Sir, Mr Robert Hantusch (letter, February 24) compares the position of Dr Andrew Wakefield with that of the paid expert witness, but a key difference separates the two. The expert witness is required to certify, on each report produced, that he or she is aware of his or her sole responsibility to the court, as opposed to any responsibility to the plaintiff or defendant, irrespective of which party is providing the funding. Having acted as an expert on many occasions I can vouch for the serious attitude doctors take to signing such documents, and I was always reminded of my overriding duty to advise impartially when signing that declaration.

The increasing trend towards employment of joint experts funded by both parties is not just a matter of cutting costs. It also increases the likelihood that a truly impartial opinion, based only on an unbiased assessment of the facts, will be obtained.

In contrast Dr Wakefield failed to declare his potential conflict. It matters little whether or not a conflict actually existed. Its concealment in itself prevented readers of his paper from forming a balanced opinion as to the weight that should be attributed to it.

Unlike the expert witness he did not declare his awareness of his responsibility to the medical community or, indeed, the wider public interest.

Yours faithfully,
CLIVE A. LAYTON,
(Consultant cardiologist, 1977-2000),
Woodview, Abbess Roding,
Ongar, Essex CM5 0JJ.
clive.layton@datacam.net
February 28.

From Mr Michael Place

Sir, In my view the crisis over MMR was caused by the NHS, and not by Dr Andrew Wakefield’s paper in The Lancet (letters, February 24).

The refusal of the NHS to accede to the requests of some mothers for separate vaccinations generated the publicity that provoked the crisis. If these mothers had been allowed to make a choice in the light of the advice given to them by their GPs, there would be no problem over the level of measles and other immunity.

Yours faithfully,
MICHAEL PLACE,
(Health economist, 1997-2002),
115 Caraway Apartments,
Cayenne Court, SE1 2PP.
February 28.

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