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GMC: MMR doctor 'abused position of trust'

By Tom Clarke

Updated on 28 January 2010

A disciplinary panel finds Dr Andrew Wakefield, who sparked the controversy over the MMR vaccine, "showed a callous disregard" for the suffering of children and "abused his position of trust".

Dr Andrew Wakefield (credit:Getty Images)

It has been the longest hearing ever held by the General Medical Council, into one of the most serious public health scares of modern times.

Today, the General Medical Council (GMC) gave its ruling on whether a British doctor was guilty of serious ethical misconduct in dealing with child patients and a lack of scientific accuracy, honesty and transparency.

Dr Wakefield's conduct in paying £5 for blood samples from children at his son's birthday party brought the medical profession "into disrepute", the disciplinary hearing found. 

The panel also said he "failed in his duties as a responsible consultant" and went against the interests of children in his care during the research, adding that he acted dishonestly and was misleading and irresponsible in the way he described a study published in The Lancet medical journal.

Dr Wakefield, who was not present at the hearing, now faces being struck off the medical register.

This has been a very complex inquiry, a panel of three GPs and two lay members has sat for a total of 187 days since July 2007 when the hearing was first launched. They are considering a charge sheet that runs to 95 pages, 34 of them are devoted to Dr Wakefield alone.

What is crucial to this case is that it is not MMR, or even Dr Wakefield's science that is on trial. What is under scrutiny is the professional conduct of Dr Wakefield and his colleagues.

In a 1998 Lancet paper Dr Wakefield, along with Professor John Walker-Smith, Professor Simon Murch and 10 other researchers proposed a new type of bowl disorder in children and a link between it and autism. They did not directly identify MMR as a cause. Andrew Wakefield later made a link between the vaccine and the disorder.

The other 10 researchers have long since disowned the findings of the paper and Prof Murch has since maintained that MMR is safe.

The GMC hearing focused on whether the research was conducted in an ethical manner and whether the paper was an honest reflection of that research. The three researchers deny any wrongdoing.

Nearly all of the serious allegations the GMC have been considering were raised by the Sunday Times journalist Brian Deer.

He revealed in 2004 that Andrew Wakefield had been working for a lawyer who was trying to build a case against the manufacturers of MMR for causing harm to children. This, a serious conflict of interest not disclosed to the Lancet, resulted in the paper being retracted by the medical journal.

However, it was subsequent allegations of ethical misconduct made by Mr Deer that prompted the GMC investigation. Because a doctor's primary responsibility is the welfare of their patients, it is these allegations that are most grave in the eyes of the medical community.

The GMC has been considering allegations that the three researchers carried out procedures on 12 autistic children recruited for the study that were not in accordance with the ethical approval given to them by the Royal Free Hospital where the initial research was carried out. Also that the children studied did not properly qualify to be included in the study and that they carried out procedures that were not suitable given the decision of the ethical review board.

Some of the procedures were invasive, involved taking samples of tissue and fluids from the children's bowels and spines. Because these procedures are risky they can only be carried out when there is a genuine medical need. The researchers also stand accused of giving an experimental substance to the children without ethical approval.

Wakefield was also being investigated for taking blood samples for the research from children at his son's birthday party and offering them £5 in return. He was later filmed describing this at a conference. 

However, the charges against Dr Wakefield go further. It was alleged he was in a position to profit from his research into MMR because he was employed as an expert witness against the safety of the vaccine by a US law firm.

It was also alleged that he had taken out a patent on a single-shot vaccine against measles which he advocated as an alternative to MMR after his paper in the Lancet was published. If these allegations are true, it is information he would have been required to disclose to an ethics board and to the Lancet.

The journalist Brian Deer has made allegations against Dr Wakefield of fraud and serious scientific misconduct. Many of these have not been directly investigated by the GMC and Dr Wakefield has always denied any wrong-doing.

The GMC panel only rule on which of the charges against Wakefield and his colleagues are proven. They could take several more months to decide on what action, if any should be taken against them. However, when found guilty of serious professional misconduct, a doctor can be struck off and banned from practising medicine.

Dr Wakefield, maintains there is an unexplained link between MMR and autism. Many parents of children with autism still think he is right. The ruling by the GMC may be seen by them as the medical establishment punishing Wakefield for challenging their view that MMR is safe.

Panel chairman Dr Surinder Kumar was heckled by parents who support Dr Wakefield as he delivered the verdicts. One woman shouted: "These doctors have not failed our children. You are outrageous."

However, that battle has already been fought and ,on the balance of evidence, won by the medics. Dr Wakefield's work prompted a slew of studies and reviews into autism and MMR, none has found a link. Prominent autism researchers have also failed to find any autism-like disorder that resembles the one Dr Wakefield claims to have identified.

The legacy
The MMR scare has left a serious legacy. The number of children vaccinated with MMR began to fall as soon as media reports about Dr Wakefield's 1998 study emerged. In 1997, 92 per cent of children in England and Wales got the jab. By 2004 it was 80 per cent.

Last year only 85 per cent of children have had the vaccine. While this may sound like a lot, because measles is so infectious vaccination rates of 95 per cent are recommended to prevent spread of the disease.

And the impact on the number of measles cases has been stark. In 1998 there were just 56 cases in England and Wales. In 2008 there were 1,370.

While measles can be a mild disease for many children it can lead to serious brain swelling which can be fatal or result in deafness or subsequent degenerative brain diseases.

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