Breastfeeding and white hat bias

American style cowboy hat

Rank the following in order of dangerousness:

  • Term infants exposed to A have a death rate of 5.6/1000.
  • Term infants exposed to B have a death rate of 0.5/1000.
  • Term infants exposed to C have an excess death rate of 0.

They’re already ranked in order of dangerousness, right?

What if I pointed out to you that in all cases the death rates are low so it doesn’t really matter? Would that change your assessment of dangerousness? Probably not.

What are we looking at?

  • A is planned homebirth with a licensed homebirth midwife.
  • B is vaginal birth after C-section.
  • C is infant formula.

If homebirth is more dangerous than VBAC and VBAC is more dangerous than formula feeding, why do advocates of natural parenting promote homebirth and VBAC as safe and formula feeding as dangerous?

Because they are biased.

According to Wikipedia:

Bias is an inclination of temperament or outlook to present or hold a partial perspective, often accompanied by a refusal to consider the possible merits of alternative points of view. People may be biased toward or against an individual, a race, a religion, a social class, a political party, or a species. Biased means one-sided, lacking a neutral viewpoint, not having an open mind.

Those who promote natural parenting are biased in favor of allowing nature to take its course and against technology. They lack a neutral viewpoint and don’t have an open mind. They are innumerate, lacking awareness of or interest in the real dangers of various natural and technological choices. Their bias leads them to label formula feeding as dangerous and homebirth as safe even though there has never been a single reported death associated with properly prepared formula, but dozens of babies who die each year from homebirth.

That’s personal bias on the part of natural parenting advocates, but breastfeeding science is also afflicted with many other kinds of bias.

The actual research on the benefits of breastfeeding is surprisingly weak, filled with conflicting studies and plagued by confounding variables. That is well known by anyone who reads and analyzes the breastfeeding literature. But breastfeeding science suffers from another form of bias that is less well known: white hat bias. 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.

What is white hat bias?

‘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. Such demonization and sanctification may come at a cost…

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. We suggest that authors be more attentive to reporting primary results from prior studies rather than selectively including only part of the results, to avoiding PB, and to ensuring that their institutional press releases are commensurate with the studies described…

In other words, breastfeeding researchers are so sure that breastfeeding is beneficial, and are so angry at the infant formula industry that they exaggerate findings that place breastfeeding in a positive light and ignore findings that the benefits of breastfeeding in industrialized countries are actually trivial (approximately 8% of breastfed infants have one fewer cold or diarrheal illness in the first year).

White hat bias is bias in the service of what are perceived to be righteous ends, but it’s bias nonetheless and it’s wrong. When breastfeeding research is presented in biased fashion, we deprive women of the right to make informed decisions about infant feeding choices, and we substitute the beliefs of lactivists for the actual data.

Breastfeeding is great. I breastfed four children without too many difficulties and I (and they) enjoyed it. But it’s simply one of two excellent ways to nourish infants, and anyone who attempts to convince you otherwise is likely to be righteously but regrettably biased.