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3. Looking at the Founder/Parent of the “Syndrome”—Dr. Roy Meadow
[Seventh and Final Essay]
Though it is neither charitable nor wise to assume that a hard-favored visage in the parent necessarily implies ugliness in the child, we ought to pause if the parent, once thought to be beautiful and now exposed as quite unsightly, continues to tout the beauty of his child. To get to the point of this section, the founder and original “namer” of MSBP, Dr. Roy Meadow, has now been discredited in his native England for hyper-inflated child-abuse statistics he gave in several cases where he was an expert witness. Whether this professional misjudgment fully discredits the syndrome he named is not immediately apparent, but what is ironic is that the he, the doctor who discredited early MSBP statistics (in Rosenberg’s 1987 essay) for being irresponsibly high has now himself been caught exaggerating statistics. So, we have the interesting problem that if one convicted, so to speak, of exaggerating, says that the numbers of other MSBP researchers are exaggerated, where does that leave the numbers cited by MSBP writers? Doubly-exaggerated?
But even if it can’t conclusively be demonstrated that the founder’s exaggerations necessarily imply that MSBP is a “hyped” diagnosis, the way that he became discredited ought to give pause to those in America who still think that MSBP is a useful diagnostic tool. Space only permits a brief narration of the two leading incidents: the wrongful conviction of Solicitor Sally Clark and Dr. Meadow’s subsequent disciplinary proceedings before the General Medical Council. The “Net” is full of both stories, if you want to pursue them at your leisure.
To set the context: after Dr. Meadow’s 1977 article and his tireless efforts to identify and deal with the shocking problem of child abuse, he was knighted by the Queen. His career, which rose meteorically in the wake of these events, began to include testifying as an expert witness in parental termination cases. His developed a special expertise in SIDS (Sudden Infant Death Syndrome) cases and, throughout the 1990s, testified on possible parental responsibility for many SIDS deaths. After the 1997 publication of The Death of Innocents, mentioned in a previous essay, he became an expert witness in the murder trial of Sally Clark, accused of murdering her two boys, both of whom died as infants.
In December 1996, Clark’s son Christopher was found dead in his crib at 11 weeks of age while her husband Stephen was away on business. In January 1998 her second son, Harry (eight weeks old), was also found dead at home. Though there were no signs of foul play, and though prosecutors were unsure how to handle the cases, they decided to move for her arrest in February 1998 on two murder charges. When she came to trial in Chester crown court in October 1999, one of the leading prosecution witnesses against her was Dr. Roy Meadow. He had developed “Meadow’s Law” with respect to crib deaths (called “cot deaths” in England) which some sources say was never actually uttered by him but became associated with him during the 1990s. It was that one sudden infant death was a tragedy, two were suspicious and three were murder. During the 1990s he had discovered, he claimed, 81 cases of SIDS which were actually parental murder of children but, unfortunately for all, he had destroyed the evidence linking the parents to the murders. In the case at hand, he testified that the chances of Sally and Stephen’s two sons dying of SIDS was 1 in 73,000,000. In other words, the chances of “innocent deaths” of the boys, in Dr. Meadow’s judgment, would happen about once per century in England.
On the strength of his testimony, a sort of “evidentiary steroid” as I earlier referred to it, as well as other testimony, Mrs. Clark was convicted and sentenced to life in prison. The prosecution had argued that she smothered her first son and shook her second son to death. Her sentence was upheld on appeal in 2000. But Meadow’s number sparked immediate and vociferous controversy in England. Statisticians almost universally condemned his numbers, and the President of the Royal Statistical Society wrote the Lord Chancellor that the figure had “no statistical basis.” (90) An article that goes into the statistics in detail and explains it for a high school audience, is here. (91) The truer numbers, as suggested by the just-cited article, are the product of 1/1,303 (the chance of a loss of the first child innocently) and 1/100 (the chance of a loss of the second child to SIDS) or about 1/130,000. Since about 650,000 children are born in England and Wales each year, the country really could expect about 5 families a year in England to suffer an “innocent” second tragic loss, such as suffered by the Clark family. Though the incidence is still rare, it is nothing like the 1 in 73 million that Dr. Meadow suggested.
In 2002, while Sally Clark was in prison, the former doctor for her younger son Harry came forth with information, which he had already known at trial but for some reason didn’t reveal, that Harry had suffered from Staphylococcus aureas, a common staph infection. This new evidence, combined with the controversy swirling around Meadow’s inflated and irresponsible statistic, led to another consideration in the court of appeal, and in January 2003, Mrs. Clark’s conviction was overturned. Although the reason for reconsideration didn’t in the first instance have to do with Dr. Meadow’s numbers, the judges stated in their opinion that “if this matter had been fully argued before us we would, in all probability, have considered that the statistical evidence provided a quite distinct basis upon which the appeal had to be allowed.” (92)
(92) Op. Cit., note 87.
Three reactions followed the quashing of Sally Clark’s conviction for murder. On the political front the reversal allowed politicians of all stripes to call for the cessation of a MSBP as a diagnostic tool. This culminated in the statement of Lord Howe, speaking in February 2003 in the House of Lords, to the effect that a diagnosis of MSBP was “one of the most pernicious and ill-founded theories to have gained currency in childcare and social services over the past 10 to 15 years.” He went on to say, “It is a theory without science. There is no body of per-reviewed research to underpin MSBP. It rests instead on the assertions of its inventor and on a handful of case histories.” Then, on the judicial front there was a cry both to re-examine the cases in which Dr. Meadow had served as expert witness where the mother was convicted of killing or seriously injuring her child. Though only a few cases were re-opened, his testimony in the June 2003 trial of Trupti Patel for killing her three babies was disregarded by the jury and a verdict of “not guilty” was quickly brought back. In December 2003, the highly-publicized reversal of the conviction of Angela Cannings for murdering two of her three children largely on the testimony of Dr. Meadow, took place. Thus, one might say that by the end of 2003 his reputation as an expert witness had been considerably compromised if not tarnished completely.
But that wouldn’t be the final thing that Dr. Meadow had to face. Chagrined by the false allegations against his daughter Sally Clark, Mr. Frank Lockyer, a retired police officer, submitted a complaint against Dr. Meadow to the General Medical Council (“GMC”), which regulates the practice of medicine in England. In July 2005 the GMC struck him from the list of qualified physicians in England, a fall from grace seemingly only surpassed by Mulciber’s fall from heaven after siding with Satan in his revolt against God. (93) So severe was this sanction for one who had been knighted for his work that many felt that such severity would cause professionals to reconsider whether they would make themselves available as expert witnesses in later trials. Yet, the GMC’s sentiment reflected the public outcry against MSBP, Dr. Meadow, and the way that his cavalier use of numbers had destroyed the reputation, family and health of an honorable English woman. Indeed, Mrs. Clark would end up dying in 2007, at age 42, of complications which many thought were brought on by the horrifying, humiliating and heart-rending process she suffered for most of the decade before her death.
(93) The story of Mulciber (Hephaestus) being thrown out of heaven is graphically told by John Milton in Paradise Lost I. 735ff.
Dr. Meadow, as expected, launched an appeal against the GMC ruling and in February 2006 the High Court judge found in his favor, reversing the decision to strike him from the medical register. On appeal, the Appeal Court, in October 2006, held that the High Court decision that Dr. Meadow was not guilty of serious professional misconduct should stand. On that issue, however, the court divided 2-1, with the dissenting judge, Sir Anthony Clarke, opining that Meadow was guilty of serious professional misconduct. (94) One judge who sided with Meadow, however, said that he was “undoubtedly guilty of some professional misconduct,” but it “fell far short of serious professional misconduct.” While the upshot of this case has as much to do with immunity of expert witnesses as it does with Dr. Meadow’s conduct, it sent a clear signal that what he had done, though not a damning professional error, was serious nevertheless. (95)
(95) In December 2007 the other leading figure in England active in aggressively pursuing suspected MBSP mothers, Dr (Professor) Said Southall, was struck from the registry of physicians in England for severe professional misconduct. The GMC, which concluded that Dr Southall had a "deep-seated attitudinal problem," found him guilty of serious professional misconduct twice in three years. Southall was already suspended from child protection work because of his irresponsible action in the Sally Clark case (opining murder with no basis). The fallout from this Southall verdict will probably take years, though it adds to the growing revulsion in England regarding the precipitate, arrogant and irresponsible way in which "diagnoses" of MSB" were used irreparably to harm families. See
As a result of the furor surrounding Dr. Meadow and Dr. David Southall (see note 95), MSBP has largely been discredited as a diagnosis in England. The Wikipedia article on “Fabricated or Induced Illness” stresses also how Australian Courts are now more than chary to grant credence to allegations of MSBP. (96) England’s experience with Dr. Roy Meadow ought to inform lawyers and judges in the United States who face this problem. We ought to recognize that the diagnosis stands on such a flimsy evidentiary basis that it is best for all concerned that these diagnoses be eliminated or significantly curtailed.
Until the following five issues are clarified, the “diagnosis” and expert testimony for or against MSBP/FDBP ought to be eliminated. First, we need to know what the alleged phenomenon is and what it ought to be called. There are three very different definitions and names of the phenomenon “out there” and they simply can’t be “smushed together” to come up with one grand syndrome. The “classic” MSBP definition comes out of Rosenberg’s 1987 article; her definition has been quoted dozens, if not hundreds, of times in subsequent literature. Is that what MSBP is? Or, in fact, is it to be called FDBP and is its definition found in the Appendix of the DSM-IV and DSV-IV-TR? I have laid out how the definitions differ considerably earlier in this paper.Which is it? Or, are you one of those people who say, after Shakespeare, “a plague o’ both of your houses” and have constricted the definition of the phenomenon in agreement with the professional society on child abuse so that you now call it “Pediatric Condition Falsification”? Which is in view here and which definition will you use? And, once you decide which terminology/definition you will use, which literature actually is appropriate for your definition? Some of the literature builds off one, some off another, and some indeed off the third definition.
Second, diagnoses and expert testimony on MSBP/FDBP ought to be curtailed until we know who are the proper people to diagnose this problem. Throughout the literature and court cases we have “diagnoses” by pediatricians, other attending physicians, social workers, teachers, psychiatrists, and other mental health professionals. Because of the imprecision regarding who can diagnose it, internet “gurus” and others have arisen who for a large fee will fly around to pronounce on it whenever diagnosis is needed. Until we decide, however, if this is something that can be divined by anyone who hangs out a shingle, we ought not to permit it in the courtroom.
Third, we ought to stop the diagnosis until it is clear when the diagnosis ought to happen and what its function is. Is it a tool of suspicion, something that can be mentioned at the beginning of the process, when parental abuse is just one possible explanation for baffling medical symptoms in a child? Or, is it a product of examination, testing and investigation, with the diagnosis only arrived at after a well-considered process? This question isn’t completely separate from the second concern. That is, if anyone can diagnose, we might as well let them diagnose whenever they want. If you give a whistle to a child and call him a referee, then he might just blow the whistle whenever he wants, sometimes even for his own pleasure.
Fourth, we ought to stop the diagnosis of MSBP/FDBP in the legal proceedings until we have some good statistics to know what exactly we are talking about. Ever since Dr. Meadow discredited some leading numbers in Prof. Rosenberg’s 1987 paper (and I showed how others of her numbers either didn’t make sense or were not properly keyed to her definition of MSBP), there has been strong suspicion that the “numbers game” played by proponents of MSBP is a sort of “shell game.” It certainly is with respect to mortality figures. It probably is with respect to cases actually diagnosed. Without good numbers courts are held hostage by experts who opine without data or with data that are based on so few studies that they mean next to nothing. Until we have some good numbers, then, the diagnosis is suspect and expert testimony on MSBP ought not to be permitted.
Fifth, until we answer some of the preceding four questions, courts and other legal proceedings ought not to allow “profile data” on MSBP. One of the powerful tools prosecutors have is to paint the likelihood of a person’s guilt by showing a “typical profile” of an MSBP perpetrator. But this “typical profile” fails the base rate test, as I showed when discussing the work of Dr. Eric Mart, and it really isn’t “typical” after all. Profiling is used as an impressionistic tool, a sort of postmodern “throw the paint on the canvas” to see if any of it sticks and then call it art. Profiling MSBP mothers is no different than profiling African-American or Latino drivers in American cities or profiling Terrorists by the complexion of their skin, length of beard or variety of dress. If civil rights groups and others rightly call “Foul!” when the latter is used to the exclusion of other forms of evidence-gathering or even as an evidentiary “boost,” why shouldn’t we all cry “Foul!” when the same kind of profiling is used against mothers who are suspected of being “MBSP” moms?
Thus, the problems with a MSBP/FDBP diagnosis are, like the spirits Jesus cast out of the Gadarene demoniac, Legion. (97) These are significant and severe problems, problems that should make any judge or lawyer pause before pursuing a case where suspected MSBP is a factor. In the closing words of this essay, I will suggest what to do when credible allegations of something that may have traditionally been called Munchausen Syndrome by Proxy are brought forth.
(97) The interesting Biblical story about this exorcism is told in Mark 5.
One must realize that the physicians who treat the child will be the principal witnesses in any legal case that goes forward. But, they will be “fact witnesses” and not “expert witnesses.” They will rely on their specialized knowledge, to be sure, but they will be testifying regarding what they actually saw in the child or the behavior of the mother/caregiver. If the court decides that the mother/caregiver ought to be subject to a examination, then it can so order a mental health professional preferably with an expertise in deception to examine the suspected perpetrator. Such a professional could be called as a witness in a legal proceeding and would, in fact, be an expert witness. If it could be demonstrated that there was such a thing as MSBP (the five hurdles listed above must first be cleared), then the expert could testify as to whether the caregiver was so afflicted. But until the questions I have posed are answered, the role of the expert mental health witness will be to describe, to the best of his/her ability, the psychological profile of the caregiver without the aid of an MSBP/FDBP diagnosis.
If after all this the trier of fact (judge or jury) decides that the caregiver is guilty of child abuse, then s/he should be convicted under the abuse statutes of the state. If the conduct demonstrated at trial doesn’t reach the level of abuse as contemplated by the statutes, the child still may at times be removed from the home, since a lesser burden of proof is needed to remove than to convict. But in all of this any word about MSBP ought either not to be permitted or be permitted only in very narrow circumstances—where the mother’s/caregiver’s conduct seems to “fit” the DSM-IV or the 1987 definition perfectly.
But until the five issues raised here are competently and clearly answered, we ought to declare a “moratorium” on MSBP/FDBP diagnoses. And, if the scholarly community is given a period of time within which to come up with some kind of consensus on this so-called disorder, and it is unable to do so, then MSBP/FDBP ought to be declared dead, brought in through the lichgate of the cathedral, honorably commended to the dust, carried out to the prepared plot and, without further ado, solemnly interred next to the remains of its eponymous ancestor, Karl Friedrich Hieronymus, Freiherr von Munchhausen. (98)
(98) This is the official German spelling. The Americanized spelling drops an "h" from Munchhausen, and also drops the umlaut over the "u."