Book Review

The Death of Innocents: A true story of murder, medicine, and high-stakes science

N Engl J Med 1998; 338:1778June 11, 1998

Article

The Death of Innocents: A true story of murder, medicine, and high-stakes science
By Richard Firstman and Jamie Talan. 632 pp. New York, Bantam Books, 1997. $24.95. ISBN: 0-553-10013-0

Salisbury. His passion is so ripe it needs must break.

Pembroke. And when it breaks, I fear will issue thence

The foul corruption of a sweet child's death.

(Shakespeare. King John, Act IV, Scene 2, Lines 79–81.)

So starts the 1961 Journal article “Slaughter of the Innocents: A Study of Forty-Six Homicides in Which the Victims Were Children” (L. Adelson. 1961;264:1345–49). This classical theme echoes throughout the accompanying grim editorial, “Murder in the Tower” (1961;264:1368–69). Thirty-seven years later, the same themes of passion, corruption, and the death of sweet children reverberate through the pages of The Death of Innocents: A True Story of Murder, Medicine, and High-Stakes Science.

The book opens with a gripping tale of the investigation into the deaths of the three Van Der Sluys siblings — deaths that had been written off as due to accidental choking or the sudden infant death syndrome (SIDS). Ten years, three exhumations, and a dramatic trial later, the dogged determination of a group of tenacious law-enforcement officials was rewarded when a judge found the father of the children guilty of murder. He had suffocated the children for the life-insurance money. If the book had ended there, it would have been a better-than-average true-crime story, but it would not have been reviewed in the Journal. What makes this book appropriate for review in these pages is a piece of the medical literature itself.

In 1972, Pediatrics published an article that described five patients with abnormally prolonged periods of apnea, two of whom were siblings who eventually died of SIDS (A. Steinschneider. “Prolonged Apnea and the Sudden Infant Death Syndrome: Clinical and Laboratory Observations.” 1972;50:646). In fact, those two children had three older siblings who had died. This paper provided support for the theory that prolonged apnea and SIDS are linked and hereditary, and it was carefully studied by the attorneys in the Van Der Sluys case. Just as they had been suspicious of the three deaths in the Van Der Sluys family, the prosecutors suspected foul play in the deaths of the five siblings. By coincidence, the Pediatrics paper originated from upstate New York, close to where the Van Der Sluys murders had occurred. After some clever detective work, the investigators identified the second family in the article as the Hoyts, and Mrs. Hoyt was eventually convicted of murder. She was a pathetic murderer, suffering from Munchausen syndrome by proxy. Contrary to the conclusions of the Pediatrics article, the children were victims of a serial killer, not a genetic disease.

Although they are the only murderers in the book, Mr. Van Der Sluys and Mrs. Hoyt are not the only villains. The authors, former reporters at Newsday, paint an ugly picture of the clinical investigators in the SIDS field. Starting with the 1972 Pediatrics paper, we are given a detailed description of scientists whose arrogance, ruthlessness, and lust for success prevented them from viewing either their data or their patients objectively. They are shown denigrating colleagues who criticized their interpretation of the data, ignoring the nurses who confronted them because of concern about the research subjects, and marginalizing members of the house staff who questioned the diagnosis and management of familial SIDS. As one of the investigators admits, “When you do research, you can easily be seduced into believing what you want to.”

It is hard to judge how accurate this gruesome portrait is, although the authors are careful to document much of what they report in a very creditable fashion. I must admit that as a house officer in the early days of the familial SIDS flurry, I was too beleaguered to insist that the emperor did not seem to be wearing anything.

This book is a most absorbing way to be reminded of the pitfalls of clinical investigation and how to avoid them by involving a diverse research team and listening to their conclusions.

Orah Platt, M.D.
Children's Hospital, Boston, MA 02115