Wednesday, 24 August 2011

The Megrahi debate: justice done or justice denied?

[This is the main heading over a page in today's edition of the Scottish Review. It contains interesting contributions from Labour-supporting Brian Fitzpatrick; SNP-supporting David McEwan Hill; and Dr Alasdair Galloway. This last item addresses recent criticisms of the medical evidence on which Kenny MacAskill acted. It reads as follows:]

Its interesting that Dr Simpson's comments on Megrahi's release should appear within a few days of the intervention by Professor Roger Kirby, who has suggested that much of the reason for his survival can be explained by the use of a hormone drug that isn't available in the UK even now. Professor Kirby refers specifically to abiraterone which he says 'is transforming the prospects for patients with advanced prostate cancer. They just are living longer and longer'. However, he then goes on to condemn the decision to offer a three month prognosis since treatment advances could keep him alive for several years.

This point of view seems to be extremely unfair for several reasons. First of all abiraterone is not, and was not then, available in the UK, so Megrahi couldn’t have been treated with it, either then or now. Moreover, as with many other such advanced treatments, there may well be a high cost associated, and it's very easy to imagine the furore there would have been had Megrahi been medically treated at that sort of cost.

This leads on to the issue of what question Dr Fraser and his colleagues were required to address. Were they asked to consider what his prognosis would be as a prisoner in Greenock Prison? Or were they asked to give an estimate of his survival were he to be released and returned to Libya? The problem with the latter question is that those charged with answering it have no idea and no control over what treatment he might receive in Libya. The only treatment regime they could be sure of, would be that extended to him in the UK prison system. Given that the specific treatment Professor Kirby refers to was not available, and that it is very likely there would have been serious political ructions if it had been made available to him, then, even on the basis of Professor Kirby’s argument, had he not been treated with abiraterone (or similar) it does seem more likely that he would have succumbed by now.

Dr Simpson, as we know, had serious doubts about the prognosis at the time, but with his considerable expertise in this area of medicine, I am sure he knows that prognosis with advanced cancer is more art form than science. He also knows that a comparison of Megrahi’s survival in Libya – with his family around him, not to mention the different treatment regimes that he will be on – to his likely survival in Greenock is a classic comparison of an apple with a pear.

I have no background in medical matters, but it does seem obvious that a longer life span could have been predicted for Megrahi back in Libya. But since Dr Fraser had no knowledge or control over Megrahi’s conditions in Libya, it seems reasonable for him to have addressed the question of prognosis on the basis of his continuing imprisonment at Greenock. Therefore, perhaps we need to understand the prognosis of three months as being 'if he continues to be held in Greenock Prison, his life expectancy is approximately three months'. To contrast that with the outcome at home in Libya is not comparing like with like.

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