"THE STUDY ALSO COULD LESSON THE GUILT FELT BY PARENTS AND DEFLECT THE SUSPICION OFTEN AIMED AT THEM, SAYS DR. ERNEST CUTZ, A PATHOLOGIST AT TORONTO'S HOSPITAL FOR SICK CHILDREN. "THESE KINDS OF STUDIES REINFORCE THE NOTION THAT SIDS IS ACTUALLY A DISORDER OR A DISEASE, NOT AN ACCIDENTAL DEATH. SOMETIMES THEY THINK THESE ARE HOMICIDES," HE SAYS. A 22-YEAR-OLD SINGLE MOTHER LOST CUSTODY OF HER UNBORN BABY TO THE CHILDREN'S AID SOCIETY AFTER NOW-DISGRACED TORONTO PATHOLOGIST DR. CHARLES SMITH CONCLUDED THE EARLIER DEATH OF AN INFANT SON, BELIEVED TO BE SIDS, WAS NOT ACCIDENTAL."
HEALTH REPORTER JOSEPH HALL: THE TORONTO STAR;
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PUBLISHER'S NOTE: Dr. Smith's erroneous conclusion that the death of the infant son was non-accidental - in spite of findings at the time of the death that the death was attributable to Sudden Infant Death Syndrome - followed the release in 1995 by the Ontario Chief Coroner's Office of what is now known as the notorious "think dirty" protocol." The protocol, later condemned by the Goudge Inquiry which looked into many of Smith's cases, read: "Unfortunately, in this day and age CHILD ABUSE IS A REAL ISSUE (sic) and it is extremely important that all members of the investigative team "THINK DIRTY". (Sic). They must actively investigate each case as potential child abuse and not come to a premature conclusion regarding the cause and manner of death until the complete (underlined) investigation is finished and all members of the team are satisfied with the conclusion." One can only imagine what effect an order to "think dirty" would have had in the mind of Dr. Charles Smith, who testified at the Goudge Inquiry that he believed his role was to serve as a member of the prosecution team. Justice Goudge concluded in his report that "Whereas clinical medicine properly approaches treatment by considering the worse possible explanation, forensic pathologists fulfill a very different role. They are providing information that may influence criminal proceedings. In this context it is dangerous and inappropriate to leave any impression that forensic pathologists begin with a premise of foul play that must be disproved. Their objectivity requires that any such impression must be avoided. They must "think "truth," not "think dirty." They must also be seen to do so." The protocol was circulated by former Chief Coroner Dr. James Young. The "think dirty" provision in the protocol was later dropped by Dr. Barry McLellan who replaced it with a "think truth" orientation.
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"It is among the most cruel and inexplicable calamities in medicine – the death of an infant during its peaceful sleep," the story by Health reporter Joseph Hall published earlier today under the heading "Crib death due to chemical imbalance, study says," begins.
"But the crib deaths suffered by thousands of newborn babies each year in North America are caused by a chemical imbalance in the part of the brain that controls breathing during sleep, a new study suggests." the story continues.
"Cases of Sudden Infant Death Syndrome (SIDS) have been routinely attributed to improper sleeping positions or such crib hazards as loose blankets or stuffed toys.
The study found most babies who succumb to SIDS do face those hazards, but the majority also have a shortage of the neurotransmitter serotonin in their brain stems.
The research, published Wednesday in the Journal of the American Medical Association, raises hopes for a diagnostic tool that could identify infants at risk of SIDS.
"The idea would be to find some accessible tissue, like blood, that would reflect on what's happening in the brain stem," says Dr. Hannah Kinney, a Harvard University pathologist and senior study author.
"If we could identify the infant at risk. ... we could presumably treat that defect with a serotonin-related drug," says Kinney, who practises out of Children's Hospital Boston.
Kinney stresses that the diagnostic and therapeutic goals the study suggest are "a long way off" and that other neurochemicals also might play a role in SIDS deaths.
Still, the study represents a major advance toward predictive tests, says Dr. Peter Liu, head of respiratory health at the Canadian Institutes of Health Research. "This may help in the future to design a blood test to figure out which children may be at risk and then design a way to treat them," he says.
The study also could lesson the guilt felt by parents and deflect the suspicion often aimed at them, says Dr. Ernest Cutz, a pathologist at Toronto's Hospital for Sick Children.
"These kinds of studies reinforce the notion that SIDS is actually a disorder or a disease, not an accidental death. Sometimes they think these are homicides," he says.
A 22-year-old single mother lost custody of her unborn baby to the Children's Aid Society after now-disgraced Toronto pathologist Dr. Charles Smith concluded the earlier death of an infant son, believed to be SIDS, was not accidental.
Cutz, who has worked extensively on SIDS for decades, adds more work needs to be done to determine why serotonin levels are low and how that can lead to crib death.
About three Canadian babies die each day from SIDS. And one in every 2,000 newborns likely has a serotonin deficiency, Kinney says.
Kinney says three-quarters of the 41 SIDS babies she studied through autopsy samples also faced other "modifiable" risk factors, such as sleeping on their stomachs, or loose bedding and stuffed animals in their cribs. But "we found this serotonin defect ... in the majority of the babies ... whether or not they had a particular risk factor."
Serotonin is one of the brain's key neurotransmitters. In upper parts of the brain, for example, it plays a key role in regulating areas devoted to emotional stability. But in the brain stem, serotonin is an important regulator of breathing, especially during sleep, Kinney says. While they're awake, babies' breathing is controlled by numerous parts of the brain. While asleep, however, they rely solely on their brain stems to regulate air intake.
"So a baby who's awake seems normal, but when the baby falls to sleep this problem is unmasked."
Babies with normal serotonin turn their heads if blankets or toys are impairing their breathing, Kinney says. "But a SIDS baby has a defect in that (serotonin) circuit and can't get out of that situation."
Among the study subjects, levels of the chemical were on average 26 per cent lower than those found in babies who had died of unrelated but known causes." The story can be found at:
http://www.healthzone.ca/health/newsfeatures/research/article/759763--crib-death-due-to-chemical-imbalance-study-says?bn=1
Harold Levy...hlevy15@gmail.com;
