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NEWS: Owen Dyer Meadow faces GMC over evidence given in child death cases BMJ 2004; 328: 9 [Full text]

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Who should give statistical advice?

Graham B Byrnes   (2 January 2004)

The Royal Statistical Society is wrong then?

Penny Mellor   (2 January 2004)

We've been here before

Kiaran Asthana   (2 January 2004)

Re: We've been here before

Penny Mellor   (3 January 2004)

Relevance of prone positioning and mattresses in SIDS.

Richard G Fiddian-Green   (3 January 2004)

Re: We've been here before

Jenny L Robertson   (4 January 2004)

Re: We've been here before

Michael D Innis   (4 January 2004)

The madness of MSBP

Neil Elliot   (4 January 2004)

Every day's news

Wiliam G Pickering   (5 January 2004)

Re: We've been here before

CA Johnson   (5 January 2004)

We've been here before; postscript

Kiaran Asthana   (6 January 2004)

www.sallyclark.org.uk

Jay Ilangaratne   (7 January 2004)

Let him who is without sin throw the first stone

Terence Ford   (8 January 2004)

Yes we have been here before!. Too many times.

Charles Pragnell   (8 January 2004)

Little errors can lead to massive injustices

Lisa C Blakemore-Brown   (8 January 2004)

Is This CORRECT?

Jay Ilangaratne   (9 January 2004)

Stoning sinners

Mark Struthers   (12 January 2004)

Sinning and getting stoned

Mark Struthers   (13 January 2004)

Re: Let him who is without sin throw the first stone

CA Johnson   (15 January 2004)

'Meadows' Law' is wrong

Dr Glynwr Walters   (18 January 2004)

What positives can come out of this ?

Terrence Ford   (20 January 2004)

Carry on Sinning

Mark Struthers   (21 January 2004)

Atoning sin

Mark Struthers   (21 January 2004)

Re: What positives can come out of this ?

CA Johnson   (23 January 2004)

Re: We've been here before; postscript

Davina Hollisey-Mclean   (24 January 2004)

An olive branch?

Davina Hollisey-Mclean   (26 January 2004)

Who should give statistical advice? 2 January 2004
Graham B Byrnes, Research Fellow Centre for Genetic Epidemiology, University of Melbourne VIC 3010 Australia Send response to journal: Re: Who should give statistical advice?	I do not wish to comment on the many issues in this case. However one point seems outstanding: Professor Meadows gave statistical advice to the court, reporting the risk of two cot-deaths being one in 73 million. This is actually a first-year student error. The appropriate probability to provide is the probabilty that the two deaths were both cot -deaths, given that both deaths had occured. Unconditional probabilities are extremely misleading: while it is highly unlikely that any given individual will win the lottery, we do not conclude that anyone who does must have cheated. My concern is not Professor Meadow's understanding of statistics, but the court's willingness to accept statistical advice from a clinician. I doubt that my PhD in mathematics would encourage a jury to consider me an expert witness in pediatric medicine. Yet a pediatrician's amateur understanding of statistics was considered persuasive enough to bring a conviction. Yours sincerely, Graham Byrnes Competing interests: None declared
The Royal Statistical Society is wrong then? 2 January 2004
Penny Mellor, Advocate h Home WV9 5HX Send response to journal: Re: The Royal Statistical Society is wrong then?	Being a mere mother and housewife and "self appointed child welfare campaigner" I can't comment from a professional standpoint on the reliability of the statistical evidence presented by "Roy". Is Professor Craft now saying that 2 deaths from infection in one family is a 73 million to 1 chance? Can he support this with statistical evidence? Professor Craft states that "Roy gave the right answer to the wrong question," let's just take that as a truism, if "Roy" has been giving the right answers to the wrong questions as an expert in both the family and criminal division, then we can assume that other cases are flawed! Actually I'm beginning to get confused!!! Why am I bothering to pursue this, all you ever get is the runaround, because no paediatrican in this country ever gets it wrong, it's always somebody elses fault, as in the Crown didn't make themselves clear!!!! Is it any wonder the paediatric world is under such intense scrutiny and they want the public's trust HAH! Please don't think for one moment that this is the only complaint going to PCC at the GMC because it isn't and just as the media have been accused of latching onto this statistic and making much out of it, so are the medical profession by using it as a smoke screen to mask far more serious issues currently being investigated. Competing interests: Campaigner against false allegations of MSbP
We've been here before 2 January 2004
Kiaran Asthana, General Practice Lakeside Medical Centre,Church Rd, Perton, wolverhampton WV6 7PD Send response to journal: Re: We've been here before	Most of us will remember the allegations of widespread child abuse in the Cleveland area, and the response that followed. The paediatricians concerned were pilloried in the courts and in the press. Their careers never recovered. Social work evidence, central to the allegations, was disallowed, and the processes of law and justice unhinged to give the public the story they wanted. The children were returned to their parents, often to face years of further abuse. It's happening again. We know that proxy Munchausens' exists. Mothers admit to it, survivors testify to it and Prof.Southall has even videod' it. Yet a conviction quashed on the basis of withheld evidence becomes a proof of innocence, and a postulated "cot death gene" becomes accepted fact. And those who presume to doubt the sanctity of motherhood court professional ruin. We seem unable as a society to face bad news. If we don't like what we hear, then we shout and demand until we get the news we want, preferably with a professional scapegoat attached. It's a childish response, and in a populist climate an entirely predictable one. Unlike their counterparts in Cleveland, the victims of infanticide will never tell their own story. Who will do it for them? And how will we learn? Competing interests: None declared
Re: We've been here before 3 January 2004
Penny Mellor, Advocate Home WV9 5HX Send response to journal: Re: Re: We've been here before	"Munchausen exists we know it does because mothers have admitted to it" Afer being told if they admit they can have their children back and if they don't admit they will never see their children again. Fact, I have taped evidence that this is what has happened. Some choice. It is not an unknown phenomena for people to confess to something they didn't do out of fear of something worse happening to them and in fact is well recognised in the psycho-analytical world. "Southall video'd it" Ah perhaps the author should contact Professor Colin Morley a neonatologist now working in Australia ,(colin.morley@rwh.org.au) who, probably unlike the author, has reviewed the CVS tapes and states that he didn't see child abuse at all in a considerable number of the cases. Oh and the little matter that Southall is up before the PCC on 8 cases so far, for allegedly making false allegations of child abuse. With further complaints made by the CNEP parents still to be considered. (http://www.thesentinel.co.uk/displayNode.jsp?nodeId=67725&command=displayContent&sourceNode=67252&contentPK=8240521) I have also taken the liberty of sending Sally Clark's legal team a copy of this response, given that the author is implying guilt in her case. As to genetics, is the author a geneticist? Perhaps Professors Patton and Drucker might want to respond to this GP, who would seem to know more about these cases than they do, having been involved. And YES we have seen all this before, whacky unscientific theories passed off as facts and children wrongfully removed. Point is YOU the medical profession, learnt nothing, protecting children isn't about furthering an over popularised label, it's about gathering evidence, concrete medcine based evidence. Not "the mother was on her own when the baby died therefore she killed it!" How scientific is that! Nobody wants any child to die at the hands of a parent or carer, but I personally will not stand by and watch entire families ripped apart on a theory, with no supporting evidence other than anecdotal stories from the MSbP accolytes. The man that "discovered" this syndrome, "Roy" is unable to provide any of the data on which he alleges he can prove it exists, because it's all shredded...........conveniently. Where else in medicine could this happen, a condition in the medical literature that can't be peer reviewed and amounts to nothing more than "me too" stories, is accepted as a medical?/psychiatric? condition? One final point, the author lives just down the road from me, if they would like to come and review the evidence, that evidence being reports from some of the world's leading geneticists, paediatric pathologists, microbiologists etc relating to these high profile cases, instead of forming an opinion based on media coverage, they are more than welcome. Competing interests: Campaigner against false allegations MSbP
Relevance of prone positioning and mattresses in SIDS. 3 January 2004
Richard G Fiddian-Green, None None Send response to journal: Re: Relevance of prone positioning and mattresses in SIDS.	It has been proposed that SIDS might be the the product of an impairment of mitochondrial oxidative phosphorylation, be it inherited or acquired in utero, during or after parturition (1). If so muscle weakness is likely to be an early manifestation judging from the known effects of inherited disorders of mitochondrial dysfunction. In which case babies with this putative defect might have an impaired ability to adjust their position effectively if they were to experience any respiratory obstruction from their mattress or bedclothes when placed prone especially if they had been placed on a soft rather than a hard mattress. 1. K M Sheehan, M McDonnell, E M Doyle, T Matthews, and D M Devaney The quality and value of sudden infant death necropsy reporting in Ireland J Clin Pathol 2003; 56: 753-757 (Electronic correspondence). Competing interests: None declared
Re: We've been here before 4 January 2004
Jenny L Robertson, journalist SW15 5DP Send response to journal: Re: Re: We've been here before	We have indeed been here before - the latest Munchausen abomination has a great many similarities with the Cleveland witch-hunt. Most people will remember the Cleveland debacle as being a tragedy for innocent children and their families rather than a tragedy for paediatricians whose "careers have never recovered." No doubt some of the wrongly accused family members in the Cleveland witch-hunt have not fully recovered either. An atmosphere of hysteria pervaded in the Cleveland cases. Scientific rigour and objectivity were thrown to the wind, exaggerated theories ran out of control and the ducking-stool came back as a form of justice. Good grief - this could be an exact description of the latest Munchausen fiasco. How many of the children returned to their parents following the Cleveland witch-hunt were subsequently proven to have been further abused? I think the author should provide us with this information, as it is obviously highly relevant. No-one disputes that parents occasionally harm their children. But that does not justify false accusations. With regards to the Munchausen disaster, we are not just talking about one conviction quashed but a total of three - so far. I would suggest that, rather than giving the public the story that it wants, these appalling miscarriages of justice give the public the story that the medical profession would rather it did not have. Not quite the same thing. Competing interests: None declared
Re: We've been here before 4 January 2004
Michael D Innis, Director Medisets International Home 4575 Send response to journal: Re: Re: We've been here before	Editor, Kiaran Astana comments, “Unlike their counterparts in Cleveland, the victims of infanticide will never tell their own story. Who will do it for them? And how will we learn? How will we learn? By listening carefully to what the parents or carers say and not automatically assuming that any bruise they cannot explain is due to “non-accidental injury” and by an intelligent investigation of all the circumstances of the case. That is how we will learn. Profound ignorance of the pathophysiology of certain disorders is the basis of, not only the deaths of children, but also of the incarceration of their carers. This ignorance is now manifest in the GMC whose charge of professional misconduct of Dr Paterson for drawing the attention of the Medical Profession to the hitherto unrecognised condition of Temporary Brittle Bone Disease (Osteopenia of Prematurity or Rickets of Prematurity) is a measure of the extent of that ignorance. It was just such a lesion on the 2nd rib of the infant Harry that was attributed to “inflicted injury at some time in the past ----“ by one witness in the trial of Sally Clarke that no doubt assisted in her being found guilty. Radiologists are particularly guilty of attributing rib calluses to inflicted injury. They ignore Dr Paterson’s outstanding contributions to the subject and pay no attention to the associated biochemical and haematological evidence when it is available. I would encourage Penny Mellor to maintain her rage against the incompetence and ignorance or some in the Medical Profession, including those in the GMC, until the law is changed to prevent miscarriages of Justice – rife in the UK, USA and Australia. Michael Innis Competing interests: Advised some accused
The madness of MSBP 4 January 2004
Neil Elliot, member of public n/a Send response to journal: Re: The madness of MSBP	Much is written and spoken of MSBP. Sides are chosen, trenches are dug and shots exchanged. The Madness is that right in the middle of all this is the families of those falsely accused who suffer the most, the children. Nowhere and I repeat nowhere, have I ever seen anyone deny that child abuse exists. Even those who oppose the use of MSBP as a "diagnosis", know that abuse exists and they will fight to halt any abuse. Why do some in the medical profession feel they need to label a mother "Munched" when there already exists the term "child abuse". So let's call a spade a spade and not a shovel or garden impliment for the transportation of soil. Stand up say this is child abuse and here is my evidence. As for Sir Roy Meadows looking forward to his day at the GMC, I doubt it , although given the GMC's previous track record, it's probably where he'll be given the most sympathy for his position. He has been given many opportunities to defend his position in public. He has chosen to remain silent under advisement. One thing that has always puzzled me about the shredding of Sir Roy's paperwork, is quite simply WHY? Why would you destroy things that represent a hugh piece of your lifes work and indeed professional reputation? " Roy gave the right answer to the wrong question." What's this supposed to mean? More double talk and gobbledy gook. So to me this mean he was right about 73 million to 1, I don't seriously think so and the courts don't either now. Kiaran Asthana states that "The children were returned to their parents, often to face years of further abuse." I would like him to direct me to where the evidence for this is. Also contained within this is the use of the word "often", by this I take it he believes that not all were abused. If so, I wonder if he would be so vocal in his defense if he were one of those falsely accused. Mr Morton states "Dear Kiaran You are a brave man. Truth is a stranger on these shores and those who dare speak its name risk personal abuse, a torrent of accusations in the rapid response columns, and, something nasty pushed through the letter box. Best wishes Ferdinand" A strange response from a retired pianist. I would merely like to say that abuse of a personal nature is a two way street and the supporters of MSBP have dished out there fair share. Truth may be a stranger, but to whose lips. As for Mrs Mellor, I don't agree to all she says, but I'm sure we can all agree that a full and independent inquiry into all that has gone on is required to sort out , what is a very messy and emotive subject. I would rather that I had not been dragged into this subject, but I have and it has fundementaly changed my life. So in parting, let's cut through the crap and have the inquiry, where everyone can lay down there evidence and even Sir Roy can have his say. Competing interests: if looking for the truth is a competing interest, then I've got it.
Every day's news 5 January 2004
Wiliam G Pickering, Medical practitioner 7 Moor Place, Gosforth, Newcastle upon Tyne, NE3 4AL Send response to journal: Re: Every day's news	Date: 4.1.04 Rapid respose to Dyer O. Meadow faces GMC over evidence given in child death cases. BMJ 2004 328:9 Every day's news. Those interested in medical debacles will have found in this week's BMJ many ingredients familiar to them from past serial clinical disasters. It is true that children and adults, and surgery, medicine, general practice or paediatrics differ, in their own way. Yet the themes and mechanisms of disasters are so often the same, and so often recurrent. As a famous Duke might have put it "The news is old enough, yet it is every day's news" (Ref 1). The Editor titles his editorial 'A tough time for paediatricians' (Ref 2), which probably mirrors pretty accurately what some of them want to hear. Perhaps it is a tough time too for Editors of medical journals. They must somehow respond to repeated medical mishaps reported in the public press. 'More medically inspired heartaches for parents' would be no way to start a piece to be read primarily by doctors — not if the editors wish to stay in employment. Oddly enough, progression in clinical medicine requires similar diplomatic compliance to blinkered medico-politicians — one reason, as it happens, for serial medical disasters. The News correspondent gives a clear report (Ref 3). Craft, we learn, the president of the Royal College of Paediatrics and Child Health, is 'glad' that Meadow, a former president of this august body, can give evidence to the GMC. Craft thinks Meadow 'gave the right answer to the wrong question'. Did Dr Williams do this too? It is easily done and we must have sympathy. Even patients and parents may do it sometimes, resulting perhaps (and not infrequently it seems) in sundry horrors, including imprisonment. Another recent BMJ editorial, by a paediatrician (Ref 4), and not irrelevant to the Cannings case, managed to avoid mentioning the Cleveland affair (Ref 5). It would seem that each new medical disaster, whether brought to legal attention or not, is seen by some as exceptional and different from the rest. They never are though, and they are never as complicated as some would have us believe. Importantly, they are invariably augured by previous incidents, some with a very high profile indeed. The ignoring of these helps facilitate fresh medical disasters of all varieties. Acting purposefully, ie. with certain medical sensibilities relegated to secondary importance, on the lessons of even one disaster is an idea hitherto untried. (Ref 5). One question many may like an answer to is why did the GMC reel in Meadow when they did? After all, they hadn't blinked after previous cases in which he had officiated. Why now? Days of howling tabloids may have had their effect. Public opinion and the press have once again it seems brought the tardy profession and its alleged regulators to account. Which, as the Duke said, is 'news old enough'. Author: Dr William G. Pickering. MB.BS. MRCP. MRCGP. DCH. DRCOG. AFOM. MSC Date 4.1.04. Ref 1. Shakespeare. Measure for Measure. III.ii.219. Ref 2. Smith R. A tough time for paediatricians. Editor's choice. BMJ 2004;328 3 Jan. Ref 3. Dyer O. Meadow faces GMC over evidence given in child death cases. BMJ 2004 328:9 Ref 4. Hey E. Suspected child abuse: the potential for justice to miscarry. BMJ 2003; 327: 299-300 (9 August). Ref 5 Pickering W.G. Systematic clinical accountabi Competing interests: None declared
Re: We've been here before 5 January 2004
CA Johnson, Parent LA9 Send response to journal: Re: Re: We've been here before	Kiaran Asthana, We have indeed been here before; but as others point out, more often than you might think. Contributors have stressed the need for scientific rigour behind theories, in place of the inadequate belief systems behind the false accusations we see. I wonder, do you believe a paediatrician can diagnose MSbP by merely failing to see an alternative at the time? Do you believe he can diagnose sexual abuse if, when examined, a child's anus does not conform to the paediatrician-ordained diameter he requires? Do you believe he can diagnose a curse if, when pricked, a woman's skin does not bleed to the satisfaction of he who wields the pin? You see, aside from the advancement of its proponents, a flawed theory is help to none save the rare felon whose crime by being flawed it can not prove. If as you claim some of the Cleveland children were abused by their parents, it is as much down to the paediatricians' failure to use an adequate diagnostic method for all that they continued to suffer. When one fails to separate the wheat from the chaff, the wheat may still suffer even at the chaff's expense. If one or two wise women and cunning men use their knowledge of nature to do harm, that does not reveal an epidemic of witches cursing crops, men and beasts to sickening and to death. If a violent man batters his baby, that is not evidence that every baby with similar head trauma has been struck or shaken to injury or to death. And if an inadequate or greedy mother fakes her child's illness for excitement or to coin in donations from wellwishers, that is not evidence that children presenting with difficult symptoms comprise an epidemic of mothers with the emotional maturity of three-year-olds. The witchfinders named a cause for the tide of malice they perceived: Satan active in the world. What do the paediatric hawks think is behind all the otherwise normal mothers and fathers who seem prone to dreadful violence or deceit where their children are concerned? Had the witch experts known to test the dead for toxins, or merely checked the accused's pantry for crushed laburnum or foxglove, they might have identified a rare felon with ill intent. But the former was beyond them and the latter was beneath them, so in their respective ignorance and arrogance they condemned countless wart or mole-afflicted innocents for any smooth-skinned posioner they left free to act. We need scientific discipline, not superstition. Perhaps it should not surprise us that the false accusers, now feeling the heat, retaliate with yet more false accusations against those they condemned. Cries of intimidation were the witchfinders' defence; they too cast themselves as courageous professionals braving the malicious in a noble cause. Babies still die from rare conditions, rare reactions to vaccines and medications, and (surprise!) from the unkown. Paediatric careers that could have been spent researching the prevention of such deaths are wasted in destroying the bereaved families instead. While we look at past madnesses with despair and contempt, we should realise that a future generation will look upon our present tragic scandal with similar eyes. We must hope that they will do what we have not; that is, not merely remember history, but learn from it. Competing interests: None declared
We've been here before; postscript 6 January 2004
Kiaran Asthana, GP Lakeside Medical Centre,Church Rd, Perton, wolverhampton WV6 7PD Send response to journal: Re: We've been here before; postscript	Thank you all for responding to my posting. I'm sorry that it caused so much anger. Penny Mellor; it was never my intention to imply guilt to any individual, and I apologise for leaving you with that impression. I fully accept and agree with all the court rulings. It's the way that we use words and conduct arguments that worries me. And yes, if you have some information that you feel I should see, please let me know. I may have a view, but I'm prepared to change it. And I'd rather speak up and be told I'm wrong than sit quiet and believe I'm right. Neal Elliott, let's have the enquiry with, CA Johnson, the scientific discipline. I don't know the truth behind the pMch argument, but a rational debate based on observed evidence will seem to be the way to find it. My suspicion is that the truth lies somewhere in between the polar opposites that dominate the argument. My real concern is the way in which rhetoric can take over an argument. This happened in Cleveland, and there are survivors to bear witness(see the Ch4 Dispatches documentary). Please don't let it happen again. Competing interests: None declared
www.sallyclark.org.uk 7 January 2004
Jay Ilangaratne, Founder Medical-Journals.com Send response to journal: Re: www.sallyclark.org.uk	"What Peter Fleming, the author of the article in which Roy Meadow found the 73-million-to-one figure says: Peter Fleming, professor of child health at Bristol University: 'This statistic was never intended as an estimate of real risk. It was never meant to suggest that this was an unnatural occurrence. This statistic is of no relevance to a jury trying to understand whether babies had died naturally or unnaturally. It was used completely out of context and so, without explaining how it was arrived at, it is potentially misleading and dangerous.'"---the above is from the website,www.sallyclark.org.uk The 'clark website' gives a good idea of the workings of the English judiciary. I wonder whether anyone would be kind enough to identify the first-instance trial Judge and the corresponding counsel who led the prosecution's case, in the trials of Sally Clark,Trupti Patel,and Angela Cannings.Thank you in advance. Competing interests: None declared
Let him who is without sin throw the first stone 8 January 2004
Terence Ford, Consultant paediatric emergency physician Canada Send response to journal: Re: Let him who is without sin throw the first stone	"To a hammer, everything looks like a nail." Prof. Meadow made his name with MbP work, and therefore was, not unreasonably, asked for his opinion on many cases. Maybe this is the danger of expertise, as cited by David Sackett. I know it is bloody difficult to spot child abuse. While it may be amusing to read the the wailings of those with too much time on their hands, whose monochrome world must be comforting to live in, this is one of our professional colleagues who we are allowing this to happen to. I want to support him, not necessarily because I believe he is right, but because he has courage to stand up for his beliefs, which have been shown to have a good basis in many cases. While the BMJ should report news dispassionately, it has also a duty to defend key members of our profession who are smeared by the tabloids. If Meadow does a David Kelly, who among the British medical establishment will be able to hold their head up? To the hysterical Sally Lewis camp- if you want to play doctors, go to medical school. Life is dirty, nasty, and for some unfortunate babies, short. Competing interests: None declared
Yes we have been here before!. Too many times. 8 January 2004
Charles Pragnell, Expert Defence Witness - Child Protection and Child/Family Advocate Victoria - Australia Send response to journal: Re: Yes we have been here before!. Too many times.	Your correspondent, Kiaran Asthana, seems to have been seriously misinformed regarding events and occurrences in Cleveland in 1987. The infamy of Cleveland was that it involved the misuses and abuses of power by child protection agencies. (See Butler-Sloss Report – 1998). Between January and June of that year, 121 children were removed from their homes, many in midnight and dawn raids reminiscent of oppressive regimes, following allegations of sexual abuse based solely on an unproven medical theory and often without social work investigations and assessments. Matters were brought to a head by the withdrawal of cooperation in child protection investigations by the police, who were concerned regarding the validity of the allegations that the children had been abused. The cases of 96 of the children were dismissed by the Courts and there is no valid evidence that they had been abused prior to their removal, nor in the three years succeeding their return to their homes. Two of the accused men, with charges unproven against them, took their own lives. The children suffered immense trauma from the investigations and many were left with severe and long-lasting emotional harm. Videos of social worker interviews with the children show that leading questions, threats, and bribery were used to try extract information from the children and despite the social work mantra at the time of “Always believe the child”, the children’s statements that they had not been abused, were ignored and the questioning persisted. The paediatricians involved continued to practice in paediatrics. Munchausen Syndrome By Proxy, or Fabricated or Induced Illness in Children as it was euphemistically re-termed by the Department of Health (now DFES), does not exist. There is no scientifically-based research subjected to independent review nor replicated findings to support its existence. There has been no verification nor validation of its existence by any national body responsible for medical or social work theories. There exists only a belief system based on conjectures, speculations, assertions, and suppositions. There is no universally agreed definition of FII and its multi-titled variants, nor any common tests used for its recognition and identification. If such tests do exist, perhaps Kiaran Asthana can provide the sensitivity, specificity and predictive value of such diagnostic tests?. FII/MSBP seems to have attained a cult following in certain quarters of the medical and social work professions and it is quite remarkable that otherwise intelligent people can suspend their faculties for critical analysis and rational thought, and adopt and apply such a label with no scientific basis and questionable original suppositions and clearly flawed subsequent literature. A very similar situation to that which led to the Cleveland Child Abuse Scandal and the other situations in the Orkneys, Nottingham, and Rochdale involving allegations of Satanic Ritual Child Abuse. Just as a mythology has been created to try to exonerate events in Cleveland and which has influenced Kiaran Asthana, so a mythology has been developed around MSBP/FII. Conversely to what Kiaran Asthana claims, our society is well able “to face bad news”. National and local newspapers and television carry little else every day. What our society can no longer tolerate is a deeply flawed, erratic, and dysfunctional child protection system which draws in many thousands of children and their families every year following false allegations (No substantive basis) and leaves them seriously harmed by the unnecessary intrusion into their lives but without redress or even an apology. And on the other hand, a system which makes serious errors and misjudgements which lead to serious harm and even the deaths of other children. Yes Kiaran Asthana, we have been here before. Too many times and leaving too many children damaged and dead because of a grossly incompetent and erratic child protection system. A Public Inquiry into the workings of the U.K. Child Protection system is long overdue. The government's current Green Paper does nothing to correct the faults and flaws in the present system and merely gives greater powers and resources to a dysfunctional system proven many times over the last thirty years which has constantly given assurances that "lessons have been learned" and the will "improve and change the procedures", but remain dysfunctional and punitive to the innocents. Competing interests: Principal Officer -Research and Statistics Cleveland Social Services 1985 -1990.
Little errors can lead to massive injustices 8 January 2004
Lisa C Blakemore-Brown, Psychologist UK Send response to journal: Re: Little errors can lead to massive injustices	Getting a name wrong - as in Lewis instead of Clark - is easily done when you don't check your facts. Such an error is unlikely to cause much harm in the context of Rapid Responses. However, in Court, simple errors occurring for exactly the same reason, combined with a desire to agree with a professional because he stands up for what he believes in, without even knowing much about it at all, easily lead to gross miscarriages of justice and the possibility of children and their families suffering forever as a result. Simple errors and blind faith in influential people and their theories also lead Judges and Juries - and paediatricians - up wrong paths - and in doing so the real reasons for child death or illness are much more likely to be completely disregarded. Competing interests: None declared
Is This CORRECT? 9 January 2004
Jay Ilangaratne, Founder Medical-Journals.com Send response to journal: Re: Is This CORRECT?	In continuing his unstinting support to Prof Meadow, Prof Alan Craft is quoted as saying(1),"He only ever said that once. It has been used in every subsequent court case to get people released.The important thing now is that we move on from him." [that=1 in 73 million chance] (i)Based on Prof Craft's assertion,is it not right that neither in the case of Trupti Patel nor Anegla Cannings,the 1 in 73 million figure was advanced as evidence either by Prof Meadow or the prosecution's counsel? (ii)As to "It has been used in every subsequent court case to get people released", I would appreciate if someone could enlighten us with real evidence given Prof Craft's revelation,in particular,that it has been used in *every subsequent court case*. References (1) Hospital Doctor,8 January 2004 www.hospital- doctor.net/hd_news/hd_news_article.asp?ID=13884&Section=News [accessed 8 January 2004] Competing interests: Trying to ascertain the truth
Stoning sinners 12 January 2004
Mark Struthers, GP HMP Bedford Send response to journal: Re: Stoning sinners	The person by far the most likely to kill you is yourself. Jock Young, British criminologist, 1994. It is not known who lodged the complaint against Professor Meadow. Sir Roy will not provide comment on the GMC case against him, reports Owen Dyer for the BMJ. However, Professor Craft is glad the case will come before the GMC and he is sure that Sir Roy will be too. After all, “it will be his first chance to publicly answer the criticisms that have been levelled against him.” Alan Craft has been president of the Royal College of Paediatrics and Child Health for only a short time. He cannot have been aware that Sir Roy has already answered those criticisms and in a very public way. Professor Craft will be pleased to learn that just two years ago Sir Roy wrote a personal treatise, ‘a case of murder and the BMJ’. To this day, his stout defence can be read on the World Wide Web at the BMJ. In the autumn, will the GMC provide the same level of worldwide publicity as the BMJ, I wonder? Sir Roy has already redressed the balance and answered the criticisms levelled at him from his critics and the mad, the bad, and the misinformed. At the GMC, Sir Roy will continue to fight his corner. Some doctors will continue to support him, not because they believe he was right but because be has the courage to stand up for his beliefs. In today’s nasty, dirty world, it is inevitable that, despite the appeal judges finding that he gave ‘grossly misleading’ evidence, the GMC will treat him with respect. The case will consume considerable resources. Competing interests: None declared
Sinning and getting stoned 13 January 2004
Mark Struthers, GP HMP Bedford Send response to journal: Re: Sinning and getting stoned	“All sin tends to be addictive, and the terminal point of addiction is what is called damnation.” W. H. Auden Paediatrics is in a hole. Why then do paediatricians dig it deeper? Your transatlantic drivel was as astonishing as it was offensive Dr Terence Ford. I was not at all amused or comforted to read your wretched little wailings or learn of the nasty, dirty and monochromatic world in which you live. I find it still less funny to imagine you a professional colleague; your arrogance takes my breath away. Do you have an imagination Dr Ford? Imagine, if you can, the sudden loss of two infant children of your own. Imagine the police and then the trial and then your wife being jailed for smothering them. Then how hysterical would you be? Just imagine! You would support Sir Roy of course, not necessarily because you believe he’s right, but because he has the courage to stand up for his belief that your wife is a murderer. Despite the success of her appeal, you may still believe that Sally Clark is guilty. However, “which is worse, missing one (a smothered baby) or finding someone guilty who is in fact innocent” [1]. Dr Harvey Marcovitch doesn’t know. He’s an eminent paediatrician on this side of the Atlantic and editor of ‘Archives of Disease in Childhood’. You are not alone Dr Ford; Dr Marcovitch finds it bloody difficult to spot child abuse as well. Paediatricians are having a tough time we are told [2]. If paediatrics wants to avoid a hammering, then paediatricians will have to stop digging holes. [1] Jeremy Laurance. ‘Doctors warn cot death verdict could alter legal climate’ The Independent Friday 13 June 2003. (Text included this quotation and the story of a case of attempted infant murder that was missed by Dr Harvey Marcovitch.) [2] Richard Smith. Editors Choice ‘A tough time for paediatricians’ 3 January 2004 Significant for acknowledging that the murder of an infant by its mother might not be best dealt with by the courts. Competing interests: None declared
Re: Let him who is without sin throw the first stone 15 January 2004
CA Johnson, Parent LA9 Send response to journal: Re: Re: Let him who is without sin throw the first stone	Terence Ford writes, "I know it is bloody difficult to spot child abuse." A few medical professionals seem to find it easy. If a radiologist can diagnose abuse simply by looking at an X-ray, why bother with the more difficult, time-consuming process of testing for natural abnormalities which may have caused the injuries observed? If a paediatrician can diagnose smothering of a baby he has not examined and a murderous personality disorder in a mother he has never met, why bother with the extensive family research and genetic testing which may show a real cause of death? Rather it is professionals such as these who live in a "monochrome world". You write that you want to support Meadow, "... not necessarily because I believe he is right, but because he has courage to stand up for his beliefs..." He thinks he's right. Well that's okay then. Support away, regardless. He stood up for his beliefs all right. He did indeed stand up for his belief system - many times in court - and was financially rewarded for doing so. Crucially, it was not his freedom or family's future on the line at such times. He did not suffer for his belief system, rather mothers lost their freedom, husbands lost their wives, and children lost their mothers. Most courageous of him. However you perceive his suffering now, it does not make much of a comparison. You ask, "If Meadow does a David Kelly, who among the British medical establishment will be able to hold their head up?" They seem to hold their heads up despite the suicides and attempted suicides of innocent parents falsely accused. Why the concern now? You suggest, "To the hysterical Sally Lewis (sic) camp- if you want to play doctors, go to medical school." Define yours as an occult art which the uninitiated may neither observe nor critique if you like. Your arrogance and our ignorance will make fine bedfellows. Or perhaps your arrogance and disregard for accuracy will make even better ones? Sincerely, CA Johnson Competing interests: None declared
'Meadows' Law' is wrong 18 January 2004
Dr Glynwr Walters, Consultant Chemical Pathologist (retired) 4 Parsonage Close, Salsbury, SP1 3LP Send response to journal: Re: 'Meadows' Law' is wrong	18th January 2004 Editor The remarks attributed to Professor Craft in your news item about Sir Roy Meadow (Jan 3) seem to imply support for Meadow’s view on multiple sudden infant deaths. The meaning of the statement “Roy gave the correct answer to the wrong question” is not clear, but it is clear from the response of statisticians and the Royal Statistical Society that the evidence in question given by Meadow in the Sally Clark case was wrong. The furore about the one in 73 million statistic is beside the point because it is the erroneous belief in the impossibility of three and the near impossibility of two deaths in a family that matters. The source of the belief, which is easily conveyed to a jury without mentioning statistics, appears to be a statement in “Forensic Pathology” by two American pathologists, DJ and VJM Di Maio, (New York, Elsevier, 1989, page 290): “Siblings of SIDS victims probably have the same risk as the general population”. Later they say: “It is the authors’ opinion that while a second SIDS death from a mother is improbable, it is possible and the mother should be given the benefit of the doubt. A third case, in our opinion, is not possible and is a case of homicide.” In contrast with the remainder of this book, the authors quote no references for this proposition. Meadow puts it slightly differently in The ABC of Child Abuse “…there is no reason to expect recurrence within a family.” These statements would be true only if multiple cot deaths in a family were independent events, whereas siblings are exposed to the same environmental factors and similar genetic influences. The alleged impossibility of multiple cot deaths cannot therefore be justified by multiplying the probability of a single death by itself as though they were independent. This is statistically invalid. Multiple cot deaths are rare, but not impossibly so, for example Beal and Blundell (Arch. Dis. Child 63, 924-930,1988) concluded that a second cot death is ten times more likely than the first; the Confidential Enquiry into Sudden Death in Infancy (London: Stationery Office; 2000) suggest a similar figure. All deaths where no obvious cause is apparent must be properly investigated. But mothers should only be treated as serial baby killers on the basis of sound evidence of criminal activity and not on the opinions of non-statisticians mis-stating statistical probability or theories unsupported by scientific evidence. Dr Glyn Walters Consultant Chemical Pathologist (Retired) Competing interests: I was a Defence expert in the second Sally Clark Appeal and in the Angela Cannings' Appeal
What positives can come out of this ? 20 January 2004
Terrence Ford, Consultant Paediatric Emergency Physician Canada Send response to journal: Re: What positives can come out of this ?	oops, my fault, one of my co-workers is called Sally Lewis (whose children are very well). CA Johnson, thanks for reinforcing my points better than I could hope to. At his time of life he is unlikely to be doing medico-legal work for the money - you don't get paid that much really, for the amount of work you put in. Trying to get appearance fees out of lawyers is painfully difficult, believe me. If all the other injuries that Meadows claims were there in the Clark case, then it seems that all this statistics guff really is just a red herring. Anyway, to trying to refocus the debate in a slightly more positive way - does anyone else wonder why we have allowed the lawyers to set the agenda here? If their precious legal process is so clever, surely it should be robust enough to be able to cope with flawed testimony? We are allowing them to shoot the messenger, and charge it to our medical indemnity bill. The lawyers are the only ones who never lose. The only good news I can see is that this fiasco might lead to a less confrontational, more inquisitorial type of legal process to handle these types of issues. The lawyers don't want this because it means less work for them. Another positive would be a reform of the expert witness system, so that only the court appoints expert witnesses. This would go a long way to solving the problem. Anyone who knows the expert witness game will tell you that there are various 'guns for hire' who will give you the opinion you require. I have never heard that said about Meadows though. Competing interests: None declared
Carry on Sinning 21 January 2004
Mark Struthers, GP Her Majesty's Prison, Bedford, UK Send response to journal: Re: Carry on Sinning	Oops, well played sir! You play a straight bat Dr Ford on a very sticky wicket! As a professional colleague, I applaud your robust grasp of the witness ballgame. I am comforted too, by your expert ability to keep on digging, albeit in a slightly more positive way. Professor Meadow will be glad of your support of course, knowing that you have the courage to stand up for his beliefs. Life is nasty and dirty Dr Ford - as well you know. Despite the various ‘guns for hire’, there is no need to be hysterical; with all that protective body armour, I know you’d be safe. I would be glad to lend you one for your own use – a gun that is – and I suspect a few paediatricians would be too. Competing interests: None declared
Atoning sin 21 January 2004
Mark Struthers, GP Bedfordshire Send response to journal: Re: Atoning sin	Wrongdoing can only be avoided if those who are not wronged feel the same indignation at it as those who are. Solon (6th century BC) Athenian statesman. On Monday 19th January, Lord Justice Judge, sitting with Mrs Justice Rafferty and Mr Justice Pitchers, announced their reasons for clearing Mrs Angela Cannings of killing her two children. Medical science was "still at the frontiers of knowledge" about unexplained infant deaths, said Lord Justice Judge. "A mother, already scarred by the unexplained deaths of her babies, may find herself in prison for killing them. With that, the Attorney General announced an urgent review of all criminal cases involving 'cot death' over the last ten years. [1] How can Professor Meadow, a man 'not beset by self doubt', have got it so wrong. [2] The disaster of course is not confined to the criminal courts, to one paediatrician, and a pathologist. The damned diagnosis of Munchausen by Proxy has spread far and wide to the family courts held in secret. The GMC can't deal with this. Helena Kennedy, joint working parties and protocols won't sort this out. A criminal case review by Lord Goldsmith will not provide any sort of resolution or any kind of justice to those who have been so badly wronged in the family courts. There needs to be an inquiry, a big inquiry, and one that will consume considerable resources. If inquiries are going to be useful, they need to be got right. [3] The penny may have finally dropped; the inquiry will have to be in public. The criticisms will have to be answered publicly and doctors will be glad of that chance. We have been here before of course, and it is quite clear that no one is satisfied, least of all doctors, if inquiries are not conducted in public. [4] Lawyers know how to conduct inquiries justly, and though doctors may resent it, Helena Kennedy will be needed to allow due process. It should be remembered that those doctors being questioned during an inquiry often feel as if they are being accused and denied the safeguards they would have in a court of law. [3] There is perhaps an answer to all this. In South Africa, the new government of national unity set up a commission to help deal with the appalling abuses that had occurred during the apartheid era. It was very successful at bringing peace and reconciliation and diffusing the explosive tensions between the sides. The scandal in child protection is enormous. There is much damage to be repaired and harmony to be created out of discord. Public confidence has to be restored. A Truth and Reconciliation Commission needs to be convened. [1] BBC News online 19.1.04 [2] The Independent 20.1.04 [3] Richard Smith. Inquiring into inquiries BMJ, Sep 2000; 321: 715 - 716. [4] Hey E, Chalmers I. Investigating allegations of research misconduct: the vital need for due process. BMJ 2000; 321: 752-756 Competing interests: None declared
Re: What positives can come out of this ? 23 January 2004
CA Johnson, Parent LA9 Send response to journal: Re: Re: What positives can come out of this ?	Terence Ford writes, "If all the other injuries that Meadows claims were there in the Clark case, then it seems that all this statistics guff really is just a red herring." Well, Meadow's apologists do indeed seem to be focusing on this one aspect of the debacle - Professor Craft is even quoted claiming that it has been used in subsequent cases to get people released (http://www.hospital-doctor.net/hd_news/hd_news_article.asp?ID=13884&Section=News). It hasn't. Not in any. But who needs accuracy? Perhaps a short extract from the full appeal judgement of Sally Clark's case will encourage questioning of the other injuries allegedly found: ' "192 Finally in relation to Dr Williams' involvement with this case, it is perhaps pertinent to record an overview of the pathology evidence expressed by Professor Byard a Specialist Forensic Pathologist at the Forensic Science Centre in Adelaide, Australia, who has particular expertise in cases of sudden infant and childhood deaths. He had been sent the papers in this case by the appellant's solicitors. His view was: "Unfortunately there appears to have been significant and ongoing problems in the investigation of these deaths. Standard protocols were not followed and essential steps such as routine dissection and histology were omitted which prevented verification of alleged autopsy findings. As well, a number of potentially important diagnoses and conclusions were altered over time. For example, Christopher's initial cause of death of lower respiratory tract infection was withdrawn, observations of no significant haemorrhage within his lungs were changed to marked haemorrhage, .. The finding of retinal haemorrhages in Harry which was vital to sustain the diagnosis of shaken-impact syndrome was altered to no haemorrhage, brain lacerations were found to represent postmortem artefact, swelling of the spinal cord was not present and bruising of paraspinal tissues was also not able to be substantiated." ' Competing interests: None declared
Re: We've been here before; postscript 24 January 2004
Davina Hollisey-Mclean, Housewife and mother SA4 3DT Send response to journal: Re: Re: We've been here before; postscript	We have been away so I have only just had a chance to look at the rapid responses. My reaction to Dr Kiaran Asthane's posting would have been similar to some of the other postings I have seen but I have to say in the light of Dr Kiaran Asthane's postscript I have to take my hat off to him! (I guess you could say that this posting has the benefit of hindsight) "Yes, if you have some information that you feel I should see, please let me know. I may have a view, but I'm prepared to change it. I’d rather speak up and be told I'm wrong than sit quiet and believe I'm right " Oh, what we'd have given 13 years ago, to hear those words! Regardless of what Dr Kiaran Asthane's view may be after he sees the "information" at least he is prepared to look". Dr Ford however is another matter! " I want to support him, not necessarily because I believe he is right but because he has the courage to stand up for his beliefs which have been shown to have a good basis in many cases " What about the beliefs of the parents? What about truth and justice? What about all those children, the children of yesterday, the children of today and the children of tomorrow, all whom have been so dismally failed by the system that was supposed to be their to protect them. When the truth comes out will there be any among the “British medical establishment” who will be able to hold their heads up? The answer of course is a yes, but there will be many too who should hang their heads in shame. I have heard it said that the intellect of doctors and dentists is within the top three percent, I would like to suggest that maybe Dr Ford should use just a few of those brain cells to form an opinion and a belief of his own. I seem to recall something about Lemmings following each other and falling of the cliff. Maybe all those Lemmings followed the first one because it had the courage to stand up for its belief too! Is this the same reason that over the years so many child protection agencies i.e. Police, Social Services have not challenged Meadow and his acolytes in any way; because they too were not capable of using their own brain cells and although they didn’t necessarily believe that these "hawks of child abuse" were right they decided to support them anyway because they had the courage to stand up for their belief? Only time will provide the answer to that one. , Maybe. Oh, and one final point, I pray that Dr Meadow and the others do not commit suicide, that would be the easy way out and we want answers. Incidentally suicide could be seen has proof of their guilt given that they say if a mother commits suicide following an allegation of MSBP it is proof of her guilt. I say what’s good for the goose is good for the gander, and what goes around comes around! Competing interests: Complainant
An olive branch? 26 January 2004
Davina Hollisey-Mclean, Housewife and mother SA4 3DT Send response to journal: Re: An olive branch?	As a wrongly accused parent I’m sure that I can speak for others and say that we are calling for a public inquiry and will not give up until we get one. However I do not feel that in this posting I can speak for other parents. This is from one mother who was wrongly accused, it is my opinion, my belief and my own personal plea to each and every one of you. When we came face to face with an allegation of MSBP in 1991 we were overcome with grief, horror and sheer terror. The thoughts and emotions of losing our children, and the fact that we were totally unable to protect them from what was happening, I cannot even begin to describe. Initially we fought in desperation to keep our family together, then we fought in desperation to get it back and then we continued to fight not only to clear our names so that we could escape the life sentence that we had been given but also in the hope that we could somehow make people see what was happening and as a result they could prevent this happening to other innocent and loving families, then, and in the future. I gave it another name “ The 4 M’s Misinformation Misinterpretation, Misunderstanding and misdiagnosis! This may not sound a very medical term but it came about because of something that was said to us. Someone involved in our case sat opposite us and said “I was in my garden yesterday and I was thinking of you. This was a case of the 3 M’s Misinformation, Misinterpretation and Misunderstanding and it has destroyed your family and everything that you believed in, but the corner stone remains “love” and on that you can rebuild and flowers will once again be found in your garden” The M for misdiagnosis was not included, that was added my me. If it had been included it may have released us from a life sentence. To quote a piece from a poem I wrote at that time“ Put it in writing that you were wrong. I’ll never ask of you anymore. I don’t want your money or someone to blame but my soul, my freedom, my life, my all!” We couldn’t wait for our son to come home we thought that, that would be the end, but we realised very quickly that it was not in fact the end that we had dreamt of ,instead it was only the beginning. It was the alpha not the omega. We failed dismally in our bid to stop this happening again to the families and especially the children who came along, many years later, and I feel so, so bad and a great sadness about that, but there is still hope for the children of tomorrow if we can some how find a middle road so that we can work together, the wrongly accused acknowledging that you are the experts but with recognition by yourselves that we are not mad, bad or liars but people with the same desire as you, to protect children from abuse of any kind. That must also include system abuse. We do in fact have something of value to say about all of this because we too are experts in our own field, our expertise being in the field of parents who have been wrongly accused of child abuse. ( MSBP ) Not a field of our choosing but something that we would willingly give our time to, without lining our pockets in the process! I can’t begin to tell you what the postscript of Dr Kiaran Asthane meant to me, other than to say it gave me some hope for the future. This may not be possible but I would ask that the Medical profession join us in a call for a public inquiry into how MSBP became “ one of the most pernicious and ill-founded theories to have gained currency in childcare and social services over the past 10 to 15 years” I am not saying that parents, carers and others never ever fabricate or exaggerate a Childs illness, only that in my opinion it should be dealt with in a manner that is considered appropriate to each case, not a continuation of the “Witch hunt” that has been allowed to continue for all these years in the name of MSBP. If it didn’t catch you on the way up, it caught you on the way down there was no escape. You are considered guilty until proven innocent and how do you prove a double negative? There will be those in the medical profession who will at least be sympathetic to my opinion, there will be others who’s views will never ever be changed, in the same way that some wrongly accused parents will support my plea, others though may not Personally I am tired of fighting, can we not at this time attempt to reach the middle ground? The pendulum has now swung totally the other way and tragically some babies/ children will get thrown away with the bath water. No-one would have wanted this, and if this witch hunt had been stopped 13 years ago we wouldn’t be in this situation and there would not be a need now to review all the cases that have gone through the criminal and family courts. It was said to us when our case was “over” that even though it had been wrong it was justified because if you had six cases that were wrong and just one that was right it was worth it to save the children in that one family from abuse. Sorry but as tragic as that is, the needs of the few cannot outweigh the needs of the many. The damage done to our family by the system that was set in place to protect ALL children can never be undone. I hope that one day the remit of the inquiry announced by the Solicitor General will include all families with an allegation of MSBP on the files, those like us who have had their child/children removed and then returned and even those who have never had their children taken away from them. Merely to have a MSBP allegation on your file means that you are given a life sentence, not just the parents, but also the children who will one day grow up and have children of their own. Given that it has been said that MSBP is heredity God help our children and their children if they happen to have one that is poorly i.e. a inherited illness that has gone unrecognised, because it was diagnosed instead as MSBP. It would leave them wide open to an allegation of MSBP too Of course first priority must be given to the cases who have gone through the criminal courts, and also to the families whose cases have gone through the family courts who have not had their children returned. We live in hope that there will be a genuine effort on every ones part to learn from these horrific miscarriages of justice. What is done, is done and it can never be undone. How we all wish that we could turn the clock back. As Sally Clark said on her release from prison “ There are no winners “ Competing interests: Mother wrongly accused of MSBP