Questioning the benefits of breastfeeding is nothing like questioning the benefits of vaccination. Here’s why.

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Last week March for Science censored scientific information in an effort to squelch discussion that questioned the benefits of breastfeeding. It was a startling tactic for an organization that claims to promote science.

Referring to Sci Moms, a group that dared to suggest that breastfeeding promotion has risks as well as benefits, the administrators of March for Science Facebook page accused them of:

… a history of denying the well-established science on infant nutrition and criticizing health promotion initiatives of the World Health Organization and other health orgs.

…[W]e want to encourage everyone to treat the SciMoms with some healthy skepticism and remind everyone that there are more reliable resources out there on infant nutrition, such as the World Health Organization, the American Academy of Pediatrics, and the Academy of Breastfeeding Medicine…

This week, Dr. Lori Feldman-Winter, the chair of the American Academy of Pediatrics’ Section on Breastfeeding was quoted in The New Yorker. Dismissing the data of economist Emily Oster, author of the best selling parenting book CribSheet — data that also questions the benefits of breastfeeding — Feldman -Winter had this to say:

Doctors who won’t change their recommendations about breastfeeding in light of new evidence risk harming their patients.

That’s the really scary part of having a person like Oster, who is not an epidemiologist, distilling this information to the lay public. It’s basically as bad as the anti-vaxxers.

But questioning the benefits of breastfeeding is nothing like questioning the benefits of vaccination. Here’s why: We have copious data on the benefits of vaccination; nearly every prediction made by doctors and scientists about the impact of vaccination has come true. In contrast, though we have nearly two generations worth of data on breastfeeding promotion, almost none of the predictions made by doctors and scientists on its impact have come true.

Over the past generation, breastfeeding organizations, lactation consultants, and advocates of natural mothering assured us that if we increased breastfeeding rates, we would reap the benefits of lower incidence of conditions from allergy to obesity, lower rates of infant hospital readmission and even lower infant death rates. The US invested millions in public health campaigns promoting breastfeeding and the Baby Friendly Hospital Initiative’s “Ten Steps” became integral in many hospitals, accompanied by the hiring of thousands of lactation consultants in hospitals and doctors’ offices.

In the US, the rate of breastfeeding initiation increased from a nadir of 22% in 1972 to over 80% in 2015. In that time, rates of conditions from allergy to obesity have not fallen; indeed, they’ve risen. Hospital admission rates have increased, and there has been no observable effect on infant mortality.

Perhaps more shocking, because it was unanticipated, promoting exclusive breastfeeding has caused serious health problems. It turns out that breastfeeding, like all natural processes, has a failure rate; up to 15% of first time mothers will have difficulty producing enough milk to fully nourish a baby, especially in the early days. There has been a dramatic increase in neonatal dehydration, severe jaundice and related complications. Indeed, exclusive breastfeeding has become the leading risk factor for newborn hospital readmission.

Doctors are trained to expect that half of what we are taught at the beginning of our careers will ultimately shown to be wrong within the next five years; unfortunately, no one knows which half. We read scientific journals each month to learn not only about new discoveries, but new data that overturn old discoveries. The key to providing excellent care to our patients rests on our flexibility to change if the scientific evidence changes. Doctors who can’t or won’t change their recommendations based on new evidence do their patients a terrible disservice and possibly cause them harm.

The March for Science justified its efforts to prevent debate by referring to the recommendations of the World Health Organization, the American Academy of Pediatrics, and the Academy of Breastfeeding Medicine. Anyone with grounding in science will recognize this as the logical fallacy known as the argument from authority:

Insisting that a claim is true simply because a valid authority or expert on the issue said it was true, without any other supporting evidence offered.

It is an especially problematic logical fallacy when discussing new data. For example, I was taught that routine episiotomy in childbirth reduced the risk of vaginal tears. In the 1990’s new data suggested the opposite. It would have been both inappropriate and unprofessional for obstetricians to justify ignoring the new data by claiming that major obstetric textbooks and organizations still recommended episiotomy. It is equally invalid to dismiss new data on the risks and benefits of breastfeeding simply because major textbooks and organizations still strongly recommend breastfeeding.

It seems that Dr. Feldman-Winter of the AAP might have been trying to advance a similar logical fallacy by referencing anti-vaxxers. Anti-vaxxers do indeed disagree with all major health organizations on the safety and efficacy of vaccination. But vaccines aren’t safe and effective because major health organization recommend them; they are safe and effective because the data show them to be safe and effective, dramatically reducing the burdens of disease and death from vaccine preventable illnesses. The predictions that doctors made about the impact of vaccines did indeed come to pass and serious side effects have been rare.

When a fabricated claim was advanced that vaccines cause autism, it wasn’t dismissed out of hand. It was investigated in large studies involving hundreds of thousands of individuals and demonstrated to be untrue.

New evidence about the benefits and risks of breastfeeding has been published and actual experience — including tens of thousands of hospitalizations each year for insufficient breastmilk — adds urgency to the need to reassess current recommendations. Dismissing new evidence out of hand, attempting to silence discussion of that evidence, and demeaning anyone who dares question the conventional wisdom in light of the new evidence isn’t science; it’s defensiveness.

We face a crisis; tens of thousands of newborns are suffering preventable complications each year because their mothers have been convinced that breastfeeding will provide benefits that have failed to materialize. We need immediate action from pediatricians and lactation professionals to prevent ongoing harm. Instead we are getting disparagement of those who use new data to question old certainties. Babies and mothers deserve better.

  • mabelcruet

    Are you seeing this recent publication being presented in the media in USA?

    https://advances.sciencemag.org/content/5/5/eaav3058

    “Pre-conception maternal helminth infection transfers via nursing long-lasting cellular immunity against helminths to offspring” in mice, and its being spun in the British media as babies who are breast fed can get life-long immunity from infection because of transfer of white cells in the milk, so therefore breast is best.

    • rational thinker

      great more bias influenced studies

      • mabelcruet

        It’s mice with parasitic worms, not exactly comparable, but its being seized on as ‘landmark breakthrough’, and I’ve seen the anti-vaxxers starting to get excited, because if you get life-long immunity to infection, who needs those nasty poisonous vaccines?

        • rational thinker

          yeah I didn’t think it was too comparable. But some people will believe anything without really looking into it as long as it fits into their current mindset.

    • Daleth

      by definition and everything I have read is
      unpreventable, it just happens

      Well, not exactly. There are things you can do to reduce the
      risk. First, the obvious is to follow safe-sleep recommendations. In addition:

      1. Use pacifiers (UK: dummies; US alternative term: binkies).

      2. Share a room (but not a bed – that increases the risk).

      3. Keep your baby away from smokers.

      A few links:

      Overview: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Preventing-SIDS.aspx

      “Pacifier use and SIDS: evidence for a
      consistently reduced risk” https://www.ncbi.nlm.nih.gov/pubmed/21505778

      “Use of a dummy (pacifier) during sleep and
      risk of sudden infant death syndrome (SIDS): population based case-control study” https://www.ncbi.nlm.nih.gov/pubmed/16339767

  • Ayr

    Slightly OT: This reminds me of something I read on FB the other day. A FTM wrote into a mothers community page asking for advice on how to prevent SIDS, which by definition and everything I have read is unpreventable, it just happens. Anyway, one woman replied, in all caps, do not vaccinate. She listed other things as well, but when I read her no vaccination comment I almost spit my Dr. Pepper out from laughing so hard! She had no evidence to support her claim and many other posters asked for it, just a you should vaccinate, vaccines are evil and cause all sorts of problems like Autism and SIDS.

    • Heidi

      I’m pretty sure facts show quite the opposite, that vaccinated babies are less likely to die of SIDS.

      • Ayr

        Oh, you and I know this, but anti-vaxers will say anything to make their claims sounds legitimate. She also claimed that EBF prevents SIDS…

  • rational thinker

    Has there ever been a study that takes maybe a thousand exclusively formula fed babies and compares it to a thousand exclusively breastfed babies to see the numbers of which group had more readmissions for jaundice/dehydration.

    Surely that kind of study should prove it outright, but then again this is an ideology we are dealing with and not rational scientific based thought.

  • The thing is, the benefits of vaccination HAVE been questioned. Thoroughly. Even remote risks have been explored, and the studies doing so have been numerous, robust, and unambiguous; vaccination doesn’t provide a marginal benefit, but an overwhelming, obvious, clinically meaningful benefit, regardless of other variables.

    The same is not true of breastfeeding. Although there have been plenty of studies on them, they’ve been studies with serious confounders or even mathematical models showing theoretical benefits (I remember proofreading one that really made me roll my eyes as it used some model to predict thousands of lives and millions of dollars saved if only more women would breastfeed more). Shorn of white-hat bias, the only really clear benefits are reducing necrotizing enterocolitis in preemies and a small decrease in colds and stomach bugs that isn’t even really clinically significant.

    Put it this way: Vaccination’s been interrogated by the CIA, the FBI, and a hostile Congressional committee and emerged as an upstanding character; breastfeeding was an honored guest on The View and still fails to convince others of its scientific benefits.

    • BeatriceC

      1. Can I please steal this?

      2. The studies that showed a benefit in the prevention of NEC are almost 30 years old and some more recent studies have called into question whether or not they are still relevant. Between improvements in formula and NICU procedures, there’s enough evidence to justify further study into the topic, but not enough to say anything one way or another. I went looking for the one I read a while back and can’t find it, and then asked around and several others remember reading it, but none of us can find it anymore. It’s weird.

      • Ozlsn

        I also am curious if the move to routine probiotics being given to prem babies (which I believe has also been associated with a decrease in NEC) means that any differences seen between BF and FF babies in NICU have now vanished. I really should look up the results of the studies I enrolled my son in (who was fed numerous things starting with TPN – which has also made me wonder about whether NEC is affected by that too.)

        • BeatriceC

          The study I read and now can’t find identified several factors that could be contributing. Improved formula and infection control measures are two that I recall, and then just 30 years of experience treating the tiniest babies and identifying the risk factors earlier allowing for earlier treatment was another. They also found NEC happened in clusters regardless of how babies were fed, which could mean it has more to do with specific NICU procedures and not with feeding method itself. I’m super irritated I can’t find it.

          Also, there was one that associated vaginal delivery of micros with increased risk of death from NEC. Off to go find that one again. Be right back.

      • Be my guest!

  • fiftyfifty1

    Ugh, I have no patience when ideologues try to piggyback their little pet causes onto true problems. Questioning the benefits of breastfeeding is the same as being an anti-vaxer? Oh sure it is. Just like how evangelical Christians are discriminated against just like African Americans are. Just like how GMOs growing in a field is the same as a factory dumping poisons into a river. Hysterical bogus comparisons are such a turnoff.