There is a free circus in town, or rather in the Coliseum, for the next month. Get your tickets at the GMC, and hear good doctors made fools of trying to defend an open mind.
I spent the morning at the GMC, on Euston Rd, where they will decide whether Andrew Wakefield is a son of Satan or a misunderstood honest researcher doing his best to make sense of a complex topic. This morning's session was one of the supporting or warm-up acts, Richard Horton, Editor of the Lancet. Horton is one the few remaining voices for free medical thought, fewer since Richard Smith left the British Medical Journal.
The first few hours raised the following questions
The procedure - Can the GMC set the standard, prosecute offenders and judge the case? All in all, a bit like the Inquisition
The GMC Panel - ? fit for purpose - too early to say - none of them said very much.
The prosecution, 'Miss (married) Smith' more of an actress than a barrister - perfect pitch, excellent vocal modulation, and a full range of styles. She was able to encompass serious, pitiful, scathing, patronising and even attempt humour, using a wonderfully contrived Sloane-style diction, within one speech. RADA 1985?
The defence, I warmed to the defence Barrister, sensible, down to earth and very aware of the size of the storm in the GMC teacup. Everyone should have one.
The question to be decided Galileo or Shipman? - Not Shipman, as no patients have ever come to harm as a result of Dr Andrew Wakefields clinical activity. But you can't tell that from the size of the party.
Galileo? Yes and No! This is not a big controversy, these are not ideas that will shake the universe. MMR and autism are they associated? the paper about which there is all the fuss, actually concluded that there was no evidence that they were.
However, what did Galileo actually change? were his ideas earth shattering? not immediately but they opened the floodgates to allow scientific thought to think the unthinkable and unseat the Church from its position as the arbiter of knowledge.
Wakefield is guilty of looking for a cause for autism. Autism, like Alzheimers, like Polycystic ovaries, like heart disease did not exist in Galileo's time. They are all conditions of which we do not know the cause. They are spreading faster than the plague in the middle ages. The plague left a third of the population dead. By contrast, these diseases are big business. The healthcare industry provides reliable growth, year on year. The economy of health would bankrupt America and most of the Western world.
As doctors we are taught that we do not know the cause of these conditions. We tell you, our patients that we do not know the cause of these conditions but take these drugs, and it will all get better.
But we know the cause of everything else, we know how computers work, how to get rockets in space, we know what caused the World Trade Center to collapse, we even know how to predict a hurricane. But we don't know the cause of diseases that are unheard of in the developing world, that people only get when they move to the West, diseases that are rising in incidence year on year, that even in the West occur more often with an unhealthy lifestyle than with an unhealthy lifestyle ??? has anyone in the audience got any ideas??
Are they
1) - Visitations from outer space
2) - Down to processed food, the way we live and what we do to ourselves
3) - Caused by viruses at the neuromuscular junction *
Even twenty years ago these diseases were rare, dementia in the under eighties was rare, so rare that if a 'youngster' became demented, they warranted a brain biopsy. Now dementia is so common patients rarely even get a CT Scan. Polycystic ovaries were called SteinLeventhal syndrome and went to a specialist clinic. And type II diabetes - there was no type II diabetes.
Andrew Wakefield dared to ask what causes Autism. We live in a cause and effect universe, that is not an unreasonable question.
So if you can think what might be causing the current epidemic of disease, from glaucoma to dementia, from diabetes to cancer - answers on a postcard please
The first correct answer wins a cat and the editor's decision is final
* Recent answer from a Teaching Hospital consultant when asked what he thought caused irritable bowel syndrome.
Copyright (c) Dr. Liz Miller
http://www.drlizmiller.co.uk
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