[back] Wakefield GMC Hearing 2007

[Monday 28th July - Thursday 31st July]

GMC Prosecution Exploits Vaccine Damaged Children with Autism

by Martin Walker MA

GMC Prosecution Exploits Vaccine Damaged Children with Autism and Attacks Good Doctors While Covering up the Crimes of Politicians and Pharmaceutical Companies.

Brian is back, in and out of the hearing, sitting palely in the corner like a scab on the sore of these festering proceedings. Apparently he is not so interested in the fate of Professor Walker-Smith, he now chooses his time to be present, even the beginning of Miss Smith's cross examination didn't seduce him. Still the air is a lot clearer when he isn't there, the low smog of sulphur happily dispersed.

On Tuesday 29th of July, Mr Miller stopped taking Professor Walker-Smith through his evidence-in-chief relating to the Lancet paper's 12 children. I haven't covered this evidence in detail because I have reported on it previously, instead I reduced the evidence to bullet points in my last article.

It has occurred to me that some readers who have read my last two reports might think that in not relating the evidence about the 12 children more specifically, I was doing a disservice to these children and their parents. I want to stress that the evidence brought against the three defendants in relation to the Lancet children, has nothing whatsoever to do with the children themselves. This evidence only reflects upon the children in as much as Miss Smith and prosecution are saying that on the whole the children did not have serious bowel problems and they were manipulated into being subjects of research, while the defence is saying that in each case, there was sufficient evidence of serious illness for the children to be examined on the basis of clinical need. The prosecution do not really want to discuss the real children, except to infer that the three defendants performed unnecessary procedures on them.

The GMC has used the children in the most cruel manner by refusing a voice either to them or their parents. No doubt if one asked the GMC why they have not called the parents to give evidence, they would say, 'We believe that the parents were duped, that they gave up their children to Wakefield and the Royal Free in the vain hope that their autism might be remedied but what actually happened was that the three defendants experimented on these children trying to prove that their autism was caused by MMR'. This of course is hogwash, they didn't want to bring the parents of the 12 children into the hearing because all of them would have sung the praises of Dr Wakefield, Professor Walker-Smith and Professor Simon Murch .

One might well ask, how would the testimony of the parents have affected the case? The answer is simple. The appearance of the parents would have reversed the thinking in the case and made it clear to the panel how sick the children were, how their regressive autism occurred after their MMR vaccination and finally, would have given considerable support to the way in which the doctors at the Royal Free had behaved; ethically and always with the children's interests at heart. Inevitably, the question that remains hardest to answer, is why the defence has not called any of the parents. Not being privy to their reasoning on this, it has occurred to me that it might be the case that the lawyers see the parents as loose cannons, who might at any time in their evidence, tip-over the defence case.

Any rational view of this case, would, I think see the evidence of the parents about the condition of their children and their search to get them properly examined and diagnosed, their contact with Doctor Wakefield and their treatment at the Royal Free, as a very good counterweight to the evidence of the General Practitioners who appeared ostensibly for the prosecution. I say ostensibly because a number of them, like other prosecution witnesses actually gave evidence for the defence, recognising their own limitations and lack of specialisation while expressing their gratitude for the work of the doctors at the Royal Free.

For those who would be happier with a detailed impression of the evidence relating to the 12 Lancet children, they could do no better than read Olivia Hamlyn's account, below, of the morning of Monday the 28th of July. Olivia who was only there for the morning on this day, managed to produce two pages of detailed record, which I reproduce below and which gives a full picture of how the defence is preparing to answer the onslaught of continuously repeated questions which is bound to come from Miss Smith when she begins her cross-examination of Professor Walker-Smith.

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When I arrived it was 10.10am so the hearing had already been in session for about 40 minutes. I had thought that by this time Mr Miller would have finished going through the 12 children which he had begun last Monday. However, this morning was dedicated to child 9 and child 10, and I left half way through child 10, when the hearing adjourned for lunch. The previous few times I have been, not much of huge interest was said. This morning a few things of more interest came up and some charges were touched upon directly, so I'll give a brief account of those things.

The evidence regarding child 9 centred mainly on the correspondence between Dr Clifford Spratt and Professor Walker-Smith, but the main points being made, I think, were that the investigation and treatment of child 9 had nothing to do with research and that Dr Wakefield and Dr Dillon were not involved. Likewise, giving child 9 asacol was merely to see if it might help, not for research purposes. Regarding whether a lumber puncture was clinically indicated, Walker-Smith stated that it clearly was, given that a sibling of child 9 had had the neurological condition, Hoffmann's syndrome.

Mr Miller also touched on Professor Walker-Smith's monitoring of child 9's folate (folic acid) levels, simply for information should it be useful for later research. This, however, never got any further but he stated that it could have been useful for diagnostic or therapeutic reasons. The evidence also focused partly on the monitoring of child 9's lead levels which were unusually high and Walker-Smith expressed puzzlement as to why Dr Spratt continued to involve him in what he saw as the typical remit of a local, community paediatrician. Professor Walker-Smith speculated that it could have been because child 9's bowel pathology might be linked to these lead levels but he also noted that Dr Spratt was asking him questions outside his area of expertise.

Regarding the referral and investigation, Professor Walker-Smith made it quite clear that child 9 was not to be included in what was referred to as the 172/96 study - a study that didn't actually get off the ground but which the prosecution insist was the basis for the 1998 Lancet paper. He stressed that child 9 was not part of any research study. When asked by Mr Miller why he had continued to correspond, on the matter of the lead, with Dr Spratt, Professor Walker-Smith replied that the correspondence was purely for child 9's benefit and that it was appropriate to be involved in this discussion. Walker-Smith made the point that he had general experience as a paediatrician and that he was not about to abandon a patient as soon as the issue at hand moved outside of his area of expertise.

In a letter from Professor Walker-Smith to Dr Spratt written in Sept 97, JWS recommended that child 9 stop receiving the drug he was on and mentioned that he had discussed this with Dr Wakefield. Walker-Smith had to explain why he discussed such a matter with Wakefield and said that it had been a matter discussed by a group of doctors on a trip to Freiburg. The question of how to get objective evidence of whether anti-inflammatory drugs worked, by repeating tests the children had had previously, for example, was a research issue and it therefore had been appropriate to discuss it with Dr Wakefield. He had written to Dr Wakefield on this subject because he didn't see him much. His discussion on the same subject with the other doctors had taken place face-to-face because he saw them more often; this was why there was no paper evidence of his discussions with them. Mr Miller went on to predict what the prosecution's question would be regarding this matter, ie . Why discuss clinical treatment with Dr Wakefield? Walker-Smith replied (and this is something he has mentioned before) that he wasn't aware of the limitation to Wakefield's clinical contract and had thought he was a full time clinical gastro researcher. He also noted that Dr Wakefield was an internationally recognised leader on IBD, its manifestation and treatment, therefore implying that it was perfectly reasonable and sensible to consult him.

That concluded the evidence regarding child 9 and Mr Miller then moved on to child 10. Child 10 was unique in that this was the only child who had significantly raised measles antibodies, and this was remarked upon by his GP. Professor Walker-Smith discussed the diagnostic skills he'd had to acquire where autistic children were concerned, as these children could not communicate with him. Out of this question rose the matter of whether colonoscopies were clinically indicated in these children, the prosecution line being that a number of other less invasive tests should have been investigated first and other causes of the pain should be considered, before opting to carry out a colonoscopy. Professor Walker-Smith simply informed the panel that other sources of abdominal pain, such as stones, would be rare and that these positive diagnostic features (e.g. the behaviour of the children in trying to alleviate their pain) and this type of pain were very familiar to him. He also stated that he could tell the difference between colic associated with stones and that associated with this type of pain, and that various accompanying symptoms would also suggest a gastro diagnosis. Looking at Professor Walker-Smith's evidence all round in relation to colonoscopy the prosecution are going to have difficulty proving these procedures were not clinically indicated.

Professor Walker-Smith also made the point that the tests were certainly not carried out simply because child 10's parents were keen that they should be. He stated that the parents had been painted in a bad light in the hearing but he had understood their position at the time, i.e. there was no way a parent would want their child to undergo such investigations other than to help the child. He also commented that the lab evidence (from usual tests carried out by Dr Davis) of the raised measles antibodies was unique and of interest since the whole unit was interested in the link between MMR, autism and bowel problems.

Moving onto ethics committee approval, 172/96 was given ethical approval but child 10 didn't become a part of that study or any other study, though he would have been eligible.

Regarding the colonoscopy carried out by Professor Simon Murch , on child 10, Walker-Smith stated that the reason for this was the high measles antibody and various other matters. There was then some discussion of the nature of lymphoid hyperplasia and the respective merits of colonoscopy and histological investigations. Finally, before I left, they dealt with the fact that the lumber puncture had taken place after the colonoscopy under the same anaesthetic – the reason for this was that since no other tests were being done, this was the only opportunity. Professor Walker-Smith explained that the lumbar puncture had been clinically indicated because of the history of regression and especially here because of the high measles antibody. The result was normal and, clearly anticipating the prosecution line, it was explained that this result was not something which could have been predicted, thus indicated the necessity of the lumbar puncture.

In a case with more than one defendant, evidence of the co- accused   becomes increasingly important. If none of the defendants have decided upon a 'cut-throat defence'   - one that thoroughly places the blame on another or other defendants - the path through the defence evidence of each defendant has to be carefully trodden. Every moment of dissonance will be used by the prosecution to damage not only the present witness but the other defendants. In some instances, however, it might be almost impossible, given the evidence against one defendant, not to damage another.

Professor Walker-Smith's counsel, Mr Miller, evidently struggled hard to   minimise the damage his client might do to Dr Wakefield. As well, it has to be borne in mind that some of the charges have been structured and worded with such erudite stupidity, that it would be impossible for one defendant not to damage the case of another. Take for instance the substantive charge that Dr Wakefield in telling the press briefing that it might be best to return to single vaccines until research at the Royal free was finished, was acting unprofessionally in not telling his colleagues what he would say.

It might be easy for Miss Smith to make something of this point, especially if panel members have not completely grasped what happened at the Press briefing. Dr Wakefield with the complete agreement of Professor Zuckerman, the Dean of the Medical School, and in association with Roy Pounder, the head of the hospital department in which Dr Wakefield worked, had in fact been perfectly clear about what he would say about single vaccines, some time prior to the press briefing. And when a journalist had spontaneously asked the relevant question, Zuckerman, who also supported the idea of single vaccines, had dealt it to Wakefield who answered as had been arranged. It might well be that at a later date both Professor Walker-Smith and Professor Murch , would rue Wakefield's words and obviously go so far as to say that they didn't agree with them, but that doesn't either put Dr Wakefield in the wrong or suggest that he committed a cardinal offence in having a different perspective from two of his colleagues.   Nevertheless, it is exactly this kind of transparent conflict that most prosecutors look forward to exploiting.

As I have said previously from the beginning of Professor Walker-Smith's evidence, he did everything possible to ensure that he treated Dr Wakefield with the respect and the affection that he evidently felt for him. However, there was no avoiding the fact that Dr Wakefield and Professor Walker-Smith were and are in some respects, quite different professionals who had been through quite different trials in the MMR years.

First and foremost, of course, there are their ages, and their approach to their profession. Professor Walker-Smith gives off an aura of the old school, one might even say conservative . The watchwords of the Professor's approach to medicine, would appear to be caution and constraint. Which is not to say that Dr Wakefield is an aggressive promoter or a self publicist; but while he is not the kind of doctor who would to go out into the community armed with leaflets, he clearly has a populist approach to his work. In fact one of the most striking things about Dr Wakefield and about the accusations that have been levelled against him in this hearing, is that he is clearly a man of his patients. While one might wonder about many other doctors; who they are going in to bat for, themselves, the drug companies, an ideological NHS or even an intellectual or professional establishment, the signs are written all over Dr Wakefield that he is a man acting in concert with his patients.

This is not to say of course that Professor Walker-Smith or Professor Murch are any less acting for their patients, just that in Dr Wakefield's case, his populism appears to be a major aspect of his professional persona. But something else is different about these two doctors and that is their experience. Professor Walker-Smith has spent a life time building up a unit linked through two hospitals in a major urban centre. He is a man completely committed to the organised system of medicine, he has the patience of Job and the strategic foresight of a good politician. He seems to be a man who would avoid confrontation at all costs, a man who would far rather use diplomacy.

When Professor Walker-Smith arrived at the Royal Free Hospital in late 1995, ready to take on the heady responsibility for the clinical work in a large new department of experimental gastroenterology, Dr Wakefield had been spoiling for a fight for some time. It was already four years since he sent his first letter to Dr Salisbury asking for a meeting which even then hadn't been arranged. By 1996, Andrew Wakefield, was to some extent someone who had slipped his moorings. His work was producing exciting results, but at every turn these results that had thrown him into serious confrontation with the medical, paediatric and vaccine establishment. He was still vitally involved in his work, in patients, and in research but he no longer knew to whom he was reporting. Because a large number of parents came first to him, and he had to absorb the collective pain of the vaccine damaged children and now autistic children, he was slowly turning into an activist, still acting in the interests of his patients but now appearing on the public rather than professional stage.

And it is at this point, just before the Lancet paper, and the press briefing that accompanied it, that the trajectory of the careers of Dr Wakefield and Professor Walker-Smith begin to separate.

There could, of course, be no conflict between the defendants about the evidence of the examination, treatment and diagnosis of the children. This is because, on all counts relating to these issues the GMC inhabits a peculiar 'no-man's land' where there is no evidence, no motive and no logic in their accusations: all the doctors acted with the utmost approbrium during their dealings with these vaccine damaged children and their parents.

But as the doctors rudderless boat drifted towards the Niagra of the 1998 Lancet paper, their different styles and approaches began to come to the surface.     

Professor Walker-Smith, giving his evidence – in - chief, is still very disturbed by this sudden public mauling of the work at the Royal Free. He comments that speaking to the press in this way was not at all his style. While Professor Walker-Smith did not even attend the Press briefing that followed the publication of the Lancet paper because he considered that medical science should pursue it's course through journals and scientific meetings and not press briefing, Wakefield used the briefing to express what was actually the departmental view that parents might be better using the single vaccine until the science about the triple vaccine was resolved.

In this respect, the last day and a half of the hearing last week were by far the most interesting. As soon as Mr Miller had dissected the cases of the 12 Lancet children, upon which evidence from Walker-Smith appeared as stable as granite, he moved on to look at the 'political' and 'personality' issues that clearly divided the opinions of Dr Wakefield, and Professor's Walker-Smith and Murch . From this short disclosure of Professor Walker-Smith's evidence, it was immediately apparent that Miss Smith - perhaps even without laying too much emphasis upon professor Walker-Smith's clinical work which she will have immense difficulty in calling into question - will be able to make considerable progress in analysing the differences in the personal approaches to the medical and political issues the Lancet paper and its press briefing raised. These differences, do not as they say, speak to the issues, they can not be considered 'signs of crime', although of course Miss Smith will do her utmost to make them such.

The issues that were raised after the review of the 12 Lancet children, ranged over   a wide area of what might be termed the 'politics' of Dr Wakefield's work and the manner in which he represented himself and made things public.

Entering the maze around the referral, diagnosis and treatment of the Lancet children, their is little dispute between Dr Wakefield and Professor Walker-Smith. All three doctors know that having resolved a protocol for how they might examine, diagnose and then treat these children, they did the best they could do to care for these young and vulnerable patients. Despite the fact that the children have found themselves at the centre of one of the most furious medico-political battles of the last half century, all the doctors know that faced with a new syndrome and children who were in considerable pain, they tried their hardest to find and treat the cause. They did this, whatever the prosecution says, on the basis of clinical need.

Around the time that the ethical committee approval was sought for the clinical study 172/96 - a study that never actually took place - divisions begin to emerge between Dr Wakefield and Professor Walker-Smith. There is correspondence between Dr Pegg the chair of the ethics committee, Professor Zuckerman and at least one outsider, suggesting concern over Dr Wakefield's work, with it's implied criticism of MMR.

In the lead up to the publication of the Lancet paper, the opinions of Professor Walker-Smith and Dr Wakefield appeared to diverge even more. When Mr Miller introduced the matter of Legal Aid money for research, it was evident that this left a very bad taste in the mouth of Professor Walker-Smith and he stressed the fact that he had never played any part in legal aid actions or claims for damages. Although as with a number of other things, Professor Walker-Smith appears to be complaining mainly about the precipitous nature of Wakefield's actions; it is not that he disagrees with 'going public', but it should be done when the science has run it's course and can be relied upon as serious evidence.

Professor Walker-Smith expressed the surprise that he had felt when he did find out that legal aid money was being received by the department - this knowledge was speeded on by a phone call from Brian Deer informing him, wrongly as it turned out, that Dr Wakefield had been given £55,000 by the legal aid board (as discussed in previous reports, in fact this money did not go to Dr Wakefield).

In July 1997, Professor Walker-Smith had been very disturbed to read an article in Pulse a free medical industry newspaper. The article apparently drew upon an interview with Dr Wakefield. Oddly, the paper ran with the story making public Wakefield's first suspicion that there might be a link between MMR and autism. The resultant article seeped into other news media and for the first time there came a suspicion that serious conflicts were lying just beneath the surface. Professor Walker-Smith said that his position had always been that there should be no contact with the media until the results of research were published in a peer reviewed journal. The fact that Pulse had reported that there were five as yet unpublished studies made him 'very very uneasy' and filled him with 'considerable foreboding'.

Walker-Smith was next concerned about a meeting that had been arranged with Tessa Jowell , he couldn't understand, he had said at the time, why Dr Wakefield should arrange such meetings and give such interviews to the media when they were so close to publishing the case review. But by now each person was seeking refuge in their own safest arguments, and professor Walker-Smith was little interested, for instance, in the fact that Dr Wakefield had asked for a meeting of this kind almost six years ago, nor was he aware of the setting up of JABS and the rising consciousness of the parents who were beginning to campaign in many different ways.

When it came to the press briefing, even though this had been organised by Professor Zuckerman, Professor Walker-Smith was clearly against it. He made it clear that they had never had any media attention at Bart's. He didn't go to the press briefing and in answering Mr Miller's questions about it, Professor Walker-Smith made his distaste very clear when he said, 'I don't think it was right to discuss such things at a public meeting'. And he re-iterated his view, which must be evident even to the blind prosecutors, that the Lancet paper had been quite clear about the fact that it did not state a proven link between MMR and autism. He shook his head, about this matter, evidently still troubled by it and said clearly like someone regretting an avalanche; '…everything that happened grew from the extraordinary press briefing'.  

But this again points to the considerable difference in analysis and perspective between Walker-Smith and Wakefield. I'm sure that. were one to get Andrew Wakefield to comment on this statement he would most probably interpret it as: '…everything that happened had been happening for six years or so'. When Mr Miller eventually went through the specific charges against Walker-Smith, quite rightly he became quite agitated on re-hearing a number of them, in particular those which accused him of dishonesty. One angry exchange, ended with the Professor answering the charge that he had examined the children with research rather than clinical need in mind, with the words: 'Why would I, what would be my motive?'

And of course this exchange brings one of the most important matters, that of motive, into sudden focus. Why would Professor Walker-Smith with a forty odd year blameless career behind him, risk it all to carry out experiments on sick children. Those who could show the absurdity of this allegation, the parents, of course have not been brought to the GMC or allowed to express their perception of the care that Walker-Smith had afforded those very ill and disturbed children.

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At mid-day on Thursday 31st July, Professor Walker-Smith finished his evidence-in- chief, he had been at the witness table for just over two weeks. The barristers, as appears to be their collective wont when a new subject opens, awarded themselves a day and a half rest, agreed by the panel Chairman. The possibility of what might happen if these barristers and the panel Chairman were transplant surgeons, is intriguing.

'Well we've finished opening him up, we're done with that part', Mr Miller might say looking at the anaethetised patient on the operating table, the flesh of his abdomen wall, held back with clamps.

'I was just wondering, as we are moving to a completely new matter, the removal of the liver, and as it's approaching three thirty anyway, whether or not we might take a break and start again in the morning. Everyone looks dubiously at the opened body under the glare of theatre lights.

The Chairman looks to Mr Koonan on the other side of the Theatre, who, beneath his mask is vigorously stroking his beard.

'I'm not going to be long at all, just a bit of mopping up and a couple of stitches. I'm quite happy to leave this until after the weekend'.

'How does Professor Murch's representative feel about this?'

'Well, we have had the new organ for some time, although after seeing the work that Mr Miller has just completed we might find that we need to have a few more days to understand exactly what he did'.

'Oh, and of course', The Chairman languidly turns to the end of the operating table, 'We should not forget the anaesthetist Miss Smith'.

A razor sharp grin flits across Miss Smith's face.

'I did give the patient quite enough to keep him under for a couple of days and, yes, we would like the opportunity to examine Mr Miller's work more closely'.

'Well that's that then, thank you gentlemen and of course Miss Smith'.

The Panel Chairman casts his eyes round the operating theatre and sees that there is no dissent.

'I think we can safely say that we can adjourn until Monday morning'.

He looks intently into the closed eyes of the patient.

'I am sorry about this, I know that you have been in and out of the hospital over ten years now waiting to have this operation, but I do have to remind you, please, not to talk to anyone else about the treatment you have received on the NHS. It is important that you don't move and obviously you can not have anything to eat. If you happen to come round before Monday we will be leaving a bottle of sleeping tablets next to you on the gurney'.

Everyone begins to leave the theatre as a nurse tents a green cloth over the patient's open abdomen.