Editor-in-Chief, Encyclopedia of Forensic and Legal Medicine	September 2005
	"The problem with forensics is that you’re not curing people, you’re not curing cancer and things like that. But increasingly people are recognizing that issues of human rights, ethics, people’s liberty and how they are treated, and how people behave toward each other is becoming increasingly important."

Forensic and legal medicine is such a popular subject right now. How did you develop an interest in forensic medicine?
I trained in medicine in London and my initial intention was to become a surgeon. The way training goes in the UK, you do a number of jobs, and at that time would take 10 or 12 years to become a consultant. I was an anatomy lecturer for a year after I qualified in medicine generally, and then I started a series of surgical jobs with various hospitals in London and around the southeast of England. I then developed an interest in the gut and gastrointestinal surgery. In the UK, you are required to go on to do a period of research. I moved into medical gastroenterology, as opposed to surgical gastroenterology, and through that developed an interest in clinical nutrition. At that stage I was also developing a part-time career in medical writing, and by about 1988 or so, I felt that I didn’t want to have a full time career devoted solely to surgery in hospitals in the UK, so I did a part-time law degree. Eventually, I was asked by a forensic pathologist in the UK whether I was interested in becoming a forensic medical examiner in London.

What is the role of a forensic medical examiner?
A forensic medical examiner doesn’t do pathology; they are not medical examiners the same way as they are in the US. We look at the clinical aspects, the living aspects of medicine, predominately related to police and criminal issues. After a year or two working as a forensic medical examiner, I decided I didn’t want to go back to full-time hospital surgery. There isn’t a formal career structure in clinical forensic medicine in the UK, but possibly because of my research and academic background from my hospital-based surgical and gastroenterology work, I was able to develop a niche in clinical forensic medicine.

Is this during the time that you edited a London police journal?
Yes. I was asked to edit what was then a journal called The Police Surgeon. The Police Surgeon was edited by a Scottish doctor called David McClay, who coincidently had trained as a surgeon who had also trained in law, and had been President of the Association of Police Surgeons. I was asked if I would be interested in taking over Editorship, and I said I would be interested, only if we were able to develop it into a peer reviewed international journal. The Association of Police Surgeons gave full support to that, and with some of the fellow members of the Association of Police Surgeons we created from The Police Surgeon, the Journal of Clinical Forensic Medicine. I remain the Editor-in-Chief of that journal, and it’s now been published about 10 or 11 years under Elsevier. All along in the last 15 years or so, there has been a gradual increase in recognition of the importance of having properly trained people involved in the care of prisoners in police custody, the forensic interpretation of issues that arise, and particularly in the last few years, a much greater awareness of the need for people with particular interests in human rights and medical ethics. The whole subject of forensic and legal medicine, which really embraces everything to do with the law, medicine, the judiciary, and in some cases governmental bodies, has expanded hugely over the years. Now part of the subject of forensic and legal medicine is, of course, expert witnesses giving evidence in certain court settings.

And that is part of what you currently do?
I do that. Expert witness work is part of forensic and legal medicine, but expert witness work is something that many doctors do, irrespective of whether or not they have legal or forensic training. They may do expert witness work in their own particular subject. Forensic and legal medicine is broader than that, and my own view is that just in the same way as any other specialty (i.e. cardiology or gastroenterology), you have to have particular training that may include exams, accreditation or validation, and certainly specific experience.

Does the United Kingdom offer a particular training system for forensic medicine?
I’m giving you my perspective at the moment, but I feel the recognition for the need for this is something that has expanded worldwide. There are very few countries where forensic and legal medicine is actually recognized as a specialty of medicine. In the UK, forensic pathologists are recognized and have their own training system, but forensic physicians (those who deal with the living aspects of crime and human rights and torture) don’t have a formalized training system. However, it is developing. It is hoped that in the next couple of months there will be a formal announcement in the UK, of the creation of a new faculty of forensic and legal medicine, which will be a part of the Royal College of Physicians, one of our senior medical bodies.

It sounds like things are moving in the right direction.
My ambition is that I can say that for the last fifteen, twenty or thirty years I have been practicing in a recognized medical specialty. At the moment, I can’t.

What is the difference between a forensic physician and a police surgeon?
It’s a different name for the same thing. In 1951 the Association of Police Surgeons was established, although the term has been used for over a century. They were people who assisted the police and the courts with their work. The term police surgeon is now rarely used and those of us who practice clinical forensic medicine call ourselves forensic physicians. The term forensic medical examiner is often used. These terms are to emphasize that we have an independent, non-partisan and non-judgmental role. The term Police Surgeon was always considered to be somewhat anachronistic because the role of the doctor has always been to be independent of the police. A forensic physician works predominately with the living. This includes the general medical care of a prisoner in police custody, or a forensic assessment which may relate to drug or alcohol misuse, psychiatric issues, wounding, child abuse, sexual assault etc. They may be assessing the victim, or the alleged perpetrators of these various things. This might include people who have been arrested who are taken into police custody who, for example, need to be reviewed for offensive and defensive injuries in cases of assault. There might be a requirement to go into hospitals to assess people who have been injured and may be on ventilators because hospital based doctors don’t necessarily have the training, or their role there is to treat a patient’s injuries rather than to document and interpret causation of those injuries.

So the terms Police Surgeon and Forensic Physician and Forensic Medical Examiner are interchangeable?
Right. A number of us have been unhappy with the term Police Surgeon over the years, because when you mention the word ‘forensic’ in association with medicine, people automatically assume that you’re a forensic pathologist because the terms forensic pathology and forensic medicine have been used interchangeably. Some years ago, in the London Metropolitan Police Service it was decided to emphasize independence from police so the term forensic medical examiner was created. The term Police Surgeon happened to be a somewhat archaic term, but it assumed general use. A forensic physician may, for example, also be working for bodies that examine refugees or asylum seekers for signs of torture. We may be called in by defense solicitors, or attorneys to undertake assessments or reviews of clients in other settings. We wanted to make sure that the living forensic medicine that we were doing had a name, so in the last few years the Association of Police Surgeons has become the Association of Forensic Physicians. The term physician in the UK refers to those people who are not surgeons. It’s slightly anomalous with me, because I happen to have trained as a surgeon. I have a fellowship with the Royal Colleges, but I no longer practice as a surgeon.

You wear a lot of hats, a forensic medical examiner with the London Police, a writer, a consultant, an expert witness….
Yes, but most of my work relates predominantly to the medical legal setting. For example, I will be called in to give opinions on death in custody, or sometimes I’ll be asked to give opinions on driving under the influence cases, etc.

Are you inspired by the fact that there are so many facets of forensic medicine?
People often say to me, “Do you regret giving up general surgery or being a surgeon?”. I can say no, when I was doing it I loved it, it was part of my life. My surgical background and training in things like the treatment of trauma, orthopedics and thoracic surgery all add on to what I developed further interests in. I think the problem that I, and so many people have in the forensic world, is trying to focus on what areas interest you most, because there are so many areas that are fascinating.

What is your hope for forensic medicine in the future?
I hope that a training program for forensic medicine, embracing all its facets will be developed in the UK. Perhaps it would last for about four or five years like residency programs or fellowship programs, whereby somebody can get involved and will be expected to do some training in the clinical aspects of forensic medicine. Perhaps working with the police, some aspects of autopsy work, forensic psychiatry, human rights, medical ethics, science and forensic toxicology, etc., and within each of those areas being able to move forward. If you want to be a forensic pathologist, then you focus on that. If you want to deal with the living aspects of forensic medicine, then you can move that way. I think the broader your base in the inter-related forensic aspects, the better.

What would a typical week be like for you?
I have a very odd career, to be honest (laughter). I suppose in an average week I would spend a couple of twelve hour sessions working as a forensic medical examiner for the Metropolitan Police in London. I may appear in court for a couple of expert witness cases. I will be liaising with police or solicitors or coroners about different cases and I still have a small gastroenterology practice which I do part-time. It’s partly due to my surgical and gastroenterology background that I am particular about time of death related to stomach contents. I am asked to give opinions on cases where time of death may be unknown or the police or investigators may want to collaborate certain things within the limitations. There are a lot of limitations of what you can do with stomach contents. I’m able to give opinions in those settings. Although I don’t do any forensic pathology, I may be asked to give an opinion on the stomach contents findings of a body that’s been found dead and issues relating to last meals and when they could have been eaten and when they have been alive.

That wouldn’t be considered forensic pathology?
Well, that is forensic gastroenterology…a new specialty (laughter).

Is there a great deal of new research going on right now in the field of forensic medicine?
Because we generally don’t use drugs that are manufactured by large pharmaceutical companies, like for example, cardiological drugs or gastroenterology drugs, there is really a shortage of funds for research in forensic medicine. The need to do research is in all areas. For example, timing wounds, seeing how the findings are after non-consensual sexual intercourse, determining the range of normality in issues of child abuse, what are true findings after a baby has been shaken aggressively. All of these are huge areas where there is a great deal of emotion and concern about the evidence base that we have in forensic and legal medicine. Gradually, I think that there is heightened awareness of the need for justice to properly be carried out, to make sure that the right people are convicted of crimes and the wrong people are not wrongly convicted. I think government and society generally has a duty to try to establish more research in all these fields, but we just don’t have the money. We don’t have the same financial support that you would when you’ve got large pharmaceutical companies doing research. You can’t compare it. I use the term, a Cinderella specialty. That applies throughout the world. I’ve published and written for many years on certain aspects of forensic medicine and areas of nutrition and gastroenterology, and it’s very important that the awareness of the need for research is increased. We need to establish a true evidence-base in the subject and when that is established we can see where the priorities for research are needed.

Are there other reasons for the shortage of funds for research in forensic medicine?
The problem with forensics is that you’re not curing people, you’re not curing cancer and things like that. But increasingly people are recognizing that issues of human rights, ethics, people’s liberty and how they are treated, and how people behave toward each other is becoming increasingly important. Certainly, with all the people who work in all aspects of forensic medicine, whether they are forensic toxicologists, forensic scientists, forensic pathologists, forensic physicians, there is a huge corpus of expertise throughout the world of people who want to collaborate, and do collaborate, and are keen to ensure that progress is made. The Encyclopedia of Forensic and Legal Medicine is one example of that. You’ve got a large number of people devoting a lot of time and effort in producing a major work.

How long have you been working on the Encyclopedia of Forensic and Legal Medicine?
I think we started in 2001. Originally I was approached by Elsevier after the publication of the Encyclopedia of Forensic Sciences. It was Nick Fallon, who is no longer with Elsevier, who approached me with the idea of an Encyclopedia of Forensic Medicine. I thought we should broaden it out so that it was accessible to not just medics, but to lawyers and all others who work in the field. I wanted to build on the work done by Jay Siegel, Pekka Saukko and Geoffrey Knupfer on the Encyclopedia of Forensic Sciences.

How were the contributors chosen?
The key was establishing the other three co-editors, who are Roger Byard, Tracey Corey and Carol Henderson. It was very important to have a representation from around the world in terms of people with established reputations. We have all worked together and knew each other from lecturing in places around the world. Whenever you do a project like this, and this is the biggest one so far, you want to have a group that can work together and you have no doubt about their skills and energy. The four of us had a number of meetings and gradually developed the content. We then created a larger editorial board that represented all specialties or disciplines and all geographical regions, but all of whom had established reputations in their respective fields. The invitations went out, and the support we received was enormous. From that point we gradually began to develop who the authors would be of particular topics. We depended on the support of Elsevier and their systems for developing major reference works, and having people like Mark Knowles to act and put things together. It’s absolutely essential to have someone who is able to relate to all the authors and editors. Every member of the editorial board was responsible for reviewing various manuscripts, criticizing and critiquing them, and asking for changes. That’s where the big time element comes in. There are also new subjects that come up while you’re actually working on a project. With a project like this, you’re constantly becoming aware of things that you have left out. One of the early things that I liked was the plan to continuously update the Encyclopedia when the online version comes out on ScienceDirect.

What do you think people will find fascinating or exceptional about this work?
It does represent the most up-to-date, relevant and best opinions in each of the subject headings. We tried to adopt the approach of a peer reviewed journal in this. Everything has been peer reviewed by more than one person and everything has been returned for assessment and re-writing. We hope that people recognize that it does embrace more aspects of work related to forensic medicine in a single publication. I hope it provides all the information anyone working within a department would need. Each entry stands on its own as a comprehensive review. The idea is to give a good overview and to direct people where to go elsewhere if they need to.

Do you expect this work to have a wide audience?
It is written for a broad audience. It doesn’t diminish the level at which it’s written. We intended for it to be accessible to attorneys who deal in child and family issues, or who deal in sexual assault, etc., and it will provide a source of information to doctors who don’t encounter certain things frequently. Journalists can benefit from it. I think it’s fair to say, virtually every day there will be at least one story in almost any daily paper that will have some forensic, medical or legal significance. For example, stories regarding the instance of drug misuse, stabbings, gangs, sexual assault, bad doctors or organ donation. Journalists need more information on this subject. We hope that people will look at the Encyclopedia as something that has been written by experts for an expert audience but in a way that is accessible to those who don’t have medical training.

Where do you see yourself in ten years?
On a large boat somewhere in the Southern Ocean.

That sounds great. Do you think in ten years you’ll still be practicing forensic medicine?
Yes, it’s very difficult to get forensic doctors to retire.

I understand, because it’s just so interesting, and you want to keep learning.
Yes, that’s it. I also think that even if you are physically not up to rushing around all the time, there are always a lot of mental challenges. In England, I would like to see more academic units of forensic and legal medicine, and I think in ten years time I would like to see that forensic and legal medicine would embrace all its aspects and is recognized as a really important specialty socially and medically.

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