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PEDIATRICS Vol. 114 No. 1 July 2004, pp. 330

Junk Science and Glass Houses

Patrick Lantz, MD
Department of Pathology
Wake Forest University School of Medicine
Winston-Salem, NC 62357-1072

To the Editor. —

In lieu of pillorying other peer-review journals for publishing junk science, perhaps the editor of Pediatrics should critically review committee reports prior to publication that represent the official position of the American Academy of Pediatrics.¹ An article in BMJ has exposed a lack of objective scientific evidence that perimacular retinal folds accompanying retinal hemorrhages are diagnostic of abusive head trauma in young children.² The Committee on Child Abuse and Neglect has issued encyclical edicts bearing the imprimatur of the American Academy of Pediatrics that "retinal and vitreous hemorrhages and nonhemorrhagic changes, including retinal folds and traumatic retinoschisis, are characteristic of shaken baby syndrome."^3,4 References cited corroborating that canon are a nonsystematic review article, a noncomparative case series, and a book chapter.^5–7 Citations in those articles and book chapter indicating diagnostic specificity or presumptive causal mechanism of retinoschisis and retinal folds consist solely of noncomparative, observational reports.^5,8–12 The vested dogma that vitreoretinal traction causes traumatic retinoschisis and perimacular retinal folds during a presumed shaking episode is a faith-based assumption, not a scientific fact.

REFERENCES

1. Lucey JF. Fillers [letter]. Pediatrics. 2004;113 :432 –433[Free Full Text]
2. Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. BMJ. 2004;328 :754 –756[Free Full Text]
3. American Academy of Pediatrics, Committee on Child Abuse and Neglect. Shaken baby syndrome: inflicted cerebral trauma. Pediatrics. 1993;92 :872 –875[Abstract/Free Full Text]
4. American Academy of Pediatrics, Committee on Child Abuse and Neglect. Shaken baby syndrome: rotational cranial injuries—technical report. Pediatrics. 2001;108 :206 –210[Abstract/Free Full Text]
5. Greenwald MJ, Weiss A, Oesterle CS, Friendly DS. Traumatic retinoschisis in battered babies. Ophthalmology. 1986;93 :618 –625[Web of Science][Medline]
6. Levin AV. Ocular manifestations of child abuse. Ophthalmol Clin North Am. 1990;2 :249 –264
7. Levin AV. Retinal haemorrhages and child abuse. In: David TJ, ed. Recent Advances in Paediatrics. Vol 18. London, United Kingdom: Churchhill Livingstone; 2000;chap 10.
8. Gaynon MW, Koh K, Marmor MF, Frankel LR. Retinal folds in the shaken baby syndrome. Am J Ophthalmol. 1988;106 :423 –425[CrossRef][Web of Science][Medline]
9. Harcourt B, Hopkins D. Ophthalmic manifestations of the battered-baby syndrome. Br Med J. 1971;3(771) :398 –401
10. Massicotte SJ, Folberg R, Torczynski E, Gilliland MG, Luckenbach MW. Vitreoretinal traction and perimacular retinal folds in the eyes of deliberately traumatized children. Ophthalmology. 1991;98 :1124 –1127[Web of Science][Medline]
11. Mills M. Funduscopic lesions associated with mortality in shaken baby syndrome. J AAPOS. 1998;2 :67 –71
12. Mushin AS. Ocular damage in the battered-baby syndrome. Br Med J. 1971;3(771) :402 –404

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Robert W. Block, MD, FAAP
Chairperson
American Academy of Pediatrics Committee on Child Abuse and Neglect

In Reply. —

Dr Lantz is correct when stating that committee reports "represent the official position of the American Academy of Pediatrics." Unfortunately, he is not correct when he gives credit to his own article, recently published in BMJ, for having "exposed a lack of objective scientific evidence" for specific eye findings being "diagnostic" of abusive head trauma.¹ The characterization of reports as "encyclical edicts" exposes both an uninformed bias and a failure to recognize the work performed by American Academy of Pediatrics (AAP) committees. Dr Lantz fails to appreciate the difference between the words "characteristic" and "diagnostic." There is no doubt, based on accumulated scientific experience with hundreds of examples, that retinal hemorrhages and other ocular manifestations are characteristic findings, along with other biologic and sociologic markers, in cases of abusive head trauma. Although there may be some physicians who falsely assume all retinal hemorrhages or retinal folds are indicative of abuse, most have evolved medical opinions based on an accumulation of reports, including the single case reported by Dr Lantz and his colleagues. Unfortunately, many of Dr Lantz’s references in both his article and his letter are old, dating from 1971 to 1993, with only 1 citation in the article and none in his letter referring to work done in this century. When an AAP committee debates an issue and publishes technical reports, policy statements, or clinical reports, consideration of evidence representing evolving and current science weighs heavily on outcomes. As Dr Lantz would emphasize, a single case is an unlikely representative of scientific fact. Perhaps it would be better for all advocates for children and science to work together rather than tossing those stones at each others’ glass houses.

REFERENCE

1. Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. BMJ. 2004;328 :754 –756

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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