Comment by Morizero
17 hours ago
> 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".
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?
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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.
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> 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.”"
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.
> 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.
> 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.
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.
This should be further up: it's metabolized into morphine.
There are some giant red flags with this situation. How awful.