Dr. Michael F. Holick

Why It’s Plausible That Nearly All of Dr. Holick’s Patients Have Hypermobile EDS

Reframing the Criticism with Updated Prevalence Data

In the past, Child Abuse Pediatricians have claimed that it is “implausible” for Dr. Michael Holick to diagnose hypermobile Ehlers‑Danlos syndrome (hEDS) in nearly all of the children he evaluates. This criticism incorrectly assumes his patients represent the general population, which they do not. When examined in context, his high diagnosis rate is both logical and medically defensible.

1. A Highly Self‑Selected, High‑Risk Population

Dr. Holick does not evaluate a random sample of children. His patients are:

  • Families accused of abuse, often facing allegations of causing non‑accidental fractures.

  • Parents actively seeking medical explanations for injuries dismissed by others as abuse. Parent who have not had others report any abuse, just an abuse diagnosis stemming from a visit to a hospital out of concern for their child. 

  • Children with unexplained, often mild fractures, a subgroup where connective tissue disorders are disproportionately likely.

These are not typical pediatric patients. They represent a highly specific, pre‑screened population already enriched with EDS indicators.

2. Referral Bias & Pre‑Identification of Symptoms

Families who seek out Dr. Holick often self‑identify features of EDS (joint hypermobility, stretchy skin, easy bruising, family history). Many arrive already suspecting connective tissue disorders as a cause. This referral bias makes a near‑universal diagnosis rate unsurprising.

3. Updated Prevalence: hEDS is Far More Common Than Once Believed

Older studies estimated EDS at about 1 in 5,000 people.
Newer research dramatically changes that picture:

  • hEDS + related Hypermobility Spectrum Disorders may affect as many as 1 in 500–900 people.

  • hEDS accounts for 80–90% of all EDS cases, making it by far the most common subtype.

  • Many individuals remain undiagnosed, especially in pediatric populations.

This means children with unusual fracture patterns are much more likely than previously thought to have hEDS.

4. The “Statistical Implausibility” Argument Collapses

When you combine:

  • A self‑selected pool of families seeking connective tissue evaluations,

  • Referral bias from pre‑identified symptoms, and

  • Updated prevalence data showing hEDS is far more common than assumed,

…it becomes entirely plausible — even expected — that nearly all of Dr. Holick’s patients would meet diagnostic criteria for hEDS.

Bottom Line

The criticism that Dr. Holick’s diagnosis rate is “statistically impossible” ignores selection bias and updated medical knowledge. His patient population is uniquely high‑risk for connective tissue disorders, and new prevalence data supports a much higher baseline likelihood of hEDS. In this context, his findings are neither implausible nor indicative of bias — they are consistent with the population he serves.

Why Dr. Holick’s Opinions Deserve Serious Consideration

Dr. Michael Holick’s evaluations of children with unexplained fractures—most commonly attributing injuries to hypermobile Ehlers‑Danlos syndrome (hEDS)—have drawn criticism for methods including remote assessments. Yet his perspective plays a critical role in a process where Child Abuse Pediatricians (CAPs) themselves face scrutiny for overreach and diagnostic inconsistency.

A Balanced Perspective:

  • CAP critiques: Medical literature and legal commentary have raised concerns about CAPs conducting minimal or biased examinations, over-interpreting injuries, and leaning heavily toward abuse diagnoses even when alternative medical explanations exist .

  • Holick’s counterpoint: While Holick's approach—especially diagnosing without in-person exams—is controversial, he often offers a substantive, non-legal medical perspective, emphasizing connective tissue disorders as alternative explanations. This is especially relevant in cases where CAP conclusions might be premature or speculative .

Why His Expertise Matters:

  • Balance: Holick provides a counterweight to default abuse assumptions, helping to ensure families are not penalized when testable medical explanations might exist.

  • Alternative Focus: His involvement widens the diagnostic lens beyond developing abuse-centric conclusions, promoting thorough clinical evaluation.

  • Ethical overlap: CAP oversight literature suggests that neither extreme—automatic abuse conclusions nor blanket dismissal of abuse findings—is in the public interest.

References

  1. Kristine A. Campbell et al., Critical Elements in the Medical Evaluation of Suspected Child Physical Abuse, expert consensus guidelines outlining variability and potential bias in CAP evaluations .

  2. “Questions Lawyers Should Ask Child Abuse Pediatricians,” American Bar Association, noting CAP tendency to diagnose abuse in easy cases and the importance of independent scrutiny .

  3. Anne Zimmerman, Our System for Reporting Child Abuse Is Unethical, highlighting ethical concerns over CAP-driven family separation and over-reporting bias .

Why Remote Evaluations by Dr. Holick Should Not Be Dismissed

Critics have also attacked Dr. Michael Holick for diagnosing hypermobile Ehlers‑Danlos syndrome (hEDS) without in‑person examinations, implying this invalidates his findings. While in‑person assessment is ideal, such criticism ignores the real‑world barriers faced by accused families and the systemic shortage of medical experts willing to challenge abuse assumptions.

1. Barriers for Families—Especially Those in Poverty

  • Accused families are often from marginalized or low‑income backgrounds who cannot afford to travel across states to see rare subspecialists willing to provide independent evaluations.

  • These families are already burdened by legal costs, child removal proceedings, and loss of income, making extensive travel or multiple in‑person specialist visits prohibitive.

  • Remote evaluations are often their only access to expert medical opinions that could prevent wrongful family separation.

2. Severe Shortage of Independent Experts

  • Child Abuse Pediatricians (CAPs) dominate this field and frequently serve as state witnesses, making them unlikely to provide independent assessments for accused families.

  • Medical professionals willing to consider alternative explanations—like connective tissue disorders—face public and institutional attacks, deterring many from offering such services.

  • Dr. Holick represents one of very few experts willing to evaluate these complex cases from a non‑abuse perspective, filling a critical gap in access to justice.

3. Remote Assessment Can Be Clinically Reasonable

  • For conditions like hEDS, key diagnostic features (joint hypermobility, family history, skin findings) can often be reliably assessed through detailed history, photos, videos, and patient‑provided documentation.

  • Many medical fields (e.g., genetics, dermatology, psychiatry) already rely on telemedicine assessments, especially in underserved regions.

  • While remote diagnosis is not perfect, it is often better than no evaluation at all, particularly when families face irreversible harm (e.g., loss of custody) without independent input.

4. A Critical Counterbalance in a Biased System

  • CAP evaluations are frequently criticized for bias, minimal physical assessment, and failure to consider alternative explanations.

  • Holick’s involvement provides a counterweight to the state‑driven narrative, ensuring that plausible medical causes of injury are explored before families are branded as abusers.

Conclusion

While remote diagnosis is not ideal, it must be viewed in the context of systemic inequities: poor families under investigation, a severe shortage of independent experts, and widespread reluctance among physicians to challenge CAP conclusions. Until access to in‑person independent subspecialists improves, remote evaluations remain a vital—often the only—lifeline for ensuring medical fairness in abuse investigations.