2.2.7. Duration & Dosages Sufficient to Form Dependency

According to the verdict, it states that there was no possibility of becoming dependant on the doses and duration of Dr. X’s prescriptions but this is in complete contrast to Professor Ashton’s expert opinion (See below).

“Tolerance and dependence can develop if benzodiazepines are used regularly for longer than 2-4 weeks. There is no minimum dose, for example tolerance and dependence have been observed after the regular use of 2.5-5mg of diazepam” (Evidence article Koh A35 - Dr. Judson’s Report 3, article 2.1).

NB: Professor Ashton is the world leading expert in benzodiazepine dependency – there is no one on this earth who has greater expertise than her in this field (Appendix 6-2). Professor Ashton has provided references and expert opinions which have been included in Dr. Judson’s reports.

2.2.8. Individuality Was Not Considered

Specialist Dr. Judson’s Report 5 discusses individuality and states the following:

“The duration and degree of withdrawal symptoms are often different for each individual and depend on many factors”.

Professor Ashton also noted the following based on clinical studies. “…each person's experience of withdrawal is unique”. “These variables according to individuality are one of the reasons why careful monitoring during the treatment is important” (Appendix 9: Report 5, article 2.2).

However, looking at the verdict, it is clear that the High Court did not consider individuality.

(TN: Warning: significant translation error below)

Dr. Judson also stated the following in article 1.3 of his third report:

“Subsequently, before we even begin to consider the content of Wayne’s patient files, based on his symptoms, the overall clinical picture and the application of the DSM-IV-TR we can already determine that there was at least a 50~100% chance that he was dependent simply by the duration and dosages of his prescriptions alone. NB: The reason for the wide range in possibility of dependence is because individuality needs to be considered.”

NB: The above Japanese translation by the translation company is incorrect. It should read as follows:

“Subsequently, before we even begin to consider the content of Wayne’s patient files, his symptoms, the overall clinical picture and the application of the DSM-IV-TR, we can already determine that there was at least a 50~100% chance that he was dependent simply based on the duration and dosages of his prescriptions alone. NB: The reason for the wide range in possibility of dependence is because individuality needs to be considered”.

2.2.9. Translations Errors

We have been contracting the translation company for the task of translating Dr. Judson’s reports.

However, as the preparation of these reports necessitated working across two countries, using two languages between a lawyer and a doctor, preparing materials (patient file releases, content deciphering, translations etc), we were always struggling just to get the report translations submitted on time, and subsequently, we never had the time needed to check the accuracy of the translations. As a result, the degree of conviction in some parts has been affected.

(Translation Errors Include)

The translation company always translated the word “most likely” as “osoraku”.

E.g:

The word “osoraku” is equivalent to “perhaps” but this only indicates about a 40% degree of certainty. However, the word “most likely” refers to the highest possibility and indicates a degree of certainty around 90%. Subsequently, “most likely” and “osoraku” are completely different and this needs to be clearly understood.

NB: What Specialist Dr. Judson was referring to in the above articles was that the appellant’s symptoms following the treatment were “most likely” caused by dependency and withdrawal effects from the drugs - not from mere stress caused by daily life pressures (Appendix 7: Evidence article Koh A35 - Dr. Judson’s Report 3, article 3.3).