BMJ Report (Wakefield - January 2011)

January 06, 2011

CryShame Response to BMJ Report

From UK's CryShame:


Once again, the BMJ gives a platform for Brian Deer's investigation of the research behind Dr Andrew Wakefield at el's 1998 Lancet paper. This time the BMJ editors criticise all 13 co-authors for failing to check the data, warn all medical researchers and ethics committees to check carefully before they publish, and urge scrutiny of all Wakefield published papers (presumably all 100 plus papers). The BMJ allies itself with Deer's potentially defamatory attack on Wakefield.

As in past publications, Deer's 'expose' rehashes material gleaned from confidential medical casenotes he obtained on 12 seriously disabled children, whose parents did not consent to their release. He refuses to disclose his sources, claiming confidentiality for his informants.

Now Deer uses revelations taken from the GMC hearing to elaborate his initial findings, which he submitted to the GMC, so starting the hearing which led to Dr Wakefield and Professor Walker-Smith being found guilty of serious professional misconduct and delicensed (subject to appeal to the High Court).

However, nothing in the latest revelations nor in the GMC findings changes the irreversible decline thousands of parents witnessed as they saw their children fall to autism after the MMR.

The BMJ editors' attack on Wakefield raises questions about their own ethical stance. As editors of one of the world's most respected medical scientific journals, they are duty bound to scientific ethics that demand full disclosure of research findings and protection of the identity of patients used in research. Yet the editors publish the findings of an investigative journalist who refuses to disclose the sources of the children's confidential notes and is content to publish confidential medical and legal details of disabled child patients.

Though Deer and the BMJ editors hope the GMC findings are the final word on the MMR-autism saga, they should remember that

  • the children's GPs and consultants who appeared for the GMC prosecution were recounting events that took place 15 or more years ago
  • discrepancies in medical notes are not unusual and would probably be found in any randomly accessed medical records were they subject to the intense and prolonged scrutiny the Lancet children's notes underwent since 2004 when GMC began its investigations
  • medical science is not an exact science and often relies on expert interpretations of data where no clear cut interpretation exists. The discrepancies and anomalies Deer reveals are not unusual, especially in the field of gastroenterology. This is why Walker-Smith, the senior author, set up rigorous cross checks and controls for the pathology findings, and why he sought independent high level expertise to reach final judgments on differences in interpreting pathology findings
  • variations in what doctors wrote and in what they said under cross-examination at the GMC may explain the discrepancies Deer who has no medical expertise whatsoever ‒ makes so much of
  • likewise diagnoses of autism are subject to interpretations which frequently differ between clinicians
  • given these uncertainties, the BMJ should offer Wakefield the right of reply on grounds of fairness and even-handedness
  • to refuse this is to seek to foreclose a medical debate which will continue until an alternative and more rigorous explanation for regression following MMR is given.
  • To date there is no agreed scientific explanation for the regression many parents of autistic children have witnessed.

The BMJ editors and Deer fail to point out that the 5-page paper was a small case series of findings of 12 children with autism and bowel disease which the Lancet placed in its 'early report' section. It was no more than a record of clinical findings of sick children treated at the Royal Free Hospital in the mid-1990s. These studies have a legitimate place in medical science in bringing to public attention new conditions (eg autism associated with bowel disease), reviewing the clinical evidence and commenting on hypotheses. Their role is to pave the way for further more rigorous research.

The link between MMR and autism/bowel disease was carefully couched as one of a number of hypotheses the paper reviewed. The MMR hypothesis had appeared in medical journals before. As the paper's aim was to review possible environmental triggers for the association between autism and bowel disease, the authors were duty bound to record the accounts of the parents of eight children that the onset of autism followed MMR. However, the paper expressly stated We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described (p.164), and recommended further research into this possibility ‒ a responsible and legitimate conclusion to reach.

Deer and the BMJ coin the term 'Piltdown medicine' to dismiss the paper and its authors. Not once do the editors refer to the testimony of parents who witnessed their children's regression following MMR. Such testimony is dismissed as parental 'beliefs'. Many thousands of parents have shared the same story via social networks, email groups, Facebook, etc. The temporal association between MMR and autism clearly does not in itself demonstrate a causal relationship. But neither is it an association to be dismissed. There has been no substantial scientific study of autistic regression following MMR based on parental interviews. Instead parental accounts are dismissed as anecdote. Yet the frequency of these accounts represents a pattern deserving of serious research.

Deer, the GMC, Lancet and BMJ are hell bent on erasing Wakefield's work from the historical record.

The GMC hearing declined the offers of parents to testify before it and staff refused to submit a letter from the parents of eight Lancet children supporting Drs Wakefield, Walker-Smith and Murch's work and ethical care.

The phenomenal growth in autistic children ‒ from one in 2000 in 1987 to one in 64 today ‒ is of epidemic proportions and cannot all be explained away as improvements in diagnosis. No one, least of all Deer and the BMJ editors, can explain why the tragedy of autistic regression is happening to children and families.

A state of denial continues to silence the medical profession and government, whilst our children suffer in silence. Parents who speak out are dismissed by the BMJ and GMC and ridiculed as attention-seekers by Deer on his website and the many blogs he inhabits. Yet both parties are neglectful of the role played by parents of autistic children and the responsibilities they shoulder.