A Sudden Silence Descends on the GMC as Miss Smith Stops Hammering

Wednesday 21st, Friday 23rd and Sunday 25th January.

If the only tool you have is a hammer,
it is tempting to treat everything as a nail.
Abraham Maslow

Sitting on Sunday

When they decided to sit on Sunday, although I thought it was silly in the extreme, I was kind of relieved because it suggested that maybe they were going to try to claw back some of the many non-sitting days that have spattered the two year hearing. Of course I have no idea why these non-sitting days were taken, to do Christmas Shopping, visit friends, lunch-out or maybe cover some of their professional commitments.

When they gave the time-table for Sunday 25th, I was amazed. Because it was a Sunday, and the transport was difficult, they weren't sitting until 11.30. So the situation began to look like what my debt counsellor would call 'increasing your debt'; she always says this in a friendly kind of way whenever I offer to pay back an ultra-minimal amount of money, 'No', she says, 'Really, I can't condone that, because before you've made any gains, you'll be hit with another bill and you're debt will be increased'. And blow me down, that's just what happened at the GMC, although they didn't take any more days off the last week, they did finish two and a half days early and then up pops Miss Smith and asks for another full week’s non-sitting at the beginning of the March session because the dog has chewed her homework. So not only was the Sunday sitting not entirely necessary, except for the Panel being paid time-and-a-half which would help the poorer members, but by the end of the sitting they had actually increased their debt by 4 whole days.

I'm right aren't I? That's what they're doing at the GMC, they are making what seems like a decent gesture for pay-back; a whole Sunday, no less, and then they say next week they'll take three whole days off because Tuesdays and Fridays are the only days that they can get to the hairdresser or avoid leaves on the railway line, and there you are, they've just considerably increased their debt.

On my worst nights, the nights when the nightmares are most severe, the hearing never ends and I'm ancient with white hair down past my shoulders stooping and walking with a cane. It's always someone's funeral, someone who came to the hearing quite young and full of hope and then gradually deteriorates. The nightmares are always interrupted with one of those cinematic conventions, like the leaves of dates blowing off the Calendar, or the years passing at the centre of a wheel; 2007, 2008, 2009.

The Serious Side of the Hearing: Professor Murch's Evidence

On the morning of Wednesday 28th of January, on the seventh day of her cross examination of Professor Simon Murch, Miss Smith, seemingly aware that she was digging a hole in which she was burying herself, threw in the towel. Those who were there to see this historic moment will no doubt savour it for many years. However, it has to be said that much more time could ultimately have been saved if Miss Smith had relented in her cross-examination with each of the other defendants as well; perhaps one question would have been sufficient. 'You do agree don't you Dr Wakefield' that the GMC case against you is absolutely preposterous?'

Apart from making the proceedings far more transparent, this course would have saved Britain's doctors the millions of pounds spent by the GMC on the prosecution. Miss Smith began her cross examination of Professor Simon Murch on Wednesday 21st of January and it continued for only five days, through Friday 23rd., Sunday 25th., Monday 26th., and Tuesday 27th.

It might be claimed of some barristers that they start each new cross-examination with their own persona, approaching the defendant with a pleasant empathy, and as the exchange goes on they begin their mordant act, forcing themselves to appear callous and biting. With Miss Smith, the opposite seems most often the case, she begins with a cold but friendly exchange of what appear to be pleasantries, this is her act and within minutes her real character has surfaced and she is barking like the maddest of dogs. Nevertheless, I am always beguiled by her opening shots and then suddenly confronted by her apparently cold aggression, from nought to very angry in 10 seconds; and I wonder, why was I taken in like that?

It was clear from the very beginning of the cross-examination that Professor Murch was going to be an exceptional and difficult witness. While some observers thought that he lacked the steeliness to take on Miss Smith, this proved not to be the case. Professor Murch began as he meant to go on, polite, reasonable, sensitive and while always willing to concede reasonable points he was as solid as set concrete in his constant refutation of the prosecutions main off-the-wall ideas.

Professor Murch's evidence given under cross-examination was a splendid narrative of denial which reproduced the defence story in great detail; it was also scattered with wise and perceptive comments just bordering on quiet humour. In the first part of her cross-examination Miss Smith drew Dr Wakefield back into the prosecution. Professor Murch had mainly left Wakefield out of his evidence, although where he had introduced him he had worked hard to lessen the differences that evidently existed between them. Miss Smith's drive was to push Dr Wakefield back into the clinical area and Professor Murch's intent was to stand his ground and repel Dr Wakefield from this arena; this he did with some success. Professor Murch, had similar problems to Professor Walker-Smith in relation to his approach to Dr Wakefield, but what might, at the beginning of the hearing, have threatened to be a cut-throat blood-letting, turned into a well balanced review of respected differences between the three doctors.

We can list below the, by now, well known strings to Miss Smith's bow, before we dwell with some pleasure upon Professor Murch's style as a defendant.

• Miss Smith tried to show as she had done in Dr Wakefield's case that Professor Murch was not a paediatrician.
• Miss Smith introduced Dr Wakefield early to Professor Murch's evidence, in the hope that she could show that he was the criminal master mind behind the actions of the two other defendants. She attempted to maintain the fiction that Dr Wakefield was deeply involved in the clinical work of the department.
• Miss Smith consistently made out that the clinical diagnostic protocol was actually the research protocol for 172/96. This was despite the fact that she has no real argument when it was put to her that project 172/96 was never actually carried out.
• Miss Smith insisted that the 12 child case series in the Lancet is actually a fully blown research 'study'.
• In her references to Brian Deer, Miss Smith assumes that his motives for involvement in the case are straightforward and no mention is made of the war that Deer has waged against Wakefield, or of him being the complainant.
• Miss Smith claims that for their own purposes, these doctors refused to give the children neurological examinations. This is all part of her plan to present the children as 'simply' autistic and to ignore their IBD.
• Miss Smith reacts with horror to the fact that some of the children were given lumbar punctures, in an attempt to test important diagnostic information.
• The matter of ethical committee approval dragged on for a whole half day. At the centre of Miss Smith’s argument is the assertion that the procedures carried out on children, and cited in the Lancet paper, did not receive ethical committee approval. It doesn't matter how many times the point is made by the defendants that the 12 children were investigated for clinical purposes, Miss Smith carries on digging.
• Miss Smith embraced a long and undignified discussion about the 'report' that Professor Murch was brow beaten into writing in answer to Brian Deer's complaints against all three doctors, just before his expose was published in the Sunday Times in 2004. Professor Murch argues time and again that this rebuttal, in which he made a number of mistakes, was written in response to a very lengthy document suddenly thrust at him by Deer. He had 24 hours to reply, with work intervening and with none of the documentation available. Miss Smith who had over 3 years to prepare the prosecution case and who even now has no qualms about asking for an extra seven days to prepare her closing speech, insists that every word Murch wrote is valid.
• Great emphasis is placed by Miss Smith on the principal medical expert witness, Professor Booth. You might remember him as the enlightened doctor who made the point that constipation is a condition on it's own, unrelated to any other factors beyond its own incidence. He also had grave doubts about food allergy and intolerance while suggesting that marker tests were the single most effective diagnosis of IBD and could obviate the need for colonoscopy. The repetition of Professor Booths minority views led to a prolonged dispute with Professor Murch about whether or not colonoscopy was an appropriate investigation in the Lancet cases.

If Miss Smith's cross examination could be described as pedantic, repetitive and simply wrong, Professor Murch's rebuttal in his answers could by comparison almost be described as brilliant. Refusing to stick to brief responses, to Miss Smith's inane questions, Murch gave lengthy responses that, while answering the questions, also gave listeners a real understanding of the context within which the three doctors were working.

Professor Murch built up a real picture of himself as a caring but also very honest doctor, whose placid agreement even with some of Miss Smith's notions showed him to be utterly unafraid of compromise on reflection while determined to emphatically state the truth as he saw it when Miss Smith tried to harry him.

When Miss Smith wantonly accused him of carrying out too many tests and being over concerned with Wakefield's theoretical position on such things as measles vaccine, he answered; 'Ours was a thoughtful approach to complex cases. We were no more interventionist than the centres in Italy or France or other centres in Britain'.

He tried wherever possible to put Miss Smith's accusations within a wider context, so making the whole picture accessible to the panel and the public. This practice was of particular value in the area which I have come to consider one of the most important in the whole hearing. From the beginning Miss Smith has insisted that the children cited in the Lancet paper where the subjects of research and not clinical cases. The number of complex investigations were, the defendants have claimed, needed because they were trying to deduce the cause of a novel and complex condition. Professor Murch stuck to his guns and explained the position simply, again and again to Miss Smith. It was necessary, he said, to build up a diagnostic protocol so that the doctors could formulate an approach to treatment.

The problems around this treatment protocol were in many ways the central issues of the case. Simply put we can say that Miss Smith claimed that the twelve children cited in the Lancet paper were not ill; they were children with autism, prone to behavioural disorders. By looking at the children in this top down manner, the prosecution was able to avoid a close scrutiny of IBD and a complete separation of the children from their parents and in turn their suggestion that MMR might have been implicated in their children's illnesses. If the children were 'only' autistic, there was no need for any kind of 'novel illness' investigation and so no need for a diagnostic protocol.

While all three of the defendants have defended the diagnostic protocol built within the department, none of them did this as successfully as Professor Murch. Frequently departing from the evidence, Murch went out of his way to stress that the parents’ narrative and the actual presentation of the children's condition were the most important facts in the clinicians examining the children. Accused by Miss Smith of 'relying on a nebulous theory' in the examination of the children - or in her terms, research into them - Professor Murch answered, 'No, there we part ways, we were relying on the children's symptoms'.

Miss Smith has gone to extraordinary lengths to try to establish the idea that the twelve children were principally autistic and did not need any further medical intervention. At one point on Friday 23rd, she insistently said to Professor Murch, 'Didn't it disturb you that these children didn't have a neurological examination'. This was followed some time later with the bizarre question-statement 'The children were sent to the Royal Free for behavioural disorders, you would not expect them to be sent to a paediatric gastroenterologist!?' This bizarre 'question', speaks volumes about the prosecution ability to distort utterly the picture of work at the Royal Free Hospital. Professor Murch, along with the other two defendants, having made it completely clear that the children arrived at the Royal Free, principally because of bowel disorders, answered Miss Smith's stupidity in a quietly understated way. 'If a child with a purely neurological disorder was sent to a gastroenterologist, yes, this would be odd'.

In his narrative describing the investigations into the children, Professor Murch took every opportunity to explain the need for a multifaceted search for any cause of regressive autism. He constantly brought up the work of their department on mitochondrial dysfunction that had been well under way even in nineteen ninety six. Miss Smith inevitably steered well clear of such information, despite Professor Murch's offering her entreaties such as 'I don't know whether you are aware of ...'. During one particular exchange, with Miss Smith insisting the children were autistic and that was the end of that, Professor Murch made two classic statements which one hopes will be well quoted for a long time.

'A diagnosis of autism is not a signal to stop looking for the cause'.

and

''A wide variety of different causes of autism are possible'.

Professor Murch, came across as a man, even in the torrid climate of the GMC prosecution, willing to make himself vulnerable. At one point, when Miss Smith was criticising the report that he had hurriedly cobbled together at the insistence of his department head and Brian Deer, Murch said words to the effect; 'I had no occasion to think that my report was not all right. I thought it was a good report 'from the bottom of my heart'. I was struck by the openness of Murch's language and a brief comparison with Miss Smith and Mr Deer flitted across my mind; 'Heart? What's that?'

Where lesser men might have broken down, Professor Murch, as had Professor Walker Smith and Dr Wakefield, retained an exasperated cool and it seems now almost impossible that none of them lost their temper on a single occasion. But it was Professor Murch who showed an exceptional ability not just for cool, but for calm intelligence in his confrontational replies.

Talking about what Miss Smith considered his failure to have responded to a legal letter, he said; 'You're asking the impossible'.

On ethical approval for the investigations he carried out, he said: ' Your questions and their implication is unfair ... You are continually casting doubt on my integrity and I don't think that's right'.

Accused of being gung-ho with his colonoscopy investigations, he said: 'I don't undertake any investigation lightly nor do I shrink from them if they are necessary'.

On one occasion, exasperated by Miss Smith's insistence that he could remember why he had done such a thing, he answered mockingly; 'Miss Smith you appear to have a better insight into my memory than I do myself'.

Often throughout the cross-examination, Miss Smith seemed to only just have a grasp of the English language. At one point she accused Murch of 'trying to explain everything away'. To which the Professor answered, 'I'm not trying to explain anything away, I'm trying to give an interpretation'.

There was a flash of the old Miss Smith on Monday 26th, that made me warm to her again, as I had done in the very early days of the hearing. She had just finished berating Professor Murch for having ignored a 'neurological' diagnosis of Asperger's Syndrome. Having made clear that his expertise was in gastroenterology, Murch said; 'I think you're making too much of what is essentially a small point'. Seeing that she was losing ground Miss Smith retreated with a very precise intonation of; 'Well ... Well ... Well'. And I thought that Miss Smith had got out of this habit of endearing vacuity.

Following the sudden and perhaps premature end of the cross examination on Wednesday, the Panel asked their questions of Professor Murch. All the questions were insightful and showed that the Panel were on the ball. A couple of questions were slightly unsettling; one from one of the medical members who asked if Professor Murch thought that 'Time was a good treatment'. Although Professor Murch answered the question gracefully, it suddenly occurred to me that perhaps the panel had not grasped the full picture of these children's history. A number of them had in fact been languishing in the byways of poor quality diagnosis with no treatment far away from any centre of gastrointestinal excellence for long periods.

Another question assumed that the children were seen under 172/96 and my stomach turned over at the thought that the continual refutation of the fact that the children were not examined under this research protocol was still not taken for granted by the panel.

Law-making on the hoof at the GMC

In the last throes of the case against the three defendants, Brian Deer has become increasingly concerned that the Panel might believe their defence. Just before Professor Murch began the presentation of his Evidence in Chief, Deer apparently sent a number of emails to the GMC, reinforcing, as he thought, the prosecution case and putting Miss Smith right as to what had happened between him and Professor Murch at a meeting engineered at the Royal Free Hospital by Brent Taylor, Murch's head of Department in 2004.

It has always been Deer's claim that this meeting went swimmingly and that Professor Murch happily confessed to all three doctors having carried out research while thinking little of a clinical approach to formulating diagnostic guidelines for treating the children.

This attempt by Deer to ensure that the prosecution had the full facts, seems especially bizarre when you consider that Miss Smith has had over four years now, to consider the details of the prosecution based upon Deer's original complaint. Not just bizarre but also, it turned out, auto-destructive. It appears that Professor Murch's counsel had no intention of bringing out Murch's opinion of Deer's pressurising behaviour at the Royal Free meeting or anywhere else. However, having read the emails sent by Deer to the GMC, Murch's counsel Adrian Hopkins QC, felt impelled to introduce questions about Deer's attitude.

When Deer heard the evidence given by Murch against him, he lost it and his further actions led to what has become known in the quiet ante-rooms of the GMC, as The Incident in the Coffee Machine Queue that took place on Monday 19th January.. The GMC has remained remarkably quiet about The Incident…, which all adds weight to the idea that Mr Deer is well protected by powerful people. I do feel bound to report on this incident in full now that we know more about it, and I do this in the spirit of all my reporting over the last eighteen months, during which I have tried hard to draw attention to breaches in due process committed at the GMC.

The grandest of these breaches is clearly that the GMC has framed the charges while employing the prosecution counsel and the Panel, making a mockery of any system of self-regulation. From those dizzy heights we pass down to matters of only slightly lesser importance and have been bound to look previously at the role of Mr Deer in the lodging of the complaint to the GMC and the investigation and expose of the many charges brought against the three defendants. At the end of these breaches of due process come some minor issues, such as the response of the GMC to my essay An Interest in Conflict. Some of you might recall that when I wrote about a conflict of interest of one of the Panel, my essay and myself were roundly and publicly condemned by the Panel's Legal Assessor and it was suggested that had the hearing been a court of law, which of course it is not, he might have seen fit to bring charges of contempt of court against me.

I raise these matters now, not because I harbour any ill-will against the Legal Assessor who I have warmed to increasingly over the weeks since he berated me; I raise it because I want to put The Incident in the Coffee Machine Queue, involving Brian Deer into some kind of legal context. I have waited for over two weeks before putting up this piece because I wanted to be absolutely sure that there were no unnecessary interruptions to the evidence of Professor Murch. I have to make clear, that in discussing this matter, that I consider happened 'outside' of the hearing, I am not in any way attempting to prejudice any party in the proceedings. I am however, hoping that even at this late date it might be possible to push the GMC into a more transparent approach to their proceedings.

The manner in which the GMC handled this incident raises much more serious questions than my essay or even matters of conflict of interest. The incident raises question about Mr Deer's attitude to the three defendants, and the GMC's conciliatory approach to Mr Deer.

The Incident.

On the morning of January 19th, between the hours of 10 am and 11.30, Professor Simon Murch was taken through his Evidence in Chief by Mr Adrian Hopkins. Some part of that evidence concerned Brian Deer’s aggressive nature and another matter to do with the origins of information he held in 2004 about the children cited in codified form in the Lancet paper.

Clearly, it is not my role to comment on the weight of this evidence and we are concerned here, only with Brian Deer's personal reaction to it. As I pointed out in my last report, the evidence appeared to make Deer very uncomfortable and at the 11.30 break, he left the hearing immediately in the wake of Professor Murch. What happened next, in the foyer of the Fitness to Practice hearing room, really needs a proper enquiry, conducted briefly by the GMC and then published with a record of the actions to be taken against Mr Deer, if in the event he was found to be guilty of any transgression of GMC rules or guidelines.

Because the GMC and the hearing has remained silent about the incident I can only briefly describe what appears to have happened. I have to stress that I gathered this information from a three sources and I did not at any time approach or try to approach, the witness Professor Murch who was still giving evidence, up to the end of this session.

The impression of the incident I have put together is as follows. Professor Murch on being released, went out of the hearing and approached the coffee machine in the foyer. I myself witnessed Brian Deer purposefully leave the hearing immediately in his wake. Arriving in the coffee machine queue directly behind Professor Murch, Deer proceeded to knock into the witness and then standing level with him, turned to place his face directly in from of the witness almost nose to nose glaring angrily at him.

There can be little doubt that if this account is correct, Deer's act was tantamount to the intimidation of a witness. What does this mean? In relation to legal situations generally, the intimidation of witnesses in any form has especially since the 1950s - through the criminal gang trials of the sixties and then into the anti-terrorist trials of the 1970s and 1980s - been considered one of the most serious charges that could be brought against someone acting inside or outside the court.

The idea that witnesses or jury members should under no circumstances be approached, bribed or threatened has been the corner stone not only of changes in statutes affecting trials, but also in the architecture of the modern courts. At the Old Bailey and other important courts in the 1970s and 1980s, even a hard stare at a witness from a person in the public gallery could result in the starer being questioned by the police.

In relation to the GMC and it's hearing procedures, we might look briefly at what appears to have happened and then put it in context. Following the incident, a complaint was made to the GMC and it might be that everyone watched the CCTV footage of the incident. No reference was made to the incident publicly. We might assume that Mr Deer was spoken to by GMC staff and on the Wednesday when he next attended. Professor Murch was assigned a 'minder' as he left the hearing for a break.

What might we say about the GMC's approach to the incident? Admittedly, the whole matter is somewhat confused by the fact that the Fitness to Practice hearing is not being held in a court and inevitably therefore the GMC is continually faced with having to act 'on the hoof' as it were. I can well see that in the case of this incident, the GMC must have thought itself with limited options.

However, there are clearly a number of questions that might be asked. Some weight has been placed on the behaviour of the public gallery during this hearing, members of the public have frequently been told off, for slight noise or other infringements, while last year, an autistic child was expelled with his father on two occasions from the public gallery, for making noises. Every morning, the public gallery is told in quite abrupt terms to turn off their mobile phones and witnesses are quite rightly warned by the Panel Chairman about speaking to anyone about their evidence while they are giving it. I might add to this list, the fact that I was gratuitously named, while I sat in the public gallery, by the legal assessor and it was suggested on very flimsy grounds that I had broken the criminal law. We might also cite with this list of 'quibbles' the fact that it was common practice at the beginning of each round of the hearing in 2007, for the public's bags to be searched.

I might add to this list an odd story that I have so far not related to you. A couple of weeks ago it happened that one of the downstairs receptionists employed by the GMC was leaving. This young woman had on the whole been very helpful as well as charming and consequently, on the morning of her leaving, I bought her a small box of hand made chocolates. She wasn't there when I went up to the hearing at 9.20am, so I left them with another receptionist. Returning through the reception at lunch-time, the receptionist told me that she was very pleased to have received the small present, but sadly, she had been told to return the chocolates to me on the instructions of her supervisor. Apparently, her supervisor had told her that no GMC staff were able to accept presents, as such a present could well constitute a bribe.

It goes without saying that I was gob-smacked by this. What did her supervisor imagine I would ask this young woman to do? If I worked quickly, would I be able to get her to hand over the transcripts of the hearing? Perhaps if I worked at the relationship for a long period I might be able to get her to slip some cognitive mind altering substance in Miss Smith's tea so that she could experience the emotion of empathy? As my imagination ran wild, I came back down to earth remembering the young woman, whose name I did not know was actually leaving the employ of the GMC that very day, and due to return to Australia, could be of little use to me. However bizarre this incident, it shows clearly that the GMC has an inflated opinion of its legal and security status, with regards to those by whom it feels threatened. I would add that I refused to accept the return of the chocolates and found later that the woman's supervisor had in fact relented.

It might be, that in a long and complex hearing, and one that addresses controversial issues, such as does this hearing, all of the above are things we have to put up with. Also continuously poor sound quality, and the odd late cancellation and uncancellation aside I can't say, that the hearing has been conducted in an oppressive or even a 'difficult' manner from a public point of view.

However, throughout the hearing, there has been in the background a consistent question of whether the GMC as a self regulating body, has been fair and without bias. This question has arisen especially in terms of the relationship between the GMC and Mr Deer. When it appears that Mr Deer is caught up in an incident involving a witness against whom he has made a complaint, while that witness is giving evidence, we would surely expect a real effort from the GMC to assure the public that there exists openness and transparency in its dealings with him.

I myself, have no solutions to offer, although a couple of alternatives could be suggested, perhaps arguing for a week's suspension from the hearing or a clear statement about what happened from the Legal assessor, so that the incident could become a matter of record. At the very least it appears to me that in the absence of criminal proceedings that might well have been the outcome had the incident occurred in a real court, the legal assessor has a duty to admonish Brian publicly, regardless of his presence or not in the hearing room.

I must make the point, that quiet words with Mr Deer by GMC staff and the minding of witnesses by them, which appears to have been their response, are both clearly wrong moves. The second move in particular, is classically wrong in intent and action. The witness's story in such circumstances, has always to be believed and the transgressor together with any threat there might be, has to be removed for as long as he represents a threat to the witness. The imposition of a minder, which makes the victims circumstances more difficult, by curtailing their mobility, while taking no public action against the perpetrator, places quite the wrong emphasis on the incident.

Not being a lawyer, I remain particularly confused about the nature of Deer’s actions in relation to Professor Murch's evidence. What is the 'legal' position in the case of a defence witness giving evidence on a complainants aggressive disposition - as Professor Murch did - being threatened by this same person? Should the perpetrators actions be entered into the proceedings as corroboration of the witness’s evidence?

It is not too late for the GMC to act with authority on this situation now, but whatever their response, one would hope that their management will learn serious lessons from this uncommon occurrence and if it ever happens again, will have procedures to set in motion. After all we must be careful that the law or regulation is not brought into disrepute and anarchy seen to rule in judicial chambers.

The summer session: Towards 2010

On the last Wednesday, after the Panel had asked their questions, everyone listened to submission about the dates for the next session. Happily I had asked the previous day for a copy of these dates, otherwise, I wouldn't have had the faintest idea what they were talking about.

The next session entails all the counsel giving closing speeches, beginning with the prosecution and being followed by counsel for each of the defendants. Miss Smith had an application. Beginning the next session on the 2nd March, would not she said, give her adequate time to prepare her closing speech. Miss Smith is always, humorous, however, and she brushed away the week long delay at the beginning of that session as she looked gravely round the room; 'The prosecution doesn't set the agenda, it isn't me who wastes time'. I wondered whether she believed that fiction, as Shakespeare’s words rang in my ears, 'The lady doth protest too much, methinks.' (Hamlet III, ii,). No less amusing, however, was the twittering of the defence counsel, inevitably unaffected by the credit crunch; 'We really must protest' they huffed and puffed. 'This hearing was supposed to finish after four months', huff and puff. 'And we have been here now for two years'. They make these noises as if the length of the hearing had nothing whatsoever to do with them.

The panel sat in camera to deliberate this weighty matter, before deciding that if Miss Smith's professional opinion is that she needs one month and ten days to prepare her closing speech, on top of the five years she has already had, then she should have it.

We are now set for the final leg of this regulatory, sub-legal marathon, with the closing speeches being given throughout March and the final deliberations spluttering on throughout May and June and who knows how long after this. One thing can be said with certainty, that a few of the press might drift in through the closing speeches but when it comes to the verdict on the charges, the GMC will be packed with journalists and other freeloaders who will, with a few exceptions, circulate reports which bear no relationship at all to the evidence. We should prepare ourselves for this time.