Why do we allow zealots to make breastfeeding policy?

There has been a furor over the latest American Academy of Pediatrics recommendation to breastfeed children for two years.

The paper that offers the new recommendation is Policy Statement: Breastfeeding and the Use of Human Milk written by Joan Younger Meek, MD and Lawrence Noble, MD.

Extended breastfeeding dramatically increases the physical, psychological and economic burdens on mothers. The recommendation, in addition to being utterly tone deaf in the wake of the overturning Roe v. Wade, it is NOT supported by scientific evidence. The paper is filled with weasel words like “might,” “associated,” and “linked.” Indeed extended breastfeeding has been linked to improved health outcomes for both babies and mothers but that’s because it is a proxy for something far more important: maternal education and socio-economic status.

Breastfeeding in industrialized countries like the US and the UK is highly socially patterned. Better educated, wealthier women are far more likely to breastfeed. It is the higher socio-economic status, including greater access to health insurance and healthcare, that is responsible for the improved health outcomes “associated with” and “linked to” breastfeeding. The idea that breastfeeding improves maternal and infant health is particularly absurd in the case of the UK. The United Kingdom has literally the LOWEST breastfeeding rate IN THE WORLD, yet one of the lowest infant mortality rates in the world.

How did breastfeeding guidelines become completely unmoored from reality? It has happened because we allow lactivist zealots like Dr. Younger-Meek and Dr. Noble to make policy.

This is hardly the first time that either of them have made completely unsupported, nonsensical health claims about breastfeeding.

Back in 2018 Dr. Younger Meek wrote Breastfeeding has been the best public health policy throughout history. Only a zealot would make such an absurd claim.

For most of human history breastfeeding was the standard and often the only method of feeding babies and throughout that time infant mortality rates remained astronomical.

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.

Dr. Noble is, if anything, more zealous and more obnoxious, in his promotion of breastfeeding. In 2015 he gave a talk entitled What’s Really Wrong with One Bottle: Microbiota & Metabolic Syndrome which advanced the scientifically false and psychologically vicious claim that “just one bottle” of formula harms babies.

He starts with this ugly cartoon:

I reviewed all 83 slides of his standard professional talk and there is NOT EVEN ONE that shows any evidence that a single bottle of formula causes any impact at all, let alone a harmful impact.

Indeed the scientific evidence strongly indicates that there is no harm from use of formula. But how deliciously humiliating and guilt producing to emotionally fragile new mothers to pretend that one bottle of formula is harmful! How delightful to pretend that new mothers should be bullied into breastfeeding for the good of their babies.

Imagine if we tried to address smoking related illness by humiliating anyone who ever had ONE cigarette. Imagine if we tried to address obesity by shaming anyone who ever ate even ONCE at McDonald’s. That’s absurd, right? But that’s the equivalent of what lactation zealots do.

It is important for mothers to understand that the recommendation to breastfeed infants for two years is yet another absurd claim about the “benefits” of breastfeeding from two people who have a history of absurd claims unsupported by scientific evidence.

Who am I to criticize the claims of Drs. Younger Meek and Noble? 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 either (or both!), in print or in person, on their ridiculous claims.

I doubt my challenge will be accepted. Zealots never put themselves in positions where those who disagree could challenge them. Though they choose personal beliefs over facts, they are aware that they could not win a scientific debate. In addition, they fear alerting women to just how weak and specious their claims really are.

Who knows? Maybe they, unlike other professional breastfeeding zealots, have the courage of their convictions. I’ll be waiting to find out.