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PRESUMPTIVE LOGIC (APPLIED EPISTEMOLOGY)
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Mick Harper
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Paul Goldwater has sent me his follow-up paper for comments
https://www.nature.com/articles/s41390-023-02611-4.epdf?sharing_token=TusnHh-swFowzFxE1-K_HtRgN0jAjWel9jnR3ZoTv0N0_uDGLtgckHO0APoE7nfwgA8Qc1Ko8LpGpOBigWO4yvyEk12BHfs--ynliexKoWYhJRWie_Fsbmyb-_0_1numV40zH9gxbAMzdXmFf2pPOs2Hk-SGQMpUbiQsvhkCbjg%3D

Formidable looking but not too long. I am embarked on it, I hope you all will. It's not often we get asked. The first thing to note is that it's in Nature, no small thing.
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Ishmael


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SIDS is a vaccination side effect. The evidence is definitive.
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Mick Harper
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Is that an Ismaelian definitive or an ordinary definitive?
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Ishmael


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I thought all this anti-vax stuff was adjacent to Astrology. I've looked into this deeply over the past three years. The available material is utterly damning. SIDS is a vaccine side-effect. Its incidence reduces in cases where vaccinations are delayed.
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Wile E. Coyote


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The more I look at it, the more it seems to me Nurse Letby might have been misconvicted.

Baby deaths at the Chester facility
2009 - 3
2010 - 1
2011 - 3
2012 - 3
2013 - 2
2014 - 3
2015 - 8
2016 - 5

The Countess of Chester, which looks after about 400 babies in its neonatal unit each year above under consideration, stopped providing care for babies born earlier than 32 weeks after this. So we don't know comparable figures after this time which would have enabled us to see if this was due to poorer than average medical care, rather than the actions of a serial killer. The doctors claim that any problems identified by the increase in deaths in 2015-16 stopped when Letby's role was switched.

Letby suffered depression and anxiety after being accused by doctors, she started scribbling notes questioning whether her own care had failed the babies, these ramblings were then used to suggest she had actually confessed at trial.

Although the evidence looks damming you have to keep in mind that babies do die at these facalities for reasons that health professionals cannot always explain, without serial killers being present. The truth is boring......

The opposite side of the case presented here.

https://news.sky.com/story/how-the-police-caught-lucy-letby-12933640
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Mick Harper
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I had Bayesian qualms of my own but because of the material found in her flat I decided not to stick my neck out.

The more I look at it, the more it seems to me Nurse Letby might have been misconvicted.
Baby deaths at the Chester facility 2009 - 3 2010 - 1 2011 - 3 2012 - 3 2013 - 2 2014 - 3 2015 - 8 2016 - 5

This seemed to me not to be the behavioral pattern of a serial killer, more like the record of an incompetent maternity unit.

The Countess of Chester, which looks after about 400 babies in its neonatal unit each year above under consideration, stopped providing care for babies born earlier than 32 weeks after this. So we don't know comparable figures after this time which would have enabled us to see if this was due to poorer than average medical care, rather than the actions of a serial killer.

Do you know how it compares with other neonatal units?

The doctors claim that any problems identified by the increase in deaths in 2015-16 stopped when Letby's role was switched.

So are they conceding there was no increase in 09, 10, 11, 12, 13 and 14?

Letby suffered depression and anxiety after being accused by doctors, she started scribbling notes questioning whether her own care had failed the babies, these ramblings were then used to suggest she had actually confessed at trial.

They are not though quite what you would expect from merely 'a wronged woman'.

Although the evidence looks damming you have to keep in mind that babies do die at these facilities for reasons that health professionals cannot always explain, without serial killers being present. The truth is boring......

The evidence always looks damning by the time it gets to court but you have to wonder why the admin kept refusing to take it seriously. Nurses, unlike doctors, don't have enough clout to be kept on regardless.

The opposite side of the case presented here. https://news.sky.com/story/how-the-police-caught-lucy-letby-12933640

Doesn't sound it from the title but I will wade through it wearing my Wileyan spectacles and report back.
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Wile E. Coyote


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Mick Harper wrote:
This seemed to me not to be the behavioural pattern of a serial killer, more like the record of an incompetent maternity unit.

The hospital manager at the time seems to have believed that the doctors who accused Letby actually should have apologised to her.

Mick Harper wrote:
Do you know how it compares with other neonatal units?

My understanding is that the unit had been performing at an average level until 2015-6. The increase in numbers triggered concerns. Not a suspicious death.

They are not though quite what you would expect from merely 'a wronged woman'.

They appear the ramblings of someone trying to make sense of what has happened to them, normal humans are indeed known to feel guilt and shame for things of which they are accused but have not done. Surely it would be unusual for her to feel remorse if she was a serial killer? Shipman certainly didn't. But of course I am, as they say, feeling guilty about my own cod psychology here.....I don't know what happened.

The opposite side of the case presented here. https://news.sky.com/story/how-the-police-caught-lucy-letby-12933640

It's the sensational prosecution case. I like to pretend balance.
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Boreades


In: finity and beyond
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Mick Harper wrote:
This seemed to me not to be the behavioral pattern of a serial killer, more like the record of an incompetent maternity unit.


How can we tell the difference?

Granted it's not always easy to spot the incompetence. It is, after all, and and sad as it might be, an environment where some deaths are just the natural order of things. It's especially upsetting when it's a very young person, who should be at the start of a (hopefully) long life. In the natural order of things, some will be coming back some years later, and adding to the statistics of older people dying in NHS care. In which area there may be other serial killers lurking...

Any truly incompetent maternity unit is a de-facto serial killer. We're just quibbling about what kind of serial killer, group incompetence -v- individual malevolence. It's impossible to detect the crucial difference (group incompetence -v- individual malevolence) just from the anonymous numbers.

One might hope that the "worse than average" statistics would eventually catch-out any rogue solo operators (the real individual malevolence). Was that the way Shipman was caught? But it can take years before anyone notices and actually do anything. Sorry, I'll correct myself. I believe it's the usual story of low-level people being the first to notice "something's not quite right" but it takes a long while for the message to penetrate up through levels of management. Which are usually operationally organised to filter-out bad news and exclude whistle-blowers. Or in extreme, save themselves by finding a sacrificial goat.

Despite all the TV soap operas with portrayals of heroic and brillant medical expertise, the reality is dull and boring. Most medical staff are like any large population group. Most are (by definition) average, with a few edge cases of both brilliance and incompetence. My personal experience, working alongside many doctors, is they may be qualified but they are not always competent. The NHS's own institutional problem is how to detect and deal with the incompetence. Which kills far more people (day in and day out) than any rogue individuals that end-up in MSM fear-porn stories.

By way of one example, the Mid Staffordshire NHS Foundation Trust. That got the public attention by virtue of being the worst of the worse. It's not the only case.

Another one of the problems is the background noise. Yer actual serial killer, if there was one, could easily hide in the statistical forest for years. By which I mean that other maternity units all over the country are continually adding to the statistics. Which are confounded and confused by geographic and ethnic differences, there's always some places better or worse than others. But then we go round in circles, again trying to tell the difference (incompetence -v- malevolence).
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Boreades


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More on that Mid-Staffs example.

The inquiry found a deep rooted, pernicious cult of management, obsessed with achieving ill-conceived targets yet isolated and wilfully oblivious to day-to-day operational reality, and fixated on image management and cultivating positive publicity while demonstrating little or no interest in acknowledging or addressing problems.

First thing, well, that's normal. Anyone who's worked in any very large organisation will recognise shades of this. It's the nature of the beast (large organisations). Executive management always fixates on progress -v- budgets and targets. That's what the bonuses are tied to. Along with how good the press releases are (especially on diversity and inclusivity)

Throughout the period considered by the inquiry, from 2005 to 2008, the executive management of the Mid Staffordshire Trust was blinded to the appalling care given to patients at their hospitals by their excessive focus on securing Foundation Trust status. An oppressive atmosphere in which intimidation and bullying were rife prevented staff from raising concerns, and, when they did, swept them under the carpet.

Mid-Staffs got a hammering by virtue of being worse than other NHS Trusts. Not by virtue of being the only one with problems. All the others "get away with it" by being no worse than average. No matter how bad the average might be.
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Mick Harper
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sad as it might be, an environment where some deaths are just the natural order of things. It's especially upsetting when it's a very young person, who should be at the start of a (hopefully) long life.

Please avoid mawk in this section.

Any truly incompetent maternity unit is a de-facto serial killer. We're just quibbling about what kind of serial killer, group incompetence -v- individual malevolence. It's impossible to detect the crucial difference (group incompetence -v- individual malevolence) just from the anonymous numbers.

Please avoid weird comparisons in this section.

One might hope that the "worse than average" statistics would eventually catch-out any rogue solo operators (the real individual malevolence). Was that the way Shipman was caught?

No. That was the whole point.

But it can take years before anyone notices and actually do anything. Sorry, I'll correct myself. I believe it's the usual story of low-level people being the first to notice "something's not quite right" but it takes a long while for the message to penetrate up through levels of management.

I thought it was the doctors.

Which are usually operationally organised to filter-out bad news and exclude whistle-blowers. Or in extreme, save themselves by finding a sacrificial goat.

Usually? Extreme? How common are these cases?

Despite all the TV soap operas with portrayals of heroic and brillant medical expertise, the reality is dull and boring. Most medical staff are like any large population group. Most are (by definition) average, with a few edge cases of both brilliance and incompetence.

Please avoid truisms in this section.

My personal experience, working alongside many doctors, is they may be qualified but they are not always competent.

You mean by definition a few will be incompetent.

The NHS's own institutional problem is how to detect and deal with the incompetence.

It won't be able to if it is drawing from a pool of brilliance and incompetence.

Which kills far more people (day in and day out) than any rogue individuals that end-up in MSM fear-porn stories.

Another truism since the people the NHS treats outnumbers rogue individuals by a million to one.

By way of one example, the Mid Staffordshire NHS Foundation Trust. That got the public attention by virtue of being the worst of the worse. It's not the only case.

Then tell us who the others are. See the section on 'bogus lists' in this section.

Another one of the problems is the background noise. Yer actual serial killer, if there was one, could easily hide in the statistical forest for years. By which I mean that other maternity units all over the country are continually adding to the statistics. Which are confounded and confused by geographic and ethnic differences, there's always some places better or worse than others. But then we go round in circles, again trying to tell the difference (incompetence -v- malevolence).

I think you already made this point.

More on that Mid-Staffs example. The inquiry found a deep rooted, pernicious cult of management, obsessed with achieving ill-conceived targets yet isolated and wilfully oblivious to day-to-day operational reality, and fixated on image management and cultivating positive publicity while demonstrating little or no interest in acknowledging or addressing problems.

Very interesting, I'm sure, but we are dealing with serial killers. For general beefs there is a Health section.

First thing, well, that's normal. Anyone who's worked in any very large organisation will recognise shades of this. It's the nature of the beast (large organisations). Executive management always fixates on progress -v- budgets and targets. That's what the bonuses are tied to. Along with how good the press releases are (especially on diversity and inclusivity)

Yes, it's a problem that's been around since Ug organised Og.

Throughout the period considered by the inquiry, from 2005 to 2008, the executive management of the Mid Staffordshire Trust was blinded to the appalling care given to patients at their hospitals by their excessive focus on securing Foundation Trust status.

At last, a fact. Can you say whether any such eye-off-the-ball factor was in operation at Chester?

An oppressive atmosphere in which intimidation and bullying were rife prevented staff from raising concerns, and, when they did, swept them under the carpet.

Consequent on getting Trust status or just normal?

Mid-Staffs got a hammering by virtue of being worse than other NHS Trusts. Not by virtue of being the only one with problems. All the others "get away with it" by being no worse than average. No matter how bad the average might be.

Just normal. Please, people, this is the AE Theory section. Higher standards are demanded.
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Mick Harper
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I watched (or rather read) your URL, Wiley. Though Sky News isn't, as it were, forensic it gives an insight into the way Bayesian statistics work on the public (and, it seems, the judicial) mind

A TRAUMATIC WEEK How the police caught Lucy Letby -- Data and Statistics
When nurse Lucy Letby returned from a trip to Ibiza, she texted a colleague to say she would be "back in with a bang". Within 72 hours of that message, two triplet siblings were dead.

If the jury were given all her texts to all her colleagues, I doubt whether this would have stood out.

It was June 2016 and the ward was busy
Maternity wards are always busy
the triplets had just been born
All babies in maternity wards have just been born

and it was Letby's first shift back from holiday. She texted a colleague enquiring about how the new arrivals were doing and discussing her return to work.

Though the inference is that Letby did the killing on her first shift back (i.e. thirsting to get back to her wicked ways) she is actually doing two normal things: referring to a noteworthy happening at work and her own return to it.

She later told her trial that message was merely referencing what would be a "busy shift". But the prosecution claimed she was "out of control" and "playing God" with her patients - the text giving a sinister insight into her frame of mind.

Presumably busy because triplets had been born.

That traumatic week was the end of a killing spree by the nurse who worked on the Countess of Chester Hospital's neonatal unit.

Two of the three triplets died.

Letby was charged with killing seven babies and attempting to murder 10 more infants between June 2015 and June 2016.
She was accused of injecting air into babies' bloodstreams, overdosing them with insulin, removing breathing apparatus or sabotaging their care in other ways.

I'm pretty sure serial killers don't normally vary their modus operandi quite so much but what hasn't been mentioned is that none of these things are known to have, or even suspected to have, killed the seven victims. It is simply a list of ways medical staff can kill patients unobtrusively. They have no connection to the Letby case.

Her harrowing trial has included thousands of pieces of evidence, expert testimony and repeated denials from the 33-year-old, who pleaded not guilty to all 22 charges against her.

It is often supposed that 'thousands of pieces of evidence' is damning. It is quite the opposite since no prosecution with a good case would use more than the minimum number necessary for fear of confusing the jury.

There is absolutely nothing here yet this is how two experienced journalists chose to present it. Open and shut. And presumably these are the highlights.
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Wile E. Coyote


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Mick Harper wrote:
This seemed to me not to be the behavioural pattern of a serial killer, more like the record of an incompetent maternity unit.

Boreades wrote:

How can we tell the difference?


This is the key point if you don't want to suffer prosecutor's fallacy, ie what are the chances of there being another cause or causes?

One of my questions is were they understaffed? Google confirms that by 2018 Countess of Chester were 60 nurses short.
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Mick Harper
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Two important factoids came to my attention yesterday.

(1) Letby was arrested in 2018 but did not come to trial until late 2022. This is an inordinate delay even in such a complex matter. It may happen in a fraud trial but surely not in a case of such national and international notoriety. Of course Covid intervened but I cannot imagine that would have much of a bearing. It suggests there was some difficulty in the prosecution getting its ducks in a row.

(2) Eight of the prosecution witnesses asked for anonymity. This is quite rare and is usually granted only to victims, those in fear of their lives, part of the secret state or whose reputation would be unjustly harmed. None of this applied to the eight who were simply witnesses-to-fact, not even decision-makers (none of whom sought anonymity). They claimed mystifyingly that being named in open court would 'affect the quality of their evidence'. Even more mystifyingly the judge granted their request despite the nationals seeking a joint injunction on the grounds that reporting would be 'an alphabet soup'. [The babies were already referred to as Baby A, Baby B and so on.)

True, I'd prefer not to be subject to "Ooh, see him, he was involved in that serial baby killing business" but I wouldn't expect to be given anonymity because of it. But I'd be more worried about, "It says here on the application you were working closely with Lucy Letby, how was it you didn't spot anything?" There are going to be one hell of a lot of people in this position for a long time to come.
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Boreades


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Mick Harper wrote:
"It says here on the application you were working closely with Lucy Letby, how was it you didn't spot anything?" There are going to be one hell of a lot of people in this position for a long time to come.


Actually a very good point. We can expect a very long-period of "letting the dust settle" before there will be any kind of enquiry (public or internal) into How The Hell Did Nobody Spot This Sooner?

Many of the usual suspects will be put on the field of play.

    We've all been traumatised by it and gone on sick leave / compassionate early retirement / gone away / died
    Everyone was busy
    Nobody was looking
    I've forgotten
    It was the managers' job
    The managers didn't have a Key Performance Target to measure anything like this


M'Lady Boreades actually has her own history as a Senior Person inside the NHS; she witnessed many exponents of Serial Incompetence and General Muppetry. So much so, she says, she would have cheerfully killed a few. But she says she didn't (who am I to disagree?). "Blundering on" and ignoring the cock-ups is a universally widespread phenomenon in almost all large organisations (private or state run). The NHS just has the benefit that they can usually bury the evidence.

M'Lady did ask if the Lucy Letby prosecution actually produced any hard physical evidence. Not a tapestry of circumstantial evidence and "opportunity to do harm". Actually, I don't know the answer, does anyone? It raises the lingering doubt that Lucy Letby is a sacrificial goat.

For example, the chart displayed (with much gasps of shock from the court) which showed how many times LL was on duty when babies died compared to how many times other colleagues were on duty. It looked like a slam-dunk cast-iron piece of evidence, but it was not forensic evidence.

A medical acquaintance, actually a medical analytics person, pointed out a very fundamental flaw in that chart. It started with a query of how many times LL was on duty when babies died compared, and only then correlated, with which other colleagues were on duty at the same time. The flaw is that you can do exactly the same with any one of the colleagues (how many babies died while that other colleague was on duty) and then correlate which other colleagues were on duty at the same time. You would get very similar charts. Correlation is not causation.

It remains to be seen whether it will be in the public interest to declare that Lucy Letby's colleagues were guilty of Serial Incompetence.
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Mick Harper
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M'Lady Boreades actually has her own history as a Senior Person inside the NHS; she witnessed many exponents of Serial Incompetence and General Muppetry. So much so, she says, she would have cheerfully killed a few. But she says she didn't (who am I to disagree?). "Blundering on" and ignoring the cock-ups is a universally widespread phenomenon in almost all large organisations (private or state run). The NHS just has the benefit that they can usually bury the evidence.

So presumably she supports my idea of abolishing the NHS and setting up stand-alone (genuinely so) local units offering health provision free at the point of delivery? There will be truckloads of complaints about postcode lotteries, tell her, as each unit makes decisions off their own bat about what and whom gets treated and how but she will join me in saying, "Tough bananas, it's a price worth paying for greater efficiency."

But, I wonder, will she still be on board when every Health District discovers that the most efficient way of delivering healthcare is to tender it all out to private enterprise? Oh, how everyone will howl. The unions loudest, then the left ideologues. But you won't hear a squeak from the long suffering British public getting treated by the same people in the same places but at half the price or -- as it will seem to them -- in half the waiting time.

A medical acquaintance, actually a medical analytics person, pointed out a very fundamental flaw in that chart. It started with a query of how many times LL was on duty when babies died compared, and only then correlated, with which other colleagues were on duty at the same time. The flaw is that you can do exactly the same with any one of the colleagues (how many babies died while that other colleague was on duty) and then correlate which other colleagues were on duty at the same time. You would get very similar charts. Correlation is not causation.

That's what we've been saying for years. It's like serial killer profiles: you can use such a technique to generate lists of likely suspects but you can't use it to convict one of them because 'he fits the profile'. There's one other difference. With serial axe-murderers you know that crimes have been committed.

PS Letby didn't seem to fit the profile from what I've seen of her. But then nor did Shipman so maybe there isn't one. On the other hand, that's what finally saved the obviously nice mums with shaken-baby syndrome dead babies and the obviously nice dads who had been having anal intercourse with their still living babies in Middlesborough.
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