Roy Meadow

Sir Samuel Roy Meadow is a British retired paediatrician who facilitated several wrongful convictions of mothers for murdering their babies. He was awarded the Donald Paterson prize of the British Paediatric Association in 1968 for a study of the effects on parents of having a child in hospital. In 1977, he published an academic paper describing a phenomenon dubbed Munchausen syndrome by proxy. In 1980 he was awarded a professorial chair in paediatrics at St James's University Hospital, Leeds, and in 1998, he was knighted for services to child health.
His work became controversial, particularly arising from the consequences of a belief he stated in his 1997 book ABC of Child Abuse that, in a single family, "one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise". This became known as "Meadow's law" and was influential in the thinking of UK social workers and child protection agencies, such as the National Society for the Prevention of Cruelty to Children.
Meadow's reputation was severely damaged after his appearances as an expert witness for the prosecution in several trials played a crucial part in wrongful convictions for murder. Despite having fundamental misunderstandings of statistics, he presented himself as an expert in the field. Meadow's miscalculations significantly contributed towards the wrongful imprisonment of innocent mothers whom he branded murderers. The British General Medical Council struck him from the British Medical Register after he was found to have offered erroneous and misleading evidence in the 1999 trial of Sally Clark, who was wrongly convicted of the murder of her two baby sons. Clark's conviction was overturned in 2003 but she never recovered from the experience, and died in 2007 from acute alcohol poisoning.
Clark's father, Frank Lockyer, complained to the GMC, alleging serious professional misconduct on the part of Meadow. The GMC concluded in July 2005 that Meadow was guilty, but he appealed to the High Court, which in February 2006 ruled in his favour. The GMC appealed to the Court of Appeal, but in October 2006, by a majority decision, the court upheld the ruling that Meadow was not guilty of the GMC's charge. The reason was that his behaviour in court did not impact his care for his own patients.

Career

Meadow was born in Wigan, Lancashire, the son of Samuel and Doris Meadow. He was educated at Wigan Grammar School and Bromsgrove School, before studying medicine at Worcester College, Oxford. From 1962 to 1964 he practised as a general practitioner in Banbury, Oxfordshire, before progressing to junior appointments at various hospitals in London and Brighton. In 1967 he became a Medical Research Council Fellow at the University of Birmingham, and three years later was appointed senior lecturer and consultant paediatrician at the University of Leeds. Meadow was appointed professor of paediatrics and child health at Leeds in 1980, based at St James's University Hospital. He retired with the title Emeritus Professor in 1998.
Throughout his early years in medicine, Meadow was a devoted admirer of Anna Freud, whose lectures he would often attend. Speaking in later life, he said: "I was, as a junior, brought up by Anna Freud, who was a great figure in child psychology, and I used to sit at her feet at Maresfield Gardens in Hampstead. She used to teach us that a child needs mothering and not a mother." There is some controversy over these claims. According to the London Evening Standard, representatives of the Anna Freud Centre claimed to have no record of him completing a formal training there and repudiated his description of her philosophy.
In 1961, Meadow married Gillian Maclennan, daughter of Sir Ian Maclennan, the British ambassador to Ireland. The couple had two children, Julian and Anna, before divorcing in 1974. Four years later he married his second wife, Marianne Jane Harvey.

Munchausen Syndrome by Proxy

In 1977, in The Lancet medical journal, Meadow published the theory which was to make him famous.
Sufferers of his postulated Munchausen Syndrome by Proxy or MSbP harm or fake symptoms of illness in persons under their care in order to gain the attention and sympathy of medical personnel. This claim was based upon the extraordinary behaviour of two mothers: one had poisoned her toddler with excessive quantities of salt. The other had introduced her own blood into her baby's urine sample. Although it was initially regarded with scepticism, MSbP soon gained a following amongst doctors and social workers.

Expert testimony

In 1993, Meadow gave expert testimony at the trial of Beverley Allitt, a paediatric nurse accused of murdering several of her patients.
Meadow went on to testify in many other trials, many of which concerned cases previously diagnosed as cot death or sudden infant death syndrome. Meadow was convinced that many apparent cot deaths were the result of physical abuse. Families that had suffered more than one cot death were to attract particular attention: "There is no evidence that cot deaths runs in families", said Meadow, "but there is plenty of evidence that child abuse does". His rule of thumb was that "unless proven otherwise, one cot death is tragic, two is suspicious and three is murder".
Although this dictum is believed not to have originated from Meadow's own lips, it has become almost universally known as Meadow's law.

Cot death trial controversies

This trend was to reach its apogee in 1999 when solicitor Sally Clark was tried for allegedly murdering her two babies. Her elder son Christopher had died at the age of 11 weeks, and her younger son Harry at 8 weeks. Medical opinion was divided on the cause of death, and several leading paediatricians testified that the deaths were probably natural. Experts acting for the prosecution initially diagnosed that the babies had been shaken to death, but three days before the trial began several of them changed their collective opinion to smothering.
By the time he gave evidence at Sally Clark's trial, Meadow claimed to have found 81 cot deaths which were in fact murder, but he had destroyed the data. Amongst the prosecution team was Meadow, whose evidence included a soundbite which was to provoke much argument: he testified that the odds against two cot deaths occurring in the same family was 73,000,000:1, a figure which he erroneously obtained by squaring the observed ratio of live-births to cot deaths in affluent non-smoking families. In addition he extrapolated his erroneous figures stating that the 1 in 73,000,000 incidence was only likely to occur once every hundred years in England, Scotland and Wales. He further illustrated his miscalculation by stating that the very unlikely odds were the same as successfully backing to win an 80/1 outsider in the Grand National for four successive years. The jury returned a 10/2 majority verdict of "guilty".

Misuse of statistics

Meadow's 73,000,000:1 statistic was paraded in the popular press and received criticism from professional statisticians over its calculation. The Royal Statistical Society issued a press release stating that the figure had "no statistical basis", and that the case was "one example of a medical expert witness making a serious statistical error." The Society's president, Professor Peter Green, later wrote an open letter of complaint to the Lord Chancellor about these concerns.
The statistical criticisms were threefold: firstly, Meadow was accused of applying the so-called prosecutor's fallacy in which the probability of "cause given effect" is confused with that of "effect given cause". In reality, these quantities can only be equated when the a priori likelihood of the alternative hypothesis, in this case murder, is close to certainty. Murder is itself a rare event, whose probability must be weighed against that of the null hypothesis.
The second criticism concerned the ecological fallacy: Meadow's calculation had assumed that the cot death probability within any single family was the same as the aggregate ratio of cot deaths to births for the entire affluent-non-smoking population. No account had been taken of conditions specific to individual families which might make some more vulnerable than others. Finally, Meadow assumed that SIDS cases within families were statistically independent. The occurrence of one cot death makes it likely that the family in question has such conditions, and the probability of subsequent deaths is therefore greater than the group average.
Some mathematicians have estimated that taking all these factors into account, the true odds may have been greater than 2:1 in favour of the death not being murder, and hence demonstrating Clark's innocence.
The perils of allowing non-statisticians to present unsound statistical arguments were expressed in a British Medical Journal editorial by Stephen Watkins, Director of Public Health for Stockport, claiming that "defendants deserve the same protection as patients."

Sally Clark appeals

Meadow's statistical figure was amongst the five grounds for appeal submitted to the Court of Appeal in the autumn of 2000. The judges claimed that the figure was a "sideshow", which would have had no significant effect on the jury's decision. The overall evidence was judged to be "overwhelming" and Clark's appeal against conviction was dismissed. Clark's supporters rejected this decision. Meadow considered that he had been fully vindicated. He responded to Watkins in a BMJ paper of his own, accusing him of being both irresponsible and misinformed. He reiterated his erroneous claim that "both children showed signs of both recent and past abuse" and underlined the judges' controversial ruling that Clark and her husband had given "untrue evidence".
Meadow's vindication was to be short-lived: after the campaigning lawyer Marilyn Stowe obtained new evidence from Macclesfield Hospital, it emerged that another expert witness, Home Office Pathologist Dr Alan Williams, had failed to disclose exculpatory evidence in the form of results of medical tests which showed that her second child had died from the bacterial infection Staphylococcus aureus, and not from smothering as the prosecution had claimed. A second appeal was launched and in allowing Clark's appeal to proceed Lord Justice Kay stated in open court that Meadow's statistics were 'grossly misleading' and 'manifestly wrong'.
Although the central reasons for the Clark appeal's success were separate from Meadow's evidence, the discredited statistics were revisited in the hearing. In their ruling, in marked contrast to the opinions at the first appeal, the judges stated that:
Sally Clark's conviction was overturned in January 2003.