[Morizero]

> A toxicological screening of the “white curdled material” had detected codeine but not morphine. But Koren had claimed that the gastric contents “exhibited high morphine” levels—with no mention of codeine—“ruling out administration of Tylenol-3 to the baby.”

> “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?

[alterom]

> Does no one care that this is potentially a murder case?

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.

[hiyer]

Not just that, but potentially 17 other guilty caregivers have been cleared of suspicion based on the findings in that paper.

[teraflop]

I'd guess that everybody involved (including the coroner's office) tacitly understands that even if the baby was deliberately or negligently killed, there's very little chance after 20 years of finding evidence of who did it, in order to demonstrate guilt beyond a reasonable doubt. And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.

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.

[thaumasiotes]

> And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.

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.

[pickleRick243]

> And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.

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".

[mindslight]

The "happy ending" where one of the parents and their three other kids find out that the other parent likely killed the older brother they never met? That doesn't sound very happy to me, but maybe we have different definitions of happy?

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.

[BLKNSLVR]

Man, SIDS. It's specifically non-specific, but the worry it causes is quite specific.

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 :)

[mindslight]

I swear, all the shit they push at new parents. You can see the point to much of it, and it's obviously going to be a very stressful time regardless. But there's the same inescapable bureaucratic dynamic where once something becomes legible, the system pathologically emphasizes those few bits over and over and over, to the detriment of balanced judgement - both your own and most healthcare providers if you try to get some nuance out of them.

It's understandable that they're trying to help the people who might not be the most competent at following the guidelines, because there is still harm reduction to be had there. But it pushes the instruction-followers into the territory of "well, this probably doesn't apply to us because XXX", which is an epistemologically terrible place to be.

We're still joking about how much they repeated the advice to keep the belly button dry, when it was relevant for like maybe two whole weeks.

[globalnode]

during covid they actually laid hospital patients face down (suspended i think?) to help with breathing when a ventilator wasnt available. this behaviour reminds me of that, perhaps your baby was doing this to help with breathing? i dont know...

[maxbond]

We don't know it was the parents. Could've been a babysitter. Could've been a grandparent. New parents often have help.

[lmm]

> The "happy ending" where one of the parents and their three other kids find out that the other parent likely killed the older brother they never met? That doesn't sound very happy to me, but maybe we have different definitions of happy?

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.

[radiator_1451]

I mean, if it was the case that one parent killed the child (Which, to be clear, we don't know. It could have been anybody who had access to the child at the time), then I'd think the best outcome is them getting convicted of it. I don't know why so many people treat homicide as "not a big deal" when it comes to babies.

Consider an unrelated hypothetical scenario, a family father accidentally hits and kills somebody with his car. He flees from the scene and is not discovered for 20 years. Would you then not attempt to prosecute him because it would be sad for his family to know? And now consider the case if it was his own child that died.

[mindslight]

It's not that it's "not a big deal", rather the problem is you're up against the limits of details fading to time, negligence, etc. The best case here you're probably looking at each parent blaming the other parent for either doing it or at least letting it happen.

But really my main issue was with characterizing such a thing as a "happy ending". While it's generally good for justice to be served, we should still be wary of people who are a bit too gleeful about punishment.

[t0bia_s]

SIDS was named in 1969, might be related to combined vaccines.

https://www.chop.edu/vaccine-education-center/vaccine-safety...

[VMG]

have you read the linked page?

> However, since immunizations are given to about 90 percent of children less than 1 year of age, and about 1,600 cases of SIDS occur every year, it would be expected, statistically, that every year about 50 cases of SIDS will occur within 24 hours of receipt of a vaccine. However, because the incidence of SIDS is the same in children who do or do not receive vaccines, we know that SIDS is not caused by vaccines.

[teraflop]

Serious question: if the chance of evidence leading to a convistion is very very small, what would be the benefit of opening an investigation? Just to go through the motions on principle? And what would they even investigate?

[j-bos]

One benefit is demonstrating at least a facade of seeking justice. Also, obscuring a crime for personal benefit is itself a crime.

[knowitnone3]

so cops driving around is good enough, they don't have to actually catch criminals because it's it facade that really matters.

[happosai]

It's security theater, like airport security where red teams succeed in 95% cases

https://abcnews.go.com/US/exclusive-undercover-dhs-tests-fin...

[brianpan]

It's a cost-benefit analysis like many other things. There are limited resources, they should be spent on investigating cases that have a chance of getting closed.

Cold cases might get reopened because of advances in technology or other changes over time.

[cucumber3732842]

There is no potential "principal" here that is distinguishable from posturing and dick swinging.

Unless you find some unforeseeable smoking gun any conviction will necessarily be questionable at best. That doesn't really serve much of a purpose beyond saying "we're the prosecutor's office, look how bad ass we are, look how we somehow manage to convict someone decades later, fear us". Never mind the fact that dredging this stuff up is not likely to be good for the family and that odds are all of these deaths are purely accidental/negligent so it's not like you're going after a "real criminal".

[radiator_1451]

Investigating a murder is posturing? I really don't understand the "bad ass, fear us" language. Do you consider all criminal investigations to be as frivolous?

> odds are all of these deaths are purely accidental/negligent

How can you say that given that the article presents evidence that

> "... someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula

Is that an accident according to you, or do you have any evidence that the article is wrong about that conclusion?

[cucumber3732842]

>Investigating a murder is posturing? I really don't understand the "bad ass, fear us" language. Do you consider all criminal investigations to be as frivolous?

>How can you say that given that the article presents evidence that

Take a freakin step back and look at the big picture. Someone lost their kid, their first kid FFS. Even if a crime was technically committed along the way call it time served.

On a technical level, this is almost certainly not chargeable as a murder. Evidince of intent is lacking and almost certainly does not exist. The best you might be able to do is some negligent wrongful death manslaughter type thing, exact details depending on how such things are defined in the jurisdiction. Just based on plausibility these cases are almost certainly accidents. Very few mothers or the people around them murder newborns in the jurisdictions we're talking about. So if you did find intent, like a text exchange or something, the best you're likely to do is prove intent in the exact opposite direction and that no harm was meant. So then you have to prove negligence or something, which is also likely to be uphill. And this all assumes you can pin it on one person.

No good purpose is served by this. You're not getting some hardened criminal off the streets or putting someone in jail for an act committed with a bad frame of mind. Best case you wind up punishing someone using some negligince wrongful death type statues that's written based on the assumption that the person who caused the death DGAF about the deceased. Even if you pull that off this person is probably the mother or father or a grandparent who already lost their kid or grandkid for it so there's a real tinge of double jeopardy to the whole thing. This serves no purpose other than a show of force by the prosecuting office. The "real" crime committed here is not accidentally giving one's infant the wrong pills (someone gave a kid Tylenol, it's not like it was Xanax or booze to shut them up or some other thing everyone knows you don't do), the facts are likely to stack up in a way that make that act a non-criminal accident. So what you're doing in practice is screwing up one or more people's lives, to much fanfare, because they failed to tell the whole truth to the state a decade or more ago. Now, I get that that might sound like a good thing to some people, but those people are bad people and their ideas are bad ideas.

>Is that an accident according to you, or do you have any evidence that the article is wrong about that conclusion?

Stop trying to re-frame my assertion as an issue with the article rather than a critique of the proposed action (prosecuting someone). I know you'd rather discuss that, because that's much more defensible than a hypothetical decision to prosecute, and I do not accept your slight of hand.

[Thorrez]

Why do you think someone intended to kill the baby?

>But the forensic-toxicology laboratory’s measurements showed that his acetaminophen concentration was in the range of what you’d expect to find in a baby’s bloodstream soon after he’d been administered a standard dose.

>“I am familiar with patients whose babies have died after a caregiver gave the opiate directly.”

Maybe the person thought the tylenol-3 would help the baby.

[radiator_1451]

Maybe the person thought that, but that would still be an absurd belief for them to hold. First of all, it doesn't seem like he had any problems he needed "help" with, the article only says he was "developing normally". Second of all, why would you give a random pill meant for adults to a baby not even two weeks old, without asking a nurse or at least reading the package insert?

[Thorrez]

Maybe the person thought "I've given Tylenol to babies in the past and it was fine" without realizing the difference between Tylenol and Tylenol-3.

It's possible the person even thought "Tylenol-3, hmm, that must be another term for children's Tylenol, Tylenol for 3-year-olds. I've given that to babies before."

[steelbrain]

> Does no one care that this is potentially a murder case?

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.

[pickleRick243]

Are you Koren? Did we read the same article? The one that calls into question anything Koren says or claims?

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.”"

[Twisol]

Also relevant to the quote selected by 'steelbrain:

> 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.

[maxbond]

> If this is in the breastmilk, ...

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.

[alterom]

> GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.

It appears that they didn't really read the article before commenting.

The entire point, the damning evidence is that the child that died had codeine in his stomach, which he absolutely couldn't get from breast milk.

[mlyle]

The original death finding falls just from simple back-of-napkin math.

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.

[Twisol]

> I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.

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.

[likpok]

The article goes into detail about how this level of morphine in the breastmilk could not have given the baby a lethal (or even clinically effective) dose.

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.

[irishcoffee]

This should be further up: it's metabolized into morphine.

There are some giant red flags with this situation. How awful.