Following is the full transcript of neuropathologist Waney Squier’s TEDx Talk titled: I Believed in Shaken Baby Syndrome Until Science Showed I Was Wrong at TEDxWandsworth conference.
Listen to the MP3 audio while reading this transcript: I believed in Shaken Baby Syndrome until science showed I was wrong _ Waney Squier _ TEDxWandsworth
I am a mother, a grandmother, a pathologist and a scientist. I want to tell you Linda’s story.
Linda and James had a baby boy called Tom. He was Linda’s third baby. When he was about four months old, she was alone with him one night. I think many of you may have looked after young children at some time, your own children, grandchildren or while babysitting. Sometimes, you’ve been alone with them.
This particular night, James is working and Linda became concerned about Tom’s breathing. She phoned her doctor and she said, “I woke up to give him his feed and found he wasn’t breathing, not until I picked him up and lifted him out of his cot. And then, he was fine. He’s right as rain now.” But the doctor decided to visit anyway.
He found Linda a calm and experienced mother. He examined baby Tom who had a mild fever and was a bit snuffly, but he found nothing else and concluded there was nothing seriously wrong, so he left. But there was something wrong.
Because an hour later, Linda found Tom unconscious. He was not breathing and had no pulse, so she called an ambulance and he was rushed to hospital, and put on a life-support machine.
A consultant pediatrician examined Tom and found he had bleeding in the retina, the membrane at the back of the eyes. A brain scan showed he had a thin film of blood in the dura, the membrane that surrounds the brain and the brain was swollen.
But 24 hours later, Tom was dead. Linda was arrested and charged with killing her baby. At her trial, Linda was described as a woman of good character, a caring and careful mother. She said she’d done nothing to harm Tom, but she couldn’t explain why he collapsed.
But doctors, medical experts, said that those three findings meant that Tom must have been violently shaken some time after the doctor had left her house. The jury found Linda guilty and she was sentenced to three years in prison. A few years later, she appealed and her conviction was overturned.
So she’d been innocent all along! Her name was cleared, but her life was ruined. Her parents had died, and James had left her. And because she was in prison, when Tom was buried, nobody told her. So she was denied the opportunity of attending her own son’s funeral. But that’s not all.
While Linda was on bail awaiting her trial, she became pregnant. She gave birth to a little girl, Lucy, when she was in prison. Lucy was immediately taken away and placed for adoption. Even when her name was cleared, her conviction overturned, Linda was not allowed to make contact with her daughter. She lost Tom, and now she lost Lucy as well.
This is not a dystopian nightmare, this is a true story. And it’s a story that’s repeated day in, day out, all around the world. In the US, some 2,500 people are in prison, five of them on death row, awaiting their execution. In this country, we hear the story hundreds of times every year in our courts. It’s heard in Sweden, in France, in Australia and New Zealand.
And what all of these stories have in common is that a doctor has made the diagnosis of “shaken baby syndrome.” In Linda’s case, I was one of those doctors. As a pediatric neuropathologist, I studied the brains of babies who’ve died, hoping to find out why. The police asked me to examine Tom’s brain, which I did. It was swollen, nothing out of the ordinary, but that fitted with what the other doctors were saying in this case: shaken baby syndrome. They believed in it, and I believed in it. So my report was part of the evidence that cost Linda so much.
What is “shaken baby syndrome?”
Central to it is a young baby who presents with one or more of those three features that Tom had, known together as the triad of retinal haemorrhage, subdural haemorrhage and a swollen brain. Remember that word “triad,” because I’m going to be using it again. There are many causes of the triad, but historically, it was associated with trauma.
Now these babies have no evidence of trauma. They have no head impact, no fractures, no bruises. So the shaken baby hypothesis depends on the assumption that shaking is the cause, and that shaking can generate enormous forces, equivalent to a fall from a second storey window or a road traffic accident.
And what’s more, the shaking event is never witnessed, and its effects are almost always immediate. So with this hypothesis, it’s easy to identify the perpetrator.
It’s the person who was alone with the baby, and who brought him for medical care. The idea that shaking might cause the triad was first proposed back in the early 70s by a small group of doctors in the US. It wasn’t based on research studies but on anecdotal reports, an article in Newsweek and speculation. Nobody then, had ever witnessed a normal baby being shaken and develop the triad. And nobody has, to this day.
So you might be wondering, as I did, how such a tenuous hypothesis could ever have been accepted? Well, back then, these doctors were deeply concerned that parents might be harming their babies and absolutely rightly so, because some parents do.
So laws were introduced across the US, requiring doctors to report even the mere suspicion of abuse. Failing to do so could result in prosecution. On the other hand, when doctors do report something as abuse, they’re granted immunity from prosecution, even if their report is unfounded or totally false. And so, reports of abuse went from tens, to hundreds, to thousands a year.
And the shaken baby hypothesis grew from an idea, speculation, into a “syndrome” and that syndrome was taught as fact in the textbooks and in medical schools. Well, this was nearly 50 years ago. By now, you’re probably thinking that researchers must have found the evidence-base to support this hypothesis. But they haven’t.
It wasn’t even tested until 1987, when bio-mechanical studies showed that adults shaking a crash test dummy as long and as hard as they could generated only half the forces of about one foot fall.
Now, that’s not even as much as a baby rolling off a bed. Clearly, we can’t do these biomechanical experiments on babies but we can learn by observing the world around us. Some of you might remember that, many years ago, we used to put young babies in forward-facing car seats If those cars were involved in head-on collisions, the babies suffered enormous whiplash. But case studies of those babies showed they didn’t have the triad. They had fractures and dislocations of the neck.
In 2001, Jennian Geddes, a neuropathologist and colleague in London showed that the brain damage in babies alleged to have been shaken was not due to traumatic tearing of the nerve fibers of the brain as we had thought, but is due to lack of oxygen. That’s something that’s seen in babies dying from all sorts of natural conditions and indeed, it’s seen in babies who have collapsed and died while being nursed on a ventilator, like baby Tom.
A few years later, brain scans showed that almost half of normal new-born babies have subdural haemorrhage. A similar number have retinal haemorrhage.
So two of the cardinal features of Shaken baby syndrome are common in normal babies after normal birth. These two findings are also seen in babies dying from a whole range of natural conditions as well as minor accidents and low falls.
So, if we turn to the medical literature for evidence to support this hypothesis, we find it’s riddled with errors, mostly due to circular logic and poor case definition. At the end of last year, an independent authority in Sweden published its review of more than 3,700 research papers and found only two that offered any support to the hypothesis that shaking causes the triad.
Just think about that: nearly 4,000 papers and only two offered any support, and those two were both found to be of only moderate scientific quality.
So today, as I stand here, I’m sure that shaking can harm babies, and we certainly shouldn’t shake babies. But nearly 50 years of research have failed to provide us with the justification to make the assumption that a baby who has the triad or any one of its components must have been shaken. That leaves us with the hypothesis that it seems it’s not fit for purpose for diagnosis, or in the Courts. In the courts, it gets a bit more complicated.
Back in 2001, the Geddes research stopped me in my tracks. It wasn’t what I had expected. So I read everything I could about Shaken baby syndrome. As a scientist, I’m ashamed to admit I hadn’t done so before I’d been making the diagnosis based on my uncritical acceptance of what was in the textbooks and what I had been taught. I was startled to learn that there was no scientific foundation for the hypothesis.
The triad is nearly a function of immaturity. It’s infant brain’s response to a whole range of different conditions. So what I had been taught was wrong. What I believed was wrong, and importantly, what I had been telling the courts was wrong. So I had to change my mind.
Having given evidence for the police in Linda’s first trial, I gave evidence to support her in her appeal. I wasn’t on my own, but my voice was certainly now in the minority. But changing my mind turned the tables on me. Back then, in the criminal courts, judges and juries were also questioning the hypothesis and were tending to acquit parents accused of shaking their babies. But in the Family Courts, the courts that decide, typically behind close doors, whether mothers like Linda can keep their babies, they were ever more adamant in their endorsement of the hypothesis.
It wasn’t very long before I was harshly criticized by family courts judges, because I was challenging the majority view. In 2010, a report was made to the General Medical Council, the doctors’ licensing authority, on the basis of those judicial criticisms. The complaint didn’t come from the judges who made them, nor did they pursue any of the avenues available to them to restrict me. No, the complaint came from the police, because I was, and they actually said, “I was confusing juries with science.” And I was getting in the way of them achieving their desired rates of conviction in these cases.
The complaint was not about my evidence while I was a prosecution expert, it was only about cases where I challenged Shaken baby syndrome. My published research on the subject was never questioned, nor the content of my opinions. It was just the way I expressed them and ironically, my use of the scientific literature to support my views. I faced a six months hearing, and my licence to practice medicine was suspended. I was struck off.
I appealed and my license was restored, but I was banned from giving evidence in the courts for three years. All of this has had a profound effect on the delivery of justice. Back in 2005, Linda had seven medical experts to support her. Today, she would likely have none. Experienced, highly qualified doctors are afraid to become expert witnesses and to challenge the hypothesis for fear of suffering the same fate as me.
Instead, prosecution experts are emboldened and today, cases are routinely decided on the basis of such careless opinions such as: “It’s generally considered” or “Most doctors believe that shaking causes the triad.” These are articles of faith. They have no scientific foundation. Science is not a democracy. Scientific fact is determined by experiment, by observation, not by how many people happen to believe in one hypothesis or another.
But today, these opinions are unlikely to meet any significant challenge. And this leaves families defenceless against unfounded allegations of abuse.
What can we do?
There are two things. Firstly, at the point of initial contact, when a baby with the triad or any part of it is brought to a hospital for medical care, we must have in place, as standard, a protocol for the complete and rigorous medical, familial and social assessment of every case and look for all of the causes of the triad. Getting it wrong at this initial stage means that parents are assumed to be guilty, and have to prove their innocence, which is a complete reversal of the burden of proof of our legal system.
Getting it right at this stage means that we will identify the treatable causes of the triad and can get on with treating them and save these babies’ lives. If we do find evidence of violence and abuse, then we can be stringent in our prosecution of offenders and increase the rates of conviction of the real child abusers. If we don’t find evidence of violence and abuse, we can save the emotional and financial burden of unnecessary prosecutions. Sometimes, there will be no clear diagnosis, and doctors must not be afraid to say clearly and unequivocally, “I don’t know.”
The second place where something must be done concerns the courts. All of us, we must demand an Inquiry so we can all see what is happening in these cases, particularly behind the closed doors of the Family Division. These courts have the power to impose draconian sentences. The separation of a baby from his mother is a life sentence for that baby. It’s a life sentence for his mother. It’s a life sentence for his father, for his siblings. It’s a life sentence for every member of the family.
Is it right that decisions of such gravity should be made in secret, hidden from public scrutiny and accountability? Is it right that in an area of medicine which has become so controversial, and opinions so polarized, that these courts, in order to save money, should appoint a single doctor as the expert to represent both sides of the argument? Is it right that a doctor whose views are entrenched in the belief system should go unchallenged, unquestioned by his peers? No, the courts must hear the scientific dissent on Shaken baby syndrome, fully and fairly. These courts must be opened. Justice must be seen, to be done. Otherwise, it is not justice.
If we do nothing, then ordinary people, people who have already suffered the tragedy of the death of a baby, will continue to have their families torn apart by incorrect and unscientific opinions. Mothers like Linda go to prison and babies like Lucy suffer forced adoption on the basis of belief. This lies at the feet of the medical profession who has forgotten the fundamental principle of medicine: “First, do no harm.” By ignoring the science and adopting unproven hypothesis, doctors have done great harm, and have led the courts astray. If we do nothing, this travesty will continue.
This travesty of the willful refusal of the courts and the doctors advising them to recognize the science that shows they’re wrong, will continue. If we do nothing, they will continue to do harm to innocent babies and their families. Thank you for listening.
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