Scientific information in public health trials.
The Mediator case

This project, which I have been carrying out in collaboration with Dr Isabelle Drouet and Prof Anouk Barberousse, lies at the intersection of my interests in judges' evidential reasoning on the one hand, and in the role and status of scientific expertise for informing decision-making on the other hand.

The Mediator case originates in a resounding scandal in France, whereby a pharmaceutical firm (Les Laboratoires Servier) was accused of having intentionally lied to both the public (doctors and patients) and the French health authorities, so as to keep on the market nearly 40 years a drug that they allegedly knew to be toxic (and largely inefficient in its indication against diabetes). The scandal gave rise to a gigantic criminal trial, whose appeal phase has recently been closed by an extremely severe sentence against the firm (20 December 2023).

The facts reproached to the firm essentially consisted of a series of lies and concealments concerning the nature and properties of the benfluorex molecule, the active ingredient in the Mediator drug. To decide whether the firm is guilty, the judges must, therefore, decide not only on the actual effects on the compound but also on what the various actors of the long history of Mediator could have known or guessed at different times. But how do judges who receive no specific training apprehend scientific issues that are often complex and (partially) unresolved? How do they assess the conflicting answers given by different experts, and how do they link them to their legal reasoning, to finally forge their own convictions? When media pressure is strong and the suffering of victims is on everyone’s mind, how are scientific evidence and arguments received and used in the legal arena? What is the place and value of scientific evidence, in comparison with other types of evidence and testimony? How, in brief, can science inform legal decisions?

These are the questions that motivated our long-term investigation into this case, which has involved consulting the gigantic legal file (including the first instance hearing minutes and written judgement), examining the scientific literature, conducting numerous interviews, and, lastly, our daily presence at the Court of Appeal throughout the six-month hearing. This ‘immersive’, fascinating study of a real case in all its richness and complexity enabled us to shed light on a great number of issues raised by the use and communication and scientific information in the legal context - and beyond, by how science can inform decisions.

A monograph drawn from this inquiry will be published by the Presses universitaires de France.

We have presented - and will present - some of the insights we got from this case study in several talks in Cambridge HPS Department (March 2023, ‘The relevance of scientific questions (and answers) for decision-making. The Mediator trial in France), at the European Philosophy of Science Association in Belgrade (September 2023, ‘Penalising opacity about pharmaceutical risks. The example of the Mediator drug trial’ - this talk was part of a symposium I co-organised with Dr Isabelle Drouet on Transparency in pharmaceutical research), Lyon (‘Which role for scientific evidence in public health trials? The example of the Mediator, October 2023), Louvain (forthcoming, ‘Science in court. Reflections on the Mediator case’, March 2024).

A paper under review making a case for the importance of relevance in providing expert reports was also inspired by this case ("About the relevance of experts' reports", with Anouk Barberousse, preprint in French and extended synopsis in English here).