Saturday, 16 October 2010

SBS: Pediatrics Academy President-Elect On ‘Shaken Baby Syndrome’

Courtesy of AAP
American Academy of Pediatrics President-Elect Robert Block
This CommonHealth post – The Real Consensus On Shaken Baby Syndrome — has brought such a cornucopia of powerful comments that one media-watcher even called it an interesting exploration of Internet journalism. The Knight Science Journalism Tracker, which critiques science media, writes here:
It’s an interesting way of doing journalism in the blog era. Instead of calling sources for comment, open it up to anyone who cares to respond. I’m guessing that even reporters as good as Goldberg and Zimmerman would not have found some of these fascinating responses using the old-fashioned tricks of our trade.
Too true! And we thank you all for allowing us to host your discussion. Our own contributions for today: Rachel Zimmerman heard again from Deborah Tuerkheimer, the law professor whose New York Times op-ed piece triggered this outpouring of response (see below). She also gained some helpful insights from a Children’s Hospital Boston specialist.
And I spoke with Dr. Robert W. Block in his official capacity as the president-elect of the American Academy of Pediatrics, which has 60,000 members. If anyone knows what the consensus really is, I figured, he must.
The debate will surely continue, I said, but if you could post the final word on this, what would it be?

“I think that stated most simply, there are decades now of accumulating reports, clinical observations, and evaluations of both individual cases and other data relating to the ways babies are injured through shaking, shaking with impact or perhaps impact alone.” Dr. Block said.
“The debate has been fueled by a few people who ignore the known science and excuse the confessional literature, the clinical experience that many of us have working with babies who are injured or killed and the people who hurt them, and choose instead to come up with alternative hypotheses, none of which are substantiated by reasonable science.
And unfortunately, then this becomes a courtroom and media display rather than a sound discussion of the science in medical and other scientific forums where it ought to occur.”
“Is this a doctors vs. lawyers fight?” I asked.
“I don’t think so,” Dr. Block said. Prof. Tuerkheimer “has been heavily influenced by only one side of the discussion, and she has written a piece that ignores the overwhelming majority of science in favor of expressing the unsupported statements of a few people who occupy their days testifying for defenses in cases across the country.”
As Prof. Tuerkheimer presents it, Dr. Block said, “Doctors are looking at some key findings that do have a variety of causes, and are only looking at one diagnosis, the shaken baby sydnrome. And that is actually a gross misrepresentation of the process of considering what we call a differential diagnosis, where we look at not only the medical aspects of the case but also coordinate the medical findings with investigatory findings from law enforcement, human services and other folks putting together the entire case before it goes into a courtroom.
So I think that creating reasonable doubt in the minds of the jury by presenting evidence that has no science to support it can be very confusing, and also puts in the hands of the jury the responsibility to understand medicine, which doesn’t make much sense.”
Prof. Tuerkheimer wrote in her op-ed piece that “experts are questioning the scientific basis for shaken baby syndrome.” What sentence, I asked, would Dr. Block substitute for that one?
He replied: “I’d say the real experts are the physicians who work every day with these cases and have both authored and read voluminous literature that substantiates the existence of abusive head trauma, and those are the folks who are the most capable of informing the public about what the issue really is, rather than creating these sham media blasts that casue great confusion.”
Now this from Rachel:
CommonHealth once again asked Prof. Tuerkheimer to comment on the torrent of responses to her op-ed piece. Again, she declined but wrote in an email:
“I would make two observations. First, as to the scientific debate surrounding SBS, my claims are more modest than the tenor of many comments might lead one to believe. Second, the evolution of forensic understandings and diagnostic protocols – highlighted even by those medical professionals who take issue with the op-ed – has important implications for the criminal justice system.”
Hmm, her claims are more modest? But isn’t she saying the science underlying shaken baby syndrome is, well, shaky? That doesn’t seem terribly modest.
But, as Allison Scobie-Carroll, program director for the child protection program at Children’s Hospital Boston, said in an interview: “For those us who actually see these children, there is no debate.”
Ms. Scobie-Caroll commented on-line: “Each year our team consults on approximately 1800 cases of child maltreatment. And each year we are directly involved in the care of dozens of cases of abusive head trauma. It has been my experience that despite our wishes to the contrary, some caregivers, (even those with no known documented history of violence toward others, and even those who closely resemble the very lawyers and physicians enlisted to defend them) do, in fact, inflict devastating and irrevocable harm on children.
Like many serious acts of maltreatment of children, the severe shaking of an infant is rarely witnessed. This may be, in part, due to the “guardian” effect that was noted in an earlier post. That is, that people, when in the presence of others, may exercise restraint in their response to the frustrations of care giving. It may also be due to the fact that individuals who lack the internal or external resources (maturity, stability, judgment, sobriety, social supports etc) necessary to manage the stresses of a crying infant are sometimes left alone to do so.
In just a few frustrated seconds of rigorous shaking, whether intended to stop a child’s crying or simply to relieve the caregiver’s frustration, the child’s life, and the lives of those that love that child, are forever changed. Denying that this occurs does little to prevent future incidents of such abuse, and it is a profound invalidation of the maltreatment that these children have endured.”

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