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The Vitamin D Newsletter March 2011

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This newsletter has the following two supporting documents:

  • Griffith paper x-ray reproductions and critique
  • Kempe paper x-ray reproductions and critique

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Vitamin D Deficiency Rickets: Yet Another Family Shattered

In this newsletter, another family is destroyed, and Dr. Jane Smith (real name), Deputy Editor of the British Medical Journal (BMJ) refuses to rectify the tragic failure of the review process made by the BMJ almost 50 years ago. Will the Journal of the American Medical Association (JAMA) do better? Will the editors of JAMA cover up their mistake as the BMJ editors did?

Dr. Cannell: My Name is Michelle Gonzalez and I am a 20-year-old mother of one. My husband Miguel and I have known each other since early childhood and grew up together in a small farming town in Southern Colorado. We are a very tight knit community where everyone knows everyone. April 28th 2010, my daughter Maria was born. It was the happiest day of my life.

Throughout my pregnancy, I had planned on breastfeeding and was determined not to quit like so many other woman had told me they did due to the pain. But at 2 months of age, my pediatrician informed me at one of our regular checkups that she was not getting enough nourishment from my breast milk and that I would have to switch to formula for the sake of her health, which I did immediately.

No more than a few days later my daughter came down with a severe cold that had her coughing all night and day along with a runny/stuffy nose. I immediately took her in to get her checked out where they gave us the equipment to give her breathing treatments and were told to try and keep her comfortable until the cold passed.

After about a week into her cold, her arms, hands, and fingers suddenly stopped moving. It was like she had no control of them anymore and when you would hold her she would just let her arms hang which I knew was not normal, so off we went to the Doctor again. Their conclusion as to why they had stopped moving was because of her chest being sore from all the coughing and that it was probably uncomfortable for her to move them and then sent us home. And I'm sure most of us trust our pediatrician's decisions and advice to the fullest extent.

Throughout the next 3 weeks we were at the Doctors office 2 to 3 times each week because her cold didn't seem to be getting any better and neither did her arms. As you probably realize, as first time parents we were overly worried, as I'm sure all first timers are, but in my gut I just knew something wasn't right with this picture.

Then about 1 week before her 3 month birthday, all of a sudden, like literally overnight, her right leg had stopped moving and had swelled up to twice the size of her left leg. Again, off to the Doctor we went where he finally started to think something more was going on than her just being sore. He believed that she may have developed a blood clot and should be immediately admitted to the hospital.

After arriving at the hospital, the Doctors there informed us that they wanted to do a full body x-ray and an ultrasound on her right leg to see if their truly was a clot. After the x-ray though, my whole life flipped completely upside down.

My husband and I were informed that my daughter had multiple fractures throughout her body and that her spine was also fractured which was the cause of her loss of movement in her arms. I just about fainted when they told me this. They then informed me that they had to report it to child protection, which I fully understood and in my heart knew they would figure out that this was not abuse but something more.

But I was wrong.

After being at the hospital for almost 2 weeks, the police and a couple social workers came to tell us that we had to leave the hospital immediately and that if we came back or even called we would be arrested. That was July 28th, the day she turned 3 months, and the last time I ever saw my daughter.

The reason I am writing you is because brittle bone disease has been ruled out but they told me her vitamin D levels were low but not low enough to cause the breaks. I'm wondering if you can tell me anything about vitamin D levels being low enough to cause brittle bones and if the formula had possibly raised those levels enough by the time that we went to the hospital her levels were up quite a bit.

Mind you, my pediatrician never suspected us of abuse during all those visits before the hospital and for having not one bruise on her during the time these breaks occurred, I believe whatever was going on with my daughter was happening on the inside, not the outside. So please, if you have any information or thoughts on this, write me back as soon as possible because in April our parental rights will be terminated and she will be adopted out.

Please help me and my family. I just have a really strong feeling that this is our answer. Thank you for your time and hope to hear from you soon! Sincerely, Michelle Gonzalez

Dear Michelle: I have sent you via another email the name of an attorney and the name of a pediatric radiologist. However, both are swamped with almost identical cases.

I suspect that your baby suffered from hypocalcemia (low blood calcium), which was bad enough to cause her lack of movement, before rickets made her bones fall apart. As you know from reading previous newsletters, the District Attorney in your case has destroyed evidence, however unwittingly. If he had only obtained a 25(OH)D and X-rays of the wrist and ankle on the day your baby was taken away, your family would not be devastated. I am sure those tests will be normal now, because the state has been giving your baby formula, formula that contains the vitamin D your breast milk did not, formula that destroyed evidence of your innocence.

I have obtained the seminal papers in both the U.S. and England on child physical abuse. Seminal papers are the original papers, sort of like the first time scientists discover the issue. I sent the illustrations of the X-rays in these seminal papers to several radiologists and discovered both papers contain errors, errors appalling in their implication.

I first asked the editors of the BMJ to correct their errors in the seminal BMJ paper, because BMJ brags about the fairness of their review process. In my letter below, I pointed out that their editorial review failure may have directly led to thousands of innocent parents undergoing nightmares like your family.

  • Editor
  • British Medical Journal

Dear Sir/Madam: In 1963, Griffiths and Moynihan, writing in the British Medical Journal, introduced a new syndrome to medicine, the "Battered Baby Syndrome." Griffiths DL, Moynihan FJ. Multiple epiphysial injuries in babies. ("Battered Baby" syndrome). Br Med J. 1963 Dec 21;2(5372):1558–61. The authors presented four cases, three of which involved only boney x-ray abnormalities and parents who vehemently and repeatedly denied hitting their child. However, the authors dismissed such parental denial stating:

"This is one of the few conditions in which the x-ray films can be read with complete disregard for the clinical history, which is usually misleading. . . . These babies are to be regarded as having been injured by brutal violence and the culprit is almost always a parent."

A year earlier, the Journal of the American Medical Association published a similar paper with a simple message: infants or young children with boney abnormalities and multiple fractures were physically abused, usually by one or both parents, until proven otherwise. Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered-child syndrome. JAMA. 1962 Jul 7;181:17–24. Before 1962, such a diagnosis was rare; at least I can find little or nothing in the medical literature on the subject. The message from the lead author, pediatrician Henry Kempe of the University of Colorado, as quoted in Time Magazine, was clear:

"To the informed physician, the bones tell a story the child is too young or too frightened to tell... The radiologic features are so distinct that other diseases generally are considered only because of the reluctance to accept the implications of the bony lesions [bone injuries]." Time Magazine. Medicine: Battered-Child Syndrome. Friday, Jul. 20, 1962.

Kempe and his colleagues described 310 children in their series. Some of the children had obviously been battered as evidenced by (1) multiple other injuries besides fractures, (2) mentally disturbed parents witnessed beating their child, (3) parents who quickly confessed to the beatings, or (4) otherwise adequately corroborated evidence. However, a significant subset of the cases involved only radiographs showing bony abnormalities and parents who vehemently protested their innocence.

Both the Kempe et al and the Griffiths and Moynihan papers make it clear that parents lie but x-rays do not. That is, both papers claim that x-rays in such cases are definitive and thus dispositive in the courtroom. Indeed, once an abnormal x-ray is presented as evidence of child abuse in the courtroom, and is accompanied by the child abuse interpretation of an expert radiologist, little is left for the defense but a plea bargain.

The Griffiths and Moynihan contains 10 figures, all reproductions of radiographs. After reviewing the radiographs, I conclude that almost all of the reproduced radiographs show rickets, some severe, a diagnosis not considered by the authors and apparently not by the BMJ editors or reviewers. I have sent the Griffiths and Moynihan paper to several pediatric radiologists who all agree that rickets is the skeletal pathology.

Some may object saying, just because the x-rays show rickets, that does not mean the parents did not abuse the child. That is, the parents may have abused their child. This statement is certainly true, just as it is true that some of the editors of the British Medical Journal may have had sex with children in the last few weeks. For painfully learned reasons, judicial systems require more evidence to convict than a "may."

If true, the tragedy the editorial failure in the Griffiths and Moynihan paper entails is difficult to overstate. How many British families were needlessly destroyed when experts relied on this paper to erroneously diagnose child physical abuse? How many innocent British subjects were unjustly incarcerated due to expert testimony that relied on this paper?

I ask that the editors send the 10 figures, sans the text and sans the text in the captions, to several pediatric radiologists in Britain who are competent in diagnosing rickets, for a blind review. If my fears are confirmed, I ask that the BMJ editors of today attempt to rectify the mistake of their predecessors by: (1) officially withdrawing the Griffiths and Moynihan paper, (2) notifying appropriate British legal authorities, and (3) by locating all child physical abuse papers in the BMJ publishing group that reproduces x-rays and likewise send those radiographs for blind review. Sincerely, John J Cannell, MD

  • RE: BMJ/2010/827410
  • tragic failure of review process
  • by John J Cannell

Dear Dr. Cannell Thank you for sending us your paper. We read it with interest but I regret to say that we have decided not to publish it in the BMJ.

We are also not inclined to review the 1963 paper — your challenge is essentially based on hearsay, and the point about research is that it gets superceded by more research.

We receive over 8000 submissions a year and accept less than 10%. We do therefore have to make hard decisions on just how interesting an article will be to our general clinical readers, how much it adds, and how much practical value it will be.

I am sorry to disappoint you on this occasion. Best wishes, Jane Smith Deputy editor BMJ, BMA House Tavistock Square London, WC1H 9JR Phone: +44 (0)20 7383 6309 Fax: +44 (0)20 7383 6418 [email protected]

Dr. Cannell's Comment: Hearsay! The British Medical Journal covers-up an appalling error in their review system, one that helped unleash an injustice too terrible to contemplate, one based on a disastrous misreading of X-rays, and the BMJ's Dr. Jane Smith says my request is based on "hearsay." Dismissing my reading of the X-rays as "hearsay," allows them to continue not looking at their catastrophic mistake.

If our PDFs are not clear enough, academics and reporters can obtain library copies of the two seminal papers (which will have better reproductions of the X-rays in question) and show any radiologist experienced in rickets about the X-ray reproductions in both papers, asking, "Could this be rickets?" We have posted the reproductions of the X-rays and the readings of Dr. David Ayoub, a radiologist, of both the BMJ and the JAMA paper at the top of this page. In the meantime, email Dr. Jane Smith if you dislike the BMJ's refusal to reopen the cover-up of their review process: [email protected]. Tell her to stop the cover up.

JAMA's copyright rules will not allow us to post a link to the entire 1962 seminal Kempe, et al, paper, The Battered-Child Syndrome.

However, Dr. David Ayoub, obtained a copy of the JAMA paper from the library (where the X-ray reproductions are good). As with the BMJ paper, he sent the Vitamin D Council his interpretations of the X-rays, X-rays Dr. Henry Kempe (a pediatrician, not a radiologist) said were definitive evidence of child abuse. We have posted Dr. Ayoub's interpretation along with Dr. Kempe's original interpretation. Print these two PDFs out, take both to an experienced radiologist, one that knows rickets, and ask "Could this be rickets?"

Thus, as tragic as it sounds, the two seminal papers in the child physical abuse field contain multiple examples of infantile rickets misdiagnosed as definitive examples of child abuse. Not all child physical abuse cases are rickets; that is, some of the cases are clearly child abuse but other cases are clearly rickets without any evidence, other than X-rays, that abuse occurred. I will submit a letter to JAMA, asking them to re-review the Kempe et al paper, as I did with the BMJ, asking JAMA to send the X-rays to three different academic radiologists experienced in the detection of rickets, asking, "Could this be rickets?"

Some will say, "The children may have also been abused, Dr. Cannell can't say for sure." This is a true statement. However, it is also true that the reader may be an abuser; do you want to live in a country where you have to prove that you are not?

My allegation that the State is destroying evidence (unwittingly) is as serious a charge as you can make against a District Attorney. However, when child protective services gives that first bottle of vitamin D-rich formula, without first having obtained a vitamin D blood level and x-rays of the wrist and ankle, what may be the only exonerating evidence is on its way to eternity.

The enormity of this calamity is hard to overstate. Child abuse experts have used these flawed BMJ and JAMA papers as evidence against the innocent for almost 50 years. If we had just listened, we would have heard the falsely accused praying for the nightmare to stop.

Because, for the innocent, nothing is as important as their innocence.

John Jacob Cannell MD Executive Director

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