Prometheus: Vol 35, No 5 (2020)

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By Stuart MacDonald This debate on shaken baby syndrome (SBS – now often called ‘abusive head trauma’) is the latest (and probably the last) Prometheus debate. Over the years, these debates have explored such areas as the role of scientific advice in shaping government drug policy; the impact of British libel laws on innovation, and what is going wrong with our universities, areas in which innovation was central and where there was need for a critical, social science perspective. Prometheus offers an academic forum for its debates in which some of the constraints of academic discourse areloosened to allow free flow of ideas. Participants are not, for instance, required to explain a methodology or present a literature review. Prometheus debates were themselves an innovation and apparently a successful one in that they attracted much attention. The mechanism is simple, though strict: the general editor approaches an individual at the heart of a relevant controversy. Possibilities are discussed and a draft proposition paper produced. Meanwhile, the general editor casts a wide net - well beyond the obvious academics – inviting knowledgeable individuals to write response papers. Only once individuals have shown an interest in a project are they sent a copy of the draft proposition paper. Authors of response papers write as individuals (not as representatives of organisations) and are not told who else is writing or has been approached. Similarly, the author of the proposition paper is not told who is writing response papers or even who has been invited – and certainly does not suggest possible respondents. Only on publication do debate authors discover the identity of the other authors. page: 3 - 21 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350500
Paper
Proposition
By Waney Squier About ten years ago, a colleague of mine, a prominent prosecution expert, told me there was a move afoot to have me reported to the General Medical Council (GMC)[1] for my evidence in shaken baby syndrome cases. I shrugged this off, telling him that I prepared my reports to the standard of my published research papers, based on my professional experience and supported by critically-reviewed and valid scientific evidence. In fact, I would be confident defending them at an international conference of my peers, something with which I was very familiar as an academic paediatric neuropathologist. The following year, I was subject to harsh criticism in a raft of family court judgments, one of which was [1] In accordance with the rules of the family court, I was not able to respond to the specifics of these criticisms.[2]Judges are regularly invited to reach adverse findings about the nature and quality of evidence given by expert witnesses; this is part and parcel of the adversarial process. My nonchalance may have sprung from complacency, or arrogance or sheer naivety, but it came as something of a shock to be informed, in the course of an ongoing criminal case in June 2010, that I and the other defence expert in that case (Marta Cohen) had been reported to the GMC on the basis of these critical judgments. I had failed to realise that casual comments in a hospital corridor were the first rumblings of a storm that was to engulf the next decade of my life and to alter profoundly the potential for families to defend themselves against allegations of abuse. This paper describes how a campaign was forged to suppress legitimate scientific evidence presented in courts and to silence dissent. This campaign has had a profound impact on the delivery of justice. [1] The doctors’ regulatory body in the UK:“We are an independent organisation that helps to protect patients and improve medical education and practice across the UK” (http://www.gmc-uk.org/about/role.asp). page: 22 – 66 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350501
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Response
By Heather Kirkwood For decades, Waney Squier was the leading pediatric neuropathologist in the UK and possibly in the world. She was also the recipient of the prestigious 2016 Innocence Network Champion of Justice award. Yet her views on shaken baby syndrome – the very views that generated the Champion of Justice award – also brought her a six-month hearing before a panel of the General Medical Council (GMC) that removed her medical license, followed by an appeal that largely reversed the panel’s findings, but restricted her from testifying in the UK for three years. Only rarely in these proceedings, however, was the real issue addressed. The real issue was not whether Waney Squier used the right words in her testimony in six cases involving shaken baby diagnoses, but rather whether there was any evidentiary basis for the shaken baby diagnoses in these cases, or in others. The answer is straightforward: as confirmed by a comprehensive 2014-2016 review of the literature by the Swedish agency for health technology assessment, there is – and has never been – a valid research basis for shaken baby syndrome. Instead, the medical testimony that has been used – and is still being used – to destroy families and imprison parents and caretakers constitutes a fraud on the courts that has been perpetuated through intellectual inertia and intimidation. There is no better example than the trial of Waney Squier. Just as Watergate was a stain on the American presidency, the trial of Waney Squier – Waneygate – is a stain on the medical profession in the UK and elsewhere. page: 66 – 89 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350502
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Response
By Susan Luttner On an otherwise lovely afternoon in the spring of 1996, sitting on a bench under the redwood trees in the city park with a friend while our children played, I heard a piece of news that made me blench. My friend’s adult niece, Stephanie, had been accused of shaking a baby into permanent brain damage.Stephanie said the 5-month-old she was watching had choked on a bottle and quit breathing in her arms. At the hospital, though, doctors said bleeding and swelling in the child’s brain and eyes proved the little girl had been violently shaken - so violently, in fact, that the effects would have been immediately obvious. My friend was confident an investigation would exonerate her niece. The baby had been dropped off that morning with ‘a touch of the flu’,and vomiting is a well-known sign of head injury. Doctors found no external signs of battering - no bruising, abrasions, or grip marks - but they did find healing rib fractures estimated to be maybe 10 days oldthe afternoon she collapsed at Stephanie’s. They also found blood in the girl’s brain of several different ages, the oldestestimated at a week, and she had an undatable skull fracture with no bruising of the scalp above it - all possibly implying she had suffered a blow to the head a week or 10 days earlier. page: 89 – 110 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350503
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Response
By Niels Lynøe There is a murder story, from 400 BC, about the deaths of two members of the Pythagorean society. The circumstances are unclear, but it is assumed that they were actually killed. Why? They had betrayed the basic ideas of the Pythagorean worldview (Farrington, 1949). According to this scientific world order,everything that matters could or should be described and transformed into mathematical numbers and symbols. A point was referred to as 1, a line as 2, an area as 3 and a body as 4. The sum of 1+2+3+4 is 10 and ten was considered a holy number. The circle was thought to be perfect and hence divine (Witt-Hansen, 1961). Pythagorean mathematics was also thought to be perfect and divine, and accordingly definitive. However, the Pythagorean numerology didnot include what we currently refer to as‘irrational’ numbers, such as the square root of 2. These numbers were actually given a name by the Pythagoreans, who regarded them as beyond all reason and thus irrational. Members of the Pythagorean scientific society were not supposed to discuss this issue. The ‘crime’ committed by the two members of the societywho died mysteriously was discussing the irrational numbers and talkingabout themwith people outside the society (Farrington, 1949). They had been consideringthat in a rectilinear triangle the hypotenuse cannot be expressed in integers if the other sides are expressed in integers(Johansson and Lynøe, 2008). They had been dealing with a scientific anomaly(see Figure 1). The story may not be true, but it does represent the most extreme means of silencing and punishing people who question basic assumptions within a scientific society. Currently, members of a scientific society who discover inconsistencies or observe scientific anomalies are shunned and marginalized. They might encounter problems in renewing their positions, in receiving financial support or in having their papers accepted for publication in scientific journals. After reading Waney Squier’s proposition paper, a via dolorosa through scientific purgatory, the Pythagorean mystery murder story springs to mind. Even though Waney Squier did not receive a death sentence, what happened was close to a character assassination. Her opponents certainly thought they had silenced her. They definitely succeeded in sending a signal to all other concerned scientists - and potential expert witnesses: if they want to avoid being subject to a similar ordeal, they should abstain from giving testimony which does not support mainstream ideas. page: 111 – 128 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350504
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Response
By Dave Marshall This paper consists of some brief personal thoughts and observations from my own experience, many of which I have previously outlined in my book (Marshall, 2012).Rather than answers, these are views developed over many years of investigating child deaths andinvolvement with those impacted by them. I will group my thoughts into themes which I hope will contribute to the debate.The paper will stress the importance of looking at abusive head trauma (AHT), non-accidental head injury (NAHI) andreactive attachment disorder (RADI)with a wide-angle lens and in a general context,as well as with a microscope focused on a specific area. This will reduce the risk of not being able to see the wood for the trees.My motivation for agreeing to contribute to this debate is that I think it essential that weget it right. page: 129 – 140 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350505
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Response
By Brian Martin Waney Squier had a highly successful career as a medical specialist and researcher, is the author of numerous scientific publications, and was one of the most experienced figures in her field. But then her professional behaviour was questioned and she had to spend years defending a charge brought by the General Medical Council. The hearings damaged her reputation and her livelihood was threatened. She has been through a terrible ordeal. The question I want to address here is whether Squier has been fairly treated. I address this indirectly by looking at the methods used against her, adopting two approaches. The first is to compare Squier’s experiences with the patterns common in cases of suppression of dissent in science. The second is to look for techniques commonly used to reduce outrage from injustice.Ultimately, it would require a much more in-depth investigation, perhaps equivalent in scale to the GMC hearings, to pass a more definitive judgement about fairness. My examination is more limited and hence my assessments are potentially open to challenge. Nevertheless, available evidence strongly suggests that Squier was unfairly treated. page: 141 – 149 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350506
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Response
By Michael J Powers Waney Squier's proposition paper points to the need for challenges to be made to scientific dogma,notwithstanding the personal professional costs of doing so. In the field of shaken baby syndrome (SBS), the importance of challenging an unproven hypothesis goes beyond academic interest.The determination of our liberty and whether our children should be taken away from us depends upon the reliability of medical expert opinion. Emotion fosters prejudice, destroys objectivityand undermines the scientific approach,leading to unsafe decisions.The General Medical Council's principal purpose is to protect the public from bad doctors.It should not take sides where medical and scientific opinion is polarised.It is for the courts alone to control the admissibility and evidential weight to be placed upon expert evidence. page: 150 – 158 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350507
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Response
By Toni C. Saad By recounting her involvement in the controversy around Shaken Baby Syndrome and making an evidence-based case against the validity of this diagnosis, Waney Squier has given the medical profession an opportunity for uncomfortable reflection. In this short response, I draw out some of this case’s implications forthe medical profession in relation to the scientific process and its involvement in the legal process. I argue that the case Waney Squier brings against Shaken Baby Syndrome is naturalto the iterative process of scientific investigation, and that its implications demand the attention and action of the medical profession. page: 159 – 165 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350508
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Response
By Terence Stephenson The General Medical Council (GMC) is now doing more than ever to intervene earlier so that only those cases that really need to go to fitness to practice investigationsactually go there. Putting aside our work with medical schools and employers, the GMC’s core standards – Good Medical Practice(GMC, 2014) and accompanying explanatory guidance – are the bedrock of how we both protect patients and support doctors by clearly setting out what is expected of doctors in any given set of circumstances. Any doctor who follows this guidance has nothing to fear from the GMC. Recent court proceedings, notably the hearings involving Waney Squier and her testimony in so-called ‘shaken baby syndrome’ cases, highlighted a number of important issues around the role of expert witnesses. Some reporting about these matters sought to characterise her fitness to practise case as concerned with the issue of whether the evidence she gave on the controversial topic of shaken baby syndrome was, or was not, ‘correct’. This was not the case: instead, the fitness to practise proceedings focused only on the way she gave expert evidence and her failure to fulfil her duties to the court and to meet the standards expected of an expert witness in a number of court cases. page: 166 – 168 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350509
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Response
By Stephen J. Watkins What happens in a court case when experts disagree? It occurs all the time and the answer is straightforward: the experts must act reasonably, trying to reach as much of a shared understanding as they can, and giving honest, balanced evidence. Then the judge of fact, be that the judge or a jury, must decide which view to accept. But suppose that the question at issue is not the application of a shared body of knowledge to a difficult situation, but rather scientific truth itself? Should a jury decide scientific truth? Science does not advance because scientists are right. It advances because every true scientist has at the core of her soul a passionate belief that she might be wrong. The legal profession does not share this belief. It deals in certainties and in finality. Faced with scientific dissent, it believes the dissenters are, at best, misguided. Otherwise, why would they deny what everybody in their discipline knows to be true? page: 169 – 175 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350510
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By Peter Wilmshurst I believe that when a national regulator is inconsistent in dealing with complaints and when statutory legal tribunals make decisions that appear to be arbitrary and politically motivated, we need to question whether justice is being served and whether the public is being protected. page: 176 – 191 Prometheus: Critical Studies in Innovation Volume 35, Issue 5 SKU: 350511