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Prof. Walker Smith’s memories perhaps not so enduring

Posted Nov 12 2012 12:52am

Prof. John Walker-Smith was a pediatric gastronterologist  (now retired) who worked with Andrew Wakefield on the research that formed the basis for the now retracted 1998 article in The Lancet that sparked the public fear over a possible link between the MMR vaccine and autism. Multiple studies since have demonstrated that the MMR does not increase autism risk and even Prof. Walker-Smith has stated through his attorney that the Wakefield autism/MMR hypothesis is without merit.

Prof. Walker-Smith was found guilty of misconduct and stripped of his medical license by the General Medical Council (GMC), but that ruling was quashed on appeal. In the appeal decision the judge ruled:

It had to decide what Professor Walker-Smith thought he was doing: if he believed he was undertaking research in the guise of clinical investigation and treatment, he deserved the finding that he had been guilty of serious professional misconduct and the sanction of erasure; if not, he did not, unless, perhaps, his actions fell outside the spectrum of that which would have been considered reasonable medical practice by an academic clinician.

Prof. Walker-Smith and Andrew Wakefield took the position that the work they performed was not research driven, but was clinically indicated tests on children later collected as a case series. That the study for which they received ethical approval was not performed. So there was no problem in that children were seen before the approval was granted.

Prof. Walker-Smith wrote an autobiography (Enduring Memories). Two autobiographies, really. One in 2003 (before Brian Deer exposed the ethical lapses involved in the Royal Free Hospital’s research program) and another in 2012 (after the GMC hearings).

Mr. Deer has contrasted some excerpts from the two versions. Here is a snippet fro the 2002 edition:

The centre piece of the research however would be first a study to see if there was significant bowel inflammation in these children which could be treated. A secondary but important question would be whether measles virus, especially the vaccine virus strain, was present in any inflamed tissue which might be found. “

The inflammation study-the Lancet work-was the center piece of the research with the measles virus work as a secondary project. The first measles virus effort was unpublished.

According to Prof. Walker-Smith in 2003, ethical approval was obtained and a pilot study went ahead:

My own role in all this was permissive as Andy Wakefield was the research leader, the conductor of the orchestra, a classical role in research for a gastroenterologist. A team was assembled, an ethical committee application was obtained and a pilot study went ahead.

The 2012 version differs notably from the above. The center piece is no longer the inflammation study, but the measles virus study and the work was not part of an ethics board approved study, but as a byproduct of routine investigation:

The centre piece of the research per se would be to determine whether measles virus, especially the vaccine virus strain, was resent in any inflamed tissue which might be found in these children and to investigate a pathogenetic hypothesis. This research could only be contemplated as a by-product of routine investigation.

Where the ethical approval statement from 2003 says a study went ahead, in 2012 the statement indicates that the project “was not implemented”.

A team was assembled, an ethical committee application was developed to investigate an hypothesis and was submitted by Andy Wakefield but based upon our clinically indicated diagnostic approach. The Ethical Committee approved the application but in the event the study was not implemented.

More modest studies based upon ethically approved research biopsies went ahead

The 2003 version is basically consistent with the GMC charges and the story unearthed by Brian Deer. The 2012 version is consistent with the failed defense Prof. Walker-Smith and Andrew Wakefield gave to the GMC. The decision against Prof. Walker-Smith was quashed.

For many reasons the argument that the quash of the GMC decision somehow exonerated Andrew Wakefield was not convincing from the start. From where I sit, it is even less so in light of a 2003 account clearly setting out the work as a research project.

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