Dr. Lori Frasier is a Professor of Paediatrics at Penn State Hershey School of Medicine and Chief of the Division of Child Abuse Paediatrics at Penn State Hershey Children's Hospital, Pennsylvania, USA. She is also on the governing board of the National Centre for Shaken Baby Syndrome (NCSBS) and is its immediate past chair. She recently gave a presentation at the NCSBS annual conference, organized in partnership with the Sydney Children’s Hospital Network and held in Sydney. The event was sponsored by the NSW state government.
In her presentation, Frasier critiqued the alternative theories for infant brain injuries, the types of injuries that SBS advocates take as diagnostic of shaking. She considered alternative causes such as short falls, Intradural fluid channels in foetal and early infancy, vitamin K deficiency, Benign Expansion of the Subarachnoid Space (BESS), Cortical Venous Thrombosis and choking, amongst others. She explored the literature pertaining to these proposed causes and argued that none has a convincing scientific evidentiary basis.
I wondered why she did not present the evidence in favour of shaking.
In other words, why is the “shaking” theory accepted, whilst the others are not? Why not conclude that the causes remain uncertain? Which study or studies provide an evidentiary basis that allows us to conclude that shaking is the cause, i.e. that certain brain injuries are a “smoking gun” that a baby was shaken? This is the Shaken Baby Syndrome hypothesis: that certain brain injuries can be used to diagnose shaking. I also wondered if the scientific evidentiary basis for the shaking hypothesis would withstand the type of critique that Dr. Frasier applied to the other suggested causes.
So I emailed Dr Frasier and asked her to suggest one or two studies that, in her mind, provide the best evidence for this notion, for the Shaken Baby Syndrome hypothesis. This should be an extremely easy question for someone with her long history in the field.
Dr. Frasier did respond to my email. However, she still has not answered my question. She seems to be avoiding it. My email correspondence with Dr. Frasier is copied in full below.
Why can she not provide a response to my straightforward question?
19 Sep 2019, 09:49 subject: Presentation at Sydney Conference
Dear Dr. Frasier,
I found your presentation at the Sydney conference informative. You were able to critique the evidence base of a number of proposed alternative theories for brain injuries associated with SBS.
What concerns me is that a similar critique could be made of the evidence base for shaking. Have you done such an exercise? That is, subject the evidence base for shaking to the same scrutiny as you do the evidence relating to e.g. BESS?
Is there any study linking the SBS related injuries to shaking that would be beyond such criticisms? Is there any study that you recommend as providing clear positive support for shaking? You did not really provide such a reference in the presentation. Or did I miss something? I think providing such a positive reference would add a lot to your presentation, on top of criticizing the alternative theories.
20 Sep 2019, 00:31
Hi. Thank you for your thoughtful and thought provoking comments. I am.still travelling in Australia and want to.answer your questions in the way that honors those questions, and I will. My purpose of course was to address the so called mimickers which is not the same thing as evidence shaking. Look for more from me.
Mon, 23 Sep, 09:46
Dear Dr. Frasier,
I hope you have enjoyed your time in Australia. I look forward to your response. I really dont want a link to meta-studies or consensus statements. These never provide sufficient detail of particular studies. I think it would be most powerful to know what you consider the best one or two studies that have established the link between the SBS brain injuries, and shaking.
Mon, 30 Sep, 21:35 Hi, I was wondering if you were actually present during my talk, or if someone sent you my presentation? Lori Frasier
Tue, 1 Oct, 08:08 Hi Dr Frasier,
I was in Spain that week, so a colleague took notes and passed some materials. I did not want to bother you about his but I thought it would not take too much effort on your behalf to respond to my question, given your expertise. I just hoped for you to point out one or two key studies that establish the link between certain brain injuries and shaking, just to add that aspect to the materials I now have.
8 Oct 2019, 15:52 Hi Dr Frasier,
I was hoping you would have sent a response to this request. I would just like for you to point out one or two key studies that establish the link between certain brain injuries and shaking. I do not think it is an onerous question. If someone asked me a similar question in my field of science, such as "can you provide one or two studies that provide evidence for the existence of dark matter", I could respond in two minutes, and could explain how each study provides such evidence in a few short sentences.