MEDICINE AND THE MEDIA
quently been referred again to the social
Thames Television This Week 13 July
Breaking the Silence New Statesman and
Society 14 July
Why shoot the
messenger?
This interview with Dr Marietta Higgs
was also reported together with an editorial
headed "Media abuse" in New Statesman and
Society on 14 July. The editorial said that the
press (or at least some part of it) had on
the subject of Cleveland "plunged into the
depths of journalistic standards," in that it
quickly and without due cause or considera-
tion condemned the paediatricians involved
as "obsessional zealots ... uncaringly des-
troying families." Both the editorial and the
television programme pointed out that of all
the professionals involved in the Cleveland
affair and criticised in the Butler-Sloss report
only Dr Higgs stands to lose her job.
During the interview Dr Higgs was able to
explain her approach to the paediatric con-
sultation, and she was asked about the diag-
nosis and subsequent management of sexual
abuse. Reflex anal dilatation was illustrated
with a rather clumsy and confusing animated
diagram and Dr Higgs repeated the assertion
made previously by other people that in no
child in Cleveland was the diagnosis made on
the basis of that finding alone. Asked about
management, she admitted that a number of
children and families had not been helped as
she would have liked: "There simply wasn't
the time, manpower, and resources."
Interspersed with the interview were clips
of Dr Higgs in her clinic and at home with her
family, and of two mothers. One mother, in
silhouette, claiming that her child had been
diagnosed wrongly and that her family had
been shattered, said "I hate her." The other,
seen through frosted glass, told how she had
come to realise that the diagnosis was correct
and that her husband had been the abuser;
she was glad that the diagnosis had been
made but was strongly critical of the subse-
quent management, wishing that she had
been allowed to put things right herself.
Facts and figures were offered- 121 child-
ren were diagnosed in five months as sexually
abused, of whom 42 had been referred to
the paediatricians with the diagnosis of
sexual abuse in mind; 39 were siblings or
"associates," and 42 were diagnosed after
presenting with other. problems. Diagnostic
guidelines formulated after Cleveland gave
an 80% correlation when applied subse-
quently. Of 28 children judged by the courts
not to have -been abused, five have subse-
268
Clapham omnibus that such a demand would
services, presumably because of a suspicion
of repeated abuse.
So what? What does it mean? What's the
point? What does it prove? Well, of course,
it doesn't prove anything. That's not the
function of television programmes. I don't
know Dr Higgs, I've never met her. I've felt
that her photographs and the shots of her on
the television news have made her seem a
rather cold and aloof person and that the
publicity has presented her as hard, self
D H.M
Dr Marietta Higgs
assured, and unbending. This programme
showed her as an attractive woman, the
mother of very normal and healthy looking
children, soft spoken, and vulnerable. It was
as if we were being told "let him who is
without sin cast the first stone." Certainly the
New Statesman and Society believes that it
would be unjust for her to be singled out to
bear the blame for Cleveland by being the
only one to lose her job. Its editorial is
accompanied by a cartoon in which a woman
doctor is presenting the "facts about child
abuse" with a revolver pointing at her
head; above her are the words "Shoot the
messenger?"
At the end of the interview Dr Higgs was
asked what assurance parents should be
given that they will never be wrongly accused
of sexual abuse. She turned the question back
on the interviewer. There can be no guaran-
tee: in the diagnosis of child abuse we cannot
achieve 100% sensitivity or specificity and
there will inevitably be false positives and
false negatives. In other topics this is ac-
cepted as axiomatic. Who asks that the courts
shall never falsely convict or wrongly acquit?
It is clear to even the dullest traveller on the
be unrealistic. The task of all professionals
concerned in child abuse is to refine tech-
niques so that diagnostic accuracy is the best
achievable and to make sure that subsequent
management really serves the best interests
of the child.
Television programmes like this serve a
useful purpose if they show the public the
difficulties and uncertainties. Obviously,
mistakes were made in Cleveland; but if they
hadn't been made in Cleveland they would
almost certainly have been made somewhere
else, and we have all learnt a lot. -D P ADDY,
consultant paediatrician, Dudley Road Hos-
pital, Birmingham B18 7QH
Ciba Foundation Media Resource Service
Maladies sans
frontieres
For the past three years a journalist wanting
background information on a scientific topic
has been able to get it from a British horse's
mouth: a telephone call to the Media Re-
source Service (01 631 1634 or 01 580 0100)
has put him or her in touch with a national
expert. Soon the service, like everything else,
is to go European, and it is recruiting experts
in science, medicine, and technology from
bodies such as the French Ministry of
Science and the European Space Agency.
A wider database should be useful because
the topics most requested in recent months
were:
* Cold fusion
* The spillage of oil in the Antarctic
* The spillage of lindane in the English
Channel
* Explosives: the ICI van that caught fire
while carrying explosives in Peterborough;
Semtex; and the bombing of Bristol Univer-
sity's students' union by animal rights pro-
testers
* Bovine spongiform encephalopathy
* Chlorofluorocarbons and the ozone layer.
One problem may arise, however, from the
variation of medical practice within Europe
(BMJ May 20, p 1334): it will be interesting
to see whether doctors here will soon be
expected to know about spasmophilia and
other non-British syndromes because their
patients have read about them in the daily
papers. -TRISH GROVES
BMJ VOLUME 299 22 JULY 1989