Comment: Reflections on investigating Wakefield

BMJ online, 2 February 2010

Brian Deer

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.

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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.