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Comment by steelbrain | Hacker News Reader

> Does no one care that this is potentially a murder case?

Did we read the same article? Why are you so quick to jump the gun here?

> Koren obtained a sample of Rani’s breast milk, which she had kept in her freezer. His lab measured its morphine concentration at eighty-seven nanograms per millilitre.

If this is in the breastmilk, it will end up in the stomach, and it may end up in gastric contents. I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.

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Are you Koren? Did we read the same article? The one that calls into question anything Koren says or claims?

From the article I read:

"A twelve-day-old infant cannot crawl. It cannot grab, and it cannot put something into its own mouth. “It also cannot swallow a Tylenol-3 pill,” Juurlink told me. “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”"

Also relevant to the quote selected by 'steelbrain:

> Recently, Parvaz Madadi has undergone a painful process of revisiting her past work and memories. [...] She added that she had no confidence in the measurement of Rani’s breast-milk sample, because it had been handled by Koren’s lab.

There is a lot to process in this long article. The quote selected by 'steelbrain, concerning Koren's measurement occurs very, very early on, and much of the rest of the article is about contrasting Koren's early presentations of the material against others' testimony. It's worth reading the whole thing

To 'steelbrain: cherry-picking one single quote out of a nuanced article does the journalism here a dire disservice. It's okay for different people to have different beliefs and takeaways from the article. However, your own defense of the biological mechanism here is directly argued against in the "same article" you are admonishing others over reading. That is not conducive to a discussion in good faith.

> If this is in the breastmilk, ...

Note that you and GP are talking about different values of "this." GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.

> GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.

It appears that they didn't really read the article before commenting.

The entire point, the damning evidence is that the child that died had codeine in his stomach, which he absolutely couldn't get from breast milk.

The original death finding falls just from simple back-of-napkin math.

87 ng/mL.

Baby eats 30mL per hour. That's 2.6 micrograms of morphine.

Elimination half life in neonates of ~8 hours means 30 micrograms in system at equilibrium if constantly fed this and the baby absorbs all of it (takes 4-5 half lives to get to that) and pharmacokinetics are linear. In reality a neonate likely absorbs well under 1/3rd, so you'd expect under 10 micrograms in equilibrium.

25-50 micrograms/kilogram is normal dosing of morphine in a neonate when it is necessary, every 6 hours (resulting in a peak systemic concentration of ~60-120 ug/kg after repeated dosing).

Compare -- 60-120 ug/kg therapeutic dosing to 10 micrograms in the neonate's body (3-4 kilos, so 3 ug/kg??)

And then, you end up with acetaminophen and codeine in the neonate's stomach, with no morphine... Even though these do not end up in breast milk in significant quantities.

> I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.

Neither the article nor the commenter you replied to has demonized the parents. Yes, both the evidence discussed in the article and the opinions of those interviewed indicate direct administration of a pharmaceutical; it is appropriate to discuss this. Nobody has pointed the finger at anyone; it would indeed be quite inappropriate for such a discussion to be held in this forum.

The article goes into detail about how this level of morphine in the breastmilk could not have given the baby a lethal (or even clinically effective) dose.

Furthermore, Koren lied about what the tests showed the stomach contents to be: he omitted codeine entirely. Codeine (per the article) would not be expected to be transferred by breastmilk -- it's metabolized into morphine to be effective.

This should be further up: it's metabolized into morphine.

There are some giant red flags with this situation. How awful.

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