There is a nomenclature and interpretation that can only be expressed by those with a deep understanding of all aspects of clinical and research medicine, terms like 'colitis' expressed by experts may be entirely different to that expressed by a layman.
The general public and the common reader then should give more credence to those experts like Professor John Walker-Smith, Professor Simon Murch, Professor Amar Dhillon and others that have exclusively seen all aspects of the patients that were present at the Royal Free Hospital. Who then made collective decisions based on that knowledge rather than retrospective
interpretation.
Professor John Walker-Smith gives an erudite and detailed explanation of many of the aspects of the bowel pathology at the General Medical Council Procedures from day 75 and on (Thursday 17 July 2008 and on ...)
An example is given...
A description of Child 2's bowel pathology by Professor Walker-Smith Day 77
"Well, this is a very significantly abnormal report. What is of particular interest is that there are inflammatory changes in the ileum. There is mild chronic inflammation with the lamina propria. That virtually occurs in no other situation than Crohn's disease. It is almost specific for Crohn's disease, to have definite inflammation of the ileum, and like, as I have been saying during this hearing, where inflammation in the colon is not so specific, having on the first day mentioned a range of causes. In the large bowel it is highly abnormal to see these lymphoid follicles with active germinal centres within the ascending and transverse colon, and there is a patchy increase in chronic inflammatory cells, but clearly there is the occasional focus of very acute inflammation, cryptitis, inflammation within the crypts, and with mild crypt distortion would suggest that there has been inflammation before, and the large bowel a mild chronic inflammation and very focal cryptitis. So this is a very abnormal result. This is showing both acute and chronic inflammation and with the evidence that there is ileitis, this is very suspicious of Crohn's disease. Simon Murch’s endoscopy report with the aphthoid ulcers and the swollen, and with the halo round the enlarged lymph nodes was, I suggested, early Crohn's disease, and when I saw this report at that time, not at that time, subsequently, I think on 9 September I first did a ward round, it seemed to me that it was at least a possibility that this child had early Crohn's disease."
The reader then should not be surprised by the positive clinical outcomes reported ...
John Walker-Smith Day 77 Correspondence
"Dear Mark,
I was really quite surprised to see the progress [Child 2] had made in his behaviour since he had been commenced on sulphasalazine. His performance in the clinic room was quite transformed. He was no longer destructive, he was quiet and calm and I was able to examine him without any particular difficulty. This change behaviour is difficult to assess objectively.
I have written to the school authorities to get their opinion. From my own perspective (and that of David Casson, who knew him before), there seems to be quite a dramatic improvement in his behaviour. However, I would be most grateful if you could re-assess him yourself and give us the benefit of your opinion.
The clinic sister here tells me that 3 people were required to hold [Child 2] down whilst blood was taken previously, but on this occasion he just said ‘Ouch’ when he had a venopuncture. It is the clinic sister’s independent opinion that there has been quite a dramatic improvement in his behaviour.”
Dr Wozencroft Day 77 correspondence
“On 7th April I saw [Child 2] again with his mother. I observed a striking change in him.
Twice in the course of the interview, he made eye contact with me. As we walked down the corridor towards my office, his mum gave him a specific instruction about how he should walk. He changed his walk accordingly. In the course of the discussion, he made two verbal interventions which, on the face of it, appeared to be relevant to the matter his mother was discuss with me.
I had never seen [Child 2] responding in such an ordinary way. Something has made a significant difference to him since our last interview. Mother believes that it is the medical treatment he has been receiving from the Royal Free Hospital."
Of course the original clinical bowel investigations continued and was reported by letter in the Lancet and described at Day 84 GMC transcripts.
"this mucosal abnormality has been apparent in 47/50 children within the autistic spectrum, whether or not there is any perceived link with immunisation. Thus the lymphoid hyperplasia/ microscopic colitis changes were found in over 90% of the autistic children studied." (Simon Murch, Mike Thomson, John Walker-Smith 1998.)
Further commentary Day 84 GMC transcripts - John Walker-Smith
"What is quite astonishing about this review of children is the high evidence of abnormality. In suspected Crohn's disease, as I say, we had a lower incidence of abnormality. Here we have mucosal abnormality in 47 of 50 children investigated with the autistic spectrum, which almost suggests that this could be a feature of autism per se, although these are children all with bowel problems. So this is a very important observation. The observation I was making, we are going back into a time warp, were just in the early days; here we have a new observation from Simon Murch’s group showing that the germinal centres, which we have commented upon and I have always regarded as so significant, that many of the inexperienced consultant pathologists at the Royal Free did not, that the germinal centres are particularly important in lymphoid hyperplasia. Ki67 is a marker of proliferation. Simon Murch can speak to this himself later on, but his observations are that these are highly abnormal findings in these particular children. Furthermore, it is of importance that by now we have here moved on from the original descriptions of recognising that faecal loading – I am afraid we call it constipation here which does overlap with faecal loading – but here we have emphasised X-ray of the abdomen. Plain radiography is important. We hoped the medical community, by reading this, would perhaps focus more on what was important in this paper – namely the innovative observations – clinicopathologically. "
It is then difficult to balance and reconcile another 50 pathology reports and slides that further evidenced aberrant bowel pathology against the interpretation presented previously by others.
Once again it would be remiss of me not to acknowledge the very clear, caring and professional treatment of disabled children, that continues to be elucidated each time I read the testimony of the doctors involved in this issue controversial as it is.
General Medical Council Fitness to Practice Panel - Tuesday 22 July 2008 Day 77 - Day 84
1. The Lancet, Volume 351, Issue 9106, Page 908, 21 March 1998
doi:10.1016/S0140-6736(05)70323-8Cite or
Autism, inflammatory bowel disease, and MMR vaccine,Simon Murch, Mike Thomson, John Walker-Smith
Authors’ reply
Competing interests:
Father of ASD Son. Family fully vaccinated. No association placed on son's Autism and vaccines.
Rapid Response:
Re: Pathology reports solve “new bowel disease” riddle
There is a nomenclature and interpretation that can only be expressed by those with a deep understanding of all aspects of clinical and research medicine, terms like 'colitis' expressed by experts may be entirely different to that expressed by a layman.
The general public and the common reader then should give more credence to those experts like Professor John Walker-Smith, Professor Simon Murch, Professor Amar Dhillon and others that have exclusively seen all aspects of the patients that were present at the Royal Free Hospital. Who then made collective decisions based on that knowledge rather than retrospective
interpretation.
Professor John Walker-Smith gives an erudite and detailed explanation of many of the aspects of the bowel pathology at the General Medical Council Procedures from day 75 and on (Thursday 17 July 2008 and on ...)
An example is given...
A description of Child 2's bowel pathology by Professor Walker-Smith Day 77
"Well, this is a very significantly abnormal report. What is of particular interest is that there are inflammatory changes in the ileum. There is mild chronic inflammation with the lamina propria. That virtually occurs in no other situation than Crohn's disease. It is almost specific for Crohn's disease, to have definite inflammation of the ileum, and like, as I have been saying during this hearing, where inflammation in the colon is not so specific, having on the first day mentioned a range of causes. In the large bowel it is highly abnormal to see these lymphoid follicles with active germinal centres within the ascending and transverse colon, and there is a patchy increase in chronic inflammatory cells, but clearly there is the occasional focus of very acute inflammation, cryptitis, inflammation within the crypts, and with mild crypt distortion would suggest that there has been inflammation before, and the large bowel a mild chronic inflammation and very focal cryptitis. So this is a very abnormal result. This is showing both acute and chronic inflammation and with the evidence that there is ileitis, this is very suspicious of Crohn's disease. Simon Murch’s endoscopy report with the aphthoid ulcers and the swollen, and with the halo round the enlarged lymph nodes was, I suggested, early Crohn's disease, and when I saw this report at that time, not at that time, subsequently, I think on 9 September I first did a ward round, it seemed to me that it was at least a possibility that this child had early Crohn's disease."
The reader then should not be surprised by the positive clinical outcomes reported ...
John Walker-Smith Day 77 Correspondence
"Dear Mark,
I was really quite surprised to see the progress [Child 2] had made in his behaviour since he had been commenced on sulphasalazine. His performance in the clinic room was quite transformed. He was no longer destructive, he was quiet and calm and I was able to examine him without any particular difficulty. This change behaviour is difficult to assess objectively.
I have written to the school authorities to get their opinion. From my own perspective (and that of David Casson, who knew him before), there seems to be quite a dramatic improvement in his behaviour. However, I would be most grateful if you could re-assess him yourself and give us the benefit of your opinion.
The clinic sister here tells me that 3 people were required to hold [Child 2] down whilst blood was taken previously, but on this occasion he just said ‘Ouch’ when he had a venopuncture. It is the clinic sister’s independent opinion that there has been quite a dramatic improvement in his behaviour.”
Dr Wozencroft Day 77 correspondence
“On 7th April I saw [Child 2] again with his mother. I observed a striking change in him.
Twice in the course of the interview, he made eye contact with me. As we walked down the corridor towards my office, his mum gave him a specific instruction about how he should walk. He changed his walk accordingly. In the course of the discussion, he made two verbal interventions which, on the face of it, appeared to be relevant to the matter his mother was discuss with me.
I had never seen [Child 2] responding in such an ordinary way. Something has made a significant difference to him since our last interview. Mother believes that it is the medical treatment he has been receiving from the Royal Free Hospital."
Of course the original clinical bowel investigations continued and was reported by letter in the Lancet and described at Day 84 GMC transcripts.
"this mucosal abnormality has been apparent in 47/50 children within the autistic spectrum, whether or not there is any perceived link with immunisation. Thus the lymphoid hyperplasia/ microscopic colitis changes were found in over 90% of the autistic children studied." (Simon Murch, Mike Thomson, John Walker-Smith 1998.)
Further commentary Day 84 GMC transcripts - John Walker-Smith
"What is quite astonishing about this review of children is the high evidence of abnormality. In suspected Crohn's disease, as I say, we had a lower incidence of abnormality. Here we have mucosal abnormality in 47 of 50 children investigated with the autistic spectrum, which almost suggests that this could be a feature of autism per se, although these are children all with bowel problems. So this is a very important observation. The observation I was making, we are going back into a time warp, were just in the early days; here we have a new observation from Simon Murch’s group showing that the germinal centres, which we have commented upon and I have always regarded as so significant, that many of the inexperienced consultant pathologists at the Royal Free did not, that the germinal centres are particularly important in lymphoid hyperplasia. Ki67 is a marker of proliferation. Simon Murch can speak to this himself later on, but his observations are that these are highly abnormal findings in these particular children. Furthermore, it is of importance that by now we have here moved on from the original descriptions of recognising that faecal loading – I am afraid we call it constipation here which does overlap with faecal loading – but here we have emphasised X-ray of the abdomen. Plain radiography is important. We hoped the medical community, by reading this, would perhaps focus more on what was important in this paper – namely the innovative observations – clinicopathologically. "
It is then difficult to balance and reconcile another 50 pathology reports and slides that further evidenced aberrant bowel pathology against the interpretation presented previously by others.
Once again it would be remiss of me not to acknowledge the very clear, caring and professional treatment of disabled children, that continues to be elucidated each time I read the testimony of the doctors involved in this issue controversial as it is.
General Medical Council Fitness to Practice Panel - Tuesday 22 July 2008 Day 77 - Day 84
1. The Lancet, Volume 351, Issue 9106, Page 908, 21 March 1998
doi:10.1016/S0140-6736(05)70323-8Cite or
Autism, inflammatory bowel disease, and MMR vaccine,Simon Murch, Mike Thomson, John Walker-Smith
Authors’ reply
Competing interests: Father of ASD Son. Family fully vaccinated. No association placed on son's Autism and vaccines.