Professor Sir Samuel Roy Meadow (born 1933) is a former British paediatrician. He is best known for identifying the condition commonly called Munchausen Syndrome by Proxy (MSbP. Year 1933 (MCMXXXIII) was a common year starting on Sunday. ... Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants and children. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...

Early career

Professor Sir Roy Meadow was born in Wigan, Lancashire, the son of Samuel and Doris Meadow. He studied medicine at Worcester College, Oxford, and later practised as a GP in Banbury. Throughout his early years in medicine, Professor Meadow was a devoted admirer of Anna Freud (daughter of Sigmund Freud), whose lectures he would often attend. Speaking in later life, he said: "I was, as a junior, brought up by Anna Freud, who was a great figure in child psychology, and I used to sit at her feet at Maresfield Gardens in Hampstead. She used to teach us that a child needs mothering and not a mother." This article or section does not cite its references or sources. ... Lancashire is a county in North West England, bounded to the west by the Irish Sea. ... Worcester College has been an institution of learning since the late thirteenth century, even though the current college was founded only in the eighteenth century. ... The University of Oxford, located in the city of Oxford in England, is the oldest university in the English-speaking world. ... Anna Freud (December 3, 1895 - October 9, 1982) was the sixth and last child of Sigmund and Martha Freud. ... Sigmund Freud (May 6, 1856 – September 23, 1939; IPA pronunciation: []) was an Austrian neurologist and the co-founder of the psychoanalytic school of psychology. ...

In 1961, Sir Roy married Gillian Maclennan, daughter of Sir Ian Maclennan, the British ambassador to Ireland. The couple had two children, Julian and Anna, before divorcing in 1974. Four years later he married his second wife, Marianne Jane Harvey.

In 1970, Professor Meadow was appointed Senior Lecturer at St. James' University Hospital in Leeds, where in 1980 he become Professor of Paediatrics. Statistics Population: 443,247 Ordnance Survey OS grid reference: SE297338 Administration Metropolitan borough: City of Leeds Metropolitan county: West Yorkshire Region: Yorkshire and the Humber Constituent country: England Sovereign state: United Kingdom Other Ceremonial county: West Yorkshire Historic county: Yorkshire (West Riding) Services Police force: West Yorkshire Police Ambulance service... Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants and children. ...

Munchausen Syndrome by Proxy

In 1977, in The Lancet medical journal, Meadow published the theory which was to make him famous (Meadow,1977). Sufferers of his postulated Munchausen Syndrome by Proxy or MSbP (a name coined by Sir Roy himself) harm or fake symptoms of illness in persons under their care (usually their own children) in order to gain the attention and sympathy of medical personnel. This claim was based upon the extraordinary behaviour of two mothers: One had (he claimed) poisoned her toddler with excessive quantities of salt. The other had introduced her own blood into her baby's urine sample. Although it was initially regarded with scepticism, MSbP soon gained a following amongst medics and social workers. The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...

Expert testimony

The Allitt case

Meadow rose to public prominence in 1993, when he brought expert testimony in the trial of Beverley Allitt, a nurse accused of murdering several of her patients. Allitt was found guilty and sentenced to life imprisonment. Many saw this as a vindication of Meadow's theories. Beverley Allitt, dubbed the Angel of Death, was a nurse who was convicted of killing four children and injuring nine others on the ward she worked at Grantham Hospital, Lincolnshire. ...

MSbP and cot death

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 child abuse brought on by MSbP. Sudden Infant Death Syndrome (SIDS), also known as cot death and crib death, is the term for the sudden and unexplained death of an apparently healthy infant aged one month to one year. ... Child abuse is the physical or psychological maltreatment of a child by an adult, often synonymous with the term child maltreatment or the term child abuse and neglect. ...

Families which 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". (Although this dictum is believed not to have originated from Meadow's own lips, it has become almost universally known as Meadow's law.) Meadows Law was a precept much in use till recently in the field of child protection, specifically by those investigating cases of multiple cot or crib death — SIDS — within a single family. ...

Throughout the 1990's, a great many parents (mostly women) whose children had suffered apparent cot-deaths were convicted of murder on the basis of Meadow's expert opinion. A great many more parents, whom Meadow suspected of MSbP had their children forcibly removed and taken into care. In 1998, Meadow was knighted for "services to child health".

Controversy

The Clark case

The original trial

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. 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 obtained by squaring the observed ratio of live-births to cot-deaths in affluent non-smoking families (approximately 8,500:1). The jury returned a 10/2 majority verdict of "guilty". The British solicitor Sally Clark was convicted in November 1999 for the murder of her two children, Christopher in 1996, and Harry, early in 1998, both within a few weeks of their birth. ... This article or section does not cite its references or sources. ...

Statistical controversy

Meadow's 73,000,000:1 statistic was paraded in the popular press, and provoked an uproar amongst professional statisticians who considered it dangerously over-simplistic. The president of the Royal Statistical Society wrote an open letter of complaint to the Lord Chancellor, stating that the figure had "no statistical basis". The Royal Statistical Society is a learned society for statistics and a professional body for statisticians in the UK. Founded in 1834 as the Statistical Society of London, it became the Royal Statistical Society in 1887. ... This article or section needs a complete rewrite for the reasons listed on the talk page. ...

The criticisms were twofold: 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 likelihood that innocence will result in the observed double-cot-death). In reality, these quantities can only be equated when the a priori likelihood of the alternate 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). To meet Wikipedias quality standards, this article or section may require cleanup. ... The alternate hypothesis, or alternative hypothesis, together with the null hypothesis are the two rival hypotheses whose likelihoods are compared by a statistical hypothesis test. ... In statistics, a null hypothesis is a hypothesis set up to be nullified or refuted in order to support an alternative hypothesis. ...

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. The occurrence of one cot-death makes it likely that such conditions exist within the family in question, and the probability of subsequent deaths is therefore greater than the group average (estimates are mostly in the region of 1:100). The ecological fallacy is a widely recognised error in the interpretation of statistical data, whereby inferences about the nature of individuals are based solely upon aggregate statistics collected for the group to which those individuals belong. ...

Some mathematicians have estimated that taking both these factors into account, the true odds may have been greater than 2:1 in favour of Clark's innocence (Joyce, 2002). 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" (Watkins,2000). The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ...

To his credit, Meadow never actually claimed that 1:73,000,000 was the likelihood of Clarke's innocence (though many believe that this was how the court interpreted it). Furthermore, he later admitted that his calculation was "of limited significance", but claimed that this did not devalue his overall testimony. Since no other experts were at that time suggesting typical cot death, the statistics were in any case irrelevant.

The first appeal

The discredited 1:73,000,000 figure was amongst the five grounds for appeal submitted to the Court of Appeal in the autumn of 2000. The judges agreed that the figure was a "sideshow" which would have had no significant effect on the jury's decision. The overall evidence was judged to be "overwhelming" and Clark remained a convicted murderer. Her Majestys Court of Appeal is the second most senior court in the English legal system, with only the Judicial Committee of the House of Lords above it. ...

Clark's supporters were disgusted by this decision, calling it "intellectually dishonest". Meadow however felt himself fully vindicated. He now responded to Watkins in a BMJ paper of his own (Meadow, 2002), accusing him of being both irresponsible and misinformed. He reiterated his claim that "both children showed signs of both recent and past abuse" (injuries which the defence claimed were either misidentified in a badly-performed autopsy, or caused by the mother's attempts at resuscitation) and underlined the judges' controversial ruling that Clark and her husband had given "untrue evidence". He went on to bemoan the time likely to be "wasted" on any further investigation of the case: "In today's world," he wrote, "it is inevitable that....formal letters of complaint from the family to the Police Complaints Authority, the General Medical Council, the royal colleges, or other statutory bodies will be treated with respect and will consume considerable resources."

The second appeal and its aftermath

Meadow's apparent vindication was to be short-lived: It transpired that another expert witness had failed to disclose the results of medical tests which had suggested that at least one of the Clark babies had died from the bacterial infection Staphylococcus aureus (and not from smothering as the prosecution had claimed). A second appeal was launched and, in January 2003, Sally Clark's conviction was overturned. Binomial name Staphylococcus aureus Rosenbach 1884 Staphylococcus aureus (commonly called staph infection) is a spherical bacterium, frequently living on the skin or in the nose of a healthy person, that can cause illnesses ranging from minor skin infections (such as pimples, boils, and cellulitis) and abscesses, to life-threatening diseases...

Technically, the central reasons for the appeal's success had nothing to do with Roy Meadow. However, the discredited statistics were revisited in the hearing. In their ruling, the judges stated that "....if this matter had been fully argued before us we would, in all probability, have considered that the statistical evidence provided a quite distinct basis upon which the appeal had to be allowed."

The furore now began afresh. Speaking in the House of Lords, the opposition spokesman for health Lord Howe described MSbP as "one of the most pernicious and ill-founded theories to have gained currency in childcare and social services in the past 10 to 15 years. It is a theory without science. There is no body of peer-reviewed research to underpin MSbP. It rests instead on the assertions of its inventor. When challenged to produce his research papers to justify his original findings, the inventor of MSBP stated, if you please, that he had destroyed them". This article is about the British House of Lords. ... Richard Edward Geoffrey Howe, Baron Howe of Aberavon, CH, PC, QC (born 20 December 1926), usually known until 1992 as Sir Geoffrey Howe, is a senior British Conservative politician. ...

The Patel case

The CPS stuck to their guns, but soon experienced a further defeat. In June 2003 they used Meadow's expert testimony against Trupti Patel, a pharmacist accused of killing three of her babies. After a highly publicised trial lasting several weeks, the jury took less than 90 minutes to return a unanimous verdict of "not guilty". Even then, a spokesperson for the prosecutors stated that the crown would still be "very happy" to use Meadow's evidence in future trials. However, the Solicitor General Harriet Harman effectively barred Meadow from court work; she warned prosecution lawyers that the defence should be informed of court criticisms of Meadow's evidence. The Crown Prosecution Service, or CPS, is a non-ministerial department of the Government of the United Kingdom responsible for public prosecutions of people charged with criminal offences in England and Wales. ... Her Majestys Solicitor General for England and Wales, often known as the Solicitor General, is one of the Law Officers of the Crown, and the deputy of the Attorney General, whose duty is to advise the Crown and Cabinet on the law. ... Harriet Ruth Harman MP (born July 30, 1950, London) is a British Solicitor and Labour politician. ...

The Cannings case

Yet another blow to Meadow's credibility came the following December. Angela Cannings, a mother convicted on Meadow's evidence was freed on appeal. She had been accused of murdering two of her three babies, all of whom had died in their first few weeks of life. (The story is told in Cannings' autobiography Against All Odds, published in 2006.) Following the quashing of her convictions, Meadow found himself under investigation by the British General Medical Council for suspected professional misconduct. Angela Cannings was convicted in 2002 of smothering her (seven week old) son Jason in 1991 and her (eighteen week old) son Michael in 1997 and released on a second appeal. ... The General Medical Council (the GMC) is the regulator of the medical profession in the United Kingdom. ...

The original trial

Cannings' case differed from Clark's in that there was no physical evidence. The prosecution rested upon what was perceived to be "suspicious behaviour" on the part of the mother (telephoning her husband instead of emergency services when one of the deaths occurred) and upon Meadow's opinion that she was an MSbP sufferer. Meadow had told the jury that the boys could not have been genuine cot death victims because they were fit and healthy right up until the time of death (contradicting other experts who claim this is precisely typical of SIDS cases). The prosecution had also rejected any genetic explanation, stating that there was no family history of cot death. Although no enumerated statistics had been presented, Meadow had told the jury that double cot death was extremely unlikely (an alleged ploy to get his false statistics "in by the back door"). The jurors had taken nine hours to return a verdict of "guilty".

The 2003 appeal

Cannings had already lost one appeal but, in the wake of the Clark and Patel acquittals, the case was "fast tracked" for a second appeal. In the weeks that followed, an investigation by the BBC showed that the prosecution's "no family history" argument had been incorrect: At least two of Cannings' paternal ancestors had lost an abnormally large number of infants to unexplained causes, making a genetic predisposition to cot death highly plausible. The British Broadcasting Corporation, invariably known as the BBC (and also informally known as the Beeb or Auntie) is the largest broadcasting corporation in the world, employing 26,000 staff in the UK alone and with a budget of £4 billion. ...

The appeal was heard in December 2003. Despite the new evidence, the Crown fought tooth and nail to have the conviction upheld, forcing Cannings to remain in jail until the date of the hearing. The three judges were not impressed with their arguments; they declared the conviction "unsafe" without even retiring, promising to give their full reasons at a later date.

Aftermath

In January 2004, the Deputy Chief Justice, Lord Justice Judge, gave the full reasons for the success of Cannings' appeal. His comments were scathing about the entire MSbP/cot-death/murder theory, calling it a "travesty of justice". It was anticipated that many convictions would quickly be overturned. In the event, however, only a relatively small number of appeals were actually launched, though most of these were successful (including that of Donna Anthony, who served six years for allegedly murdering her son and daughter). In addition to this, the law was changed such that no person can be convicted on the basis of expert testimony alone. Sir Igor Judge Lawyer. ...

Meadow appeared before a GMC fitness to practise tribunal, which started on 21 June 2005. On 13 July, the tribunal ruled that Meadow's evidence in the Clark case was indeed misleading and incorrect and on 15 July decided he was guilty of "serious professional misconduct". A decision was made that his name should be struck from the medical register. The Society of Expert Witnesses commented that the severity of Meadow's punishment would cause many professionals to reconsider whether to stand as expert witnesses. The General Medical Council (the GMC) is the regulator of the medical profession in the United Kingdom. ... June 21 is the 172nd day of the year (173rd in leap years) in the Gregorian calendar, with 193 days remaining. ... July 13 is the 194th day (195th in leap years) of the year in the Gregorian Calendar, with 171 days remaining. ... July 15 is the 196th day (197th in leap years) of the year in the Gregorian Calendar, with 169 days remaining. ...

The following month, Meadow launched an appeal against this ruling. On 17th February 2006 High Court judge Mr Justice Collins found in Sir Roy's favour, ruling against the decision to strike him from the medical register. The judge stated that although the GMC had been right to criticize Meadow, his actions could not properly be regarded as "Serious Professional Misconduct".

On 26th October 2006 the Appeal Court overturned the High Courts earlier ruling, allowing expert witnesses to be disciplined once again but ruled that the High Court decision that Sir Roy was not guilty of serious professional misconduct should stand.

Meadow has never expressed any regret to the women his flawed evidence helped to jail.

References

• Joyce, Helen (2002), "Beyond reasonable doubt", +Plus Magazine...Living Mathematics, September 2002.
• Meadow, Roy (1977) "Munchausen Syndrome by Proxy: The Hinterlands of Child Abuse", The Lancet, August 13, pp.343-5, 1977.
• Meadow, Roy (2002), "A Case of Murder and the BMJ", British Medical Journal, Vol.324, pp.41-43, 5 January 2002.
• Watkins, Stephen J (2000), "Conviction by Mathematical Error?", British Medical Journal, Vol.320, pp.2-3, 1 January 2000.

August 13 is the 225th day of the year in the Gregorian Calendar (226th in leap years), with 140 days remaining. ... For the album by Ash, see 1977 (album). ... January 5 is the 5th day of the year in the Gregorian calendar. ... For album titles with the same name, see 2002 (album). ... January 1 is the first day of the calendar year in both the Julian and Gregorian calendars. ... This article is about the year 2000. ...

External links

• [1] BBC report on the reactions of the women Sir Roy Meadow's flawed evidence jailed to his lack of any apology to them for his actions.
• The Royal Statistical Society press release concerning Sir Roy Meadow's alleged misuse of statistics in the case of Regina vs. Clark can be found under Society and Statistics, Media & News, Press Releases, Press Release on the Sally Clark case, Oct 2001.
• AsherMeadow, a web-based information resource devoted to Munchausen Syndrome by Proxy.
• Judgment of the Court of Appeal in the case of Regina vs. Cannings.
• Meadow faces GMC misconduct hearing from The Guardian.
• Information on Munchausen Syndrome by Proxy, a website devoted to Munchausen syndrome and Munchausen Syndrome by Proxy by expert Dr. Marc Feldman.