MMR, the Murdochs and British Medical Journal: Questions Unanswered as Editor Godlee Plans Washington Triumph
Posted Sep 01 2011 12:00am
By John Stone
BMJ editor, Fiona Godlee, is scheduled to give a presentation under the auspices of the National Institutes of Health in the Washington DC area on Tuesday renewing her and BMJ’s onslaught on the reputation of gastro-enterologist Andrew Wakefield (See NIH news/events) . The allegations, made by journalist Brian Deer, which are fundamentally flawed were originally published in the Sunday Times in 2009 days after proprietor James Murdoch was appointed to the board of MMR manufacturer GlaxoSmithKline with a brief to defend the group’s reputation, but were largely ignored in the wider media until they were re-launched by British Medical Journal earlier this year Meanwhile, Godlee and BMJ have despite months of pressure failed to disclose that the journal itself is in partnership with another MMR manufacturer, Merck, through BMJ Learning and Merck’s not-for-profit information arm, Univadis . Contrary to normal academic conventions BMJ have taken a legalistically defensive position over their claims against Wakefield, have blocked legitimate comment in their columns, and not required author Deer to respond to criticisms ( See Guardian UK comments and BMJ reply ).
The story began in 2003 when a Sunday Times section editor told Deer “I need something big” on "MMR" . This editor was Paul Nuki, the son of Prof George Nuki, who sat on a licensing authority committee when MMR was introduced in the United Kingdom in 1988 . Shortly afterwards Deer, with support of the newspaper, was interviewing litigant parents in the MMR vaccine damage case under a false identity (an unethical practice known as ‘blagging’ which the paper has recently been forced to abandon under parliamentary scrutiny) ( See Age of Autism: An Elaborate Fraud Part 1 ). Deer was also supported by MedicoLegal Investigations (MLI) , a bureau affiliated to the Association of the British Pharmaceutical Industry (ABPI) which specialises in bringing doctors before the General Medical Council, the UK’s disciplinary body. Unknown to Sunday Times readers or the wider public Deer made a series of expertly drafted complaints against Wakefield and colleagues to the GMC and came to an agreement with GMC lawyers that he would not be named (thus allowing him to continue reporting with an undisclosed interest in the outcome) ( See Spectator UK here ). In 2010 Dr Godlee refused to allow reference in BMJ’s columns to Deer’s GMC conflict or require Deer to make a correction to his already published BMJ articles ( See Age of Autism Godlee Must Go ), although euphemistic reference to the matter is made in his 2011 disclosures.
Deer has stated on his website that “almost all the key facts and documents” in his MMR investigation "are not public domain." When Deer stated in BMJ on-line last year “I know the names and family backgrounds of all 12 of the children enrolled in the study, including the child enrolled from the United States” the journal edited or removed all letters questioning Deer’s access to such confidential material, on the pretext of a legal complaint, but without further explanation . Deer also claims specifically to have studied confidential papers in the MMR litigation without explaining his access to them ( see here and ), and published several of the names of children in the Lancet paper on his website between 2004 and 2007. All these apparent breaches of medical and legal confidentiality are known to BMJ, who have chosen to turn a blind eye and stop discussion of them in its correspondence columns.
BMJ’s present raft of fraud allegations against Wakefield derive from 2009 and were published in the Sunday Times six days after proprietor James Murdoch was appointed the board of MMR manufacturer GSK with a brief “to review…external issues that might have the potential for serious impact upon the group's business and "reputation." While there is no proof that Murdoch intervened with the paper to publish Deer’s allegations it would be characteristic of his brash style. Writing about current Murdoch family feuds in the Guardian three days ago Dan Sabbagh commented :
"Now those close to the family worry that the only options are "fratricide or patricide", with critics of James saying that he mishandled power with a series of crude corporate moves such as switching from Labour to the Conservatives in 2009 in the middle of the Labour party conference."
The allegations against Wakefield remain grotesquely flawed.
The most basic objection, which was pointed out by Wakefield early on in 2009 was that there were 12 other signatories to the 1998 Lancet paper who have never repudiated the data and he could not possibly have fabricated it on his own (as Deer and BMJ claimed) has never been answered . In fact Wakefield’s co-defendants at the GMC, Prof John Walker-Smith and Simon Murch, offered detailed defences of the paper’s data, and a third signatory, histopathologist Dr Susan E Davies, wrote a blistering rebuttal to BMJ of Deer’s interpretation of her evidence at GMC hearing . Other systematic flaws in the Deer/Sunday Times/BMJ claims were that the paper’s authors including Wakefield had never had access to General Practitioner notes that Deer had trawled through in constructing his case against Wakefield, but also that Deer had not had access in drawing his conclusion to the parent held developmental records (known as the Red Books) which the Royal Free staff had used in investigating the children . Deer dismissed the issue of the Red Books in a BBC interview, referring to them witheringly as ‘baby books’ (as if the very mention of babies provoked disgust) but a Department of Health pamphlet states emphatically “This is the child’s main health record and should be kept safe."
BMJ also refused to publish or get Deer to respond to more detailed criticism such as those of parent Martin Hewitt who subsequently posted detailed critiques based on the GMC record on Age of Autism ( Revisit Deers Claims Part 1 , Part 2 and Part 3 ). Deer’s interpretations of the record remain substantially unchanged in BMJ from the 2009 Sunday Times reports, have had no apparent expert input and ignored two detailed rebuttals by Wakefield first of all to the Press Complaints Commission in 2009 and then in his book ‘Callous Disregard’ in 2010. Perhaps Deer’s single most egregious error was to interpret the deafness of Child 1 in the Lancet paper at age 10 months as an early sign of autism when the child’s GP had noted an ear discharge and diagnosed Otitis Media. In February Godlee was forced into a statement “The case we presented against Andrew Wakefield that the 1998 Lancet paper was intended to mislead is not critically reliant on GP records” ( Why AofA left BMJ and Deer high and dry ) which took no account of the fact it marginalised at a stroke what appeared to be the main details of Deer’s article “Secrets of the MMR scare: How the case against the MMR vaccine was fixed." So, we continue to wonder, what is it based on?
A further troubling aspect is that Godlee’s editorial accusing Wakefield of fraud was aberrantly co-signed by associate BMJ editor Harvey Marcovitch who doubles as chairman of GMC panels. While Marcovitch acknowledged the conflict it seems inappropriate that he should have signed, particularly since the GMC findings are still under appeal by Prof Walker-Smith (while Wakefield has been forced to withdraw due to cost). On the other hand Marcovitch failed to disclose initially his connection with United Kingdom Research Integrity Office, where until recently he was director with Richard Tiner a former director of both ABPI and MLI. As chair of GMC panels Marcovitch also failed to take action against the chairman of the Wakefield disciplinary panel, Surendra Kumar, who failed disclose shareholdings in MMR manufacturer GSK, membership of medicine licensing authority committees, and led a debate calling for MMR to be made compulsory shortly after the hearing was concluded.
While BMJ and its editor-in-chief pose as arbiters on research ethics there are many questions about the journal’s involvement in the MMR affair going back to the publication of Deer’s first article in 2004, which concluded with a gratuitous and prejudicial soundbite from the then editor, Richard Smith: "That MMR paper is the best example there has ever been of a very, very dodgy paper that has created a lot of discomfort and misery." The paper, however, reported accurately and made few claims. The time has come, on the other hand, to probe the gigantic smokescreen created to defend the reputation of MMR vaccine on both sides of the pond. If people are really concerned about research and publication ethics they should take a long hard look at BMJ.