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opportunity to obtain a second medical opinion as this is labelled innocence. The MSBP profiling is extremely prejudicial, ‘doctor shopping’, part of the MSBP child abuse profile—even inaccurate, paradoxical and often nonsensical, leading to grave though doctors are ethically obliged to allow it and it is a patient's injustices." She also noted: "The MSBP profile used by doctors right to obtain a second medical opinion." contains paradoxes that make it very difficult, almost impossible, According to Hayward-Brown, good mothers are accused of for mothers to prove their innocence. For example, being an child abuse, as this fits the so-called munchausen syndrome over-protective parent is part of the MSBP profile, but so is being "profile" of a child abuser. These mothers are seen as a negligent parent." "perpetrators", pretending to be good, caring mothers. "A mother Major public hospitals with child protection units as well as could be doing nothing wrong, other than showing anxiety and child protection agencies in New South Wales, in other Australian care for her child and questioning doctors on the care of her very states, in the USA, the UK and other countries share the view that sick child. Before long, she could be accused of child abuse and a mother must be guilty, but they fail to undertake appropriate face criminal charges. It is just like the witch-hunts of centuries investigations. ago that were based on guesswork." Some doctors, according to Hayward-Brown, are predisposed to Munchausen syndrome by proxy is based on a "profile" or making child abuse allegations in the medical context. While "label" that allegedly indicates the mother's behaviour. The acknowledging that parents may occasionally harm their children, "profile" includes the mother who shows too much interest in she said MSBP allegations are prejudicial. Professionals suffer medical procedures, paradoxically taking no from confirmatory bias where they maintain interest in the child's medical care, and the their beliefs, even in the face of counter- mother who passively accepts everything but evidence. "It does not matter if it is called a also seeks attention by going to the media. Munchausen disorder, behaviour or syndrome. It does not The "profile" has also been extended to include matter if it is seen to be psychiatric or the "anxiety" a carer may show concerning the syndrome by proxy paediatric. The outcome is the same." child's illness. If the mother protests her (MSBP) 1s based ona innocence, then that is seen as "denial" in | AP " " Meadow's questionable MSBP research psychological terms, but if she "confesses", as profile or ‘label that However, the legitimacy of the munchausen in a response to blackmail, that is seen as allegedly indicates syndrome by proxy theory is now undergoing confirmation of the physician's conclusions, th m th r intense scrutiny worldwide for its lack of sci- albeit entirely without corroborative evidence. eé mother s entific integrity, the highly questionable sup- Dr Terry Donald from the Adelaide Children's behaviour. port literature in medical journals and its con- Hospital, South Australia, is concerned if tinuing use by a minority of influential a mother calls him by his first name at members of the medical profession. hen first meeting. payware Brown said The "profile" Meadow is Facing sotto. professional that generally a mother will be told that . misconduct charges by the British General she has little hope of her children being includes the mother Medical Council, which registers doctors reed unless she con fesses to MSBP. b who shows too much in the UK, and is hearing i scheduled arles Pragnell, an expert Britis . . . or © He has been accused of giving defence witness in child protection, now interest in medical misleading and contradictory evidence in based in Melbourne, Australia, said that procedures... courts. The Royal Statistical Society on the labelling of a carer, usually the mother, with child abuse prevents proper investigation of the child's medical condition or legal action by the carer, as the carer is labelled a liar and fabricator. 23 October 2001° publicly condemned his statistical methodology, with emphasis on his evidence in the Sally Clark case. One of his strongest supporters, Professor David Southall, was found guilty of seri- He said bringing legal action or making a complaint against a ous professional misconduct by abusing his position in a mun- doctor is therefore very effectively stopped. Pragnell said a high chausen syndrome by proxy case. Southall also failed to disclose proportion of allegations of munchausen syndrome by proxy that he consulted with Meadow on the case. He was banned from followed a threat by the parent to report the physician for child protection work for three years. Southall is facing another malpractice, errors of diagnosis or treatment, doctor negligence or seven official complaints. Hayward-Brown is also concerned incompetence. "MSBP allegations have also been made with no about the use of US MSBP proponents such as Dr Herbert attempt having been made to thoroughly investigate possible Schreier in Australian cases. causes of the child's illness from genetic disorders, vaccine In the UK, Meadow's theories are under sustained attacked in damage, effects of prescribed medications, exposure to toxic government, legal, medical and community circles and the whole substances, or severe allergic reactions." legitimacy of MSBP is being strongly questioned. In the House Associate Professor Dr David Coats, an American ophthalmol- of Commons on 17 June 2004, Children's Minister Margaret ogist, said that child abuse should be considered when the pieces Hodge ordered reviews involving 30,000 care orders. of the medical puzzle don't fit, e.g., when the child has unusual The government is also investigating the manner in which ocular abnormalities or other medical conditions that cannot be expert medical evidence is used in child protection courts. The explained through medical evaluation.* Solicitor-General, Harriet Harman, alerted prosecutors that In this way, Hayward-Brown said, if a doctor cannot determine Meadow was criticised by the UK Court of Appeal. the cause of a child's illness then the parent, usually the mother, is Pragnell said it was because of concerns about the validity and alleged to have caused the medical problem in the child. "The integrity of Meadow's evidence that the prosecutors, under pres- mother is guilty without appropriate medical or police sure from the UK government, would no longer use Meadow as investigation and it is usually impossible for a mother to prove her an expert witness. "Cases where Meadow was involved were Munchausen " allegedly indicates the mother's behaviour. The "profile" includes the mother procedures... 38 = NEXUS interest in medical www.nexusmagazi ne.com OCTOBER — NOVEMBER 2004