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

Source:

http://pediatrics.aappublications.org/cgi/content/full/114/1/330