In Boston in 1997, nineteen year old British nanny Louise Woodward was accused of murdering Matthew Eappen, an 8 month old child under her care. At trial, medical doctors testified that the injuries to Eappen could only have resulted from Woodward having violently shaken the baby. The case made headlines on both sides of the Atlantic, with Woodward’s reserved nature portrayed as cold and lacking emotion in the U.S., dignified and unperturbable in the U.K.[1] The case projected Shaken Baby Syndrome into the international spotlight.
Protesting her innocence, Woodward was represented at trial by superstar barrister Barry Scheck, part of the ‘dream team’ that represented O.J. Simpson in the ‘trial of the century’. Scheck is also the co-founder of the Innocence Project, which has exposed hundreds of wrongful convictions in the U.S. One of Scheck’s strengths is his knowledge of forensic science and he drew on a slew of scientists to dispute the medical evidence presented against Woodward. In particular, they disputed the scientific basis for the belief that certain brain injuries, could only be caused by violent shaking. These brain injuries, subdural haematoma, retinal haemorrhages and encephalopathy, are collectively known as the 'triad'. Despite the rigorous defense, Woodward was convicted of murder and initially sentenced to 15 years in prison, although the conviction was downgraded to manslaughter on appeal and Woodward served less than a year.
Controversy over Shaken Baby Syndrome and its diagnosis has continued to rage in courtrooms throughout the world over the past couple of decades. There have been hundreds of convictions, many for murder[2]. There have also been many reversals of convictions, and several doctors who initially provided evidence for the prosecution changed their mind. Dr. Patrick Barnes, who gave evidence that helped convict Louise Woodward, is one of those doctors. A pediatric radiologist at Stanford University, Dr. Barnes ‘started realizing there were a number of medical conditions that can affect a baby's brain and look like the findings that we used to attribute to shaken baby syndrome or child abuse’[3].
In 1996, Audrey Edmunds was sentenced to eighteen years in prison for killing a 7 month old girl in her day care centre in Wisconsin. Dr. Robert Huntington III testified that Edmunds had shaken the infant but Huntington later recanted, stating that his testimony had been the conventional wisdom of the time but that he no longer believed that the brain injuries suffered by the infant were conclusive evidence of shaking[4].
Dr. Waney Squier testified for the prosecution in a range of trials in the U.K. before she looked deeper into the science and changed her mind, and started testifying for defendants.
The controversy also raged in Europe. The Swedish government wanted answers, and commissioned an independent review of the evidence base for Shaken Baby Syndrome. The comprehensive review[5], published in 2017, concluded that there is insufficient scientific evidence to assert that particular the brain injuries associated with Shaken Baby Syndrome (the triad) can be used to conclude that traumatic shaking must have occurred. The study went further, stating that there is only limited, 'low quality' scientific evidence to suggest that shaking actually causes these brain injuries, let alone that it is the only possible cause. This was not the first review of the SBS that concluded that it lacked a scientific evidentiary basis, with similar conclusions reached in a smaller scale review back in 2003[6].
Medical records certainly show an alarming number of cases of infants having been shaken. For example one study concluded that shaking kills as many Australian infants as car crashes[7]. Yet the conclusions of such studies that babies had been shaken were arrived at by reference to the 'triad', not by using scientific methods. The doctors had assumed that the triad can only be caused by shaking, and thus concluded that the infant that presented with such injuries must have been shaken and this was recorded in the records. The 2017 Swedish study found that this type of circular reasoning had been employed in the vast majority of studies purporting to demonstrate that the triad could be used to diagnose shaking. It was a self-fulfilling prophecy.
Another way of saying 'circular reasoning' is 'not science'. It is just not science.
[1] Moyes, J Nanny Trial: How Louise lost the image battle The Independent, Saturday 1 November 1997
[2] E.g. Tuerkheimer, D. Flawed Convictions: "Shaken Baby Syndrome" and the Inertia of Injustice
Oxford University Press, 2014
[3] Frontline, Interview Dr. Patrick Barnes, June 28, 2011, WGBH Educational Foundation
[4] Breed, A. G. Studies Disagree on Shaken-Baby Syndrome The Associated Press, April 28, 2007
[5] Lynøe N, Elinder G, Hallberg B, Roseen M, Sundgren P, Eriksson A. Insufficient evidence for ‘shaken baby syndrome’ – a systematic review. Acta Paediatr 2017; 106: 1021–7
[6] Donohoe, M. (2003) ‘Evidence-based medicine and shaken baby syndrome; part I: literature review’ American Journal of Forensic Medicine and Pathology, 24, pp.239-42.
[7] Liley W, Stephens A, Kaltner M, Larkins S, Franklin RC, Tsey K, Stewart R, Stewart S. Infant abusive head trauma - incidence, outcomes and awareness Aust Fam Physician. 2012 Oct;41(10):823-6. Review.