> 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?
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.
> 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".
> 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.
> 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.
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.”"
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.
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.
> 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.
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.
>“The fact that the paper still exists means that medical students, pharmacy students, and, presumably, genetics students are being taught this as if it’s a real thing, and it has implications,” Juurlink told Scherer.
Yup. This paper was a lesson in my genetics class (2017)
The toxicology is pretty damning: codeine without morphine in stomach contents means someone crushed up Tylenol-3 and gave it to a 12-day-old baby. That's not a metabolic quirk—it's
homicide.
Koren's "ultra-rapid metabolizer" theory provided cover, and his research went on to clear 17 other caregivers in similar deaths. How many of those were actually murdered infants?
The idea of an opioid OD from breast milk immensely strains credulity in the first place. Such a claim should really have been put under much more of a microscope.
> The only data point in the scientific literature that had shaken his theory of the case was the near-death of Baby Boy Blue. He asked Rieder about the case. “Oh, we made it up,” Rieder replied.
I'd just like to invoke Betteridge's Law of Headlines.
"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.
I'd just like to invoke the principle to "not judge a book by its cover".
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.
I would suggest that when there's a possible crime, as there would be in this case, even a clearly guilty murderer caught red-handed holding a knife and screaming "I DID IT" will be an "alleged" perpetrator.
The article clearly lays out that the answer is yes. It points to specific ways the researcher adjusted their reporting to mislead readers. I think the key here is where Koren attempts to specifically account for the stomach content explanation: he misrepresents the lab results and claimed they showed the opposite of what they did.
>I'd just like to invoke Betteridge's Law of Headlines.
To say that it doesn't apply here, I hope?
Spoiler: the "celebrated researcher" in the title was discovered to commit fraud on a massive scale, was stripped of his physician license, and had multiple articles recalled.
He absolutely did obscure a baby's poisoning.
But that's not the main point of the article, nor is the story.
Tylenol 3 is an old & inexpensive medication. One has to wonder if one of Koren's undisclosed revenue sources was a manufacturer of pricier on-patent opioids (like Sackler).
Humans are fallible. Humans have egos. Humans can be intentionally dishonest.
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.
This is a nuanced point that anti-science people often get wrong.
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.
Ironically, being anti-science is pro-science. Skepticism of institutions and consensus is the scientific method.
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."
It means we need to be careful about distinguishing scientific consensus, and truth. Science can be used to find truth, but that is the science itself, not the consensus.
We can only have "scientific consensus" in maths (and even there there are doubts), every other science is a social science if one digs hard enough. Even particle physics.
obviously the scientific method is perfect , but i think i remember reading that the majority of studies are non reproducible, so things clearly arent perfect in practice. if one truly believes in the fallibility of humans, they also believe in the fallibility of the applying the scientific method - how could the output of of a fallible process ever be non fallible? confounding variables, hidden variables, incomplete sample spaces, etc ... these cannot ever be accounted for with certainty , thus i trust the scientific method as much as any human lol
Doing a PhD, I got to see a tension first hand that clarifies the reproducibility question: most of the papers I read were visibly garbage, but reading papers was a necessary step in achieving tasks. Every student at some point tries to achieve their concrete tasks without sifting through the dung heap to see how other people lied about their approach to the tasks, and it doesn't work- the garbage is a necessary ingredient and or enough authors are truthful.
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.
If they are not reproducible, then they are not valid studies and not using the scientific method which requires reproducibility. So yes, the scientific method is indeed perfect. lol
> 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?
Not just that, but potentially 17 other guilty caregivers have been cleared of suspicion based on the findings in that paper.
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.
> 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".
18 replies →
> 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.
> 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.
> 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.
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.”"
1 reply →
> 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.
1 reply →
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.
> 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.
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.
>“The fact that the paper still exists means that medical students, pharmacy students, and, presumably, genetics students are being taught this as if it’s a real thing, and it has implications,” Juurlink told Scherer.
Yup. This paper was a lesson in my genetics class (2017)
Such a distressing yet believable story where ambition overtook integrity … I hope Lancet improves its handling of such case studies.
The toxicology is pretty damning: codeine without morphine in stomach contents means someone crushed up Tylenol-3 and gave it to a 12-day-old baby. That's not a metabolic quirk—it's homicide. Koren's "ultra-rapid metabolizer" theory provided cover, and his research went on to clear 17 other caregivers in similar deaths. How many of those were actually murdered infants?
> He asked Rieder about the case.
> “Oh, we made it up,” Rieder replied.
Interesting anecdote. Something to keep in mind.
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I'm not surprised that The Lancet is slow or unwilling to correct the record after falling for yet another fraud.
[1] https://en.wikipedia.org/wiki/Fraudulent_Lancet_MMR_vaccine-...
[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
The idea of an opioid OD from breast milk immensely strains credulity in the first place. Such a claim should really have been put under much more of a microscope.
Great read.
> The only data point in the scientific literature that had shaken his theory of the case was the near-death of Baby Boy Blue. He asked Rieder about the case. “Oh, we made it up,” Rieder replied.
What the actual fuck.
I'd just like to invoke Betteridge's Law of Headlines.
"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...
I'd just like to invoke the principle to "not judge a book by its cover".
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.
Razors should guide, not replace, your engagement with the subject matter.
Yeah I thought about that when seeing the title; but after reading the article I'm quite certain the answer is yes in this case.
Also, Koren may have been a "celebrated researcher" at some point but he's now disgraced.
The headline was editorialised for the web. It originally ran under the headline "A Fatal Error".
I would suggest that when there's a possible crime, as there would be in this case, even a clearly guilty murderer caught red-handed holding a knife and screaming "I DID IT" will be an "alleged" perpetrator.
The article clearly lays out that the answer is yes. It points to specific ways the researcher adjusted their reporting to mislead readers. I think the key here is where Koren attempts to specifically account for the stomach content explanation: he misrepresents the lab results and claimed they showed the opposite of what they did.
In this case Betteridge's Law is wrong. The article (quite convincingly) argues "yes."
I am invoking Meta-Betteridge's Law:
"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.
It's a rhetorical device.
>I'd just like to invoke Betteridge's Law of Headlines.
To say that it doesn't apply here, I hope?
Spoiler: the "celebrated researcher" in the title was discovered to commit fraud on a massive scale, was stripped of his physician license, and had multiple articles recalled.
He absolutely did obscure a baby's poisoning.
But that's not the main point of the article, nor is the story.
Tylenol 3 is an old & inexpensive medication. One has to wonder if one of Koren's undisclosed revenue sources was a manufacturer of pricier on-patent opioids (like Sackler).
Humans are fallible. Humans have egos. Humans can be intentionally dishonest.
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 Scientific Method is really just one method of science. It's a very good one, but it has strict requirements that can't be met in all studies.
This is a nuanced point that anti-science people often get wrong.
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.
Ironically, being anti-science is pro-science. Skepticism of institutions and consensus is the scientific method.
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."
6 replies →
It means we need to be careful about distinguishing scientific consensus, and truth. Science can be used to find truth, but that is the science itself, not the consensus.
It does when science literally kills babies.
> and the scientific consensus
We can only have "scientific consensus" in maths (and even there there are doubts), every other science is a social science if one digs hard enough. Even particle physics.
Science as an "institution" serves only to protect egos, fraudsters, and politicians.
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.
1 reply →
obviously the scientific method is perfect , but i think i remember reading that the majority of studies are non reproducible, so things clearly arent perfect in practice. if one truly believes in the fallibility of humans, they also believe in the fallibility of the applying the scientific method - how could the output of of a fallible process ever be non fallible? confounding variables, hidden variables, incomplete sample spaces, etc ... these cannot ever be accounted for with certainty , thus i trust the scientific method as much as any human lol
Doing a PhD, I got to see a tension first hand that clarifies the reproducibility question: most of the papers I read were visibly garbage, but reading papers was a necessary step in achieving tasks. Every student at some point tries to achieve their concrete tasks without sifting through the dung heap to see how other people lied about their approach to the tasks, and it doesn't work- the garbage is a necessary ingredient and or enough authors are truthful.
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.
If they are not reproducible, then they are not valid studies and not using the scientific method which requires reproducibility. So yes, the scientific method is indeed perfect. lol
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