Tuesday 14th August GMC hearing
Here is an account of what happened today at the hearing...
By Olivia Hamlyn (daughter of Susan, sister of Francis)
Dear All,
I arrived at about 11.15am and so missed the prosecution cross-examining Dr
Revell. He was the Head of Histopathology at the RFH at the time the Lancet
paper came out etc.
Miller [defence counsel] was the main cross-examiner and most of his
cross-examination as far as I could see was spent 1. establishing the
relationship between Revell and his department and those carrying out the
clinical work and research work and 2. The difference between clinical work and
retrospective research work.
Revell made it clear that where investigations were taking place, i.e., here
involving slides taken from colonoscopies, there was much discussion between
clinicians and pathologists in weekly meetings. He didn't attend the meetings
and therefore couldn't say what went on in them exactly, but their purpose was
to reach a consensus about what had been found and about the care and treatment
of patients and so that departments would be in communication with each other.
These meetings were mainly in Dr Sue Davis' (later witness) hands. He made it
clear though, in summary, that all processes used for the care etc. of patients
were professional and contained nothing to raise concern.
Miller then established that should the interpretation of the slides change
after later examination for research purposes, then treatment of the patient
would not change. Furthermore, that in order to conduct retrospective research
now, the patient's consent would be needed. This was a result of the Human
Tissue Act (2004), which hadn't been around when this research was being carried
out. Revell did regard it as a retrospective study, he said and added that Dr
Davis and Dr Dillon did their own retrospective review of the same slides in
order to verify the description in the article. He assumed this review was the
same as that referred to in the Lancet paper.
In relation to the Lancet paper, he said that what had been found were
interesting observations and would need a larger study.
In response to panel questions, he thought there had been nothing unusual about
the biopsies except that one was for an autistic child. He had concerns about
this so investigated as part of his job to check that the NHS was being used
appropriately. He was obviously satisfied. It was unusual for a child with
autism to be biopsied but then again, he wasn't a gastroenterologist. When
pressed about the necessity for ethical approval he said in 1998 one wouldn't
have necessarily needed ethical approval for writing retrospective case studies
but couldn't remember when it changed.
Next up was Professor David Candy who is a paediatric gastroenterologist and was
a peer-reviewer to the Lancet paper. Smith [prosecuting counsel] took him
through the process by which one becomes peer-reviewer and the background to his
being asked to peer-review the Lancet paper. Briefly, one can be nominated by
the authors of the paper or chosen by the editor (there are probably other ways
too). This was his first peer-review for the Lancet although he had experience
doing it for other journals. He received two papers: the first one being the
clinical paper (the one which was published) and the second one being a basic
science paper (which was actually rejected) and a letter from John Bignall of
the Lancet asking him for a swift review of both warning him of the implications
of publishing these papers and requiring him to make sure the findings were
absolutely watertight.
Several clear points came out in his cross-examination which can't have done the
prosecution much good.
Firstly that he knew the papers would be excellent because he knew and admired
Professor John Walker Smith. He needed to make no major amendments and would
have been surprised if he had had to, he said. He said that the second paper
especially led to his endorsement of the pair.
Secondly, the major criticism of the Lancet paper both in the editorial that
accompanied it and from other sources was that there was a lack of virological
evidence/virus infection to support/explain the claims made in it. He said,
however, that the these criticisms would have been met if only the second
scientific paper has been published too, along with the first paper. The first
paper implicated the measles component of MMR because the authors knew what the
second paper said, i.e. The presence of the measles protein in the gut had been
identified. He also noted that it was puzzling that the editorial should contain
such harsh criticism of a paper which had been accepted for publication!
Thirdly, he talked about the research techniques used to detect the measles
virus such as PCR and these were techniques which he had faith in and had
experience of. He gave both papers positive reviews and doesn't know why the
second paper was rejected. He conceded however, that because the peer-review
process was not transparent then and he didn't know who the other reviewers
were, then it could have been negatively reviewed by someone with more
expertise. But then again, we won't find out for sure why the second paper was
rejected because the no one seems to know what happened... However, he made it
clear that he was not happy that only the first paper was published without, as
he put it, "the missing piece of the puzzle" and felt that it would have been
better to publish nothing, rather than just the clinical paper. He described the
two papers as "indivisible" and said that the observations in the first paper
were strengthened and confirmed by the second paper. Koonan [defence counsel]
suggested that the publication of the first paper without the second looked like
an error and Candy replied that it had definitely been an error not to consult
the peer-reviewers on this matter. He felt that if there had been a disagreement
among the peer-reviewers then the authors should have been asked to comment and
it should have been resolved that way. Apparently this is Horton's usual method,
as he stated last week, but evidently it didn't happen...
Fourthly, he felt that taken together, the findings of the two papers were
watertight and both were well-written and excellent research. He also said that
the existence of measles viral infection in the bowel was a revolutionary
finding. He said he was aware of what measles virus could do to the brain and
that it was not implausible that the measles virus could damage the bowel and
brain.
He made it clear too that he was annoyed at the criticism insinuating that the
peer-review process had failed and because he was unable to answer due to the
need to remain confidential. He said the concern expressed by third parties
could have been avoided with the publication of the second paper and the level
of adverse comment could have been lower.
Finally, in response to panel questions, he reiterated his confidence in the
findings of the paper because of the quality of the authors and the reputation
of the institution.
Apparently tomorrow there's just going to be wrangling between the two sides
over whether the witness statement of Dr Clifford Spratt is admissible as he is
too ill to attend. There is no hearing on Thursday and Friday [16th and 17th
August].
Apparently too, David Salisbury will be called to witness at the start of next
week.