In 1977, a British paediatrician, Roy
Meadow, was recognizing a variation of Munchausen syndrome he called Munchausen
syndrome by proxy. This was, he
explained, where people faked illness in others under their care, usually their
own children, to gain attention and sympathy for themselves.
Special form of child abuse
This curious condition hit the headlines
recently when an American mother was convicted of killing her son by
overloading him with salt.
Read: Mom found guilty of killing 5-year-old son with salt
After some initial doubts, the concept
soon became accepted by doctors and social workers, as it seemed to explain
some otherwise deeply puzzling cases. It was a special form of child abuse. Meadow,
however, overreached himself in a parallel issue when he became sure that many
cases of “cot death” or SIDS (Sudden Infant Death Syndrome) were due to physical
abuse also being disguised as illness.
SIDS was beginning to cause alarm
at that time, and was little understood. It was especially not understood that it can indeed occur more than once
in a family. Meadow declared that cot deaths do not run in families, and became
associated with the rule that "unless proven otherwise, one cot death is
tragic, two is suspicious and three is murder".
Sadly, his alarming ideas in this regard
became an obsession, which obscured his important and original observations on
Munchausen by proxy.
Lawyers love an acknowledged expert who
speaks convincingly about an issue they can use in court, and Meadow began to
be used as expert witness in too many cases.
Notably, in the trial of Sally Clark, he
claimed he had found 81 cases of “cot death” which were actually murder, but that
he had, peculiarly, disposed of the data. In his evidence, he insisted that the
odds against two cot deaths happening within the same family were 73,000,000 to
1. By a majority of 10 to 2, the jury found Clark guilty.
A very different conclusion
The trouble was that Meadow was wrong and
had miscalculated the odds hugely, making a number of false assumptions. Others
have estimated that the true odds may have been more than 2 to 1 in favour of
the death NOT being murder, a very
The case was appealed on various grounds
including his bad mathematics, but the Court of Appeal considered the evidence
“overwhelming” and dismissed the appeal. Meadow wrote a paper dismissing his
critics and opposing the waste of time on further investigating of the case.
But a skilled lawyer found new evidence, and
it was shown that another expert witness had not revealed important evidence,
i.e. that other tests showed another, infectious, cause for the death of one of
the children. On a second appeal, Clark’s conviction was overturned in
Read: Steps to prevent cot death
The judges had also examined Meadow’s
statistics, and in their ruling declared that they would probably have granted
the appeal on this basis as well. Sally Clark never recovered from both the
loss of her children and being convicted of their murder. She died only four
years later of acute alcohol intoxication.
Soon afterwards, Angela Cannings, a mother
also convicted of murdering two of her three babies on the basis of Meadow’s
evidence, was set free on appeal. This time, Meadow was himself investigated by
the British General Medical Council.
He had testified that the mother suffered
Munchausen by Proxy, and that two cot deaths within one family was extremely
unlikely. The prosecution also argued that there was no family history of cot
death. Investigation by the BBC found at least two of her ancestors had lost a
large number of infants without explanation, making it very plausible to
consider that there was indeed a genetic predisposition to cot death. Considering this, the Court of Appeal declared
the conviction unsafe, and Canning was released on appeal.
Wary of providing expert evidence
The Deputy Chief Justice, the aptly named
Lord Justice Judge, discussed the appeal and was contemptuous of the theories
about Munchausen by Proxy and Cot Death, calling it a “travesty of justice”. Indeed, the law was changed to prevent anyone
from being convicted on the sole basis of expert evidence and opinion.
In 2005, Meadow was brought to a GMC
tribunal, which found his evidence in the Clark case has been wrong and
misleading, and found him guilty of “serious professional misconduct”. They decided to remove his name from the
Medical Register. There was concern,
though, that this decision might make experts wary of providing expert
Meadow appealed, and a High Court Judge
agreed and ruled that although it was correct for the GMC to have criticized
him, this did not amount to “serious professional misconduct”, and that he
should not have been struck from the register.
In 2009, however, he voluntarily gave up
his registration with the GMC, and was no longer able to practice medicine.
Meanwhile, there had been another very
troubling case. In 2005, Ian and Angela
Gay were tried for the death of their adopted son Christian, and the
prosecution leaned heavily on Meadow’s 1993 paper on “non-accidental salt
poisoning”. The judge was clearly
impressed and quoted from it five times in his summary. They were found guilty
of manslaughter, but after 15 months in prison, their convictions were quashed.
Read: Reduce your salt intake
In the media, other professors had
challenged the conclusions of this paper, and suggested that in similar
situations the well-recognized disease diabetes insipidus had to be considered as
a more likely cause of high salt levels in the body than deliberate poisoning.
Despite misjudgements and mistakes in
these cases, the syndrome definitely does exist, and causes genuine suffering
in children at the hands of the person in the world they trust most. It is one
of the many possibilities a doctor needs to bear in mind when assessing
puzzling clinical situations.
Munchausen syndrome: why people fake illness
Social media can feed Munchausen by proxy
SIDS: co-sleeping the culprit
Image: Empty baby cot from Shutterstock
Professor MA Simpson is Health24's CyberShrink. A South African psychiatrist, he qualified in medicine and in psychiatry in Britain. He has been a senior academic, researcher, and Professor in several countries. Read more of his columns.