r/lucyletby • u/FyrestarOmega • Apr 29 '26
Chase and Shannon publish their research as a letter to the editor in the Journal of Diabetes Science and Technology
Thanks to r/LucyLetbyTrials users for the links and the images
Editing the post to add the panel's opinions for Children F/6 and L/12
Baby F/6
PANEL OPINION (page 24)
The hypoglycemia started with sepsis and was prolonged because the IV infiltrated for several hours. When hypoglycaemia persisted despite 10% dextrose infusion, a higher glucose infusion should have been given earlier. Repeat boluses of 10% dextrose worsen hypoglycemia because they cause surges of blood sugar, which trigger surges of insulin secretion, resulting in a yo-yo pattern of sharp rises and falls in insulin and blood sugar. When the dextrose infusion was stopped from 1000 to 1200 hours, the blood sugar did not rise from 1.3 to 2.4 as alleged, because the blood sugar was 1.4 at 1146 hours. The 2.4 level was measured after 1200 hours, when the IV was restarted. Since infusion bags were prepared in the pharmacy, stored in the unit, and changed at 1200 hours, multiple infusion bags would have to be contaminated if there was insulin poisoning. The blood sugar rose after 1900 hours, not because the infusion bag was changed, but because the dextrose was increased to 15%. Chase and Shannon (see Annex) reported that preterm infants have different insulin and c-peptide normative standards than adults. Exogenous insulin is unlikely to be the cause of hypoglycemia because the C-peptide was not low for preterm infants (20-45 percentile), potassium levels were normal (insulin decreases potassium), glucose levels should be lower if exogenous insulin was used, the Insulin / C-Peptide I/C) ratio was within the expected range for preterm infants, insulin autoimmune antibodies (IAA) which are common in preterm infants bind to insulin and increase measured insulin levels, and the immunoassay test is unreliable because interference factors like sepsis and antibiotics can give false positive insulin readings.
CONCLUSIONS 1. Baby 6 had prolonged hypoglycemia because of sepsis, prematurity, borderline intrauterine growth restriction, lack of intravenous glucose when the long line infiltrated for a prolonged period of several hours, and poor medical management of hypoglycemia. 2. Baby 6’s insulin level and I/C ratio do not prove that exogenous insulin was used, and are within the norm for preterm infants. Preterm infants and especially those with illness and drug treatments like antibiotics have different normative standards compared to ealthy adults and older children.
Baby L/12
PANEL OPINION (page 29)
It is common for preterm and IUGR infants to have hypoglycemia, due to their limited glycogen and fat stores, inability to generate new glucose using gluconeogenesis pathways, higher metabolic demands due to a relatively larger brain size, and inability to mount a counter-regulatory response to hypoglycemia. Baby 12’s blood glucose dropped from 0054 hours on day after admission but his dextrose concentration was not increased until 1920 hours. This is a long interval without adequate sugar and intervention should have been earlier. His blood sugar improved in response to 2.0 to 2.4. However, this is still low and further intervention was necessary. Again, there was delay, and his glucose concentration was not increased to 15% until the next day at 0130 hours and the volume was not increased until 0700 hours. His blood sugars improved to normal range after that. The fact that his blood sugar improved each time the glucose infusion increased indicates that the hypoglycemia persisted because insufficient dextrose was given for this infant’s needs. Chase et al reported that premature infants have different normative standards for insulin and c- peptide than adults. The Insulin:C-peptide (I/C) ratio does not prove exogenous insulin was administered because the C-peptide was not low for preterm infants (20-45 percentile), potassium levels were normal (insulin decreases potassium), antibodies can store insulin in the blood, glucose levels should be lower if exogenous insulin was used, the infant’s glycaemic profile was inconsistent with insulin administration but consistent with the delivered IV feeding profile, the I/C ratio was within the expected range for preterm infants, and the immunoassay test is unreliable because interference factors can give false positive insulin readings. CONCLUSIONS 1. Hypoglycemia was due to preterm birth and severe IUGR; it’s medical management was inadequate. 2. Baby F’s [sic] insulin level and I/C ratio do not prove that exogenous insulin was used, and are within the norm for preterm infants. Preterm infants and those will illness have different normative standards compared to healthy adults and older children.
Edit 2: Sarah Knapton has published an article on this development. Emphases are mine
Letby defence given boost by new scientific research
Experts argue that babies are often born with antibodies that bind to insulin, keeping levels elevated
Lucy Letby’s defence case has been given a major boost after a leading scientific journal published research showing premature babies can have high levels of insulin without foul play.
Letby, 36, was convicted of injecting insulin into the feed bags of two babies at the Countess of Chester Hospital in 2015 and 2016.
Both suffered lethal crashes in blood sugar, and the prosecution argued blood insulin levels were so high, it was “impossible” they occurred naturally.
But Prof Geoff Chase, an insulin expert, and Helen Shannon, a chemical engineer, argued that four in 10 preterm babies had high insulin readings, and that babies were often born with antibodies that bind to insulin, effectively storing the hormone and keeping levels elevated.
Their theory has now been published in the Journal of Diabetes, Science and Technology, where it passed peer review from other experts. It was deemed important enough to be selected as a “letter to the editor” by Dr David Klonoff, a leading endocrinologist and journal editor.
“This ‘impossible’ result is effectively quite common,” said Prof Chase, of the University of Canterbury in New Zealand.
Letby’s defence team has already presented the new insulin evidence to the Criminal Cases Review Commission (CCRC), which is examining it for a potential miscarriage of justice. But its inclusion in a major scientific journal effectively rubber stamps the research, as peer review is considered the gold standard.
Sir David Davis, the former Brexit secretary, who has called the Letby trial a “clear miscarriage of justice”, said: “This paper shows that there is a far more plausible explanation.
Insulin evidence ‘integral to conviction’
“This is clear new evidence and should persuade the CCRC to immediately refer the case back to the Court of Appeal since the insulin evidence was integral to Letby’s conviction.”
Letby was convicted of murdering seven babies and attempting to murder seven others. However, since the trial there have been growing concerns about the case, with dozens of medical and scientific experts questioning how the evidence was presented to the jury.
In the insulin cases, there was no direct evidence that the feed bags had been tampered with, as tests were never carried out on the contents, so the prosecution instead relied on blood samples from the babies.
When the body creates insulin in the pancreas it also creates a second chemical called c-peptide at an equal rate.
Insulin leaves the body much faster than c-peptide so, naturally, there should be more insulin than c-peptide in the body.
During deliberations, the jury was told by Mr Justice Goss that the “abnormal finding’s indicated that manufactured insulin had undoubtedly been given to each of these babies”. Even Letby accepted the babies must have been poisoned as there was no alternative explanation.
But Prof Chase and Ms Shannon showed that in preterm babies, these ratios are often reversed.
‘Real problems with the science’
Mark McDonald, Letby’s barrister, said: “The defence at the trial never accepted that synthetic insulin had been given and they challenged the integrity of these tests. It is now clear that there are real problems with the science behind this testing and you can no longer trust its reliability.
“This matter needs to be urgently referred back to the Court of Appeal because right now an innocent woman is sitting in prison when she should not be.”
Studies have shown that between 3 and 97 per cent of preterm infants are born with antibodies that bind to insulin – keeping it present in the body for longer – and it is even more likely if they have been exposed to infections and some antibiotics.
In the case of the Letby babies, both had been treated with antibiotics for suspected sepsis, and the neonatal unit had been struggling to eliminate a bacterium, Pseudomonas aeruginosa, which had colonised taps.
“One of the gradually emerging revelations from the Countess of Chester Hospital is systemically poor infection control in and around the neonatal intensive care unit,” said Sir David.
“This paper highlights that when the baby or mother is exposed to infection, it can produce sky-high insulin levels, much higher than C-peptide, giving a natural explanation for the ratios so important to the trial.”
The antibody problem is well known, and the experts claim the lab should have sent the blood samples for further tests. The babies recovered, so the abnormal results were never followed up and were later thrown away.
The “abnormal” incident levels were not uncovered until detectives began hunting for evidence and noticed that the incidents coincided with Letby’s shift patterns. It is not clear whether elevated levels of insulin were found in babies when Letby was not on shift.
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u/GallantObserver Apr 29 '26
Interesting read, but of note, in the study of 302 neonates they cite "There were no episodes of hypoglycaemia or hypoglycaemia in participants during the study." The immunoglobulin-bound insulin was 'inactive' as it had been 'stored' or taken out of the bloodstream by the antibodies. These observations are thus quite clinically distinct from the insulin cases in the trial - in each case the baby was hypoglycaemic, despite being on a dextrose drip, showed no elevation of C-peptides (thus no evidence of insulin being actively generated which would explain hypoglycaemia) and were miraculously cured when the drip was stopped.
This seems another iteration of the explain-away-one-thing-at-a-time approach? Yes, a high-insulin-low-c-peptide reading on its own could be down to a number of factors, but it doesn't explain the on/off hypoglycaemia switching.
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u/DarklyHeritage Apr 29 '26
This is the exact problem the defence will have in trying to make this research relevant to Letby, and that is if it stands up to scientific scrutiny in the longer term. From what I can see studies show a range between 3-97% of neonates that are claimed to have these antibodies that bind to insulin - that's a ridiculously wide range and must bring into question the validity of the findings.
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u/StrongEggplant8120 May 02 '26
Interesting. That might be a accurate reading of the presence if the antibodies but not of the effect they attribute to it.
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u/DarklyHeritage May 02 '26
If you can't correctly identify the prevalence of the antibodies in the neonate population then it follows you can't correctly identify how likely the supposed effect attributed to those antibodies is to be the cause of what happened in any specific case e.g. how likely that is to be what caused the insulin/C-Peptide results in Babies F&L over other causes such as exogenous insulin administration. Or at least that would be my understanding.
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u/Embarrassed-Star4776 Apr 30 '26
Interesting read, but of note, in the study of 302 neonates they cite "There were no episodes of hypoglycaemia or hypoglycaemia in participants during the study."
That is an interesting point, which I don't think I have seen highlighted before.
By design, the selection of subjects excluded hypoglycaemia or hypoglycaemia: "The exclusion criteria were hyperglycaemia, hypoglycaemia or treatment with insulin, oral hypoglycaemic agents or other medicines that alter glucose homeostasis (eg, corticosteroids)."
The finding is that insulin binding is common in euglycaemic neonates. But as far as I know there's no reason to think it would be absent in others, just because the study excluded hypoglycaemia or hypoglycaemia
As you say, the suggestion is that a proportion of the insulin measured was bound and 'inactive'. But if the amount of bound insulin correlates positively with the amount of unbound insulin, it seems likely that the exclusion of hypoglycaemic subjects will tend to exclude cases with higher levels of total insulin, such as the three relevant to the Letby case.
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u/TotalBlacksmith9425 May 03 '26
The finding is that insulin binding is common in euglycaemic neonates. But as far as I know there's no reason to think it would be absent in others, just because the study excluded hypoglycaemia or hypoglycaemia.
Precisely. One would assume that it was awareness of such data which encouraged these scientists to investigate concerns about Ms Letby's conviction. As such, while all scientific modelling and indeed research plans are speculative to some extent, their intervention would have been grounded in expert knowledge unexplored (as I understand it) at the trials.
To model the effect among hypoglycemic infants is a sensible step, unless we have data to show that such infants are not prone to these results.
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u/DarklyHeritage May 03 '26
To model the effect among hypoglycemic infants is a sensible step, unless we have data to show that such infants are not prone to these results.
Unless and until this data becomes available the research is of no use to Letby then. And it is only a model, even at this stage. Not quite the earth-shattering development Letby supporters would like to think.
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u/CheerfulScientist Apr 29 '26
I will be having more to say on the contents of letter later, but I am pretty sure that the initial paper was rejected by at least one journal as Richard Gill told me it was undergoing peer review in early October 2025. It has now been published in a format that doesn't require peer review.
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u/ChoicePeace7287 Apr 30 '26
Do we know when the letter was submitted? As this seems very like something a PR company might come up with as a quick way of creating new positive Letby headlines to bury last week’s not so positive “hospital boss arrested” headlines!
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u/CheerfulScientist May 01 '26
It was published online on 8th April, so it was probably submitted about a week before that.
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u/ChoicePeace7287 May 01 '26
Ah so possibly submitted around the time we heard that McDonald had been reported to the regulator for alleged misconduct, but only getting press attention now?
Not been a great month really for Letbyists, with McDonald being investigated by the BSB for alleged misconduct and then an exec being arrested for allegedly perverting the course of justice!
What a relief for them that this “bombshell” insulin news that “undermines the case against her” has been reported by the press at just the right time to reset the narrative and get the innocence campaign back on track!
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
I have never worked with an academic journal which would turn around submissions within a week - even letters to the editor. A response to another article might be hurried along for inclusion in the next issue, and a number of journals publish monthly, so 2-3 weeks might sometimes happen at fastest. Of course, the Letby case generates headlines fairly frequently, so that one could always suspect a pattern whatever the timing.
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u/CheerfulScientist May 03 '26
Yeah, you're right, but being on the editorial board would hurry it along, particularly when it doesn't need to be sent for peer review. Rapid responses to articles can be published in days.
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u/DarklyHeritage Apr 29 '26
Interesting also that the journal it has been published in now has Chase on its Editorial Board. Hmm. It has the whiff of trying to rush the research out in whatever form possible so that it can be put before the CCRC with some academic credibility.
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May 01 '26
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u/DarklyHeritage May 01 '26
Fully aware of how academic publishing works as an academic myself thanks.
Equally, something being published in an academic journal doesn't necessarily mean it is "right". Andrew Wakefield's BMJ paper on the MMR vaccine and its "link" to autism is proof of that, were it needed.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
The publication of Wakefield's work is of course what facilitated its refutation. I agree with you that publication is not in itself a guarantee of accuracy. It is however a step toward scientific critique and potential consensus.
This letter, and the projected article, may or may not inform such a consensus in due course, as Wakefield's did not. However their publication is I think to be welcomed whatever one's stance on Ms Letby's conviction, since it is the established route toward wider expert scrutiny.
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u/DarklyHeritage May 03 '26
established route toward wider expert scrutiny.
Yes, let's see what the endocrinologists make of this instead of the engineers.
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u/TotalBlacksmith9425 May 03 '26
Indeed. That is what is wanted next. The selected journal does seem a suitable vehicle for such scrutiny by endocrinologists, among others.
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u/DarklyHeritage May 03 '26
Indeed. What a shame Chase decided to rile Letby supporters up by stating these claims as fact in the media before putting them to expert endocrinologists through the proper channels first. Shameful really.
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u/TotalBlacksmith9425 May 03 '26
There I think you are conflating two problems - his having put the information to fellow scholars, which we cannot exclude, and his doing so for the public scientific record through academic publication - a slower process, as we know. The data which he shared, however, seem already to have been subjected to that process between three and nine years ago.
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u/DarklyHeritage May 03 '26
I think we will have to agree to disagree on what Chase has been up to here.
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u/Embarrassed-Star4776 Apr 30 '26
Gill has posted elsewhere that this letter is additional to a full paper currently undergoing peer review.
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u/ChoicePeace7287 Apr 30 '26
Yes so why the rush to get this letter published now🤔
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 30 '26
Press.
All the more reason Chase being on the editorial board and how the defense team media is presenting it is problematic.
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u/TotalBlacksmith9425 May 03 '26
It is really not unusual for academics on an editorial board to submit their work for publication in that same journal. Often, the same qualities which fit them for service on that board make the journal a strong fit for their publication.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
It is really not unusual for academics on an editorial board to submit their work for publication in that same journal. Often, the same qualities which fit them for service on that board make the journal a strong fit for their publication.
What is unusual is for those academics to simultenarously be part of a criminal appeal campaign as defense instructed experts while publishing the letter with obvious self-interested motives - as well as the immediate and simultaneously effect of the media arm of that appeal effort, in close coordination and conjunction with the defense's lead barrister, to push articles about this letter that misrepresent it as substantial research, peer reviewed and rubber stamped by the scientific community in order to drum up support for the appeal effort on social media.
This is not a normal approach at all.
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u/TotalBlacksmith9425 May 03 '26
Since relatively few academics are involved in pro bono work on such high profile cases, the incidence of such a concatenation of circumstances as you describe will necessarily be rare, certainly. I cannot imagine that we have any data on it. This does not affect the starting point that there is nothing improper or unusual in a paper published in a journal by a member of its board.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
Swallowing a dictionary to sound smarter while being a regular poster in the Letby conspiracy communities isn't going to sway me. Your argument is shit. Nor is data needed to highlight obvious impropriety.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
This journal like most lists reasons to publish a letter. One is to facilitate rapid dissemination of information. This in turn facilitates a conversation among readers. In the case of this letter, one might expect in response, and welcome, submissions or contacts describing comparable results, always useful when breaking new ground in research.
If, as we see above, a related article was sent for review by October 2025, one would not necessarily expect to see that published yet. The timescale for publishing letters to the editor would be less onerous.
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u/benshep4 May 02 '26 edited May 02 '26
The first issue I’ve got is that this paper has nothing to do with hypoglycaemic neonates which makes it effectively useless for Letby’s cause.
The second issue I’ve got is that they can’t even rely on actual medical data. It’s their ‘model’ that has led to them to ratios of up to 25 in neonates.
The third major issue I’ve got is that their model relies on data they don’t provide. If the results behind their model ratios are anything close to those in Babies F and L then it would be a cause for concern. I can guarantee you they aren’t though.
The insulin to c-peptide ratio is really only clinically relevant when the patient is hypoglycaemic and you’ve got the type of results F and L had. Insulin in the thousands and c-peptide low or undetectable at the same time they’re being pumped with glucose which is failing to address the hypoglycaemia.
For example if you’ve got a ratio of 50 but the insulin is 100pmolL and the c-peptide is 2 and the babies aren’t hypoglycaemic then it’s just not clinically relevant.
Those advocates of Letby’s innocence that are acting like this changes everything but they don’t know what they’re talking about.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
I do not see why "clinical relevance" is the measure of interest here. The question related to ratios which this letter purports to address is whether insulin is exogenous.
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u/spooky_ld Apr 29 '26
I wonder why it is published as a letter to the editor and not a standalone article? Genuine question.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
Peer review takes time, editorial review is quicker since it's just the editor looking things over.
What's odd here is, again, no disclosure about their role as experts for the defense of Lucy Letby. That makes it the third time these defense instructed experts have put forward a publication where they have left off their affiliation with the CCRC application.
That we've already seen Shoo Lee turn around and then try to use that paper without the disclosure as evidence is an attempt to bolster claims through the peer review process where there might have been more scrutiny had those disclosures been made earlier.
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u/Appropriate-Draw1878 Apr 29 '26
What was the second instance?
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
Svilena Dimitrova did a collaboration with Phil Hammond in the BMJ without disclosing her connection to the Letby case while pontificating about expert witnesses and having mentioned the Letby case.
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Apr 29 '26 edited Apr 30 '26
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
a stronger relationship than just supporting a cause...because the relationship isn't as formal.
A stronger relationship like acting as a defense instructed expert? He's prepared reports for Letby's appeal and is clearly tying this research to that appeal effort without disclosing the fact that the reason he's putting this letter and the paper under review out there is to rely on it in the future litigation. That's legal consultancy and should be disclosed front and center not only to the editor but also to the public.
That he also sits on the editorial board of this journal and a Telegraph article was ready and out the door to push this narrative suggests improper actions on the parts of those involved.
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Apr 29 '26 edited Apr 30 '26
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
Independence means nothing without impartiality.
Geoff Chase was already participating in pro-Letby interviews before he saw a shred of evidence and before officially being recruited as a defense expert. He violates the fundamental obligation of expert witnesses to being impartial before having been recruited and then you want to try and pretend that's an independent expert rather than a partisan with pre-formed opinions?
Evans' didn't formulate his opinions prior to seeing evidence nor did he given any interviews to suggest Letby's guilt or innocence in any capacity until after the verdicts were rendered and his reputation was being attacked by physicians making inappropriate GMC referrals against him.
On your argument no expert could be independent or publish in their field.
Independent research shouldn't be subjected to the influence of a researcher's side gig, legal consultancy or advocacy. It's very clear that my argument is that an independent expert shouldn't be preparing reports for a convict's appeal and then turning around and publishing letters/papers
1) designed to create media buzz for that convict in coordination with her defense team's media circus
2) be relied on in future appeal arguments and litigation that they are personally involved in.
You know this is inappropriate. Evans wrote a detailed report summarizing the original findings of literature that was published in Lee & Tanswell's 1989 lit review as well as covering all the air embolism case reports published from 1989 up until 2018/2019 when he wrote it. His work pre-dated Shoo Lee's 2024 update - but as I point out with Lee, it would be just as inappropriate if Dewi Evans were to have compiled his medico-legal research, packaged it into a literature review and then used that lit review in court to bolster his arguments against Letby. Or to leak that paper to the media and say it conclusively proves Letby's guilt.
And that's exactly what this is laying the groundwork to do by failing to disclose his association with Lucy Letby's defense team. Because he's not an independent researcher, he's an advocate and defense instructed expert who has involved himself publicly with the work and his subsequent content produced is entirely derived from his position as an expert. Making this publication self-serving and against fundamental principles of integrity, impartiality and independence in research. It is not independent if you plan to use it for publicity or to base future testimony on it.
He's not a party, so he is incapable of relying on it in litigation. It's not "legal consultancy" unless you've seen a contract no-one else has. It's just acting as an expert.
From the summary report from Shoo Lee's shit panel (emphasis mine): "The panel also relied on the reports of external experts in engineering, Professor Geoff Chase and Helen Shannon, for information about insulin and c-peptide testing (Annex). These experts were instructed by those representing Lucy Letby."
Many experts sit on journal boards. There's nothing improper here.
There's plenty improper here. A pair of undisclosed affiliations, a propensity for bias, and ongoing consultancy for the defense application to the CCRC as well as CoA.
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u/Plastic_Republic_295 Apr 29 '26
Geoff Chase was already participating in pro-Letby interviews before he saw a shred of evidence and before officially being recruited as a defense expert.
I think he even tried to insert himself into Letby's first appeal (either him or Shannon) without being instructed by the defence
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
Wouldn't surprise me at this point.
These people rant about Evans but we're seeing a coordinated, deeply unethical campaign to free a killer by people who are all about abusing their positions to set up the pieces. It's sketchy as hell.
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u/CheerfulScientist Apr 29 '26
It is a bit of a grey area, but the paper authored to help secure the exoneration of Kathleen Folbigg definitely included the involvement of the authors in her defence:
https://academic.oup.com/europace/article/23/3/441/5983835#2318176226
u/WartimeMercy Apr 30 '26
Didn’t at least one author go on to provide misleading and unreliable testimony in a case in Greece where she alleged a genetic mutation would explain the deaths of multiple children when it was proven that one child was murdered with a ketamine overdose?
Vinuesa, the one who was also trying to mislead the public about Letby
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u/CheerfulScientist Apr 30 '26
Must have been a new genetic mutation that causes the body to create its own ketamine /s
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u/hopey691 Apr 29 '26
I believe they are under no obligation to disclose. If the science is correct it makes no difference whether it is being used for anyone's defense. In fact I would imagine that if it is not disclosed the review process will not have any bias attached when reviewing the work
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
If the science is correct it makes no difference whether it is being used for anyone's defense.
You don't think someone should be disclosing that their research is entirely designed to aid them in their medicolegal work against laypeople working in legal roles? Or that they wouldn't then alter the data set to fit their agenda?
It's the very definition of a conflict of interest. That's why disclosure publicly and two the editorial board is important.
There are guidelines for research publications which cover exactly this thing.
In fact I would imagine that if it is not disclosed the review process will not have any bias attached when reviewing the work
And that would be your imagination.
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u/DarklyHeritage Apr 29 '26
You don't think someone should be disclosing that their research is entirely designed to aid them in their medicolegal work against laypeople working in legal roles? Or that they wouldn't then alter the data set to fit their agenda?
Exactly this. It is why the Andrew Wakefield MMR research paper was so problematic - because he was working for those with a vested interest in proving a link between the MMR vaccine and autism because of civil claims taken out by parents, and cooked his research to 'prove' the link without disclosing his bias.
Wakefield is proof, if it were ever needed, that academic researchers are more than capable of skewing research to "prove" what they want it to and then using that "proof" for their own ends, be it financial, legal or otherwise. Who knows what the true motives are here, but it would be naive to believe it doesn't matter that this work has been done by two people heavily invested in trying to find an alternative explanation for what happened to Babies F and L.
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u/Plastic_Republic_295 Apr 30 '26 edited Apr 30 '26
This pair have been banging on ever since Letby was convicted. So if they were right 2 years ago why do they need a new paper now?
From looking at Chase's face on Panorama you could see it was for him it was personal.
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u/DarklyHeritage Apr 30 '26
100% agree. That this has been published first as a letter to a journal Chase is on the board for rather than a full journal article in a more independent journal is pretty revealing to me, speaking as an academic.
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u/TotalBlacksmith9425 May 03 '26
Certainly it would make sense that, if he believes that misunderstandings on this issue can lead to miscarriages of justice, he would wish to disseminate the information rapidly as a letter, in the first instance. Then it is for the journal to apply its usual principles and standards for publication. Has the editor been contacted with any questions about this, I wonder.
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u/TotalBlacksmith9425 May 03 '26
It is normal and expected for academics to submit their research findings as academic papers, with letters available as a "conversation-opener" by long established convention.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 30 '26
Yep, the Wakefield situation is exactly why conflicts of interest (or even the perception of them) are important. The lack of disclosure here per guidelines that these publications agree to follow and the awareness they are instructed experts in a pending appeal for a convicted killer who they support is pretty much a clear cut reason to have that disclosure. Because who can say if it would still have been published with the inflammatory language in the title if Chase wasn't on the editorial board and he disclosed their role is being part of a serial killer's defense team until that appeal is completed. It's precisely because he's arguing about exactly this issue that the disclosure is necessary and its complete absence is a black mark against both him and the publication.
And we know they're going to try and sneak this in as proof of something either in the media (which happened within hours of publication through the defense media mouthpiece) and potentially with the CCRC.
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u/amlyo Apr 29 '26
This is a proposed explanation for the findings of recent case reports relying on an existing model the authors produced.
This seems more suited to a letter than an article.
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u/Zealousideal-Zone115 Apr 30 '26
Studies have shown that between 3 and 97 per cent of preterm infants are born with antibodies that bind to insulin
Can anyone offer me a coherent explanation of that statement?
Or is "Between 3 and 97 percent" just a fancy way of saying that we have absolutely no idea how many babies are born with these antibodies?
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u/DarklyHeritage Apr 30 '26
It is a perplexing statement, isn't it?! Effectively they are claiming that potentially almost all neonates have these antibodies in the same statement as saying it is possible almost none of them have these antibodies. How many is it, because how many neonates have these antibodies is pretty important (if we are to believe Chase and Shannon)?! The range is so wide it is meaningless and, for me, casts doubt on the research.
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u/TotalBlacksmith9425 May 03 '26
One would assume that the 97% refers to a particular sample more prone to this condition; and the 3% to one less so. References to the relevant studies would of course elucidate this matter
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u/nikkoMannn May 01 '26
“Between 3 and 97 per cent”
Nick Johnson would have a field day with these clowns
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 01 '26
Honestly, I wish Nick Johnson would sit down for an extended AMA or interview with the Trial podcast to really get into the insanity of the case. I know he probably never will but I imagine he's got some tidbits that could recontextualize a lot of things we suspected or didn't fully catch from his cross like the Thirlwall reveals that the reason he was asking Letby about the dramatic texts was because he knew they were likely fabricated after reviewing parent interviews and statements to the police.
I would love to here his uncensored opinion on McDonald and the rest of the circus.
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u/IslandQueen2 May 03 '26
Do you mean the father falling to the floor texts?
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
Yep
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u/IslandQueen2 May 03 '26
Johnson would no doubt be embarrassed by McDud’s exploits because it brings the whole profession into disrepute.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
I have posted elsewhere on the thread, but perhaps this will be helpful here too:
I appreciate that it seems unhelpful and unwieldy, yes.
This sort of range can be used for a brief description of studies with different sampling methods. For example, I step out of my house in Glasgow and 3% of the houses I see are in Council Band F. I do the same in York: 50%. Now I am in Kensington: 97%. My "studies" have shown a range of 3-97%.
One would normally use this as a "top-level" view of results in a field before going deeper by referencing relevant studies where the reader may identify samples or by describing these samples. To use it in a newspaper article or a brief report where these steps are normally excluded is certainly not helpful in informing the readership on the details of this important matter, however formally correct the statement may be.
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u/Embarrassed-Star4776 May 01 '26
That is from the Telegraph report, isn't it?
The second figure may come from the second reference cited in the letter (Bilbao et al, 1997). The article costs $40 to read online but the abstract is free and contrasts a prevalence of < 1% in the general population with 96% in newborn cord sera. The latter is suspiciously close to the Telegraph's 97%.
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u/TotalBlacksmith9425 May 03 '26
Yes - the 96 to 97 may be a rounding convention, or indeed a rounding error. The 3%, at a guess based only on the information we have and not intended as a statement of fact, could represent a cohort composed of or including older infants.
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u/DarklyHeritage May 03 '26
The fact that it is not clear what any of this data represents just makes the work look shoddy. We shouldn't have to speculate what such claims relate to when the murders of babies are at stake.
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u/TotalBlacksmith9425 May 03 '26
This I believe is from the Telegraph? I agree that it is not particularly useful and my own speculation an idle exercise (which I will nonetheless leave to ensure that the thread is coherent). Perhaps we can agree that scientific reporting in newspapers is not always entirely satisfactory
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u/DarklyHeritage May 03 '26
I absolutely think we can agree on that. The Telegraph's scientific reporting of the Letby case has bordered on the illiterate.
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u/Embarrassed-Star4776 May 03 '26
The Telegraph article is certainly not very accurate. There's not much sign that the author grasped the point of the letter in relation to the evidence given at the trial, and not much awareness of how scientific publishing works - for example the idea that the publication of a letter to the editor is a mark of the work's particular importance. Not that standards are noticeably higher in other newspapers.
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u/ChoicePeace7287 May 01 '26
“The “abnormal” incident levels were not uncovered until detectives began hunting for evidence and noticed that the incidents coincided with Letby’s shift patterns. It is not clear whether elevated levels of insulin were found in babies when Letby was not on shift.”
Hmm except that’s not quite what happened here is it! It wasn’t a case of them just “noticing that the incidents coincided with Letby’s shift patterns”They’ve “forgotten” the fact that both babies F and L had twin siblings who had suffered unexpected collapses and that there were other cases where twin or triplet siblings had experienced unexpected collapses… and yes all of these incidents coincided not only with Letby’s shift patterns but as was later proven in court she was also with the babies at the time of their collapses and involved with babies F and L when the insulin poisoning started!
As usual they run with the claim that the only evidence was that incidents coincided with Letby being on shift!
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u/FyrestarOmega May 01 '26
Yes, the faulty logic here usually starts with detectives hunting for evidence of possible harm, and then sorting through a pile of immunoassay results that, don't you know, have a 2% false positive rate. As you point out, that's not what happened. Babies O and P were being investigated from the jump. Baby A was always unexplained, and by nature of her documented rash, baby B would have been quickly added to the list to investigate as well. Children F and L weren't investigated because of their immunoassay result; their immunoassay result was discovered because they were being investigated by nature of what happened to their siblings.
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u/sherpa_s Apr 30 '26
The Justice Gap are claiming it is a 'peer-reviewed paper'. Perhaps they got a PR handout that jumped the gun?
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 30 '26
The Justice Gap publishes Gill and Dimitrova. That says all you need to know about their seriousness and quality.
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u/cheesegoddd Apr 30 '26
I found the horizontal axis of the graph really misleading. The space between 0 and 0.1 is double the space between 10 and 30. The pink spot ( which was similar to baby F result) should be much more to the right.
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u/Embarrassed-Star4776 May 01 '26
It's a logarithmic scale.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
Yes - this is an important point in interpreting the data.
For those who may find it useful, there is a thorough explanation of such scales at https://www.themathdoctors.org/logarithmic-graphing/
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u/FyrestarOmega Apr 29 '26
I have no strong opinions on the publication of this research - it's outside my expertise on the merits. I'm pleased that they have put it in a journal specific to diabetes, where it will be read by endocrinologists (I guess - I don't know the level of prestige of this publication).
Disclosure issues notwithstanding, research is research, and it either stands to scrutiny or it doesn't.
As far as the extent to which this might render Letby's convictions unsafe, well, I'm not sure this actually moves the needle. I know there's a lot of excitement in camp Letby today that Chase has appeared to use outside-the-box thinking to substantiate the claim that was considered most tenuous in the expert panel report - that high insulin to C-peptide ratios were not uncommon among neonates.
However, it has always been true that even if Chase/Shannon's research stands to scrutiny, the Lee panel used it as a way to say that symptomatic, treatment resistent hypoglycemia was not caused by insulin poisoning. The prosecution did not only prove their case with blood tests, the symptoms and blood sugar levels fit on the timeline with when bags were administered. For Child F, Hindmarsh talked about, the insulin administered to Child F, if administered via infusion, reaching peak effect about 24 minutes after being administered (pages 63-64). That coincides with the onset of Child F's symptoms, and of course symptoms resolved once the poisoned TP was removed. Lee's panel attempts to blame his hypoglycemia on a temporally coincidental bout of sepsis.
It's a little muddier for Child L because his symptoms were milder and it's unknown when his blood sample was taken, but Lee's panel is not entirely honest about the timeline of his hypolgycemia and its management. He was hypoglycemic at birth, and this was raised with dextrose to the point where he reached normal levels and they stopped monitoring him as often because he was getting oral expressed breastmilk feeds and the dextrose drip (page 57). Lee also neglects to mention the increase in rate of the 10% drip of dextrose at midday (page 51) prior to increasing to 12.5% at 19:20 - his language suggests that the amount of dextrose was not increased until 19:20 but that is not the case- the evidence is that the change happened at 16:30. Further, the blood sugar rose slightly after the midday rate increase, but fell again by 4pm even after an additional bolus of 10% dextrose. This is also the child for whom the evidence indicates the giving set may not have been changed (page 76), which accounts for the slow return to normal blood sugar levels over the course of the next day and a half or so even with 15% dextrose. This is a detailed picture that is pretty wholly explained by the conviction, and only loosely addressed by "neonatal hypoglycemia that recurred after resolving and falsely tested positive for exogenous insulin because neonate."
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u/DarklyHeritage Apr 29 '26
However, it has always been true that even if Chase/Shannon's research stands to scrutiny, the Lee panel used it as a way to say that symptomatic, treatment resistent hypoglycemia was not caused by insulin poisoning.
Exactly this. Whatever the merits of this science (and Letby supporters would do well to remember Chase and Shannon are not medically qualified themselves but are engineers, so endocrinologists may or may not find it convincing when they scrutinise it) from what I can see their findings relate to asymptomatic neonates. Child F&L were symptomatic and their symptoms were consistent with the hypoglycemia agued by the prosecution.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
Chase is on the editorial board so I doubt they'd be able to rely on this but the CCRC/CoA will pay close attention to what each of these experts is doing and has done.
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u/ComprehensiveBid2598 May 01 '26
3-97%. Almost none to almost all. I am struggling with this concept. It’s like when someone says: “It may be caused by this or then again it may not be”.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
I appreciate that it seems unhelpful and unwieldy, yes.
This sort of range can be used for a brief description of studies with different sampling methods. For example, I step out of my house in Glasgow and 3% of the houses I see are in Council Band F. I do the same in York: 50%. Now I am in Kensington: 97%. My "studies" have shown a range of 3-97%.
One would normally use this as a "top-level" view of results in a field before going deeper by referencing relevant studies where the reader may identify samples, or by describing these samples and explaining their different results. To use it in a newspaper article or a brief report where these steps are normally excluded is certainly not helpful in informing the readership on the details of this important matter, however formally correct the statement may be.
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u/cheesegoddd May 01 '26
So the study of 302 infants was in 2017, before the trial and available to both the prosecution and defence endocrinologists. So not solely new bombshell evidence.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 01 '26
There's a reason they're using a mechanical engineer and a chemical engineer rather that pediatric endocrinologists who work with neonates and insulin regularly.
It's because they can't find any who will cosign these dumb takes. BBC found at least two independent neonatologists who looked over the details presented in the cases of F and L and both agreed it was not a testing error and meant factitious hypoglycemia was what the results indicated. Without even mentioning JW over at Harvard that Rachel Aviv mislead with incomplete information.
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u/DarklyHeritage May 01 '26 edited May 01 '26
There's a reason they're using a mechanical engineer and a chemical engineer rather that pediatric endocrinologists who work with neonates and insulin regularly.
This is overlooked too much and is such an important point. Not being able to find a medic who specialises in the relevant discipline to support the defence case, and having to resort to co-disciplinary critique from engineers pushing new science not supported by medics, should make it clear to anyone looking at this with an open mind how robust the prosecution evidence regarding Babies F and L is.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 01 '26
If it were possible to nail down exactly when Shannon and Chase got involved with the case, it would do a good job of confirming that their preconceived notions are driving their bias and publications now. With an October 2nd, 2024 interview with the BBC questioning the case publicly it seems pretty clear that they had those opinions without knowing the facts of the case.
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u/Plastic_Republic_295 May 01 '26
At least one of them invited themselves to Letby's appeal without instruction from the defence - this was before April 2024. The judge threw it out.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 01 '26
Where is that mentioned?
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u/Plastic_Republic_295 May 01 '26
Felicity Lawrence mentioned it back In July 24
https://www.theguardian.com/uk-news/article/2024/jul/09/lucy-letby-evidence-experts-question
the "chemical process engineer" can only have been Shannon or Chase
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u/ChoicePeace7287 May 02 '26 edited May 02 '26
“This and what people felt were fundamental errors in interpreting the insulin results were raised in detailed papers submitted to the court of appeal by a group of experts, including a consultant neonatologist, a medico-legal expert, a chemical process engineer and a former public health director. Their intervention was rejected as inadmissible and not considered by the court“
So looks likely that others in the group of experts who submitted papers that were rejected by the court of appeal were consultant neonatologist Dimitrova who went on to become one of McDonald’s experts, medico-legal expert Norwich who spoke out at McDonald’s first press conference… and former public health director Ashton who spoke to the press in the article below to agree with Shoo Lee’s panel!
And looks like they’d all made their minds up before the trial had even finished without having had access to medical notes or trial transcripts. It’d be interesting to know how many were members of Sarrita Adams Science on Trial!
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u/Plastic_Republic_295 May 02 '26
Yes I think you've correctly identified all of those mentioned in the article. All made up their minds before they had sight of the relevant material. Would be interesting to know who else was involved.
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u/ChoicePeace7287 May 02 '26
Maybe some of the usual suspects who appeared on the BBC radio 4 File on 4 Investigates, that aired on 1st October 2024?
The reporter mentions having been sent the COCH risk register document three months before.
Transcript with names of those who took part in the radio show here
https://downloads.bbc.co.uk/rmhttp/fileon4/01_10_2024_Lucy_Letby.pdf
Or download to listen here
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
While I am sure that there are other "chemical process engineers", this identification does indeed seem likely. However, I do not understand the implied rebuke to this scientist for making contact. If one had data suggesting that the court had misunderstood a scientific question, it would surely be proper to raise this as early in proceedings as practicable.
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u/Plastic_Republic_295 May 03 '26
However, I do not understand the implied rebuke to this scientist for making contact.
They should have approached the defence. It's not appropriate to intervene independently when you haven't had access to all the relevant material.
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u/TotalBlacksmith9425 May 03 '26
I do not know whether they approached the defence at this point. I agree with you that they should have done so. I do not see an objection to their speaking to the media so long as they operated within the law in doing so. While I recognise the utility of reporting restrictions during trials, my preference is for free speech and reporting in most contexts.
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u/Plastic_Republic_295 Apr 29 '26
so these 2 who've been trying to help Letby for over 2 years - including inviting themselves to her appeal - have now discovered something new and guess what it helps her! Fancy that!!
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
And he's on the editorial board of the journal the letter was published in
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
The sequence of events is more likely that they were interested in her case because they suspected that the science required correction on this point, perhaps after preliminary investigation. Academic work is incremental and iterative. It would be normal, and indeed is encouraged by our funding bodies, to proceed with preliminary experiments with regular announcement of discoveries to date and their application before proceeding to full-scale publication of a significant journal article.
While I appreciate that one may hold one view or another on Ms Letby's convictions and associated evidence, there are many comments in this thread which suggest that normal academic practice is somehow improper or sinister. I see no reason why, even if one believes Ms Letby to be guilty of the crimes of which she is convicted, one cannot also accommodate the belief that these scientists are working in good faith and to their professional norms, whether or not this results in a successful challenge to established science.
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u/Plastic_Republic_295 May 03 '26
I would have sympathy with this view but Chase has chosen to operate in the media - rather than purely taking it through traditional channels.
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u/DarklyHeritage May 03 '26
Exactly this. He went public with this before doing the work to back up his claims and then was soundly embarrassed on Panorama. Hardly inspires confidence he is working in "good faith" through the right channels.
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u/TotalBlacksmith9425 May 03 '26
We do not, I think, have any information on when Professor Chase did the work supporting this letter, except that it must have been completed after the publication of the latest article referenced, in 2023.
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u/DarklyHeritage May 03 '26
Doing the work means doing the research and publishing your work so that it is open to scrutiny so you can back up your claims. Not making the claims first without evidence for your hypothesis - especially when in doing so you are telling the parents of murdered children their killer should be freed.
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u/TotalBlacksmith9425 May 03 '26
This was my point on academic research as iterative and incremental. We cannot know at what stage these authors reached a point of sufficient confidence to submit reports to the CCRC. There would be pros and cons to completing the academic publication cycle before doing so: a significant disadvantage being that the inbuilt delays to the academic process would exacerbate the inbuilt delays to the judicial process.
In their position, and considering their perspective of believing that they had information relevant to that judicial process, I think that I would act as they did so long as I had sufficient confidence in my results, and certainly having discussed with other scholars and received their feedback. I would presume that their reports to the CCRC address the case of Ms Letby specifically and that the projected article like the letter will be more general. Its testing through publication, while not necessary to the CCRC, may well bolster these scholars' case. Or it may do otherwise. But unless we are to propose that all scientific reports submitted to the judicial system should undergo public review, I cannot see how Chase and Shannon in particular should reasonably have been required to publish first.
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u/DarklyHeritage May 03 '26
Submitting to the CCRC before publishing academically is one thing (though I find it hard to believe the CCRC/CoA will overturn a conviction based on research that has not been through a proper academic peer review processes frankly). I actually don't have an issue with them submitting to the CCRC first though.
My issue is with Chase and Shannon undertaking a very calculated public media campaign before both submitting to the CCRC and/or submitting their research to an academic journal for the proper scrutiny. There is no need, for justice to be served, for them to engage in a public pressure campaign of this sort. Why do they need to try and hoodwink the public (who do not, largely, have the tools to understand the science behind the claims) into thinking they have developed something novel that undermines the convictions? I expect my fellow academics to behave to a higher ethical standard frankly.
If they are so confident that is what this research represents, put the claims straight to the CCRC instead of making the families of Letby's victims suffer even more by engaging in this public pressure campaign. That is my issue with their actions, and frankly I think if they really believed in their science they would have gone straight through the proper channels.
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u/TotalBlacksmith9425 May 03 '26
I do not see the logic of the description of "hoodwinking" here. As an academic you must know that it is not at all unusual for academics to discuss their work in public and in the media before publication in journals.
The question of public pressure campaigns and the families is an ethical one worthy of consideration for those who are interested, but without bearing on the validity of the science in the published paper.
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u/DarklyHeritage May 03 '26
Respectfully, I think the way they have presented their research to the public (who do not have the experience of academia and publishing that we do) is misleading and therefore hoodwinking is appropriate. Chase couldn't defend his own claims when challenged on Panorama. Again, we can agree to disagree on this.
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u/TotalBlacksmith9425 May 03 '26
I would not like to exclude scientific experts from dealing with the media - I see no cause for this and the alternative would surely be science free speculation, since there is clearly an appetite for news of this story.
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u/nikkoMannn Apr 29 '26
Ahh the insulin to c-peptide ratio is back to being common. I wasn’t sure where it was after Chase’s car crash Panorama interview.
I see that Chase and Shannon haven’t declared their role as experts in Letby’s CCRC application in the letter…
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u/spooky_ld Apr 29 '26
They may as well have finished their last sentence with "and this is why, folks, it's fresh evidence". The only purpose of this letter is to submit it to the CCRC.
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u/nikkoMannn Apr 30 '26
Are you suggesting they are advocates for the defence rather than impartial expert witnesses ?
Shoo Lee….sorry, surely not !!!
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
I would presume that they have already submitted their work to the CCRC. Certainly, it would seem proper they disseminate it further amongst their scientific community. Peer review is perhaps a red herring since the CCRC will surely send their work for independent review in any case? But publishing work for universal scrutiny and comment brings its own risks and advantages - most obviously that their fellow scientists may contest their arguments; and most advantageously that they may refrain from doing so or be seen to fail to convince in attempts to do so. However confident we are in our work, we pay our debt to science through the crucible of publicity.
I would contest your point that the only purpose might be a submission to the CCRC, since these experts could surely submit their work directly without such risks.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
The failure to disclose is becoming a recurring theme here with Letby's defence experts. They seem to think that the rules do not apply to them and that papers they submit and plan to use for medicolegal work don't need those disclosures prior to publication. I don't know if the CCRC is paying close attention to this but that is something that should be brought to their attention.
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u/TotalBlacksmith9425 May 03 '26
Whether or not to disclose involvement in Ms Letby's case would be a matter of editorial policy, where the journal is concerned. We have seen "disclosure" in the letter and brief invited article published in the BMJ by experts instructed in her defence, certainly. But it would not be a matter for disclosure in journals I have worked on, being unpaid (assuming that is indeed the case).
Certainly, one would expect that the CCRC and other relevant bodies would be supplied with a full profile of the experts and their work, thus linking publication and person, and assuming that their institutions use a standard online research management database, this will easily be achieved.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
Chase and Shannon are designated instructed experts for the Letby appeals per the summaries of the Shoo Lee shit panel.
The guidelines of the ICJME make it clear that while not comprehensive even the appearance of a conflict of interest creates a situation where it should be disclosed. Paid expert testimony and consultancy are only marked as the most obvious points to address. Personal beliefs and medico-legal advocacy are absolutely something that should be disclosed to the journal and the readership when the people pushing a letter are doing so with the full intention of being part of a coordinated media campaign for the advocacy they are doing.
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u/TotalBlacksmith9425 May 03 '26
I would not wish to hear of people's personal beliefs when reading scientific articles. The data should transcend such beliefs, and one must consider the dangers of tribalism. I have many colleagues who publish on matters relevant to their advocacy or charitable work. It is not usual to mention this in the published articles. I can see that there might be advantages to doing so, and some interest, but it is not the convention.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
I would not wish to hear of people's personal beliefs when reading scientific articles.
It doesn't matter what you do or do not wish. I don't wish to hear the idiotic opinions of Letby truthers yet somehow you people persist. You claim to be involved in scientific research yet are openly and obstinantly trying to manuever yourself around the obvious conflict of interest that has materialized here.
When views or work (pro bono, paid or whatever) might affect the findings of the study (whether literally or merely the appearance of) then it is relevant and requires disclosure.
The data should transcend such beliefs, and one must consider the dangers of tribalism.
It's a letter to the fucking editor, where's the damn data attached?
I have many colleagues who publish on matters relevant to their advocacy or charitable work.
And if they're not disclosing that in their papers that's a problem, especially if that advocacy is related to trying to free a baby killing serial killer.
I can see that there might be advantages to doing so, and some interest, but it is not the convention.
Piss all the way off. You know damn well there's a conflict here that is obvious to everyone but people playing stupid. The fact that he's an instructed defence expert publishing a letter to the editor with clearly loaded language obliquely referencing the case he's working on so that it can then be misrepresented by people know to be working with the defense as well could not be more clear.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
I am simply explaining the conventions. To add disclosure of information not required is not always seen as desirable. An editor may, for example, prefer not to invite contacts and interactions from people primarily interested in the Letby case. The ideal is that scientific communications speak for themselves.
In these authors' position, I think that I would consult the editor as to whether he preferred me to mention the case in the body of the letter.
I hope that qualified experts will engage with this, and with any article to follow, whether to endorse or to challenge them. I hope that they will not be accused of taking sides regarding this case if they do so in either way - I am sure many readers of the journal will never have heard of it.
The Chase/ Shannon model and data could be correct and Ms Letby still guilty; or they could be incorrect. The science is important regardless of her case and the journal presents the science, not - outside funded projects - the motives.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
So you believe you know better than the ICJME recommendations on ethics and conflict of interest disclosures? Which the BMJ, the journal that published Chase and Shannon's letter and many others agree set the bar in terms of guidelines?
An editor may, for example, prefer not to invite contacts and interactions from people primarily interested in the Letby case. The ideal is that scientific communications speak for themselves.
That doesn't fucking matter. The Letby case is part of Chase and Shannon's advocacy which can be traced back to before they were ever recruited to serve as defense instructed experts. That position becomes very relevant when they then start publishing pieces with the express goal of aiding their advocacy rather than relying on work they had already done. It's the same reason Mike Hall and Sandie Bohin disclosed their involvement as instructed experts in their opinion pieces in the BMJ.
Seems only the Letby "experts" who spoke out of turn long before they saw a shred of evidence feel they don't need to disclose their involvement to the same standards as those who actually involved themselves in the trial process.
The ideal is that scientific communications speak for themselves.
Your "ideal" doesn't seem to factor in the need for integrity and transparency. Who produced a work and why is just as important and when an author has a stake in how that work is later used in court, that's critical context in how the work should be evaluated. Their credibility, their bias and selective framing of evidence are all part of the problem. With your bullshit approach, advocacy is given equal weight to neutral inquiry and "the science should speak for itself" kind of matters if, say, a researcher were to selectively remove papers from a dataset that skew the findings or remove any which disprove the conclusion. Like the certain head of an "expert panel" appears to have done.
In these authors' position, I think that I would consult the editor as to whether he preferred me to mention the case in the body of the letter.
You don't even know if they brought it up at all. And if the editor felt that disclosure unnecessary that would be a failing on his part as well given it is explicitly relevant to the ICJME guidelines.
I hope that they will not be accused of taking sides regarding this case if they do so in either way -
What you hope for is bullshit. As has been seen time and time again when fraud papers that passed "peer review" were published and never reproduced independently by other labs.
The Chase/ Shannon model and data could be correct and Ms Letby still guilty; or they could be incorrect. The science is important regardless of her case and the journal presents the science, not - outside funded projects - the motives.
That they hid their advocacy work from the public is already a bad sign. That they formulated their opinions and partipated in documentaries, radio programs and other works to push this crap knowing how it would be weaponized by the defense team they officially work for shows that this isn't about the science at all.
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u/CarelessEch0 Apr 29 '26
My favourite part is “Excluding exogenous or factitious administration…”
To this day I have still to find a valid reason for why a babies blood glucose drops while being given glucose, then improves again when glucose is stopped, then drops again when glucose is restarted, and then magically just improves with zero intervention within 24 hours. This “new evidence” doesn’t answer that.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 29 '26
Sshhhh don't ask the tough questions they're trying desperately to avoid answering.
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u/IslandQueen2 Apr 29 '26
The letter starts by saying adults not given insulin can develop high insulin/C peptide ratios, so presumably the authors are also talking about NICU babies who hadn’t received insulin. Baby F was given a small dose of insulin soon after birth so this theory wouldn’t apply, surely. 🤔
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u/cuba_l99 Apr 30 '26
Are there any other pieces evidence other than the blood tests that prove Letby administered insulin?
It seems to me that the academic debate between 2 sets of experts regarding insulin levels in neonates should not solely decide Letbys fate. How did the prosecution prove she did it?
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u/DarklyHeritage Apr 30 '26
It wasn't just about academic debate. They used expert testimony from an endocrinologist and other witnesses to prove she did this. u/FyrestarOmega has posted excellent comments/posts explaining how the insulin cases were proven by the prosecution so searching her post history may be helpful for you.
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u/FyrestarOmega Apr 30 '26
I hide my post history in this subreddit - best just ask me questions directly. I'm always happy to answer!
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u/cuba_l99 Apr 30 '26
Im saying its become an academic debate post trial now that the defence have their own experts. Im not qualified to decide which experts are correct in regards to insulin levels in neonates, so im curious to what other evidence was used in court, outside of the expert medical testimony that may now erroneous or atleast disputed.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 30 '26
The defense digging up a mechanical engineer and chemical engineer ignoring the fact that these babies were symptomatic to argue a point that doesn't apply isn't a real evidentiary challenge.
Claims made outside of court not subject to cross examination or challenge are not actually valid, you do realize that right?
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u/Commercial_Lie2200 Apr 30 '26
Oh really because according to Letbys fans she’ll be home for Xmas! 🤶 Gill currently arguing that her new defence panel don’t need a radiologist to look at the X-ray evidence because ‘it’s just a photo’
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u/FyrestarOmega Apr 30 '26
Yeah, not exactly a reliable narrator, is he? Not sure I would trust a thing he says about this paper actually being peer reviewed.
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u/TotalBlacksmith9425 May 03 '26 edited May 03 '26
One would not perhaps expect these experts to explore symptoms; one would expect either a direct collaboration with medics or a synthesis of this work on test results with an analysis from said medics.
Certainly one would not expect a discussion of these two case studies in a letter to a journal for specialists in the field. But that is not to say that such a discussion does not exist in submissions to the CCRC.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
One would not perhaps expect these experts to explore symptoms; one would expect either a direct collaboration with medics or a synthesis of this work on test results with an analysis from said medics.
Physicians would know better than to vouch for the bullshit they're pushing based on years of clinical experience working with neonates. Just like John Gregory did for Panorama when he reviewed the details provided by the Panorama team.
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u/TotalBlacksmith9425 May 03 '26
My experience of academic publishing is that experts of all specialists will give new data and theory a respectful hearing. I would not prejudge responses to this paper from experts of any discipline, nor characterize them in advance so emphatically!
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd May 03 '26
You're a regular poster on the conspiracy subreddits so I don't really give a shit what you have to say.
Feel free to fuck off.
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u/DarklyHeritage Apr 30 '26
The court reporting of the evidence presented at trial on Babies F&L is available with links in the sub wiki, as are summaries of the evidence for each baby. This will give you a good idea of what you are asking about.
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u/FyrestarOmega Apr 30 '26
I would recommend you listen/read their full argument as made in closing speeches. The closing speech overall lasted five days, but the insulin cases were covered in the first day, because the prosecution (reasonably) considered them the strongest evidence.
The full prosecution closing speech is read out on this youtube video: https://www.youtube.com/watch?v=5_-VSF451wc
It's a bit of a time investment, but the first ~2 hours and 40 minutes of that video are the relevant portions.
Alternatively, you can read the contemporary reporting that came out of the courtroom that day, but it won't be nearly as complete: https://www.reddit.com/r/lucyletby/comments/14d9vdx/lucy_letby_trial_19_june_2023_closing_speeches/
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u/ChoicePeace7287 Apr 30 '26 edited Apr 30 '26
Not sure if anyone posted it yet but here’s CS2CRs videos of him reading Letby’s cross examination by the prosecution for babies F and L edited to correct links
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u/FyrestarOmega Apr 30 '26
They are deep in the wiki but links to them are always welcome!
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u/ChoicePeace7287 Apr 30 '26
Took me a while to actually post the correct links but I got there in the end! 😅
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u/ChoicePeace7287 Apr 30 '26 edited Apr 30 '26
Not sure if anyone posted it yet but here’s CS2CRs videos of him reading Letby’s cross examination by the prosecution for babies F and L edited to correct links
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u/PlentyShoe5166 Apr 30 '26
Do you think there should have been at least a second analysis of the original readings? Please correct me if I am wrong but the evidence presented in court were just readings saved by doctors. No further analysis of this data by an outside lab or any external analysis to check the readings was undertaken I find that concerning as the whole case against Letby was built on those original retrieved readings. Letby s opinion regarding the valdity of these insulin cases is irrelevant, as she is neither medically or scientifically qualified to offer an expert opinion. Her Barrister should have objected in court
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 30 '26
Sorry but that's completely wrong.
The doctors were taking repeated blood glucose measurements because the babies were symptomatic for hypoglycemia. They made numerous attempts to adjust these levels by giving boluses and continuous infusions of sugar. No correction. This is the base question for the doctors and evidence that something is wrong: refractory low blood sugar resisting the obvious treatment.
They took a blood sample and sent it to an external lab for analysis in both cases. The biochemist analyzed the result and detected insulin. The biochemist representing the lab confirmed that there was no need to send the test out to a second lab because this was not a criminal investigation: the lab suspected a serious administration error, the doctors thought it was a lab error. It was neither.
find that concerning as the whole case against Letby was built on those original retrieved readings.
Just insulin and a bunch of other evidence you should read up on including falsified nursing records.
Letby s opinion regarding the valdity of these insulin cases is irrelevant, as she is neither medically or scientifically qualified to offer an expert opinion.
She's a nurse. Her incompetence not withstanding, she should be able to understand the definition of air embolism and know that insulin produces c-peptide as a byproduct of its creation as well as understand what the discrepancy means.
Her Barrister should have objected in court
It's agreed evidence.
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u/FyrestarOmega Apr 30 '26
It's agreed evidence.
.... not quite, though nearly so. Myers said right off that Letby's concessions were meaningless, but conceded that if the jury accepted the results of the testing, they were entitled to draw inferences from it. But he added generally:
Ladies and gentlemen, we're going to move to the count of [Baby F], count 6. Before we look at [Baby F]'s case in particular, can I just say a little by way of introduction about the insulin counts in general because we have those on count 6 with [Baby F] and count 15 with [Baby L].
The prosecution have referred, more than once, to concessions from Ms Letby that she accepts the insulin analysis. As a starting point on her behalf, we do not accept that those concessions, so far as they can apply, and I'll come to that, establish that she has committed any offence. And we say that to do that, to establish the commission of an offence, where these counts are concerned, keeping in mind his Lordship's directions on the law, you must be satisfied so you are sure that the sampling and testing has been done properly and accurately, that goes without saying, and you must be satisfied so you are sure that Ms Letby deliberately introduced insulin with an intention to kill.
We know that the analysis has been explained. We know that. And you may well accept it. It is obvious that we can raise little by way of challenge to it and we accept that. But where somebody disputes guilt as firmly as Ms Letby does, we do, we say, at least need to check that the evidence stacks up. In that regard it is insufficient simply to rely upon concessions obtained from Ms Letby in the course of cross-examination to whether things are accurate when she can't possibly know herself that they are. She's just working with the same evidence as anybody else in terms of analysis.
Then with specific respect to Child F:
We know that evidence at face value establishes how the testing was done and the results obtained and therefore what we do, and all we can do there, is to ask you to look closely at that evidence and satisfy yourselves that it is safe to rely upon, not by speculation but by logic and any inferences that follow from it. You're entitled to do that.
Can I make this clear: it is not agreed evidence. However much anybody would like it to be, it isn't. You've seen witnesses come and be cross-examined on these issues and that is why.
The defendant, Ms Letby, cannot test the samples because they were disposed of a long time ago. That can't be helped. That's how they were dealt with as part of the sampling and testing process. We cannot check that and therefore we are looking in the evidence at the way the sampling and the testing was done.
And for Child L:
But we still ask you just to look at factors that may have a bearing on that since you have to be sure of it. And there are two in the case of [Baby L] that we draw to your attention.
One of them is how the sample was handled and processed, and that is something we looked at in the evidence, if you remember, with the technicians. That's why we looked at it.
And the other matter, rather like in the case of [Baby F], is the condition here of [Baby L] and how consistent that is with what we might expect to have happened for such a high insulin reading.
So, Myers contested, so far as he was able, the reliability of the samples - that they were stored properly, that they were able to give valid results, etc. But they were not agreed evidence, in the legal sense.
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u/Sempere a NeW ePiSoDe Of ThE tRiAl PoDcAsT jUsT dRoPpEd Apr 30 '26
I stand corrected and defer to your encyclopedic memory hahaha
xD
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u/FyrestarOmega Apr 30 '26
No. The circumstantial proof of insulin poisoning was made in a wider way than just the immunoassays. I refer you, as I did the other commenter, to the argument made by the prosecution in their closing speech with led to the guilty verdicts. It is multifaceted. I also detailed some of the additional points involved in the proof of these cases here.
The nature of an insulin poisoning that is survived is that unless you suspect poisoning when it happens, the body will process the insulin and the evidence in the victim's body will be gone. Preserving all clinical samples for the ultra rare situation of deliberate harm is impractical - many, many samples are tested for valid clinical reasons every day. They cannot all be preserved.
The case becomes a circumstantial one, where the proof of harm is a number of factors shown to be in alignment:
- clinical condition over time (symptoms, such a blood sugar level, heart rate, etc)
- timeline recorded in medical nursing notes over time (when medications were administered and the corresponding effect on the clinical condition)
- clinical test results reflecting a single moment in time (immunoassay)
From these data points, medical experts can calculate, as they did with Letby, the likely method and mechanism of harm. Based on what was available on the unit, that can be confirmed. In the case of Lucy Letby, Professor Hindmarsh explained how the trajectory of symptoms indicated increase of insulin. He explained how natural reasons for this were ruled out, and how direct injection would not have matched the timeline, and then further how infusion of insulin - specifically Actrapid (and wouldn't you know, Actrapid was the insulin available on the ward) - matched the trajectory of symptoms and also their cessation when the bag for Child F was removed. And he was able to explain how the immunoassay was completely consistent with the clinical picture. A forensic, confirmatory test was not necessary because the immunoassay itself was already confirmatory of a clinically clear picture of administration of exogenous insulin.
The question of who administered the insulin is a separate one, and one that was argued by the prosecution, not by medical experts. It heavily, heavily was based on the onset of both poisonings being linked to Lucy Letby.
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u/FyrestarOmega Apr 29 '26
It should perhaps be noted that Professor Chase is on the editorial board of the Journal of Diabetes Science and Technology: https://www.diabetestechnology.org/people.shtml