Our Bodies Ourselves Our Delete Button

UPDATED AUG. 3, 2010

This exchange began here.   

http://www.ourbodiesourblog.org/blog/2010/07/much-ado-about-a-meta-analysis-on-home-vs-hospital-birth/comment-page-1#comment-3830

The purpose was to explore these vague condemnations of a recent meta-analysis unfavorable to midwives and/or homebirthers.    Is the statistical banter merely lifted from basic non-major textbooks by those who don’t really understand it?  Is it  a show to dress up professional turf-protection propaganda in objectivity to deflect from midwifery’s serious shortcomings?    If the bloggers can’t address basic stats questions without deleting or evading, it probably is.  

After a more than a week, it is clear the moderator refuses to address the issues in post the below,  she preferred to deceive women who might google her blog looking for info on the homebirth study in question.    

MIDWIVES DON’T WANT YOU TO SEE

This has never been about differences of opinion.  It has been about  deception on the part of those pushing midwifery on the rest of us.

 

Yes, Tinfoil hat was interesting.  She launched into a diatribe about preciptious delivery.  Because that’s been the standard excuse for discrediting the Washington study was these were miscategorized.    But, the study did a great job of excluding them……to anyone who actually reads and understands it.

 

http://childbirthtruthsquad.wordpress.com/our-bodies-ourselves-our-delete-button/

 

Her blog’s comments were non-stop statistical or factual misrepresentation of the debate passed off as scientific critiques to bolster their points.

 

This seems to be the modus operandi of midwives and their supporters to hide or deflect attention away from data that shows they are not safe.   This is acting like a professional guild protecting its turf and concerned with money and control far mmore than ACOG ever could.

 

Women have a right to know what they are getting into, otherwise you end up with stories like this:  

 

http://ecmama.blogspot.com/2010/06/answers.html

http://ecmama.blogspot.com/2010/06/answers.html

http://www.ourbodiesourblog.org/blog/2010/07/much-ado-about-a-meta-analysis-on-home-vs-hospital-birth/comment-page-1#comment-3830

This comment was posted:

bobbie Says: July 21, 2010 at 4:27 pm The critiques of this study by the midwifery community leave something to be desired as well. Amy Romano’s criticisms were laughable. She won’t publish any of the comments from statisticians and researchers pointing that out. http://childbirthtruthsquad.wordpress.com/2010/07/21/things-amy-romano-of-science-fiction-and-sensibility-doesn%e2%80%99t-want-you-to-read/ http://childbirthtruthsquad.wordpress.com/2010/07/20/can%e2%80%99t-see-the-forest-through-the-trees/

The blog hostess came to CBTS and completely embarrassed herself with this exchange.   She, like many in the midwifery community,  believe that amateurish publications for non-researchers and similar websites were some rule book for conducting research.   When she was informed that there is actually research on how to do research and her supposed “norm” was actually not, she stopped commenting here. 

http://childbirthtruthsquad.wordpress.com/2010/07/20/can%e2%80%99t-see-the-forest-through-the-trees/

She returned to the safety (and the delete button) of  her own blog and postured, similar to her (now we know) friend, that she would not respond because it was rude.

 Rachel Says: July 22, 2010 at 7:27 pm bobbie, We obviously disagree, and I personally prefer to have civil discussions about issues here rather than simply pointing people to anonymous attack posts focused on individuals elsewhere. Amy Romano, author of the birthing blog Science and Sensibility, is also part of the editorial team for the forthcoming (2011) edition of Our Bodies, Ourselves. Our Bodies Ourselves, as an organization, appreciates and supports Amy’s work, and does not support sites that encourage anonymous attacks.

She refused to publish this:  Update She has been down upgraded to merely evasive, second chance to answer vs evade at bottom

Pretending that valid are scientific criticisms, different opinions, or anecdotes that are unflattering are somehow rude or uncivil or attacks is a common evasive tactic among midwifery proponents.

 

They are used liberally whenever they embarrass themselves.  Have you ever considered that posturing like you know research to discredit a study simply because it doesn’t promote your career is rude or uncivil?  Have you ever considered that calling a respository of women’s voices that would otherwise be silenced an attack blog is rather uncivil?   

 

Over on the “attack blog” you, like Romano, pretty much stuck your foot in your mouth by claiming that the lack of a forest plot in this study was some kind of error. 

 

You pulled out a quote from amateurish books and sources on research.  An objective analysis of meta analyses  on this very subject shows that most professional researchers don’t do what your amateurs claim is a necessity, and their work it superior anyway.

 

Do you have any response to this paper?   Or you don’t and you will just hit the “Trash Comment” and post about how rude…….

http://childbirthtruthsquad.wordpress.com/2010/07/20/can%e2%80%99t-see-the-forest-through-the-trees/

 

“Here’s objective evidence that the cookbook (Cochran et al) methods don’t do anything much to promote understanding and certainly aren’t some monolithic standard.

 

So, not following them might mean you are someone who is an expert and way past the cookbook level. Commenting on their absence marks you as an amateur.

 

All the Cochrane reviews had forest plots (2197 in total), and a random sample of 500 of these plots were included. In total, 28 of the non-Cochrane reviews had forest plots (139 in total), all of which were included.

 

In other words, all the Cochrane amateurs used them (it’s required!) and only about 1/5 of the professional researchers did.

 

“Conclusions Forest plots in Cochrane reviews were highly standardized but some of the standards do not optimize information exchange, and many of the plots had too little data to be useful. Forest plots in non-Cochrane reviews often omitted key elements but had more data and were often more thoughtfully constructed.”

 

Guess who won?

http://ije.oxfordjournals.org/cgi/content/abstract/dyp370v1

 

Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice”

Rachel Says:
July 23, 2010 at 8:24 am

Look, I just find it unseemly. Initially, you didn’t come here and make any valid scientific criticisms, you came here and said, effectively, “I think someone else is wrong, come over to my site to find out why, where I anonymously focus on this one individual.” I think discussion of valid scientific criticisms is important, and welcome it here, but also believe firmly that it is important to remind people to have those discussions in a civil, adult way that is centered on the evidence related to legitimate points of disagreement, rather than on anonymously bashing individuals. I don’t think it’s necessary to be hostile or condescending to disagree about legitimate points.

That said, I disagree with your interpretation that the Schriger paper invalidates forest plots as a tool for effectively communicating the results of papers analyzed in meta-analyses. What it actually does is compare ways of constructing forest plots, and whether certain ways of presentation or amounts of data are more of less useful. It suggests that there are ways the plots used in Cochrane reports might be made better for information communication. It describes forest plots as “a concise graphical way of summarizing the quantitative findings of a systematic review. Such plots are informative whether they contain a summary diamond from a meta-analysis of the included study results or just present the results of individual studies.” It also refers readers to the very PRISMA statement suggesting the use of such plots that I referred to at your own site.

That said, I don’t think continuing to argue about this one point is productive or useful.

Do you have any objective evidence that supports your claims in this article?

By objective evidence is would be research papers about research, specifically meta analysis.  Similar to the one I presented.  Can you show that what you imply is some sort of standard that wasn’t met by showing that it is used by the vast majority of meta, outside of those produced under cookbook methods? 

Can you please be specific about exactly what is there and what is missing?  Can you show papers similar to the above that demonstrate the inclusion of the alleged standard or norm actually objectively improve the analysis?

“The Pang study, for example, contributed a large chunk of the population analyzed for neonatal deaths, but has been widely debated and criticized for including unplanned home births in its analysis of neonatal death at home birth.”

 

How could this possibly make a difference?   It was limited to near or full-term deliveries.   People simply don’t have many near full term at home accidentally.   These have to be things like getting snowed in.

Do you have any data about what percentage this is?  Did you know you can calculate how big the effect would have to be to shift the results. (hint: if it is huge, than it can’t make a difference)   Have you done that?   If you haven’t why do bring this up?  

Rachel Says:
July 26, 2010 at 7:44 am

I expressed in the original post that in many ways the Wax paper could have been more detailed or otherwise could have presented data from the original studies that would have helped readers (at least this one) better understand the context and findings of the included papers. For me, a forest plot would have helped me get a better, more immediate picture. I don’t see the point of continuing to debate that or look for “evidence” of such a plot’s efficacy, because the point (for me) was communicating my preferences as a reader for devices that help me better understand the findings an author is presenting. I don’t think desire for such a plot is an evidence issue for me (although studies certainly could and maybe should be done) – I think it’s a design issue, and a communication issue. Forest plots are one tradition of representing data that for me make papers like Wax’s easier to understand. They’re certainly not the only possible way of representing data – perhaps there are better ways of visually representing these characteristics, or perhaps a YouTube video from the authors discussing the strengths and limitations of the included studies is a better tool today, and that is worth investigating. I don’t think it’s necessary to have a mountain of data to express what I would have liked to see for increasing my own comprehension.

Now, the Pang study – I agree that their gestational limits may have helped to exclude some unplanned home births, and that the effect of those births on the described outcomes may be very small. The authors themselves state that future research use a study design that “accurately assesses the intention to deliver at home” in order to further reduce any potential effect of this factor. I think the authors provide a pretty good explanation of their views on this in a reply letter in Obstetrics & Gynecology 2003 Jan. 101(1); 199-200. They also elucidate there that they did not characterize home as the intended birth location unless it was “attended or certified by a health professional,” which I did not catch in my previous read of the full paper and I think would also work to minimize the number of included unplanned home births. Mom’s Tinfoil Hat has further discussion of this issue at http://momstinfoilhat.wordpress.com/2010/07/24/reply-turned-post-conjecture-about-home-birth-morbidity/. Because there was a fair bit of discussion/back-and-forth on the Pang paper (in letters to the editor, online, and otherwise) such as these examples, I would have liked to have seen more discussion of issues such as these with a few more details in the Wax paper itself for best illumination of the topic.

Finally, though, with regards to this little back and forth we’re having – I try not to take an approach to discussing these things that involves questions like, “who won?” It’s not a competition, it’s a discussion. Reasonable people can disagree, reasonably. If the goal is to score some imaginary points by somehow proving or getting me to admit that I’m wrong, hey, I’m wrong sometimes. I try to minimize it, but I’m human, and that’s a condition uniquely suited to being wrong. From time to time a person (including myself) will make a mistake and hopefully learn something new. I’ve been around the internet (and people) too long to worry too much about “winning.” Likewise, I don’t think home vs. hospital birth is a battle to win – I think some women are going to continue to choose this option, and having papers such as Wax’s be as detailed as possible yet communicate information in readily understandable ways is useful in helping those women (and their providers) best understand the potential risks and benefits of their choices. The genie is not going back in the bottle with regards to the general public accessing the medical literature (especially with initiatives such as the NIH public access policy), so at the very least we can start to talk more about understanding this literature instead of being condescending/combative to one another about it and trying to “win” – helping each other understand is IMHO a much more worthwhile activity than trying to make one another feel like “losers.”

Rachel and Romano, separated at (very natural unmedicated child) birth ya think?