Since I have had epidemiology up the wazoo, I sometimes forget how studies
might appear at face value to others.

When looking at race issues, I apply the same approach as James McKenna does
to articles on infant deaths in parental beds.  The flaw in all of those
articles is that when a child dies in a crib, the cause of the death is
investigated.  When a child dies in the parents bed, it is the parent's bed
that caused the death.

This can often happen with articles on race.  When a difference is found
between races in a particular statisitic (e.g. lower death rates in VLBW
African American infants vs. Caucasian infants) the potential reasons for
that difference may not always be investigated.  The very reasons for VLBW
infants in African Americans may be quite different from those among
Caucasian infants because of SES.  For instance, some of those VLBW infants
might be due to the increase in fertility treatments and higher order
multiples (my NY bias is showing) which can only be afforded by higher
income clients.  That might make a difference in their survival rates
compared to some other cause of VLBW.  So, one needs to look very carefully
at these broad based statements.

Just to give another example, Kathleen Rasmussen's article on obesity and
lower success in breastfeeding bears closer examination.  Is it PCOS?  Is it
getting adequate help for positioning?  The underlying reasons should be
examined.

Best regards, Susan E. Burger, MHS, PhD, IBCLC

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