Another day, another opinion piece overselling breastfeeding

Ethiopian woman takes water from a well

There once was a time when all babies were breastfed … and they died in droves

You might think that people would reflect on this before promoting breastfeeding as a lifesaving panacea. Sadly, you would be wrong.

There’s an appalling presumption that only Western, well off, mostly white women know how to do breastfeeding right.

The latest example, Breastfeeding Could Save 800,000 Children a Year, appears under Nicholas Kristof’s byline but was written by Aneri Pattani, “a freshly minted graduate of Northeastern University, is the winner of Nicholas Kristof’s annual win-a-trip contest.” She visited Nigeria.

She certainly means well:

While traveling around Liberia, I discovered a super-medicine. In a world full of intractable health problems, it’s a low-cost, practical and easily administered substance that saves children’s lives like almost nothing else.

… I’m talking about breastfeeding.

Breastfeeding is a foundation for good nutrition. It reduces child mortality by providing protection against illnesses like diarrhea and pneumonia, which kill 1.4 million children each year. In fact, by implementing proper breastfeeding practices alone, we could save the lives of 800,000 children a year in the developing world, according to estimates from the medical journal The Lancet.

Yet nearly all those children die in countries that have HIGH breastfeeding rates. Virtually none of them occur in places with clean water and easy access to infant formula.

Consider the United Kingdom where lactivists endlessly bemoan the low breastfeeding rate:

Only one in every 200 children here – just 0.5 per cent – is breastfed until the age of 12 months, placing us bottom of a global league table published in The Lancet medical …

The latest infant mortality rate in the UK — 3.6/1000 — is the lowest ever recorded.

Compare that to Liberia where over 98% of babies are breastfed for some portion of time. The infant mortality rate — 54/1000 — is 1400% higher than in the UK.

Why such a massive difference? As is distressingly typical in the neo-liberal accounting of health, Pattani blames mothers:

Myths and traditional customs often contradict best practices for breastfeeding… [M]any are also given water or solid food when they are young.

Yei Vahn, a 39-year-old mother of 12, told me she’d been giving her youngest son, Arthur, water since he was 4-months-old. “I noticed he would cry a lot when it was very hot outside, so I gave him water from the well,” she said. It’s a habit she developed while raising her 11 older children, and one that she passed on to her daughters as well.

The problem is, it is a dangerous practice. Giving a baby water, especially when it’s not boiled, can introduce harmful pathogens into the child’s system, leading to illness or death. That’s the most obvious problem, but not the only one.

It seems never to have occurred to Pattani that the traditional customs she decries might reflect very real problems with the adequacy of breastfeeding. Pattani is in good company. Though exclusive breastfeeding beginning within an hour of birth is aggressively promoted in industrialized countries, there’s no evidence that indigenous or ancient peoples followed what are now deemed to be “best practices.”

Pre-lacteal feeding (giving substances in addition to or instead of colostrum) is practiced worldwide. Indeed:

Colostrum avoidance has been reported across the globe, in varied places such as India, Nepal, Bangladesh, Indonesia, West Java, the Philippines, Vietnam, Thailand, Bolivia, Guatemala, Guinea-Bissau, Nigeria and Tanzania. Using the term ‘delayed breast-feeding’, Morse et al. found that fifty of 120 cultures described in the Human Research Area Files ‘withheld’ colostrum.

Obviously we cannot know the original reasoning behind the practice, but odds are high that it reflects the fact that 5-15% of women (or more) have insufficient or delayed production of breastmilk. Without supplements, those babies would have died of dehydration. With pre-lacteal feeds, babies lived who would otherwise have died. Over time, that observation was transmuted into a belief that colostrum was harmful and supplements were lifesaving.

The same reasoning may apply to supplementing breastfeeding with water or other substances. The mother quoted above (who has 12 children) explained that she supplemented with water because her baby cried for it when it was particularly hot. In other words, he appeared to her to be dehydrated and she couldn’t produce enough milk to prevent dehydration.

But Pattani, like most of those who promote breastfeeding as lifesaving, ignores reality in favor of blame:

The challenge for breastfeeding in very poor countries is not so much the use of infant formula, which is more of a problem in nations just a bit better off. In the poorest countries, very few have the money to buy formula.

Rather the problem is that breastfeeding isn’t done quite right. Moms delay breastfeeding after birth. They offer the baby sugar water or tea, cassava or fruit, well before six months — or they stick to exclusive breast milk too long.

A mother who has breastfed 12 children, comes from a culture where 98% of babies are breastfed, and has never been influenced by formula manufacturing isn’t doing breastfeeding quite right? Apparently only Western, well off, (mostly white) women know how to do breastfeeding “right.” The presumption is appalling.

No one seems to see what is right in front of their faces: it isn’t mothers who are deficient, it is breastfeeding. It is simply assumed that Liberian mothers who supplement are ignorant when the reality is more likely to be that breastfeeding is not the perfect process that lactivists pretend. Breastfeeding, like conception and pregnancy, is very imperfect. Infertility is far from rare and 20% of established pregnancies end in miscarriage. The rate of inadequate breastmilk supply may not be as high, but it’s high enough to cause significant rates of infant death. Supplementation is not an ignorant custom practiced by backward women, but a reasonable response to a very common problem.

Babies die because the water and other substances used for supplementation are contaminated (as they inevitably are in nature). Supplementation is a bad solution to a serious problem — insufficient breastmilk. Pattani, in company with most lactivists, simply assumes that all Liberian women could breastfeed exclusively, but choose not to do so. She further assumes that if women didn’t supplement (with contaminated water), their babies would be healthier. It is equally possible that their babies would be dead due to dehydration or starvation.

That’s why the Lancet’s claim that 800,000 lives could be saved each year if all women breastfed exclusively is both heartless and witless, not to mention unproven. The Lancet arrived at that figure by extrapolating from small studies. There is simply NO EVIDENCE that breastfeeding rates have any impact on infant mortality rates. And why would they? Breastfeeding didn’t prevent an astronomical infant death rate prior to the advent of sanitation, vaccinations and antibiotics. There’s no reason to think it would prevent astronomical death rates now.

The Lancet’s claim that breastfeeding could save 800,000 lives per year is wrong on so many levels. It is not supported by population data; it is not supported by historical evidence; and it is not supported by the fact that most babies die from causes that cannot be prevented or cured by breastmilk. But what bothers me most about the Lancet claim is its implicit medical colonialism: look at the poor women of color breastfeeding “wrong.” Watch their Western, wealthy (and mostly white) sisters “teach” them how to do breastfeeding right.

It is a terrible tragedy that Liberian babies are dying in such high numbers. But the truth is that they are dying for lack of access to formula made with clean water, lack of access to vaccines, lack of access to antibiotics, not from lack of access to breastfeeding. If we want to save those young lives we should send water purification facilities and clean water, vaccines and antibiotics, not lactivists pontificating about perfection of a process, breastfeeding, that is imperfect to a deadly extent.

  • Nick Sanders

    OT: A comic I sometimes read recently posted this, and I thought people here might get a kick out of it:
    http://www.smbc-comics.com/comics/1499009089-20170702.png
    Particularly the bonus panel:
    http://smbc-comics.com/comics/1499009105-20170702after.png

  • Amazed

    OT: Today, the Intruder and SIL returned after three days of absence. Amazing Niece who has cried a little for them a few times a day but otherwise spent the time playing happily with her grandparents, hurled herself at her mum and that was it. She would not climb down. SIL had to eat with Amazing Niece in her lap, my mother said.

    Sounds like quite an attached kid, IMO. Wonder how much more attached she is supposed to be according to the so called APs. Except for being so traumatized by the separation with her mom that she went into shock, I mean. Hardly a good thing but this is just me. Pretty sure SIL wouldn’t want THIS proof either. And we’re talking about the kid who is all Daddydaddydaddydaddy all the time. This time, Daddy didn’t even get a notice.

    Children get attached without being a permanent fixture at their mum’s side all day. Who would have thought!

  • Empress of the Iguana People

    OT: Hi, guys. A friend wanted me to post this here
    ” What is the relative risk of STD transmission in oral, anal, and vaginal sex?”
    S/he wants to know for academic reasons.

    • Dr Kitty

      For what population?
      Heterosexuals?
      Sex workers?
      The clients of sex workers?
      Men who have sex with men?
      Women who have sex with women?
      Prison population?
      In the USA? Europe? Globally?

      Which diseases?

      The answer depends on the question.

      • Empress of the Iguana People

        Hetero US couples with multiple partnerrs
        S/he wouldn’t mind just some appropriate links to look through themselves.

        • Empress of the Iguana People

          They can handle the science studies much more easily than I could!

        • Dr Kitty

          https://www.google.co.uk/amp/s/srconstantin.wordpress.com/2015/04/30/std-statistics/amp/

          I found this, which was interesting and gives per episode risk for various STDs.

          CDC has general statistics (search CDC STD) too.

          Not my area of expertise by any means.

          • Empress of the Iguana People

            Thanks, Dr. K. S/he’s lurking so I’ll probably hear back soon enough if s/he’s gotten what s/he is looking for.

        • Roadstergal

          I’m always leery of trying to apply overall statistical risks for such specific situations. They’re good for public health policy, but when it comes to 1 on 1 encounters… I mean, how well do you prepare for anal? How well do you take it? Any light bleeding during or after? How conscientious are you with condoms? With dental dams? Do you put on the condom only after preliminaries? Do you come on the face or is it swallowed? Etc etc…

          It seems like the best way to avoid STDs is to be as open and honest as possible, use protection, and stick to the lowest-risk sex possible with unknown partners (skip the anal and oral, do PiV with condoms on the whole time), but there are no guarantees.

          Speaking as a former sex worker now in an occasionally poly relationship who has managed to avoid disease so far. :p

          • Sarah

            Face is safer than swallowing isn’t it?

          • Roadstergal

            I’d think so. I mean, not wholly safe, as stuff is still getting into your mucus membranes, but you’re not swallowing a bolus…

          • Charybdis

            I once had my evil ex ejaculate UP MY NOSE.
            That was horrible.

          • Nick Sanders

            Part of me want’s to know, “How in the hell does something like that happen?”. A much larger part is loudly screaming, “Nope, NOPE! I am good, thanks! I can live without knowing. N-O-P-E!!”

          • Roadstergal

            *blorf*

    • mabelcruet

      Probably completely irrelevant, but one of my placentas yielded an interesting find. When we look at placentas microscopically, we take a membrane roll-cut a strip of the membranes from rupture point to the attachment to the disc, then roll it up like a swiss roll and take a slice for processing. Its great for showing us inflammation but also maternal blood vessels for various maternal vasculopathies.

      Anyway, we had a mum who was a sex worker and on various drugs and her pregnancy was high risk (because of the recreational drugs among other things) so the placenta got sent to us after delivery. I did my usual dissection, and on microscopy there was a creature present-insect type of some sort. My consultant (our version of senior attending doctor) had a huge interest in all sorts of insects as his father had been an entomologist, and he confidently identified this as Pthirus pubis, a pubic louse. I’ve never seen one before in a placenta, but it seems logical to find one there I suppose. We told the ward-they had been treating the mum as high risk anyway because of her IV drug use, but they went completely nuts about the lice. They are easily treated, but the midwives apparently hadn’t noticed them at delivery.

      • Empress of the Iguana People

        EGAD! EWWWWWW

        • mabelcruet

          This was years ago, and it was well dead, it had been pickled over the weekend in formalin!

          However, we did have cockroaches in the mortuary, and we put one of them into a pot of formalin. After two days it was still alive. I swear, when the Mango Mussolini has reduced the world to radioactive ashes, the cockroaches will still be there, waving their tentacles.

          • Empress of the Iguana People

            Hardy little beasts

          • fiftyfifty1

            “This was years ago”

            …must have been. I haven’t seen pubic lice in years. Probably because pubic HAIR is so much more rare than it used to be.

          • mabelcruet

            Nothing to hold onto anymore! My mother told me once about a hen party she was at years ago. They’d gone to see a bunch of male strippers and at the end of the show, one of the dancers threw his underwear into the audience where it landed on the face of one of her friends. A few days later the friend noticed tiny black specks in her eyebrows. She went to the GP and was diagnosed as having pubic lice on her face. I honestly don’t know if it’s true, but if so-YUCK!

          • Azuran

            The parasitologist in vet school once had an elderly owner who came in with small bugs she found in her bed sheet. She thought the dog had parasites, since it slept in the bed.
            Those where pubic lice… That resulted in a very awkward conversation.

          • maidmarian555

            That is quite possibly the grimmest thing I have ever heard! Bleeeuurgh!!!

          • Eater of Worlds

            Ticks also live for a long time without oxygen. They don’t die instantly in alcohol the way that other insects do. We’d often do that to squick pet owners out, the ones who wouldn’t bother to treat their dogs for ticks and we’d show them just how long they’d live without air. It almost always worked to get them to treat the dogs.

          • mabelcruet

            So covering them in Vaseline wouldn’t work? I’m sure I’ve seen that on YouTube, but come to think of it, maybe it was mangoworms? In any event, both are equally YUCK!

          • Eater of Worlds

            Basically, what we’re worried about is in the tick’s gut. As they feed, they burp up gut contents and that’s how we get things like Lyme disease and Rocky Mountain Spotted Fever. Some also have things like Lyme spirochetes in their spit, not just their gut so removing asap is more important. Covering with vaseline and waiting for them to drop off means prolonging the time they are attached, which means improving your chances of getting one of the various diseases (or your pet getting it). Burning the tick off with a match, putting gasoline or kerosene or vaseline on the tick just increases the chances of the tick hurking its gut contents into the bite it made in your body. Squeezing or pinching the tick will also make it puke its guts. Use tweezers and pinch the head or use a tick removal tool http://organicdailypost.com/tick-removal-tool-reviews/

            It’s more important to remove the tick without squeezing than it is to worry about leaving a mouth part embedded in your skin. That will fall out on its own without causing infection. The tiny ticks (young ones in the nymph stage of growth) are hardest to remove because of their size and are most likely to barf into the bite, so use a tick removal tool on them instead of tweezers. This is a cheap and good tool http://www.lymefight.info/avoiding-a-tick-bite/how-to-properly-remove-a-tick/ The tick removal tools work like the nail removal end of a hammer, you slide the tick towards the tightest spot of the v shape and pry up the tick. http://www.lymefight.info/product/tick-removal-kit/ has a magnifying glass attached to it so you can easily find the head of the nymph. I also like tick keys, you can even keep one on your dog’s collar they are light and durable https://www.amazon.com/Tick-Key-Products-TickKey-Remover/dp/B000R1D3KQ

            And this is why some tick removal products have a plastic magnifying glass sold with them https://www.cdc.gov/ticks/life_cycle_and_hosts.html This shows the sizes of the ticks relatve to a dime.

            I can overload you with more information if you’d like!

          • mabelcruet

            Dear god, no more-I am completely squeamish when it comes to creepy-crawlies and spiders and anything remotely insectoid. I have recurring nightmares about earwigs-I got given some dried poppy seedheads once and as I was arranging them an entire army of earwigs crawled out and all over my hand-I screamed so loud my next door neighbour heard. I’m quite happy with decomposing corpses (I’m a pathologist) as long as there are no maggots!

          • Eater of Worlds

            I adored skinning specimens for collections preparation. The only thing that grossed me out were the rabbits. Every single cottontail that came into the museum were packed full of parasites. They all had cysticercosis. When you cut open the gut and went to pull the legs out (minus the feet, those you cut off at the wrist/ankle and left in the skin to dry) the tapeworm cysts would literally pour out of the body of the rabbit onto our work surface. We almost always ate while we did the skinning, no matter what we skinned. Anyway, after seeing the guts of those rabbits I swore off eating any wild caught rabbits. The thing is, you can pick out the tapeworm cysts and happily eat the rabbit if the infection isn’t at a pathological level. The level that I am talking about you don’t want to eat, but generally the only issue with humans is if you swallow the egg stage of dog tapeworms. That pretty much just happens if you’re a wildlife worker and you handle scat, and the tapeworm cysts I was talking about are not usually dog tapeworms, they are a generic carnivore tapeworm. Here’s a photo and more info, and this rabbit had maybe 1/3 of the amount of cysts of the rabbits we were prepping http://www.michigan.gov/dnr/0,4570,7-153-10370_12150_12220-26630–,00.html

          • mabelcruet

            Wonderful, thank you. However, I’m sure you’re an incredibly busy person so don’t feel like you have to post any more about creepy-crawlies. Please, pretty please-no more!!

          • Eater of Worlds

            Nah, I was hit by a car and my life pretty much ended. I have plenty of time to talk about disgusting insects. I can even look up stuff I don’t know just to fill you in. You’ll never know when an obcsure disgusting piece of information will help you with a diagnosis.

          • mabelcruet

            When I was a medical student, we had a 3 day teaching seminar on tropical diseases and parasitology. In the UK, we don’t have too many exotic diseases so that was all the training we had (and it was mostly on malaria). The lecturers who ran the course were visitors from the Liverpool School of Tropical Medicine, and they brought specimens with them-huge worms of various sorts and various other creatures. It was horrible-half the class were very strangely fascinated, the other half were trying hard not to scream and run away!

            It did come in useful though-I was once sent a specimen that a patient had brought into her family doctor, she’d passed it in the toilet and scooped it out and put it in a jar thinking she had worms. The GP simply sent it to the path lab with the clinical history ‘? worm’. Because of my training in tropical medicine I could safely say ‘No, its not a worm, its a strip of undigested carrot’.

          • Empress of the Iguana People

            undigested carrot?! omigerd

          • Roadstergal

            We use tick treatment on our dogs, but Latte has a fairly hairless lower belly and the inside of her rear legs, so every once in a while one manages to glom on. We check her whenever she comes back in the house, and when we find one, we pull it off with tweezers (by the head, as you note) and set it on fire. :p

            I like that tick key that you linked, though! I’m going to get a pair.

          • Eater of Worlds

            You really shouldn’t set it on fire. The reason is that when they pop, they really explode. You can then breathe in exploded tick, which is bad because of transmission of illness. Additionally, if your pet gets sick, you no longer have a tick to test to see what kind of illness it was carrying. Put it in an old medicine vial, the kind with a child “proof” lid, for thirty days after you remove it to make sure the pet doesn’t get sick with something. Or use one of the ziploc heavy duty bags (the freezer bags) and seal it tightly. It can take at least 30 days for symptoms of some tick diseases to show up.

          • Roadstergal

            Ugh, thanks for the tip. Is freezing it in one of those bags OK?

          • Eater of Worlds

            Freezing is just fine. Just make sure you freeze it for long enough, a half an hour or so isn’t going to kill the tick. I’d leave it for 24 hours and make sure no one decides to munch on it as a snack.

            My dog also has a hairless belly and he sometimes gets raw nipples from running in the brush near the house. One day I flicked off a black crusty thing from his nip, I totally thought it was a tick. It was just a scabby nipple that he got from rubbing against some brush or some dead tree stumps. I tell ya, though, it brought life to my withered old heart as I saw this black tick sized (and shaped) crusty thing on my bed sheets.

          • mabelcruet

            Speaking of scabby nipples, many years ago I lived with my boyfriend-he moved in with me and my cats. Both cats were big fat cuddlebums, both very placid and lazy. One day, the boyfriend got shredded by cat no 1. I asked what he had been doing to the cat to get that reaction-turned out the boyfriend had found scabs on cat no 1’s belly and was trying to scratch them off. I had a look, boyfriend had been trying to tweak off the cat’s nipple. He didn’t believe me when I told him male cats had six nipples, same as female cats.

          • Eater of Worlds

            I don’t know why people think that male dogs and cats don’t have nipples. HUMAN males have nipples, one for the baby and a spare, so to speak. My dogs are medium sized dogs and both have 9 nipples, they have an extra one for their size. They tend to have 7 pups, so they have 7 nipples and a spare plus their random supernumerary nipple. My dogs are related to each other (fathers are littermates) so not surprising both have an extra nip. Larger dogs or dogs that have a lot of puppies like labs tend to have 10 nipples. Cats tend to have 6, because they have 3-5 kittens (see, 5 and a spare!)

          • mabelcruet

            That was the reasoning I used with him-count how many nipples I have (female), and count how many you have…

            In humans, you can have supernummary nipples all along the milk line-basically a vertical line going down approximately from your standard chest nipples. As a pathologist, I’ve been occasionally sent skin lesions that turned out to be nipples-one from the labia and one from the foot stand out in my memory!

          • Eater of Worlds

            I’m one of those lucky extra nipple people but mine isn’t fully formed and it’s where you’d expect a nipple to be. I used to be an evolutionary biologist and you had no idea how many times I’d have to explain nipples and why we sometimes had extra ones (and also why they’d sometimes show up in the weird places you mentioned).

            The one thing I never did argue was evolution, because I said this was a biology class and we assume evolution to be true, if you wanted to argue against it do that in your theology class.

          • Nick Sanders

            I remember doing a google search on either “superfluous” or “supernumerary” nipples once that turned up a picture of a fully formed nipple on the underside of a grown man’s foot. I was baffled as to why he would walk on it rather than have it removed, because it seems like it would be extremely uncomfortable.

            (Before you ask, I wasn’t searching for any perverted reason, it had to do with a Simpsons quote)

          • shay simmons

            Sounds like plantar fascia to me.

          • Nick Sanders
          • AnnaPDE

            I wonder if it being touched feels the same as it does on regular nipples. Probably not, otherwise the guy would have had it removed in a hurry long ago.

          • shay simmons

            Gack.

      • Dr Kitty

        When I was working in paeds there was a long term inpatient (lovely child, special needs, medically fragile) who kept getting head lice from his siblings every time they would visit.

        Nurses who took everything else in stride were totally squicked out by the lice and that child was combed to within an inch of his life after every family visit (because his parents never did bother to treat the siblings).

  • Tigger_the_Wing

    These are not at all comparable:

    Only one in every 200 children here – just 0.5 per cent – is breastfed until the age of 12 months, placing us bottom of a global league table published in The Lancet medical …

    Compare that to Liberia where over 98% of babies are breastfed for some portion of time.

    0.0 per cent of my children were breastfed ‘until the age of 12 months’.

    100% of them were breastfed for ‘some portion of time’.

    Apples and square dancing.

    • shay simmons

      No kidding

      “Only one in every 200 children here – just 0.5 per cent – is breastfed until the age of 12 months, placing us bottom of a global league table published in The Lancet ”

      There are obviously other factors involved, but would the Lancet like to compare the UK and Nigeria’s infant mortality rates?

      • Tigger_the_Wing

        Indeed. It could be that babies in the UK are all exclusively breast fed for eleven months, and 98% of babies in Liberia are breast fed for thirty minutes, then put on a bottle. Or a goat teat. The way the two sentences have been phrased makes it impossible to draw any conclusions as to how much breast feeding is actually happening in each country; and, as you say, what about infant morbidity and mortality?

        • Roadstergal

          Plus, combo feeding is a very safe option in the UK and the US – not so much so where the water isn’t trustworthy. You can breastfeed ‘for some portion of time’ here much more safely.

  • The Bofa on the Sofa

    OT: I just saw this comment, and it reminds me of the tone trolls that we get here

    I have three things I’d like to say today. First, while you were sleeping last night, 30,000 kids died of starvation or diseases related to malnutrition. Second, most of you don’t give a shit. What’s worse is that you’re more upset with the fact I just said “shit” than you are that 30,000 kids died last night.

    http://www.patheos.com/blogs/unfundamentalistchristians/2017/06/christian-upset-wrong-things/

    It’s about what happens when we get upset about the wrong things.

    • J.B.

      Sounds like criticism of some politicians for theoccasional f bomb (so SHOCKING) while arguing that “we don’t know people will die without health care! HULK SMASH!

  • Sarah

    OT, but are any UK posters following the Charlie Gard situation? Desperately, desperately sad, but I don’t think threats to picket Great Ormond Street and publishing names and details of the treating clinicians is going to help anyone.

    • Empress of the Iguana People

      I can’t read the articles; the headlines are too sad and ppd doesn’t play well with these situations. Doesn’t the poor baby have something with a very high fatality rate? Weren’t the parents hoping for some experimental treatment in the US? They must be so very desparate. He’s an adorable wee mite for all his horrible luck.

      • Young CC Prof

        The child’s condition is terminal and the child is already on full life support, near death. The experimental treatment, even if it works, for which preclinical data is lacking, is unlikely to do anything at such an advanced stage.

    • EmbraceYourInnerCrone

      I think people need to let this be between the parents, the hospital and the court. He was born with infantile onset encephalomyopathic mitochondrial DNA depletion syndrome.

      He became ill and was hospitalized at less than two months. His disease is genetic, progressive and almost always terminal. He apparently has permanent severe brain damage and is on a ventilator as he can not breath on his own. His parts sued to be able to take him out of hospital and take him to the U.S. for experimental treatment. I feel so bad for his parents but I feel just as bad for the people who care for him every day.

      The people who work in pediatric intensive care are some of the bravest people I know and the people picketing have no idea what they are picketing. Threatening to doxx people who work at the hospital is horrifying.

      • Sarah

        Not just threatening, apparently names and details were given. That’s contempt of court so hopefully we see some prosecutions.

      • Cat

        I strongly agree with your first sentence. These kind of cases are emotionally and ethically difficult enough as it is – if, from now on, they’re going to have to be played out at the centre of a social media storm, then heaven help us all. Half the people yelling on social media don’t even seem to be aware of the basic facts of the case: I’ve lost track of the number of comments I’ve read which propose that the parents should just walk out of the hospital with their child and run off to the US with him (I’m following the case as a lawyer, not a doctor, but I’m pretty sure that that’s going to be hard if he can’t breathe by himself). I can’t see that all this can be helping the poor parents either. If they’re in denial about their child’s prospects – and, god knows, it’s more than understandable if they are – the last thing they need is the kind of “support” which just validates their belief that the doctors are baby-killers and their son is going to make a miracle recovery. Poor parents, poor hospital team and poor, poor little boy.

        • mabelcruet

          I’ve now seen some brain dead moron on Twitter post photographs of some of his imaging reports, claiming that the doctors are lying about his condition and falsifying the seriousness of it (undoubtedly for nefarious purposes of their own) because the report says ‘normal’. They could only have got these via the parents I think.

          • mabelcruet
          • Dr Kitty

            That scan report is from more than nine months ago.

          • Cat

            Some days, I just want to give up on the human race. Have they offered any theory as to why people who have dedicated their whole lives to treating sick kids would decide to let a baby die unnecessarily, just for the hell of it? Or is it just bog-standard anti-intellectualism/ anti-education/ “we know better than some expert” bollocks?

    • maidmarian555

      I think the idea that his doctors could be doxxed is horrifying. It’s a really awful case and I feel so badly for him and his parents. I’ve not read too much about it, I’m currently 26wks with #2 and I’ve found the whole thing upsetting.

      I do wonder if the Ashya King case has made people question decisions such as this one more than perhaps they used to. I mean, his parents were proved right in the end. They risked an awful lot legging it with their child out of the country in order to get him the treatment they wanted him to have and by all accounts it worked. That case was widely publicised and wasn’t that long ago. Even though the illnesses, circumstances and details all differ quite wildly, it’s sort of the same underlying theme, with parents wanting to try treatments not available on the NHS and then finding there are barriers in the way when they try and access them- even when they are able to pay for said treatment. I can’t imagine what it must feel like to have that last vestige of hope snatched away from you like that. It’s awful. But for other people to decide they need to picket Great Ormond Street? Or publish threats? What will that solve?

      • Empress of the Iguana People

        Who doesn’t want to believe their kid is the one-in-a-million who’ll survive?

        • swbarnes2

          Sadly, unscrupulous quacks can make a lot of money milking that sentiment.

        • Merrie

          I mean, if there’s any evidence whatsoever, and the kid will die anyway if you don’t try the experimental treatment, what do you have to lose? It would depend on what the treatment was and how unpleasant it would be, but being pretty desperate makes total sense.

          • Dr Kitty

            In the case of Charlie Gard, he stood to lose dignity and to suffer futile treatment and further pain to assuage his parents’ guilt about not trying everything.

            That is what multiole courts found in this case – that it can be unethical to try an experimental treatment on a terminally ill child with a very poor quality of life, if that treatment is highly unlikely to work, just for the sake of ensuring that all options have been exhausted.

            I have no doubt that the decision of the courts will exacerbate his parents’ distress BUT the decision was not about making their grief easier to bear, but about acting in Charlie’s best interest.

            The hospital is trying to do that now- prioritising his comfort and dignity and continuing his final care in familiar surroundings with people he knows around him.

            The clinicians caring for him are probably devastated too.

          • swbarnes2

            There’s only so much money. How many people could get good, long lasting health benefits using the money that will be spent to not touch this poor baby’s brain damage?

            Also, I’m having a hard time finding info on what American is offering the treatment. Sometimes in these cases, the parents are demanding access to expensive nonsense. There’s no reason anyone should be supporting enriching quacks. Desperate people are inclined to make bad decisions. That when society at large should protect them from themselves, and prevent dishonest people from taking advantage.

          • maidmarian555

            I think quite possibly the way that these cases are reported doesn’t help people understand that. One would have thought details like who is offering the treatment and what the treatment is exactly should be easy to find, the story has been in all the major news outlets here in the UK. The parents also raised over £1million for it, you would have thought that information would be easily found.

          • Sarah

            IIRC the court ordered the name of the proposed hospital in the US to be kept secret.

          • Heidi_storage

            I did read that the parents had raised money to fund the treatment, so the money spent was voluntarily given…although it probably wouldn’t have done the poor baby any good.

          • mabelcruet

            The proposed treatment was purely experimental, and had only been tried experimentally on a condition similar to the one Charlie has, not identical. And only tried in one case I understand. And the scientist suggesting this has since withdrawn his offer when he found out how severely affected Charlie was, so it’s no longer being offered, even at the cost of one million pounds plus.

            Charlie has severe irreversible brain damage. Even if there is a miraculous treatment out there that can restore mitochondrial function in his muscles and allow his muscles to work again, his irreversible brain damage will persist and he won’t be able to control his muscles anyway. Its horribly, desperately sad, but nothing short of a brain transplant is going to cure this child.

            The papers are full of ‘doctors playing god’ criticism, which is extremely unfair. If you believe in a deity, then doctors currently are mitigating the effects of his creation. This poor child will likely die within minutes of the ventilator being withdrawn. Do you really think it’s appropriate that a child this critically ill should spend his last few hours being hauled around the world for experimental and in all probability, useless treatment rather than spending time with his family receiving comfort care?

          • The Bofa on the Sofa

            The proposed treatment was purely experimental,

            If this is an “experimental” treatment in the US, then it should be supported by research funding. You can’t ethically charge patients to carry out experiments on them.

          • mabelcruet

            I’ve found it difficult to get any specific information about the proposed treatment, but it’s some form of nucleoside bypass therapy and has only been used in one human case which is different from the condition Charlie has. So I don’t know if the treatment is licensed for use for the condition the first child had, and so would be used unlicensed on Charlie, or if it was considered experimental on the first child. I’ve no idea where the costs of £1 million pounds come from, whether it’s treatment costs or the costs of medical transportation to get him there and paediatric ICU costs that he would have needed for ventilation whilst receiving treatment.

          • The Bofa on the Sofa

            Where do I go to donate? I mean, I don’t know what the money is for, don’t know where he is going or what they are going to do. Sounds like the exact type of cause I want to donate to.

          • mabelcruet

            This is the official court report of the judgment. The USA centre and doctor involved isn’t named, but the doctor gave evidence saying that he has never treated a case of the mitochondrial depletion syndrome that Charlie has, that there is no scientific basis to indicate any chance of success, that he doesn’t know if the substance he’s providing will cross the blood brain barrier, and that there is no realistic prospect of any improvement. The doctor himself is saying this, not the courts, and yet people are calling the GOSH doctors for murdering Charlie rather than send him for this treatment.

            http://www.bailii.org/ew/cases/EWHC/Fam/2017/972.html

          • EmbraceYourInnerCrone

            I believe the funds would have been mostly needed for medical transportation and round the clock specialized nursing care. Charlie Gard is on a ventilator, a vent would have to go with him and he would need a special medical transport most likely to be flown to to states.

            This is the story about the little boy in the U.S. who has a similar(but not the same and not as severe) mitochondrial disease.

            https://www.thesun.co.uk/living/3318065/arthur-olga-estopinan-arturito-charlie-gard-court-case/

          • Dr Kitty

            In context.
            £30million is the entire annual budget for GP services for the 1.5million people in Northern Ireland.

            Gard’s parent’s raised £1.3million through crowdfunding for a treatment that had no realistic chance of success.

          • AnnaPDE

            That says a lot about the NHS though.

          • Eater of Worlds

            No doctor is offering treatment. That’s because the doctor that did offer the experimental treatment was unaware that the child was as sick as he was. When the doctor found out how sick the child was he said he can’t offer the treatment, the child is too sick. He’d apparently always been too sick for the treatment when they sought out this doctor’s help, but had neglected to pass on that important bit of information.

          • Sarah

            There isn’t any evidence, unfortunately. There isn’t a doctor on the planet who’s come forward to say they think there’s a chance.

          • Eater of Worlds

            Even the doctor who offered treatment in the US said that he was unaware of just how sick the child was, and because of how sick the child was the treatment wasn’t going to work and he’s rescinding his offer of the treatment.

          • mabelcruet

            It actually clearly states that in the original court judgement in the UK, and again in the judgement of the European court-the doctor in USA (the same doctor who treated the boy Arturito Estopinan who has a similar condition, and who’s father is all over the papers and the TV calling the British doctors useless, cruel murderers who knew nothing) explicitly said that the treatment would not work, that there was no biological mechanism through which it would work for Charlie, that there was no benefit, that the treatment could not cross the blood-brain barrier, and that it would have no effect on his brain damage. But apparently this evidence isn’t enough for the British press, who think we should experiment on the infant anyway.

      • swbarnes2

        King’s case is much different. Ashya King had surgery for his tumor, then the parents wanted a different kind of follow-up treatment than the NHS would support.

        The surgery was the treatment that worked, not the proton therapy the parents left the country to get for him. He probably would have had the same outcome with the therapy the NHS authorized.

        • Heidi_storage

          You’re right that the cases are different, but I think maidmarian could also be right that this kerfuffle eroded trust in the court-NHS decision-making process. And it is probably not widely considered that the surgery was in fact the treatment that worked, and that follow-up with NHS-approved therapy would probably have had the same outcome; the bare, broad headlines are “Parents Arrested For Trying to Get Their Child a Different Treatment Vindicated; Child Is Now Healthy and Attending School”

          • mabelcruet

            I think a lot of the opprobrium is from those who struggle to accept that doctors can make a decision regarding a child’s medical condition without involving the parents. There seems to be this insistence that a child ‘belongs’ to its parents and only they can decide what happens, whereas the legal position in the UK is very different. And there is also this attitude that any sort of treatment, regardless whether it’s proven, unproven or entirely experimental is better than doing nothing. It’s this that concerns me most-it’s like people are saying ‘go on, inject him with whatever you want, he’s going to die anyway so you may as well experiment’, It’s unethical and goes against everything we are taught-primum non nocere, first of all, do no harm. Allowing him a peaceful dignified passing is better than subjecting him to useless and potentially harmful experimentation.

          • Cat

            This case has made me wonder whether some kind of compulsory medical ethics module in schools might actually be a good idea. I’ve been really disturbed by the number of people who don’t see the problem with subjecting a baby to medical treatment that, realistically, has no benefit for him, on the basis that it might be beneficial for other people. Also, about a third of the comments on the Daily Mail’s website seem to be along the lines of “how can they do this when assisted suicide is illegal in this country?” , which confirms my suspicion that most people who comment on the Daily Mail’s website have shit for brains.

          • Sarah

            Most?

          • mabelcruet

            That’s a good idea. A lot of schools do a GCSE (exam taken at age 16) in ‘Learning for Life and Work’, basically teaching them the fundamentals of being an adult, global citizenship, social justice, home economics, personal development. Medical ethics would actually slot in quite well-they do a module on economics, social funding, health and social care economics etc.

          • Dr Kitty

            Agreed.

            This why doctors are not supposed to treat our loved ones.
            Because when one lacks objectivity, bad medical decisions can easily be made.

            The idea that the next of kin always make decisions in the best interest of their loved one is patently untrue.
            As anyone who has spent time in geriatric medicine can attest.

    • Dr Kitty

      Oh good, now the Pope and the Apricot Autocrat have weighed in, and needless to say it has not been to support the findings of the courts and multiple objective medical experts.

      • Sarah

        I dunno, I think the Pope’s does. He said that although deliberate ending of life isn’t appropriate, it’s also not necessary to pursue every single avenue when there’s no real hope of success. That’s basically what the judges making rulings have said. The bit about his parents staying with him to the end is more ambiguous, I grant you, but the first part isn’t too different in principle to the Supreme Court justices.

    • Sarah

      The latest development- another court hearing today. GOSH gave the parents extra time to say goodbye etc after the last verdict, Charlie is still alive and now being given morphine, and the parents appear not to accept anything the clinicians are saying. Total circus.

      I recommend Joshua Rosenberg’s tweets for anyone wanting to know more. Next hearing is Thursday.

  • Cody

    OT but the placenta encapsulators are doing backflips right now to try and explain how infected placenta pills are not the cause of infection in that newborn that got sepsis twice.

    • Sarah

      Ew

      • Sue

        Or, in other words, Eeeeeeeewwwwww!

    • Um. What? Also, ew.

      • Cody
        • Well. That seems pretty damned clear. Also, still ew.

          • Cody

            You’d think so.

          • How could anyone argue with it? The strain of bacteria is identical from both, and the infections stopped when the mom stopped taking the pills.

          • Cody

            I’ve read a few comments where reading comprehension definitely comes into play. Some people are saying that the strains were different??? Not based on what I just read. Some people are saying this is just one small case and proves nothing. Others are saying she must have colonized the babe during birth. Others are wondering how the pills could have caused it, because ingesting infected pills couldn’t possibly, full stop.

            It’s concerning because these are the people that promote these services and prepare the placentas.

          • It is just one small case. It doesn’t “prove” anything, but you don’t fuck around with GBS sepsis in newborns either, and it’s strong enough evidence that at the very least you want to make sure you’re sterilizing any placenta going through your workspace. Regulations get written on less-strong evidence than this.

            But why would anyone involved in NCB/woo ever worry about actual safety or ethics in their services? They’re a business, like any other. Ethics are sacrifices made on the altar of making money.

          • Cody

            It’s enough proof for me.

          • EmbraceYourInnerCrone

            Not sure why they would be surprised, playing around with human organs in ones kitchen is stupid and dangerous and should be illegal. I work in a path lab and everything about these placenta encapsulating nuts makes me want to throw something. How are they not cross-contaminating EVERYTHING!

          • Cody

            You can’t autoclave a food dehydrator. Tattoo parlours could teach these people a few things.

          • Young CC Prof

            Dried food is dried at pretty low temperature. I know this because I have severe oral allergy syndrome, and although I can eat canned fruit, I can’t eat dried fruit, as it’s never heated enough to break down the proteins.

            If it’s not heated enough to denature sensitive proteins, it’s not heated enough to sterilize.

          • mabelcruet

            I was an expert witness in court this week. The defence expert claimed that the cause of death could not possibly be X because he had absolute proof. The proof turned out to be a case study in rats, not even humans. And then only 2 rats out of the group (of 20) had the result he needed to ‘prove’ that the person could not possibly have died of X. Even the non medically qualified judge, barristers and other court officials were looking at him like ‘You what??’

            It’s not just lay people deluding themselves if the evidence doesn’t give them the answers they want.

        • MI Dawn

          Oh. My. Dog.

    • Cody

      Apparently one small, old study that wasn’t done on humans is enough to prove the benefit of eating your placenta; however, one small study about placenta pills causing sepsis does not prove anything.

    • swbarnes2

      So how does the infection get to baby from mom taking pills?

      • Cody

        All she needed to do was handle a pill, and then touch her nipple. She’s likely breastfeeding so that’s highly possible.

        • swbarnes2

          Ah, that makes sense. I hope someone sues the shit out of the encapsulation company, though I fear the only one with standing is the mother, who clearly doesn’t give a damn about what happened.

          • mabelcruet

            If the placenta was infected, its possible that the encapsulation process didn’t kill off the bacteria during processing. The placenta was dehydrated using only gentle heat, not boiled at 100 degrees celsius, so the bacteria may well have thrived and multiplied in gentle heat, particularly with placentas being so full of yummy goodness for bugs to feast on. And that means that mum was getting a good dose of GBS with every pill she ate.

    • lawyer jane

      I can’t fathom that she was GBS positive, and yet thought it was a good idea to encapsulate the placenta! That probably spread germs EVERYWHERE.

      • Cody

        Oh no no. She was negative at 37 weeks. This means that it might not matter whether you test negative or not.

        • Young CC Prof

          The baby had a round of GBS sepsis immediately after birth, which means either the test was wrong or mom colonized after the swab.

          Here’s what I don’t get. Your baby is in NICU with a congenital infection, and it doesn’t occur to you that the placenta might be less than yummy?

          • mabelcruet

            She probably told herself it was a hospital acquired infection picked up after baby was born, and nothing to do with the placenta. After all, placentas are perfect in every way, they’re natural, don’t you know?

            TFIC, obviously.

    • Gene

      What the actual f*ck??? I just had a likely GBS sepsis kiddo. Scared my resident bad. GBS is not something to take lightly.

  • Sarah

    OMG, some privileged Westerner went to a poor country and had a revelation? How fascinating.

    • KQ Not Signed In

      You don’t even need to pair this with that one picture of Willy Wonka. I can already see it.

  • StephanieJR

    OT: I had one of those hypothetical thoughts yesterday; if you had a medium sized wish that changed the world, what would you wish? Nothing big like ‘Trump never got elected’ or ‘world peace’, but something like (my wish): all those awful tabloid newspapers (looking at you, Daily Mail) went out of business, or (my mother’s): anti-vaxxers stopped, changed their minds, and vaccinated their children. Stuff like global access to clean water, medical care, education, birth control; things we might already be working towards, but a wish could make it overnight.

    I imagine immediate cessation of lactivists would be a good one.

    What medium sized thing would you wish for?

    • MaineJen

      Replicators.

      Or, alternatively, a cheap, clean, safe, easily accessible source of power.

    • Empress of the Iguana People

      Easy access to clean water

    • lawyer jane

      Definitely access to long-term birth control for everyone! After that, free college. After that, better teacher training schools in the US and a nation-wide program to refuse to accept that any US child won’t learn to read and do math at a basic level by 10 years old.

      • Empress of the Iguana People

        Special ed teachers who talked in front of me generally *hated* the no child left behind rules. There are some for whom learning to recognize their own name when it’s written is a challenge.

        • Gene

          A family friend was a special ed teacher. She retired early after the school demanded she set better goals for her incredibly medically disabled children. Those for whom “he smiled and pointed at the sun today” was a laudable goal. I don’t know many teachers who like NCLB.

          • Empress of the Iguana People

            ‘Xactly. The vast majority can, and should be given every bit of help they need to do it, but to mandate “to refuse to accept that any US child won’t learn to read and do math” is to mandate the impossible.

          • lawyer jane

            I get all the criticism of NCLB but I think it’s unconscionable that we can’t manage to ensure basic literacy and numeracy for all kids without disabilities that make basic literacy unacheivable:

          • Empress of the Iguana People

            You left the more complex part out of your first message, and because the NCLB does also, i wasn’t sure you were aware of it.

          • lawyer jane

            Oh god no, the last thing I would want is to replicate NCLB and the punitive impact on teachers. Living in a city with a huge acheivement gap, I do understand much better now the need for testing, but the test shouldn’t drive the policies. It’s absurd to try to make the test do the work instead of focusing on how to actually make improvements.

  • Sue

    “Even when ​it lacks food, a mother’s body will deplete its own resources to produce enough milk for the child.”

    She’s saying that as if she believes it’s a good thing.

    And the iron-deficient breastfeeding mother? Produces an iron-deficient child.

    • Roadstergal

      Is it even accurate?

      We’ve evolved to shut down non-essential functions to preserve ourselves. Sorry, lactivists, but lactating is a non-essential function… I would think it’d be one of the first things to go? Much the way stress and/or starvation affects menstruation.

      • AnnaPDE

        I could notice the impact of having or skipping a large bowl of porridge in the morning on my supply in the first few months. And I’m a well-fed Western woman who has no qualms eating substantial amounts whenever she feels like it.
        I think this claim is simply a myth, basically another side of the “babies take what they need, and they only need a few drops” medal.

      • EmbraceYourInnerCrone

        It’s basic survival on the part of stressed bodily systems, in a low resource situation, which has the better chance of survival, the adult who can look for their own food and water sources or the completely helpless infant?

        • EmbraceYourInnerCrone

          Kind of like the saying on planes that if the oxygen mask drops on a plane, put your own mask on before putting on the child’s mask. Because if the adult collapses the child is probably not going to make it.

    • Breast milk normally is iron deficient. Babies are born with a month’s supply of iron, after which, they need supplements. And it’s not the only thing that breast milk lacks, either. Even enriched formula-fed babies get supplemental vitamin D.

    • Merrie

      It makes total sense that the mom’s body will deplete itself some, but not too much. From an evolutionary standpoint, mom’s body wants to try to keep her genes alive in a separate container (the baby) if possible, and will take on some amount of adversity to do that, but if it gets to be enough to threaten her, then it’ll abort that mission. She can have another baby later if she lives through the stress, but not if she dies.

      • Young CC Prof

        That’s basically what happens with inadequate calories during pregnancy or lactation, the mother’s body depletes itself to maintain the child only up to a point, then lactation ceases as the body concentrates on saving itself.

        Evolutionarily, it makes total sense to burn fat reserves to keep the growing child fed in the short term, maybe the hunting was just bad today and tomorrow it’ll be better. But weeks without enough food, that’s a famine, and the child is probably going to die either way, so better to stop sacrificing calories.

      • mabelcruet

        It makes sense from a ‘survival of the species’ evolutionary point of view. An adult female capable of reproduction is far more valuable than a new born in terms of resources having been spent. Sacrificing the young at the expense of the reproductive aged adults is common across all history and many species.

    • lawyer jane

      I think she has no idea that women will actually abandon children in this scenario to save themselves and their other children. (Not just talking about Africa – Europe also has a long history of this.) It’s a horrific Sophie’s choice, but to focus on breastfeeding still being possible as some kind of good thing? Ugh.

  • Luna

    Pattani is extremely ignorant. As recently as 25 to 30 years ago, pediatricians used to recommend starting with some solid foods at 4 months (not 6), and giving infants younger than 6 months small amounts water between breastmilk and formula to prevent dehydration in hot weather. The recommendation to exclusively breastfeed till 6 months is quite recent, and definitely post La Leche League. As one can clearly see, an entire generation survived on these so-called dangerous guidelines, so they couldn’t have been that bad. The problem here is contaminated water, not the act of giving water itself.

    • Spamamander, pro fun ruiner

      Only 24 years ago my midwife had me start my first child on cereal at 4 months because she just was a hungry baby. I went nuts nursing and moved to formula, and at 4 months she drank 40 oz a day. They also had me give water early on because we live in a hot climate, especially when I was just starting nursing.

    • Roadstergal

      “As one can clearly see, an entire generation survived on these so-called dangerous guidelines, so they couldn’t have been that bad”

      Given all of the emerging data that introducing common food allergens around the 4-6 month window reduces the risk of food allergies, I’m going to move from ‘not that bad’ to ‘pretty good.’ :p

    • As a matter of fact, the most recent recommendations have backtracked to four months to begin solids. In this, as in so much else, in a career spanning nearly half a century, I’ve seen theories come and go, sometimes more than once. Somehow, everybody manages just fine as long as common sense prevails. A breastfed baby cries from hunger: give supplements. A very hungry baby can begin some veg, cereal, and fruit earlier than one who is gaining weight satisfactorily on breast or bottle alone. (However, all infants need solids by a certain point)

    • maidmarian555

      I was told by my Health Visitor only last year to give my son cooled, boiled water to drink to keep him hydrated in the hot weather. And I live in the UK so we only have about 4 days of that during the summer months. I’d imagine mothers living in hot, dry climates would need to offer water in between feeds much more often than I did. You’re absolutely right that the issue with what she saw wasn’t the act of giving water in and of itself, it’s the potential contamination that the water harbours.

    • Mattie

      Interestingly there’s been some recent research arguing that any amount of water for babies younger than 6 months is harmful as it can cause hyponatremia, but IMO that’s a load of hooey. Small amounts of water aren’t going to do that, although breastmilk and formula are enough to hydrate a baby so you shouldn’t need to give water in addition to that.

      • Have you ever tasted cooled, boiled water? Most babies don’t like it. Even adding just a few drops of sugarless camomile or fennel tea to a bottle of water makes it tastier.

      • lawyer jane

        I had a newborn during one of the hottest summers on record and was told that it was OK to give him a few sips of water.

        • Empress of the Iguana People

          me too. ‘though in our case, we watered her formula a tiny bit, with her ped’s approval

      • Young CC Prof

        Basically, in most humans, the kidneys regulate the amount of electrolytes in urine to maintain the proper balance in the bloodstream. Newborn kidneys cannot do that, so drinking any substantial quantity of liquids that are lower or higher in salt than healthy breastmilk or correctly prepared formula can cause dangerous electrolyte imbalance.

        But they develop the ability, and when they are old enough to eat solids, they’re old enough to have a little water, too.

        • Busbus

          But what about very hot weather? At what age do babies start to sweat? Wouldn’t that change the equation? Just curious…

          • Young CC Prof

            Sweat consumes salt as well as water, so even in very hot weather, newborns need fluids WITH the appropriate level of salt. (Athletes in extreme conditions can develop low sodium, too, although in people with normal kidneys, that’s rarer than sports drink makers would have you believe.)

  • JDM

    A big problem with claims like the “breastfeeding could save 800,000 lives per year” is similar to one of the little-remarked problem with wrongful convictions: the real culprits are getting away because resources are being wasted on bogus culprits.

    • Sue

      If lactivist and “Mommy Bogger” sites were all closed down, and the potential profits diverted to providing nutrition, clean water and vaccinations in impoverished communities, millions of lives could be saved.

  • Roadstergal

    “The challenge for breastfeeding in very poor countries is not so much the use of infant formula, which is more of a problem in nations just a bit better off. ”

    A problem.

    What kind of shitwit do you have to be to visit a place lacking consistent access to clean water, and come away with the idea that clean, uncontaminated infant formula is a _problem_??

    • Chi

      A heavily biased shitwit who believes that formula is poison and leads to all manner of health problems in whatever babies eat it.

      In other words a rabid lactivist.

  • Mel

    OMG! Moms feed their babies food before 6 months! Oh, the horrors!

    The author seems clueless that three out of the four foods listed – tea, cassava and guava – are probably at least somewhat less dangerous in terms of microbial load that a surface water source.

    Likewise, if my options were to give Spawn water from a subsurface well or a surface water source, I’d pick the well. Many cultures have traditions involving where and how to do various hygiene things to attempt to protect water from sewage.

    Also, a overheated baby might not be able to keep down breastmilk.

    On a personal note, I’ve been giving Spawn a finger dipped into various liquid foods like butternut squash-carrot soup, tomato soup and applesauce since he three months old. His doctors could care less and he’s growing just fine….

  • namaste863@gmail.com

    I hope Allison Dixley finds this post. Her head will explode.

  • Amazed

    OT: Does anyone else think that the Crissy woman at Dr Amy’s Facebook page sounds dangerously unhinged? I am horrified that someone like this has access to patients.

    • Emilie Bishop

      Yeah, I hope she doesn’t stick around much. I mean, Brooke is obnoxious but harmless. Crissy and Iris are another level of troll.

      • Amazed

        I think she did a dirty delete when she was told that her nursing board had already been contacted about the insane behavior she displayed over there.

        I hope someone has a screencap. I have one but since I don’t know how to delete my personal information (I use facebook sparingly, and for work contacts mostly), I refrain from posting it here. I will send it to Dr Amy if needed.

        • KQ Not Signed In

          NOW I’m curious!

  • Young CC Prof

    Can you imagine what would happen if everyone STOPPED “promoting” breastfeeding, or researching the benefits, and instead poured all that money into actual research into the biology of breastfeeding? Maybe we’d have actual answers to why it fails. Maybe we’d even have treatments. I mean, infertility and miscarriage are also common, but at least we have some actual science there. When a couple has infertility, we can do tests to look for a reason, and hormone therapy or IVF is helpful in many cases. With miscarriages, we know that most are caused by karyotype errors, but some are caused by treatable medical problems.

    But in order to do that, lactivists would have to accept the truth, that far and away the biggest cause of suboptimal breastfeeding and/or early weaning is physical difficulty breastfeeding, that insufficient supply is not a question of perception, or predominately caused by doing it wrong.

    Breasts fail a lot. Shouldn’t we at least try to find out why?

    • LaMont

      Applying science to the female body is sexist, according to these lunatics. So, no we shouldn’t try to find out why, because our inner goddesses will all shrivel up and die in the shackles of patriarchal modernity.

    • Mel

      But that would take all the fun out of that, Doc!

      In the absence of a scientific understanding of lactation, the lactivists can give themselves a big pat on the back for earning breast-feeding brownie points through using the correct gnostic ideas.

      Once science shows that breast milk production is pretty heavily influenced by genetics – not forcing mothers to stick to bizarre breast-feeding schedules while eating the correct foods and interacting with their babies in the correct method – it removes the halos from the heads of lactivists.

      They don’t like that idea….

      • The Bofa on the Sofa

        Once science shows that breast milk production is pretty heavily influenced by genetics

        What do you mean “once science shows…” Jeez, that’s the whole friggin basis for the dairy industry….

        • Mel

          Oh, I know. But lactivists don’t like to think that bovine and human lactation is similar.

          They really freak out when I give them a study that showed that women will continue lactating as long as they have roughly 5 pumping sessions for a minimum total of 100 minutes a day.

          That’s no fun compared to telling women to pump 12x for ~20 minutes per pump for 240 minutes a day…

          • Emilie Bishop

            I know. What would the world be coming to if everything about our bodies and our children weren’t totally in our control?/s

        • kilda

          but if we point out to them that it’s genetic then they’ll go all eugenic on us, and say that babies whose moms can’t lactate enough are going to weaken the gene pool so we should let them die. I mean let them pass peacefully to wherever it is babies hang out before coming earthside.

          • Dr Kitty

            My grandfather was born six weeks early in 1898 and spent his early days literally wrapped in cotton wool in a shoebox by the oven being fed milk (I know not whether it was breastmilk, I suspect not) with an eye dropper.

            And yet, he was the only one of his family who survived WW1 and the holocaust.

            Eugenics forgets luck.

          • Tigger_the_Wing

            My husband was also born six weeks early, in 1955; he got almost identical treatment, except that his shoebox was in front of an open fire and they added tinfoil around the cotton wool.

            And yet by the time our own twins were born six weeks early, 95 years after your grandfather, there was a massive amount of modern technology to keep them alive and well; and an improvement on the equipment that was used on their premature older brother, ten years earlier.

          • Merrie

            The existence of formula has removed selective pressure on the ability to successfully breastfeed. People who previously would have had less reproductive success for that reason can now feed their kids formula. Similarly, those with pelvises that are suboptimal for vaginal birth, or difficulties conceiving or staying pregnant, can now access treatments to help them have healthy babies anyway. And those babies may grow up to be adults with the same problems and have babies of their own with medical help. So there may be an uptick, over generations, in people needing help with these biological functions. But I think the suitable answer to this is “So what?” The medical help is available, might as well use it, and there’s no reason to think that the people who are in need of help with these functions are not perfectly good human beings who contribute positively to the world. Then again, my definition of a worthwhile human being doesn’t include how well their body functions without medical assistance. I’ve got multiple friends for whom they and/or their kids wouldn’t have lived through pregnancy and birth in the wild, so it’s a good thing they don’t live in the wild then!

          • Sarah

            Tbh, the prevalence of wet nursing for centuries, millennia even, is likely to have gone some way to reducing selective pressure a long time before the existence of formula.

          • Steph858

            Yep. Because of course all those eugenicists would thrive living a hunter-gatherer lifestyle without any technology more advanced than whatever they can cobble together from the materials available in the natural environment. PS: Using knowledge gained through modern technology to determine plants’ edibility is cheating. PPS: The Printing Press counts as ‘modern technology’. Good luck playing Russian Roulette with all those delicious mushrooms!

        • Young CC Prof

          I really really really want to organize a dairy farmer convention and a breastfeeding medicine convention in the same space at the same time and just watch the total dissonance and confusion.

    • fiftyfifty1

      “Breasts fail a lot. Shouldn’t we at least try to find out why?”
      But should we really? I mean it’s an interesting question– I’m curious– basic science is important– unexpected benefits can come out of it, etc. etc. But failed lactation is a problem that already has an excellent solution: formula.

      • Azuran

        Yea, but that’s also kinda like saying that we shouldn’t invest in infertility treatment because there is adoption.
        Having solution to breastfeeding problems is good. If we can have real solutions to low supply, it will help women and babies. Same if we can properly predict and explain low supply. It would help women to have realistic expectation and maybe accept that exclusive breastfeeding isn’t going to be a thing.
        It gives information and options.

        • fiftyfifty1

          I think it’s different than adoption. Adult adoptees frequently search for their birth parents. But I have yet to meet an adult who was formula fed as a child who cares even a little. Do we really need a test to tell pregnant women their odds of having poor milk production? We wouldn’t if lactivists hadn’t hyped up breastmilk and scared women away from formula and told them that low supply wasn’t a real thing. Back before lactivism, it was common knowledge that low supply and late supply occurred, and it was common knowledge that if and when that happened, all you had to do was supplement and/or switch to formula. Problem solved.

          I can imagine a prenatal test. Realistically it will cost $100+. The test won’t even be able to say “yay” or “nay”, just “good odds” or “bad odds”. There are 4 million babies born each year in the US. Let’s say half of pregnancies get tested. That’s maybe $200,000,000 per year to make an unreliable prediction about an outcome that already has an excellent solution.

          So do I support research into lactation failure? Sure, but only because I think there is value in basic science research. You never know what you might learn. But if we do learn something of value, I predict it won’t be directly related to lactation. Instead I suspect it will help us elucidate fundamentally more important pathways (e.g. we might learn something important about insulin sensitivity, etc.)

          • Azuran

            It’s not so much about the kid caring than about the mother.
            I absolutely know that breastfeeding doesn’t give my daughter any significant benefits. However, I love breastfeeding and I find it extremely convenient. I would have been sad if it hadn’t worked out. And if, hypothetically, I hadn’t been able to breastfeed but there was a pill that made it possible, I would totally take that pill.
            Likely, it probably won’t ever be a thing. But being able to predict that someone might have problems, and maybe have some answer as to why they have problems, even if you can’t fix it, is a good thing.
            Telling women ‘who cares, just give her formula, problem solved’ isn’t really going to make it easier for any women to cope with lactation failure.

      • Young CC Prof

        That’s another point. The people who think breastfeeding is Really Important don’t do basic science research because they think that breasts are naturally perfect and low supply is almost always caused by bad thoughts. Other scientists don’t do the basic research because formula exists and works fine when used correctly, so they don’t consider lactation problems to be a high priority compared to, say, heart disease. Grocery stores don’t have heart substitute in a can.

  • moto_librarian

    Ms. Pattani: This is one of those times where stopping to think before writing, let alone publishing, a piece would have served you well. Your implication is that the women of Liberia are uninformed, even stupid. These women all breastfeed because there is no other choice, and you have the gall to claim that they are doing it wrong. This is peak colonialism. I feel embarrassed for you.

    Let me clue you in: Even in developed countries with easy access to nutritious foods, women still encounter primary lactation failure and insufficient supply. Is it really that difficult to imagine that malnutrition would have a detrimental impact on supply above the baseline? While you bemoan a mother giving her thirsty four month old water, you refuse to accept the fact that this child is not getting enough hydration/nutrition from breastmilk. Rather than delve into that question, you chide the mother. I’ll also state that while colostrum is indeed beneficial, it’s not magic. Vaccines for HIB pneumonia and rotavirus would have a huge impact on infant health, as would access to clean water and ample food. Get over yourself.

  • Zornorph

    I thought that mud hut super moms were the source of all wisdom? Odd to see some snotty-nosed member of the Breastapo sneering at them for doing it ‘wrong’.

    • MaineJen

      I would have loved to see the looks on those mothers’ faces as a 22 year old recent college graduate gently tried to correct their breastfeeding technique.

      • Mel

        That reminded me of one of the episodes where one of the Duggar girls who had a baby was in a Central American country as a “missionary”.

        The facial expressions of every adult woman who saw her was classic. An older woman saw her carrying her son is a fairly flimsy carrier, visibly shook her head and disappeared inside a home or store. She comes out with a length of cloth and ties it into a much better baby sling for a kid that size.

        Between that and the fact that their Spanish was so rudimentary that vendors would spend time correcting their accents, I was a happy, happy person.

        • MaineJen

          My favorite was when the family visited the UK…one of the sons asked a man they met what church he attended, and he replied that he was an atheist. You could practically hear the kid’s jaw hitting the ground.

      • Sue

        And a recent graduate of JOURNALISM, not a health care profession.

  • Emilie Bishop

    Also? This falls squarely in the realm of “Don’t give parenting advice before you’ve been a parent.” Yes, this is appalling medical colonialism, but it’s also good ol’ American I’m-23-and-I-took-this-class-at-college-so-I-know-everything bs. Go to the NICU at your nearest hospital before you write anymore, Little Miss Knowitall.

    • Sue

      Not to mention that her degree is in Journalism – not health care.

      • Emilie Bishop

        That too. As someone with an English degree plus some classes and work experience in journalism, let me be the first to say I’m not a reliable source of information on health care! Especially not from just watching people in another country go about their business!

    • Zen

      Not that you necessarily need to be a parent to dispense sound parenting advice: plenty of perfectly qualified pediatricians don’t have children themselves. Though they’re usually not walking around spouting nonsense like this chick. I am actually kind of embarrassed for her.

      • Emilie Bishop

        I agree. Teachers and experienced caregivers too. But she is none of these things, yet decides to make her first major published column about how breastfeeding moms in Liberia aren’t parenting right. Someday she’ll probably regret this–at least I hope so.

  • lawyer jane

    I also don’t know what to think about that last paragraph about the malnourished 18 month old! So breastfeeding in such harsh circumstances that it depletes the mother is supposed to be some kind of GOOD thing? It sounds like a desperate situation for everyone.

    • The Bofa on the Sofa

      Yep. One of the advantages we have living in a first world country is that we don’t HAVE TO breastfeed at 18 mos to nourish our kids.

      • Sue

        or to “deplete” the mother to keep the infant alive.

  • lawyer jane

    Is there any actual research on the risks of prelacteal feeds/early complementary foods in developing nations? I tried to look some up once but couldn’t find anything that seemed convincing. This is also something that seems like it could vary a LOT with the setting and the types of foods/liquids traditionally used.

    • Sarah

      I expect it would vary greatly depending on what was being fed and the water supply.

  • MaineJen

    She no sooner finishes informing us that “illnesses like diarrhea and pneumonia, which kill 1.4 million children each year” are common to the region, and then she tries to tell us that all this wonderful breastfeeding somehow…prevents these illnesses?

    Oh, but wait, the problem is that “Breastfeeding isn’t done quite right?” Let me take a wild #$%^ guess and say that ‘newly minted’ graduate Aneri Pattani has never breastfed a baby in her life. So now we’re practicing cultural tourism, huh? We’re picking the indigenous practices that suit our world view and selling them as panacea, and we’re panning the rest of the indigenous practices as ‘ignorant.’

    Pardon me while I vomit.

    • AnnaPDE

      She clearly hasn’t even held a baby yet. Otherwise she wouldn’t imagine that you can just ignore a thirsty baby’s crying and not give them something to drink – breastmilk, water, whatever is there really, just to make that screaming stop. That urge to satisfy whatever the baby seems to need is incredibly strong.

  • kilda

    So women in developing countries don’t breastfeed right, and most western women don’t breastfeed enough. Out of all the world, only a small subset of modern, western, crunch women is doing it right. It reminds me of those splinter religious groups who think that out of all the world, their small sect of 312 people in rural Northwestern Wyoming or somewhere are the only ones with the Real Truth that Jesus Intended.

    The patronizing way we look at women in other cultures is so exasperating. Are they backward savages who don’t know how to breastfeed? Or pure souls with the wisdom of the ages?

    • MaineJen

      Funny how, in all those cults, it always turns out that “jesus” wants the cult leader to be able to keep all the money and marry teenagers.

    • maidmarian555

      My mum is in one of those cults. They’re slightly more generous and believe that about 2 million people will be saved come the Apocalypse. Basically them and ‘some Jewish people’ although they aren’t entirely clear what the actual criteria for being saved if you’re Jewish is. They originally believed the apocalypse was coming in the 70s and have been coming up with increasingly bizarre reasons for the delay ever since. Delightful bunch.

  • The Bofa on the Sofa

    There once was a time when all babies were breastfed … and they died in droves

    You might think that people would reflect on this before promoting breastfeeding as a lifesaving panacea.

    I don’t know why you’d think that. It’s not like anyone ever pays attention to such things.

    I’ve mentioned this example previously. “Traditional Chinese medicine.” You hear about all the great potential benefits. But if you look at rural China in the early 20th century, you know, the place where they would be using “traditional Chinese medicine” if there ever was one, the life expectancy was 25 for men, and 24 for women. Women were dying from homebirths. That is not a great endorsement of TCM.

    • EmbraceYourInnerCrone

      Traditional Chinese medicine was heavily promoted by Mao’s government in China due to a lack of doctors in the years immediately following the revolution:

      http://www.slate.com/articles/health_and_science/medical_examiner/2013/10/traditional_chinese_medicine_origins_mao_invented_it_but_didn_t_believe.html

      From a 1950 speech by Mao: “Our nation’s health work teams are large. They have to concern themselves with over 500 million people [including the] young, old, and ill. … At present, doctors of Western medicine are few, and thus the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine. (Translations from Kim Taylor’s Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution.)”

      So they encouraged people especially rural people far from medical doctors and hospitals to use “traditional” cures (think willow bark tea being used for fever and headaches in colonial america) Because they HAD nothing else available!

      From the Slate article: “For thousands of years, healing practices in China had been highly idiosyncratic. Attempts at institutionalizing medical education were largely unsuccessful, and most practitioners drew at will on a mixture of demonology, astrology, yin-yang five phases theory, classic texts, folk wisdom, and personal experience.”

      • Zornorph

        Hey, I read those Clan of the Cave Bear books – Willow Bark tea cures EVERYTHING!

        • EmbraceYourInnerCrone

          In that case can I get some? might work on my migraines! And it could, but I’ll take my nice doctor prescribed meds instead.

          • Zornorph

            Read the books – Jean Auel shares the recipe once every fifty pages.

          • MaineJen

            I kind of skimmed over those parts…

          • EmbraceYourInnerCrone

            Some willow bark tea that is…

        • MaineJen

          Also pedophilia, if I remember those books correctly :/

          • Charybdis

            Pedophilia cures EVERYTHING!?? /sarcasm
            ;P

          • MaineJen

            Oh geez, no. 🙂 But pedophilia does factor into those books, disturbingly enough…

          • kilda

            weird, I don’t remember that part at all. I do remember lots and lots of paleolithic sex scenes, but only with grownups.

          • MaineJen

            I’m speaking of the “deflowering” ceremonies…

          • Charybdis

            Random semi-related thought…
            I’ve always hated the phrase “lost your virginity” for a number of reasons. Mainly because “lost” implies that it can be found again, maybe under the couch, in a winter coat pocket. or tucked away in the back of your sock drawer. You know, you’ll discover it someday during a move or spring cleaning or some such: “Holy CRAP!!! That’s where my virginity was! I lost it a long time ago and thought I’d never see it again!”
            Every time I hear that phrase, I can’t help but think about a search party being formed, posters being put up and your Mom saying “Well, where did you see it/have it last? Look there first!” and “It’s not up to me to keep track of your stuff!”
            We need a better word than “lost”. “Donated”, maybe? “Abandoned”? “Relinquished”?

          • Tigger_the_Wing

            “Escaped from”?

          • Zornorph

            I really wouldn’t call that pedophilia so much as Auel trying to accurately depict cavemen. They did have sex really young, after all.

          • MaineJen

            Well that’s true, but they only lived until age 20, so that makes sense 🙂

        • Which is why, in 1904, the Bayer company isolated the active ingredient, acetosalicylic acid, and patented it as Aspirin. (Capital A. Only the Bayer product is legally allowed to do so)

          • The Bofa on the Sofa

            1) Acetyl, not a aceto
            2) the active ingredient is just salicylic acid; however, it is a bad irritant so Bayer converted it to the milder acetic ester, which hydrolyzes, in part, to the acid; however, the ester itself is also an analgesic

      • The only real problem with “traditional Chinese medicine”, besides that it doesn’t work, is that most of it isn’t very traditional; even acupuncture only goes back a century or so.

        Maybe we should return to bloodletting. That was wildly popular for centuries, if not millennia as a cure for everything.

        • Sue

          Interesting that you should say that, because some people say that acupuncture, as practiced in ancient times, WAS bloodletting.

          There wasn’t the technology to make immensely fine stainless steel needles – the “needles” they used were make of other metal shards and even sharpened bamboo, used for cutting rather than tiniy skin piercings.

          Hence the irony of current-day acupuncture outside China being justified as “the Chinese have used it successfully for thousands of years”.

          Incidentally, there is also no real “acupuncture anaesthesia” – lots of surgery is done under local or regional anaesthesia, sometimes supplemented by intravenous sedation, with acupuncture just for show.

          https://sciencebasedmedicine.org/acupuncture-doesnt-work/

          • The Bofa on the Sofa

            Yeah, the first time I read about the “thousands of years” crap about acupuncture, it made me laugh. They were talking about “spokes” and things like that. I was like, what does that have to do with acupuncture? Needles =/= spikes

  • AnnaPDE

    Thanks for taking apart that article, it was really needed.

    “But what bothers me most about the Lancet claim is its implicit medical colonialism: look at the poor women of color breastfeeding “wrong.” Watch their Western, wealthy (and mostly white) sisters “teach” them how to do breastfeeding right.”

    Can I just add:
    And watch how those primal, un-adulterated, un-medicalised, un-industrialised child-related practices held by the poor women of colour are classified as ignorant and dangerous when they don’t reflect the white sister’s preferred ways. As opposed to the primal, un-adulterated, un-medicalised, un-industrialised child-related practices that agree with the white sister’s ideas, in which case that woman of colour is the custodian of sacred knowledge that everyone should marvel at and strive to emulate. Even if said woman of colour would choose very differently if she had the opportunity, e.g. not have a home birth if there were hospitals available.

    • Dr Kitty

      Indeed.
      Lots of praise for African baby wearing (which anyway isn’t so much about being responsive to baby’s needs, as about keeping mum’s hands free so she can do whatever she needs to do).
      No so much the spanking and shouting which are the cornerstones of many African culture’s child discipline, nor the cultural expectation that from toddlerhood kids entertain themselves, do whatever chores their parents need doing and don’t complain.

      • Zornorph

        You know, it’s funny, every now and then I read a novel about cavemen or some other ‘noble savage’ like society. And the authors (if they touch on it at all) nearly always say that the parents don’t spank and have some wonderful new age way of disciplining their children. I just laugh and wonder if they actually believe that was true.

        • Empress of the Iguana People

          I mind less in a lot of books I read; the protagonist is clearly unusual in their new age wisdom. They may be more connected to nature or something, but since they’re also the only one who can talk to the fairies or whatever, I just suspend disbelief for the whole lot. Its the ones that’re supposed to take place in *our* world and some 8th century Brit is cooking squash that it annoys me.

          • MI Dawn

            What! You mean Richard III shouldn’t be smoking cigarettes, either? 😀

          • Roadstergal

            Only in the gritty reboot.

          • I believe the first English king to smoke tobacco — and he didn’t like it — was James I.

          • MI Dawn

            I know. I was just being funny.

          • Young CC Prof

            Plants exclusive to the New World: Tomatoes, potatoes, sweet potatoes but not yams, all peppers, squash, tobacco, corn, wild rice, chocolate, blueberries.

        • MI Dawn

          Yeah, they may spank less, or whatever. On the other hand, children learning through injury (a bad cut from a sharp knife, a severe burn from a fire, boiling fluid, stove) isn’t really how I wanted to raise my kids. Sure, they learn not to repeat the action. But it’s a rather harsh way to learn. Possibly appropriate for the culture, but not how I wanted to raise my kids.

          • Young CC Prof

            Spanking makes a whole lot more sense when there’s an open fire in your house and you really don’t have a good way to keep your toddlers out of it other than aversive conditioning.

          • Dr Kitty

            Yup.
            As well as open sewers, deep wells, rabid dogs, venomous snakes and insects, poisonous plants etc.

            There is no “safe” play area- you better yell at the toddler who tries to pet the snake.

          • The only real difference in the education of the primitive toddler and the Western one is that the latter doesn’t try to pet snakes, he tries shoving forks into electric sockets

            (OT: yesterday my three year old grandson demonstrated that he is more computer-savvy than his grandfather. Granted, that’s not hard, since my husband doesn’t even know what to do with a mouse)

          • Charybdis

            Sometimes it takes the harsh method for the message to penetrate their skulls. My 13 year old is one of *those*. Wouldn’t stop climbing out of his crib as a young toddler until he managed to fall and split his head open on the edge of his dresser. Urgent care visit, 4 stitches, a black eye and he never did it again.

          • Steph858

            You lucky sod! Mine managed to give himself 2nd degree burns by trying to grab daddy’s freshly brewed tea. Did that stop him from trying again before the bandages required from his last attempt had even come off? Pah! Course not. My son isn’t the sort to let such a minor setback come between him and his daddy’s oh-so-interesting tea.