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Hilary's Desk

On the matter of the Lancet retraction

Hilary Butler - Monday, February 01, 2010

The Lancet has retracted the 1998 paper (1). Now, all the pillorying and slandering of Andrew Wakefield will start in earnest. The question is, "How does Richard Horton manage to go to sleep each night?". And here's why.  In 2004, the Lancet "partially" retracted the paper, on the basis that Andrew Wakefield never declared to the Lancet, financial conflicts of interest. When confronted in front of the GMC, with 1997 faxes , and proof of receipt, showing that that required information had indeed been received by the Lancet, Richard Horton said that he had never seen it.

How convenient. Again, in front of the GMC, when asked what he thought of the 1998 case-study, Richard Horton was effusive in praise, saying words to the effect that it was an excellent example of a case study and conformed to the highest scientific standards.

Interesting then, to see that one reason for the full retraction is because the study didn't have ethical approval. How strange. That document was tabled to the GMC and was also provided to the media outside the GMC by Dr Andrew Wakefield a few days ago. Did the GMC lose that piece of paper, as well as a whole heap of others provided?

Richard Horton's other excuse for retracting the paper, is because the study purported that the children were 'consecutively referred' and the Lancet now believes that's false. Okay, so what about this science that Richard Horton lauded so highly in front of the GMC?

So what do I think of Richard Horton's decision to withdraw the paper?

It's ironic in the bigger picture of things, that Richard Horton should retract the paper. 

First, as an Editor of the Lancet for many years, you would think that the "paper" systems would be in order. 

For him not to see documents for which there are office receipts, raises just a few questions.

Second, the Lancet is a peer review journal, and requires several "independant" reviewers to sign off studies.  Obviously there wasn't anything wrong with the science or you'd think it would not have got past get-go.  But to what extent does the Lancet, actually do it's job properly? Because it seems to me that either Richard Horton is incompetent, as were the peer reviewers, or he's expediently twisting the truth to suit an agenda. Whose agenda?  That's the 64 million dollar question.

Given the revelations in front of the GMC panel, you wonder why the media isn't talking about the inconsistencies between what Richard Horton said, and what he has now done

The future will be interesting, because I have no doubt that the documents presented to the GMC will be released to the public, uploaded onto internet sites, and a definitive book will be written on the topic.  Where will that leave the GMC?  And then the "Deers, Offits and Oracs" will flood the market with their ninth hand replies.

What readers must remember is that the primary supporters of Andy Wakefield are provaccine parents who believe that their fully vaccinated children became seriously ill after being given - not just the MMR - but often two or three other concomitant vaccines at the same time.

The ultimate irony of all this, is that most those of us who are pilloried as anti-vaccine, have no experience of either gastrointestinal issues, or autism in our children.  This is a mystery and a totally foreign world to most of us. 

Whether or not there is a higher rate of autism and other disorders in vaccinated children, compared to totally unvaccined children in New Zealand, is also something, that IMAC and the Ministry of Health could prove first hand - if they had the will to do so.

As everyone knows, Dr Paul Hutchison is chairman of a select committee in Parliament looking at ways to increase New Zealand's supposedly disgraceful immunisation rates.  In other words, New Zealand has a very large, unvaccinated cohort of children who could be compared with fully vaccinated children.  In that group will be children who are not vaccinated at all, because parents chose not to vaccinate.  Other children aren't vaccinated because parents simply default.

What is the overal health of children whose parents chose not to vaccinate like?  What is their rate of autism, chronic illnesses, autoimmune disorders like?  We have no idea.  But we could know, if the Government had the will to find out, and they have the means at hand, to do that study, very easily.

How's that?  The National Immunisation Register  (NIR) has on it the names addresses and doctors of all children vaccinated. It's primary function is a reminder service to make sure everyone has all their shots.  It's certainly not being used to it's full potential as a health checker or vaccine reaction flag-alert system.  (We could even compare the children of parents who chose not to vaccinate with the children of parents who simply default without chosing.) 

The National Immunisation Register has on it, some names and addresses of people who have chosen not to vaccinate, and who have asked to be taken off the register.  Actually they are not taken off the register.  The names, addresses etc, are all supplied to the register, go on the register, but the register is not used to harrass those parents, ...  or if it is, the Ministry, or the Health and Disability Commissioner, soon knows about it. 

There is also another separate numbering system, which all New Zealanders are given at birth, and that is the National Health Index. (NHI) Those who are not on the NIR, are on the NHI. By accessing both sets of data, New Zealand hospitals have potential access to a huge amount of information.

If the National Immunisation Register was ALSO used to record all deaths, all acute, chronic and autoimmune disorders,... and autism diagnoses..., then with the flick of a switch a comparison of the fully vaccinated children, and the totally unvaccinated children, might answer a whole lot of questions.  It's not like they would have to set up an expensive new system to do this.  The fundamentals are all there, today, now....

As far as I know, both those systems are run using compatible computer software.

To use these systems to compare the health of children, and also to see whether or not there are a few more Jasmine Renatas out there, could be done.  But it won't be done.

 

Back to Richard Horton and the Lancet. 

 

The ultimate irony of the situation is this. 

The Lancet was originally set up in 1823 by Dr Thomas Wakley who couldn't get any other journals of the day, to publish his views on the medical profession.  After all, he called them liars, incompetents, nepotistic and corrupt.  Dr Wakley used his own money to say exactly what he wanted how he wanted and be damned to his own colleagues.  For many years, the Lancet fearlessly exposed the medical profession's conflicts of interest; damage to patients, and became the darling of the disenchanted.

By 1900, the Lancet was a leader; a shaker; a mover; a catalyst for badly needed change. 

In 2010, 187 years later, it is pretty safe to say that the Lancet, is now as "respectable" as the journals in 1820, who would not publish Wakley's articles

But there is a huge fundamental difference today, which was not there in 1823.  Would BIG PHARMA, the GMC, and other controlling, or regulatory bodies today, stand for Andrew Wakefield and others like him, setting up their own "medical journal" and pointing out their colleagues sins of commission and ommission?

 

NO WAY!!!

 

Would such a journal be allowed to remain in publication?  Would it be listed on PUBMED?

 

NO WAY!!!

 

I like to think that Richard Horton had no choice but retract Andrew Wakefield's article.  That he had both arms wrestled behind his back and a metaphorical gun put to his head and was told, "Do this or else!"  But having watched his evolution over the last two and a bit decades, I somehow doubt it.  What he said to the GMC showed me that Richard Horton runs with the hares and hunts with the hounds.

Medical science is no longer about honest enquiry and truth. 

We have come right back, full circle, to 1820 but with one big difference.  Medical $cien$e is now about keeping pharma above water in a recession; about adhering to dogma; and protecting "ones own".

As to the very sick children, or provaccine parents who are pulling their hair out?  Where do they fit in  in all this?  Nowhere. 

And that's the way it's always been, and always will be.

~~~~~~~~~~~~~~~~

 

(1) Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Lancet. 1998 Feb 28;351(9103):637-41.
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