Hi Jennifer, 

Just wanted to chime in on the comment on evidence-based practice. It is a discussion I have been on for the last few weeks with local friends/colleagues, so your comment peaked my interest. And please, I hope I am not getting too far of subject or misusing this listserv, but I do think the concept of evidence is an important discussion to have for anyone practicing in any aspect of health/health education/counseling. Your posts often get me thinking:). 

I readily agree that there are many practices in western medicine that are not based on evidence. However, I do disagree with you on a sense I am getting from you concerning the general importance of clinical evidence. I do think as educators, consultants and practitioners, our practice must be evidence based. It doesn’t change who does the actual healing (which is truly the body itself), but it does matter in the context of what information we give to clients. May I clarify just to be specific, are we talking about clinical research studies as “evidence?” That is how I interpret “evidence” but don’t want to assume that is everyone’s interpretation. I am getting a sense that you see the process of research as inherently flawed and therefore not very useful to you in your practice? Please correct me if I have misinterpreted your meaning. 

While the article you referenced is interesting and raises some good questions to ponder, it is editorial and is one man’s opinion. I am not implying he is incorrect or implying disrespect by calling it editorial, but (and this is a rhetorical question) how do we know the things he says are accurate? In fact, how do we know any health information is “accurate” or “reliable” unless it has been tested? What method are we using to test? I am the first to agree that research is frequently flawed, that because fallible people are conducting the studies and drawing conclusions, there can be many flaws along each step (and yes, abhorrently, there is intermittently fraud as well). I take the personal stance that research is currently our best tool for determining accuracy, flawed as it has the potential to be. Although any study has the *potential* to be flawed, that does not mean it *will* by nature be flawed. Not all research is deeply flawed. Some is very soundly conducted, not perfect, but replicable. 

I personally think what is VITALLY important is that practitioners not rely on the researcher’s conclusions (sometimes, due to being very busy, practitioners tend to either read only summaries or the abstract or maybe skim down to the conclusion section of a study and never evaluate the study methods, inclusion/exclusion criteria, etc…this can lead to practitioners making adaptations to their practice or continuing the same practice based on a poorly done study. This I think all of us could agree can be detrimental. I believe practitioners and consumers should always take information (whether it is a research article, editorial, anecdotal, etc) and not blindly believe everything they hear, nor change their course because of one piece of information. We need to weigh varying sources and should be careful not to see ourselves as having “arrived” at a final conclusion or somehow peaked in wisdom. We’ll always be learning and growing and yes, sometimes changing our philosophy on practices. I challenge those perhaps on the more “medical” side (sorry, not trying to put anyone in boxes:)) of the spectrum not to put the concept of clinical research on a pedestal, or be overly trusting of it, but to use it as simply a tool. Similarly, I have a challenge that I would give to those more on the “natural” (again, not meaning boxes) side of health approaches is to acknowledge that although research has the *potential* to be flawed, it also has the great potential to be highly useful and can be a standard by which we measure accuracy and that there are many studies that are not flawed.

I don’t single you out with this question, Jennifer, but am curious for anyone who is interested in answering it:  What tools do you personally use to determine the accuracy of health information? What specific steps do you use to compare information to assess whether it is reliable? I personally believe in absolutes, that although the application may be different for each person, the facts themselves are fixed and not relative concepts. (I also don’t believe we can state that a piece of information is true because it agrees with the philosophy we already hold (I personally believe this is reverse logic), rather shaping our philosophy to fit the replicable information is more sound. I say that not to start a philosophical discussion (I know that is not what this forum is for:)), but to demonstrate that there do need to be standards of health practice and ways for determining what those standards should be. If others have ways of assessing accuracy that does not involve the widely used research/scientific method, I would love to hear about those methods. I believe that despite there being flaws at times, clinical research is a very useful tool on which to base practice. 

As an aside, I am trying to learn how to collaborate effectively and professionally with all other disciplines (MD’s, DO’S, RNs, ND’s, DC, RD’s, PT/OT, LC’s etc) to help foster better, more comprehensive and complimentary care for families. I am always discouraged by provocative comments that appear to bash on one of these other health disciplines. I feel like in the long run, the people who are the most short-changed and even at times damaged by potentially divisive comments/attitudes are our clients, whom I know we all desire to help and not hurt. To all you wise and more experienced LC’s, please help me (and others) as a future IBCLC and growing lactation practitioner to learn how to be a professional collaborator and patient advocate and to eliminate divisiveness from my practice. I will be forever grateful:)

Deborah Wetherill, RN, BSN, CCCE, Lactation Counselor
(Enjoyed the first snow of the season yesterday) in Colorado, U.S.

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