London Calling

With a British court’s vindication of a prominent English neurologist and expert on epilepsy, Singapore’s ruling Lee family has discovered that other countries don’t share the island republic’s – or the Lee family’s – idea of what is legal and proper.

In a written decision adjudicated in December and handed down on January 12 (decision here), the British High Court effectively ended Singapore’s pursuit of Simon Shorvon, the former principal investigator of a medical research project in Singapore, after a protracted international dispute in which the Singapore Medical Council alleged Shorvon was guilty of professional misconduct. Shorvon is now a professor at the University College, London.

The charges were brought against Shorvon by Lee Wei Ling, a physician, who also happen to be the daughter of patriarch Lee Kuan Yew and the sister of Lee Hsien Loong, the current prime minister. Over the past two to three decades, the Lee family and other Singaporean officials have filed a plethora of writs and lawsuits on various charges of libel and other misconduct against almost anyone who has had the nerve to stand up against them – but almost always in Singapore courts, where they have a 100 percent winning record, particularly against journalists and opposition politicians.

The just-ended four-year dispute is a serious blow to Singapore’s hopes to make the country an international center for biomedical research and attract top researchers. Using a combination of tax holidays and other incentives, Singapore sought to attract some of the world’s major pharmaceutical companies and distinguished researchers to conduct basic drug research and development. Some 30 companies have responded.

The government opened a seven-building biomedical complex in 2003 at a cost of S$500 million, outfitting it with the latest high-tech equipment, including a day care center and facilities to house a sophisticated embryonic stem cell research facility.

Among those the government lured was Simon Shorvon to head Singapore’s National Neurology Institute in 2001 to conduct a wide-ranging joint research project with the University College, London, into the ravages of Parkinson’s disease. The second most common neurodegenerative disorder after Alzheimer’s, Parkinson’s has become a major focus of concern partly because it has afflicted such personalities as the boxer Muhammad Ali and the actor Michael J. Fox. Symptoms include tremor, stiffness, impeded movement and loss of balance.

According to the findings of the UK High Court, Shorvon was “a highly accredited and world-renowned researcher in this field” when he was appointed principal lead investigator. Shorvon set out to conduct the study with Lee Wei Ling, who would later resign from the research project. The project was one of the largest research endeavors ever undertaken in Singapore

Ultimately, however, it collapsed in 2002 in a storm of controversy when the neurology institute, urged on by Lee Wei Ling, brought 30 charges against Shorvon alleging patients had been recruited to take part without the knowledge or consent of their treating physicians and without the patients’ fully informed consent. It was also charged that Shorvon or researchers under his supervision had altered patients’ medication without their knowledge or the consent of their physicians.

After months of controversy, in 2003 a panel recruited by the Neurological Institute held an inquiry and reported that “the research was carried out in serious breach of ethical guidelines which are applicable in Singapore as well as internationally.” Patients’ rights were disregarded and their safety and wellbeing were compromised, the panel found. Also, patients’ records were disclosed without their consent, according to the panel, and no ethics approval had been obtained for testing a Parkinson’s drug called Levo-Dopa.

Finally, according to the high court, the panel concluded: “The patients were treated like experimental subjects without any rights…the patients’ welfare was disregarded…the way the testing was done compromised patients’ wellbeing and safety. Such a procedure of testing on human subjects would not be acceptable in any civilized society.”

Shorvon, however, contended that he had never been shown the inquiry’s terms of reference or the specific allegations against him. He said he was given no advance disclosure of documents and was asked to comment on them without notice. Nor, he said, was he given a chance to respond to the inquiry’s allegations before they were pronounced. He never saw the report until after it had been signed, he said.

Although he later signed a letter stating he accepted the report and its conclusions, he said he did so under threat of being reported to the police and, he told the UK High Court, he would not be permitted to leave Singapore, “as by then he was most anxious to do so, unless he signed such a letter.”

Shorvon signed and left. He was succeeded as director of the Neurological Institute by Lee Wei Ling, the former prime minister’s daughter.

But that wasn’t the end of it. An inquiry committee of Singapore’s Ministry of Health issued its own report in March 2003 that contained no personal censure of Shorvon – only to have individual members of the committee two months later issue a supplemental letter that did criticize him.

The whole matter was later referred to the Singapore Medical Council for another round of inquiry. Shorvon refused to participate, partly on advice of counsel that the medical council had no jurisdiction and also, according to the High Court, because “by now Professor Shorvon had, rightly or wrongly, come to the view, given his experiences, that he was not going to receive a fair hearing in Singapore and that the result was a foregone conclusion.”

A subsequent medical council 10-day hearing predictably concluded that Shorvon had failed to safeguard the best interests and health of his patients and had exposed them to unnecessary risk. The council demanded that Shorvon’s name be removed from the register of medical practitioners in the UK, that he be censured and that he pay costs, which he did under protest.

That got the General Medical Council, the UK equivalent of the Singapore Medical Council, involved. The UK medical council screened the Singapore proceedings and documents and referred the case to a professional conduct committee. Ultimately, independent expert evidence supported Shorvon. The GMC concluded it was not in a position to prove Shorvon was guilty of misconduct and in 2005 it told the Singapore council it was cancelling the proceedings.

Singapore found that unacceptable and appealed it to the British High Court, where Queen ’s Counsel – the very elite of the British legal profession – hired by Singapore charged that they were there to “stop Professor Shorvon from getting away with it.”

Adrian Williams, a professor of clinical neurology at the University of Birmingham called as an independent witness for the general medical council, said he would not dispute what he called “the clear-cut facts of the case,” but said the alleged offenses were so minor that they weren’t worth bothering with.

“As with all big studies,” Williams concluded, “particularly ones that fail, there are clearly things that could or should have been done differently. However, at the level of serious professional misconduct, I cannot find anything here that should cause serious concern about Professor Simon Shorvon.”

For his part, Shorvon issued a statement saying that “This judgment removes an unjustified slur on my reputation. I am delighted. I hope that now I can be left in peace to pursue my research.”

A spokeswoman for the Singapore Medical Council would only say the judgment is under study and that an appeal is possible.