The repercussions the Folbigg case has had over the past few weeks are nothing strange; it has all the ingredients of a true thriller: a woman accused of murdering her four babies, a scientist determined to save her Proving innocence through genetic research, a justice system hesitates to admit the new data, a final acquittal that leaves “the worst serial killer in Australian history” the victim of “Australia’s judiciary’s gravest error”…
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Among the nonsense piling up in the case is that of the prosecutor, who said, “There has never been a case like this in the history of medicine.” The truth is that after the Australian case, there are many similar cases culminating in a scathing verdict in 2003 against the “intellectual originator” of these imprisonments: Professor Sir Roy Meadow, who went from being one of British medicine’s most glorious figures to becoming one of its worst villains. He, too, received his punishment: the twenty years of ignominy he has endured ever since. Meadow’s story is a unique source of insight into the many, complex, and diverse factors involved in the fascinating process by which disease arises, changes, and disappears over time.
In 1977, Meadow described “Munchausen by proxy syndrome,” in which some mothers (and, more rarely, fathers) seriously injure their young children and seek medical help; sometimes they even lead to death. It was an extension of the then-known Munchausen syndrome, in which an adult invents or causes their own symptoms. Meadow’s contribution made him a scholarly authority.
Perhaps Meadow was stunned by his own discovery and made a connection between proxy Munchausen syndrome and sudden infant death syndrome. This last, quite common and well-known picture occurs in apparently healthy babies during sleep and has no objective cause. Meadow posited that a mother with multiple cases of cot death would have vicariously Munchausen and harm her children by seeking medical attention. This is how he formulated the law that bears his name: “The first case is tragedy, the second is suspicion, the third is murder, unless proven otherwise.” Cases tried in England before 2004 as expert witness. Many of the judgments were based on his opinion.
The result has been imprisoned women and couples who have lost custody of their children. But in December 2003, a judge issued a ruling challenging Meadow’s theory after data was released showing genetic changes that could explain repeated infant deaths. And on January 19, 2004, Britain’s Attorney General announced that all trials based on his theories and opinions would be reviewed. Many families have requested the return of custody of the children that medical science and the legal authorities stripped them of years ago. More than fifty people waited in British prisons for the experts to finish their discussion on whether or not the “scientific” law that served as the basis for their imprisonment was valid. And the Minister’s spokesman, with a degree of sincerity unusual for his union, publicly stated that the government did not know what to say given the gravity and complexity of the situation.
Are new diseases discovered or invented? Many opinions circulate in the Academy, from those who think they are natural phenomena that are becoming more well known, to those who think they are social constructions.
dr Meadow’s story dramatically raised a multitude of questions about the way diseases are conceived and dismissed, discovered or invented; the degree of reliability of medical knowledge (the sacred notion of “evidence” in medicine); the difficulty of thinking about important issues in conditions of uncertainty; about the profound human, familial, social and criminal consequences of the always more or less reasonable but never infallible medical conclusions.
The unusual situation that occurred in England in 2004 – and which has now been repeated in Australia – was the result of a legal opinion which refuted Meadow’s “evidence”. Other scientists contributed genetic data supporting its cancellation. The controversial pathological entity, the “scientific law” created by a pediatrician and initially advocated by his colleagues, was eventually abolished by a judge.
Are new diseases discovered or invented? Many opinions circulate in the academic literature, from those who think diseases are natural phenomena that science is increasingly exploring, to those who believe they are social constructions that each cultural group creates or destroys . What evidence supports the existence of a new syndrome? In the Meadow case, it was a plausible hypothesis, supported by some true facts and unprovable conclusions, clothed in flawed statistics, and anchored in the consensus of other colleagues. New evidence led to the failure of his theory and an indictment of misconduct by a senior professional court. Meadow’s mistake was mistaking his assumptions for reality. And it was the judges who finally ruled (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 can rest assured that what is happening will be explained to them with certainty
The type of evidence used in the British trials suggests what one of the convicts said to the press: “They asked me if I had suffocated my baby and I said no.” They told me I was lying , and since lying is one of the symptoms of Munchausen syndrome, they confirmed the diagnosis.”
As always, personal factors (and grudges) weren’t lacking. One of the key witnesses for Australian prosecutors was the defendant’s ex-husband. And Meadow’s ex-wife also volunteered for the firing squad, saying he saw murderous mothers everywhere and was a misogynist with serious personal problems in his relationships with women. He even revealed that when he was young, Meadow played the role of Judge Danforth in Arthur Miller’s The Witches of Salem, a character who falsely accused women of witchcraft and infanticide. According to her, Meadow had admitted that she identified with the character far more than was reasonable.
If we were to accept this statement, we would come to a disturbing but not insignificant conclusion: the creation of a new concept of disease can arise from personal conflicts rooted in the darkest mental zone of the scientist postulating it.
Can we say with absolute certainty that Kathleen Folbigg and all the other women who were first imprisoned and later released were innocent? No we can’t. Criminal proceedings, like clinical proceedings, are almost always probabilistic and almost never irrefutable. All we can say is that, from today’s perspective and knowledge, it seems highly likely that these beliefs were wrong, and highly unlikely—but not impossible—that any of these women were deranged enough to murder their children in order to to attract attention. medical.
Some of his colleagues said Meadow was a solid scientist but had little ability to doubt his ideas. The husband of one of the women convicted on the basis of his testimony added that this is precisely why he is so valued as a forensic expert: judges, like patients, are troubled by the uncertain probabilistic theories of science, but they are confident in explaining exactly what is going on. Doctors sometimes find it difficult to accept that they are working with a complex network of biological facts and values of the most diverse nature (personal, family, cultural, social…) that do not allow the application of a logic of certainties, but rather a rational and multifactorial one Analysis under conditions of uncertainty. The authors of great scientific discoveries often have an understandable fondness for their theory, which sometimes leads them to overestimate its scope and underestimate the possibility that it is wrong.
A respected Spanish family doctor, Francesc Borrell, says that the most important subject not taught in medical schools is what doubt should be taught.
Jose Lazaro He is Professor of Medical Humanities at the Department of Psychiatry at the Autonomous University of Madrid. Author of The Genres of Violence.
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