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NEWS ROUNDUP: Clare Dyer Group to review babies' deaths BMJ 2003; 327: 10-a [Full text]

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A Tapestry of Errors and Influence

Lisa C Blakemore-Brown   (5 July 2003)

Conspiracy?

C Johnson   (10 July 2003)

Limited value

Michael D Innis   (10 July 2003)

A Tapestry of Errors and Influence 5 July 2003
Lisa C Blakemore-Brown, Psychologist UK Send response to journal: Re: A Tapestry of Errors and Influence	Lord Goldsmith has made a wise decision to review cases in which Dr Williams and Professor Meadow have been involved, following the outcomes of the Sally Clark and Trupti Patel trials. Scrutiny of the evidence in both cases in open Court has enabled the public to see for themselves the same types of errors and flawed methodologies which have existed for many years in Family Courts, held in secret. There must therefore also be a very strong argument for reviewing all the cases in which the same methods and theories have been used by all 'MSBP/FII' Experts - in Criminal and Family Courts. One fundamental reason for this relates to the likely considerable number of miscarriages of justice in all cases involving MSBP reasoning and MSBP `Experts`, if the methods are flawed. Back in May 2002, Stephen Watkins, a statistician, responded in the BMJ to Sir Roy Meadow's response to his BMJ Editorial `Conviction by Mathematical Error` in which he discussed statistical errors and the potential that a miscarriage of justice had occurred, given those errors, in the Sally Clark case. In his excellent article Dr Watkins wrote: "There is also a fundamental assumption in Sir Roy’s article and the Court of Appeal decision that the pathology evidence was independent of the statistical evidence. If however the misunderstanding implicit in the statistical evidence formed part of the body of knowledge which shaped the pathologist’s perceptions of probabilities, and hence their index of suspicion, the two sets of evidence would not be independent. Rather they would embody exactly the same error, one of them directly and the other indirectly." (1) It is precisely this raised 'index of suspicion' through an influence by MSBP Experts on the perceptions and subsequent actions of others, including other Experts, which I have argued for many years is pivotal to wrongful allegations in MSBP. As a psychologist with many years of experience in cases of false allegations of MSBP, I know that these influences on the perceptions and actions of other Experts, Paediatricians, Social Workers, Psychologists, Psychiatrists, Police, CPS, Courts, Juries etc. are not only related to misunderstandings about probabilities, although without a doubt statistical errors lie at the root of the lack of logic in the theory of MSBP. In my first letter of concern in 1997(2)I infer my concerns about statistical error in the theory, as well as expressing my grave concerns about the lack of a robust scientific basis for the assumptions inherent in the theory and the entire manner in which cases were handled. It was clear that, for instance, certain attributes/circumstances of individuals who may have committed offences against children were used to accuse all those with those attributes of either committing similar offences or of having the potential to do so. The latter has led to an epidemic of MSBP, as we might expect. Once the theory has been used to accuse a parent, the errors are compounded by the extraordinary ongoing influence of leading MSBP Experts, across the entire world. In many cases no actual statistics are given at all, though probability is implied as in 'I'm pretty sure she did it', or, more usually, a dogmatic `she put a pillow over his head/she fed her 14 tablets' with not a shred of evidence at all, could easily be enough to shift uncertainty nearer to certainty for `disbelievers` if stated by a person of power and eminence. Astonishingly, the Government Guidelines on Factitious Disorders advise that if someone in a case conference finds it difficult to accept an MSBP accusation, they will need to be guided by a more senior and `expert` specialist in MSBP. Much groundwork is done prior to an actual Court case and the very involvement of a powerful and eminent Expert can in itself easily shift perceptions. The Expert can also improve the chances of his opinion being accepted by other Experts before they get to Court, with a mere phone call, a scribbled note or a stunning performance in the pre-trial experts' conference. The gossamer breath of rumour then whispers its foul message far and wide. Given a raised 'index of suspicion' toward the theory of MSBP, further raised by all the shocking thoughts and images about a mother's behaviour which it conjures up - if not graphically described by the MSBP expert - and the mind numbing effect of those thoughts, given the sickening challenge to the universally accepted maternal instinct, no wonder many Experts have lost their common sense and abandoned their formerly sound scientific methods, good practice and attention to detail of real evidence when formulating opinion. It is therefore of vital importance, in my humble opinion, that the problems and errors now exposed in the Clark and Patel cases, are seen in the context of MSBP methodology and its profound and increasingly compounded influence. I do believe that if we do not take this wider view, a lot of precious time, opportunity and public money could be wasted - as with other limited Inquiries - trying to find out what went wrong, with very limited answers likely at the end of the deliberations. Whilst I welcome this move by the Government and the Attorney General, could I suggest that reviews should not be limited to separated out statistical and pathology evidence in a small number of cases related to cot death involving just two of the many MSBP experts. Instead, the patterns of error in all cases involving the use of the phenomenon of MSBP and the use of MSBP Experts should be recognised as responsible for the interdependency of expert prosecution evidence and influence and the ultimate profound miscarriages of justice. This tapestry of errors and influence should be unravelled with some urgency by reviewing all cases involving MSBP methodology and MSBP Experts in both Family and Criminal Courts. 1. Watkins S.J. Response to A Case of Murder bmj.com 14th May 2002 2. Blakemore-Brown L.C. Munchausen Syndrome by Proxy Letters to the Editor The Psychologist September 1997 Competing interests: Gave evidence at the Griffiths' Inquiry which recommended a Government Working Party to look at MSBP, which in turn led to the production of the Factitious Disorder Guidelines. Competing interests:   I gave evidence at the Griffiths Inquiry which recommended that the Government set up a Working Party on MSBP. From this emerged the Guidelines on Factitious Disorder.
Conspiracy? 10 July 2003
C Johnson, parent LA9 Send response to journal: Re: Conspiracy?	"The Expert can also improve the chances of his opinion being accepted by other Experts before they get to Court, with a mere phone call, a scribbled note or a stunning performance in the pre-trial experts' conference." When non-Expert witnesses do this it is usually called conspiracy to pervert the course of justice. Competing interests:   None declared
Limited value 10 July 2003
Michael D Innis, Director Medisets International Home 4575 Send response to journal: Re: Limited value	Editor, Confining the Lord Chancellor's investigation to the cases which involved Dr Williams is of limited value. First and foremost let me say again from my interpretation of the Clinical, Laboratory and Post mortem findings, which were sent to me, SALLY CLARK IS INNOCENT OF THE CRIMES FOR WHICH SHE WAS CHARGED. Both children died of natural causes. Of that I have absolutely no doubt whatsoever. Having clarified that point I believe it is a mistake to take Dr Williams to task for not making known to the Jury what he, and for that matter I and some others, regard as a post mortem artefact. To claim that staphylococci in the cerebrospinal fluid when associated with neutrophil leucocytes in a post-mortem specimen is evidence of meningitis is illogical and was rightly ignored by Dr Williams. Why was there no neutrophil response in the other half dozen or so sites colonized by staphylococci? Surely it was because the tissues were already dead and could not respond to the staphylococcal invasion. But if dead then why were neutrophils seen in the brain? Because the neutrophils were a response to the subdural haemorrhage which occurred before death. After death the staphylococci, normal inhabitants of the nose, were free to disseminate unchecked by any immune reaction and by chance some lodged in the brain. Much more good will be done for the long suffering English speaking world community, where “think dirty”[1] is the order of the day, if His Lordship can make Paediatricians, Radiologists and Forensic Pathologists desist from claiming rib calluses are “rib fractures”. A callus is a subperiosteal haemorrhage in the process of healing. There are more than two dozen reasons why a child may suffer a naturally acquired subperiosteal bleed. One doesn’t have to postulate an adult stomping on the infant as some would have the blissfully innocent Jurors believe when they use the term “fracture”. Harry Clark had a callus on the left second rib in the midaxillary line – that is under the armpit. Much was made of this by the prosecution. Yet how absurd to attribute a lesion in that situation to a vicious blow to the chest. It was obviously a subperiosteal bleed following Vitamin K deficiency. When a Paediatrician gets those “non-specific feelings” induced by “reported symptoms which do not correlate with any recognizable disease …” [2] the carer is doomed. The Jury assumes the paediatrician is an infallible diagnostician with a knowledge of all “recognizable” diseases. I have reports from Iceland, America, England and Australia where Liver Disease, Vitamin K deficiency, Vitamin C deficiency and Atypical Kawasaki disease have been misdiagnosed partly because of failure to carry out the appropriate investigations. The Experts are not infallible. While on the subject of misdiagnoses perhaps it is worth reminding Ophthalmologists that retinal haemorrhages, with or without retinoschisis, can no longer be claimed to be pathognomonic of Non- accidental injury.[3] Lord Goldsmith will be doing humanity a great service if he can stop innocent carers from incarceration and children from being separated from their parents by an over enthusiastic and misguided Child Protection Service. Instead of concentrating on Dr Williams’ reports His Lordship might consider looking into all reports in which Radiologists have reported “rib fractures” and all cases in which Ophthalmologists have reported “retinal haemorrhages” with or without “retinoschisis”. Pathologists examining the lungs might also be reminded that “attempted suffocation “ is not the only reason for the presence of siderophages in alveoli of the lung and these cases are also worth re-examining. The report of Geddes et al [4] casts a new light on brain swelling and intracerebral haemorrhages which all should heed. And last, but not least, His Lordship might investigate the pernicious habit of the Police offering “plea bargains” to intimidated less well educated alleged perpetrators. Not all have the intelligence and fortitude of Sally Clark to resist such pressures. Michael Innis FRCPA; FRCPath. Reference: 1. Protocol for the investigation of sudden and unexpected deaths in children under 2 years of age. Toronto Ministry of the Solicitor General and Correctional Services, 1995 (Memorandum No 63.1) 2 Fabricated or Induced Illness by Carers. p34 www.rcpch.ac.uk 3.Judge acquits man of baby shaking death www.sundaytimes.news.com.au/story_page/0,7034 4. Geddes JF, Tasker RC, Hackshaw CD, Nickols CD et al; Dural haemorrhages in non-traumatic infant deaths: does it explain the bleeding in “shaken baby syndrome”. Neuropathology and Neurobiology 2003 (29) 14-22 Competing interests:   I have advised the Defence in 10 cases of alleged Non-accidental Injury.