A.B.
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Horton wrote an article defending Roy Meadow.
Sir Samuel Roy Meadow (born 1933) is a retired British paediatrician, who first came to public prominence following a 1977 academic paper describing a phenomenon dubbed Munchausen Syndrome by Proxy (MSbP). For his work, ‘The Captive Mother’, he was awarded the prestigious Donald Paterson prize of the British Paediatric Association in 1968; in 1980 when a second professorial chair in paediatrics was inaugurated at St James’s University Hospital, Leeds, he was invited to accept it; in 1998, he was knighted for services to child health. [1] His work became controversial, particularly arising from the consequences of a belief he stated in a book, ABC of Child Abuse,[2] that, in a single family, “one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise“. This became known to some as "Meadow's Law" and was influential in the thinking of UK social workers and child protection agencies, such as the NSPCC.[3]
Meadow's reputation was severely damaged after he appeared as an expert witness for the prosecution in several trials, in at least one of which his testimony played a crucial part in a wrongful conviction for murder. The British General Medical Council (GMC) struck him from the British Medical Register after he was found to have offered “erroneous” and “misleading” evidence in the Sally Clark case.[4] Clark was a lawyer wrongly convicted in 1999 of the murder of her two baby sons, largely on the basis of Meadow's evidence; her conviction was quashed in 2003 after she had spent three years in jail.[5] Sally Clark never recovered from the experience, developed a number of serious psychiatric problems including serious alcohol dependency and died in 2007 from alcohol poisoning.[6]
In 1993 Meadow gave expert testimony at the trial of Beverley Allitt, a paediatric nurse accused (and later found guilty) of murdering several of her patients.[14]
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 physical abuse.
Families that 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".[15] Although this dictum is believed not to have originated from Meadow's own lips, it has become almost universally known as Meadow's law.
In 2003 Dr James Le Fanu wrote to The Lancet pointing out the self-agrandisment within the scientifically unfounded circular logic that Meadow used to promote the weight (and thereby influence upon juries) that his own opinions carried.[16]
Cot death trial controversies
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. Medical opinion was divided on the cause of death, and several leading paediatricians testified that the deaths were probably natural. Experts acting for the prosecution initially diagnosed that the babies had been shaken to death, but three days before the trial began several of them changed their collective opinion to smothering.
By the time he gave evidence at Sally Clark's trial, Roy Meadow claimed to have found 81 cot deaths which were in fact murder, but he had destroyed the data.[17] Amongst the prosecution team was Meadow, whose evidence included a soundbite 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 erroneously obtained by squaring the observed ratio of live-births to cot deaths in affluent non-smoking families (approximately 8,500:1). In addition he extrapolated his erroneous figures stating that the 1 in 73,000,000 incidence was only likely to occur once every hundred years in England Scotland and Wales. He further illustrated his miscalculation by stating that the very unlikely odds were the same as successfully backing to win an 80 to 1 outsider in The Grand National for four successive years.[18] 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 [19][20] and received criticism from professional statisticians over its calculation. The Royal Statistical Society issued a press release stating that the figure had "no statistical basis", and that the case was "one example of a medical expert witness making a serious statistical error."[21] The Society's president, Professor Peter Green, later wrote an open letter of complaint to the Lord Chancellor about these concerns.[22]
The statistical criticisms were threefold: 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 probability that an innocent person would lose two children in this manner). In reality, these quantities can only be equated when the a priori likelihood of the alternative 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).[21]
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.[23] Finally, Meadow assumed that SIDS cases within families were statistically independent. The occurrence of one cot death makes it likely that the family in question has such conditions, and the probability of subsequent deaths is therefore greater than the group average.[21] (Estimates are mostly in the region of 1:100.)
Some mathematicians have estimated that taking all these factors into account, the true odds may have been greater than 2:1 in favour of the death not being murder, and hence demonstrating Clark's innocence.[24]
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."[23]
