Is midwifery/breastfeeding research real scientific research?

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There’s a critical difference between midwifery/breastfeeding research on the one hand and real scientific research on the other. Indeed, midwifery/breastfeeding research has more in common with Big Pharma research than it does with actual science.

What’s the difference?

Scientific research seeks to learn, specifically to learn how the human body works and how to maximize healthy outcomes. Midwifery/breastfeeding research, like Big Pharma research, seeks to justify the product that they are already selling.

Midwifery/breastfeeding research, like Big Pharma research, seeks to justify the product that they are already selling.

Don’t believe me?

The hallmark of Big Pharma research is that it always shows that the drug being tested is safe, efficacious and worthy of being prescribed routinely. No doubt Big Pharma does research that shows that it’s drugs aren’t safe, don’t work and shouldn’t be prescribed, but that research is never allowed to reach the light of day.

Search any midwifery journal for whichever years you choose and you will find that anything a midwife can do is safe, efficacious and worthy of being prescribed routinely. You will never find a paper that calls into question any aspect of contemporary natural childbirth advocacy.

Similarly, if you search any breastfeeding journal, you will find that every single article concludes that breastfeeding is safest, always better than formula and therefore worthy of being forced on every mother and baby. You won’t find papers that call into question the assumed superiority of breastmilk.

That difference extends to professional conferences.

Attend obstetric conferences and you will find countless sessions on “controversies in obstetrics.” When is induction appropriate? What’s the right C-section rate? What’s the best way to prevent postpartum infections? In those sessions there are always people on both sides of the controversy, arguing their point of view vigorously and the attendees are encouraged to make their own decisions based on what they have heard.

Attend any midwifery conference, in contrast, and it is a festival of mutual support and midwifery promotion. There are no controversies in midwifery because everyone agrees a priori that midwifery care is the ideal, vaginal birth is the goal, and safe outcomes are secondary and perhaps not even mentioned.

There are no controversies in breastfeeding either. Everyone in the profession agrees a priori that breastfeeding is the one and only spectacularly superior way for every mother to nourish every child. Everyone agrees that the central focus of breastfeeding research should be finding new benefits and. New ways to promote it and no one is discussing any drawbacks.

This reflects a profound difference in focus.

Scientific research always starts with the null hypothesis: the new technique/drug/intervention is no better than the old. The object of scientific research is to determine if the null hypothesis is true or false. Either conclusion is acceptable since the point is to learn.

Midwifery/breastfeeding research starts with the conclusion: unmedicated vaginal birth/breastfeeding is superior and worthy of being promoted and sold. It bears a striking resemblance to Big Pharma research which starts with the conclusion that the product under study is great and should be marketed as such.

That’s why it’s nearly impossible to take most of midwifery/breastfeeding research seriously. It isn’t research if the conclusion has been determined in advance.

There’s another important difference in midwifery/breastfeeding research and real scientific research and that is the arrow of time.

Real scientific research looks forward and believes that we can often do better than nature, cure more disease, save more lives. Midwifery/breastfeeding research, in contrast, always looks backward to prehistory, believing that we can’t possibly improve on nature and ignoring the fact that infant and maternal mortality in nature are astronomically high.

That means that we should approach midwifery/breastfeeding research the same way we approach Big Pharma research, alert for conflicts of interest and aware that the research was designed to reach a predetermined conclusion. That doesn’t mean that all midwifery/breastfeeding research is wrong; just like Big Pharma research, there is plenty that is correct. But no one should think that either is real scientific research.

  • David

    Hi dr Amy
    Check this out. Midwives think they deserve equal pay to doctors. https://www.thestar.com/news/gta/2016/05/31/ontario-midwives-allege-gender-based-pay-gap-compared-to-doctors.html

  • Julia B

    I did what Dr Amy said and had a look at a couple of breastfeeding journals. The current issue in “top breastfeeding journal” the Journal of Lactation (http://jhl.sagepub.com/content/current) has an article on the mechanism of breastfeeding (Suck-Swallow-Breathe Dynamics), apparently because there is plenty of research on bottle feeding, but a lack on how this actually occurs in breastfeeding, then one on the effect of donor milk banks on breastfeeding rates, then how a donor milk program can improve maternal breastfeeding in VLBW infants (for which breastmilk is strongly recommended over formula due to decreased risk of necrotising enterocolitis), then a discussion on why people who sell their breast milk to peers do not donate to milk banks, the effect of paying for infant formula on the BFHI, an article on why it is more difficult for overweight/obese women to initiate or maintain breastfeeding, articles showing a link between postpartum depression and breastfeeding cessation that finds that women with postpartum depression stop breastfeeding as they have too many domestic duties, one that looks at the problem of methamphetamine use in pregnant women and reports on how long it takes before it is no longer found in breast milk….and more. I also looked in the International Breastfeeding Journal and found a similar range of research papers (https://internationalbreastfeedingjournal.biomedcentral.com/). I don’t find that they are a long series of articles that conclude that breast milk is the safest and bestest for mothers and infants.

    Also, while I agree that Big Pharma is guilty of not publishing some negative results, there have been a series of measures introduced over the past decade to try to prevent this (clinical trial registration in a publically accessible database), and a proportion of Big Pharma research showing null results was also published before these measures were introduced. E.g. the following clinical trial shows that the drug rosuvastatin does not affect the main outcome, all cause mortality, published in The Lancet, no less: Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. GISSI-HF investigators, The Lancet , Volume 372 , Issue 9645 , 1231 – 1239. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61240-4/abstract

    Maybe Big Pharma research is designed to reach a pre-determined conclusion, however if it goes wrong, a proportion of it is still published even if it is not as much as should be published. Come to think of it, all research should begin with a hypothesis that is subsequently proved or disproved using the results. Is that not a “pre-determined conclusion” in a manner of speaking?

    Dr Amy presents a highly polarised view of both breastfeeding research and medical research that is not correct.

  • SporkParade

    I’ve said it before and I’ve said it again – If breastfeeding research was really about helping women and babies, we would have more studies looking into the frequency of breastfeeding problems, the risk factors for breastfeeding problems, and the effectiveness of various protocols to deal with breastfeeding problems. Instead, we have poorly controlled study after poorly controlled study trying to justify the moralizing of a biological function. Until we live in a world where women are counseled, “Based on your personal medical history, you are likely to have delayed lactogenesis. Here’s how to deal with it,” instead of being told, “Breast is best, and all problems can be solved by just trying harder,” I can’t believe that breastfeeding promotion is about anything other than keeping women tied to the home.

  • jsterritt

    “Pharma research… starts with the conclusion that the product under study is great and should be marketed as such.”

    There is much that is troubling about your analogy comparing “midwifery/breastfeeding research” to “Big Pharma research.” For starters, you create a false dichotomy that precludes midwifery/breastfeeding or pharma research from being “real scientific research.” So-called Big Pharma is held to the highest standards of research protocols under the highest degree of public/regulatory scrutiny (if they hope to gain licensure/approval). Similarly, midwifery/breastfeeding research merely has to hold to high standards of study design (methods, analysis, etc) and submit to standard scientific publishing protocols (review, replication, etc). The way you characterize drug companies is more akin to popular conspiracy thinking than critical thinking — hardly the hallmark of a medical/scientific skeptic.

    By likening midwifery/breastfeeding researchers to a fake thing (evil pharma scientists with dollar signs in their eyes) you are essentially making spurious, well-poisoning ad hominems instead of a reasoned argument. You don’t even define your terms, just warn that “no one should think that either [midwifery/breastfeeding or pharma] research is real scientific research.”

    If your argument is that midwifery/breastfeeding research is steeped in pseudoscience or lacks scientific rigor, then you should argue that position (easy enough to do). By comparing something you disdain to something that doesn’t exist (evil scientist-villains from the movies), you sell your own argument short.

    PS: Love the blog!

  • Margo

    Oh dear Dr Kitty, take a small flask of “tea” with you laced with….um something fortifying. You brought back memories for me, those were the days….endless staring at flax weaving (seen for the third time not that riveting) or…grooming a horse, now that was a beauty! Ten six year old kids all busily grooming a horse whilst my charmer fell in the poo bucket, lucky me…only an hours drive home in a very small car with extra stinky kid. The joys of mum hood!

  • Dr Kitty

    OT:
    I have agreed to take my children to a folk park tomorrow.
    You know, replica buildings, historical re-enacting, LONG bloody walks between demonstrations of weaving and spinning and cooking over an open fire and the like.
    The forecast is 19C and sunny.
    My daughter’s favourite thing there is the blacksmith.
    Last time she made us stay 30minutes to watch him make a poker.

    Pray for me.

    • fiftyfifty1

      Do what I do at those things: drink.

    • Who?

      Where I live 19C is the max on the coldest day of winter. My ‘winter’ flowers are in-violas, primulas, primroses, snapdragons etc. Love it.

      Just saying.

      • Monkey Professor for a Head

        19C sounds lovely, our last electricity bill was over $1000 because of running the aircon all day. Bloody North Queensland!

        • Who?

          And it is so miserably humid up there. We’ve had such a mild autumn, but the colder weather has hit in the last fortnight. This will be the first May since we’ve had air-con for heating that we won’t have used it. We have the coldest house in the land, which is great in summer but not so good in winter.

          You’ll have a lovely winter in the tropics.

          • Who?

            Huz relented and put the heating on last night. But he was in shorts.

            I said nothing, being a patient wife of long standing.

      • LibrarianSarah

        It got down to -38C here this winter.

        Just saying.

        • BeatriceC

          I’ve lived at both extremes. I grew up in Miami where it’s hot and humid, but not too extreme on the hot (max around 36C), but extremely humid (90% relative humidity is kinda normal). I lived for a little while in North Dakota, where the winters can be brutal (I know what -50C feels like), and now I live in Southern California where it can get up to 42C, but it’s so dry that it’s not really as bad as Miami can get, plus the nights cool down quite a bit. Honestly, I think I’d rather take the North Dakota weather out of all of it.

          • guest

            I also lived in SoCal, and the heat is certainly bearable without the humidity. My first two summers in Boston I did not do well. But I love winter, and I don’t want to give snow and cold up for SoCal again.

        • Who?

          Cannot even imagine. Going outside must be quite the expedition.

          • LibrarianSarah

            Are you nuts! I didn’t go outside in that! Any exposed skin would’ve instantly gotten frostbite! Nah I stayed home and hoped my landlord filled the heater with oil.

          • Azuran

            Meh, when you have a few weeks of -30 to -40 every winter, you kinda have to learn to live with it.
            Usually there are 2 kind of people who live in the cold:
            -Those who are ready and have proper warm winter clothes to go out.
            -And those like me who don’t have proper winter clothes, freeze to death outside while removing the ice from the car and then complain about the cold.

            But really, most annoying thing is when your car won’t start…

          • Who?

            My daughter has just moved to a much colder climate, and their winter is kicking in fast. She has her first real job, and a proper pay packet, and needed to buy a coat. So when she was up here for the weekend a month or so ago we looked at coats and she decided they were all too expensive.

            Anyway last week she went and bought the expensive one-after much soul searching-and got a free cardigan with it. She is finding them both so cosy I am getting constant updates about how warm she is, how comfy these clothes are, how she can be outside and not freeze, etc. It’s above zero, but far colder than she’s been used to.

            Not sure what kind of coat you’d need in the climate you’re describing…

          • Azuran

            XD from my point of few it’s basic winter clothing so I’m not really sure how to describe it, we’ve also gotten pretty good have having warm normal looking not too puffy coats.
            It’s actually more in the accessories. If you want to stay warm you need nice warm gloves, a scarf or something around your neck, something on your head, warm boots. And if you’re planning on staying outside more than 15 minutes, you better also have winter pants.
            It’s one of the things that make me laugh so much when I watch game of thrones. It’s ridiculous how the night watch have 6 layers of fur on their body, but no hat, nothing to protect their faces and nothing on their hands.

          • Who?

            We were just doing the scarf conversation-I think not too woolly as it’s annoying. She claims hats are beyond her at this stage. She has my leather gloves with cashmere lining-what a kind mother.

            And I agree re GoT-my hands would have dropped off long ago!

          • sdsures

            You can get non-itchy scarves. I knit mostly with non-itchy yarn because of allergiees.

          • sdsures

            I taught my British parents-in-law how to thaw out their car locks with a hair dryer and an extension cord when they froze one morning in 2013. #Winnipeg

        • sdsures

          Canada? Winnipeg, I presume?

    • sdsures

      I have actual drop spindles spindles and hand-spin wool from time to time, to knit with. It’d be cheaper to come and visit me. Plus, I have coffee, tea, biscuits and chocolate!

  • AA
    • Irène Delse

      Seconded.

      • Amazed

        Me too.

        You know, I was pleasantly surprised when I saw that the majority of posters were saying, “Go to the ER now!” or “Supplement!” And then, they were all, “Oh, if your wife has started breastfeeding on demand, you can wait a little to bring the baby to be evaluated.” What the hell? You can’t! The kid might be dangerously malnourished and waiting until mom’s supply grows will only make her worse. Let alone the very real possibility that mom’s supply may never grow. At this moment, it’s still an emergency.

        FFS, there was even this chick who was advising “do what the LC tells you and give it 72 hours to work”. WTF? 72 hours for a dangerously malnourished baby to possibly keep getting starved?

    • Dr Kitty

      FTT, quite possibly PPD/PPA too.

      There is something wrong.
      Whether it is a simple supply and demand mismatch or something more serious, baby needs inpatient evaluation, ASAP.

      Tough as it is, dad needs to follow HIS gut that the baby needs help and that his wife is not thinking clearly at the moment and probably needs some help too.

      She will forgive him if the baby gets formula but thrives, she’ll never forgive herself, or him for not steeping in, if the baby stays EBF and doesn’t.

      As the parent NOT in a sleep-deprived hormonal guilt stew, he needs to step up and get both of them the care they need.

      • An Actual Attorney

        Is anyone here on reddit to say that? Put baby in car. Drive to hospital. No more talk. Go!

        • AA

          I think the OP has gotten good advice to go t o the hospital, including a gilded response to go to the hospital immediately. The question is whether OP has done it or not, we haven’t gotten an update.

          On that note, we have no evidence that the LC advised the parents to seek medical care. The LC should have told the parents to load the kid into the car and get to a doctor immediately.

          • Amazed

            He hasn’t gone to the hospital. Last he posted, a LC was having his wife breastfeed on demand (what, then, does “feeding all the time” which she supposedly did before, as he says in OP, even mean?), so he guesses he can wait for a few days before going to the hospital.

            The usual loons started showering praises on breastfeeding on demand without mentioning that it’s still an emergency. I think to them, low supply is the problem, not the fact that the kid is STARVING like, right now. They seem to imply that she can wait until breastfeeding fixed itself.

          • AA

            The OP’s response was the same day as his original post. Perhaps after the flood of responses the same day, changed his mind. From a chronological post order, the pediatrician response was after the OP’s response. Hopefully the baby si being evaluated right now.

          • Amazed

            Let’s hope, then!

          • Heidi

            I keep going back to his user page, hoping to see an update that he took the baby to the hospital or the doctor. I really hope that baby is getting help.

            I want to SCREAM at the people that think feeding this baby much needed nutrition is a “slippery slope.” What don’t they understand?! Worst case scenario is mom decides to exclusively formula feed. So what? It’s no big deal! My child gets mostly formula and he is absolutely fine! He has yet to grow two heads, he hasn’t even caught his first cold yet. He is meeting all his milestones, he isn’t obese. Most importantly, he’s alive and thriving. These people would rather risk a DEAD baby than someone giving up on breastfeeding.

            And it’s not all about supply and demand. I know they like to think any woman can make enough milk with enough demand, but it just ain’t so. It’s so hurtful and dangerous to keep telling women this.

          • Roadstergal

            Denying a baby food based on ideology seems like a far more slippery slope.

          • An Actual Attorney

            Is the LC. named Nikkilee?

          • Who?

            AA it is in fact ‘nikkilee’-a nod to self-effacement that fools no one.

          • Gatita

            Serious question:

          • guest

            My daughter was premature and low birth weight for her gestational age, so my pediatrician appointments may have been more frequent just because of that, but at our first appointment my pediatrician immediately had concerned because she had only gained three ounces since her last hospital weigh-in (she was about two weeks old at this point). We had to keep coming back to make sure she wasn’t FTT. In the end she wasn’t – she slowly but surely pulled herself from off the chart to 15th percentile, but any pediatrician worth her salt would be on low or no weight gain, never mind continued loss at that age.

      • Margo

        Yes Dr Kitty, you are so right. He needs to step in, that baby should not be losing weight.

  • Gatita

    So my sister is being induced today because she’s at 41 weeks and she’s freaking out because of all the bad crap she’s read online and I’m seriously pissed off about it. I don’t want her to feel stressed and it’s not cool that she’s worried about something that’s safer for her baby then waiting for”natural” onset of labor. She got my mother worked up too and I just had to have a texting conversation with Mom to explain the increased risk of fetal death and the increased likelihood of cesarean section. At least my Mom feels better about the whole thing now. My sister is still upset.

    • CSN0116

      Poor thing 🙁 At 41 weeks I’m sure it will take very little to nudge baby along. He doctor should be easing her fears so that she dismisses what Google said. I don’t understand why people fear induction, especially when they’re significantly past due. What are the leading rumors: (1) it will hurt more? and (2) it increases the likelihood of needing a C-section?

      I’m rather certain #2 has been dispelled and there are very similar C-section rates for natural and medically induced labors. And #1 – just LOL. Labor hurts like all fuck no matter what, but there are glorious drugs to curb that. As someone who has gone into labor “naturally” twice before, my body has this fucked up way of putting me in pain beyond what Pitocin ever could. My body labors as follows: a bunch of close, strong contractions that hurt immensely but give me almost no dilation progress; I take 8-10 hours of that shit just to get to 4/5 cm; then my water breaks on its own; then HOLY FUCK, I contract so hard and so fast that I’m 10 cm and holding a baby a mere 45 minutes later. I cannot breathe, see, hear, or move during those 45 minutes. I scream and yell and thrash and wish for death out loud. It’s whacked but what my body does. I’d take a controlled induction over that noise any day!

      Best of luck to sis. Welcome to motherhood, just fucking roll with it or you’ll be miserable indefinitely 😛

      • Gatita

        Yeouch your labor sounds miserable! Unfortunately, the rumors are that induction hurts the baby which is such bullshit. She went into labor naturally with her first so she didn’t have to worry about this last time.

      • KeeperOfTheBooks

        I want to enlarge your last sentence to about 40-point font, frame it, and mount it over the crib.

        • demodocus

          I might plaster the walls with a braille version. Someone I know could use the reminders

      • demodocus

        I think it’s part of the whole all-the-things-are-bad-for-baby vibe we get. Even I was leery of induction and I’m “all science-y”

      • Gatita

        So sis gave birth to my nephew last night with no problems. Yay!

        • The Bofa on the Sofa

          She was induced?

          • Gatita

            Yes and all went easy peasy

          • The Bofa on the Sofa

            Excellent. Great teaching moment: “Notice that all that crap you read on on-line was bullshit.” Maybe she will remember that next time.

        • momofone

          Congratulations!

        • demodocus

          Congrats!

        • KeeperOfTheBooks

          Hurray, and congrats, auntie!

        • Amazed

          Congrats! Welcome, little one!

      • guest

        Well, everyone goes around saying induced contractions are more painful, so I think that’s part of the fear. I could not say, as my only pregnancy was induced. My doula tried to console me for getting an epidural (not that I needed consoling) by saying the induced contractions were so close together I wasn’t getting a rest. But whether it’s true or not, if people tell you something might be more painful than some other thing, you’re likely to create a fear response to the idea of the first thing.

  • Megan

    OT but has anyone had experience with their premenstrual symptoms changing drastically after a baby? I know things can change but I seem to have gone from no PMS at all to severe mood symptoms and first trimester like fatigue, on order of what I might call PMDD. Did anyone else have this happen to them? Did it get better after you’d had a few periods or was it your new “normal?” I literally feel like a different person for the week before my period (about to have my second PP period). Really depressed/anxious/irritable, downright exhausted like first tri of pregnancy (even can sleep through my baby cry, which I can never ever do), headaches, back pain. It’s horrible. I hate it and it feels entirely out of my control. I really hope this isn’t here to stay. I don’t like the side effects I get from SSRI’s.

    • demodocus

      Odd. Mostly i’m pretty consistent. My cycles are a little wobbly, and I gather i get a bit irritable, but nothing too bad in my case.

    • Guest

      After my second 2, my first maybe 2 or 3 pp cycles were insane. I basically turned into a psycho person. My first pp cycle is always kind of shocking because we don’t understand why I’m so irritable – even angry. Cry at the drop of a hat, and then boom there it is. So far, it seems to settle down after maybe 3 cycles. I’m on my third pp cycle with #3, and I was surprised to see it start this time (I’m still nursing so it just kind of randomly comes and goes every 25-32 days, fun times.)

      • Megan

        My friend said three cycles for her too. I hope it’s just a few cycles. It’s bad enough I was considering meds but don’t want to start something if it’s temporary. It’s just been awful. I hate feeling this way. And my poor family. Maybe I’ll give it another cycle or two and see if it resolves.

    • Kelly

      My first period post partum is always awful. After that, I go back to my normal periods. Although, my ovulation cues change with each child.

    • Heidi

      I used to get pretty bad PMS, verging on, if not, PMDD. I don’t even remember what my first and second PP periods were like, but this third one was strange. About two weeks ago, I thought I was experiencing PMS or had an almost immaculate conception as I got super depressed (like really questioning why I had a baby, feeling like I was going to be a failure as a mother), super anxious, exhausted, had horrible heartburn, nausea and food aversions, thought to take an ovulation test as a pregnancy test from when I was trying to conceive, it was positive. I freaked out, ran to the grocery store, and thankfully the real deal was negative. I was indeed ovulating, just on cycle day 26 when last period I started on cycle day 26. When the PMS time came, I didn’t really experience much of anything. Not sure if it’s breastfeeding or just general PP hormones making things wonky.

    • KeeperOfTheBooks

      My first cycle or two were absolutely freaking horrible, but I returned to normal (or as normal as I get :p) after that. Extremely emotional, raging when I wasn’t crying (and I never cry)…it was awful.

    • J.B.

      Emotionally and sleep wise yes. When I tried to go back on a conbo pill after weaning I got sick every morning. Mirena is my friend. The midwives were concerned I wouldn’t tolerate it but the constant low dose of progesterone is a lifesaver.

  • corblimeybot

    OT: Dr. Amy, when I was at work this week, my boss brought up your article in the NY Times. She loved it. She had no idea how bad the motherhood cult had become.

    I’ve told her about your blog many times. So it was funny when she read your article, and didn’t realize it was written by the same doctor blogger I’d been talking up.

  • Amy M

    I work in research in Big Pharma. I don’t think you can compare midwife/breastfeeding research to Big Pharma research because they have different goals.

    I’m not saying Pharma never publishes papers to justify a drug, but the vast majority of industry pharma research isn’t published at all. It’s for internal purposes, and the research itself is done by scientists and generally held to the same standards as academic research in terms of what is considered rigorous, and good study design (so starting from a pre-determined conclusion is not good research in pharma either). A lot of new things are learned from this type of research, but its very specific to the disease/system/compound being researched and was never meant to be just a general information expedition. A lot of the research is actually based on previously done academic work, taking what the academic group learned and trying to apply it to drug development or translational medicine.

    As Dr. Amy says, academic research’s primary purpose is to learn something, and for the individual PI, to publish that data.
    Big Pharma has clinical research and pre-clinical. Clinical research is to determine if a drug is safe and effective, so it can be sold for profit. Pre-clinical research is to find potential drugs, or learn how different diseases/conditions work so new or better drugs can be developed. If the research shows that the drug isn’t safe/effective, then that drug will not be able to get to market. The end goal for all the research is development of safe, effective drugs that can be sold for profit. Sometimes Big Pharma publishes papers, but that’s not a primary goal.

    It seems like midwife/breastfeeding research is not trying to learn anything, but rather to persuade people that [the viewpoint of the author] is correct. Also, I get the impression that they publish papers to lend an air of academic legitimacy to their fields. Sure they aren’t getting published in Nature or Science, but perhaps some of the people interested in reading their work don’t realize that journal quality can vary widely. Also, while the midwives/lactation people may be interested in selling their services, or related goods, publishing papers in journals is a pretty indirect way to do that, so even there, I don’t see it as comparable to pharma research.

    • mostlyclueless

      Kind of OT, but how do you like Big Pharma, especially as compared to academia? I have considered making the transition myself but always seem to land on staying in academia.

      • Amy M

        Well, I worked in academia for years, but I do not have a PhD. I am a research associate (basically, hi-tech lab tech). For me, the type of work has been similar, but I have learned way more in industry, have achieved greater levels of independence and get paid way better than in academia. I like the science and the work is fine, but as a non-PhD, I’m not really respected as/considered a scientist.

        I’m actually looking to shift careers somewhat because I want to go into health communication—I’ve just started a master’s degree program, so I’m not sure exactly where I want to take it yet. But my main goal is bring science/health info to people who are not scientists—be the bridge basically. I like doing the science now, but I can only go so far in the lab wo/a PhD, so I’m thinking to try something that maybe I can go further with.

        Anyway, I think Big Pharma companies, like any big corporations, have their pros and cons. The science is driven by what is profitable, not necessarily what is interesting or exciting. They are pretty risk-averse, so something that an academic lab could work on indefinitely could get killed in industry if it would take too long/too much $ and/or is not an obvious candidate for some kind of product. On the other hand, I work with some really bright, fun people, the benefits are great (yay, tuition assistance!) and the work can be challenging in a good way.

        • mostlyclueless

          Thanks.

    • fiftyfifty1

      So basically, pharmaceutical research mat not be all that great, but it’s better quality than NCB/lactivist research.

      • Roadstergal

        Honestly, I drank the ‘academe is always better’ Kool-Aid when I was in it, but since making the jump, I have to say that each side has its ups and downs. There’s a lot of ‘publish or perish’ in academe, and what publishes is sexy new stuff that feeds the Excitement Machine, and that introduces a fair amount of bias.

        That is, in biotech, I’ve found that negative results and reproducibility experiments are much more valued than they are in academe, to massively oversimplify. :p

        And some of the understanding of biostats in academe is horrifying.

        • Valerie

          Brilliant, yes, we feed the Excitement Machine. I’ve been telling people (and I never know how to say it) that a problem in research is that we are so constricted by our own psychology about what is “interesting” or “exciting” or what sounds like a good story. Biology doesn’t have to work that way.

      • Amy M

        I think it depends on the company, group, etc. I don’t doubt that Dr. Amy is right when she says there have been publications by Big Pharma that started from a conclusion, or exist to justify a product. However, I believe, from my experience working in academic and pharma research, that most research in both areas is conducted in a similar way, with similar standards. The main differences are why the research is being done, and what is done with the results.

        I haven’t really read any lactivist/NCB research other than what Dr. Amy sometimes links to, so I can’t really comment on the overall quality. However, I do believe that 2014 MANA paper on homebirth stats, for example, was poorly done, because the data collection was haphazard. If most NCB/Lactivist research is conducted like Dr. Amy says, from the conclusion backwards, then that would be poor quality indeed, but that would go for any research done like that, regardless of institution.

    • jsterritt

      Well said! As Dr Tuteur has compellingly explained here and in her book, the NCB/lactivist camp is basically a pseudoscientific enterprise with a paucity of positive studies supporting their ideological agenda. As such, they resort to cherry-picking, “statistical skullduggery” (thank you Harriet Hall), intimidation, misinformation, FUD, and the usual tricks of propagandists, hucksters, and quacks. On the other hand, the pharmaceutical industry relies almost exclusively on sound science to inform a complex, lengthy, and expensive development process. I don’t want to be called on to defend every single actor and action of pharma science ever, but comparing pharma to NCB/lactivists is being really mean to pharma.

      I think Dr Tuteur makes a big mistake comparing pseudoscientists to a caricature of evil and uncaring “Big Pharma” scientists. This is precisely one of the myths NCB/lactivists use to gain the confidence of the credulous — that doctors and scientists “don’t care” and are really just part of a conspiracy to keep their wallets fat at the expense of patient well-being. I don’t understand why Dr Tuteur would provide fodder by drawing a false equivalence between pharmaceutical science research and pseudoscience.

      Maybe there was some next-level irony that was lost on me 🙂

  • Susan

    Great one Dr. Amy. Having personally been at natural childbirth, midwifery conferences and mainstream medical conferences I can attest to the truth you speak here. As a nurse, I worry our profession is buying into process over outcome too. It’s becoming not cool to question practices that are in the natural realm. To do so makes us look intolerant, rigid… Even old and archaic. I also hate how the term “evidence based” has become the vernacular of the natural movement as most only seem to look at, as you said, the evidence that supports what they already believe. They like the evidence for breastfeeding being best, they like the evidence for only rare episiotomies… But the evidence that saves lives that they don’t like… Home birth has a higher risk to baby, vitamin K saves lives, active management of the third stage of labor,
    Pacifiers decrease sids, bedsharing is dangerous…
    So many ignore ALL those evidence based conclusions! In fact,
    When a rare natural childbirth breaks ranks and says “something is wrong here” like Evidence Based Birth and Vitamin K and Navelgazing
    midwife and CPMs… We applaud it because it’s such a shock to see someone in these groups actually think in a scientific fashion. Your point could not be more important.

    • nomofear

      The sad thing is that their appropriation of science terms works on laypeople like me. I ate up their b.s., til Google gave me this site in the list of results on a search for Ina May Gaskin, and I didn’t stop reading posts and comments for weeks. This site made me do a 180 on the whole “natural” thing. I shudder to think where my second baby and I might be today if Google hadn’t led me here.

  • Roadstergal

    Hey, now. I work for Big Biotech, and we pre-specify endpoints. I suppose the difference between our research and midwifery research is that we fail primary endpoints when the drug doesn’t work… :p (See, Birthplace study)

  • Irène Delse

    Totally OT: End of the week makes for a foggy brain; in the article above, I just read “Cthulhu birth” for childbirth! XD

    • Guest

      Just make sure it’s a “natural” Cthulhu birth!

      • Irène Delse

        Oh, sure! I wouldn’t want to interfere with the natural spawning of Cthulhu ^^°

        • KeeperOfTheBooks

          I suspect that interfering with Cthulhu-spawning could be…*painful*…for the interferer.

          • Irène Delse

            Unspeakably so.

      • Charybdis

        Waterbirth on R’lyeh with Deep Ones instead of dolphins in attendance!

        • MI Dawn

          Well, that’s one way to get rid of the natural birthers! But is it fair to Cthulhu to give him/her/it such poor fare?

  • Jennifer

    Well not all bf research. The probit study was really solid and also the sib pairs studies. But in general people need to remember correlation doesn’t necessarily equal causation. My problem is when reputable journal publish observational studies with huge confidence interval and tiny point estimate and them use causal language. I read a study in American journal of Epidemiology, which should know better, that said we were unable to obtain significant results due to wide confidence intervals. LOL. NOT because there was no association. So stupid.

    • Jennifer

      Sorry I realize the comment above has several typos. Was on my phone.

    • fiftyfifty1

      “The probit study was really solid ”

      Even with the PROBIT study you can see the authors twist themselves into knots trying to come up with something, anything, that will justify their preconceived notion that Breast is Best. For example they take one minor difference on a single (unblinded) subtest of intellectual functioning and trumpet the hell out of it. But when the breastfed group, against their expectations, turns out to be more overweight/obese than the control group they dismiss it as a fluke.

      • Jennifer

        I totally agree. Sorry I meant it was well designed but yes the write up did seem overly enthusiastic given the modest, mostly null results or as you point out results that conflict with their original hypothesis.

    • Anne Catherine

      Actually there have been A LOT of large scale, well done research studies published that do not come to the conclusion that breastfeeding can cure any disease under the sun. These are all conventionally ignored by the breastfeeding community who are the ones writing the policy statements and breastfeeding literature.

      Sometimes the advocates will just kind of twist the results –like a study will conclude that breastfed babies have less obesity, but the there is no causal relationship–the reduction is due to other factors– and their statement will read that breastfeeding can reduce obesity by 25%–which is totally misleading.

  • mostlyclueless

    I have to disagree with you on the basic premise of this one. I’m applying for funding from a pharmaceutical company right now, and they are very explicit that they have no role in the study design or decision to publish results (ie, they are explicit that ALL results should be published regardless of what is found). They don’t even select which studies will be funded; they’ve assembled a team of world experts to choose.

    “Big Pharma” is a popular bogeyman and believe me I agree pharmaceutical companies have done a lot of seriously fucked up things. But the fact that a pharmaceutical company was involved in a research study doesn’t inherently undermine its scientific validity or credibility.

    In fact I think this is becoming a popular trope for people to use to dismiss scientific findings they don’t like — identifying a funding source linked to industry, and then claiming you can’t believe the study’s findings at all.

    • Jennifer

      Interesting. I didn’t know that. I know drug trials have to be registered before they begin to prevent hiding results.

    • BeatriceC

      I was thinking along the same lines. MrC was a research scientist for “big pharma”. Most of what he worked on never saw the light of day because it didn’t work or caused more harm than good and was scrapped. They weren’t hiding anything, just not continuing research on something that was proven problematic.

    • Clorinda

      I believe Dr. Tuteur is using the woo version of Big Pharma to show what many on that side believe to be true about pharmaceuticals and science in general. That only the good results will be published, the rest buried or fudged to make it look better and comparing the ways that they claim “Big Pharma” acts with how they act (in other words, no differences). Later on, she does talk about actual science and its methods.

      • Sue

        I suspect Dr Amy is using this style to make a point. Anti-scientists are quick to label the Pharma industry as corrupt, but this article makes a direct comparison between those practices that ARE suspect, and how the wooresearch ‘industry’ works.

        In other words: “If you think Pharma is corrupt, then using the same strategies, you must be too.”

    • Amy Tuteur, MD

      I’m not trying to demonize Big Pharma; I and my family have benefited in countless ways from their discoveries. Nonetheless, there have been major scandals involving withheld evidence and we need to be aware that there are often conflicts of interest that impede the dissemination of negative research results.

      • mostlyclueless

        “That means that we should approach midwifery/breastfeeding research the same way we approach Big Pharma research, alert for conflicts of interest and aware that the research was designed to reach a predetermined conclusion. That doesn’t mean that all midwifery/breastfeeding research is wrong; just like Big Pharma research, there is plenty that is correct. But no one should think that either is real scientific research.”

        I actively participate in “Big Pharma” research that is indistinguishable from the work I do that is funded by the NIH. It is definitely real scientific research. I agree that an additional layer of scrutiny is warranted when conflicts of interest are present, but that’s a far cry from dismissing the study as “designed to reach a predetermined conclusion.”

        • Sue

          This is what a lot of anti-scientists – including antivaxers and others – don’t understand. A COI does not automatically invalidate the work – it means that additional scrutiny is required.

          ALmost every researcher has some form of COI – even if it is just keeness to publish a new finding. COnclusions often buff-up the findings.

          But that’s why research is published – so an informed readership can analyse the methodology and how the numbers were crunched, how the data were distributed, whether the results justify the conclusions and, importantly, whether the fiindings should contribute to a change of policy or practice.

          COmpetent readers of science don’t expect all published studies to be equally valid – they have the expertise to critically analyse them. That’s what journals, journal clubs and presenting work at conferences are all about.

  • BeatriceC

    MK update: they are in the middle of the scopes. They can’t reach the spot in his small intestine where the CT spotted the mass, but they did find another very small mass in his colon. The doc just popped out to get updated consents signed to remove it and send it to the lab.

    • PeggySue

      Whoa. At least it sounds as if something information will be available in the next days. Hang in there.

    • Charybdis

      He made it through the prep, then. ;P

      I’m glad (in a way) that they have found something in the colon; they can remove it, send it off for histo and find out what it is. Then you might have a better picture of what is going on. Do you know yet if they are still planning on exploratory surgery for the mass in the small intestine?

      Hang in there. Hopefully this will provide answers instead of more questions.

      • BeatriceC

        She wants to wait for pathology to come back on what they removed today. There’s some sense in that. But now she’s talking ten days not three months.

    • Dr Kitty

      Best wishes for a speedy diagnosis!

      I was just thinking…
      If your Paeds team couldn’t cope with MK trying to leave, I don’t know how they would have coped with my 16 year old Traveller patient who was told couldn’t go to her birthday party because she was too unwell.
      She wrecked the joint…which is impressive for someone with severe Cystic Fibrosis…

      • BeatriceC

        Yeah, they would not have handled that well at all. So they removed the thing in his colon and gave me some pictures. She said it’s a polyp, which could be “good” news, but maybe not. It’s not “small”. That sucker was about 1.5 cm long. The lower portion of his small intestine is inflamed, but nothing they could find to explain that. She doesn’t think that it explains his symptoms. Pathology will take about a week, and she’s going to have her office call me to set up an appointment for the following week.

        • Irène Delse

          Well, a polyp is something for pathology to chew on (metaphorically).

    • Kelly

      I am so glad that they are moving forward with this. Sometimes I think the waiting is the worst part of this. I really hope they find something to explain all his symptoms.

  • Cartman36

    OT – I just started Joan Wolf’s “is breast best”. It’s a slow read for me because it’s so technical but the book is awesome! I keep wanting to stand up and applaud when I finish a chapter

    • guest

      I got rid of all the pregnancy/childbirth/childrearing books I had when my kids turned one – except that one, that book from the 60s with all the fetus pictures, and one book about twins that was more fluffy than advice-giving. I’ll never breastfeed again, but I figure someday I’ll be able to give it to someone on the fence who really needs it.

    • Deborah

      I was like that with Courtney Jung’s “Lactivism”. I wanted to go out and buy hundreds of them to give out to patients and leave a few discreetly placed copies in bedside lockers like Gideon’s Bibles. (We are BFHI)
      “Lactivism” should be required reading for midwives and anyone involved in the care of mothers and babies.

    • Anne Catherine

      Suzanne Barston’s “Bottled Up” is really good too–I think that it’s the best of the bunch. Well —Joan Wolfs was different than than the other two –like you said— really technical –I had trouble reading the whole thing–my attention span isn’t all that good!!! But it was really well done.