LETTERS THE JOURNAL OF PEDIATRICS

FEBRUARY 2001

296

drome. Although complete objectivityin medical science is illusory, it isnonetheless one of medical science’smost important endeavors.

Second, in citing the Harris case asan instance of what can happen if FASis not diagnosed at an early age andconveying the impression that two ofits ineluctable outcomes are mental re-tardation and an inability to knowright from wrong, Dr Jones has lefthis readers with an impression that allchildren with FAS are destined to fol-low in Harris’ footsteps. Dr Jonesshould know better. Although manychildren with FAS do go on to commitcrimes and even murders, many morepeople who do not have this disorderalso commit crimes and murders. Al-though mental retardation is a featureof FAS, it is hardly universal,5 andcriminal behavior is certainly not theineluctable consequence of mental re-tardation.5 If we were to speculate onwhat early event in Harris’ life mayhave predisposed him to his antisocialbehavior, it is much more likely thatthe abuse he experienced at the handsof his alcoholic father was much moreinfluential than FAS.

People with FAS and their caretak-ers must contend with enough adver-sity without the added burden DrJones has laid on their shoulders. I’msure it was not Dr Jones’ intent tostigmatize people with FAS further bycreating the impression that they aredestined to act out uncontrollableurges that will eventually cause themto commit criminal acts. But regard-less of how well-meaning one’s inten-tions may be, we should not blithelyaccept such hyperbole, lest it becomeuncritically accepted.

Ernest L. Abel, PhDProfessor of Obstetrics and Psychology

Director, Division of ReproductiveToxicology

Wayne State UniversityDetroit, MI 48201

9/35/107612doi:10.1067/mpd.2001.107612

REFERENCES1. Jones KL. Early recognition of prena-

tal alcohol effects: a pediatrician’s re-sponsibility. J Pediatr 1999;135:405-6.

2. Stoler JM, Holmes LB. Under-recog-nition of prenatal alcohol effects in in-fants of known alcohol abusing women.J Pediatr 1999;135:430-6.

3. Petition for executive clemency on be-half of Robert Harris to the HonorablePete Wilson, Governor of the State ofCalifornia. April 10, 1992.

4. Harris v Vasquez, 885 F2d 1354 (9thCir 1988); 913 F2d 606 (9th Cir 1990);943 F2d 930 (9th Cir 1990); 949 F2d1497 (9th Cir 1991).

5. Abel EL. Fetal alcohol abuse syndrome.New York: Plenum Press; 1998.

ReplyTo the Editor:

I am disturbed that Dr Abel wouldso completely misconstrue my editorialcomments on the article by Stoler andHolmes,1 and I appreciate the oppor-tunity to reply. My remarks in that ed-itorial were intended to emphasize theimportance of early recognition of theprenatal effects of alcohol as perhapsthe most important way to preventsome of the secondary disabilities asso-ciated with FAS.

Streissguth et al2 have recently pub-lished a report sponsored by the Cen-ters for Disease Control and Preven-tion indicating that a number of highlysignificant secondary disabilities in-cluding mental health problems,disrupted school experience, inappro-priate sexual behavior, confinement,and trouble with the law occur in50% or more of individuals withFAS or fetal alcohol effects. Withinthe category, “trouble with the law”crimes against persons including theft,shoplifting, burglary, assault, and mur-der occurred most frequently. Impor-tantly, early diagnosis was a strongprotective factor for all secondary dis-abilities. In the analysis by Streissguthet al,2 the early recognition of FAS orfetal alcohol effects led to eligibility forservices from the state of Washington’sDivision of Developmental Disabili-ties, which provides case managers,job placement and coaching, and shel-ter. Access to these services was themost effective factor protecting against“trouble with the law.”

My purpose in bringing up the case ofRobert Alton Harris was not to re-opena discussion of the merits of his deathpenalty conviction but rather to illus-trate the most extreme secondary dis-ability that can occur when an individualwith FAS is not recognized at an earlyage and therefore is not given the op-portunity to benefit from available in-tervention programs. To suggest that allchildren with FAS are destined to com-

mit murder, as Dr Abel states that I did,is obviously ridiculous and is a misrep-resentation of my editorial comments.

Finally, I would like to comment onDr Abel’s concern about stigmatizingpeople with FAS. There are clearly anumber of very serious social and be-havioral problems associated with FAS.To deny that the potential for these sec-ondary disabilities exists under the “mis-guided hope of avoiding stigmatization”would be doing a great disservice to af-fected individuals and their caretakerswho are already keenly aware of theanguish this disorder can cause forthemselves and for the society in whichthey live.

Kenneth Lyons Jones, MDDepartment of Pediatrics

University of California, San DiegoUCSD Medical Center

Division of Dysmorphology andTeratology

San Diego, CA 92103-84469/35/107610

doi:10.1067/mpd.2001.107610

REFERENCES1. Stoler JM, Holmes LB. Under-recog-

nition of prenatal alcohol effects in in-fants of known alcohol abusing women.J Pediatr 1999;135:430-6.

2. Streissguth AP, et al. Understandingthe occurrence of secondary disabili-ties in clients with fetal alcohol syn-drome (FAS) and fetal alcohol effects(FAE). Atlanta: Centers for DiseaseControl and Prevention.

Thymic size andchorioamnionitis in verylow birth weight infantsTo the Editor:

I read the interesting article by DeFelice et al1 describing small thymusin very low birth weight infants bornto mothers with subclinical chorioam-nionitis (CA). In their cohort of 132babies, 75 (58%) were noted to havehistologic CA. What was the explana-tion for that high incidence? Does itimply that we are missing such a highnumber of cases of subclinical CA?Should we use placental histologic ex-amination in all very low birth weightpreterm infants who are admitted tothe neonatal intensive care unit?

It was mentioned that the patholo-gists conducting the histologic exami-