> “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”
Does no one care that this is potentially a murder case?
The scientific case about infant opioid poisoning in general is a separate issue, of course. But assigning blame in this particular case doesn't have any bearing on that.
It's probably true that without a chance of conviction, standard protocol dictates that public resources should not be expended on reopening the investigation. But I was also heavily distracted while reading the article, scanning optimistically for the happy (under the circumstances) ending where justice is served. I certainly don't think there is "no benefit to anybody".
When I tried reading into the causes of so-called SIDS it seemed like at least some of the cases were a catch-all diagnosis that included cases where parents inadvertently killed their infants (eg co-sleeping and rolling onto them). Fundamentally I think there often isn't much upside to fully fleshing out the truth of cases where parents have already paid the heaviest price.
My daughter, as a baby, always managed to find a way to sleep on her stomach. Wouldn't sleep on her back, but almost magically by comparison would fall asleep lying on her stomach (face to one side or the other, not straight down, obviously - I hope). We tried various combinations of devices, arrangements of pillows and cushions, tight wraps, to keep her lying on her back, but babies are remarkably, if involuntarily, wilful (or she was, anyway, and remains to this day).
I worry about very few things, but for the first few nights we'd regularly get up to check on her, and literally be holding our breath waiting for her to expel hers.
Out of necessity the every-parents-SIDS-fear, from allowing the baby to sleep on their stomach, had to be removed from our psyche so that we could continue to function day-to-day.
Said baby is now, thankfully, a semi-healthily functional teenager. As functional as teenagers get anyway :)
While "happy" isn't the word I'd use, that seems better than knowing that this could happen to any baby at any time and nothing would be done.
https://abcnews.go.com/US/exclusive-undercover-dhs-tests-fin...
Cold cases might get reopened because of advances in technology or other changes over time.
The benefit would be to formally reject the fake science that was used to close the investigation the first time. A conviction is beside the point.
I'd say, a very low chance of murder, and a near-certainty of at least manslaughter (unintentional killing), with a zero chance of prosecution due to lack of evidence.
Plus, I hardly see any value of jailing any of the caregivers for this. Whether an investigation should be made, I don't disagree.
Did we read the same article? Why are you so quick to jump the gun here?
> Koren obtained a sample of Rani’s breast milk, which she had kept in her freezer. His lab measured its morphine concentration at eighty-seven nanograms per millilitre.
If this is in the breastmilk, it will end up in the stomach, and it may end up in gastric contents. I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.
87 ng/mL.
Baby eats 30mL per hour. That's 2.6 micrograms of morphine.
Elimination half life in neonates of ~8 hours means 30 micrograms in system at equilibrium if constantly fed this and the baby absorbs all of it (takes 4-5 half lives to get to that) and pharmacokinetics are linear. In reality a neonate likely absorbs well under 1/3rd, so you'd expect under 10 micrograms in equilibrium.
25-50 micrograms/kilogram is normal dosing of morphine in a neonate when it is necessary, every 6 hours (resulting in a peak systemic concentration of ~60-120 ug/kg after repeated dosing).
Compare -- 60-120 ug/kg therapeutic dosing to 10 micrograms in the neonate's body (3-4 kilos, so 3 ug/kg??)
And then, you end up with acetaminophen and codeine in the neonate's stomach, with no morphine... Even though these do not end up in breast milk in significant quantities.
From the article I read:
"A twelve-day-old infant cannot crawl. It cannot grab, and it cannot put something into its own mouth. “It also cannot swallow a Tylenol-3 pill,” Juurlink told me. “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”"
> Recently, Parvaz Madadi has undergone a painful process of revisiting her past work and memories. [...] She added that she had no confidence in the measurement of Rani’s breast-milk sample, because it had been handled by Koren’s lab.
There is a lot to process in this long article. The quote selected by 'steelbrain, concerning Koren's measurement occurs very, very early on, and much of the rest of the article is about contrasting Koren's early presentations of the material against others' testimony. It's worth reading the whole thing
To 'steelbrain: cherry-picking one single quote out of a nuanced article does the journalism here a dire disservice. It's okay for different people to have different beliefs and takeaways from the article. However, your own defense of the biological mechanism here is directly argued against in the "same article" you are admonishing others over reading. That is not conducive to a discussion in good faith.
Note that you and GP are talking about different values of "this." GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.
Neither the article nor the commenter you replied to has demonized the parents. Yes, both the evidence discussed in the article and the opinions of those interviewed indicate direct administration of a pharmaceutical; it is appropriate to discuss this. Nobody has pointed the finger at anyone; it would indeed be quite inappropriate for such a discussion to be held in this forum.
Furthermore, Koren lied about what the tests showed the stomach contents to be: he omitted codeine entirely. Codeine (per the article) would not be expected to be transferred by breastmilk -- it's metabolized into morphine to be effective.
Same family as the Purdue Pharma people?
> “Oh, we made it up,” Rieder replied.
Interesting anecdote. Something to keep in mind.
"Any headline that ends in a question mark can be answered by the word no."
It is based on the assumption that if the publishers were confident that the answer was yes, they would have presented it as an assertion; by presenting it as a question, they are not accountable for whether it is correct or not.
https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
The article here is very well written and does a great job of conveying the perspectives and opinions of many parties. I would recommend reading the article in spite of its headline.
Also, Koren may have been a "celebrated researcher" at some point but he's now disgraced.
"any comment that dismisses an article based on it's headline has no value"
For large publications like the New Yorker, it is an Editor, NOT THE AUTHOR who writes a headline.
But the Scientific Method is the only functional bullshit detection system we have. When it is allowed to work, science corrects itself and excises the falsehoods.
It’s a shame that outsized egos within The Lancet and other orgs are still very much in play.
The existence of fraudulent studies, dishonest researchers, the replication crisis, etc. does not invalidate science as an institution. It just means we need to be careful about distinguishing between individual opinions and the scientific consensus. We also need to keep in mind that the consensus is never 100% correct; it's always subject to change and we need to update our beliefs as new evidence comes in.
The main reason being scientific consensus can lag reality significantly, especially when career incentives discourage dissent. The history of science includes many cases where consensus was wrong and critics were marginalized rather than engaged.
Deference to science as an authority is the opposite.
Feynman has a quote on this:
"Science is the belief in the ignorance of experts. When someone says, 'Science teaches such and such,' he is using the word incorrectly. Science doesn't teach anything; experience teaches it. If they say to you, 'Science has shown such and such,' you might ask, 'How does science show it? How did the scientists find out? How? What? Where?' It should not be 'science has shown' but 'this experiment, this effect, has shown.' And you have as much right as anyone else, upon hearing about the experiments — but be patient and listen to all the evidence — to judge whether a sensible conclusion has been arrived at."
I think we've been pampered by a few hundred years of rapid "scientific advancement" and now we're firmly in the area where things are not grade-school science fair easy to see or prove.
skepticism is necessary, but not sufficient.
if they merely nay-say institutions and then go with their gut, it's certainly not.
only when someone attempts to rationally disprove a position, offering alternate testable theories and actually performing those tests is science done.
if you suspect an institution is wrong, that's fine, but it's just a hunch until someone does a test.
Which is why one of the core tenets of practicing Science is “trust, but verify”.
Science is based on the trust of what came before.
But the fallible, ego-driven, and dishonest nature of humanity means that trust alone cannot be relied upon. Hence the “but verify”. That is why replication studies and falsification tests exist - to cull that which cannot be reliably replicated.
Unfortunately, capitalism has stepped in and f*ked up even that, when for-profit universities who rely on public funding place “publish or die” mandates on researchers. This makes any repeat experiments untenable because it takes researchers away from publishing new data. So they just cite prior papers and chase the latest shiny -- because their continued employment is predicated upon publishing.
We have perverse incentives in place that have distorted science, sure. And almost all of these distortions come directly down to a violently coercive economic system that forces you to be profitable to someone else least you suffer homelessness, destitution, and even death.
But what else is there? Belief in an insane, evil, and omnicidal sky-daddy?
Sorry, but no. We should counteract the sources of distortions by crushing capitalism and the corrosive influence of money, not switching over to systems that have always proven themselves to be supremely untrustworthy.
When citizen science is ridiculed and "the institution of science" is glorified this is what you get.
And anyone who dares to profess this, is a loony, a conspiracy theorist, an anti-scientific person, etc.
The best media representation I've seen of this process is the youtube channel Explosions&Fire, which attempts to replicate entertaining-looking chemistry papers. He's often mad at the authors of the papers he's using in any given episode, but following their breadcrumbs is still effective enough (compared to I guess mixing acids and stuff based on vibes?) that he keeps at it.