Nancy Wight interjects concern that this article is not solidly enough
grounded to be used in arguments for increasing BF rates, and I agree.  We do
have enough such evidence that IS well documented; this article is more an
incitement to debate, and it is so provocative that it could even cause a more
damaging backlash, which would be very sad, as I am sure the author did not
intend that.

I am in the midst of a course in epidemiology at the Nordic School of Public
Health, and methods is what the course is all about.  Another thing to keep in
mind any time you read something - anything, really! - is, how critically did
the editors examine the article before printing it?  While there is no one
above reproach, the publication in which this article appears, does not seem
to have a scientifically qualified panel of reviewers.  By that I mean a group
of people trained in systematic critical analysis who examine the papers sent
in, to see whether:
** the methods are suited to answer the research question being posed
** the sources listed do indeed say what the quoting author claims they say
** the right math is done right
... and more.  The key word is peer review, and that is why articles published
in peer-reviewed journals carry more weight than a book published at the
author's expense to promote a view the author holds dear, for example.

I am busy enough at this course without having to do a critical review of the
use of the source material in this article, but on looking over the cases
presented in it, I notice that NEC is mentioned as a risk for formula fed
babies.  Yes, it is, but how often does that crop up in a population of term
newborns?  If you use the incidence of NEC among VLBW babies fed formula to
demonstrate ill effects of formula in term healthy babies, you are going to
look less than rational, and ultimately that hurts our cause.

The article WAS very interesting (for its provocativeness if nothing else),
and the list of references will come in handy for many of us, I'm sure.  But I
am not convinced that the author has the qualifications to do the kind of
meta-analysis this purports to be, and therefore the final result should be
taken with a healthy dose of critical thinking.  Critical thinking is a
positive mindset, it expresses trust that people are always capable of
improving.

Now I have to write a short letter to the journal of the Norwegian medical
association, about their small news item based on the Scheers et al study in
Pediatrics (on suffocation deaths of infants related to the surfaces on which
they were found), which is summed up in this journal as 'Where should babies
sleep?  Not with their parents, that's for sure!  Infants bed-sharing with
parents run a forty times higher risk of dying ...'   And they don't even give
enough of the citation for a reader to find the source article without
unnecessary bother.  This is definitely not a problem of lay people alone.  We
all need to be awake, and cautious, all the time.  Sometimes that means coming
on like a wet blanket, but wet blankets are a good thing when bonfires are
threatening to burn out of control.

Note: I do assume there is a difference in mortality between breastfed and
artificially fed infants in any population.  But Palmer's article does not
come close to convincing me that it is of the order of magnitude claimed here.
 I will be no less adamant in future in supporting, promoting and protecting
breastfeeding than I always have been.

Rachel Myr
Kristiansand, Norway but writing from Gothenburg, Sweden where it is 7:30 a.m.
and pitch dark outside

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