> Valerie writes:    We cannot ignore breast pump companies, we need their information.
>
> But we also have to be aware of the possibility of built-in bias.
>
> "Given the rapid pace of technological developments and therapeutic
> advancements in medicine and biotechnology, both students and practicing physicians
> [and LCs]
> rely on education providers and professional societies for objective, up-to-date
> health care information. Commercially sponsored information offered in such
> settings can be biased in favor of manufacturers and has the potential to unduly
> affect the independent judgment of medical professionals (2-5)."

Valerie, I think you and I are finally in total agreement.  In fact, it segues nicely
into one of my favorite subjects:  the importance of evaluating critically all the
information we receive from all sources.  It is true that any commercial marketing by
definition most favorably reflects upon its products (much as a mother does when she is
feeling favorably disposed towards her child).

As individuals, I think we do the same thing.  We tend to be biased in favor of our own
prejudices.  I spent a lot of time with each of the three women I mentored who later
became IBCLCs talking to them about what sources are reliable and how to critically
evaluate the breastfeeding information we receive.  In fact, I had more than one
discussion regarding the fact that it is not appropriate to take something read on
Lactnet and immediately put it into practice without first carefully evaluating its
accuracy.  (I guess they didn't read their Lactnet "Welcome" letter carefully enough!)

One of the most valuable parts of my work on The Breastfeeding Answer Book was the
necessity of reexamining my prejudices while evaluating new information.  There were
innumerable times when I came across a study or a suggestion from a colleague or even a
Lactnet post, when I was stunned, because whatever I had just encountered was totally
contradictory to what I had previously believed only to find out after lengthy
evaluation that the information was clearly right.  This happened as many times with
the third edition as the first edition.

It was this experience that convinced me how much we still have to learn in our field,
and hopefully, keeps me open-minded.

During this process, I also found quite a bit of "information" that looked interesting
on the face of it but proved to be baseless.  This is why the concept of
"evidence-based" practice is so important.  But it can be challenging, because--like
the non-existent breast pump research I mentioned in an earlier post--there are many
times where there is *no* evidence, but we still have to come up with guidelines for
practice or make a decision.  Hopefully, as the years go by and we have more and more
research, there will be fewer times that we have to cross our fingers as we move
forward.

It is my fondest hope that all of us have our critical thinking caps on all the time no
matter what the source of information.  I have found over the years that even those
more experienced LCs that I learned from early on were wrong about some things.  All of
us need to be vigilant about looking more deeply into everything we hear and read
before incorporating it into our lactation practice toolboxes.  I would hope that
everyone approaches everything I say and write with the same attitude.  If I can't
convincingly prove that what I'm saying is valid, then you have no business believing
it.

Those who have heard me speak recently have heard me quote Julian Huxley, a famous
scientist, who said to his students around 1900:  "During the next century, half of
what we know now will be proven wrong.  Unfortunately, we don't know which half."
Because we are in the infancy of our field, we are in much the same boat.

It is my fondest hope that we ALL approach ALL information from ALL sources with an
attitude of skepticism and humility, and look closely and carefully to separate the
wheat from the chaff.

Climbing slowly off my soapbox...

Thanks, Valerie, for the reminder of how vital it is to be critical thinkers.

Nancy Mohrbacher, IBCLC
Lactation Education Specialist, Hollister, Inc.
Chicago suburbs, Illinois USA

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