Denouement for the MMR scare – updated

In which Dr Aust looks back over four years of commenting about MMR, and many more years of a modern tragedy

In just a few hours Dr Andrew Wakefield, of MMR infamy, will be facing the General Medical Council (GMC) for what is almost certainly the final time. The GMC Hearings calendar says:

“Update: It is now expected that on Monday 24th May 2010 at 9.30am the Fitness to Practise Panel will announce the final determinations on serious professional misconduct and, if necessary, sanction in the hearing of Dr Andrew Wakefield, Professor John Walker-Smith and Professor Simon Murch.”

It is widely believed, after the damning GMC findings released back in January, that Wakefield will be “struck off” – removed from the register of licensed medical practitioners. Even the man himself seems to think so, as publicity for his book – yes, he has written a book* – on Amazon says:

“In the pursuit of possible links between childhood vaccines, intestinal inflammation, and neurologic injury in children, Dr. Wakefield lost his job in the Department of Medicine at London’s Royal Free Hospital, his country, his career, and his medical license

Does he know, er, something we don’t? Anyway: today.  And if you want a preview and a bit of a retrospective, Brian Deer, the man above all responsible for exposing Wakefield, offers both in the Sunday Times.

Words, words…

Now, over the years I have been writing on the blogs and forums – it is roughly four years, since the early Summer of 2006 – I suspect I have typed in more actual words about the MMR farrago, and Andrew Wakefield, than about anything else. Indeed, he, and the press coverage of his work and its aftermath, probably did more to make me into a blogger than any other single instance of media misreporting of science.

You won’t find many of these words here, though.

I have, in fact, not done all that many actual blogposts on MMR. I have done most of this writing in comments threads. Sometimes I try and stick to correcting obvious misconceptions about things that are sort of scientific, or that I know a bit about – aluminium in vaccines, or formaldehyde in vaccines, or antibiotics in vaccines, or thimerosal in vaccines (which it usually isn’t). But I have also, against my better judgement, got involved in some long arguments with the anti-vaccine mafia, e.g. on autism blogs, or at the Guardian’s depressingly troll-infested Comment is Free, and at the now sadly disappeared NHS Blog Doctor blog.

These arguments have actually involved some of my most seminal internet commenting experiences. For instance:

- I have been denounced for being pseudonymous by several of the anti-vaccine zealots  (if you want to see one reason why I have a ‘nym, keep reading).

- I have had comments “deleted by a moderator” at Comment is Free –  the only place I have ever been deleted, apart from on some of the madder homeopathy blogs.  Apparently at CiF it is non-PC to call a conspiracy theorist a “conspiracy theorist”, something  I would argue is a simple statement of fact when it is demonstrably true.

- I have, in a rare bit of writing under my real name a few years back, been “trailed” back to my medical school website by an anti-vaccine campaigner. He then picked the names of a couple of pharmaceutical companies off the list of “organisations the Faculty have ties with” – note this usually means something like “funds a student prize in” – so that he could smear me on the thread where we were arguing with:

“I notice there is no response from Dr Aust of the Faculty of Science at the University of Snarkfield, corporate partners EvilPharma and BigPharma”

- yes, the  famous Pharma Shill Gambit, favourite opening salvo of conspiracy theorists and health crazies.

But nonetheless, despite all the commentary, there have been fairly few actual posts.

This is partly since all one could think of to say about MMR would typically already have been said much better. For the MMR saga has generated a vast amount of skeptical coverage, reflecting its status as the mother and father of all “bad science” stories.

Above all, the peerless Brian Deer has dug into Wakefield’s lies and evasions, doggedly and relentlessly, until ultimately the whole edifice of Wakefield’s carefully cultivated image as “the caring doctor” came tumbling down.

Ben Goldacre has documented, over many years and many articles, the laziness, conspiracy-theorising and scare-mongering of the media that helped give birth to, and sustain, the scare.

And other Badscience bloggers, like jdc325, Holfordwatch, and infectious disease doctor DeeTee have done their bit too.

Not to mention the many excellent autism sites that have covered each twist of the story in exhaustive detail, like Left Brain/Right Brain and Action for Autism

And there are many, many others, who I haven’t time to mention here.

So I have only rarely felt I had anything much to BLOG about on the MMR scare. But I like to feel I have done my bit in the comments department.

Indeed, the MMR scare was one of the first things I found myself commenting on over at Ben Goldacre’s Bad Science blog – see e.g. this thread about MMR from June 2006, where you will find me, er, holding forth.

And it was also one of the frst things I commented on over at the Bad Science forums. You can see a typical four-year old comment here.

I will quote one bit:

“People in science and medicine that I know find the determination of Melanie Phillips et al to see Wakefield as a “wronged crusader for the children” utterly barmy. That is as restrained as I can put it.”

Indeed, probably the thing I have written about most in commenting on the MMR scare was this idea that, given the trust parents had placed in Wakefield, and their belief that he was a caring and sympathetic doctor, he could not possibly be a “wrong ‘un”.

Another aspect of this is the belief, fervently-held among many of Wakefield’s followers, that he was a scientist of the highest class, and that his record of publications meant, again, that his scientific standing and integrity were beyond question.

Of course, this is nonsense, not even in any way specific to Wakefield, but simply because scientists – and doctors-turned-scientists – are human beings. They are not wholly dispassionate and logical. Anyone who works in science, like me, can tell you this, if it wasn’t already blindingly obvious. There is a thread talking about it over on the scientiists forum Nature Network right now.

Scientists are human.

They have pet theories. They have hobby horses.

Some even have idées fixes.

Andrew Wakefield, as was obvious long before his work on the children in the Lancet paper, had an idée fixe about the MMR vaccine. In particular, he had earlier tried to finger the vaccine as a cause of Crohn’s Disease in adults, an idea which got a little bit of attention in the literature and then sank without trace, as ideas which do not pan out tend to.

Plus: here is something else that anyone in the business can tell you. As human beings, researchers – whether, scientists or doctors, or doctors-turned scientists – face ethical challenges.

For instance:

- How much data editing is “making the true pattern emerge from nature’s noise?”

- How much is “making the data fit the hypothesis?”

- And how much is “research fraud”?

Now, these are real questions, and they are not a secret, and we debate them in PhD student training programmes. Indeed, I once even got to debate these things with Ben Goldacre at just that sort of forum. But they are everyday questions that scientists face. We wrestle with them, and we see our colleagues wrestle with them.

Most people are after the truth, and understand that they are fallible. So they try and watch themselves for “wishful thinking”.

Some are not so good at it.

And still others are so blinded by their pet theories, or their ambition, that they cross the line.

And some can’t even see that they crossed it.

Now, if you work in scientific research, you see all sorts.

You see some people who would no sooner “tweak ” the data than they would murder a bunch of people.

And you see others who are more “flexible”.

And just occasionally you may come across someone who is so convinced of their pet theory, and perhaps of their own brilliance, that people in the field will mention their papers with a special raised eyebrow that says “Don”t be too sure of anything coming out of this lab”

Which is, of course, one of the reasons why it is so important that science is a collective-but-also-competititve endeavour. Results get picked over. More spectacular or ground breaking results more so. Experiments get repeated. People compare their data with other peoples’ data. People look and say:

“Well if this is true, then we should be able to see this too, with our method”.

And so on, and so on.

And if, after all that, a result doesn’t stand up, people wonder how the result came out the way it did. Maybe it was an error. Maybe it was an artifact. Those are the common reasons.

Or maybe – just maybe – it was something a bit more sinister.

Considered, checked – and rejected

And that is what has happened with Wakefield’s work. It was published. People critiqued it. They looked carefully at the findings in the paper to see if they stood up. Other researchers tried to look for the relationship he suggested between autism and MMR vaccination in other kinds of studies. Or for the postulated relationship between autism and inflammatory disease in the bowel.

People also did the same with Wakefield’s subsequent work. His methods, particularly the “virus detection molecular biology”, were repeated in other labs.

Now, all of this was an entirely normal part of the scientific process, if rather more urgent because of the connection to the MMR vaccine.

And the answer? None of Wakefield’s work stood up. None of it.

But the more the evidence mounted up that the connection between MMR and autism was a mirage, the more Wakefield stuck to it. Right up until now.

At which point you essentially have two choices.

Either Wakefield is the saint his followers still insist he is, and all the evidence that contradicts his work is wrong, or fabricated, and this is a witch-trial.

Or…  the vast array of science that speak against Wakefield’s work is sound, and Wakefield is as we now see him – exposed as “callous, unethical … dishonest”, in the GMC’s words.

It comes down to the evidence, and how you see it. Two kinds of evidence, actually. First, the scientific evidence, in totality. And second, the evidence we now have of how Wakefield did his research, and reached his conclusions.

And it also comes down, of course, to how you see Wakefield.

As I frequently repeat when I am talking about this, and have repeated for the last several years,  I have never talked to a doctor or scientist about MMR – and I must have talked to hundreds – who doesn’t have a clear view on Wakefield. Universally, it is a view that does not cast him in a favourable light.

You can work the rest out for yourself.

Can this really be… the end?

So is this likely to be the end? If Wakefield is removed from the register? Will that be it for vaccine scares?

Somehow I doubt it. As others have observed, the furore over MMR was eerily reminscent of earlier vaccine scares, like that over Dip-Tet.

And there are sectors of the media that still find vaccine scares irrestible. The Daily Mail and Sunday Express coverage of the recent introduction of the HPV vaccine was, again, scarily reminscent of their “work” on MMR.

In fact, I fear that as long as anti-vaccine stories make headlines, and sell papers, the stories are not going to die. And they will always make headlines , and sell papers, because they play on fear. And that gives them power.

Looking at the old Bad Science Forum thread I linked to, I noticed another of my old comments,  this one rather melodramatically headed “Fear is the Key:

“Fear – even irrational fear with absolutely no basis in fact, like of Autism-from-vaccines – is incredibly powerful. You kind of have to take the decision to vaccinate despite some Id-type part of you wanting NOT to vaccinate because your fears have been aroused [i.e. by all the media scare stories]. What you know fights with your primal fear of the unknown, if that doesn’t sound too portentous…

People don’t just operate on higher reasoning. They operate on beliefs (rational or not) and Hollywood’s old favourite “gut instinct”. That is why it is often so hard to change peoples’ minds through reasoned argument, no matter how compelling.”

And that is also, of course, why the media coverage of MMR, keying on tragic families, and mothers’ fears, was so incredibly damaging.

Which brings me to a final point. The familiies’ tragedies are real. The anti-vaccine mob, like John Stone, make a habit of accusing those sceptical of their hero of  “callous disregard” for the suffering of the autistic children Wakefield was investigating, and of their families.

Which is a crock. Brian Deer has always been crystal clear about this, regardless of the mob baying for his blood outside the GMC:

Among the worst victims of the MMR scare were the parents who believed Wakefield’s findings — a few of whom will no doubt once again be shouting slogans tomorrow. I feel only compassion for them. Imagine how terrible it must be to believe that your son or daughter’s autism is your own fault, just because you had your child vaccinated.

“In a way, making the connection was worse for us,” said the mother of the youngster referred to as Child 12 in The Lancet. “We had convinced ourselves it was nothing we had done. Now we knew it was our fault.” ….”

As I said on another blog, the parents had to be “sold” the guilt in order to then be sold the conspiracy: “But you did it because they [i.e. the doctors and the Govt] lied to you!”

And I would call that selling them the guilt…  plain wicked. There is no other word.

————————————————————————————————

Update 1:  10:55 Monday

As predicted by everybody, including himself, Wakefield has been struck off.

So the old sceptical joke has come true:

“Disgraced ex-researcher Andrew Wakefield – or, to give him his full medical title…

…Andrew Wakefield.”

Update 2: 3.45 pm

Professor John Walker-Smith, the senior paediatric gastroenterologist at the Royal Free involved in the autism work, is also to be removed from the Medical Register – like Wakefield, he has been found guilty of “serious professional misconduct”. Walker-Smith is 73 and retired a decade ago.

The third of the doctors involved, Professor Simon Murch, has been found not guilty of serious professional misconduct and is free to continue in practise. Murch is currently Professor of Paediatrics at the University of Warwick.  The GMC’s press release discussing Murch’s role can be found here. It indicates that Murch had concerns at the time of the work about the ethical approval for the project, and had sought reassurance from senior colleagues. One of these was Professor Walker-Smith, under whom Murch had trained at the Royal Free. Murch also discontinued doing lumbar punctures on the children when he felt that they were revealing no clinically useful information. More on the story in the Guardian here.

The text of the GMC’s press release detailing the reasons for erasing Wakefield from the Medical Register can also now be found over at Left Brain Right Brain.

Update 3: 9.30 pm

Tom Chivers of the Daily Telegraph has a good post on Wakefield and the MMR saga here. The comments thread seems to be gradually filling up with anti-vaccine people. Of course, as anyone familiar with MMR-related threads will know, they tend to “out-last” other commenters. Anyway, Tom seems to be doing a good job of rebutting their dafter assertions, though he could perhaps do with some help.

An interesting aspect of the whole sorry saga is precisely how the 1998 Wakefield paper came to get published in The Lancet in the first place.

Well, they submitted it, it was peer-reviewed and then published… but of course, with journals at the “high-impact” end of science and medicine there often tends to be more to it than that. Anyway, over at the Guardian, clinical  epidemiologist Professor Christopher Butler has written a piece which talks about some of the likely behind-the-scenes stuff – and also points out some of the technical shortcomings in the paper that a referee with the right background might have picked up on.

Another of the murky stories from the start of the MMR scare is how his colleagues at the Royal Free Hospital Medical School regarded Andrew Wakefield and his work, something which probably had a significant influence on how events played out. I discussed this some time back in a comment here. Like many people, I am hoping that Brian Deer will one day write the definitive book on the whole saga.

Wakefield? Who he?

Finally, back in the Bad Science blogosphere, jdc325 has been noting the Daily Fail’s remarkable selective amnesia on their ex-hero Andrew Wakefield. They seem not to remember that he was once their poster boy of the “Brave Maverick Doctor”. You would think they would remember, given the vast amount of anti-vaccine guff they have printed over the last few years – see jdc’s post for the details.

————————————————————————————————

* The book is due to go on sale… today. May 24th. What an amazing co-incidence. Not.

63 Responses to “Denouement for the MMR scare – updated”

  1. Cybertiger Says:

    More appallingly drippy drivel from draust. By any stretch of the imagination, you’re not a scientist, droopy or otherwise, you’re just a dreadful fraud, draust.

  2. Cybertiger Says:

    Draust knows it isn’t vaccines that cause autism. So what causes autism, draust?

  3. Allo V Psycho Says:

    Excellent post. But I think you are unusually self deprecating in describing one of your comments as that of a typical four year old.

  4. Bugs Says:

    A good summary of the MMr situation, with very good links. I will add one to a very well done comic that covers the whole sorry story: http://tallguywrites.livejournal.com/148012.html

    As a parent I understand the angst and worry of others, I actually went and researched the effect of vaccination myself when I heard about the MMR “problems”. Thankfully I am a scientist (microbiologist) so had access to and the training to understand the literature, but the vast majority aren’t – this is not a judgement value BTW, I am in awe of electricians! The role of the media in these scare stories has been so shameful I sometimes wonder whether vetting of stories shouldn’t be re-introduced.

    @Cybertiger: no substance to your first comment, that’s just trolling. Second comment, autism has existed since before vaccines, and vaccines have been the most safe drugs ever invented by humans. You might want to rethink your argument.

    @Draust, like Allo I thought we had a vaxxer comment coming up after the 4-year-old bit :-)

  5. Dr Zorro Says:

    Spot on. And drawing an entirely predictable response from your house troll.
    Wakefield was clearly simply trying to advance his own reputation and income without any scruples at all. Colonoscopies on children for no good reason, blood samples taken, again from kids, for a fiver. What a despicable turd.
    If The GMC strike him off today they will have redeemed themselves a little in my eyes.

  6. Dr Zorro Says:

    Update. Struck off!
    http://news.bbc.co.uk/1/hi/health/8695267.stm

  7. draust Says:

    Thanks for the update link, Dr Z. In a way I am most curious to see what happens to Murch and Walker-Smith. Murch is the one with the most to lose, since he is Professor at Warwick. Walker-Smith has long retired and Wakefield is busy, as the autism site Left Brain, Right Brain says, “Turning Disgrace into Publicity”. He was on Radio 4 this morning smarming out the usual self-justifications. Ugh.

    AV, Bugs – thanks for spotting my inadvertent misspeaking about four years olds…!

    And Bugs – many thanks for the comic link, I had meant to put that in somewhere but forgot. It is truly brilliant.

    Dr Z – completely agree about Wakefield. Ever since Deer started digging out the facts, and in particular since the “burying” of the negative PCR results on the biopsies came out, the take on Wakefield in the (biomedical research) trade has been

    “A man in a desperate hurry to be famous who wasn’t going to let inconvenient facts get in the way”.

    Of course, since the revelations about the colonoscopies and lumbar punctures the picture has got far darker. I remember sitting in the kitchen and telling Mrs Dr A (the one in our family with the medical degree) about the tests Wakefield had run, and she was practically speechless, and genuinely horrified.

  8. Demeter Zoppel Says:

    As a parent I understand the angst and worry of others, I actually went and researched the effect of vaccination myself when I heard about the MMR “problems”. Thankfully I am a scientist (microbiologist) so had access to and the training to understand the literature, but the vast majority aren’t – this is not a judgement value BTW, I am in awe of electricians! The role of the media in these scare stories has been so shameful I sometimes wonder whether vetting of stories shouldn’t be re-introduced.

  9. Nash Says:

    That’s Mr Wakefield to you

  10. Cybertiger Says:

    Oh, how droll of you, Dr Nash. Prat!

  11. Evelyn Haskins Says:

    Wakefield would not be the only batty doctor around, nor the only one who advises against standard recommended practice.

    I have heard of doctors who are Creationists!(??)

    I have heard of doctors who refuse patients oral contraceptives — not on medical grounds but religious grounds — and they are still permitted to practice.

    I know a doctor who sincerely believes that it is the anti HIV medication that *causes* AIDS.

    I have heard of doctors who believe in and recommend homeopathy!(??)

    And probably many many more. Yet these people are permitted to continue Practice.
    Then there is Australia’s favourite Bete Noir, William McBride, who was struck off the register for “enhancing”his research findings — though he was only discovered to be fraudulent because his dissatisfied co-workers sued him for claiming authorship or THEIR work.

    And do not forget Dr Arpad Pusztai and the Genetically Modified potatoes fracas.

    It seems to me that we need to be very very careful of deregistering doctors when their research findings are found to be wanting for fear of drying up independent research. We wouldn’t want to have to rely on the pharmaceutical companies themselves for research, would we??

    (And THAT is a whole nuther kettle of fish — the useless and in some cases dangerous chemicals that drug companies manage to get onto the market — not to mention their “courting” of doctors to prescribe their stuff.)

  12. Evelyn Haskins Says:

    Cybertiger Says:
    May 24, 2010 at 7:40 am
    Draust knows it isn’t vaccines that cause autism. So what causes autism, draust?
    ***

    Well it certainly isn’t the measles vaccine since Autism has been with us since time immemorial. Not of course called Austism — that is the new name for what used to be ‘simply’, ‘barmy’, ‘mad’. ‘weird’, ‘eccentric’ etc, etc.

    And it runs in families too — so it is likely genetic.

  13. draust Says:

    Hi Evelyn

    Wakefield has not been erased from the register “because his research findings were inconvenient”, or because what he and the others did was not standard care.

    He has been erased for doing unnecessary invasive investigations on kids for absolutely no good reason.

    Or course, we know the “not-good” reason – it was in pursuit of his pet theory.

    It is even worse, since these were (mostly) kids on the autistic spectrum, for whom the procedures would likely have been painful, frightening and disturbing. They would have had a very limited, if any, sense of understanding of why what was being done to them was being done. Their average age was six years old.

    So Wakefield has been struck off because he used a vulnerable group of autistic children as human guinea pigs. That is a grievous breach of one of the most fundamental of all the ethical rules that doctors follow, namely to act in the best interests of the patient.

    Hence “callous disregard… unethical…”

    Wakefield also tried to obscure what he had done, hence “dishonest”.

    PS William McBride was actually struck off the Australian medical register when his research fraud came to light in the early 90s. He was only reinstated after five years.

  14. BSA SciComms Conference 2010 (Part 1) « Purely a figment of your imagination Says:

    [...] is Brian Deer, who managed to expose Andrew Wakefield (finally struck off today! See jdc325, Dr Aust, Guardian and elsewhere for coverage) without any science background at [...]

  15. Cybertiger Says:

    Why do the BMJ call on useless hasbeens (aka useless tossers) to provide comment? Here the former upstanding member for Oxford West and Abingdon (now flaccid member for nowhere) comments on the erasure of Andrew Wakefield from the GMC’s register.

    http://www.bmj.com/cgi/content/full/340/may24_2/c2803

    “Commenting on the judgment Evan Harris, the former Liberal Democrat MP who originally urged the GMC to investigate the case, said, “Today’s decision, while welcome, does not close this matter because it is about more than one man. There needs to be an enquiry as to how these unacceptable invasive tests came to be done on so many vulnerable children despite the existence of ethics committees designed to prevent this sort of abuse, and the medical establishment needs to ask itself whether there are any other published papers, based on the same flawed research, that need to be retracted as the Lancet paper eventually was. “It took a determined journalist to expose what happened to these children and to public funding and I am not satisfied that something similar could not happen again. Medical journals need to review their systems of checks and hospitals must ensure their ethical oversight is fit for purpose.””

    Pompous prat!

  16. Cybertiger Says:

    Herr draust tells us that … infectious disease doctor DeeTee has done his bit too. Twat!

    http://www.bmj.com/cgi/eletters/340/apr15_2/c1127#236196

    And Dr DeeTee has been doing his tosser act over at the BMJ too. Prat!

  17. draust Says:

    I was wondering where you’d got to, Shabby.

    Well, I agree with Harris. The Guardian article by Chris Butler certainly asks some pertinent question about the Lancet and how they came to take a small case study and give it such a red-carpet treatment. A perusal of the documents on Brian Deer’s site strongly suggests that the “old boy network” had a definite part in it.

    Butler’s article also suggests that it is highly unlikely anyone with much epidemiological training was among the Lancet reviewers of the 1998 paper – either that or the paper was published over any such reviewers’ objections. It is worth noting that an astute commentary on the Wakefield paper by Chen and DeStefano appeared in the very same issue, and pointed out all the shortcomings of the study. The commentary is amazingly prescient and deserves to be more widely known. As a letter-writer in the following issue said:

    “You print[ed] a commentary, which if it had been a peer reviewer’s report, should have led to the rejection of the paper.”

    As to the research ethics, history unfortunately shows that doctors can get carried away, sometimes by their enthusiasm for research, and sometimes by their desire to help patients, and do things that are ethically unacceptable. That is why there are Ethics Committees, and also why doctors can be held to account if they lose sight of the balance between seeking to do good and actually doing (predictable) harm.

  18. Cybertiger Says:

    Even Deer Brian has nailed the scumbag. Here is Deer, shaking his shoe, as if he’s just stepped on a steaming turd …

    http://www.bmj.com/cgi/eletters/340/may26_2/c2829#236275

    … which of course, is what Evan is.

  19. Cybertiger Says:

    Deer Brian writes,

    “Nevertheless, I’m grateful to Dr Harris for his quotes, and particularly for the legal letter copy which I refer to above. I also appreciate the kind things that, at least until now, I know he says about me. However, the investigation which led to the GMC proceedings and to the retraction of Wakefield’s research from the Lancet came from outside both medicine and politics.”

    You ‘av to larf. Deer Brian is like a growling tabby cat circling its fallen prey while hissing at stray toms who want in on the act and a chance to pick over the carcase.

  20. draust Says:

    Deer seems mainly to want to make it clear Harris had nothing to do with Deer’s investigation, which is fair enough. I do think, though that Harris mentioning the whole business in parliament did do something to focus even more attention on it all. But anyway, no-one is disputing that it is Brian Deer who has revealed the truth behind Wakefield’s junk science and finagling.

  21. LeeT Says:

    Supporters of Andrew Wakefield often claim he is being persecuted.

    To me, at least, it seems the GMC hearings went on for a very long time as if they were bending over backwards to be seen to fair to him.

    Is there anyone out with knowledge of how these things work? Did the proceedings last longer than normal or was he treated exactly the same as anyone else?

  22. Cybertiger Says:

    LeeT feebly wittered,

    “Did the proceedings last longer than normal or was he treated exactly the same as anyone else?”

    R u naive or ignorant … or jus ‘avin a larf? Twit!

  23. draust Says:

    It was an unusually long hearing, Lee, but most people would say that reflected in part their bending over backwards to be seen to be fair to him.

    Of course, his supporters, like Shabby, vehemently disagree, as any number of websites will reveal.

    Other reasons for the protracted nature of the hearings:

    - involving three doctors, not just one;

    - passage of nearly ten years since the original events;

    - involving a whole series of cases playing out over a matter of months to years, not just a specific incident;

    - complexity of the cases;

    - complexity of documentation (e.g. relating to ethical approval) that had to be obtained and reviewed, plus piecing together the timeline;

    - right of the doctors to defend themselves by questioning all the evidence and witnesses;

    - need to keep re-convening the hearing periodically (unlike a trial, it could not simply run without pause until concluded);

    - and so on, and so on.

    A typical GMC hearing would involve a single doctor and a series of related incidents close together in time, often where the facts are not in that much dispute.

    The GMC publishes a bi-monthly newsletter called GMC Today which contains little “case studies” of why doctors have been disciplined. An example is here.

    One of the most serious failings a doctor can show, which bears a bit on the Wakefield hearings, is dishonesty. To give a simple example of why:

    Say a junior hospital doctor is told to order a test, but doesn’t bother for some reason (forgets, too busy, doesn’t think it matters, lazy, whatever). Then the patient suddenly gets sicker, and the more senior doctor reviewing it says “But what was the XYZ test result? It isn’t in the notes.”

    Now at this point, the junior doctor has to front up that they didn’t order the test. But the very worst thing they can do is say “Oh yeah, we did, it was fine”. That lying, and covering up, would be considered far worse than admitting they f*cked up in the first place.

  24. Cybertiger Says:

    It’s the Economy, stupid!

    And Herr Draust knows all there is to know about the economy of Truth: in fact I’ll bet he’s got a degree in it. But the real Truth is that Herr u Dr Frau Draust have the Morals of a couple of squealing alley cats and neither would know an Ethic if it banged their highly economical heads together.

  25. LeeT Says:

    @ DrAust – thank you for your comments

    @Cybertiger – do we know each other? I don’t usually encounter such rudeness from total strangers.

  26. Cybertiger Says:

    LeeT encounters rudeness from those who know him. I can understand that. Twat!

  27. Dr Zorro Says:

    Don’t take it to heart LeeT, in fact the contrary is true. Cybertiger is rude to everyone he encounters.

    I think your question perfectly reasonable bearing in mind the GMC claim to deal with most complaints in six months.

    I don’t know what their figures are overall. However I am aware of one case where a doctor was referred to NCAS for a number of allegations. NCAS took one afternoon to consider and reject them all. The accusers repackaged the complaints and sent them to the GMC who took two years to do the same.

  28. draust Says:

    A depressing, if funny, story, Dr Z. Though not at all funny for the doctor concerned.

    Of course, judging by those sorts of standards one might consider the Wakefield et al. GMC hearing to have been quite expeditious at a mere two hundred or so days spread over several years.

    It is certainly accurate to say that most of the doctors I know are not exactly tremendous fans of the GMC’s procedures, particularly their glacial pace. The general response to the Wakefield case from my mates has been something like “Finally the bloody GMC does something right”.

    I think that in a way the GMC ended up having to do something because other organisations who really should have investigated aspects of the story earlier didn’t, or did so half-heartedly. The Lancet had half a go in 2004 but seemed really not to want to confront the full implications of Wakefield’s finagling as revealed by Brian Deer. And nor did the Royal Free (or UCL by then as it had taken over the RFH), at least in my opinion. I have offered some speculative thinking on the possible reasons why here, based on my take on the way things actually happen in Univs. But by normal academic practise they (as the institution where the work was done) should have investigated the allegations of research misconduct.

    Anyway, if the Lancet had formally asked the Royal Free/UCL to run a full-scale investigation of allegations of ethical breaches and research misconduct in 2004, after Deer’s Feb 2004 programme, then it seems to me that Wakefield could have been exposed five years earlier. But what seems to have happened was that the Wakefield et al. were just asked to “clarify and give reassurance”, without any of the kind of full forensic investigation the GMC did later.

    PS My favourite narrative account of the whole business, which I think is especially revealing about the timeline of Wakefield’s developing obsession with MMR, is on Deer’s website here. If that is the outline for a book then I hope we get to read it in due course.

  29. Cybertiger Says:

    Herr Draust: if the GMC got it so wrong over Meadow and Southall, why do you assume the GMC have (finally and bloodily) got it right over Wakefield and Walker-Smith?

  30. draust Says:

    I don’t think I’ve ever said the GMC “got it so wrong” over Meadow and Southall. I don’t know nearly as much about their cases as I do about Shabby’s hero, but it is fairly obvious that the Meadow and Southall cases were far more “nuanced” than that of Wakefield and Walker-Smith.

    The GMC findings on the extent of Wakefield’s repeatedly unethical behaviour – and the subsequent lying about it multiple time when specifically given the chance to put the record straight – are breathtaking. Meadow and Southall’s cases were far more to do with being “honestly wrong”, plus in Meadow’s case being inept with statistics but seemingly not being aware of it.

    I think there is a sort of triple stage to most of the high-profile cases, which is:

    (i) have the doctors done something wrong, and, if so, exactly what? (i.e. what ethical or professional rules have they breached)

    (ii) does that add up to “serious professional misconduct?” and if so;

    (iii) what is the appropriate punishment in the case?

    The High Court reviews in the Meadow and Southall cases basically show that the stages there were not that clear cut. In the Wakefield case the answers were not remotely in dispute, to put it mildly, once the evidence was in. In my opinion, and based on the GMC findings, the answers for Wakefield would go:

    (i) “Yes, practically everything you can think of, lots of times, and lied about it afterwards, also a bunch of times, and did everything he possibly could do to cover it up.”

    (ii) “Yes, about twenty or more times over” – and

    (iii) “Striking off, though in his case it is completely and utterly inadequate as a penalty.”

    Walker-Smith is a little different. In his case I think his erasure was largely because, as the boss paediatrician, he really should have known better. As the collaborator / senior clinician partner of a “thrusting but dangerously short-cutting man on a mission” (i.e. Wakefield) it was Walker-Smith’s job above all to look after the kids’ interests. Instead of which he seems to have been completely swayed by Wakefield’s patter, and ended up as a kind of enabler (perhaps largely unwittingly) to Wakers’ glory-hunting.

  31. Cybertiger Says:

    Herr Draust: after that little homily, I think you’ve very capably confirmed your utter moral destitution and complete ethical bankruptcy. Noddy!

  32. draust Says:

    Glad you liked it, Shabby.

    Now that you’ve unmasked me as a moral pigmy, are you going to go away? Please? Special please?

  33. Cybertiger Says:

    I didn’t call you a pigmy. I said you were a moral destitute. And an ethical bankrupt. You’re not being fair to pygmies. ‘Multum in parvo’ … is right for the pygmy … but wrong for your intellect, scientific and all else otherwise. And what was all that crap about the Meadow/Southall cases being more ‘nuanced’ than Wakefield et al? That really takes the biscuit. I would call you a ‘tosser’ for that, but ‘tosser’ just seems too nuanced.

  34. Cybertiger Says:

    The giant plonker said,

    “Meadow and Southall’s cases were far more to do with being “honestly wrong”, plus in Meadow’s case being inept with statistics but seemingly not being aware of it.”

    This statement gets the pulitzer prize for the greatest example of crass plonkerism in the whole of the pseudo-scientific literature. Congratulations, draust!

  35. draust Says:

    Thank you so much for the accolade-by-insult, Shabby.

    I thought my comments were perfectly clear. It is a basic principle of law that cases have to be dealt with according to law but on their individual merits and circumstances. The observation that some cases are more clear-cut than others, or have more “weight of evidence” than others, is hardly that startling. It is even the basis of a famous saying, the one about:

    “Difficult cases make bad law”

    As I said above, I am no expert on Meadow and Southall, nor do I claim to be. Sure, I have an opinion, based on what I know/read/have heard, but I am aware that that is necessarily a partial database – one of the points where you and I differ.

    For anyone interested in my opinions from a few years back, they can be found here, here and especially here. These come from a very interesting thread of Ben Goldacre’s from October 2006 about statistics and Roy Meadow’s testimony on the Sally Clark case, called “The Prosecutors Phallusy”. There is another interesting article on Meadow, covering the same sort of ground, here.

  36. Dr Zorro Says:

    Dr Aust you seem like someone who has a tapeworm. You know the worm is there, and you don’t like it. You could get rid of it so easily but for some strange reason you don’t. Do you feel pity for the worm?
    Go on! Take the piperazine!

  37. Cybertiger Says:

    Piperazine won’t do much for Draust’s tapeworm but sadly he’ll end up doing a lot more crapping … and hasn’t he done enough?

    PS. You’re not a very clever doctor, are you, Zorro.

  38. draust Says:

    Dr Z

    There is a kind of unwritten “netiquette” around the Bad Science blogosphere that you don’t ban anyone. The US blogs are particularly keen on this. The question of whether this really is a free speech principle has even been known to lead to lengthy and heated online arguments.

    My own main rule of thumb tend to be:

    “Comments that consist of nothing other than personal abuse may be censored and deleted, or may lead to the user being barred”.

    - so I suppose Snittykitty has gone over the line on that one repeatedly. I tend to leave personal abuse directed at me up, though, on the grounds that having a blog means I am fair game. Also, I guess perhaps I let Cybertiddles stay because he acts as a prompt for things I wanted to say anyway… but he is certainly getting very tedious.

    The other reason for leaving ravings like Shabbytabby’s up is David Colquhoun’s position that such people reveal themselves for public view as raving loons far more succinctly/overtly than one’s responses to them ever could.

  39. Cybertiger Says:

    Endless mirth, Draust! You are a pompous prat but I love the way you provide an inexhaustible round of loopy laughs … like crap on crack, you crack me up … with thine holy sh*t.

  40. Dr Zorro Says:

    Mad as a bucket of frogs.

  41. draust Says:

    Shabby:

    If the alternative to your stream-of-subconsciousness style is “pompous” (I prefer “measured”), then I guess I’ll have to plead guilty to that. Oh well.

    I am still puzzled what you get from all this frantic on-line weenie-wagging. Our five yr old sometimes likes to shout words like “Poo” and “Wee” for effect, and our toddler sometimes sits there contemplatively scratching his bits. But they are both small children, and will grow out of it. I seriously doubt the same can be said for you.

  42. Cybertiger Says:

    While wagging his puzzle-bits, Herr Draust wibbled,

    “But they are both small children and will grow out of it.”

    I suppose I would stop puzzling the sophist scientist if he would only grow out of his bumbling scientific sophistry. In the end, Draust, you’re a fraud who’s matured into a stinky cheese.

  43. Cybertiger Says:

    It seems I’m not the only GP to recognise what a load of old cobblers the GMC have come up with. Here, James le Fanu writes today’s ‘Doctor’s Diary’,

    http://www.telegraph.co.uk/health/healthadvice/jameslefanu/7804264/MMR-vaccine-the-hidden-hand-of-powerful-forces.html

    “It is not necessary to be a conspiracy theorist to recognise that the General Medical Council’s recent ruling to strike professors Andrew Wakefield and John Walker-Smith off the register had the fingerprints of the medical establishment all over it.”

    Of course, Herr Doktor Draust is a mere shoe-shine boy, busily rubbing fingerprints off establishment sneakers.

    Dr le Fanu goes on to say,

    “Leaving aside the question of whether the MMR vaccine is implicated in this form of autism – as the parents’ accounts would certainly suggest – it is perhaps not unreasonable to detect the hidden hand of those powerful forces for whom the crushing of a professional reputation is a price worth paying for the continuation of the ever-expanding child immunisation programme.”

    Of course, Herr Doktor Draust is well prepared to pay the price … and the GMC registration fee is a price worth paying … even though Herr Draust doesn’t pay it … to crush good doctors reputations. What have I been saying about bankrupty and destitution, Draust?

  44. Dr Aust Says:

    Snore again.

    I see Jdc325 has already penned a meticulous point-by-point take-down of Le Fanu’s ill-informed ramblings.

    Incidentally, Le Fanu is a veteran promulgator of the MMR scare (see the comment by Dorothy Bishop below jdc’s post for links). He is also a fan of Intelligent Design (sic) and has written what Times science editor Mark Henderson just described on Twitter as:

    “the worst science book I have read in recent years”

    and:

    “a celebration of ignorance.”

    (Book review in New Scientist here)

    None of which makes Le Fanu’s views on MMR any more credible, to put it mildly.

    As for all this guff about the “medical establishment” crucifying Wakefield and Walker-Smith: it is fairly evident to anyone looking closely at the start of the MMR hoax that it was only Wakefield’s impeccable London medical establishment “embedding” and credentials, and in particular the patronage of figures like Professor Walker-Smith and Professor Roy Pounder, that finessed the dire 1998 paper into the Lancet in the first place. This is something Lancet editor Richard Horton has never adequately explained, in my opinion.

  45. Cybertiger Says:

    Mark Henderson is obviously a fan of weasels. I see the author of ’50 Genetics Ideas You Really Need to Know’ is looking forward to the Evan Harris show at the Cheltenham Festival. To my mind, the number one idea has got to be how to prevent weasels contributing to the gene pool anywhere in the scientific universe.

  46. Cybertiger Says:

    Richard Horton writes this …

    http://briandeer.com/mmr/horton-wakefield.htm

    … and then stabbed Wakefield in the back. Beware the weasel.

  47. draust Says:

    Perhaps Horton was another of the people taken in by Wakefield, and when confronted with all the evidence finally realised that he had been duped?

    Just a thought.

  48. Cybertiger Says:

    You’re the dupe, draust. Just a thought.

    But not a far fetched one.

  49. draust Says:

    For anyone still following this thread, I have left a fairly extended comment on some of Wakefield’s shenanigans over on jdc325′s blog.

    I may “repatriate” it here as a post and extend it as time permits

  50. Dr. Mike Says:

    A fine write up, draust. 2 things surprise me though.

    (1) I always imagined the kitty was female for some reason.
    (2) Now it claims to be a GP. I imagine this can only stand for Grand Prick You’ll have to pardon my French.

    Regardless, he/she is a total pussy.

    The Lancet and the curtain twitching press have done an incredible disservice to the general public in thus whole affarce. Has anything gone through the Press Complaints commission?

  51. Cybertiger Says:

    I see another upright member of the medical establishment has made a grand entrance. Goon!

  52. Dr. Mike Says:

    Awwww, kitty. Wrong again! I am not a member of the medical establishment.
    At least you still have a perfect record. And I enjoyed being accorded a grand welcome.

    I guess the PCC can’t do anything about the Lancet, but what is the possibility of the anonymous reviewers ever coming forward to state their recommendation for the Lancet paper publicly?

    It kinda makes me wonder what role Chen & DeStefano played in the review process.

    I’ve come across situations in scientific publishing when those critical of a paper during a review were given an opportunity to publish their concerns alongside the paper.

  53. Cybertiger Says:

    Dr. Mike: I dub you an honorary member of the medical establishment, an upright tosser of the grandest perfection.

  54. draust Says:

    Dr Mike wrote:

    “It kinda makes me wonder what role Chen & DeStefano played in the review process.

    I’ve come across situations in scientific publishing when those critical of a paper during a review were given an opportunity to publish their concerns alongside the paper”

    Yes, I wondered exactly the same thing, Mike.

    I had thought at one stage of writing a “hypothetical” scenario for how I imagine the Lancet paper got through the review process, based on just such a idea (inter alia). Perhaps I should get on and do it.

  55. Dr. Mike Says:

    Ahhh, tiddles, if only my cricketing ability were as proficient as you make out. And if only my salary were as established as a member of the medical profession. If only…

    I agree, draust, that it would be fun to write such a scenario, but I worry that it may be used and abused by those nefarious cranks out there who wish to further confuse the general public with their egregious misrepresentations and lies. Costs and benefits need to be carefully weighed in these tiresome times.

  56. draust Says:

    One of the things I am most amused by (in an eye-rolling sort of way) is that the anti-vaccine loons continue resolutely to ignore that the 1998 Lancet paper has been dismantled by post-publication analysis / further science.

    This despite their regular statements such as: (looking at the marathon current Guardian comments thread):

    17th Jun 12.22 by John Stone:

    “The issue of peer review is a red-herring. It should not be the point of peer review that an article takes on the metaphysical cloak of bureaucratic truth”

    21st Jun 12.53 pm by Clifford G Miller:

    “That is what peer review is. It is the process which takes place after publication when the work is scrutinised and subjected to criticism.”

    And yet…. they still regard Wakefield’s repeatedly-busted-and-finally-retracted 1998 finagle-fest as the apotheosis of truth, despite this precise process having demolished it.

    Go figure.

    PS Mike, welcome to the unofficial fraternity of those of us in science / medicine / the blogosphere whom StubbyTugger has labelled a goon / dupe / tosser. I think we are an expanding group.

  57. Dr. Mike Says:

    Thanks – Spike Milligan and Peter Sellers were always grumpy heroes of mine, so I feel we’re all in rather good company.

    Another facet that’s confused me about the anti-vax blog behaviour is the continuous trashing of the peer-reviewed literature, as it shows no causal link between vaccination and autism (except Wakefield’s retracted work, which, uhhh, didn’t even show a link).

    The reasons given for trashing published research are continuously shifting, generally slanderous and never proven. How exactly did one author from 176 manage to influence the genetic results so completely as to negate the findings of the recent Nature ASDs paper? Did he tie up all the others and threaten to vaccinate their families if they claimed that less than 3% of genes relating to ASDs could be identified? Where’s the actual evidence that he abused his position of power from his endowed chair, stroking his white cat? Are you that cat, tigerlily?

    Charlatanism and unethical behaviour were demonstrated beyond a shadow of a doubt by a newspaper journalist in the Wakefield debacle, surely another journalist could do the same thorough job here, if any impropriety existed. Those 176 people must surely have pissed off a couple on the way who might point the finger.

    But we’re left in a position where everybody working in the field has a question mark over their independence, and nobody is fit to carry out the only “acceptable” medical trial that would unbiasedly confirm that MMR-autism link (the only one that does eventually show a link). This trial has never had an appropriate, unbiased experimental methodology defined. It’d be nice to see one of those.

    I’m starting to wear a palm shaped groove in my forehead with all this.

  58. Claire Says:

    Going off at a bit of a tangent, apols, but spotted this report today – Measles does not protect against asthma and allergies – it’s an epidemiological study from S Korea.

  59. draust Says:

    Thanks, Claire.

    Certainly relevant to the mammoth Guardian comments thread about autism – * sigh * – which is currently approaching 400 (!) comments.

    The inevitable Clifford G Miller and John Stone have been over there claiming, as usual, that all the evils of the modern world (mainly autism on the thread, but I’m pretty sure they think it is the same for every other chronic disease, including asthma) are due to vaccinations, and that getting natural measles / mumps / rubella would be much better. All evidence to the contrary, of course.

    Anyway, jdc and a few other recognisably science / bad science types have been arguing with Millerstone (Stonecliff?), but it all rather recalls that old joke about wrestling with a domestic member of the Genus Sus.

  60. Claire Says:

    I’m ashamed to confess I’m too faint of heart (and short of time) to grapple with threadzilla over at the Graun. I have commented on similar about the reported German experience since unification, where, I have read, childhood immunisations were compulsory in the former East Germany so coverage was very high up to 1989 with about 99% “durchgeimfpt”. But rates of allergic disease were lower there than in the richer West, where immunisation is not legally mandated and which had lower coverage. Since unification childhood vaccination coverage in former East Germany has reportedly declined but rates of allergic sensitisation in children are increasing, suggesting there might be something – or things – about the lifestyle of richer countries which favours this process.

    Not that pointing to this kind of information makes any dent in the certainty of anti-vax camp but (just perhaps) it might give some who are on the fence food for thought.

  61. Dr Aust Says:

    Off the top of my head, some variant on the “hygiene hypothesis” seems a good bet – or possibly more central heating and carpets /warmer rooms and hence house dust mites.

    Interesting info on vaccination, anyway. I may try and see if I can track down proper sourcing for that.

    Of course, the anti-vaccine mob have so many variants of their paranoia that it is hard to pin down what they really want to indict as the Cause of All Badness. If you find a study saying “it wasn’t MMR” then they just switch to “oh no, it’s the total vaccination schedule”, and vice versa.

  62. Claire Says:

    There is a comment here on East/West Germany rates of allergy & vaccination – haven’t time to do the nice blue writing (& many thanks for prettying up my previous comment!) – http://www.netdoktor.at/health_center/impfen/impfgegner.shtml
    3rd para from end:

    “…Eine Analyse von Daten für das geteilte Deutschland ergab etwa, dass in der reichen BRD mit den besseren Hygienebedingungen die Rate der allergischen Erkrankungen deutlich höher war als in der ärmeren DDR mit den schlechteren Hygienebedingungen. In der DDR lagen aufgrund staatlich verordneter Impfpflicht die Durchimpfungsraten allerdings bei annähernd 99 Prozent und damit viel höher als in der BRD. Weniger Allergien bei höherer Durchimpfungsrate in der DDR erteilen dieser Argumentation der Impfgegner also eine Absage. …”

    There is a list of sources given at the end of the article but can’t see which one relates to above.

    Recent article on allergic sensitisation trends E/W germany in Feb Clinical & Experimental Allergy (U. Krämer, H. Oppermann, U. Ranft, T. Schäfer, J. Ring and H. Behrendt, Clinical & Experimental Allergy, 2010 (40) 289- 298 Differences in allergy trends between East and West Germany and possible explanations ) but have seen only abstract so don’t know if changes in immunisation rates discussed.

  63. Who needs facts? These vaccine conspiracy pieces write themselves… « Dr Aust’s Spleen Says:

    [...] story will know, Wakefield is now gone from Thoughtful House, his departure closely following the damning GMC judgement. However, the TH website now tells us that Laura Hewitson "joined Thoughtful House in 2008 as a [...]

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