February opened with a pair of important and complementary postings, a bold academic statement signed by 34 physicians, attorneys, and child-protection professionals with “deep concerns” about shaken baby theory in the courtroom, and a beautifully written examination of the Johan Aspelin case that illustrates why the experts are so concerned.
Published in the British journal Argument & Critique, the Open Letter on Shaken Baby in the Courts: A False and Flawed Premise argues that a diagnosis of shaking “risks blurring the line between diagnosis and verdict,” and that “SBS has never been proved as anything more than an hypothesis.” Citing the dearth of scientific research underlying the theory, the authors write:
Noticeably, the requirement for scientifically based evidence is far more rigorous in medical negligence cases than in the family or criminal courts where believing something to be true appears to have achieved sufficient evidential value to sway the determinations of the court.
The letter also notes that the justice system has tended to suppress arguments about shaken baby syndrome:
One of the consequences has been the vilification of experts prepared to advance competing theories and the suppression of sensible debate.
One example of such vilification is unfolding now in England, where pediatric neuropathologist Dr. Waney Squier is facing a challenge to her license triggered by complaints to the General Medical Council (GMC), reportedly from the Metropolitan Police, that her courtroom testimony exceeds her area of expertise and ignores the opinions of her peers. Dr. Squier has been testifying on behalf of accused parents for about the past decade, since her own research, clinical experience, and reading of the literature convinced her that the prevailing model of shaken baby syndrome is flawed.
My favorite report about Dr. Squier’s GMC hearings, which opened in the fall and continue intermittently, is a legal-training company’s blog posting that features praise from readers for her intellectual honesty in the face of peer pressure. A general practitioner offered this striking parallel with an historical report to the GMC:
Surely the Met investigating a Dr who happens not to agree with the consensus — and holds an expert view — is a little like the tobacco companies (circa 1960s) reporting Sir Richard Doll to GMC for his novel theory that tobacco caused lung cancer.
In the U.S., meanwhile, an in-depth treatment of the Johan Aspelin case published last week on Medium by reporter Elizabeth Weil also reveals striking new facts, like the botching of Johan’s initial intubation at San Francisco General, which caused the complete collapse of one lung and serious damage to the other. And that Johan received several times the recommended dosages of two different sedatives, which, Weil writes, “left him essentially paralyzed and unable to communicate distress as air was pumped into his compromised lungs.” The article notes:
Nowhere in the police investigation transcripts does it suggest that doctors considered Johan had a brain injury and retinal hemorrhaging due to low blood-oxygen levels and high carbon dioxide pressure, problems that may result from faulty intubation.
Johan’s mother Jennie Aspelin learned about the error and resulting crisis only because she’d contacted the organ-donation agency to find out why there had been no recipient reported for Johan’s lungs, as there had been for his other organs. Even then she received only the oblique message that it was “a matter of function,” enough to send her on a focused search for the full medical records.
In November of 2010, Johan’s father Kristian Aspelin told emergency responders that he had fallen in the kitchen while holding 3-month-old Johan, but child-abuse expert Dr. Chris Stewart rejected that explanation and told police that the boy had been violently shaken to death.
In December of 2012, the county dropped murder charges against Kristian, after defense attorney Stuart Hanlon turned over a collection of exonerating reports from outside experts as well as a carefully assembled medical time line that included the hospital’s mistakes. By that time, the family had lived apart for two years, when they’d lost their baby and needed each other more than ever. They’d sold their house and taken on a staggering debt to cover legal bills, and they’re not slated for any compensation from the state.
But the people who train child abuse physicians continue to teach that children seldom if ever suffer serious injury in short falls, and that only abuse causes severe retinal hemorrhages. In a January, 2015 lecture titled “Is There a ‘Shaken Baby Syndrome’?,” for example, which earns the medical viewer one continuing education credit, child abuse pediatrician Dr. Mark Feingold reported that hypoxia does not cause “macroscopic subdurals” and that children do not suffer serious injury in short falls:
A lot of our opponents say, “Well, the child died. That’s too bad. But it was a short fall, just like Mom said. He fell from Mom’s arms.” The evidence shows that children who fall more than 20 feet can die, but children who fall less than 3 feet almost never die, and when they do, it’s a different kind of accident. It’s a playground accident. It’s an older child. They die of a large subdural that causes lots of pressure. And the RH if present are not the kind we see in abuse cases (emphasis added). But nonetheless, different versions of “I was carrying the baby and I tripped and fell” are often offered.
Slipping and falling with the baby is the explanation Kristian Aspelin offered, like countless parents and caretakers before him and countless more to come, while pediatricians are being trained to reject that story, and to dismiss the hypoxia that frequently accompanies head injury as a source of compounding symptoms.
The retinal hemorrhages in Johan’s eyes were widespread and multi-layered, the kind that child abuse pediatricians insist do not result from short falls or lack of oxygen to the brain. So were the hemorrhages in the eyes of the toddler in the care of René Bailey, who said the little girl had fallen off a chair—Bailey’s murder conviction was vacated in December. Doctors also pointed to extensive retinal hemorrhages when diagnosing shaking injuries in the cases of exonerated babysitters Jennifer Del Prete and Audrey Edmunds and exonerated father Drayton Witt, and in an exasperating case local to me in which paramedics pulled a rubber band from the child’s throat during resuscitation and the only physical evidence of abuse was the triad. It seems to me that the world now offers quite a few examples of extensive retinal hemorrhages from plausible, non-abusive accidents and medical conditions.
I don’t know how we will move forward, but I welcome the growing chorus of voices in the journals, in the press, and in the courtroom, who demonstrate through their work and their testimony that the Open Letter on Shaken Baby is representing the situation correctly in its message to the courts:
In short, we would inform members of the judiciary and legal profession in those countries which utilise the SBS construct, that it does not have the undivided support of the relevant professional community, an essential consideration in the assessment of expert testimony.
The letter was edited by Argument & Critique’s managing editor Dr. Lynne Wrennall, whose doctorate is for work in child welfare, from a draft prepared by solicitor Bill Bache and veteran child social worker Charles Pragnell. The signers include 16 physicians, a handful of scientists, and a variety of social work professionals, from both academia and the field.
For the observations of Phil Locke at the Wrongful Convictions Blog, see his posting about the Open Letter.
The film company Mighty Myt is making a film about Johan Aspelin’s case, In a Moment: The Johan Aspelin Story.
copyright 2015, Sue Luttner
If you are not familiar with the debate about shaken baby syndrome, please see the home page of this blog site.
10 responses to “Shaking: “A False and Flawed Premise””
Tissue Scurvy is an autoimmune disorder in which Vitamin C is unable to enter cells because of the lack of Insulin resulting in disruption of cellular function. Vitamin C functions as an antioxidant blocking the damage caused by free radicals, a product of cellular metabolism, and ensures normal cellular function. Tissue Scurvy is the result of a failure of this process.
Tissue Scurvy Misdiagnosed
Michael D Innis MBBS;DTM&H;FRCPA;FRCPath
Princess Alexandra Hospital
Key Words Autoimmunity, Tissue Scurvy. Encephalomyelitis, Non-accidental Injury, Shaken Baby Syndrome
Requests from distressed parents and relatives seeking help after having been accused of injuring their children are not uncommon. Viral, parasitic infections and vaccines cause an autoimmune disorder, Tissue Scurvy, misdiagnosed as child abuse and this report presents the evidence.
Method. Relevant hospital and laboratory reports of three children were examined for evidence of Tissue Scurvy as the cause of the neurological lesions, fractures, bruises and haemorrhages found on them.
Results. In all the cases in which appropriate histories and tests were done there was evidence that the laboratory evidence was ignored or doctors were unaware of the significance of abnormal tests suggesting Tissue Scurvy as the cause of the problems.
Conclusion. Tissue Scurvy, absence of Vitamin C within the cell in the body, is an autoimmune reaction resulting in extensive lesions misdiagnosed as Non-accidental Injury.
At a conference on Encephalitis held in Cardiff in 1928  the Pathologist Hubert Turnbull stated “I understand that the primary subject of the discussion is the nature of encephalomyelitis following vaccination. It is no longer necessary to argue that an encephalomyelitis is sometimes a complication of vaccination. The exact cause of the encephalomyelitis need only be discussed.”
A plausible explanation for the encephalomyelitis following vaccination which Hubert M Turnbull sought to address is provided by the work of Wakefield et al; who showed Urinary Methylmalonic Acid was significantly raised in all eight children vaccinated with the MMR vaccine who were tested, compared with age-matched controls (p=0•003) .
Raised urinary methylmalonic acid is a confirmatory test for Vitamin B12 deficiency . A deficiency of Vitamin B12 is the result of an autoimmune reaction destroying the parietal cells in the stomach thereby inhibiting the uptake of Vitamin B12 in the diet.
“Shaken Baby Syndrome or Vaccine Induced Encephalitis” was the subject of an extensive review by Buttram  where he draws attention to the work of others on the subject of demyelination of the central nervous system following the a6dministration of vaccines.
The suggestion by Yazbak that an autoimmune reaction was the basis of adverse vaccine reactions anticipated subsequent observations  and proved to be correct He stated, “resuming routine vaccination of the newborn period with a Thiomerosal – free vaccine will not be prudent, as the reported reactions seem auto-immune, and do not suggest a heavy metal poisoning”. 
Yazbak’s suggestion of an autoimmune reaction and that of Herroelen, de Keyser and Ebinger  who reported 2 patients had neurological symptoms and signs, with evidence of central-nervous-system demyelination, 6 weeks after administration of recombinant hepatitis B vaccine suggesting the time interval would fit a proposed immunological mechanism is further explored here.
The late Dr Archie Kalokerinos was the first to point out that Scurvy was the cause of what doctors were calling Shaken Baby Syndrome. In his book, Every Second Child, he said, “during one trial the prosecution said scurvy was no longer seen. I replied – “yes it is, but it is not called ‘scurvy’ it is called Shaken Baby Syndrome”. By reducing or delaying immunization he was able to reduce the mortality in infants.
Tissue Scurvy, unlike the “Seafarer Scurvy” of yesteryear, is a condition in which Vitamin C is abundant in the blood but is unable to enter the cell because of a lack of Insulin which is required to transfer the Vitamin C into the cell.
Normally insulin binds to its receptor on the cell surface and initiates a chain of events that leads to the insertion in the plasma membrane of a trans membrane glucose transporter called GLUT 4 which facilitates the transport of Vitamin C, glucose and other nutrients into the cell . Within the cell Vitamin C functions as an antioxidant blocking the damage caused by free radicals, a product of cellular metabolism, and ensures normal cellular function. Tissue Scurvy is the result of a failure of this process.
Tissue Scurvy involving the liver cells (hepatocytes) leads to under carboxylation of the extrinsic coagulation factors and osteocalcin resulting in bruises, haemorrhages, fractures and encephalopathy  – the so-called “triad” of Non-accidental Injury.
When Tissue Scurvy involves the parietal cells of the stomach it leads to the failure of the production of Intrinsic factor and hence failure of absorption of Vitamin B12 in the diet.
Besides neurological lesions the many faces of Tissue Scurvy in Childhood include the diagnoses Sudden Infant Death Syndrome, Non-accidental Injury, Shaken Baby Syndrome, Abusive Head Trauma, Inflicted Brain Injury, Reye’s Syndrome, Kawasaki Disease, Anaphylaxis and Diabetes Type 1..
All have one feature in common – hyperglycaemia, the signature of Insulin deficiency resulting from vaccines, and other forms of antigenic stress which damage the Beta cells of the Islets of Langerhans resulting in hypoinsulinaemia and Tissue Scurvy.
Regrettably doctors in the English speaking world are taught “abused infants may have bleeding around the brain and in the eyes – the hallmarks of SBS but most also bear signs of the violence which killed them, fractures, bruises, burns, malnutrition or neglect”.
Adding to the problem is “the American justice system is not designed to determine scientific truth but, rather, to balance contested facts and bring closure to a dispute ”, and the systems in the UK, Australia, Canada and New Zealand would appear to be similarly afflicted.
It is precisely this failure to seek the truth that is destroying hundreds, perhaps thousands of lives and the American justice system and others are urgently in need of change.
Reviewed here are some instances in which a father, family member, or caretaker has been accused of causing the death of an infant or child from Shaken Baby Syndrome while the true cause of death was an autoimmune reaction.
Doctors making these accusations ignore the fact that Haemostasis and Osteogenesis require the carboxylation of some Clotting factors and Osteocalcin, a process which takes place in the liver and which is impaired in Tissue Scurvy. Tests for Liver Function are done but the results when abnormal are completely ignored or their significance misunderstood and the unfortunate parent bears the consequences of the error.
Case Report 1.
John, not his real name, was the second child of a 34 year old mother who suffered from
severe morning sickness for about 5 months of her pregnancy which lasted 9 months. A forceps delivery was necessary and the infant weighed 3860 gm. There was some bruising on the left side of the face possibly from the forceps. Apgar scores were 8 an 9 at 1 and 5 minutes. Vitamin K was given by intramuscular injection.
The infant was both breast and formula fed for 3 weeks and then given formula only. He was circumcised and did not bleed excessively but the wound became infected and he was given a course of antibiotics which controlled the infection.
When he was 6 weeks old he was noticed to be very pale and some bleeding occurred from the nose and he developed diarrhoea and was “grizzly”. Shortly thereafter he had difficulty in breathing and was taken to the nearest hospital.
Investigations in hospital
1. CT scan showed a Right Sided Subdural Haemorrhage. No retinal haemorrhages were seen
2. Skeletal X-Ray showed Periosteal reaction along the distal half of the right femur and a healing corner metaphyseal fracture of the distal right femur.
3. Ophthalmoscopy showed
a. Right retina clear
b. Left retina ”Boat shaped” haemorrhages involving all layers.
4. Blood Tests
1. Haemoglobin 63 gm/L NR 95 – 100
2. Platelets 706 x 109/L 160 – 600
3. Monocytes 1.3 x 109/L 0.2 – 1.2
Blood smear shows
a. Fragmented cells
d. Abnormal monocytes
5. CRP 13.9mg/L NR < 6.0
6.Plasma Glucose 6.1 mmol/L 3.0 – 5.5
The child failed to respond to treatment and died shortly after admission.
Official Diagnosis – Non-accidental Injury.
Birth and Early History.
Birth was by normal delivery after a gestation period of 9 months. Apgar scores were 9/5 and 9/10 and screening for T4, PKU AND Galactosemia were all normal. He was given an IM injection of Vitamin K and Hepatitis B Vaccine was given 2 days later. He was breast fed.
Mother noticed this child was different from her two previous children in that “his body and head were never quite in proportion” in that his head was disproportionately large. He was vaccinated with DPaT, HiB, Polio vaccine.
At the age of 10 weeks he suddenly became lethargic, began twitching and passed urine which was tinged with blood and was immediately admitted to hospital.
a. Haemoglobin 7.9b/dL NR 9.4 – 13
b. WBC“ 4.57 x10^3/UL 5.0 – 19.5
c. Platelets 741 x 10^3/UL 150 – 450
a. pH 6.78 7.35 – 7.45
b. HCO3 7.2 mmol/L 22 – 28
c. Glucose 398 mg/d/L 70 – 105
d. Calcium 8.4 mg/dL 8.5 – 10.5
Liver Function Tests
a. AST 399 U/L 20 – 60
b. ALT 138 U/L 6 – 50
c. GGT 93 U/L 11 – 82
d. ALK PHOS 202 U/L 110 – 320
a. Prothrombin Time 18.3 sec 11.5 – 14.5
b. INR 1.6 0.9 – 1.2
c. PTT 33.7 sec 24.0 – 35.0
Healing posterior rib fractures of the right 10th and 11th ribs.
Healing fractures of anterior aspects of the right 6th and 7th ribs.
CT Brain without contrast.
Extensive subdural of mixed density overlying the right greater than the left cerebral hemispheres.
The Diagnosis was Non-accidental Injury and death occurred shortly after admission.
Autopsy confirmed the clinical findings and was reported as a Non-accidental Death.
A 2.9kg female infant was born by normal vaginal delivery after a gestation period of 9 months and mother and daughter returned home within 8 hours of the child’s birth. Mother noticed a bruise on the child’s leg but thought it was accidently bumped by a sibling.
At the age of 8 weeks the child was immunized with DPaT, HiB, Polio and Meningitis vaccine. Within 24 hours of having these vaccines the infant started vomiting intermittently and developed diarrhoea and was admitted to hospital.
Appropriate therapy was administered and the infant was fit to return home after a stay of 3 days in hospital.
While at home and being fed by the father she suddenly collapsed, stopped breathing and went limp. An ambulance was called and the child was returned to hospital.
The infant was unconscious and numerous bruises were noted on the face and trunk. She was intubated and further investigations were carried out.
Skeletal X-Ray examination was performed which revealed multiple fractured ribs on both sides of the body
1. Urea 3.8 mmol/L 2.5 – 7,5
2. Creatinine 32 umol/L 0 – 61 3. Sodium 142 mmol/L 135 – 146
4. Potassium 3.3 mmol/L 3.5 – 5.5
5. Calcium 2.32 mmol/L 2.37 – 2.74
6. Albumin 28 g/L 35 – 55
7. Alkaline Phosphatase 321 U/L 65 – 265
8. Alanine Transaminase 59 U/L 5 – 45
1. Protein Trace
2. Glucose + by Multistix
The child died shortly after admission and an Autopsy was performed and the cause of death was reported as HEAD INJURY.
The father was arrested and charged with Murder.
In case 1 the blood test showing markedly reduced Haemoglobin with an increase in monocytes, spherocytes, fragmented cells and anisocytosis when associated with an increase in CRP is highly suggestive of a Congenital Mononucleosis, a viral infection, causing an autoimmune haemolytic anaemia.
Laboratory investigations to demonstrate Liver dysfunction shown by an abnormal Alanine Transaminase levels and the presence of Glucose in the urine confirms hyperglycaemia was a feature of the infant’s illness.
In case 2 the child has clear evidence of both defective liver function as shown by the abnormal Liver Function Tests and hypoinsulinism as demonstrated by the increased level of Glucose in the blood.
In case 3 an abnormal Alanine Transaminase is evidence of a defective Liver function and the presence of Glucose in the Urine establishes hypoinsulinemia.
In all three cases there is clear evidence that a metabolic disorder brought on by an autoimmune response to an antigen, including vaccines, caused hypoinsulinism which led to Tissue Scurvy. Tissue Scurvy could explain the neurological lesions reported in the literature.
A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it. T.S. Kuhn, The Structure of Scientific Revolutions).
'All truth passes through three stages. First, it is ridiculed, second it is violently opposed, and third, it is accepted as self-evident.' – Arthur Schopenhauer
The late Dr Mark Struthers reminds us that infantile scurvy, brought to our attention by Dr Archie Kalokerinos , is a potential cause of false allegations of child abuse.
Acknowledgements: I wish to thank the parents of the children reported here for providing me with the evidence needed to prepare the respective reports and I wish to thank my wife for helpful insights.
1.Turnbull HM. Encephalo-myelitis In Viral Diseases And Exantemata. Br Med J.1928 August 25,2(3529):331-334
2. A J Wakefield, S H Murch, A Anthony, J Linnell, D M Casson, et al;RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children Lancet Vol 351, Number 9103 28 February 1998
3. Kwok T, Cheng G, Lai WK, Poon P, Woo J, Pang CP. Use of fasting urinary methylmalonic acid to screen for metabolic vitamin B12 deficiency in older persons.Nutrition. 2004 Sep;20(9):764-8.
4. Innis MD. Autoimmunity and non-Accidental Injury in Children Clinical Medicine Research. MM-DD-2013, pp. x-x. doi:10.11648/j.
5. Buttram H E. Shaken Baby Syndrome or Vaccine Induced Encephalitis Medical Sentinel;2001:6(3),83-89
6. Innis MD Autoimmunity and non-Accidental Injury in Children Clinical Medicine Research. MM-DD-2013, pp. x-x. doi:10.11648/j.
7. Yazbak FE Testimony of Michael Belkin before the Advisory Committee on Immunization Practices – Centers for Disease Control and Prevention February 17,1999 _Atlanta Georgia
8. Herroelen L, de Keyser J, Ebinger G. Central-nervous-system demyelination after immunisation with recombinant hepatitis B vaccine. Lancet 1991;338:1174-1175. Lancet. 1991 Nov 338(8776):1174-5.
9.Kalokerinos A. Every Second Child. 1981 pp 3-165 Thomas Nelson (Australia)
10. Cunningham JJ. The Glucose/Insulin System and Vitamin C:Implications in Insulin-dependent Diabetes Mellitus. J Am Coll Nutr; 1998:vol 17 p105-108
11.Cunningham JJ, Ellis SL, McVeigh KL, Levine RE, ,Jorge Calies Escandon Reduced mononuclear leucocyte ascorbic acid content in adults with insulin-dependent diabetes mellitus consuming adequate dietary vitamin C Metabolism 1981;vol 40;148-149.
12. Innis MD. “Vitamin K Deficiency Disease”. Jour of Orthomol Med 2008;vol 23; 15-20
13. Innis MD. We should harness the power of our colleagues’ fresh ideas. BMJ Rapid Responses 24th July 2013.
14. Squier W. Beyond reasonable doubt Guardian March 13 2008.
15. Christian CW, Block R, and the Committee on Child Abuse and Neglect Abusive Head Trauma in Infants
As I said before, when will we be able to grab adjudicators and prosecutors by the scruff of the neck and make them at least read this kind of information? The more intelligent ones will ‘get it’. The compassionate few will even reflect on their own convictions. The rest, including Pierce County in Washington State, will consider it heretical and stay firmly entrenched in their narrow, disavowed, archaic SBS protocol because it allows them to ‘win’ in their ‘kangaroo courts’, even if incarcerating innocent parents and other care givers. We need to speed up enlightenment of this kind of information among county and state judiciary to prevent further wrongful SBS prosecutions.
I am so sorry, Mr. Yerger, that your family has been drawn into this medico-legal nightmare.
I’ve been to many conferences, and I’m afraid they use much harsher words than “heretical” to describe us. I believe change is happening, but I never imagined when I took on this project in the late 1990s that progress would be so slow. The problem is that 30 years of convictions have convinced both the physicians and the prosecutors that their theory is correct. Thank you for adding your voice to our efforts to be heard.
My best wishes to you and your family.
I am flattered that you have been sharing your work with me, Dr. Innes. I think I need to collect your papers and give them a place on the blog higher than the comments.
My fear is that, despite the rising tide of exonerations where a successful defense has been mounted by a proficient litigator in an enlightened and intelligent courtroom that is not blatantly prejudiced in favor of SBS, it will not have effectively reached Pierce County in time to prevent further unmitigated damage to my son Jeremy, his beautiful, healthy son Jason and his wife. What has been lost – two years of life with his infant son and his wife – can never be recovered because he made the 911 call that saved his son’s life. That was April Fools Day 2013 and he hasn’t been allowed to see or hold either of them since. Meanwhile a vicious prosecutor and prejudiced adjudicator plod along on a two year campaign to try unsuccessfully to railroad him into an invalid conviction. Justice may be blind but, it can also be deaf and dumb.
Please accept my condolences to your family. Nothing that happens now can ever replace those two key years in your grandson’s life. I am glad he has loving grandparents who are convinced of his father’s innocence. I hope his early months as the treasured son of a happily married couple can help him through these years of stress, now that the state has forced his mother to become a single parent. The harm to innocent families is staggering.
It is so painful, as a parent and grandparent, to see your son’s family suffer under the savage and unjust attack of such ignorant and blatantly prejudiced prosecution. It’s like watching them die slowly as time passes. We’ve got to do something. Soon.
Nobody is saying that SBS does not exist, just that it is often misdiagnosed. The open letter is a sign that people are talking. We just need to get them to listen as well. Technicalities of law should not prevent new evidence from being heard. Therein lies the conflict with the pre-Louise Woodward cases.
Stay strong, Dr. Squier!
This contribution puts my 1971 paper where it belongs…in the file of interesting observations…I have protested before that elevating SBS to a syndrome was premature. Now it seems that the error can be corrected without undue loss of face! Norman
Thank you so much for commenting, Dr. Guthkelch. I am flattered that you read my blog.
I myself think that shaking without impact can cause brain injury, which is what you proposed. The problem is the notion that the brain injury proves shaking, which is not a logical extension of the thought.