The reaction to the Trump administration’s decision to oppose the World Health Organization’s formula advertising restrictions has highlighted how conventional wisdom shapes thinking on a topic. The conventional wisdom about breastfeeding is that it is lifesaving, but the conventional wisdom is dead wrong.
Here is one of the best descriptions of conventional wisdom I’ve seen.
In most cases, CW is a lumbering beast: slow to move, but difficult to alter course once its big bullish head is set on moving in a certain direction… It’s loud, pervasive, and impossible to ignore – and avoid. Oftentimes, entire careers are staked on maintaining its veracity. When that veracity is challenged, either by critics or by experiment, the challenger is often silenced… [A] conforming chorus of assent can be mobilized to drown out even the most rigorously defended thesis, just as long as Conventional Wisdom is at stake.
For decades the conventional wisdom on stomach ulcers was wrong.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If breastfeeding saves lives why can’t the WHO find any term babies whose lives have been saved?[/pullquote]
When I started medical school, the conventional wisdom was that stomach ulcers were caused by excess acid. The conventional wisdom was loud, pervasive and impossible to ignore. Whole careers in gastroenterology had been staked on maintaining its veracity. When that veracity was challenged, the challengers were silenced.
At about the time I graduated from medical school researchers Robin Warren and Barry Marshall discovered H. pylori, the bacteria that actually causes ulcers.
The backlash was brutal. Dr. Larry Altman, medical correspondent for The New York Times, who reported these results, later wrote, “I have never seen the medical community more defensive or critical of a story.” I spoke with Dr. Altman about these events, and to this day, he recalls that “this was the review that got me the most heat for misleading the public” …
Warren and Marshall eventually broke through the conventional wisdom, and ultimately won the Nobel Prize in Medicine. But someone else had actually made the exact same discovery more than 40 years before they did.
As a young researcher at the Harvard-affiliated Beth Israel Hospital in Boston in 1940, Dr. [A. Stone] Freedberg became curious about stomach ulcers while studying the effects of fever on the heart and circulatory system when infections caused it to collapse. Scientific reports taught him that many such patients developed tiny bleeding ulcers in the stomach and small bowel…
He published his findings but was ignored. His superiors were convinced that he had made a mistake and counseled him to give up his claim and move on.
The conventional wisdom that ulcers were caused by acid was so strong that it suppressed the true cause for decades and people with ulcers, denied effective treatment, died as a result.
Today the conventional wisdom is that breastfeeding saves lives, that breastmilk is the “perfect” food and that women must be pressured into breastfeeding for the good of their infants. Whole careers (including careers at the World Health Organization) have been staked on maintaining the veracity of these claims. When that veracity is challenged, arbiters of the conventional wisdom attempt to silence the challengers.
The conventional wisdom on breastfeeding is DEAD wrong.
The evidence has been around for centuries. There once was a time when all babies were breastfed and 20-30% or more died in infancy. Indigenous cultures on nearly every continent practice pre-lacteal supplementation, giving babies teas, water or honey, in recognition that breastfeeding is often not enough to fully nourish a baby. Formula was invented in 1860’s specifically because some mothers could not produce enough breastmilk or because they died in childbirth. Indeed, as far as I can determine, there was NEVER a time or place where exclusive, extended breastfeeding was practiced in the way the World Health Organization now recommends.
The WHO insists that breastfeeding is lifesaving, quoting a variety of mathematical models that predict that when more women breastfeed fewer babies die. Yet the WHO can’t manage to find any term babies whose lives have been saved or any countries where increasing the breastfeeding rate has resulted in a decrease in infant mortality.
Nonetheless, everyone “knows” that breastfeeding saves lives.
The countries in the world with the lowest breastfeeding rates have the BEST infant mortality rates and the countries with the highest breastfeeding rates (approaching 100%) have some of the WORST infant mortality rates.
Nonetheless, everyone “knows” that breastfeeding saves lives.
In June 2017, NPR published Secrets Of Breast-Feeding From Global Moms In The Know:
It’s almost like in the U.S. we’ve lost the breast-feeding instinct. That Western society has somehow messed it up. [Evolutionary biologist Brooke] Scelza wanted to figure out why: What are we doing wrong?
So a few years ago, she traveled to a place with some of the best breast-feeders in the world.
In the desert of northern Namibia, there’s an ethnic group that lives largely isolated from modern cities. They’re called Himba, and they live in mud huts and survive off the land…
Moms still give birth in the home. And all moms breast-feed.
“I have yet to encounter a woman who could not breastfeed at all,” Scelza says. “There are women who have supply issues, who wind up supplementing with goat’s milk, which is not uncommon. But there’s basically no use of formula or bottles or anything like that.”
NPR neglected to mention that the infant mortality rate among the Himba is astronomical. According to USAID, the infant mortality rate in Namibia is 32.8/1000 (compared to 5.82/1000 in the US).
Nonetheless, everyone “knows” that breastfeeding saves lives.
During World Breastfeeding Week, Melinda Gates posted this on Twitter:
Between 2009 and 2014 breastfeeding rates tripled to 57% in Vietnam, soared to more than 80% in Bangladesh and increased to more than 80% in Ethiopia. But what happened to infant mortality rates in response? As far as I can determine, the change in breastfeeding rates had no impact on the trajectory of infant mortality rates.
Everyone “knows” that breastfeeding saves lives despite the fact that no one can find any term babies whose lives have been saved.
Meanwhile, as a result of aggressive breastfeeding promotion, we are literally breastfeeding babies to death.
The Baby Friendly Hospital Initiative was implemented around the globe without any evidence that it increases breastfeeding rates. The Ten Steps of the initiative directly violate both scientific evidence and medical ethics. There is no evidence that locking up formula improves breastfeeding rates; there is no evidence that banning supplementation improves breastfeeding rates (and there is evidence that supplementation increases breastfeeding rates); there’s no evidence to justify banning pacifiers and considerable evidence that pacifiers reduce the risk of sudden infant death syndrome (SIDS); and it is deeply unethical to restrict what providers can say when counseling patients about infant feeding.
Worst of all, there’s a growing body of evidence that aggressive breastfeeding promotion is leading to brain injuries and deaths of infants from hypoglycemia, jaundice, dehydration, starvation and infants falling from or being smothered in their mothers’ hospital beds because well baby nurseries have been closed.
But everyone “knows” that breastfeeding saves lives. That’s what the conventional wisdom about breastfeeding tells us but the conventional wisdom is wrong.
Don’t believe me? Ask those, including those at the WHO whose entire careers have been staked on the claim that breastfeeding save lives, to show you the term babies whose lives have been saved. Don’t allow yourself to be fobbed off by mathematical models; insist on real population data.
But don’t hold your breath while waiting for that data; because while everyone “knows” that breastfeeding saves lives, no one knows any term babies whose lives have been saved.
