Richard Smith: A successful and cheerful whistleblower

Richard SmithPeter Wilmshurst is that rare thing—a successful whistleblower. What’s more, he’s a cheerful one, despite having lost £25 000, faced bankruptcy and the loss of his house, and spent every evening, weekend, and his annual leave for three years successfully defending an egregious libel case.

Most readers of the BMJ must be familiar with the libel case of Wilmshurst, a now semiretired cardiologist from Shrewsbury, but let me recap briefly. He was the coprincipal investigator on a trial funded by NMT, an American company, to see whether closing a hole in the heart of patients with migraine would cure their migraine. It didn’t. He refused to agree to be an author on a paper published in the journal Circulation because the paper was misleading, and he gave an interview to a journalist in the US pointing out the problems in the study. NMT sued him for libel, not in the US, where proving libel is difficult, but in England, where the onus is on the defendant to prove his innocence.  NMT probably assumed (rightly in the case of most people) that the financial risk would cause Wilmshurst to cave in. They were wrong, and the case collapsed when NMT went bust.

Circulation has published a very lengthy correction, and two doctors who worked on the study with Wilmshurst are facing hearings with the GMC. One of the authors on the paper, the most distinguished of the several cardiologists, actually died before the study began. Yet that hasn’t stopped him being an author on a recently published letter that he cannot have read in response to another letter that he cannot have read about a paper that he cannot have read. Wilmshurst, it is clear, finds this absurdity amusing. Death is no impediment to continuing to be an author in prestigious medical journals.

I travelled to Telford last month to hear Wilmshurst give a lecture to the Royal Statistical Society on libel and other barriers to exposing research misconduct. It took me back to 1996 when we invited him to come to the BMJ and give a talk—behind closed doors—to our staff and advisers and colleagues from the Lancet. He reeled off case after case of misconduct, many of them involving prominent people. The audience listed intently, but I was unsure of the reaction. Might somebody leap up and say “How dare you accuse x of misconduct. He is one of the great men of British medicine”? In fact in my memory the reaction was the opposite. People said things like “Actually, it’s worse than you know…”

For me, it was a defining moment.

Now 16 years later Wilmshurst has a longer and updated list, and somebody in the audience asked if he thought things are getting better or worse. He thinks probably worse: he’s had seven whistleblowers contact him in the last two months.

Perhaps strangely it was his first story that best captured the corruption that Wilmshurst has been fighting all his professional life. It was the early 80s at St Thomas’ Hospital in London, and Wilmshurst was doing research into amrinone, a new drug for heart failure manufactured by Sterling Winthrop, a company since taken over. The drug was supposed to increase myocardial contractility, but Wilmshurst found that it didn’t. Worse, it had serious side effects. Wilmshurst and his boss prepared to publish, but Sterling Winthrop, the manufacturers of the drug, threatened legal action. The company also asked if Wilmshurst and his boss would be willing to meet with their experts. They agreed. The message was that St Thomas’ was getting very different results from everybody else and that their lab would be discredited if they were to publish.

Nevertheless, they published, and three other groups subsequently said that they had got the same results but had been afraid to publish because they had received the same message from Sterling Winthrop. Soon after this the drug was withdrawn, although Wilmshurst discovered that it was still on sale in Africa and helped to have it banned worldwide. His attempt to tell the story in medical journals was stymied because of their fear of libel.

Wilmshurst pointed out that the evidence that amrinone would be useful was based on a paper published in the New England Journal of Medicine in 1978. The paper included only eight patients, and, according to Wilmshurst, the conclusions are not supported by the data. The five authors were all described as coming from Harvard Medical School, although two were employees of Sterling Winthrop. No conflicts of interest were declared, which was, as I know from my own research, normal for that time.

One of the things that seems to make Wilmshurst so cheerful is the black humour of his stories. Many of them involve doctors who are guilty of misdemeanours but who sit in judgement on others. He told the story of Peter Richards who decided to bury the fact that Clive Handler, a doctor, at Northwick Park Hospital, was found guilty of using NHS research funds to subsidise his private practice at a time when Richards was medical director of the hospital and chair of the professional conduct committee of the GMC. Previously he had been dean of St Mary’s Medical School, prorector for medical education at Imperial College, and chair of the Council of Deans of UK Medical School and Faculties. When Handler eventually appeared before the GMC, the GMC’s lawyers ask that Richards stand down from chairing the committee. As Wilmshurst said, it’s as if a judge at the Old Bailey were to say “I’ll have to excuse myself from hearing this case as I helped the accused bury the body.” After having to stand down from this committee Richards continued to chair other conduct committees. Wilmshurst told several stories of doctors who had been found guilty of research misconduct but gone on to be deans and others in charge of researchers.

Sadly the stories of medical leaders and institutions trying to hide research misconduct is very familiar, and nobody has blown the whistle on such behaviour as often as Wilmshurst. All the evidence shows that whistleblowers usually suffer much more than the crooks on whom they blow the whistle, and I find it very pleasing that Wilmshurst is not only a successful and cheerful whistleblower but is also now widely respected for what has done to help clean up medicine.

Competing interest: RS has known Wilmshurst for 16 years. Both were involved in the early days of the Committee on Publication Ethics, and the BMJ was sued for libel over an article by Wilmhurst that was published when RS was editor of the journal. The article has not been retracted but is not available on the BMJ website.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.