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being carefully scrutinised and reviewed by child care agencies." When writing on MSBP, Meadow offers no scientific evidence The Opposition spokesperson on children and health in the that MSBP exists, and his references generally only include House of Lords, Earl Howe, called for a public inquiry into the articles written or co-written by him. A great deal of his references use of MSBP in prosecutions. Labour MP Vera Baird on 21 June includes material he wrote for the journal he edited, the Archives 2004 asked questions in the Commons on munchausen syndrome of Disease in Childhood. The list of reference material does not by proxy and on what role disgraced doctors Meadow and include any scientific or evidence-based studies on MSBP that Southall have played in the child protection cases. were peer reviewed by independent medical specialists. Howard Fishman, a former education director at the Harvard Medical School's psychiatry department, said that some so-called Court judgements on MSBP eminent paediatricians and self-proclaimed child abuse experts are Evidence involving the label or profile of munchausen syn- in the business of manufacturing victims while destroying count- drome by proxy is also being rejected by courts, e.g., the less innocent families. "The child abuse industry has devoted Queensland Court of Appeal (R v LM [2004] QCA 192), as preju- itself to the removal of children from their homes based on spec- dicial and inadmissible. The South Australian Supreme Court tral evidence, phantom disorders and fanciful modes of purported (S4118, 1993) ruled that Professor David Southall's MSBP testi- abuse that should be assigned to the trash bin of junk science." mony could only be regarded as a layperson's opinion, albeit a Hayward-Brown said the doctors could not acknowledge that well-informed one as he is a paediatrician. some illnesses are very hard to diagnose and treat and that they do Meadow's cot death theory—that one child death in the same make mistakes. The British Medical Journal (9 August 2003) family is a tragedy, two suspicious and three murder—has been cited the UK Court of Appeal which noted the case of a six-year- rejected by the UK Court of Appeal (R v Angela Cannings [2004] old boy who was said by Southall to be a victim of fabricated EWCA Crim. 01) and in Tennessee, USA (2003, no. 99-D-2836). illness.’ The BMJ reported that the boy was removed from the at- In the Cannings judgement, the Court said the cot death theory risk register after three months when "had to stop". Judicial comments in the he was diagnosed with severe UK Clark case (R v Sally Clark [2003] allergies. Southall has also been 200203824 Y3) were that Meadow's involved in Australian MSBP cases. “1: . medical and statistical evidence in the US lawyer Tracy Emblem said that The MSBP profiling Is case is "wrong" and "grossly overstat- a problem in her country is the "multi- extremely prejudicial, ed" and that such evidence "should not disciplinary" approach to evaluating have been put before a jury". The cases, as "group think" contributes to inaccurate, paradoxical and flawed evidence Meadow gave at erroneous accusations. She wonders often nonsensical, leading Clark's trial was said to serve "to how one ju s the reckless aban- aa A undermine his high reputation and donment of science and the truth. One to grave injustices. authority as a witness in the forensic of her clients has been in prison for 21 process". Meadow also gave expert years because of false medical testi- evidence against British woman Julie mony, but it has finally been admitted Ferris, who was held in a psychiatric that the charge was based on insuffi- hospital. Ferris was later released on cient evidence and a new trial has now been ordered. bail, and in August 2004 it was reported that she will not face a Meadow has been instrumental in many child protection cases retrial. and has provided significant evidence for various authorities In Queensland, Australia, the Court of Appeal (R v LM [2004] across the world that has often resulted in children being taken QCA 192) in a unanimous judgement said MSBP (or factitious away from their mothers and placed into care.Pragnell said the so- disorder by proxy) is not a recognised psychiatric disorder or called MSBP "research" conducted by Meadow was not scientifi- mental illness in the American Psychiatric Association's cally based and was merely his own conjecture, speculation and — Diagnostic and Statistical Manual (DSM IV). The judges went on assertions that had questionable origins. "It has never been peer _ to say that MSBP has no agreed sets of symptoms or signs that reviewed, although a great deal has been written on the subject. allow it to be classified into a recognised psychiatric diagnostic Much of this is people writing on the views of others." system. The Court also found that MSBP is not a recognised Little information has been made available on the way Meadow medical condition, disorder or syndrome. By finding that MSBP prepared his reports and the investigations he undertook, as they does not relate to an organised or recognised reliable body of are generally confidential as a result of the secrecy of children's knowledge or experience, the Court ruled that evidence from a courts and closed civil courts. But in one report on an Australian —_ psychiatrist was "extremely prejudicial" and thus excluded it. mother, he alleged after he had read medical and other reports Justice Holmes noted that the MSBP argument is inherently circu- sent to him in England that the mother had harmed her children. lar and does nothing to prove criminal conduct. While the Court He had never met the mother or personally discussed the chil- agreed it may be a behaviour, it was like "laughing, malingering dren's medical problems with the mother or any of the doctors or engaging in criminal conduct". In other words, a behaviour involved in the case. Meadow acknowledged that he did not see may exist, but the description of this behaviour is not helpful in or he dismissed reports of doctors and specialists who suggested a determining the guilt of a particular individual in a particular con- natural cause for the children's illnesses. One of these doctors text; facts are required. was the children's treating paediatrician. In opposition to this pae- Legal opinion is that this Queensland Court of Appeal diatrician, Meadow concluded—and without attributing any judgement is very traditional law, where facts—not ambiguous robust evidence—that the mother had harmed her children. labels—are required to justify a case for guilt. The Australian Nowhere in the report does Meadow declare his interest in mun- Capital Territory's Director of Public Prosecutions, Richard chausen syndrome by proxy or that he coined the term in his 1977 Refshauge, said the QCA decision on MSBP is conservative and a Lancet article. down-the-line law judgement. "It makes clear that if a woman is When writing on MSBP, Meadow offers no scientific evidence that MSBP exists, and his references generally only include articles written or co-written by him. A great deal of his references includes material he wrote for the journal he edited, the Archives of Disease in Childhood. The list of reference material does not include any scientific or evidence-based studies on MSBP that were peer reviewed by independent medical specialists. The MSBP profiling is extremely prejudicial, inaccurate, paradoxical and often nonsensical, leading to grave injustices. NEXUS + 39 OCTOBER — NOVEMBER 2004 www.nexusmagazine.com