Monday, December 12, 2005

The Eliza Jane Scovill case on Primetime Live

I was debating whether or not to write about the Eliza Jane (EJ) Scovill case yet again, given that I've already written two different articles about it, the last of which summarized the commentary of myself and two other physicians. I didn't think that I had much more to say, barring new developments. Then, on Thursday night, ABC News broadcast a lengthy report on this case on Primetime Live. Even after watching the show, I wondered whether it would be worth commenting. True, there was indeed new information in the report that I didn't know about, but was it enough to justify another post? Then, on Friday morning, I checked out what ABC News had posted about the story on their Primetime Live. Amazingly, ABC News had posted a link to the actual coroner's report about EJ's death.

Wow. Finally, I could compare what Dr. Al-Bayati said about the coroner's report with what the coroner's report actually said! Also, Trent McBride of Catallarchy, who had already also commented on this case, has made some relevant observations about the Primetime Live story.

Before I get to the coroner's report, I'll briefly discuss the news report itself. First, my impression was that Christine Maggiore alternated between appearing very sympathetic (not surprising, since, whatever her scientifically incorrect and dangerous beliefs about HIV not causing AIDS, she is a grieving mother who did love her daughter and it's hard not to feel sympathy for her on that basis, particularly after hearing her 911 call from the night EJ collapsed) or deluded (prominent showing of old footage from 1998 of her breastfeeding her older son in public, even though it is known that breastfeeding increases the risk of transmission of HIV to the child). Another example of the depth of her belief that HIV does not cause AIDS, as Trent mentioned, when asked what it would take to persuade her that her daughter had died of AIDS, Maggiore said, "He would need to show evidence of fatal pneumonia. If there is such evidence I welcome that being brought forward." Then, the coroner showed her slam-dunk evidence of Pneumocystis carinii pneumonia under the microscope, and she still didn't believe it. In fact, that segment was the most effective part of the report, where the coroner showed Maggiore the actual slides from EJ's lungs and brain. EJ's lungs showed clear evidence of Pneumocystis pneumonia, with organisms and foamy infiltrates, but what surprised me the most was the slides of the brain. The immunohistochemical staining for HIV p24 protein was very intense, even seen on a video of a video monitor. My only complaint is that they didn't show the slides long enough for me to get a better look, but I understand that the vast majority of viewers are not doctors and would probably not appreciate lingering shots of the slides. It would have been nice if they could have posted some of the images on their website.

The next point that soon became apparent is that, contrary to previous descriptions by Maggiore and other HIV "dissidents," this story as presented strongly implied that EJ was sicker right from the very start of her illness than what has been described previously. Maggiore's own description of EJ's rasping cough and rapid, shallow breathing sounded pretty bad, and this was three weeks before her daughter's death. Consider: Maggiore is a woman who clearly has an extreme distrust of "conventional" medicine. She didn't get her children tested for HIV, and she didn't get them vaccinated. She doesn't trust "conventional" doctors. Yet, after EJ became sick, Maggiore became so concerned about her daughter that she actually took her to see three different pediatricians in three weeks and kept her out of school that whole time. Her explanation for her seeking three opinions was:
There was a stirring in my soul. That's about all I can say. It motivated me to seek a third opinion.
Clearly, despite the protestations by her apologists that EJ wasn't very sick, Maggiore was all but admitting that she had become very concerned that her daughter was seriously ill, so much so that she acted on that fear by taking her to three different pediatricians. Unfortunately, at least one of these pediatricians (Dr. Jay Gordon) may not have known about Maggiore's HIV status at the time he examined her daughter and now says that, given EJ's symptoms, he wishes that he had insisted on an HIV test. (The original LA Times story states that Dr. Gordon did know about Maggiore's HIV status, and the Primetime Live report was not clear one way or the other but seemed to imply that he was not aware.) Not surprisingly, Maggiore ultimately blamed mainstream medicine for EJ's death, with the explanation:
I believe the unfortunate irony in this situation is that the one time that we were asked to and that we complied with mainstream medicine, we inadvertently gave our daughter something that took her life.
Later, Maggiore's HIV/AIDS denialism hindered the search for the cause of her daughter's illness and collapse after it happened. For example, Maggiore failed to volunteer information about her HIV status to the treating physicians at the hospital where EJ was taken after her collapse. Her reason? She wasn't asked. Her rationalization for not volunteering the information was that she "wanted an unprejudiced evaluation of her daughter," even though her HIV status would have been very important for the treating physicians to know. Later, she did not let the coroner know about her HIV status. Ultimately, the coroner's office apparently found out about it independently. In the past, Maggiore has expressed anger that the direction of the investigation changed once the coroner became aware of her HIV status, and did so again in the Primetime Live report. (Of course the investigation changed direction. That sort of information makes a huge difference.)

The one thing that bothered me about the Primetime Live report, however, is how the story dealt with Dr. Al-Bayati's "rebuttal" of the coroner's report. It concentrated too much on Al-Bayati's lack of qualifications (certainly a valid point to bring up, but not as the--seemingly--primary reason that his report is a pile of rubbish) and not enough on the many deficiencies of his "rebuttal," which have been outlined in some detail by Dr. McBride, Dr. Bennett, and me. The treatment of the report left the reporters open to the common charge by HIV/AIDS denialists of ad hominem attack (an attack some of them aren't shy about making themselves despite their complaints when they perceive it being leveled at them). The Primetime Live producers did make up for this lapse somewhat by sending both the coroner's report and the Al-Bayati "rebuttal" to an independent medical examiner, who concluded that the coroner's report was accurate and the Al-Bayati report was not. Unfortunately, there is no link to the independent report on the Primetime Live website. It would have been interesting to be able to read that report in addition to the coroner's report and the Al-Bayati "rebuttal." It would have been even better if the pathologist who prepared the independent report had been interviewed on screen.

Overall, though, the real added information was the link to the coroner's report on the Primetime Live website. The first thing I noticed right away when perusing the coroner's report is that, contrary to what Dr. Al-Bayati said about the report, the neuropathology section of the report states clearly that positive and negative controls were done for the p24 protein found in EJ's brain:
Select immunohistochemical reactions were performed on the blocks 1-3, 2-3, and 3-3. These studies included the HIV core protein, p24 and HSV 1 and 2. Appropriate positive [and] negative controls were used on the paraffin sections. A strongly positive p24 reactivity was detected in all three sections in the previously described zones of subcortical and deep white matter focal demyelination with microglial-giant cell reaction. No signal was recognized for HSV 1 or 2.
Nick Bennett, who wrote perhaps the best rebuttal of the Al-Bayati pointed this out in his updated rebuttal (once again kindly hosted by Trent):
Al-Bayati says that such controls were not performed. It is interesting to note that he quotes VERBATIM from the section which mentions the use of controls but DELETED all reference to the use of controls. In fact Al-Bayati specifically states that no control tissue types were used, but the common interpretation of this in the online discussion groups has been that no controls at all were used. This misconception needs to be corrected.
Nick's right. He's corrected it, and I'm trying to correct it here. If you don't believe me or Nick, though, feel free to compare the coroner's report to Dr. Al-Bayati's report for yourself. While you're at it, you might notice that Dr. Al-Bayati repeats over and over that a "pneumonia" requires consolidation and that there was no evidence of pneumonia in EJ's lungs. Note that the coroner's report plainly states that there was consolidation of the lungs, in addition to congestion, not to mention the findings of foamy alveolar infiltrates consistent with Pneumocystis pneumonia. Note that the coroner's report also mentions on p. 22:
On 05-04-2005, the mother took her [EJ] to Dr. Jay Gordon in Santa Monica for a second opinion. He thought she may have had pneumonia and she was then found to have a "low grade ear infection."
To me this indicates that at least one clinician had entertained the diagnosis of pneumonia before EJ collapsed (although he must have rejected pneumonia as the cause of her illness, since he didn't prescribe any treatment for pneumonia). Given that PCP is an atypical pneumonia that is often hard to diagnose until it is advanced, it is difficult for me to decide in retrospect, not knowing what clinical findings were there when he examined EJ, whether Dr. Gordon should have made the correct diagnosis or not. For one thing, if Dr. Gordon truly didn't know that there was reason to suspect that EJ might be immunosuppressed, then there would have been little, if any, reason for him even to consider the diagnosis of PCP in the differential. On the other hand, if he did know Maggiore's HIV status at the time, then he definitely should have at least considered an HIV-related infection in the differential diagnosis. It was not clear from the broadcast whether he did consider an HIV-associated illness or not.

The bottom line is that the pathologic evidence from the autopsy clearly shows that EJ died of AIDS, no matter how much Maggiore believes otherwise and no matter how much Dr. Al-Bayati tries to spin and distort the coroner's report to suggest the cause of death was some fantastical anaphylactic reaction to amoxicillin (a reaction that, if you believe Dr. Al-Bayati, supposedly caused a type of liver damage that amoxicillin has never been reported to show in the scientific literature). However, it should not be forgotten that, as tragic as EJ's death is, the real danger of the pseudoscientific belief that HIV does not cause AIDS is to dissuade people from being tested, being treated, or taking prudent measures to halt the spread of the virus, potentially leading to many more tragic and largely preventable deaths like EJ's. An additional tragedy of this case is that Christine Maggiore is still preaching the same pseudoscientific nonsense that HIV does not cause AIDS that she was before EJ died, only now she's claiming the mantle of martyr and blaming "conventional" medicine for the very death that her own beliefs contributed to.

(Note: If you wish to be reminded yet again of the rest of the distortions, half-truths, and selective quoting in the Al-Bayati hatchet job, check out Trent's, Nick's, and my rebuttals again. Pay special attention to Nick's updated rebuttal--also linked to here--as it's the most comprehensive. To go over that material in detail again here would be needlessly repetitive.)

ADDENDUM: Apparently ABC News has removed the link to the L.A. County coroner's report. Perhaps the bandwith was too great. (It was a PDF containing a scan of the file and weighed in at 2.3 MB.) However, in the comments of a previous post, a reader has pointed out another link where the coroner's report can be found.)

26 example(s) of insolence returned:


At 12/12/2005 8:36 AM, Blogger Lord Runolfr said...

Then, the coroner showed her slam-dunk evidence of Pneumocystis carinii pneumonia under the microscope, and she still didn't believe it.

Of course she didn't believe it. If she believed it, she would have to accept the role of her own actions in her daughters death, and I can see how any parent would accept almost any rationalization to avoid that kind of guilt.

 

At 12/12/2005 10:22 AM, Anonymous Deetee said...

The Al-Bayati report is one of the worst examples of investigative and scientific analysis one could ever hope to see.
I have only just become aware of the existence of a published Coroner's report, but the links to it at ABCnews is not functional. Does anyone have an alternative link, or has the report been pulled?
If so, is there anyway to get hold of a copy?

 

At 12/12/2005 10:22 AM, Anonymous Anonymous said...

In fairness to Dr. Al-Bayati, what he said was that no controls with lesions comparable to Eliza Jane's had been used as controls in the staining. Now I understand that it might be difficult to come up with control sections that show lesions characteristic of HIV-encephalitis that don't HAVE HIV-encephalitis and if you add in a requirement for the brain to come from a child of a similar age with similar symptoms with respect to the anaemia and the PCP in the lungs, I expect it would be pretty much impossible. But that was my interpretation of what Al-Bayati was saying was necessary.

 

At 12/12/2005 12:46 PM, Anonymous Anonymous said...

"In fairness to Dr. Al-Bayati, what he said was that no controls with lesions comparable to Eliza Jane's had been used as controls in the staining."

Right. In carefully crafting the syntax of his statements, and then deleting all references to controls in the report he quoted, he was being intentionally misleading. Denying and lying. Period.

 

At 12/12/2005 3:15 PM, Anonymous HCN said...

I get "Cannot find server" when I try to check out Nick Bennett's updated report.

 

At 12/12/2005 6:42 PM, Blogger JM O'Donnell said...

I think what credibility the report from Dr. Al Bayati had left is now all but gone. Will Dean admit to any of this however? Probably not, instead his last (and usually only) defence will be to ignore the points raised and scream "BUT HE HAS CREDENTIALS".

The last cry of those without anything else.

 

At 12/12/2005 7:49 PM, Anonymous Anonymous said...

Orac,

I have reasoned previously that Maggiore must have feared EJ was deathly ill to have given her Amoxicillan. Google this: "My Bout of So-Called AIDS" and read Christine Maggiore's own words describing her treatment of an abnormal Pap Smear (Grade 3 for Cervical Cancer). She ignored her OB/GYN's advice of a colposcopy and chose "colon hydrotherapy, digestive enzymes, daily juicing, food combining, some new supplements, and regular exercise."

So we're to believe this woman whose distrust of mainstream medicine is so profound that she treated potential cervical cancer with juice and exercise but she fed her daughter Amoxicillin (tantamount to poison in her mind) for the "sniffles" and an "ear infection?!"

What's more, Maggiore claims in her open letter to the LA Times that her daughter was never diagnosed as having had pneumonia while at the hospital, yet the very coroner's report says EJ WAS diagnosed with pneumonia at the hospital fighting for her life.

And finally, how is it possible that Christine Maggiore withheld her HIV status to the hospital while her daughter was "inexplicably" dying?

Christine Maggiore took her child via ambulance to a mainstream medical hospital knowing 99% of the mainstream medical experts would consider her HIV status to be critical information, yet she withheld it.

How does any of this make sense? Why take EJ to a mainstream hospital to save her life and withhold mainstream medical information? If you're asking mainstream medicine to help save your child's life then you have to provide them with information they'd deem vital, no?

Just appears to have been a twisted game to see if the doctors would find AIDS in EJ without her offering it up first - to sort of challenge the medical establishment, knowing they wouldn't suspect an untreated HIV+ 3 year old girl would be fighting for her life while her mother says nothing. This ensured they'd look for other possibilities of EJ's collapse first - and time ticked ticked ticked away.

 

At 12/12/2005 8:51 PM, Anonymous Anonymous said...

The illogical Christine Maggiore:

Cuomo: What would suffice to you as evidence of EJ having had PCP?
Maggiore: "He would need to show evidence of fatal pneumonia. If there is such evidence I welcome that being brought forward."
Coroner: shows slides of PCP "teacup shape" black microbes and HIV-related Encephalitis lesions in her brain.
Maggiore: That's ridiculous, she sat here and had a popsicle the day before she died, lucid and healthy.

So she just waves her hand in dismissal at the scientific evidence she wanted "brought forward."

Maggiore plays the pea and shell game. You ask her what would satisfy her, she tells you specifically, you provide exactly that and she says it doesn't add up.

Ms. Maggiore, why not say that from the start? Why not just say, "no amount of evidence could convince me of PCP because she had a damned popsicle and she was lucid and healthy." Why not save everyone the trouble of getting you the evidence you request when you've already decided EJ didn't have PCP, despite requested evidence.

Why doesn't Christine Maggiore cut to the chase: Listen everyone, HIV doesn't cause AIDS. In fact, I'm not sure HIV even exists. Sure, the orthodox scientists have hundreds of studies to support the virus and its parthenogenesis to AIDS but, like EJ's lung and brain tissue, I dismiss it. Ergo, there is no evidence for HIV or HIV=AIDS and anything you show me in support of that, I'll also dismiss so please don't bother. Now, let me get back to my conspiracy group.

 

At 12/13/2005 7:59 AM, Blogger bcpmoon said...

I can understand why the mother of EJ must wave off any evidence of HIV being the cause of her daughters death, just as Lord Runolfr said. Her whole life is based on her denial, it is like being in a cult or being religious. Who is strong enough to question the most basic assumptions, even more so if these have killed your child? Poor woman.

 

At 12/13/2005 1:20 PM, Anonymous HCN said...

Bcpmoon said: "Her whole life is based on her denial, it is like being in a cult or being religious. Who is strong enough to question the most basic assumptions, even more so if these have killed your child? Poor woman."

The problem with this "poor woman" is that she is actively trying to convince other mothers to do the same as she has. She has claimed that she has convinced 50 other mothers to forego the meds and to breastfeed. There are now at least several dozen other children whose lives have become endangered because of her.


On October 29th she went into www.amazon.com to add her own review of her book to counter the reviews that have mentioned that her daughter died due the actions of the parents. Perhaps this whole fiasco is damaging sales.

 

At 12/13/2005 4:02 PM, Anonymous concerned pediatrician said...

The other problem is this poor woman has another child whose HIV status is unknown, correct? At this point, shouldn't Child Protective Services come into play? If a child's life is in danger, and the parents for religious or other reasons refuse to treat the child, court orders are commonly obtained to legally force the child's treatment. Has this even been discussed as far as anyone is aware?

 

At 12/13/2005 5:21 PM, Anonymous HCN said...

The other child was taken into foster care for a very short time. He has been tested and turned out negative. He has been returned to his parents, since foster care would be more detrimental to his well being than being with his parents.

This was in the news reports in September.

 

At 12/13/2005 5:42 PM, Blogger Jay Gordon said...

I did know that Eliza Jane's mother was HIV positive. There were other medical facts which were not revealed to me until after her death.
The PrimeTime taping ran about an hour and they used 30 seconds.
This is an extremely complex case and is being simplified by people who have too few details.
As I said on television, if I had had the information then that I have now, I would have acted differently. However, no one involved in girl's life can be proud of the way they acted.
Her brother has been tested and the HIV negative results have been publicly released.

JNGMD

 

At 12/13/2005 6:45 PM, Anonymous Anonymous said...

Also her husband and son tested negative. Why do you keep saying Christine is HIV+.I thought she was tested once + then - then indeterminate,her status is not known.
If she is + has you have stated, how do you explain her husband and son being negative.

 

At 12/13/2005 7:04 PM, Anonymous HCN said...

Anonymous said:
"If she is + has you have stated, how do you explain her husband and son being negative."

The chances of a child getting HIV from the mother is actually around 25% to 30%, with the breastfeeding the chances could be pushed up 50%. Also, female to male transmission is fairly low. In other words, they beat the odds that her daughter did not.

You can check out the literature by going to www.pubmed.gov and plugging in the appropriate search terms. There are several papers listed, and some of the reviews (click on the "Review" tab) are available without charge. You can also get information here:
http://www.nlm.nih.gov/medlineplus/aidslivingwithaids.html

And if you look above, you will see that Dr. Jay Gordon KNEW that Christine Maggiore was HIV+. So if he says so, who are you to say she wasn't?

 

At 12/13/2005 7:12 PM, Anonymous Anonymous said...

If female to male transmision is low, how do you explain the explosion of HIV+'s in Africa.

 

At 12/13/2005 7:20 PM, Anonymous Chris Noble said...

Dr Jay Gordon wrote: There were other medical facts which were not revealed to me until after her death

Are you at liberty to reveal what these medical facts were?

One thing that is definite is that not all of the facts are available and that all people, from both sides of the fence, are forming opinions on limited information.

However, the people withholding the information are Christine and Robin. I suspect they had the ability to release the Coroner's report previously. Instead they made Al-Bayati's hack rewrite available on the internet. There still appears to be more that they aren't telling us. Her supporters are entitled to the truth.

 

At 12/13/2005 7:45 PM, Anonymous HCN said...

Well one reason was a rumor that a person could be cured by having sex with a virgin... sometimes these virgins were children:
http://www.snopes.com/inboxer/petition/babyrape.htm

Then there are the problems with transmission due to OTHER sexually transmitted diseases... and other factors not ofen associated with a middle class family in Southern California. Here is some literature (something that I as a lowly engineer can seem to find, but Mr/Ms Anonymous has trouble doing):
http://www.icmr.nic.in/ijmr/2005/April/0413.pdf
and
http://www.iasusa.org/pub/topics/2004/issue5/130.pdf
and
http://www.iasusa.org/pub/topics/2004/issue4/104.pdf
and
http://www.paho.org/English/AD/GE/Viol-HIV_FS0705.pdf (another rape paper, it seems that many of the women get it because they are victims of violence, like rape... oops that was in South and Central America).
and
http://www.ajtmh.org/cgi/content/full/71/2_suppl/41 (having malaria also increases viral load)
and
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15228727&query_hl=3 ... it is very common in African health care to reuse supplies, like needles, so it was sometimes spread AT a medical clinic!
and the same thing here:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15034989&query_hl=3
and this is another rape/violence, but in South Africa:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14708401&query_hl=3

Does this give you some answers?

 

At 12/13/2005 8:52 PM, Anonymous kyle said...

I presume you know how AIDS is defined in Africa.
The Bangui definition, read up on it, you don't need an HIV test to be classified with AIDS in Africa.
The numbers are extrapolated from testing done in pre-natal clinics,
sounds like good science to me.
If AIDS is killing so many in Africa, why is the population increasing.

 

At 12/13/2005 9:26 PM, Blogger Trent said...

In addition to the above, part of the more extensive transmission is vertical, meaning mother to baby. In the US, pediatric AIDS is rapidly becoming extinct dut to C-sections and no breastfeeding, which almost elimnates the risks of transmission. Alas, the same is not true in Africa.

 

At 12/13/2005 9:34 PM, Blogger JM O'Donnell said...

Dr. Gordon, although I may be reading into this a little too much from the defensive tone of your post, nobody is blaming you for what happened. It wasn't your fault that you weren't told relevant details when you should have done. You did what you could with what you knew at the time.

 

At 12/13/2005 10:03 PM, Blogger Orac said...

I'm not going to attack Dr. Gordon here, either. He seems to realize that he should have ordered an HIV test and has said so on at least two occasions that I am aware of (the LA Times article and the Primtime Live interview).

 

At 12/14/2005 7:55 PM, Anonymous HCN said...

Kyle said: "If AIDS is killing so many in Africa, why is the population increasing."

Depends on the country. Some of the countries in the south will have negative population trends. This is a fairly good summary, even though it is about three years old:
http://www.prcdc.org/summaries/aidsinafrica/aidsinafrica.html

For more recent data. Check out page 8 of:
http://www.prb.org/pdf05/05WorldDataSheet_Eng.pdf ... You will see that Botswana and Lesotho do have a net negative population change.

 

At 12/15/2005 8:50 PM, Anonymous Anonymous said...

Dr. Gordon, if that is indeed you, I would like to comment on your sentence above "I did know that Eliza Jane's mother was HIV positive. There were other medical facts which were not revealed to me until after her death."

I don't know how that sentence could make a different case for you.

You knew Christine Maggiore was HIV positive and that EJ had never been tested, correct? So what "other medical facts" could be relevant that were not revealed to you until after the death of Eliza Jane that would have or should have excused you from not having immediately considered the strong possibility of AIDS in Eliza Jane?

When you say, "if I had the information then that I have now, I would have acted differently," I'm truly perplexed by what in the world that could be? What more did you need to know to have sought an HIV test, for starters?

I trust you're not saying that you would have acted differently if you’d known about her having PCP. I mean, I would hope that goes without saying.

Perhaps Christine did not express to you the level of illness she'd witnessed in Eliza Jane. I can buy that. Long before the Primetime segment and the Coroner’s report, Christine described perfect health in individuals presenting with single digit CD4’s. She is unmoved by crippling immune systems in young men and women with the one common denominator of HIV. She partakes in a conspiracy theory so wide, so evil and unfathomably implausible that the Roswell-alien-crash-testing-site would pale by comparison. So I don’t consider it even remotely difficult for her to have perverted the gravity of EJ’s condition in the least. Simply put: she denies EVERYTHING all the way down the line.

I do appreciate that you’re the only one of 3 physicians who has gone on record as having regretted your inaction but Dr. Gordon, even understanding all of the above of Christine Maggiore, I still don’t see how any of it is relevant to your professional neglect of EJ.

Mother had HIV. Daughter hasn’t been tested. Even if those two facts were the ONLY ones you’d known, they would have been more than ample to have set off deafening bells and whistles in your head the instant that child had the mildest fever, the tiniest sniffle, the most minor malaise.

I certainly wish you could clarify your statement.

 

At 12/16/2005 1:32 PM, Anonymous Deetee said...

Dr Gordon,
In the transcript of the autopsy report there is a witness statement by Dr Liu, admitting physician.
In it he details a discussion he had with Christine Maggiore over the phone on the 17th May, the day after EJ's death.

Quote:
"On 05-04-2005 the mother took her to Dr Jay Gordon in Santa Monica for a second opinion. He thought she may have had pneumonia"

You knew that Maggiore had HIV and that there was a significant risk that the daughter might have HIV also. She had an illness you thought was pneumonic in nature.

What "other medical facts" did you need to know before acting?

 

At 12/30/2005 8:51 AM, Blogger Doctor Duke said...

Yes, Doctor Gordon. You claim to have known not only that the mother was HIV-seropositive, but also that she had never taken antiretrovirals during the pregnancy and breastfeeding of Eliza Jane. What "other medical facts" were so importantly missing to you at the time???

 

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