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Toronto’s Sick Kids Hospital. (Simon Hayter For The Globe and Mail)
Toronto’s Sick Kids Hospital. (Simon Hayter For The Globe and Mail)

André Picard

After Motherisk report, Sick Kids needs some serious self-reflection Add to ...

Just before Christmas, the findings of an independent review of the Motherisk Hair Testing Laboratory were released. The report, prepared by Justice Susan Lang of the Ontario Court of Appeal, makes for bone-chilling reading.

After a meticulous dissection of the evidence, Justice Lang concluded that the hair testing – which was used to determine alcohol and drug use in child protection investigations and criminal prosecutions – was “inadequate and unreliable,” and so, too, was much expert testimony.

While Motherisk founder Gideon Koren rarely testified himself, the judge said he was ultimately responsible for ensuring interpretations were done properly.

The findings will have sweeping repercussions because the hair testing was used in 16,000 child-protection cases and six criminal cases that resulted in convictions.

The key case was that of Tamara Broomfield, who was convicted of administering a noxious substance (cocaine) to her child and various other charges in 2009. Her conviction was overturned in 2014 when the Ontario Court of Appeal expressed serious doubts about the validity of Motherisk’s hair testing.

In response, the Toronto Star published a series of investigative articles, which, in turn, forced the province to commission an independent review, and led to the suspension and permanent closing of the drug-testing lab.

The technical details of how the hair testing was inadequate are important, but the short version is that while the lab promised “gold standard” results, it barely delivered a tin standard.

That this could happen for a decade beggars belief, but, according to Justice Lang, the fundamental problem was lack of oversight, a culture that allowed shoddy science to flourish and be rewarded. To understand this we need a bit of history and context.

Motherisk, a unit of the Toronto Hospital for Sick Children, was founded back in 1985 to conduct research on drugs and environmental chemicals, and how they could affect breastfeeding moms and newborn babies in particular.

Motherisk did groundbreaking research, especially on the role of folic acid preventing birth defects and cancer, and how codeine-based medicine can be fatal to babies after surgery. But labs, no matter how successful, need to generate funds. So Motherisk created a spinoff hair-testing business – one that proved quite lucrative, bringing in up to $1.3-million a year.

Dr. Koren became a much-called-upon expert witness. Problem was he was not an expert in this kind of pathological testing. Justice Lang found that much of his testimony was grossly misleading – there were huge leaps made based on flawed tests.

How does this happen?

In modern society (and perhaps even more in the legal and courts system), we are enamoured by TV series, such as CSI, where a single strand of hair tells a rich, definitive tale.

In real life, science is rarely that magical. Things like hair testing provide some information, but it requires much interpretation and even more caution.

When you have a financial interest in offering black-and-white interpretations, and little oversight and accountability, trouble can ensue. The hair-testing debacle demonstrates this all too well.

But what’s most troubling of all is that the Motherisk story is oddly familiar.

In 2008, an inquiry revealed that Charles Smith, a forensic pathologist at Sick Kids who was responsible for investigating suspicious child deaths, had grossly misinterpreted autopsy results and overstated his expertise. The tragic result there was that at least 13 people were wrongly convicted because Dr. Smith testified there was foul play (often shaken baby syndrome).

Stephen Goudge, who led that inquiry, made some recommendations to Sick Kids Hospital (and to the health and research community more generally) that apparently need to be reiterated: Oversight is essential, and so, too, is training and the verification of credentials.

Dr. Smith and Dr. Koren were passionate about their work and beliefs – often to the point of religious-like fervour. They built little empires and reputations as unassailable experts.

This kind of hero worship ended up being costly, especially for parents who found themselves in their crosshairs. Parents have gone to jail and been deprived of their children.

That this has happened, at least in part, because of managerial and administrative failures of the Hospital for Sick Children, which also has a world-class reputation, is deeply troubling.

In the Motherisk case, there has been a summary apology, but some serious self-reflection is still in order.

Children, their parents and the public deserve better from Sick Kids.

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André Picard’s advice to Canada’s future doctors from his 30 years of health reporting (Courtesy University of Manitoba)

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