Modern Myths

It would be good to think that we don’t live in an age of ‘medical myths’, that life was logical and scientific, all things proven, substantiated. Dream on.

We should all drink 3 litres of fluid (or water) a day, shouldn’t we? The figure of ‘3 litres’ seems to have come from fluid balances in kidney patients. Obviously, we all have to drink some fluid a day, and there is an upper limit to how much we can pee out, but ‘3 litres’ is more like a number plucked from a hat than anything else. I have yet to find any reputable scientific support for this.

And while we on about healthy living, we should all eat ‘5 portions’ of fruit a day, shouldn’t we? Unless we live abroad, when we should eat 8 or more. And sometimes potatoes are included, and sometimes they aren’t. Oh, I did discover that a ‘portion’ is 80 grams.

So where did the ‘5’ come from? As far as I can discover, it started with the fruit growers in California who wanted to improve their sales. So they suggested doubling the amount of (their) fruit that people age, and lo! The magic ‘5’ was born. And this was subsequently taken over by the World Health Organisation. The cynics amongst you will recall how shampoo manufacturers doubled sales — by telling consumers that they should shampoo twice. I’m sure that fruit is good, as part of a ‘balanced diet’ (whatever that might mean), yet the rationale for 5 — or any other number — is more belief than something clearly proven.

Munchausen’s syndrome was first described by Richard Asher in the early 1950s; it’s typically characterised by patients seeking medical attention with strange neurological, abdominal or ‘bleeding’ complaints. Baron Munchausen was famous for his fabulous adventures, as recounted by his ‘biographer’ Rilke. Richard Asher ‘talked sense’ on many topics — and was also the father of Jane.

Anyhow, the idea of ‘Munchausen’s by proxy’ developed; patients with psychiatric problems whose children presented with strange symptoms and problems — due to abuse by their mothers. Professor Sir Roy Meadow is credited with its identification. What became known as Meadow’s law is: “unless proven otherwise, one cot death is tragic, two is suspicious and three is murder”, though he seems not actually to have said this.

You may recall the trial of the solicitor, Sally Clark, prosecuted after the death of two of her children. Sir Roy gave evidence, she was convicted, though this was much later overturned on appeal.

The chance of a cot death¹ is roughly 1:8500, that is, there will be one cot death for every 8500 births. Sir Roy gave evidence to the effect that the ‘chance’ of a second cot death was about 1:73,000,000. He seems to have squared 1:8500 to arrive at this figure.

However, he did not seem to recognise that ‘chance’ here refers to a random finding, something that cannot be predicted; and that chance has no memory. If you flip a coin, and it comes down heads, the next time you flip it will be either heads or tails — equally. That it came down heads the first time is totally irrelevant. So, if you have had one cot death, your chance of a second remain exactly the same.

Or not: the cause or causes of cot death are unknown, which is not the same as saying that there are no causes, that it’s entirely a random, chance event. Moreover, you could well argue that whatever the cause or causes are, if you have had one cot death, these same causes could well make you more likely to have a second.

And here I must hang my head; I remember the original trial well, and I remember thinking then that the evidence, as reported in the newspapers, was flawed; yet it is to my continuing shame that I did nothing.

Munchausen’s syndrome by proxy may well be a real problem; but, as so often in the past, those who believe blindly in it (a syndrome of their own discovery) are unable or unwilling to see and accept other explanations.

1. It is conventional to declare an interest; I do so declare.