—Dr Epstein asserts that we stated that we systematically excluded mothers with scleroderma from our study. Actually, the article states, "The mothers had all been asymptomatic while breast-feeding, and none subsequently developed scleroderma." Data on the mothers in the study were collected in a manner using standard history-taking techniques. We were unaware that any mother had been diagnosed with scleroderma. Additionally, on examination, no mother in the study was found to have scleroderma (ie, hard skin). We agree with Epstein that the reliability of diagnoses cited in court may be questioned, and some patients who have been labeled as having scleroderma may not satisfy diagnostic criteria. It would be improper of us to comment specifically on any individual whose children participated in the study.Even if one or more of the mothers had scleroderma and we were unaware of the diagnosis, the likelihood of the observed abnormalities in
Levine JJ, Ilowite NT. Silicone Breast Implants and Sclerodermalike Esophageal Disease in Breast-fed Infants-Reply. JAMA. 1996;275(3):184–185. doi:10.1001/jama.1996.03530270024018
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