Shaken baby syndrome no ‘controversy’ at all
For the past few weeks, I have attended the murder trial of a babysitter accused – and now convicted -- of inflicting abusive head trauma that resulted in the death of six-month-old Ridhima Dhekane. I am a father who also lost his 1-year old daughter, Rehma Sabir, to abusive head trauma, sometimes called shaken baby syndrome, in 2013. Unlike Ridhima, Rehma was denied the opportunity for justice, as the case against her caregiver was derailed from going to trial after the medical examiner changed her ruling on the cause of death from “homicide” to “undetermined” based on reports prepared by multiple defense experts.
In Ridhima’s case, the pathologist who was a fellow-in-training in the medical examiners office at the time of the infant’s autopsy also revised her opinion. But she did so more than a year after she had left the Massachusetts ME’s office. She now works for a North Carolina pathologist who frequently testifies for the defense in shaken baby cases.
Her supervisor during the 2014 autopsy, now former chief medical examiner Dr. Harry Nields, testified at the trial that he had overseen the autopsy and had no doubt that Ridhima died of blunt force trauma to her head and being shaken.
Several of the experts who testified on behalf of the defense were the same as those who opined in my daughter Rehma’s case. As re-traumatizing as it was, I wanted to listen to their testimony. I wanted to try to understand their position and rationale, as well as why they believed they were even qualified to testify in these cases.
Media coverage around this, ours, and similar cases tends to focus on the supposed controversy surrounding shaken baby syndrome. I say “supposed” because controversy implies a real and substantial disagreement. In fact, within the medical community, there is a high degree of consensus about the validity of abusive head trauma (AHT) as a medical diagnosis.
For example, a wide-ranging survey on this topic was conducted across multiple medical specialties by Dr. Sandeep Narang, a former Navy lawyer turned pediatrician and chief of Child Abuse Pediatrics at Northwestern University. Published in 2016 in the Journal of Pediatrics, the peer-reviewed study concluded that AHT is an overwhelmingly accepted diagnosis by those physicians who frequently treat children. Those medical professionals firmly believed that the combination of symptoms associated with AHT are only typically associated with severe inflicted traumas -- whether accidental or intentional.
During the trial, I watched doctors from multiple disciplines at Boston Children’s Hospital who had actually treated Ridhima express the unified view that, based on her symptoms and injuries, she died of a traumatic brain injury. The prosecution’s expert witnesses, all with deep experience treating and evaluating babies and young children, also testified that, given Ridhima’s symptoms and the fact that she had not been in a motor vehicle accident nor fallen from a great height, she must have suffered from abusive head trauma. Without exception, each explained the careful process of differential diagnosis that was performed to exclude other potential causes of death.
However, I was completely unprepared for the defense experts who testified next. I found the flimsiness of their arguments as disconcerting as their credentials.
I recall the testimony of a pediatrician who spent most of his career treating college-age kids at the University of Alabama student health center. He testified he was “self-taught” in the field of child abuse medicine. A long-retired orthopedic surgeon claimed expertise in bone pathology in part because he was “six months away from being board-certified in pathology.”
The former chief medical examiner of Rhode Island insisted that a key piece of information in her review of the case was peer-reviewed simply because a committee accepted it for oral presentation at a medical conference. That’s very different from the rigorous peer-review required by scientific journals to publish new research.
Common to many witnesses in this and other cases is that testifying for the defense in shaken baby cases is a significant source of their income.
There is nothing wrong with being paid as an expert witness to review a case or testify in a trial, for either the prosecution or the defense – in fact, it is a necessary part of our adversarial system of justice. However, motives become questionable when, as it is in many cases, a main source of income.
In Ridhima’s case, the jury was able to discern, in the words of one of the prosecutors, that “not all doctors are created equal” and the defendant was convicted of second degree murder.
Unfortunately, a tiny group of self-professed experts have had and will continue to have disproportionate influence in shaping the narrative around cases involving shaken baby syndrome because of their willingness to create hypothetical medical scenarios in the courtroom that can fit the symptoms after the fact. In doing so they are ignoring evidence-based medicine.They peddle their own brand of science much as anti-vaxxers put children and other vulnerable populations at risk through their efforts to prevent vaccination, and climate change denialists put our planet at risk.
The “controversy” surrounding shaken baby syndrome is yet another example of a vocal minority shunning facts in favor of a self-serving narrative and personal gain. The ones who suffer are always the defenseless, voiceless child victims.
Sameer Sabir works in life sciences.