The impact that the outcome of the Folbigg case there is nothing strange about it, it contains all the ingredients of a real thriller: a woman accused of having murdered her four babies, a scientist determined to prove her innocence through genetic research, a judicial system reluctant to admit the new data, a final acquittal that transforms “the worst serial killer in the history of Australia” in the victim of the “most serious error of Australian justice”…
Among the nonsense that accumulates in the case, the one of the prosecutor who said: “There has never been, in the history of medicine, a case like this.” The truth is that after the Australian case there are many similar cases, which concluded in 2003 with a devastating sentence against the “intellectual author” of those imprisonments: Professor Sir Roy Meadow, who went from being one of the most glorious figures in medicine British to become one of its worst villains. He, too, has had his sentence: the twenty years of opprobrium that he has endured ever since. Meadow’s story is a unique source of insight into the many, complex, and varied factors involved in the fascinating process by which disease appears, changes, and disappears over time.
Meadow described, in 1977, the “Münchhausen syndrome by proxy” in which some mothers (and, less frequently, fathers) seriously injure their young children, trying to get medical attention; sometimes they even cause death. It was an extension of the then well-known Münchhausen Syndrome, in which an adult invents, or causes, her own symptoms. That contribution from Meadow established him as a scientific authority.
Perhaps dazzled by his own finding, Meadow established a link between Münchhausen syndrome by proxy and sudden infant death. This last picture, quite frequent and well known, occurs during sleep in apparently healthy babies and with no objective cause. Meadow postulated that a mother with several cases of sudden infant death would have Münchhausen syndrome by proxy and would injure her children seeking medical attention. He thus formulated the law that bears her name: “The first case is a tragedy, the second a suspicion, the third a murder, unless proven otherwise.” His prestige as an expert on the subject meant that he was requested to act as an expert in most of the cases that were tried in England before 2004. Many of the sentences were based on his opinions.
The result was incarcerated women and couples who lost custody of their children. But in December 2003, following the publication of data showing genetic alterations capable of explaining repeated infant deaths, a judge handed down a ruling challenging Meadow’s theory. And on January 19, 2004, the British State Attorney General announced that all prosecutions based on his theories and his opinions were to be reviewed. Many families requested that custody of the children that Medical Science and Legal Authority had taken from them years before be returned to them. More than fifty people were waiting in British prisons for the experts to finish discussing whether or not the “scientific” law that had served as the basis for imprisoning them was valid. And the ministerial spokesman, with a degree of sincerity unusual in his union, publicly declared that, given the seriousness and complexity of the situation, the Administration did not know what to say.
Are new diseases discovered or invented? Many opinions circulate in the academy, from those who think that they are natural phenomena, which are getting better and better known, to those who believe that they are social constructions.
Dr. Meadow’s story dramatically brought to the table a wide variety of questions about the way diseases are conceived and dismissed, discovered or invented; on the degree of reliability of medical knowledge (the sacred concept of “evidence” in medicine); about the difficulty of reasoning about vital issues under conditions of uncertainty; about the profound human, family, social and penal consequences of the always more or less reasonable, but never infallible, medical conclusions.
The unusual situation that occurred in England in 2004 —and that has now been repeated in Australia— was the consequence of a legal opinion that overturned Meadow’s “evidence”. Other scientists contributed genetic data that supported the repeal of it. The disputed pathological entity, the “scientific law” created by a pediatrician and initially endorsed by his colleagues, was finally abolished by a judge.
Are new diseases discovered or invented? Many opinions circulate in the academic literature, from those who think that diseases are natural phenomena that science is learning more and more to those who believe that they are social constructions that each cultural group makes or breaks. What evidence demonstrates the existence of a new syndrome? In the Meadow case it was a plausible hypothesis, supported by some true facts and unprovable inferences, clothed in erroneous statistics, and enshrined by the consensus of other colleagues. New evidence (which is how we should translate the English term evidence) led to the collapse of his theory and an accusation of malpractice by a high professional court. Meadow’s mistake was mistaking his hypothesis for reality. And it was the judges who ended up ruling (too late for many victims) that the Meadow Law was not a discovery but an invention.
Judges, like patients, are bothered by the uncertain probabilistic theories of science, but they are reassured that they are explained with certainty what is happening
The type of evidence that was used in the British trials gives an idea of the statement in the press of one of the convicted: “They asked me if I had suffocated my baby and I answered no. They told me that she was lying, and since lying is one of the symptoms of Münchhausen syndrome, they confirmed the diagnosis.
As always, personal factors (and grudges) were not lacking. One of the main witnesses for the Australian prosecutor was the defendant’s ex-husband. And also Meadow’s ex-wife volunteered for the firing squad declaring that he saw murderous mothers everywhere, as well as being a misogynist with serious personal problems in his relationship with women. He even revealed that in his youth Meadow had played the role of Judge Danforth in Arthur Miller’s play Witches of Salem, a character who falsely accused women of witchcraft and child murder. According to her, Meadow had confessed that she identified with that character much more than was reasonable.
If we were to accept this testimony, we would reach a disturbing but not insignificant conclusion: the creation of a new concept of disease can be done from personal conflicts rooted in the darkest mental zone of the scientist who postulates it.
Can we say with absolute certainty that Kathleen Folbigg and all the other women imprisoned first and released later were innocent? No, we can not. Criminal trials, like clinical trials, are almost always probabilistic and almost never irrefutable. All we can say is that, with today’s perspective and knowledge, it seems highly likely that those convictions were wrong, and highly unlikely—but not impossible—that any of those women were deranged enough to murder their children to gain attention. medical.
Some of his colleagues declared that Meadow was a sound scientist, but had little ability to doubt his ideas. The husband of one of the women sentenced as a result of his testimony added that precisely for this reason he was so appreciated as a forensic expert: judges, like patients, are bothered by the uncertain probabilistic theories of science, but they are reassured that they Explain for sure what is going on. Doctors sometimes find it difficult to assimilate that they work with a complex network of biological facts and values of many kinds (personal, family, cultural, social…) that do not allow the application of a logic of certainties, but rather a rational and multifactorial analysis under conditions of uncertainty. The authors of major scientific discoveries often have an understandable parental love for their theory, which sometimes leads them to overestimate its scope and underestimate the possibility that it is wrong.
A prestigious Spanish family doctor, Francesc Borrell, says that the most important subject that is not taught in medical schools is the one that should teach doubt.
Jose Lazaro He is a professor of Medical Humanities in the Department of Psychiatry at the Autonomous University of Madrid. Author of the book The genres of violence.
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