The General Medical Council’s FITNESS TO PRACTISE PANEL HEARING of Dr Andrew Wakefield, Professor John Walker-Smith & Professor Simon Murch Martin J Walker Contents 1. Countdown to Character Assassination 2. The Indictment 3. The Hearing Opens 4. The Hearing Trundles On 5. Prosecuting For The Defence 6. A Massive Abuse of Process 7. The Utter Irrelevance of Professor Salisbury 8. Dealers in Second Hand Words 9. Expert in What? 10. Grub Street Medicine 11. The Defence Opens to a Prosecution Continuing Downhill 12. Last Day of Reckoning 13. The cross-examination begins, begins, begins, begins 14. The Patients of Job 15. Just When You Thought it was Safe to go Back in the Water 16. A Lifetime's Defence in the Court of Dunces 17. Tell me, how many forks are in your tongue? 18. GMC Prosecution Exploits Vaccine Damaged Children with Autism 19. And Your Conscience Miss Smith? 20. The Plot Thins and Humbug Sets in 21. Miss Smith and Her Junior Warlocks Stir the Brew 22. A Brief Stopover in Another Reality 23. The Big Question 24. The Circus On Euston Road 25. The Worm in the Bread 26. A sudden Silence Descends on the GMC 27. A Right Palaver 28. This Contemptuous Hearing 29. Broken English 30. Swimming in the Shallows 31. Deeper into the Shallows 32. The End of Mr Miller's Closing Speech 33. Eye Witness Report from the GMC Wakefield, Walker-Smith, Murch Hearing 34. Counterfeit Law: And They Think They Have Got Away With It 35. Counterfeit Law, Part 2: A Tale of Two Trials 36. Counterfeit Law, Part 3: Houdini Horton 37. Return to the House of Lies 38. Journalist with No Medical Training Solves Mystery of Enterocolitis! 39. The Bolted Horse 40. The UK GMC Panel: A Sinister and Tawdry Hearing Countdown to Character Assassination 1990 Early in the 1990s Dr Wakefield’s research into the causes of Crohn’s disease, an inflammatory disease of the lower intestine, moved on to consider the possible role of wild or vaccine strain measles virus. 1990 – 1997 A number of patients presenting with a pervasive development disorder and gut problems were referred to the Royal Free Hospital. In most of the initial cases parents (or the child’s GP) reported a temporal association between onset of symptoms and exposure to MMR vaccine. Wakefield and others were some of the first doctors in the country who sought to develop an understanding of the condition affecting these children. In these cases there appeared to be a possible link between measles virus, inflammatory bowel disease and autistic-like regression. 1998 Dr Wakefield and 12 other doctors and scientists at the Royal Free Hospital published an initial case series of 12 children in the Lancet. At a press conference following publication, Dr Wakefield suggested that it might be wise to return to single vaccines whilst research continued into the possible link between MMR, inflammatory bowel disease and autistic- like regression in a subset of children post-vaccination. Following this statement, Dr Wakefield became the subject of an all out attack by the government, science lobbies and the pharmaceutical industry. Eventually his funding was withdrawn, his contract at the Royal Free was not renewed and he was forced to leave his post. These events prompted many people to further question the safety of the MMR vaccine. 2003 In 2003, Sunday Times journalist Brian Deer published a long ‘expose’ of Dr Wakefield, accusing him of a number of acts of professional, regulatory, ethical and legal misconduct. The article, which quoted a contribution from the Minster of Health, suggested that Dr Wakefield should be reported to the General Medical Council (GMC) of the UK. Following the article and a subsequent television programme, the GMC began framing charges against Dr Wakefield. 2007 After a three and a half year wait with the charges hanging over him, during which the government vaccine policy continued relatively unchanged and Dr Wakefield’s public reputation was destroyed, he and two other doctors, Professor Walker-Smith and Professor Simon Murch were arraigned before the GMC panel on over 80 charges of professional misconduct. The hearing opened on July 16th 2007. The GMC hearing is scheduled to last for three months. The Indictment Like the rest of this affair, the indictment is a complex document. Below, are the main charges as they are drawn up against Dr Andrew Wakefield. Both Professor Walker- Smith and Professor Simon Murch have similar, but a lesser number, of charges. The charges as they are laid out below are bereft of both the background detail, and obviously, the defence rebuttal. In relation to the Legal Aid Board, Dr Wakefield is charged that: He was dishonest, misleading and in breach of his duty in managing finances and in breach of his duty in accounting for funds. In relation to research and Ethics Committee Approval, and in relation to eleven children whose cases were reported in the Lancet paper, Dr Wakefield is charged that: He carried out research on children which did not meet the inclusion criteria laid down by the ethics committee, and who did not meet the time criteria of the study given approval. He ‘ordered’ investigations to be carried out without the paediatric qualifications to do so. That such investigations and research were contrary to the clinical interests of the children involved. That he caused such investigations to be carried out without some children being assessed first by a neurological or psychiatric expert. That he caused some investigations to be carried out which were not clinically indicated. In relation to the Lancet Paper (28 February 1998), Dr Wakefield is charged that: In reporting a link between MMR and a regressive autistic state, as he did in the Lancet, he was dishonest, irresponsible and misleading. This charge amounts to spreading ‘alarm and despondency’ Clearly the science lobby, the pharmaceutical companies and various government departments consider it ethically correct to ‘draw a line under’ any research whose results reflect badly on their product or their political approach. In reporting cases of children who for various reasons fell beyond the inclusive criteria of the ethics committee, he acted, dishonestly, irresponsibly and contrary to ensuring the provision of accurate information. In relation to the Lancet paper, Dr Wakefield is charged that he failed to declare disclosable interests with respect to funding which he received from legal aid. In relation to Transfer Factor, Dr Wakefield is charged that in relation to one child who was prescribed Transfer Factor, he acted against the clinical interests of this child and abused his position of trust as a medical practitioner. At the time of his son’s birthday party, he took blood from children, paid them £5 for so doing and later recounted the incident at a presentation in March 1999. In doing these things, he did not have ethics committee approval, carried out the procedure in an inappropriate social setting, offered children inducements, showed a callous disregard for the suffering and pain of the children involved, abused his position of trust and brought the medical profession into disrepute. The Hearing Opens Monday July 16 Inevitably the atmosphere inside the building was quite different from that outside. Inside the glass shell, there was a feeling of being in an underwater bubble. Anyone entering was greeted by an almost entirely black security personnel, attractively dressed young women with fixed smiles and confident young men in casual dress. On the third floor, through two sets of glass doors past a lounge area and the doors to the rooms provided for the press, off a corridor on the right is the entrance to the hearing room. All attendees in the public gallery and members of the press are searched before entering the long room. About 60 foot long and 40 feet wide, the room is flanked by glass panels down one of its long walls. The atmosphere is one of quiet efficiency. There are between 30 and 40 participants in the hearing. The defendants and the adjudicators sit facing each other, the doctors with their legal teams are down the left hand side and the panel and GMC clerks down the right hand side. It is difficult to imagine that this long mainly white room, with an oblong of tables in its centre, will be the daily place of work for the three doctor defendants in this case. For the next three months these highly trained doctors will have to defend many of the professional decisions which they have made over the last decade. Things that ‘just happened’ and that carried no particular importance at the time could now, in the light of this room, spell the end to their medical careers. The room is not really like a court room, there is no central point of authority, although the principal prosecutor for the GMC, Miss Smith, sits at one end of the rectangular tables, she is not sitting higher than anyone else and is sometimes hardly noticeable amidst the books, boxes and reading rests that surround her. Nor are the ‘accused’ sitting together in a dock of any kind but dispersed amongst their lawyers. Almost everyone in the room, outside the public area, is wearing black, its deadness only interrupted by the silver hair and white shirts of the men and on some women brief touches of ochre or translucent white of arms and legs. There is a round and almost classic clock on the wall at the far end of the room, on its face time passes very slowly. The first days of any juridical hearings, whether they be at the Old Bailey or the General Medical Council (GMC) are always the worst for defendants.