Sudden Infant Death Study Raises Concerns

In a special report, freelance journalist Jonathan Gornall raises questions about the paper's findings and asks was the message of this study misleading"

In January 2005 the Lancet published an analysis of sudden infant deaths which suggested that almost 90% of second deaths in the same family are natural. The paper was sponsored by the Foundation for the Study of Infant Death.

The paper was written at the height of public debate on child protection issues. It formed part of the evidence that led to Professor Meadow being struck off the General Medical Council Register in July 2005, and led to a change of policy by the American Academy of Pediatrics.

Its findings were also seized on by the media. The study, reported one newspaper, showed that: "The vast majority of second infant deaths in families who have already suffered the sudden loss of a baby are down to natural causes." Another said the study proved Professor Meadow's "murder theory" was wrong.

But the BMJ investigation shows that classification of deaths in the study was changed after a senior author, Professor John Emery, died in May 2000. Deaths that he had classed as unnatural or of indeterminate cause were counted as natural. The BMJ has also learnt that before its publication, the interpretation of the data was questioned internally at the foundation.

Furthermore, evidence of Professor Emery's views shortly before his death suggests that his name has been used to support a conclusion with which he would not have agreed.

The three authors interviewed by the BMJ accepted that they could not be certain that Professor Emery would have agreed with what they had done. However, they thought that their approach had been within the spirit of Professor Emery's attitude towards parents.

But evidence shows that Professor Emery's lowest estimate for the proportion of second sudden infant deaths that were unnatural was 34.5% - a striking contrast with the 13% in the 2005 paper.

Gornall also reveals that serious concerns about the paper were expressed by Professor David Hall, then immediate past president of the Royal College of Paediatrics and Child Health. In a letter to the Lancet in November 2005, he concluded that he and others regarded the paper's findings as "seriously misleading" and thought they could have "serious consequences" for child protection.