Old World News
2003; Wiley; Volume: 33; Issue: 5 Linguagem: Inglês
ISSN
1552-146X
Autores Tópico(s)Child Abuse and Trauma
ResumoTruth is rarely pure, and never simple--Oscar Wilde And in the case of Baron Munchausen's accounts of his extraordinary adventures in Russia, the truth was mostly absent. His name is now associated with two medical syndromes in which individuals fabricate medical histories. The second syndrome is more troublesome. In Munchausen syndrome by proxy (MSBP), a person fabricates illness in a child the person is ostensibly caring for. Tactics include partial suffocation, poisoning with salt, or adding a drop of blood to the child's urine sample. The prevalence of MSBP is uncertain because its diagnostic criteria are so vague. The criteria for children victimized by MSBP can sound very like those for childhood autism, for example. The breadth of the criteria was shown in a letter to the British Medical Journal last year. (1) Three pediatricians claimed that parents who fabricate illness in their children also abuse the National Health Service's complaints systems. That puts parents wrongly accused of child abuse in a Catch-22: they can remain silent and be assumed to accept the diagnosis, or they can vehemently deny it and have the diagnosis thereby confirmed. The danger of such imprecise criteria is that the diagnosis is too easy to make. Epidemiological data collected a decade ago suggested an annual rate of only case per 200,000 children. (2) But attitudes to child abuse among some pediatricians appear to have changed: they are now more ready to diagnose MSBP. Indeed, in several cases I know, pediatricians have labelled children with unusual illnesses, difficult to diagnose, as having fabricated illness within two weeks of first presentation. There has also been a change in attitude to or sudden infant death syndrome--at least in the coterie of pediatricians who follow Sir Roy Meadow, who first described MSBP. He has said of cot deaths that one is a tragedy, two are suspicious, and three are murder. He has frequently been an expert witness in cases involving mothers charged with child abuse. Twice this year, however, his evidence has been rejected. The jury hearing a charge of murder against a pharmacist, three of whose infants died suddenly, took little over an hour to acquit her, and the Court of Appeal overturned the conviction, based on Sir Roy's evidence, of a lawyer said to have killed two infants. The Appeal judges were so scathing in their criticism of his evidence that the Solicitor-General wrote to all prosecutors warning them about using him as an expert witness. These cases were heard in criminal courts where the accused, both professional women, ensured proper examination of the evidence. …
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