Roy Meadow
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Sir Roy Meadow is a prominent British paediatrician. He is best known for identifying the (now controversial) condition commonly called Munchausen Syndrome by Proxy (MSbP) or Meadow's Syndrome.
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Early career
Roy Meadow was born in Wigan in 1933, the son of Samuel and Doris Meadow. He studied medicine at Oxford University, and later practiced as a GP in Banbury. Throughout his early years in medicine, Meadow was a devoted admirer of Anna Freud (daughter of Sigmund Freud), whose lectures he would often attend. Speaking in later life, he said: "I was, as a junior, brought up by Anna Freud, who was a great figure in child psychology, and I used to sit at her feet at Maresfield Gardens in Hampstead. She used to teach us that a child needs mothering and not a mother."
In 1961, Meadow married Gillian Maclennan, daughter of Sir Ian Maclennan, the British ambassador to Ireland. The couple had two children Julian and Anna before divorcing in 1974. Four year later he married his second wife Marianne Jane Harvey.
In 1970, Meadow was appointed Senior Lecturer at St. James' University Hospital in Leeds, where in 1980 he become Professor of Paediatrics.
Munchausen Syndrome by Proxy
In 1977, in The Lancet medical journal, Meadow published the theory which was to make him famous. Sufferers of his postulated Munchausen Syndrome by Proxy or MSbP (a name coined by Meadow himself) harm or fake symptoms of illness in persons under their care (usually their own children) in order to gain the attention and sympathy of medical personnel. This claim was based upon the extraordinary behaviour of two mothers: One had (Meadow claimed) poisoned her toddler with excessive quantities of salt. The other had introduced her own blood into her baby's urine sample. Although it was initially regarded with scepticism, MSbP soon gained a following amongst medics and social workers.
Expert testimony
The Alitt case
Meadow rose to public prominence in 1993, when he brought expert testimony in the trial of Beverley Allit, a nurse accused of murdering several of her patients. Allit was found guilty and sentenced to life imprisonment. Many saw this as a vindication of Meadow's theories.
MSbP and cot death
Meadow went on to testify in many other trials, many of which concerned cases previously diagnosed as cot death or sudden infant death syndrome (SIDS). Meadow was convinced that many apparent cot-deaths were in fact the result of child abuse brought on by MSbP.
Families which had suffered more than one cot death were to attract particular attention: "There is no evidence that cot deaths runs in families", said Meadow, "but there is plenty of evidence that child abuse does". His rule of thumb was that "unless proven otherwise, one cot death is tragic, two is suspicious and three is murder". (Although this dictum is believed not to have originated from Meadow's own lips, it has become almost universally known as Meadow's law.)
Throughout the 1990's, a great many parents (mostly women) whose children had suffered apparent cot-deaths were convicted of murder on the basis of Meadow's expert opinion. A great many more parents, whom Meadow suspected of MSbP had their children forcibly removed and taken into care. In 1998, Meadow was knighted for "services to child health".
Controversy
The Clark case
The original trial
This trend was to reach its apogee in 1999 when solicitor Sally Clark was tried for allegedly murdering her two babies. Her elder son Christopher had died at the age of 11 weeks, and her younger son Harry at 8 weeks. At her trial, Meadow presented pathological evidence for the prosecution, together with a "titbit" which was to provoke much argument: He testified that the odds against two cot deaths occurring in the same family was 73,000,000:1, a figure which he obtained by squaring the observed ratio of live-births to cot-deaths in affluent non-smoking families (approximately 8,500:1). The jury returned a 10/2 majority verdict of "guilty".
Statistical controversy
Meadow's 73,000,000:1 statistic was paraded in the popular press, and provoked an uproar amongst professional statisticians who considered it dangerously over-simplistic. The president of the Royal Statistical Society wrote an open letter of complaint to the Lord Chancellor, stating that the figure had "no statistical basis".
The criticisms were twofold: Firstly, Meadow was accused of applying the so-called prosecutor's fallacy in which the probability of "cause given effect" (i.e. the true likelihood of a suspect's innocence) is confused with that of "effect given cause" (the likelihood that innocence will result in the observed double-cot-death). In reality, these quantities can only be equated when the a priori likelihood of the alternate hypothesis, in this case murder, is close to certainty. Murder (especially double murder) is itself a rare event, whose probability must be weighed against that of the null hypothesis (natural death).
The second criticism concerned the ecological fallacy: Meadow's calculation had assumed that the cot death probability within any single family was the same as the aggregate ratio of cot deaths to births for the entire affluent-non-smoking population. No account had been taken of conditions specific to individual families (such as the hypothesised cot death gene) which might make some more vulnerable than others. The occurrence of one cot-death makes it likely that such conditions exist within the family in question, and the probability of subsequent deaths is therefore greater than the group average (estimates are mostly in the region of 1:100).
Some mathematicians have estimated that taking both these factors into account, the true odds may have been greater than 2:1 in favour of Clark's innocence (Joyce, 2002) (http://plus.maths.org/issue21/features/clark/). The perils of allowing non-statisticians to present unsound statistical arguments were expressed in a British Medical Journal (BMJ) editorial by Stephen Watkins, Director of Public Health for Stockport, claiming that "defendants deserve the same protection as patients" (Watkins,2000) (http://bmj.bmjjournals.com/cgi/reprint/320/7226/2?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Watkins&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1076111120150_15661&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1,2,3,4).
To his credit, Meadow never actually claimed that 1:73,000,000 was the likelihood of Clarke's innocence (though many believe that this was how the court interpreted it). Furthermore, he later admitted that his calculation was "of limited significance", but claimed that this did not devalue his overall testimony. Since no other experts were at that time suggesting typical cot death, the statisticals were in any case irrelevant.
The first appeal
The discredited 1:73,000,000 figure was amongst the five grounds for appeal submitted to the Court of Appeal in the autumn of 2000. The judges agreed that the figure was a "sideshow" which would have had no significant effect on the jury's decision. The overall evidence was judged to be "overwhelming" and Clark remained a convicted murderer.
Meadow felt himself fully vindicated. He now responded to Watkins in a BMJ paper of his own (Meadow, 2002) (http://bmj.bmjjournals.com/cgi/reprint/324/7328/41?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Meadow%252C+Roy&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1076013273132_15057&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1,2,3,4), accusing him of being both irresponsible and misinformed. He reiterated his claim that "both children showed signs of both recent and past abuse" (injuries which the defence claimed were caused by the mother's attempts at resuscitation) and underlined the judges' ruling that Clark and her husband had given "untrue evidence". He went on to bemoan the time likely to be "wasted" on any further investigation of the case: "In today's world," he wrote, "it is inevitable that....formal letters of complaint from the family to the Police Complaints Authority, the General Medical Council, the royal colleges, or other statutory bodies will be treated with respect and will consume considerable resources."
The second appeal and its aftermath
Meadow's apparent vindication was to be short-lived: It transpired that another expert witness had failed to disclose the results of medical tests which had suggested that at least one of the Clark babies had died from the bacterial infection Staphylococcus aureus (and not from smothering as the prosecution had claimed). A second appeal was launched and, in January 2003, Sally Clark's conviction was overturned.
Technically, the central reasons for the appeal's success had nothing to do with Roy Meadow. However, the discredited statistics were revisited in the hearing and provoked some damning comments from the judges.
The furore now began afresh. Speaking in the House of Lords, the opposition spokesman for health Lord Howe described MSbP as "one of the most pernicious and ill-founded theories to have gained currency in childcare and social services in the past 10 to 15 years. It is a theory without science. There is no body of peer-reviewed research to underpin MSbP. It rests instead on the assertions of its inventor. When challenged to produce his research papers to justify his original findings, the inventor of MSBP stated, if you please, that he had destroyed them". It was about this time that independent campaigners such as Penny Mellor and the Mothers Against MSbP Allegations (MAMA) began to gain massive public support.
The Patel case
The CPS stuck to their guns, but soon experienced a further defeat. In June 2003 they used Meadow's expert testimony against Trupti Patel, a pharmacist accused of killing three of her babies. After a highly publicised trial lasting several weeks, the jury took less than 90 minutes to return a unanimous verdict of "not guilty". Following the acquittal, the Solicitor General Harriet Harman effectively barred Meadow from giving evidence at future trials: She warned prosecution lawyers that the defence should be informed of court criticisms of Meadow's evidence.
The Cannings case
Yet another blow to Meadow's credibility came the following December. Angela Cannings, a mother convicted on Meadow's evidence was freed on appeal. She had been accused of murdering two of her three babies, all of whom had died in their first few weeks of life. Following the acquittal, Meadow found himself under investigation by the British General Medical Council for suspected professional misconduct. At time of writing, the outcome of this investigation is still pending.
The original trial
Cannings' case differed from Clark's in that there was no physical evidence. The prosecution rested upon what was perceived to be "suspicious behaviour" on the part of the mother (telephoning her husband instead of emergency services when one of the deaths occurred) and upon Meadow's opinion that she was an MSbP sufferer. Meadow had told the jury that the boys could not have been genuine cot death victims because they were fit and healthy right up until the time of death (contradicting other experts who claim this is precisely typical of SIDS cases). The prosecution had also rejected any genetic explanation, stating that there was no family history of cot death. Although no enumerated statistics had been presented, Meadow had told the jury that double cot death was extremely unlikely (a alleged ploy to get his false statistics "in by the back door"). The jurors had taken nine hours to return a verdict of "guilty".
The 2003 appeal
Cannings had already lost one appeal but, in the wake of the Clark and Patel acquittals, the case was "fast tracked" for a second appeal. In the weeks that followed, an investigation by the BBC showed that the prosecution's "no family history" argument had been incorrect: At least two of Cannings' paternal ancestors had lost an abnormally large number of infants to unexplained causes, making a genetic predisposition to cot death highly plausible.
The appeal was heard in December 2003. Despite the new evidence, the Crown fought tooth and nail to have the conviction upheld, forcing Cannings to remain in jail until the date of the hearing. The three judges were not impessed with their arguments: They declared the conviction "unsafe" without even retiring, promising to give their full reasons at a later date.
The present situation
In January 2004, the Deputy Chief Justice (the appropriately named Lord Justice Judge) gave the judges' full reasons for allowing the Cannings appeal. His comments were scathing about the entire MSbP/cot-death/murder theory, calling it a "travesty of justice". Many more cases in which Meadow testified are now likely to be reopened in the largest ever judicial review of its kind.
As a result of the Cannings ruling, the law has been changed such that no one can be convicted on the basis of expert testimony alone.
Many, however, see the discrediting of Meadow as a mixed blessing. While many wrongful convictions may be overturned, there is the possibility of a witch hunt against other paediatricians who may be tarred with the same brush. It is feared that this climate may hinder the work of police and social services in combating genuine cases of child abuse.
Meadow is currently appearing before a GMC fitness to practise tribunal, started on 21 June 2005.
References
- Joyce (http://plus.maths.org/issue21/features/clark/), Helen (2002), "Beyond reasonable doubt", +Plus Magazine...Living Mathematics, September 2002.
- Meadow (http://bmj.bmjjournals.com/cgi/reprint/324/7328/41?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Meadow%252C+Roy&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1076013273132_15057&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1,2,3,4), Roy (2002), "A Case of Murder and the BMJ", British Medical Journal, Vol.324, pp.41-43, 5 January 2002.
- Watkins (http://bmj.bmjjournals.com/cgi/reprint/320/7226/2?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Watkins&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1076111120150_15661&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1,2,3,4), Stephen J (2000), "Conviction by Mathematical Error?", British Medical Journal, Vol.320, pp.2-3, 1 January 2000.
External links
- The Royal Statistical Society (http://www.rss.org.uk/) press release concerning Sir Roy Meadow's alleged misuse of statistics in the case of Regina vs. Clark can be found under Society and Statistics, Media & News, Press Releases, Press Release on the Sally Clark case, Oct 2001.
- AsherMeadow (http://www.ashermeadow.com/), a web-based information resource devoted to Munchausen Syndrome by Proxy.
- Judgment of the Court of Appeal (http://www.bailii.org/ew/cases/EWCA/Crim/2004/1.html) in the case of Regina vs. Cannings.
- Meadow faces GMC misconduct hearing (http://society.guardian.co.uk/nhsperformance/story/0,8150,1469735,00.html) from The Guardiannl:Roy Meadow