Shaking Wrong Beliefs By F. Yazbak, MD, FAAP

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Dr. Yazbak, a pediatrician, now devotes his time

to the research of autoimmune regressive autism and vaccine injury.

Shaking Wrong Beliefs

By Red Flags Columnist, F. Yazbak, MD, FAAP

(tlautstudy@...)

The medical controversies section of the recent

issue of the Journal of American Physicians and

Surgeons (1) features three outstanding articles

on the more and more controversial subject of shaken baby syndrome (SBS).

Together, these papers contribute immensely to

the understanding of this obscure syndrome by

debunking assumptions that have been accepted for

some time as “proof” of abuse of young and innocent infants:

* That subdural and retinal hemorrhages can

only be due to severe shaking and, therefore, must be intentional;

* That the presence of a “fracture or

fractures” in the ribs and long bones is “evidence” of inflicted trauma.

The papers are:

* " Shaken Baby Syndrome:” Do Confessions by

Alleged Perpetrators Validate the Concept? by Jan E. Leestma, MD, MM. (2)

* Vaccines, Apparent Life-Threatening

Events, Barlow’s Disease and Questions about

" Shaken Baby Syndrome " by D. Innis, MBBS. (3)

* Caffey Revisited: A Commentary on the

Origin of " Shaken Baby Syndrome " by C. Alan B. Clemetson, MD. (4)

Jan Leestma is a former professor at the

University of Chicago’s division of biological

sciences and the Pritzker School of Medicine

(pathology and neurology), and neuropathologist

and associate medical director for the Chicago

Institute of Neurosurgery and Neuroresearch,

Innis is a hematologist and pathologist,

former consultant hematologist at Princess

andra Hospital in Australia, and the director of Medisets International.

Alan Clemetson is a professor emeritus at Tulane

University School of Medicine in New Orleans, Louisiana.

The credentials and qualifications of these

distinguished authors are evidently impeccable.

* * * *

The Leestma paper

“The concept that a certain constellation of

findings develops immediately after a baby is

shaken, with no impact of the head, is based

solely on confessions or admissions by alleged

perpetrators…. A review of the literature reveals

very few cases of admissions of “pure” shaking.

Methodologic flaws preclude any definitive

conclusions about causation from these cases….

“The studies have been regarded by many as strong

support for the theory of SBS. Of prime concern

in these papers, however, is the basic issue of

the value of a supposed confession in determining

a mechanism for injury. With any confession or

admission, there is the issue of veracity.

Accused individuals are well known to fabricate historical information….

“It should be apparent that from virtually every

perspective many flaws exist in the theory that

shaking is causative. No case studies have ever

been undertaken to probe even a partial list of the potential causes….

“The confessions or admissions of a perpetrator

are at best tenuous support for the shaking

mechanism for infantile head injury. A critical

appraisal of any literature that proposes a

causal mechanism of shaking for brain injury must

include an investigation of case selection

methodology, population or sample size, possible

case control issues, data analysis methods, and

whether the conclusions reached are justified by the data presented….”

The Innis paper

“Apparent Life-Threatening Events (ALTE), as

defined by the National Institutes of Health,

encompass all the findings hitherto attributed to

open “Shaken Baby Syndrome” (SBS), and may follow

routine vaccination. Vaccines may also induce

vitamin C deficiency (Barlow’s disease),

especially in formula-fed infants or infants whose mothers smoke….

“Shaken Baby Syndrome (SBS) is a collection of

findings, not all of which may be present in any

individual infant diagnosed to have the

condition. Findings include intracranial

hemorrhage, retinal hemorrhage, and fractures of

the ribs and at the ends of long bones….

“The National Institutes of Health, and its 1986

Health Consensus Development Conference on

Infantile Apnea and Home Monitoring, defined

“Apparent Life-Threatening Event (ALTE) as an

episode that is frightening to the observer and

is characterized by some combination of apnea

(central or occasionally obstructive), color

change (usually cyanotic or pallid but

occasionally erythematous or plethoric), marked

change in muscle tone (usually marked limpness),

and choking and gagging. In some cases, the

observer fears that the infant has died. ALTE is

not so much a specific diagnosis as a description of an event….

“The current concept of SBS includes intracranial

bleeding, usually in the form of a subdural

hematoma, which may be acute or chronic;

parenchymal injury and/or anoxic changes in the

brain; skull fracture (if impact occurred); and

retinal hemorrhages. Constant features are

subdural and retinal hemorrhages. Various

fractures including those of the long bones and

ribs are often used to support an impression of

child abuse, but it should not be forgotten that

Barlow’s disease can resemble “battered baby”….

“Animal experiments have demonstrated that

administration of vitamin C can counter some of

the ill effects of nicotine in newborns. This

suggests that mothers who smoke may compromise

vitamin C levels in their children….

“One essential function of vitamin C is

maintenance of normal connective tissue by the

hydroxylation of praline and lysine in

procollagen, using the enzyme prolyl hydoxylase

with Vitamin C as a cofactor. While vitamin C has

numerous other functions, this one maintains the

integrity of the blood vessels, bones, and

dentine, which is compromised in scurvy, leading

to manifestations that might be mistaken for

SBS. Expansion at the ends of the costochondral

junctions is highly suspicious for scurvy, and

should in itself have raised questions about the diagnosis of SBS.

“Formula feedings are often heated before being

given to the infant and heat destroys vitamin

C. Under such circumstances, vitamin C

supplements are needed to prevent scurvy….

“As part of the immune response to vaccines, mast

cells liberate histamine, causing further

widening of the intercellular spaces between the

vascular endothelial cells in children who may

have subclinical scurvy. Although it has not been

established that vaccinations cause vitamin C

deficiency, the inverse relationship between

histamine and vitamin C levels in the blood would

support the hypothesis that vaccinations could

lead to vitamin C deficiency, and might explain spontaneous bleeding….

“Post-immunization deaths in aboriginal children

in Australia were greatly reduced when

Kalokerinos administered vitamin C by IM

injection before, and sometimes after, immunizing

the child. Many of these children had the

classical signs and symptoms of scurvy.”

The Clemetson paper

“Caffey is often cited as the source of the

diagnosis of “shaken baby syndrome” (SBS). Once

that “classic” findings attributed to SBS are

identified, it is rare for differential diagnosis to be considered…

“In 1946, Caffey, a radiologist, described

multiple fractures in the long bones of infants

suffering from chronic subdural hematoma. None of

the parents reported any knowledge of falls or

physical injury, but Caffey suspected child abuse to explain the injuries.

“Following this retrospective, radiologic study

by Caffey, the diagnosis of “shaken baby

syndrome” (SBS — including retinal petechiae,

multiple fractures of the long bones, and

subdural hematomas) evolved and has resulted in

many men and women being convicted of child

abuse, all without any meaningful consideration of a differential diagnosis….

“In addition to the long-bone fractures and

subdural hematomas, other clinical signs

consistent with infantile scurvy were evident in most of Caffey’s six cases….

“Even with adequate dietary vitamin C intake,

infections can rapidly deplete ascorbic acid

stores and increase the blood histamine level….

“Many factors affect vitamin C metabolism, but

the most important is systemic infection. Hess,

in his Cutter Lecture at Harvard Medical School,

recognized that infection and vitamin C

deficiency were both related to the development

of infantile scurvy. It was a number of years,

however, before he realized that each affected

the other — vitamin C deficiency predisposes to

infection, and infection predisposes to vitamin C

deficiency. Blood levels of vitamin C are also

inversely related to blood histamine levels….

“The hypothesis that subdural hemorrhages,

retinal petechiae, and spontaneous fractures of

the ribs and long bones can occur as an early

variant of scurvy at about 8 to 10 weeks of age

has not been adequately studied, and, therefore,

has not been disproven. Unless and until vitamin

C and histamine levels are actually measured in

these infants, who are automatically classified

as victims of SBS, we will not know the truth about causation….

The effects of various vaccinations, given alone

or together, on whole blood histamine level and

plasma ascorbic acid levels, should be further

studied. Concerted research may increase our

understanding of the toxicity of different

vaccines and the effects of giving single versus

multiple, simultaneously administered vaccines.

Their impact on vitamin C, histamine, and

clinical manifestations of deficiency/toxemia

must be assessed. It should be helpful to reduce

the number of vaccines given simultaneously or in rapid succession.”

* * * *

In his paper, Leestma summarized the findings of

his careful review of the extensive

English-language medical literature on child

abuse between 1969 and 2001, where he only found

54 cases in which someone had admitted “shaking”

the injured infant. (5) In only 11 cases, there

was no sign of cranial impact and the infant

could have been “free-shaken.” Such a small

number of cases obviously did not allow valid statistical analysis.

As mentioned in a previous column (6), a young,

scared and disadvantaged parent can literally

confess to anything “just to get it over with.”

In any other criminal investigation, such

“confessions” would not be worth the paper they

are written on. In shaken baby trials, they

effectively destroy families and put innocent

adult caretakers in jail for years.

Innis strongly highlights lessons we should have learned in medical school:

* Take a good history

* Investigate judiciously

* Interpret findings correctly

* Consider all the possibilities in the differential diagnosis

* Reach the diagnosis carefully

* Treat appropriately

Without repeating his now famous challenge, Innis

recommended that the diagnosis of SBS not be made

until malnutrion, coagulation/hemostatic

difficulties, liver dysfunction, gestational,

delivery and neonatal factors, and recent

vaccinations had been seriously reviewed and found to be non-contributory.

By carefully reviewing every one of Caffey’s

original six cases, which had become the bases on

which the theory of shaken baby syndrome was

built, and by showing that most of them suggested

vitamin C deficiency in one way or another,

Clementson contributed immensely to the subject.

With his very original approach to destroy the

cornerstone, he may have brought the whole edifice down.

In a communication to the British Medical Journal on June 27, 2005, Innis said:

“A name change from ‘Shaken Baby Syndrome’ to

‘Kalokerinos-Clemetson Sydrome,’ when

haemorrhages, fractures and intracranial lesions

follow immunization within 28 days, should be the

first step in stopping false allegations against innocent individuals.

“Both [Archie] Kalokerinos and Clemetson have for

years been trying to educate the medical

profession on the risks of vaccines to some children.

“The witch hunt will be over once the name is changed.”

I can safely add that if this happened, justice

would be better served and so would science.

We not only should, we must, recommend that upon

detecting retinal and subdural hemorrhages, with

or without rib and long bone “fractures”,

admitting physicians immediately order blood

histamine and serum ascorbate levels, in addition

to the usual bleeding and coagulation battery of

tests, which should include a PIVKA II test and

fibrinogen level, fibrin split products and D

Dimer tests. Abnormalities in the liver and

kidney function tests should be taken seriously

and not discounted as so often happens.

A review of recent vaccinations is also

essential. Accessing the VAERS web site is

relatively easy and often very informative.

Discounting the role of multiple vaccinations

without investigating it properly has been

evident for years; it should not be permitted any longer.

* * * *

The editor of the Journal of American Physicians

and Surgeons should be complimented for

publishing these three very important papers in the latest issue.

Reprints of the articles in bundles of 25 to 500

copies are available for those individuals and

organizations who wish to distribute them. (7)

Conclusions

Three recent articles in the Journal of American

Physicians and Surgeons have helped disperse much

of the misinformation about shaken baby syndrome.

Histaminemia and vitamin C deficiency may be

responsible for SBS and should be tested in every

case in which such diagnosis is suspected.

The role of multiple recent vaccinations in SBS

cases should be carefully evaluated before it is discounted.

The Kalokerinos-Clemetson Syndrome is a more

appropriate label for cases that present with an

apparent life-threatening event soon after

vaccinations and where retinal and intracranial

hemorrhages and long bones and rib “fractures” are identified.

References

1. The Journal of American Physicians and

Surgeons, Vol. 11, No. 1, spring 2006 issue. Also

available at http://www.jpands.org/

2. J.E. Leestma. Shaken Baby Syndrome " : Do

Confessions by Alleged Perpetrators Validate the

Concept? J Am Phys Surg. 2006; 11(1): 14-16.

Also available at http://www.jpands.org/vol11no1/leestma.pdf

3. M.D. Innis. Vaccines, Apparent

Life-Threatening Events, Barlow’s Disease, and

Questions about " Shaken Baby Syndrome. J Am Phys

Surg. 2006; 11(1): 17-19. Also available at

http://www.jpands.org/vol11no1/innis.pdf

4. C.A.B. Clemetson. Caffey Revisited: A

Commentary on the Origin of " Shaken Baby

Syndrome " J Am Phys Surg. 2006; 11(1): 20-21.

Also available at http://www.jpands.org/vol11no1/clemetson.pdf

5. J.E. Leestma. “Case analysis of

brain-injured admittedly shaken infants: 54

cases, 1969-2001.” Am J Forensic Med Pathol.

September 2005. 26(3): 199-212. Review.

6. F.E. Yazbak. Shaken Baby Syndrome:

Pitfalls in Diagnosis and Demographics. Red

Flags,February 2006. Available

at http://www.redflagsdaily.com/yazbak/2006_feb17.php

7. http://www.jpands.org/reprints.pdf