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EDITORIALS: David P H Jones and Margaret A Lynch Diagnosing and responding to serious child abuse BMJ 1998; 317: 484-485 [Full text]

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re: Confronting Deceit and Denial

Brian Morgan   (24 September 1998)

re: Confronting Deceit and Denial 24 September 1998
Brian Morgan, Freelance Journalist Cardiff Send response to journal: Re: re: Confronting Deceit and Denial	Jones and Lynch [1] have made mistaken claims, purportedly drawn from the epidemiological study of McClure et al [2] by failing to notice that the study collected data from 'Munchausen syndrome by proxy (MSBP), non-accidental poisoning and non accidental suffocation', not just MSBP. They say: 'In an epidemiological study in the United Kingdom McClure et al identified 128 cases' of 'factitious illness by proxy'. This is untrue - the actual figure for MSBP was 97. 128 is the global figure. They say '8 children died' from MSBP - again this is a global figure and closer reading of the study shows these cannot all have been from MSBP, in fact only one of them 'may' have been. Elsewhere in the report, the necessary condition for confirmation of a diagnosis of MSBP is given - namely the convening of a first case conference for suspected abuse. For a child to have died from MSBP and to have been recorded in this study this must either have been following referral and registration at a case conference or have been the sibling of a child thus registered for the first time. I put it to one of the authors of the epidemiology study that there could not have been as many as 8 deaths from MSBP reported to the researchers during the study period, and he confirmed that only one of the 8 deaths 'may' have been the result of MSBP abuse [3]. The author drew my attention to the two cases of carbon monoxide poisoning, in table 1 of McClure et al. These two poisonings resulted in the deaths of 2 children in a motor car in conjunction with the suicide of their father; hardly cases of MSBP. Of course absence of evidence of MSBP mortality is not evidence of absence of mortality. Finding only one possible MSBP death over a two year period will not persuade expert MSBP 'finders' to modify their opinion as the extreme dangerousness of the abuse, however, readers might reflect that if the mortality rate is around 15% in index cases plus siblings as some claim, then the authors of the epidemiology study might reasonably have come across around 15 deaths attributable to MSBP rather than just a possible one. The mortality from MSBP abuse may not be as great as some would have us believe. References 1 Jones DPH., Lynch MA. Confronting Deceit and Denial. BMJ 1998;317:484-485 ( 22 August ) 2 McClure RJ, Davis PM, Meadow SR, Sibert JR. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child 1996; 75: 57-61 3 Davis PM. Personal communication 1996