Will Bordell
by Will Bordell

This piece was originally published on The Justice Gap.

After months of delay and despite losing its publisher, an academic journal has finally released a special ‘debate issue’ about shaken baby syndrome with a lead paper written by Dr Waney Squier. Dr Squier is the leading neuropathologist and critic of the syndrome who is currently banned from giving expert evidence in court (see here on the Justice Gap).

The special issue of the Prometheus has had a long and troubled gestation. Progress has been held up for the best part of a year by what editor Professor Stuart Macdonald has called ‘censorship by procrastination’.

The 40-year old journal considers innovation and an issue will tackle a contentious issue with the editorial team commissioning a proposition paper - in this instance, they approached Dr Squier - and then experts from a variety of standpoints are invited to write responses. Dr Squier’s paper was first sent to the publisher in October 2017. However the issue has finally been published independently after the publisher (Taylor & Francis) divested itself of the journal of over 40 years’ standing. You can read the journal here.

In his introduction, Prof Macdonald writes that the editors of the journal ‘became increasingly intrigued by what such a long-standing and increasingly bitter dispute might tell us about innovation – the primary interest of Prometheus’ ‘We pressed on, little realising just how close to the front line of battle we would be drawn,’ he wrote.

The Justice Gap reported on their decision to axe the publication last September. Lawyers for Taylor & Francis suggested that many, if not all, of the articles were defamatory including one written by Sir Terence Stephenson. Sir Terence’s contribution was judged to potentially libel the General Medical Council despite the fact that the author is currently its chair.

Proponents of the controversial syndrome, otherwise known as abusive head trauma, argue that a ‘triad’ of symptoms – brain swelling, bleeding on the brain, and bleeding in the retina – indicate an inflicted injury and therefore child abuse. The science behind SBS has repeatedly been called into question not least by Dr Waney Squier.

In her proposition paper, Dr Squier concludes that her ban and the discouragement of other expert witnesses to take the stand means that the courts were offered ‘old hypotheses, deeply entrenched in mainstream belief and supported not by science but by repetition and reputation’.

‘The message is clear any expert who questions mainstream opinion faces not only the risk of unwelcome publicity, but also a GMC investigation, with all that this entails. The greater evil is that this leaves parents and caretakers essentially defenceless against unsupported medical claims with the unthinkable consequences of wrongful incarceration and the removal of babies from innocent parents.’

Dr Waney Squier, Prometheus

Dr Squier’s article tracks the growth of the SBS phenomenon from 1972 when a radiologist called John Caffey first suggested the relationship between shaking and brain haemorrhages in infants citing ‘a 10-cent comic’ called Master Detective as one of his sources.

She argues that child abuse professionals latched onto the theory and support for it changed pitch in the 1990s with the high profile trial of Louise Woodward, the British au pair convicted for manslaughter after an eight-month-old baby died in her care in Massachusetts.

But then, as Squier describes, scientific studies began to chip away at the ‘triad’. Studies showed that the symptoms of SBS could have many potential explanations – and that the evidence on which the SBS hypothesis is based was limited, as contended (as reported on the Justice Gap) in a major review conducted by an independent Swedish healthcare watchdog in 2017.

Dr Squier herself changed her mind about the triad in 2001. As she recalled: ‘I read in depth many articles on every aspect of SBS; to my shame, I had not done this earlier…. I became convinced that there was little scientific support for the shaken baby theory and that there were many alternative causes for the triad. I had changed my mind, and the evidence I gave in family and criminal courts in infant death cases changed. I could no longer assert that the triad was sufficient evidence to make a diagnosis of abuse.’

Dr Squier begins her proposition paper with a wry reference to a colleague of hers who told her about 10 years ago that ‘there was a move afoot’ to have her reported to the General Medical Council (GMC). ‘I shrugged this off,’ she said. But, soon enough, she found herself hauled before the GMC, where she was struck off the medical register in March 2016. Her licence was restored later on that year, but she remains banned from giving expert evidence in court.

Dr Squier believes what she sees as an attempt to silence her and other doctors who share her views will fail. She ends her paper by commenting that ‘even the most vicious attacks on those who cannot accept mainstream opinion will not change the anatomy or workings of the infant brain.’

The issue focuses on the role of the expert witness. As the editor Professor Macdonald explains Dr Squier was struck off ‘not because the information she gave the court was wrong but because she misbehaved as an expert witness’. ‘In other contexts, misbehaviour might be welcomed: rebels, mavericks, troublemakers, those who flout the rules play a critical role in bringing about change,’ he writes. ‘Such renegades are needed to challenge established systems before advancing sclerosis renders them totally inflexible.’

‘The environment of a UK court is hostile to innovation; precedent is honoured, not novelty. The courts are intolerant of uncertainty and shades of grey, suspicious of the very conditions – doubt, disquiet, frustration – the social sciences consider conducive to innovation…. Only orthodoxy is accepted without question as expertise: dissent must prove itself.’

Prof Stuart Macdonald

Sir Terence Stephenson argued that reporting about Dr Squier’s case wrongly sought to characterise it as concerned with the issue of whether the evidence she gave was, or was not, correct. He continued: ‘This was not the case: instead, the fitness to practise proceedings focused only on the way she gave expert evidence and her failure to fulfil her duties to the court and to meet the standards expected of an expert witness in a number of court cases.’

Toni Saad, a doctor at University Hospital of Wales in Cardiff, wrote that it would have worrying implications for scientific integrity if expert witnesses were incentivised to give opinions in line with the orthodoxy, rather than to risk broaching an alternative theory for fear of endangering their careers. ‘Historians might one day remember Squier’s account of the putative shaken baby syndrome as another example of an established opinion being overturned by scientific evidence,’ he argues. ‘She has challenged the widely accepted hypothesis of shaken baby syndrome and has made clear that such a challenge is justified.’