Emily Bazelon’s article illustrates the need to reform a system in which expert medical witnesses who may have conflicts of interest argue complex cases to a lay jury. These expert witnesses are paid lucratively, can legally opine on anything outside their field and rarely face repercussions for incorrect testimony. To remove conflict of interest, the courts should seek interpretation of M.R.I.’s and other test results from multiple independent court-employed neuroradiologists who don’t have knowledge of or involvement with the case.
Bazelon’s article shined a light on the tragedy of infants who are killed or injured by caregivers. Child abuse and neglect is a serious issue in this country and globally. Pediatricians, particularly those who deal with child abuse on a daily basis, continue to update the diagnostic criteria of abuse based on the best scientific evidence.
Hypotheses that are raised in court without scientific support do not signal a change in mainstream medical opinion about what causes trauma in children. To imply that they do, as this article has, is wholly unfair to the children who have been harmed. Babies should never, ever be shaken. The American Academy of Pediatrics urges new parents and caregivers to talk with their child’s pediatrician about how to safely handle stressful situations, like when a baby is crying. Resources are available at healthychildren.org that can help and guide caregivers in protecting children from harm.
O. MARION BURTON, M.D., F.A.A.P.
President, American Academy of Pediatrics
Columbia, S.C.
Shaken-baby theory is in a state of flux: previous “truths” are now known to be untrue or unproved, and new “truths” arise on a regular basis. Biomechanical modeling and the absence of neck injury or grip marks cast doubt on the “shaking” mechanism and may disprove it entirely. In light of these changes, innocence clinics at many law schools are beginning to review past convictions and, in some cases, to seek exoneration.
Child-abuse texts make clear that the findings previously viewed as the “three telltale signs” of shaken-baby syndrome — subdural hemorrhage, retinal hemorrhage and brain swelling — may also be caused by prenatal conditions, birth trauma, accidental injuries, infection, genetic abnormalities, metabolic disease, clotting disorders (including stroke) or nutritional deficiencies. Confirmed accidental causes include falls from a short height — including from a highchair and a plastic indoor play structure. At least two of the cases cited in the article involve childhood stroke (including Julie Baumer’s case, on which I worked), which peaks in the first month and continues through childhood. If a premature diagnosis of abuse is made, the stroke may be missed, the wrong treatment provided and grieving parents or caretakers imprisoned, sometimes for life.
Since this is an area in which emotions run high, there is a pressing need for an objective review by the National Academy of Sciences. We hope that the medical profession, courts, prosecutors, defense lawyers and child-protective services will join us in requesting this review and in developing a rational evidence-based approach to these issues.
HEATHER KIRKWOOD, J.D.
SeattleWritten on behalf of the Arizona Justice Project and innocence clinics in nine states.
http://www.nytimes.com/2011/02/20/magazine/20Letters-t-SHAKEN_LETTERS.html?_r=1
GIA DEANGELIS, M.D.
Associate Professor, Diagnostic Radiology University of Virginia Health System,
Charlottesville, Va.
Associate Professor, Diagnostic Radiology University of Virginia Health System,
Charlottesville, Va.
Bazelon’s article shined a light on the tragedy of infants who are killed or injured by caregivers. Child abuse and neglect is a serious issue in this country and globally. Pediatricians, particularly those who deal with child abuse on a daily basis, continue to update the diagnostic criteria of abuse based on the best scientific evidence.
Hypotheses that are raised in court without scientific support do not signal a change in mainstream medical opinion about what causes trauma in children. To imply that they do, as this article has, is wholly unfair to the children who have been harmed. Babies should never, ever be shaken. The American Academy of Pediatrics urges new parents and caregivers to talk with their child’s pediatrician about how to safely handle stressful situations, like when a baby is crying. Resources are available at healthychildren.org that can help and guide caregivers in protecting children from harm.
O. MARION BURTON, M.D., F.A.A.P.
President, American Academy of Pediatrics
Columbia, S.C.
Shaken-baby theory is in a state of flux: previous “truths” are now known to be untrue or unproved, and new “truths” arise on a regular basis. Biomechanical modeling and the absence of neck injury or grip marks cast doubt on the “shaking” mechanism and may disprove it entirely. In light of these changes, innocence clinics at many law schools are beginning to review past convictions and, in some cases, to seek exoneration.
Child-abuse texts make clear that the findings previously viewed as the “three telltale signs” of shaken-baby syndrome — subdural hemorrhage, retinal hemorrhage and brain swelling — may also be caused by prenatal conditions, birth trauma, accidental injuries, infection, genetic abnormalities, metabolic disease, clotting disorders (including stroke) or nutritional deficiencies. Confirmed accidental causes include falls from a short height — including from a highchair and a plastic indoor play structure. At least two of the cases cited in the article involve childhood stroke (including Julie Baumer’s case, on which I worked), which peaks in the first month and continues through childhood. If a premature diagnosis of abuse is made, the stroke may be missed, the wrong treatment provided and grieving parents or caretakers imprisoned, sometimes for life.
Since this is an area in which emotions run high, there is a pressing need for an objective review by the National Academy of Sciences. We hope that the medical profession, courts, prosecutors, defense lawyers and child-protective services will join us in requesting this review and in developing a rational evidence-based approach to these issues.
HEATHER KIRKWOOD, J.D.
SeattleWritten on behalf of the Arizona Justice Project and innocence clinics in nine states.
http://www.nytimes.com/2011/02/20/magazine/20Letters-t-SHAKEN_LETTERS.html?_r=1
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