Dear all:

Nora Ephron dropped entirely off my list of women I find amusing when she wrote her 
highly flawed New York Times op ed piece.  I was already finding her commentary on the 
neck tiresome after I had heard it for the fourth or fifth time, but the op ed piece really 
pushed me over the edge.  She basically argued that because food allergies were 
increasing and so was breastfeeding, that food allergies were caused by breastfeeding.

This is a classic example of "ecologic fallacy" that gets taught in every epidemiology 101 
class.  Just because two events happen at the same time doesn't mean one caused the 
other --- and even when there is an apparent temporal relationship of one event 
occurring before the other it still doesn't prove causality.   

We also often forget that infanticide and letting babies slip away was common practice 
until fairly recent times in human history.  I think it was a New Yorker or a New York 
magazine article that described how obstetricians did not attempt to save 'blue babies' 
until the Apgar score was invented.  Unfortunately obstetricians have not really gone 
much further than the Apgar in terms of evaluating their interventions.  They need to 
start delving into a longer horizon of outcomes.  In Puno Peru, a group of anthropologist 
that I met claimed that it was common practice to put newborn infants in a corner of the 
room for three days.  The infant was only fed if it survived the three days.  How many 
tongue tied babies would survive after three days of not being fed and then attempting to 
feed from moms that were severely engorged?  

When we look for "associations" it can be an interesting starting point to explore further 
evidence about whether our assumptions are correct or incorrect.  And this means 
HONESTLY evaluating not just our own assumptions but all the counterexplanations as 
well that might refute our own ideas.  I recently went to one website that provided a so-
called critique of the literature on a popular intervention.  Unfortunately, the website also 
failed to disclose the conflicts of interests of the prime authors they cited that were 
criticizing the intervention.  The conflicts of interest on both sides were just as deep as 
were the flawed assumptions.

So, while it is intriguing to look at our own situations to substantiate our speculations, we 
need to move beyond samples sizes of a few, and look more closely at evidence and 
counterevidence.  Explore further, but always challenge your own assumptions as 
rigorously as you challenge those of others.

Best, Susan Burger

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