Dear all:

I really have to differ with the Binns and Lee letter to the editor of the Lancet.  The letter 
really completely misses the purpose of growth charts and feeds into the 
misinterpretation of their purpose.  Their criticism misses the point.  What is especially 
annoying is that village women in Tanzania actually understood the basic underlying 
principal of the growth charts much better than many health care practitioners.  They 
used the growth charts appropriately to evaluate their own practices.  Interventions 
included breastfeeding babies more frequently when ill, not supplementing.

The flaw has NOTHING to do with the curves.  And in fact, Binns and Lee are wrong. The 
weight in the three to six month period are much lower than the old charts.  In terms of 
the selection process -- the problem is that so few infants are exclusively breastfed that 
it is extremely difficult to get an adequate sample.  Would you really want infants 
included that were not exclusively breastfed?  At the same time that they wrote this 
letter, my son's pediatrician is extremely happy because he knows that there are more 
obese infants these days (bottle fed) and he can use this information to work with parents 
to slow down on shoveling the bottles down their baby's throats. 

Binns' and Lee's suggestion for how the growth charts will be used is actually how they 
should NEVER be used.  You should NEVER diagnose on the basis of the percentile.  This is 
a holdover from the days when the food distribution organizations used it for criteria to 
give out foods in famine and emergency conditions.  And of course using a screening tool 
like that leads to abuses because parents want to get that extra food.

Until or unless health care practitioners use the CURVES as a tool to EXPLORE further, 
they will never be used appropriately regardless of the statistics involved.  The rate of 
gain is not a DIAGNOSIS it is an INDICATOR which MAY indicate a SYMPTOM of something 
to be explored.  

I really hate sloppy letters and this letter didn't prove anything at all.  It is conjecture 
based on how growth curves have often been misused -- which is completely separate 
from the particular curves that were developed.  I hardly think that a sample of white 
infants in the midwest that were fed by a variety of mixed methods is better than this 
more comprehensive sample of exclusively breastfed infants.  But that is the WRONG 
question.  The RIGHT question is how to use the curves appropriately so as to not do 
harm and, as in the case of the Tanzania study, to empower mothers to improve their 
breastfeeding practices.

Susan Burger, MHS, PhD, IBCLC

*****************
At the same time, my other listserve marked the passing of Dr. David Morley who was 
always about appropriate teaching tools.  It is unfortunate that his legacy has been 
transformed into a total misinterpretation of the original intent of his Road to Health 
charts.  I think the Tanzania project, expensive as it was, represented the ideal of what 
could be done, but has never yet and may never be, scaled up in a way that makes the 
charts useful.

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

Professor David Morley

It is with great sadness that we, his colleagues at TALC, regret the death of David Morley, 
our founder and President, who died on 2nd July 2009 aged 86 years.

David was a visionary who cared passionately about sick children in countries across the 
world. He inspired so many of us and will be greatly missed. We will continue the work 
he began through TALC - as his legacy to health workers everywhere.

Founded in 1965 by Professor David Morley CBE, Teaching-aids At Low Cost (TALC) is a 
unique charity whose main objective is to promote the health of children and advance 
medical knowledge and teaching in the UK and throughout the world by providing and 
developing educational material.

Some of Professor David Morley’s outstanding achievements included:
·   Founder  of TALC – Teaching-aids at Low Cost – a non-profit organization that provided 
high quality and affordable community health related books, information and tools.
·   Design of a simple low cost, tough weighing scale, that could easily be used by 
community health workers throughout the world.
·   Design and promotion of the “Road to Health” chart for children under five years old.  
This holistic card, owned by the caregiver and used by health personnel,  provided 
information on the mother – child development visually representing the child’s growth 
curve over time along with information on immunizations, breastfeeding, illnesses and 
family planning.
·  Child to Child education curricula – an achievement that won a UNICEF Maurice Pate 
award in 1991.
 
Professor Morley will be sorely missed by all of us in the community health field, as a 
champion and advocate of what can be done at the household and community level.   
 
 

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