and a scientist and I want to tell you
Linda’s story Linda and James had a baby
boy called Tom he was Linda’s third baby
and when he was about four months old
she was alone with him one night I think
many of you may have looked after young
children at some time your own children
or grandchildren or when babysitting or
sometimes you feel alone with them well
this particular night James is working
and Linda became concerned about Tom’s
breathing so she phoned her doctor and
she said I woke up to give him his feed
and I found he wasn’t breathing
not until I picked him up and lifted him
out of his cot and then he was fine and
he’s right as rain now but the doctor
decided to visit anyway he found Linda a
calm and experienced mother he examined
baby Tom who had a mild fever and was a
bit snuffly but he found nothing in us
and he concluded there’s nothing
seriously wrong so he left but there was
something wrong because an hour later
Linda found Tom unconscious he wasn’t
breathing he had no pulse so she called
an ambulance and he was rushed to
hospital and put on a life-support
machine a consultant paediatrician
examined Tom and found he had bleeding
in the retin that was the membrane at
the back of the eyes a brain scan showed
he had a thin film of blood in the dura
the membrane that surrounds the brain
and the brain was swollen he had just
those three things nothing else but 24
hours later tom was dead and Linda was
arrested and charged with killing her
baby at a trial Linda was described as a
woman of good character a caring and
careful mother she said she’d done
nothing to harm Tom but she couldn’t
explain why he’d collapsed but doctors
medical experts said that those three
findings meant that Tom must have been
violently shaken sometime after the
doctor had left the house the
amenda guilty and she was sentenced to
three years in prison a few years later
she appealed and her conviction was
overturned so she’s been innocent all
along her name was cleared but her life
was ruined her parents had died and
James had left her and because she was
in prison when tom was buried nobody
told her so she was denied the
opportunity of attending her own son’s
funeral that’s not all while Linda was
on bail awaiting her trial she became
pregnant and she gave birth to a little
girl Lucy when she was in prison
Lucy was immediately taken away and
placed for adoption
and even when her name was cleared her
conviction overturned Linda was not
allowed to make contact with her
daughter she lost all and now she lost
Lucy as well this is not a dystopian
nightmare this is a true story
and it’s the story that is repeated
day-in day-out all over the world in the
United States some two-and-a-half
thousand people are in prison five of
them on death row awaiting their
execution in this country we hear the
story hundreds of times every year in
our course it’s heard him Sweden in
France in Australia New Zealand and what
all of these stories have in common is
that a doctor has made the diagnosis of
shaken baby syndrome in Linda’s case I
was one of those doctors as the
paediatric neuropathologist I studied
the brains of babies who’ve died
hoping to find out why the police asked
me to examine Tom’s brain which I did it
was swollen nothing out of the ordinary
but that fitted with what the other
doctors were saying in this case shaken
baby syndrome they believed in it and I
believed in it so my report was part of
what is shaken baby syndrome central to
it is a young baby who presents with one
or more of those three features that Tom
heard known together as the try
of retinal hemorrhages subdural
hemorrhage and a swollen brain remember
that word triad because I’m going to be
using it again there are many causes for
the triad
but historically it was associated with
trauma now these babies have no evidence
of trauma they have no head impact no
fractures no bruises
so the shaken baby hypothesis depends on
the assumption that shaking is the cause
and that shaking can generate enormous
forces equivalent to a fall from a
second-story window or a road traffic
accident and what’s more the shaking
event is never witnessed and its effects
are almost always immediate so with this
hypothesis it’s easy to identify the in
the perpetrator it’s the person who was
alone with the baby and to abort him for
medical care the idea that shaking might
cause the triad was first proposed back
in the early 70s by a small group of
doctors in the United States it wasn’t
based on research studies but on
anecdotal reports an article in Newsweek
and speculation nobody’s then had ever
witnessed a normal baby being shaken and
developed the triad and nobody Hurst to
this day so you might be wondering as I
did have such a tenuous hypotheses
hypothesis could ever have been accepted
well back then those doctors were deeply
concerned that parents might be harming
their babies and absolutely rightly so
because some parents do so NORs were
introduced across the United States
requiring doctors to report even a mere
suspicion of abuse failure to do so
could result in prosecution on the other
hand when doctors do report something as
a bit of abuse they granted immunity
from prosecution even if their report is
unfounded or totally false
also reports the abuse went from tens to
hundreds of thousands a year and the
shaken baby hypothesis grew from an idea
of speculation into a syndrome and that
syndrome is taught as fact in the
textbooks and in medical schools
well this was nearly 50 years ago so by
now you’re probably thinking that
researchers must have found the evidence
base to support this hypothesis but they
haven’t
it wasn’t even tested until 1987 when
biomechanical studies showed that adults
shaking a crash-test dummy as long and
as hard as they could
generated only half the forces of her 1
foot fall no that’s not even as much as
a baby rolling off a bed clearly we
can’t do these biomechanical experiments
on babies but we can learn by observing
the world around us some of you might
remember that many years ago we used to
put young babies in forward-facing car
seats
if those cars were involved in head-on
collisions the babies suffered enormous
whiplash but case studies of those
babies showed they didn’t have didn’t
try had they had fractures and
dislocations in the neck in 2001 Jenny
and Geddes and neuropathologist and
colleague in London showed that the
brain damage in babies alleged to have
been shaken was not due to traumatic
tearing of the nerve fibers of the brain
as we’re deformed but it’s due to lack
of oxygen that’s something that seen in
babies dying from all sorts of natural
conditions and indeed it’s seen in
babies who have collapsed and died who
are being nursed on a ventilator right
baby Tom a few years later brain scans
showed us that almost half of normal
newborn babies have subdural hemorrhage
a similar number have retinal hemorrhage
so two of the cardinal features of
shaken baby syndrome are common in
normal babies after normal birth these
two findings are also seen in babies
dying from a whole range of natural
conditions as well as minor accidents
and low Falls so if we turn to the
medical literature for evidence to
support this hypothesis we find it’s
riddled with errors mostly due to
circular logic and poor case definition
at the end of last year an independent
authority in Sweden published its review
of more than 3,700 papers and found only
two that offered any support to the
hypothesis that shaking causes the Triad
to
nearly 4,000 papers and only two offered
any support and those two were both
found to be of only moderate scientific
quality so today as I stand here I am
sure that shaking can harm babies and we
certainly shouldn’t shake babies but
nearly 50 years of research has failed
to provide us with the justification to
make the assumption that a baby has a
triad or any one of its components must
have been shaken so that leaves us with
a hypothesis that it seems is not fit
for purpose but diagnosis or in the
courts in the courts it gets a bit more
complicated back in 2001 the Geddes
research stopped me in my tracks
it wasn’t what I had expected so I read
everything I could about shaken baby
syndrome and as a scientist I’m ashamed
to admit to you I hadn’t done so before
I’d been making this diagnosis on the
basis of my uncritical acceptance of
what was in the textbooks and what I had
been taught I was startled to learn that
there was no scientific foundation with
a hypothesis the triad is merely a
function of immaturity it’s the infant
brains response to a whole range of
different conditions so what I had been
taught was wrong what I believed was
wrong and importantly what I had been
telling the courts was wrong so I had to
change my mind having given evidence
with the police in Linda’s first trial
I gave evidence to support her in her
appeal I wasn’t on my own but my voice
was certainly now in a minority but
changing my mind
turned the tables on me back then in the
criminal courts judges and jurors were
also questioning the hypothesis and
we’re tending to to acquit parents
accused of shaking their babies but in
the family course the courts that decide
typically behind closed doors where
their mothers like Linda can keep their
babies they were ever adamant in their
endorsement of the hypothesis so
very long before I was harshly
criticized by Family Court judges
because I was challenging the majority
view in 2010 a report was made to the
General Medical Council the doctors
licensing authority on the basis of
those judicial criticisms the complaint
didn’t come from the judges who made
them nor did they pursue any of the
avenues available to them to restrict me
no complaint came from the police
because I was and they said this
actually said I was confusing juries
with science and I was getting in the
way of them achieving their desired
rates of conviction in these cases the
complaint was not about my evidence when
I was a prosecution expert was only
about cases where I challenged shaken
baby syndrome and my published research
on the subject was never questioned nor
was the content of my opinions it was
just the way I expressed them and
ironically my use of scientific
literature to support my views
I faced a six-month hearing and my
license to practice medicine was
suspended I was struck off I appealed
and my license was restored but I was
banned from giving evidence in the
courts for three years all of this has
had a profound effect on the delivery of
justice back in 2005 Linda had seven
medical experts to support her today she
would be likely to have none experienced
highly qualified doctors are afraid to
become expert witness isn’t challenge
the hypothesis
for fear of suffering the same thing as
me instead prosecution experts are
emboldened and today cases are routinely
decided on the basis of such candice
opinions as it’s generally considered or
most doctors believe that shaking causes
the triad
these are articles of faith they have no
scientific foundation science is not a
democracy scientific fact is determined
by experiment by observation not by how
many people happen to believe one
both assists or another but today these
opinions are unlikely to meet any
significant challenge and this leaves
families defenseless against unfounded
allegations of abuse what can we do
there are two things firstly at the
point of initial contact when a baby
with the triad or any part of it is
brought to hospital the medical care we
must have in place as standard a
protocol for the complete and rigorous
medical family and social assessment of
every case and look for all of the
causes of the Dryad getting it wrong at
this initial stage means that parents
are assumed to be guilty and have to
prove their innocence which is the
complete reversal of the burden of proof
of our legal system getting it right at
this stage means that we will identify
the treatable causes of the triad and we
can get on with treating them and save
these babies lives if we do find
evidence of violence and abuse then we
can be stringent in our prosecution of
offenders and increase the rates the
conviction of the real child abusers if
we don’t find evidence of violence abuse
we can save the emotional and the
financial burden of unnecessary
prosecutions sometimes there will be no
clear diagnosis and doctors must not be
afraid to say clearly and unequivocally
I don’t know the second place where
something must be done concerns the
courts and we that’s all of us we must
demand an inquiry so we can see what is
happening in these cases particularly
behind the closed doors of the Family
Division these courts have the power to
impose draconian sentences the
separation of a baby from his mother is
a life sentence for that baby it’s a
life sentence for his mother it’s the
life sentence for his father for his
siblings it’s the life sentence that
every member of the family is it right
that decisions of such gravity should be
made in secret hidden from public
scrutiny and accountability is it right
that in an area of Medicine which has
become
controversial an opinion so polarized
that these courts in order to save money
should appoint a single doctor as the
expert to represent both sides of the
argument is it night that a doctor whose
views are entrenched in the belief
system should go unchallenged
unquestioned by his peers no the courts
must hear the scientific dissent on
shaken baby syndrome fully and fairly
these courts must be open justice must
be seen to be done otherwise it is not
justice if we do nothing then ordinary
people people have already suffered the
tragedy of the death of a baby will
continue to have their families torn
apart by incorrect and unscientific
opinions mothers might Linda go to
prison and babies like Lucy suffer
forced adoption on the basis of belief
this lies at the feet of the medical
profession who have forgotten the
fundamental principle of medicine first
do no harm by ignoring the science and
adopting an unproven hypothesis doctors
have done great harm and have led the
courts astray if we do nothing this
travesty will continue this travesty of
the willful refusal of the courts and
the doctors advising them to recognize
the science that shows they are wrong
will continue if we do nothing they will
continue to do harm to innocent babies
and their families thank you for
listening [Applause]