the Wakefield MMR saga, he is absolutely correct that the histopathologists must take full responsibility for their part of the study. They have regrettably not done so and distanced themselves from the Lancet paper2.

However Professor Wright then invokes Professor Walker Smith’s concerns about the competence of the Royal Free’s pathology services (most hospital have clearly defined pathways to deal with such governance issues), as if this justified altering the initial diagnostic histopathology reports by the other investigator(s) who may not have been accredited in histopathology.

I was a one-time “collaborator” to Wakefield’s group, advising on quality of data underlying the concept of “autistic enterocolitis” including assessing the validity of techniques used for studying small bowel function in this putative condition, the interpretation of the results and whether there were plausible mechanistic links between gut inflammation and CNS symptoms in these patients. I assessed the references cited by Professor Wright and many more and concluded, unlike the Professor (who is not a small bowel expert Gastroenterologist), that there was no justification for the term whatsoever.

Needless to say none of my suggestions for change were acted on, my name was removed from the draft paper and our “collaboration” was terminated. The histopathology part of the MMR case although riddled with irregularity, not least the disappearance of the paraffin blocks and slides, is only one piece of evidence presented to the GMC. It is the repeated irregularities throughout entirety of the case that are so worrying.

Certainly science is a self-correcting process but defective scientific integrity is not and hence the need for the GMC. Sadly for our brotherhood the case was brought about by an astute journalist, which is symptomatic of our complacency when it comes to integrity.

1. Wright NA. Duplicate publication: additional comments. Gastroenterology. 1995;108:950

2. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637-41

Professor Ingvar Bjarnason
Department of Gastroenterology King’s College Hospital Denmark Hill London SE5 9RS

Competing interests: None declared

Competing interests: No competing interests

25 May 2010
Ingvar Bjarnason
Professor of Digestive Diseases, Consultant Physician and Gastroenterologist
King's College Hospital, Denmark Hill, London SE5 9RS