No base in evidence for your unprofessional smear

The photo of an airstrike in Gaza sent by Dr. Summerfield to Pepys et al.

Letter from Dr. Derek Summerfield to Sir Mark Pepys et al

24 April 2015

Dear Sir Mark Pepys and signatories

I am aware that Professor Graham Watt and colleagues have already sent
you a response to your attack on The Lancet editor Dr Richard Horton and
the signatories to the Manduca et al letter published in The Lancet
during Operation Protective Edge in Gaza last summer. As one of the
signatories of that letter I wish to reply on my own account.

An early indication that yours is simply an indiscriminate smear letter
is the inclusion of entirely irrelevant material- the Lancet publication
of the Wakefield MMR paper 17 years ago, your highlighting of what one
signatory might have said in a talk somewhere, what Internet material
another signatory might have looked at etc.

Our case rests on the substantive evidence base from a range of
international and regional human rights and documentation centres
generated by Operation Protective Edge and precedent events like the
long-running seige of Gaza. The indiscriminate bombardment and mass
killing of a helpless, trapped civilian population (including the
killing of hospital patients in their beds, and of health professionals
on duty) is at the centre of all these accounts. Look at the photo I
attach. You cannot be unaware of this evidence base but your letter
ignores it entirely. I attach just one example, an independent medical
fact-finding report organised by Physicians for Human Rights-Israel and
other reputable documentation centres. (1)

Your detachment from the human costs of Operation Protective Edge, and
the medical ethical issues thrown up, was there from the start. I note
that you, Sir Mark, were quoted in the Telegraph of 22 September 2014 as
saying on 29 August, at the height of the bombardment, that the Manduca
et al authors were displaying “most serious, unprofessional and
unethical errors”. Not a word about events on the ground in Gaza, yet
these were the events which even then the UN, Amnesty International and
Human Rights Watch were all recording as prima facie evidence of war
crimes!  Since then The International Criminal Court has opened a
preliminary examination of war crimes violations during Operation
Protective Edge.

I would suggest that if a letter of protest with exactly the same
contents had appeared in The Lancet, but where the State concerned was,
say, Sudan or Syria, you would have no reason to see as it as
objectionable or as inappropriate material for a medical journal, and
might well have applauded such coverage- after all, the medical
profession has a duty to individual patients, but also a generally
recognised wider ethical duty to address the social origins of distress
and disease. So how are we to understand the apparent exceptionalism you
display? In his classic work “Phenomenology of Sociopolitical Actions: A
Methodological Approach to Conflict”, the sociologist Max Weber
distinguished between an “ethic of responsibility” and an “ethic of
conviction”. By “ethic of responsibility”, Weber meant conformity to
professional standards and accountability. In our profession this means
the ethical standards by which doctors should practice, including a
commitment to factual evidence- standards determined by their peers,
employers, the General Medical Council and, on the international scene,
by the World Medical Association. By “ethic of conviction”, Weber was
identifying actions that were inspired by personally valued ideals,
political or other philosophies, or identities.

In my 29 years of conflict-related human rights work (23 on Israel-Palestine), I have
witnessed how regularly an ethic of conviction trumps an ethic of
responsibility, not least amongst doctors, and this is sadly true of you
too. The signatories of your letter seem united around a felt connection
with Israel and a wish to defend it, and this is what counts. In the
service of this you can dismiss war crimes, seek to bludgeon a medical
journal into silence, and demand that a letter grounded on so multiply
documented an evidence base be retracted. This is a flagrant abuse of
medical ethics. You write as if you had the ethical clarity that would
attach, say, to your discovery of research fraud in a published paper,
and your further discovery that the editor of the journal concerned had
been in knowing collusion with this fraud!

Those signatories who are Israeli are in support of the state of which
they are citizens; the majority of signatories who reside elsewhere are
serving the propaganda interests of a foreign power.

Your allegations are defamatory and libellous: that we published
“deliberately inflammatory falsehoods….abusive
dishonesty…..unverifiable dishonest ‘facts’…..malignant wilful
disregard of honest and ethical medical authorship and
editorship…..under the direction of Horton, The Lancet has become a
vehicle for publication of deliberately false material…” So we – both
authors and editor- are publishing lies which we know to be lies in a
famous international medical journal? Few allegations made against a
doctor could be much graver than this.

I quote from the GMC publication Good Medical Practice (2006).  In the
section on Working with colleagues, doctors must “respect the skills and
contributions of your colleagues” (para 41); “you must treat your
colleagues fairly and with respect.  You must not bully or harass them
or unfairly discriminate against them by allowing your personal views to
affect adversely your professional relationship with them.  You should
challenge colleagues if their behaviour does not comply with this
guidance” (para 46); “you must not make malicious and unfounded
criticisms of colleagues that may undermine patients’ trust in the care
or treatment they receive, or in the judgement of those treating them”
(para 47).  In the section on Probity, the GMC says that “probity means
being honest and trustworthy, and acting with integrity: this is at the
heart of medical professionalism” (para 56); “you must make sure that
your conduct at all times justifies your patients’ trust in you and the
public’s trust in the profession” (para 57).  In the section on Writing
reports, giving evidence etc, the GMC says that “you must do your best
to make sure that any documents you write or sign are not false or
misleading. This means that you must take reasonable steps to verify the
information in the documents, and that you must not deliberately leave
out relevant information” (para 65); …you must be honest in all your
spoken and written statements. You must make clear the limits of your
knowledge or competence” (para 67).

As one of the signatories whose academic reputation your letter seeks to blacken, I am an involved party and I challenge you retract your allegations promptly or justify them evidentially. If you fail to do so I will look to appropriate action, starting with a formal complaint to the General Medical Council naming yourself as lead signatory for a start.

Yours
Derek Summerfield

Honorary Senior Lecturer, Institute of Psychiatry, King’s College,

London Consultant Psychiatrist, South London & Maudsley NHS Trust

Formerly Research Associate, Refugee Studies Centre, University of

Oxford;

Consultant to Oxfam and other humanitarian organisations;
Principal Psychiatrist, Medical Foundation for Care of Victims of
Torture.

1.  Gaza 2014. Findings of an independent medical fact-finding mission.
Physicians for Human Rights-Israel, Al Mezan Centre for Human Rights-Gaza, Gaza Community Mental Health Programme,  Palestinian Centre for Human Rights-Gaza.

Gaza 2014: findings of an independent medical fact-finding mission, pdf file.

No Safe Place , summary of report above.