Monday, March 12, 2012

What the UK High Court's Ruling on John Walker-Smith Means and Doesn't Mean

Liz Ditz
lizditz.typepad.com

On March 3, 2012, Mr. Justice Mitting of the UK's High Court of Justice ruled that the UK's General Medical Council (GMC) had acted improperly in Professor John Walker-Smith's hearing on charges of serious professional conduct, and therefore he quashed both the finding  of serious professional misconduct and the sanction of erasure.  (You can find the entire ruling at http://www.bailii.org/ew/cases/EWHC/Admin/2012/503.html.)

It's important to be very clear about what this ruling means. Mr. Justice Mitting did not find that Professor Walker-Smith's actions were medically necessary or ethical. The ruling does not exonerate Walker-Smith. That was not what the hearing was about. Mitting was only ruling on the conduct, the decision-making, of the GMC's Fitness to Practice panel. More broadly, Mitting found aspects of the GMC's procedures to be flawed.

And Mitting's  ruling has nothing to do with the retraction of the 1998 paper. It's still retracted. It does not validate Andrew Wakefield's integrity, or affect the likely outcome of Andrew Wakefield's defamation suit in Texas, (see below).

Mr. Justice Mittings wrote in his opinion:
"There is now no respectable body of opinion which supports [Wakefield's] hypothesis, that MMR vaccine and autism/enterocolitis are causally linked."
The Back Story 

On October 15, 2004 charges of serious professional misconduct, brought by the UK's General Medical Council (GMC) against Dr. Andrew  Wakefield, Professor John  Walker-Smith, and Professor Simon Murch, were sent a to a Fitness to Practice Panel.  The charges related to the medical treatment of 12 children between August 1995 and February 1997. The findings from the treatments were reported in the study "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children" published in The Lancet on February 28th 1998.

The Fitness to Practice hearings began July 16 2007 and ran for 217 non-consecutive days, the longest hearing in the GMC's history. (You can find a a partial transcript here).  On May 24th, 2010, the panel ruled that  Dr. Wakefield and Professor Walker-Smith were guilty of serious professional misconduct, but that Professor Murch was not. It ordered that the names of Dr. Wakefield and Professor Walker-Smith be erased from the register of medical practitioners.

Both Dr. Wakefield and Professor Walker-Smith appealed the ruling. Dr. Wakefield subsequently withdrew his appeal, but Professor Walker-Smith did not.

But there's more.

The Fitness to Practice hearings came about because of the published investigations of a UK reporter, Brian Deer.  Although he had previously published on vaccine issues and scandals, Mr. Deer paid scant attention to Dr. Wakefield's activities from 1998 to September 2003, when he was approached by an editor at the Sunday Times to investigate the MMR scare. On Sunday, February 24, 2004, the Sunday Times published two articles by Deer: “Revealed: MMR Research Scandal and “MMR: The Truth Behind the Crisis.” An interview with The Lancet's editor, aired before February 24, caused the government’s Health Secretary to announce that he believed that the General Medical Council, which licenses all UK doctors, should investigate the matter. Mr. Deer cooperated with the GMC, supplying details that were not included in the articles.

A few days after Deer's articles were published, 10 of the original authors of The Lancet article (including Professor Walker-Smith) published a partial retraction:
"We wish to make it clear that in [the 1998] paper no causal link was established between MMR vaccine and autism as the data were insufficient. However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon [the] findings in the (1998) paper, according to precedent."
After the February London Times article, Deer also made a documentary-exposé on Wakefield's activities, which was aired in November 18, 2004. In response, on January 31, 2005, Wakefield filed two libel suits, one against Deer and the television channel; the other was against Deer and his website, which contained many background elements to Deer's published work.

 Filing suit against Deer was a mistake on Wakefield's part.  It both motivated and enabled Deer to dig deeper into Wakefield's conduct before and during the research on the 12 children.

As a part his defense of these two suits, Deer was granted limited access to confidential, full medical records of 11 of the 12 children in The Lancet project. Deer also used a new legal ruling granting Freedom of Information (FOI) requests, to gather information on Wakefield's manipulation of data in the Lancet report and on his business interests. Wakefield  dropped the suit on January 2, 2006, and was ordered to pay legal costs.

Deer attended every day of the GMC hearings, and became aware of even more inconsistencies in the histories and pathology findings of the 12 children whose cases were reported in the Lancet. As a consequence, The British Medical Journal commissioned a series of articles from Deer, which ran between January 5, 2011 and February 7, 2011.

In January 2012, Wakefield filed a defamation suit against Deer, Godlee, and The British Medical Journal in Travis County, Texas. http://www.courthousenews.com/2012/01/04/BritMedJ.pdf. In the US, some states have Strategic Lawsuits Against Public Participation (SLAPP) laws. Texas has just enacted an aggressive anti-SLAPP law.
Anti-SLAPP laws, for those not familiar with them, are statutes allowing defendants who have been sued based on their speech to force the plaintiffs to establish they have a valid basis for their suit before going forward, and to collect attorney fees if the plaintiff fails. 
On March 9, 2012, Brian Deer, Fiona Godlee, and the British Medical Journal countered Wakefield's suit with an anti-SLAPP motion. (Read the introduction and links to additional supporting material: http://briandeer.com/solved/slapp-introduction.htm)

Reactions to Walker-Smith suit by those who regard Wakefield as a disgrace to medicine:
Reactions to Walker-Smith suit by those who regard Wakefield as a medical hero
Reactions to Wakefield's defamation suit and the anti-SLAPP response by those who regard Wakefield as a disgrace to medicine:
Reactions to  Wakefield's defamation suit and the anti-SLAPP response by those who regard Wakefield as a medical hero:
  • None as of March 11, 2012 at 10:00 pm PDST
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