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'Caesareans harm future fertility'

Dr Martin Shutkever feels he has to redress the balance over paediatrician Roy Meadow

At 10.30pm on a miserable winter's evening in 1989 I received a phone call asking me to visit a child who was going blue and kept stopping breathing. At that time GPs often did their own on-call and I found myself visiting a rather agitated young single mother in a gloomy council house. Her first child was about eight months old and now asleep in his cot. I had seen her and her child before ­ perhaps three times in the previous two weeks with similar concerns. Each time I could find nothing wrong with him.

Warning bells

I examined him, once again finding no sign of illness to explain why he might be having breathing difficulties. I was considering my options and explaining to his mother that again I could find nothing wrong when she interrupted me: 'If you don't find something wrong this time, I'll make sure I show you that he's ill...'

Instantly my decision was simple. I admitted him to the local hospital for observation. The next morning I told a specialist at the nearest teaching hospital how concerned I was about my conversation the previous evening. Dr Roy Meadow, as he was then, agreed to have the child transferred to Leeds. Two days later he told me he had thoroughly checked the child and the nurses had closely observed him and found nothing wrong. His intention was now to confront the mother with his view that there was nothing medically wrong and that he wanted her to accept increased help and support from her family and social services.

She was initially annoyed with me for my part in these events. I attended case conferences over the subsequent months where progress was discussed. Her son never had another episode where he went blue or was breathless. She was supported through her difficulties and went on to have four other children, none of whom have ever had any such problems. She forgave me within a year or so although I have never felt inclined to ask her now if she can recall making that remark to me 16 years ago and what she meant by it.

It is possible that Roy Meadow saved her son's life and also saved her the anguish of losing a child. It was not just because of what he did when I sought his help; but through his teachings at Leeds University where I studied ­ when I became aware of the potential for parents to harm their own very young children.

I claim no extensive knowledge of the various legal cases that have led to Roy Meadow being found guilty of erious professional misconduct and struck off the medical register by the GMC. Like many others, I have read argument and counter-argument about the abnormalities found in the children who had died. Unlike most reporters who have seen fit to refer to Sally Clark's case, I have considered details of the case which show that neither the prosecution nor the defence were basing their evidence on a proposition that her children died of cot death. There were many abnormalities that suggested a pathological cause and the real question was whether the pathological changes were due to disease or violence. At her first trial and appeal it was found that they could not be explained by natural causes. Subsequently other evidence, apparently suppressed by a forensic expert for the prosecution, lent weight to the possibility of previously overlooked natural causes. Rightly, Sally Clark was therefore released.

Roy Meadow is now being attacked by the media for his mathematical calculations relating to the Clark case. While it is easy to understand how a parent who has been wrongly accused of harming their child would feel, surely this should not be a signal for the media and the public to assume that no parent ever does it and that any doctor who suggests otherwise is a fool and a malevolent fool?

I cannot know how many times Roy Meadow's opinion on a case of parental harm has been right and how many wrong. What I am sure of is that he spent many years carefully observing his patients and proving to my satisfaction and to most thoughtful professional observers that parents can sometimes be capable of harming their children in ways that may be subtle and difficult to prove.

Judgment

He deserves judgment not on the basis of a few, often mis-reported, cases where his opinion, although honestly given, may have been wrong. He deserves respect for his efforts to understand a most troubling and distressing phenomenon; but one that undoubtedly exists and that takes and blights lives every week.

A recent opinion article in The Daily Telegraph by Tom Utley, a writer who presents himself as a consummate parent, concluded by stating that the kindest thing that can be said about Roy Meadow is that he 'is intensely stupid'. Whatever qualifications Mr Utley has as a parent, he surely exceeds his expertise by offering his opinion on the paediatrician's intelligence. If commentators treat the medical profession in this way they will get the doctors they deserve ­ ones who are unwilling to take difficult decisions or give opinions in controversial areas.

Dr Martin Shutkever

Pontefract, West Yorkshire

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