Inductive Risk, Science, and Values: A Reply to MacGillivray.

The argument from inductive risk (AIR) is perhaps the most common argument against the value-free ideal of science. Brian MacGillivray rejects the AIR (at least as it would apply to risk assessment) and embraces the value-free ideal. We clarify the issues at stake and argue that MacGillivray's criticisms, although effective against some formulations of the AIR, fail to overcome the essential concerns that motivate the AIR. There are inevitable trade-offs in scientific enquiry that cannot be resolved with any formal methods or general rules. Choices must be made, and values will be involved. It is best to recognize this explicitly. Even so, there is more work to be done developing methods and institutional support for these choices.

Is there an elephant in the room? Addressing rival approaches to the interpretation of growth perturbations and small size.

Two interpretations of growth perturbation and small size are commonly applied in human biology: an adaptationist approach in which small size is considered to be an a relatively beneficial adjustment to environmental stressors, and a biomedical approach in which small size is considered nonadaptive, a sign of dysfunction or pathology. These two interpretations conflict, but are used without acknowledging or addressing the conflict. This article reviews the strengths and weaknesses of the two. This exercise does not prove the indisputable superiority of either approach. Considerations of epistemology show that biologists will never be faced with a decisive test of either, much as they might like such clear cut evidence. Nevertheless, it is possible that a gradual decrease in the productivity of one approach will become a sufficient reason to abandon it. Alternatively, if specific areas of application can be distinguished, each approach might continue to be productive in its own domain.

Hormone research as an exemplar of underdetermination.

Debates about the underdetermination of theory by data often turn on specific examples. Cases invoked often enough become familiar, even well worn. Since Helen Longino's discussion of the case, the connection between prenatal hormone levels and gender-linked childhood behaviour has become one of these stock examples. However, as I argue here, the case is not genuinely underdetermined. We can easily imagine a possible experiment to decide the question. The fact that we would not perform this experiment is a moral, rather than epistemic, point. Finally, I suggest that the 'underdetermination' of the case may be inessential for Longino to establish her central claim about it.

The paucity of breast-feeding in an urban clinic population.

The lack of breast-feeding among mother-infant dyads utilizing public sector clinics in Los Angeles is presented in this brief study. Whereas the middle and educated classes have begun a resurgence of breast-feeding, this renaissance is missing among the poor. Awareness, health education (by peer advocates), early intervention and reassurance by all levels of health providers is suggested to prevent the dissolution of the lactation bond among the population least apt to breast-feed.

Breast-feeding and failure to thrive.

PIP: In his paper of March 10 (p.541), Dr. Davies, not for the 1st time, misrepresents our ideas on assisting the mother and her infant to preserve lactation as an exclusive form of nurturing. Citing us, Davies states that: "A view has been expressed that drawing attention to the failure of breastfeeding will not help to encourage breastfeeding." All we say is that healthcare workers should be loath to label an infant who fails to thrive as a product of inadequate lactation without observing the breastfeeding process. Davies does not mention that some poor gainers have sucking defects; we have noted problems such as tongue sucking, flutter sucking (rapid and weak motions), and a lack of drawing the nipple far enough into the mouth (baby falls off breast easily). However we do agree with most of Davies' comments for diagnosis and treatment and commend him for his preventive approach to the impediments of lactation based on the community healthworker. We doubt if we could give the naturally nervous baby who is a difficult feeder 30-60 mg of chloral hydrate as he suggests. While we do not have the answers for all of the psychosocial problems which may interfere with lactation, there is another measure which can be instituted if all of Davies' approaches fail. By introducing complementary total bottlefeeding to make the baby thrive, you introduce the mechanical problem of nipple confusion and may make exclusive breastfeeding even less likely. For infants who are small for gestational age, premature, have sucking defects, or fail to thrive (without organic disease) and whose mothers wish to continue with human milk, we use a device called the Lact-Aid Supplementer (J.J. Avery, Inc., Denver). This gives additional milk (and calories) and corrects most abnormalities in sucking patterns without the use of a bottle. The availability of early well-baby or lactation clinics at 10-14 days postpartum would provide reassurance and counseling to the mother. When there is true failure to thrive at the breast, it is unfair to hand over the problem to chloral hydrate or the bottle without a trial with the Lact-Aid Supplementer. Many troubled mothers whom we have assisted to continue breastfeeding successfully have had subsequent children who did well at the breast without any problems.^ieng