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Andy Wakefield exonerated because John Walker-Smith won his appeal? Not so fast there, pardner…

I sense a disturbance in the antivaccine crankosphere.

Actually, maybe “disturbance” is the wrong word. Unabashed whooping it up is closer to correct. High-fiving is perhaps a better term. Or maybe partying like it’s 2005. The question, of course, is what is the inciting event was that sparked such widespread rejoicing in the antivaccine world. I’ll give you a hint. It has to do with the hero of the antivaccine movement, the man who arguably more than anyone else is responsible for the MMR scare that drove down MMR vaccine uptake in the UK to the point where measles, once vanquished, came roaring back. Yes, we’re talking about Andrew Wakefield, whose incompetent and now retracted research launched a thousand biomedical quacks. (Actually, that’s probably an underestimate.) However, we’re not talking about Andrew Wakefield directly. Rather, we’re talking about Professor John Walker-Smith, one of the co-authors of Andrew Wakefield’s now rightly discredited 1998 Lancet paper. The anti-vaccine crank blog is going wild with the news that Professor Walker-Smith has succeeded in his appeal of the General Medical Council’s decision that he should be struck off the medical record along with Andy Wakefield:

A High Court judge quashed the finding of professional misconduct against Professor Walker-Smith, who had carried out some of the tests for the controversial paper that suggested a link between the MMR vaccine and autism.

Mr Justice Mitting also called for the reform of the General Medical Council’s disciplinary hearings after the lengthy battle by Professor Walker-Smith to clear his name.

The Wakefield paper prompted a nationwide scare over the safety of the jab after the study of 12 children was published in the medical journal The Lancet.

On AoA, we’ve been treated to some articles with titles like this:

The full ruling can be found here. Let’s dig in, shall we? As usual, what the antivaccine movement is promoting and what is in the ruling are not necessarily the same thing. If there’s one thing that’s obvious from the outpouring of verbiage from various antivaccine blogs, Twitter feeds, and press releases, it’s that the antivaccine movement somehow thinks that this decision exonerates Andrew Wakefield, too. Let’s disabuse them of that delusion right now, shall we? According to Mr. Justice Mitting:

At a press conference, which Professor Walker-Smith did not attend, convened to accompany publication, Dr. Wakefield stated publicly the view which he had previously expressed privately to Professor Walker-Smith that he could no longer support the giving of MMR vaccine. The joint view of Professor Walker-Smith and Dr. Murch, stated in a letter to Dr. Wakefield on 21st January 1998, was that it was inappropriate to emphasize the role of MMR vaccine in publicity about the paper and that they supported government policy concerning MMR until more firm evidence was available for them to see for themselves. They published a press release to coincide with publication stating their support for “present public health policy concerning MMR”. Dr. Wakefield’s statement and subsequent publicity had a predictable adverse effect upon the take up of MMR vaccine of great concern to those responsible for public health. There is now no respectable body of opinion which supports his hypothesis, that MMR vaccine and autism/enterocolitis are causally linked.

Correct. There is no respectable body of opinion supporting Wakefield’s hypothesis that the MMR is somehow linked to autism or the entity Wakefield made up called “autistic enterocolitis.” It’s rather annoying that Mitting would refer to it as a “body of opinion.” One can only speculate that it’s his legal background that leads him to use this particular phraseology. No scientist would. Scientists would (and do) point out that not only is there no good scientific evidence supporting Wakefield’s hypothesis, but there is a lot of evidence that falsifies his hypothesis. There’s a reason why Wakefield is viewed with such contempt in the scientific world. Actually, there are multiple reasons, not the least of which is that Wakefield is an incompetent scientist willing to commit research fraud to provide evidence for trial lawyers to use in lawsuits against vaccine manufacturers, a plot that Brian Deer uncovered and described in excruciating detail and with excruciatingly detailed documentation. This ruling says nothing about that; it’s primarily about methodology and Mitting’s legal ruling that the GMC didn’t adequately explain the rationale behind its findings that Walker-Smith committed professional misconduct. Mitting’s decision also relies a lot on his clearly poor understanding of medical research issues. (More on that below.)

It’s a simple fact, though, that Mitting’s decision regarding has nothing to do with whether Wakefield is a fraud or a pseudoscientist or not. Nor does it have anything to do with the question of whether vaccines, specifically the MMR vaccine, cause autism, as much as Wakefield’s many apologists would like to convince people otherwise. In fact, as I’ve pointed out before, Wakefield’s being struck off the British medical registry has nothing to do with the validity of the science. Even if Wakefield had prevailed and been allowed to keep his medical license, his claimed findings that vaccines cause autistic enterocolitis and/or autism would have been just as bogus. Legal rulings are not science. They can be based on science, but often they are not. It’s nice when they don’t go against science and nicer still when they resoundingly agree with science, but such is not always the case. To try to argue that a legal ruling such as the one regarding Professor Walker-Smith exonerates Wakefield is an even worse folly than arguing that his being struck off necessarily proves he is a quack. He’s an antivaccine quack based on science; it matters not what the courts say.

Admittedly, I haven’t paid much attention to Professor Walker-Smith. Back when I wrote about Andy Wakefield being struck off, I said very little, if anything about Walker-Smith. The reason, of course, is that I viewed the Walker-Smith decision as being at best peripheral. I didn’t know enough about him to decide for myself whether the GMC decision was justified or not. Still, it’s useful to look at the court’s decision to see why it concluded that Walker-Smith didn’t deserve to be struck off.

The first thing that needs to be considered is a dichotomy. John Walker-Smith appealed the GMC decision. Andrew Wakefield did not. Why not? It’s hard to say. Was it because he was too busy being the medical director of the quack clinic Thoughtful House in Texas? After all, at the time he was already making plenty of cash without a medical license. There was no need for him to appeal, which would cost a lot of money and effort. He had already left England anyway, his reputation trashed long ago. In contrast, Professor Walker-Smith appears to have had more reason to fight. He had stayed behind and, unlike Wakefield, who had never been particularly respected, Walker-Smith had been highly respected in his field. There was a lot more motivation for him to try to salvage his reputation.

In any case, here is the conclusion of the appeal decision:

For the reasons given above, both on general issues and the Lancet paper and in relation to individual children, the panel’s overall conclusion that Professor Walker-Smith was guilty of serious professional misconduct was flawed, in two respects: inadequate and superficial reasoning and, in a number of instances, a wrong conclusion. Miss Glynn submits that the materials which I have been invited to consider would support many of the panel’s critical findings; and that I can safely infer that, without saying so, it preferred the evidence of the GMC’s experts, principally Professor Booth, to that given by Professor Walker-Smith and Dr. Murch and by Dr. Miller and Dr. Thomas. Even if it were permissible to perform such an exercise, which I doubt, it would not permit me to rescue the panel’s findings. As I have explained, the medical records provide an equivocal answer to most of the questions which the panel had to decide. The panel had no alternative but to decide whether Professor Walker-Smith had told the truth to it and to his colleagues, contemporaneously. The GMC’s approach to the fundamental issues in the case led it to believe that that was not necessary – an error from which many of the subsequent weaknesses in the panel’s determination flowed. It had to decide what Professor Walker-Smith thought he was doing: if he believed he was undertaking research in the guise of clinical investigation and treatment, he deserved the finding that he had been guilty of serious professional misconduct and the sanction of erasure; if not, he did not, unless, perhaps, his actions fell outside the spectrum of that which would have been considered reasonable medical practice by an academic clinician. Its failure to address and decide that question is an error which goes to the root of its determination.

As you can see, the decision all boils down to the question of research and whether Walker-Smith thought he was doing research or actually treating autistic children using interventions that were clinically indicated. If the interventions were clinically indicated, then it could be argued that he did not commit professional misconduct. If the interventions were done with the knowledge that they were being done for research purposes rather than to treat the children, then Walker-Smith is guilty of misconduct. The reasons, of course, are the lack of ethical committee approval yet, as is discussed in the decision:

At the heart of the GMC’s case against Professor Walker-Smith were two simple propositions: the investigations undertaken under his authority on eleven of the twelve Lancet children were done as part of a research project – Project 172-96 – which required, but did not have, Ethics Committee approval; and they were clinically inappropriate. Professor Walker-Smith’s case was that the investigations were clinically appropriate attempts at diagnosis of bowel and behavioural disorders in children with broadly similar symptoms and, where possible, treatment of the bowel disorders or alleviation of their symptoms. The GMC’s case was that he was conducting research which required Ethics Committee approval. His case was that he was conducting medical practice which did not. Accordingly, an unavoidable and fundamental question which the panel had to answer was: what is the distinction between medical practice and research?

In light of this introduction, what follows is profoundly contradictory in that the judge acknowledges that what Walker-Smith did could be reasonably viewed as research, but exonerates him because it could also be viewed as therapeutic:

The panel made no express finding on this issue and cannot have appreciated the need to do so. It was not helped by the premise upon which the GMC’s case was founded. There was a good deal of evidence, to which I refer in greater detail below, that Professor Walker-Smith and his team were undertaking what any reasonable body of medical practitioners would categorize as research – but also that he intended and genuinely believed that what he was doing was solely or primarily for the clinical benefit of the children. When such an issue arises, a panel will almost always have to determine the honesty or otherwise of the practitioner.

Justice Mitting then lists facts supporting and negating the proposition that what Walker-Smith was doing was research. I must admit, I find some of the “facts negating’ to be questionable. Particularly bizarre was Mitting’s listing of a fact that no parent other than one was required to sign the consent form in the proposals submitted to the Ethics Committee or in the revised form approved by it. Well, duh! That was part of the problem, now, wasn’t it? You know? Doing research without having obtained adequate informed consent from the parents?

Also rather odd was Mitting’s other reasoning that “none of the five clinicians involved in the investigation of the Lancet children who gave evidence to the panel considered that they were following Project 172-96.” So what? The children’s information and clinical histories ended up being used in Wakefield’s Lancet paper. I suppose one could argue that Walker-Smith was an unwitting dupe of Andy Wakefield an therefore was not guilty of research professional misconduct, but, if that’s the case, it’s hardly flattering to Walker-Smith. it’s also hard to imagine what clinical indications existed to subject these children to lumbar punctures. As a clinician, I always had a hard time figuring out how Wakefield, Walker-Smith, and the rest justified doing lumbar punctures on these children.

The implications of Mitting’s ruling are frightening in their potential. Think about it. Basically, if his ruling stands, it’s hard not to wonder whether it’s open season on human research subjects in the UK. As long as the physician can construct a quasi-legitimate-sounding rationale that he can point to aside from a research protocol for doing research-related tests on human subjects, he apparently doesn’t need to get ethical approval anymore. He can cite Mitting’s ruling that, as long as he doesn’t think he’s doing research–even if that is incorrect–then he’s not, and the GMC can’t do anything about it. So much for the Helsinki declaration! Similarly, his “any reasonable physician” test fails spectacularly as well, at least in the way he applied it. “Any reasonable physician” would not subject autistic children to a battery of invasive tests including lumbar punctures for dubious clinical reasons. Those tests were quite correctly judged by the GMC to have been ordered for research purposes rather than for routine clinical care. Autism quacks in the UK have good reason to rejoice. As it stands, one has to wonder whether they can now get away with essentially anything.

Of course, none of this stops the antivaccine movement from lapsing into full mental jacket conspiracy mode. For instance, our old friend Ginger Taylor, speaking for the Canary Party, issued a press release:

“It is quite obvious to me that James Murdoch, Brian Deer and GlaxoSmithKline orchestrated the smear attack on Dr. Andrew Wakefield,” said Ginger Taylor, executive director of the Canary Party. “A judge has now ruled that the GMC hearings were a farce. Parents are waiting for journalists to find their spine and start some honest reporting on the character assassination of doctors that is blocking medical treatments for vaccine injured children, and the role that GSK and Merck may be playing to protect their profits on the MMR vaccine. The Canary Party honors and stands by doctors of integrity like Prof. Walker-Smith, who continue to fight and defend their hard-won reputations for going the extra mile to investigate and improve the chronic, difficult-to-treat cases that now permeate our society.”

Uh, no.

I do love the conspiracy mongering, though. From my perspective, Judge Mitting’s decision strongly implies that, rather than being involved in Wakefield’s professional research misconduct, Walker-Smith was an unwitting dupe. Neither conclusion speaks particularly well of Walker-Smith, but I suppose it’s better to be an honest dupe than a dishonest research cheat. Personally, I’d rather be neither. No matter how hard the antivaccine movement tries to spin this as some sort of exoneration of its hero Andy Wakefield, it’s not.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

538 replies on “Andy Wakefield exonerated because John Walker-Smith won his appeal? Not so fast there, pardner…”

I find Justice Mitting’s reasoning quite flawed in many respects. This is just one of them:

He refers several times to the “Bolam” test, which say that someone is not acting with negligence if they are doing what any other reasonable and responsible doctor would do. He seems to have decided that the justification for doing these invasive procedures was sound, because the clinicians (ie WS) said so, but their justification for many of the later cases seems to be of the nature: “We suspect this child needs these investigations because we have already seen a few children who we have investigated and found they had something wrong with their bowels”.

But we know that in no case was a lumbar puncture abnormal, and we know that the evidence for inflammation of the bowel was weak or non-existent in many cases (though at the time I can understand why the clinicians thought they might have been “onto something”).

But Justice Mitting ignores the wider implications of his ruling. The pertinent question is “What would other resonsible doctors have done?” according to the Bolam criterion, and he fails to realise that faced with a child with autism (several of whom had aspergers rather than severe autistic problems) and bowel problems (which included constipation in at least one child, and which we know is extremely common in autistic children), that other pediatric specialists would NOT be referring these children for a battery of investigations including MRI head scans and lumbar punctures under general anaesthetic, colonoscopy with 10 biopsies, and barium meals and followthrough examinations.

There was nothing inherently unusual about these autistic children, except that their referral was engineered on the back of the MMR litigation.

Does Justice Mitting think autistic children need to undergo these tests then? If so, then the job to be in is clearly radiology or pediatric gastroenterology, since one child in 100 will need assessment.

The Bolam test also applies to clinical negligence, which is distinct from what might constitute “professional misconduct”. No-one accused WS of being negligent in his investigation of these children, so why even bring Bolm into it?

From my perspective, Judge Mitting’s decision strongly implies that, rather than being involved in Wakefield’s professional research misconduct, Walker-Smith was an unwitting dupe.

Poor old Walker-Smith has hardly walked away with his reputation unsullied – he either didn’t know (and should have done) what was going on with research he was co-operating in and lending his name to, or he was complicit in unethical practices. Judge Mitting has concluded that there was no evidence to contradict the former proposition.

It’s important to understand the context of the decision – the Judge was not ruling on Walker Smith, he was ruling on the GMC’s quasi legal processes. The Judge has no power to ‘exonerate’ Walker Smith, rather he has ‘tried’ the GMC and found its decision in the case of Walker Smith to be ‘unmet’, and further that in general, aspects of the GMC’s procedures are unsatisfactory. The effect is that legally Walker Smith should not have been subject to the sanctions imposed upon him because the GMC preffered a weight of evidence which in Law, it was not entitled to do.

The decision does appear to leave UK medical research with a serious regualtory problem, that is: any clinician is absolved of the need to gain ethical approval for research, where all the research subjects are claimed to be recipients of necessary treatment – this in a circumstance where the clinician can claim protection of her/his own independent clinical judgement for the treatment prescribed. This is clearly open to abuse.

Successive UK Governments have failed to provide a modern legislative framework for medical registration and professional practice, the Walker Smith case is just another example of how inadequate the present system is.

IVI

If there’s one thing that’s obvious from the outpouring of verbiage from various antivaccine blogs, Twitter feeds, and press releases, it’s that the antivaccine movement somehow thinks that this decision exonerates Andrew Wakefield, too.

Further than that: JB Handley thinks that this will somehow help in Wakefield’s defamation lawsuit against Deer, even though the lawsuit is about an article which has nothing to do with the GMC hearings.

Can you Hear The Silence,?? Orac your Blog reads as if you have been slapped in the face with a shovel.. Messiah Deer has spun you all lies by association and supporting his lies you are all implicated…Shame on you all…

I see many articles/One time friendly Deer reporters now turning on Deer this one yesterday eh!get dug in..why dont ya!!

http://www.guardian.co.uk/science/the-lay-scientist/2012/mar/06/2

“Brian Deer’s subsequent investigations were great journalism, but largely irrelevant to any scientific question about MMR; yet he seems to see himself as the hero of the story, once declaring in a bad-tempered Guardian piece that, “13 years passed before I slayed the MMR monster.” The monster was long since dead of course, its twitching corpse dutifully held aloft by a legion of crappy hacks for St. Brian to stick his sword into.
The irony of Deer’s pursuit of the MMR dragon is that it reinforced the mistaken belief that Wakefield and his study ever mattered in the first place. A debate that should have been about the weight of scientific evidence became instead a personality contest. Deer’s investigation of Wakefield was informed by the same flawed world-view that led to the scare in the first place; the belief that personalities, bold statements and single studies matter more than evidence, context and consensus.”

Queerfish you have queered my pitch exactly. Thankyou. Your explanation completely supports the reason for Wakefield’s defamation case against Deer and Godlee, namely that it is founded on fraudulent and more importantly, malicious allegations, against him personally.

@One Queer Fish:

Can you Hear The Silence,?? Orac your Blog reads as if you have been slapped in the face with a shovel..

The Unix word count utility “wc” clocks Orac’s post at 2,480 words, which I’d hardly consider “silence”. Or are you so used to Orac’s wordiness that nothing less than 10,000 words will do?

I see many articles/One time friendly Deer reporters now turning on Deer this one yesterday eh!

In the article you link, the author doesn’t say (or even imply) that Deer got any facts wrong about Wakefield’s misconduct. Instead, the author criticized Deer for putting too much importance solely on Wakefield and not putting enough importance on the scientific consensus about MMR.

@patricia:

Your explanation completely supports the reason for Wakefield’s defamation case against Deer and Godlee, namely that it is founded on fraudulent and more importantly, malicious allegations, against him personally.

The BMJ article which deer wrote and the editorial which Godlee wrote weren’t rehashings of the GMC hearings, so a GMC decision being overturned has no bearing on the defamation lawsuit.

OQF: Your ramblings are somewhat in line of a global warming denialist who insists that it is “crumbling” – or indeed those of a quack or quack apologists who insists that [pick your euphemism for quackery] is the new wave of “Science” which is brushing aside the tired old ways. “Can you hear the slience” – really? What nonsense.

Why on Earth should we care what other journalists/columnists say about Brian Deer? Especially when they appear, as the one you have quoted does, to be entirely wrong?

Mathew cline

“The overturning of the GMC decision has no bearing on the defamation lawsuit….” I wonder about that.

Now that Brian Deer and his supporters have been utterly discredited – by bringing this malicious and entirely unfounded case to the GMC in the first instance – they are shown up for what they truly are, lackeys of a corrupt Public health authority and the pharma industry. Such actions don’t exactly enhance their credibility in AJW’s case I would have thought.

@patricia

Umm, patricia? Could you please point to anywhere in the judgment that states that Deer’s reports are false or malicious? Again, if you’ll note, the judgment is about Prof. Walker-Smith and the GMC. Or, more specifically, about how the GMC administratively went about their actions with regard to Prof. Walker-Smith. You seem to be reading far more into the judgment than is actually there.

@patricia: Obviously, you have reading comprehension problems, so I’ll try to make this simple.

This does not mean Wakefield did not commit fraud in his research

All this means is that Professor Walker-Smith was found by the court to not have exceeded his authority (oops – big word – sorry) as a physician who performed procedures on the children.

It does not mean Wakefield didn’t lie about the results, lie about the cause, or hide his own conflict of interest. It doesn’t mean ANYTHING about the article Wakefield wrote that 10 of the 12 authors (including Walker-Smith) repudiated (oh dear, another big word. Sorry).

I don’t think Dr. Godlee or Mr. Deer have anything to worry about, except maybe finding your bile disgusting. They certainly haven’t been discredited. Try again, dear.

Todd
and MIDawn dear,

Where have I stated that AJW had been exonerated by this overturning of the GMC Tribunal conclusion? Only Orac has done that, my dear Dawn.

I have said that thw whole case should never have been brought in the first place. As indeed Judge Mitten has emphasised in his quashing of their verdict.

And I have said that it was only brought by the persistence of an “award winning” so called journalist and his supporters in the Government and in the pharma industry through malice and fear. Fear of profit loss and fear of the loss of credibiltiy on the part of the Governments Health department. The malice lies clearly at the door of a certain so called “award winning” journalist.

@patricia

Again, I ask, where in the judgment (available in full here) is there anything supporting your statement that “thw whole case should never have been brought in the first place”?

Just like there is nothing in there indicating that Deer was discredited or that his actions were malicious, there is nothing in the judgment stating that the actions by the GMC should never have been brought in the first place.

The judgment really is about how the GMC presented and supported its case, not whether it should have been brought.

“Fear of profit loss and fear of the loss of credibiltiy on the part of the Governments Health department.”

Oh dear Patricia. You do realise that we in the UK have (just about) a National Health Service where everything is free at the point of use. What profits exactly?

I’m confused – I thought Wakefield didn’t matter? Why is AoA & the crank-sphere harping that this someone clears Wakefield? (I mean, I know why – the hypocricy is deafening).

Orac writes: “The first thing that needs to be considered is a dichotomy. John Walker-Smith appealed the GMC decision. Andrew Wakefield did not. Why not? It’s hard to say.”

I believe it was in the Mitting’s decision that was written that W-S had insurance coverage to cover the High Court appeal, but Wakefield did not.

Anyone else see anything along those lines?

Another thing I note in the judgement – the case summaries for 10 children of the “Lancet 12” give the timelines between vaccination and development of symptoms of autism.

#1: Jan 94 to Nov 95 (22 months)
#2: Nov 89 to Feb 91 (15 months)
#3: Mar 91 to June 92 (15 months)
#4: not stated
#5: Apr 90 to Mar 91 (11 months)
#6: Jun 83 to May 94 (12 months)
#7: Nov 95 to July 96 (8 months – convulsions, child NOT autistic)
#8: Jan 95 to Jan 95 (2 weeks)
#9: Oct 91 to “mid 93” (20 months)
#10: Feb 94 to Oct 94 (8 months)
#11: not stated
#12: According to parent was 18-24 months later

What did Wakefield claim?

That for 8 children the average onset of autistic behaviours was only 6.3 days after MMR, enabling him to make a temporal link incriminating the vaccine.

There appears to be some major discrepancy.
I know that for some of these kids there may be an argument that symptoms were present from a time earlier than the first documented suspicion, but still….
We also know through Brian Deer’s efforts that Wakefield heavily massaged the timeline data in the Lancet publication to arrive at a close temporal association, which supported his unwarranted notions about MMR.

@particia:

Such actions don’t exactly enhance their credibility in AJW’s case I would have thought.

Deer’s personal credibility has nothing to do with a defamation case, as tried in Texas. Wakefield has to establish that Deer either knew or suspected that he was wrong about what he wrote in the BMJ article. And the BMJ article had nothing to do with the GwMC hearings.

I have said that thw whole case should never have been brought in the first place. As indeed Judge Mitten has emphasised in his quashing of their verdict.

So far as I can tell, the judgement written by Mitten said:

1) The GMC placed more weight on the expert testimony against Walker than the expert testimony for Walker.

2) The GMC failed to consider that Walker ordering a test for research purposes didn’t preclude him also ordering the same procedures for medically indicated purposes.

Nothing about “thw whole case should never have been brought “.

@Proscientifica

The only mention of Wakefield’s appeal is this:

It ordered that the names of Dr. Wakefield and Professor Walker-Smith be erased from the register of medical practitioners. Both initially appealed, but Dr. Wakefield has subsequently abandoned his appeal.

The judgment says nothing of the reasons why Wakefield abandoned the appeal. Insurance is not mentioned anywhere in the decision.

AJW’s supporters are whooping up a storm because they conflate issues, jump to un-warranted conclusions and dismiss evidence ( and people) they don’t like- which appears to be their usual mode of thinking when writing about research et al.

Rather than going all psychological and looking at their motivations I think I’ll just focus on one person. AJW had the opportunity to appeal and didn’t. Think about it: if you were unjustly found guilty of something you didn’t do, lost your professional status and were disgraced because someone made up stuff about you, wouldn’t you appeal? Wouldn’t you stand your ground? He comes from a well-to-do family, is married to a doctor, had friends and supporters- he’s living in posh digs and raising funds now, as we speak- it can’t just be money.

Also he could have sued the BMJ, Deer and Godlee in the UK. Why didn’t he do that? Might have been easier legally. Maybe he figured that he couldn’t win either case in the UK. Perhaps his present case is a way to garner attention and lift flagging interest in his cause.

Wakefield is still a fraud. Deer’s reporting is still valid and helped to uncover that fraud thereby preventing harm to children the world over. W-S had no vaccine COI. Wakers did. Clearing W-S of poor judgement does nothing to move Wakers out of the cesspit he dug, filled and jumped in all on his own.

And another thing……

Justice Mitting displays incredible arrogance. The GMC fitness to practice panel was constituted from 3 medical experts and 2 laymembers. In the GMC panel documentation they commented that the Lancet article was aimed at general readership (ie general medical readership, rather than specialist gastroenterologists or another subspecialty)

What does Justice Mitting do, but erroneously assume because it was described as being for “general” readership that it was aimed at non-medical readers, ie people like him. He uses this to justify his own odd interpretation of what were the “consecutive referrals” of the Lancet children, rather than using the standard interpretation placed upon this phrase by practising clinicians.

“157 On the premise that the panel was right to find that the Lancet paper was addressed to the general reader and that it was the interpretation of the general reader which mattered, I am as well qualified as the panel to construe its meaning. Further, I am entitled to and do, apply the familiar canon of construction used by judges in construing documents: to read and construe the whole document, not just selected words. Thus construed, this paper does not bear the meaning put upon it by the panel. The phrase “consecutively referred” means no more than that the children were referred successively, rather than as a single batch, to the Department of Paediatric Gastroenterology. The words did not imply routine referral.”

What arrogance and pomposity.

Sorry, Justice Mitting, but the entire Wakefield construct was that these were “routine”, run of the mill patients consecutively referred by GPs and not pre-selected in any way.

This is what the GMC found:

First, in a published letter in response to correspondents who had suggested that there had been biased selection of the Lancet children, Dr Wakefield stated that the children had been referred through the normal channels, a response which was dishonest and irresponsible. He provided an inaccurate statement which omitted relevant information when he knew that the description of the population in the study was being questioned by the scientific community.
Second, at a meeting of the Medical Research Council, the Chair, Professor Sir John Pattison referred to the seriousness and importance of the implications of Dr Wakefield’s research and its major public health implications. At that meeting and on the issue of bias in generating the series of cases, Dr Wakefield stated that the children had come by “the standard route”, a response which was dishonest and irresponsible.

In the light of that evidence, Justice Mitting’s conclusions about this seem bizarre, to say the least.

It is absolutely no surprise that AoA et al are reacting in this way to the news. It’s completely consistent with their support of the entire vaccines-cause-autism notion, and their general approach towards expanding knowledge: if an item offers any support whatsoever, no matter how tenuous, for their premise, it is enthusiastically embraced. If it doesn’t, it is either ignored or enthusiastically repudiated. If an item does both, its support is championed while the rest is totally ignored.

Never mind whether or not this decision had merit; it has absolutely zero bearing on Brian Deer, Wakefield’s lawsuit against Deer, Wakefield being struck off, the merits of Wakefield’s “research”, etc. But they ignore that. They see everything through the filter of vaccines causing autism and a massive conspiracy to suppress that information; thus, everything they see is interpreted in that light.

You all remember the case of the kid who Walker Smith declared should be “not for MRI or LP”?

Paradoxically, this fact was used to help exonerate WS. Justice Mitting stated that this demonstrated WS was acting in the interests of the child, and not fixed to a research protocol.

What happened?

The child, who was under WS’s direct clinical care, ended up having an MRI scan and a lumbar puncture anyway. So who was to blame for that? Ummmm… no-one it would appear. We should just forget they ever happened. They weren’t research, and nor was this action professional misconduct on the part of the clinician in charge of the case.

Welcome to bizzaro world.

I’ll remember this little ruse anytime I want to do something unwarranted to a patient for any reason, such as underhand research. I’ll just write in the notes “Don’t pluck out Mrs Brown’s left eyeball”, and then quietly arrange for it to be done, and the eye sent to my friend’s lab where he is doing eyeball research. When I appear in court, the fact that I expressly stated it should not be done will totally exonerate me from any blame or responsibility.

I have to say something about *malice*: if you look through alt med sites, that idea the medical establishment, the government and the media are compromised *malign* influences seems to be tossed around a lot. Getting closer to home, it appears to be a frequent taunt hurled at our esteemed ( and often steamed) host and many regular participants, yours truly included. Why is that?

If someone doesn’t agree with you, does that make them malicious? How can you attribute personality traits and judge the worth of people you don’t know? Is it possible that they may have come to a different conclusion than you did because they have a different perspective, different information and they *don’t dismiss information* because they don’t like the messenger?**

Alt med leaders engender distrust of critics to rally their own followers- how can you trust evil compromised miscreants? Looking closely at why people might support SBM ( not AJW) might reveal that they have reasonable concerns and are working towards fixing _something wrong that they saw on the internet_- that might hurt people.

** and JB doesn’t like me: oh goody!

Clearing W-S of poor judgement does nothing to move Wakers out of the cesspit he dug, filled and jumped in all on his own.

I don’t think W-S was even cleared of poor judgement. My reading of the judgement is that the GMC did not sufficiently explain their reasoning for finding him guilty of professional misconduct serious enough for him to be struck off.

I agree with Orac about the lumbar punctures not being clinically indicated. I was taught that an investigation is only clinically indicated if the results could lead to a change in the management of the patient. Fishing expeditions – doing a wide range of tests with no clear idea of what differential diagnosis you intend to confirm or exclude – are not considered to be clinically indicated, especially when a test is invasive and carries significant risks, like lumbar puncture. The potential benefits of an investigation must outweigh its risks.

I don’t see how the results of any of the tests Walker-Smith ordered on CSF could have led to a change in the clinical management of a child with suspected autism, unless an underlying condition like meningitis was suspected, which was not the case. I don’t see how the benefits of the CSF tests done could possibly outweigh the risks of lumbar puncture.

For example in research studies CSF from autistic patients has been examined and elevated cytokine levels have been observed. This is interesting, and has increased our understanding of developmental disorders, but doesn’t change the way that autistic patients are managed. This would have required ethics committee approval and informed consent.

By this measure lumbar puncture in autistic patients can only be a research tool. It looks to me as if the judge didn’t properly understand what “clinically indicated” means, and the important distinction between clinical practice and research in this case.

Whatever way I look at it, this makes Wakefield look even worse. He did not have the excuse of carrying out clinically indicated investigations as his contract forbade him from doing any such thing. Whatever tests he ordered or carried out were research, and required ethics committee approval which was clearly not the case.

It seems Deer” only sings when he thinks he is winning” gone to ground (eh! no surprise)..

Simply and firstly Dr Wakefield’s paper never claimed a link between autism and MMR…What it DOES report is a link between bowel disease and ASD. That finding still stands and is now endorsed by paediatric gastroenterologists worldwide. JWS and his team were the first to investigate and report on this. The GMC decision – which is now DISCREDITED – did untold damage to the continuing work on this issue…it simply follows that Deer,Godlee and perpetrators of the lies and fanning the lies should be held to book, and kicked up the arse so hard they never sit down again…happy days guys…happy days a discredited GMC once again..

Simply and firstly Dr Wakefield’s paper never claimed a link between autism and MMR

His press conferences did.

What it DOES report is a link between bowel disease and ASD.

That he made up – the patients in question had no bowel disease.

That finding still stands and is now endorsed by paediatric gastroenterologists worldwide.

[citation needed]

JWS and his team were the first to investigate and report on this.

First to make up lies about it, you mean.

The GMC decision – which is now DISCREDITED – did untold damage to the continuing work on this issue…it simply follows that Deer,Godlee and perpetrators of the lies and fanning the lies should be held to book, and kicked up the arse so hard they never sit down again…happy days guys…happy days a discredited GMC once again..

How exactly does a conclusion that Walker-Smith believed he wasn’t doing research (all the ruling really says) have any of those implications?

So let me get this straight: Mitting’s opinion states that Walker-Smith should have known he was doing research, but he is off the hook because he claims (plausibly enough to convince the judge, even though few doctors or scientists would be convinced) that he was treating the patients? That’s definitely in exploding heads territory. And I agree with Orac about the consequence of this ruling: that it effectively guts any consent requirement for human subjects in the UK.

As for his “body of opinion” remark: Mitting is drawing an analogy between judicial precedents and peer-reviewed literature. There are some similarities between the two, e.g., reference points for explaining your reasoning to your peers (be they judges or scientists). But there are important differences: judicial precedents are often binding, but peer-reviewed research can be and sometimes is explicitly rejected when new evidence contradicts the earlier published result. I would say Mitting is mischaracterizing the peer-reviewed literature in a way that many people trained in law but not science would mischaracterize it.

The ruling clearly does not exonerate Wakefield. The key to the ruling is that judge felt Walker-Smith believed that what he was doing was primarily therapeutic and not research, but about Wakefield, the judge said this:

“Facts supporting the proposition
a) It was Dr. Wakefield who first perceived a link between behavioural and gastrointestinal disorders and between both and measles/measles vaccines. As a researcher, he was, throughout, principally interested in testing his hypotheses.”

The High Court said the decision was “flawed, in two respects: inadequate and superficial reasoning and, in a number of instances, a wrong conclusion”.

Ruling, Mr Justice Mitting stated: “The panel had no alternative but to decide whether Professor Walker-Smith had told the truth to it and to his colleagues, contemporaneously. The GMC’s approach to the fundamental issues in the case led it to believe that that was not necessary – an error from which many of the subsequent weaknesses in the panel’s determination flowed.

“It had to decide what Professor Walker-Smith thought he was doing: if he believed he was undertaking research in the guise of clinical investigation and treatment, he deserved the finding that he had been guilty of serious professional misconduct and the sanction of erasure; if not, he did not, unless, perhaps, his actions fell outside the spectrum of that which would have been considered reasonable medical practice by an academic clinician.

“Its failure to address and decide that question is an error which goes to the root of its determination.”

You lot have a brain cell between ya! yeah!!na!thought so just keep taking the pharma dollars trolls

One Queer Fish, could you please learn the English language before you post again?

“Its failure to address and decide that question is an error which goes to the root of its determination.”

Wow, what a ringing exoneration! So the GMC made the error of ruling on the factual basis that Prof. Walker-Smith carried out research under the guise of therapy, without considering the possibility that somehow Prof. Waler-Smith might have actually believed that there was a therapeutic rationale.

Todd
Once again you have twisted my words. I did not write that Judge Mitten in his conclusion said that the case should not have been brought. I stated that by overturning the GMC’s ruling and by finding it full of “errors, misstatements and inadequate reasonings”, he emphasised my belief that it should never have been brought in the first instance.
It was Deer’s twisted interpretations and flawed research which led directly to the GMC’s faulty case. And as the case against Prof JWS has been judged to be full of holes – it can justifiably be said that the case against the other 2 doctors could well have been similarly exposed during appeal by them. As to why AJW did not appeal I have covered this over and over before on this site. But to reiterate in brief. AJW was advised by his Attorny’s to drop his case against Deer (insufficient time to prepare)and that proved to be extremely costly, as a consequence of which his insurers would not/could not, fund another even more costly appeal against the GMC decision, which in point of fact would have been a case against the Government and the Pharma industry, all rolled into one neat little ineffectual, easily manipulated umbrella Institutional vehicle called the General Medical Council.

I think it is Denice who appears to be also under the illusion that because Andrew Wakefield is in her words “posh” – then he is automatically also extremely wealthy. I wish. And no doubt so does Andrew.

Miss Grace

I am a UK citizen. And I do know about th good old NHS. The Profit I was referring to was that of the Pharmaceutical Industry who have a massive influence and vested interest in all cases involving vaccine injury.

Mathew cline

Godlee and Deer are being sued for defamation, slander (a nasty one IMO) and libel, heinous libel in fact. Well if that isn’t all wrapped up in malicious intent(my words not the Judge’s) I don’t know what is babe. I would have thought this GMC case, which was wholly instigated by Deer and his employer’s and which has now been oveturned pronto by a High Court for being basically unsound, doesn’t exactly bode well for Deer’s credibility.

That’s all folks.

OQF has to be a Poe-troll. No way someone can directly cite the ruling like that (assuming that this is, in fact, what he is doing) and fail to realize this has nothing whatsoever to do with Brian Deer or Andrew Wakefield.

Right? Right?

Now I just had an exceedingly crappy, awful thought: although the outcome for JW-S has no bearing on the fate of AJW, I realise that not all people think like I do- those who link vaccine and autism ( and AJW fans) might interpret the result as a harbinger of advantageous events to come- is it possible that this ruling may in-directly assist in enriching the coffers of the Andy Fund? While many people may support underdogs, don’t others like to bet on whomever they perceive as being likely to win- like in a horse race? I’d love to see a dated graph of contribututions in 2012.

just keep taking the pharma dollars trolls

I’ve heard of all kinds of trolls, but I’ve never heard of a pharma dollars troll. Or is our genius (who has more than one brain cell between her) missing a comma here and there?

Compose99

Wrong! Wrong!

You none of you get it do you. It is NOT that AJW has been exonerated by this case being overturned. It is that the case (which was aimed at discrediting all 3 doctors) has been found to be built on unsafe and unsound and inadequate and mistaken foundations. That finding is enough simply to discredit the GMC Tribunal altogether. It cannot stand.

And for those who still cherish the idea that the Lancet children were all fixed cases – as someone else poetically put it – drink this in folks!

“It is in its findings on the clinical issues of the Lancet children that the most numerous and significant inadequacies and errors in the determination of the panel occur. In no individual case in which the panel made a finding adverse to Prof. Walker Smith did it address the expert evidence led for him, except to misstate it. The issues to which this evidence went, were of fundamental importance to the case against him. Universal inadequacies and some errors in the panel’s determination accordingly go to the heart of the case. They are not curable….the panel’s determination cannot stand”.

@ Eric Lund

So let me get this straight: Mitting’s opinion states that Walker-Smith should have known he was doing research, but he is off the hook because he claims (plausibly enough to convince the judge, even though few doctors or scientists would be convinced) that he was treating the patients?

It’s my reading, too. In short, Mitting ruled that the GMC failed to provide evidence enough of the doctor’s guilt.

If I was merciful, I would say everyone deserves the benefit of the doubt. It is, after all, the basis of a fair trial – innocent until proven guilty.

If I was mean, I would file this case in-between Dominique Strauss-Kahn (“I didn’t assaulted this woman, it was consensual”) and Richard Virenque (“Illegal drugs were given to me without my knowledge or my own will”).

Patricia (dear)…you already “tried” these same arguments at LB/RB and you were already told that your “arguments” on behalf of Wakefield have nothing to do with W-S’s court case.

Your continued support of your *hero* and the reasons “why Wakefield didn’t appeal the GMC ruling” were shot down at LF/RB…

“Denice you ask why AJW didn´t appeal. The answer is twofold.

a)He didn´t have the funds to do so. He was advised to drop a suit for defamation against Brian Deer as there was insufficient time to prepare for his defence. As a result of the Judge´s decsion not to allow his counsel to persue this defamation case, (it was a very costly decision), AJW´s insurance would not fund an appeal against the GMC decision to remove his licence to practice in the UK.

b) Of equal importance in deciding not to appeal was the fact that he did not need the accreditation to practice in a clinical capacity; his work is in research in an academic capacity (and had been for many years), unlike Prof JWS.”

BTW, “dear”, which reputable research institute would ever employ a physician whose license was revoked due to serious medical misconduct?

I see that the OQF Troll is back…with his brain droppings and his feeble attempt to derail this thread.

@patricia

You have a bit of spittle still on your lip. Now, do you care to actually address any of the points that I made in response to you, rather than some straw man blather you think I said?

he GMC’s case was that he was conducting research which required Ethics Committee approval. His case was that he was conducting medical practice which did not. Accordingly, an unavoidable and fundamental question which the panel had to answer was: what is the distinction between medical practice and research?

Which begs the question, why did the Lancet authors claim they had ethics approval?

“Investigations were approved by the Ethical Practices Committee of the Royal Free Hospital NHS Trust”

The paper includes subheadings “clinical investigations” and “laboratory investigations”. Were these approved or not? The paper doesn’t say, “we didn’t need ethical approval because these were all clinically indicated”.

His hospital considered this work a research project. Ari Zuckerman at the Royal Free wrote a letter to Prof. Walker-Smith

I am reassured that the children with autism are investigated according to the clinical need and their clinical management. Nevertheless, it would be prudent to obtain ethical approval if, as I understand it, Andy Wakefield is collecting cases for report by publication, which is therefore a research project

Todd
I did answer in great detail but that post never made it to the site. I don’t know where it went. I shall try to rewrite it if I can find the impetus and the energy. I may have left out my address details.

Didn’t know you cared Todd….

“That finding is enough simply to discredit the GMC Tribunal altogether. It cannot stand.”

If that were true, why are only 10% of appeals granted? If the court finds that the GMC is corrupt or whatever other label you wish to use, why are so few appeals being granted?

Frankly I would expect people to trumpet the fact that the court allows so few appeals through.

The court certainly thinks the GMC needs to change procedures. But “it cannot stand” is an amazing stretch. Likewise “discredit altogether”.

Just to say that the Lancet Paper should now be reinstated pre-GMC decision .Richard Horton , he took the decision without discussion with authors after the GMC decision was made public to remove the paper. It would be entirely appropriate I think – to demand he takes action now to reinstate the paper and issue an apology. I note the attacks on the messengers rather than on the subject matter …very commendable and true to PHORM, pharma trolls more dollars please Pharma “what a good job I just did”..pat on the back …or a shovel in the face from me..

@Heliantus

It’s my reading, too. In short, Mitting ruled that the GMC failed to provide evidence enough of the doctor’s guilt.

Slightly more nuanced than that I think. It was more to do with the balance of evidence and that the GMC tribunal failed to give adequate weight to Walker Smiths’s own claims (which he was qualified to make as a clinician), and that therefore the Tribunal was wrong to determine that the evidence weighed against Walker Smith to the degree that would allow the test of ‘beyond reasonable doubt’ to be made for the charge of professional misconduct to have been met.

One of the very unfortunate consequences of the judgement is that it effectively approves of collusion between parents and clinicians in subjecting vulnerable children to unnecessary investigations where the parents are determined tests are needed and the clinician finds it advantageous in providing research material under the guise of clinical need. It might be considered to border upon a charter to accede to Munchausen’s By Proxy vicariously delivered by iatrogenia.

My esteemed Lilady

No one has “shot me down” on LBRB as you so graphically put it. I must say your name suits your literary tone. Shades of the saloon bar?

You ask “what reputable research institute would ever employ
a physician whose license had been revoked due to serious medical misconduct?” Someone who has unbounded admiration for a man who was prepared to put his head above the parapet in a high profile battle zone, a man who was even prepared to flush his own career down the toilet, (Wakefields own words not mine), in order to stand by his belief in the necessity for safe vaccines in an unsafe world of profiteers and politicians with vested interests, perhaps?

Now that is what ah too would call a real man Lilady!

Regarding lumbar punctures (LPs), I was taking a look around to see when an LP is clinically indicated. Generally, it is to confirm a bacterial, viral or fungal infection due to a diagnosis of meningitis, encephalitis or syphilis; to help with a cancer diagnosis; or to get more information on an inflammatory condition of the central nervous system. I was not able to find anything indicating that it is standard of care for treating gastrointestinal disorders, nor is it indicated for the diagnosis or treatment of autism spectrum disorders.

Wakefield and company were investigating a new, never-before-seen diagnosis and were gathering data to investigate and prop up that diagnosis. By definition, that means that any LP would be for research purposes, rather than clinical necessity. I could, of course, be wrong in my assessment of the standard indications for LPs and welcome a physician knowledgeable in such procedures to correct me, but, as Orac and others already noted, it seems that Justice Mitting erred with regard to any of the LP bits.

While there are many questions I would like to ask JWS in the presence of Judge Mitting, there is one question that gets to the heart of the GMC decision. What was the justification for doing LP’s (not to mention MRI’s and bowel biopsies) on autistic children? The answer: there is none … other than speculative research. That being the case, it is quite clear that JWS knew that these tests were for research and not treatment. There is no medical justification for the tests done on these children and I find it hard to believe an IRB approved this research. This is not as the the judge would have you believe, a matter of mindset. There is no way JWS believed what he was doing was therapeutic or anywhere approaching the standard of care for autism evaluation or treatment.

L.P.`s who is talking about that.. the position should at least revert to where it was prior to the GMC findings and which it has been tested very thoroughly by Judge Mitting…you can`t argue with a decision from a High Court Judge it is the highest law in the UK…you lot need a reality check with non Pharma earth one day soon..

for those who claim this appeal exonerates Mr. Wakefield, I suggest you look at the GMC findings. Specifically, look for those charges which were found to have been “serious professional misconduct”.

The costing proposal set out costs in respect of the investigation of five children. It covered each child’s four-night stay in hospital with colonoscopy, MRI and evoked potential studies. Dr Wakefield admitted that the funding subsequently provided by the Legal Aid Board had not been needed for these items because these costs were borne by the National Health Service as the patients were being admitted as NHS patients.

The Panel found that Dr Wakefield had a duty to disclose this information to the Legal Aid Board via Mr Barr. It was dishonest and misleading of him not to have done so. The Panel concluded that his intention to mislead the Legal Aid Board was sufficient on its own to amount to serious professional misconduct.

With regard to nine of the eleven children (2,1, 3, 4, 6, 9, 5,12 and 8) considered by the Panel, it determined that Dr Wakefield caused research to be undertaken on them without Ethics Committee approval and thus without the ethical constraints that safeguard research. Ethical constraints are there for the protection both of research subjects and for the reassurance of the public and are crucial to public trust in research medicine. It was in the context of this research project that the Panel found that Dr Wakefield caused three of these young and vulnerable children, (nos. 3, 9 and 12) to undergo the invasive procedure of lumbar puncture when such investigation was for research purposes and was not clinically indicated. This action was contrary to his representation to the Ethics Committee that all the procedures were clinically indicated. In nine of the eleven children (2,1, 3, 4, 9, 5,12, 8 and 7) the Panel has found that Dr Wakefield acted contrary to the clinical interests of each child. The Panel is profoundly concerned that Dr Wakefield repeatedly breached fundamental principles of research medicine. It concluded that his actions in this area alone were sufficient to amount to serious professional misconduct.

In regards to his connection with work with the Legal Aid Board (LAB) for funding and his work with the litigation, the GMC found that Mr. Wakefield should have revealed his involvement to the ethics committee at his hospital:

However, given the importance of an Ethics Committee’s reliance on the probity of an applicant, the Panel determined that this was a failure by Dr Wakefield and his actions amounted to serious professional misconduct.

In terms of his patent:

Dr Wakefield was insistent that his involvement with the new patent had not given rise to any prior need to disclose. Despite the clear terms of the patent, he did not accept that the invention was envisaged as an alternative vaccine to MMR. He acknowledged that he had envisaged the use of transfer factor for at least a proportion of the population and that he had a financial and career interest in its success, but he said that it did not cross his mind to disclose it, and even with hindsight he insisted that there was a reasonable argument, as he put it, for non-disclosure. The Panel considered that his actions and his persistent lack of insight as to the gravity of his conduct amounted to serious professional misconduct.

In regards to his work with the “transfer factor”, where child 10 was given this “therapy”.

Dr Wakefield’s actions were contrary to the clinical interests of Child 10 and an abuse of his position of trust as a medical practitioner. The Panel considered these to be serious departures from the standards of a registered medical practitioner and concluded that these amounted individually and collectively to serious professional misconduct.

With regards to the famous birthday party blood draw:

Dr Wakefield defended the ethical basis for the taking of blood at a birthday party contrary to the experts who gave evidence to the Panel and who strongly condemned this action. The Panel determined that his conduct fell seriously short of the standards expected of a doctor and was a breach of the trust which the public is entitled to have in members of the medical profession. It concluded that this behaviour amounted to serious professional misconduct.

There isn’t much overlap between those findings and those of Prof. Walker-Smith. Even if one throws out the charge of performing test not clinically indicated for research purposes (parts of which I believe would likely still stand. For example, calling for tests when he did not have clinical responsibilities), Mr. Wakefield still would have been found guilty of “serious professional misconduct”.

BTW Todd

I do not have any spittle on my lip. That is not a very nice thing for a gentleman to say to a lady.

I will now attempt to summarise my lost post.

Did the judge say anywhere in his judgement that the case should never have been brough to court? Answer No, he did not. And I never stated otherwise. I did however say that as he had proclaimed in his Judgement that the case was full of “errors, inadequate reasonings and wrong conclusions” I said that this view emphasised my belief that the case as such, should never have been presented in the first place. It was an unprofessional and wholly inadequate case presented by a bunch of amateurs with insufficient legal expertise. Oh, and since the whole case had been perpetrated in the first instance solely by Brian Deer and his cohorts, it therefore challenged their credibility in pursueing their twisted and wrongful interpretation of events. My words not Judge Mitten’s.

Have I missed out stuff?

@One Queer Fish:

Just to say that the Lancet Paper should now be reinstated pre-GMC decision

The Lancet’s editors on the retraction:

… it has become clear that several elements of the 1998 paper by Wakefield et al1 are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.

Neither of those two things (consecutive referrals or ethics committee approval) were contradicted by the judgement, so The Lancet has no reason to undo the retraction.

Moderation,

there is much discussion of lumbar punctures on day 13 of the GMC hearing transcripts.

He was able to produce a number of papers using lumbar punctures. Except they were all research projects.

Q You were asked particularly about the lumbar punctures. You have made it clear to us that it was not your decision that they should be included, but Mr Miller particularly asked you about a Medline search that you had done as to whether lumbar punctures were done on children with autism and you said that you had, indeed, done that and you have turned up some results. You referred in particular to Gilberg, is that correct?
A And I think I have shared those results with the GMC solicitors.

Q Yes, you did indeed. Those were all research projects, were they not?
A Yes. (Pause) I should not try to defend the lumbar puncture because I was not the person who tried to order it. What I am trying to defend is the logic that might lead a doctor, listening carefully to parental concerns, to conclude that a lumbar puncture is a worthwhile investigation. But it is not for me to say lumbar punctures were indicated. I am thinking more about the inherent logic and whether we use that sort of logic in ordinary practice.

The Royal Free doesn’t do them as a rule for autistics:

“We do not, in child psychiatry at the Royal Free, do lumbar punctures in our assessment of an ordinary child with autism without any other clinical hypothesis. ”

http://wakefieldgmctranscripts.blogspot.com/2012/01/day-13.html

patricia:

In your reply to me you cite part of the ruling, a part which appears to be carefully snipped either by yourself or by your source (Age of Autism, perhaps?). Let me quote the full section:

It is in its findings on the clinical issues in the individual cases of the Lancet children that the most numerous and significant inadequacies and errors in the determination of the panel occur. In no individual case in which the panel made a finding adverse to Professor Walker-Smith did it address the expert evidence led for him, except to misstate it. The issues to which this evidence went were of fundamental importance to the case against him. Universal inadequacies and some errors in the panel’s determination accordingly go to the heart of the case. They are not curable. Unless the remainder of the panel’s findings justify its conclusion that Professor Walker-Smith was guilty of serious professional misconduct, its determination cannot stand. [Emphasis mine]

The section of the ruling you are clearly misrepresenting specifically pertains to the GMC panel’s findings against Walker-Smith.

It also seems fairly clear in the judge’s ruling that Walker-Smith had serious reservations about aspects of Wakefield’s behaviour (as per his communications to Wakefield regarding the litigation in-progress, noted in paragraph 6 of the ruling and his & Dr Murch’s letter to Wakefield expressing their concerns over his publicity regarding the 1998 paper as noted in paragraph 7).

So I am confident that my conclusion about the ruling not being applicable to Wakefield’s GMC ruling or Brian Deer’s investigations stands.

Just to say that the Lancet Paper should now be reinstated pre-GMC decision .

All the justice found was that the GMC did not have sufficient evidence to conclude that Walker Smith believed he was undertaking research in the guise of clinical investigation and treatment. That’s all. That fact isn;t sufficient to require Lancet reverse it’s retraction of the publication, in light of the facts that

1: 10 of the paper’s 12 co-authors of the paper have requested its retraction

2: Wakefield demonstrably committed scientific fraud by misrepresenting or otherwise altering the medical histories of all 12 of the subjects the paper addresses (five of which showed developmental problems before receiving the MMR vaccine and three of which never were diagnosed with an autism spectrum disorder)

3: Wakefield failed to inform the Lancet’s editors of serious conflicts of interest (the fact he was being paid by lawyers to manufacture evidence to support of a class action suit, the fact that having patented an alternative vaccine and incorporated a company which he would have accrued considerable financial gains if confidence in the existing MMR vaccine’s safety were undermined, etc.)

This ruling and some of the comments on this blog, especially patricia’s, illustrates the profound disconnect between the point of view of science (or at least working scientists and those who try to use science in their daily work like physicians) and the law (which is more familiar to journalists like Brian Deer and the general public).

I keep thinking back to Dr Paul Offitt’s comment after Dr Andrew Wakefield was struck off by the GMC. He said (if I remember correctly) words to the effect that: from the point of view of science, it doesn’t matter if Wakefield’s work was fraudulent, the science was wrong.

That is, well done research after the Lancet paper had failed to confirm Wakefield’s results showing that those results were most likely incorrect. Whether they were honest or fraudulent was irrelevant to whether the results were correct.

A scientific assessment of how reality works is based on a consensus of experimental results which are consistent with each other. It doesn’t stand or fall based on any one experiment.

However, a legal assessment of guilt (which is what the general public sees every night on TV crime shows) depends on a lot of separate pieces of evidence all fitting together to show proof of guilt beyond a reasonable doubt. If one or two of those pieces of evidence are removed from the puzzle (whether they are incorrect, misinterpreted or just fail to meet legal standards to be admitted as evidence), the case to prove guilt may collapse.

This can be seen in the efforts of those who support the vaccine-autism link. There has been very little effort to do good research to prove the scientific truth of that link (and what has been done is mediocre at best). Wakefield himself declined to try to do that.

Instead there are lots of attacks on individuals like Paul Offitt, Brian Deer and Paul Thorsen with the hope that this will show that their evidence against the vaccine-autism connection (or Andrew Wakefield) is wrong, hence exonerating Andrew Wakefield, hence proving the truth of the Lancet paper, etc.

Their argument is a giant house of cards, but they keep trying to build it up anyway.

For more discussion of the science versus fraud angle, I suggest these two blog posts from a year ago in January:

http://respectfulinsolence.com/2011/01/misdirected_criticism_by_someone_from_wh.php

http://respectfulinsolence.com/2011/01/british_science_accused_in_the_wake_of_t.php#more

And for a follow-on discussion of the issues in coping with fraud in science, I suggest these posts from last August:

http://respectfulinsolence.com/2011/08/in_which_i_disagree_with_brian_deer.php#more

http://respectfulinsolence.com/2011/08/scientific_fraud_and_journal_article_ret.php#more

“We wish to make it clear that in [the 1998] paper no causal link was established between MMR vaccine and autism as the data were insufficient. However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon [the] findings in the (1998) paper, according to precedent.”

from Retraction of an Interpretation by Simon H Murch, Andrew Anthony, David H Casson, Mohsin Malik, Mark Berelowitz, Amar P Dhillon, Michael A Thomson, Alan Valentine, Susan E Davies, John A Walker-Smith (10 of the original 12 authors; John Linnell could not be reached)

Do read the subject matter before comment please..

All this can easily be cleared up. JWS can come out and give his medical justification for LP’s, MRi’s and bowel biopsies. All these evaluations have very specific indications, and if JWS believed he was preforming a therapeutic evaluation, he can easily give the indication for their use. If he cannot then the GMC was right to discipline him.

@ Patricia dear, you just shot down your own argument about why Wakefield didn’t appeal the GMC decision…and inadvertently shot down Wakefield’s pending lawsuit against the BMJ, Godlee and Deer, claiming defamation and loss of potential earnings.

What are the clinical indications for performing a lumbar puncture, dear?

“Now that is what ah too would call a real man Lilady!”

Now that is what I would call a disgraced former practicing physician, dear.

-FTFY

@OQF #53:

you can`t argue with a decision from a High Court Judge it is the highest law in the UK

The Court of Appeal and the Supreme Court are both able to overturn High Court decisions. But then you’ve already demonstrated you know nothing and are unable to do even basic research.

@patricia

Your story seems to be morphing. You said

Did the judge say anywhere in his judgement that the case should never have been brough to court? Answer No, he did not. And I never stated otherwise.

Yet the bit I was responding to, you stated:

I have said that thw whole case should never have been brought in the first place. As indeed Judge Mitten has emphasised in his quashing of their verdict.

Earlier, you also stated this:

Now that Brian Deer and his supporters have been utterly discredited – by bringing this malicious and entirely unfounded case to the GMC in the first instance – they are shown up for what they truly are, lackeys of a corrupt Public health authority and the pharma industry.

You have yet to show anywhere in Justice Mitting’s decision that Deer’s work was “entirely unfounded” or malicious or that what he found has been discredited. As I pointed out before, this ruling is primarily about how the GMC went about its work and the conclusions drawn from the evidence as it relates to Prof. Walker-Smith; it says nothing about the evidence itself, nor does it really address Prof. Walker-Smith’s innocence or guilt.

Let me put it this way: suppose a man robbed a bank. The police put together a case, charge the man and bring him to court. They present their evidence, and the judge convicts the man. He appeals, and the appeals court finds that the evidence that had been presented did not rise to the level of “beyond a reasonable doubt”. The appeals judge overturns the conviction and the man is free to go. Nothing has changed the fact that the man did in fact rob a bank. The appeals ruling is an indictment of the shoddy work of the police and attorneys general, but does not actually address the real guilt or innocence of the man.

Justice Mitting’s ruling is along these lines.

The retraction of the interpretation is often misquoted as being most of the authors disowning the paper (as posts above) . The data within the paper holds true. Wake up call for you Pharma whores…

Denice has a theory that being “posh” means you are also automatically wealthy. I wish.

There is no doubt in my mind that Andy Wakefield unleashes in some people a tsunami of jealousy and resentment. Just for being educated, erudite. And so they absolutely revel in his downfall and cannot get enough of it.

Couldn’t be because he is also goodlooking and nice could it? No. Course not.

I have a comment on the legal/scientific issue in moderation.

Meanwhile, for those who make think a lumbar puncture is just another medical test which is a nuisance but no real harm done, I will offer an illustrative anecdote.

I have been medically diagnosed with a seizure disorder for 35 years now. Fortunately, it is relatively minor and well controlled by medication.

However, in order to diagnose that condition and decide on an effective treatment plan, I have had two lumbar punctures or spinal taps. The second one, about 20 years ago, went fairly easily. Medical testing technology had improved and they didn’t need to draw very much fluid and there were no significant ill consequences.

The first one was quite the opposite. I was advised beforehand that removing the spinal fluid would cause stress on the ganglia(?) that support the brain and might cause a severe headache and that I should lie still for 24 hours and not move or raise my head. (I wonder how you would get an autistic child to comply with that?) But, I did that after the procedure on a Friday. Saturday I felt all right and started raising my head and sitting up for a while. Then I started getting headaches, which got worse and worse and worse. And pain medication had to be authorized by a doctor, most of whom were gone for the weekend and no one seemed to figure out that I might need it on a regular basis. I think I talked them into giving me something 2 or 3 times. By Monday, the headache was still excruciating and I was driven to a commercial airport for a flight home. I didn’t have money or time to buy medicine and missed a flight connection and had to wait in an airport for several hours waiting for the next flight and trying to rest my head on the awful airport “couches”.

Finally, I got home and could buy some aspirin and really lie still on a comfortable bed and start to recover.

This is only an anecdote, and the probability of such a severe side effect is probably low.

Perhaps it was indicated for child #7 who had convulsions, but why a medical professional would risk inflicting it on a patient to diagnose or treat a bowel disorder is beyond me.

The retraction of the interpretation came out before it was discovered that Wakefield made up the data within the paper. You cannot therefore credibly claim that it means the data is instead correct.

patricia, do you realize that the only actual issue in the ruling was whether Walker-Smith considered what he was doing research? How exactly does that stretch to the extents you’re claiming? I want a specific chain of reasoning that leads from “Walker-Smith didn’t think he was doing research” to “That finding is enough simply to discredit the GMC Tribunal altogether. It cannot stand.”

Oh Todd I see where you are coming from!
The Judge didn’tsay that the Professor was innocent of all charges! Just that those charges were unfounded and mistaken and lacking in evidence and reasoning and that therefore…

Umm sorry Todd, don’t get it…..

“The retraction of the interpretation came out before it was discovered that Wakefield made up the data within the paper. You cannot therefore credibly claim that it means the data is instead correct.”

Where does The Highest Court in the UK ,London High Court Judge Mitting dispute the paper and its data?

Now why is it, that the highest court in the UK did not discover that??answers on the back of the postage stamp please…to Brian Deer ,he told you all so that, the data was flawed…

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