Looking for Someone to Blame

 

Science and the law have long had an uneasy relationship. The law is slow to catch up. 

We fear what we don't understand, and we look for someone to blame when tragic and inexplicable events occur, especially to the most vulnerable. 

From the Salem Witch Trials to the preschool molestation scandals of the 1980s to the West Memphis 3 "Satanic Ritual" murders to the DNA exonerations of today.

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Add Shaken Baby Syndrome to that list. 

Originally posed as a hypothesis by a British doctor to explain how children got unexplained subdural hematomas without external injuries, it morphed into a diagnosis of child abuse.

The triad: a medical diagnosis of murder

For over three decades, Shaken Baby Syndrome was diagnosed when doctors found bleeding on the brain and two other symptoms: bleeding in the retina and brain swelling. This was known as "the triad." 

For years it was a slam dunk prosecution.

But we now know that many things can cause these same medical findings, including natural disease, accidents, and other processes that go awry in a baby's body that we still don't yet fully understand.

The hypothesis has never been proven by scientific testing or experiments.

More recent biomechanical studies tend to show that shaking alone cannot generate enough force to cause these injuries, and short falls can generate more force than shaking. It was likely for that reason that in 2009 that the American Academy of Pediatrics changed the nomenclature to "Abusive Head Trauma," suggesting that some type of blunt force trauma must be added to the mix.

What's more, subdural hematomas can occur in 50% of newborns, and retinal hemorrhages are non-specific findings that can be caused increased inter-cranial pressure or other diseases.

And we know that a "lucid interval" of several hours or longer can exist between a serious brain insult and a collapse with the loss of consciousness. 

Abusive Head Trauma/Shaken Baby Syndrome suffers from classic circular reasoning: doctors have previously diagnosed abuse when the triad was present, so when the triad is present doctors will diagnose abuse.

Of course, kids are abused. No one is excusing that or looking to evade punishment for real crimes.

But to accuse people of one of the most heinous crimes - killing of a baby - we have to be sure beyond a reasonable doubt that the accused inflicted an injury.

Skeptics of the diagnosis now rely on evidence-based medicine, which is the conscientious, explicit, and judicious use of scientific evidence in making medical decisions and cautions against unsystematic, untested reasoning and intuition based clinical applications.

Evidence-based medicine has shown that many other nature or accidental causes mimic what has for years been a diagnosis of abuse.

Please check on the links page for more detailed information on the history of SBS and the current science.