The NYTimes article Older Americans Are ‘Hooked’ on Vitamins starts with an anecdote:
When she was a young physician, Dr. Martha Gulati noticed that many of her mentors were prescribing vitamin E and folic acid to patients. Preliminary studies in the early 1990s had linked both supplements to a lower risk of heart disease.
She urged her father to pop the pills as well …
But just a few years later, she found herself reversing course, after rigorous clinical trials found neither vitamin E nor folic acid supplements did anything to protect the heart. Even worse, studies linked high-dose vitamin E to a higher risk of heart failure, prostate cancer and death from any cause.
Why were cardiologists prescribing vitamins that ultimately turned out to be not merely ineffective, but potentially harmful?
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]You can be sincere and be wrong at the same time.[/pullquote]
Often, preliminary studies fuel irrational exuberance about a promising dietary supplement, leading millions of people to buy in to the trend. Many never stop. They continue even though more rigorous studies — which can take many years to complete — almost never find that vitamins prevent disease, and in some cases cause harm.
You could say almost exactly the same thing about breastfeeding. Indeed, a prominent breastfeeding researcher has. Dr. Michael Kramer, known for the PROBIT studies of breastfeeding gave a fascinating interview to Canadian radio in early 2016.
Dr. Kramer is a lactivist, but the interview is remarkably nuanced. There’s no transcript, but I’ve linked to the audio file.
When asked why lactivist organizations continue to insist on benefits that have been shown not to exist, he explained that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He was quite blunt about the fact that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe.
Kramer was speaking before publication of a spate of papers that show that the benefits aren’t merely exaggerated, the risks and dangers have been completely ignored.
Such papers include:
- The revised United States Preventive Services Task Force (USPSTF) guidelines
- Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
- Unintended Consequences of Current Breastfeeding Initiatives
- Health Care Utilization in the First Month after Birth and Its Relationship to Newborn Weight Loss and Method of Feeding
- The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature
- The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial
Taken together they show that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact lead to babies falling from their mothers’ hospital beds or suffocating while in them. The leading cause of jaundice induced brain damage (kernicterus) is breastfeeding and breastfeeding doubles the risk of neonatal hospital admission leading to literally tens of thousands of hospital admissions per year.
When it comes to vitamins:
There’s no conclusive evidence that dietary supplements prevent chronic disease in the average American, Dr. Manson said. And while a handful of vitamin and mineral studies have had positive results, those findings haven’t been strong enough to recommend supplements to the general American public, she said.
The National Institutes of Health has spent more than $2.4 billion since 1999 studying vitamins and minerals. Yet for “all the research we’ve done, we don’t have much to show for it,” said Dr. Barnett Kramer, director of cancer prevention at the National Cancer Institute.
But, but, but vitamins are natural! And it seems like every week some researcher publishes a paper and a press release claiming this or that vitamin prevents cancer or heart disease.
Similarly, breastfeeding is also natural and it seems like every week some researcher publishes a paper and a press release claiming breastfeeding prevents cancer or heart disease or obesity or asthma or allergy or … the list goes on and on.
Why is the lure of vitamin supplements so attractive?
A big part of the problem, Dr. Kramer said, could be that much nutrition research has been based on faulty assumptions, including the notion that people need more vitamins and minerals than a typical diet…
But:
..[M]ost Americans get plenty of the essentials, anyway…
Also, American food tends to be highly fortified — with vitamin D in milk, iodine in salt, B vitamins in flour, even calcium in some brands of orange juice.
Without even realizing it, someone who eats a typical lunch or breakfast “is essentially eating a multivitamin,” said Catherine Price a journalist …
A big part of the problem with breastfeeding research is the faulty assumption that babies need whatever breastfeeding has that formula lacks. But formula provides everything a baby needs for health and growth. There’s no magic to breastmilk, just like there’s no magic to vitamins.
There’s another thing that breastfeeding has in common with vitamins: confounding variables.
People who take vitamins tend to be healthier, wealthier and better educated than those who don’t, Dr. Kramer said. They are probably less likely to succumb to heart disease or cancer, whether they take supplements or not. That can skew research results, making vitamin pills seem more effective than they really are.
We know that women who breastfeed are also healthier, wealthier and better educated than those who don’t. That inevitably skews research results. The purported benefits of breastfeeding are really benefits of better education, more money and easy access to health insurance.
Dr. Gulati’s experience is instructive. When she recommended vitamin D and folic acid to her dad, she believed that they would be beneficial. She was entirely sincere in her recommendation. Unfortunately, she was wrong but she was willing to change her mind and her recommendations in response to more complete data.
Dr. Gulati, the physician in Phoenix, said her early experience with recommending supplements to her father taught her to be more cautious. She said she’s waiting for the results of large studies — such as the trial of fish oil and vitamin D — to guide her advice on vitamins and supplements.
“We should be responsible physicians,” she said, “and wait for the data.”
It’s time for breastfeeding researchers to be responsible physicians and scientists, too. They need to wait for the results of large studies — and wait further until they are reproduced — before recommending breastfeeding for every mother and every baby.
It’s not enough to sincerely believe in the benefits of breastfeeding. You can be sincere and be wrong at the same time. Breastfeeding researchers must change their minds and their recommendations in response to more complete data like that in the papers linked above. Otherwise, babies will continue to suffer and die because lactation professionals’ irrational exuberance about the benefits of breastfeeding.
