It is not necessary to be a conspiracy theorist to recognise that the General Medical Council's recent ruling to strike professors Andrew Wakefield and John Walker-Smith off the register had the fingerprints of the medical establishment all over it. They had, it was alleged, brought the profession into disrepute by showing a callous disregard to the children in the (in)famous study investigating the possible role of the MMR vaccine in inducing a regressive variant of autism associated with severe bowel symptoms. But this charge against them, as everyone knows, cannot possibly be true. Professor Walker-Smith, who supervised the investigation, is, from personal experience and by common consent, the epitome of the saintly doctor – "dedicated, honorable, held in the highest regard, a man of the highest calibre in his integrity, professionalism and clinical ability", as just one of the hundreds of affidavits from colleagues around the world puts it. And so to the opinion of the parents of the vulnerable children whose best interests he had allegedly disregarded. "We were all treated with the utmost professionalism and respect… were kept fully informed about the investigations recommended… they were carried out without distress to our children, etc, etc." It seems only sensible, given this moral confusion that would portray a decent and honest man as deceitful and exploitative, to reserve judgment about the GMC's verdict and to speculate what lies behind it. Leaving aside the question of whether the MMR vaccine is implicated in this form of autism – as the parents' accounts would certainly suggest – it is perhaps not unreasonable to detect the hidden hand of those powerful forces for whom the crushing of a professional reputation is a price worth paying for the continuation of the ever-expanding child immunisation programme. The introduction of clot-busting drugs administered to people in the immediate aftermath of a stroke, to minimise damage to the brain, ranks as the single most important medical development of recent years. None the less, strokes remain life-challenging events and a fair proportion of those afflicted subsequently (understandably) become a bit gloomy, and may require treatment with antidepressants. Recently Dr Ricardo Jorge of the University of Iowa has suggested that these drugs should be prescribed more widely (or indeed universally) as they have the further specific advantage of improving verbal and visual memory and "global cognitive functioning". He claims, in a study in the Archives of General Psychiatry, that this effect is independent of any improvement in mood they might cause. "The utility of antidepressants in post-stroke recovery warrants further investigation," he writes. The case of the gentleman whose left hand goes icy cold at the breakfast table while his right remains pink and warm has prompted a similar account from a lady from Sandhurst who, since retiring, has become something of a keep-fit fanatic. She has a daily regime of running, power-walking and cycling, after which "the contrast in temperature between my hands is extreme. It is my party trick in the bar afterwards to get my friends to feel the difference." Clearly something is compressing the blood flow to the arm and I am grateful to Dr Tony Platts for suggesting thoracic outlet syndrome as a possible explanation – the thoracic outlet being the small space behind and below the collarbone through which the nerves and blood vessels travel to the arm. Those in whom the outlet is narrowed may experience a range of symptoms, depending on which structure is being compressed: if it is the nerves – pain, numbness and tingling; the veins – swelling and bluish discolouration; or the artery – a pale cold hand. Whichever, an operation to widen the outlet is usually curative. This week's conundrum comes courtesy of Mrs K J from Berkshire writing on behalf of her 70-year-old father-in-law who, since having an angioplasty to widen his coronary arteries a couple of years ago, has been troubled by pins and needles from head to toe as if he had just rolled in a nettle bush – and which is partially relieved by moving around. He also has a dry mouth, sore gums and a rushing in his ears. He has seen a fistful of specialists, but sadly is none the wiser. James Le Fanu's most recent book 'Why Us? How Science Rediscovered the Mystery of Ourselves' is now available in paperback from Telegraph Books for £9.99 plus 99p postage and packing. Please call 0844 871 1515 or go tobooks.telegraph.co.ukThe hidden hand of powerful forces
Doctor's Diary: Conspiracy theories and the GMC's recent
ruling to strike professors
Andrew Wakefield .and John Walker-Smith off the register.
Monday, 7 June 2010
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