> A toxicological screening of the “white curdled material” had detected codeine but not morphine. But Koren had claimed that the gastric contents “exhibited high morphine” levels—with no mention of codeine—“ruling out administration of Tylenol-3 to the baby.”
> “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”
Does no one care that this is potentially a murder case?
I'd guess that everybody involved (including the coroner's office) tacitly understands that even if the baby was deliberately or negligently killed, there's very little chance after 20 years of finding evidence of who did it, in order to demonstrate guilt beyond a reasonable doubt. And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.
The scientific case about infant opioid poisoning in general is a separate issue, of course. But assigning blame in this particular case doesn't have any bearing on that.
> And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.
It's probably true that without a chance of conviction, standard protocol dictates that public resources should not be expended on reopening the investigation. But I was also heavily distracted while reading the article, scanning optimistically for the happy (under the circumstances) ending where justice is served. I certainly don't think there is "no benefit to anybody".
Serious question: if the chance of evidence leading to a convistion is very very small, what would be the benefit of opening an investigation? Just to go through the motions on principle? And what would they even investigate?
It's a cost-benefit analysis like many other things. There are limited resources, they should be spent on investigating cases that have a chance of getting closed.
Cold cases might get reopened because of advances in technology or other changes over time.
There is no potential "principal" here that is distinguishable from posturing and dick swinging.
Unless you find some unforeseeable smoking gun any conviction will necessarily be questionable at best. That doesn't really serve much of a purpose beyond saying "we're the prosecutor's office, look how bad ass we are, look how we somehow manage to convict someone decades later, fear us". Never mind the fact that dredging this stuff up is not likely to be good for the family and that odds are all of these deaths are purely accidental/negligent so it's not like you're going after a "real criminal".
Investigating a murder is posturing? I really don't understand the "bad ass, fear us" language. Do you consider all criminal investigations to be as frivolous?
> odds are all of these deaths are purely accidental/negligent
How can you say that given that the article presents evidence that
> "... someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula
Is that an accident according to you, or do you have any evidence that the article is wrong about that conclusion?
>Investigating a murder is posturing? I really don't understand the "bad ass, fear us" language. Do you consider all criminal investigations to be as frivolous?
>How can you say that given that the article presents evidence that
Take a freakin step back and look at the big picture. Someone lost their kid, their first kid FFS. Even if a crime was technically committed along the way call it time served.
On a technical level, this is almost certainly not chargeable as a murder. Evidince of intent is lacking and almost certainly does not exist. The best you might be able to do is some negligent wrongful death manslaughter type thing, exact details depending on how such things are defined in the jurisdiction. Just based on plausibility these cases are almost certainly accidents. Very few mothers or the people around them murder newborns in the jurisdictions we're talking about. So if you did find intent, like a text exchange or something, the best you're likely to do is prove intent in the exact opposite direction and that no harm was meant. So then you have to prove negligence or something, which is also likely to be uphill. And this all assumes you can pin it on one person.
No good purpose is served by this. You're not getting some hardened criminal off the streets or putting someone in jail for an act committed with a bad frame of mind. Best case you wind up punishing someone using some negligince wrongful death type statues that's written based on the assumption that the person who caused the death DGAF about the deceased. Even if you pull that off this person is probably the mother or father or a grandparent who already lost their kid or grandkid for it so there's a real tinge of double jeopardy to the whole thing. This serves no purpose other than a show of force by the prosecuting office. The "real" crime committed here is not accidentally giving one's infant the wrong pills (someone gave a kid Tylenol, it's not like it was Xanax or booze to shut them up or some other thing everyone knows you don't do), the facts are likely to stack up in a way that make that act a non-criminal accident. So what you're doing in practice is screwing up one or more people's lives, to much fanfare, because they failed to tell the whole truth to the state a decade or more ago. Now, I get that that might sound like a good thing to some people, but those people are bad people and their ideas are bad ideas.
>Is that an accident according to you, or do you have any evidence that the article is wrong about that conclusion?
Stop trying to re-frame my assertion as an issue with the article rather than a critique of the proposed action (prosecuting someone). I know you'd rather discuss that, because that's much more defensible than a hypothetical decision to prosecute, and I do not accept your slight of hand.
Calm down. I'm not trying to re-frame anything, perhaps I misunderstood you because your reasons for not prosecuting are incomprehensible to me. Do I understand correctly that you think a murder (or involuntary manslaughter etc) is not "as bad" because the perpetrator was close to the victim?
> this person is probably the mother or father or a grandparent who already lost their kid or grandkid
Would you say the same about a man who (perhaps accidentally) killed his wife 20 years ago and covered it up? "He's already lost his wife, time served, no reason to investigate."
Speaking as a parent, giving a 12 days old infant Tylenol is clearly absurd and just as unreasonable as giving them booze.
>Would you say the same about a man who (perhaps accidentally) killed his wife 20 years ago and covered it up? "He's already lost his wife, time served, no reason to investigate."
There is a massive gulf of intent there and I think it speaks volumes that you cannot (or worse, decline to) identify it.
>Speaking as a parent,
And also speaking as a person who's been espousing the opinions you've been espousing thus far, that's more than just "parent"
>giving a 12 days old infant Tylenol is clearly absurd and just as unreasonable as giving them booze.
People are stupid. Shit happens. I know it seems wild now and everyone turns into a screeching moron about it now but the "suck on a finger dipped in booze" thing was not abnormal (note for said screeching morons: I did not say "considered tasteful") for decades. Doesn't surprise me that someone would give an infant a fraction of a pill of Tylenol as a sleep aid not knowing they have the opioid type and that the fraction they chose is enough to kill the kid one shot.
> Doesn't surprise me that someone would give an infant a fraction of a pill of Tylenol as a sleep aid not knowing they have the opioid type and that the fraction they chose is enough to kill the kid one shot
Note that this is just a story you made up, we really don't know what happened. You're also leaving out that if somebody did this by accident, they also chose to keep quiet about it for 20 years. Doesn't that speak about "intent"?
Also, giving a 12 days old baby a "normal" Tylenol, say one with 500 mg acetaminophen, is a very bad idea. The normal dose for a 3 month old is 60 mg (for fever, not as a "sleep aid"). Doses above 200 mg/kg can cause acute toxicity, so for a slightly small baby of 2500 g, you're there already. Perhaps thinking that there's a "safe" type of Tylenol to give a baby as a "sleep aid" (what??) is a good example of "People are stupid".
With my example with the wife, I'm simply trying to establish why you seem to consider children (or rather babies) to be not worthy of the same justice as adults. How about an adult who accidentally kills their elderly parent, would you consider that worth investigating, or should it also not be investigated on the principle of "they lost their parent"? Or further, at what age do you no longer consider it morally justifiable to accidentally (or otherwise) kill one's child and cover it up? 5 years old, 10, 18?
To me, being stupid does not mean you're allowed to give your elderly father 10 Tylenols as a "sleep aid" and claim "shit happens" if he dies. I might want to call a person of that viewpoint a "bad person with bad ideas" or a "screeching moron", but I'd like to stay above such childish namecalling.
The "happy ending" where one of the parents and their three other kids find out that the other parent likely killed the older brother they never met? That doesn't sound very happy to me, but maybe we have different definitions of happy?
When I tried reading into the causes of so-called SIDS it seemed like at least some of the cases were a catch-all diagnosis that included cases where parents inadvertently killed their infants (eg co-sleeping and rolling onto them). Fundamentally I think there often isn't much upside to fully fleshing out the truth of cases where parents have already paid the heaviest price.
Man, SIDS. It's specifically non-specific, but the worry it causes is quite specific.
My daughter, as a baby, always managed to find a way to sleep on her stomach. Wouldn't sleep on her back, but almost magically by comparison would fall asleep lying on her stomach (face to one side or the other, not straight down, obviously - I hope). We tried various combinations of devices, arrangements of pillows and cushions, tight wraps, to keep her lying on her back, but babies are remarkably, if involuntarily, wilful (or she was, anyway, and remains to this day).
I worry about very few things, but for the first few nights we'd regularly get up to check on her, and literally be holding our breath waiting for her to expel hers.
Out of necessity the every-parents-SIDS-fear, from allowing the baby to sleep on their stomach, had to be removed from our psyche so that we could continue to function day-to-day.
Said baby is now, thankfully, a semi-healthily functional teenager. As functional as teenagers get anyway :)
during covid they actually laid hospital patients face down (suspended i think?) to help with breathing when a ventilator wasnt available. this behaviour reminds me of that, perhaps your baby was doing this to help with breathing? i dont know...
I swear, all the shit they push at new parents. You can see the point to much of it, and it's obviously going to be a very stressful time regardless. But there's the same inescapable bureaucratic dynamic where once something becomes legible, the system pathologically emphasizes those few bits over and over and over, to the detriment of balanced judgement - both your own and most healthcare providers if you try to get some nuance out of them.
It's understandable that they're trying to help the people who might not be the most competent at following the guidelines, because there is still harm reduction to be had there. But it pushes the instruction-followers into the territory of "well, this probably doesn't apply to us because XXX", which is an epistemologically terrible place to be.
We're still joking about how much they repeated the advice to keep the belly button dry, when it was relevant for like maybe two whole weeks.
> The "happy ending" where one of the parents and their three other kids find out that the other parent likely killed the older brother they never met? That doesn't sound very happy to me, but maybe we have different definitions of happy?
While "happy" isn't the word I'd use, that seems better than knowing that this could happen to any baby at any time and nothing would be done.
I mean, if it was the case that one parent killed the child (Which, to be clear, we don't know. It could have been anybody who had access to the child at the time), then I'd think the best outcome is them getting convicted of it. I don't know why so many people treat homicide as "not a big deal" when it comes to babies.
Consider an unrelated hypothetical scenario, a family father accidentally hits and kills somebody with his car. He flees from the scene and is not discovered for 20 years. Would you then not attempt to prosecute him because it would be sad for his family to know? And now consider the case if it was his own child that died.
It's not that it's "not a big deal", rather the problem is you're up against the limits of details fading to time, negligence, etc. The best case here you're probably looking at each parent blaming the other parent for either doing it or at least letting it happen.
But really my main issue was with characterizing such a thing as a "happy ending". While it's generally good for justice to be served, we should still be wary of people who are a bit too gleeful about punishment.
> However, since immunizations are given to about 90 percent of children less than 1 year of age, and about 1,600 cases of SIDS occur every year, it would be expected, statistically, that every year about 50 cases of SIDS will occur within 24 hours of receipt of a vaccine. However, because the incidence of SIDS is the same in children who do or do not receive vaccines, we know that SIDS is not caused by vaccines.
Why do you think someone intended to kill the baby?
>But the forensic-toxicology laboratory’s measurements showed that his acetaminophen concentration was in the range of what you’d expect to find in a baby’s bloodstream soon after he’d been administered a standard dose.
>“I am familiar with patients whose babies have died after a caregiver gave the opiate directly.”
Maybe the person thought the tylenol-3 would help the baby.
Maybe the person thought that, but that would still be an absurd belief for them to hold. First of all, it doesn't seem like he had any problems he needed "help" with, the article only says he was "developing normally". Second of all, why would you give a random pill meant for adults to a baby not even two weeks old, without asking a nurse or at least reading the package insert?
Maybe the person thought "I've given Tylenol to babies in the past and it was fine" without realizing the difference between Tylenol and Tylenol-3.
It's possible the person even thought "Tylenol-3, hmm, that must be another term for children's Tylenol, Tylenol for 3-year-olds. I've given that to babies before."
> Does no one care that this is potentially a murder case?
I'd say, a very low chance of murder, and a near-certainty of at least manslaughter (unintentional killing), with a zero chance of prosecution due to lack of evidence.
Plus, I hardly see any value of jailing any of the caregivers for this. Whether an investigation should be made, I don't disagree.
> Does no one care that this is potentially a murder case?
Did we read the same article? Why are you so quick to jump the gun here?
> Koren obtained a sample of Rani’s breast milk, which she had kept in her freezer. His lab measured its morphine concentration at eighty-seven nanograms per millilitre.
If this is in the breastmilk, it will end up in the stomach, and it may end up in gastric contents. I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.
Are you Koren? Did we read the same article? The one that calls into question anything Koren says or claims?
From the article I read:
"A twelve-day-old infant cannot crawl. It cannot grab, and it cannot put something into its own mouth. “It also cannot swallow a Tylenol-3 pill,” Juurlink told me. “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”"
Also relevant to the quote selected by 'steelbrain:
> Recently, Parvaz Madadi has undergone a painful process of revisiting her past work and memories. [...] She added that she had no confidence in the measurement of Rani’s breast-milk sample, because it had been handled by Koren’s lab.
There is a lot to process in this long article. The quote selected by 'steelbrain, concerning Koren's measurement occurs very, very early on, and much of the rest of the article is about contrasting Koren's early presentations of the material against others' testimony. It's worth reading the whole thing
To 'steelbrain: cherry-picking one single quote out of a nuanced article does the journalism here a dire disservice. It's okay for different people to have different beliefs and takeaways from the article. However, your own defense of the biological mechanism here is directly argued against in the "same article" you are admonishing others over reading. That is not conducive to a discussion in good faith.
Note that you and GP are talking about different values of "this." GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.
The original death finding falls just from simple back-of-napkin math.
87 ng/mL.
Baby eats 30mL per hour. That's 2.6 micrograms of morphine.
Elimination half life in neonates of ~8 hours means 30 micrograms in system at equilibrium if constantly fed this and the baby absorbs all of it (takes 4-5 half lives to get to that) and pharmacokinetics are linear. In reality a neonate likely absorbs well under 1/3rd, so you'd expect under 10 micrograms in equilibrium.
25-50 micrograms/kilogram is normal dosing of morphine in a neonate when it is necessary, every 6 hours (resulting in a peak systemic concentration of ~60-120 ug/kg after repeated dosing).
Compare -- 60-120 ug/kg therapeutic dosing to 10 micrograms in the neonate's body (3-4 kilos, so 3 ug/kg??)
And then, you end up with acetaminophen and codeine in the neonate's stomach, with no morphine... Even though these do not end up in breast milk in significant quantities.
> I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.
Neither the article nor the commenter you replied to has demonized the parents. Yes, both the evidence discussed in the article and the opinions of those interviewed indicate direct administration of a pharmaceutical; it is appropriate to discuss this. Nobody has pointed the finger at anyone; it would indeed be quite inappropriate for such a discussion to be held in this forum.
The article goes into detail about how this level of morphine in the breastmilk could not have given the baby a lethal (or even clinically effective) dose.
Furthermore, Koren lied about what the tests showed the stomach contents to be: he omitted codeine entirely. Codeine (per the article) would not be expected to be transferred by breastmilk -- it's metabolized into morphine to be effective.
This statement shocked me! These are professional people whose careers are on the line? It's no wonder many don't trust "experts" today, despite knowing almost nothing about the expert's field of knowledge. (I don't fall into this group, but I admit to being fearful of what highly educated humans are capable of.)
>“The fact that the paper still exists means that medical students, pharmacy students, and, presumably, genetics students are being taught this as if it’s a real thing, and it has implications,” Juurlink told Scherer.
Yup. This paper was a lesson in my genetics class (2017)
My motto has always been: "Don't let your car or your doctor get too old, they'll both kill you." Doesn't exactly apply to this case, but the idea is you have to trust something, so you must err on the side of caution.
I know a thousand more things about cars then I will ever know about doctoring, which scares the hell out of me.
The idea of an opioid OD from breast milk immensely strains credulity in the first place. Such a claim should really have been put under much more of a microscope.
I truly believe the training medical doctors receive affects how they conduct research. They are far more likely to ignore uncertainty and jump to conclusions.
I'd just like to invoke Betteridge's Law of Headlines.
"Any headline that ends in a question mark can be answered by the word no."
It is based on the assumption that if the publishers were confident that the answer was yes, they would have presented it as an assertion; by presenting it as a question, they are not accountable for whether it is correct or not.
I'd just like to invoke the principle to "not judge a book by its cover".
The article here is very well written and does a great job of conveying the perspectives and opinions of many parties. I would recommend reading the article in spite of its headline.
I would suggest that when there's a possible crime, as there would be in this case, even a clearly guilty murderer caught red-handed holding a knife and screaming "I DID IT" will be an "alleged" perpetrator.
The article clearly lays out that the answer is yes. It points to specific ways the researcher adjusted their reporting to mislead readers. I think the key here is where Koren attempts to specifically account for the stomach content explanation: he misrepresents the lab results and claimed they showed the opposite of what they did.
>I'd just like to invoke Betteridge's Law of Headlines.
To say that it doesn't apply here, I hope?
Spoiler: the "celebrated researcher" in the title was discovered to commit fraud on a massive scale, was stripped of his physician license, and had multiple articles recalled.
He absolutely did obscure a baby's poisoning.
But that's not the main point of the article, nor is the story.
Humans are fallible. Humans have egos. Humans can be intentionally dishonest.
But the Scientific Method is the only functional bullshit detection system we have. When it is allowed to work, science corrects itself and excises the falsehoods.
It’s a shame that outsized egos within The Lancet and other orgs are still very much in play.
This is a nuanced point that anti-science people often get wrong.
The existence of fraudulent studies, dishonest researchers, the replication crisis, etc. does not invalidate science as an institution. It just means we need to be careful about distinguishing between individual opinions and the scientific consensus. We also need to keep in mind that the consensus is never 100% correct; it's always subject to change and we need to update our beliefs as new evidence comes in.
Ironically, being anti-science is pro-science. Skepticism of institutions and consensus is the scientific method.
The main reason being scientific consensus can lag reality significantly, especially when career incentives discourage dissent. The history of science includes many cases where consensus was wrong and critics were marginalized rather than engaged.
Deference to science as an authority is the opposite.
Feynman has a quote on this:
"Science is the belief in the ignorance of experts. When someone says, 'Science teaches such and such,' he is using the word incorrectly. Science doesn't teach anything; experience teaches it. If they say to you, 'Science has shown such and such,' you might ask, 'How does science show it? How did the scientists find out? How? What? Where?' It should not be 'science has shown' but 'this experiment, this effect, has shown.' And you have as much right as anyone else, upon hearing about the experiments — but be patient and listen to all the evidence — to judge whether a sensible conclusion has been arrived at."
Somewhere there's a quote about how the old guard has to literally die out before certain new ideas can take root; even if the new idea is obviously correct.
I think we've been pampered by a few hundred years of rapid "scientific advancement" and now we're firmly in the area where things are not grade-school science fair easy to see or prove.
"A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it." - Max Planck
>Ironically, being anti-science is pro-science. Skepticism of institutions and consensus is the scientific method
skepticism is necessary, but not sufficient.
if they merely nay-say institutions and then go with their gut, it's certainly not.
only when someone attempts to rationally disprove a position, offering alternate testable theories and actually performing those tests is science done.
if you suspect an institution is wrong, that's fine, but it's just a hunch until someone does a test.
I was a witness of wrong prescribing medication by doctors many time. For example Novalgin for mother releasing from hospital after painful birth. This medicament is not suitable for breastfeeding mothers!
Skepticism needs to be calibrated based on the weight of the evidence. There's a broad spectrum from being skeptical about the latest overhyped study in subfield X to being skeptical about quantum mechanics. If you want to challenge established science, you need to bring the receipts. To quote Carl Sagan, "extraordinary claims require extraordinary evidence".
> Skepticism of institutions and consensus is the scientific method.
Which is why one of the core tenets of practicing Science is “trust, but verify”.
Science is based on the trust of what came before.
But the fallible, ego-driven, and dishonest nature of humanity means that trust alone cannot be relied upon. Hence the “but verify”. That is why replication studies and falsification tests exist - to cull that which cannot be reliably replicated.
Unfortunately, capitalism has stepped in and f*ked up even that, when for-profit universities who rely on public funding place “publish or die” mandates on researchers. This makes any repeat experiments untenable because it takes researchers away from publishing new data. So they just cite prior papers and chase the latest shiny -- because their continued employment is predicated upon publishing.
We have perverse incentives in place that have distorted science, sure. And almost all of these distortions come directly down to a violently coercive economic system that forces you to be profitable to someone else least you suffer homelessness, destitution, and even death.
But what else is there? Belief in an insane, evil, and omnicidal sky-daddy?
Sorry, but no. We should counteract the sources of distortions by crushing capitalism and the corrosive influence of money, not switching over to systems that have always proven themselves to be supremely untrustworthy.
It means we need to be careful about distinguishing scientific consensus, and truth. Science can be used to find truth, but that is the science itself, not the consensus.
We can only have "scientific consensus" in maths (and even there there are doubts), every other science is a social science if one digs hard enough. Even particle physics.
obviously the scientific method is perfect , but i think i remember reading that the majority of studies are non reproducible, so things clearly arent perfect in practice. if one truly believes in the fallibility of humans, they also believe in the fallibility of the applying the scientific method - how could the output of of a fallible process ever be non fallible? confounding variables, hidden variables, incomplete sample spaces, etc ... these cannot ever be accounted for with certainty , thus i trust the scientific method as much as any human lol
Doing a PhD, I got to see a tension first hand that clarifies the reproducibility question: most of the papers I read were visibly garbage, but reading papers was a necessary step in achieving tasks. Every student at some point tries to achieve their concrete tasks without sifting through the dung heap to see how other people lied about their approach to the tasks, and it doesn't work- the garbage is a necessary ingredient and or enough authors are truthful.
The best media representation I've seen of this process is the youtube channel Explosions&Fire, which attempts to replicate entertaining-looking chemistry papers. He's often mad at the authors of the papers he's using in any given episode, but following their breadcrumbs is still effective enough (compared to I guess mixing acids and stuff based on vibes?) that he keeps at it.
If they are not reproducible, then they are not valid studies and not using the scientific method which requires reproducibility. So yes, the scientific method is indeed perfect. lol
Tylenol 3 is an old & inexpensive medication. One has to wonder if one of Koren's undisclosed revenue sources was a manufacturer of pricier on-patent opioids (like Sackler).
> The only data point in the scientific literature that had shaken his theory of the case was the near-death of Baby Boy Blue. He asked Rieder about the case. “Oh, we made it up,” Rieder replied.
The toxicology is pretty damning: codeine without morphine in stomach contents means someone crushed up Tylenol-3 and gave it to a 12-day-old baby. That's not a metabolic quirk—it's
homicide.
Koren's "ultra-rapid metabolizer" theory provided cover, and his research went on to clear 17 other caregivers in similar deaths. How many of those were actually murdered infants?
> A toxicological screening of the “white curdled material” had detected codeine but not morphine. But Koren had claimed that the gastric contents “exhibited high morphine” levels—with no mention of codeine—“ruling out administration of Tylenol-3 to the baby.”
> “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”
Does no one care that this is potentially a murder case?
Not just that, but potentially 17 other guilty caregivers have been cleared of suspicion based on the findings in that paper.
I'd guess that everybody involved (including the coroner's office) tacitly understands that even if the baby was deliberately or negligently killed, there's very little chance after 20 years of finding evidence of who did it, in order to demonstrate guilt beyond a reasonable doubt. And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.
The scientific case about infant opioid poisoning in general is a separate issue, of course. But assigning blame in this particular case doesn't have any bearing on that.
> And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.
It's probably true that without a chance of conviction, standard protocol dictates that public resources should not be expended on reopening the investigation. But I was also heavily distracted while reading the article, scanning optimistically for the happy (under the circumstances) ending where justice is served. I certainly don't think there is "no benefit to anybody".
Serious question: if the chance of evidence leading to a convistion is very very small, what would be the benefit of opening an investigation? Just to go through the motions on principle? And what would they even investigate?
One benefit is demonstrating at least a facade of seeking justice. Also, obscuring a crime for personal benefit is itself a crime.
so cops driving around is good enough, they don't have to actually catch criminals because it's it facade that really matters.
It's security theater, like airport security where red teams succeed in 95% cases
https://abcnews.go.com/US/exclusive-undercover-dhs-tests-fin...
It's a cost-benefit analysis like many other things. There are limited resources, they should be spent on investigating cases that have a chance of getting closed.
Cold cases might get reopened because of advances in technology or other changes over time.
There is no potential "principal" here that is distinguishable from posturing and dick swinging.
Unless you find some unforeseeable smoking gun any conviction will necessarily be questionable at best. That doesn't really serve much of a purpose beyond saying "we're the prosecutor's office, look how bad ass we are, look how we somehow manage to convict someone decades later, fear us". Never mind the fact that dredging this stuff up is not likely to be good for the family and that odds are all of these deaths are purely accidental/negligent so it's not like you're going after a "real criminal".
Investigating a murder is posturing? I really don't understand the "bad ass, fear us" language. Do you consider all criminal investigations to be as frivolous?
> odds are all of these deaths are purely accidental/negligent
How can you say that given that the article presents evidence that
> "... someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula
Is that an accident according to you, or do you have any evidence that the article is wrong about that conclusion?
>Investigating a murder is posturing? I really don't understand the "bad ass, fear us" language. Do you consider all criminal investigations to be as frivolous?
>How can you say that given that the article presents evidence that
Take a freakin step back and look at the big picture. Someone lost their kid, their first kid FFS. Even if a crime was technically committed along the way call it time served.
On a technical level, this is almost certainly not chargeable as a murder. Evidince of intent is lacking and almost certainly does not exist. The best you might be able to do is some negligent wrongful death manslaughter type thing, exact details depending on how such things are defined in the jurisdiction. Just based on plausibility these cases are almost certainly accidents. Very few mothers or the people around them murder newborns in the jurisdictions we're talking about. So if you did find intent, like a text exchange or something, the best you're likely to do is prove intent in the exact opposite direction and that no harm was meant. So then you have to prove negligence or something, which is also likely to be uphill. And this all assumes you can pin it on one person.
No good purpose is served by this. You're not getting some hardened criminal off the streets or putting someone in jail for an act committed with a bad frame of mind. Best case you wind up punishing someone using some negligince wrongful death type statues that's written based on the assumption that the person who caused the death DGAF about the deceased. Even if you pull that off this person is probably the mother or father or a grandparent who already lost their kid or grandkid for it so there's a real tinge of double jeopardy to the whole thing. This serves no purpose other than a show of force by the prosecuting office. The "real" crime committed here is not accidentally giving one's infant the wrong pills (someone gave a kid Tylenol, it's not like it was Xanax or booze to shut them up or some other thing everyone knows you don't do), the facts are likely to stack up in a way that make that act a non-criminal accident. So what you're doing in practice is screwing up one or more people's lives, to much fanfare, because they failed to tell the whole truth to the state a decade or more ago. Now, I get that that might sound like a good thing to some people, but those people are bad people and their ideas are bad ideas.
>Is that an accident according to you, or do you have any evidence that the article is wrong about that conclusion?
Stop trying to re-frame my assertion as an issue with the article rather than a critique of the proposed action (prosecuting someone). I know you'd rather discuss that, because that's much more defensible than a hypothetical decision to prosecute, and I do not accept your slight of hand.
Calm down. I'm not trying to re-frame anything, perhaps I misunderstood you because your reasons for not prosecuting are incomprehensible to me. Do I understand correctly that you think a murder (or involuntary manslaughter etc) is not "as bad" because the perpetrator was close to the victim?
> this person is probably the mother or father or a grandparent who already lost their kid or grandkid
Would you say the same about a man who (perhaps accidentally) killed his wife 20 years ago and covered it up? "He's already lost his wife, time served, no reason to investigate."
Speaking as a parent, giving a 12 days old infant Tylenol is clearly absurd and just as unreasonable as giving them booze.
>Would you say the same about a man who (perhaps accidentally) killed his wife 20 years ago and covered it up? "He's already lost his wife, time served, no reason to investigate."
There is a massive gulf of intent there and I think it speaks volumes that you cannot (or worse, decline to) identify it.
>Speaking as a parent,
And also speaking as a person who's been espousing the opinions you've been espousing thus far, that's more than just "parent"
>giving a 12 days old infant Tylenol is clearly absurd and just as unreasonable as giving them booze.
People are stupid. Shit happens. I know it seems wild now and everyone turns into a screeching moron about it now but the "suck on a finger dipped in booze" thing was not abnormal (note for said screeching morons: I did not say "considered tasteful") for decades. Doesn't surprise me that someone would give an infant a fraction of a pill of Tylenol as a sleep aid not knowing they have the opioid type and that the fraction they chose is enough to kill the kid one shot.
> Doesn't surprise me that someone would give an infant a fraction of a pill of Tylenol as a sleep aid not knowing they have the opioid type and that the fraction they chose is enough to kill the kid one shot
Note that this is just a story you made up, we really don't know what happened. You're also leaving out that if somebody did this by accident, they also chose to keep quiet about it for 20 years. Doesn't that speak about "intent"?
Also, giving a 12 days old baby a "normal" Tylenol, say one with 500 mg acetaminophen, is a very bad idea. The normal dose for a 3 month old is 60 mg (for fever, not as a "sleep aid"). Doses above 200 mg/kg can cause acute toxicity, so for a slightly small baby of 2500 g, you're there already. Perhaps thinking that there's a "safe" type of Tylenol to give a baby as a "sleep aid" (what??) is a good example of "People are stupid".
With my example with the wife, I'm simply trying to establish why you seem to consider children (or rather babies) to be not worthy of the same justice as adults. How about an adult who accidentally kills their elderly parent, would you consider that worth investigating, or should it also not be investigated on the principle of "they lost their parent"? Or further, at what age do you no longer consider it morally justifiable to accidentally (or otherwise) kill one's child and cover it up? 5 years old, 10, 18?
To me, being stupid does not mean you're allowed to give your elderly father 10 Tylenols as a "sleep aid" and claim "shit happens" if he dies. I might want to call a person of that viewpoint a "bad person with bad ideas" or a "screeching moron", but I'd like to stay above such childish namecalling.
[dead]
The "happy ending" where one of the parents and their three other kids find out that the other parent likely killed the older brother they never met? That doesn't sound very happy to me, but maybe we have different definitions of happy?
When I tried reading into the causes of so-called SIDS it seemed like at least some of the cases were a catch-all diagnosis that included cases where parents inadvertently killed their infants (eg co-sleeping and rolling onto them). Fundamentally I think there often isn't much upside to fully fleshing out the truth of cases where parents have already paid the heaviest price.
Man, SIDS. It's specifically non-specific, but the worry it causes is quite specific.
My daughter, as a baby, always managed to find a way to sleep on her stomach. Wouldn't sleep on her back, but almost magically by comparison would fall asleep lying on her stomach (face to one side or the other, not straight down, obviously - I hope). We tried various combinations of devices, arrangements of pillows and cushions, tight wraps, to keep her lying on her back, but babies are remarkably, if involuntarily, wilful (or she was, anyway, and remains to this day).
I worry about very few things, but for the first few nights we'd regularly get up to check on her, and literally be holding our breath waiting for her to expel hers.
Out of necessity the every-parents-SIDS-fear, from allowing the baby to sleep on their stomach, had to be removed from our psyche so that we could continue to function day-to-day.
Said baby is now, thankfully, a semi-healthily functional teenager. As functional as teenagers get anyway :)
during covid they actually laid hospital patients face down (suspended i think?) to help with breathing when a ventilator wasnt available. this behaviour reminds me of that, perhaps your baby was doing this to help with breathing? i dont know...
I swear, all the shit they push at new parents. You can see the point to much of it, and it's obviously going to be a very stressful time regardless. But there's the same inescapable bureaucratic dynamic where once something becomes legible, the system pathologically emphasizes those few bits over and over and over, to the detriment of balanced judgement - both your own and most healthcare providers if you try to get some nuance out of them.
It's understandable that they're trying to help the people who might not be the most competent at following the guidelines, because there is still harm reduction to be had there. But it pushes the instruction-followers into the territory of "well, this probably doesn't apply to us because XXX", which is an epistemologically terrible place to be.
We're still joking about how much they repeated the advice to keep the belly button dry, when it was relevant for like maybe two whole weeks.
We don't know it was the parents. Could've been a babysitter. Could've been a grandparent. New parents often have help.
> The "happy ending" where one of the parents and their three other kids find out that the other parent likely killed the older brother they never met? That doesn't sound very happy to me, but maybe we have different definitions of happy?
While "happy" isn't the word I'd use, that seems better than knowing that this could happen to any baby at any time and nothing would be done.
[dead]
I mean, if it was the case that one parent killed the child (Which, to be clear, we don't know. It could have been anybody who had access to the child at the time), then I'd think the best outcome is them getting convicted of it. I don't know why so many people treat homicide as "not a big deal" when it comes to babies.
Consider an unrelated hypothetical scenario, a family father accidentally hits and kills somebody with his car. He flees from the scene and is not discovered for 20 years. Would you then not attempt to prosecute him because it would be sad for his family to know? And now consider the case if it was his own child that died.
It's not that it's "not a big deal", rather the problem is you're up against the limits of details fading to time, negligence, etc. The best case here you're probably looking at each parent blaming the other parent for either doing it or at least letting it happen.
But really my main issue was with characterizing such a thing as a "happy ending". While it's generally good for justice to be served, we should still be wary of people who are a bit too gleeful about punishment.
SIDS was named in 1969, might be related to combined vaccines.
https://www.chop.edu/vaccine-education-center/vaccine-safety...
have you read the linked page?
> However, since immunizations are given to about 90 percent of children less than 1 year of age, and about 1,600 cases of SIDS occur every year, it would be expected, statistically, that every year about 50 cases of SIDS will occur within 24 hours of receipt of a vaccine. However, because the incidence of SIDS is the same in children who do or do not receive vaccines, we know that SIDS is not caused by vaccines.
> And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.
The benefit would be to formally reject the fake science that was used to close the investigation the first time. A conviction is beside the point.
Why do you think someone intended to kill the baby?
>But the forensic-toxicology laboratory’s measurements showed that his acetaminophen concentration was in the range of what you’d expect to find in a baby’s bloodstream soon after he’d been administered a standard dose.
>“I am familiar with patients whose babies have died after a caregiver gave the opiate directly.”
Maybe the person thought the tylenol-3 would help the baby.
Maybe the person thought that, but that would still be an absurd belief for them to hold. First of all, it doesn't seem like he had any problems he needed "help" with, the article only says he was "developing normally". Second of all, why would you give a random pill meant for adults to a baby not even two weeks old, without asking a nurse or at least reading the package insert?
Maybe the person thought "I've given Tylenol to babies in the past and it was fine" without realizing the difference between Tylenol and Tylenol-3.
It's possible the person even thought "Tylenol-3, hmm, that must be another term for children's Tylenol, Tylenol for 3-year-olds. I've given that to babies before."
> Does no one care that this is potentially a murder case?
I'd say, a very low chance of murder, and a near-certainty of at least manslaughter (unintentional killing), with a zero chance of prosecution due to lack of evidence.
Plus, I hardly see any value of jailing any of the caregivers for this. Whether an investigation should be made, I don't disagree.
> Does no one care that this is potentially a murder case?
Did we read the same article? Why are you so quick to jump the gun here?
> Koren obtained a sample of Rani’s breast milk, which she had kept in her freezer. His lab measured its morphine concentration at eighty-seven nanograms per millilitre.
If this is in the breastmilk, it will end up in the stomach, and it may end up in gastric contents. I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.
Are you Koren? Did we read the same article? The one that calls into question anything Koren says or claims?
From the article I read:
"A twelve-day-old infant cannot crawl. It cannot grab, and it cannot put something into its own mouth. “It also cannot swallow a Tylenol-3 pill,” Juurlink told me. “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”"
Also relevant to the quote selected by 'steelbrain:
> Recently, Parvaz Madadi has undergone a painful process of revisiting her past work and memories. [...] She added that she had no confidence in the measurement of Rani’s breast-milk sample, because it had been handled by Koren’s lab.
There is a lot to process in this long article. The quote selected by 'steelbrain, concerning Koren's measurement occurs very, very early on, and much of the rest of the article is about contrasting Koren's early presentations of the material against others' testimony. It's worth reading the whole thing
To 'steelbrain: cherry-picking one single quote out of a nuanced article does the journalism here a dire disservice. It's okay for different people to have different beliefs and takeaways from the article. However, your own defense of the biological mechanism here is directly argued against in the "same article" you are admonishing others over reading. That is not conducive to a discussion in good faith.
> If this is in the breastmilk, ...
Note that you and GP are talking about different values of "this." GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.
> GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.
It appears that they didn't really read the article before commenting.
The entire point, the damning evidence is that the child that died had codeine in his stomach, which he absolutely couldn't get from breast milk.
The original death finding falls just from simple back-of-napkin math.
87 ng/mL.
Baby eats 30mL per hour. That's 2.6 micrograms of morphine.
Elimination half life in neonates of ~8 hours means 30 micrograms in system at equilibrium if constantly fed this and the baby absorbs all of it (takes 4-5 half lives to get to that) and pharmacokinetics are linear. In reality a neonate likely absorbs well under 1/3rd, so you'd expect under 10 micrograms in equilibrium.
25-50 micrograms/kilogram is normal dosing of morphine in a neonate when it is necessary, every 6 hours (resulting in a peak systemic concentration of ~60-120 ug/kg after repeated dosing).
Compare -- 60-120 ug/kg therapeutic dosing to 10 micrograms in the neonate's body (3-4 kilos, so 3 ug/kg??)
And then, you end up with acetaminophen and codeine in the neonate's stomach, with no morphine... Even though these do not end up in breast milk in significant quantities.
> I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.
Neither the article nor the commenter you replied to has demonized the parents. Yes, both the evidence discussed in the article and the opinions of those interviewed indicate direct administration of a pharmaceutical; it is appropriate to discuss this. Nobody has pointed the finger at anyone; it would indeed be quite inappropriate for such a discussion to be held in this forum.
The article goes into detail about how this level of morphine in the breastmilk could not have given the baby a lethal (or even clinically effective) dose.
Furthermore, Koren lied about what the tests showed the stomach contents to be: he omitted codeine entirely. Codeine (per the article) would not be expected to be transferred by breastmilk -- it's metabolized into morphine to be effective.
This should be further up: it's metabolized into morphine.
There are some giant red flags with this situation. How awful.
> He asked Rieder about the case.
> “Oh, we made it up,” Rieder replied.
Interesting anecdote. Something to keep in mind.
This statement shocked me! These are professional people whose careers are on the line? It's no wonder many don't trust "experts" today, despite knowing almost nothing about the expert's field of knowledge. (I don't fall into this group, but I admit to being fearful of what highly educated humans are capable of.)
[dead]
>“The fact that the paper still exists means that medical students, pharmacy students, and, presumably, genetics students are being taught this as if it’s a real thing, and it has implications,” Juurlink told Scherer.
Yup. This paper was a lesson in my genetics class (2017)
Such a distressing yet believable story where ambition overtook integrity … I hope Lancet improves its handling of such case studies.
My motto has always been: "Don't let your car or your doctor get too old, they'll both kill you." Doesn't exactly apply to this case, but the idea is you have to trust something, so you must err on the side of caution.
I know a thousand more things about cars then I will ever know about doctoring, which scares the hell out of me.
The idea of an opioid OD from breast milk immensely strains credulity in the first place. Such a claim should really have been put under much more of a microscope.
I truly believe the training medical doctors receive affects how they conduct research. They are far more likely to ignore uncertainty and jump to conclusions.
Great read.
I'm not surprised that The Lancet is slow or unwilling to correct the record after falling for yet another fraud.
[1] https://en.wikipedia.org/wiki/Fraudulent_Lancet_MMR_vaccine-...
[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
I'd just like to invoke Betteridge's Law of Headlines.
"Any headline that ends in a question mark can be answered by the word no."
It is based on the assumption that if the publishers were confident that the answer was yes, they would have presented it as an assertion; by presenting it as a question, they are not accountable for whether it is correct or not.
https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
I'd just like to invoke the principle to "not judge a book by its cover".
The article here is very well written and does a great job of conveying the perspectives and opinions of many parties. I would recommend reading the article in spite of its headline.
Razors should guide, not replace, your engagement with the subject matter.
Yeah I thought about that when seeing the title; but after reading the article I'm quite certain the answer is yes in this case.
Also, Koren may have been a "celebrated researcher" at some point but he's now disgraced.
I would suggest that when there's a possible crime, as there would be in this case, even a clearly guilty murderer caught red-handed holding a knife and screaming "I DID IT" will be an "alleged" perpetrator.
The article clearly lays out that the answer is yes. It points to specific ways the researcher adjusted their reporting to mislead readers. I think the key here is where Koren attempts to specifically account for the stomach content explanation: he misrepresents the lab results and claimed they showed the opposite of what they did.
The headline was editorialised for the web. It originally ran under the headline "A Fatal Error".
I am invoking Meta-Betteridge's Law:
"any comment that dismisses an article based on it's headline has no value"
For large publications like the New Yorker, it is an Editor, NOT THE AUTHOR who writes a headline.
In this case Betteridge's Law is wrong. The article (quite convincingly) argues "yes."
It's a rhetorical device.
>I'd just like to invoke Betteridge's Law of Headlines.
To say that it doesn't apply here, I hope?
Spoiler: the "celebrated researcher" in the title was discovered to commit fraud on a massive scale, was stripped of his physician license, and had multiple articles recalled.
He absolutely did obscure a baby's poisoning.
But that's not the main point of the article, nor is the story.
Humans are fallible. Humans have egos. Humans can be intentionally dishonest.
But the Scientific Method is the only functional bullshit detection system we have. When it is allowed to work, science corrects itself and excises the falsehoods.
It’s a shame that outsized egos within The Lancet and other orgs are still very much in play.
the Scientific Method is really just one method of science. It's a very good one, but it has strict requirements that can't be met in all studies.
This is a nuanced point that anti-science people often get wrong.
The existence of fraudulent studies, dishonest researchers, the replication crisis, etc. does not invalidate science as an institution. It just means we need to be careful about distinguishing between individual opinions and the scientific consensus. We also need to keep in mind that the consensus is never 100% correct; it's always subject to change and we need to update our beliefs as new evidence comes in.
Ironically, being anti-science is pro-science. Skepticism of institutions and consensus is the scientific method.
The main reason being scientific consensus can lag reality significantly, especially when career incentives discourage dissent. The history of science includes many cases where consensus was wrong and critics were marginalized rather than engaged.
Deference to science as an authority is the opposite.
Feynman has a quote on this:
"Science is the belief in the ignorance of experts. When someone says, 'Science teaches such and such,' he is using the word incorrectly. Science doesn't teach anything; experience teaches it. If they say to you, 'Science has shown such and such,' you might ask, 'How does science show it? How did the scientists find out? How? What? Where?' It should not be 'science has shown' but 'this experiment, this effect, has shown.' And you have as much right as anyone else, upon hearing about the experiments — but be patient and listen to all the evidence — to judge whether a sensible conclusion has been arrived at."
Somewhere there's a quote about how the old guard has to literally die out before certain new ideas can take root; even if the new idea is obviously correct.
I think we've been pampered by a few hundred years of rapid "scientific advancement" and now we're firmly in the area where things are not grade-school science fair easy to see or prove.
"A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it." - Max Planck
>Ironically, being anti-science is pro-science. Skepticism of institutions and consensus is the scientific method
skepticism is necessary, but not sufficient.
if they merely nay-say institutions and then go with their gut, it's certainly not.
only when someone attempts to rationally disprove a position, offering alternate testable theories and actually performing those tests is science done.
if you suspect an institution is wrong, that's fine, but it's just a hunch until someone does a test.
Skepticism should be norm.
I was a witness of wrong prescribing medication by doctors many time. For example Novalgin for mother releasing from hospital after painful birth. This medicament is not suitable for breastfeeding mothers!
Skepticism needs to be calibrated based on the weight of the evidence. There's a broad spectrum from being skeptical about the latest overhyped study in subfield X to being skeptical about quantum mechanics. If you want to challenge established science, you need to bring the receipts. To quote Carl Sagan, "extraordinary claims require extraordinary evidence".
> Skepticism of institutions and consensus is the scientific method.
Which is why one of the core tenets of practicing Science is “trust, but verify”.
Science is based on the trust of what came before.
But the fallible, ego-driven, and dishonest nature of humanity means that trust alone cannot be relied upon. Hence the “but verify”. That is why replication studies and falsification tests exist - to cull that which cannot be reliably replicated.
Unfortunately, capitalism has stepped in and f*ked up even that, when for-profit universities who rely on public funding place “publish or die” mandates on researchers. This makes any repeat experiments untenable because it takes researchers away from publishing new data. So they just cite prior papers and chase the latest shiny -- because their continued employment is predicated upon publishing.
We have perverse incentives in place that have distorted science, sure. And almost all of these distortions come directly down to a violently coercive economic system that forces you to be profitable to someone else least you suffer homelessness, destitution, and even death.
But what else is there? Belief in an insane, evil, and omnicidal sky-daddy?
Sorry, but no. We should counteract the sources of distortions by crushing capitalism and the corrosive influence of money, not switching over to systems that have always proven themselves to be supremely untrustworthy.
It means we need to be careful about distinguishing scientific consensus, and truth. Science can be used to find truth, but that is the science itself, not the consensus.
It does when science literally kills babies.
> and the scientific consensus
We can only have "scientific consensus" in maths (and even there there are doubts), every other science is a social science if one digs hard enough. Even particle physics.
Science as an "institution" serves only to protect egos, fraudsters, and politicians.
When citizen science is ridiculed and "the institution of science" is glorified this is what you get.
And anyone who dares to profess this, is a loony, a conspiracy theorist, an anti-scientific person, etc.
obviously the scientific method is perfect , but i think i remember reading that the majority of studies are non reproducible, so things clearly arent perfect in practice. if one truly believes in the fallibility of humans, they also believe in the fallibility of the applying the scientific method - how could the output of of a fallible process ever be non fallible? confounding variables, hidden variables, incomplete sample spaces, etc ... these cannot ever be accounted for with certainty , thus i trust the scientific method as much as any human lol
Doing a PhD, I got to see a tension first hand that clarifies the reproducibility question: most of the papers I read were visibly garbage, but reading papers was a necessary step in achieving tasks. Every student at some point tries to achieve their concrete tasks without sifting through the dung heap to see how other people lied about their approach to the tasks, and it doesn't work- the garbage is a necessary ingredient and or enough authors are truthful.
The best media representation I've seen of this process is the youtube channel Explosions&Fire, which attempts to replicate entertaining-looking chemistry papers. He's often mad at the authors of the papers he's using in any given episode, but following their breadcrumbs is still effective enough (compared to I guess mixing acids and stuff based on vibes?) that he keeps at it.
If they are not reproducible, then they are not valid studies and not using the scientific method which requires reproducibility. So yes, the scientific method is indeed perfect. lol
Tylenol 3 is an old & inexpensive medication. One has to wonder if one of Koren's undisclosed revenue sources was a manufacturer of pricier on-patent opioids (like Sackler).
> The only data point in the scientific literature that had shaken his theory of the case was the near-death of Baby Boy Blue. He asked Rieder about the case. “Oh, we made it up,” Rieder replied.
What the actual fuck.
[dead]
The toxicology is pretty damning: codeine without morphine in stomach contents means someone crushed up Tylenol-3 and gave it to a 12-day-old baby. That's not a metabolic quirk—it's homicide. Koren's "ultra-rapid metabolizer" theory provided cover, and his research went on to clear 17 other caregivers in similar deaths. How many of those were actually murdered infants?