I was upset to read on the BBC that "A solicitor representing the families of six victims of Lucy Letby said online speculation about the safety of the nurse's conviction was "upsetting" for all of her clients". I remember being impressed by Dr Jim Swire, the father of one of the dead in the Pan Am Flight 103 bombing arguing that he did not accept the guilt of al-Megrahi - he wanted the truth, not a scapegoat. Sadly, the rejection by arXiv and medRxiv tells me there is something to hide, there are powerful interests that do not want the truth. You are presenting a novel analysis of clinical relevance.
A few weeks ago I came across BlackBeltBarrister on YouTube who recently has made some comments on oddities in the Letby trial. Worth a view.
Personally, on that other front I can’t believe that I have been send an email about having that latest covid booster, which I have declined for three years. The system is trying to kill me off.
Brilliant. Thanks. I do love to see when others - as Matt Damon said in The Martian - science the sh*t out of it ;-) in other ways and come to similar/the same conclusions. I too looked at other methods (for example, normative distributions across each year for five years) and even on those methods CoCH at worst was simply skirting the upper bound for a neonatal unit of their size and elevated acuity. Nice work.
That quote from The Martian made me laugh. Like the film, Cube (1997), The Martian is one of those films reminding you that you should sharpen your reasoning skills if ever in trouble. We are definitely living through times where it is crucial to remain focused.
That is missing in these stats ? It makes a difference if a baby is a "one" or twins, or triplets. One triplet in the Lucy trial consisted of one separate baby with its own placenta, and two babies that shared a placenta.
So the number of babies and their period of gestation is important but it seems also important whether the babies were part of twins or triplets.
If I understand correctly, IVF babies have on average a 10% lower birth weight compared to babies conceived the classic way.
Many of the parents who lost a child in the CoCH ward for premature babies, indicated that they had trouble conceiving and had their baby/babies after several miscarriages (up to eight).
Re. the year 2014 - could the (unnecessary) death of baby Noah have led to heightened levels of attention and care, especially under junior doctors ?
While the statistics may shed doubt, they are only one brick in the wall. For example, why were nursing notes altered post hoc, and why were sheets of nursing notes found at the suspect’s house? Those two facts raise alarm bells with me. The insulin evidence is also damning.
Some with long memories may recall the acquittal of Sally Clarke because of a statistical error. A second expert, not the one who made the decimal point error, had indicated that if she had not killed her children the only conclusion was that her husband had. At the acquittal hearing was a court clerk who happened to be a patient of mine, who confronted the defence barrister after the acquittal and blurted out to him that they thought the evidence of guilt was overwhelming. They told me that the barrister smiled and winked. Justice and truth may not be the same.
The characterisation that "nursing notes were found in her house" was misleading nonsense by police. You simply cannot take actual nursing notes home (they are all digital and stored within an EPIC or Cerner Oracle database). What she had at home were the handover sheets that any nurse or midwife self-authors during a shift to remind herself what she has to do for her patient/s and what she has done, so that when she later sits at the computer to write up the nursing notes in the electronic patient care record (ePCR) she can remember everything she did for that patient. Most nurses would find these little folded sheets of paper in their pockets when they get home after a shift and go to wash their uniform. They are her own work product, not some patient record owned by the NHS.
"Justice and truth may not be the same" is an odd statement. Justice is what people of integrity wish to achieve, it follows that justice has to be the truth. The big problem with our adversarial legal system is that it is adversarial and justice/truth are often fortunate, not a given. Your anecdote referencing the Sally Clarke case is in itself odd. If she was wrongly convicted based on false statistics which were then disproved at retrial, what unique knowledge did the court clerk have to make such a suggestion to the barrister?
There is no insulin "poisoning" evidence. The tests that were done came back with a disclaimer: "Not Suitable for Forensic Purposes". Additional testing was not done because the babies had by then already recovered. How Dr. Dewi Evans managed to do just that - turn the tests into proof - is one of the big questions re. the Letby trial.
It is unclear whether the blood samples were timely transported. It did not happen under conditions (e.g. temperature) required for evidence. Also, the blood was apparently not taken from a vein but from a line, also used to administer medications. A lab technician indicated that the value was the upper limit of the equipment, so possibly higher, indicating an incorrect value.
As said, both babies recovered and no one gave the tests another thought. It was a few years later that Dr. Breary - who should have been a person of interest, but was allowed by Chester PD to rummage through the files - found the lab teets and thought the values were high. So did Dr. Evans. Neither man is a neonatal endocrinologist.
Furthermore, there were THREE suspected "insulin poisonings". Lucy attached ONE bag. Yet was convicted for trying to poison TWO (different) babies.
So you had a patient who was a court clerk - do they not have a code of conduct ? - who thought Sally Clark was guilty - was said clerk also a medical expert ? - and she shared with you that the defense barrister "smirked" when she voiced her opinion. Why do you share that "information" here with us ? If you think that Ms. Clark was guilty, feel free to share your opinion - based on (medical) facts.
Her two children died of SIDS. It was seen as unrelated events. However "babies with siblings who died of SIDS are at higher risk for SIDS" (source: Mayo Clinic).
Home Office pathologist Dr Alan Williams withheld the results of bacteriology tests on Clark's second baby which showed the presence of the bacterium Staphylococcus aureus in multiple sites including his cerebro-spinal fluid.
Don't know about changing computerised notes - you can't - but sometimes you have to amend if you forget something or write in the wrong patients record etc. Very common. Also
Lost my thread. Also the insulin 'evidence' is very problematic. Non forensic test, see the pathology form.
Ridiculously high level in view of fully conscious babies who did not die. I'f I see a ridiculously high level of say K I query it. This is a very delicate test from blood collection, spinning down, freezing, transporting, analysing. It measure antibodies not actually insulin. If it is correct the corresponding peptide would also be very high bringing into play the Hook Effect. Look it up.
Can I say honestly what I think ? Too little, too late. Statistics, risk analysis, it means nothing to ordinary people. Baby-esian Statistics ? All hocus-pocus, that you - and others - try to exonerate an evil serial killer nurse with.
Pay attention to what the father says: "reflecting on it now". In other words, the well has been poisoned. Many parents remember nurse Lucy next to a cot, with an evil smile on her face. Many think back to how their baby crashed - when she went near it. And they are bringing their grief, and their suspicions, or better, their knowledge about what happened, to the Lady Thirwall inquiry. Which is not surprising because the hurt these people feel must be enormous.
We need more, we need different. We need facts. Facts that people can understand.
- E.g. the accusation that Lucy killed this baby by administering air in the stomach through the NS tube, leading to air-embolisms.. Again I want to point out that baby Noah, who received in 2014 a considerable amount of air in his stomach, did not die from it - he died because the air did not go into his lungs. I have not read that his autopsy showed air-embolisms- which should have been visible if we go with Dr. Evans' theories.
- Did anyone talk to the technician who did the insulin testing ? Was the hospital indeed called about the high reading ? Is it true that the call was received by a junior doctor who had no idea what the tech was talking about ?
- Anyone, someone, look into the Consultant who went from a clinic for children with Cystic Fibrosis - known to often carry Pseudomonas Aeruginosa - to the neonatal ward ?
- Did anyone interview Mr. Mansutti, the plumber about the issues at CoCH, the leaking pipes, the wash basins backing up, the leak in the rooms above the ICU ward ? How often did he have to go there ?
- Did anyone look into the remarks from cleaners at CoCH that their activities were limited in 2015 because they cost too much and the hospital needed to economize ?
- Is there reporting on the situation on the obstetrics/maternity ward ? Not just anecdotal evidence, but complete, reports. Especially of deliveries by Caesarean section.
- Is there reporting on the time it took before babies got the much needed antibiotics, other medications, blood, glucose ? Is there an overview of the doctors who had problems inserting lines, tubes ?
- Did the pathologist who did the initial autopsy of the baby with the damaged liver, see the liver ? Did he keep parts for further examination ?
- How did Dr. Evans select the cases he thought circumspect ? Did he look at original notes ? Could he have recognized hand-writing ? Style of describing things ?
- Who were the experts that looked at the selected cases ? What were there qualifications ?
OK, I'll stop, but I think by now you get my gist.
The trouble is that you top brains are not on the jury; just twelve simple folk who rely on evidence honestly presented. Shoving that silly chart in their faces was likely to carry immediate conviction of guilt, the rest of the trial devoted to speculation of how she might have set about it.
And there the problem lies - the prosecutors "evidence" was presented by a pro - a retired pediatrician who had a business doing this, who was an expert, as he regularly had appeared in court for the past 20 years. He knew how to play the game.
The evidence was not "honestly presented". It never is in an accusatory system. The prosecutor wants to win. The truth is trampled. The defendant's only chance is good lawyers - and most people cannot afford that.
Apparently the prosecution knew about the malfunctioning door in the security/access system, but pretended it to be a non-issue. And thanks to the UK "black-out" period, members of the jury had not seen any exonerating evidence.
This case should have been handled by a jury of experts, scientists, with full access to all the materials. A "lay" jury is as antiquated as the wigs UK lawyers wear in court.
I am not top-brains, far from that. But there is such a thing as common sense. The prosecutor had the plumber state that the problem with the shit-laced waste water was mainly in adjacent rooms. Have you ever seen a pathogen obey boundaries ? How could a jury believe that, after the Covid pandemic - where a virus escaped from a lab in China and traveled the world in a few weeks time, causing millions of sick people and many of them died. Yet the jury believed that pathogens in Chester leaked shit would not cause health issues ?
There's a claim on the other side that the statistical arguments aren't the compelling case and that it's the details of the individual cases, particularly Baby O with the damaged liver, that raised the alarm. I don't think Baby O has been covered here; any thoughts?
Once it’s decided she’s guilty it’s easy then to trawl individual cases for data that might support the guilty decision. It’s called confirmation bias. If there was enough evidence that Baby O had been murdered by the nurse, then the trial should have focused on that particular case, which should have been provable. But there wasn’t enough evidence, it remains conjecture and therefore had to be aggregated with other circumstantial evidence to make the police case seem credible.
It seems a very unsafe conviction based on the evidence presented, or lack of it - more lynching than fair trial.
Prolonged CPR can rupture the liver. Also read up on subcapsular liver trauma in neonates, especially if very premature - can occur at birth but the capsule 'protects' it until disrupted.
If I understood correctly, in the original autopsy-reports no (unexplained ?) liver damage was mentioned. The causes of death were for five babies deemed natural - NEC and/or pneumonia. For a sixth baby it was "unascertained".
The three pathologists who did the autopsies saw the babies, their organs, for real. The experts in the trial(s) only saw X-rays. I have not read that the bodies were scanned.
So the liver-damage is puzzling to me. If it was so extensive, would the first pathologist not have seen it ? Mentioned it ? Removed the liver and kept it for further examination ?
We had a serial killer nurse in my hometown.. several people I went to high school with had a parent murdered at the local hospital.. they ended up only
Convicting him for a few & so many many are lost 😞
If I've understood this correctly you have shown that the *totality* of 17 deaths do not represent an unusual enough event to warrant criminal prosecution?
But Letby was only convicted of causing 7 of those deaths - how does this analysis change if we take only this subset?
To my eyes, this split into suspicious/non-suspicious deaths (7 Letby vs 7 'other' deaths over and above some nominal 'expectation' of 3 giving 17 in total) is without any foundation whatsoever.
I'm not phrasing my question very well, but I hope you can see what I'm getting at.
You make an interesting point. However, If we were to split out the subset it makes it more, not less, likely that you would see that smaller number of deaths. I did a complete analysis with a non-beta binomial learning model that Prof Fenton had put together and what we found was that the expected number of neonatal deaths for CoCH fell within a range from 3-10... less than 3 (i.e. 0, 1 or 2) in either year was too low to be credible, and more than 10 (i.e. 11 or greater) actually did appear to be a noteworthy spike. Anything in between was entirely within expectation... so whether it was 5 in one year and 2 in another, or all 9 in one year and 8 in the other - either value by virue of being between 3 and 10 was within expectation for the unit.
Having said that thee is another more broader issue that makes dividing the babies up like that completely wrong - and that is this: If there was a non-human actor causing the deaths (say a hospital acquired - nosocomial - infection) then you need to look first at all of the deaths and consider them as one large group BEFORE dividing them up into 'hers and theirs'. During the first week of the Thirlwall enquiry we have learnt that not only were many of the Letby babies, as I have already reported, suffering from or with suspected or diagnosed infections - but at least four of the babies Letby wasn't accused of harming also had sepsis or infection recorded as their cause of death. There is now a wealth of information suggesting that, as I have already done in my substacks, infection is the most likely cause for many of the deaths during the period.
One of the Consultants also examined, in another clinic, children with Cystic Fibrosis - known to often carry Pseudomonas Aueruginosa, and went from there to the CoCH neonatal clinic.
Could you check this reference as it doesn't match with either table nor row placement. Thanks "The first thing we observe is that neonatal deaths per 1000 births for mothers in Cheshire West and Chester were below the national average in all years except 2014 (bottom row of the Table above contrasted with the national average contained in the first row) while on the raw data alone, they appear above average for CoCH in 2015 and 2016."
I will rewrite that sentence now... the initial draft of this article had a slightly different table wih additional rows showing other averages and normative distributions that we pared down in the final article.
And the other reference to the tables is unclear. The bottom row of the table above it is Northern Devon while the national average is England in the table below.
I was upset to read on the BBC that "A solicitor representing the families of six victims of Lucy Letby said online speculation about the safety of the nurse's conviction was "upsetting" for all of her clients". I remember being impressed by Dr Jim Swire, the father of one of the dead in the Pan Am Flight 103 bombing arguing that he did not accept the guilt of al-Megrahi - he wanted the truth, not a scapegoat. Sadly, the rejection by arXiv and medRxiv tells me there is something to hide, there are powerful interests that do not want the truth. You are presenting a novel analysis of clinical relevance.
A few weeks ago I came across BlackBeltBarrister on YouTube who recently has made some comments on oddities in the Letby trial. Worth a view.
Personally, on that other front I can’t believe that I have been send an email about having that latest covid booster, which I have declined for three years. The system is trying to kill me off.
Great work. It is so wrong that there has been no publication in the preprint servers.
For what it is worth, I used a completely different method of analysis and obtained the same result [ https://deepd1ve.substack.com/p/independently-confirmed-lucy-letby ].
Brilliant. Thanks. I do love to see when others - as Matt Damon said in The Martian - science the sh*t out of it ;-) in other ways and come to similar/the same conclusions. I too looked at other methods (for example, normative distributions across each year for five years) and even on those methods CoCH at worst was simply skirting the upper bound for a neonatal unit of their size and elevated acuity. Nice work.
That quote from The Martian made me laugh. Like the film, Cube (1997), The Martian is one of those films reminding you that you should sharpen your reasoning skills if ever in trouble. We are definitely living through times where it is crucial to remain focused.
Any data of how many multiple births as these are not independent of each other? CoCH had twin & triplet deaths.
Is there an IVF clinic nearby resulting in more multiple births?
That is missing in these stats ? It makes a difference if a baby is a "one" or twins, or triplets. One triplet in the Lucy trial consisted of one separate baby with its own placenta, and two babies that shared a placenta.
So the number of babies and their period of gestation is important but it seems also important whether the babies were part of twins or triplets.
If I understand correctly, IVF babies have on average a 10% lower birth weight compared to babies conceived the classic way.
Many of the parents who lost a child in the CoCH ward for premature babies, indicated that they had trouble conceiving and had their baby/babies after several miscarriages (up to eight).
Re. the year 2014 - could the (unnecessary) death of baby Noah have led to heightened levels of attention and care, especially under junior doctors ?
While the statistics may shed doubt, they are only one brick in the wall. For example, why were nursing notes altered post hoc, and why were sheets of nursing notes found at the suspect’s house? Those two facts raise alarm bells with me. The insulin evidence is also damning.
Some with long memories may recall the acquittal of Sally Clarke because of a statistical error. A second expert, not the one who made the decimal point error, had indicated that if she had not killed her children the only conclusion was that her husband had. At the acquittal hearing was a court clerk who happened to be a patient of mine, who confronted the defence barrister after the acquittal and blurted out to him that they thought the evidence of guilt was overwhelming. They told me that the barrister smiled and winked. Justice and truth may not be the same.
The characterisation that "nursing notes were found in her house" was misleading nonsense by police. You simply cannot take actual nursing notes home (they are all digital and stored within an EPIC or Cerner Oracle database). What she had at home were the handover sheets that any nurse or midwife self-authors during a shift to remind herself what she has to do for her patient/s and what she has done, so that when she later sits at the computer to write up the nursing notes in the electronic patient care record (ePCR) she can remember everything she did for that patient. Most nurses would find these little folded sheets of paper in their pockets when they get home after a shift and go to wash their uniform. They are her own work product, not some patient record owned by the NHS.
"Justice and truth may not be the same" is an odd statement. Justice is what people of integrity wish to achieve, it follows that justice has to be the truth. The big problem with our adversarial legal system is that it is adversarial and justice/truth are often fortunate, not a given. Your anecdote referencing the Sally Clarke case is in itself odd. If she was wrongly convicted based on false statistics which were then disproved at retrial, what unique knowledge did the court clerk have to make such a suggestion to the barrister?
There is no insulin "poisoning" evidence. The tests that were done came back with a disclaimer: "Not Suitable for Forensic Purposes". Additional testing was not done because the babies had by then already recovered. How Dr. Dewi Evans managed to do just that - turn the tests into proof - is one of the big questions re. the Letby trial.
It is unclear whether the blood samples were timely transported. It did not happen under conditions (e.g. temperature) required for evidence. Also, the blood was apparently not taken from a vein but from a line, also used to administer medications. A lab technician indicated that the value was the upper limit of the equipment, so possibly higher, indicating an incorrect value.
As said, both babies recovered and no one gave the tests another thought. It was a few years later that Dr. Breary - who should have been a person of interest, but was allowed by Chester PD to rummage through the files - found the lab teets and thought the values were high. So did Dr. Evans. Neither man is a neonatal endocrinologist.
Furthermore, there were THREE suspected "insulin poisonings". Lucy attached ONE bag. Yet was convicted for trying to poison TWO (different) babies.
So you had a patient who was a court clerk - do they not have a code of conduct ? - who thought Sally Clark was guilty - was said clerk also a medical expert ? - and she shared with you that the defense barrister "smirked" when she voiced her opinion. Why do you share that "information" here with us ? If you think that Ms. Clark was guilty, feel free to share your opinion - based on (medical) facts.
Her two children died of SIDS. It was seen as unrelated events. However "babies with siblings who died of SIDS are at higher risk for SIDS" (source: Mayo Clinic).
Home Office pathologist Dr Alan Williams withheld the results of bacteriology tests on Clark's second baby which showed the presence of the bacterium Staphylococcus aureus in multiple sites including his cerebro-spinal fluid.
Don't know about changing computerised notes - you can't - but sometimes you have to amend if you forget something or write in the wrong patients record etc. Very common. Also
Lost my thread. Also the insulin 'evidence' is very problematic. Non forensic test, see the pathology form.
Ridiculously high level in view of fully conscious babies who did not die. I'f I see a ridiculously high level of say K I query it. This is a very delicate test from blood collection, spinning down, freezing, transporting, analysing. It measure antibodies not actually insulin. If it is correct the corresponding peptide would also be very high bringing into play the Hook Effect. Look it up.
Good to have this particular statement so comprehensively debunked.
Can I say honestly what I think ? Too little, too late. Statistics, risk analysis, it means nothing to ordinary people. Baby-esian Statistics ? All hocus-pocus, that you - and others - try to exonerate an evil serial killer nurse with.
Please read the following.
https://www.examinerlive.co.uk/news/uk-world-news/killer-nurse-lucy-letby-tried-29949008
Pay attention to what the father says: "reflecting on it now". In other words, the well has been poisoned. Many parents remember nurse Lucy next to a cot, with an evil smile on her face. Many think back to how their baby crashed - when she went near it. And they are bringing their grief, and their suspicions, or better, their knowledge about what happened, to the Lady Thirwall inquiry. Which is not surprising because the hurt these people feel must be enormous.
We need more, we need different. We need facts. Facts that people can understand.
- E.g. the accusation that Lucy killed this baby by administering air in the stomach through the NS tube, leading to air-embolisms.. Again I want to point out that baby Noah, who received in 2014 a considerable amount of air in his stomach, did not die from it - he died because the air did not go into his lungs. I have not read that his autopsy showed air-embolisms- which should have been visible if we go with Dr. Evans' theories.
- Did anyone talk to the technician who did the insulin testing ? Was the hospital indeed called about the high reading ? Is it true that the call was received by a junior doctor who had no idea what the tech was talking about ?
- Anyone, someone, look into the Consultant who went from a clinic for children with Cystic Fibrosis - known to often carry Pseudomonas Aeruginosa - to the neonatal ward ?
- Did anyone interview Mr. Mansutti, the plumber about the issues at CoCH, the leaking pipes, the wash basins backing up, the leak in the rooms above the ICU ward ? How often did he have to go there ?
- Did anyone look into the remarks from cleaners at CoCH that their activities were limited in 2015 because they cost too much and the hospital needed to economize ?
- Is there reporting on the situation on the obstetrics/maternity ward ? Not just anecdotal evidence, but complete, reports. Especially of deliveries by Caesarean section.
- Is there reporting on the time it took before babies got the much needed antibiotics, other medications, blood, glucose ? Is there an overview of the doctors who had problems inserting lines, tubes ?
- Did the pathologist who did the initial autopsy of the baby with the damaged liver, see the liver ? Did he keep parts for further examination ?
- How did Dr. Evans select the cases he thought circumspect ? Did he look at original notes ? Could he have recognized hand-writing ? Style of describing things ?
- Who were the experts that looked at the selected cases ? What were there qualifications ?
OK, I'll stop, but I think by now you get my gist.
The trouble is that you top brains are not on the jury; just twelve simple folk who rely on evidence honestly presented. Shoving that silly chart in their faces was likely to carry immediate conviction of guilt, the rest of the trial devoted to speculation of how she might have set about it.
And there the problem lies - the prosecutors "evidence" was presented by a pro - a retired pediatrician who had a business doing this, who was an expert, as he regularly had appeared in court for the past 20 years. He knew how to play the game.
The evidence was not "honestly presented". It never is in an accusatory system. The prosecutor wants to win. The truth is trampled. The defendant's only chance is good lawyers - and most people cannot afford that.
Apparently the prosecution knew about the malfunctioning door in the security/access system, but pretended it to be a non-issue. And thanks to the UK "black-out" period, members of the jury had not seen any exonerating evidence.
This case should have been handled by a jury of experts, scientists, with full access to all the materials. A "lay" jury is as antiquated as the wigs UK lawyers wear in court.
I am not top-brains, far from that. But there is such a thing as common sense. The prosecutor had the plumber state that the problem with the shit-laced waste water was mainly in adjacent rooms. Have you ever seen a pathogen obey boundaries ? How could a jury believe that, after the Covid pandemic - where a virus escaped from a lab in China and traveled the world in a few weeks time, causing millions of sick people and many of them died. Yet the jury believed that pathogens in Chester leaked shit would not cause health issues ?
There's a claim on the other side that the statistical arguments aren't the compelling case and that it's the details of the individual cases, particularly Baby O with the damaged liver, that raised the alarm. I don't think Baby O has been covered here; any thoughts?
Once it’s decided she’s guilty it’s easy then to trawl individual cases for data that might support the guilty decision. It’s called confirmation bias. If there was enough evidence that Baby O had been murdered by the nurse, then the trial should have focused on that particular case, which should have been provable. But there wasn’t enough evidence, it remains conjecture and therefore had to be aggregated with other circumstantial evidence to make the police case seem credible.
It seems a very unsafe conviction based on the evidence presented, or lack of it - more lynching than fair trial.
Two reputable doctors, Dr. Bohin and Dr. Marnerides, agreed with Dr. Evans assumptions.
Prolonged CPR can rupture the liver. Also read up on subcapsular liver trauma in neonates, especially if very premature - can occur at birth but the capsule 'protects' it until disrupted.
If I understood correctly, in the original autopsy-reports no (unexplained ?) liver damage was mentioned. The causes of death were for five babies deemed natural - NEC and/or pneumonia. For a sixth baby it was "unascertained".
The three pathologists who did the autopsies saw the babies, their organs, for real. The experts in the trial(s) only saw X-rays. I have not read that the bodies were scanned.
So the liver-damage is puzzling to me. If it was so extensive, would the first pathologist not have seen it ? Mentioned it ? Removed the liver and kept it for further examination ?
We had a serial killer nurse in my hometown.. several people I went to high school with had a parent murdered at the local hospital.. they ended up only
Convicting him for a few & so many many are lost 😞
There's a typo in your opening line. It should be: 2022
Thanks. Fixed.
If I've understood this correctly you have shown that the *totality* of 17 deaths do not represent an unusual enough event to warrant criminal prosecution?
But Letby was only convicted of causing 7 of those deaths - how does this analysis change if we take only this subset?
To my eyes, this split into suspicious/non-suspicious deaths (7 Letby vs 7 'other' deaths over and above some nominal 'expectation' of 3 giving 17 in total) is without any foundation whatsoever.
I'm not phrasing my question very well, but I hope you can see what I'm getting at.
You make an interesting point. However, If we were to split out the subset it makes it more, not less, likely that you would see that smaller number of deaths. I did a complete analysis with a non-beta binomial learning model that Prof Fenton had put together and what we found was that the expected number of neonatal deaths for CoCH fell within a range from 3-10... less than 3 (i.e. 0, 1 or 2) in either year was too low to be credible, and more than 10 (i.e. 11 or greater) actually did appear to be a noteworthy spike. Anything in between was entirely within expectation... so whether it was 5 in one year and 2 in another, or all 9 in one year and 8 in the other - either value by virue of being between 3 and 10 was within expectation for the unit.
Having said that thee is another more broader issue that makes dividing the babies up like that completely wrong - and that is this: If there was a non-human actor causing the deaths (say a hospital acquired - nosocomial - infection) then you need to look first at all of the deaths and consider them as one large group BEFORE dividing them up into 'hers and theirs'. During the first week of the Thirlwall enquiry we have learnt that not only were many of the Letby babies, as I have already reported, suffering from or with suspected or diagnosed infections - but at least four of the babies Letby wasn't accused of harming also had sepsis or infection recorded as their cause of death. There is now a wealth of information suggesting that, as I have already done in my substacks, infection is the most likely cause for many of the deaths during the period.
One of the Consultants also examined, in another clinic, children with Cystic Fibrosis - known to often carry Pseudomonas Aueruginosa, and went from there to the CoCH neonatal clinic.
Could you check this reference as it doesn't match with either table nor row placement. Thanks "The first thing we observe is that neonatal deaths per 1000 births for mothers in Cheshire West and Chester were below the national average in all years except 2014 (bottom row of the Table above contrasted with the national average contained in the first row) while on the raw data alone, they appear above average for CoCH in 2015 and 2016."
I will rewrite that sentence now... the initial draft of this article had a slightly different table wih additional rows showing other averages and normative distributions that we pared down in the final article.
"deduce that the probability of observing at least 9 neonatal deaths by chance alone is 40.4%"... Surely should read 8?
Yes it should be 8
I have corrected the typo now.
And the other reference to the tables is unclear. The bottom row of the table above it is Northern Devon while the national average is England in the table below.