I received an email from Harry Orf, PhD, Senior Vice President for Research, and Research Integrity Officer Massachusetts General Hospital informing me that I disseminated incorrect information. Much to my regret I repeated false claims and mischaracterized the situation. For that I am deeply sorry and want to correct the record as soon as I can.
How could the original reporter have gotten it so wrong? Where did she come up with these accusations if not from the Harvard investigation?
Let’s look at whom she quotes: all three earn their money from the billion dollar breastfeeding industry. Another leading avatar of the breastfeeding industry, Melissa Bartick, MD, apparently filed the original complaint.
I want to offer a heartfelt apology to Dr. Kleinman for my original piece. I repeated misinformation and for that I am deeply sorry. I’ll be waiting for Bartick, Seals Allers, Sullivan and McEnroe to do the same.
*****
Kudos to Dr. Melissa Bartick for holding leading breastfeeding safety expert Ronald Kleinman, MD to account. He has failed to fully disclose payments from the formula industry.
Now if only she and other lactivists would only hold the Baby Friendly Hospital Initiative to account for iatrogenic brain injuries and deaths as a result of aggressive breastfeeding promotion.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Though Kleinman behaved unethically, there is no question that babies have been injured and died — and continue to be injured and die — on the altar of breastfeeding promotion.[/pullquote]
In 2016, Kleinman and two other physicians co-authored an article published in the highly-regarded peer-review journal, JAMA Journal of Pediatrics, which was viewed as critical of the Baby Friendly Hospital initiative, a global initiative designed to promote better breastfeeding practices in hospital maternity units. Specifically, the study entitled, Unintended Consequences of Current Breastfeeding Initiatives, reported the rooming-in practice, where a baby stays in the same hospital room as the mother at Baby Friendly Hospitals, could, as Time Magazine described, “lead to mothers’ accidentally smothering their children and possibly contribute to sudden unexpected postnatal collapse, a rare but often fatal respiratory failure.”
The revelations could hardly be worse:
At the time, Kleinman failed to disclose his deep financial ties to Mead Johnson, the parent company of Enfamil infant formula, which spanned eight years (2006 to 2014). He had also received an honorarium from Mead for chairing the Mead Johnson Iron Infant Nutrition Panel, funding for a hospital initiative (which he described as a “fruitful partnership”), and was the author of two Mead-funded studies…
Additionally, Kleinman has published at least six articles in the last three years, which some advocates claim are critical of breastfeeding initiatives…
In a more recent article published in the November issue of JAMA Pediatrics critiquing the skin-to-skin guidelines for the Baby Friendly Hospital Initiative, Kleinman disclosed his vast industry connections, including financial ties to the infant formula maker Mead Johnson, General Mills, Ocean Spray and the Alliance for Potato Research and Education (APRE), among others…
Kleinman’s explanation:
In an email response to Women’s eNews, Kleinman responded that his previous failures to disclose his industry connections were an “inadvertent omission.”
What was Dr. Bartick’s role in uncovering Kleinman’s unethical behavior?
I also filed a complaint about Kleinman’s conflicts of interest to the Harvard Medical School Office of Academic and Research Integrity in December 2017, which was never addressed.
Apparently Dr. Bartick was unaware of the investigation that she put in train.
I find Kleinman’s behavior inexcusable for two reasons. First, he deprived other doctors and researchers of relevant information needed to evaluate his papers. Second, by discrediting breastfeeding safety research he puts babies at continued risk of brain injuries and deaths from aggressive breastfeeding promotion.
Make no mistake: though Kleinman behaved unethically, there is no question that babies have been injured and died — and continue to be injured and die — on the altar of breastfeeding promotion.
In taking money from the formula industry, Dr. Kleinman is no different from leading lactivists who take money from the breastfeeding industry. The payments he received are no more or less likely to affect his research conclusions than the payments from the breastfeeding industry affect the conclusions of lactivist.
Moreover, financial conflicts of interest and not the only conflicts of interest that can affect breastfeeding research. White hat bias is equally if not more important. Indeed, breastfeeding research was identified as a paradigmatic example of white hat bias in the seminal commentary by Cope and Allison, White hat bias: examples of its presence in obesity research and a call for renewed commitment to faithfulness in research reporting.
‘White hat bias’ (WHB) [is] bias leading to distortion of information in the service of what may be perceived to be righteous ends… WHB bias may be conjectured to be fuelled by feelings of righteous zeal, indignation toward certain aspects of industry, or other factors. Readers should beware of WHB and … should seek methods to minimize it.
Cope and Allison note that researchers have been so anxious to establish a connection between formula feeding and obesity that they have ignored or misrepresented what the scientific evidence actually shows.
Certain postulated causes have come to be demonized (… formula feeding of infants) and certain postulated palliatives seem to have been sanctified…
Whether WHB is intentional or unintentional, stems from a bias toward anti-industry results, significant findings, feelings of righteous indignation, results that may justify public health actions, or yet other factors is unclear. Future research should study approaches to minimize such distortions in the research record…
I suspect that it is white hat bias — feeelings of righteous indignation toward the formula industry — that lead lactivists like Prof. Amy Brown to make irreponsible claims that she is subsequently forced to withdraw.
Earlier this week, Brown tweeted:
There is a misleading post circulating suggesting a newborn’s stomach is larger than medical textbooks say it is. It suggests that the volume at 40 weeks could be 33ml rather than approx 7ml. Based on this it incorrectly claims colostrum is not enough and top ups are needed.
It was repeatedly brought to her attention that the size of 7 ml comes from a 1920 paper that has been superceded by multiple recent papers that show a newborn stomach size of 20-30 ml. Brown refused to back down until she was shown this excerpt from a pediatric surgery text:
[Stomach] size increases rapidly from 30 ml in a term baby to 100 ml by the fourth week.
Brown responded:
Ranges seem to go from 5-30 which happy to accept. But again … stomach size is irrelevant…
But if it were irrelevant she wouldn’t have created a Twitter thread attempting to discredit the true size. The lactation profession has spent at least a decade attempting to normalize infant starvation by insisting that colostrum must be enough to assuage infant hunger because infant stomach size is too small to require larger amounts. That has always been a lie.
Why lie about newborn stomach size? It may be the result of the financial conflict of interest of lactation professionals who make their money by promoting breastfeeding. It almost certainly the result of white hat bias in the form of a near irrational hatred of the formula industry that has led to the irresponsible claim that formula supplementation destroys the breastfeeding relationship when the scientific evidence shows the exact opposite.
So thank you Dr. Bartick for doing the strenuous work required to hold another physician to account for his egregious failure to disclose his conflicts of interest. Now may I suggest that you perform a similar service by holding the breastfeeding industry to the same high standard. Because though Kleinman behaved unethically, there is no question that babies are being injured and are dying from aggressive breastfeeding promotion.
