country di�ers from those countries with higher mean tempera-tures. In fact warmer regions of Turkey had an increased risk ofHEV infection [7].

Our data may suggest that HEV infection is infrequent and nota health problem in Turkey during childhood, however furtherstudies are necessary to outline the real epidemiology of HEV.

References

1. Aggarwal R, Shahi H, Naik S, Yachha SK, Naik SR (1997)Evidence in favour of high infection rate with hepatitis E virusamong young children in India. J Hepatol 26:1425±1430

2. Babacan F, SoÈ yletir G, EskituÈ rk A (1990) Age and seasonaldistribution of acute hepatitis A infection and of anti-HAV IgGprevalence. J Turk Microbiol Soc 20:131

3. Clayson ET, Shrestha MP, Vaughn DW, Snitbhan R, ShresthaKB, Longer CF, Innis BI (1997) Rates of hepatitis E virusinfection and disease among adolescents and adults in Kathm-andu, Nepal. J Infect Dis 176:763±766

4. Goldsmith R, Yarbough PO, Reyes GR, Fry KE, Gabor KA,et al (1992) Enzyme-linked immunosorbent assay for diagnosisof acute sporadic hepatitis E in Egyptian children. Lancet339:328±331

5. Hyams KC, Purdy MA, Kaur M, McCarthy MC, HussainMAM, et al (1992) Acute sporadic hepatitis E in Sudanesechildren: analysis based on a new Western blot assay. J InfectDis 165:1001±1005

6. Krawczynski K (1993) Hepatitis E. Hepatology 17: 932±9417. Thomas DL, Mahley RW, Badur S, PalaogÏ lu KE, Quinn TC

(1993) Epidemiolgy of hepatitis E infection in Turkey. Lancet341:1561±1562

A. YuÈ ce (&) á G. HascË elikHacettepe UÈ niversitesi CË ocuk Hastanesi,Ped. Gastroenteroloji UÈ nitesi,06100, Ankara, Turkey,Tel./Fax: +90-312-3117715 j

O. Baenziger á H.-U. Bucher

Authority or evidence?

Received and accepted: 25 November 1998

Sir:We have read the letter of Dickstein, Van der Hofstadt, and Vis[1] with great concern. These authors suggest that a randomizedcontrolled multicentre study [3], challenging a small part of thebackground of the UNICEF-WHO recommendation for breastfeeding, is ``misdirected'' and ``creates a false debate'' about breastfeeding. We would like to emphasize the importance of studies thatchallenge dogmas, even if they are created by ``authorities'' or largeglobal international organizations and would like to underline theneed of evidence based medicine for the daily routine on neonataland maternity wards. The language used in this letter [1] (i.e.misdirected studies, false debate, creating unnecessary confusion¼)may be appropriate for a political newspaper but not necessarilyfor a scienti®c journal. The authors criticize only vaguely the studydesign. However, the randomized, controlled, multicentre studyful®lls most of the criteria of evidence based medicine [2],Furthermore, the limitations of the study are extensively discussedwithin the original paper of Schubiger [3]. The authors of the letterproposed not to publish such studies because in their opinion theycreate a false debate and unnecessary confusion. We think that toban studies from publication that do not con®rm one's own belief isunethical, whereas concerns about study design, data collection,data analysis or interpretations of the results should create livelydiscussions. It seems dangerous to us to try to prevent thepublication of studies that do not match the belief of large

organizations or so called ``authorities'' that may be in¯uenced byother than science. We would rather recommend that the threeauthors present their own data that support the useful UNICEF-WHO recommendation about breast feeding.

References

1. Dickstein M, Van der Hofstadt J, Vis H (1998) The Supple-mentary feeding of breastfed babies may cause breastfeedingfailures: a ¯awed survey and a false debate. Eur J Pediatr157:861

2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, RichardsonWS (1996) Evidence based medicine: what it is and what it isn't.BMJ 312:71±72

3. Schubiger G, Schwarz U, ToÈ nz O (1997) For the neonatal studygroup. UNICEF-WHO baby-friendly hospital initiative: doesthe use of bottles and paci®er in the neonatal nursery preventsuccessful breastfeeding? Eur J Pediatr 156:874±877

O. Baenziger á H.-U. BucherDepartment of Neonatology,University Hospital,Frauenklinikstrasse 10,CH-8091 ZuÈ rich,Switzerland,e-mail:obae@fhk.usz.ch,Tel.: +41-1-255 53 45,Fax: +41-1-255 44 42

j

686