- REFLECTIONS
ON INVESTIGATING WAKEFIELD
BMJ
2 February 2010 - BMJ 2010;340:c672;
Brian
Deer, journalist, London
What
will become of the man at the centre of the longest
running case to be heard
by a GMC fitness to practise panel?
It
was the longest General Medical Council fitness to
practise hearing ever: three
gastroenterologists hit with a Chinese menu of
charges.
The
highlights, I suppose, were the panel’s
conclusions last week and the Lancet’s
retraction five days later of the
controversial paper. Andrew Wakefield, the "MMR
research doctor," stood exposed, in
disgrace, and the paper that caused the
mischief is no more.
"The
allegations against me and my colleagues are both
unfounded and unjust," he declared to
the cameras on 28 January. "I repeat: unfounded
and unjust."
As
the journalist whose investigations led to the
charges and the retraction, I sometimes
wondered whether we would ever see a
result from the GMC. This was the Jarndyce versus
Jarndyce of medical proceedings. The five
member panel sat for 197 days.
For
me the story started with a lunch. So many do.
"I need something big," said a Sunday
Times section editor. "About what?" I
replied. Him: "MMR?"
But I
didn’t fancy that one at all.
This
was September 2003, and litigation was pending in the
High Court over alleged damage to children
from the MMR vaccine. Better to hang on
and cover that, I suggested. But the next week
that trial was cancelled. Expert reports had been
swapped, and the claimants’ lawyers
said they couldn’t make the case.
So I
took an empty notebook and made my own inquiries. It
was the largest Sunday Times
medical investigation since thalidomide. No
media have yet itemised the verdicts produced last
week, and I’ve space only for those
found proved against Wakefield: dishonesty
(four counts); research on developmentally disordered
children without ethical approval (11 counts);
contrary to their clinical interests (nine
counts); causing a child to undergo lumbar
puncture without clinical reason (three counts);
ordering medical tests without appropriate
qualifications and in breach of a
non-clinical employment contract (three counts).
Then
we get the birthday party. Wakefield, 53, paid
children £5 each for blood samples. Also,
the now retracted 1998 Lancet
paper: the original focus of my interest. This, the
GMC panel confirmed, included a false
claim of ethical approval and a
"dishonest" description of inclusion
criteria.
You
don’t need to ask Confucius to know what will
happen at the hearing’s next stage,
to run between April and June: the panel
will undoubtedly decide that serious professional
misconduct occurred and that Wakefield should
be struck off.
"It’s
a case about breaches of some of the most fundamental
rules in medicine," Sally Smith QC, for
the GMC, told the panel: a GP, a
psychiatrist, a geriatrician, and two lay members.
But
let’s not forget the two doctors left in the
shadows: John Walker-Smith, 73, and Simon
Murch, 53. They were also last week
walloped with a raft of proved charges, although
neither was found to be dishonest.
What
they were found to have done was to collaborate with
Wakefield in his bid to make a case
against the vaccine. Together, in the late
1990s, they brought a dozen brain disordered
children, aged 2 to 9, to the Royal Free
Hospital, north London.
There,
in stays of six days, those kids endured batteries of
tests that in many cases, the panel found,
weren’t indicated. Ileocolonoscopy:
12. Lumbar puncture: 9. Barium meal: 10. Magnetic
resonance imaging: 10. Electroencephalography:
9. Upper endoscopy: 2. Blood tests: 12.
Some of the kids, moreover, had general anaesthetics,
while others were bowel prepped through nasogastric
tubes.
The
point of this exercise: to hunt for measles virus in
guts and spines. Wakefield’s theory
was that the virus—live in the MMR
vaccine—caused Crohn’s disease and autism.
He failed to prove it.
At
the time a lawyer was paying Wakefield £150 (170;
$240) an hour as the claimants’
expert for the MMR lawsuit I had planned
to report on. So, the longer the show stayed on the
road, the more money he made. I say: nice work if you
can get it .
In
the end he grossed £435 643, plus expenses: eight
times his reported annual salary. But the
real sting was his call for the triple
vaccine to be suspended in favour of single shots.
Remember that?
As
the chief expert in a lawsuit, he had to say
that the triple vaccine was unfit for
marketing, or the case would have collapsed, the
vaccine scare wouldn’t have happened, and the
shedloads of money would have stopped.
This
underbelly wasn’t known until I brought it to
light. I ought to feel proud. And I do. So
many people have told me that to nail a
baseless health scare is, in itself, justification
for a life.
But I
also think about the chief clinician: Professor
Walker-Smith. A tragedy. He’d been
warned time and again about Wakefield. "Prof"
surely hadn’t qualified, 50 years ago last
month, to act against the interests of
children.
I’ve
seen a photo of Walker-Smith as a student in 1958,
at the King George V Memorial Hospital, Sydney.
He’s washing a baby that he’d
just delivered, and his face betrays the
tension you sometimes see in young doctors. He was
trying to look professional while amazed.
That
he should be brought down by a man who I say is a
charlatan is part of the legacy of the MMR
scandal. The epidemics of fear, guilt, and
disease are now passing. But I hope that the lessons
for medicine endure.
Copyright,
Brian Deer. All rights reserved. No portion of this
article on MMR and Andrew Wakefield may be copied,
retransmitted, reposted, duplicated or otherwise used
without the express written approval of the author.
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