Cot death expert: we were victims of a smear campaign

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Their controversial findings have ripped families apart, divided the medical profession and triggered the biggest review of criminal convictions in British legal history. But yesterday a leading paediatrician at the centre of the bitter row about child protection broke his silence to defend the disputed diagnosis of Munchausen's syndrome by proxy and its chief protagonist.

Their controversial findings have ripped families apart, divided the medical profession and triggered the biggest review of criminal convictions in British legal history. But yesterday a leading paediatrician at the centre of the bitter row about child protection broke his silence to defend the disputed diagnosis of Munchausen's syndrome by proxy and its chief protagonist.

Professor David Southall, a consultant paediatrician at the North Staffordshire Hospital in Stoke on Trent, who faces eight charges of serious professional misconduct before the General Medical Council (GMC) in relation to his use of the diagnosis, hit back at his accusers, sayingthat he and his colleagues had been the victims of a campaign of vilification and misrepresentation.

Speaking to The Independent, Professor Southall said he believed the scale of child abuse by parents who caused illness in their offspring to win medical attention was greater than had been recognised.

He said: "The diagnosis has not been over-used. I think it has been grossly under-used but to prove that needs more research. Cases where parents have fabricated or induced illness in their children have been grossly under-diagnosed and under-reported."

Professor Southall, an expert in child protection, said he was speaking out to defend his colleague, Professor Sir Roy Meadow, whose reputation as an expert witness is in tatters after the collapse of criminal cases in which mothers were jailed for murdering their children. Sir Roy, who is to face a charge of serious professional misconduct before the GMC later this year, gave evidence in the cases of Sally Clark, Trupti Patel and Angela Cannings.

Professor Southall said Sir Roy, a former president of the Royal College of Paediatrics and Child Health, had been "victimised" and his position "grossly misrepresented" by the media. Asked what he thought the outcome of the GMC case against Sir Roy would be, he said: "He will get off. He has done absolutely nothing wrong."

Ms Clark and Ms Cannings were jailed, partly on the evidence of Sir Roy, but later freed by the Appeal Court, and Ms Patel was cleared and did not go to jail. The collapse of the cases, and criticism by the Appeal Court of Sir Roy's evidence in the Cannings case, led the Attorney General to order a review of 258 child protection cases, the biggest in legal history.

Ministers have launched a review of an estimated 5,000 cases where children were taken away from their parents by the family courts.

Professor Southall, who is accused of intervening in the Clark case by making allegations against Ms Clark's husband on the basis of a television programme, said he could not speak about his case, on the advice of his lawyers. But he defended Sir Roy, whom he described as "a colleague, not a friend" whose work he had long admired.

Professor Southall said: "Roy would very much like to speak out but has been advised against it by his medical defence union. He has been victimised over this and it is not fair. He is such a nice person. He is not the kind who complains, he just suffers."

Sir Roy had been criticised for telling the court that the chances of two cot deaths occurring by chance in the same family were one in 73 million, a remark later dismissed by the Appeal Court in the Cannings case as "wholly erroneous".

But Professor Southall said the statistic was not calculated by Sir Roy, as widely thought, but came from a government report, The Confidential Enquiry into Sudden Unexpected Deaths in Infancy 1993-96, published by the Stationery Office.

Professor Southall said: "He was quoting from a government report and if anyone is to be criticised it should be the authors of the report."

Sir Roy had been criticised for suggesting that while one cot death was an accident, two was suspicious and three was murder in what has been dubbed "Meadow's Law". But Professor Southall said the "law" was devised not by Sir Roy but by an American specialist, Professor Dominic Dimaio, who set it out in a textbook, Forensic Pathology, published by Elsevier in 1989.

Professor Dimaio says in the book: "It is the authors' opinion that while a second [cot] death from a mother is improbable, it is possible and she should be given the benefit of the doubt. A third case, in our opinion is not possible and is a case of homicide."

That view was repeated in the standard textbook on child abuse, The Battered Child, edited by Helfer, Kempe and Krugman, published in 1997 (fifth edition). It said: "Should a third infant death without an obvious natural disease process occur in the same family, the cause of death should be identified as asphyxiation, and the manner of death classed as homicide."

But The Battered Child was not cited by the Appeal Court judges in the Cannings case, Professor Southall said. "The Appeal Court did not apprise itself of one of the main publications on child abuse. Roy Meadow was quoting from one of the standard world texts."

Sir Roy's chances of rebutting the charges against him at the GMC will depend on what he said in court and on how he presented it. It is a standard defence for a professional accused of making an error that if he can prove it was accepted professional opinion, even though wrong, he cannot be held liable.

But the Appeal Court judges in the Cannings case observed that, in addition to demonstrating that "even the most distinguished expert can be wrong", it provided a "salutary warning against the possible dangers of an over-dogmatic expert approach".

Professor Southall said: "I cannot comment on Roy's performance in court - I have never seen him give evidence. What I can comment on is the quality of his publications. I am very impressed with his research."

The illness

Munchausen's by proxy was first described by Professor Roy Meadow in 1977 and he became a world authority on it as one of the most eminent paediatricians of his generation.

The diagnosis was applied to mothers who deliberately harmed their children to gain medical attention.

But the Royal College of Paediatrics now prefers the term "fabricated illness", which makes no reference to the motive.

It also encompasses mothers who smother their children in desperation as well as those who induce symptoms to win a hospital appointment.

Cot deaths fell sharply in the past decade but there are still 350 unexplained baby deaths a year. The Foundation for the Study of Infant Deaths believes 22 of the deaths in 2002 aroused grounds for suspicion.