The Death of Innocents: A True Story of Murder, Medicine, and High-Stake Science [Hardcover]

Richard Firstman (Author), Jamie Talan (Author)

Book Description

Publication Date: September 2, 1997

Unraveling a twenty-five-year tale of multiple murder and medical deception, The Death of Innocents is a work of first-rate journalism told with the compelling narrative drive of a mystery novel.  More than just a true-crime story, it is the stunning expose of spurious science that sent medical researchers in the wrong direction--and nearly allowed a murderer to go unpunished.

On July 28, 1971 a two-and-a-half month-old baby named Noah Hoyt died in his trailer home in a rural hamlet of upstate New York. He was the fifth child of Waneta and Tim Hoyt to die suddenly in the space of seven years. People certainly talked, but Waneta spoke vaguely of "crib death." There was plenty of unease, but over time the talk faded.

Nearly two decades later a district attorney in Syracuse, New York was alerted to landmark paper in the literature on Sudden Infant Death Syndrome--SIDS--that had been published in a prestigious medical journal in 1972.  Written by a prominent researcher at a Syracuse medical center, the article described the brief lives and sudden deaths of "N.H." and his sister "M.H.", part of a family in which three other children had died suddenly without explanation. The more the D.A. pushed and probed, the more he was convinced something was very wrong about this account. It was the start of an intensive quest by a team of investigators, and it came to its climax on April 20, 1995, when after a dramatic trial Waneta Hoyt was found guilty of the murder of all her children.

But this book is more than a vivid account of infanticide revealed. It is also a riveting medical detective story. That journal article by a charismatic doctor had legitimized the deaths of the last two babies by theorizing a cause for the mystery of SIDS, suggesting it could be predicted and prevented, and fostering the presumption that SIDS runs in families.  In the years thereafter, this theory became the prevailing wisdom about SIDS, every new parent's nightmare. More than two decades of studies have failed to confirm any of these widely-accepted premises.

How this happened--could have happened--is a compelling story of high-stakes medical research in action. And the enigma of familial SIDS has given rise to a special and terrible irony.  Today there is a maxim in forensic pathology: One unexplained infant death in a family is SIDS. Two is very suspicious. Three is homicide.

Editorial Reviews

Amazon.com Review

A rule of thumb in forensics: one dead baby is Sudden Infant Death Syndrome(SIDS); two dead babies is suspicious; three dead babies is murder. The Death of Innocents starts off a bit slow, but as soon as a new district attorney decides to pursue an old case of five siblings whose deaths were attributed to SIDS, the story kicks into high gear. There are two villains: the quietly furious mother who admitted to smothering her children--one of whom was 2 years old, and kicked and flailed as he died--and the arrogant medical researcher who was so eager to make a name for himself that he was willfully blind to the warnings of danger. Richard Firstman and Jamie Talan, a husband-wife team, write about abuse of the scientific method as suspensefully as they write about parental abuse of babies. The Death of Innocents was named a 1997 Notable Book of the Year by the New York Times. The NYT writes, The Death of Innocents "...seamlessly weaves the tales of the earlier and later murder cases, separated by two decades, with the complicated scientific and social issues, the many disparate personalities, documents, interviews and dramatic moments. The book is paced like a thriller, and it will be read like one."

From The New England Journal of Medicine

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

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

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

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

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

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

Reviewed by Orah Platt, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Product Details

• Hardcover: 640 pages
• Publisher: Bantam; 1 edition (September 2, 1997)
• Language: English
• ISBN-10: 0553100130
• ISBN-13: 978-0553100136
• Product Dimensions: 9.2 x 6.1 x 1.8 inches
• Shipping Weight: 1.8 pounds
• Average Customer Review: 4.7 out of 5 stars  See all reviews (31 customer reviews)
• Amazon Best Sellers Rank: #1,431,347 in Books (See Top 100 in Books)

Customer Reviews

Most Helpful Customer Reviews

14 of 14 people found the following review helpful:

5.0 out of 5 stars An Incredible Book, March 6, 2001

By 

BeachReader (Delaware) - See all my reviews

This review is from: The Death of Innocents: A True Story of Murder, Medicine, and High-Stake Science (Paperback)

This book was <<an epistemological adventure--how do we know what we know?--as well as a study of crippling ambition, a detective story, a courtroom drama, and a showcase for superb research and organization>> according to Frederick Busch, who reviewed it for The New York Times.

The quote above just about says it all. The book read like fiction and was carefully detailed. All of the medical terminology was easily understood and thoroughly explained. The authors stated that the theme of the book is "the emotionally-charged intersection of SIDS and infanticide."

Almost all of what we have known of Sudden Infant Death Syndrome (SIDS) for the last 20 years was based on work done by Dr. Alfred Steinschneider in upstate New York. His findings were based primarily on two children (Molly and Noah Hoyt) who died while under his care in the early 1970s, following the deaths of three of their siblings in previous years. Steinschneider thus "determined/concluded" that SIDS was familial and caused by apnea (pauses in breathing while sleeping). To combat these deaths, he pushed the use of home monitors for babies who were considered "at risk". His landmark paper in 1972 in The Journal of Pediatrics shaped medical thinking for the next 20 years. Yet he had used only a tiny sample and had no control group. This article and subsequent ones cleared peer review committees despite obvious flaws. He arranged facts to fit his theory over the next years. His fundamental deception/fabrication was that apnea episodes were documented in the hospital for the two children who died --but there was NO documentation!! In fact, Steinschneider had repeatedly ignored concerns of the pediatric nursing staff about the mother, Waneta Hoyt.

I found it incredible that a hypothesis was presented and accepted by the medical community based on only 5 cases and 2 deaths! I think this shows how desperate people were for a quick way to predict and prevent SIDS. Because of the prevalence and acceptance of this theory, Munchausen Syndrome by Prozy (when a parent, usually a mother, harms or kills a child, usually to get attention) was rarely considered when a very young child died.

In the next 20 years, the monitor business became a multi-million dollar business and many people got rich from it. Steinschneider himself never owned stock in any monitor company, but his research was underwritten by one of them, Healthdyne, whose fortunes then became dependent on the doctor's continuing research findings about apnea. A vicious circle! Also, leading SIDS researchers conducted seminars, which were funded by Healthdyne grants, then gave out information on monitors to the participants.

What particularly disturbed me was the fact that Dr. David Southall, from England, had refuted Steinschneider's theories and proven them to be false with very extensive research of his own But until the 1986 Apnea Consensus Conference, no one appeared to listen to him. This conference was the first time that Steinschneider's theory was formally investigated or questioned by an official group of his peers.

In the early 90s, a coincidental series of events led a district attorney in upstate NY to begin investigating the deaths of the Hoyt children. This led to the 1994 arrest and conviction of Waneta Hoyt for the murder of all five of her children. The authors make it clear that not only was the mother on trial for murder, but that Steinschneider's theory was also on trial.

The trial's outcome demonstrated that the entire premise for SIDS for the last 20 years was false. In the words of several prominent pediatric forensic specialists: if there is one infant death in a family, it is probably SIDS. Two deaths should be considered suspicious. Three deaths are homicide.

What was especially shocking to me was the information in this book about Massachusetts General Hospital's SIDS program. Mass General had positioned itself as "the" place to bring babies thought to be "at risk" for SIDS. Yet the program, run by Drs. Kelly and Shannon, disciples of Steinschneider, was governed by a false, 20- year-old theory. The pediatric department had had a long history of ignoring suggestions of child abuse, some of it fatal, when a young doctor named Tom Truman arrived for a research fellowship in pediatric critical care. Truman secretly investigated all of the deaths of children who were "at risk" and found that in 155 deaths which occurred after multiple "events" (instances of unconsciousness, etc.), Munchausen Syndrome by Proxy was never considered, even in one family when the "events" stopped after the children were placed in foster care.

The authors said: "In the Shannon-Kelly team, some [abusive] mothers found the allies they needed. In their babies, the doctors found the data they needed. Locked in this symbiosis, Mass General appears to have become a Munchausen haven, while contaminating the research of SIDS with highly dubious data."

I would highly recommend this book not only for its interesting subject matter but because it was so well done. The meticulous and documented research was presented in a scholarly yet easily-understood manner.

8 of 8 people found the following review helpful:

5.0 out of 5 stars Must read by all in pediatrics and clinical research, June 9, 1999

By A Customer

This review is from: The Death of Innocents: A True Story of Murder, Medicine, and High-Stake Science (Paperback)

Pediatricians as well as clinical researchers will not only enjoy this book but will find that it will help them in their practice. Arrogance in the practice of medicine as well as research continues to be as much a problem today as it was during the 20 year span that events of the book were described. We as medical researchers must constantly question our own research as well as that of others. I have made this book required reading by the pediatric residents I work with. It has provoked great discussions with my peers as well as my students. It is a great narrative of a tragedy and easy to read by those in the field as well as the lay public.

Ron Sklar M.D. Portland, Oregon

6 of 6 people found the following review helpful:

5.0 out of 5 stars The perfect true crime book, April 26, 2004

By 

Marie Growden (Mandeville, LA United States) - See all my reviews

This review is from: The Death of Innocents: A True Story of Murder, Medicine, and High-Stake Science (Paperback)

I can't say enough how much I enjoyed this book. I came across a mention of the Hoyt family and this book while reading Michael Kelleher's "Murder Most Rare" (another really good read), and decided to order it. From page one, I was hooked.
It starts with a case of familial infanticide, then explores the earlier Hoyt case that was so important. The best part about the book is when the authors leave the Hoyt case and take us on a detailed tour of the history of SIDS and apnea. The very scientific and potentially dry discussion of research projects is told in a way that leaves you with the feeling that you really understand what is going on in the SIDS research arena, and you also feel like you know each player in this community. When the story turns back to the Hoyt case and its conclusion, the reader fully undertands the what, why, and how of the events. Without the exploration of the history of SIDS, the ending of the story would have much less impact. I didn't realize until I was finished just how personal the book had become for me. I went immediately online to Amazon and typed "Munchausen by Proxy" in the search bar.