Roy Meadow

Professor Sir Samuel Roy Meadow (born 1933) is a former British paediatrician notorious for his 1977 academic paper on Munchausen Syndrome by Proxy (MSbP), in which he claimed that parents fabricate their child's illness. His dictum that “one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise“ became known as Meadow's Law.

The General Medical Council (GMC) struck off Meadow after he was found to have offered “erroneous” and “misleading” evidence in the Sally Clark case. Clark was a lawyer wrongly convicted in 1999 of the murder of her two baby sons, largely on the basis of Meadow's evidence; her conviction was quashed in 2003 after she had spent three years in jail. Sally Clark died in 2007, apparently never having recovered from her wrongful imprisonment.

Clark's father, Frank Lockyer, who is a retired senior police officer, complained to the GMC, alleging serious professional misconduct on the part of Meadow. The GMC concluded in July 2005 that Meadow was guilty of serious professional misconduct and ordered that his name be erased from the register. Meadow appealed to the High Court, which ruled in his favour in February 2006. The GMC appealed to the Court of Appeal and in October 2006 by a majority decision, with the Master of the Rolls, Sir Anthony Clarke, dissenting, the Court of Appeal upheld the decision of the High Court.

Early career
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, 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."

In 1961, Meadow 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.

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 Meadow 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 (Meadow 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 doctors and social workers.

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.

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.

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.)

Throughout the 1990s, a number of parents (mostly women) whose children had suffered apparent cot deaths were convicted of murder on the basis of Meadow's expert opinion. A greater number of parents, whom Meadow suspected of MSbP had their children forcibly removed and taken into care.

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".

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 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).

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).

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 Royal Statistical Society issued a press release in 2001 saying that the Clark case involved "a medical expert witness making a serious statistical error".

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 claimed 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 convicted as a murderer.

Clark's supporters were disgusted by this decision, calling it "intellectually dishonest" even though Meadow had been fully vindicated. He 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 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. Sadly, Sally Clark died on 16 March 2007, having never recovered from the trauma of her wrongful conviction and imprisonment following the death of her two children. Many people consider Meadow to be personally responsible for her death. He certainly profited greatly from his many court appearances as an "expert witness".

Although the central reasons for the Clark appeal's success had nothing to do with Meadow, 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" (see Lord's Hansard text).

Trupti Patel
In June 2003, the CPS 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 for England and Wales, Harriet Harman - whose sister is Sarah Harman QC, a lawyer involved in another subsequent high profile case where the parents had been accused of harming their children - effectively barred Meadow from court work; she warned prosecution lawyers that the defence should be informed of court criticisms of Meadow's evidence.

Angela Cannings
The following December Angela Cannings, a mother convicted on Meadow's evidence was freed on appeal. She had been wrongly convicted of murdering two of her three babies, both of whom had died in their first few weeks of life. Following the quashing of her convictions, Meadow found himself under investigation by the British General Medical Council for suspected professional misconduct.

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. He 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 appeal was heard in December 2003 when the Court of Appeal declared the conviction unsafe.

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". Some people expected 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.

Meadow then appeared before a GMC fitness to practise tribunal, which started on 21 June 2005. On 13 July, the tribunal ruled that his 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, although the Society of Expert Witnesses commented that the severity of this punishment would cause many professionals to reconsider whether to stand as expert witnesses.

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

On 26 October 2006 the Appeal Court overturned the High Court's earlier ruling, allowing expert witnesses to be disciplined once again but ruled that the High Court decision that Meadow was not guilty of serious professional misconduct should stand. However, on the issue of serious professional misconduct, the three person Appeal Court panel was split 2:1 with the dissenting judge, Sir Anthony Clarke, concluding Meadow was "guilty of serious professional misconduct" and provided detailed reasons for his conclusion. One of the other two judges, Lord Justice Auld, said Meadow "was undoubtedly guilty of some professional misconduct" but that it "fell far short of serious professional misconduct" (see Richard Webster's article discussing the judgment).

Ian and Angela Gay
In the 2005 trial of Ian and Angela Gay over the death of their adopted son Christian, the prosecution relied heavily upon Meadow's 1993 paper "Non-accidental salt poisoning", citing it many times throughout the trial. The judge also referred to the paper citing it five times during his summing up. Ian and Angela Gay were found guilty of manslaughter and spent 15 months in prison before their convictions were quashed.

In interviews for BBC Radio 4's File on 4 programme, Professor Jean Golding and Professor Ashley Grossman both questioned the reliability of the Meadow paper. The naturally occurring condition diabetes insipidus was suggested as a more likely cause of an elevated salt level than deliberate salt poisoning.