Doctors reopen controversy over cot deaths and murder

It is one of the most fraught issues in medicine. When two babies die unexpectedly in the same family is it ever legitimate to suspect the parents of murder? The controversy is set to be reopened today by the publication of a new analysis of a major study of families that lost two babies which suggests that homicides by parents are more common than thought.

The issue was at the centre of the now infamous cases of Sally Clark and Angela Cannings, who were jailed for killing their children after the child abuse expert Professor Sir Roy Meadow wrongly gave evidence that the chances of two cot deaths in the same family were 73 million to one.

The convictions of both women were overturned on appeal and the Government responded with the biggest review of criminal convictions in legal history. A major factor that undermined support for "Meadow's law" - the view that one cot death was a tragedy, two suspicious and three murder - was the publication in The Lancet in 2005 of a study claiming that almost 90 per cent of second deaths were natural. The highly influential finding contrasted with earlier studies which found that a much higher proportion of repeat cot deaths were probably homicide.

The study examined 6,373 babies whose families had experienced one cot death, including 46 families where a second death occurred. Led by Robert Carpenter, professor of statistics at the London School of Hygiene and Tropical Medicine, it concluded that 87 per cent of the second deaths were natural.

Now Edmund Hey and Christopher Bacon, retired consultant paediatricians, say in the British Medical Journal that the Lancet study was seriously flawed.

Many of the deaths were wrongly classified and less than half can be described as natural. In 18 families in the original study both deaths were categorised as cot death yet there were concerns about the second deaths including violent family relationships, post-mortem findings suggestive of suffocation and mental problems in the parents.

They say 13 per cent of the second deaths were probably unnatural and 43 per cent should be categorised as "undetermined", leaving a degree of suspicion about their cause.

It is the second time that the BMJ has raised concerns about the Lancet study. Last December the journal claimed that classification of deaths in the study was changed after the death of a senior researcher on the paper, Professor John Emery. He had concluded in 1998 that 40 per cent of second deaths were unnatural. By the time the Lancet paper was published, on which he was cited as an author, that figure had fallen to 13 per cent.

Dr Bacon and Dr Hey acknowledge it is important to avoid unjustified suspicion of parents but say it is equally important to avoid mistakes that could leave children at risk.

The Meadow evidence

Professor Sir Roy Meadow, a consultant paediatrician and child abuse expert, was at the centre of a cot death scandal. He wrongly told the jury in the Sally Clark case that the odds of two cot deaths in one family were 73 million to one.

Sally Clark was jailed for murdering her two sons in 1999 but her conviction was overturned in 2003.

The Government ordered a review of 297 convictions which had relied on expert medical evidence and the expectation was that scores could be overturned. There was no procession of wrongly convicted parents. Two had convictions quashed and one had his sentence reduced from murder to manslaughter. Sir Roy Meadow was struck off, but the verdict was overturned. Sally Clark was found dead at her home in March. She was 42.

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