Shaken baby expert witness wins High Court appealBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5985 (Published 08 November 2016) Cite this as: BMJ 2016;355:i5985
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Medical experts writing reports for both the prosecution and the defence in SBS may often overlook:
1. “The truth, the whole truth and nothing but the truth” if their reports are inaccurate, withhold vital information to be politically correct, and not appropriately referenced.
2. Doctors are not scientists (Richard Smith 2004) .
3. Most doctors ‘believe’ that vaccines are safe and effective despite the existing overwhelming body of published medical research to the contrary. Most may fail to continue educating themselves post graduation, relying on what they were taught in medical schools. Much of that knowledge may became obsolete.
4. In their reports many doctors may fail to disclose the vaccination status of the SBS and ill babies. One exception is Southall et al. (1987), even though they did not causally link the administered vaccines to the observed deaths. A discerning reader can make up his/her own mind. I can see the clustering of those death along the critical days (Scheibner 2004).
5. Many doctors may not see the difference between facts and hearsay. Many may fail to read ‘old’ (published before1990), seminal medical papers. Instead resorting to hypothesising, speculating, politicising and failing to properly recognise and analyse all material facts thus forgetting that this might amount to withholding the vital information from the courts. They may ignore the administered vaccines or deny vaccines’ deleterious effects even though these are listed in medical, hospital and pathology and postmortem reports and instead rely on meaningless political disclaimers that the causal link has not been proven. After Sally's untimely death in 2007, Neville Hodgkinson wrote in the Spectator,”Even paediatricians who gave testimony on Mrs Clark’s behalf told defence lawyers that if vaccination were mentioned as a possible cause of Harry’s death, they would dispute it. With hindsight, it is clear that this was a bad decision.”
6. The experts may display the “kill the messenger” attitude by blaming the innocent parents and other carers or a person who was last alone with the affected baby, thus “showing not only a lack of experience with severe childhood illnesses and death but also an attitude of suspicion and/or hostility probably contributed to these misdiagnoses Kirschner and Stein 1985)..”
7. The empathy and responsibility for the real harm done to innocent parents who are incarcerated and their remaining children taken away and put into foster homes or even adopted straight away and lost for ever, even when the accused parents are acquitted. Moreover, some 200 US parents were executed for SBS.
8. Even the infamous Maximilien Robespierre, who during the French Revolution sent thousands of innocent people under the guillotine, is quoted as saying to the effect of: “It is better for 100 criminals to go free than one innocent person incarcerated.” Others are credited with similar statements. Still valid to this day.
The alleged act of shaking babies resulting in the injuries considered pathognomic of SBS has never been witnessed, and remains, according to a US judge, a factitious, misdiagnosis carefully fabricated by medical doctors.
I urged the lawyer in one case of SBS to go for an appeal simply on the basis of insufficient evidence in the first instance. He did just that and won. The convicted father was completely exonerated with no criminal conviction. This may apply to other parents accused of shaking their babies. Where is the evidence of shaking?
Guthkelch (1953) wrote “It should be emphasised that infantile subdural effusion is not a rare condition. Study of the records of the Royal Manchester Children’s hospital for the four years covered by this series shows that, of all surgical conditions of the central nervous system occurring in the first two years of life, only spina bifida and hydrocephalus were seen more often than subdural haematoma…The series here reported comprises 24 cases – 18 cases of subdural haematoma in infancy; 5 cases complicating purulent meningitis; and 1 case of subdural effusion in a patient with sagittal sinus thrombosis…Most cases occur in the first few months of life (table 1). Of the series reported here 11 developed symptoms before the age of 3 months, five between 3 and 6 months and only two thereafter”. [Those are the ages when the first 3 DPT + Polio vaccines are administered.]. The causes were birth injuries and precipitate labour, prematurity, not known, twins and ‘head injury’ two weeks before admission, and not known” (7 years old child). Guthkelch quoted 17 references with similar cases.
One wonders what made Guthkelch (1971) change from a reasonable analysis and description of common natural birth injuries and infections in his 1953 article to a highly hypothetical and undocumented assertion that subdural haematoma is one of the commonest features of the battered child syndrome, albeit without external marks of injury on the head. He claimed that ”This suggests that in some cases repeated acceleration/deceleration rather than direct violence is the cause of the haemorrhage, the infant having been shaken rather than struck by its parents. Such an hypothesis might also explain the remarkable frequency of the findings of subdural haematoma in battered children as compared with its incidence in head injuries of other origin, and the fact that it is often bilateral.” A documented fact is that the 1970s was the time of intensified vaccination with corresponding major increase in vaccine injuries and death. Not even the prevalence of SBS ages between 2-6 months alerted Guthkelch to vaccines.
Hiller (1972) described bizarre bone fractures ascribed to child abuse as characteristic of scurvy.
Scheibner (2008) explained that the so called rib fractures are a separation of ribs at costo-chondral junctions due to scurvy.
Scurvy used to be referred to as haemorrhagic disease or haemorrhagic diasthesis (Gilman and Tanzer (1932)). Toxic vaccines cause an acute scurvy which results in haemorrhaging into several organs (Scheibner 2004).
Late in his life, Guthkelch admitted his error (Scheibner 2016), yet new SBS cases are still popping up. The latest one in the UK just a few days ago. Sweden decided that SBS is a non-existent diagnosis. Enough is enough.
References and suggested articles
Richard Smith 2004. Doctors are not scientists. BMJ June 19; 328(7454):0.
Southall et al.1987. Sudden and unexpected death between 1 and 5 years. Arch Dis Child;62: 700-702.
Scheibner 2004. Dynamics of critical days as part of the dynamics of non-specific stress syndrome discovered during monitoring of babies’ breathing with Cotwatch breathing monitor. .J ACNEM; 23(3): 1-5.
Guthkelch 1953. Subdural effusions in infancy: 24 cases. BMJ; January 31: 233-239.
Hiller 1972. Battered – or not – the reappraisal of metaphyseal fragility. Am J Roentgenol Radiol Therapy & Nuclear Medicine; 114(2): 241-245.
Scheibner 2008. Unexplained fractures explained. BMJ.com rapid response 12 December 2008.
Scheibner 2014. Is animal research sufficiently evidence based to be a cornerstone of biomedical research? (The relevance of animal research for humans.) BMJ 2014: 348:g3387 (published 30 May 2014):348:g3387).
Guthkelch 1971. Infantile subdural haematoma and its relationship to whiplash injuries. BMJ; 2: 430-431.
Kirschner and Stein. 1985. The mistaken diagnosis of child abuse- a form of medical abuse? Arch Dis Chjld; 139(9): 873-875.
Amiel 1976. The effects of Bordetella pertussis on cerebral vascular permeability. Br J Exp Pathol;’ 57:653-662.
Steinman et al. 1982. Murine model of pertussis vaccine encephalopathy: linkage to H-2 . Nature 299: 736-740.
Steinman et al. 1985. Pertussis toxin is required for pertussis vaccine encephalopathy. Proc Natl Acad Sci USA; 82 : 8733-8736.
Bergman and Munoz. 1978. Vascular permeability: changes in the central nervous system in rats with hyperacute experimental allergic encephalomyelitis induced with the aid of a substance from Bordetella pertussis. Infection and Immunity; 21 (2): 627-637.
Gilman and Tanzer. 1932. Subdural hematoma in infantile scurvy. JAMA; Sep17: 989-991.
Scheibner 2016. The law is not equipped to consider scientific dispute. BMJ 2016; 352:i1768. (published 31 March 2016).
Competing interests: No competing interests
It was a given that Dr Squier would be re-instated in the High Court, her contributions to Humanity
and Medical Science are not in question by anyone. But there is a far bigger issue that stems from
the defaming and prosecution of Dr Squier, and many others, that urgently needs to be addressed.
The question that this case raises is;
- Why has Medicine degenerated into a Religion based on Faith and Belief?
With regard to Science and Shaken Baby Syndrome, a recent survey found that most doctors
believe that if an infant is shaken, that it will produce what is known as the Triad of
signs and symptoms within the brain (1). And yet, what Science tells us is that an athletic male cannot generate sufficient forces to disrupt the Bridging Veins of the Dura Mater, but short falls can (2).
I have struggled for years with the concept where two doctors could examine a patient and have
completely opposing views. If we all adhered to the "Belief" that shaking a baby produces the Triad,
it would leave no room for Scientists (such as Dr Squier), to raise questions. When they stray out of
the "widely held beliefs", they are branded Heretics, Deniers and Non Believers and their
reputations are burned at the proverbial Stake. This is what Medicine has become.
Science relies on questions and constant dialogue. With "Peer Review" a theory is either bolstered or
ruined by constant attack. Anyone falling afoul of the Herd Thinking is to be reported to the GMC
as a Denier and attacked personally rather than challenging their theories. Isn't that called "Witch
But we have to remember that the Witch Hunters of Salem, Mass. were good, God-fearing people
even though they brutally killed their own citizens. Their faith in the Devil was equal to their faith
in God. I have long been a proponent of Evidenced Based Medicine and a Forensic Diagnosis being
reached before allegations being made.
My position is SBS could not exist, not my opinion but scientific fact. In fact I would go further and
suggest that any Physician who "Believes" it it possible to cause the Triad by shaking alone is
dangerous to patients and shouldn't be allowed to practice. SBS has never been more than an
unproven hypothesis and the original theorist Dr Norman Gutkelch has never stood by this theory.
SBS is dangerous because the dogma says that shaking an infant produces the Triad, but short falls
from a couch or bed are not harmful, scientific experiments prove the complete opposite is true. See
note (3) Biomechanical studies prove beyond all doubt that even the most violent shaking can only
produce 1/12 of the Acceleration as a short fall. There are documented cases now of physicians
dismissing babies who have fallen from beds or couches and dismissed because the dogma. Indeed,
even the factually incorrect information on the Crown Prosecution website (4) claims that short falls
are not harmful. A theory, as yet unstudied, is that the Subdural bleeding builds up over days,
increases Intra-cranial Pressure and causes Retinal Haemorrhage (Triad), will never be studied as
long as 90% of physicians believe that short falls are not harmful. Even if you are not familiar with
the mathematics involved in the Biomechanical studies by Lloyd et al, this short video should be
sufficient to see that the current dogma "believed" by the 90% is incompatible with Science. (5) or a
longer version (6) Science shows that falls produce 12 times more force than the most vigorous
shaking. The Brain does not “float” within the skull, the “free space” is taken up with CSF which
maintains a constant pressure. The brain cannot “bounce off” the skull and if it did would more
likely produce Epidural rather than Subdural bleeding. Take an egg and shake it as hard as you like
for as long as you like. When you break open the shell, the yolk will be intact. Now try dropping an
egg from 3 feet (1M) onto concrete.
Dogma must be replaced with Evidence Based Medicine. What we can also learn from
Biomechanics is is that Helmets protect the head, but do not protect the brain. We have seen athletes
such as boxers dying for years in the ring and wrongly believing that the punch and not the fall was
the cause of death. As a physician, if you treat a baby who has fallen from a couch or a bed, don't
be guided in your diagnosis by dogma alone. Dr Gutkelch original theory on shaking was out of
concern for babies dying for inexplicable reasons. We are no further ahead today in the study of
Sudden Infant Death Syndrome, other than placing babies on their back, than we were 35 years ago
suggested we look at shaking as a possible cause. Hundreds of caregivers have been caught on
video violently shaking babies, and none of those babies suffered the Triad. In the hundreds of
prosecutions for SBS, nobody has ever witnessed a baby being shaken where the baby was
diagnosed with the Triad. They have even re-branded SBS into Abusive Head Trauma, the
implication being that the Triad is caused by abuse causing trauma, thereby eliminating the
possibility that the 21 other known causes of the Triad. (7)
My hope is that doctors will stop killing babies with junk science. While many are sceptical on
SBS, sticking their head above the parapet leads to a Witch Hunt. Sweden has decided recently that
SBS is unproven. (8) Again, this is all reminiscent of a Moral Panic that occurred hundreds of years
ago in Salem. 90% of people have an unshakable faith in a Devil, a Devil that Science has proven
It is unbelievable that in 2016 that we are even having this conversation.
Competing interests: No competing interests
In response to Clare Dyer’s article, Dr Geddes has pointed out the injustice suffered by the doctors who testified as defence experts on behalf of Dr Squier and who have no channel for complaint about or response to the Tribunal’s criticisms of them.
Like Dr Geddes I gave evidence before the MPTS Tribunal for Dr Squier, but as a character witness testifying to her dedication, integrity and commitment to justice. I also testified about the difficulties confronting defence expert witnesses in criminal trials where the prosecution may have a battery of experts from different specialisms but, due to the restrictions on legal aid, the defence only one. Nobody challenged a word of my evidence. Yet the Tribunal in its judgment said of me that it believed that I “lacked some credibility”. Friends and colleagues were astonished by this gratuitous attack on my integrity. So was Mr Justice Mitting, who in his appeal judgment said that these words were the “most egregious example” of findings about defence witnesses which were “as expressed untenable” and that there was “no foundation” for them.
Frankly the absurd slur on my reputation did not trouble me very much. What troubled me far more was the point Dr Geddes makes in her letter: that if experts asked to testify for the defence before an MPTS Tribunal have reason to fear that they may be subject to a gratuitous attack in the judgement, they are likely to refuse. Doctors accused of professional misconduct may find themselves unable to call expert evidence vital to their defence. Dr Geddes is quite right. The GMC Council needs to examine as a matter of urgency what went wrong in this case; how Tribunal members are trained; what guidelines should now be issued and what steps can be taken to prevent recurrence of a situation where a Tribunal whose remit was to examine the alleged misconduct of one doctor ended up by defaming a number of others.
Michael Birnbaum QC
9 – 12 Bell Yard
London WC2A 2JR
Competing interests: I was called as a witness for Dr Squier and was criticised by the Tribunal.
As a medico-legal expert of 30 years' standing, I read this article with interest. It is always tempting for an expert to give evidence in a polarised way and I think the Courts recognise this easily when it happens.
In my salad days, I can recall trying desperately to defend an argument I had put forward very unsuccessfully but realised even at the time, that I was probably wrong. I learned then that to be malleable and accept when one is wrong is the only way forward, even while giving evidence. Many experts argue themselves into a corner even though it is plain that they are incorrect. One wonders why one does this - I suspect it is because one is afraid that when shown to be wrong, we feel our reputation is besmirched.
My advice is to never to be afraid to admit when you are wrong.
I have long since resolved this feeling because I always now refer to conventional wisdom and state both contrary and supportive views, because otherwise one cannot be objective. In most negligence cases I disregard which side has instructed me, because my role as an expert is not only to assist the Court but to ensure that instructing solicitors and barristers are not sent into court to do battle armed only with the 'fruit knife' of unsupportable expert opinion.
My advice to any expert is to be completely objective and state both points of view and indicate the spread of opinion. In your expressed opinion it is vital that you demonstrate why you have formulated that opinion. In some cases academic research can be used, but since in almost any case or condition, articles can be found with a contrary evidential view, it does not help the Court. This is because as trained clinicians, we have experience of the clinical picture but also we have training in assessing medical literature and its significance, which the Court does not.
In the 'shaken baby cases' the correct manifestation of objectivity would have been a stated opinion which contains the facts, then the personal opinion and then a review of contrary opinion and reference to the majority view. Doing so will provide the Court with a clear guidance upon which to base its judgements.
Bottom line - never support either side. Be objective and never fear being shown to be wrong in your views or admitting that you are.
Competing interests: No competing interests
Mr Justice Mitting’s observation that GMC ‘tribunals needed more understanding of the difficulties of being an expert witness in an adversarial court system where proceedings were controlled by judges and lawyers’, was indeed worryingly demonstrated in the case against Dr Squier. Dr Squier had called five expert witnesses, and some of the tribunal’s conclusions about four of them were, the Judge said, “as expressed, untenable.”
I was the fifth defence expert, but I escaped criticism. However, the tribunal made a series of dismissive and critical statements about the other four without giving reasons or examples, suggesting that each was biased and/or unreliable – a series of defamatory remarks against which the they have no right of appeal.
There are two consequences. The first is that the judgment can be used to attack the credibility of any of the four. For example the tribunal’s criticisms of one of the experts, who has a large medicolegal practice in the USA, have been used against her on several recent occasions in American courts, in an attempt to discredit her. She has been unable to refute them, because she has no idea of their basis. The Mitting judgment may have resolved this problem.
But the judgment does not address the second and more insidious consequence. If MPTS tribunals are free to behave in this way, then the risk of being treated so unfairly in a public hearing may well deter experts asked to testify on behalf of accused doctors, from doing so.
Over recent months I have written letters to the Chair of the MPTS, Judge Pearl [who was not the chair of the panel who heard the Squier case], and to the Chair of the GMC, Professor Terence Stephenson. I set out the tribunal’s criticisms of the experts and argued that they had a right to be treated fairly. I asked Professor Stephenson to refer my complaint to the Council of the GMC. I received brief replies from both men to the effect that the only avenue of complaint about a tribunal’s judgment was the right of the defendant doctor to appeal. The American expert’s own letters of complaint about her treatment to both Judge Pearl and Professor Stephenson have been met with similar answers.
I then made a formal complaint to the GMC about the conduct of the tribunal, and about the refusal of Professor Stephenson to refer my complaint to his Council. This was dealt with by the GMC’s routine customer complaints department, who dismissed the complaint without addressing most of the issues I raised. My latest letter to Professor Stephenson has gone unanswered.
It is astonishing that the GMC refuses to investigate a formal complaint about the conduct of a tribunal for which it is responsible. The correspondence leads me to the conclusion that the MPTS, which was ‘established ... to provide a clear separation between the GMC’s investigation function and the adjudication of hearings,’ cannot be considered to be independent of the GMC, and that the GMC is unlikely ever to uphold a complaint against one of its tribunals. However, in the light of Mr Justice Mitting’s comments it is to be hoped that the GMC will now agree at the very least to discuss in Council the treatment of expert witnesses during tribunal hearings, and issue guidelines to prevent a recurrence of what happened in this case.
Jennian Geddes BA MBBS MA FRCPath
 BMJ 2016;355:i5985
 MPTS website http://www.mpts-uk.org/about/1603.asp
Competing interests: I acted as expert for the defence in the case of the GMC vs Dr Squier