An expert witness falls from grace
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7406.110 (Published 10 July 2003) Cite this as: BMJ 2003;327:110
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Medical experts are in the firing line - and quite rightly so. Why
they alone should enjoy immunity from their negligent actions is nothing
short of a national scandal. If a medical expert is proven to have
deliberately misled the court, or given false testimony, then he or she
has attempted to pervert the course of justice. This is a serious offence.
Currently, the lack of scrutiny and control of this unregulated - but
highly lucrative - line of work is leading to widespread abuse. Cases such
as Sally Clark, where experts have been shown to be highly economical with
the truth, should serve as a warning. If errant experts are seen to 'get
away with it' the medical profession will be brought into further
disrepute and the public's faith and trust in the British justice system
will be futher undermined. Wake up and smell the coffee GMC!
Competing interests:
Parents pursuing a medical negligence case on behalf of their child
Competing interests: No competing interests
his opinion that natural infant deaths do not run in families
As I understand it, SIDS is "Sudden Infant Death Syndrome". It is a non-specific finding of cause of death because medical science does not yet know or have the means to determine the specific physiological cause. Any infant that dies naturally, suddenly and unexpectedly must, therefore, have died from SIDS unless or until a more specific cause is determined (respiratory infection, metabolic disorder, etc). It is a subjective finding - not so much a determination of the cause as an admission that the pathologist can not specify the cause. It is an honest "We don't know". It is an absence of certainty, not a discovery of such.
It is therefore pointless for Meadow to claim, and for Davies to cite that claim in his defence, that Meadow's flawed statistical evidence was not relevant "because none of the experts were suggesting that the cases were SIDS". If the experts not claiming that the deaths were SIDS were significant, what was the point of his giving his SIDS statistic to the jury in the first place? That is rather like making up a statistic about knife wounds in a trial where everyone agrees that the cause of death was a gunshot.
Clearly his point was to impress upon them his opinion that natural infant deaths do not run in families(because if not, why bother mentioning it at all?
That is why his deeply flawed statisitcal evidence was indeed very relevant to the false conviction of Sally Clarke; and I'm inclined to conclude that Meadow and Davies are insulting our intelligence.
I also wonder why Davies takes such exception to Naomi Marks' cool observations of the current debate.
Competing interests:
None declared
Competing interests: No competing interests
I respond to the article by Naomi Marks debunking Sir Roy Meadows
(reference 1).
This article is monstrously unbalanced. Sir Roy is one of the giants
in the field of Child Protection and whatever his performance in the case
of Sally Clark deserves better treatment by the BMJ.
The medical issues in the Sally Clark trial are complex and although
the article makes reference to Sir Roy not choosing to make reply to
recent inquiries by the BMJ, no reference is made to his defence of his
evidence in the BMJ in January 2002 (reference 2). In that article Sir Roy
makes it clear that the statistical statement of exceptionally low risk of
a second SIDS was taken from a respected publication (reference 3) and,
anyway, was irrelevant in the case because none of the experts were
suggesting that the deaths in the case were from SIDS. There is much else
relating to the medical evidence in this case that would give any
paediatrician who works in Child Protection food for thought.
There is no doubt that there were unfortunate errors involving
incomplete provision of pathological evidence in this case. Sir Roy will
have taken the pathological evidence at face value and, for instance, not
known that there was a significant bacterial growth obtained from various
body fluids of one of the deceased children. As paediatricians we
scrutinise the pathological evidence, but we rely on our consultant
pathology colleagues for its completeness & accuracy. Sir Roy seems to
have been let down by his pathological colleagues in this case.
Outside the law court Sir Roy's record of research and discovery in
Child Protection is secure. A glance at his publication list in Index
Medicus or one of the medical computer engines would quickly convince
doubters of this. Famously he described the condition of Munchausen's
Syndrome by Proxy (now less colourfully known as Factitious Disorder by
Proxy)(reference 4)and has published much about various features of that
syndrome since. His works, which have taken place in the company of other
experts, remains standard references on the subject for paediatricians
& others.
Paediatricians who are prominent in the field of Child Protection
seem to have a high risk of suffering media vilification. I am sad that
the BMJ has joined the hue and the cry of the media pack by publishing
this article by a journalist. A better way of conducting an inquiry into
the controversy would have been by emulating your sister journal, the
Archives of Disease in Childhood as it did in 1995 by conducting a
published debate of experts on the subject of Munchausen's Syndrome by
Proxy (reference 5,6&7).
Yours sincerely,
R.H.Davies FRCPCH
Named Doctor Child Protection
NWWalesNHSTrust.
References
1. Marks M. An expert falls from grace. BMJ 2003; 327:110. (12 July).
2. Meadow R. A case of murder and the BMJ. BMJ 2002; 324:41-3 (5
January).
3. Fleming P, Blair P, Bacon C, Berry J eds. Sudden unexpected deaths
in infancy. London:Stationary Office, 2000.
4. Meadow R. Munchausen syndrome by proxy. The hinterland of child
abuse. Lancet 1977;ii:343-5.
5. Morley CJ. Practical concerns about the diagnosis of munchausen's
syndrome by proxy. Arch Dis Child 1995; 72:528-530.
6. Fisher CF, Mitchell I. Is munchausen by proxy really a syndrome?
Arch Dis Child 1995; 72:530-534.
7. Meadow R. What is and what is not, munchausen syndrome by proxy?
Arch Dis Child 1995:534-538.
Competing interests:
None declared
Competing interests: No competing interests
Since the Trupti Patel trial there has been much coverage in the
press of what has become known as Meadow's Law, according to which one cot
death is a tragedy, two is suspicious and three is murder until proved
otherwise. A change in the attitude of the media was referred to in the
BMJ very recently by Naomi Marks 1. The "law" has been repeatedly
criticised because of the lack of scientific evidence to support it, but
another major aspect seems so far to have escaped comment, namely, that it
appears to be based entirely on a statistical fallacy.
Professor Meadow did not originate the law. It appears to be
attributable to D.J. and V.J.M. Di Maio, two American pathologists who
state in their book "Forensic Pathology" 2 ;-
"It is the authors' opinion that while a second SIDS death from a mother
is improbable, it is possible and she should be given the benefit of the
doubt. A third case, in our opinion, is not possible and is a case of
homicide."
It is clear that the statement is the authors' opinion. It is not a
conclusion reached by analysis of their observations; no supportive data
are presented and there are no illustrative case histories, or references
to earlier publications. This is in striking contrast with the rest of
the book which is replete with illustrative case histories and cites many
references throughout. A recent examination of Meadow's own contributions
to the medical literature has likewise failed to uncover supportive
pathological evidence or references to it.
This lack of scientific evidence has led many pathologists to view
the supposed aphorism with great scepticism and to base their own
conculsions in a given case on the pathological findings, as in the recent
Trupti Patel and Sally Clark cases. Trupti Patel was cleared of murdering
her three babies by a jury in ninety minutes, after a six week trial. In
the Sally Clark case, six of the seven pathologists who gave evidence
reached the same conclusion that the cause of death was not ascertained,
contrary to Professor Meadow's own opinion.
But a more cogent reason for wholly disregarding any conclusion based
on Meadow's Law is a sentence that precedes the Di Maios' statement of
opinion:-
"Siblings of SIDS victims probably have the same risk as the general
population". 3
This is the assumption made by Meadow when he said that the chance of
a second cot death in a family was one in 73 million, an assumption that
was widely rejected by statisticians and epidemiologists as invalid 4.
It follows that Meadow's Law must be just as invalid and it should
not be used in the courts because when stated in an authoritative manner
it could have a strongly prejudicial effect even though it is wrong.
I suggest that in future it should be referred to not as Meadow's Law
but as Meadow's Myth.
Glyn Walters
Salisbury SP1 3LP
Retired Consultant Pathologist
1 Marks N. An Expert Witness falls from grace. BMJ 2003; 327; 110
2 Di Maio, D.J and Di Maio V.J.M,Forensic Pathology, chapter 11, page
291. Published by Elsevier, New York, 1989.
3 Ibid Page 290
4 Watkins
Competing interests:
1.I assisted the defence in the second Sally Clark appeal.
2.I am in touch with the Solicitors acting in the case of Angela Cannings but I have not been instructed by them or by anyone else.
Competing interests: No competing interests
Reliability of Experts
"Famously he described the condition of Munchausen's Syndrome by
Proxy (now less colourfully known as Factitious Disorder by
Proxy)(reference 4)and has published much about various features of that
syndrome since. His works, which have taken place in the company of other
experts, remains standard references on the subject for paediatricians
& others." writes your respondent about Professor Sir Roy Meadow.
Surely the readership, especially paediatricians, know that Professor
Sir Roy Meadow was - actually - not the creator of this theory, despite
his own assertions? Could this be plagiarism?
The person who coined the phrase was John Money, a New Zealand
psychologist who worked on gender studies and was famously involved in the
Bruce/Brenda story, in which a young boy had his penic burnt off
accidentally in a circumcision. John Money convinced the parents that he
could help by turning Bruce into Brenda. This was to be achieved through
years of operations and psychotherapy.
The suffering of this young child, continuing into adulthood, has
never been acknowledged by the people who claimed glory for this gender
experiment. They claimed this was wholly successful. But this young man
was grossly isolated throughout childhood. He knew he was male yet was
being expected to act female. He has since married and adopted children.
He had no idea that those who had experimented on him were claiming the
destruction of his life was a success.
In Money's 'Kasper Hauser Syndrome' Prometheus Books (1992) he
describes how he reached the position of coining the term MSBP :
"In discussing the finding of their paper on collusion (Chapter 18)
Money and Werlwas in 1976 coined the term, Munchausen's syndrome by proxy
and utilized it for the first time with reference to the abuse induced and
neglect induced symptoms of the syndrome of abuse dwarfism. They wrote as
follows (p.360)
'In its classic form Munchausen's syndrome is a condition in which
the etiology of symptoms appears completely hidden whereas. in fact, the
symptoms are self-induced. There is a close parallel with the symptoms
observed in abuse dwarfism except that the symptoms are parent produced in
the child instead of self induced. Whereas in Munchausen Syndrome the
patient gives a false medical history, in abuse dwarfism the parents give
the false history while the child remains silent. That is to say, one has
a case of Munchausen's syndrome by proxy.' "
Meadow first used the term in 1977, and it is enlightening that he
does not quote Meadow!
How reliable, then, are either of these `experts`?
1. Money,J.,and Werlwas,J. Folie a deux in the parents of
psychosocial dwarfs: Two cases. Bulletin of the American Academy of
Psychiatry and the Law, 4: 351-362, 1976
Competing interests:
None declared
Competing interests: No competing interests