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Rapid Responses: Rapid Responses published:
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Newspaper may be used for a variety of purposes
- Trevor Watts (27 February 2004)
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The wrong issue
- GH Hall (27 February 2004)
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Conflict of interest with paid court work
- Brian Morgan (27 February 2004)
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Re: Medical Journalism
- Stanley Shaldon (27 February 2004)
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Medical Journal Malpractice
- Lenny Schafer (28 February 2004)
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Re: Newspaper may be used for a variety of purposes
- Jenny L Robertson (28 February 2004)
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The Lancet Caves In,Finally
- Jay Ilangaratne (1 March 2004)
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Re: Re: Newspaper may be used for a variety of purposes
- Trevor Watts (1 March 2004)
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Editorial conflicts of interest.
- Richard G Fiddian-Green (3 March 2004)
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Re: Newspaper may be used for a variety of purposes
- s m latta (3 March 2004)
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Is peer review & disclosure of financial competing interests effective in judging the quality of research paper?
- Vireshwar K Singh (7 March 2004)
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Re: Is peer review & disclosure of financial competing interests effective in judging the quality of research paper?
- Brian Deer (4 April 2004)
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Why cannot Brian Deer address these simple questions?
- John Daniel Stone (7 April 2004)
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Re: Why cannot Brian Deer address these simple questions?
- John D Stone (11 April 2004)
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"MMR - SCIENCE AND FICTION": the Richard Horton story
- John Stone (25 September 2004)
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"MMR - SCIENCE AND FICTION": the Richard Horton story II
- John Stone (27 September 2004)
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"MMR - SCIENCE AND FICTION": the Richard Horton story III
- John Stone (30 September 2004)
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"MMR - SCIENCE AND FICTION": the Richard Horton story IV
- John Stone (1 October 2004)
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The New Science Fiction best seller!
- Carol Johnston (1 October 2004)
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"MMR - SCIENCE AND FICTION": the Richard Horton story V
- John Stone (1 October 2004)
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"MMR - SCIENCE AND FICTION": the Richard Horton story VI
- John Stone (4 October 2004)
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Re: "MMR - SCIENCE AND FICTION": the Richard Horton story IV
- susanne mccabe (4 October 2004)
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'A critical appraisal': Stott on Greenhalgh on Wakefield
- John Stone (19 November 2004)
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Trevor Watts, HoD, Department of Periodontology and Preventive Dentistry, Guy's, King's and St Thomas' Dental Institute, London Bridge, SE1 9RT
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The attitude of some parts of the press is nothing new, and is part of a larger scenario of trying to maintain circulation by impressing their readers. For some years I have referred in lectures and discussions with undergraduates and postgraduates to those patients “who come furtively into my surgery looking over their shoulders and to right and left as if they are being followed. Finally they reach into a secure inside pocket, and with some difficulty extract a carefully folded newspaper cutting. They look at you with an air of triumph and earnest interest as they present the document to you. They ask whether you have heard about this amazing new treatment or health fact, as you gaze at the document with an increasing sense of incredulity. And it’s always from the Daily Mail………” I won’t tell you what I advise my patients about the press, but they usually seem to believe me. One of the useful pieces of evidence on this comes from a BMA survey 2 or 3 years ago, when doctors came top of the public trust poll, and journalists came bottom, which seems appropriate. Competing interests: None declared |
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GH Hall, Retired EX1 2HW
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The controversy about the alleged association between MMR and autism has distracted the profession, the media, and the public from the real problem with vaccine safety testing. It is impossible to find out the nature of the tests done and what the results have been. This information is declared confidential on grounds of commercial sensitivity. Why this situation has been tolerated for so long, despite protests by among others NICE and the parliamentary Select Committee on Health, is a disgrace. The fact that the routine test methods have proved inadequate to reveal important side effects like the 60 fold increased risk of Bell's palsy after intranasal 'flu vaccine must surely bring this issue back to proper public scrutiny. Until the promised openness and honesty becomes real distrust will persist, and rightly so. Competing interests: None declared |
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Brian Morgan, Freelance Journalist Cardiff CF11 6LF
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If Dr Wakefield is culpable for not declaring a conflict of interest in connection with MMR publications, and the jury is still out on that of course, then what about multiple publications on the MSBP phenomenon, including covert video surveillance as part of the investigative proces? Key researchers and practitioners failed to declare potential conflicts from earnings in the family, criminal and civil courts where their testimony was based on the work being reported? Should they be investigated by the GMC for this? Should their papers be withdrawn? I only ask. Competing interests: Currently reporting for television with payment on related issues. |
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Stanley Shaldon, Retired Monaco 98000
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Since Dr Horton became editor of the Lancet and the ownership of the Lancet changed, it has in my opinion, sold out to the necessity of circulation increase rather than the publication of medical science and the policing stringently of scientific fraud. Thus it is difficult to imagine that the MMR controversy could have become a hot media issue, unless one was preoccupied with circulation needs rather than scientific objectivity. The issue of conflict of interest is a minor point compared to the poor quality of the publication in question. The suggestion that peer review determines Lancet publication decisions is in itself unusual, as the journal has always prided itself on the decision making responsibilities lying with the editor and in house staff. Stanley Shaldon MA.MD.FRCP Monaco Competing interests: None declared |
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Lenny Schafer, Editor Schafer Autism Report
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Sir, It would appear that Lancet editor Richard Horton is so desperate to put distance between his publication and the findings of Dr. Wakefield that he burned an "ally" journalist in the rush to profit from the findings. This is not surprising given the specious and overblown nature of the charges against Wakefield. To launch such a feeble smear campaign will likely backfire on Dr. Horton for the the puerile nature of it alone. Dr. Horton's rushed tatty tailing will only result in embarrassing himself and the bandwagon of public health officials he's dragged down along with him, as the truth emerges. Dr. Wakefield is clean. His research is clean. But it is his opponents who will stand smudged for their disingenuousness. The Lancet owes Dr. Wakefield and the public an apology, which should be one of the first duties of its new editor. Lenny Schafer Schafer Autism Report Editor www.SARnet.org Competing interests: Writer has a son with autism. |
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Jenny L Robertson, Freelance journalist and writer SW15 5DP
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Newspapers - and magazines - are most certainly used for a variety of purposes, including, not necessarily in order of importance, mopping the floor, wrapping fish and chips, and dispensing propoganda. "In a BMA survey 2 or 3 years ago, doctors came top of the public trust poll, and journalists came bottom." Well, there are lies, damned lies and public trust polls which can be manipulated to come up with pretty much anything you want, if you ask the right questions (ask any politician). Not that I am an apologist for members of the press: far from it. Journalists can be economical with the truth and the media can manipulate facts. To deny it would be absurd, but then journalists as a breed are not particularly paternalistic - thankfully. Nevertheless, ethically challenged as I may be, I would consider it very bad practice to patronise my readers, even if I were writing for the Daily Mail. And, surprising as it might seem to certain members of the medical profession, even their patients are fairly sceptical about what they read in the press. Quite rightly so. This public trust poll which delivered such a resounding vote of confidence in the UK medical profession was compiled by the BMA? Could there just be a little conflict of interest here? Furthermore, no doubt the article was reported by journalists or BMA editorial staff and appeared in the mainstream as well as medical press. In which case, given that no-one can trust anything that journalists say, why on earth should anyone believe it? Competing interests: None declared |
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Jay Ilangaratne, Founder Medical-Journals.com
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Obviously,the Lancet editor has now changed his mind.If Wakefield's non-disclosure of legal aid work is the primary reason for the Lancet's latest stance,then why now,given a reference was made to it about three months after the original publication. The editor,Dr Horton also suggests that had he known the legal aid work("conflict of interest"),that paper wouldn't have been published. I think,that remark will not stand the test of basic logic and common sense.Perhaps, the editor could give us an assurance that the Lancet had never published material where the authors were motivated by financial recompense they received,but I doubt it.If Dr Horton's 'logic' as to conflict of interest is to be followed,any informed view of a paid-expert would become instantly invalid;a cynic might say that we might even have to shut the courts, and invite Lord Hutton to initiate an impartial inquiry rather urgently. Further,it is not clear whether an author who had undertaken paid- research work--has only a minimal chance or no chance--of getting any related material published in the Lancet, in the light of Dr Horton's remarks. If Dr Horton and the commercial conglomerate that he belongs,wish to impugn the real facts that have emanated from Wakefield's paper,then they must do so using objective and transparent scientific data that we might be able to understand. Personal attacks alone will not suffice to win the hearts of the public.Arguably,Dr Horton's rather late sensationalism,might even backfire. Now Dr Horton says,"Until the Wakefield paper, I had not seen this media management role as one for a scientific medical journal editor. I now see it as one of my main responsibilities".Correct,perhaps, but unlikely to be the top priority for a scientific journal editor. Competing interests: None declared |
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Trevor Watts, HoD, Department of Periodontology and Preventive Dentistry Guy's, King's and St thomas' Dental Institute
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Readers may like to read the details. Sorry I didn’t give the reference. It’s a MORI poll quoted in BMJ 2001;322:694 in an article called “Poll shows public still has trust in doctors”. Sorry, the journalists were actually next to bottom at 18%, one point above politicians. In comparison, doctors were trusted by 89% of the public. The problem, of course, is not that no one believes journalists in the national press (I myself have great respect for some writers and broadcasters), but that some people apparently do so even when the journalists in question are patently wrong. How are such readers to know otherwise? Maybe in some cases they want to believe the untruths they read. If wrong beliefs were not reinforced in this way, less damage might result. The power of the press to create public health problems was very apparent in the MMR crisis, and still is, because some journalists refuse to abandon entrenched positions in the face of overwhelming scientific evidence against their beliefs. Competing interests: None declared |
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Richard G Fiddian-Green, None None
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Dr Horton is reported to believe that the UK needs an independent body to investigate the conduct of research and that authors have a duty to reveal the context of their work and potential conflicts of interest. He expands on this theme in the article he has just written for The New York Review of Books (1). Are these his views or is he being used as an infuential spokesman for a third party, specifically in regards to Gutierrez at al's and Andrew Wakefield's papers? To what extent are editorial opinions today being dictated by governmental or legal directives? More importantly has the Lancet or indeed the BMJ ever been forced to withhold publication of a manuscript that the editor wished to publish? In addition were the editors of the Lancet and BMJ ever instructed to write an editorial justifying the retraction of the Centoxin paper and the government's refusal to pay for Centoxin after the efficacy of the monoclonal antibody to endotoxin had been reported in the NEJM? [A member of my division of surgery, MP Fink, was a co-author of that paper. He mght have give me a party line when he tried to justified the retraction to me]. I believe the NEJM may have published a retraction of the paper that reflected Fink's view that there had been a fatal statistical flaw in the study, retrospective randomisation. The true story were evidently disclosed in another journal to which I do not have access(2). As a result Centocor, the very innovative start-up company that had funded Centoxin's development went out of business and those investors who had not sold their shares after the rise in share price that followed publication of the NEJM paper may have sold their interests at an unacceptably low price. From my recollection this retraction occurred just after the Gutierrez et paper, subsequently accepted by the Lancet (2), had been rejected by the NEJM for reasons that were to thebest of my recollection never made known to me or if they did not make an impression on me. It may well have been the same statistical objection. If so the retraction of the Centoxin paper may have been politically inspired and implemented in the most clandestine of manners with an hidden agenda. Are the Lancet and/or the BMJ actively involved in the evaluation of publising practices without full disclosure to prospective authors and/or readers? I get the distinct impression that someone may have been tracking references with the specific intent of discovering just how "mind viruses" or false memes enter clinical practice. They may even have gone so far as to introduce false memes in order to track false memes prospecitively. Indeed I recall having been asked to give written permission to use my submision for some form of study in one recent paper I had submitted for publication. Might the Centoxin and Wakefield papers have been false memes intended to expose these issues? What of tonometry? Has someone been trying to use it too? From a tonomnetric perspective someone has definitely been muddying the waters for a long time and it has done enormous harm. What is more some parties in the know have been going to extraordinary lengths to conceal the fact. Perhaps Richard Horton and Richard Smith would be good enough to enlighten us. 1. Horton R. Has the lure of profits corrupted biomedical research. The New York Review of Books. March 2004;L1(4):7-9. 2. Choyce MQ. Centoxin: the full story of its withdrawal. Br J Hosp Med. 1993 Apr 7-20;49(7):517. 3. Gutierrez G, Palizas F, Doglio G, Wainsztein N, Gallesio A, Pacin J, Dubin A, Schiavi E, Jorge M, Pusajo J, et al. Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet. 1992 Jan 25;339(8787):195-9. Competing interests: INVOLVEMNT IN THE COMMERCIAISATION OF TONOMETRY |
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s m latta, director po16
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A few yaers back i myself would have been one of those who would have trusted a doctor over a journalist, now i see thing a little different. If it were not for the fact of when it comes to vaccines it will not be accepted that adverse reactions can happen then i would still trust the doctor. If you look at any other medication, reactions are stated as a possibility however small that possibility is. Vaccines however well if you dare say it you are greeted with a brick wall. Conflict of interest, well the medical arena is full of it and this is not exclusive to Dr Wakefield. What about so called prosecution experts who earn tens of thousands of pounds in the family and criminal courts, independant they say they are....a greater percentage only work for the prosecution. A conflict of interest indeed, maybe this should be headline news, after all people are jailed off the back of it and children put up for adoption. What one see's one knows, prior to that i would have had faith in a doctor over the printed press any day of the week. Sadly this for me is not so now. Competing interests: None declared |
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Vireshwar K Singh, Gp Registrar The Surgery, Escrick, York, YO19 6LE
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Sir, The Sunday Times article (1) regarding non-disclosure of financial competing interest by Dr Wakefield and subsequent media debate raises many questions which require serious discussion regarding relevance of peer review and declaration of coflict of interests.The article raised the issue of ethics in research and implied that failing to disclose the financial competing interests leads to obvious conclusion that the paper was flawed and unreliable.The responses of Dr Richard Horton, editor of Lancet(Publisher of original paper in 1998) and Dr Donaldson,chief medical officer further reinforced the conclusion regarding credibility of original paper. Dr Horton responded that Lancet would not have published the paper if the conflict of interest was disclosed & it would have strongly affected the peer reviewers about the credibility of the work and Dr Donaldson concluded that the paper was 'poor science' and should never have been published.(today programme,Radio four,BBC).Are these conclusions fair and justifiable? The debate raises the following issues. 1. How effective is peer review in judging the quality of research? 2. Does declaration of financial competing interests and conflict of interest affects the quality of research? There is little evidence for effectiveness of peer review in judging quality of research and it is completely useless at detecting research fraud concludes a systemic review from International cochrane collaboration (2).Another review has noted that there is appreciable bias and parochialism in peer review system and developing an instrument to measure the manuscript quality remains a great challenge.(3).Although peer review has become the norm but it is surprising that in the age of evidence based medicine so much resources are wasted on peer review when there is little evidence in its support. Does the declaration of conflict of interests improves the quality of research? There is again little evidence to suggest such a conclusion. The declaration may have significant effect on perception of scientific credibility of published medical research(4), but is perception of quality true indicator of quality of research? In a cross sectional review of disclosure of financial competing interest in randomised trials has shown that there is variable adherance to disclosure guidelines.(5). In another study on declaration of financial competing interests in five leading medical journals from 1989 to 1999 only 1.4% of published articles declared interests, which included 3.5% of papers,1.7% of editorials & 0.9% of letters.(6). Its quite obvious that declaration of financial competing interest was not the usual practice till 1999 so should we conclude that all research papers published till 1999 are unreliable and of doubtful credibility? If 96.5% of published research papers did not declare financial interests then why only Dr Wakefield's paper is being singled out for not disclosing the conflict of interest? There is no evidence to suggest that non-declaration of financial competing interests makes the paper 'poor science' or of doubtful credibility. The issue can only be resolved by encouraging more independent research & not by smear campaign. References:1. Brian Deer-Revealed:MMR Research scandal;Sunday Times;22 Feb 2004. 2.Caroline White-Little evidence for effectiveness of scientific peer review, BMJ 2003;326:241(1 feb). 3. Sandra Goldbeck-wood - Evidence on peer review-scientific quality control or smokescreen. BMJ 1999;318:44-45(2Jan) 4. Samena Choudhury & others - Does declaration of competing interest affect readers perception? a randomised trial; BMJ 2002;325:1391-1392(14 Dec). 5. Cary Gross & others -Disclosure of financial competing interest in randomised controlled trials: cross sectional review. BMJ 2003;326:536- 527(8 Mar). 6. Amina Hussain & others - Declaring financial competing interests- survey of five general medical journals. BMJ 2001;323:263-264(4 Aug). Competing interests: a physician and a parent |
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Brian Deer, journalist The Sunday Times
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Dr Singh is incorrect in his analysis of the problems with the 1998 Lancet paper reporting Wakefield et al's apparent research, as revealed in The Sunday Times six years later. My exposure of Dr Wakefield's conflict of interest was neither a "smear campaign" as Dr Singh suggests, nor the whole story of what was revealed. Perhaps in his enthusiasm to attack the messenger, Dr Singh failed to notice that parents of children participating in the Wakefield study were revealed in significant numbers to be litigants against pharmaceutical companies. For six years, however, the professions had been led to believe that the Wakefield case series, in which 8 of 12 parents blamed MMR for their children's autism, was compiled from routine admissions to the Royal Free hospital. This makes a difference. To report on litigants without making clear their status and then to report their, obviously highly-motivated, allegations about MMR is not to make a scientific "finding" in any sense that the public would hold in respect. Yet that is at the heart of the fatally flawed Lancet paper. Far from supporting Dr Singh's apparent belief that financial conflicts can often be disregarded, the Wakefield saga may painfully confirm the old adage about calling the piper's tune. Competing interests: Investigated the Lancet paper |
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John Daniel Stone, none 34 Outram Road, London N22 7AF
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The trouble with Brian Deer's story is that acting as an expert witness in a court case does not constitute "an interest" as in fact Prof. Elizabeth Miller was keen to point out on her own account to Private Eye (19 March 2004) in relation to acting as an expert witness for the defence in the same case, and not declaring her "interest" in relevant articles. Moreover, it has not been news that Andrew Wakefield was acting in this way for six years and he wrote to The Lancet to acknowledge his involvement as witness in the legal proceedings on 2 May 1998, and nobody seems to have thought it worth making anything of it at the time. This point re-emerged in a report in The Independent on 27 February 2004, but Brian Deer persists with his story blanking out these factors which bear substantially on its validity. Is it not about time that he addressed them? Competing interests: Parent of an autistic child |
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John D Stone, None London N22
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It remains unclear why Brian Deer thinks his story stands in the light of events, and the criticisms levelled against him by myself amongst others. When it is pointed out that there was no legal basis for the claim of a conflict of interest he is silent, and when it is pointed out that everyone had known about the involvement for 6 years he is silent. But he continues all the same to bristle with moral indignation. After the publication his story the Chief Medical Officer, Sir Liam Donaldson remarked to the BBC Today Programme (23 February): "Now a darker side of this work has shown through, with the ethical conduct of the research and this is something that has to be looked at". On the same day the Prime Minister said to ITV: "I hope now that people see the situation is somewhat different from what they were led to believe". On the other hand Dr James Le Fanu wrote in the Daily Telegraph (2 March): "None the less, it is beginning to look as if, as Neurologist Peter Harvey points out in the same issue [Lancet 14 February], there is now "a step-by-step cascade of evidence" linking the MMR vaccine to some cases of autism." "This could explain the assault on Dr Wakefield's integrity. The validity of his original findings, it is claimed, may have been compromised by a conflict of interest involving research funds that he failed to disclose. This might be relevant if it were true, but it is not, as anyone can check for themselves: Dr Wakefield acknowledged the source of his funding in 1998. It would seem that neither the Government nor the medical establishment can afford for Dr Wakefield to be vindicated - and they are getting pretty desperate." Competing interests: Parent of an autistic child |
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John Stone, none London N22
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Richard Horton's new book is evidently an attempt to set the record straight for a wide readership: I found a stack of copies at our local bookshop so there are evidently thousands of people out there hanging on his words. The book begins with the meeting on 18 February 2004 in the Lancet offices in which Sunday Times journalist Brian Deer challenges the Lancet, Andrew Wakefield, and members of the original Royal Free team John Walker- Smith and Simon Murch with a series of allegations most of which are quickly shown to be unfounded. The one remaining allegation which was left hovering above Wakefield and was to prove the basis of the media trial which ensued in the following days, was that he had failed to disclose a potentially embarrassing conflict of interest. It is strange in this context that Horton does not mention the letter that Andrew Wakefield wrote to the Lancet (published 2 May 1998) in which Wakefield first dealt with the matter publicly: "A Rouse suggests that litigation bias might exist by virtue of information he has downloaded from the internet: from the Society for the Autistically Handicapped. Only one author (AJW) has agreed to help evaluate a small number of these children on behalf of the Legal Aid Board. These childen have all been seen expressly on the basis that they were referred through normal channels (eg, from general practitioner, child psychiatrist, or community paediatrician) on the merits of their symptoms. AJW has never heard of the Society for the Autistically Handicapped and no fact sheet has been provided by them to distribute to interested parties. The only fact sheet we have produced is for general practitioners, which describes the background and protocol for the investigation of children with autism and gastrointestinal symptoms. Finally all those children referred to us (including the 53 who have been investigated already and those on the waiting list that extends into 1999) have come through the formal channels described above. No conflict of interest exist." So, what Horton does not tell us here is that this matter had been made public and had been known by him since May 1998 and had not hitherto - in nearly six years - been considered embarrassing. It remains extraodinary that there is no mention that I can see of this letter in Horton's book until p. 50, where it appears rather incidentally in Horton's account of an exchange between Dr Evan Harris MP and the proprietor of the Lancet Crispin Davis at the Commons Science and Technology Committee on 1 March 2004. Davis tells Harris: "You can imagine that it is virtually impossible for every editor to research every single author in terms of conflict of interest, and in this one Dr Wakefield said there was no conflict of interest, and in fact three months later in written form repeated that there was no conflict of interest. In all fairness, I do not hold our editor to blame...", and again Davis is quoted on p.51 reiterating: "It actually says: 'There is no conflict of interest'. Should the editor then-". Without going into the full context of what Davis is claiming it seems extraordinary, at least, for Horton to quote Andrew Wakefield's statement that "there is no conflict of interest" so completely out of context. The other critical point to be made here was that Andrew Wakefield was legally correct in stating that there was no conflict of interest. In defending herself against a parellel claim made in Private Eye (19 March 2004), Professor Elizabeth Miller - presumably with the best legal advice - wrote: "there can be no conflict of interest when acting as an expert for the courts, because the duty to the courts overrides any other obligation, including to the person from whom the expert receives the innstruction or by whom they are paid". Interestingly, Horton quotes from this very same letter p. 56, but not this bit of the letter. This legal view was also given by barrister Robert Hantusch in a letter to the Times of 24 February 2004: "But the courts do not consider that the engagement of someone to act as an expert witness in litigation has the effect that that person is then biased. Indeed, if this were the legal position, no paid professional could ever at any time give evidence to a court" There are therefore two key points here which Horton's book would seem to disguise: (a) that Andrew Wakefield's involvement in the court case had be known by him and not considered embarrassing for nearly six years and (b) that engagement as an expert witness is not generally regarded as constituting a conflict of interest. To disclose such an involvement may be sensible but to disclose it as "a conflict of interest" might suggest that you were compromised in court. I note that Richard Horton has not been so super-sensitive to other cases of non-disclosure which I have recently documented on these boards concerning the Lancet, Eric Fombonne [1] and Michael Pichichero [2]. [1] Prof Fombonne, Dr Horton and the Lancet: double standards on competing interests http://bmj.bmjjournals.com/cgi/eletters/329/7463/411#74042 , 12 September 2004 [2] Thimerosal - a case of non-disclosure in the Lancet http://bmj.bmjjournals.com/cgi/eletters/329/7463/411#71574 ,20 August 2004. Competing interests: Parent of an autistic child |
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John Stone, none London N22
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In his account of the meeting at the Lancet offices of 18 February 2004 Richard Horton recounts (p.5): "There the concensus ended. Wakefield admitted that he had been commissioned by the Legal Aid Board to conduct a pilot study on behalf of parents of allegedly MMR-vaccine-damaged children. Some of his colleagues claimed that he had not disclosed this fact to them. Simon Murch and John Walker-Smith were visibly shocked by this revelation." The only colleagues present according to Horton's earlier narrative (p.3) were Walker-Smith, Murch and Peter Harvey. You might think that however embarrassed Murch and Walker-Smith were - given the present professional pressures - they could scarcely have been shocked by the revelation of information which had been in the public domain since 2 May 1998 (see my previous post of 25 September 2004). In his statement to the Lancet, 6 March 2004 Walker-Smith states: "None of the children at the time of the referral was known by the team of paediatric gastoenterologists who cared for and investigated these children to be involved in a pilot project commisioned by the Legal Aid Board. At the time of the consultation, I was aware that some of the parents were engaged in legal proceedings." Interestingly, neither Walker-Smith or the ten contributors to the original 1998 report (including Walker-Smith) in their joint statement also in the Lancet of 6 March 2004 makes the claim that Andrew Wakefield witheld information from them. If there was any disagreement after Wakefield's letter of 2 May 1998, it has also never come to light. Perhaps, what is most significant is the apparent extreme motivation to find irregularities after the event. Thus Horton writes (p.4-5): "It was true, however, that the referral of some of these children had been unusual. They had not simply turned up at the Royal Free by chance. Some of the parents knew of Wakefield's interests and his prior view that measles was somehow linked to bowel disease." What would have been odd is if they had all been referred to a chiropodist. This is surely a skewed narrative. Competing interests: As above |
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John Stone, none London N22
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Richard Horton tells us little about Sir Crispin Davis, Chief Executive of Reed Elsevier plc, publishers of the Lancet, except to give an account of his evidence to the Commons Science and Technology Committee (1 March 2004). It may be of some interest that Sir Crispin was appointed as a non-executive director to the board of GlaxoSmithKline - defendants in the MMR litigation - in July of last year. Sir Crispin's knighthood was announced in the birthday honours, June 2004. http://www.gsk.com/about/boardofdirectors.htm Competing interests: As above |
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John Stone, none London N22
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Richard Horton writes rather disparagingly about the pharma/bio-tech lobby organisation, chaired by Lord Taverne [1], Sense about Science remarking p.155: "Unfortunately, Sense about Science has allowed itself to become an easy target for attack. Its financial donors include GlaxoSmithKline, one of the manufacturers of MMR vaccine and a defendant in the litigation brought by claimant families. Among the forty-five people who make up Sense about Science's board of trustees and advisory council, there are Lords (five), Knights (seven), Professors (fifteen), luminous Fellows (fourteen), distinguished doctors (twelve), a Baroness and a Dame." Richard Horton does not mention that among the "distinguished doctors" is Michael Fitzpatrick [2], a regular columnist in the Lancet. In the issue of the Lancet of 21 February 2004 - the very weekend that Richard Horton decided to throw Andrew Wakefield to the wolves - Michael Fitzpatrick wrote a polemical piece on the Government's promotion of choice in healthcare: "Nor is the continuing promotion of choice going to be much help in the ongoing struggle to improve uptake of the measles, mumps and rubella (MMR) vaccine, given the government's - entireley legitimate - refusal to allow parents the choice of separate vaccines." [3] At no time in all this controversy has Michael Fitzpatrick declared the Sense about Science-GSK link as a competing interest, he did not on this occasion, and Richard Horton has taken no public action against him. THE TROUBLE WITH RICHARD HORTON'S ACCOUNT IS THAT HE AFFECTS TO BE ABOVE IT ALL BUT THE DOCUMENTS SUGGEST OTHERWISE. [1] See Rapid Responses to Dick Taverne 'The legal aid folly that damages us all' (24 July): http://bmj.bmjjournals.com/cgi/eletters/329/7459/239 [2] www.senseaboutscience.org.uk. See also Rapid Responses to Michael Fitzpatrick 'George and Sam'(26 June 2004): http://bmj.bmjjournals.com/cgi/eletters/328/7455/1571 [3] 'Choice',The Lancet, 21 February 2004, vol.363 no 9409. Competing interests: As above |
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Carol Johnston, Carer Carshalton, surrey
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Reading John Stone's comments on Mr Horton's book. One wonders just how far can "poetic licence" be applied to stretch the truth. Indeed it seems by reading Mr Stone's version of events this book surely belongs in the category of "Science Fiction". Perhaps Richard Horton would like to reply regarding Mr Stone's version of events and explain the anomolies with the versions in his book? I for one would be very interested to hear what Mr Horton has to say. Also reading Brian Deer's response I would like to query his choice of words in referring to the MMR litigants as "highly-motivated" in their allegations about MMR. Of course they were highly motivated, their children became severely disabled following MMR. What parent would not be "highly motivated"? I wonder what thoughts were crossing Mr Deer's mind whilst he was sitting at the back of the Case Management Hearing in July, listening to the harrowing and emotional accounts of each parent as they each recalled their own personal set of circumstances. Does he really believe that the parents are pursuing this purely for financial gain? The most pressing reason why the parents are pursuing the litigation case is for research to be re-instated which will provide answers as to just what happened to these children and indeed children like mine who have regressed after having MMR. My children regressed in 2000 and 2001 and indeed, is still happening. How does Mr Deer and Mr Horton account for the presence of the measles virus in the guts and brain stem of these children, the onset of symptoms such as mutiple seizures, autistic behaviours, loss of previously acquired skills and bowel disease following MMR. Does Mr Deer honestly believe that because the UK MMR litigants were referred to Dr Wakefield as part of the trial, are sufficient grounds for dismissal of his clinical findings? Incidentally, Dr Wakefield has my greatest respect not only as a doctor and a scientist but as a person who believes in his work. I reckon, if Dr Wakefield were to publicly retract his findings he would be richly rewarded and welcomed back into the UK medical/scientific/political fold like a long lost prodigal son. If he was a lesser man he would indeed retract his findings like many others have already, but perhaps he belives in something that alot of the scientific community seemed to have overlooked in the bid to prove that the MMR is safe. That is "TRUTH". Something has happened to these children, so far in all the furore over the smearing of Dr Wakefield's the medical community have neglected to look at these children to offer a valid reason as to why these children and thousands of others like them have regressed and become severely disabled following MMR. If the supporters of MMR are so sure that the MMR is innocent of a role in these children's illnesses then why have they not examined these children? Why do they not prove Dr Wakefield wrong with solid clinical science, not with epidemology, spin, character assassinations and smear campaigns. I have never had the pleasure of meeting Dr Andrew Wakefield but I would like to thank him for the personal sacrifices both he and his family have made in the pursuit of the truth. Rather than being above all this, it seems that Mr Horton is stuck- fast in the boggy mire of half-truths, untruths and finger pointing, but everytime he tries to extricate himself, he sinks a little deeper. Does Mr Horton agree that these children and their parents deserve an explanation as to what has happened to them? Because of the political implications of the MMR debate many vaccine damaged children continue to suffer in silence because doctors are afraid to recognise the underlying cause of their conditions. As a parent of two such children it makes my blood boil when I see people like Richard Horton ignoring the fate of these children. My little boy suffers chronic stomach pains, is frequently violently sick and suffers chronic dirroeah. He cannot speak he is conveniently overlooked by the likes of Richard Horton. Has Richard Horton ever attempted to address the parents of the children who were damaged by the MMR. This is what people like Richard Horton forget that at the centre of all this are sick children. The biggest mistake Andrew Wakfield made was that he cared enough to listen to these parents. When the truth is finally revealed I sincerely hope that the likes of Richard Horton, Brian Deer, Elizabeth Miller et al have the decency to publicly apologise to Dr Wakefield. Competing interests: 2 ASD kids following MMR |
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John Stone, none London N22
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The Lancet today publishes a letter from Dr Mark Geier relating to non-disclosure of interest by Prof Pichichero (2 October 2004 Vol 364 No 9441), as mentioned in my letter above of 25 September 2004 (""MMR - SCIENCE AND FICTION": the Richard Horton story"). I have electronic copies of correspondence which show that Dr Geier first wrote to the Lancet on this matter on 29 April of this year. After much toing and froing the Lancet agreed to publish a letter from Dr Geier providing it did not draw parallels with the Andrew Wakefield affair, and Prof Pichichero was given the opportunity to defend himself (letter of 1 July 2004). Notwithstanding this, it seems to have taken a further three months for the Lancet to produce Dr Geier's letter, perhaps embarrassed by my post. If as they claimed in the correspondence Prof Pichichero had a sound defence it is hard to understand why they were not anxious to clear the air. Where, we might ask, are the transparent upholders of the public good? (Documents provided) Competing interests: As above |
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John Stone, none London N22
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On page 10 Richard Horton writes: "On this occasion, we had discovered an error of judgement, an important error of judgement to be sure: a failure to disclose a perceived conflict of interest that would almost certainly altered peer reviewers' and editors' view about a preliminary and controversial finding. Did this behaviour amount to scientific misconduct? It was hard to tell. But it certainly invalidated Wakefield's central claim - namely that the link between MMR vaccine and autism was a serious independently arrived-at scientific hypothesis that needed to be investigated urgently." The question might conceivably arise whether professional misconduct was involved if in fact the paper contained such a hypothesis, but there is no such passage and Horton does not (cannot) cite it. Horton goes on (p.10-11): "We needed a partial retraction, erasing as far as one reasonably could the interpretation concerning the vaccine and the autism. None of the factual material in the 1998 paper was in doubt. Twelve children did exist. Their clinical histories were not disputed..." But Horton does not tell the reader what is contained in their clinical history: "In eight children, the onset of behavioural problems had been linked, either by the parents or the child's physician with measles, mumps and rubella vaccination. Five had had an early adverse reaction to immunisatisation (rash, fever, delirium, and in three cases, convulsions). in these eight children the average interval from first exposure to the onset of behavioural symptoms was 6.3 days (range 1-14). Parents were less clear about the onset of abdominal symptoms because children were not toilet trained at the time or because behavioural features made children unable to communicate symptoms..." [1] But where we have to ask was the claim made which related to Andrew Wakefield's alleged conflict of interest. The reason for Wakefield's concern is evident, but the claim that his interest somehow distorted the paper cannot be substantiated. It would not have been proper to omit such information. And again Horton does not tell the reader what they need to know. [1] Wakefield et al: 'Ileal-lymphoid-nodular hyperplasia, non- specific colitis, and pervasive developmental disorder in children', The Lancet Vol 351, No 9103, 28 February 1998. Competing interests: As above |
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susanne mccabe, retired cf 24 3pf
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What is a 'luminous fellow'?! Does he glow in the dark? If readers are interested in reading the views of Michael Fitzpatrick, 'distinguished doctor' - they are as often published on 'spiked-online/health' as in the Lancet. They may be read less often there by health workers but he makes no secret of his opinions; see 'The Sickness at the Heart of Medicine' (Spiked on-line 27th September 2004). In this article Michael Fitpatrick reviews two interesting books 'Hippocratic Oaths:Medicine and it's Discontents',by Raymond Tallis and 'NHS plc: The Privatisation of Our Health Care' by Allsion Pollock ,whilst using them to expound his own critical views on the modernisation of health care in UK. In the light of the latest scandal involving Glaxo-Smith Clyne and the licensing of a drug known to cause tragic deaths and extremely harmful effects - SEROXAT - it would be sensible for anybody, such as members of Sense About Science, to declare any kind of involvement with the company. Just as Peter Tyrer, Editor of Journal of Psychiatry, and Mike Shooter, President of College of Psychiatrists, who both took part in the TV Panoram documentary last night,which exposed the horror story of SEROXAT, might have declared why the college continued to advertise the drug in the Journal after it became known as a 'dirty drug'. David Healey, psychiatrist, Bangor N. WAles, has been speaking out for years with liitle support from colleagues. Peter Tyrer stated that he has noticed that people with certain personalities may have serious adverse effects from taking SEROXAT but went on to suggest that work needs to be done to indentify these personalities. It is impossible to monitor such a drug in this way. Yet again pussy footing around puts real people with real lives to lose at risk. IS the advertsing money worth it? Ssurely the company should be boycotted and medical journals should be seeking cleaner ways of funding their publications. I have no involvement with individuals or campaigning groups which raise issues/lobby through the BMJ. My own work is a more braodly based concern with ethical issues. Competing interests: None declared |
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John Stone, none London N22
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On his website Brian Deer publishes a critique by Trisha Greenhalgh of the 1998 Wakefield Lancet paper (http://briandeer.com/mmr/lancet- greenhalgh.htm), which is cited on the MMR the Facts website, thus creating a link between MMR the Facts and the Deer site. Interesting, in turn, to read the critique by Carol Stott of Greenhalgh: "Comment on 'A critical appraisal of the Wakefield et al paper' by Prof Trisha Greenhalgh" at: http.//www.mmrthequestions.com/TG_Flaws.pdf Competing interests: Parent of an autistic child |
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