BMJ Report (Wakefield - January 2011)

The British Medical Journal Shows Misjudgement, Bias in Further Attack on Andrew Wakefield

January 05, 2011

Managing Editor's Note: We have covered the MMR/Wakefield/Lancet story in dozens of posts. Please click to read the history.

By John Stone

The publication of new/old allegations of fraud against Andrew Wakefield in BMJ (HERE) follows on a succession of events in 2010 in which manifest editorial bias was shown, and in which the journal seemed to be falling over backwards to aid journalist Brian Deer in his crusade against Wakefield. The journal removed correspondence from its website questioning Deer’s prolonged access to confidential medical and legal documents, blocked correspondence from both professionals and members of the public questioning Deer’s understanding and representation of the evidence at the GMC hearing, and refused to acknowledge Deer’s competing interest (documented and established in a High Court judgement) as the complainant in the GMC case against the three doctors.

In the first episode Deer raised eyebrows when he posted a letter BMJ’s Rapid Responses questioning whether US paediatrician Ed Yazbak’s grandson was one of the 12 Lancet cases (which Yazbak had not claimed):

“ I know the names and family backgrounds of all 12 of the children enrolled in the study, including the child enrolled from the United States. I don't believe that Dr Yazbak has a family relationship with any of them.”

Yazbak had only claimed that his grandson was a patient in the department, but Deer had patently raised the issue of his access to medical and legal documents to which the authorities have persistently turned a blind eye. A number of posts followed which laid the issue on the line but which were eventually censored by BMJ. Without any further explanation letters editor Sharon Davies posted the statement (HERE):

“Following a legal complaint several responses have been removed.”

But remarkably BMJ not only removed claims they removed all questions about Deer’s access, even Yazbak’s mild remark:

“I must say I am troubled that Mr Deer was obtain the names and family backgrounds of the original 12 study patients”

A further eight posts were completely removed including one from eminent paediatric gastroenterologist Prof John Dodge (HERE). The final straw seems to have been the post of the present writer:

“The question of confidentiality has often arisen in Brian Deer's reporting of the Wakefield/Lancet affair. It arose implicitly in the allegations he made about the referral of patients (which seem to me to be of no account) at the outset of this affair but which involved the complicity of responsible parties, if only by their silence on the matter. It arose when Deer published names of patients on his website (links supplied), it arose last year when he made claims in the Sunday Times about the medical status of the children in the Lancet study, whch were unverifiable from published documents…and it has also arisen from his apparent access to legal documents on which he reports, for instance as here (some might think the rancorous tone inappropriate for a professional journalist):

“"Call me old fashioned, but I think JABS should know better than to invoke poor Mrs xxxxx saying - presumably out of ignorance - that "legal aid was mysteriously taken away". There was no mystery, as Jackie surely knows. It followed the exchange of reports. In fact, having read them, I defy anyone with an IQ greater than their waist measurement to study those documents and not come to the conclusion that the Wakefield case was a bust. Even I was shocked - and I thought I was past that - by the calibre of much of the work. For the huge sums paid - in amounts I revealed last Christmas - the material for the children was, well, shocking."

 “This is a real question for the government and the medical profession, when the confidentiality of patient records are already a major political issue. It cannot be right - and this would be a striking example - for everyone to turn a blind eye because it was considered politically expedient (which is exactly why we need patient confidentiality). And it surely poses a particular problem to Prof Greenhalgh, who has contributed to Deer's site and Dr [Evan] Harris who accompanied Deer to the Lancet offices to make his accusations and subsequently led a House of Commons debate on the matter under the cloak of privilege... People need to ponder this matter deeply, whatever their views on MMR and autism.”

Thus a succession of posts which had already passed BMJ generally tight inclusion criteria for non-establishment opinions were removed without explanation of what the legal issues were, effectively placing the matter of Deer’s extensive access to confidential documents outside the possibility of further discussion in the journal, or on its website. This was further complicated by his extraordinary website claim (HERE):

"For reference, with regard to Brian Deer's MMR investigation, almost all of the key facts and documents are not public domain, and, such is the culture of plagiarism, he will act against authors who represent his writing, interviews, documents, or other research, as the fruit of their own inquiries, whether referenced or not."

Thus BMJ have actively disallowed discussion of the provenance and context of Deer’s unusually privileged status as a commentator, and their bias continues to permeate their present coverage.

BMJ compounded their anomalous position by failing to get a proper disclosure of competing interest from Deer, including the fact that he was the author of at least three complaints about the three doctors to the GMC as stated in High Court ruling by Mr Justice Eady, and repeatedly refused to publish this information when it was drawn to their attention (HERE). Deer’s latest statement is a masterpiece of obfuscation:

“Competing interests: The author has completed the unified competing interest form at (available on request from him) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; BD’s investigation led to the GMC proceedings referred to in this report, including the charges. He made many submissions of information but was not a party or witness in the case, nor involved in its conduct.”

This seems to be a tortuous admission of his role as the complainant against the doctors (and therefore as a journalist with a vested interest in a successful prosecution), but what about a complete résumé of his professional activities since he was approached by a Sunday Times editor in September 2003 to find something “big” on MMR (HERE). It is by now obvious that if his allegations were to come apart publicly (as many believe they deserve) he would be cast into complete professional oblivion.

Another aspect of bias was manifest over the publication of Deer’s last article in BMJ ‘Wakefield’s autistic enterocolitis under the microscope’ (HERE). There was consternation amongst both professionals and parents as BMJ blocked responses for days, ultimately allowing some of the professional responses to be posted. Only after the GMC proceedings were concluded, and a full seven weeks later, was a grandparent of one of the affected children allowed to respond. The letter by Jennie H Allen is worth quoting extensively (HERE):

“ Declan Fox asks 'What about the children?' What I would like to ask is why have neither the GMC and BMJ nor anyone else within the UK medical establishment asked this question before? Surely these twelve Lancet children should have been 'central' to any investigation about whether autistic enterocolitis or any other bowel syndromes exist as a condition specifically associated with autistic persons?

“My Grandson was not one of the original Wakefield twelve; he was part of a later group of children treated at the Royal Free Hospital by Professors Walker Smith and Murch. My daughter was told that he had exactly the same bowel condition as the rest.

“My Grandson is now seventeen and will soon become a voting adult. Yes, he still suffers a lot of pain and discomfort from his bowel problems and yes he is still autistic. (Both of these conditions are life long ones; there is presently no cure). Fortunately he is a very high functioning Asperger's autism case and is now becoming only too well aware of the injustices that have been done to him by a very uncaring NHS system which seems less concerned with his wellbeing than in following a government imposed politically correct agenda.

“My Grandson now lives in Scotland and regularly attends both neurological and gastro clinics. His epilepsy is very well controlled and monitored by the neurologists; his autism needs have been left to the education department. The doctors in the gastro clinics take one look at his casenotes and run scared at the sight of the dreaded names 'Walker Smith' 'Murch' and horror of horrors, 'Wakefield'!! Officially his impacted bowel is 'chronic constipation' for which he is prescribed an assortment of laxative bottles. We have learned from experience how to best ameliorate his condition using dietary interventions. He is a lovely young man and we are all very proud of him.”

But all of this is only a matter of indifference to the BMJ’s editor-in-chief, Fiona Godlee, providing nothing ever impedes the vaccination programme.

John Stone is UK Editor for Age of Autism.