Bad Medicine Parents the State and the Charge of “Medical Child Abuse”

230 University of California, Davis [Vol. 50:205
from literature on the far more narrow category of MSBP behavior
that, to boot, lacks any credible proof. 113 This literature contends, as
well, that “[t]he reported incidence [of MCA] is approximately 0.5 to
2.0 per 100,000 children” 114 — although there have been no valid
incidence studies of MCA behavior. 115 Furthermore, those trained to
even when it is recognized.”).
113 As Eric Mart points out, this assertion is reminiscent of the children’s riddle,
“How many undiscovered islands are there in the Pacific Ocean?” No sensible answer
is possible given that the undiscovered islands in the Pacific are exactly that —
undiscovered. See MART, supra note 37, at 44. The 2013 AAP Report makes the claim
that “many cases go unreported” by asserting that a 1996 study showed that
“pediatricians needed to have a strong degree of certainty before reporting”, and
suggesting, on that basis, that pediatricians are not reporting genuine MCA cases
when there are less certain. 2013 AAP Report, supra note 29, at 592 (citing R.J.
McClure et al., Epidemiology of Munchausen Syndrome By Proxy, Non-Accidental
Poisoning, and Non-Accidental Suffocation, 75 ARCHIVES OF DISEASE IN CHILDHOOD 57
(1996)). The 1996 study, however, concerned MSBP behavior rather than the far
broader category of actions identified by the MCA diagnosis. More importantly, the
relevant finding in that study, which considered pediatricians’ reports of MSBP
behavior, was that “one hundred and nine (85%) of paediatricians estimated the
probability of their (MSBP) diagnosis being correct as greater than 90%. In fourteen
cases the probability of abuse was estimated to be between 71% and 90% and in four,
between 50% and 70%. In only one case was the probability less than 50%.” McClure,
supra, at 59. This result is remarkable for the extent of perceived certainty with
respect to the MSBP, when few such cases will present with strong evidence of
symptom induction or fabrication. Such a result demonstrates underreporting of
MSBP behavior by pediatricians only if both these pediatricians were in fact correct
about their MSBP diagnoses that they did report, and, in addition, they did not report
correctly diagnosed cases of MSBP when they were less confident of their diagnosis.
The McClure study provides no data that answer these questions. However, we know
that pediatricians of that era in the United Kingdom, including Roy Meadow, a
coauthor of the study, were overconfident of their diagnoses of MSBP, and made false
diagnoses based on overly broad diagnostic criteria. See supra notes 48–49. This
suggests that, what the McClure study reveals, contrary to the suggestion of the 2013
AAP Report, is not underreporting by pediatricians, but instead overconfidence in
false diagnoses of MSBP.
114 2013 AAP Report, supra note 29, at 592.
115 The incidence rates reported are from studies seeking to measure rates of MSBP
behavior, rather than the far broader category of MCA behavior. Yet the methodology
of the studies cited for these rates are doubtful even for MSBP behavior. The higher
estimate of 2.0 per 100,000 children is derived from a New Zealand study on MSBP. See
S.J. Denny, C.C. Grant & R. Pinnock, Epidemiology of Munchausen Syndrome by Proxy
in New Zealand, 37 J. PAEDIATRICS & CHILD HEALTH 240, 240 (2001). The authors
counted as MSBP cases all cases that doctors reported to child protection officials or
they believed were highly suspicious but did not report; the authors made no attempt
to confirm the validity of these cases. See id. at 241. To the extent that reporting
physicians made false positive rather than true positive diagnoses, which, given what
we know about the number of wrongful diagnoses of MSBP during this period is
eminently possible, see supra notes 48–49 and accompanying text, this study tells us