In January 2007, following work I had done for the British Medical Journal, I was commissioned by the Times Higher Education Supplement to write an article about a campaign being waged by a British MP, under the cover of parliamentary privilege, against doctors working in child protection. The article was published on January 26, 2007, but was later withdrawn in its entirety following a threat of legal action by John Hemming MP. The first paragraph of this version has been altered to reflect Mr Hemming's claim that the original opening paragraph was defamatory. None of the facts of the article, however, have been challenged, or altered. For background reading, click here to read John Hemming's December 19, 2006, speech in Hansard. Click here to read John Hemming's Early Day Motion 2727. JG

January 26, 2007

Great accusations

A campaign to discredit a paediatrician has plumbed new depths, with an MP accusing him of 'managing research likely to lead to brain damage', says Jonathan Gornall.

ON December 19 last year [2006], John Hemming, the Liberal Democrat MP for Birmingham Yardley, rose in the House of Commons to continue an extraordinary campaign against the paediatrician David Southall with a speech riddled with inaccuracy and misleading innuendo.

"In essence," Hemming told the House, "what we have is evidence of a doctor managing research likely to lead to brain damage and/or death in infants. There is evidence of a substantial number of babies being brain-damaged at the same hospital. There are also records of babies dying from symptoms that could have been caused by that type of research."

So extreme was the speech, in which Hemming compared Southall to Josef Mengele, the Nazi doctor who conducted inhuman experiments on Jewish children, that it was disowned by Evan Harris, a fellow Liberal Democrat MP and the party's Science Spokesman.

"I do have a view on this speech," Harris tells The Times Higher. "It's rubbish. The Speaker and the authorities frown on people using privilege in this way, when they are not accurate and when there are obvious falsehoods. I think this is an abuse of parliamentary privilege and that the references to Josef Mengele are deeply offensive."

Hemming told the House that "over decades he [Southall] was allowed to do research just as damaging as that of Josef Mengele, without proper action by the authorities". By association, the Mengele comparison was extended to more than 30 co-researchers also involved with the work Hemming was attacking - among them a German doctor.

Hemming's attacks on Southall, which have included a series of early day motions (also protected by parliamentary privilege), began last August after the MP started communicating with Penny Mellor, a self-proclaimed "high-profile campaigner against false allegations of child abuse", and other contributors to the website Mothers against Munchausen Accusations (Mama).

In April 2004, Mellor, a mother of eight from Coven, Staffordshire, accepted an award from the Citizens Commission on Human Rights - a branch of the Scientology movement - for "her vigorous campaigning to expose the psychiatric label Munchausen's syndrome by proxy" (MSBP).

Mellor and her fellow campaigners, many of whom are parents who claim to have been falsely accused, have been waging a bitter propaganda war for more than a decade against various doctors involved in child protection work, and Southall is high on their list of targets. In 1999, although Southall had never treated any of her children, Mellor made a series of serious allegations against him, among which was that he "instigates care proceedings in order to appear as an expert witness for which he is paid a phenomenal amount of money", and succeeded in having him and another doctor suspended from North Staffordshire Hospital in Stoke-on-Trent for almost two years.

After two independent investigations, North Staffordshire Hospital Trust announced in October 2001 that all the allegations had been without foundation and that "Professor Southall always acted in a way that promoted the best interests of children under his care". The episode cost the National Health Service close to £1 million.

In March 2002, Mellor was sentenced to two years in prison after being found guilty of conspiring to abduct a child whose mother Southall and others suspected of MSBP. Mellor blames Southall for the eight months she served. The judge at Newcastle Crown Court said she had been "the Svengali of the whole plan" to keep the child out of the hands of social workers and added: "What you are guilty of is orchestrating the abduction of a child for your own propaganda purposes."

Peter Fleming, professor of infant health at Bristol University and one of Britain's leading cot-death researchers, told The Times Higher that the destructive campaign with which Hemming had allied himself was undermining vital national research into sudden infant death syndrome (Sids) and other unexpected deaths in childhood.

"It has created an atmosphere where people ask: 'Why should I get involved?'" he said. "It's very hard to get any research in this area off the ground because there's an awful lot of people who have chosen to stay out of anything related to unexpected death in childhood or the investigation of it.

"They see what has happened to David Southall, so why should they take on something that potentially puts them in conflict with people they perceive to be particularly unpleasant and outspoken and who seem determined to destroy the careers and lives of other paediatricians?"

Hemming's pre-Christmas speech was a 1,800-word "best of" compilation of many of the accusations against Southall that have been posted over the years on the Mama website. He began by conflating two entirely different studies.

"Perhaps the biggest project was known as Protocol 85.02," Hemming said, apparently unaware that according to Southall the study known as 85.02, although ethically approved, had never taken place.

"Southall looked at the response of babies to asphyxiation, shortage of oxygen and the presence of carbon dioxide. The experiments were known as sleep studies and started with about 7,000 babies born in the mid-1980s at Doncaster and Rotherham hospitals."

Protocol 85.02 and the study of 7,000 babies to which Hemming referred were not one and the same thing. Protocol 85.02 had been preceded by a multicentred prospective study into Sids, funded by the British Heart Foundation and the Foundation for the Study of Infant Death. Between July 1980 and July 1981, Southall and colleagues had recorded the heart and breathing movements in 6,914 full-term and 2,337 pre-term or low-birth-weight infants in three British hospitals - Brighton, Doncaster and Exeter.

This was a prospective study on an impressive scale. All the babies enrolled were "tagged" by the Department of Health and the researchers notified of any who went on to die of Sids.

At the time, Sids was costing the lives of 8,000 babies a year in the US and 1,500 in the UK. Much time and money was being expended investigating the theory that there was a relationship between apnoea - a temporary halt in breathing - and Sids. Southall and colleagues changed all that. Studying the recordings they had made earlier, they found no link between Sids and either prolonged apnoea or cardiac rhythm disorders. They reported their findings in "Identification of infants destined to die unexpectedly during infancy: evaluation of predictive importance of prolonged apnoea and disorders of cardiac rhythm or conduction", published in the British Medical Journal in April 1983.

This work was a milestone in cot-death research. The US paediatrician Abraham Bergman, one of the founding fathers of cot-death research, acknowledged the value of Southall's contribution in an article published in Pediatrics, the journal of the American Academy of Pediatrics, in 1997.

He recalled that most research in Sids over the past 25 years had been carried out "with three assumptions that have turned out to be false". One of those assumptions was of a relationship between Sids and apnoea.

The researchers had planned to follow up the success of the 1983 paper with another study that would have built on the earlier work, and it was this that was outlined in the application for ethical approval known as Protocol 85.02. Its full, and less sinister-sounding, title was "Do infants who suffer sudden infant death syndrome have abnormal episodes of hypoxaemia, hypercapnia, sinus tachycardia or periodic apnoea during the first six weeks of life?".

The researchers had hoped to study thousands of infants to determine whether "recordings of oxygenation, electrocardiogram and respiratory activity will be able to identify infants who will suffer Sids". Like the earlier research, this was to have been a prospective study. If a significant association were found between Sids and episodes of below-normal blood- oxygen levels, excess carbon dioxide in the blood, rapid heartbeat or periodic cessation of breathing, then the study would enter phase three and "the second objective - to identify the mechanisms producing these abnormalities".

Although, as Southall says, the study never went ahead because funding was not forthcoming, ethical approval was granted at a meeting of the Royal Brompton Hospital Ethics Committee on May 8, 1985. Nevertheless, it was the proposed third phase of this study that Hemming attacked in his speech.

"Phase three," he said, "involved choking babies for ten sessions of ten seconds, depriving them of oxygen by giving them only 15 per cent oxygen rather than the normal 21 per cent, and then giving them too much carbon dioxide."

Phase three would not have involved the "choking" of babies - Hemming is, perhaps, referring to occlusion tests, a standard non-invasive lung-function test outlined in the protocol. As for oxygen deprivation, 15 per cent is the proportion of oxygen in the air breathed by all passengers, including infants, who travel in commercial aircraft.

Some parents, including at least one involved with Mellor and mentioned in Hemming's speech, continue to insist not only that this study took place, but also that their children were a part of it and suffered brain damage as a result.

In his speech, Hemming again misleadingly conflated events. "A large number of brain-damaged babies were born in Doncaster in the 1980s. However, the records showing which babies were in the experiments were not in the medical files, because Southall kept secret files, known as special case files. Although compensation was paid, the causation was not entirely clear."

It is true that parents of children born with brain damage at Doncaster Royal Infirmary between 1986 and 1990 called for a public inquiry, but this had nothing to do with Southall. What's more, although some parents did receive compensation, an inquiry by Trent Health Authority concluded in October 1992 that no more babies had suffered brain damage during delivery at Doncaster than anywhere else in the UK. Hemming, however, went further, suggesting "what is clear from the experience of (Mrs B) and (Mrs H) is that their children were forced into the experiments and probably suffered brain damage as a result".

This extraordinary claim is, however, anything but clear. Southall is midway through an adjourned hearing by a General Medical Council Fitness to Practise Panel into various allegations levelled by five parents, including Mrs H (Hemming has named the complainants, in his speech and on his blog, even though the family court released details to the GMC on the basis of anonymity). Tellingly, none of the complaints being considered features Hemming's accusations about experiments and brain damage.

As Richard Tyson QC, for the complainants, told the hearing on Day 1, the case was "not about unlawful research involving infants with bona fide medical conditions", but about the alleged conduct of Southall towards some of the five parents and "what we say is the inappropriate retention... of documents".

The extent of Southall's involvement 18 years ago with Mrs H's child was, however, established on Day 6 of the GMC hearing on November 20. The panel was told that the child was born in 1985 and, failing to thrive, was admitted to hospital two months later. The child went on to suffer apnoeic episodes and was referred by a doctor at Great Ormond Street Hospital to Southall for overnight monitoring at the Brompton Hospital, London, in September 1989. The referring doctor had noted: "The question of Munchausen by proxy has been raised."

The child underwent two separate sessions of monitoring, which revealed nothing unusual. However, Mrs H claimed to have discovered a copy of Protocol 85.02 in her son's medical records and said she feared that the "experiments" it had outlined had caused her son's severe learning difficulties.

No evidence was heard at the GMC that Protocol 85.02 was in her son's records or how it might have got there. However, there is evidence that a copy of the protocol was in the hands of the campaign group with which Mrs H is associated. Three selected pages from the protocol, along with other assorted documents, have been posted on the web by Mellor.

It emerged at the GMC that Mellor had been acting for at least three of the five women making allegations against Southall, including Mrs H. What didn't emerge was that Mrs H's solicitor, Bill Bache, is listed on Hemming's campaigning website, Justice for Families, as its "legal adviser" and that Mellor was also listed briefly as the organisation's "family advocacy co-ordinator".

Protocol 85.02, continued Hemming in his speech, "was not the only research project operated by Dr Southall. He also gave carbon monoxide to babies with breathing problems [and] caused so much damage to babies in his experiments that they needed resuscitation".

This reference appears to be a misrepresentation of research carried out not by Southall but by US paediatrician Carl Bose, a sometime collaborator of Southall's. Bose told The Times Higher that he assumed the passage was a reference to "research that I conducted while in England, and working with David, in 1992-93" and an established technique that uses "tracer" quantities of carbon monoxide to test respiratory function, "with complete safety, I might add".

"This particular gas has a certain 'horror effect' when its use is not understood," said Bose, professor of paediatrics at the University of North Carolina and an expert in neonatal pulmonary physiology and disease. "The use is limited to about one minute for each test and the amounts are tiny."

Another of Hemming's allegations, that Southall "did considerable damage through his experimental continuous negative extrathoracic pressure tanks", flies in the face of all the available evidence. Few studies can have been so exhaustively investigated as Southall's CNEP trials, conducted in Stoke between 1989 and 1993 and carried out to test a new way of ventilating premature babies born with severe breathing problems.

The Griffiths Inquiry was set up in 1999 after allegations by parents that they had been duped into taking part in the trials, that consent signatures had been forged and, most seriously, that CNEP had caused death or brain damage. Once again, Mellor was involved. Although none of her children had been part of the trial, she gave evidence to the inquiry in which she made a number of very serious allegations against Southall.

These allegations - being repeated six years later by Mellor's new ally, Hemming - were examined by several authorities and found to be without foundation, but not before Southall and a colleague had been suspended for almost two years.

As he reported in 2000, Rod Griffiths found no evidence of harm, although he did conclude that the trial had lacked proper safeguards to ensure that the parents knew what was happening. Even this criticism was overturned. A report commissioned by the Medical Defence Union, published in 2000, found that almost every statement about the CNEP trial in the Griffiths report was "ill-informed, misguided or factually wrong".

Furthermore, in March 2004 the GMC's preliminary proceedings committee found no grounds to support allegations that Southall had conducted the trial without consent or had forged patients' signatures.

In April 2006, Griffiths wrote in The Lancet: "We now know that despite what seemed to be an increase in issues related to brain damage when the original trial reported, the longer term study shows that CNEP might, if anything, be kinder on the brain."

He criticised the campaign-driven media coverage of the CNEP trials. "We can now see the headlines about baby deaths in perspective. They were lurid and misleading, and in making such headlines the mass media did not do anyone a good service; it created unnecessary anxiety and did nothing to further the research that might save lives".

Hemming concluded his attack with further unsubstantiated insinuation. "Earlier this year, in Yokohama," he said, "a German doctor presented an abstract of research referring to babies being monitored during a Sid. What that means is that records were kept of babies as they died." He added: "That particular doctor worked for some time with Southall on projects that could have led to such measurements being taken."

The German doctor was Christian Poets, who, as a visiting research fellow from Hanover Children's Hospital, did indeed work with Southall between 1990 and 1992. However, Poets told The Times Higher that the study to which Hemming referred had had nothing to do with Southall but had been conducted with US colleagues who had sent him recordings of Sids cases for analysis.

In his speech, Hemming appeared to be implying that doctors had stood by as babies died. In fact, the deaths had been recorded by monitors attached to babies who had died unexpectedly at home. The recordings were later analysed to gain information on the cardiorespiratory changes that occur immediately before sudden infant death. Such data, although obtained in tragic circumstances, is far from sinister and of obvious value in the search for a cause of Sids.

In 1997, Bergman concluded that in the battle against Sids the need for large-scale prospective studies of the type once conducted by Southall and colleagues "seems obvious" but "none seems likely to be conducted in the future." Why? "The leadership and money for such an endeavour are lacking."

The Mama campaigners can take credit for undermining the leadership that Southall once demonstrated in this complex field and, according to Fleming, can also take credit for impeding vital research into cot death. But he believes there is another tragically ironic consequence to a campaign that purports to support falsely accused parents.

"Families under suspicion are having increasing difficulty in getting paediatricians to provide expert witness assessments for the defence in criminal court hearings or in family court hearings," he said. "I am approached by lawyers several times almost every week, but because of my heavy clinical and academic workload can only take on a maximum of three or four such cases a year.

"Many families cannot find a paediatrician with the relevant experience willing or able to become involved. From my recent experience I am sure that the absence of such expert opinions may seriously compromise these families' chances of achieving justice."