The Elephant on the Moon                               E   L A I N E            W     H I T F I E L D                 S   ...
of brain injury in children are routinely      ty of the philosopher. For the next 2,000        tific method sets out to d...
THE ELEPHANT ON THE MOON                                                                    admissibility of scientific   ...
THE ELEPHANT ON THE MOONnal indictments and parental rights ter-       An untested syndrome that is both a                ...
THE ELEPHANT ON THE MOONphysicians whose writings reflect more         So, for him, the association between the       repo...
THE ELEPHANT ON THE MOON100 years in which short falls caused skull    aged their colleagues to jump to the con-       no ...
THE ELEPHANT ON THE MOONgeon, set out to determine the amount of       In 1971, yet another doctor weighed in         the ...
THE ELEPHANT ON THE MOONBecause the toothpaste is relatively             ments, Guthkelch and Caffey also read            ...
THE ELEPHANT ON THE MOON                                                              baby syndrome.” Many of them        ...
THE ELEPHANT ON THE MOONimpact was not conclusively ruled out.          able to generate was a mean of 1,138              ...
THE ELEPHANT ON THE MOONnificant association between shaking and                CONFESSIONS DO NOT                     art...
THE ELEPHANT ON THE MOONnurses (and others) report child abuse. In     The federal and state governments and           fat...
Upcoming SlideShare
Loading in...5
×

I The Elephant On The Moon Law Review On Sbs

559

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
559
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

I The Elephant On The Moon Law Review On Sbs

  1. 1. The Elephant on the Moon E L A I N E W H I T F I E L D S H A R P ,TLC ‘98 There is no greater assault on American families by the State than the current use of junk science to accuse and convict mothers, fathers, brothers, sisters, grandparents, friends and babysitters of abusing babies by so-called “shaken baby syndrome” (SBS). This article is the first in a series presented to suggest ways to first understand the history and background of the scientific disputes about the SBS diagnosis and then, in turn, defend cases of alleged shaken baby syndrome (SBS). Part I is about some of the major scientific flaws in the theory of shaking as a cause of pediatric brain injury. Part II is about alternative theories of causation, such as, accidental short falls, as explanations for the signs and symptoms commonly attributed to shaking. Part III is about how to make a (state) Daubert or Frye motion to challenge the State’s science in cases of alleged shaken baby syndrome. PART I of their theories to see if they are false. Courtroom scientific evi- dence critic Peter Huber describes some of the problems plagu- THE ELEPHANT ON THE MOON1 ing this myopic approach:Sir Paul Neal, the renowned 17th century astronomer, couldn’t [P]athological science often depends on experiments at thebelieve his eyes. He had been peering through his telescope at thresh hold [sic] of detectability, or at the lowest margins ofthe dimly-visualized details of the moon when he spotted an ele- statistical significance. The claims frequently emerge fromphant on the lunar surface! As a highly-regarded member of the a body of data that is selectively incomplete; wishfulRoyal Society, he felt it was his obligation to announce his find- researchers unconsciously discard enough “bad” data toing to a world in which the possibility of men living on the make the remaining “good” points look important. Thatmoon had developed into a topic of serious debate among mem- the measurements are at the very threshold of sensitivity isbers of learned societies. Neal was publicly humiliated and an advantage, not an obstacle: data that don’t fit the theo-ridiculed—and the Royal Society with him—when it turned ry are explained away; those that fit are lovingly retained.out that, in fact, what he had taken for the trunk of an elephant Professional statisticians call this “data dredging.”2was actually the tail of a mouse The medical literature uponthat had crept into his telescope. which the diagnosis of ShakenNews of Neal’s illusory elephant Baby Syndrome (SBS) is based ison the moon sent a thunderclap replete with more than half a cen-through the scientific community tury of confirmation bias of theof the day forcing scholars to sit kind that caused Sir Paul Neal’sup and take note of the fact that, demise. It is composed of a patch-when one sets out to prove a work of “studies” each often con-hypothesis, the truth may be the sisting of less than a handful offirst casualty of the quest. cases which include suspect “con- fessions” to shaking and inconsis-Truth is often the casualty when tent methods of analyzing thejunk science is used in the court- ‘science.’room. Junk science or, as it’ssometimes called, “pathological The “data” that have been cob-science,” relies heavily on faulty bled together to support thescientific methodology where hypothesis that shaking causesresearchers set out to prove The Elephant and the Moon: Sir Paul Neal announced his brain injury to children has a sta-hypotheses they have prejudged as finding to the world. But, in fact, all he had found was a tistical significance of zero. And,correct (as did Sir Paul Neal) mouse trapped in his telescope. “bad data” that outright disproverather than first testing the limits or challenge shaking as the cause28 T H E W A R R I O R • F a l l 2 0 0 3
  2. 2. of brain injury in children are routinely ty of the philosopher. For the next 2,000 tific method sets out to disprove thediscarded and explained away because years, the validity of any particular “sci- hypothesis rather than by confirming itthey do not fit the prevailing misdiagno- entific” claim was based upon the reputa- (as did Sir Neal). This is the process ofsis of Shaken Baby Syndrome (SBS). In tion of its proponent in the established “falsification” proposed by 20th centurythis area of medicine and forensic pathol- scientific community and his rhetorical philosopher Karl Popper.ogy a mere hypothesis has become a sci- reasoning skills.3entific conclusion without a reliable sci-entific basis. THE MODERNIn the United States alone, where there SCIENTIFICmay be as many as 5,000 to 6,000 crimi- METHODnal prosecutions annually involving shak- Science began toing as the claimed cause of brain injury to prevail over reasonbabies, it is critical to understand whether with, for example,shaking a baby is, indeed, the cause of Francis Baconbrain injury, or merely a mouse trapped (1561-1626), anin a telescope. English philoso-But first, a little history. pher and a pioneer of the modern sci- THE GREAT DEBATE: entific method. REASON VS. SCIENCE Bacon taught that truth was derivedThe debate over junk science in SBS res- not from the rea-onates in the age-old debate between rea- soning ability ofson and science. It’s a debate that has an authoritativeraged in many scientific circles about one person, but fromhypothesis or another throughout histo- experience, obser-ry. For example, the Greek philosopher vation, and testing,Aristotle (384-322 B.C.) reasoned that i.e., experimenta-matter was continuous and that it could tion.be subdivided indefinitely, without ever The debate between reason versus science has raged for millennia, How does a partic- such as that between aristotle and Democritus over whetherreaching any limit. He argued that matter ular scientific matter was continuous.had no ultimate underlying structure. proposition come Copyright 2003 by Sidney Harris. Reprinted with permission.Another Greek philosopher, Democritus into being? While(about 460-370 BC), reasoned that mat- every discovery has its own path, one thatter was discontinuous, i.e., that it did is frequently twisted and full of wrong SCIENCE GOES TO COURThave an underlying structure so that at turns, what follows is the basic map. First,some point matter could no longer be someone notices some thing, such as, a In Daubert v Merrell Dow, 509 U.S.subdivided. He called this smallest unit of phenomenon, and based on that observa- 579, (1993) the U.S. Supreme Courtmatter the “atom” (from the Greek word tion develops a theory or hypothesis relied heavily on the work of Karl Poppera tomos, meaning “not cuttable”), a basic about what it may mean or how it’s and others to redefine the meaning ofunit that he believed was indestructible. caused. Take, for example, Newton’s ‘science’ that is deemed sufficiently reli- falling apple and his hypothesis of gravi- able for a jury’s consideration. JusticeHaving now split the atom, we now ty. He saw the apple fall (observation and Blackmun wrote for the majority:believe we know who was right in this experience) and he formed a hypothesisarea of what is called “particle physics.” about the cause (gravity). To test the Ordinarily, a key question to beBut, at the time, the problem with the validity of the theory or hypothesis, answered in determining whether aGreek philosophers’ approach was that it Newton had to design an experiment or theory or technique is scientificwas based only on a debate between com- have a measuring tool: He developed an knowledge that will assist the trier ofpeting reasoning. The battle of competing area of mathematics (now called “calcu- fact will be whether it can be (andreasoning could not resolve the scientific lus”) to help him test his hypothesis. has been) tested. ‘Scientific method-dispute about the continuity of matter. In ology today is based on generatingthe times of Aristotle and Democritus, However, as Sir Paul Neal and the Royal hypotheses and testing them to see ifexperimentation was not used in any sys- Society learned, it is futile to set out to they can be falsified; indeed, thistematic way to decide between alternative prove a theory and run the risk of con- methodology is what distinguishestheories or hypotheses. Observations led firming a fallacy, rather than first investi- science from other fields of humanto hypotheses, but the process, in general, gating, testing and identifying reality. To inquiry.’ …Id., at 593. (Italicsended there. As a result, the acceptability avoid the danger of announcing ele- added.)of a hypothesis was based on the authori- phants on the moon, the modern scien- T H E W A R R I O R • F a l l 2 0 0 3 29
  3. 3. THE ELEPHANT ON THE MOON admissibility of scientific field in which it belongs.” Id., at evidence was whether the 1014. alleged “science,” was “gen- Today, under Daubert, the fact that a par- erally accepted in the rele- ticular scientific proposition is “generally vant scientific community.” accepted” is only one criterion for what Frye v United States, 54 makes something reliable science for pur- App. D.C. 46 (1923). poses of admissibility. General acceptance In 1923, James Alfonso Frye is subject to the fallibility of human poli- was on trial for murder in tics, and is to be viewed with great cau- Washington, D.C.. Frye had tion. For, as Galileo’s experience taught taken a systolic blood pres- us, the powers that be may generally sure test that supposedly accept and sponsor a belief, such as, “the measured his physiological world is flat.” General acceptance in the responses to questions to Holy Roman Empire and elsewhere did determine truth or falsehood not, however, make it so. (innocence or guilt). Frye argued that the test results SHAKEN BABY SYNDROME would prove his innocence. AND GENERAL ACCEPTANCE The device was invented by Most state courts admitted testimony William Marston, creator of about SBS in the days when physicians the comic book character generally accepted shaking as the cause of Wonder Woman and her a certain group of head injury symptoms truth-inducing lasso. The with which the children came into the systolic blood pressure test hospital. While the science of head injury Aristotle’s authority carried the day because he was was actually a crude precur- has advanced, many judges and doctors more authoritative in the days when experimentation sor to the modern poly- are impervious to these advances. The sci- was not used in any systematic way to resolve disputes graph. The defense offered ence of head injury causation, developed over competing hypotheses. to have Frye take the test by biomechanics over the last 30 years, Copyright 2003 by Trevor Goring. Reprinted (and converted to right in front of the jury. has slipped through the cracks in our jus- black and white) with permission. But, the trial judge reasoned tice system and our medical schools.Quoting Popper, Justice Blackmun con- that the blood pressure testtinued: “[T]he criterion of the scientific was not generally accepted in the relevant It is time to judge the science by whichstatus of a theory is its falsifiability, or scientific communities of physiology and we are being judged.refutability, or testability.” Id., 593. psychology and refused to admit itsPopper said this criterion was the defin- results. When convicted, Frye filed a sin- WHAT IS SHAKEN BABY SYNDROME?ing characteristic of empirical—i.e., gle-issue appeal of the judge’s ruling on It is claimed in medical literature, med-good, reliable and, therefore, relevant— the systolic blood pressure results. ical records and, consequently, in crimi-science. If a hypothesis has not been falsi- Affirming the trial judge’s refusal tofied despite searching inquiry, then its admit them, the D.C. Circuit in a two-scientific proposition is accepted. page opinion made what is probably the most famous, (or infamous) statementIn addition to the falsifiability question, about the admissibility of scientific evi-the Daubert Court gave other criteria for dence in American law:the trial judge to use on remand to evalu-ate the scientific reliability of the plain- “Just when a scientific principle ortiff ’s claim that the prenatal, anti-nausea discovery crosses the line betweendrug Bendectin caused plaintiff-Jason the experimental and demonstrableDaubert’s horrendous birth defects. This stages is difficult to define.list, which necessarily changes depending Somewhere in this twilight zone theon the area of science being offered as evi- evidential force of the principle mustdence, includes whether the scientific be recognized, and while courts willtests being proffered have known or go a long way in admitting expertpotential rates of error, whether the testimony deduced from a well-rec-results have been peer reviewed, and ognized scientific principle or dis-whether the science is generally accepted covery, the thing from which the deduction is made must be suffi- English statesman and philosopher Francisin the relevant scientific community. Bacon (1561-1626) pioneered the modern sci- ciently established to have gainedBefore Daubert, the sole standard for entific method teaching that scientific truth is general acceptance in the particular derived from experimentation, not argument.30 T H E W A R R I O R • F a l l 2 0 0 3
  4. 4. THE ELEPHANT ON THE MOONnal indictments and parental rights ter- An untested syndrome that is both a State continues to sponsor and promotemination proceedings, that another diagnosis and a statement of causation, shaking as a cause of pediatric brainhuman being, by violently shaking a made by someone in the medical profes- injury by prosecuting mothers, fathers,baby, can inflict one or more of the fol- sion untrained in the science of injury brothers, sisters, grandmothers, friendslowing injuries: causation, is hardly the way of reliable sci- and neighbors for injuring or killing • Subdural hematomas (SDH’s), bleed- babies by violently shaking them. ing beneath the dural covering of the The real science available about SBS sug- brain over the convexities of the gests that one prosecution for allegedly brain. This is termed “intracranial inflicting brain injury on a child by shak- injury”; ing, alone, is one too many, just as it was • Subarachnoid hemorrhages (SAH’s), 21 too many when 19 men and women bleeding beneath the arachnoid cover- and two dogs were falsely accused of, and ing of the brain over the convexities of hanged for witchcraft in 1692 in Salem, the brain. This is also termed intracra- Massachusetts. nial injury; Yet, shaken baby syndrome (SBS) as a • Diffuse axonal injury (DAI) (tearing cause of brain injury enjoys institutional and sheering of nerve fibers in the support from the American Academy of brain, itself ). This is termed “cerebral Pediatrics (AAP), and the National or intercerebral injury”; Association of Medical Examiners • Contusions or bleeding in the body of (NAME), among others. The AAP, the brain, itself (also termed intercere- Philosopher Karl Popper (1902-1994): which receives substantial federal grants bral injury); and “The criterion of the [modern] scientific to devise programs to recognize and pre- • Retinal hemorrhages (RH’s), such as, status of a theory is its falsifiability, or vent child abuse, including so-called bleeding in the vitreous inside the eye, refutability, or testability. “shaken baby syndrome,” recently and/or between the retinal layers received such a grant for $1.5 million, behind the eyes. ence. Nor is this helpful in our system of which it announced on its web site. The justice where one is supposed to be inno- AAP’s committee on child abuse forOther alleged ‘diagnostic signs’ of SBS cent until proven guilty. It only makes 2000-2001—through which the AAPinclude bruising to the neck, shoulders, matters worse that people are prosecuted affirmed it’s belief in SBS as a real form oftorso or arms where the child was alleged- for this form of child abuse in spite of the child abuse—is composed of severally grabbed and shaken, broken ribs, and fact that thebroken arms and legs, i.e., fractures of the hypothesis that‘long bones.’ shaking aloneThis article focuses on cases involving injures babies’injuries to the head only, that is, on the brains has nowbaby who is brought to the emergency been falsifiedroom with bleeding above the brain or (disproved) bydamage to the body of the brain, itself, experiments inretinal hemorrhages, or all of these. biomechanical(Injuries to arms, legs, ribs and other testing using aareas raise other forensic issues that can’t model baby andbe covered here.) by other corrobo- rating works. SBS: AN UNPROVED HYPOTHESIS (More on this MASQUERADES AS ‘SCIENCE’ later.)The central forensic fault with the theory A fair number ofor hypothesis that people can injure physicians nowbabies’ brains by shaking alone is that, challenge shakingfrom its inception, the hypothesis was as the cause ofbased on reason and inference, rather brain injury inthan reliable testing. It has been “con- babies, and thefirmed” solely by further reason and theory of shakinginference. If, for example, a baby is has come underbrought to the emergency room with serious attack inSDH’s and RH’s, the diagnosis is “shaken cases and medicalbaby syndrome.” The symptoms are used literature since Infant head exposing the veins in the subdural space.to infer the cause. 1987. Still, the Copyright by John Harrington, CMI, 2003. Reprinted with permission. T H E W A R R I O R • F a l l 2 0 0 3 31
  5. 5. THE ELEPHANT ON THE MOONphysicians whose writings reflect more So, for him, the association between the reported in Newsweek. A photograph ofmedical anecdote and ideology than brain and long bone injuries he suggested her carried the cutline:knowledge of serious science or evidence- was an exciting development. Size and strength: The brutal andbased medicine on the subject. The Virginia Jaspers case in 1956 was to tragic career of nurse Virginia Jaspers THE ORIGINS OF SBS increase his excitement. It cannot be is tied to her massive physical traits. entirely blamed for the beginning of the Now 33, she is an ungainly 6 feet,Where did it all begin? The origins of modern nightmare called “shaken baby weighs 220 pounds, has a 52-inch“shaken baby syndrome” lie in the early syndrome,” for Caffey and others bear waist. Police concluded that shewritings of a radiologist, John Caffey, responsibility for failing to scientifically probably had no idea of the strengthM.D. In 1946, Caffey reported four cases scrutinize Jaspers’ claims. However, of her cruelly big arms and hands.of children who had broken bones and Jaspers’ story was partly responsible for opening floodgates The cat about shaking was out of the that are still not bag—or so it seemed. The problem was closed. The daugh- that whether it was possible under the ter of a New Haven laws of physics for Jaspers to inflict these railroad executive, injuries by shaking alone—despite her Jaspers was vicious- confession—was never even questioned. ly described in the Confessions do not a science make. Even national media as Galileo confessed at his Inquisition to an “ugly duckling” teaching heresy when he knew that, in and a “large and fact, the world was round. (Had some of ungainly girl” with us represented Galileo, we may have “ham sized hands” advised him to do the same.) who, with limited No doubt the confessions of the shake- options, left school prone nurse (as she was later called by at age 19 to study Caffey) emboldened one doctor, C. pediatric nursing, Henry Kempe, M.D., to announce in then the ghetto of 1962 that any child with subdural the field. hematomas and retinal hemorrhages had Five years later, 11- been abused by shaking. Writing through week-old Cynthia the institutional voice of the American died suddenly of a medical establishment, the Journal of the cerebral hemor- American Medical Association (JAMA), rhage while Jaspers Kempe urged doctors to look for subdu- was her nursemaid. rals and retinal hemorrhages in children Doctors suspected with broken bones, and to diagnose shak- abuse because there ing as the cause of these injuries if they were signs that were found. While Caffey was to call it baby Cynthia had the Parent-Infant Traumatic Stress An infant subdural hematoma (intracranial injury) shown on been dropped or Syndrome (PITS), Kempe called it “the CT scan. The white, long concentric shadow on the left thrown. Still, battered child syndrome” inflicted by represents the subdural hematoma. Cynthia’s parents parents on their babies. There was neverchronic (old) subdural hematomas and trusted their nurse- any question about the matter. The chil-retinal hemorrhages. He wondered maid and asked Jaspers to return when dren had been abused. All critical think-whether there was an association between their next child was born. (Jaspers also ing about other possible causes—such as,the broken arms and legs (i.e., long cared for the children of several other accidents, short falls, birth injuries andbones) and subdural hematomas. He was families.) Three years after baby Cynthia’s genetic defects—had ceased.later to suggest they had been shaken. death, another child in Jaspers’ care— Kempe also claimed that if there was aBut, of the four cases, none were autop- three-month-old Jennifer—asphyxiated marked “discrepancy between clinicalsied, and so there was no information on her own vomit and died. Jaspers findings and historical data as supplied byabout whether any of these children suf- protested that she had done nothing to the parents” this was a “major diagnosticfered internal or external blunt trauma to harm the child and, in fact, had tried to feature of the battered child syndrome.”the head—either by accident or intent— save her by shaking her to get a “bubble” He was referring to parents’ claims thatto otherwise explain the brain injuries. At up. Then, in August 1956, Jaspers admit- their children were injured from shortthis phase of his career, Caffey was con- ted to shaking one of her charges, 11-day- falls or other impacts. Despite the factcerned to establish pediatric radiology as old Abbe, when she refused to take her that there had been reports in clinical“a respectable and valid medical entity.” formula. Abbe died. Jaspers’ story was neurosurgical literature for more than32 T H E W A R R I O R • F a l l 2 0 0 3
  6. 6. THE ELEPHANT ON THE MOON100 years in which short falls caused skull aged their colleagues to jump to the con- no autopsy, and this was before the daysfractures, subdural hematomas and reti- clusion of child abuse in cases where the of CT scans. As part of the process ofnal hemorrhages related either to brain children had SDH’s, RH’s and no evi- diagnosis, physicians must attempt toswelling or impact, Kempe claimed that dence of external trauma to the head. rule out, that is, disprove or falsify, a diag-parents’ stories about short falls causing nostic theory, and fail to do so, before The role of the doctor is to diagnose andthese injuries to their children were cate- accepting it as the cause of a condition. If treat. It is not the role of a physician togorically false. Kempe had no foundation a doctor sets out to prove rather than fal- accuse others, at least not without reliablefor such a claim. He had conducted no sify his or her first diagnostic impressions, science. Nothing could be more harmfulresearch to determine the minimum he or she risks treating the patient for to a child than to have his parents falselyimpact velocity required to cause these something the patient does not have. accused and taken away. Since Kempe’sinjuries to the head. Probably, he had not Indeed, in Kempe’s first reported case, the medical profession would not accepteven considered that in a drop of only parents explained that another child had explanations of short falls or other condi-three or four feet, one hits the ground at thrown a toy hitting the one-month-old tions as the cause, and since the parents10 miles per hour. Parents’ protestations baby on the head. Their account was dis- could not explain why the child hadof innocence and denials of wrongdoing counted as part of the denial associated SDH’s and RH’s, parents were doomedwere just part of the battered child syn- with “the syndrome.” by Kempe and others who inferred anddrome, he inferred. reasoned that they must have had a hand Kempe did no experiments to test theKempe advocated that physicians material properties of the pediatricask questions that were designed skull or of the underlying materialto trap the parents into admitting properties of the pediatric brain,they lost control and lashed out, and no analysis of the impact veloc-such as: “’Does he cry a lot?’; ‘Is ity with which the toy may have hithe stubborn?’; ‘Does he obey the baby’s head to see if he couldwell?’; ‘Does he eat well?’; ‘Do rule out the parents’ account as theyou have problems controlling cause of the injury before he ‘diag-him?’.” Kempe also urged doctors nosed’ (accused) them of abuse.to delve into the parents’ own In the second case Kempe reported,family history—had they been there was evidence of blunt traumaabused?—and, worse, advocated to the head—a skull fracture. Brainthat “nurses or other ancillary injury by shaking alone was incon-personnel,” watch (spy?) on the clusive even on Kempe’s own exam-parents while in the hospital with ples. As has happened so manytheir injured child. times in the sordid history ofThings were taking a really nasty humanity, reason had prevailedturn. In the Salem witch trials of over science and had done so with1692, it was said that as suspicion The vasculature (arteries and veins) of the brain with the the help of the members of theescalated, people began to “break brain tissue removed. when the brain rotates, it tears and medical establishment.charity” with one another, accus- sheers these vessels.ing and naming each other as ANOTHER VOICE:witches. By advocating that physi- in injuring their own children. THE SCIENCE OF HEAD INJURYcians go beyond diagnosis and treatment While the child abuse doctors were busyand become investigators of injury causa- Facing accusations of being a witch when beating the drums about shaking, at leasttion, against a child’s own parents, he could neither explain strange phenom- one physician was trying to develop andKempe was, in effect, telling the medical ena nor recall all ten commandments in apply the science of head injury biome-community to break charity with its 1692, John Proctor, the character in chanics to determine what forces it actu-patients. Auther Miller’s classic play, “The ally takes to cause brain injuries from Crucible,” put it this way: “I never knew THE DARK SIDE OF DIAGNOSIS what later became popularly-known as until tonight that the world is gone daft “whiplash.” Whiplash is rapid movementHippocrates’ ideal was “First, do no with this nonsense.” The night, like the of the head back and forth withoutharm.” In “Ancient Medicine,” he wrote daftness, was only just beginning. Kempe impact.that those who leap to conclusions about gave scant ‘proof ’ that his theory of shak-the origin of an illness are “clearly mis- ing as the cause of these injuries was sci- Whether rear end car crashes could causetaken in much that they say.” If entifically valid. He reported only two whiplash injuries was controversial andHippocrates were alive today, it is not cases in his article. disputed in the 1960’s, even more so thanmuch of a stretch to believe that the In the first case Kempe reported blunt today. Beginning in 1966 and 1968,Father of Medicine would have had harsh trauma to the head could not be ruled Ayub K. Ommaya, M.D., a Pakistani-words for Kempe and others who encour- out because the baby survived. There was born and Oxford-educated neurosur- T H E W A R R I O R • F a l l 2 0 0 3 33
  7. 7. THE ELEPHANT ON THE MOONgeon, set out to determine the amount of In 1971, yet another doctor weighed in the brain as the quick bending of theforce it takes to cause certain types of on shaking. Citing Caffey’s 1946 article infant skull occurs from sudden impact.brain injuries ranging from subdural on the association between broken bones The work of biomechanicians show thathematomas (intracranial bleeding) to and SDH’s, Kempe’s 1962 article and slow changes in skull shape, such as thosebleeding in the body of the brain, itself Ommaya’s 1968 monkey data as proof occurring in the birth canal, allow the(e.g., intercerebral contusions). Ommaya that human shaking causes brain injuries brain to adjust its internal pressure andwanted to test the hypothesis that rear in children, A.N. Guthkelch, M.D., make accommodation for the externalend car crashes could cause such injuries announced in the British Medical Journal squeezing on the skull. Blood flow andwhen the occupants were (1) not that when a child with subdural flow of cerebral spinal fluid are regulatedrestrained and (2) did not bang their hematomas (SDH’s) and retinal hemor- to decrease or increase volume. But, asheads. rhages (RH’s) and no external marks on with a precipitous birth, there is no time his or her head comes to the ER, one canOmmaya’s experiments were gruesome for this adjustment of blood and cerebral infer (reason) that the child had beenand unpopular, and later ones by other spinal fluid pressures in the fast bending repeatedly shaken, rather than being ascientists were to be shut down under of the skull that happens when an infant victim of impact.pressure from animal rights groups. But, falls and hits his or her head.in the research climate of the mid-to-late This doctor made no distinction between According to Ommaya and others who1960’s, Ommaya was able to use Rhesus the power that a human being can gener- have studied the material make up ofmonkeys in place of humans to mimic car ate versus the power of a machine, even brain tissue, it consists mostly of wateraccidents by accelerating them on chairs citing the case of a “prominent Americanfixed to a track and decelerating them neurosurgeon whowithout impacting their heads at all. developed a SDH after his head hadAfter these grisly experiments, the mon- been jerked by thekeys were anesthetized, killed and autop- violent motion ofsied. Ommaya’s 1966 and 1968 experi- the bobsled whichments showed that it took between he was riding at the35,000 to 40,000 radians per second fun fair,” as an(squared4) of angular or rotational acceler- example thatation to cause intracranial and intercere- human shakingbral bleeding in the monkeys. That was injures babies’the equivalent of forces not merely in a brains. Nor did thisstraight line (so-called “linear”), but doctor appreciateforces occurring as the monkeys’ heads that blunt impact, The 1968 Ommaya rhesus monkey experiments. The cars were shotrotated or arced on their necks. as with an acciden- forward and quickly stopped causing whiplash injury at about tal fall, may leaveTo compare what would happen to 120-G forces, more than 10 times the 11-G forces a human being is no telltale marks,human brains during the angular or rota- able to generate by shaking, alone. especially in thetional acceleration-deceleration of a car case of an infant.accident, Ommaya mathematically scaled and fat. As such, it would take aboutthe size of the monkeys’ brains to human Head injury biomechanics was not even 100,000 square inch pounds of pressurebrains and determined that it would take part of the question about whether shak- to compress it to a smaller size. To under-between 6,000 and 7,000 radians per sec- ing could cause the so-called SBS head stand the magnitude of this force, imag-ond (squared). Relying on this and other injuries. For example, as with Caffey and ine a woman wearing shoes with a one-head-injury data, Ommaya concluded Kempe, Guthkelch did not appreciate square-inch heel. If she weighed 100that forces generated by some rear-end that the infant skull is pliable and is capa- pounds and stood on one foot with a heelcar accidents caused whiplash brain ble of bending on impact and, in some that size, she would exert 100 square inchinjury to humans. cases, leaves no evidence of injury as it pounds of pressure on the ground. resumes its shape. There was little excuseTo put in perspective some of the rota- Under pressure, like water, the brain fol- for failing to appreciate this situation, fortional or angular forces that must be lows the path of least resistance. On the pliable nature of the infant skull wasexceeded to cause human head injury impact, when the skull indents or, as bio- described in the medical literature as farwithout impact, there are a few reports in mechanicians say, when it “transiently back as 1888. Still, when one is set onthe Japanese neurosurgical literature deforms,” some computer models show proving a hypothesis, contrary informa-claiming that some riders exposed to the that the brain tissue rotates inside the tion is discarded and supportive data ismassive angular forces created by roller skull. To visualize this, imagine that lovingly retained.coasters as they climb, dip, corkscrew and under the pressure of impact to the head,turn, have developed SDH’s diagnosed Nor did Guthkelch, or any other physi- the brain behaves a bit like toothpaste inafter experiencing “roller-coaster cian claiming that shaking injured babies’ a capped tube which when squeezed fromheadache.” brains, consider what might happen to the outside rotates under the pressure.34 T H E W A R R I O R • F a l l 2 0 0 3
  8. 8. THE ELEPHANT ON THE MOONBecause the toothpaste is relatively ments, Guthkelch and Caffey also read gleams,incompressible, it cannot get any smaller. Ommaya’s 1968 monkey experiment It’s stretch, squeeze, stretch; not bash, hitBut it can get relief from the pressure by article. Because he was traveling along his batter,turning or rotating in the tube. own “scientific” track intent on reaching a preconceived destination, Caffey con- Which bloody your bones and dura The rotation of the brain caused by skull cluded that just as acceleration-decelera- mater.5change on impact would be harmless if it tion, without impact (i.e., free shaking or On one level, given the development ofwere not for the fact that the brain is a ‘whiplash’) damaged the monkeys’ brains, the modern scientific method by Bacon,labyrinth of blood vessels (as are found in this also explained how parents inflicted Popper and others, it is amazing that nothe subdural and subarachnoid spaces) brain injury on their babies. He actually one at the time questioned or challengedand of millions of connections (such as telephoned Ommaya to thank him for the assumptions and conclusions reachedneurons and their axons) that cannot be the 1968 article. Today, Ommaya is by Caffey, Kempe or Guthkelch, especial-stretched beyond their limits. Once these adamant that he told Caffey that the ly when the liberty of other humanstructures are stretched by rotation, they acceleration-deceleration forces involved beings, and the love between parents andwill shear, tear and die causing excessive in the monkey experiments were much children were at stake. Instead, as withbleeding and, often, lethal swelling of the greater than he believed could be generat- the debate between Aristotle andbrain. ed by a human. Indeed, Ommaya recent- Democritus, it appears that the authorityIn the early days of the SBS diagnosis, the ly affirmed that communication in the of these prominent physicians, who werescience of head injury biomechanics was British Journal of Neurosurgery in 2002. publishing their hypotheses about pedi-still in its infancy. The development of Caffey’s subsequent misapplication of the atric head injury causation in the estab-this science would have to await, among 1968 Ommaya monkey data to alleged lishment medical journals, rather thanother catalysts, the advent of products lia- shaken babies was to further compound any true claim to reliable science, carriedbility cases against manufacturers of auto- the problem of “shaken baby” theory, the day.mobile companies, playground equip- already a hopeless house of cards con- In terms of the medical culture of the day,ment, bikes, helmets and toys. For exam- structed of unproved hypotheses fueled it is not surprising that there were fewple, in attempts to design more crashwor- by Kempe’s call to physicians to cultivate challenges, if any, to these physicians.thy vehicles and minimize liability and suspicion of patients’ parents. They were publishing their theories at adamages, the auto makers would employbiomechanicians to start working out the In 1972, Caffey wrote and published, time when the practice of medicine was athresholds and causes of head injury at “On the Theory and Practice of Shaking more refined and ostensibly gentilecrash test facilities, and later with com- Infants.” By then, Caffey and Kempe endeavor, when learned men publishedputer-generated models. shared the limelight with the newly iden- case studies in journals, and gave defer- tifiable form of child abuse being called, ence, rather than challenged, one anoth-Guthkelch and other physicians advocat- among other names, “the Caffey-Kempe er’s assumptions and conclusions. It wasing human, manual shaking, alone, as the Syndrome.” Their careers as discoverers all very gentlemanly and polite, but rarelycause of brain injury to babies also did of the new scientific frontier had taken scientific. Most senior physicians then,not know that their hypothetical descrip- off. And, Caffey’s publicly-expressed and even now those currently in practice,tions of parents injuring their babies by desire that pediatric radiology become a were trained under the old system thatshaking them from front to back was to “respected and valid medical entity” was started with an undergraduate degree inbe further questioned by later head injury being realized. From Caffey’s viewpoint, almost any field followed by years ofresearch. In 1982 biomechanician it was through the magical eye of the X- intense training by professors of medi-Lawrence Thibault and neurosurgeon ray (then called the roentgen) that the cine. The professors taught by impartingTom Gennarelli (and others) showed that shadows of pediatric head injury abuse their years of anecdotal experience andbrain injury occurs more easily from side- were being exposed. Caffey was later to their beliefs to the new medical students.to-side rotation, like the tick-tock of a call the X-ray “the pristine probe,” and in Experimental medicine (evidence-basedmetronome, that is, in the coronal plane, a 1972 address to Boston- and Harvard- medicine) used to be mentioned onlyand not in from front to back like a based radiologists read them this poem he occasionally, and the conclusions of thechild’s swing, that is, in the sagittal plane. penned: limited number of experiments (clinicalAnd this was in an experimental situation trials) often were of limited validity orwhere the forces far exceeded what a Poor shaken babe, guileless tyke, were even incorrect because of poorlyhuman being can generate. It’s a question Rocked by love and hate alike, designed clinical trials and poor under-of magnitude. standing of the statistics of clinical trials. Your mother’s tongue locked in silence,HEAD INJURY SCIENCE SLIPS THROUGH The development of “evidence-based Hush untold tales of guilty violence, medicine”—large medical studies, apply- THE CRACKS OF MEDICINE ing the scientific method in study design, But when we flood your flesh with radi-As the automobile companies and other testing and interpretation of results—was ant streams,manufacturers were studying the science still at least two decades away whenof head injury to minimize money judg- Bruised bones shine through in truthful Caffey published his 1972 paper. T H E W A R R I O R • F a l l 2 0 0 3 35
  9. 9. THE ELEPHANT ON THE MOON baby syndrome.” Many of them (AAP’s) reliance on Caffey’s work to justi- joined the parade by reporting fy the existence of “SBS” is at best negli- their own anecdotal and self- gently misplaced and at worst ideologi- confirmed theories in the med- cally infected. Caffey’s article contains ical literature. Today, there are within itself an absence of reliable and several hundred such articles. complete data to support his hypothesis Most of them refer and rely on and conclusions about Virginia Jaspers’ Caffey, Kempe and Guthkelch. alleged shakings: It is a legal and moral outrage “The most gruesome and, at the that even though the SBS “diag- same time, the most significant nosis” is a statement of causation examples of proved…whiplash-shak- pediatricians are not required to ings and of burpings are recounted study the science of head injury in the story of an infant nurse…She causation either in medical is reported to have killed three school or in their pediatric resi- infants and maimed 12 others dur- dencies. This is also true of ing a period of eight years, largely by forensic pathologists who are fre- shaking and jolting infantile brains quently called to testify about and their blood vessels…. In one The scattergram from the 1987 Thibault study shows the issues of force. instance she was invited back by the thresh hold for injury from human shaking, alone. Note parents to care for their second that by shaking the model baby without impact, the One forensic pathologist testify- ing in a murder trial in a case of infant after she had shaken their first researchers were not able to generate the forces Ommaya child to death.” (Emphasis added.) reported are necessary to cause brain injury. The circles alleged SBS haughtily told a in the bottom, left corner are the measurements from the Kansas jury in November 2000, Caffey ignored the fact that the first accelerometer on the baby’s neck from the pure shaking “I have no interest in infant showed evidence of blunt trauma experiment. No one got over 11 G forces. But, when the [bio]mechanics. I am a doctor.” and continued: “Eventually, she admitted model baby was slammed (the slams are represented by Yet she was there to testify about killing three infants and maiming two the triangles) the force generated was about 50 times head injury causation in relation others.” Not only was Caffey’s 1972 arti- greater than pure shaking. to the manner of death: cle heavily dependent on Jaspers’ descrip- Homicide by violent human tion of how she believed (once accused)Even today, a bias toward reliance on shaking, alone. She was there for the State that she injured the babies, but it alsoanecdotal rather than on evidence-based to refute the defendant’s account of the lacked any detailed autopsy (then calledmedicine continues in this field. Only in child who fell head first down concrete “necropsy”) information on which any-recent years has the concept of medicine steps. The child’s injuries were caused one could make an independent judg-as a research science (evidence-based when the defendant violently shook him ment about the validity of the scientificmedicine) been introduced into the med- and then slammed him down, the med- hypothesis, i.e., that by shaking a childical school curriculum. Current medical ical examiner claimed. The SDH’s, the violently, an adult could inflict braintraining, on the other hand, emphasizes RH’s, could not have been caused by this, injury.the science of medicine (evidence-based she further reasoned before the jury. Shemedicine) and addresses the validity of had not even bothered to calculate the In 1974 Caffey wrote more about Jaspersspecific clinical trials and of different impact velocity (if she even could) with “whiplash shaken” baby cases and thistypes of clinical trials in making medical which the child would have hit the time included some autopsy informationrecommendations. ground to rule out foul play. She had about one of the babies. One very haunt- read the medical literature about SBS and ing problem about the case of the (11-The entire concept of “shaken baby syn- week-old) baby whom Jaspers was was confident and satisfied that she wasdrome” arose when most physician-train- accused and convicted of killing is that, an expert in shaking as a cause of braining was based on the medical culture of based on the autopsy information that injury in babies.the mid-twentieth century, a time when was provided, this child may well havenew ideas did not require rigorous scien- The Kansas forensic pathologist had, of had birth injuries. (Obstetricians knowtific validation to survive. The same con- course, read Caffey’s 1972 article. That only too well that even babies born bycept, if introduced de novo today, would article now forms part of the “scientific” normal birth sometimes have subduralnot survive scientific evaluation and foundation of the American Academy of hematomas.) In that autopsy of the 11-would not have become established as Pediatrics’ [AAP] technical report affirm- week-old, shaking was not ruled out bypart of our medical and legal folklore. ing that human, manual shaking, alone, examination of the brain stem or upper without impact, causes baby brain injury. cervical spine. The age of the subduralThe biomechanics of head injury was not The AAP reaffirmed its position as blood was not tested to see if Jaspersconsidered by pediatricians who contin- recently as July 2001. could be ruled out as a killer by compar-ued to rely on Caffey and others and to“recognize” their own cases of “shaken The American Academy of Pediatrics’ ing the age of the initial injuries with the nursemaid’s care of the child. And, blunt36 T H E W A R R I O R • F a l l 2 0 0 3
  10. 10. THE ELEPHANT ON THE MOONimpact was not conclusively ruled out. able to generate was a mean of 1,138 RECENT STUDIES DEBUNK SBSThere was a clear effort to prove the radians per second (squared). That was ahypothesis that the baby had been shak- far cry from the required 6,000 to 7,000 Other more recent studies have also refut-en, and shaken by none other than radians per second (squared) which ed that shaking is the cause of brainJaspers, rather than to falsify it by search- Ommaya established were needed to injury. In June, 2001, two British neu-ing inquiry. In some of Caffey’s reported cause brain injury by whiplash to man, ropathologists, Jennian Geddes andcases were there was no evidence of skull i.e., shaking without impact, in the 1968 Helen Whitwell, announced their find-fractures or external scalp injuries and, monkey experiments. ings after studying a number of childrenbased on this, he reasoned that these who, it was claimed, had been victims of Secondly, the experimenters asked the shaking. They found that there was a sig-babies were victims of whiplash shaking athletes to slam the model baby on three(WLS). On the “data” provided by different surfaces. Only when it wasCaffey, it is clear that no one investigated slammed on hard metal and padded sur-whether there were internal injuries to the faces did the accelerometer on the modelscalps of those children. Certainly, no one baby’s neck register the forces needed tomentioned the fact that some blunt cause concussion, SDH’s and diffuseimpact injuries do not cause external or axonal injury. In fact, the forces generat-internal scalp damage. And no one men- ed by impact were 52,475 radians per sec-tioned the pliable nature of the infant ond (squared).skull or considered what might happen tothe underlying brain on impact. The experiment had falsified the hypothesis that a human being, byAlthough shaking as a cause of injury is manual shaking, alone, could injure ablindly accepted by segments of the med- baby’s brain. The results of the experi-ical establishment, this hypothesis of how ment have never been invalidated, butbabies’ brains are injured has never been prior and subsequent studies are consis-validated by pediatric head injury biome- tent with them.chanicians, i.e., by the relevant scientificcommunity to whom the science of injury Critics of the 1987 Thibault experimentcausation belongs. claim that the results are invalid because the baby was not real. But, that was notQuite the contrary. the point. The 1987 Thibault biome- SBS FALSIFIED BY chanical experiment focused on the ques- tion of whether it was possible, as a mat- RELEVANT SCIENTIFIC COMMUNITY ter of physics, for the shaker to generateIt would be 15 years after the 1972 the forces Ommaya determined were nec-Caffey article before an experiment essary to cause brain injury withoutwould be performed that would prove impact. Football players capable of inflict-that a human being could not possibly ing tremendous physical violence couldgenerate the forces necessary to cause not do so.internal head injury by human, manual If anyone really wants to reproduce thisshaking, alone. It appeared that Jaspers experiment with biofidelic models, it canhad confessed to something she had not be done using finite element analysis, adone or, more sinisterly, she had done technique through which head injury canmore than that to which she confessed. be simulated on a computer. It’s a tech-Unlike physicians, biomechanicians nique based, in part, on US military pro-experiment with the forces needed to grams released into the public domain,cause human injury. In 1987, a biome- and has been used by the auto industry,chanician and a group of neurosurgeons among others, to make safer products.set out to prove that SDH’s and other But, the cost of this is high, and funds forbrain injuries in babies were not caused alleged child abusers are not.by shaking, alone, but by impact. Following the release of the 1987 Nursemaid Virginia Jaspers: when she confessedThe biomechanician was Lawrence E. Thibault study the hypothesis of “shaken in 1956 to shaking a number of infants in herThibault. The Thibault team members baby syndrome” has sometimes been care, Jaspers opened floodgates that are still dif-made a model baby and attached an recycled as the “shaken-impact-baby syn- ficult to close, despite the fact that the 1987accelerometer to its neck. First, they drome” (SIBS), but pure shaking is often Thibault study conclusively invalidated theasked some burly “Penn State” football still used as the theory of causation in Caffey-Kempe-Guthkelch hypothesis that shak-players to shake the model as hard as they criminal indictments regardless of ing, alone, injures babies’ brains. Did she reallycould. The most force these hulks were whether there is evidence of impact. do what she confessed to doing? T H E W A R R I O R • F a l l 2 0 0 3 37
  11. 11. THE ELEPHANT ON THE MOONnificant association between shaking and CONFESSIONS DO NOT articles. A person, perhaps like Jaspers,brain stem injury or upper cervical spine EQUAL SCIENCE might confess to shaking alone, becauseinjury. The term “association” in medi- the impulse behind it is emotionallycine is loaded. It means that if one sees A common theme in SBS cases is that the understandable. Hitting or slamming a“A,” one will expect to see “B.” If a child accused confessed to shaking. baby’s head is much less forgivable. Ahas been shaken, there should be corre- Even though Virginia Jaspers confessed in confession to shaking, alone, is more like-sponding brain stem or upper cervical ly to help in plea negotiations and at sen- 1956 to shaking some of the babies in herspine injury. The physics of this proposi- tencing than if the defendant were to say, care, it is clear she did not kill them thistion make sense and are supported by “I shook the baby violently then slammed way, if at all. After being told by a pedia-other head injury research by Ommaya, her head against the mattress.” Simply trician that she murdered the infants inand others. At least one biomechanician put, as with other areas of criminal law, this way, she may well have believed shehas compared the neck to a straw, and the many confess out of sheer terror—or did. However, the science of head injuryhead to a grapefruit. When shaken, the because they are actually made to believe developed since her confession tells a dif-more fragile neck is the first part to be they did cause the injury. A sentencing ferent tale. Today, after serving manyinjured. This analogy is consistent with deal gets a defendant a lower sentence, years in a State prison, Jaspers still lives instead of risking life without parole orthe work of Ommaya and others who with her “crimes,” an elderly woman whofound that the tolerance criteria for neck the death penalty after jury conviction. is afraid and wants to slam the lid on theinjury is exceeded long before that for coffin of her past. She actually believes Others, who have found a baby nothead injury. So, if there is intracranial or she killed the babies, and in this she is not breathing and blue (cyanotic) confess tointercerebral injury and RH’s, but no alone. Many people are actually made to shaking the baby to revive them. Oneupper cervical spine or brain stem injury, believe they killed. The doctors told them young father in Erie, New York weptone has to assume another cause, such as so. before grand jurors in 1999 telling themblunt impact. British neuropathologists that when he shook his baby boy to reviveGeddes and Whitwell found that brain Some of these, like Jaspers’ confessions, him on finding him not breathing, he didstem and upper cervical spinal cord are included the medical literature and not know he was causing the terribleinjury were rare findings. If shaking is so are used to provide ammunition against brain damage the doctors told him killedcommon, one must wonder why the others. Jan E. Leestma, M.D., a Chicago- his son. In fact, the father’s own injuriesfinding is not more common. based forensic neuropathologist, recently corroborated that had fallen down the reviewed 324 cases of allegedly abused stairs with the child and the baby’s headProponents of SBS also claim that diffuse infants whose cases had been variously had been banged. But, no one wanted toaxonal injury (DAI)—axons injured dif- reported in more than 100 medical arti- rule out SBS. Why bother?fusely in the brain—is a “diagnostic cles about shaken baby syndrome. Of themarker” for shaking. As with shaking as 324 cases, Leestma analyzed 57 of them The fact is no one has ever confessed tothe cause of intracranial and intercerebral specifically because they involved confes- shaking a baby with force equivalent toinjuries, the DAI-by-human-shaking sions to shaking. These cases had enough more than 6,000 to 7,000 radians perhypothesis was also falsified in 1998 by “data” on which he was able to make an second (squared) necessary to cause brainGerman pathologist Manfred independent judgment about the author’s injury in the absence of impact. If theyOehmichen. He studied the brains of claim of scientific and medical reliability. have confessed to injury by shaking,252 people, some of whom had been Of those, Leestma found that only 11 alone, the 1987 Thibault study provesdeprived of oxygen, a common, second- had both a confession to shaking and no they are lying or have been manipulated.ary effect of head injury referred to as evidence of impact. Eleven cases, which In fact, some biomechanicians and neu-hypoxic or anoxic insult. Oehmichen were gleaned from three decades of med- rosurgeons believe that because the baby’sfound that people who had been on res- ical literature, hardly add up to enough brain is smaller than an adult’s, it wouldpirators to help them breathe all had evidence-based medicine to prove the take even more force to injure a baby’sdamaged axons, which he termed “axonal hypothesis that the babies were injured brain by “whiplash.”pathology.” In cases of oxygen depriva- by human shaking, alone. And, keep intion, there is no way to tell whether the DOCTORS DESTROY mind that not all blunt impact injuriesperson’s axons were injured by the pri- THE PRESUMPTION OF INNOCENCE result in evidence of external or internalmary trauma, such as, by whiplash, or by impact, especially if the baby’s skull “Confessions” to revival shaking are usu-the cascade of events following primary changed shape on impact and resumed ally recorded and repeated in medicaltrauma known as secondary injuries, such normal shape after. records by doctors and nurses who,as, anoxia or hypoxia. It’s critical to note because of their training that To any serious scientist or physician, andthat in forensic medicine, the finding of SDH’s+RH’s=SBS, are presuming foul to judges, it should be common senseaxonal pathology is “non-specific,” mean- play when the child comes to the emer- that confessions are not reliable indica-ing that one cannot infer anything about gency room. Most states—as a require- tors of the science head injury causation.its origin or cause. British neuropatholo- ment of federal funding for all kinds ofgists Geddes and Whitwell also con- The circumstances of the confessions in child-centered programs—have enactedfirmed this in another study in 2000. the eleven cases were not included in the statutes mandating that doctors and38 T H E W A R R I O R • F a l l 2 0 0 3
  12. 12. THE ELEPHANT ON THE MOONnurses (and others) report child abuse. In The federal and state governments and fatal brain injury. The evidence is thatmost states, the standard for reporting private foundations currently pump mil- there are many other causes of intracra-abuse is a mere “suspicion” that an injury lions of dollars every year into “recogni- nial and intercerebral injury and retinalwas caused by abuse. A mere suspicion is tion and prevention” programs to stop so- hemorrhages in babies that are just beingdangerous to report when it involves a called SBS. It has become a self-perpetu- ignored and that other potential causes“syndrome” like SBS that is both a state- ating industry of child abuse ‘expertise.’ are not being researched.ment of diagnosis and a statement of Money for much-needed research into Instead of applying the scientific methodinjury causation. As the machinery of the the actual cause of pediatric head injury, to this area and using the evidence, manyState gears up, this mere suspicion-cum- the results of which could end the risk of physicians seem content merely to gazediagnosis quickly morphs into probable false accusations and, possibly, free some upon the elephant in the moon. Ascause and, by the time of trial, has moms and dads from behind bars and lawyers, it is our job to expose thebecome a diagnosis to a reasonable degree reunite them with their children, is fun- mouse’s tail in the telescope. qof medical probability or certainty. In neled into the wrong pockets for theeffect, what frequently happens is that wrong cause. Physicians who have staked ENDNOTESthis systemic glitch allows self-appointed their careers on SBS being a real diagno-judges and jurors wearing white coats to sis, who have published, received grants, 1 This is part of a book currently being written by Elaine Whitfield Sharp. Copyright bypull the plug on the presumption of and who have testified in countless trials Elaine Whitfield Sharp, July, 2003. Permissioninnocence. are understandably reluctant to buck the to publish given to The Warrior. system that feeds them. And, in face of 2 Huber, P. W.,“Galileo’s Revenge—Junk A QUESTION OF INTENT this powerful lobby, accused and convict- Science in the Courtroom,” p 27, BasicBooks, 1991.Why, in face of the increasing scientific ed child abusers are not much of a match. 3 Credit for this excellent discussion of theflap about shaking, doesn’t the State just When Illinois Governor George Ryan development of the scientific process goes to,drop the “violent shaking” language from “The Five Biggest Ideas in Science,” Chapter freed some of that state’s death row 1, Wynn, C.M and Wiggins, A.W., (Wiley,its indictments, opening statements and inmates and commuted the death the 1997).closing arguments? Why, like the Salem sentences of others in January, 2003, he 4 Squared: With each passing second as anwitch trials, does the State insist on spon- said: “I started this issue concerned about object falls the force of gravity, which issoring only one side of the scientific approximately 32.2 feet per second, is doubled fairness. Fairness is fundamental to the or “squared.” Thus, for the first second, thedebate? The answer lies in the need for American system of justice and our way speed of the fall is 32.2, and for the nextintent. The argument goes that there is of life.” second, it is 64.4, and so on.no way a person could accidentally and 5 The “dura mater” is a meningeal covering ofviolently shake a baby to death. And, just Unfortunately, the topic of SBS, while no the brain beneath which “sub” dural bleeding more important, is much more complex occurs.in case someone should claim diminishedintent for such an act, in at least one than ruling someone out as a culprit by Next Issue:state, parents of newborns are now made DNA testing. And, there may be more people in prison wrongly convicted of When it comes to protecting children, itto watch a video in which they are taught child abuse than any other segment of the might seem like scientific sophistry to argueat the hospital—and sign a declaration prison population. Nevertheless, when it that only impact is capable of causing brainthat they understand—that shaking caus- comes to the relationship between par- injury to a baby. But, it has critical impli-es brain injury to babies. Should their ents and children, as well as questions of cations. Many accused of shaking a childchild appear in the ER with injuries “con- liberty, it is perhaps even more important have explained that the child suffered asistent with SBS,” the prosecutor’s cross- to be patient in unraveling this mess as it short fall. According to the 1987 Thibaultexamination of the testifying defendant- is with DNA innocence cases. experiment, and all the other head injuryparent with this document is not hard to research, these accused people were tellingimagine. Fairness is fundamental, and junk science the truth about one thing: they had not Philosopher Thomas Kuhn in his book, used to convict is fundamentally unfair. caused these injuries by shaking. Blunt“The Structure of Scientific SBS is a ‘diagnosis’ from Hell for it sets in impact, on the other hand, could just asRevolutions,” explains that scientific rev- motion the machinery of the State well be caused by an accidental fall from aolutions happen when people start think- against parents and others who merely short height as it could from being hit. Iting outside the box, in what he calls “new went to the hospital desperately seeking one falls three to four feet, one hits theparadigms.” help for a sick child and ended up in ground at 10 miles per hour. This intro- prison and, more often than not if the duces the notion of accident in an areaIn the area of SBS, we are locked in an child survives, with their parental rights where the State claims only intentionalold and destructive paradigm that, as in terminated. shaking caused the injuries. In the next issuethe times of Aristotle, is promoted by the in Part II, the science of blunt impact andauthority of the speaker—in this case If you have a case of alleged SBS, there is issues of timing of the injury will be dis-some ideological segments and members a defense. The evidence is that human cussed. Part III will outline how to chal-of the medical establishment—and not shaking, alone, does not injure babies’ lenge the State’s ‘science’ using the state ver-the quality or reliability of the head brains. The evidence is that short falls sions of Daubert and Frye.injury science. may cause catastrophic and sometimes T H E W A R R I O R • F a l l 2 0 0 3 39

×