I've now watched the documentary. I better understand the argument about the apparent hyperinsulinaemia now, although it was touched on by the expert panel. It's a common issue with many types of assay, that all the analyte present in the sample is detected, although it may well be that only a small proportion of it is biologically active with the remainder being protein-bound (in this case antibody-bound) and so not biologically active. It's a bit like counting all the cars in a city, including the ones in car parks, and presenting that as the number of cars actively being driven on the roads. It's a regular issue with calcium. Usually we just assume half the detected calcium is biologically available, so the active calcium is directly proportional to the total calcium result and you just run with that, but you can request an ionised calcium assay to give you the actual bio-available calcium concentrations if you need it.
The programme explained that due to high levels of maternally derived antibody (passive immunity) neonatal babies have high levels of antibodies that bind insulin and so the total insulin result is artificially elevated and not clinically relevant. Meanwhile the c-peptide is not protein-bound and is cleared from the bloodstream, leaving the bound insulin behind on its own. Hence the appearance of a "factitious insulin poisoning" result which isn't real. I note there was a warning about this on the request form of the lab that did the assays, but the prosecution still presented the results as evidence of poisoning. This in-utero antibody transfer is not something that happens in animals due to a different placental structure so it's not something I was aware of, but I understand it now. It's astonishing this wasn't being picked up by the doctors in the neonatal unit.
As an aside (and please, I am not trying to derail this thread), I wish very much that someone would make a documentary like that about my Lockerbie findings. Such a documentary would absolutely kill the conviction stone dead, even more so than this one affects Letby's conviction. But I didn't get the book out until 12 years after the conviction and the circus had moved on. The documentary-makers that did approach me were only interested in pursuing their own pet theories about who actually carried out the bombing, and explaining the science of why the prosecution theory about how the bomb got on the plane was wrong wasn't really interesting to them.
I say this partly because I hit the same legal brick wall that's mentioned at the end of this documentary. All the evidence I relied on was available to the defence at the time of the original trial, and most of it was even presented in court. That's how I got access to it. It was a failure of both prosecution and defence to analyse the data properly, just as in the Letby case. I got my findings in front of the SCCRC, and they said, in writing, exactly what it's predicted the CCRC will say about the Letby submission. If this reasoning is correct then the prosecution case is utterly destroyed, however the evidence was available at trial, and we find nothing to support an allegation of defective representation (they practically never do), so hard luck, nice try, bye-bye.
This is a huge issue with the system that needs to be addressed in its own right, not just because of these two cases. It happens again and again. Even genuinely new evidence has been dismissed in some cases because "there was nothing stopping the defence from having looked for this at the time of the original trial." I kid you not.
If anyone wants to pick up on any of these points, there are threads on the CCRC and on the Lockerbie case where they can be discussed further.
