5

Prosecuting For The Defence

Monday July 30th to Monday August 6

Despite having chosen to sit directly beneath the air conditioning vents in the hearing room, I occasionally nod off. On Wednesday of last week I had a very disconcerting experience, I nodded off during the evidence of Dr Berelowitz, a psychiatrist who was one of the co-authors of the Lancet paper and who acted at that time as a psychiatric-paediatric liaison worker.

I must have only dozed for a moment but it was long enough for me to become caught up in a disturbing dream which I now can’t remember. I can, however, remember just before I woke, my head was full of the sound of stampeding people, running and shouting as if they were trying to escape a natural disaster. I could see the front runners as they scrambled over everything in their path, amongst them I recognised Dr Berelowitz and realised that the deserting crowd were mainly witnesses fighting to get out through the door of the GMC hearing room. Behind them was Andrew Wakefield sitting completely alone apart from some vague ghosts of friends and his defence counsel.

I woke with a start and tuned back in to Berelowitz’s evidence. He was saying that he had been happy to be a part of the research which led to the Lancet paper. He was happy with the ethical position of the research team, yes, he was also happy with the investigative tests which were carried out on the children. As far as he was concerned such tests were common in the diagnosis of bowel disorders.

However, Berelowitz went on, he had been upset and disconcerted about what had happened at the press conference. As far as he was concerned, the Lancet paper should naturally have called an end to the rather spurious tenet of the research into any link between MMR and autism. The paper clearly stated that no link had been proven and Berelowitz, for some reason apparent only to himself, had taken this to mean that no link could ever be proven. On the basis of this fundamental and rather startling misunderstanding he had expected any future research to take a completely new direction. This, naturally, had proved not to be the case and Dr Berelowitz seemed unsure of who was to blame. Was it the media? Was it Andrew Wakefield?

He suggested that his relationship with Wakefield, and his association with the research, had utterly collapsed after the press conference. Berelowitz recounted the story of how a journalist friend, present at the press conference, had got up to interview Wakefield, who had just opined that perhaps use of the triple injection should be suspended until research definitively answered the question of a link between MMR and regressive autism. Berelowitz had apparently said to his friend, 'The story is here in the paper, it shows that there is no connection between MMR and autism', his friend had answered, 'No, the story is over there with Wakefield'.

So, as far as Berelowitz was concerned, he had opted out of the research either because Wakefield was intent on pursuing the MMR theory or because the media seemed determined to pursue it. Both these reasons gave Berelowitz a way out, a way of setting himself free from his association with Wakefield and his 'crimes'.

Dr Berelowitz would, he said, have nothing to do with Wakefield after the press conference. So vehement was he on this matter, that it occurred to me for a second that he was going to say that Wakefield had forged his signature on the protocol form for subsequent research in which he had clearly been involved. In the event, however, Berelowitz claimed that he was tentatively involved in the research in name only and after a time had not gone through with any involvement. His parting shot on this matter was the simple logic that Paul Shattock was involved in the research and he, Dr Berelovitz would never be involved in anything in which Shattock was involved because his research methodology had been found wanting.

In many ways Dr Berolovitz was hoist by the same petard as all the other prosecution witnesses. He had willingly taken part in the research for a period of time, and he, as those before him, now had to somehow cast that involvement in an innocent light, while appearing happy to endorse the prosecution against Wakefield.

This situation is perhaps the worst in which any prosecutor could find themselves, calling upon a gaggle of reluctant witnesses who should, if the defendants are in fact guilty, all be with them in the dock. This predicament further accounts for the manner in which Miss Smith and Owain Thomas, the prosecutors, often appear to all intents and purposes to be presenting the case for the defence when leading their witnesses through their evidence-in-chief.

Take the matter of Dr Berelowitz and lumbar punctures. The GMC prosecution have presented these as highly invasive, risky procedures which should on no account be used on children; they were portrayed as arcane and evil experimental methods. But how could Dr Berelowitz agree with the prosecution on this matter? If he did, he too would surely be admitting guilty involvement. So, on this, as on a number of other matters, Berelowitz, witness for the prosecution, essentially gave evidence for the defence.

He had, he told the hearing, done his own research into lumbar punctures and children, just to assure himself that he was not involved in anything unethical. His quick perusal of the literature had led him to believe that lumbar punctures were commonly used in a whole series of clinical situations involving children and were used in research by some of the most authoritative institutions in Britain and America.

Dr Berelowitz had to make a similar defence on the issue of ethical approval, another of the main planks of the prosecution case. On this he maintained very clearly, as others have done before him, and as others will no doubt do after him, that the writing up of a case-series does not require ethical approval.

It has been apparent from the first day of the hearings that the prosecution is leaking like a stricken boat trying to get to harbour in a storm. Not only has Miss Smith presented portions of the defence case, but the GMC is having to depend upon, in the main, entirely reluctant witnesses who are busy watching their own backs.

The last week has been a week of extremes. It began with the pleasant and clear minded evidence of Mrs Cowie, a solicitor who worked for what was at the time the Legal Aid Board (LAB). Richard Barr, the solicitor who by 1994 had been approached by a number of parents of potentially vaccine damaged children, had applied to the LAB for money to fund research which might, or equally might not, turn out to be of use to these claimants.