I haven't read the whole study but I did read the abstract on Medline, and
found it interesting.  (Thanks to whoever it was who posted the url for JAMA
to LN earlier this week.)

They found something subtle and not obvious but which rings partly true for
me.  As I understand it from the abstract it goes like this:

Breastfeeding dyads without obvious feeding or health problems randomly
assigned to either intervention group, which gets strong advice that
pacifiers are bad and to avoid them, or control group with gets no specific
advice -- eg, is subject to the ambient culture and their own experience
unmitigated.

Intervention group reports less paci use, less often, for fewer minutes, for
fewer months, than control group -- so far, so not surprising.  Now here's
the subtle part:

 If you analyzed all the dyads comparing their paci use to their bf duration,
they were indeed negatively correlated -- more paci went with shorter bf.

But the random allocation to intervention or control group, even though it
did correlate with less paci, did NOT correlate with duration of bf.

The researcher's conclusion from this is that the very real correlation
between paci use and shorter bf duration is not causative -- that paci use is
a marker for other things that shorten bf duration, both things like parent
attitudes and things like material or infant difficulty in bf.

I am not a good enough statistician to say that this is wholly persuasive  --
there could well be faults in the analyisis that I am missing.  But it
certainly doesn't sound crazy to me.   Folks on LN whom I respect -- notably
Barbara -- have been teaching me for a long time that babies and parents
compensate, so that "needing" a paci or being happy with one can surely be a
result of a feeding problem.   And we have all seen (sadly) cases where
maternal unwillingness to put the baby back to the breast "so soon" is the
cause, rather than the result, of sticking in the pacifier.

What do you folks think about this?   Is there a way to understand this data
as actually reflecting cause after all?

Curious and learning, Elisheva Urbas, NYC

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