I read a terrific new book this weekend, Bad Blood: Secrets and Lies in a Silicon Valley Startup.
John Carreyrou of the Wall Street Journal tells the story of Theranos, a company with a brilliant idea that promised a revolution in healthcare but ended up as a billion dollar scam that delivered nothing.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]When will we accept that the claims of breastfeeding advocates were always too good to be true?[/pullquote]
It reminded me of breastfeeding.
Theranos was the brain child of Elizabeth Holmes, who dropped out of Stanford at 19 to create it, a needle-phobe who envisioned running hundreds of blood tests using a single drop of blood drawn from a finger stick.
It was an idea that was too good to be true — literally. But Holmes would not, could not admit the truth even though it became clear early on that her vision was a physical impossibility. Despite what her engineers were telling her, Holmes doubled down again and again: 200 test results from a single drop of blood became 800; the number of companies supposedly using her test successfully multiplied while in reality no one was using it; most egregiously, she faked test results and offered those results as real. Along the way, naysayers were fired and silenced with iron clad non-disclosure and non-disparagement agreements.
Theranos was the healthcare version of “vaporware”: software announced with great fanfare, promising the moon to secure massive outside investment, but ultimately delivering nothing but misery and bankruptcy. Breastfeeding is another healthcare version of vaporware, promising extraordinary savings in lives and healthcare dollars, endlessly touted to secure ever larger outside investment, but ultimately delivering more than its share of misery and medical illness.
The claims about breastfeeding have always been too good to be true. It has been promoted as the “perfect” food for newborns when we know that nothing in nature is perfect. It has been promoted as lifesaving when we know that for most of human existence all infants were breastfed and they died in droves and though contemporary countries with the highest breastfeeding rates have the highest infant mortality rates. It was promoted to solve a problem that was fundamentally misrepresented. Babies died in Africa as a result of Nestle’s greed in encouraging African women to formula feed. But the problem was never the formula; it was the contaminated water used to prepare it.
The similarities don’t end there. Elizabeth Holmes had a wonderful vision of hundreds of tests from a single drop of blood and she was determined to “fake it until you make it.” She really believed that if she could dream it, she could make it happen. She would not compromise her vision merely because reality got in the way.
For the past 40 years or so professional lactivists have had a wonderful vision of every baby being breastfed and surviving until old age because of it. They really believed that if they could dream it, they could make it happen. They refuse to compromise their vision merely because reality gets in the way. The benefits don’t materialize and the risks keep mounting, yet they’re still trying to fake it until they make it.
Elizabeth Holmes sold many otherwise hard headed people on her vision to the tune of billions of dollars in investment. They believed in the dream; they wanted it to be true; and they were taken in by her lobbying efforts. Once a few prominent investors were on board, it was easy to recruit others. If former Secretaries of State Henry Kissinger and George Schultz were investing, it must be true! Others rushed to copy them.
Professional lactivists sold many healthcare professionals on their vision to the tune of millions of dollars. Lactivist lobbying initially swayed the World Health Organization and ultimately recruited the CDC, the American Academy of Pediatrics and the American College of OB-GYNs. If those eminent organizations were supporting breastfeeding, the claimed benefits must be true. Others rush to copy them. The Baby Friendly Hospital Initiative was created and welcomed into hospitals; it promised to increase breastfeeding rates and save money at the same time!
Elizabeth Holmes ran into problems early on; the product failed to perform. In response she began to fake results; testing blood on conventional machines back in company headquarters and wirelessly transmitting the results to her machines to make it look as though they were working. She continued to ignore the evidence brought to her by her staff that the product not only didn’t work but couldn’t work.
Breastfeeding advocates ran into problems early on; some women didn’t have enough breastmilk. In response, they began to lie, claiming insufficient breastmilk was rare when it is actually common. Then the touted benefits failed to appear. In response, they began promoting mathematical models which extrapolated weak, conflicting data riddled with confounders to make it look like the claims were true. Whenever new evidence appears that contradicts early claims, and it appears often, it is simply ignored.
When Holmes deployed her devices, they began to harm people by delivering faulty results. Holmes did not back down. She and her lawyers harassed and threatened the doctors and patients who complained.
Aggressive breastfeeding efforts are harming babies, increasing injuries and deaths from dehydration, jaundice and babies smothered in their mothers’ hospital beds. Professional lactivists have not backed down, dead babies be damned. Their organizations harass and demean founders and members of the Fed Is Best Foundation, accusing them of being in the pay of formula companies without even a shred of evidence to support those claims.
To this day Elizabeth Holmes maintains that her dream of hundreds of tests performed on a single drop of blood is possible and will happen. This despite the fact that she has been sanctioned by various government organizations, has seen her net worth drop from billions to zero, and may face criminal charges for fraud. She cannot be shaken from her conviction that merely imagining something is possible makes it possible.
To this day professional breastfeeding advocates repeat the claims of lifesaving benefits of breastfeeding without any risks. This despite the fact that babies have literally died from insufficient breastmilk and the closing of well baby nurseries, despite the scientific papers showing that most of the claimed benefits don’t really exist, and despite the utter failure to appear of touted improvements in lives and money saved. They cannot be shaken from the conviction that merely insisting breastfeeding is lifesaving makes it so.
One of the saddest incidents in Bad Blood occurs when Tyler Schultz, grandson of major Theranos investor George Schultz goes to work for the company. He quickly realizes Theranos is a scam that is harming patients. He quits, tells his grandfather what he’s learned and cooperates with the Wall Street Journal investigation. It destroys his relationship with his grandfather who refuses to believe that Holmes’ claims weren’t and couldn’t be true. Tyler Schultz is excluded from his grandfather’s 95th birthday party; Elizabeth Holmes is invited.
It remains to be seen how organizations and providers scammed by the breastfeeding industry react to the rising tide of data showing that breastfeeding saves neither lives nor healthcare dollars and may actually put both at risk. Will they reject the scientific evidence and the growing clamor from mothers of babies who have been harmed or will they accept reality that the claims of breastfeeding advocates were always too good to be true? Only time will tell.
On the topic of Theranos: What’s so great about being able to do hundreds of tests from a single drop of blood anyway? I don’t suffer from a phobia of needles, so I don’t know the ins and outs of what triggers it and and what kinds of steps can be taken to help sufferers when giving them vaccines/blood tests/etc. Which is why I’d like to hear from someone more knowledgeable about such things.
Since getting jabbed with a needle hurts, phobia or not, I can understand wanting to minimise the number of jabs one is subjected to. If I had to be tested for 10 different diseases/deficiencies/whatever, I would much rather have one needle go in and take the required amount of blood and have that blood split among 10 different containers AFTER it’s been taken out of my body rather than have to endure 10 different needles being inserted into me (either concurrently in different parts of my body, or consecutively in the same place). That makes sense; 1 owiee is preferable to 10 owiees.
But once that needle has gone in, what difference does it make (to either the needle-phobe or just the pain-avoiding wimp) whether it draws out a drop or a pint? Does the needle-phobe wish to mimimise the amount of time during which a needle is in their body? I was going to say:
“I regularly donate blood, and it takes all of 10 minutes to draw out a pint (500ml). Most blood tests can be done with 3ml of blood, though some need up to 10ml. Let’s overestimate slightly and say that a typical test will need 5ml; a single needle, in place for just 10 minutes, can take enough blood to perform 100 tests.”
But I guess for the severely needle-phobic that 10 minutes could feel like an eternity. I always thought that needle-phobes where scared of needles *going in* to their bodies; once in, a needle would be no more scary than a mildly annoying splinter. I’m willing to be corrected on this, though.
Or is it the place in which the needle goes? Is a needle going in to the inside of one’s elbow many orders scarier than a needle which goes in to one’s fingertip?
TL;DR: What’s the great benefit in mimimising the amount of blood taken (below the standard pint or so which I and many other blood donors regularly ‘lose’ without much trouble) anyway? Minimising the number of needles going in, sure, I get that. But that can be done anyway without needing to resort to expensive (if it even worked!) technology to reduce the *amount* of blood needed (as opposed to the number of times it needed to be taken).
It’s not just for needle phobic reasons – if a drop of blood at point-of-care-like testing systems can run multiple panels, it would be a literal lifesaver and revolution in time/processing costs/biochemical analytical requirements especially in resource poor nations, when looking at anaemia, electrolytes, HIV, BHcg, etc. So many of these countries DONT perform simple blood tests at all because it would require sending the tubes out of the region/country and not getting results for days to weeks – by which time the illness has progressed, or not
Like, i’m needle phobic but just get on with it, like most people do… what Theranos promised was SO MUCH MORE than avoiding needlesticks. I remember reading about her and her company when it just started as a medical student and i was so inspired and just… woah.
Now.. bloody hell. What a disappointment.
Thanks for that explanation. “Thanks to Theranos Tech, tests which used to have to be done in a faraway lab and which took weeks to get the results of can now be done on-site in a matter of minutes.” Makes a lot of sense as a boast. Which just makes me all the more puzzled as to why “From a single drop of blood” was the lie that Theranos decided to market itself with.
To me, that’s like if someone came up with a revolutionary new washing machine which could literally do all your laundry for you – as in EVERY step, from picking dirty clothes off your teenage son’s bedroom floor through to ironing, folding and returning the clean clothes to the wardrobe. And the inventor of this amazing device decided to market it with the slogan: “1cm narrower than its nearest competitor!” Like, who cares?
My medical team frequently have to fill six vials for blood tests, because I have complicated health issues. There is only one needle which has to be inserted into my arm; the other end is in something similar to the outside of a syringe, into which each vial (entirely empty, hence ‘containing’ a vacuum) is inserted in turn. And they don’t need to tie a tourniquet; in the three countries in which I’ve lived (UK, Ireland and Australia), they’ve been using velcro straps for decades.
There’s a video on YouTube which shows the process of drawing blood with such a device. Search ‘blood draw using vacutainer’.
I think I had a similar procedure done once (one needle going to a few different vials), so I was vaguely aware it was already standard procedure for doing multiple blood tests. Which is partly why I was so puzzled as to why “Only needs a drop of blood” was supposed to be such a big selling point. If your blood levels are so low that you can’t afford to lose an extra 50ml or so, you’ve got bigger problems to worry about!
It was capitalizing on peoples needle phobia I think. Also the ‘Look it’s revolutionary and new !!” aspect that seems to draw so many people, when people who know a field know that discoveries are made by multiple groups of people and then have to be independently VERIFIED. Multiple vials are needed because sometimes different types of tests are done by different labs in different locations, tests done for HIV, cancer, or parasites are different than tests done for genetic diseases or abnormalities (although DNA testing is often done if one is diagnosed with certain forms of leukemia, as some leukemia’s are strongly correlated with mutations to specific genes.) I am seriously skeptical that such a tiny amount of blood could get a valid, detailed result and kind of angry at this company for trying to sell something that is the medical version of magic beans…
Not to mention there are companies that have been actually working on testing machines like this…without making fantastic claims:
https://www.wired.com/story/theranos-diagnostics-business/
It would be great for medicine in countries without access to many labs/tests to be able to do point of care testing, but NOT if its going to be with a piece of crap machine that gets many false results.
tigger_the_wing important
Sorry, late to the party, but – it’s the whole process. Drawing a lot of blood through a vein has a higher chance of adverse events than a finger stick. You don’t need a trained phlebotomist for a finger stick.
Those specialized vacutainers cost money. Shipping them costs money. Every separate test costs money for the machine, the reagents, and the person running the assay. Getting a panel from a drop of blood has a lot of advantages.
I got a lot of blowback at the time for my opined skepticism of Theranos. I would have been happy to have been proven wrong, but here we are.
When I lost my milk supply, I got so much bad, unethical, and downright dangerous advice from lactation consultants that I could have sued for malpractice…if they were medical professionals. but they are not.
I always like the breastfeeding posts. I found this site 7+ years ago by Googling breastfeeding + skeptical. The tide really is turning.
Agree. It’s how I landed here too. So glad I did.
I think one of the problems with the alleged Many Major Benefits of Breastfeeding (MMBB) is that often even people who normally have good critical thinking skills somehow can’t apply those skills when it comes to breastfeeding. I don’t know about you, but I’ve seen it many times (one time, when I wrote on a science-friendly Facebook page about how breastfeeding studies are weak and conflicting and mentioned the PROBIT and Colen studies, I got accused of… cherry picking). I think there is a “skeptical continuum” on which breastfeeding is very close to the “skeptical” end. It also doesn’t help that most (?) science advocates don’t even touch this subject even though it’s so full of b***it bordering on altmed (e.g. using breastmilk for eye infections). And all institutions insist MMBB are real, so it’s difficult to argue with people who use the argument “from institutional authority”. What do you think?
Every single day I hate the fact that the same institutions promoting vaccination (legitimate) are claiming MMBB (illegitimate).
It makes me question their scientific abilities and integrity, and go conspiracy theory-ish. I should 100% trust them, but I can’t. And I hate it.
Exactly. I find it uncomfortable to cite e.g. WHO with regard to vaccines, knowing how scientifically accurate they can be about women’s reproductive health or acupuncture. What else are they getting wrong? It’s sad because such institutions often have very good quality information on many important issues, yet they lack, as you say, integrity.
I’m basically to the point where I no longer consider the WHO or UNICEF reputable sources. The AAP and ACOG are working their way there as well. It’s disappointing.
I feel like until the AAP explains how they arrived at their allergy-causing allergy advice on peanuts, I’m not really going to pay attention to any of their stances. AAP and other health authorities need to do a real reckoning about how they arrive at their guidance. They all need to be more like the US Preventative Service, which may end up making controversial recommendations (eg age of mammogram screening) but have a very clear and transparent methodology.
Peanuts – way to screw an entire generation btw – AND why does the evidence clearly show that 4 to 6 months is the time to start solids (with solid evidence that there are advantages to starting closer to 4 months, namely reduced allergies) but all the literature says, “breastfeed exclusively for 6 months.”
I really need someone to just tell me why they can’t reconcile that evidence.
And when you contradict them on MMBB you’re suddenly lumped in with anti-vax, because “the medical professionals know best.”
I totally agree!! It really sullies them.
I’m trying to suss out a discussion that isn’t completely polarizing, so forgive me if I fail.
Is there any benefit to breastfeeding? It seems like we have to land in one camp or the other:
Breastfeeding has Many Major Benefits
vs.
Breastfeeding has No Benefits.
Is there context where there is benefit? That benefit even being personal preference and choice?
Are both methods acceptable methods of feeding a baby? Again, there is context that comes into play. Insufficient breastmilk production makes breastfeeding a less acceptable and safe method. Contaminated drinking water for mixing powdered formula makes formula feeding less acceptable and safe.
But both are acceptable, aren’t they? Is it the superiority of one over the other, without regard to individual factors and context, that makes this discussion so fraught?
It really is circumstantial, isn’t it?
There are slight, short term benefits to breastfeeding for the baby. There is evidence for that. There is no good evidence for health benefits for the mother, no good evidence for long term benefits for baby; most studies are hopelessly confounded, with nursing mothers being richer and better educated. The PROBIT studies mostly neutralized those fgactors, and found virtually no long term differences.
That all assumes that by “breastfeeding” I mean that your body is making enough breastmilk for the baby at all times. And by using formula, I mean that you have enough money to pay for enough formula to feed your baby properly. Trying to “stretch” an insufficient amount of either can be very bad, if not deadly for baby.
Economically, formula is probably the loser, but if you shell out tons of money on lactation consultants, pads, special shirts, (or have to throw away shirts due to ruining them with leaks) pillows, herbal supplements, or if there is a significant loss of income due to breastfeeding that wouldn’t happen with formula, that changes things. Breastfeeding mothers also eat more, which costs money.
So with all that, it comes down to what works best for your family situation, and the mother. if a woman likes breastfeeding, and her life is structured so that she can nurse/pump without a problem, then that’s totally good. If a mother hates nursing, and bottles make everything easier, that’s totally good too.
There is no reason for a family to work themselves to pieces for breastfeeding
Breastfeeding probably works out cheaper for more people, especially if you do it for longer, but any costs you might incur are front loaded. No pun intended. It’s the whole thing about it being more expensive to be poor. You may need £100 of help at the start in order to save yourself £400 in the long run, but if you don’t have that right now but do have £10 a week, it’s going to be formula.
Only if the woman’s time is worth nothing.
I have described many times how breastfeeding our two kids would have cost us up to $15000 in lost income, and that is even after accounting for the cost of formula and daycare. That’s because my wife earns money when she is working.
Well I come from a British perspective where we get paid maternity leave, and there is very little breastfeeding going on by the time the average British woman returns to work. We combine fairly long paid maternity leave (not at a very high rate though) with some of the world’s lowest breastfeeding rates. But yes of course, there are absolutely women, especially in the US and other societies without much paid leave, who do/would experience significant loss of income due to breastfeeding.
Of course there is benefit – for those who want to and can breastfeed comfortably. And there is, it seems, a small health benefit, too. It’s just not big enough to warrant national breastfeeding promotion programmes, lamenting in the media about breastfeeding rates, etc. People are scared that something bad will happen if we stop doing things the way we’ve always done them, and breastfeeding may be seen as an example of very few “natural” things left in our lives. And it involves babies.
Right. I agree.
“Breastfeeding has Many Major Benefits
vs.
Breastfeeding has No Benefits.”
I think of it more like Breastfeeding Is Very Context Dependent So It Is Down To The Individual Circumstances To Determine If There Are Major Benefits, Minor Benefits, Minor Drawbacks, Or Major Drawbacks.
BIVCDSIIDTTICTDITAMBMMMDOMD
Not terribly catchy, but true!
It doesn’t fit on a bumper sticker, that’s for sure. :/
Or, ya know, just feed your kid however it works for you and your family.
But breastfeeding is critical for babies’ health, so any obstacles you might experience are not the reason to not breastfeed. MMBB, end of story. YOU MUST SOMEHOW EXTRACT THIS MILK FROM YOUR BOOBS AND PUT IT IN YOUR BABY’S MOUTH!!! EVERY DROP COUNTS!!! There is now some sort of breastfeeding promotion week here where I live and these are things I heard on TV: “In breastmilk there are stem cells, probiotics, antibodies, anti-cancer, anti-inflammatory, antiviral and antibacterial substances and .. I could go on and on”. After watching something like this no wonder women are stressed out when difficulties arise.
Oh, and they also said that the components of breastmilk ensure the optimal gut flora, which determines whether in the future the child will have diabetes, leukemia or Parkinson’s disease. And from the psychological point of view a child who was breastfed will – in his/her adult life – form safer relationships, be a much more predictable and emotionally stable person. I. am. not. joking. I’ve translated it for you word after word 🙂 going to sleep now, it’s already midnight.
Yep, that’s what it basically boils down to: Breastfeed or end up with a horribly sick psychopath for a kid. And don’t you dare wean before they go to college.
We had a breastfeeding superfan on here once who was telling us all about it. So I asked her-can you reliably select the breastfed 1 month old baby from a group of babies the same age? The one year old? Two year old? Kindergartner? School kid? University entrant/graduate?
Of course not, was her answer.
By which she admitted that this massive advantage was invisible to the naked but trained eye.
I felt at that moment my work here was done.
Even better are the morons who claim you CAN tell the difference between them, by looking in their eyes and crap like that.
They are way off in la la land.
“I see this one was bottlefed breastmilk for 11 months…this one was breastfed 6 months, then combo-fed for 6 more months…this one had formula at first, then was breastfed 16 months….”
My depression is going to have a much bigger affect on my daughter than her formula
I heard that the biggest factor in preventing leukemia was daycare attendance. Apparently being exposed to other kids during their first year helps. Also I’m pretty sure Parkinson’s disease is genetic. This is just so much wrong in that PSA I can hardly believe it.
Just use Bofa’s Second Law:
All else equal, breastfeeding is better than not breastfeeding. But all else is never equal.
Nice law, Bofa. Works for me.
It just depends on the family. It happened to work for my family, benefits included: it was easy and not painful for me after the first few days, it helped me lose weight in the first months after having a baby, and it saved us a little money on formula for the first few months. For my brother and sister in law, it had nothing but drawbacks: getting the baby to latch was difficult and painful, she wasn’t getting enough to eat so they were supplementing with formula anyway, and trying to breastfeed was turning into a major ordeal during a time when my sister in law needed to be concentrating on recovering!
In summary: yeah, breastfeeding can be great, but if it’s not going great for you (or if you just don’t want to!), formula is a perfectly good alternative and there should be no guilt associated with using it.
Assuming sufficient supply of either and availability of clean water for formula, at best there are slightly more respiratory and gastro illnesses for formula fed babies on a population level. This assumes you can actually entirely control for social factors and confounders, which you can’t really.
It’s one thing controlling for eg income, genetic conditions, other children in the home attending childcare settings etc- that’s easy enough (though apparently not so easy that some research doesn’t). It’s another controlling for things like attitude and what one person on here, I forget who, described as breastfeeding in higher income countries being generally associated with things going well. And just generally social class, large and imperfect a term as that is.
As an example, I’m from a very white working class area in the UK, with high formula feeding rates, and there’s so much incredibly early weaning that goes on, for example (by this I do not mean starting at 4 months after critically appraising recent research on allergies, I mean baby rice at 5 weeks). And unsafe formula use too, both through poverty and lack of education. Both of these things can be dangerous, and are not typically conveyed to healthcare providers. Eg I have heard other mums chatting about baby rice in bottles at a few weeks old whilst at playgroups, and not telling the health visitor about it because they knew what the response would be. So they don’t ever get recorded anywhere, meaning they can’t be controlled for when looking at our feeding methods and outcomes. Breastfeeding being linked to social class as it is in the UK, women who breastfeed just aren’t going to be engaging in practices like this in the same way. White working class women sometimes do (I am from that group myself, at least originally though perhaps no longer by education and income) and it just isn’t known about. You would have to be in the community to be aware. Things like that.
Are there studies that control for daycare attendance or exposure to siblings in daycare? I don’t know if any and I think it’s a big confounded. Anecdotally, my breastfed kid was much sicker than my formula fed kid. Both are in daycare.
That should read: “I don’t know of any and I think it’s a big confounder.” Sorry. Autocorrect fail.
It’s easily the biggest confounder, and no, I do not know any study that has controlled for it.
I have never read a single one that controlled for daycare usage. My, would I love to read it though.
Two thoughts.
One, you can’t talk about “benefits” without also talking about “costs!” Particularly where the costs (the labor of the breastfeeding mother) are quite high, and can literally only be borne by the woman’s body.
Two, it’s a peculiar thing where any benefit, no matter how small or how costly, becomes a driving for for major public health campaigns. It makes me think you have to look for other factors driving the campaign — like money and ideology. As an example, the science seems pretty clear that breastfeeding for extended lengths of time reduces breast cancer risk. This is somehow held out as a “benefit” that justifies the push for breastfeeding. But it seems quite nonsensical to push women to breastfeed to reduce their breast cancer risk! If that were the REAL justification, why not push women at risk of breast cancer to induce lactation? So I surmise that labeling the breast cancer reduction as a so-called “benefit” is actually a rhetorical device intended to apply further pressure on women to breastfeed; not legitimate health advice.