Dear all:

I think I have been asked for "the one study" that proves an issue, one too many times.  I 
just got asked by a mother who attended my breastfeeding clinic on behalf of her 
pediatrician for "THE study" that shows the risks of powdered formula over the telephone.  
First, I had to explain how getting the issue and volume numbers right over the telephone 
is exceedingly challenging and that there is not one study but many that speak about the 
risks of E-sak and about hypo and hypernatremia.  So, I suggested that her pediatrician 
email me so I could send several references. Sometimes discussions on Lactnet hinge on 
whether or not there is THE study that will provide proof for one perspective of an issue 
that we are all viewing from different perspectives. 

I am not well-versed in the social sciences or philosophy.  I was such a nerd, that I 
managed to get through my MHS taking only science or math courses with only four 
exceptions:  one class in the history of medicine, one class in the history of women, one 
class in cultural anthropology, and required classes in language which happened to be 
French.  As part of my doctoral program, the requirements forced me into expanding my 
world view and included a course on the philosophy of science and another on ethics.  So, 
skating on thin ice here, I will point out my minimal understanding of how the 
"philosophy" of science does not support "just one study" as justification for anything.

My understanding is that science is not about "proving" theories.  It is about developing 
theories and disproving alternative hypotheses.  Studies that use statistical probability 
theory, cannot NEVER predict with 100% accuracy what will happen in the future.  ANY 
finding that shows statistical significance of one event preceding another or one 
randomized treatment having a bigger impact than another randomized treatment has a 
probability of being merely due to chance alone.  It takes many studies to build both a 
plausible and a probable case that two events are causally related.  Plausible means that 
the chemical, biological, physiologic, cultural, etc events make sense -- or in other words 
have "construct" validity.  Probable refers to the statistical validity of the findings.  In 
fact, in science one never really proves anything the way you can in pure math.  You can 
merely disprove more and more alternative explanations until you have a plausible and 
probable case for your theory.  There is no guarantee that in the future better theories 
may be developed that are more plausible and probable.

So unlike "just one bottle" which can disrupt breastfeeding, "just one study" is not 
sufficient to warrant a paradigm shift in our practices without gathering further supportive 
evidence.  It may very well be the pivotal "tipping event" that causes us to look further 
and find that that "one study" INITIATED the paradigm shift that was substantiated with 
further evidence. 

Best, Susan Burger

 

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