Aspirin and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome

 

Commentary

This is an important judgment for obstetricians as it shows in precise detail how the court, relying on not just the experts’ evidence but a critical analysis of the literature on which they relied, decided whether the claimant would have avoided developing HELLP had she been advised to take 75 mg aspirin at 12 (or 14) weeks instead of at 23. Twelve publications were put under the microscope and considered also in the light of research concerning the relative value of aggregate data and individual participant data.

Although the issue in this case was the prevention of HELLP, it may be an important judgment to consider in pre-eclampsia cases.

Learning points:

General

• It is important to investigate the full history of symptoms

• It can be misleading to quote only investigation results that support an opinion and not to quote results that undermine the opinion.

• An inability to explain why some results have been quoted and others ignored can call an expert’s credibility into question.

• Where an expert’s opinion is inconsistent with the observations and conclusions of a range of healthcare professionals, and without a convincing explanation, this can affect the expert’s credibility and the weight given to their opinion.

• More than symptoms are needed to make a diagnosis.

• Where an expert is passionate about their opinion, this may be evidence of their sincerity but combined with being unwilling to recognise and balance countervailing evidence and unwillingness save in very limited respects to make any concessions, and show the ‘flexibility of mind’ referred to in Loveday v Renton, along with, in this case, proneness to making sweeping statements, their objectivity may be in question.

• When criticising the methodology of a study upon which another expert relies, consider whether the same point could be made about other studies, including those upon which you rely.

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