UK - Nurse Lucy Letby, murder of babies, 7 Guilty of murder verdicts; 8 Guilty of attempted murder; 2 Not Guilty of attempted; 5 hung re attempted #37

[Sweeper2000]

Thank you very much for this. I found it very convincing indeed and that's despite being - as a grumpy old non-doggie person - initially put off by the dog and Dr Oliver's constant wide smile (men aren't expected to smile all the time but women it seems are, so I do understand it).

Among other things it reminded me (thanks to her use of CS2C's transcripts) just how painstaking was the detail of the medical evidence produced during the trial. As she said, why does Professor Shoo Lee present Professor Chase - primarily an engineer as we noted a long time ago - as if he knew far more about neonatal levels of insulin and C-peptide than the neonatologist Professor Hindmarsh, who gave clear evidence at the trial?

OK, there was a lot I didn't really understand properly, but there were clear inconsistencies and flaws all the way though Lee's presentation of the insulin poisonings that Dr Oliver has brought out most damningly.

i thought one of the most damning aspects of their conference was the fact that they didn't entertain the thought that it could have been murder otherwise they would have paid attention to the trial and Dr Lee said he didn't do that. he said it wasnt murder but then would leave the question of why LL was lying? and what would he think of that? Its quite shocking really to have that level of ego that he thought he could just dismiss peoples lives works and the entirety of our systems processes. never known a ego outsize a mountain like that. bit more humility is in order i think.

 

[Tortoise]

its interesting actually, she uses a paper in which a contributor was one of the new panels experts. prof geoff chase was actually the guy who recorded the normal insulin/c peptide levels for neonates in that paper and the recorded levels are not in line with the recordings proving that insulin was administered, this goes against what Dr Lee was saying in the conference and it beggars belief. she seems quite spot on and easy to follow for what is a complex subject.

Looks as if Prof Chase might have confused his nanomoles and picomoles.

 

[magikarpmagikarp]

Looks as if Prof Chase might have confused his nanomoles and picomoles.

That explains a lot.

 

[marynnu]

Looks as if Prof Chase might have confused his nanomoles and picomoles.

You can get an ointment for that I believe.

 

[May72031]

Do you believe that since the international panel led by a Harvard-educated professor did not agree with Dewi Evans, that, by default, also puts them into WTC and Handy Hook conspiracy theorists group? Or are these terms, so to say, for “internal use”?

I will judge by the evidence they present, not their titles. Same with the "Architects and Engineers for 9/11 Troof" rabble. They never presented any credible evidence.

So far, I have not seen any credible evidence from Shoo Lee's panel of "eminent experts" that challenges the evidence that was presented in court.

What do you make of the fact that Shoo Lee presented a doctor at the first PR event who claimed a doctor had contributed to the death of a baby by inserting a needle into their liver, only for this conjecture to be dropped at the second PR event, where alternative opinions were offered as the cause of the baby's liver injury?

 

[Sweeper2000]

Looks as if Prof Chase might have confused his nanomoles and picomoles.

at least i ad ana excuse to not know what they was. e shud stik 2 engineering.

 

[joltz]

Definitely they don’t apply to me; in my time, I loved the books of Chris Hitchens and followed Sam Harris.

And to remember, the relationship between the late Christopher and his brother Peter who is now writing articles in support of Lucy Letby was complex. Yet as I am reading the interview of the brothers at the Guardian Hay Festival, I am thinking: four years of a hiatus in their relationship, and yet, they talk, despite diverging outlooks, graciously communicate, and listen. Importantly, they don’t even think of depriving each other of the right to regard the same situation in an autonomous way. Ultimately, out of their different positions, presented with respect and ability to listen, so many new ideas can be extracted. Even from that tiny article.

Twenty years later, I, a person who adored Christopher Hitchens’ books, am not subscribing to “who is not with us, is a conspiracy theorist” mentality. First, it is not helping the discussion and then, oh boy… “She doesn’t subscribe to LL’s guilt, so, probably she is into 9/11 conspiracy, Sandi Hook conspiracy, and a Letbyist”.

Do you believe that since the international panel led by a Harvard-educated professor did not agree with Dewi Evans, that, by default, also puts them into WTC and Handy Hook conspiracy theorists group? Or are these terms, so to say, for “internal use”?

I hope that people of the country that has provided us with so many illuminating writers and journalists, can and will do better than “Letbyists”.

Peter Hitchens is a joke. JMO

 

[Ruthbullock]

Dr. Oliver has posted another excellent video, this time about the insulin evidence. In this video she uses transcripts that CS2C has purchased as well as clips from Dr. Lee's press conference. I'm not sure if she is considered an accepted source but I have found her YouTube channel Back to the Science to be accurate and accessible.

What do you make of Dr Ellen Storms assessment of the insulin you tube video and blog- you have the knowledge so I would appreciate your feedback of her summary

 

[Charlot123]

You're so close, Charlot. The answers you've come up with are wrong but you're asking the right questions. The answers are in the trial. And even more in the Inquiry.

But she wasn't a clutzy nurse. She was malicious. And the insulin evidence hasn't fallen apart. She had a trial and an excellent professional defense doing the best they could with what they had. She appealed. She can go to the CCRC. But she's not going anywhere because there is no new evidence. Just smoke and hand waving.

Head-twister, this case, because the detective work is from a tiny center moving outwards, opposite to the usual.

(Was there someone who had said, “mate, please keep me out of it, but some of us felt the same when she was training here as well”?). Suspecting a killer makes little sense as the babies did not bear evidence of human malice. There were collapses. And, the unit was far from ideal, so the doctors could not say, “we crossed this and that out.” Usually, intensive care doctors are busy, logical and have no time for formalities. Dr. Breary’s type. Before killer-hunt, they’d probably demand from Tony Chambers fixing the unit especially after the sewage spill, “Fix this cr@p or we are out!” And something would have been done for sure.

I can imagine doctors wondering if someone with “bad practices” inadvertently caused air embolism, hence the “klutzy nurse or registrar” theory. I can imagine the jokes like “why don’t we pay her for not picking a shift tomorrow”. But a huge leap of logic between (allegedly) similar joke and “Nurse Death” is genuinely baffling. And mainly: if Dr. Breary is truthful in stating that his response was “not the nice Lucy”, then it seems that they were initially suspecting all nurses? Looks strange, something is missing here, and I suspect that the piece is factual.

But then there is another, somewhat contradictory, story by Dr. Jay and baby K. That is simply tattered, sorry. The nurse doesn’t have the same recollection of the events, the intern’s story is somewhat different, “I looked at my watch” sounds like a prelude to a bad play.

Honestly, I do ask myself, what if Dr. Jay had what is called intuition about Lucy? He seems emotionally aware. Such people can easily spot liars. (But then I am reminded of Muriel Spark’s “Memento Mori”, a great English book: ”Mrs Anthony knew instinctively that Mrs Pettigrew was a kindly woman. Her instinct was wrong.”) Plus, would so many doctors rely on someone’s instinct? I did read through initial information and was constantly stopped by, “a rash that I never saw”. Or, from pathology “I never saw it in my life”. (A string of bubbles). Everything is more emotional than descriptive and mostly post-factum.

And if the first CEO paid no attention to doctors’ concerns and the next one did, it just means that new facts emerged. Something is missing in trial documents or I am overlooking it but then, so does everyone else. The jury knows it but the information can’t be presented openly. JMO.

 

[Charlot123]

i thought one of the most damning aspects of their conference was the fact that they didn't entertain the thought that it could have been murder otherwise they would have paid attention to the trial and Dr Lee said he didn't do that. he said it wasnt murder but then would leave the question of why LL was lying? and what would he think of that? Its quite shocking really to have that level of ego that he thought he could just dismiss peoples lives works and the entirety of our systems processes. never known a ego outsize a mountain like that. bit more humility is in order i think.

Not their role to entertain murder. I think he had two goals, one, “don’t link my name to this case”, and two, “for any “attack” or “murder” explanation, there is a reasonable explanation that doesn’t include murder”. He is a skeptic, it seems. The man who doesn’t believe in ghosts, spirits or witches.

 

[magikarpmagikarp]

What do you make of Dr Ellen Storms assessment of the insulin you tube video and blog- you have the knowledge so I would appreciate your feedback of her summary

This is really interesting! I have read through once and will need to do so again. She is far more knowledgeable than I am on this topic. She addresses one of the questions I have been wondering about, which is whether premature infants show a different rate of clearance of c peptide than older children. I think I'm going to have to listen to her /read her post several times to really get what she is saying. I've noticed that she is, in this post, very circumspect about what conclusions she might draw from the information she discusses, and also very careful to state that her opinion is based on what she knows at that time, but that if she got more information her opinion might change.

I think I'd love to hear a conversation between her and Dr. Oliver.

 

[Sweeper2000]

Not their role to entertain murder. I think he had two goals, one, “don’t link my name to this case”, and two, “for any “attack” or “murder” explanation, there is a reasonable explanation that doesn’t include murder”. He is a skeptic, it seems. The man who doesn’t believe in ghosts, spirits or with

I dont think he believes in good practice either judging by his reasoning being dismantled quite thoroughly. remember the "if this was canada the hsopital would be shut down line"? wonder how that stands now.

 

[Furore]

I am confused, when one would imagine most murders in the UK are unwitnessed - forensics being helpful / it’s a smoking gun no one saw LL inject air. Most medications for neonates are so small in dose they’re given in a 1ml syringe - for comparison these are about as long as a little finger and the diameter of a thin straw. Unless you’re a foot away and inspecting it, no one is going to see air in it…

MOO

 

[magikarpmagikarp]

What do you make of Dr Ellen Storms assessment of the insulin you tube video and blog- you have the knowledge so I would appreciate your feedback of her summary

Ok I do think it's worth listening to Dr. Oliver's video in tandem with this one. For instance Dr. Oliver discusses that there is a difference in clearance of c peptide vs insulin. This is something Dr. Storms also discusses.

I think the discussion at hand contains questions for a pediatric endocrinologist. I believe that we got this expert opinion in Dr. Hindmarsh, who in speaking was plain for his non expert listeners. As someone who is receiving and interpreting these types of labs daily, he has great practical experience in what those labs can look like. There are many things which can be theoretically possible in lab work but which don't play out in real life.

I think Dr. Storm's discussion of pre test probability was really wonderfully done. I think she also makes a good point for why the results were initially dismissed. The baby had recovered. When you get unexpectedly unexpected results you are more likely to assume error in testing than attempted murder because error seems more likely. In either case it is the clinical context that determines the interpretation.

Regarding congenital hyperinsulism....the labs sent were meant to test for this. Dr. Storms explains that there may be some issues with the testing with regard to reference ranges and data sets, however this is a (in my experience) fairly common set of labs to send on babies. The lab that did the testing probably does all of this testing for a particular region. They are going to see lots of results for newborns. The pediatric endocrinologist interprets lots of these too. This is where real world experience may come in handy.

My thoughts on the clearance of c peptide vs insulin. It sounds like the literature is pretty clear that there is a difference. Dr. Oliver also discusses this. Dr. Chase's research actually attempts to leverage this difference in monitoring insulin levels. But if I understood his paper (and I may be wrong!) That's because insulin is typically cleared faster! Hence the ratio >1. The c peptide level is considered a more accurate reflection of how much insulin the body made because it sticks around longer than insulin. This means - I think - that you would expect c peptide to be the same or higher than the insulin level. Not that it would be so much lower. Happy to be corrected on this by any of our doctors.

Dr. Storms makes the case that there is a physiologically plausible mechanism for a <1 ratio in a sick baby. This is basically the starting point for a research question, which is what she tells us.

There is a pretty big difference between a ratio of <1 vs a ratio measured in hundredths.

Dr. Oliver makes the point that whatever deficiencies these assays have, they are good enough to test and treat babies for CHI, and also to rule out CHI in many cases. I suspect that if it was really common to see a super super super insanely low ratio of c peptide to insulin in sick preemies this is something that would be seen and noticed by the people who have to receive and interpret these tests - the pediatric endocrinologists. (That's because refractory hypoglycemia is actually not terribly uncommon and these labs get sent quite a bit more frequently in hospitals that see more acuity. But usually the results make more sense.)

Dr. Storms is quite cautious and I think purposeful in just saying that she's identified an area for more learning.

I think she's also been very transparent that this reflects HER current knowledge. She hadn't said that this reflects THE current knowledge.

I think a pediatric endocrinologist is the person who will have the best insight into this. As we've heard from one pediatric endocrinologist, I am not inclined to shift my view unless I hear different specifically from another pediatric endocrinologist.

 

[Ruthbullock]

Ok I do think it's worth listening to Dr. Oliver's video in tandem with this one. For instance Dr. Oliver discusses that there is a difference in clearance of c peptide vs insulin. This is something Dr. Storms also discusses.

I think the discussion at hand contains questions for a pediatric endocrinologist. I believe that we got this expert opinion in Dr. Hindmarsh, who in speaking was plain for his non expert listeners. As someone who is receiving and interpreting these types of labs daily, he has great practical experience in what those labs can look like. There are many things which can be theoretically possible in lab work but which don't play out in real life.

I think Dr. Storm's discussion of pre test probability was really wonderfully done. I think she also makes a good point for why the results were initially dismissed. The baby had recovered. When you get unexpectedly unexpected results you are more likely to assume error in testing than attempted murder because error seems more likely. In either case it is the clinical context that determines the interpretation.

Regarding congenital hyperinsulism....the labs sent were meant to test for this. Dr. Storms explains that there may be some issues with the testing with regard to reference ranges and data sets, however this is a (in my experience) fairly common set of labs to send on babies. The lab that did the testing probably does all of this testing for a particular region. They are going to see lots of results for newborns. The pediatric endocrinologist interprets lots of these too. This is where real world experience may come in handy.

My thoughts on the clearance of c peptide vs insulin. It sounds like the literature is pretty clear that there is a difference. Dr. Oliver also discusses this. Dr. Chase's research actually attempts to leverage this difference in monitoring insulin levels. But if I understood his paper (and I may be wrong!) That's because insulin is typically cleared faster! Hence the ratio >1. The c peptide level is considered a more accurate reflection of how much insulin the body made because it sticks around longer than insulin. This means - I think - that you would expect c peptide to be the same or higher than the insulin level. Not that it would be so much lower. Happy to be corrected on this by any of our doctors.

Dr. Storms makes the case that there is a physiologically plausible mechanism for a <1 ratio in a sick baby. This is basically the starting point for a research question, which is what she tells us.

There is a pretty big difference between a ratio of <1 vs a ratio measured in hundredths.

Dr. Oliver makes the point that whatever deficiencies these assays have, they are good enough to test and treat babies for CHI, and also to rule out CHI in many cases. I suspect that if it was really common to see a super super super insanely low ratio of c peptide to insulin in sick preemies this is something that would be seen and noticed by the people who have to receive and interpret these tests - the pediatric endocrinologists. (That's because refractory hypoglycemia is actually not terribly uncommon and these labs get sent quite a bit more frequently in hospitals that see more acuity. But usually the results make more sense.)

Dr. Storms is quite cautious and I think purposeful in just saying that she's identified an area for more learning.

I think she's also been very transparent that this reflects HER current knowledge. She hadn't said that this reflects THE current knowledge.

I think a pediatric endocrinologist is the person who will have the best insight into this. As we've heard from one pediatric endocrinologist, I am not inclined to shift my view unless I hear different specifically from another pediatric endocrinologist.

Thank you for breaking it down and sharing your thoughts and writing down some of the comparisons - it’s an interesting read and appreciated

 

[Charlot123]

I dont think he believes in good practice either judging by his reasoning being dismantled quite thoroughly. remember the "if this was canada the hsopital would be shut down line"? wonder how that stands now.

Well, it is obvious that Dr. Lee was upset that no one even contacted him about that article but called livido reticularis “Lee sign”. And by nature, he seems fair. He was not upset with Dr. McConville who actually criticized that old article. He did the right thing: rewrote the article and came to the UK to protect the woman who, as he feels, suffered, although there is absolutely no fault of his. So I assume that he is right in being angry. The consultants pulled together the whole trial without following the rules of common courtesy.

About Canada, I don’t know. Hospitals in US differ, IMHO. I assume one can’t compare a big hospital at the University of Alberta, Canada’s richest province, with something small and local in New Brunswick or Northern Territories. But this is strictly my opinion.

Why Dr. Lee is upset is obvious. He directed it all mostly at Dr. Jay. IMHO, the true fault lies with Dr. Evans. He is the trial consultant, it is his job to communicate. But, you might agree, what they did totally backfired.

 

[Charlot123]

Ok I do think it's worth listening to Dr. Oliver's video in tandem with this one. For instance Dr. Oliver discusses that there is a difference in clearance of c peptide vs insulin. This is something Dr. Storms also discusses.

I think the discussion at hand contains questions for a pediatric endocrinologist. I believe that we got this expert opinion in Dr. Hindmarsh, who in speaking was plain for his non expert listeners. As someone who is receiving and interpreting these types of labs daily, he has great practical experience in what those labs can look like. There are many things which can be theoretically possible in lab work but which don't play out in real life.

I think Dr. Storm's discussion of pre test probability was really wonderfully done. I think she also makes a good point for why the results were initially dismissed. The baby had recovered. When you get unexpectedly unexpected results you are more likely to assume error in testing than attempted murder because error seems more likely. In either case it is the clinical context that determines the interpretation.

Regarding congenital hyperinsulism....the labs sent were meant to test for this. Dr. Storms explains that there may be some issues with the testing with regard to reference ranges and data sets, however this is a (in my experience) fairly common set of labs to send on babies. The lab that did the testing probably does all of this testing for a particular region. They are going to see lots of results for newborns. The pediatric endocrinologist interprets lots of these too. This is where real world experience may come in handy.

My thoughts on the clearance of c peptide vs insulin. It sounds like the literature is pretty clear that there is a difference. Dr. Oliver also discusses this. Dr. Chase's research actually attempts to leverage this difference in monitoring insulin levels. But if I understood his paper (and I may be wrong!) That's because insulin is typically cleared faster! Hence the ratio >1. The c peptide level is considered a more accurate reflection of how much insulin the body made because it sticks around longer than insulin. This means - I think - that you would expect c peptide to be the same or higher than the insulin level. Not that it would be so much lower. Happy to be corrected on this by any of our doctors.

Dr. Storms makes the case that there is a physiologically plausible mechanism for a <1 ratio in a sick baby. This is basically the starting point for a research question, which is what she tells us.

There is a pretty big difference between a ratio of <1 vs a ratio measured in hundredths.

Dr. Oliver makes the point that whatever deficiencies these assays have, they are good enough to test and treat babies for CHI, and also to rule out CHI in many cases. I suspect that if it was really common to see a super super super insanely low ratio of c peptide to insulin in sick preemies this is something that would be seen and noticed by the people who have to receive and interpret these tests - the pediatric endocrinologists. (That's because refractory hypoglycemia is actually not terribly uncommon and these labs get sent quite a bit more frequently in hospitals that see more acuity. But usually the results make more sense.)

Dr. Storms is quite cautious and I think purposeful in just saying that she's identified an area for more learning.

I think she's also been very transparent that this reflects HER current knowledge. She hadn't said that this reflects THE current knowledge.

I think a pediatric endocrinologist is the person who will have the best insight into this. As we've heard from one pediatric endocrinologist, I am not inclined to shift my view unless I hear different specifically from another pediatric endocrinologist.

While theoretically, C-peptide is cleared much slower than insulin, there may be lots of potential issues with the assays as C-peptide cross-reacts with protoinsulin, for example. It might be the situation when no one truly knows.

A Practical Review of C-Peptide Testing in Diabetes - PMC

C-peptide is a widely used measure of pancreatic beta cell function. It is produced in equimolar amounts to endogenous insulin but is excreted at a more constant rate over a longer time. Methods of estimation include urinary and unstimulated and ...

pmc.ncbi.nlm.nih.gov

But if I were to look at a case with data, this will be it. While no specialist might have the ultimate knowledge, the discussions will be a great learning material. For students, too.

 

[Tortoise]

Well, it is obvious that Dr. Lee was upset that no one even contacted him about that article but called livido reticularis “Lee sign”.

Could you provide a link for your claim that anyone other than Dr Lee himself named the characteristics "Lee's Sign".

The consultants pulled together the whole trial

No, witnesses don't pull together trials. That is the role of the CPS.

 

[magikarpmagikarp]

While theoretically, C-peptide is cleared much slower than insulin, there may be lots of potential issues with the assays as C-peptide cross-reacts with protoinsulin, for example. It might be the situation when no one truly knows.

A Practical Review of C-Peptide Testing in Diabetes - PMC

C-peptide is a widely used measure of pancreatic beta cell function. It is produced in equimolar amounts to endogenous insulin but is excreted at a more constant rate over a longer time. Methods of estimation include urinary and unstimulated and ...

pmc.ncbi.nlm.nih.gov

But if I were to look at a case with data, this will be it. While no specialist might have the ultimate knowledge, the discussions will be a great learning material. For students, too.

if proinsulin reacts with the assays for c peptide then the c peptide reported will be falsely high.

There is no point in trying to become substitute endocrinologists.

 

[Charlot123]

if proinsulin reacts with the assays for c peptide then the c peptide reported will be falsely high.

There is no point in trying to become substitute endocrinologists.

It is never too late to learn. And, it is not as much about the case as about the assays. I have podcasts or YouTube because it is so slow as opposed to reading; however, it is an interesting topic. What YouTube video would people recommend to start with?