Bad Science + Zealotry = The Wisconsin Witch Hunts. The Case of John Cox, MD

John Cox, MD

I stumbled upon a very disturbing report on NBC News today of a physician couple in Wisconsin accused of abusing their adopted infant daughter.  It is surreal and horrifying and worth a read - not because these physicians abused their daughter, but because they almost assuredly did not.  One driving force behind the case appears to be a well-meaning and perfervid, if misguided and perfidious, pediatrician at University of Wisconsin who, with her group, coined the term "sentinel injuries" (SI) to describe small injuries such as bruises and oral injuries that they posit portend future larger scale abuse.  It was the finding of SI on the adopted infant in the story that in part led to charges of abuse against the father, Dr. Cox, got his child put in protective services, got him arrested, and threatens his career.  Interested readers can reference the link above for sordid and sundry details of the case.

Before delving into the 2013 study in Pediatrics upon which many contentions about SI rest, we should start with the fundamentals.  First, is it plausible that the thesis is correct, that before serious abuse, minor abuse is detectable by small bruises or oral injuries?  Of course it is, and it sounds like a good narrative.  But being a good plausible narrative does not make it true and it is likewise possible that bruises seen in kids who are and are not abused reflect nothing more than accidental injuries from rolling off a support, something falling or dropping on them, somebody dropping them, a sibling jabbing at them with a toy, and a number of things.  To my knowledge, the authors offer no direct evidence that the SIs they or others report have been directly traced to abuse.  They are doing nothing more than inferring that facial bruising is a precursor to Abusive Head Trauma (AHT), and based on their bibliography they have gone out of their way to promote this notion.