Lockerbie cancer specialist defends prognosis

The doctor at the centre of the increasingly bitter international debate over the early release of the Lockerbie bomber has spoken in his first interview since his expert evidence was used to justify the decision.

Talking ahead of Saturday's first anniversary of the release of Abdelbaset Ali al-Megrahi, Professor Karol Sikora strongly attacked the way his prognosis was portrayed.

The leading cancer specialist said he would have made his evidence "more vague" if he could have foreseen that it was going to be interpreted as a fact that the convicted terrorist was going to die within three months of being released from Scotland's Greenock Prison.

Sikora's claims are likely to reignite the row over the grounds on which al-Megrahi was released. As one of three doctors paid by the Libyan Government to provide an expert opinion on al-Megrahi's life chances after he was diagnosed with prostate cancer, Sikora has been attacked for his role in the affair.

Claims by US senators that the release was orchestrated by BP, who wanted to win drilling concessions in Libya, have provoked a bitter international row.

Two of the physicians paid by the Libyans - Sikora, and Professor Ibrahim Sharif, a Libyan oncologist - agreed al-Megrahi's death was "likely" within three months. The third, Professor Jonathan Waxman, conceded that al-Megrahi did not have long to live.

Sikora denied that he succumbed to pressure from Libya to agree that al-Megrahi had under three months to live so that he could be returned to Libya on compassionate grounds. "I felt, on the balance of probability, you could justify that [claim], but you couldn't say he was definitely going to be dead in three months," he said.

"When I was asked 'Is he likely to die in three months?', my opinion was that he was. If you look at the survival curve, there's about a 60 per cent chance of someone being dead in three months, but that doesn't mean he will die in three months. The legal side has to have it one way or another; it (the prognosis) can't be mousey. If I did it again, I'd really test the grounds for compassionate release. This three months (rule) - is it based on the balance of probability or more than that? Is it beyond reasonable doubt?"

Sikora said it was not the job of doctors to deal in certainty, but to make politicians and lawyers aware of the spectrum of potential outcomes when asked to assess how long a terminally ill patient had to live: "If I could go back in time I would have probably been more vague and tried to emphasise the statistical chances and not hard fact."

He agreed that the al-Megrahi affair had, as with the MMR and swine flu scares, highlighted how there can be explosive reactions when science, politics, media and law collide.

"In medicine we say 'Never say never and never say always', because funny things happen. All you can do is give a statistical opinion, and that's fraught because the media, the law, and indeed patients, don't like statistical opinion. They want to know 'Is it this or is it that?' A court is all about guilty or not guilty."

He questioned whether the law governing compassionate release if a prisoner had only three months to live was established under Scottish law: "There was no written rule about compassionate release. Was it three months or not?"

He added: "What I find difficult is the idea I took the key and let him out.

"I provided an opinion, others provided an opinion, and someone else let him out. That decision of compassionate release is nothing to do with me. No one asked me, 'Should we let him out?' All they said was when do you think he will die?"

There has been wild speculation that al-Megrahi never had cancer, but Sikora said he had no doubts. "Initially I thought he had 18 months, but when I saw the data, the blood tests and x-ray reports and spoke to the prison doctor, who had observed the pace of the disease, I thought it would be much quicker."

Al-Megrahi's longevity should not be too much of a surprise, Sikora argued: "There is some fascinating data of people wanting to live much longer and succeeding. I've had two patients myself, one who wanted to go to her granddaughter's wedding and the other to her daughter's wedding.

"On both occasions they self-willed themselves to live and then within a week after the weddings died of end-stage cancer."

He suggested al-Megrahi's release could have given him a new lease of life: "Here's a man who has got no hope of leading a normal life suddenly going back home to his house, his kids and family. There is anecdotal evidence that this sort of thing can improve the length of life just by giving someone something to live for.

"But it's not pleasant dying over that period of time - increasing amounts of morphine. It's better to have good quality of life over three or four months and go out with a bang."

The Scottish Government has denied that the expert evidence from Sikora - and the other two doctors paid by the Libyan Government - influenced its decision.

But it was recently admitted that the evidence was shared with the prison doctor, who wrote the report submitted to the Government detailing al-Megrahi's condition and setting out the prognosis for how long he had left to live.

Sikora, medical director of CancerPartnersUK and dean of Buckingham University business school, expressed frustration that patient confidentiality rules made it impossible to publish al-Megrahi's medical records, as US politicians demanded last week.

Steps to release:

NOVEMBER 14, 1991
United States and British investigators indict Libyans Abdelbaset Ali al-Megrahi and Al Amin Khalifa Fhimah on 270 counts of murder over the 1988 bombing of Pan Am Flight 103 above Lockerbie, Scotland.

APRIL 16, 199
United Nations Security Council imposes sanctions over Libya's refusal to hand the suspects over for trial in a Scottish court.

APRIL 1998
Libya confirms it will accept a trial in a neutral country.

APRIL 6, 1999
The suspects are taken into Dutch custody and formally charged.

FEBRUARY 1, 2001
Al-Megrahi is found guilty of murder.

MARCH 15, 2002
Al-Megrahi loses his appeal.

OCTOBER 22, 2008
Al-Megrahi's lawyer says the 56-year-old has been diagnosed with terminal prostate cancer at an "advanced stage".

JULY 26, 2009
Al-Megrahi applies for release on compassionate grounds.

AUGUST 21, 2009
Following medical reports from Karol Sikora and other doctors, al-Megrahi is released by the Scottish government.

He flies home to Libya on a jet belonging to Muammar Gaddafi.

- OBSERVER