Sorry Dr. Meek, breastfeeding isn’t a public health achievement at all, let alone the greatest one!

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I don’t know Dr. Joan Y. Meek, Chair of the Section on Breastfeeding of the American Academy of Pediatrics, but I do know ridiculous hyperbole when I see it. Sadly, Dr. Meek is aggressively promoting it.

Meek wrote a piece, Breastfeeding has been the best public health policy throughout history, which has been republished in a variety of places. Too bad it’s complete and utter nonsense.

Nonsense in the service of righteous ends is still nonsense.

Dr. Meek claims:

As a pediatrician and a nutritionist, I have provided direct patient care to breastfeeding mothers and children and also advocated for breastfeeding policies and practices. The scientific research in support of breastfeeding is overwhelmingly clear, and most mothers in the U.S. have heard that message and learned from it. Marketing and sales of infant formula have surged in developing countries, however. That’s created a dilemma for the U.S., which has not wanted to restrict the US$70 billion infant formula business.

This comes at another price. Lack of breastfeeding worldwide is blamed for 800,000 childhood deaths a year.

No, breastfeeding does NOT save 800,000 lives a year. That’s based on a mathematical model that did not correct for confounding variables and assumed, but never proved, causation. Indeed, until recently, lactivists had been unable to find any supporting evidence for that claim. They could not show that breastfeeding rates are correlated in any way to infant mortality. In fact, countries with the lowest breastfeeding rates have the lowest mortality rates and countries with the highest mortality rates have nearly 100% breastfeeding rates.

The best evidence on lives saved by breastfeeding, published only recently, is Mortality from Nestlé’s Marketing of Infant Formula in Low and Middle-Income Countries by Gertler et al.

Contrary to the claims of lactivists like Dr. Meek:

The introduction of infant formula shows no statistically significant average impact on infant mortality for the population as a whole.

That’s because formula is not harmful to babies; contaminated water is harmful. How harmful?

[An analysis] yields an estimate of 65,676 infant deaths with a 95% confidence interval of [24,868, 106,485], lower than earlier estimates of one million or more, but unquestionably a substantial loss of human life.

That was 1981. How about now?

According to Gertler:

…[T]he annual death toll has dropped to about 25,000, driven by improved access to clean water in the Southern Hemisphere.

That’s just 3% of the figure claimed by Meek.

So breastfeeding is hardly the best public health policy in history; it doesn’t rate a place anywhere in the top public health achievements of all time.

Why?

Because a great public health policy saves millions or even hundreds of millions of lives. In contrast, with the exception of extremely premature infants*, breastfeeding hasn’t yet been shown to save many lives at all.

To understand what I mean, lets look at some of the real greatest public health achievements.

1. Clean water

2. Sewers and sanitation

3. Antisepsis

4. Blood transfusions

5. Antibiotics

6. Vaccination

7. Anesthesia

8. Tobacco control

9. Modern obstetrics

10. Neonatology

Each of these has saved and continues to save many millions of lives every year. Breastfeeding doesn’t come anywhere close. Moreover, the purported lifesaving effect of breastfeeding would be entirely abolished if all women had access to clean water with which to prepare formula.

Why did Dr. Meek make her ridiculous claim? Sadly, like most lactation professionals, she ignores the facts about breastfeeding in favor of the fantasy.

Meek writes:

The benefits of breastfeeding for children and mothers are irrefutable. Initiation of skin-to-skin contact immediately after delivery, with early onset of breastfeeding within the first hour of life, supports newborn stability and provides protective immunoglobulins, especially secretory IgA, and other immune protective factors. Human milk provides human milk oligosaccharides, facilitating the colonization of the intestinal tract with probiotics and establishing a microbiome that protects against pathogenic bacteria.

In contrast, formula-fed infants face higher rates of gastrointestinal diseases, respiratory infections and a higher likelihood of sudden infant death syndrome. Longer term, they have a higher risk of obesity, type 2 diabetes, asthma and certain childhood cancers when compared to breastfed cohorts.

Far from being irrefutable, most of these purported benefits have already been refuted.

  • The protective immunoglobulins exist, but they only prevent colds and diarrheal illnesses.
  • Claims about the microbiome are mere speculation.
  • While breastfeeding reduces the risk of SIDS, pacifier use reduces it by a greater amount.
  • Claims about obesity, diabetes, asthma and childhood cancers have been thoroughly debunked.

The idea that breastfeeding has been the greatest public health policy throughout history is sheer, unadulterated nonsense. I’ve no doubt that Dr. Meek is making that claim for what she perceives to be anticorporatist, righteous ends — counteracting the marketing efforts of formula companies. But nonsense in the service of righteous ends is still nonsense.

Who am I to criticize the claims of Dr. Meek? I’m a physician who is very familiar with the breastfeeding literature and I am more than willing to put my criticism to the test. I’d be happy to debate Dr. Meek, in print or in person, on these very issues.

I doubt my challenge will be accepted. Professional lactivists never put themselves in positions where those who disagree could challenge them. Though they choose fantasy over facts, they are aware that inconvenient facts about the limitations and risks of breastfeeding exist and they are afraid to face them.

Who knows? Maybe Dr. Meek, unlike other professional breastfeeding advocates, has the courage of her convictions. I’ll be waiting to find out.

 

*Breastmilk reduces the risk of necrotizing enterocolitis, a potentially deadly complication of extreme prematurity.

  • MaineJen

    By “public health achievement,” do they mean…breastfeeding itself? Which has been around since people have been around, but has failed to prevent or eradicate any major disease? Or do they mean…breastfeeding *promotion,* in which case they are just patting themselves on the back for browbeating new mothers with BREAST IS BEST until said new mothers want to punch them? All the while, ignoring the socioeconomic and medical factors that make mothers less likely to breastfeed in the first place?

    If I rolled my eyes any harder, they’d disappear into the back of my skull.

  • Sue

    Breastfeeding didn’t eliminate polio from almost all the entire world. Vaccination has.

    • Cartman36

      or small pox

  • Trees

    I’m stunned that a professional in any field could claim that breastfeeding is a huge public health achievement, much less someone in the medical field.

    • fiftyfifty1

      Well, she made her career out of it…..

  • maidmarian555

    Breastmilk is better than vaccines? Really? How can an actual doctor think that breastmilk has done more than vaccines have when it comes to public health policy? IANAD but I’m pretty sure breastfeeding did fuck all to eliminate smallpox and I am really glad I live in a world where my children are unlikely to experience the hideous childhood diseases that plagued my grandmother’s era. Wow. I am glad she’s not my doctor, that’s for sure.

    • The Kids Aren’t AltRight

      I would imagine water treatment kicks breastfeeding’s ass too, in terms of lives saved.

    • The Kids Aren’t AltRight

      I would imagine water treatment kicks breastfeeding’s ass too, in terms of lives saved.

  • Heidi

    I’m amazed how anti-capitalist people all of the sudden become once it comes to formula and breast milk! It’s so inconsistent. I don’t even consider myself exactly pro-capitalist, but no, I’m not going to let my baby starve and no matter what economic policy I may believe to be the best, that doesn’t mean formula is bad or unsafe.

    Why don’t formula companies deserve to make money exactly? It can’t be because it’s food. I haven’t heard these same people claiming the food industry should give their product away. It can’t be because it involves a baby either. These same people don’t seem to have an issue with car seat manufacturers or baby clothing manufacturers making money. If formula wasn’t profitable, it wouldn’t exist, and if it didn’t exist, we can expect to return to high infant mortality rates.

    • space_upstairs

      “Anti-capitalism” is not about being against business as a whole, given that most people who are “anti-capitalist” in this sense are actually quite successful in the current economy. It’s about being against certain models of business that the cultural elite have deemed crude or unethical for some reason. Many of them seem to be related to the notion (whether derived from actual science or ideology or some mix of the two) that they somehow excessively pollute the body or the environment or both, such as pharmaceutical-based scientific medicine, conventional agriculture, “junk food” (meaning that formulated almost entirely for tastiness and not nutritional value), and various mass-produced consumer products. Formula is a mass-produced consumer product that’s also widely believed to be a “junk food” based on the popular notions of the superiority of breastfeeding, both based on the many so-so studies on the matter and the general ideology of “anything unnatural has to be more polluting and harmful by definition” that leads to opposition to conventional agriculture and pharmaceuticals. Probably the best objection is that any mass-produced consumer product does tend to harm the environment, but then, so do many other things like preferring private over public transport, having many children, and climate-controlling a large home.

  • Mel

    I know I’m a broken record about this – but breast milk’s usefulness for micro preemies is a “better than nothing” stop-gap effort against NEC that will some day be replaced by a better set of treatment or prevention options. It’s like using surgery to treat infections before antibiotics or mid/high forceps before safe c-sections; it’s better than nothing – but not as effective as the next medical breakthrough.

    Use of human milk exclusively (including as a fortfier) drops the risk of NEC by 50% prior to 34 weeks gestation in early premature and extremely premature babies. So…that’s knocking a 12% risk down to a 6% risk.

    I’ll never know if my son’s absence of NEC was because he was in the 88% of preemies who never develop it or the 6% who breast milk reduces the risk for – but what I really want for Christmas this year is a way to prevent NEC in the remaining 6% of babies. We already know the answer isn’t using only breast milk – so I’d like a wonder drug, magical surgery or even a nice magical ritual if that does the trick.

    • Heidi

      This is why I don’t think most lactivists are really that concerned about babies and especially not premature babies. You can acknowledge that some breast milk helps some premature babies while also acknowledging the babies who still develop NEC despite breast milk. Sure, it’s the best prevention we have now, but why wouldn’t you support finding a more reliable prevention? It’s not like breast milk is going to change anytime soon. But the formula manufacturers are likely going to be the ones that develop such a prevention and well, we know they can’t have that.

    • fiftyfifty1

      The 6% are saved by the breastmilk, the other 6% will be saved by homebirth midwife care that prevents them from being born early in the first place! (sarcasm)

  • Amen! I would add the widespread use of fertilizers and pesticides to your list; I realize that this may be contentious, as the use of these agents creates its own problems, but the increased availability of food has certainly saved hundreds of thousands of lives–maybe millions.

    • MaineJen

      Don’t forget GMOs, which can produce hardier and more pest-resistant crops. That will really get some heads spinning.

    • Alia

      As well as fridges, freezers and modern food preservatives, so that people do not eat food that is moldy, starting to spoil – or preserved with huge amounts of salt or saltpetre.

      • FormerPhysicist

        I went to an interesting talk where the oncologist/researcher pointed out that stomach cancers went way down after the introduction of modern preservatives.

    • Allie

      Yes, you’re right. People don’t understand that fertilizers, pesticides and “genetic modification” have increased crop yields enormously. Before these advancements, crop yields were often barely enough to sustain planting for the following year.