Category Archives: EBMSI conference

Good Medicine: Connect at a Conference

Biomechanic John Lloyd, PhD, reviewing medical imaging with a parent at the 2012 EBMSI conference.

Biomechanic John Lloyd, PhD, reviewing tissue properties and the laws of physics with Tonya Sadowsky at the 2012 EBMSI conference.

Two exciting conferences are coming up this summer and fall, one for people who want to understand more about the troubling diagnosis of infant abusive head trauma, and another for professionals eager to witness the evolving debate.

The Evidence Based Medicine and Social Investigtion group (EBMSI), which is hosting the August conference, is a remarkable organization to begin with, a coalition of families who have weathered abuse allegations and are now offering help to the newly accused. With an expanding circle of volunteers and supporters, founders Zabeth and Paul Bayne are holding their third conference this summer, August 2–4 in Surrey, British Columbia.

Zabeth and Bethany Bayne, August 2012

Zabeth and Bethany Bayne, August 2012. Zabeth and her husband were accused of shaking Bethany when she was just a few weeks old. The parents reported one of her older brothers had fallen on her.

The conference is intended both for accused families and for professionals and paraprofessionals who work with child abuse cases. The 2013 faculty includes published experts and front-line practitioners in the arena. The setting is intimate, and the schedule provides time for consultation with the speakers.

Last year I posted summaries of the talks by forensic pathologist Dr. John Plunkett and attorney Zachary Bravos at EBMSI. Other speakers this year include pediatric neuroradiologist Dr. Pat Barnes—who testified for the prosecution in the Louise Woodward case but has since revised his opinion—and pediatric bone expert Dr. Charles Hyman.

For information about the conference, please go to

2015 update: The conference information is no longer on line.

A group of forensic pathologists, meanwhile, is attempting to move the debate forward with a “World Congress on Infant Head Trauma,” November 15–17, at the Center for American and International Law in Plano, Texas.

The conference, sponsored by the publishing arm of the National Association of Medical Examiners, is intended to “find common ground and debate controversial topics in pediatric forensic pathology.”

The conference features a series of presentations and responses by each of two teams, whose specific positions are not articulated in the conference publicity.  One team is headed by forensic pathologist Dr. Greg Schmunk, the other by forensic pathologist Dr. John Plunkett.

Speakers will submit both written and oral arguments, and an editorial board will publish a summary of the dialog in 2014. Dr. Chris Milroy will act as conference director and editor-in-chief of the published proceedings.

The content is limited to head trauma, not the larger question of infant abuse, with a specific focus on shaken baby syndrome. From the web publicity:

During their presentations and submissions to the Editorial Board, contributors are asked to consider and answer (using an appropriate scientific basis) the question “is it possible that shaking an infant results in the classical triad?”

Exciting times in the arena.

2015 update: The World Congress web site is no longer up, and I’ve not heard anything yet about a published proceedings.

-Sue Luttner

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


Filed under abusive head trauma, AHT, Dr. John Plunkett, EBMSI conference, Falsely accused, SBS, shaken baby syndrome, Zachary Bravos

Evidence-Based Medicine and Shaken Baby Syndrome

Drs. John Galaznik and John Plunkett, at the EBMSI conference

Evidence-based medicine (EBM) is a formal discipline intended to sort out what doctors really know from what they simply believe, “to differentiate objective data from opinion,” explained forensic pathologist Dr. John Plunkett at the second Evidence Based Medicine and Social Investigation conference earlier this month. “Evidence should always trump opinion,” he noted.

As detailed below, the EBM movement relies more on scientifically controlled research—and less on expert opinion and case studies—than the approach that’s traditionally dominated the medical literature.

The highest level of certainty under EBM guidelines applies more readily to drug trials, Plunkett said, where researchers can use large populations and appropriate controls, than to shaken baby syndrome research. “Nothing in the child-abuse literature is going to come anywhere near to Level I,” he conceded, on either side of the shaking debate. “There is not going to be a major bulletin about this.”

The arena itself constrains researchers’ ability to study infant head trauma, Plunkett said, and so the results are not reliable, with the exception of “the biomechanical studies that have been repeated over and over with the same results”—that is, that shaking without impact should not cause subdural hematoma.

Plunkett said he himself misunderstood the role of rotation for many years, even after he started doubting classic shaking theory in the 1980s. “I had been taught that rotation causes subdural hematoma, so I was looking for rotation in a fall,” he explained. “I didn’t realize it until 13 years ago:  Impact causes rotation.”

A number of test-dummy videos shown during the conference illustrated his point:  When a dummy’s head hit the floor, it would bounce back up, in an arc constrained by the neck, finally hitting the floor again at least once.

Rotational motion resulting from linear impact, from F.A. Bandak, Forensic Science International, 151 (2005) p. 75

Biomechanical engineers use the term “impulse loading” to describe the rotational forces caused by the head’s motion at the end of its tether, that is, the neck, which is attached to the trunk.

“Everything caused by impulse loading can be caused by impact,” Plunkett declared. “The reverse in not true.” While impact can cause subdural hematoma, retinal hemorrhage, and encephalopathy, for example, shaking cannot cause skull fracture.

There is simply no need to presume shaking, he said, when a child with the triad shows evidence of an impact.

Nor is shaking necessary to explain subdurals when the child shows no evidence of impact, because “Subdural collections occur without trauma.”  A number of metabolic and infectious diseases can cause them, as well as vascular malformations and any interruption of oxygen to the brain. Some causes, like Saggittal Sinus Thrombosis, are easy to diagnose, Plunkett said, but “Superficial Cortical Venous Thrombosis is routinely missed.”

He dismissed ruptured bridging veins as the source of small subdural hematomas, the “thin film” hematomas often associated with a shaking diagnosis. “Bridging veins are large-caliber conduits,” he said, carrying 5 to 10 ml. of blood per minute. “If one of these things is ruptured, you’re going to get a lot of bleeding, and you’re going to get it really fast.” He described stretch tests in which researchers were able to suspend 4 ounces—the equivalent of a stick of butter, which represents about 500 pounds per square inch—from a harvested bridging vein without snapping it.

“How do you break those without impact?” he asked, answering himself: “You don’t.”

When faced with the triad and no clear explanation, Plunkett concluded, “The default diagnosis is ‘I don’t know,’ not ‘Abusive  Head Trauma.'”

Evidence-based medicine guidelines vary in different places and contexts, but the U.S. Preventive Services Task Force defines these levels of reliability for published medical literature (from Wikipedia):

  • Level I: Evidence obtained from at least one properly designed randomized controlled trial.
  • Level II-1: Evidence obtained from well-designed controlled trials without randomization.
  • Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
  • Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
  • Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

The bulk of the child abuse literature is at Level III on this scale. For an evidence-based analysis of the medical literature about shaken baby syndrome, please see this journal article by Dr. Mark Donohoe.

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

-Sue Luttner


Filed under abusive head trauma, AHT, Dr. John Plunkett, EBMSI conference, SBS, shaken baby syndrome

Parents, Meet the Experts; Experts, Meet the Parents

Attorney Zachary Bravos of Illinois

“Over time, the truth prevails,” Illinois defense attorney Zachary Bravos promised his audience—parents falsely accused of abusing their children—at the second-ever Evidence-Based Medicine and Social Investigation conference this past weekend in Vancouver, British Columbia.

After 30 years of injustice rooted in a flawed model of shaken baby syndrome, Bravos said, “the legal system is getting to the point where at least it recognizes the legitimate dispute in the medical community.”

At the same time, he conceded, “These cases are still coming in by the boatload.”

Paul Bayne with sons Baden and Josiah

As his audience was well aware.  Conference organizer Zabeth Bayne and her husband Paul were accused of shaking their infant daughter, only six weeks old at the time, in the fall of 2007. While the Baynes fought the charges, their children spent four years in foster care—except for the youngest, conceived after the accusations, who was taken from his parents at birth and lived his first six months in foster placement.

All four children were finally returned a year ago, after outside experts looked at the medical records and concluded that the girl’s injuries could have been caused by the incident the parents reported at the time:  One of the older boys had fallen on the baby. The Bayne children were all present at the conference and noticeably well behaved, the older two helpful.

Zabeth and Bethany Bayne

Bravos said that the family’s experience is not unique, with forced foster placement after any accusation. Family court does not operate on the standard of “beyond a reasonable doubt,” but rather on “a preponderence of the evidence,” which takes very little for a finding of abuse. “Once that finding is made, that becomes the reality. If a spouse does not go along with the program, he or she is unlikely to get the children back.

“I can’t blame anybody in that situation who goes along with the program,” Bravos said, “I can’t blame anybody who accepts a plea bargain. But it then becomes another validation for the theory of shaken baby syndrome.”

He advised accused parents to get “every scrap of paper” relevant to their child’s case, from pre-natal records to ER and nurse’s notes. “Parents can often do this even if the attorneys can’t,” he pointed out.

Bravos also recommended filing a pretrial motion—a Daubert motion in some states, a Frye motion in others—asking to exclude testimony about shaken baby syndrome. “We file in every case, and we have lost on every one of those motions,” he reported, “but that’s not what is important.” Filing the motion preserves the right on appeal, he insisted, “These are flares in the night.”

Bravos is a veteran of the legal struggles over “recovered memories,” in which civil and criminal suits were based on presumably suppressed memories of childhood abuse that emerged during certain types of therapy, often including hypnosis. After researchers demonstrated that such memories could also be planted, those cases quit coming to court.

Attorneys Zachary Bravos and Heather Kirkwood

“We could sue for damages” in the recovered-memory cases, Bravos noted. “We could get money out of people’s pockets and, more importantly, out of their insurance companies’ pockets.” Soon insurance companies quit offering coverage to psychologists using those therapies, and the era faded, at least in court.

“We don’t have that leverage now,” he lamented, still maintaining that child-abuse professionals deserve amnesty for their honest opinions. “I don’t blame them, either,” he sighed, “It’s human nature.”

Bravos explained how the legal system let an unproven theory go so far:  Abuse cases are very difficult to begin with, he said, and the evidence can be murky and complex. “When we’re presented with complex problems, it’s really comforting to have a simple answer.” In the case of shaken baby syndrome, that answer is:  The last person alone with the baby is guilty.

Bravos also fought against the satanic ritual abuse cases in the 1980s, discussed on this blog at  “California’s Nightmare Nursery,” one of the on-line chapters of my book.

His talk wrapped up two inspiring and useful conference days that included presentations by expert witnesses from a variety of specialties as well as social service professionals. I will be reporting on more individual talks as I find the time.

My hat is off to Zabeth, her family, and the team of volunteers who made this conference so rewarding. I am dazzled by the resilience of the parents and foster parents I met there, and the people who support them.

-Sue Luttner


Filed under abusive head trauma, AHT, bayne family, EBMSI conference, evidence-based medicine and social investigation, parents accused, SBS, shaken baby syndrome, zabeth bayne, Zachary Bravos