Libow, Schreier, & Munchausen by Proxy: Part 1 – Introduction

Medical library


In Munchausen Syndrome by Proxy (MSbP), there are a few main players in the research world who can be credited for increasing awareness and building out the scientific knowledge on the subject. Two researchers who have been central the development of scientific, peer-reviewed literature on MSbP are Drs. Judith Libow and Herbert Schreier. Together, one or the other or both of these authors are listed on 15 works in the Proxy Project library, most of which are peer-reviewed scientific articles.

The works of Libow and Schreier are very important because they have laid the foundation for much of what is known about the clinical presentation of MSbP families, and have been an instrumental part of developing the literature on proper diagnostics. Therefore, I decided to do a series of blog posts on their work so we can all understand the nature of their important contributions to the field of MSbP study.

In this first post, I introduce the idea of perspective. Many people participate in authoring scientific literature, and their professional perspective influences how they see clinical problems.

Libow & Schreier as Clinician-Researchers

The fact that both doctors are clinician-researchers is extremely salient to the discussion of MSbP, in my opinion. In my earlier posts in this series, I describe the professional background of these clinician-researchers so readers can better understand their points-of-view. Next, in my later posts in the series, I describe their early foundational work. After this, I make separate posts on Dr. Libow’s research direction, which took a slightly different turn than Dr. Schreier’s research direction. Finally, I present a wrap-up of what their research means to the Proxy Project.

Public Health vs. Healthcare Delivery

I am an epidemiologist, which is important to distinguish from health care providers like Libow and Schreier.

An epidemiologist is a public health practitioner and studies the three D’s: the distribution and determinants of disease.

The purpose of public health is to stop bad health things that are either widespread, or rare and severe – with MSbP falling squarely into the latter category. The idea is that by improving the public’s health overall, less work will be left for clinicians like Libow and Schreier to deal with.

CDC Building

As an epidemiologist, I have observed that a lot of bad health in the United States in the last 15 years has been directly caused by the dysfunctional healthcare system that puts profits before people. Just check recent rates of medication errors as an example. One of the things public health people do, then, is fix parts of the healthcare system that kill people.

What’s the Difference?

The difference – as with any cultural aspect of a person – is with perspective. In my next post, I’ll explain my perspective as an epidemiologist, and how that influences my thinking on MSbP.

Interested in healthcare delivery in the US healthcare system?

See my lecture series on the topic.

Images by Scome-squ and James Gathany, Centers for Disease Control and Prevention.


One thought on “Libow, Schreier, & Munchausen by Proxy: Part 1 – Introduction

  1. I think we both like to call this Munchausen’s By Proxy, because it makes for a unique name. But I for one am not looking at this as perpetrators suffering from a mental illness. I am looking at the perpetrators as criminal child abuses. And so very little tolerance can be shown. It has to be civil judgments or criminal convictions. Without this, more parents will have children so that they can abuse them and justify it in the usual ways.



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