Guilty of Intellectual Honesty

Pediatric Neuropathologist Dr. Waney Squier At the Evidence-Based Medicine Symposium in Denver in 2009In a 96-page decision packed with irony, the Medical Practitioners Tribunal Service (MPTS) in Britain has declared pediatric neuropathologist Waney Squier guilty of practicing outside her area of expertise, ignoring the opinions of her peers, and tarnishing the reputation of the medical profession with her testimony and written opinions in a series of shaken baby cases between 2007 and 2010.

“The tribunal is in no doubt you have been a person of good character and have not acted dishonestly in the past,” the statement offers, but it characterizes her opinions about shaken baby syndrome as “dogmatic, inflexible and unreceptive to any other view” and declares her work in the arena “misleading,” “irresponsible,” and even “dishonest.”

MackSquierHead2009For about the past 15 years, Dr. Squier, a consulting neuropathologist at the Oxford Radcliffe Hospitals, has been challenging the community of child abuse experts to reconsider the unproven model of shaken baby syndrome that’s been winning in court for decades. She has not only testified to her theories but also conducted research and published in the medical journals.

The charges against her were levied by the General Medical Council (GMC) at the instigation of prosecutors concerned that her testimony was impeding convictions in shaking cases, according to Dr. Michael Powers, QC, as quoted in the coverage by Robert Booth at The Guardian. The GMC will determine her penalty later in the month, possibly loss of her status as a practicing physician.

Dr. John Plunkett

Dr. John Plunkett

Dr. John Plunkett, a pathologist who has fought off charges of perjury for his testimony regarding shaken baby theory, pointed out that Dr. Squier is receiving a Champion of Justice award next month at the annual Innocence Network conference in San Antonio, Texas. “How is it that the Innocence Network can give this award to Dr. Squier if the GMC has correctly characterized her behavior as dishonest and worthy of sanction?” he asked.

Dr. Bergina Brickhouse, a psychiatrist whose husband was cleared of shaking accusations based partly on a report from Dr. Squier, wrote in an email, “If not for the strength, fortitude, and technical expertise that Dr. Squier has shown, my family would most assuredly have been ripped apart by well-meaning but ignorant medical staff.”

Developmental Medicine & Child Neurology, 2008

Developmental Medicine & Child Neurology, 2008

I would have expected adjudication of the charges to be conducted by a panel of physicians, but the MPTS set up a team of one retired psychiatrist and two lay persons—a retired Royal Air Force wing commander and a retired police officer—to evaluate the evidence against Dr. Squier. The members seem not to have read the medical literature but based their conclusions primarily on oral testimony given over several months of hearings that started in the fall. The panel’s report describes all of the prosecution’s expert witnesses as “credible” but articulates various objections to the experts called by the defense.

Forensic pathology professor Bo Erik Ingemar Thiblin of Uppsala University, for example, had explained how circular reasoning in the early shaken baby papers allowed the theory to become established without scientific proof, the same argument that convinced the Swedish Supreme Court to revisit the legal status of shaken baby theory last year. Dr. Thiblin is an expert in epidemiology, the study of patterns, causes, and effects in health conditions, a complex field that emphasizes assessment and analysis of the known facts. In a triumph for circularity, the tribunal rejected his testimony with this explanation:

“It was clear that Professor Thiblin did not believe in the concept of shaken baby syndrome, and his view of the literature was coloured by that. He was critical of the methodology of all the research literature in relation to the subject because of its perceived circularity bias. The tribunal considered that his expert opinion on non-accidental head injury lacked credibility; therefore the tribunal attached limited weight to his evidence.”

In an insightful editorial in The Guardian today, human rights attorney Clive Stafford Smith compared the tribunal to the trial of Galileo by the church for his theory that the earth orbits around the sun and not the other way around:

“I am convinced that Squier is correct, but one does not have to agree with me to see the ugly side to the GMC prosecution: the moment that we are denied the right to question a scientific theory that is held by the majority, we are not far away from Galileo’s predicament in 1615, as he appeared before the papal inquisition… It was not until 1982 that Pope John Paul II issued a formal admission that the church had got it wrong.”

Dr. Waney Squier

One of the inexplicable elements of the decision was the tribunal’s finding that Dr. Squier had erred by testifying to biomechanical issues without any expertise in biomechanics—although the prosecution experts who testified in the hearings were, like Dr. Squier, physicians with no apparent specialized training in biomechanics (Dr. Richard Bonshek, ophthalmic pathologist; Prof. Rupert A. Risdon, pediatric forensic pathologist; Dr. Neil Stoodley, neuroradiologist; and Prof. Colin Smith, neuropathologist).

Similarly, the declaration scolds her for citing the 1987 paper by Duhaime et al. to support her observation that shaking without impact has not been shown to create forces sufficient to cause the brain injury. The tribunal said she had “completely misinterpreted what Duhaime had actually said,” even though the paper’s introduction says:

“It was concluded that severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the shaken baby syndrome.”

In a moving one-minute interview on the BBC, Dr. Squier said she is “devastated” by the finding, which she said has “enormous implications” not just for doctors but for any experts willing to testify in court. “You can give an honestly held, well-supported opinion and find yourself out of job,” she observed.

The charges against Dr. Squier are consistent with a strategy advocated by Detective Inspector Colin Welsh of New Scotland Yard in 2010 at the 11th International Conference on Shaken Baby Syndrome for improving the conviction rate in these cases by neutralizing experts willing to testify for the defense (see “Back Door Tactics Show Through“).

Proponents of shaking theory also ridicule their critics at conferences and scorn them in print, and in 2014 they attempted to block the premiere showing of the documentary The Syndrome, which they dismissed as “a national platform for the tiny handful of well-known child abuse defense witnesses to publicize their fringe message.”

An editorial this winter in the journal Pediatric Radiology, “Child Abuse: We Have Problems” by Dr. Peter J. Strouse, declares that “child abuse denialists” now pose “a growing threat to the health care of children and the well-being of children and families,” and calls on institutional rejection of doctors who defy the common knowledge about child abuse:

The court system seems ill-equipped to properly censure the denialists in spite of their deceitful and unethical behavior. Ideally, the legal system would practice peer-review by unbiased observers, but this does not occur. Institutions that harbor denialists, whether they be private practices or esteemed academic institutions, should carefully consider their employment.

Even in this environment, Dr. Squier has been willing to say in print and in court what her own research and experience were telling her about shaken baby theory.  I am in awe of both of her intellectual honesty and her courage, and I am horrified at Friday’s decision. The only silver lining I can think of is that maybe, this time, they have gone too far. The ironically named “determination of facts” released on Friday will not hold up to the scrutiny that Dr. Squier’s own work has already survived (see, for example, “When Pie in the Sky Turns Out to Be Dawning Knowledge”).

If you are not familiar with the debate surrounding shaken baby theory, please see the home page of this blog.

Copyright 2016, Sue Luttner

 

10 Comments

Filed under abusive head trauma, AHT, SBS, shaken baby syndrome

10 responses to “Guilty of Intellectual Honesty

  1. aljablan@sympatico.ca

    A beautiful case of self defeating reasoning. The ignorant panel states that Dr Thiblin did not BELIEVE in shaken baby syndrome which is a howler. First of all medicine an applied science does not depend on beliefs but facts data physical reality. So the expert witness is discounted for not sharing in the now exposed cult of shaken baby syndrome: they depend on beliefs not reality of truth. Furthermore their belief in a syndrome of itself is laughable for syndrome is for want of a better explanation. Real provable disprovable medical facts aren’t called syndromes, they are called syndromes when they are odd surprising unproven or fortuitous. They just happen to run together without any provable aetiological factors. aj

    Date: Mon, 14 Mar 2016 13:54:26 +0000 To: aljablan@sympatico.ca

  2. Alexander Jablanczy

    I have written already that the tribunal’s words to the effect of BELIEF are an admission that SBS is a cult.
    There is no such thing as belief or opinion or guess in science. It either is or it isn’t.
    Most often uncertain questionable arguable iffy.

  3. By offering opinions as to the plausibility of injury causation due to mechanical trauma, i.e. shaking and infant short falls, Dr. Squier, one of Britain’ most senior and most respected doctors, is charged with offering opinions outside the area of her expertise.
    But in cases of alleged child abuse the treating physicians and child abuse pediatricians are not practicing medicine for the purpose of diagnosing medical injury and offering appropriate treatment protocols, they are offering biomechanical opinions as to injury causation for the purpose of legal investigation. Biomechanics is a scientific discipline that is unique from medicine and requires many years of advanced education to master.
    Since the GMC has declared such practice to be disreputable, I demand that any and all medical doctors who assist in the prosecution of such matters be held to no less of a standard and also be charged accordingly with practice beyond their area of expertise.

  4. I’m immediately reminded of Dr. Guthkelch’s paper, PROBLEMS OF INFANT RETINO-DURAL HEMORRHAGE WITH MINIMAL EXTERNAL INJURY (https://www.law.uh.edu/hjhlp/volumes/Vol_12_2/Guthkelch.pdf). Under the heading PROBLEM #3, he discusses how physicians frequently testify for the prosecution regarding the amount of force necessary, often comparing to a high-speed car collision or a multi-story fall, and even more so, determining the intent of the alleged perpetrator. He states that doctors who make these statements are “exceeding his or her authority.” Such statements have been made, at least in my experience, in nearly every SBS case. Are these well-meaning, yet misinformed, physicians guilty as well? Why not? Because it has been repeated so many times in so many different venues? That is the very definition of dogma.

    • Alexander Jablanczy

      Indeed. When the court appointed rank amateurs stated that the Dr from Uppsala does not hold to the belief of SBS they in fact have admitted that SBS is simply a cult.
      A cult is matter of belief whereas all areas of medicine including forensic pathology ought to be based on some modicum of science at least.

      In actual fact of course all three possibilities must exist by simple logic: some babies and children are indeed savaged injured and even murdered by their parents or baby sitters, but some are grossly negligently misdiagnosed as such and the purported triad is a phantom piece of cultish nonsense. Belief ought to have nothing to do with it.
      Then there is the third category where we just don’t know and it is impossible to determine. Whether it is 33% 33% 33% or 90% 5% 5% in any order I don’t know.

      Here Justitia is not only blind but dumb deaf and delusional.

      Similar absurdities happened with crib death.
      First it was missed say a hundred years ago as child mortality was anyway very high so there was no mystery about finding a baby dead for apparently no reason.
      Then came the horror of horrors mothers usually were sent to the gallows for murdering their babies.
      Then came the invention of crib death and all dead babies’ parents were automatically exonerated.
      Finally came the idea that some indeed after all were murdered
      say 10% but most ie. 90% were unfortunate crib deaths.
      With a slight thought of postpartum psychosis or depression where the mother would be anyway innocent by reason of insanity.

      As these are unwitnessed events it is simply impossible to assign blame or natural death or injury or malady.
      Any fanatical distortion of truth or reality shames both medicine and the law as somewhere inferior to trial by lot or torture or abject superstition.

      Here both the medical and legal models fail execrably.

      It is intolerable that criminals and murderers go unpunished but it is even more unacceptable to subject the innocent who have already suffered the loss of a child to persecution and prosecution and false judgments of incarceration when wholly innocent..

      Instead the whole literature of the last hundred and fifty years ought to be revisited including the specious triad sometimes tetrad of signs which may have many other aetiologies. For instance retinal haemorrhage may even be a normal event of birth missed in 99% of cases. Or cerebral oedema or subdural may have numerous causes also mostly missed. Hypoxia dystocia precipitate delivery fetal distress may all be implicated.

      The problem with SBS is that once its broached no other cause will be looked for. The cult is too powerful and its acolytes are too sure of their phantom error.

      We need all to take a step back read a hundred articles if not a thousand and then formulate a rational compromise.

      Adversarial method is the worst way to arrive at truth here.

      And the medical fetish of syndrome is pure mush.
      it is ludicrous to have anyone opine an opinion who knows no medicine and less law.

      Medicine is still in the dark ages of mere cellular and gross pathology of Virchow whereas we should be in the era of cellular and molecular synaptic and axonal damage.
      This is obvious in the wholly new era of sports cerebral injuries and I dare say inapparent gross trauma in MVA.
      Medical and forensic science is in its infancy.
      So who dares say that they have the faintest what they are talking about.

      In open court no less.

      So we exonerate people who are guilty and send people to jail who are innocent.
      For want of any science.

  5. irelandssecretcourts

    I often find the comments more enlightening than the original stories. It’s also a perfect opportunity to educate people on these issues.

    I suspect that if Dr Squier is struck off, she will be re-instated by the High Court. The infamous doctors responsible for Munchausen’s Syndrome by Proxy were re-instated despite so many miscarriages of justice and being discredited. (Sally Clark case). The courts also overturned Dr Andrew Wakefield’s conviction this week and I believe he is suing the GMC. There might be enough struck off doctors for a class action lawsuit.

    Because of the excellent work by many here, SBS is no longer the “Consensus” it once was. We have seen many excellent pieces written and there is at least a doubt in many people’s minds. I believe that this is important because I have seen for myself, not being an expert, that judges also read newspapers and blogs, as well as prospective jurors.

    One idea that I had was to get the tv show “Myth Busters” on the case of SBS, but despite many attempts, I never got any response. Lately I have been trying “Adam Spoils Everything” and I still feel that SBS needs to be put on trial in a very public way. Unfortunately Science is turning into a Religion where a position is based on Faith and Belief rather than evidence. The current Witch Hunt against the heretics wont last forever, keep up the good work!

  6. Pingback: GMC Sanction Triggers Public Debate | On SBS

  7. Pingback: Dr. Waney Squier Reinstated | On Shaken Baby

  8. Pingback: GUILTY OF INTELLECTUAL HONESTY - The Informed Parent 2017

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