Tuesday 14th August GMC hearing

Here is an account of what happened today at the hearing...

By Olivia Hamlyn (daughter of Susan, sister of Francis)

Dear All,

I arrived at about 11.15am and so missed the prosecution cross-examining Dr Revell. He was the Head of Histopathology at the RFH at the time the Lancet paper came out etc.

Miller [defence counsel] was the main cross-examiner and most of his cross-examination as far as I could see was spent 1. establishing the relationship between Revell and his department and those carrying out the clinical work and research work and 2. The difference between clinical work and retrospective research work.

Revell made it clear that where investigations were taking place, i.e., here involving slides taken from colonoscopies, there was much discussion between clinicians and pathologists in weekly meetings. He didn't attend the meetings and therefore couldn't say what went on in them exactly, but their purpose was to reach a consensus about what had been found and about the care and treatment of patients and so that departments would be in communication with each other. These meetings were mainly in Dr Sue Davis' (later witness) hands. He made it clear though, in summary, that all processes used for the care etc. of patients were professional and contained nothing to raise concern.

Miller then established that should the interpretation of the slides change after later examination for research purposes, then treatment of the patient would not change. Furthermore, that in order to conduct retrospective research now, the patient's consent would be needed. This was a result of the Human Tissue Act (2004), which hadn't been around when this research was being carried out. Revell did regard it as a retrospective study, he said and added that Dr Davis and Dr Dillon did their own retrospective review of the same slides in order to verify the description in the article. He assumed this review was the same as that referred to in the Lancet paper.

In relation to the Lancet paper, he said that what had been found were interesting observations and would need a larger study.

In response to panel questions, he thought there had been nothing unusual about the biopsies except that one was for an autistic child. He had concerns about this so investigated as part of his job to check that the NHS was being used appropriately. He was obviously satisfied. It was unusual for a child with autism to be biopsied but then again, he wasn't a gastroenterologist. When pressed about the necessity for ethical approval he said in 1998 one wouldn't have necessarily needed ethical approval for writing retrospective case studies but couldn't remember when it changed.

Next up was Professor David Candy who is a paediatric gastroenterologist and was a peer-reviewer to the Lancet paper. Smith [prosecuting counsel] took him through the process by which one becomes peer-reviewer and the background to his being asked to peer-review the Lancet paper. Briefly, one can be nominated by the authors of the paper or chosen by the editor (there are probably other ways too). This was his first peer-review for the Lancet although he had experience doing it for other journals. He received two papers: the first one being the clinical paper (the one which was published) and the second one being a basic science paper (which was actually rejected) and a letter from John Bignall of the Lancet asking him for a swift review of both warning him of the implications of publishing these papers and requiring him to make sure the findings were absolutely watertight.

Several clear points came out in his cross-examination which can't have done the prosecution much good.

Firstly that he knew the papers would be excellent because he knew and admired Professor John Walker Smith. He needed to make no major amendments and would have been surprised if he had had to, he said. He said that the second paper especially led to his endorsement of the pair.

Secondly, the major criticism of the Lancet paper both in the editorial that accompanied it and from other sources was that there was a lack of virological evidence/virus infection to support/explain the claims made in it. He said, however, that the these criticisms would have been met if only the second scientific paper has been published too, along with the first paper. The first paper implicated the measles component of MMR because the authors knew what the second paper said, i.e. The presence of the measles protein in the gut had been identified. He also noted that it was puzzling that the editorial should contain such harsh criticism of a paper which had been accepted for publication!

Thirdly, he talked about the research techniques used to detect the measles virus such as PCR and these were techniques which he had faith in and had experience of. He gave both papers positive reviews and doesn't know why the second paper was rejected. He conceded however, that because the peer-review process was not transparent then and he didn't know who the other reviewers were, then it could have been negatively reviewed by someone with more expertise. But then again, we won't find out for sure why the second paper was rejected because the no one seems to know what happened... However, he made it clear that he was not happy that only the first paper was published without, as he put it, "the missing piece of the puzzle" and felt that it would have been better to publish nothing, rather than just the clinical paper. He described the two papers as "indivisible" and said that the observations in the first paper were strengthened and confirmed by the second paper. Koonan [defence counsel] suggested that the publication of the first paper without the second looked like an error and Candy replied that it had definitely been an error not to consult the peer-reviewers on this matter. He felt that if there had been a disagreement among the peer-reviewers then the authors should have been asked to comment and it should have been resolved that way. Apparently this is Horton's usual method, as he stated last week, but evidently it didn't happen...

Fourthly, he felt that taken together, the findings of the two papers were watertight and both were well-written and excellent research. He also said that the existence of measles viral infection in the bowel was a revolutionary finding. He said he was aware of what measles virus could do to the brain and that it was not implausible that the measles virus could damage the bowel and brain.

He made it clear too that he was annoyed at the criticism insinuating that the peer-review process had failed and because he was unable to answer due to the need to remain confidential. He said the concern expressed by third parties could have been avoided with the publication of the second paper and the level of adverse comment could have been lower.

Finally, in response to panel questions, he reiterated his confidence in the findings of the paper because of the quality of the authors and the reputation of the institution.

Apparently tomorrow there's just going to be wrangling between the two sides over whether the witness statement of Dr Clifford Spratt is admissible as he is too ill to attend. There is no hearing on Thursday and Friday [16th and 17th August].

Apparently too, David Salisbury will be called to witness at the start of next week.