Thursday, September 8, 2005

Without proof that either ?case? in Roy Meadow?s ?Munchausen by Proxy: The Hinterlands of Child Abuse? exists, 29 years after publication in Lancet, one may belatedly dub Sir Roy the Jayson Blair of medical journals.

?What can you say about a trusted professional who makes stuff up and publishes it as fact??

?The will to fabricate cuts across disciplines, with academics and scientists inventing data, too.?

?The unmasking of a counterfeiter tends to inspire busy discussions of his motive. ?No single explanation can cover every case, but my guess is that most liars make things up for the simple reason that they don?t have the talent or the ability to get the story any other way.?

?The lesson I learned isn?t to refrain from asking writers for detail but to be skeptical about details that sound too good or that you had to push too hard to get the writer to uncover or that are suspicious simply because any writer worth his salt would have put them in his first draft. All that said, it?s almost impossible for an editor to beat a good liar every time out.?

Appreciation for an excellent piece by Jack Shafer, Slate editor at large whose May 8, 2003 observations are quoted above http://slate.msn.com/id/2082741). He wrote about eager-to-please American reporters, professors and researchers. None enjoyed the professional crash, but because of an editor?s vigilance and acting on duty the public and publications were spared additional damage.

Deluged by ?Details?

?The Jayson Blair Project: How did he bamboozle the New York Times?? was not written about former pediatrics nephrology professor Roy Meadow?s world-changing, family-fracturing Lancet article of August 13, 1977. In principle it could have been.

http://web.tiscali.it/humanrights/articles/meadow77.html)

While Shafer?s observations on how editors may invite ?embellishing, exaggerating, and outright lying in print? hint of the adjectives overload that ultimately exposed Jayson Blair, Janet Cooke and others, Roy Meadow also weight-loaded his writing in ways that befuddle readers to this day.

Clearly Roy Meadow was not hounded by Lancet?s editor in 1977, and too few since, about the lack of scientific methodology, research approval or consent, peer reviewed findings, presumably available in his now ?shredded? notes.

Even more obviously, today?s Lancet editor avoids reference to the original sole source for MSP and subsequent FIBS (factitious illness by proxy), Meadow?s motivation probability theory. Such theories exist because ?Hinterlands? does.

Contemporary researchers and experts claim that MSP is ?now separated into two constructs?factitious disorder by proxy?FDP, and pediatric condition falsification?PCF.? That is a futile cover story for the future of MSP uncovered.

A Good ?Story?

Anyone growing up in the USA?s ?South? is likely to know the word ?story? used to mean an untrue ?story? or tall tale. ?Are you telling me a ?story??,? is asked sternly of a child offering a hopeful explanation of how the cookie jar broke.

Did Roy Meadow tell the world a ?story? in whole or part? Did unquestioned publication in prestigious Lancet bestow a blank check on his career? Did it enable him to earn while he learned just how high his fees and how wide his statistical probabilities could go until he met the limit at UK?s recent GMC hearings?

Was ?First Case? Kay?as a UK health writer asserted she was in 2004?the original MSP ?aha? experience? The 1977 Lancet article asserts about Kay?s mother that ??there was something about (her) temperament and behavior that was reminiscent of the mother described in case 2, so we decided to work on the assumption that everything about the history and investigations were (sic) false.? If that is true, doesn?t ?Second Case? become the first instead?

Could Roy Meadow have saltloaded the baby first and needed cover? Did he hope an emotive and new ?disorder??let someone else decide if it belongs in the medical, mental health, child welfare, law enforcement, you name it field?would divert attention from what happened? Did he switch order and tell on himself?

?Expressed breast milk collected from the mother of case 2 early in the course of the illness had a very high sodium content?? What if a genetic disorder she survived was overcoming the life of her less hardy infant? DNA checked? Never.

What if the baby?s monthly attacks?in ?between (which) he was healthy and developing normally??suggested chloride content of the mother?s milk might fluctuate similarly? What if a second test was ?normal? for salt but no further testing was done because ?proof? was the doctor?s opinion on its way to press?

Let?s Make it Simple

What basic elements of any story are wanted by even the least demanding editor? Remember the mantra: Who, what, when, where, how and why?

?Who? is foremost. Twenty-nine years later, after Roy Meadow continued to benefit from multiple Jayson Blair-like free passes, not a single name other than his is connected with the ?Hinterlands? stories.

Who were the ??sixteen consultants (who) had been involved in (Kay?s) care??

Surely the ??five consultants (who) came into the hospital specifically to see her?on one bank holiday? would remember so doing. Why has none offered to validate Meadow?s ?story,? after hearing his notes are ?shredded??

Nurses? Two or more were tapped to get the goods on the mothers: both specimens of combo menstrual blood and mother-child urine for ?Kay? and the surreptitiously salted breast milk for the sick baby?s mother.

Lab technicians? Surely some who did those 150 urine cultures related to Kay could step forward. Without their findings where would we and Sir Roy be?

Family members? How were ?Kay? and her real or imagined brother affected by their family?s experience? Were they barred from receiving medical services because too many were wrongly delivered to Kay per her parent proxy?

If Baby Charles were real and his two healthy older siblings thrived during the past three decades, have babies born into the family shown signs of the genetic disorder? If so, were they whisked into care as victims of ?generational MSP??

?What? may be the startling revelation of Mata Hari mothers bent on hastening undetectable infant deaths exploiting doctors as their proxies. However, from the ?no real details? article of 1977 through knighthood to a rich retirement, Roy Meadow?s life illustrates a more probable ?what?: a cobbled together motivation theory that established him as ?the first? to notice, name and claim MSP.

?When?? Meadow?s Introduction to ?Hinterlands? suggests the landmark MSP ?case? developed ?over a period of six years.? Kay came last to Leeds at age 6. That time frame trumps competition among colleagues, including any who previously alluded to the MSP epithet. Is that the purpose for ?six years??

?Where? are the names of four centers (two for each child prior to Leeds)? Surely professional courtesy informed those duped doctors that suspect (now ?proved?) Munch Moms had ?skillfully altered specimens and evaded close and experienced supervision.?

No extra space is required to name Kay?s ?district general hospital? or ?regional teaching hospital" Were centers left nameless so colleagues and others would assume events must have happened elsewhere?

?How? is easiest of all: because Lancet enabled Roy Meadow to publish that now discredited piece and, still today, assures support for the details-deficient article.

?Why?? In a word, projection. By painting targeted mothers with the attention-seeking brush he wielded for himself, Roy Meadow constructively silenced them. His stock went up; motherhood and time-honored beliefs about it plummeted.

Royal ?We? or Solo?

While asking for still lacking information, one should learn whether Roy Meadow used the real or royal ?we.? That matters. Either numbers of others were involved in saltloading actual or invented Baby Charles or Sir Roy acted alone. Or, none of it ever happened, of course.

Mind-bending example: ?We? decided, before ?we? saw ?second case??logically noted because of ?first case??we would assume ?Kay?s? mother was lying because ?there was something reminiscent of the mother described in case 2.? Wasn?t that the ?case? that could not yet have occurred? Small wonder I still find ?new? words in that compact, complex but tantalizingly vague little gem in Lancet.

In the end, and in the beginning, all a reader ever found in ?Hinterlands? was mind-numbing detail about lab results allegedly associated with unidentified children. No peer review, replication or scientific methodology supports Roy Meadow?s ?story.? It is too late now to dig up willing ?witnesses.?

Jayson Blair would take his hat off to Roy Meadow and Lancet. Parents affected by a mistaken or malicious MSP label may have had their children, their family?s future, taken off. Removals are done in the name of ?the people.? When will they really read ?Hinterlands? and bring the children back?

By Barbara Bryan ( BHBryan@aol.com)

See also: http://www.ExpertClick.com/NewsReleaseWire/default.cfm?Action=ViewMyNews&NRWID=1079)