Hi Nikki:

Good point about efficiency versus effectiveness.  You're correct.  They do have different meanings.  I have an unfortunate association of the term effectiveness with economists.  They almost never look at cost-efficiency, they look at cost-effectiveness.  

In my world of epidemiology, efficiency was measured by comparing the best possible performance from two different treatments or conditions.  For instance, measuring efficiency of a diet consisting of foods rich in vitamin A compared to capsules of vitamin A, would mean total compliance by those eating the foods and the capsules.  Measuring effectiveness would be measuring all those in a program to change diet versus a program to distribute vitamin A capsules. In the short run, the effectiveness of the capsules always wins out because nutrition education takes a long time.  Also, economists tend to look at a single outcome, so the multiple benefits of foods rich in vitamin A -- that are also rich in all sorts of other nutrients gets lost.

In terms of breasts versus pumps, you would have the same problem measuring effectiveness because feeding from the breast has multiple effects, whereas the pump only removes milk.  In fact, I think you would have to go to some other country than the United States to have a big enough pool of normally birthed babies.  I would argue that many babies in the United States are compromised in their effectiveness because of the process of how they are born.  Their innate efficiency never is given a chance to emerge.

Best, Susan

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