A Boston hospital has notified the Massachusetts medical
board that it has restricted the work of a world-renowned endocrinologist
criticized for espousing controversial theories as an expert witness for people
accused of child abuse.
The action against Dr. Michael Holick is cited on his
profile page on the board’s website under “health care facility discipline.”
The listing is intended to alert members of the public who visit the site that
Boston Medical Center, where Holick practices, has restricted his rights or
privileges.
Last September, ProPublica and The New Yorker reported that
Holick had testified in hundreds of child abuse cases worldwide and almost
always blamed broken bones and other injuries on a rare genetic disorder. At
the time, Boston Medical Center said that it had barred Holick from treating or
evaluating children under age 13 beginning in May 2017. But Holick continued
evaluating children in suspected abuse cases as part of an approved research
project, and it now turns out that the discipline was not reported to the board
until this past February.
A hospital spokesman, in an email last week, wrote that the
filing with the medical board “is consistent with” the information it provided
ProPublica last year. The spokesman, David Kibbe, also indicated that Holick is
still allowed to evaluate children who participate in his research project.
The medical board requires hospitals to report disciplinary actions
within 30 days of taking them. When asked about the 21-month gap between the
hospital barring Holick from treating children and the report to the medical
board, Kibbe responded, “We complied with our reporting obligations.” He
offered no further explanation.
A spokesman for the Massachusetts Board of Registration in
Medicine said the details of the hospital action against Holick are
confidential.
Holick, who did not respond to calls or emails seeking
comment for this story, is best known in medical research circles for
pioneering work related to vitamin D. He discovered the active ingredient in
the vitamin, leading to treatments for bone disease in kidney patients. He also
figured out that orange juice helps the body absorb vitamin D, a finding that
led to the U.S. Food and Drug Administration approving vitamin D-fortified
orange juice.
Earlier this decade, Holick began working as an expert
witness in child abuse cases in the U.S. and abroad. He has consulted or
testified in more than 300 cases, always on behalf of the accused. As of last
September, he had never concluded that a child was abused, and he had almost
always attributed the injuries to Hypermobile Ehlers-Danlos syndrome, a
condition that affects the connective tissues of the skin, bones and joints and
has been linked to bone fragility in adults.
The ProPublica-New Yorker article focused on a social
services investigation in South Carolina that found that 3-week-old twins had
allegedly been abused. The parents consulted Holick, who concluded that both
babies had Ehlers-Danlos, and that fractures attributed to abuse could have
been caused by bone fragility associated with the genetic condition. Nearly
eight months later, one of the twins suffered a severe brain injury and the
child’s father was charged with abuse to inflict great bodily injury upon a
child. That criminal case is pending.
“Thousands, if not tens of thousands,” of parents worldwide
have been falsely accused of fracturing their children’s bones, Holick told
ProPublica last year. “It’s just terrible. I feel so sorry for these parents.”
His work has drawn rebukes from other physicians who
specialize in treating patients with the genetic disorder. They cite a lack of
research supporting Holick’s view that Ehlers-Danlos can cause broken bones in
very young children. Holick has also been criticized for diagnosing the
condition in children he didn’t examine in person.
Boston Medical Center is the teaching hospital affiliated
with Boston University School of Medicine, where Holick is a longtime faculty
member. A spokeswoman for the medical school said Holick remains on the
faculty.
Boston University has defended Holick’s right to testify
about his Ehlers-Danlos theory in court. The dean of the medical school, Karen
Antman, in a letter to another physician critical of Holick, wrote that she
didn’t need to know the details of his expert defense work. “As a member of the
Boston University School of Medicine faculty, academic freedom allows Dr.
Holick to espouse his views without censorship from the University,” she wrote.
In the past seven years, Holick said, he has consulted or
testified as an expert witness in more than 300 child-abuse cases throughout
the U.S. as well as the United Kingdom, New Zealand, Australia, Germany and
Canada. In almost every case, he has made the same finding: instead of blaming
any injuries on abuse, he has diagnosed the child with a rare genetic disorder,
Hypermobile Ehlers-Danlos syndrome, a condition that affects the connective
tissues of the skin, bones and joints. A handful of studies on adults have
linked EDS to bone fragility, and Holick argues that children with the disorder
have weaker bones, which can fracture from normal handling. So far, his theory is
not supported by the scientific literature, but Holick is convinced that
“thousands, if not tens of thousands,” of parents worldwide have been falsely
accused of fracturing their children’s bones. “It’s just terrible,” he told me.
“I feel so sorry for these parents.”
In all the cases he has worked on, Holick has never
concluded that a child was being abused. On the rare occasions when he didn’t
diagnose EDS, he attributed the bone fractures to rickets or vitamin D
deficiency. Many geneticists and bone specialists find it troubling that he
diagnoses EDS in nearly 100 percent of the cases he examines. According to the
National Institutes of Health, EDS affects, at the most, 0.02 percent of people
worldwide. The rate at which Holick diagnoses the disorder “doesn’t fall into
the mathematical probability of chance,” Brad Tinkle, a clinical geneticist at
Peyton Manning Children’s Hospital, in Indianapolis, said. Holick retorts that
his clients don’t come to him by chance; parents contact him after doing their
own research and realizing that they or their children have symptoms of EDS. He
adds that he hasn’t seen a single actual abuser pretending to have EDS and
contacting him in search of a “get out of jail free” card.
Holick regularly diagnoses children with EDS without seeing
them in person. “I already know on the phone they have EDS,” he said, adding
that he questions the parents about potential symptoms. “I almost don’t have to
ask. I know the answer.”...
In 2017, he co-published an article about his EDS work in
the little-known journal Dermato-Endocrinology, where he is an associate
editor. (He was unable to get more prestigious medical journals to publish the
study.) In the study, Holick examined the cases of 72 children who the
authorities believed had been abused. He diagnosed 67 of them with EDS. In a
third of the cases, he based his diagnosis on physical exams of relatives of
the children, not the children themselves.
“How can you do that without an exam?” Brendan Lee, the
chair of the Molecular and Human Genetics department at Baylor College of
Medicine and the director of the Skeletal Dysplasia Clinic at Texas Children’s
Hospital, said. He added that hypermobile EDS “is a diagnosis that is made
based on a constellation of clinical findings, which you have to do by
examination and history.”
Lee and several other experts said that hypermobile EDS
typically cannot be diagnosed in children younger than five. Because infants
are usually very flexible, they will likely score high on elements of the test
given to older patients to determine hyperflexibility, a key aspect of EDS.
Also, symptoms of the condition do not usually manifest until later in
childhood, or even adulthood. “I would not be comfortable, ever, telling a
parent that an infant has (hypermobile) EDS,” Lee said.
There are four studies that Holick consistently cites to
support his conclusions. I asked Rodney Grahame, the author of two of those
studies and a former president of the British Society for Rheumatology, whether
he finds Holick’s theory of a link between EDS and bone fractures in infants to
be reasonable. “Not at all,” Grahame responded in an e-mail. “It may ‘stand to
reason’, but it is not supported by published scientific research. In adults,
other factors are at play including ageing and the menopause, alcohol, smoking
which are factors associated with osteoporosis that are not present in
infants.”
Cristina Eller Vainicher, the lead author on another paper
that Holick frequently cites, said that she can’t entirely discount his thesis,
because some studies have suggested that a subset of EDS patients experience
fragility fractures during childhood. Still, she wrote in an e-mail, “This does
not mean that we could state all children with hypermobile EDS are at high risk
of fractures.”
Holick’s credibility as an expert witness is buttressed by a
formidable scientific resume, mostly related to his work on vitamin D...
Holick, who is now 72, gives talks around the world on the
importance of vitamin D. He was billed as a “legend” at the most recent annual
meeting of the American Association of Clinical Endocrinologists. He has
published more than 500 articles in peer-reviewed journals and more than 200
reviews and book chapters. Since 2011, other scientists have cited him almost
110,000 times, making him one of the most frequently cited researchers in the
world...
But Holick’s career has also been dogged by controversy. He
came under fire for recommending the use of tanning beds based on research he’d
done partly with funding from a foundation established by the Indoor Tanning
Association, a relationship that I reported on in The Wall Street Journal. He
also published a book called “The UV Advantage,” in which he urged people to
soak up unfiltered sun two or three times a week. “Do not be afraid,” Holick
wrote. “You are not going to die just because you go out in the sun.”...
“It seems so intuitively obvious,” he told me. “No one ever
connected the dots. No one in the pediatric or child-abuse community ever made
an effort to find other potential mitigating circumstances to explain these
fractures, other than a rush to judgment.”
He testified in court on the family’s behalf, and the baby
was returned to his parents. Word of Holick’s success began to spread. He now
receives pleas for help from parents accused of abuse on almost a daily basis.
Holick said he doesn’t charge for his services, though he does solicit donations
for his Ehlers-Danlos research. About a quarter of the funding for his EDS
research in the past four years — about $125,000 — has come from two families
who had abuse charges dropped after Holick intervened in their cases, he said.
Holick is one of the most prominent and sought-after expert
witnesses for the defense in child-abuse cases. He told me that about half the
parents he assists end up with a positive outcome, such as getting their
children back or having abuse charges dismissed. However, he has sometimes
claimed a much higher success rate. “Before I started testifying in these court
cases on behalf of the family 100% of these cases had been won by the
prosecution,” he wrote as part of an unsuccessful plea to the editor of a
medical journal to publish his study on EDS and child abuse. “Now that I am
testifying on behalf of the family 90% of the cases have been won by the
parents and their children have been returned to them without further
incident.”...
“I truly believe you could be an angel put on this earth to
show the justice and glory of the almighty,” a father from New Hampshire wrote
to Holick in 2016. “The good you’re doing on this earth is amazing, incredible,
inspiring, loving, noble, and even incomprehensible.”...
The mutual enmity between Holick and abuse experts at
children’s hospitals is hard to overstate. Lori Frasier, the head of the
Division of Child Abuse Pediatrics at Penn State Hershey Medical Center,
started encountering Holick in court several years ago. Frasier told me that
she was struck by Holick’s arrogance. “Maybe he is feeling like he is really,
really smart and seeing something the rest of us can’t see,” she said. He might
view himself as “a Copernicus of this century, or Galileo, fighting the status
quo.”
Holick describes specialists like Frasier as zealots who,
because of their training, see abuse behind nearly every mysterious injury that
comes through the hospital door. “I naively assumed people want to be
educated,” Holick said. “They don’t. They are child-abuse experts. They have to
know.”
Unlike Holick, Frasier serves as an expert witness for both
prosecutors and defendants, and recently testified in Nevada for a father
accused of child abuse. (The father was acquitted in the case.) In May 2016, Holick appeared on a Philadelphia television
station, saying that a baby’s injuries were likely the result of EDS and a
vitamin D deficiency, not child abuse. Two days later, Frasier sent a concerned
e-mail to Karen Antman, the dean of Boston University Medical School. “Dr.
Holick makes statements regarding the infant’s medical condition that have no
evidence base,” she wrote, noting that other experts had ruled out EDS in the
case, and that even if the boy did have the condition there was no evidence it
would make his bones fragile. “He is bringing the reputation of Boston
University into disrepute.”
Antman replied with a defense of Holick and said she didn’t
need to know the particulars of his expert work. “As a private citizen and a
physician, Dr. Holick is entitled to provide consultative services and testify
as an expert witness,” she wrote. “As a
member of the Boston University School of Medicine faculty, academic freedom
allows Dr. Holick to espouse his views without censorship from the University.”...
Seven months after Frasier complained to Holick’s dean, a
pediatric geneticist at the Children’s Hospital at Albany Medical Center also
raised concerns about him with B.U. Natasha Shur wrote in an e-mail to Holick’s
department head, Alan Farwell, that Holick’s expert findings lacked scientific
support. “I hope that you are interested in considering these issues, and the
effect of BU and its involvement,” she wrote.’’
Nevertheless, she finds Holick’s assertions alarming. When
she takes the medical histories of patients with EDS, she told me, they don’t
mention frequent fractures or brittle bones. “My patients are the first ones to
state, ‘I never fractured as a baby,’” she said. “They have had to deal with
joint dislocations, joint pain, but as a whole have not had to deal with
unexplained fractures.”...
“Academic freedom is not just about saying what you want,”
John Leventhal, the medical director of the Yale-New Haven Children’s Hospital
Child Abuse Program, said. In an article for the Journal of the American
Medical Association last year, Leventhal and his co-authors said that academic
medical centers should take some responsibility for the testimony of physicians
who promote “flawed theories” in child-abuse cases. “If medical faculty at
these institutions testified under oath that smoking did not cause cancer or
that HIV did not cause AIDS, would such testimony be tolerated?” he wrote...
It wasn’t until later, after reviewing relevant literature
in the field, that Sege determined that he could not validate the link between
EDS and infant bone fractures. “I believe this is his firmly held belief,”
Sege, who is now a professor at the Tufts University School of Medicine, said
of Holick. “It is not backed by evidence.”
Still, Sege said, one comment of Holick’s unnerved him:
Holick told him that he doesn’t recommend that parents in potential abuse cases
test for osteogenesis imperfecta, the disease known to cause injuries that look
as though they might be the result of abuse. Holick acknowledges advising
against testing for the disorder. “It’s incredibly rare,” he said, and the test
“will come back negative,” adding to the impression that “you are a child
abuser.”
“That is a real red flag,” Sege said. “I am a doctor. I test
for all things out there before I go to the thing that is my invention. I test
for everything I can. It is alarming to tell someone not to get a test because
it might impact your court case.”
In May 2017, Boston Medical Center banned Holick from using
“its facilities to treat or evaluate patients under the age of thirteen for any
reason,” the hospital said in a statement for this article. It said that its
“medical leadership” made the decision, but didn’t explain why. Holick said
that complaints about his child-abuse work prompted the edict...
This past January, Holick received a phone call so
unsettling that he doesn’t even remember who was on the other end. The caller
said that the child of a family Holick helped in an abuse case was in the
hospital with a serious brain injury, and the father had been arrested.
“Look what you’ve done,” the caller said, according to
Holick.
The child was one of Jenn and Robbie Ray’s twins. Officials
in South Carolina had agreed to a plan to gradually reunite the family. They‘d
had three weekends of unsupervised visits. Now the local newspaper featured a
mug shot of Robbie Ray in orange prison garb...
But I believe that what likely happened is just like he was
stating: that he was innocently swinging his child in the swing and bumped the
head. Unfortunately, the pediatrician and or emergency doctor didn’t actually
connect dots and didn’t realize that, if that infant or child has EDS, and if
they’re having trauma, they should be more concerned about a brain bleed and
not to have sent that child home.”
The explanation is, in many ways, typical of how Holick
views these cases. He is quick to declare that a trivial accident has resulted
in injuries that can be explained by his diagnosis, that the child has received
incompetent medical care from less knowledgeable doctors and that the
authorities have rushed to judgment.
Holick’s description of the incident, however, is largely
inaccurate. The girl was 8 months old, not 2 years. Robbie wasn’t “innocently
swinging his child in the swing.” By his account, he had strapped the baby into
a motorized Fisher-Price swing, with the seat about a foot off the floor, while
he sat on the couch and fed the other child. He didn’t drive the baby to the
hospital; he called 911, and an ambulance took her. In a recording of that
call, Robbie seems to be sobbing as he tries to awaken his unconscious
daughter. “What’s wrong with her?” he asks the 911 operator. “What happened?”...
Nor could Holick’s comment that she “bumped her head”
explain the damage to the rest of her body. Her right leg was broken near the
thigh. A photograph from the hospital shows the infant lying on her back, with
one eye swollen shut and bruises on her right eye and nose. There appears to be
dried blood on her left hand.
Holick said that he called Jenn Ray to find out what
happened, and that he’s confident the latest injuries weren’t caused by abuse,
either, but were another complication of EDS.
Holick will be watching the Ray case from Boston. Mistakes
happen in medicine, but he realizes that one high-profile misstep on his part
could greatly damage his credibility.
“I’m very, very concerned this could upend this whole
activity, if even one of the cases of the hundreds turns out to be a
child-abuse case,” he said. But he acknowledged the possibility that the case
might not turn out as he would like. “You know, these types of things are going
to happen,” he said.
In another conversation, he reflected on the impact of his crusade
to reunite families divided by child-abuse allegations. “To date,” he said,
“almost all of the kids I helped return to parents are happy and well.”
https://www.propublica.org/article/michael-holick-ehlers-danlos-syndrome-child-abuse-contrarian
Courtesy of a colleague
Courtesy of a colleague
