Diagnose and be damnedBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7221.1376 (Published 20 November 1999) Cite this as: BMJ 1999;319:1376
Doctors who have exposed child abuse are being hounded. Harvey Marcovitch, editor of Archives of Disease in Childhood, believes that the media are making matters worse
A few years ago, I found a neat roll of documents tucked behind a radiator outside my office. It contained letters, minutes of meetings, and suggestions on how to run a campaign to combat doctors' diagnoses of child abuse. Most were reasoned, but some were written in crude language and bristled with anger. The package had been planted where I would find it. I think it was meant to frighten me.
Last year, sitting in the editorial office of Archives of Disease in Childhood, I was handed some letters, headed with a private address, asking whether we had ever received for publication, but subsequently rejected, papers from the North Staffordshire Hospital on continuous negative pressure ventilation. My explanation that we did not keep records of rejected submissions beyond one year met with incredulity. The correspondent wrote again complaining that she knew I was covering up the existence of unethical experiments on newborn babies.
The anti-doctor website
This week, I logged on to www.msbp.com and found a bulletin board for “Mothers against Munchausen syndrome by proxy.” It was full of attacks on named paediatricians and child psychiatrists, and diatribes against two judges, a member of parliament, and various social workers. The accusations included perjury, conspiracy to defraud, attempted blackmail, and child abuse. More than one contributor claimed that judges and an MP in the Lord Chancellor's department had connived to prevent legal aid being granted to sue doctors who had diagnosed abuse. One message, to a neurologist, stated: “I promise I will make it my life's work to finish you for good.”
Another message attacked David Southall, professor of paediatrics at the University of North Staffordshire: “Why I compared David Southall to Joseph Mengele: Joseph Mengele experimented on Jewish children in a concentration camp in Nazi Germany. Gloria's two children were named Joshua and Aaron. Need I say more? Penny.”
These events are connected. They are some of the activities of a network of individuals whose aim seems to be to discredit, humiliate, and punish doctors, and others, who diagnose child abuse. Although primarily concerned with factitious illness, the website conflates this with allegations of unethical research on newborn infants, negligent paediatric intensive care, and, just lately, how some children with chronic fatigue syndrome are treated.
Television fuels the fire
On 20 October, Channel 4 News joined in. It invited into its studio the prime target of this group, David Southall. Southall states that Channel 4 News producer, Jessica Salmon, invited him to discuss with newscaster Jon Snow the many attempts that have been made to frustrate his work in child protection and charitable aid for victims of war. Aware of the triple pronged attack on his work (the third involves research into the effects of high altitude on infant respiratory physiology), he told Salmon he was willing to take part but could not discuss his department's work on continuous negative pressure ventilation (CNEP) as it was subject to an NHS inquiry. As he watched the film preceding his live interview, Southall was horrified to find he had been ambushed, as much of it was about CNEP and contained a specific allegation of negligence from a parent of a child treated in his hospital's intensive care unit. Like all doctors in this position, he could not defend himself without breaking patient confidentiality.
The child in question had been transferred to Southall's unit after a stay in an intensive care unit elsewhere, a fact ignored by Channel 4. Staff at the referring hospital have stated that there is plenty of evidence to refute the allegation made in the programme, but, again, confidentiality forbids them saying more. Jim Gray, editor of Channel 4 News, justified the programme on the grounds that parents “are clearly in an excellent position to know about their own child, and everything we said in the report accords with what [they] told us. Whether or not Professor Southall has consent to comment on her case is clearly not a matter for us.” Does this comment mean that Channel 4 News accepts what it is told without properly checking if it is true? And is it happy to set up a target for a live interview, caring little that he is unable to defend himself because of the paradox that he does not have his accuser's permission to do so?
On 8 November BBC's Panorama performed a hatchet job on Dr Michael Prendergast, previously a child psychiatrist at Great Ormond Street Hospital. Prendergast uses active rehabilitation as a treatment for chronic fatigue syndrome. It also criticised Dr Alan Stanton, a community paediatrician who had intervened in a case where parents' views and those of the local medical team were in conflict This child's case had already led to www.msbp.com targeting Stanton for his stance in this case, and he has had to deal with complaints to his hospital trust and the GMC.
Much of the media, it would seem, has little interest in distinguishing news from propaganda. Which sections of newspapers and television programmes are the more reliable, news or advertising?
A lesson from the Washington Post
In the 1970s I was a resident in a Massachusetts children's hospital. Week after week the local newspaper published brief news stories about odd and seemingly trivial events involving politicians connected with the Nixon administration. The stories added up to no more than what Bostonians call a hill of beans. But just as I returned to Britain the whole Watergate scandal finally broke, ending Nixon's presidency Years later, I watched the film All the President's Men and understood what I had been unable to comprehend. The film detailed the policy of the Washington Post—that news was something that had to be corroborated. As long as there was only innuendo and gossip, the correct approach was to keep the story ticking over in a low key way on the inside pages, perhaps to flush out witnesses. Only when the same facts came from two unconnected sources, with no discernible conflict of interest, could the editor blow the whistle.
There's a lesson for Channel 4 News in the importance of independent corroboration, preferably by someone with no axe to grind. As one journalist said to me, if you make that extra telephone call you might just hear something that ruins your story.
Southall's work disrupted
In a largely ignored press release—except, to its credit, by the Guardian—Southall detailed his 13 years of work in child protection. In it he claimed that, since 1992, Brian Morgan, a freelance journalist, and a group of parents accused of child abuse, have conducted a campaign against him. He says this has interfered with his work to protect children at risk, damaged his research, frustrated the work of his charity Child Advocacy International (which has provided financial and medical help to Bosnia and elsewhere), and led to wasteful hospital trust and NHS inquiries. One individual, Sharon Payne (also known as Wraxall), infiltrated the charity in the guise of a volunteer and removed confidential medical documents from its office. Another individual has been charged with conspiracy to abduct a child. The National Union of Journalists paid costs of £25 000 when it funded Morgan in his failed attempt to have Payne's purloined documents made public. Morgan states there is no formal organisation, merely a “loose network of contacts” and “a grapevine.”
Southall says that he has received threats of violence, and that his charity's equipment has been destroyed. There is, however, no evidence to link this darker side of campaigning to Morgan or the public faces of the movement.
Surely Channel 4 News, the Sunday Times, the Independent, and others have been barking up the wrong tree. The real story is what drives Morgan and others like him, how the “loose network” is funded, the backgrounds of its supporters, and whether its campaign has destroyed some children's protection.
Doctors may fear diagnosing child abuse
Unsurprisingly, Sir Roy Meadow, a pioneer in the description of Munchausen syndrome by proxy, has been the group's target for many years. He has been more fortunate than Southall in that when one of the “loose network” applied for a job in his unit the person was unmasked in time. However, like Southall and others, he has to put up with poison pen letters and telephoned and written threats to himself and his family. Meadow's concern is that the campaign could encourage doctors, particularly the young and relatively inexperienced, to turn a blind eye to possible cases of child abuse when it can cause them much trouble.
Peter Milla is a paediatric gastroenterologist. I was surprised to see him demonised on the website hit list, but he told me that in his specialty a few children are referred with factitious symptoms, and the consequent involvement of a child psychiatric team can lead to being targeted. He believes a prime reason for the present spate of accusations against doctors is the failure of some social service departments to understand and get to grips at an early stage with problems presented by families in trouble.
One respected medical journalist who has written about the tribulations in the University of North Staffordshire is Jeremy Laurence of the Independent. He has known about the various allegations against Southall's group for a long time and had dismissed most as rumour mongering. However, he considered that the suggestion that consent might not have been obtained for entering newborn babies into a trial was something he could not responsibly ignore, especially as ministers had ordered an inquiry. Southall is unimpressed, pointing out that the inquiry was provoked by reaction to an article in the Independent's sister Sunday paper cowritten by Morgan, and that Laurence's article “effectively accused me of killing 28 babies and causing brain damage to a further 15.” Laurence says: “Writing for a newspaper is a high wire act where you have to balance fairness with the need to sell the paper.”
Can we persuade journalists that it is a matter of serious public concern when 11 consultant paediatricians and child psychiatrists have had to respond to letters of complaint to their employers and the GMC couched in virtually identical language? I have spoken to most of them, and most were prepared to respond only if I did not name them, because the publicity is interfering with their everyday work and because of the threats to their families. Presumably the GMC knows who they are. Sir Donald Irvine is rightly concerned about not ignoring whistleblowers and insisting on thorough airing of patents' complaints. But when complaints follow a pattern that suggests a campaign the GMC should consider changing tack towards protecting those on its register.
Jane Wynne, a Leeds paediatrician who is a leading expert in child abuse, became so frustrated with the GMC's handling of cases that she wrote suggesting she help its members understand what it was all about Perhaps Sir Donald should take up her offer. Incidentally, Wynne isn't targeted on the website. Could it be because the Mail on Sunday had to settle for a substantial sum a few years ago when she pursued a libel suit against it?
Many of the doctors I have spoken to have been defamed publicly, certainly on the website and possibly in the press and on television. None is wealthy enough to launch a personal libel action. Medical defence societies have traditionally avoided entangling themselves with actions for defamation, citing the excessive cost and the undoubted fact that most libels are quickly forgotten, except by the victim This campaign is different from the spontaneous angry or distressed comments of a parent whose child has suffered. It should be dealt with differently. Most defence society members would be happy to see their subscriptions used to nip this activity in the bud by some well placed libel suits.
Trust managers may not realise the complaining letter they receive is based on a pro forma. They should adopt a more vigorous policy of rebutting unjustified demands and involving the police if they believe their employees are being harassed. It's about time the profession hit back at those who are vilifying our colleagues in Stoke, Great Ormond Street, Oxford, York, Sheffield, Cardiff, Glasgow, and now, presumably, Banbury as well.