Does this remind you of any providers you know?
Preventive medicine displays all 3 elements of arrogance. First, it is aggressively assertive, pursuing symptomless individuals and telling them what they must do to remain healthy. Occasionally invoking the force of law …, it prescribes and proscribes for both individual patients and the general citizenry of every age and stage. Second, preventive medicine is presumptuous, confident that the interventions it espouses will, on average, do more good than harm to those who accept and adhere to them. Finally, preventive medicine is overbearing, attacking those who question the value of its recommendations.
It reminds me of most of the prominent lactation professionals who have made it their mission to promote breastfeeding.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]As the evidence mounts it is becoming clear that breastfeeding term babies is a lifestyle choice, NOT a health choice.[/pullquote]
Professional lactivists are aggressively assertive because they are true believers. They not only pursue mothers of symptomless infants, they corral them in programs like the Baby Friendly Hospital Initiative, tell them what is “best” for their babies and then force them to do it.
They are indiscriminate in their recommendations. No nuance for them. As Dianne Weissinger, arguably the mother of contemporary breastfeeding advocacy, wrote:
All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances…
They are so presumptuous as to defy belief. They don’t know you; they don’t know your baby, but they actually imagine that care more about your baby than you do.
And they are oh, so overbearing, viciously attacking anyone who dares to question the benefits of breastfeeding as shills, liars and losers.
But the quote is not about breastfeeding. It was written in 2002 by David Sackett, a physician, epidemiologist and one of the pioneers in the discipline of evidence based medicine (EBM). He was writing about the hormone replacement therapy debacle. Estrogen/progestin was recommended for nearly all healthy postmenopausal women to protect them against cardiovascular disease. All the major professional societies backed it and it was used as a metric to judge the performance of doctors within health organizations.
The Women’s Health Initiative randomized controlled trial … was stopped when it became clear that the participating women’s risk of cardiovascular disease went up, not down, on active therapy. This damage began to develop soon after randomization, and after a mean follow-up of 5.2 years the trial was stopped for harm. In human terms, the 8506 women treated with estrogen plus progestin had about 40 more coronary events, 40 more strokes, 80 more episodes of venous thromboembolism and 40 more invasive breast cancers than the 8102 women assigned to placebo. Given the frequency with which this treatment is prescribed to postmenopausal women worldwide, hundreds of thousands of healthy women have been harmed.
How could good people have done something so bad?
I place the blame directly on the medical “experts” who, to gain private profit (from their industry affiliations), to satisfy a narcissistic need for public acclaim or in a misguided attempt to do good, advocate “preventive” manoeuvres that have never been validated in rigorous randomized trials. Not only do they abuse their positions by advocating unproven “preventives,” they also stifle dissent. Others, who should know better than to promote “preventive” manoeuvres without clinical trials evidence, are simply wrong-headed. When a 1997 systematic review of 23 trials of postmenopausal hormone therapy concluded that this treatment substantially increased the risk of cardiovascular disease, the attack on its results included a public announcement from a prominent editorialist: “For one, I shall continue to tell my patients that hormone replacement therapy is likely to help prevent coronary disease.”
The purported benefits of HRT had been shown in observational trials and the experts believed. Never mind that not only could those benefits not be reproduced in larger studies, but they were debunked by larger studies. No matter. The purported benefits of breastfeeding have not been reproduced in larger studies and have never come to pass in large populations. No matter. Prominent lactation professionals (and many medical professionals) ignore those results and criticize anyone who tries to publicize the fact that the benefits don’t exist and the harms (neonatal dehydration, starvation, injury and death) are very real. When pressed, they typically retort ‘I shall continue to tell my patients that breastfeeding is best regardless.’
Over the past few days I have been involved in a discussion on Twitter that was precipitated by a meme I posted.
Imagine we learned that a product promoted as healthy for babies was responsible for 90% of cases of jaundice induced brain damage, a dramatic increase in brain injuries and deaths from dehydration and double the risk of newborn hospital readmission. Now imagine that we refused to do anything about it. That product is breastfeeding.
The response from some providers was basically ‘how dare you?’
One participant, a nutritionist/dietician from Colombia went so far as to write:
That point of view just makes no sense. It will never come to my mind the idea of recommending something different from breastfeeding, formula will never be my first advice to patients, just in some special cases…
It no longer matters to many lactivists what the data shows. They are so arrogant that the data is irrelevant and anyone who dares to disagree is maligned and shouted down.
The most astounding comment came from a woman representing herself as a physician. Pointing to my Harvard credentials she wrote:
Sigh….how much traction would you get if your bio said you were an ob/gyn from _____unknown to most University, college.
I was taken aback by this, but the more I think about it, the more pleased I am. I try to be a voice for women/babies whose suffering is routinely dismissed. Providers should stop ignoring them, but if the alternative is they can’t ignore me/my Harvard credentials, that will do.
So let me speak directly to mothers struggling to breastfeed:
As a Harvard educated, Harvard trained obstetrician who breastfed her own four children I can assure you that the benefits of breastfeeding term babies in industrialized countries are so trivial as to be undetectable.
IT DOESN’T MATTER WHETHER OR NOT YOU BREASTFEED. It’s a lifestyle choice, not a health choice.
The lactation professionals and medical professionals who tell you otherwise are no different from those who continued to aggressively promote hormone replacement therapy despite mounting evidence that it didn’t work and actually caused harmed. They are arrogant.
Please don’t let their arrogance harm your baby’s physical health or your mental health!
