When 'expert' witnesses lack the expertise

Fri 19 Dec 2003

I WAS once asked to use my knowledge of blood-clotting to appear in court as an expert witness. In fact, I was leaned on rather heavily to do this.

A man had been found drowned, and he was covered in bruises, so the question of foul play arose. A colleague had asked my opinion as to whether a terminal process of generalised clotting/bleeding could have occurred in the extremis of drowning. Such a process is well recognised in certain other severe illnesses.

Near-drowning was not a clinical problem I was familiar with, and I found little in the literature at that time to connect it with an acute bleeding diathesis; but I thought about the sequence of events, and constructed a theoretical model of how extensive bruising might have occurred in this situation. It was on this basis I was asked to masquerade as an expert witness.

I refused, of course. Imagine a competent lawyerís sarcastic shredding. "How many cases of near-drowning have you attended in your career, Dr Cook? One only? Did you see this particular patient? No? I fail to see wherein lies your expertise ..." Quite so.

And yet, eminent people have appeared and given crucial evidence resulting in convictions and life-sentences with no more personal erudition and direct involvement than I had. Expertise is often no more than getting your name linked so inextricably with a disorder that whenever an "expert" is required, Pavlovís principle ensures that your name is the first to leap to mind.

EVIDENCE-based medicine is a new concept, but it will have an uphill struggle to replace the ingrained deference-based medicine. I am referring to the three women who were accused of murdering their babies on the basis of principles enunciated by Sir Roy Meadow; and who have thankfully been acquitted or freed on appeal.

Besides Meadowís expertise on cot deaths - until evidence of genetic factors came along - the syndrome of "Munchhausenís Syndrome by Proxy" (MSBP) is also under a cloud of suspicion; with the scandalous possibility that it does not even exist. This diagnosis, which does not have a shred of evidence-base, has been used in the past to remove children suffering from post-viral fatigue syndrome (ME or CFS, call it what you will) from their parents, supposedly affected by MSBP and imposing illness behaviour on their children.

But now that ME/CFS are accepted as genuine diseases, I would like to know what our ministers of health are doing to redress the terrible injustices done to those children and parents in the past who were separated on the basis of "expert" arrogant ignorance. And under conditions of such harsh and pitiless, sanctioned secrecy that paths of appeal were blocked.

The life sentence for a mother accused of murdering her child is horrifying in itself, and reflects the male perspective of our legal system, which doles out such ferocious punishment to the vulnerable while giving piddling sentences to rapists, molesters and drug barons.

BUT letís explore the decree by other powerful men: that children and their parents can and should be separated under certain conditions. Letís think of failed asylum seekers, who, if they do not return to their countries of origin, are to be left destitute and their children taken into care - if Blunkett has his way.

The fate of a child in care, particularly a foreign child, does not bear thinking about in our uncaring society - a child with no status and no natural protector, an easy prey for abuse of all kinds. Separating a child from its parents by an authoritarian regime is a tyrannical evil on a par with capital punishment, and inconsistent with a civilised society. In this particular guise, it is cloaked racism.

How can our government plan to treat oppressed people so contemptuously while using them to justify war on their own brand of dictator?

ONE of the most worthwhile activities at Christmas time, to my mind, is the custom of keeping in touch. My Christmas-card list has snowballed over the decades, and I like to add to it every year. So much so that friends from the past often materialise in the flesh, and a marvellous meet of nostalgia and reminiscence results.

There are some close friends with whom I exchange letters, if I have not seen them; but I always write to that person as if we were in conversation, and I write by hand. The habit of sending round robins with Christmas cards is not one I adopt. Such letters tend to be typed, are usually a catalogue of sparkly achievements by offspring, additions to the family or far-flung travel destinations. They tend to read a bit like a self-congratulatory CV and can suggest: Iím too busy with my exotic life to write you a proper letter. Itís better to take a little trouble or just send the card.


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