Monday, 25 January 2010

Measles, Autism and Stock of God

As if there has not been enough controversy regarding Measles, Autism, vaccinations and the proceedings against Dr Andrew Wakefield before the General Medical Council (GMC, UK, now I feel I should write an article about it.

I met Dr Andrew Wakefield during his GMC hearing in 2007 which was running concurrently with mine. I introduced myself to him because I went to the Royal Free Medical School where he did some of his research and where I studied medicine. As a psychiatrist I had enough experience of looking after patients who have autism to know how difficult it can be. We exchanged a couple of short polite phrases and that was it. I did not think I would ever meet him again and did not see any reason why I would write about his case before the GMC until today when I discovered some historical aspects not known to me previously.

Dr Andrew Wakefield's case is complex due to many factors including political interests which is completely natural in the case of measles, illness that killed estimated 200 million people in the last 150 years.

The history of measles starts with political controversy around the second century when two Roman Emperors died from either measles or small pox and further five million people including one third of the Roman Army. Famous Roman physician of Greek origin Galen described the epidemic. (His father wanted him to be a politician or a philosopher).

However, it was Persian doctor Abu Bakr Muhammad Ibn Zakariya Razi who described measles as a separate disease in ninth century. He was a genius of his time who also founded paediatrics (amongst other medical specialties). His classic description of measles included fever, diarrhea and inflamed pharynx. Therefore, it was known for centuries that measles can cause gastric problem in acute infection.

The first known case of autism was probably described in nineteenth century although not under that name.

In 1911 Eugen Bleuler used term autism to describe one of the features of schizophrenia ie social withdrawal. The origin of the word is from Greek "autos" meaning "self".

In 1943 Leo Kanner described Early Infantile Autism, now believed to be a group of neurodevelopmental disorders distinct from Schizophrenia.

In 1944 Hans Asperger described a syndrome with some of the features of autism but in people who had normal or high IQ.

Viruses that cause measles, mumps and rubella can cause central nervous system damage each in their own right. Various syndromes have been described for example congenital rubella.

The matters can be further complicated by the fact that viruses can be reactivated in human body many years after the initial infection.

Autistic people do have a high incidence of GI problems. Some are simple such as constipation. Others are difficult to understand.

It is known that measles can cause enteritis before any vaccination is given.

Thus, there is nothing illogical in the fact that Dr Andrew Wakefield and his co-authors decided to study autistic children and gastrointestinal problems.

The allegations about the conduct of Dr Andrew Wakefield were made by a journalist working for Times newspaper allegedly owned by Rupert Murdoch Empire whose son sits as a director on the board of a company producing MMR vaccine (since May 2009). The allegations by Times journalist were made prior to this appointment.

Rupert Murdoch, I discovered only today received Pontifical Order of St. Gregory the Great from Roman Catholic Pope in January 1998 and made large donations to Catholic Church ($10 million contribution towards the construction of a new Catholic cathedral in Los Angeles). One wonders what confessions would be heard by catholic priests from media people in LA and if any would go any further. The knighthood, bestowed on behalf of the pope is given to persons of unblemished character who have promoted the interests of society, the Catholic Church and the Holy See (Vatican).

The role of Catholic church is infamous when it comes to mentally ill. For example, during Nazi period in Germany Operation T4 was conducted by government's department to eliminate mentally ill and deformed leading to murder of 100 000 mentally ill Germans and forced sterilization of about 200 000 German people from 1939- 1941. Both doctors and church were complicit and only protested after so many died.

Apart from his generous donation to Catholic Church, Murdoch bought Beliefnet in the hope of reaching out to millions (80 at least)surfing the net. Millions of emails are sent with heavenly news by Beliefnet. Somebody named Rupert's ownership as 100% Stock of God. Ideal business in many ways as no production costs or storage required for heavenly matters. Beliefnet is not just about supernatural, it contains news and entertainment links.

This is what Beliefnet advised me:

The Moon's return to your sign today reminds you that you have more options than you previously realized. Although this is an exciting prospect, it also poses problems of its own, for you might not be able to decide which course of action makes the most sense. Don't waste energy spinning your wheels trying to force an answer now, for it probably won't be the right one unless it comes to you easily. Wait for your intuition to guide you in the right direction.

Wow! What a revelation.

And what would Catholic church say about horoscopes:

"The Church Fathers were willing to impose strong sanctions against astrology to protect their flocks. In A.D. 120, the noted mathematician Aquila Ponticus was excommunicated from the Church at Rome for astrological heresies. In the quotes below, Augustine records that such sanctions were still in force in his day, three centuries later, and could result in a person’s being excommunicated. "

The General Medical Council accepted a doctor who thinks that demons cause epilepsy and mental illness and even headaches . He prayed for his patient's headache before the patient in his NHS surgery, shivered violently and felt something cold skid across the floor and leave the room.
This Christian extremist also believes that God is formed in the image of man. Presumably, not deformed and not mentally ill.

GMC never acted responsibly by accepting that Article 6 of Human Rights was breached in my hearings even when they had the firm evidence of the overwhelming conflicts of interests. They continued to harass me with endless requests for psychiatric examinations and supervision despite the fact that I never had any mental illness and they knew about it for years. I never harmed any patients and was declared not a danger to public by their own findings which did not stop them from imposing 15 conditions on my practice making it impossible for employers to give me work in a medical specialty known to be a shortage specialty. In 70% of the world's population there is 1 or less psychiatrists per 100, 000 people. GMC commanded that the world must know about the conditions they imposed on my practice and that I must not accept a post abroad without informing them and the employer abroad.

At another hearing before the GMC, they employed a Fitness to Practice panelist who did not declare her conflict of interests. She was never called to answer for that before the GMC. The conflict of interests was relevant as she was a member of the Royal College of Psychiatrists Spirituality Section whose members believe in supernatural forces and can act out their hatred of atheists.

There were Expert Witnesses including a Consultant Psychiatrist who wrote a sixty page psychiatric report on me although he never met me, never spoke with me and never communicated with me in any way. The GMC paid him to justify their request for psychiatric examinations which were never indicated. A Hired Gun. He gave his reasons why I should undergo psychiatric examinations: if a number of people complain about me that is an indication for psychiatric request, and that writing a six page letter also indicates mental illness. The GMC never did anything about requesting he undergoes remedial training and learns what are the symptoms and signs of mental illness. He was their Expert Witness, so they would not.

Another of GMC Expert Witnesses claimed that I started a sentence with a word "but" and that was an indication of thought disorder, a symptom of psychotic illness. According to that Shakespeare, Mark Twain and the rest of UK population can all be declared mad by the GMC's own Expert Witness. We all start our sentences with word "but" sometimes. GMC never asked him to undergo any remedial training either. Well, they paid him to work for them.

The above is only a selection of conflicts and there were more, for example, a doctor who made a complaint about me was allowed to sit on Fitness to Practice Committees at the GMC after he made his complaints and the head of Fitness to Practice was from the same hospital where he worked at the same time.

A Professor of Psychiatry who tried to stop me from finding out what mentally ill think about the wearing of religious uniforms by social workers employed to work with mentally ill, did not declare his conflict of interests to the GMC either. He is also a member of the Royal College of Psychiatrists Spirituality Section. Faith is more important than science to some medical people. Not ethics. The GMC acted unethically itself by allowing these people to carry on for a long time. This Professor of Psychiatry has been friends with the doctor who made initial allegations to the GMC for more than thirty years and even told the GMC he did not want the research to be done because he knew I had Employment Tribunal Hearing against his friend and did not want me to have the evidence against him! Old boy networking has never been condemned by the GMC. Infact, it seems the panel members may have wished for such loyal friends for themselves. What a noble act to save a friend! Never mind about the mentally ill, surely one should not bother about their opinions.

Mentally ill are not a priority, but egos are.

Expert Witnesses do carry out research when writing medico-legal reports eg reading scientific literature and do get paid for it. That is not a conflict of interests, presumably.

Many times I have done research for which I was never paid and did not expect to be. Countless doctors have done the same.

I have done research financed by big pharmaceutical company which had nothing to do with any drugs testing but did find that neuroleptic medication has side effects on brain functioning which was published with no pressure from anyone not to publish it.

There were reports I wrote that solicitors did not like and I never got paid for it. Once I wrote that client was high on drugs when driving and had a car accident for which he was claiming damages. There were other cases where again, truth was not welcomed and I never got paid. Other Expert Witnesses have experienced the same.

I heard from a colleague she was threatened with legal action by a very famous drug company after she wrote a paper showing one of the indications for the drug use was not valid. She told them: "Sue me, my brother is a lawyer". They did not and the drug is no longer used for that indication.

Who judges the conflict of interests? When and why? What would have happened if all the researchers in Dr Andrew Wakefield study were equally paid?

Is it easier for GMC to deal with a smaller number of doctors than a group?

Is it really necessary to give any mentally ill people who have conditions known to have immunological defects vaccines in the same way? Do mentally ill people matter?

Mental stress does have effect on the body and mentally ill have shorter life expectancy. Normal people stressed chronically have shorter life expectancy too.

Stress also switches genes on and off leading to changes in behaviour. There are genetic elements to Autism. Many questions remain on how some genes are switched on and off and by what.

Immune system is affected by chronic stress in all of us. Therefore, it is logical to consider a better approach to mentally ill people when it comes to stress physical and mental. There are problems when one is dealing with a small child and the science of psychiatric diagnosis is not accurate.

What are the basic human motivators? At its most simple, three:

1. Laziness
2. Fear
3. Pleasure

Fear can include fear of facing one's own inadequacy. Fear when faced can lead to the need to do more work which may not be pleasant. No wonder many people never face their fears and get stuck in sad or angry phase of their grief, for example.

There are people who feel confident that once they have been vaccinated they are safe for ever. But that is not the case. Previously vaccinated people can get infection although rarely.

Immunocompetent adult cases of measles subacute encephalitis are also known as well as a case of death following MMR eg in a boy who had epilepsy before he was given vaccination. Many patients who are Autistic have epilepsy. Thus, difficult ethical/medical issues do arise when vaccination is to be considered, anyway.

The cost of looking after Autistic person long term can be huge. About $3.5 million per person. Many legal/political questions do arise as the result of that cost alone.

Parents of autistic children would have all sorts of questions and conflicts of interests every day for example, what to do first in their life, what are the priorities and what is a fair thing to do. That is normal reaction if one has a sick child and others to look after, including oneself.

There are many questions to which I do not know the answers, but I do know that being before GMC may not lead to considerations one would like it to lead to.


Urgent Support for Doctors

  • Sick Doctors Trust (For those with dependency problems) 0870 444 5163
  • Doctors for Doctors 08459 200 169
  • Doctors Support line 0870 765 0001
  • NHS-Direct 08456 46 47
  • BMA Counselling Service 08459200169
  • Samaritans 08457 90 90 90
  • National Bullying Helpline 0845 22 55 787