A tough time for paediatricians

[Guest guest]

This is also of interest following the Roy Meadow article I just posted. My

heart bleeds for them...

Love, light and peace,

Sue

" He who asks is a fool for five minutes, but he who does not ask remains a

fool forever. " ~ Chinese proverb

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http://bmj.bmjjournals.com/cgi/content/full/328/7430/0-g

A tough time for paediatricians

Paediatrics is a highly attractive specialty but also, as this issue shows,

a tough one. Disease in the young is protean. Evidence is often lacking. The

wrong intervention may lead to a lifetime of damage. And the sociology is

complex: everybody is supposed to love children, but they are regularly

abused. The British, for example, object vociferously to European attempts

to stop them beating their children. " It never did me any harm, " is the cry

from people whose looks and behaviour belie their conviction.

One of Britain's most eminent paediatricians, Sir Roy Meadow, has been

reported to the General Medical Council, the body that regulates British

doctors, for his role as a prosecution witness in three trials where mothers

were wrongly convicted of killing their babies (p 9). These convictions have

all been overturned in the past year, and there may be a review of all cases

in which Meadow gave evidence.

Meadow was one of the first to argue that some seeming cot deaths were the

result of mothers deliberately harming their babies. There is no doubt that

this happens, and little is more uncomfortable than the thought of a mother

killing her child. But are such cases best dealt with by the courts? Giving

evidence in such inevitably cloudy cases must be hard, particularly when the

courts demand a binary outcome of guilty or not guilty. The process must be

excruciating for the accused, their families, and those who must assemble

and give evidence. The uncertainty that is normal in medicine clashes with

the need of the courts for a certain answer.

The clash is further illustrated by a judge suggesting that photographs

taken by colposcopy should not be used for second opinions in cases of

possible child sex abuse (see bmj.com news extra). Doctors who examined a

young girl judged that her hymen had been torn, and two experts who examined

photographs agreed. Authorities have advised using photographs in order to

avoid the trauma of further examinations, but when in the course of an

appeal the two experts eventually examined the girl they decided her hymen

was not torn.

Paediatric evidence of a different sort has come into question with the

Committee on the Safety of Medicines advising against the use of most

selective serotonin reuptake inhibitors (SSRIs) in people aged under 18 who

are depressed (p 3). The fear is that the drugs may increase suicidal

thoughts. The real problem is that there is hardly any research with these

drugs in young people. The 40 000 or so children and adolescents in Britain

taking antidepressants are doing so on the basis of evidence from a few

hundred people.

If all this wasn't enough for paediatricians to worry about, in Britain they

have also had to cope with the consequences of a television drama that

seemed to strongly support the arguments that the measles, mumps, rubella

(MMR) vaccine causes autism (p 50). Exactly what those consequences will be

we must wait and see.

, editor

rsmith@...