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Editor,—Dr Bell shows himself to be as much influenced by prejudice as the paediatricians he criticises, in his comments on “the family” (Commentary, December 1999 issue ofADC, p. 517). We agree entirely with him that advocacy should have an evidence base. It also needs to have an achievable focus and be politically attainable: neither are easy to define in relation to family life. Whilst we might agree that a two parent family is desirable, not even the Pope, the Archbishop of Canterbury, nor Mrs Thatcher can influence current trends and the role of politics is minimal.
Two other aspects of his commentary disturb us. First, advocacy as much as counselling requires careful study and applied training; we do not agree that any doctor can do either well, simply “as part of his or her work”. Second, Dr Bell disparages speaking out on women's and children's rights in developing countries as it might lead to deportation. However this view ignores the role of the West, through aid policies and transnational corporation activity, in flouting these rights. Our advocacy should be global in concept but local in focus.
Dr Bell goes on to criticise the study for being based on opinion. Certainly it was based on opinion—its very value is that nine paediatricians working in a variety of settings came together in an attempt to analyse the sorts of issues requiring advocacy that arise in the course of a working week, and to set up an agenda that they would like to see addressed. If it only serves as a springboard for discussion and action, something worthwhile will have been achieved.
Dr Bell comments:
With 38% of our children now born out of wedlock, my comments on the breakdown of family life in the UK are all too evidence based. I note that Drs Rudolf and Waterston, “... might (might!) agree that a two parent family is desirable”, and whilst I agree that the church leaders named seemed to have been ineffective in stemming the rise, I do not agree that the role of politics is minimal; indeed I fear that it has been legislation (i.e. politics) with respect to support and housing of single parents and changes in marital law and taxation that has fuelled this rise, not to mention the subtle advocacy provided by the constant fare of value-free sex in television programmes.
Some forms of advocacy may need special training, as I stated in my commentary, but many aspects of advocacy are part and parcel of a doctor's job and such skills must be acquired as part of one's general development: surely they are not suggesting that one needs to attend their course before one writes to an MP?
I did not disparage advocating women's and children's rights: what I wrote was, “shouting loudly about women's and children's rights is, in many a third-world country, more likely to result in rapid deportation, than any benefit to the women or children of that country.” My point was that to achieve an end one has to soberly consider how best to do it. For example, ideological statements such as, “... the role of the West, through aid policies and transnational corporations ...”, seem more likely to frighten off any legislator, not to mention many potential supporters. It is hardly what Berman meant by “identify friends and build coalitions”.
If, as Drs Waterston and Rudolf state, their paper was to serve as, “ ... a springboard for discussion and action ...”, why are they complaining that it achieved its aim?