Daring to question the benefits of breastfeeding


I usually write for lay people, but this post is directed specifically to medical professionals including pediatricians, obstetricians, midwives, postpartum and neonatal nurses.

Whenever a medical professional dares to question the exaggerated benefits of breastfeeding, or attempts to discuss the deadly risks of aggressive breastfeeding promotion such as hypernatremic dehydration or infant falls from hospital beds, he or she is shouted down by appeals to authority. Specifically, lactivists point out that breastfeeding is considered the standard of care by a variety of professional organizations.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Medical recommendations, including recommendations from professional societies, have been wrong in the past.[/pullquote]

It’s happened to me and I’ve seen it happen to Christie del Castillo-Hegyi, MD who has been working tirelessly to alert both parents and professionals to the risks of aggressive breastfeeding recommendations. She’s consistently shouted down by the insistence that if the AAP or the WHO recommends something, it is beyond questioning.

That’s both dangerous and unethical.

Medical recommendations, including recommendations from professional societies, have been wrong in the past. That is why it is critical to be able to question medical recommendations.

When I finished my OB-GYN residency, the standard of care was giving hormone replacement therapy (HRT) to all women. It was going to prevent heart disease and osteoporosis, with virtually no side effects. When I practiced at a large HMO, HRT was considered evidence based medicine and whether or not all post menopausal women were placed on HRT was considered a parameter for evaluation of physician care.

HRT had become the standard of care despite the fact that even at the time there were many people who questioned whether the benefits had been thoroughly documented. I can remember discussing it with a colleague who was also just out of residency. We agreed that by the time we were menopausal, we would truly know about the risks and benefits of HRT, as opposed to merely accepting preliminary data. Moreover, there were some, including breast cancer surgeon Susan Love, MD, who worked at my institution, who warned that HRT would increase the risk of breast cancer; few people paid any attention since HRT was standard of care.

Everyone “knew” that HRT was a good thing and naysayers were shouted down and silenced. We now know that the naysayers were right. We will never know how many women we harmed despite our best intentions.

I learned something very valuable from that experience: we should not silence naysayers.

Why did HRT become a standard of care despite weak evidence of benefits and plausible suggestion of serious risks? There was another player that everyone ignored, manufacturers of HRT. They pushed very hard to publicize the benefits and ignore the risks.

Why is breastfeeding the standard of care despite weak evidence of benefits and plausible suggestions of serious risks? There’s another player operating here: the breastfeeding industry, which has lobbied aggressively to promote weak evidence of benefits and suppress evidence of risks.

There is no doubt in my mind that over the next decade breastfeeding recommendations will be modified extensively in light of the actual scientific evidence, instead of basing recommendations on wishful thinking on the part of the industry.

Censorship in science is incredibly harmful. Censoring those who criticize the current standard of care is unethical. The benefits of breastfeeding have been grossly exaggerated, and the risks suppressed.

I don’t agree with everything that Christie Castillo-del Hegyi and other critics claim, but I strongly support the need to listen to them and anyone else who has plausible reason to question the aggressive promotion of breastfeeding.

They physicians who promoted HRT for all post menopausal women believed they were doing the right thing. They believed it every bit as fervently as breastfeeding advocates believe in the promotion of breastfeeding. But we shouldn’t forget that they are wrong and that breastfeeding advocates may be wrong, too.