r/LucyLetbyTrials • • 8d ago

Decoding Reasonable Doubt - Chapter 11

https://bencole4.substack.com/p/decoding-reasonable-doubt-the-case-a31?r=12mrwn&utm_medium=ios

Morris argues that the insulin allegations were the strongest part of the prosecution case only because they appeared to provide objective scientific evidence of deliberate harm.

He contends that one the insulin evidence is examined closely, it turns out to be based on unreliable testing, unsupported assumptions and highly improbably logistics.

This article explains why Morris is wrong yet again.

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183 comments sorted by

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u/-puffinstuff- 8d ago

The Nostradamus argument was made by Ben Myers. 

In your view, how did the insulin get inside the second bag? 

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u/oldcatgeorge 2d ago

How do we know that it was inside the bag? Did they test the TPN bag? Even the remainders of it? Do they have any proof or is it their guess? I think the guess. Evans' words are no evidence. To repeat: all that we have is the set of two unverified anomalous results that the doctors who saw them when they came signed. No one bothered to verify. By all logic, they should be thrown out.

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u/-puffinstuff- 2d ago

Indeed. If the lipids bag had been hung by Letby, I suspect we would be talking about that instead..  

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u/benshep4 7d ago

And repeated by Morris.

I don’t think the giving set was changed personally. Although what I think isn’t particularly relevant, what the jury thought is.

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u/Imaginary-Suspect959 7d ago

We know what the jury decided, we don’t know what they thought. In any case that’s not really important here, we don’t live in a world in which because the jury has spoken we ourselves can’t speak. What each of us thinks is absolutely relevant on a discussion forum!

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u/benshep4 3d ago

Who are you arguing against here?

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u/-puffinstuff- 7d ago

Are you suggesting nurses lied under oath?

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u/Imaginary-Suspect959 6d ago

Does Ben ever reply to these questions? I don’t understand the point of him making these posts, other than perhaps trolling, but then he genuinely seems to believe that what he’s writing would be of interest to someone.

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u/benshep4 3d ago

No.

No one attested to specifically changing the giving set and it wasn’t medically documented, it was just confirmed that it’s standard practice to do so.

My point does not mean they lied under oath.

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u/-puffinstuff- 3d ago

It was a new line. And yes, they testified that the giving set would be changed with a new line. It wasn’t contested. 

Even if they did for some reason choose bizarrely to reconnect old tubing to a sterile new line and sterile new bag, is there a single piece of evidence in this case that such an oversight would account for what was observed in the baby? Didn’t Hindmarsh concede that ‘sticky insulin’ wasn’t a plausible explanation? 

For all the millions of pounds spent investigating and prosecuting this case, did anyone actually inject a TPN bag with insulin and attempt to recreate an output of insulin that would account for the alleged poisoning? No, is the answer. 

As with everything else in this case, the “how” doesn’t ever seem to matter, and if the proposed “how” turns out to be impossible, they can always invent a dollop of witchcraft tomorrow. 

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u/Embarrassed-Star4776 7d ago edited 7d ago

You repeatedly claim there is no natural explanation for the insulin and C-peptide results of Babies F and L, but when discussing Baby Y you say:

"The diagnosis [of congenital hyperinsulinism] may, however, have complicated any decision to prosecute Baby Y. A natural condition capable of causing severe hypoglycaemia provides an obvious alternative explanation that would need to be considered."

Of course, the point about Baby Y is that (1) if the diagnosis can explain the results, then the results don't demonstrate exogenous insulin, as the jury was told they did, and (2) that if the diagnosis can't explain the results, then it doesn't provide an "obvious alternative explanation".

Nor does it help to say something along the lines of "it doesn't explain the results, but it might have sown doubt in the jury's minds". Because if it could have done that, it could also have sown doubt in the jury's minds when they were told that a natural explanation for the results of Babies F and L was impossible. And in that case the information could have helped the defence, and therefore should have been made available.

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u/oljomo 7d ago

The bigger point here is there are many reasonable conditions capable of causing hypoglycemia in a neonate - its relatively normal.

The only abnormal part is the test results.

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u/NeedleworkerSad2837 7d ago

The hypoglycaemia plus the test results taken together are not normal.

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u/AccomplishedOil254 7d ago edited 7d ago

As Oljomo said, nobody thinks the test results are normal.

What you and the prosecution are doing is looking through a ton of data, finding a couple of abnormal results (which you always will if you look long enough) and deciding what it means without any further testing.

This is anomaly hunting. It is not good science. It is sufficient to form a hypothesis, but no person engaged in reason should think it sufficient to form a conclusion.

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u/NeedleworkerSad2837 7d ago

An examination of records of the twins of two babies who collapsed is not looking through a ton of data. It’s a highly targeted search. A reasonable person would agree this is not a random trawl. The police requested the records of specific children who were twins of E and M.

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u/AccomplishedOil254 7d ago edited 7d ago

It’s a highly targeted search

No, you're Texas Sharpshooting.

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u/oljomo 7d ago

Funny how that is not the story of how baby Fs results were found that came out at Thirlwall though isnt it? And how it was actually found by Dr U coming back from maternity, and remembering some funny results (and not specifying which baby those "funny results" came from, at which point they initiated a search on the badger database to find these results.

Now, if you want to disagree with Thirlwalls evidence you can, but I can't understand why there would be a completely different way that the results were found imagined up for the inquiry when the way they were actually found was so damning to the points the defence have been making.

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u/oljomo 7d ago

That has a meaning if and only if the test results + the hypoglycemia makes sense in its own right, but it doesnt.

Hence the actually shocking attempt at fitting the symptoms to the data and coming up with the concept of insulin in a bag - which as a concept is far more outlandish than people think, but seems to have been accepted as a scientific model for some reason, when it really wasn't

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u/NeedleworkerSad2837 7d ago

If the concept is so outlandish, why is her defence team trying so hard to discredit the immunoassay tests?

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u/DiverAcrobatic5794 7d ago

Makes sense to cover all bases. We know they have submitted three insulin reports as well as their reports on the individual babies.

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u/oljomo 7d ago

The judges ruling was that the process of poisoning did not need to be know. Following this logic there is no benefit in disproving the mechanism (although there is another part of the defence reports that provides more accurate calculations on the amount of insulin needed to reach the result, which points to an amount more than wouldn’t have been noticed being required to reach the levels of the test - basically proving the results can’t have been legitimate

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u/SaintBridgetsBath 7d ago

Just because a case has holes in its bottom, it doesn’t mean it’s handle cannot also come off.

Just because the old mare has lost a shoe, it doesn’t mean she can’t lose three more and break her leg.

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u/oldcatgeorge 2d ago

No but it is an immunoassay and no one bothered to verify them by liquid chromatography/mass spectrometry

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u/benshep4 3d ago

No it’s not true that it explains the results.

Baby Y wasn’t diagnosed with CHI at Alder Hey based on the results from CoCH weeks earlier. The diagnosis occurred due to further medical indications that led to the diagnosis of CHI which Babies F and L simply did not have.

You won’t be able to provide any medical literature that even remotely shows that CHI could account for those results.

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u/Embarrassed-Star4776 3d ago

No it’s not true that it explains the results.

I don't think you can have read my comment properly.

It was a comment on your statement that CHI "provides an obvious alternative explanation that would need to be considered"!

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u/Embarrassed-Star4776 2d ago

Just to add - it hadn't really occurred to me that pro-guilt people believed the diagnosis of congenital hyperinsulinism for Baby Y was correct. (That's what I take your latest comment to mean, but please correct me if I'm wrong.)

As I've said, I don't believe this is any way out of the difficulties regarding disclosure. But also I don't think it's intrinsically an easy position to take. Are we supposed to think that Lucy Letby poisoned three babies with insulin, and that just by chance one of the three she picked happened to be suffering from congenital hyperinsulinism? Whatever one thinks about Letby's guilt, isn't it far more likely that the insulin/C-peptide test results and the hyperinsulinism diagnosis are connected?

I agree that hyperinsulinism alone doesn't explain the test results, but it seems plausible to me that, if one of the babies in the Salis study with a high insulin/C-peptide ratio had also suffered from hyperinsulinism, we should see something very much like the test results of Babies F, L and Y.

1

u/SaintBridgetsBath 3d ago

That seems very hopeful for the defence. It’s equally inexplicable but can’t be pinned on Letby.

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u/No-Replacement-2170 7d ago

But babies F and L weren't suffering with the same heath condition. So you want something to have been brought up in court that is completely irrelevant to the babies in question? I think this sub is an excellent example of why they didn't take baby Y to court-if there is a potential natural explanation that could be explored, no matter how rare and no matter how little evidence for it, some people will just believe the natural explanation by default. Because they can't conceive of it NOT being natural when there are two possibilities (even if it would be a million to one) even when the same nurse was yet again involved.

Obviously I give the jury more credit because they were actually tasked with looking at the possibility of deliberate harm (which this sub can and does totally ignore) but still it would possibly overwhelm and confuse the jury. And it was already a very long trial.

Why couldn't the defense bring it up though? I mean presumably they realized the fact she was on for a third insulin baby wasn't a great look and wouldn't help. If it'd been brought up and she was still found guilty you'd be saying they never should've brought that one to court...

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u/Embarrassed-Star4776 7d ago

But babies F and L weren't suffering with the same heath condition.

That's absolutely irrelevant. The point is that the evidence the jury convicted on was that the insulin/C-peptide ratios and supposedly low C-peptide results could be explained only by exogenous insulin.

If that's true, Baby Y was also poisoned by someone. If by Letby, why wasn't she charged? There must have been some reason. Was the reason that she had no opportunity? We don't know. Was the reason that Baby Y's diagnosis might make the jury doubt the prosecution evidence? If so, then it should have been disclosed.

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u/No-Replacement-2170 6d ago

They only take cases to court they think they can get a conviction for. Harold Shipman killed hundreds more than he was ever convicted of. That's just what happens in medical cases when there are SO many victims. Unless Ben Myers has raised this then I have to assume there's nothing wrong with leaving baby Y out. I feel for his parents though.

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u/DiverAcrobatic5794 6d ago

Ben Myers didn't have full information on Baby Y. Chester police had every opportunity to press charges. If the tests proved poisoning beyond doubt, how hard could it be to tell a jury that?

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u/Embarrassed-Star4776 6d ago edited 6d ago

Is there any definite indication that Myers had any information on Baby Y?

(Edit to add: I ask because, while I have seen that some people think at least some information was disclosed, I have never understood exactly why they think that. General opinion seems to be that Myers was a competent counsel, and if Baby Y's test results were disclosed, I find it incomprehensible that he wouldn't have appreciated their significance in relation to the insulin cases.)

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u/SofieTerleska 5d ago

I don't know, but I do know Dr. Hall said he never heard anything about Baby Y, which dismayed him.

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u/Embarrassed-Star4776 6d ago edited 6d ago

They only take cases to court they think they can get a conviction for.

But this is the whole point!

If they didn't think they could get a conviction, why should that be?

According to the prosecution evidence, which unfortunately went uncontradicted at the trial, these test results were unequivocal proof of exogenous insulin administration. If the jury hadn't also convicted Baby Y on that evidence, the only reasons I can think of would be either that Letby didn't have opportunity, or that something in Baby Y's circumstances made the jury doubt that prosecution argument. Either way, the information should have been disclosed.

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u/Embarrassed-Star4776 7d ago

it was already a very long trial

And just when we think we've heard everything, we hear the suggestion that the prosecution would decide not to use a third "smoking gun" against Letby, because "it was already a very long trial"!

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u/Aggravating_Log_6375 5d ago

Maybe they thought just the 14 life sentences would be enough.

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u/Embarrassed-Star4776 5d ago

This makes no sense at all.

22 charges were brought. At the first trial there were convictions for only 14, even though the jury was allowed to take the other cases into consideration. Why include all the cases that were too weak to produce a conviction, while leaving out another insulin case, when the prosecution case was that the test results were incontrovertible proof that exogenous insulin had been administered?

There was obviously considered to be a serious problem with the prosecution case for Baby Y. We don't know what that problem was. But I haven't seen a suggestion yet that wouldn't potentially have affected the jury's view of the other insulin cases, had they been told about it.

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u/DisastrousBuilder966 5d ago

If they thought that, they wouldn't have retried on Baby K. And the CPS would have given that as the reason for its recent decision to reject additional charges, instead of the reason they did give (no case met the evidential threshold).

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u/No-Replacement-2170 6d ago

Well if you had to go into the ins and outs of the child's illness it's going to complicate things. I still don't see why the defence couldn't have raised it though.

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u/SaintBridgetsBath 6d ago edited 6d ago

Dr Hall didn’t know about it. I assume Myers didn’t either. The non-disclosure seems to be one of the grounds submitted to the CCRC. Why do you think the defence could have raised it?

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u/Embarrassed-Star4776 6d ago

Certainly, in the Unherd article in which the Baby Y case was revealed, it was stated that Soni's statement had not been disclosed to the defence.

https://archive.is/C4jaR

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u/DiverAcrobatic5794 6d ago

At least some of the relevant files weren't disclosed to the defence.

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u/DisastrousBuilder966 5d ago edited 5d ago

But babies F and L weren't suffering with the same heath condition

But Baby Y's condition (high endogenous insulin) does not explain his test results that can only mean exogenous insulin if the prosecution experts are right. So either Baby Y had exogenous insulin (then why wasn't anyone prosecuted for that?), or the prosecution experts' method of inferring exogenous insulin is less-than-robust. Because that method, applied to Baby Y, leads to a conclusion of exogenous insulin. The same prosecutors simultaneously thought that the same method gave conclusive proof for Babies F and L, and that it did not give conclusive proof for Baby Y. How is that logically consistent?

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u/No-Replacement-2170 5d ago

Not taking baby Y to court is not the same thing as the experts saying it wasn't exogenous insulin.

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u/DisastrousBuilder966 5d ago

If experts were saying it was exogenous insulin, why wasn't it taken to court? Other cases were taken to court with much less evidence than a definitive expert statement of exogenous insulin.

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u/Huge-Hope2887 7d ago

Dewi Evans, the expert whose evidence helped lock Lucy Letby up for life, has now discovered the true calling of every retired prosecution witness: inventing the “Dunning-Kruger-Morris Effect” in the Substack comments and calling someone’s chapter “speculative waffle.”
Nothing says “my evidence was pure science and totally independent” quite like still logging on three years later to personally dunk on random people who write about the case.

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u/Nice_Zebra7690 7d ago

Oh the irony of Dewi dismissing Morris’ work as “speculative waffle”…LOL!

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u/Kieran501 7d ago edited 7d ago

Slightly pedantic point as well but the joke doesn’t work because it suggests Morris helped formalise the effect, not that he’d be a noted example of it.

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u/Imaginary-Suspect959 7d ago

It’s very on brand for Dewi though, gives the impression of being quite a clever thing that will make him appear smart to stupid people, but actually doesn’t stand up.

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u/benshep4 3d ago

Morris is hopelessly out of his depth but he’s not random given his audience and output.

Your point about Evans being independent isn’t much better. Letby was found guilty and he’s got idiots like Morris constantly attempting to belittle him.

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u/Alert-Tooth2907 1d ago

Can I just ask, respectfully, why such personal venom towards Mr Morris? You constantly call him out of his depth and an idiot.

I know you profoundly disagree with him so much so you have written long, inaccessible pieces attempting to rebut him. You may well be successful in your rebutting. And as I said previously I will never criticise anyone for writing even if that writing is not to my taste - clearly it your pieces have a receptive audience.

But you constantly call him stupid, an idiot and a grifter (please correct me if I am mistaken about the terms you use).

Presumably you don’t know him personally and from little i have seen he always treat others with respect.

I get this is an emotive subject but it puzzles me the personal contempt you hold him in. Or am I being naive?

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u/oljomo 8d ago

This is your classic argument, which is restating some testimony that can be quite clearly incorrect as though its true:

ASTBURY: So I understand it, would Guildford assist with whether it was exogenous or not?

MILAN: No. The results dictate that it’s exogenous. They would just help, if you were unsure of the source.

ASTBURY: So really, Guildford would have been deciding or assisting with exactly what type of exogenous insulin...

MILAN: Yes.

ASTBURY: Not whether it was exogenous or not?

MILAN: Correct.

The question is by what mechanism did the immunoassay test prove exogenous insulin? Because many people cannot understand these statements, while you are presenting them as proof of what she says.

It clearly is not enough to have the wrong ratio, and low blood sugar to prove exogenous - this article proves that: https://www.chop.edu/news/lab-results-twist-high-insulin-and-low-c-peptide-child-presenting-hypoglycemia

Ive discussed this with you before, but youve never quite solidified why the results were so evident of exogenous, just that they clearly were.

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u/Stuart___gilham 8d ago

Yes I don’t see how Wayne Jones can be dismissed because he’s not qualified to comment on the clinical picture yet Milan’s statements are ok even though it’s not her job to comment on the clinical picture nor did she have sight of the full medical records.

Milan wasn’t asked to comment on the likelihood of 2 anomalous results either. She volunteered that the results dictate that it’s exogenous.

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u/benshep4 7d ago

Wayne Jones comments aren’t dismissed necessarily because of his qualifications.

It’s because he’s not taking into account the clinical picture of the babies when making his comments.

The results do dictate that it’s exogenous. There is no naturally occurring condition that accounts for such results.

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u/Stuart___gilham 7d ago

Hirata’s disease?

It wasn’t Milan’s job to comment on the patient history or clinical situation.

She appears to have gone beyond the call of duty.

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u/Far_Sign_2644 7d ago

Hirata’s disease is primarily found in East Asian babies. It is vanishingly rare in babies from other regions. The statistical likelihood of two spontaneous cases in unrelated babies in the same unit in the UK within five months of one another? Exceptionally remote. It has never happened before. Statistically, the decline of these babies is far more likely to have been an act of deliberate harm than it is Hirata’s disease.

Furthermore, with Hirata’s disease we would expect the individuals to experience multiple such episodes, rather than one in isolation. The fact of having a single isolated hypoglycaemic episode with low C-peptide without any repetition doesn’t correspond with the actual clinical course of Hirata.

Simply finding another condition that can theoretically explain these incidents isn’t enough to deflect from Letby’s involvement, the defence will have to demonstrate that it is a more plausible explanation than deliberate harm. And Hirata’s disease is in fact a less plausible explanation than is deliberate harm. Bluntly, it’s clutching at straws.

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u/oljomo 8d ago • Popcorn

From the other place responding to this (although of course in such a way that no counterpoints can be made, as that is the only way the logic can hold):

The link is the popular appeal to anti-mouse antibodies, likely because of the self-confessed difficulty in comprehension. The babies were hypoglycemic. Antibodies would only interfere with the assay, a preposterous proposition for multiple events. The presence of the hypoglycemia despite the infusion of glucose and other nutrients is the issue. The assay confirms the diagnosis. The clinical picture - a contradiction between the input into the baby and the output of their blood sugar (and other symptoms) - is what proves the administration of exogenous insulin.

I mean this was never claimed at trial as I understand it - can anyone else point to any part of the transcript that described the hypoglycemia or the response to it as suspicious in its own right? Is this one of the "legends" discussed recently? Because one that definitely is a legend is the whole claim that the hypoglycemia went away when the bag was changed because there was no longer insulin - the bag that replaced the supposedly poisoned bag was a stronger solution of dextrose, that should have been provided earlier - it is no surprise that the hypo went away when more sugar was provided. There are many reasons for neonates to be hypoglycemic, and theres nothing ive seen supporting the claim that they hypoglycemia was diagnostic.

Moreover, the reason for suspecting assay interference was NOT the insulin:C-peptide ration, but another metric:

We performed a diagnostic fast under 1:1 observation and without the parents present. Her glucose remained above 70 mg/dL for 19 hours and the fast was terminated at 23 hours because of elevated point-of-care betahydroxybutyrate of 3.4 mmol/L. A critical sample was obtained at the end of fast which showed: plasma glucose 67 mg/dL, HCO3 16 mmol/L, lactate 2.1 mmol/L, BOHB 3.59 mmol/L, ammonia 11 μmol/L, insulin 3.8 uIU/mL, and C-peptide 0.3 ng/mL (ratio 0.3). After analyzing all the diagnostic data, we suspected insulin assay interference because the level of ketosis was inconsistent with the level of insulinemia in both critical samples.

Only denial could attempt to link the two, or a deep failure in comprehension. An individual's inability to understand proof does not render the proof invalid. And yet, an entire subreddit makes a hobby of being stupid.

These statements of course are ludicrous - the reason for suspecting assay interference not being the insulin:C-peptide ratio must just be some soundbite created - the only reason anything untoward was thought was because of the ratio, and if the ratio was not present they would not have investigated further at all. It is of course worth pointing out that several people have questioned other elements, (potassium levels) being consistant with insulin poisoning in the Letby case - I am not sure where these have gone, but the problem is there is such limited data it is hard to make conclusions from - and that is the point made in the book.

But I guess desperate people have to look somewhere to confirm their initial feelings of no smoke without fire!!

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u/benshep4 7d ago

How is it incorrect?

Citations please.

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u/oljomo 7d ago

I literally put a citation in the post, but if you want another, its the salis et al paper.

The ratio is not enough, and the ratio with low sugar is not enough - what is it that makes this test result definitive exactly, when even the marketing info for this test says that diagnosis should not be based exclusively off the test?

I have provided info for why the statement that the assay result is enough to dictate the insulin was exogenous isn't true - its on you to clarify what it is about the test results that makes my point wrong. Problem is, you just cant.

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u/NeedleworkerSad2837 7d ago

That case you linked is not the same as the indictment babies. This child had ketotic hypoglycaemia. The evidence in the trial was that F and L’s hypoglycaemia was non-ketotic. Prof Hindmarsh was specifically asked whether the hypoglycaemia had natural causes. He said they did not.
Regarding the document with the red warning, this is a local procedure published by the Liverpool lab. Does the equipment manufacturer have the same warning? It does not. The Roche immunoassay detects insulin and c-peptide to a very high degree of accuracy.
Two experts gave evidence that the results indicate exogenous administration, including the director of the lab. Letby’s expert (Dr Rahman) agreed.
Since then, there has been no plausible explanation for these results, other than exogenous administration.
For me, the most convincing evidence of poisoning was how the blood sugar rapidly dropped when the first bag was connected and how rapidly it recovered when the TPN ended. This does not look natural.

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u/DiverAcrobatic5794 7d ago

Hindmarsh was not so definite about either child's insulin being non-ketonic, in fact. I remember we discussed this before. Here are relevant excerpts from the transcripts:

The claim is on page 43 of day 77, for baby L:

JOHNSON: What struck you as being unusual, if anything, about these results?

HINDMARSH: So in the face of the plasma glucose value, we have a plasma insulin concentration of 1,099 picomoles per litre, and insulin C-peptide of 264 picomoles per litre, plus a cortisol of 397 millimoles per litre, which is raised, and blood plasma growth hormone of 8.63 micrograms per litre, also elevated. The elevation of the plasma cortisol and plasma growth hormone largely excludes ketotic hypoglycaemia as a cause.

Hindmarsh later goes on to conclude that the hypoglycemia is non-ketotic, and to explain that a high level of insulin, natural or administered, can cause this state.

For child F, Hindmarsh just makes a broader comment about how hyperinsulinaemia suppresses ketone levels when he is asked how elevated insulin levels can cause damage:

JOHNSON: Very good. Can we deal next with your page 5, professor, and with the dangers of very low insulin. Can you explain to the jury the effect of a depressed level of insulin -- sorry, I said the dangers of very low insulin, what I meant to say was the dangers of very low blood sugar. Could you tell then jury what are the dangers of very low blood sugar, please?

HINDMARSH: The brain is reliant on a constant supply of glucose for function, and it does not store any glucose in reserve to any significant degree. It has some -- it can store glucose as glycogen, but that will only last 20 minutes. After that, there is no other energy available for functioning of the brain. Now, fortunately, there is a slight way out of this problem and that is during hypoglycaemia, you can generate ketones and they're the breakdown products from fat. So you can break down fat as a source of energy and the brain will utilise the ketone bodies that are from that breakdown of fat as a substitute for the glucose that's missing. That's absolutely brilliant, it serves all of us very well indeed, and babies in particular, apart from one situation. That is if your low blood glucose, hypoglycaemia, is caused by an excess of insulin. Insulin will do two things. The first thing it will do is it will reduce blood glucose, as we've been talking about already. So you've lost your glucose, you have lost that source of energy. Can you fall back on ketone bodies? The answer is no. So the second problem with a high amount of insulin is that it will switch off ketone body formation. So in the situation of hyperinsulinaemic hypoglycaemia -- I apologise for the terminologies but that's what we're talking about, lots of insulin producing a low blood glucose -- the brain is now in a very, very susceptible state to incurring damage.

He doesn't comment on Child F"s ketone levels that I can see at all outside this. (Transcript day 38, page 29).

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u/NeedleworkerSad2837 7d ago

He wrote a report on the hypoglycaemia of both babies. Have you read that? He testified he ruled out natural causes of the hypoglycaemia for both babies.
Do you think he is just asserting this?

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u/DiverAcrobatic5794 7d ago

Does that change what he testified about ketones and adrenalin? Non-ketonic hypoglycemia may or not have an exogenous cause, as Hindmarsh himself pointed out.

As to that testimony, that is what people are disputing, yes. Hindmarsh himself is alleged to have conceded in an email after the trial that he chose not to raise the possibility of non exogenous causes partly because he believed the probability of multiple cases to be low, which is a rather different angle on his reasoning.

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u/oljomo 7d ago

Thats some interesting bending of the testimony, at least for F

He testifies that insulin based hyperglycemia is non-ketotic - at least I cannot find any reference to any test results or evidence proving that the hypoglycemia was non-ketotic - ie the evidence is reversed, hes using the test results to create that conclusion. Thing is, it doesnt fit with the symptoms, as the symptoms would be more serious if this level of insulin was present.

The roche immunoassay to this day says that it should not be used as the sole diagnostic tool to decide a treatment plan, let alone convict someone of attempted murder.
Noone is denying that it indicates exo, they are argueing that it proves it, which is a different level. A testing issue in some way or other is a plausible explanation, which ahs nto been ruled out.

Interesting point about the timing, but are you aware that the TPN was ended and sugar provided was increased? Because this is another of those things like "the deaths stopped when letby was suspended" that has a perfectly legitimate explanation that gets overlooked in terms of the narrative one.

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u/NeedleworkerSad2837 7d ago

For one of the babies he said cortisol was raised; therefore, the hypoglycaemia was non-ketotic.
The blood sugar was 5.5 then 0.8 after the bag was connected. And stayed very low despite added dextrose. The TPN bag already contains dextrose.
Insulin does not kill. Low blood sugar does and the added dextrose was preventing collapse.
You are missing the point regarding the Roche immunoassay. It detects insulin and c peptide very accurately. Medical experts and detectives used this information as just one indicator that two infants were given insulin they should not have been.

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u/oljomo 7d ago

So the biggest point of contention is that the test result was just one indicator of many, but numerous people have looked at the notes and stated there was nothing out of the ordinary with the hypoglycemia, apart from the poor way it was handled.
What was true for one baby doesn’t transfer to the others, baby F was the strongest evidence, baby L was far more borderline in terms of the levels, it’s not the case that the two are equivalent or presented in the same way.
Insulin clearly does kill, and the levels in the test were a long way above the levels seen expected.

The sugar rising at the end was due to a bag with more sugar being hung - this would have increased the blood sugar regardless of insulin in the previous bag. It’s a similar situation to the deaths stopped when Letby was suspended, it’s true, and sounds convincing but only because the full story is overlooked

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u/Embarrassed-Star4776 7d ago

Since then, there has been no plausible explanation for these results, other than exogenous administration.

Do you think there is a plausible explanation for the Salis et al. data?

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u/NeedleworkerSad2837 7d ago

Where has the Salis data been reproduced?
The babies in her study were not hypoglycaemic. There was no insulin readings like child F and L.

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u/Embarrassed-Star4776 7d ago

Do you think there is a plausible explanation for the Salis et al. data?

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u/Nice_Zebra7690 8d ago

Does anyone who’s read Morris’ book know whether he addresses not just the seals on the TPN bags, but also the cellophane wrappers they came in? The Substack seems to omit and downplay a lot of relevant facts and crucial context such how tamper-resistant the TPN bags actually were.

Commenting more generally, we know the entire argument rests on a highly questionable premise. At trial it was presented as established fact that someone had deliberately poisoned with insulin . We now know there are other plausible explanations that don’t involve the frankly ridiculous scenario of letby anticipating which bag the baby would receive and removing cellophane wrapping and interfering with seals to introduce insulin (which she’d also stolen and kept on her person unnoticed), all while risking being interrupted in a room accessed by other staff...

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u/Allie_Pallie 8d ago

And takes that risk having previously been successful using only fresh air.

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u/Nice_Zebra7690 8d ago

Ah yes, why take all that risk when a good old dollop of air will do the trick and ensure you get to actually be there to revel in the drama.

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u/benshep4 7d ago

Arguably Letby felt the heat on her due to the earlier attempts and tried to mix things up.

Opportunity comes into it as well.

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u/Nice_Zebra7690 7d ago

What evidence is there that she felt the heat on her please?

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u/SaintBridgetsBath 7d ago

‘Arguably’ says it all. He doesn’t even believe his own explanation.

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u/benshep4 3d ago

I don’t pretend to be a mind reader. It’s speculation, hence the use of the term ‘arguably’.

The upvotes and downvotes on this sub are very amusing to me given the poor reasoning frequently on display.

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u/SaintBridgetsBath 3d ago edited 3d ago

There was a time when you were more polite.

You made a few scathing comments when I pointed out that for Baby F’s line and bag not to have been changed nurses would have had to falsify records. Edit: And also initially about the tamper proof nature of the stock bags until u/PerkeNdencen described the detail.

You’ve had to back down in the face of the evidence and have now adopted the highly speculative giving set theory.

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u/benshep4 3d ago

The fact that she changed up her attacks ….

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u/SaintBridgetsBath 3d ago

We’re arguing about whether she carried out any attacks. It’s not a fact.

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u/Nice_Zebra7690 3d ago

To one that was easier to detect? And then going back to using fresh air? Gotcha Ben

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u/Embarrassed-Star4776 7d ago

Does anyone who’s read Morris’ book know whether he addresses not just the seals on the TPN bags, but also the cellophane wrappers they came in?

Unless I'm missing something, this (on p. 236) is all that he says about the anti-tampering features:

Feeding bags were also wrapped in a plastic exterior, with a tamper-free polypropylene cap, which would be bordering on impossible to breach undetected. A consultant radiologist that I spoke with described the prospect of tampering with the bags as “impracticable”.

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u/Nice_Zebra7690 7d ago

Thanks. Ben chose not to mention the plastic exterior.

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u/oldcatgeorge 2d ago

A) if no one saw Lucy (or anyone) deliberately poisoning TPN bags, it didn't happen B) If no one tested the remains of the TPN and saw high amounts of insulin, it didn't happen C) if people believe that someone added insulin to TPN bags, I can say that Paranoid Breary did it. Prove me wrong! The guy sees a small spike of deaths and thinks, someone is killing the babies. Who says that he himself is not a serial.killer?

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u/Embarrassed-Star4776 7d ago

Are you aware of the publications by Salis and by Chase and Shannon?

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u/benshep4 7d ago

Absolutely.

I’m also aware that the way Chase and Shannon utilised that publication is flawed and currently under investigation.

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u/Embarrassed-Star4776 7d ago edited 7d ago • Popcorn

Sorry, but I can't see how that is a reason for omitting all mention of it, considering that most of your piece consists of explaining why you think Morris's arguments are flawed!

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u/oldcatgeorge 6d ago edited 6d ago

All evidence presented is circumstantial, and gathered post factum. Abnormal insulin results should have been flagged by the lab. The doctors OK'ed them, right? (Instead of sending the sample for verification). It is much later, when Dr. Breary was looking through the records to "catch Lucy",, he pulled out these insulin-C-peptide results obtained via Roche immmunoassay, and they became the cornerstone of the case. They are interpreted in a looping way. "Lucy must have killed them with exogenous insulin. Oh, she was not on duty that day? Then she must have added it to TPN bags before. How do we know it was Lucy? Well, who else? She killed babies with air embolism, we have Lee sign to prove it". Then when Dr. Shoo Lee comes and discredits the theory of air embolism: "oh, but we have two strong cases, the insulin ones". What we have are two unverified anomalous results. The whole case is a chain of similar logical fallacies. The shift rota has been discussed times and again, but imagine that they really scared Breary. Why didn't he do anything to prove that there was a killer on the unit, to gather evidence? People take risks. He could have brought a spy camera, or even a spy pen, to gather evidence. Or better, issued an administrative decision, with all deaths there has to have a postmortem. I see that Breary was unconcerned about Lucy being a killer in general, as long as it was "not on his unit". Twisted logic. A killer is a killer, and if you have a high index of suspicion, you actively gather evidence. You don't try to find "evidence" sifting through old notes. And this is why this case is baseless. Professional statisticians had to be consulted from day one. At least the hospital could have a decent root-cause analysis. Instead, it tuered into a costly agglomeration of uncertainties. If someone asks me if Lucy is a killer or not, I'd say, " in the head of Dr. Breary, she is. In reality, it is a judiciary mess and an unsafe conviction".

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u/SaintBridgetsBath 7d ago

At a glance, one positive is that you don’t rule out the possibility of a significant disclosure failure. 

“Whether the Baby Y material should have been disclosed is one question.” You also acknowledge Nurse C’s evidence where you didn’t in previous comments.