Meadow and MSbp

MEADOW AND MSbP
Mon Nov 5 2001
Email from Ken Norman.

This will be posted to the various bods tomorrow morning. The contention here is that Professor Sir Roy Meadow is unfit for office, has given wholly inaccurate evidence in criminal cases, resulting in gross miscarriages of justice, and should face trial for the murder of a child.

Copies of this letter are being sent to the Chief Crown Prosecutor, the Lord Chancellor, the Law Commission, Lord Chief Justice, General Medical Council, British Medical Association, Council for the Registration of Forensic Practitioners, Royal College of Paediatrics and Child Health, Mr Keith Bradley (MP for Manchester and concerned with criminal justice, sentencing, and law reform), "The Lancet," "British Medical Journal" and the media.

Although on Portia Campaign stationery, for the purposes of identification, the letter is entirely my own and I bear sole responsibility for it.

The British version of Munchausen Syndrome by Proxy (MSbP) was dreamed up by Professor Meadow, but there was a prior version by two US doctors in a slightly different form. It is highly controversial; some doctors believe it is not accurately diagnosable, others that it is a convenient means of getting convictions

The "signs" of MSbP are defined as abdominal pain, apnoea, bleeding, diabetes, diarrhoea, eczema, fevers, infections, lethargy, rashes, renal failure, seizures, shock, tachycardia, vomiting, weight loss. These are also the symptoms of organophosphate poisoning.

In an article published in The Lancet on August 13, 1977, Professor Meadow reported a case that led to a murder conviction for a mother for allegedly administering salt to her daughter, and on it he based his theory of MSbP. To test the effect, he himself had salt-loaded the child.

A child-specialist such as Meadow should have been well aware of the danger of giving solid salt to an infant even in 1977 - indeed, he was aware in that he suspected that the mother was murdering the child in this way. Aware that salt-loading could be fatal, he carried out an unauthorised and highly dangerous experiment - without consent from a parent or anyone else, and described it as "difficult" to get the 20g of salt accepted by the child. There could not have been similar difficulty for the mother in her alleged dosings or this would have attracted attention from staff or visitors to the hospital - surely proof that if she was feeding salt it was in far lesser quantity than that he himself gave - yet he subsequently accused the mother of fatal salt administration and got her convicted!

Professor Meadow could have experimented on the child by administering a dilute isotonic solution - but the amount he gave was 20g of solid salt!

Salt is the chemical lethal weapon for aborting unwanted pregnancies - there is a lot of knowledge on what salt does when given in excess to an infant or foetus.

There is also the objection that over a period of time Meadow, believing that the child was being murdered, coldly watched his suffering, deterioration and eventual death. Surely any normal human being would have chosen to raise the alarm and attempt to prevent further suffering. If he had done so this child might still be alive and the mother could have been spared a murder conviction. It may be that salt, if she was giving it, was at a non-lethal level and her actions could have been entirely innocent, in the belief that an insufficiency of salt (a necessity for life) was the cause of illness. A word of advice from a dietician might have sufficed. But Meadow's only concern, apparently, was that the child should die to prove his theory of MSbP, for which he obtained a knighthood. ?

He recorded meticulously a deterioration in the child's condition after each visit by the mother. (My own daughter, as a baby, became deeply distressed after each parental visit made to her in hospital: she longed to come home.

A recent inquest (reported by the BBC) decided that death had been caused by ingestion of 9g of salt. A child of this age [three months], it was said, can digest only 0.5g a day - the pathology was that there had been massive brain damage.

A three-month-old child should weigh just over one stone - the child mentioned in the Meadow article would be about two stones (using standard tables for weight v. age).

So 20g is at the level where agonising death could be expected over five days or so.

Endocrinologists in the USA have repeated the Meadow test (not on a human being, I should add) and they have sworn affidavits that the amount Meadow administered would have been lethal. A documentary is being prepared.

The death needs to be investigated more thoroughly - but there is enough already to demand a police enquiry.

I have no pleasure in initiating this enquiry - but how many parents and carers have been falsely convicted of murder because of Meadow's venomous and astoundingly confused and flawed expert evidence? He appears to be a man on a mission - professedly to "think dirty" - who has lost all sense of proportion and reality.?

In his paper "Mothering to Death" in Arch Dis Child 1999; 80: 359-362 (April) he writes entirely of his own work - no one else is involved. The names are anonymous - how do we check for accuracy? The first four references given to back up his paper are from (1) Meadow, (2) Meadow, (3) Meadow, (4) Meadow. Altogether five of the people who agree with him are named Meadow. Is this science?

He gives as an example an account of a young woman, Pat, who was "mothered to death" (Arch Dis Child 1999;80:359-362 ( April). Other people do not agree: Local authority - "We cannot hammer down the door"; Social Services - "We cannot force ourselves on people"; doctor - "It's a free world;" the father - "there is no suggestion of cruelty or lack of concern."

Pat was 28 when she died and had not looked after herself. It is impossible to hold everyone's hand and if people want to abuse themselves, commit suicide, etc - as the doctor said - it's a free world!

An article by Meadow - "Unnatural sudden infant death" (Arch Dis Child 1999;80:7-14 (January) - describes 81 UK cases in which children were judged by criminal and family courts to have been killed by their parents. The cases were from the previous 18 years; a small number were from Meadow's locality; in the others he was involved at the request of medical colleagues, social services, or the police. The judgements, he says, were based on "a high degree of probability" (not on certainty). Before Meadow became involved, each of these deaths was regarded as being from natural causes. ?

"The reason that more than half the reported families included more than one dead child is likely to be because the courts were impressed by evidence that it was highly improbable for two or more children to die in infancy of undiagnosable natural causes: 'if there is a 1/1,000 chance of a child dying suddenly and unexpectedly of natural causes in the first year of life, the chance of two children within a family so dying is 1/1,000,000.' A parent who kills only one child is much less likely to be incriminated than one who kills or abuses two or more. Nevertheless, the findings of 26 serial killers is worrying." ?

This is absolute claptrap, and identical with the misinformation that convicted Julie Ferris, Donna Anthony and Sally Clark. The Royal Statistical Society issued an embargoed news release in October 2001 expressing concern at the misuse of statistics in the courts.

"In the recent highly-publicised case of R v. Sally Clark, a medical expert witness [Meadow] drew on published studies to obtain a figure for the frequency of sudden infant death syndrome (SIDS, or 'cot death') in families having some of the characteristics of the defendant's family. He went on to square this figure to obtain a value of 1 in 73 million for the frequency of two cases of SIDS in such a family.

"This approach is, in general, statistically invalid. It would only be valid if SIDS cases arose independently within families, an assumption that would need to be justified empirically. Not only was no such empirical justification provided in the case, but also there are very strong a priori reasons for supposing that the assumption will be false. There may well be unknown genetic or environmental factors that predispose families to SIDS, so that a second case within the family becomes much more likely.

"The well-publicised figure of 1 in 73 million thus has no statistical basis. Its use cannot reasonably be justified as a 'ballpark' figure because the error involved is likely to be very large, and in one particular direction. The true frequency of families with two cases of SIDS may be very much less incriminating than the figure presented to the jury at trial.

"Aside from its invalidity, figures such as the 1 in 73 million are very easily misinterpreted. Some press reports at the time stated that this was the chance that the deaths of Sally Clark's two children were accidental. This (mis-)interpretation is a serious error of logic known as the Prosecutor's Fallacy. The jury needs to weigh up two competing explanations for the babies' deaths: SIDS or murder. Two deaths by SIDS or two murders are each quite unlikely, but one has apparently happened in this case. What matters is the relative likelihood of the deaths under each explanation, not just how unlikely they are under one explanation (in this case SIDS, according to the evidence as presented).

"There is a real possibility that without proper guidance, and well-informed presentation, frequency estimates presented in court could be misinterpreted by the jury in ways that are very prejudicial to defendants.

"Society does not tolerate doctors making serious clinical errors because it is widely understood that such errors could mean the difference between life and death. The case of R v. Sally Clark is one example of a medical expert witness making a serious statistical error, one which may have had a profound effect on the outcome of the case. [The inference is that Prof. Meadow should not be tolerated.]

"The chance of a parent finding a child dying a natural death a few seconds before stopping breathing is very small," Meadow wrote. If this isn't nonsense, it's absurd. Apnoea monitors are offered to parents who have lost a child, in the hope that if a second child is near to breathing stoppage, they might hear the alarm and rush in to prevent death.

In some of the 81 cases there was admission of guilt, but this is far from being certainty: a parent, in extreme distress following loss of a child, is subjected to prolonged interrogation, never before having been in police hands. There will inevitably be self-questioning: "What did I do wrong? How could I have prevented this?" And then the offer: admit guilt and you'll likely get probation; deny it and you'll be jailed for life."

Meadow may have wrecked 81 innocent lives (and during the same period he was also involved in 200 other cases in which parents were alleged to have abused infants). It raises the question, "Does he like women?"; "does he enjoy crucifying them?"; sometimes there is the question, "does he even like children?"

As the result of a BMJ article and subsequent letters, plus television and radio documentaries and newspaper articles, it is now common knowledge that he oversteps the mark - e.g. on statistics such as "a cot death in an affluent family is at odds of one in 8,500 therefore two deaths must involve odds of one in 73 million and will occur only once in a hundred years." Or (in securing murder convictions against several other less-affluent mothers, "two deaths involve odds of one in a million."

There are patently double cot deaths every 18 months in Britain, and so the good paediatrician must be convinced that 55 out of every 56 such double tragedies are actually murder. Worst, still, he has such prestige that when he chooses to give "expert" evidence there is almost inevitably a conviction, followed by dismissal of appeal.

Recently, in Birmingham, Meadow gave the opinion that a child's death was "probably murder." Police had investigated and saw no reason to doubt that the death was natural - and yet on this vague opinion alone, Social Services took away the couple's second child hours after birth, and it is now well into the stage of adoption - with the blessing of a family court judge. There has been no criminal trial. Meadow's opinion of "probability" is sufficient. ?

"Gene find casts doubt on double 'cot death' murders." This was the headline for an "Observer" article on July 15, 2000, which was co-ordinated with a BBC Radio 5 documentary attacking convictions obtained by Meadow. (He was asked to respond but declined to do so.) However, the newly discovered gene does more than the headline claims. Miss Louise Woodward, Mrs Helen Stacey and Mrs Manjit Basuta (among others) were convicted of murdering an infant in their care. . . . But in all three cases there is evidence of genetic flaws and the deaths were "probably natural."

Mrs Marie Noe, of Philadelphia, who suffered the inexplicable loss of seven children, and was described in a newspaper headline as a "Momstrosity" most probably did nothing whatever to bring about their deaths. In his book "ABC of child abuse," Meadow wrote: "One sudden infant death is a tragedy, two is suspicious and three is murder until proved otherwise." (This was the aphorism used by coroner Halbert Fillinger at the trial of Mrs Noe.) But then Meadow took it further: two deaths were no longer "suspicious," but involve odds of one-in-a-million or one-in-73 million according to affluence. A single death is "probably murder."

Meadow has given successful evidence for the prosecution in criminal trials and family courts around the world and now, like Icarius, becoming egotistically confident of his own infallibility, overreach has (I hope) brought downfall.

In every "murder trial" in which he has been involved there is high probability that death was natural, perhaps due to genetic mutation. And - for genetic research is still in its infancy - there may be many mutations that kill children.

The Radio 5 documentary ended with advice for the Home Secretary: every conviction resulting from death of a child without substantial evidence of abuse should be reconsidered, from the viewpoint, "one child death is a tragedy, two is a tragedy, three is a tragedy."

John Sweeney and Bill Law wrote in the "Observer" that the damning evidence against Mrs Sally Clark was the inexpert evidence of Professor Meadow that there was "only one chance in 73 million" that the deaths of her two babies were anything but murder. This was described as a "crude aphorism by a knighted professor, a superb performer in the witness box."

John Batt, a solicitor who has known Mrs Clark since childhood, and was astonishingly successful in preventing her name being struck off the list of lawyers, said the trial jury's reaction may have been that if she could prove her two children died naturally, they would let her off, "but if she can't she must be guilty." However, he added, there is no way known to science that can prove she did not shake or smother the infants.

"No-one" [writes the "Observer"] is suggesting mothers never kill their babies. But Meadow's Law risks tarring all mothers who have suffered multiple cot deaths [or single ones] as murderers. It presumes guilt, and the presumption kicks in at the moment a second cot death occurs [or before] - when an innocent mother would be going through unendurable pain.

"Not a single statistician we have contacted has said that 'one in 73 million' - and the way in which Meadow used it - is defensible.

"Peter Donnelly, professor of statistical science at Oxford University, is scathing: 'It is poor science, it's not rigorous, it's just wrong.'

"In February Manchester University announced: 'Cot death gene identified.' Scientists looked at the DNA of 23 babies who had died from cot death or sudden infant death syndrome (SIDS) and compared it with the genetic make-up of normal babies. Babies with three particular genetic differences were three times more likely to die from SIDS. The genes 'switched on and off' the immune system. One gene was particularly important.