Sclerodermalike Esophageal Disease in Children of Mothers With Silicone Breast Implants

To the Editor. —In a recent article, Drs Levine and Ilowite 1 concluded "a relationship appears to exist between breast-feeding by mothers with silicone implants and abnormal esophageal motility." The conclusion was based on 11 children who were born to women who had breast implants; eight had been breast-fed and three bottle-fed. The authors identified 20 controls and specifically eliminated three who demonstrated a type of esophageal dysmotility, the outcome of interest. This exclusion was reportedly based on the manometric findings, indicating the selection was made after the key data were collected. Furthermore, the authors started with "67 consecutive children born to mothers with silicone breast implants... who were referred" to them presumptively in an unbiased fashion. The 67 were winnowed down to 11, an 84% attrition rate. Among the controls, after they had eliminated those they didn't like, there was absolutely no attrition. This study could be dismissed as