Dear all:

All the discussions about the Lactnet "Lord Voldemort" topics have led me to do some 
more in depth reading.  I usually don't have much time for the in depth reading that I had 
the luxury of doing while doing my graduate studies and when I do have time I tend to 
opt for fiction. But my frustration with some of the internet stuff that was poorly written 
and highly subjective led me to attempt a nonfiction book.

It is proving to be a delightful read.  History, mass death, passion to cure the world, fatal 
mistakes, the unpredictability of biology, politics, personal intrigue --- your basic human 
drama encapsulated in a public health cause.  

In this read, I find the cautions that I know from my public health training, but we often 
forget in real life when we are completely convinced we are right.

Some of the assumptions we all make as humans can lead to wonderful new insights and 
discovers, but we must always follow through and question these assumptions and test 
them out.

So, to be specific about when we really should challenge ourselves and consider 
alternative explanations and really test what we are convinced is the "right thing to do" 
include:

1) Are we assuming that one thing causes another because one event preceded the other 
or occurred at the same time?  This is known as ecologic fallacy.  They may not actually 
be connected.  

Nora Ephron used this in her NY Times OpEd piece where she stated that because food 
allergies were increasing and so was breastfeeding -- breastfeeding caused food 
allergies.  We too are guilty of doing this with various assorted conversations.   A 
temporal association is a reason to be suspicious but it is not prooff.

2) Assuming that because things get better after we intervene that it was a result of our 
intervention.  This assumption is subject to drop-out bias.

There is the "get better or die"  phenomenon seen in nutrition programs.  If you track a 
cohort of children (that means children of a certain age) over time (the same children as 
they age) then they will always appear to have better nutrition.  This is because as they 
age, the children who are not getting better will get worse and eventually die.  Because 
the dead children drop out, the remaining children are healthier.  So, it looks like the 
program is effective.

There is the self-selection bias.  If an intervention or program is not working, a certain 
proportion may leave and try some other intervention.  I am convinced this is what 
happens with almost all the baby care books --- the parents and babies who don't respond 
to the books advice move on to some other book --- and then all the authors are firmly 
convinced only their method works and all those poor parents who came to them suffered 
from the flawed methods of the other authors.  This is certainly the case with Hanna 
Rosin.  Her group of friends didn't chastise her, they simply refrained from commenting.  
What she leaves out is all the other women who are not in her group who get comments 
about infant feeding as well --- including what I am sure is a much greater group of 
women who get negative comments about breastfeeding --- and of a much more severely 
negative nature as Morgan points out in her blogs about Lactaphobia.

3) Because we are convinced we are completely right and we are doing good, we have 
the right to impose our will on everyone else because of course we (and only we) are 
right.  The savior complex I think is one of the most dangerous impulses.  We are not 
always right.  There was piece on the radio about the aid to Africa and I didn't really have 
time to pay attention to it, but I'm sure I would have disagreed on some points and 
agreed on others about the firm convictions that the aid was helping when it was not.  I 
know of wonderful examples when it really did help and many others that were travesties 
despite all the good intentions of those offering the aid.  And when we are totally 
convinced we are right, comes the impulse to bend the rules a bit because -- really ethics 
are on our side because of course we are right. This I think is when we really should look 
at ourselves more closely and question what we are doing with a critical eye before 
proceeding.

How many times have I thought I really knew what was the best way to help a mother 
with her breastfeeding and then when I stopped and started really paying attention to 
what she was saying learned something entirely new?

Finally, with our assumptions, theories and trials of new procedures however much we 
are convinced they work, I think we need to do due diligence to ensure that we have not 
overlooked some side effect that may be more important than we thought.

In reading this book, it is those little tiny unthought of things that were never considered 
when people were really convinced something was very safe, that came back and bit 
them in the b...

Best, Susan Burger
PS  Though this book has a point of view, I am finding it really would be a good read for 
anyone on either side of the issue.

             ***********************************************

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