The Utter Irrelevance of Professor Salisbury

by Martin J Walker

Monday 13 August – Thursday 24 August

The inability of prosecution witnesses to attend the hearing through illness or some other cause can be a difficult matter for the defence. This is partly because witnesses who have anything contentious to say should be required to make their accusation directly to the defendants and should be available in person for cross examination.

In the case of the witness whose statement was read on the afternoon of Monday August 13, Mr Koonan, while not objecting to the statement being read, had to say that it was not accepted by the defence and the details of it would be disputed when the defence presented its case.

Miss Smith then proceeded to read the statement of Russ Phips into the record. Phips was an Assistant Director of Finance from 1991 – 2006 and the financial administrator of the Special Trustees at the Royal Free. The statement bore witness to the fact that the money which had arrived at the Royal Free from Dawbarns solicitors had been initially lodged with the Special Trustees and then paid out to Dr Wakefield, so creating the conflict of interest which they are so keen on proving.

This of course seems to be a good point for the prosecution and they have pursued it throughout the hearing. However, like much of the prosecution case, the point has now proved to be wrong. The money sent on from the Legal Aid Board and deposited with the Special Trustees was, in fact, paid out immediately to Ros Sim a Medical Laboratory Scientific Officer concerned with viral detection at the Royal Free.

It was difficult to understand exactly what Mr Phips was saying about the money which originated from the Legal Aid Board. To put it in common parlance it seemed, very much, as if he was suggesting that there was an attempt to ‘launder’ the money through the Special Trustees before paying it into Dr Wakefield’s general research funds.

The next morning Professor Ravel gave evidence. To a great extent, Professor Ravel was a typical prosecution witness; short on facts which might incriminate the three defendants and obviously unsure of what was expected of him. This circumstance was illustrated by the Professor when he was being led through his evidence by Miss Smith. At one point, his flow on an important matter was interrupted, he thought for a moment and then said:

'I've forgotten what I was going to say'

To which Miss Smith blithely responded, ‘Don’t worry’ and passed on to the next issue.

Miss Smith’s continued in her attempt to assert, this time through Ravel, that Dr Wakefield was somehow experimenting, without permission and unethically, on children. This previously ill-fated line of attack took another turn when she tried to insinuate into the evidence the idea that Dr Wakefield’s unit might be illegally and unethically taking biopsy samples from children and then using these for research.

Professor Ravel, however, had nothing bad to say about the clinical methods of the gastroenterology team. He gave evidence about the histology group, which came together to scrutinise clinical cases, and to look at biopsies and samples taken during internal examination. This evidence succeeded simply in shedding further light on how a dedicated group of doctors worked with considerable commitment in a collegiate atmosphere to come to the best conclusions on behalf of their patients.

Having spent many wasted Saturday evenings watching programmes like Casualty, the evidence which began to blossom about the histology meetings ran completely contrary to my received opinion of how doctors in large hospitals work. It would never have occurred to me that, in a profession which is always portrayed as being full of egotists, collective discussions about diagnosis and the outcome of various procedures might be profitably held.

One of Professor Ravel’s tasks as Joint Head of the Department of Histopathology, was to police the taking of biopsy and other samples which might be snipped from patients bodies during this or that procedure. My mind was filled with cartoons of hospital administrators, acting as the docks’ police did before and just after the second world-war. Every worker was searched for stolen goods as he left for home through the dock gates. ‘So what ‘ave we ‘ere chummy, a little bit of bowel. OK, over ‘ere, empty your pockets, drop your pants and lets have a look in your orifices.’

Oddly enough although Ravel’s task had led him to ask questions about the biopsy material taken from the children, these samples had all turned out to be ethically accounted for. Further than this, he made the point that often when doctors do try to slip human material out of the operating theatre, it turns out usually to be at the behest of pharmaceutical company trials for which patients permission has not been sought.

It turned out that Professor Ravel had been the person who was asked to asses at least two of Dr Wakefield’s project proposals. In both cases he was happy to give approval to these studies. About one of them he said, as if taking it for granted, It was ‘a well prepared document; a good example of that kind of study’.

A Second Lancet Paper

The unlikely named Professor Candy is a consultant paediatric gastroenterologist and a highly qualified peer reviewer of 20 years standing for the Lancet. Whilst Richard Horton had already alluded to it in passing, it was only when the professor gave his evidence that a ‘partner paper’ came into focus. This paper, explaining the science behind claims of a link between Inflammatory Bowel Disease (IBD), persistent measles virus and regressive autism/CDD, had been handed to the Lancet at the same time as the now infamous 12 child ‘case-series’ paper.

For the uninitiated, a frightening picture now emerged of the prosecution presenting for the first time robust evidence that Dr Wakefield’s science left a lot to be desired. Professor Candy, however, turned out to be a real sweetie and yet again a great patron of the defence.

Apparently, Dr Wakefield and other signatories had expected both papers to be published in the same issue of the Lancet. In the event, the scientific model underpinning the ‘case series’ paper was turned down by two peer reviewers but supported by Professor Candy; not just supported, we heard, but supported in glowing terms.

Candy’s evidence was an eye opener for those who had often wondered about how peer reviewers work. He told an interesting story of a field which had become gradually more open over the last twenty years.

Professor Candy’s first comment about the ‘partner’ paper was that it was well written. This was stated as a throw-away line, and he followed with a barely surprised comment that this was only to be expected. ‘Professor Walker-Smith’ Candy said, ‘has written text books which are very lucid’. This was not the first, not would it be the last praise for Professor Walker-Smith’s reputation and his considerable body of work, which included a number of text books.

On Professor Walker-Smith, when I see him at the hearing, my thoughts are thrown back to the pompous, angry and defensive Professor Zuckerman, who insisted on saying that giving evidence against his colleagues was painful. Although I have no reason to assume Professor Walker-Smith, now retired for 5 years, is not holding up as stoically as the other defendants, his general demeanour exudes a world weariness which is sad to observe.

Although the emphasis throughout this whole affair has been on the injustice done to Dr Wakefield, we should always be mindful of what Brian Deer’s complaints to the GMC are doing to Professor Walker Smith. To end an entirely meritorious career in medicine with this smear of a trial is a calamity almost unbearable for a person of such obvious integrity.

The position of Professor Walker-Smith is testimony to the lengths that politicians and the medical establishment will go to keep faith with the pharmaceutical industry; to break an exceptional physician on the rack of cynicism and profitability. In all such matters I am guided almost entirely by the parents with whom I have spoken. To witness the warmth and respect that they show to Professor Walker-Smith gladdens the heart. I hope that he is aware of the affection in which he is held and that in turn this provides strength and solace.

Professor Candy’s remarks about Professor Walker-Smith were immediately followed by very flattering statements about Professor Simon Murch and Dr Thompson, whom Professor Candy informed the Panel were the two best endoscopists in the country.

Professor Candy, a learned looking man with white hair and glasses had begun giving his evidence at 12.15 and by 12.40 any fears that the prosecution had called a good witness for their case had evaporated. In fact Professor Candy got quite carried away, falling into the vernacular, with his enthusiasm for the second unpublished paper.

The second paper demonstrated measles virus protein in the gut of some of the children whose cases were reviewed in the published paper. ‘It was like a double-whammy’, he said ‘clinical observation backed up by good science.’

Professor Candy said that he was upset and surprised when the Lancet published the first paper without the second, and even more surprised when the publication of the first paper was accompanied by an editorial which suggested that there was no evidence presented for the strength of the measles virus in the gut of the children cited. This information was in the second paper, he said, and it was his opinion that both papers should have been published together; that the first paper was supported by the second. In Candy’s opinion the two papers were ‘indivisible’.

When Mr Koonan began his cross examination of Professor Candy he had little difficulty in consolidating the points which had already been brought out in his evidence-in-chief. Both papers, he said, ‘were well written and needed no significant criticism from him.’ He said that ‘the findings of measles antigen in the bowel of the treated children, some years after exposure, seemed to me to be revolutionary’.

The whole peculiar incident of this paediatrician’s evidence reminded me of the rule, doggedly adhered to by quackbusters and sceptics across the globe. While such people moan and keen over the subject of junk science, when faced with the genuine article they simply refuse to discuss it. While claiming that only science matters, in the majority these people show themselves to be ignorant of human motivation, honest purpose and most of all science in the public interest.

In fact both Mr Koonan and Mr Miller were able to make major consolidation over the work of the team who authored both Lancet papers. Almost at the end of his cross examination at 2.25, Professor Candy made the statement which all three defendants will be able to look back upon with pride.

‘The findings of the papers’ he said, in his opinion ‘were watertight’.

A Spratt to Catch a Mackerel

As the evidence continued to pile up for the defence and after an awful morning of waiting and false starts while the inner circle sat round negotiating agendas and doing what they like to call ‘housekeeping’, we were forced to listen to another statement of another absent witness, read into the hearing record by Miss Smith.

This witness, Dr Clifford Spratt, whose name bore an uncanny similarity to that of Lancelot Spratt the pompous and egotistic consultant played by James Robertson Justice in the ‘Doctor’ films, was a resident of Jersey, where he had treated child 9. However, Spratt, the victim of a heart condition and therefore not robust enough to travel through central London, let alone be taken through his paces by Koonan & co., was far from a shrinking violet when it came to criticising the clinical or research views of Dr Wakefield.

When he found that the mother of child 9 was insistent that the damage done to her son had been caused by MMR, Dr Spratt swam straight to the phone and called his friend Dr (now Professor) Salisbury. Asked to make additions to his statement, at a date near to the hearing, Dr Spratt told the GMC; that he didn’t think that child 9 had any kind of bowel disorder; that he didn’t think that there was any link between MMR and this child’s autism; and that in his opinion the child’s autism was of unknown cause.

Mr Koonan, was quick to point out to Miss Smith that while Spratt’s evidence was admissible, if read to the panel, the defence did not agree with it and the panel should be advised upon its lack of weight while it stood uncontested.

Two Days of Excruciating Boredom

When I was 15 and at secondary school, President Kennedy suggested that his US marines could easily route-march 50 miles. I can’t imagine how, but this inanity became a bye-word throughout Britain for fitness amongst teenage school children. All kids of my age, at schools like mine got shoed into a similar walk. I can remember thinking when I was thirty miles out of Manchester, with my feet blistering and my brain deadened in the half-light of night, that this is what Hell must be like.

The next two days of the hearing were just like that, as pure boredom dragged my feet and my hands alternatively between sleep and jerky autonomous movements. Fortunately, it was during the evidence of Dr David Howard Casson, now of the Royal Liverpool Children’s Hospital that the most exciting, and hilarious incident of the hearings occurred, when Miss Smith showed a previously un-revealed talent for clowning in the best tradition of Chaplin and Keaton.

Dr Casson was giving evidence for the prosecution because he had been responsible as a Registrar, for ‘clerking in’, to the Royal Free the majority of children who made up the ‘case-series’ reviewed in the Lancet.

Dr Casson was in the main a reluctant witness, perhaps because, just like other witnesses, had he agreed with Miss Smith that Dr Wakefield was involved in hole-in-the-wall research conspiracies, he would inevitably have implicated himself in the prosecution case. Because Dr Casson appeared to know next to nothing about the case-series or about any other research which went on in his department, Miss Smith concentrated on the endoscopies. In between the silent responses of much unrecalled information, Miss Smith managed to prise out the details of each endoscopy and the details of any other procedure to which each child had been subjected.

Miss Smith tried her hardest to present the clinical work with the children as a kind of conspiracy of satanic abuse. Because of this, she inevitably appeared lost in a maze, not tall enough to see over the hedges to know where her questions were taking her. Her questions yet again seemed only to endorse the fact that with each child the tests were necessary for a correct diagnosis and thereafter for proper treatment.

Dr Casson was mainly responsible for seeing each case through the hospital, from referral, during a week’s in-patient treatment, through investigative procedures usually on Mondays and then into histology discussion, usually on Fridays, before finally writing the discharge notes to the child’s GPs.

Had it been the case that Dr Casson’s evidence had revealed a dark conspiracy at the heart of the Royal Free Hospital; doctors abusing the trust of patients and failing to get parental or ethical consent for invasive investigations; discernable trauma and physical damage to the health of children; if the doctors had clearly been working for profit and personal aggrandisement, at war with parents; had any of this been the case Dr Casson’s report would have been anything but boring. However the doctors were simply doing what doctors do. Until, that is, Brian Deer and associates decided that they should be struck off for it.

It was not just the fact that each child’s case was discussed in detail which made the exchanges between Miss Smith and Dr Casson exceptionally boring. In fact one real joy of the hearing to a lay person has been that the description of the workings of a department within a large hospital has been a revelation. No, it was how Miss Smith disassembled the evidence of work. It was as if Miss Smith took some printed stanza’s from Shakespeare, cut them up with scissors, reassembled them and then began a literary analysis of their meaning. Miss Smith seemed to be examining the arms and legs of a cadaver without understanding they were joined to a body.

Stoic as always, she tried to glean as much from the evidence as possible, Ms Smith dragged Dr Casson through a detailed clinical and administrative review of the 12 children associated with the Lancet paper. None of the cases provided a single dramatic moment, not once did Casson respond to Miss Smith’s fishing expeditions, which attempted to show that the clinical investigations were unnecessary and that some of the children had no bowel problems at all. Casson, despite remaining a reluctant witness, despite tinting his evidence with a few distancing remarks which ensured that he was not seen as a ‘friend’ of Dr Wakefield, gave nothing to the prosecution.

Yet again one was left to wonder why, despite her best efforts, Miss Smith was actually consolidating the case for the defence. For the public gallery, however, the stultifying boredom of the continuously repeated questions wiped away all thought of motive or continuity in the case, numbing the mind to sleep.

When Mr Miller, counsel for Professor Walker-Smith, stood to begin his cross examination after a break at 3.15, it was difficult to see how this could be any less boring than the evidence already elicited by Miss Smith.

While Miller took Casson through the details of his CV and his work at the Royal Free, I found myself studying Miss Smith. I wrote in my notes that she always carries her largish handbag with her, grasping her arm in front of her. This pose, I realised suddenly, was reminiscent of Mrs Thatcher. I began to wonder whether this was a class thing. For the next hour and a half Mr Miller sketched in some of the more general salient points about Casson’s evidence, without discussing the detailed circumstances of the 12 children. He made it clear that he needed a day’s continuous time to address these circumstances.

When Mr Miller began his cross examination at 9.30 on the morning of Tuesday 22nd he went straight into a review of medical process, beginning with the general parameters such as consent forms for invasive procedures and then focusing on the specifics in the case of child 2.

Mr Miller’s detailed portrait of 2’s medical and administrative treatment during his week at the Royal Free hospital was masterly. To compare it to any of Miss Smith’s process narratives of yesterday would be like comparing Michelangelo’s work in the Sistine Chapel with a Jackson Pollock. For the first time since the hearings began, we saw the hospital and the department of paediatric gastroenterology within it, as a living organism. Mr Miller, like a good sociologist, articulated a structure of diagnosis and care which has been built up and perfected by physicians over a long period.

When he had finished with child 2, Mr Miller had convinced me at least, that custom and practice together with the skills of the specialists involved, made the Royal Free at the time in question the safest place to send ones child. If, that is, your child is suffering from an undiagnosed condition following vaccination. With that first patient presentation, the already chimerical prosecution case suffers yet another serious blow.

Mr Miller’s review of the other 11 children consolidated this impression. It added to the general picture of an efficient department, working in an orderly and well regulated manner and it took us a jet journey away from the portrayal of Dr Wakefield as a lone maverick. The hospital described by Mr Miller, with the help of Dr Casson, was one where a large number of doctors worked co operatively and professionally.

By 4pm Mr Miller had finished the section of his cross examination of Dr Casson where it related to the 12 children in the Lancet paper. He moved on, then, to address some broader questions before he ended for the day.

Dr Casson had a hard time, in the ‘witness box’ over two days. His reluctance made more determined by the fact that he must have had only a blurred idea of where the questions were going and whose case his answers were helping or hindering.

Miss Smith acquaints herself with the Carpet

It was at this time, just as Mr Miller was beginning to wind up his cross examination that Miss Smith moved to add immense levity and some concern to the proceedings.

Just to remind readers of the lay out of the hearing. The prosecution all sit at one table which stretches across the width of the room. Miss Smith sits in the centre of the table in relatively cramped conditions, with files stacked high behind her and books, papers and files littering the table around a box which doubles as a lectern in front of her. At the table with her, to her left as she looks down the long room, are her two male junior counsel. Facing her about 50 feet away is the witness. Down the left wing of the room, the panel and GMC administrators. Down the right wing the defendants, their counsel and solicitors. The circumstances of the hearing are relatively formal and the black clothes common to legal proceedings make for a quiet reverential process.

Miss Smith cuts a very singular figure partly because all the other leading counsel are men and partly because her appearance is distinctive; she has presence. Her silvery blond hair is cut short around the nape of her neck and while she dresses in black her white face has the sharp angularity of a Walt Disney cartoon character.

At four o’clock, while Mr Miller was still cross examining Dr Casson, Miss Smith, always working, always digging out papers to help her cause, rose from the table and turned to face the bank of ‘evidence’ files which ran behind her across the room. She took a couple of steps along the wall of files, then without falter fell, pole axed, to the floor. This appeared to be no untidy trip, no stumble or faint, but a full-blooded head-first dive into the carpet. Miss Smith lay still but definitely conscious. In fact, listening carefully one might have heard the constant question circulating in her mind as she tried to decide how to deal with her new, incredibly embarrassing position on the carpet.

As she partially disappeared from view and hit the floor, a Mexican wave swept round the hearing room tables and almost everyone was on their feet. Some moved quicker than others to go to the aid of Miss Smith, her junior counsel moved not a muscle, nor did Dr Wakefield, the nearest doctor to her (Could be grounds for a professional misconduct hearing some time in the future?). Only the witness, Dr Casson, the furthest person from Miss Smith, actually moved paces closer to her as he started off like a sprinter out of the starting blocks, round the tables.

Having come to a lonely decision about how she might stand and face her audience, Miss Smith rose from the floor and with her back to the hearing stared at the wall of file boxes before her. Watching her trying to recover herself, I was reminded of an occasion, when looking down from the window of my high rise East London flat, I saw a young guy kick a lamp post after he had run his car into the back of another parked car. I wondered if Miss Smith was contemplating a swift kick or head-butt to the boxed files, instead she turned with considerable composure, a wry self-deprecating smile on her face, and sat back in her seat.

The Panel chairman at his most ministerial, suggested it might be time for a break, but his usually strong voice trailed off as Miss Smith shooed the idea away with her hand and aggressively told him to carry on. Within minutes of Mr Miller’s cross examination beginning again, it was as if Miss Smith had never been prostrate on the GMC’s utility carpeting. As if everything was as it should be.

The afternoon session finished at 4.30 and the Chairman announced that the hearing would convene earlier the next morning, so that Miss Smith might carry out her re-examination and finish with time enough to call the next witness Professor Salisbury.

Professor Salisbury Gives a Lecture

Professor David Maxwell Salisbury, director of immunisation at the Department of Health barrelled into the GMC hearing like a man about to retrieve his car from a garage but wanting to haggle over the cost of the work. Miss Smith took him too slowly through his career awards, so he grabbed the declaration from her and set off at a brisk trot evidencing every WHO committee, virtual and real, upon which he had ever sat.

This was, in fact to be his style throughout his ‘evidence’. He took each question as an opportunity to give a short lecture on the history, effect and efficacy of vaccination policy. But then in Mandy Rice Davies’s oft quoted words, ‘He would say that wouldn’t he’. Those people who later expressed shock, or at least surprise that Salisbury had maintained that the MMR vaccine worked efficiently, clearly misunderstood the whole point of the prosecution calling him in the first place.

Professor Salisbury should never have been a witness in this hearing and his presence there only confirmed the surreal nature of the charges against the defendants. Salisbury had nothing to say which was relevant to the charges. He was brought by the prosecution to muddy the waters, to make the panel believe that Wakefield et al were charged with spreading alarum and despondency about the government vaccine programme. Although the GMC would no doubt have liked to have brought charges which echoed this Orwellian idea, unless it was framed as a charge of conspiracy this was never possible under British law.

They brought him, thinking that arriving late and with ground prepared, he could administer the coup de grace. Sadly, this was not to be. Salisbury could say nothing of evidential value about the specific charges and while he was not an expert witness of any kind, he ended up giving evidence on the theoretical and conceptual implausibility of the ideas which Dr Wakefield and others had put forward linking MMR to regressive autism.

Counsel for the defence were determined not to give Salisbury any more space than he himself grabbed from the hearing, and chose not ask him any questions in cross examination. The embarrassed silence which followed this collective denial of opportunity was amusing; there can be no doubt that Salisbury had settled into his chair anticipating a limitless opportunity to sound off about his own and the government’s greatness. In the event he quickly metamorphosed from a preening cock to a deflated balloon.

The refusal to cross examine might appear risky, in that it seemed to let Salisbury off the hook with respect to important and simple questions such as: ‘Why did it take you two years to respond to Dr Wakefield’s first communication with you, which warned the DoH of a public health crisis over MMR?’ and ‘Why did it take six years for you to organise a meeting with Dr Wakefield to discuss his ground breaking research?’ and finally, ‘Did you intend to suggest in your evidence that Dr Wakefield was trying to blackmail the Department, by suggesting he would precipitate a public health crisis unless you gave him money for research?’

All the facts relevant to the charges against Dr Wakefield, Professor Murch and Professor Walker Smith will of course be given in evidence by the defendants themselves. If they remain accused. Dr Wakefield, in particular, will be able to inform the panel about the considerable evasion indulged in by Professor Salisbury and the Department of Health from the time that they were first informed of the epidemic of adverse reaction to MMR.

A few issues raised by Salisbury’s evidence are worth commenting on here. Without eliciting a tsunami of self congratulation it might have been worth asking Salisbury how, exactly, he came by the Professorship bestowed on him only weeks, it seems, before the GMC hearing.

More important is the matter of how much Salisbury actually knew about the press briefing given before the publication of the Lancet paper. In cross examination, the defence had previously put it to Professor Zuckerman that he had co-operated with the media committee, and with Dr Wakefield, in their plan to make clear their view of MMR and regressive autism. Professor Zuckerman, who had chaired the media committee which organised the press briefing had, it turned out, been appraised of the intention to propose a return to the single vaccine.

In evidence, Zuckerman had denied this. A letter from him to Dr Wakefield produced in evidence, however, twice stated that in the event of a question being asked, he hoped that Wakefield would push the use of monovalent (single) vaccine. When asked about this letter in cross examination, Zuckerman had said that the twice used word ‘monovalent’ was on both occasions a typing error, and it should, of course, have read that they should push the ‘polyvalent’ (triple) vaccine. This was almost plausible, but if it was not true it hinted at a much deeper conspiracy on the part of the establishment than even I had imagined.

As Miss Smith, heroine of the defence, led Salisbury through his evidence, she presented him with a letter written by Roy Pounder head of Wakefield’s department, to the Department of Health. A letter which Salisbury had seen. The letter, according to the twisted narrative of the prosecution, was supposed to be an example of how the Royal Free research team had constantly tried to blackmail the DoH. In the letter, Pounder had notified the Department of their intention to recommend at the press conference that parents ask for the ‘monovalent’ vaccine. He wrote, Pounder said, making this clear because he did not want the NHS to be caught short when requests for the single vaccine were made. ‘Did they have sufficient stocks?’ he asked. Now, unless monovalent was also a typing error in this letter, a nightmare picture of conspiracy and deceit is beginning to unravel in the GMC hearing.

The other considerable matter which Salisbury onanistically droned on about was his department’s determination to understand public perception of the various vaccinations. He introduced this matter by suggesting that no one else (no other government) in the world was able to track the take-up and public perception of vaccines in the way that the British government could. The data on public perception of vaccine was massive, he said. The survey methods were infinitely sensitive, the government even knew what newspapers respondents read. In all, Salisbury and his colleagues had carried out 30 surveys into the public outlook on vaccination, costing millions of pounds.

Listening only lethargically to this ‘evidence’, one might be moved by it. ‘The government really is interested in the public experience of vaccination’, an observer might think. Of course nothing could be further from the truth. All this data, all these surveys, all these millions of pounds have been spent in order to advance the marketing of vaccines and to plan public relations strategies which will ensure that the public accept the vaccine programme without question. This is nothing to do with science, this is jury rigging.

At this point in Salisbury’s evidence I came near to shouting out - ‘How much has the department spent and how many surveys have they carried out on the study of adverse reactions?’ Actually, this would have been a stupid question because, despite the fact that Salisbury would have responded by describing the yellow card system, I actually know that millions of pounds worth of research is carried out into adverse reactions, not by the government but by large private research companies.

These multinational companies work directly for the pharmaceutical cartels, which, after all, have very good reason to monitor adverse reactions. These companies conduct the most detailed research, by contacting general practitioners and getting lists of those prescribed drugs or given vaccines. The doctors, nurses and patients are all intensively interviewed about the effects of prescribed medications. It is on the basis of this information that pharmaceutical companies change drugs or withdraw them from the market, with as little publicity as possible.

Does the DoH conduct similar research or fund these research companies to carry it out? No, of course not. Is there an obligation on pharmaceutical companies to provide such data to the Department of Health? No, of course not. In all the much vaunted PR research conducted by Salisbury’s department, it is not public health which is leading the research, but public perception of government and the defence of pharmaceutical profitability.

Unfortunately, however, the present hearing will furnish us with no answers to important questions about the working of government and pharmaceutical companies. The defence has a specific objective to realise in the hearing and that is to prove beyond doubt that the defendants are not guilty of the charges. This limited objective can best be achieved without giving people like Salisbury the chance to ‘run off at the mouth’.

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Since the virtual collapse of the prosecution case two weeks ago, we have seen Miss Smith increasingly making objections to cross examination questions put to witnesses by Mr Koonan and Mr Miller. I’m sorry that Miss Smith doesn’t seem to understand how demeaning and petty these objections appear. One can only assume, as she has been overruled by either the Chair or legal assessor of the panel on almost all occasions, that she is making them in order to break the flow of the defence argument implicit in the questioning.

When I think how the defence sat quietly while Miss Smith asked the General Practitioners fruitless questions which fell a million yards from the tree of evidence-rules, I find it hard to stomach. Because it didn’t suit the prosecution to bring parents to give evidence at the hearing, Miss Smith tried to prise parent information from the practitioners. This resulted in questions of this kind: ‘What do you think the mother was thinking when she suggested you referred child x to the Royal Free?’ and ‘Where did the mother get the information from about the work of Dr Wakefield?’ and ‘How had the mother decided that MMR caused the damage to her child?’

I was also concerned last week, by a reference Miss Smith made to the fact that the hearing ‘does have an enquiry aspect’. Is Miss Smith reading our site?