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Danger of fragile science supported by poor judgment



The news of the General Medical Council’s ruling against Prof David Southall will no doubt have been greeted with grim satisfaction not just by Sally Clark’s family and friends, but also by the thousands of other parents caught up in the nightmare of being wrongfully accused of injuring their children. The repercussions of the GMC’s hearing will resonate for a long time, but its major significance is undoubtedly the exposure to public scrutiny of the twin pillars of flawed science and poor medical judgement that underpins the scandal of false allegations.First the science. Prof Southall believes nose bleeds to be a characteristic consequence of smothering.Thus when Stephen Clark mentioned during that television interview how his son Christopher had a nose bleed 10 days before his death, Southall jumped to the conclusion “beyond reasonable doubt” that he must be the culprit.Not surprisingly the chairman of the GMC hearing Prof Dennis McDevitt found the relevant scientific evidence to be less than compelling, it being based on just a handful of cases “without adequate controls”.Not, in short, the sort of evidence from which one could reasonably draw any conclusions “beyond reasonable doubt”.But this fragile science fades into insignificance when set against Prof Southall’s lack of judgment. It would, if he had so wished, taken him just a couple of telephone calls to realise that Mr Clark could not conceivably, as he alleged, have murdered his son.He was, on that fateful evening, 30 miles away at an office party from where he was summoned to hospital. He was not, in legal jargon, present at the scene of the “crime”.And yet Prof Southall, when challenged last Friday, whether he still believed Mr Clark had murdered his children, he replied “yes”. This inability to acknowledge that hard facts take precedence over fanciful theories reveals a devastating lack of judgment.There is, however, a further, yet profounder significance to the Southall case. For in jumping to his conclusion about Stephen Clark’s guilt, he exemplified how all the contested diagnoses of child abuse – repetitive smothering, Shaken Baby Syndrome and Munchausen by proxy – are linked in being based on the same false assumption.They all involve the unwarranted extrapolation from recognised forms of “non accidental injury” (where children are asphyxiated, battered or poisoned) to infer the existence of a particular “syndrome” of abuse.The recognition of the characteristic constellation of symptoms and signs typical of a “syndrome” is immensely useful in medical practice in allowing a doctor to make, for example, a near instant diagnosis that a patient with crushing chest pain radiating down his left arm is having a coronary.The problem with syndromes in child abuse is that they encourage doctors to claim parents are guilty on the basis of alleged “characteristic” signs or patterns of behaviour – and in the absence of any other circumstantial evidence, or motive for why a parent should have inflicted such injuries.They can be, as attested by friends and relatives, the most loving, caring affectionate parents in the world but when the child abuse expert stands up in court to claim their child is victim of one or other of these syndromes then conviction is almost guaranteed. And so it would have continued were it not for Sally Clark’s successful appeal last year that finally broke the magic spell sustaining the experts’ authority in the courts.There followed the belated recognition that there are indeed, as the accused parents have insisted, “innocent” explanations for each of these syndromes: genetic defects for sudden infant death; shortfalls and birth trauma for Shaken Baby Syndrome; and genuine physical illnesses for the alleged cases of Munchausen.The Southall case provides, as it were, the final piece of the jigsaw.It was still (just) possible to presume prior to last week’s hearing that – occasional miscarriages of justice notwithstanding – child abuse experts in general were acting in good faith and would not be making such serious allegations if they were not very confident of what they were talking about. Now we know better.James Le Fanu is a GP in London