I don’t know Dr. Joan Y. Meek, Chair of the Section on Breastfeeding of the American Academy of Pediatrics, but I do know ridiculous hyperbole when I see it. Sadly, Dr. Meek is aggressively promoting it.
Meek wrote a piece, Breastfeeding has been the best public health policy throughout history, which has been republished in a variety of places. Too bad it’s complete and utter nonsense.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Nonsense in the service of righteous ends is still nonsense.[/pullquote]
Dr. Meek claims:
As a pediatrician and a nutritionist, I have provided direct patient care to breastfeeding mothers and children and also advocated for breastfeeding policies and practices. The scientific research in support of breastfeeding is overwhelmingly clear, and most mothers in the U.S. have heard that message and learned from it. Marketing and sales of infant formula have surged in developing countries, however. That’s created a dilemma for the U.S., which has not wanted to restrict the US$70 billion infant formula business.
This comes at another price. Lack of breastfeeding worldwide is blamed for 800,000 childhood deaths a year.
No, breastfeeding does NOT save 800,000 lives a year. That’s based on a mathematical model that did not correct for confounding variables and assumed, but never proved, causation. Indeed, until recently, lactivists had been unable to find any supporting evidence for that claim. They could not show that breastfeeding rates are correlated in any way to infant mortality. In fact, countries with the lowest breastfeeding rates have the lowest mortality rates and countries with the highest mortality rates have nearly 100% breastfeeding rates.
The best evidence on lives saved by breastfeeding, published only recently, is Mortality from Nestlé’s Marketing of Infant Formula in Low and Middle-Income Countries by Gertler et al.
Contrary to the claims of lactivists like Dr. Meek:
The introduction of infant formula shows no statistically significant average impact on infant mortality for the population as a whole.
That’s because formula is not harmful to babies; contaminated water is harmful. How harmful?
[An analysis] yields an estimate of 65,676 infant deaths with a 95% confidence interval of [24,868, 106,485], lower than earlier estimates of one million or more, but unquestionably a substantial loss of human life.
That was 1981. How about now?
According to Gertler:
…[T]he annual death toll has dropped to about 25,000, driven by improved access to clean water in the Southern Hemisphere.
That’s just 3% of the figure claimed by Meek.
So breastfeeding is hardly the best public health policy in history; it doesn’t rate a place anywhere in the top public health achievements of all time.
Why?
Because a great public health policy saves millions or even hundreds of millions of lives. In contrast, with the exception of extremely premature infants*, breastfeeding hasn’t yet been shown to save many lives at all.
To understand what I mean, lets look at some of the real greatest public health achievements.
1. Clean water
2. Sewers and sanitation
3. Antisepsis
4. Blood transfusions
5. Antibiotics
6. Vaccination
7. Anesthesia
8. Tobacco control
9. Modern obstetrics
10. Neonatology
Each of these has saved and continues to save many millions of lives every year. Breastfeeding doesn’t come anywhere close. Moreover, the purported lifesaving effect of breastfeeding would be entirely abolished if all women had access to clean water with which to prepare formula.
Why did Dr. Meek make her ridiculous claim? Sadly, like most lactation professionals, she ignores the facts about breastfeeding in favor of the fantasy.
Meek writes:
The benefits of breastfeeding for children and mothers are irrefutable. Initiation of skin-to-skin contact immediately after delivery, with early onset of breastfeeding within the first hour of life, supports newborn stability and provides protective immunoglobulins, especially secretory IgA, and other immune protective factors. Human milk provides human milk oligosaccharides, facilitating the colonization of the intestinal tract with probiotics and establishing a microbiome that protects against pathogenic bacteria.
In contrast, formula-fed infants face higher rates of gastrointestinal diseases, respiratory infections and a higher likelihood of sudden infant death syndrome. Longer term, they have a higher risk of obesity, type 2 diabetes, asthma and certain childhood cancers when compared to breastfed cohorts.
Far from being irrefutable, most of these purported benefits have already been refuted.
- The protective immunoglobulins exist, but they only prevent colds and diarrheal illnesses.
- Claims about the microbiome are mere speculation.
- While breastfeeding reduces the risk of SIDS, pacifier use reduces it by a greater amount.
- Claims about obesity, diabetes, asthma and childhood cancers have been thoroughly debunked.
The idea that breastfeeding has been the greatest public health policy throughout history is sheer, unadulterated nonsense. I’ve no doubt that Dr. Meek is making that claim for what she perceives to be anticorporatist, righteous ends — counteracting the marketing efforts of formula companies. But nonsense in the service of righteous ends is still nonsense.
Who am I to criticize the claims of Dr. Meek? I’m a physician who is very familiar with the breastfeeding literature and I am more than willing to put my criticism to the test. I’d be happy to debate Dr. Meek, in print or in person, on these very issues.
I doubt my challenge will be accepted. Professional lactivists never put themselves in positions where those who disagree could challenge them. Though they choose fantasy over facts, they are aware that inconvenient facts about the limitations and risks of breastfeeding exist and they are afraid to face them.
Who knows? Maybe Dr. Meek, unlike other professional breastfeeding advocates, has the courage of her convictions. I’ll be waiting to find out.
*Breastmilk reduces the risk of necrotizing enterocolitis, a potentially deadly complication of extreme prematurity.
