The Worm in the Bread by Martin J Walker

The Worm in the Bread

The GMC Thursday 15th, Friday 16th, Monday 19th January.

http://www.cryshame.co.uk

Like a tired old man looking for a bench to rest on in a crowded park, the GMC hearing is now staggering along with days and half-days of rest halting the proceedings more and more frequently. This week the GMC showed utter contempt for the parents and the public, deciding on the Monday of a week already bereft of sitting for two and a half days, to sit on the following Sunday. The legal assessor had a pressing engagement, even on this day, and politely exempted himself, suggesting anyway that it was unlikely that there would be any legal matters raised in this session. So the hearing sits on a Sunday unlike any other tribunal of its kind anywhere in the world and the legal assessor turns into a gypsy clairvoyant, able to gainsay the problems thrown up by the wily Miss Smith's cross examination.

Perhaps the only competition left in town, is trying to guess the purpose for which this hearing is being dragged out. Someone should open a book on this. My guess, for what it's worth, is that the government will announce a new MMR - perhaps with another additional ingredient – and launch their campaign the week before the Panel finally get round to stating a verdict.

If, however, there was a competition for clairvoyance, then Dear Brian would definitely break the tape first. How Brian knows that evidence naming him is coming up, will probably always be a mystery. To add to all this speculation, it is rumoured that the usually placid and lugubrious Deer lost it at the mid-day end of Monday's session.

The hearing started late that Monday morning, there having been problems on the Victoria line, as Dr Kumar explained. Funnily enough I use the Victoria line to get into the hearing, but that morning understanding that there had been work over the weekend on the line, I took a bus. Still the delayed start was only half an hour and the Panel and the witness were in place by ten.

For the previous two days, Mr Hopkins had been going through the condition of the children cited in the Lancet paper, with Professor Murch. This evidence was exemplary, extracted from Professor Murch in the most forthright manner. There was a snow-flake freshness to Professor Murch's refutation that the children might have been subjected to procedures and investigation for the purposes of research. In fact, more than any other evidence given so far, Professor Murch's evidence has stressed the inevitable need for the doctors faced with the children at the Royal Free to obtain a diagnosis which might enable them to embark upon a correct course of treatment.

For an hour between 10 and 11am, Hopkins drew out of Professor Murch the story of Brian Deer's sudden intervention in the lives of the Royal Free doctors. Although Deer had surfaced amongst the detritus of this case, in relation to both Dr Wakefield and Professor Walker-Smith, no one had so far opened the door quite so wide on Deer's attitude and strategy as Professor Murch did in this hour.

Professor Murch narrated how in 2004, the head of his department Professor Brent Taylor, who it appears was assisting Brian Deer, called him into a meeting with Deer. Taylor intimated to Murch that Deer did not have as good a grasp of the case he was presenting as he should have done. Why Taylor was privvy to this 'case' we might never know, although it is known that Taylor has, on occasion, had a place on the JCVI.

Professor Murch told the Panel that the atmosphere in that meeting was deeply unpleasant and that he found Deer's approach unduly aggressive and unsettling. Long documents, Murch said, appeared under his nose and he was pushed into making some response to a series of allegations. Now, thinking back, he suggested that following such a lengthy, hostile and adversarial meeting it was difficult to remember specifically what had been said.

Deer, Murch said, was alleging that the 172/96 document had been knowingly and fraudulently put in for ethical approval, in an attempt to provide some form of cover for a fishing expedition that would provide data for the parents court case. Deer seemed to be claiming that the procedures carried out on the 12 children, had been to provide ammunition for the legal hearing rather than a clinical diagnosis. No one had forewarned him about the allegations that Deer was about to make and Taylor had even told Murch that Deer had made it quite clear that the clinicians were 'not a target'.

Murch was quite candid about his view of Deer's operating methods; the way in which the allegations were delivered, he said, was not far from the third degree. He had not had a light shone in his eyes, but effectively it had been a hostile, aggressive and very unsettling interview. Had it not been for the fact that he was there under the instructions of his head of department, he would, he said, have turned on his heels and walked out.

Professor Murch, was, he claimed, along with Professor Walker-Smith, at a serious disadvantage, not having had the time or possibility of looking at any records. He was sure that there was no substance to the allegations being made, but the interpretation being placed, on what he knew to be innocently motivated actions, was, he said, very melodramatic. He concluded that it was important to someone that there was an adverse outcome to the Royal Free press briefing after the paper itself and the press coverage, and so some years later, he believed, it was being spun into something that sounded very sinister and therefore ultimately difficult to give credence to.

Mr Hopkins went on to discuss, with Professor Murch, the meeting organised by Horton at the Lancet. Still at this time, neither Walker-Smith nor Professor Murch had access to the children's names that had been anonymised in the Lancet paper. This was a major problem for the two of them in arguing with Deer. Eventually they managed to contact Dr Wakefield in the USA, who handwrote a document of patients’ names; Murch remembered the hospital numbers, and these were faxed to the Royal Free.

Professor Murch steadfastly denied all of Deer's allegations. He was quite adamant, reinforcing his answers to Mr Hopkins questions with such expressions as 'absolutely not' and 'quite the contrary'. He stressed time and again, as he did throughout his evidence, that the teams primary aim had always been to seek a diagnosis for the child being investigated and to construct a guide or protocol for further treatment and management. Throughout Murch's evidence in chief, Hopkins had intelligently and correctly ensured that Murch was able to give adequate details about the feelings of the parents faced with very disturbing undiagnosed illnesses in their children. And for the first time in the hearing, voice was given to pure feeling, when Murch invited those listening to… 'Imagine how you would feel with your child in such pain, but undiagnosed'.

Asked about his feelings on being accused unfairly in this manner, Professor Murch gave some of the most telling evidence yet. The accusations were, he said, profoundly disturbing and he was left with feelings of anger about the unfairness of this. He said that the lengthy documents with which he had been forced to deal, suggested that somebody had enough information to identify patients from an anonymised table, and to provide dates of their investigations. The information to which Deer had been given access, went, in Murch’s opinion, beyond the level of knowledge that a journalist might reasonably have, and suggested to him that a breach of the Data Protection Act might have taken place.

Asked to prepare a report on the ethics of the work that had taken place around 1996 he felt under great pressure and did not know quite how to deal with the situation. He had difficulty, he said, in getting his emotions under control, or his head straight to draft a reply.

Professor Murch denied every aspect of the case, put by Deer, which was eventually transformed into the charges levelled by the GMC prosecution. For the first time in the hearing, the finger was pointed directly at Deer and the suggestion was now clearly 'on the table', that Deer was behind all the charges, that they were in great degree manufactured by him and that they were not based upon supportable fact. The suspicion was there as well, that rules governing the privacy of patient information might have been broken. This is a fear that some parents have expressed on a number of occasions.

At one point towards the end of Professor Murch's evidence, I looked over my shoulder to observe any reaction. I was surprised to see the normally laid back Deer, red faced, shaking his head and straining forward in his seat. When the session ended for the mid morning break at 11.00am, I watched Deer rise out of his seat and hang back until Professor Murch left the room, at which point he slithered like a snake, out of the closing door in Murch’s wake.

Deer didn't return after the break and rumour cracked back and forth in the hearing room that an unnerving incident had taken place. Although I have to say when the Professor returned to the hearing he continued to give his evidence in the same certain and strong manner that he had observed throughout the last week. On the other hand, Mr Deer didn't return to the hearing, but slunk off to his lair where he spent the afternoon cogitating.

At the end of the hearing on Monday, Mr Hopkins closed his note book and said clearly 'those are all the questions I have to ask you Professor Murch' and sitting down he left his witness to contemplate the slow semantic torture of cross- examination by Miss Smith. However, Professor Murch, was given a respite from erosion when the day finished early, it being thought inconsiderate to let Miss Smith proceed with her cross examination, when she would have to break off in an hour. In the wake of this decision, Tuesday was suddenly declared a non-sitting day, and Thursday was known to be a long standing one, and so consequently the Chairman announced the panel would be sitting on the coming Sunday. If the hearing continues in this ludicrous manner no doubt we will all find ourselves doing nights at a hearing that begins at 10pm and goes on without break until 5.00 am when we can get the first tube or the last night bus home. And it is for this consummate organisation that Finlay Scott was awarded the CBE; oh that the Commander would command more effectively!

I only hope that the Guiness Book of Records is keeping abreast of all this, because now the GMC is not only presiding over the longest regulatory trial in history, but can probably lay claim to being the first regulatory tribunal in the developed world to sit on a Sunday. I must say that I was heartened by the sturdy individuality of the legal assessor, who was able to look the rest of the panel in the eye and even in these dark times when the barbarians are beating a path to the gates of reason on a Sunday, was able to excuse himself announcing a long standing Sunday luncheon engagement; now there's a man with the right priorities.