Online comments lead to BMJ’s disclosure of ‘competing interests’

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

In BMJ, Bob Roehr wrote about a report published by German researchers in the Canadian Medical Association Journal describing an apparent tendency for journals that accept pharmaceutical advertising to publish more positive drug-related articles than those that depend on subscription dollars to pay the bills. The study and the Roehr’s summary are good reading in their own right, but the comment section is where things really get interesting.

There, Age of Autism UK editor John Stone points to a commentary penned by the Alliance for Human Research Protection’s Vera Hassner Sharav and draws into question BMJ‘s sources of funding. His main focus is the tension between that publication’s Andrew Wakefield investigations and its receipt of money from an arm of Merck.

Sharav’s language is somewhat incendiary, but it’s BMJ editor Fiona Godlee’s response to her commentary (and Stone’s post) that push the whole thing into the realm of the remarkable. Godlee weighs in on everything right there in the comment thread, admitting that BMJ had not disclosed those conflicts of interest in the Wakefield stories simply “because it didn’t occur to us to do so,” given that it was a story focused on research fraud rather than upon vaccines and medicine.

Although Vera’s claims may seem far fetched on this occasion, she is right that we should have declared the BMJ Group’s income from Merck as a competing interest to the editorial (and the two editor’s choice articles) that accompanied Brian Deer’s series on the Secrets of the MMR scare. We should also, as you say, have declared the group’s income from GSK as a competing interest in relation to these articles. We will publish clarifications.

The whole chain of events is a promising sign that increased interactivity in online publications may lead to increased transparency, and it’s well worth reading, at the very least, all of Roehr’s story and the comments that follow it. All the key bits are there.

14 thoughts on “Online comments lead to BMJ’s disclosure of ‘competing interests’

  1. John Stone

    Many thanks for your reporting of this matter. Additionally, I note that now BMJ have published Vera Sharav’s response to Dr Godlee but not yet mine:

    http://www.bmj.com/content/342/bmj.d1335/reply#bmj_el_252629

    Also, that the conflict was first pointed out by veteran pharma wars writer Martin J Walker, and published on Age of Autism and then by Vera on AHRP:

    http://www.ageofautism.com/2011/02/mercks-medical-media-empire.html

    This is the latest episode in a long running war between Age of Autism and BMJ over BMJ’s lack of candour, undisclosed conflicts and suppression of informed debate over the Wakefield affair. It is merely the tip of the iceberg.

    -Since March of last year BMJ has banned all comment in its columns on how Mr Deer obtained access over a period of more than seven years to confidential medical and legal documents.

    -In May 2010 they refused to acknowledge that Deer was the undisclosed complainant in the Wakefield hearing, which compromised his role as a reporter not only in BMJ but more particularly in the Sunday Times and on Channel 4 TV (and is only euphemistically acknowledged in his present declaration). His lack of candour was abetted by the GMC.

    -Dr Marcovitch, who as a BMJ associated editor, signed the editorial denouncing Wakefield for fraud was conflicted in his role as head of GMC panels, although Marcovitch acknowledged this in his disclosure he should surely not have become involved with a case under judicial review. Marcovitch also failed to acknowledge his association with the industry funded body UKRIO (United Kingdom Research Integrity Office), although he did in a later related article after it was drawn to BMJ’s attention.

    -Mr Deer failed to ackowledge that he had accepted hospitality from a pharma funded conference in Baltimore in November 2010 (including MMR manufacturer and defendant GSK).

    -BMJ has restricted comment on Deer’s (and their) interpretation and findings, taking a legalistic line in protection of their allegations, out of keeping with a peer review journal. Mr Deer has never been required to answer any criticisms in BMJ’s columns.

    -The allegations were flawed and erroneous both in the broadest terms and in detail. Deer has maintained that Wakefield altered data under the noses of the 12 other signatories to the Lancet paper, but it is not clear how he could have done this without them noticing in the last 13 years. In effect, all 13 stand accused of fraud if they turned a blind eye to alterations. Deer was also in error in comparing the Lancet data with with patient GP notes, which none of the authors had access to at the time. He also, unlike the paper’s authors, did not have access to patients’ developmental records (the Red Books which are held by parents). Shockingly, for the BMJ they have allowed someone with no expert knowledge of any of the medical fields to interpret the data unchallenged: a notorious example was Deer’s account of patient 1, whom he claimed had indicated early signs autism at 10 months with symptoms of deafness, when the GP record makes quite clear he had an ear infection. This looks very like fraud.

    All of this and more is documented on Age of Autism. Here are some links:

    http://www.ageofautism.com/2011/03/bmjs-godlee-it-did-not-occur-to-us-now-where-did-i-hear-that-before.html

    http://www.ageofautism.com/2011/03/bmj-admits-competing-commercial-interests-in-wakefield-attacks-warranted-disclosure.html

    http://www.ageofautism.com/2011/01/harvey-marcovitch-and-brian-deers-investigation-the-lord-high-everything-else.html

    http://www.ageofautism.com/2011/01/the-big-lie-wakefield-lancet-paper-alleged-fraud-was-not-possible-for-anyone-to-commit.html

    Also of interest:

    http://www.spectator.co.uk/melaniephillips/3362116/a-deer-in-the-headlights.thtml

  2. Jenny Allan

    This is what Brian Deer said on a recent live web forum in Canada. He appears to ADMIT illegally obtaining copies of the Lancet 12 children’s medical records. In spite of his claim to have ‘made no use of that’, he DID INDEED make use of the children’s names and addresses in order to visit and interview parents of these children as part of his Sunday Times investigation. (The articles appeared in a 2004 edition.) Deer gave a false name, ‘Brian Lawrence’ and lied to the parents about his real purpose. His recent articles in the British Medical Journal include some of this illegally obtained medical information about the children.

    Deer never did answer Suanne’s question about UK confidentially laws, but they are absolutely clear. Medical records can normally only be shared with other medical personnel for MEDICAL reasons. All persons employed by the health services have confidentiality clauses precluding them from sharing information with any unauthorised third parties.

    Lawyers can obtain medical records for litigation purposes with the written PERMISSION of the patient. Courts of law, public Inquiries, inquests etc and GMC hearings also use patient records BUT attending press members are under strict orders NOT to disclose any of this confidential information, particularly where children are concerned. It is ILLEGAL in the UK to publicly identify children or publish their medical records without the permission of the court or the parents. Deer did NOT have parental permission.

    The GMC is NOT a ‘real’ court but is ‘quasi judicial’. If the GMC ‘show trial’ of Dr Wakefield and his colleagues had been in a real court of law, Brian Deer could have been jailed for contempt of court. But then a ‘real’ court would have instantly dismissed all those ‘trumped up charges’.

    http://live.j-source.ca/Event/CJF_Forum_The_Vaccine-Autism_Link_Controversy_Science_Jouranlism_Case_Study?Page=1

    Q from Suanne :
    “How did you track down the parents, considering privacy? In Canada, our privacy laws would make this pretty much impossible?”. 2/16/2011 12:51:01 AM 16 February 2011 00:51:01

    Deer:
    “Two things — certainly, Wakefield makes mistakes, and in the course the medical records were disclosed to me, but i could make no use of that………….

    But i could glean it was important for me to attend a 217 day hearing that went into these cases and went over and over the children’s medical records in my presence, in a public hearing. that’s where all the data was laid out.”
    2/16/2011 12:51:57 AM 16 February 2011 00:51:57″

  3. sheldon101

    What are we talking about?
    ———————————-
    PRIOR to the publication of the BMJ articles by Brian Deer, the UK medical licensing board had decided, using a criminal standard of proof that Dr. Andrew Wakefield had violated the ethical rules by doing research on vulnerable children without the necessary approval in advance. This was deliberate. If he had honestly sought ethical approval, it would not have been given. As to the article, Wakefield had hidden money conflict of interest.

    Continuing with the BMJ findings, from a public health point of view, Wakefield’s great damage was because he lied about how the children were selected. He pretended that the children had just showed up — rather than being kds whose parents were in the process of suing MMR makers.

    What did the BMJ articles add.
    One, that Wakefield had lied about the medical histories of the children. Two, that Wakefield had incredible money making plans. Three, that The Lancet had behaved abominably.

    With that background, it isn’t surprising that the BMJU editor thought that conflict of interest disclosure would in this case be mere petifoggery.

    But when vaccination opponents wrote to complain, she decided to go all politically correct. I suppose that’s all right.

    But now this blog weighs in and ignores how different the issues here are as compared to regular conflict of interest issues. May I suggest reading the comment it is responding to, once again.

  4. Jenny Allan

    In response to the comments made by sheldon 101, Dr Wakefield DID NOT REQUIRE ethical approval for taking blood, biopsies or any other tissue or body fluid samples from children, because he was NEVER involved with this. I MUST emphasise that Dr Wakefield was employed as a research scientist by the Royal Free Hospital. He had NO clinical contact with any of the Lancet 12 children (or any other child patients at the Royal free).

    Ethical approval WAS required by Dr Wakefield’s clinician colleagues at the Royal Free Hospital and was granted for taking EXTRA samples during diagnostic procedures. This required parental consent, which was obtained using the following form which was a standard form, issued ‘To parents’. This version was issued to parents of children undergoing colonoscopies. This is what it says:-

    ‘Your child has been referred for diagnostic colonoscopy and/or endoscopy. Several small pieces of tissue (biopsies) are taken during the procedure for diagnostic purposes. Clinic inflammatory bowel diseases are still little understood and their cause is unknown. It is therefore of great value for laboratory research to have such biopsies available to study how inflammation in the bowel develops and is influenced by treatment. Your permission is asked to agree for two extra biopsies to be taken for these purposes.

    Whether or not you agree to this will in no way influence your assessment or treatment.”
    (My daughter agreed to this and signed the form; the date was March 1999, AFTER the Lancet article. ) My Grandson was referred properly by his GP for treatment at the Royal Free Hospital; he was NOT one of the Lancet 12.

    This particular ethical consent was granted ‘for biopsy research on children undergoing diagnostic colonoscopy for bowel symptoms, EC 162-952″ .

    Brian Deer and the GMC have always contended that these children were subjected to ‘invasive’ tests and biopsies for purely research purposes, and that there was nothing wrong with them!! This would have required a different ethical approval, EC172-96, which the clinicians did not have because they were diagnosing and TREATING these children.

    My grandson is now an adult, still autistic, epileptic and suffering terribly with his guts. No doctor is prepared to help him, other than by dishing out laxatives, most of which disagree with him and cause him severe pain. He is very thin and unwell most of the time and I get very angry when I read comments like those of sheldon 101. He asks ‘What are we talking about?’

    My reply to him ‘We are are talking about countless thousands of sick suffering children and adults who have been left in a medical limbo’.

  5. John Stone

    Notes for journalists:

    Regarding Sheldon101

    Sheldon101 is ubiquitous on Huffington Post posting almost entirely (and tirelessly) in defence of the pharmaceutical industry on the subject of vaccines. In just 19 month since he joined the forum he has 8168 posts, and an average of approx 15 posts a day. He has sometimes signed himself as ‘Sheldon Sheps of Toronto’, and possibly has a professional background in law. It is not at all clear where his peculiar commitment to this subject comes from.

    http://www.huffingtonpost.com/social/Sheldon101?action=comments

    Also, his response is a non-sequitur, and Harvey Marcovitch who signed the BMJ editorial is also Chair of GMC panels. All roads seem to lead to Rome.

    Regarding Brian Deer. Deer is not in my opinion a balanced or professional journalist, and I give as examples some of the things he has said about me. The first extract comes from a post he removed from his own website commenting on my interesting discovery in 2007 that the judge who removed funding from the MMR case in the UK in February 2004, Sir Nigel Davis, was the brother Sir Crispin Davis, CEO Reed Elsevier publishers of the Lancet, but also from July 2003 and a non-exec director of MMR defendants GSK. As far as I know I have never said anything personally derogatory about these two men, but this is what Deer says about me:

    [Moderator: The following passage comes from http://web.archive.org/web/20070717061423/http:/briandeer.com/wakefield/jabs-cruelty.htm%5D

    “Take, for example, their latest campaign: the denigration of a High Court judge. Mr John Stone of JABS, who I’ve previously characterised as being, in my view, “the doyen of petty complainers”, notes that Sir Crispin Davis, chief executive of publishing and information giant Reed Elsevier (which owns the Lancet), and, since July 2003 a non-executive director of drug company GSK, was the brother of Sir Nigel Davis, the presiding judge in a High Court judicial review, in February 2004, related to MMR.

    “The ruling elite remains surprisingly small. But for Mr Stone this discovery is orgasmic: he’s been insinuating conspiracy for years. Promptly, Jackie and Co issued a JABS press release, impressively dated “London, England, 13 May 2007”. It was evidently hold-the-front-page stuff…

    “JABS, again, seeks to suggest a connection between the lawsuit failure and Crispin Davis. How that works, god only knows. The mind of Mr Stone is mysterious. But, if Crispin Davis had any interest or influence – which I’m sure he didn’t – it would have been to encourage the funding to continue, and to allow the MMR cases to go to trial. Although JABS has persistently suggested that somehow only they were distressed by the scheduled hearing’s abandonment, the truth is that the drug companies were anxious to see the cases heard in London: preferring the usual wisdom of an English judge to the frequent insanity of American juries.”

    http://www.ageofautism.com/2011/03/bmjs-godlee-it-did-not-occur-to-us-now-where-did-i-hear-that-before.html

    Another incidentally interesting point is that when Deer was writing this in June 2007 he must have been aware that there was only the remotest chance of this being heard in a US civil court, because he was busy secretly advising the US Department of Justice over the Cedillo case and he must have known that vaccine cases were excluded from civil proceedings (leave alone the fantasy that Sir Crispin and GSK really wanted the UK proceedings to go ahead):

    http://www.spectator.co.uk/melaniephillips/3362116/a-deer-in-the-headlights.thtml

    Now, here is another example from the Respectful Insolence blog last year:

    “I think you are a little unfair to Mr Stone. Anyone who has watched his “little professor” antics over the years recognizes that he’s a poorly-educated man, who, despite apparently having an autistic son, has shown no interest in autism, no interest in vaccines, no interest in the safety of children, no interest in medical research, indeed no interest in anything but burbling on with his nonsense about “conflicts of interest”. He wouldn’t know a conflict of interest if it bit him in the ass.

    “The upside of this clown’s cavortings was a hilarious incident where he turned up to the conclusion of Wakefield’s GMC hearing, and when the chairman read out a paragraph, Mr Stone – literally – ran from the room, screaming “wrong study, wrong study”, as though five panel members, five QCs and all their teams had been sitting there for two years and failed to realize they were looking at the wrong document. It was so monstrously stupid that it came round again as hugely value-for-money.

    “I speak with some experience, since Mr Stone is stalking me. A number of people have written to me to suggest that they believe his motivation is sexual: that he wants to be close to me, and can only achieve a sense of this online. I’m not sure, although he is plainly obsessed by me. It’s pretty creepy, I’ll admit, but I think Mr Stone is best understood as a living example of how autistic disorders, and allied conditions, such as pathological demand avoidance syndrome, psychopathy and whathaveyou, are genetic. Certainly, if you are aware of his behaviour, you can see how hard he would run from the idea that it was the expression of his own genetic makeup that lies behind his son’s disorder.

    “From my own point of view, I don’t really care what he does. As a result of his activities, I get a lot of traffic to my website, and a lot of cooperation from people who have been involved in anti-vax antics, but now realize what a charade it all is. So, in that sense, he’s not only helping to make Age of Autism look ridiculous, he (like Wakefield) are now working for me.

    “But I’m not sure it’s right to single him out in this way. Sure, he doesn’t know what an endowed chair is. He doesn’t know what any of it’s about. That’s not why he does it. He just has this compulsive disorder through which he tries to feel that he’s important by endlessly cobbling together bits of garbage that he’s Googled. I mean, for christsake, he found out that the guy had a GSK-endowed chair from the paper he’s claiming didn’t declare this. I mean, Jee-sus.”

    http://scienceblogs.com/insolence/2010/06/it_appears_mr_stone_doesnt_even_know_wha.php#comment-2587850

    This is obviously an attempt at character assassination, and I re-publish it because I honestly do not believe that this should have a place in modern journalism., and it shames a journalist that he should write such personalised invective against someone even if it is on a blog and not in newspaper.

    I also pose the question, why Deer? On Deer’s own account he was approached by a Sunday Times editor in September 2003 who said he needed something “big” on “MMR” although no explanation is offered why this thing was needed, or why Deer as freelance was held to have the peculiar skills to provide it.

    http://www.bmj.com/content/340/bmj.c672.full

    Finally, it should be recorded in this regard that the editor who hired Deer was Paul Nuki (this information used to appear on Deer’s site) who is the son Prof George Nuki who sat on the Committee of Safety in Medicines in the late 1980s when MMR and SKB’s notorious Pluserix brand were licensed for use. In 2007 Paul Nuki left the Sunday Times to manage a UK National Health Service information site ‘NHS Choices’.

    http://www.whale.to/a/nuki_h.html

    Frankly, I don’t think Andrew Wakefield stood a chance.

  6. John Stone

    Jenny

    Just to point out that at no time would any child have been subjected to a invasive procedures unless there were good clinical reasons, which would have been the case with study 172-96, the one commissioned by the Legal Aid Board, if it had ever beebn carried out (which it wasn’t). The Lancet paper was an early report – as stated – reviewing the cases of a group children seen purely on the basis of clinical need as stated. 162-95, on the other hand, was the ethical permission for given by the Royal Free ethics committee to Prof John Walker-Smith when his paediatric-gastro-enterology department transferred to the hospital in 1995, enabling him to retain biopsies for research from children who were being investigated on the basis of clinical need. Recently, Andrew Wakefield published a presentation by Walker-Smith about this group of children from December 2006 which preceded Wakefield’s involvement:

    http://www.vaccinesafetyfirst.com/pdf/BRIAN%20DEER%20IS%20THE%20LIAR%20.pdf

    This is incidently the basis on which I shouted out the GMC that 172-96 was a different study, which was the defence of all three doctors. Indeed, the panel found them guilty of breaching the terms of 172-96 in innumerable respects instead of accepting the perfectly reasonable defence that they weren’t doing it in the first place. Indeed, where Deer mocked me in the quoted passage above for disagreeing with 5 QCs (senior court attorneys) at least three of them had offered just this defence of their clients. However, there was no way that the press could have understood this. I note that when I made this point in BMJ a few days later no one came back at me: not Prof Greenhalgh (whose article I was commenting on), not Deer (though he intervened in the same correspondence on another matter shortly afterwards), and not Ben Goldacre (whose earlier opinion I referred to).

    And they won’t now.

    John

  7. Jenny Allan

    The psychiatrists would have a field day with Brian Deer!!

    John Stone’s revealing post about Deer’s assorted blogging, reminds me of a line in that erstwhile TV Sitcom ‘Faulty Towers’ when the bunch of shrinks, staying at the hotel said of mad proprietor ‘Basil’:-

    ‘There’s enough here for an entire conference!!!

    Brian Deer also seems to harbour a grudge against doctors and scientists, and even appears to include the demise of the Lancet and BMJ amongst his deranged ramblings!! This is an extract from a recent Guardian blog regarding Deer’s first two ‘Secrets of the MMR scare’ BMJ articles:-

    “Next week in the BMJ, I will go further, showing how the old boys’ network of the medical establishment was mobilised to protect him. Are you getting the picture yet?
    But times are changing. Wakefield’s fall from grace is now slicing another scalp. One of the most insidious cartels at the heart of British science is being torn apart: the two top journals in medical science.
    The Lancet once championed him. The BMJ has now nailed him – and commended my contribution. “It has taken the diligent scepticism of one man, standing outside medicine and science, to show that the paper was in fact an elaborate fraud,” they wrote in last week’s editorial.
    Let battle commence, I say. Let doctors expose each other. Let journals compete to get the truth out first. Because 13 years passed before I slayed the MMR monster. And although a single, severed hand may yet come crawling across the floor, for science and public safety 13 years is still too long.”

    http://www.guardian.co.uk/science/blog/2011/jan/12/andrew-wakefield-fraud-mmr-autism?INTCMP=SRCH

    (This url keeps changing. I suspect the Guardian Editors are now desperately embarrassed by this Deer blog.)

  8. Seonaid

    This is an amazingly illuminating collection of attacks from Brain Deer. Thank you John Stone, for showing us what this person is capable of. Surely I can’t be alone in cringing at the sarcasm, the deliberate insults and even spite, emanating from his diatribes? His writing is littered with unpleasant speculation and unfounded accusations. He personally attacks John Stone who always presents in a courteous, factual fashion, and Jackie from JABS who – incidentally – finally won compensation for her son’s vaccine damage. Yet this is the journalist who has been paraded in the media as if he were the ultimate authority on the Andrew Wakefield case and vaccine injury? I’d find it very difficult to ascribe any credibility to anything he says. How on earth can anyone take this man seriously? I can’t.

  9. Joan Campbell

    Same old, same old story over and over again
    Fiona Godlee’s comment “It did not occur to us to disclose blah, blah.
    Brings me back to the time I complained to Jack Straw when he was in government about the conflict of interest of Justice Nigel Davis who decided it was ok to take the legal aid off 1,300 families who firmly believe their children were damaged by the MR and MMR. The Davis brothers are another conflict of interest that gets brushed under the carpet. Crispin the brother of Nigel Davis was knighted 6 months after . The pharmaceuticals, government and the BMJ are mostly corrupt. It is a sad fact.

  10. Jenny Allan

    Thank you John Stone for pointing out the differences between the ethical permissions at the Royal Free Hospital.

    I should also mention that my Grandson was a patient of paediatric gastroenterologists Professors John Walker Smith and Simon Murch, both of whom were ‘dragged’ before the GMC along with Dr Andrew Wakefield. Professor Walker Smith was ‘struck off’ along with Dr Wakefield. As you explained above, Professor Walker Smith always had the correct ethical approval for carrying out diagnostic procedures on my Grandson and those other children, (including the Lancet 12) referred to him for their bowel problems.

    These clinicians were kind, compassionate and very professional and we are all very grateful to them for the excellent care and treatment given to my Grandson at the Royal Free, all paid for by the NHS, free at the point of use in the UK. It is also important to mention that Professor Simon Murch was completely exonerated of all charges by the GMC. (Brian Deer’s version implies the GMC let him off). During the latter part of the GMC trial, there was an attempt by Sallie Smith, QC for the prosecution, to ‘blackmail’ Professor Murch, by stating that they would ‘only suspend him’ if he admitted ‘wrongdoing’. I’m glad he stood firm, but the 3 year trial must have been a terrible ordeal for him.

    The guilty verdict on Professor Walker Smith was apparently due to the GMC’s conclusion that he failed to obtain proper ethical approval for ‘invasive’ procedures carried out in order to properly diagnose these children, and the extra research biopsies and other samples taken. It was a great pity the prosecuting QCs and the GMC panel members paid no attention to John Stone when he attempted to point out this mistake. The signed parental consent forms for the biopsies were put into the children’s hospital folders along with the medical notes. It seems the GMC panel simply disregarded any evidence which did not fit a verdict already decided upon.

    It was outrageous of Brian Deer to ‘mock’ John Stone for his attempt to obtain ‘fair play’ at the GMC, but then it was Brian Deer who complained to the GMC in the first place. Most of us ‘sad rump of disciples’ (Deer’s description of the children’s parents and relatives faithful to Wakefield et al), regard the GMC trial as nothing more than a travesty of justice.

    We continue to campaign, and now joined by countless thousands of other parents and supporters worldwide, we are demanding that governments and medical establishments put our children’s safety and wellbeing before vast pharma profits and powerful political interests.

  11. Jack

    I’ve seen his regurgitated CDC/Pharma bullsh*t

    Sheldon101 may be a ‘mommy blogger’

    http://www.svmoms.com/2007/11/cdc-wants-mommy.html

    “It is just that we should be grateful, not only to those with whose views we may agree, but also to those who have expressed more superficial views; for these also contributed something, by developing before us the powers of thought.” ~Aristotle, Greek Philosopher, Scientist and Physician, 384 BC-322 BC

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