Melissa Bartick, MD committed a Kinsley Gaffe.

According to journalist Michael Kinsley:

A gaffe is when a politician tells the truth – some obvious truth he isn’t supposed to say.

Furthermore:

Another definition is a statement made when [he] privately believes it to be true, realizes the dire consequences of saying it, and yet inadvertently utters, in public, the unutterable.

What was Bartick’s Kinsley Gaffe?

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Dr. Bartick shouldn’t lie about something that is so easy to check.[/perfectpullquote]

She ADMITTED that there is no evidence for most of the purported benefits of breastfeeding.

In the comment section of a piece on the Academy of Breastfeeding Medicine blog, I asked Dr. Bartick directly:

Where is the evidence that term babies lives has been saved? Where is the evidence that the diseases you insist are decreased by breastfeeding are actually decreasing as a result of breastfeeding? Where are the billions of healthcare dollars you claimed would be saved as the breastfeeding rates rose?

Her response:

…To my knowledge, no one has actually dug it up yet.

Oops!

She admitted what she privately knows to be true without realizing that she uttered for the unutterable.

What does a politician do when he commits a Kinsley Gaffe? He’s lies about it. If he’s particularly unprincipled, he lies blantantly even when his “gaffe” has been in print for years and he’s never challenged it before.

What does Melissa Bartick do when caught in a Kinsley Gaffe. She lies about it, even though it’s been in print for years, I’ve written about it for years and she never challenged it before.

I hope it’s obvious that I would have never said such a ridiculous thing. Truth and scientific integrity is not this person’s strong suit. Thanks for letting me know.

Dr. Bartick shouldn’t lie about something that is so easy to check:

Oops!

Why do breastfeeding researchers like Bartick exaggerate and mislead repeatedly? They have become confused about their ethical obligation. They proudly boast about supporting breastfeeding as if any process could or should be supported above the wellbeing of patients themselves.

Lactivism is like creationism; neither are science.

Science starts with a hypothesis and then tests it to see if it is true. The possibility always exists that the hypothesis is false. The conclusion of scientific testing is drawn from data gathered in the course of experiments and studies. It is not known a priori.

Creationism, the belief that the universe was created by an intelligent designer, is considered unfalsifiable by its adherents. They start with the conclusion that a Creator was necessary for our current existence and then arrange any experimental data to lead to that conclusion, carefully editing the data so that anything that could falsify the conclusion is excluded.

For creationists, there is no possibility that the conclusion is wrong since they start with the conclusion and, working backwards, do whatever is necessary to arrive at it. That means that creationism is not science.

Lactivist “science” also starts with a conclusion and works backward to justify it. The central tenet of breastfeeding “science” is that breast is best, despite the copious scientific evidence that in many cases it makes no difference and may even be harmful for some babies. No matter; all data is manipulated until it is forced to fit the predetermined conclusion.

Startling facts about breastfeeding — the historically high mortality rates of exclusively breastfed infants prior to the 20th century and that fact countries with the highest contemporary breastfeeding rates have the highest mortality rates — are simply ignored. There is no possibility that lactivist “science” will ever show that breast is not best; and that means it isn’t science at all.

Real science tells us that the benefits of breastfeeding for term infants in industrialized countries are trivial. Breastmilk is neither magical nor mysterious just as immunity is neither magical or mysterious. We can mimic it and we can even improve upon it.

Melissa Bartick knows this and admitted it.

And now she’s been caught lying about it.

Oops!

Midwives have a fraught relationship with maternal autonomy.

They tell themselves they are committed to autonomy. They believe deeply that women are entitled to choose place of birth, birth attendant, birth support, vaginal birth, refusal of procedures, refusal of pain medication and refusal of hospital policies (e.g. separation of mother and child after birth) that do not serve their needs. They glorify women’s agency.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Her baby, her body, her choice! And that includes epidurals, 39 weeks inductions and maternal request C-sections.[/perfectpullquote]

Until the moment a woman chooses an epidural, an induction at 39 weeks or a C-section without medical indications. They oppose those decisions and they rationalize their opposition by insisting that women have been hoodwinked by the structure of contemporary maternity care.

I’ve been writing about and puzzling over midwifery hypocrisy on autonomy for more than a decade. I recently came across a Master’s thesis that offers a compelling explanation: it’s the difference between succeeding waves of feminist philosophy.

Choosing Surgical Birth: Personal Choice and Medical Jurisdiction was written by Alexandria Vasquez, now a sociology faculty member at Mills College.

Vasquez seeks to understand whether a woman’s choice of C-section without medical indication is a choice that is worthy of respect. Midwives and other healthcare professionals have made it clear that they are NOT respectful of such decisions, going so far as to mandate psychiatric assessment for any woman who makes such a request.

Think about that for a moment: the same midwives who argue that women’s decisions to choose a medically contraindicated homebirth or refuse even lifesaving interventions in childbirth MUST be respected also insist that women’s decisions to choose surgery SHOULDN’T be respected and can be understood as psychiatric disability.

Vasquez argues that it reflects the difference between second wave and third wave feminism.

Second wave feminists argue that the intervention of medicalized childbirth has led many women to experience more pain, confusion, and ultimately less control over their own birth. Second wave feminists maintain that the pathologization of childbirth has created a rationalized, technocratic order where women’s bodies are seen as predictable machines as opposed to natural beings… To second wave feminists, the consequences harm all women as it has become customary for any woman to give birth in a hospital setting with unnecessary medical intervention…

In other words, midwives — as second wave feminists — believe childbirth interventions are only chosen as a result of the structure of contemporary maternity care. They deny that women choosing medical interventions in childbirth are exercising moral agency. Hence these women’s choices for interventions can and should be ignored.

In contrast:

…[T]hird wave feminism argues that the [second wave] perspective idealizes natural childbirth… [T]he valorization of natural childbirth fails to consider childbirth as a burden on women, and not something they have to believe defines their very being…

…[T]hey believe medicalized childbirth has proven beneficial for expecting mothers by providing less painful, more manageable, and lower stress births for those who seek out this alternative. In this regard, they contend that a woman should have full autonomy in choosing what mode of childbirth is best for her and her unborn child, and to take away or criticize this right is oppressive rather than feminist.

In the view of third wave feminists, women who choose interventions in childbirth like maternal request C-sections ARE exercising moral agency and are NOT victims of an oppressive structure of maternity care.

How can we reconcile these two perspectives? We can acknowledge the existence of structural pressures while understanding that they are not the only explanation for women’s choices.

We can analogize to the decisions women make to have children.

No one would deny that there is tremendous structural pressure to have children. Baby girls are given dolls to prepare them for the role of future mothers and girls of every age, from every ethnic background and economic stratum are encouraged to imagine futures that include children.

We recognize that women who are child-free by choice have resisted that pressure. They have exercised moral agency in the face of major structural constraints; their decisions are worthy of respect.

But — and this is the critical point — it does not mean that women who choose to have children are not moral agents or that their decisions are not EQUALLY worthy of respect. Just as we should never force women to have children against their will, we should never denigrate the choice to have children as merely the result of societal pressure.

The same principles ought to apply to childbirth interventions. We can acknowledge that there is structural pressure to medicalize childbirth. We can respect the moral agency of women who reject medicalization. But that does NOT mean that women who do choose to have childbirth interventions are not moral agents or their decisions are not equally worthy of respect. Just as we should never force women to have medical interventions against their will, we should never denigrate the choice to have medical interventions in childbirth as merely the result of structural pressure.

Her baby, her body, her choice! And that choice includes epidurals, 39 weeks inductions and maternal request C-sections.

Midwives are desperate for market share.

As I wrote in my book Push Back: Guilt in the Age of Natural Parenting:

No matter what obstetricians offered, midwives would insist that it was unnecessary, disempowering, harmful, and contradicted by the scientific evidence. Midwives would wrest childbirth back from paternalistic doctors and give it to those to whom they believed it rightly belonged—the midwives themselves. And the entire project would be promoted as being in the best interests of women and babies.

Obstetricians offer epidurals, a remarkably safe and effective form of pain relief. Therefore midwives demonize them. But women continue to love them!

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Why is there such a disconnect between what women are told to choose and what they actually choose?[/perfectpullquote]

That’s the take home message from a new paper, The “good” epidural: Women’s use of epidurals in relation to dominant discourses on “natural” birth.

Sadly, in addition to negotiating childbirth itself, women in Western societies are forced to negotiate pressure to avoid effective pain relief. The authors wanted to understand how women handle the pressure and how they construct their birth experiences in retrospect.

Making the decision to have an epidural is, therefore, not merely a straightforward matter of weighing the advantages and disadvantages of the procedure, as women’s decisions to undergo an epidural for pain management during birth actually influences what “kind” of childbirth they are thought to have had, both by themselves and by others.

In the end, the majority choose epidurals and the majority love them. Why is there such a disconnect between what women are told to choose and what they actually choose? In large part it’s because during labor women discover that midwives and other natural childbirth advocates have lied to them.

Unrealistic expectations of pain led to disappointing birthing experiences. During the post-birth interviews, the participants described feeling overwhelmed by the pain they experienced during birth… Some participants felt that the pain they experienced during birth went far beyond what they had expected and prepared for.

For example:

For instance, Bergdıs commented: “Yeah, I knew that it would be painful, but I never expected this . . . you can’t explain just how painful it is you know”. Similarly, Katrın felt that the amount of pain associated with childbirth is sometimes glossed over. Although she still felt happy with her decision to give birth without an epidural, she did question the validity of some of the information she had been given during her pregnancy, and she felt that, despite the end justifying the means, childbirth had been romanticized and misrepresented…

Sigrıður had a similar experience. She felt that her positive outlook with regard to the birth and the pain involved had not been based on reality…

Pain management turned out to be integral to having a good birth experience:

The women who experienced prolonged labour mostly asked for and received an epidural. Those participants who had an epidural described their experience of giving birth as being very positive. They did not feel let down by their need for an epidural, and the side effects of the epidural were not experienced as excessive or having a negative effect on the birthing experience…

Some participants described the epidural as a “massive relief” after having been in labour and in considerable pain for hours. They described the effects of the epidural as “wonderful”, “cosy” and “comfortable”. With the help of the epidural, they felt like they could finally have some rest and relax.

How did the women make sense of the difference between what they had been led to expect and what they actually experienced?

The findings presented in this paper indicate that … “natural” childbirth is constructed as the optimal goal for birthing women. It should, therefore, be considered the dominant institutionalized discourse concerning childbirth… The continued association of women with nature and the demands made on the maternal body to act in ways that are deemed “natural” reveal how biology is still seen as a prescriptive, determining factor for women.

Ultimately most women rejected the pressure placed on them by midwives and other natural childbirth advocates:

…[D]espite only two women initially wanting to have an epidural, the majority ended up having epidurals, and they constructed the experience as wonderful and immensely helpful. Interestingly, those who ended up having “natural” childbirth did not tend to describe the experience as empowering, while those who had a “medicalized” birth did not, in the end, perceive the experience as a failure or a disappointment…

The authors note that natural childbirth advocates might deride these women’s conclusions as the result of false consciousness. They reject that assessment:

We would argue that it would be unhelpful to take women’s positive views on epidural analgesia as an indication of the increased medicalization of birth, or in the words of Beckett, to “treat some women’s use and appreciation of technology as indicative of a kind of false consciousness, a violation of their true (essential) nature”. The participants in our research made the decision to have an epidural based on the progression of childbirth and their self-knowledge… [T]he birthing women recognized “natural” childbirth as a dominant narrative that was supposed to be better for both them and their babies, although they were still able to reject it as a normative rule because it was not suitable or achievable for everyone.

They conclude:

The agency and self-determination of the birthing woman were originally a major focus of the “natural” childbirth movement. Thus, the agency of women who freely choose, and feel empowered by, an epidural should be deemed equally important.

That means providing women with an accurate description of labor pain and honest assessment of the epidural. That’s what respecting women’s agency requires and that’s what leads to better birth experiences.

Sadly, this is not satire.

Freya Kellet is a self-proclaimed “birth keeper, coach and mentor.”

I’m all too familiar with the ignorance, arrogance and privilege of natural childbirth advocates, but Freya sets a new standard for idiocy with her ‘Radical Guide to Postpartum Hemorrhage.’

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Postpartum hemorrhage is your ally??!![/perfectpullquote]

Hemorrhage is one of the most common reasons why women fear birth.

But, what if everything you know about hemorrhage is based in cultural misconceptions?

Cultural misconceptions??!!

Our body speaks in blood. A language of crimson and dots. Bleeding in birth is an expression of our bodies innate wisdom. not of pathology…

Hemorrhage is not a mistake in the female design … Hemorrhage during birth is a physiological response to a predictable constellation of events — intervention, observation and disturbance to motherbaby. Hemorrhage is a woman’s body speaking in blood, screaming a great and bloody NO to violation and control…

Not exactly.

Postpartum hemorrhage (PPH) causes over 80,000 maternal deaths each year.

It accounts for more than 45% maternal deaths in low income countries and almost 10% of maternal deaths in high income countries.

It is estimated that around the world one woman dies of postpartum hemorrhage every 4 minutes!

Moreover, the countries with the lowest intervention rates in birth have the HIGHEST rates of death from postpartum hemorrhage. But Kellet is clueless.

She thinks hemorrhage is an ALLY!

There are no mistakes in nature…

Hemorrhage does not occur randomly, it is extremely predictable and is the result of interventions and disturbances in the birth process…

Hemorrhage is the ancient ally of women.

Hemorrhage creates a holy blood boundary to boldly remind people of the importance of protecting undisturbed, wild birth.

My favorite part of this fatally stupid nonsense is Kellet’s suggestions for “treatment.”

Some women use the power of intention to resolve excessive bleeding by speaking to their uterus. You could try telling your womb that she needs to stop bleeding NOW …

If there is a sense that the mother is not present (spiritually, emotionally) some support people try boldly calling her back in into the room …

How well does Kellet imagine that works when the mother is unconscious from hypovolemic shock?

Where did Kellet learn this idiocy? From other equally clueless birth keepers, Yolande Norris Clark and freebirth advocate Emilee Saldaya.

What I really want to know is this: exactly how gullible do you have to be to believe this crap?

Apparently very, very gullible!

I’ve written in the past about performative mothering, a central feature of contemporary parenting culture. I framed the discussion as comparing a fictional grandmother Myrna to her fictional granddaughter Mira.

When it came to raising John, Myrna might have feared the judgments of her mother and mother-in-law but she did not particularly fear the judgment of her peers since they were all doing the same thing. Everyone went to the hospital to have a baby; everyone was unconscious at the moment of birth; everyone bottle fed. For better or for worse, there was incredible uniformity in parenting practices.

Mira, in contrast, faces not merely the judgment of her peers, but she actively submits herself to the judgment of the larger world by engaging on Facebook. Mira is a stylist of motherhood, selecting from parenting identities and practices to present a meticulously crafted mothering persona designed for the gaze of other mothers.

Which raises the question: how did mothering transmute from raising children to a form of self-expression.

A new book published just this week, The Problem with Parenting: How Raising Children Is Changing across America, addresses this issue.

Its central claim:

…[B]eginning in the 1970s, the family was transformed from a social unit that functioned as the primary institution for raising children into a vehicle for the nurturing and fulfillment of the self.

Though the dominant contemporary philosophy of natural mothering (aka intensive mothering) advertises itself as child-centered, it is in reality mother-centered and governed by the mother’s therapeutic imperative.

The book identifies the source of change in mothering as the sociological upheavals of the late middle 20th Century including women’s employment outside the home, the sexual freedom that arrived with The Pill and the easy access to divorce.

The author declares:

In the context of the shift away from a sense of common purpose toward the pursuit of self-fulfillment above all, reforms that might have appeared unequivocally positive permanently undermined the child-centered family.

Mothering, which used to about meeting the needs of children has been transformed to meet the therapeutic needs of mothers.

It developed into a full-fledged mode of childrearing that emphasized the parent-child relationship over the family, expert advice over instinct, commitment to the self over society, and lifestyle over a Good life… Parents would unwittingly transform childrearing into an act of their own self-expression confusing their own needs with those of their child and making themselves and their children miserable in the process.

The parent child relationship:

As Americans embraced the ethos of the “‘Me’ Decade,” namely that their highest purpose should be self-fulfillment within a single lifetime, they began to balk at traditional notions of childrearing. Adults who aspired to cast off their inhibitions and be themselves now hoped to raise their children to avoid these inhibitions altogether…

Expert advice:

The zeal to improve Parenting led to a culture of “chasing” research. Parents and policy makers alike overinterpreted academic research. For instance, a single study conducted in 1993 that seemed to show that listening to classical music created short-term enhancement of spatial reasoning spawned a multimillion dollar industry of children’s toys, CDs, and videos claiming to make children smarter, despite the fact that the effects observed were temporary and observed in young adults, not in children. The impact of infant brain development hadn’t been studied at all!

The changeable nature of Parenting advice in combination with the idea that every moment spent with children was of lasting importance worked to undermine parents’ confidence. Would a deviation from official advice, such as formula feeding instead of breastfeeding or allowing a toddler to “cry it out” cause permanent damage down the line? Parents constantly doubted themselves and other people second-guessed their decisions.

Self-expression:

Parents raised post-1970 … were finding it hard to square their own sense of self with the inevitable self-sacrifice of parenthood. They chronicled their angst in the wave of memoirs … each a variation on the themes of their struggle to be the kind of parents they aspired to be without allowing their own sense of self to be swamped by the demands of Parenting. Many parents of this generation resolved the conflict by transforming their childrearing into an act of self-expression. This brought them into direct conflict with other people, and any individual or rule that called their parenting into question became a personal slight.

The irony, however, is that intensive mothering, which is ostensibly designed to raise happier, healthier, more successful children has done nothing of the kind. To my knowledge, not a single parameter of child mental health has improved in the past half century and many — like child suicide — have actually gotten worse.

That’s just what you’d expect when mothering changes from nurturing children to maternal self-expression.

Most people understand that we live in an era of extreme political and cultural polarization and our country is suffering terribly as a result. It has been going on for the last 25 years, and it’s easy to forget that it hasn’t always been like this nor does it have to be.

Sadly, the polarization has been extended to mothering using many of the same tactics that were deliberately contrived to promote political polarization. Many mothers and babies are suffering terribly as a result.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Lactivsts, like gun rights activists, are extremists.[/perfectpullquote]

To understand what is going on in the world of mothering, it helps to review what is going on in the world of politics. It is critical to recognize that the current state of political polarization is not an accident. Certain politicians have manipulated people in order to get elected. How? They have promoted “identities,” created “threats,” stoked grievances, encouraged a sense of victimization, and constructed compromise as sell-out.

Consider members of the National Rifle Association. For 25 years, despite increasingly lax gun policies and soaring numbers of gun massacres, the members of the NRA tell each other that they face the “threat” of all guns being banned, that they are being victimized by anyone who wants common sense gun restrictions, that they must perpetually march loaded down with weaponry to display their sense of grievance and that they must never, ever compromise on their demands.

Gun rights activism isn’t merely a choice of many NRA supporters. It is their tribe and their identity. And the outsize anger of NRA members and their vicious treatment and portrayal of anyone who disagrees is a feature of gun rights activism, not a bug.

Consider extreme evangelicals. Christianity has NEVER been under threat in this country. Yet evangelical leaders tell their followers they are facing the threat of religious persecution, that they are victimized daily by “slights” such as someone saying ‘Happy Holidays’ instead of ‘Merry Christmas,’ that they must perpetually pressure their political leaders by displaying an unending sense of grievance and that compromise isn’t merely forbidden, it is satanic.

Evangelical fervor isn’t merely the religious belief of evangelicals, it is their tribe and their identity. And the outsize anger of extreme evangelicals and their vicious treatment and portrayal of anyone who doesn’t believe as they do is a feature of contemporary evangelical politics, not a bug.

The same techniques are also being used to create extremism in mothering.

Consider lactivism. Lactivism is NOT merely support for breastfeeding. Lactivism is the cultural belief that all babies “deserve” breastmilk, that all mothers should breastfeed, that breastfeeding should be normative (and formula feeding portrayed as deviant) and to the extent that other mothers can’t or choose not to breastfeed, they are the unwitting, uneducated dupes of large multinational corporations.

Spend more than two minutes with any lactivist leader or on any lactivist blog or Facebook page and you will see the techniques designed to create political extremism used over and over again.

Even though there has NEVER been more professional and institutional support for breastfeeding, lactivists imagine they live in a world of unending “threat” to breastfeeding, that they are victimized any time anyone proposes common sense breastfeeding policies (e.g. acknowledging that insufficient breastmilk is common). They perpetually display their endless sense of grievance by demonizing women who can’t or don’t wish to breastfeed and they view any form of compassion for women who make different choices as a sign of insufficient ideological fervor.

Lactivism isn’t merely a choice, it is the tribe and the identity of lactivists. And the outsize anger of lactivists and their vicious treatment and deliberate mischaracterization of anyone who is not a lactivist (they “hate breastfeeding”!!) is a feature of contemporary lactivism, not a bug.

Consider midwives, doulas and childbirth educators, particularly those from the UK and Australia. Spend any time with any midwifery leader or on any birth blog or Facebook page and you will see the techniques designed to foster political extremism deployed repeatedly.

There has never been more professional and institutional support for (cruelly named) ‘normal birth,’ yet contemporary birth workers pretend they live in a world of unending “threat” to unmedicated vaginal birth without interventions. They insist that they are being victimized any time someone points out that birth is inherently quite dangerous for babies and mothers. They perpetually display their endless sense of grievance by demonizing obstetricians as well as women who make different choices; it’s difficult to imagine anything more vicious and cruel than insisting on psychological evaluation of women who choose C-section on request. They view any form of compromise with obstetricians, neonatologists and pediatricians as betrayal of fundamental beliefs.

Promoting “normal birth” isn’t merely the occupation of many midwives and birth workers, it is their tribe and their identity. And the outsize anger of birth workers and deliberate mischaracterization of anyone who can’t or chooses not to pursue unmedicated vaginal birth without interventions (they “want everyone to have a C-section!!”) is a feature of contemporary midwifery and childbirth care, not a bug.

If you want to see the awesome power of extremist politics, just look at the mask “debate.” Right wing extremists aren’t merely willing to overlook the massive disaster perpetuated by the current governing party’s willingness to ignore science and tolerate both the deaths and the economic destruction of anyone besides its wealthiest members. The party’s extremists are willing to bring their own world view in line with the party even though the party is literally killing them. Refusing to wear a mask has become a sign of fealty to extremism.

Easing the current political extremism is beyond my purview, but I do have ideas for addressing the current tribalism among mothers. Lactivists, midwives and birth workers need to understand the ways they have been manipulated toward extremism. Neither breastfeeding nor vaginal birth are being threatened. Women who make different choices are not victimizing them. They should drop their outsize sense of grievance and welcome compromise for what it is — the stepping stone to a better world, not a betrayal of first principles.

I’m not hopeful that those who have tied their identity to lactivism and birth work will be willing to moderate their extremism. But fortunately we don’t have to wait for them. Individual mothers who deviate from lactivist and birth orthodoxy should recognize that making choices that benefit themselves and their children is more likely to lead to thriving families than attempting to placate those have situated their identity in and pledged their fealty to mothering extremism. After all, a thriving family is the ultimate goal.

There is a veritable epidemic of “broken” baby tongues, known colloquially as tongue-tie and scientifically as ankyloglossia.

The epidemic of tongue tie is surprising since the natural incidence has been estimated as only 1.7-4.8%

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The same people who insist that women are perfectly designed to breastfeed can’t explain why so many babies supposedly aren’t equally perfectly designed.[/perfectpullquote]

But releasing (snipping) the tongue tie is big business. The surgical fee for frenectomy/frenotomy is $850. I presume that $850 is what the doctor bills; what he or she is actually paid probably varies by insurance company.

How effective is surgery for tongue-tie in reducing breastfeeding problems?

Not very.

A review of the literature published in the journal Pediatrics, Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review, found:

Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low.

And the worst part? 70% of babies referred for tongue-tie surgery don’t need it!

That’s the conclusion of a new paper published in the International Journal of Pediatric Otorhinolaryngology. As Diercks et al. explain:

Despite growing popularity of the procedure, controversy remains surrounding the diagnosis of ankyloglossia, when to perform frenotomy, and whether frenotomy even improves feeding outcomes. A 2017 Cochrane review of lingual frenotomy concluded that lingual frenotomy reduces short term maternal nipple pain, but this did not translate to improvements in breastfeeding consistently and no data about long term breastfeeding success was available . This is further complicated by introduction of the concept of posterior ankyloglossia as well as consideration of the role of the maxillary lip frenulum in feeding.

The epidemic of tongue-tie has been driven by lactation consultants:

There is disagreement among health care professionals regarding the degree to which ankyloglossia impacts infant feeding patterns, with 69% of lactation consultants attributing breastfeeding problems to anatomic restriction vs. 10% of pediatricians and 30% of otolaryngologists.

Lactation consultants are grossly over diagnosing tongue tie. Up to 70% of patients they refer don’t actually need the surgery.

The authors studied all infants referred for surgery in their institution in a year. But before performing the surgery:

All mother-infant dyads were offered a formal feeding evaluation by a pediatric speech language pathologist specializing in infant feeding and swallowing disorders approximately 3 to 14 days prior to consultation with a pediatric otolaryngologist.

What happened?

Of the 153 participants referred for frenotomy, after multidisciplinary evaluation, a procedure was recommended for only 46 (30.1%) of patients. One patient had undergone lingual frenotomy prior to consultation elsewhere and a revision procedure was not recommended… Of the infants who underwent frenotomy, 11 (23.9%) underwent labial frenotomy alone, 5 (10.9%) underwent lingual frenotomy alone, and 30 (65.2%) underwent both labial and lingual frenotomies. 94 children (71.8%) had accessed lactation consultant services prior to assessment…

The authors note:

Rates of ankyloglossia diagnosis and frenotomy have increased sharply over the past decade, perhaps due to increased desire as well as pressure for new mothers to breastfeed.

They conclude:

The majority of patients referred for ankyloglossia may benefit from nonsurgical intervention strategies based on findings from comprehensive feeding evaluation. Frenotomy is associated with higher maternal feeding-related worry and reduced breastfeeding self- efficacy scores. While tongue appearance is associated with frenotomy, functional assessment is critical for identifying patients who may also benefit from lip frenotomy.

Why has the diagnosis of tongue-tie reached epidemic proportions followed by an explosion of unnecessary surgery?

I have a theory:

Breastfeeding is supposed to be perfect, yet it is clear that many babies and mothers aren’t doing well with exclusive breastfeeding. The obvious conclusion is that breastfeeding is not perfect, and may not even be a healthy choice for some babies. That simple, obvious conclusion leads to cognitive dissonance in the lactation industry and among lactivists themselves. For them, breastfeeding must be perfect; therefore, it is babies who are “broken.”

Curiously, the same people who insist that women are perfectly designed to breastfeed can’t explain why so many babies supposedly AREN’T equally perfectly designed nor why those babies apparently need (mostly unnecessary) surgery to treat breastfeeding problems.

How ironic!

There’s been a lot of handwringing lately about whether anti-vaxxers will be willing to take a coronavirus vaccine.

Pediatrician Phoebe Danziger writes in The New York Times A Coronavirus Vaccine Won’t Work if People Don’t Take It:

If a vaccine for coronavirus is developed tomorrow, will you take it?

Many people won’t. According to recent polls, half to three-quarters of Americans intend to get the vaccine if one becomes available — woefully short of what we’ll need to protect our communities.

I might not take it either and I’m about as far from an anti-vaxxer as anyone can be.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]An independent panel, convened by a scientific organization that has no ties to government or industry, should vet the vaccine before roll-out.[/perfectpullquote]

The handwringers assume that any COVID vaccine that receives FDA approval will be adequately tested, safe and effective. But that may not be true.

Dr. Danziger recognizes the problem:

They question the safety of a vaccine developed on an accelerated timeline, and in the shadows of political pressure — a concern that has also been raised by staunchly pro-science, pro-vaccine experts.

I’ve raised that very issue, We can have a safe coronavirus vaccine or a rapidly developed vaccine; we can’t have both!

Those worried about COVID vaccine uptake inexplicably ignore this legitimate concern.

It’s not a theoretical risk. It has happened before. In 1976, faced with the looming threat of a particularly virulent form of swine flu, President Gerald Ford rushed a vaccine into production and insisted on releasing it immediately. The result: more people were harmed by complications from the vaccine than from the flu.

Emergency legislation for the “National Swine Flu Immunization Program” was signed … on April 15th, 1976 and six months later high profile photos of celebrities and political figures receiving the flu jab appeared in the media. Even President Ford himself was photographed in his office receiving his shot from the White House doctor.

Within 10 months, nearly 25% of the US population, or 45 million citizens were vaccinated …

But the vaccine wasn’t safe. Over 450 people were paralyzed temporarily or permanently by reactions to the vaccine. The worst part was that the swine flu turned out to be less of a threat than the vaccine designed to prevent it.

Why did the debacle occur?

Ford was facing a tough re-election campaign that fall (one he subsequently lost) and he feared the impact of an epidemic on his electoral prospects. He was more concerned with producing a vaccine quickly than producing it safely.

We can’t trust the FDA or the CDC on this issue; they’ve been subverted by intense pressure from the Trump administration, an administration that has repeatedly demonstrated its contempt for American lives. Given the choice between preventing people from getting sick or falsely assuring people they won’t get sick Trump picks lying every time.

We can’t trust industry. The vaccine will be a financial bonanza for the first company to gain approval. The conflict of interest is enormous.

But I would hope that we could trust the medical profession and the public health profession.

Unfortunately, they seem to be putting the cart before the horse:

First, we must build a coalition of community leaders, public figures and other influential individuals to help combat disinformation and focus on the ethical importance of immunization…

We also need to engage community leaders and public figures who can help mediate national and community discussions about the values, moral principles and identity concerns about vaccination …

We should explore ideas such as offering “green vaccines” — manufactured using transparent processes and ingredients — that vaccine-hesitant Americans may be more likely to accept.

No, first we MUST ensure that any COVID-19 vaccine is thoroughly tested for safety and efficacy by scientists unconnected either to the administration or industry. An independent panel, convened by a scientific organization that has no ties to government or industry, should vet the vaccine before widespread roll-out.

This is all the more important when you consider that the first vaccines to market are unlikely to be traditional vaccines manufactured in traditional ways. We cannot and should not extrapolate from previous vaccines if the new vaccine doesn’t use previous technology. For example, a number of scientists and pharmaceutical companies are working on mRNA vaccines, a form of vaccine that has never been used in humans and therefore may have side effects and dangers that are unanticipated.

Contrary to the fears of the handwringers, the biggest problem we now face is not how to get people to agree to be immunized with the first vaccines that gain FDA approval. The biggest problem is how to be sure the the first vaccines that gain FDA approval are safe, effective and without major side effects.

I’m NOT opposed to a vaccine against COVID-19. I’d even be willing to be part of a study to test for safety and efficacy before either were assured. But I wouldn’t simply agree to receive a vaccine merely because it has been approved unless I saw high quality, long-term safety and efficacy data.

Let’s address that issue first — before we start worrying about who will refuse to take the vaccine.

Denialism kills.

Christine Maggiore was in prime form, engaging and articulate, when she explained to a Phoenix radio host in late March why she didn’t believe HIV caused AIDS.

The HIV-positive mother of two laid out matter-of-factly why, even while pregnant, she hadn’t taken HIV medications, and why she had never tested her children for the virus.

“Our children have excellent records of health,” Maggiore said on the Air America program when asked about 7-year-old Charlie and 3-year-old Eliza Jane Scovill. “They’ve never had respiratory problems, flus, intractable colds, ear infections, nothing. So, our choices, however radical they may seem, are extremely well-founded.”

Seven weeks later, Eliza Jane was dead. She died of AIDS related pneumonia in May 2005.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Denialism kills. Don’t let your children be victims.[/perfectpullquote]

Maggiore had a homebirth with Eliza because no doctor would care for her unless she agreed to take medication to prevent the transmission of AIDS to her unborn child. She was counseled not to breastfeed Eliza, but she did so, and published pictures of herself breastfeeding Eliza to show her confidence in her belief that HIV does not cause AIDS. She never allowed Eliza to be tested for HIV, because she felt that there was “no need”.

After her daughter’s death, Maggiore acknowledged that she never mentioned her HIV status, and the fact that her daughter was almost certainly HIV positive, because she did not want doctors to “discriminate” against her daughter. Although the autopsy report and the slides of the pathology examination were released publicly, Maggiore insisted that Eliza died of an anaphylactic reaction to antibiotics, not of pneumocystis pneumonia.

Christine Maggiore was responsible for her daughter’s death. Her denialism was more important to her than her daughter’s life.

Carsyn Leigh Davis, 17, died of COVID-19 last month for the same reason. Her parents’ denialism was more important to them than their daughter’s life.

Carsyn had a complex medical history and was immunocompromised.

No matter. Her mother posted a stream of denialist nonsense on Twitter:

Not surprisingly, she was also an anti-vaxxer:

How did Carsyn get COVID-19? Her parents sent her to this party at her church.

Her mother sent her to the party despite the fact that Carsyn had just about every possible risk factor for COVID death that any white teen could have. She had fought cancer, neurologic disease and was obese.

When she got sick, her parents (a nurse and a physician’s assistant) treated her with hydroxychloroquine. When she had trouble breathing, they gave her her grandfather’s supplemental oxygen.

It wasn’t enough. Only then did her parents seek medical care for her.

She was treated in a pediatric ICU:

Carsyn’s parents declined to have her intubated, and she instead started receiving plasma therapy, the report said. But by June 22, her condition wasn’t improving and “intubation was required,” the medical examiner wrote.

Despite “aggressive therapy and maneuvers,” Carsyn still didn’t get better, leading Brunton Davis to request “heroic efforts” even knowing that her daughter “had low chance of meaningful survival,” according to the report.

She died shortly after on June 23, twelve days after the “release party”, and only two days after her 17th birthday.

Why do denialists deny?

…[D]enialism is based on irrational and illogical thinking. Denialists do not generate new information to refute scientific claims. To the contrary, they ignore established knowledge, and distort reality to support a preconceived ideology. Denialism is grounded in rhetorical tactics that are designed to give the appearance of a debate among experts, when in actuality there is none. In fact, denialists manufacture doubt by identifying any sign of disagreement among scientists at any point in history and use that false reality to claim that the evidence is inconclusive… Discarding the objectivity and logic of science, denialists use emotionally charged assertions.

Why do some people become denialists?

Psychologically, denial is a natural coping response to threatening and traumatic experiences. It is a buffering mechanism that gives a person time to adjust before facing the threat. Denialism exploits denial as a coping response by offering an escape from the threat.

Paradoxically, those most vulnerable to the threat — like Eliza Scovill’s mother and Carsyn Davis’ parents — are most susceptible to denialism. Rather than cope with fear of severe, they deny that severe illness is even a possibility.

Do denialists ever learn?

Christine Maggiore didn’t. In December 2008 Christine Maggiore died of AIDS related pneumonia. To the very end she insisted that HIV does not cause AIDS and refused the medications that could have saved her life.

It remains to be seen whether Carsyn Davis’ parents will learn from their daughter’s death. That would require accepting responsibility for their role in causing it and I suspect that won’t be happening any time soon.

Denialism kills. Don’t let your children be victims.

Is there anything more ironic than refusing to wear a mask during the coronavirus pandemic?

While anti-maskers loudly insist that no one can tell them what to do, they are in fact doing exactly what President Trump has pressured them to do: risking their very lives to demonstrate political fealty.

We have an expression for that kind of behavior. It’s called “drinking the kool-aid.”

According to Wikipedia:

“Drinking the Kool-Aid” is an expression used to refer to a person who believes in a possibly doomed or dangerous idea because of perceived potential high rewards… In recent years it has evolved further to mean extreme dedication to a cause or purpose, so extreme that one would “drink the Kool-Aid” and die for the cause.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Refusing to wear a mask is risking death to demonstrate fealty to Donald Trump.[/perfectpullquote]

But why “drinking the Kool-Aid”?

The phrase originates from events in Jonestown, Guyana, on November 18, 1978, in which over 900 members of the Peoples Temple movement died. The movement’s leader Jim Jones … proposed “revolutionary suicide” by way of ingesting a powdered drink mix lethally laced with cyanide and other drugs which had been prepared by his aides.

Followers demonstrated their fealty by literally committing suicide.

Refusing to wear a mask is no different. It’s risking suicide to demonstrate fealty to Donald Trump.

It isn’t a mark of independence; it’s a mark of utter, cult-like dependence.

It’s the ultimate “power lie.”

In her fascinating new book Surviving Autocracy, journalist Masha Gessen describes the importance of the “power lie” to a demagogue.

…It is the lie of the bigger kid who took your hat and is wearing it—while denying that he took it.

…[T]he point of the lie is to assert power, to show “I can say what I want when I want to.” The power lie conjures a different reality and demands that you choose between your experience and the bully’s demands: Are you going to insist that you are wet from the rain or give in and say that the sun is shining?

The purpose of the power lie isn’t to get you to believe something that’s untrue, as is the case with ordinary lies. The goal of a power lie is to demonstrate extraordinary power over others by insisting that denying what you know to be true is proof of political fealty.

Donald Trump has deployed the power lie from the very first moments of his presidency. Claims that his inaugural had many more attendees than what everyone could see was his first presidential power lie. By forcing his press secretary Sean Spicer to lie in such an obvious way, he didn’t change the minds of the press nor did he intend to. He was demonstrating his power over Spicer by forcing him to publicly declare something the Spicer and everyone else knew to be a bald faced lie.

Power lies are outlandish lies:

Trump’s lies are outlandish because they are not amendments or embellishments to the shared reality of Americans—they have nothing to do with it. When Trump claimed that millions of people voting illegally cost him the popular vote, he was not making easily disprovable factual claims: he was asserting control over reality itself…

The coronavirus pandemic has resulted in an endless stream of Trump power lies:

When, in the winter and spring of 2020, Trump claimed that the United States was prepared for the coronavirus pandemic, when he promised quickly to triumph over the virus, when he said that hospitals had the necessary equipment and people had access to tests, when he promised health and wealth to people facing illness and precarity, he was claiming the power to lie to people about their own experience.

His followers’ refusal to wear masks marks them as willing to embrace the lie to show fealty to Trump.

It isn’t a victory over reality; it is a surrender to an autocrat.

Are you going to believe your own eyes or the headlines? This is the dilemma of people who live in totalitarian societies. Trusting one’s own perceptions is a lonely lot; believing one’s own eyes and being vocal about it is dangerous. Believing the propaganda—or, rather, accepting the propaganda as one’s reality—carries the promise of a less anxious existence, in harmony with the majority of one’s fellow citizens. The path to peace of mind lies in giving one’s mind over to the regime.

Are you going to wear a mask to protect yourself, or are you going to risk your life to demonstrate fealty to Donald Trump? Are you going to believe infectious disease and public health experts or are you going to grasp at peace of mind by believing outrageous lies?

Refusing to wear a mask is drinking the Kool-Aid. It’s not brave, bold or independent. It’s pathetic!