POST: "Shaking up "shaken baby syndrome" by Waney Squier, published by Project Syndicate on April 26, 2014. (Waney Squier is a pediatric neuro-pathologist at the John Radcliffe Hospital in Oxford.)
GIST: "Waney Squier reviews medical evidence suggesting that many caregivers are being wrongly accused and imprisoned."
The entire post can be found at:
Shaking Up “Shaken Baby Syndrome”
CommentsView/Create comment on this paragraphOXFORD
– The most tragic event that can befall new parents is the sudden,
unexpected death of their baby. Perhaps the only thing worse is the
parents being wrongly accused of causing the death, and indeed
prosecuted, owing to the medical community’s misinterpretation of the
findings.
CommentsView/Create comment on this paragraphA
small number of babies who collapse and die unexpectedly in their first
year are found to have one or more of the following three symptoms in
common: bleeding just outside the brain (subdural hemorrhage); bleeding
at the back of the eye (retinal hemorrhage); and brain swelling.
CommentsView/Create comment on this paragraphThese
same features are also seen in some babies who have suffered trauma,
such as falls or motor-vehicle accidents. Yet many babies with these
symptoms have no history or medical evidence of trauma (such as
fractures, abrasions, or bruises), physical abuse, or neglect.
CommentsView/Create comment on this paragraphPediatricians
wrestled with this conundrum until the 1970’s, when it was proposed
that shaking might induce rotational forces and cause the “triad” of
symptoms without bruises or fractures. Over the years, these findings
evolved into “shaken baby syndrome” (SBS), a medico-legal hypothesis
that remains contentious, and scientifically unproven, to this day.
CommentsView/Create comment on this paragraphThe
SBS hypothesis attributed the triad of symptoms to the physical rupture
of blood vessels on the brain’s surface and in the retina, and the
tearing of nerve fibers within the brain. It was suggested that these
outcomes required a force equivalent to a multi-story fall or major
motor-vehicle accident, causing immediate symptoms or collapse. Because
violent shaking cannot be accidental, the hypothesis simultaneously
established a criminal act and identified the perpetrator, typically the
person with the baby at the time of collapse.
CommentsView/Create comment on this paragraphThough
the SBS hypothesis was incorporated into medical training and judicial
decisions worldwide, it remained untested for almost two decades. In
1987, the first biomechanical experiments found that the force of
shaking is much less than that of impact and concluded that shaking
alone was unlikely to cause the triad of symptoms.
CommentsView/Create comment on this paragraphSubsequent
research in my specialty, pediatric neuropathology, established that
the medical basis for the SBS hypothesis was also flawed. We learned
that the brain damage in these children did not reflect trauma to nerve
fibers, but rather a failure of blood supply. We also learned that the
typical subdural hemorrhages in these cases are too thin to result from
the rupture of the large bridging veins on the brain’s surface. And we
learned that the same findings are seen in natural deaths. In the last
decade, the list of other causes – including accidental trauma,
congenital causes, and natural illness – has continued to grow.
CommentsView/Create comment on this paragraphPerhaps
the most compelling observation in recent years is that subdural
hemorrhages are present in nearly half of normal, healthy newborns with
no evidence of birth trauma. These findings, combined with the immature
anatomy of the infant dura, suggest that dural bleeding in young babies
may be a natural protective device – a reservoir to prevent backflow
into the brain’s blood vessels during the pressure fluctuations of
normal labor and delivery.
CommentsView/Create comment on this paragraphBecause
these anatomical features persist into early childhood, the dura may
remain similarly vulnerable to bleeding beyond the newborn period.
Indeed, both birth-related bleeds and those attributed to shaking are
most often located in the folds of membranes covering the brain that
have more and larger blood vessels at this age than later in life.
CommentsView/Create comment on this paragraphWhile
scientific evidence over the last three decades has undermined the
shaken baby hypothesis, no new evidence has emerged to support it.
Instead, several researchers have relied upon the data in older studies
to calculate the statistical probability of inflicted brain injury when
certain features (such as intracranial hemorrhage, retinal hemorrhage,
brain swelling, and seizures) are present. These probabilities are then
offered as the basis for diagnosis and as evidence in court.
CommentsView/Create comment on this paragraphHowever,
the reasoning behind the studies on which these researchers rely is
circular, and based on assumptions now known to be unreliable. For
example, in some studies, the researchers decided arbitrarily that falls
of less than one meter could not harm a baby, so that parents who
described such a fall must be lying. Other studies viewed the parents’
inability to explain the findings as evidence of abuse.
CommentsView/Create comment on this paragraphGiven
these flaws, reviews of old studies do not provide a reliable evidence
base for diagnosing abuse. They simply predict the likelihood that
specific findings will be categorized as abusive, and that,
consequently, the child’s caregiver at the time will be accused or
convicted of abuse, regardless of the accuracy of the diagnosis.
CommentsView/Create comment on this paragraphLeading
proponents of the SBS hypothesis now acknowledge that the triad is a
“myth,” that SBS diagnoses consist of “informed speculation,” and that
the hypothesis is supported solely by confessions. Some courts are
following suit, with one US federal judge describing the types of
confessions obtained as “worthless as evidence,” and another noting that, given recent developments, claims of SBS may be “more an article of faith than a proposition of science.”
CommentsView/Create comment on this paragraphNo
one questions whether infants can be damaged or killed by violent
shaking or abuse; of course they can. The real issue is whether shaking
or abuse can be inferred on the basis of a hypothesis that lacks
scientific support. In no other area of medicine and law would an
unproved hypothesis provide a basis for diagnosis, let alone criminal
prosecution.
CommentsView/Create comment on this paragraphGiven
the developments of the past decade, we now face the possibility that
for the past 30 years we have been wrongly imprisoning parents on the
basis of a flawed hypothesis.
Read more at http://www.project-syndicate.org/commentary/waney-squier-reviews-medical-evidence-suggesting-that-many-caregivers-are-being-wrongly-accused-and-imprisoned#CwA4lJr6975DpmYE.99
Shaking Up “Shaken Baby Syndrome”
CommentsView/Create comment on this paragraphOXFORD
– The most tragic event that can befall new parents is the sudden,
unexpected death of their baby. Perhaps the only thing worse is the
parents being wrongly accused of causing the death, and indeed
prosecuted, owing to the medical community’s misinterpretation of the
findings.
CommentsView/Create comment on this paragraphA
small number of babies who collapse and die unexpectedly in their first
year are found to have one or more of the following three symptoms in
common: bleeding just outside the brain (subdural hemorrhage); bleeding
at the back of the eye (retinal hemorrhage); and brain swelling.
CommentsView/Create comment on this paragraphThese
same features are also seen in some babies who have suffered trauma,
such as falls or motor-vehicle accidents. Yet many babies with these
symptoms have no history or medical evidence of trauma (such as
fractures, abrasions, or bruises), physical abuse, or neglect.
CommentsView/Create comment on this paragraphPediatricians
wrestled with this conundrum until the 1970’s, when it was proposed
that shaking might induce rotational forces and cause the “triad” of
symptoms without bruises or fractures. Over the years, these findings
evolved into “shaken baby syndrome” (SBS), a medico-legal hypothesis
that remains contentious, and scientifically unproven, to this day.
CommentsView/Create comment on this paragraphThe
SBS hypothesis attributed the triad of symptoms to the physical rupture
of blood vessels on the brain’s surface and in the retina, and the
tearing of nerve fibers within the brain. It was suggested that these
outcomes required a force equivalent to a multi-story fall or major
motor-vehicle accident, causing immediate symptoms or collapse. Because
violent shaking cannot be accidental, the hypothesis simultaneously
established a criminal act and identified the perpetrator, typically the
person with the baby at the time of collapse.
CommentsView/Create comment on this paragraphThough
the SBS hypothesis was incorporated into medical training and judicial
decisions worldwide, it remained untested for almost two decades. In
1987, the first biomechanical experiments found that the force of
shaking is much less than that of impact and concluded that shaking
alone was unlikely to cause the triad of symptoms.
CommentsView/Create comment on this paragraphSubsequent
research in my specialty, pediatric neuropathology, established that
the medical basis for the SBS hypothesis was also flawed. We learned
that the brain damage in these children did not reflect trauma to nerve
fibers, but rather a failure of blood supply. We also learned that the
typical subdural hemorrhages in these cases are too thin to result from
the rupture of the large bridging veins on the brain’s surface. And we
learned that the same findings are seen in natural deaths. In the last
decade, the list of other causes – including accidental trauma,
congenital causes, and natural illness – has continued to grow.
CommentsView/Create comment on this paragraphPerhaps
the most compelling observation in recent years is that subdural
hemorrhages are present in nearly half of normal, healthy newborns with
no evidence of birth trauma. These findings, combined with the immature
anatomy of the infant dura, suggest that dural bleeding in young babies
may be a natural protective device – a reservoir to prevent backflow
into the brain’s blood vessels during the pressure fluctuations of
normal labor and delivery.
CommentsView/Create comment on this paragraphBecause
these anatomical features persist into early childhood, the dura may
remain similarly vulnerable to bleeding beyond the newborn period.
Indeed, both birth-related bleeds and those attributed to shaking are
most often located in the folds of membranes covering the brain that
have more and larger blood vessels at this age than later in life.
CommentsView/Create comment on this paragraphWhile
scientific evidence over the last three decades has undermined the
shaken baby hypothesis, no new evidence has emerged to support it.
Instead, several researchers have relied upon the data in older studies
to calculate the statistical probability of inflicted brain injury when
certain features (such as intracranial hemorrhage, retinal hemorrhage,
brain swelling, and seizures) are present. These probabilities are then
offered as the basis for diagnosis and as evidence in court.
CommentsView/Create comment on this paragraphHowever,
the reasoning behind the studies on which these researchers rely is
circular, and based on assumptions now known to be unreliable. For
example, in some studies, the researchers decided arbitrarily that falls
of less than one meter could not harm a baby, so that parents who
described such a fall must be lying. Other studies viewed the parents’
inability to explain the findings as evidence of abuse.
CommentsView/Create comment on this paragraphGiven
these flaws, reviews of old studies do not provide a reliable evidence
base for diagnosing abuse. They simply predict the likelihood that
specific findings will be categorized as abusive, and that,
consequently, the child’s caregiver at the time will be accused or
convicted of abuse, regardless of the accuracy of the diagnosis.
CommentsView/Create comment on this paragraphLeading
proponents of the SBS hypothesis now acknowledge that the triad is a
“myth,” that SBS diagnoses consist of “informed speculation,” and that
the hypothesis is supported solely by confessions. Some courts are
following suit, with one US federal judge describing the types of
confessions obtained as “worthless as evidence,” and another noting that, given recent developments, claims of SBS may be “more an article of faith than a proposition of science.”
CommentsView/Create comment on this paragraphNo
one questions whether infants can be damaged or killed by violent
shaking or abuse; of course they can. The real issue is whether shaking
or abuse can be inferred on the basis of a hypothesis that lacks
scientific support. In no other area of medicine and law would an
unproved hypothesis provide a basis for diagnosis, let alone criminal
prosecution.
CommentsView/Create comment on this paragraphGiven
the developments of the past decade, we now face the possibility that
for the past 30 years we have been wrongly imprisoning parents on the
basis of a flawed hypothesis.
Read more at http://www.project-syndicate.org/commentary/waney-squier-reviews-medical-evidence-suggesting-that-many-caregivers-are-being-wrongly-accused-and-imprisoned#Sh5DE1HDEecLTuIZ.99
Shaking Up “Shaken Baby Syndrome”
CommentsView/Create comment on this paragraphOXFORD
– The most tragic event that can befall new parents is the sudden,
unexpected death of their baby. Perhaps the only thing worse is the
parents being wrongly accused of causing the death, and indeed
prosecuted, owing to the medical community’s misinterpretation of the
findings.
CommentsView/Create comment on this paragraphA
small number of babies who collapse and die unexpectedly in their first
year are found to have one or more of the following three symptoms in
common: bleeding just outside the brain (subdural hemorrhage); bleeding
at the back of the eye (retinal hemorrhage); and brain swelling.
CommentsView/Create comment on this paragraphThese
same features are also seen in some babies who have suffered trauma,
such as falls or motor-vehicle accidents. Yet many babies with these
symptoms have no history or medical evidence of trauma (such as
fractures, abrasions, or bruises), physical abuse, or neglect.
CommentsView/Create comment on this paragraphPediatricians
wrestled with this conundrum until the 1970’s, when it was proposed
that shaking might induce rotational forces and cause the “triad” of
symptoms without bruises or fractures. Over the years, these findings
evolved into “shaken baby syndrome” (SBS), a medico-legal hypothesis
that remains contentious, and scientifically unproven, to this day.
CommentsView/Create comment on this paragraphThe
SBS hypothesis attributed the triad of symptoms to the physical rupture
of blood vessels on the brain’s surface and in the retina, and the
tearing of nerve fibers within the brain. It was suggested that these
outcomes required a force equivalent to a multi-story fall or major
motor-vehicle accident, causing immediate symptoms or collapse. Because
violent shaking cannot be accidental, the hypothesis simultaneously
established a criminal act and identified the perpetrator, typically the
person with the baby at the time of collapse.
CommentsView/Create comment on this paragraphThough
the SBS hypothesis was incorporated into medical training and judicial
decisions worldwide, it remained untested for almost two decades. In
1987, the first biomechanical experiments found that the force of
shaking is much less than that of impact and concluded that shaking
alone was unlikely to cause the triad of symptoms.
CommentsView/Create comment on this paragraphSubsequent
research in my specialty, pediatric neuropathology, established that
the medical basis for the SBS hypothesis was also flawed. We learned
that the brain damage in these children did not reflect trauma to nerve
fibers, but rather a failure of blood supply. We also learned that the
typical subdural hemorrhages in these cases are too thin to result from
the rupture of the large bridging veins on the brain’s surface. And we
learned that the same findings are seen in natural deaths. In the last
decade, the list of other causes – including accidental trauma,
congenital causes, and natural illness – has continued to grow.
CommentsView/Create comment on this paragraphPerhaps
the most compelling observation in recent years is that subdural
hemorrhages are present in nearly half of normal, healthy newborns with
no evidence of birth trauma. These findings, combined with the immature
anatomy of the infant dura, suggest that dural bleeding in young babies
may be a natural protective device – a reservoir to prevent backflow
into the brain’s blood vessels during the pressure fluctuations of
normal labor and delivery.
CommentsView/Create comment on this paragraphBecause
these anatomical features persist into early childhood, the dura may
remain similarly vulnerable to bleeding beyond the newborn period.
Indeed, both birth-related bleeds and those attributed to shaking are
most often located in the folds of membranes covering the brain that
have more and larger blood vessels at this age than later in life.
CommentsView/Create comment on this paragraphWhile
scientific evidence over the last three decades has undermined the
shaken baby hypothesis, no new evidence has emerged to support it.
Instead, several researchers have relied upon the data in older studies
to calculate the statistical probability of inflicted brain injury when
certain features (such as intracranial hemorrhage, retinal hemorrhage,
brain swelling, and seizures) are present. These probabilities are then
offered as the basis for diagnosis and as evidence in court.
CommentsView/Create comment on this paragraphHowever,
the reasoning behind the studies on which these researchers rely is
circular, and based on assumptions now known to be unreliable. For
example, in some studies, the researchers decided arbitrarily that falls
of less than one meter could not harm a baby, so that parents who
described such a fall must be lying. Other studies viewed the parents’
inability to explain the findings as evidence of abuse.
CommentsView/Create comment on this paragraphGiven
these flaws, reviews of old studies do not provide a reliable evidence
base for diagnosing abuse. They simply predict the likelihood that
specific findings will be categorized as abusive, and that,
consequently, the child’s caregiver at the time will be accused or
convicted of abuse, regardless of the accuracy of the diagnosis.
CommentsView/Create comment on this paragraphLeading
proponents of the SBS hypothesis now acknowledge that the triad is a
“myth,” that SBS diagnoses consist of “informed speculation,” and that
the hypothesis is supported solely by confessions. Some courts are
following suit, with one US federal judge describing the types of
confessions obtained as “worthless as evidence,” and another noting that, given recent developments, claims of SBS may be “more an article of faith than a proposition of science.”
CommentsView/Create comment on this paragraphNo
one questions whether infants can be damaged or killed by violent
shaking or abuse; of course they can. The real issue is whether shaking
or abuse can be inferred on the basis of a hypothesis that lacks
scientific support. In no other area of medicine and law would an
unproved hypothesis provide a basis for diagnosis, let alone criminal
prosecution.
CommentsView/Create comment on this paragraphGiven
the developments of the past decade, we now face the possibility that
for the past 30 years we have been wrongly imprisoning parents on the
basis of a flawed hypothesis.
Read more at http://www.project-syndicate.org/commentary/waney-squier-reviews-medical-evidence-suggesting-that-many-caregivers-are-being-wrongly-accused-and-imprisoned#Sh5DE1HDEecLTuIZ.99
See Wikipedia entry on false allegations of sexual abuse: "A prominent British paediatric neuropathologist, Dr Waney Squier, recently made headlines by stating she believed that ‘half or even more of those who have been brought to trial in the past for SBS have been wrongly convicted'."[19]
http://en.wikipedia.org/wiki/False_allegation_of_child_sexual_abuse
PUBLISHER'S NOTE:
Dear Reader. Keep your eye on the Charles Smith Blog. We are following this case.
I have added a search box for content in this blog which now encompasses several thousand posts. The search box is located near the bottom of the screen just above the list of links. I am confident that this powerful search tool provided by "Blogger" will help our readers and myself get more out of the site.
The Toronto Star, my previous employer for more than twenty incredible years, has put considerable effort into exposing the harm caused by Dr. Charles Smith and his protectors - and into pushing for reform of Ontario's forensic pediatric pathology system. The Star has a "topic" section which focuses on recent stories related to Dr. Charles Smith. It can be found at:
http://www.thestar.com/topic/
Information on "The Charles Smith Blog Award"- and its nomination process - can be found at:
http://smithforensic.blogspot.ca/2013/12/the-charles-smith-award-presented-to_28.html
I look forward to hearing from readers at:
hlevy15@gmail.com.
Harold Levy: Publisher; The Charles Smith Blog
