Cot Death Evidence Doubt Raised

A report raises serious concerns about the validity of a sudden infant death study used in the case against expert witness Professor Sir Roy Meadow. At a murder trial, Professor Meadow said it was unlikely cot death would strike a family more than once. But a Lancet study published in 2005 suggested almost 90% of second deaths in the same family are natural. Now a special report in the British Medical Journal casts doubt on the data and conclusions of the Lancet study.

The authors of the Lancet paper themselves acknowledge there are some uncertainties surrounding their work. The editor of the Lancet, Richard Horton, said the work had gone through very detailed peer review and the authors had been very honest about their interpretations.

He said: “The authors made very great efforts to be balanced in their interpretations of the findings and they have been very open in response to critics.”
He said the Lancet had also published critics’ concerns about the research, adding: “This is really a model of scientific debate.” He said the BMJ piece was deeply unbalanced and unfair.

The case against Professor Meadow centred on his testimony at the 1999 trial of Sally Clark for the murder of her babies. During Mrs Clark’s trial, Sir Roy said the probability of two natural unexplained cot deaths in the family was 73 million to one. Mrs Clark was convicted, but went on to win an appeal against her imprisonment and Professor Meadow was struck from his professional register.

The Lancet study into sudden infant deaths, based on over 6,000 babies, helped influence these decisions. It found as many as 80-90% of second deaths were natural, rather than attributable to unnatural causes such as abuse, neglect or homicide. But an investigation by freelance journalist Jonathan Gornall in the British Medical Journal claims some of the study information was changed after one of its senior authors, Professor John Emery, died in May 2000. Deaths that he had classed as “unnatural” or of “indeterminate” cause were counted as natural.

Before his death, Professor Emery provisionally estimated about 35% of second sudden infant deaths were unnatural – a striking contrast with the revised 13% in the final 2005 paper, says the BMJ. The BMJ article argues that by lumping together as “natural” any deaths that could not be proved incontrovertibly to be unnatural, the conclusions become biased.

Indeed, Professor Emergy’s colleagues who co-wrote the Lancet article, agreed that there was a grey area. They said they could not exclude the possibility that some of the 13 cases for which they had insufficient information on but had categorised as natural might have been cases of homicide. Also, they said they had counted as sudden infant death several cases where the verdict could equally have been smothering or asphyxia.

One of the authors, Dr Robert Coombs, said: “We stand by our findings entirely.”

A spokesman from the Foundation for the Study of Infant Deaths, which sponsored the Lancet research, said: “There is controversy and difficulty in ascertaining causes of death when a baby dies suddenly and unexpectedly. This is why FSID has been campaigning since 2000 for a thorough investigation of every infant death, without any preconceptions, to try to find out as much as possible about the causes leading to death.”