Last week March for Science censored scientific information in an effort to squelch discussion that questioned the benefits of breastfeeding. It was a startling tactic for an organization that claims to promote science.
Referring to Sci Moms, a group that dared to suggest that breastfeeding promotion has risks as well as benefits, the administrators of March for Science Facebook page accused them of:
… a history of denying the well-established science on infant nutrition and criticizing health promotion initiatives of the World Health Organization and other health orgs.
…[W]e want to encourage everyone to treat the SciMoms with some healthy skepticism and remind everyone that there are more reliable resources out there on infant nutrition, such as the World Health Organization, the American Academy of Pediatrics, and the Academy of Breastfeeding Medicine…
This week, Dr. Lori Feldman-Winter, the chair of the American Academy of Pediatrics’ Section on Breastfeeding was quoted in The New Yorker. Dismissing the data of economist Emily Oster, author of the best selling parenting book CribSheet — data that also questions the benefits of breastfeeding — Feldman -Winter had this to say:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Doctors who won’t change their recommendations about breastfeeding in light of new evidence risk harming their patients.[/pullquote]
That’s the really scary part of having a person like Oster, who is not an epidemiologist, distilling this information to the lay public. It’s basically as bad as the anti-vaxxers.
But questioning the benefits of breastfeeding is nothing like questioning the benefits of vaccination. Here’s why: We have copious data on the benefits of vaccination; nearly every prediction made by doctors and scientists about the impact of vaccination has come true. In contrast, though we have nearly two generations worth of data on breastfeeding promotion, almost none of the predictions made by doctors and scientists on its impact have come true.
Over the past generation, breastfeeding organizations, lactation consultants, and advocates of natural mothering assured us that if we increased breastfeeding rates, we would reap the benefits of lower incidence of conditions from allergy to obesity, lower rates of infant hospital readmission and even lower infant death rates. The US invested millions in public health campaigns promoting breastfeeding and the Baby Friendly Hospital Initiative’s “Ten Steps” became integral in many hospitals, accompanied by the hiring of thousands of lactation consultants in hospitals and doctors’ offices.
In the US, the rate of breastfeeding initiation increased from a nadir of 22% in 1972 to over 80% in 2015. In that time, rates of conditions from allergy to obesity have not fallen; indeed, they’ve risen. Hospital admission rates have increased, and there has been no observable effect on infant mortality.
Perhaps more shocking, because it was unanticipated, promoting exclusive breastfeeding has caused serious health problems. It turns out that breastfeeding, like all natural processes, has a failure rate; up to 15% of first time mothers will have difficulty producing enough milk to fully nourish a baby, especially in the early days. There has been a dramatic increase in neonatal dehydration, severe jaundice and related complications. Indeed, exclusive breastfeeding has become the leading risk factor for newborn hospital readmission.
Doctors are trained to expect that half of what we are taught at the beginning of our careers will ultimately shown to be wrong within the next five years; unfortunately, no one knows which half. We read scientific journals each month to learn not only about new discoveries, but new data that overturn old discoveries. The key to providing excellent care to our patients rests on our flexibility to change if the scientific evidence changes. Doctors who can’t or won’t change their recommendations based on new evidence do their patients a terrible disservice and possibly cause them harm.
The March for Science justified its efforts to prevent debate by referring to the recommendations of the World Health Organization, the American Academy of Pediatrics, and the Academy of Breastfeeding Medicine. Anyone with grounding in science will recognize this as the logical fallacy known as the argument from authority:
Insisting that a claim is true simply because a valid authority or expert on the issue said it was true, without any other supporting evidence offered.
It is an especially problematic logical fallacy when discussing new data. For example, I was taught that routine episiotomy in childbirth reduced the risk of vaginal tears. In the 1990’s new data suggested the opposite. It would have been both inappropriate and unprofessional for obstetricians to justify ignoring the new data by claiming that major obstetric textbooks and organizations still recommended episiotomy. It is equally invalid to dismiss new data on the risks and benefits of breastfeeding simply because major textbooks and organizations still strongly recommend breastfeeding.
It seems that Dr. Feldman-Winter of the AAP might have been trying to advance a similar logical fallacy by referencing anti-vaxxers. Anti-vaxxers do indeed disagree with all major health organizations on the safety and efficacy of vaccination. But vaccines aren’t safe and effective because major health organization recommend them; they are safe and effective because the data show them to be safe and effective, dramatically reducing the burdens of disease and death from vaccine preventable illnesses. The predictions that doctors made about the impact of vaccines did indeed come to pass and serious side effects have been rare.
When a fabricated claim was advanced that vaccines cause autism, it wasn’t dismissed out of hand. It was investigated in large studies involving hundreds of thousands of individuals and demonstrated to be untrue.
New evidence about the benefits and risks of breastfeeding has been published and actual experience — including tens of thousands of hospitalizations each year for insufficient breastmilk — adds urgency to the need to reassess current recommendations. Dismissing new evidence out of hand, attempting to silence discussion of that evidence, and demeaning anyone who dares question the conventional wisdom in light of the new evidence isn’t science; it’s defensiveness.
We face a crisis; tens of thousands of newborns are suffering preventable complications each year because their mothers have been convinced that breastfeeding will provide benefits that have failed to materialize. We need immediate action from pediatricians and lactation professionals to prevent ongoing harm. Instead we are getting disparagement of those who use new data to question old certainties. Babies and mothers deserve better.
