The BMJ and Brian Deer

In case you haven't heard, ex-doctor Wakefield now stands acused of being a fraud by the British medical journal BMJ.  In a scathing article and accompanying editorial, the journal says, in no uncertain terms, that Wakefield not only acted unethically but also intentionally fabricated data in his now infamous study -

Deer unearthed clear evidence of falsification. He found that not one of the 12 cases reported in the 1998 Lancet paper was free of misrepresentation or undisclosed alteration, and that in no single case could the medical records be fully reconciled with the descriptions, diagnoses, or histories published in the journal. 

Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross.

These are extremely serious charges for the editor of a prestigious medical journal to be making.  If Wakefield's career wasn't already in the toilet, it would certainly be put in jeopardy by this.  So I would expect that, given the extremely serious nature of the charges, the journal would have rock solid data to back up its allegations.  You don't accuse someone of intentionally manipulating data without being sure that you are correct.  And you don't do it using an editorial in a major journal without being very, very sure.

Or at least I thought that was would be the case.  But after reading the editorial and the article, I have my doubts.  As far as I can tell, none of the charges are anything new nor is there any new substance behind the allegations.  So I really have to wonder what the point of the whole thing is.

I am not defending Wakefield here (I repeat - I am not defending Wakefield) but I have to say that that this looks like just yet another attack on Wakefield by Brian Deer.  Brian Deer has been making these charges for years now and I strongly suspect that if there was enough evidence to make the fraud accusations stick that it would have been brought up at the GMC hearing.  I am sure the GMC would have loved to say that Wakefield committed fraud in addition to acting dishonestly and irresponsibly.

Which brings me to my real question - why did the BMJ pay Brian Deer to write yet another attack on Wakefield?

I could see a journal like the BMJ publishing a review written by researchers or doctors but I don't understand bringing in a journalist to write the piece - especially Brian Deer.  He is not what you would call an unbiased party.  Published papers are supposed to be unbiased, factual affairs - not the same sort of sensationalism that you would find in the Sunday paper.  But if you read the article it looks like something you would see in the newspaper, attempts at footnoting notwithstanding.

As a side note, I have to wonder if this is the first time that the BMJ has published a "peer-reviewed" article, like this one is supposed to be, that cited newspaper articles as an authority.  Articles which were also written by Brian Deer, I might add.  Since the newspaper articles were used to support the claims of the article, were the referenced articles peer reviewed as well?  And how exactly does citing your own newspaper article work?  As you can see, I said the exact same thing over there, and my peer, the editor, agreed with me, therefore it must be true....

One of the other things that really bothers me about this article is that Brian Deer appears to have the medical records of the children from the Wakefield study (he basically said as much last year).  It is one thing for him to have these records - presumably without the consent of the children's parents - that fact alone is bad enough (and possibly illegal, at least in the US).  It is something altogether different if those records were used to publish an article in the BMJ without the proper consent.  That would be a major problem for the journal as well - especially if the journal itself was the one that commissioned and paid for the article.

Which brings me to the next problem, the matter of payment.  Brian Deer said to CNN that he was paid to write this article -

On CNN's "American Morning" Thursday, Deer did not deny he was paid by the BMJ. "I was commissioned by BMJ to write the piece," he said. "That's what journalists do."

And yet, if you look in the competing interests section from the article it makes no mention of this fact -

Competing interests: The author has completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from him) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years

He claims to have not received any support from any organization for the article.  I would consider being paid for writing the article a form of support.  The only hint that in either the editorial or the article that Deer might have been paid is under the competing interest section of the article where it says -

Provenance and peer review: Commissioned; externally peer reviewed.

But that one word is a poor substitute for a real disclaimer.  If Brian Deer was paid to write these articles then he should have disclosed that fact appropriately.  His failure to do so is especially ironic considering that the failing to disclose relevant financial information was one of Wakefield's sins.

As I said above, I really have to wonder why these articles were written.  All of these things about Wakfield have been said before - mostly by Brian Deer - and there is nothing new here except the forum.  I don't believe in conspiracy theories but I can't that I can think of any reason why this newspaper article was publish in the BMJ.  It just doesn't make any sense.