Friday, December 01, 2006

What's good for the goose ...

Henci Goer published an article in Mothering magazine this week that is supposed to be a deconstruction of Atul Gawande's article in the New Yorker about C-sections. Goer's article is filled with so much obfuscation and so many deliberately misleading statements that it's hard to know where to begin in correcting it. However, before addressing the errors, I'd like to ask a question about what appears to be a central premise of Goer's article, that doctors do not always refrain from using a technique until it has been evaluated in a controlled trial.

Goer says:
"Gawande applauds doctors for trying whatever appeals to them without "wait[ing] for research trials to tell them if it was all right." It is sufficient that obstetric innovators "looked to see if results improved," although how they would know this without a controlled evaluation of safety and effectiveness, he does not say."
Here's what I want to know: What techniques of midwifery did midwives subject to controlled trials before they used them? Well, that's easy to answer. Absolutely none.

Midwives in general do very little research and they certainly never conducted controlled trials of various labor positions, of any herbs they might use, of delivering babies under water, of just about everything that they claim is exclusive to midwifery and not copied from obstetricians.

Goer is bitingly contemptuous of what she claims is the lack of evidence for procedures used by obstetricians. How can she possibly justify the practices of midwives when they have no evidence at all for most of what they do as midwives, and never even bothered to investigate?

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