George Santayana’s most famous quote is used so often that it has become a cliche:

Those who do not remember the past are condemned to repeat it.

It’s just as true in epidemiology as it is in history. That’s why this graph may save your life.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Beware the second wave![/perfectpullquote]

It’s a graph of the US death rate during the Spanish Flu epidemic of 1918-1919. It illustrates what happens when you stop social distancing and open up the economy too soon.

Like many pandemics, the disease and death of the Spanish flu pandemic did not occur all at once. It happened in three distinct waves.

Back in 1918 there were no medical or pharmacological tools to mitigate the severity of the disease; there were no anti-virals and no vaccines for influenza. Public health officials had only natural methods at their disposal: they implemented social distancing to reduce the spread of the disease and the number of deaths.

And it mostly worked.

Most of the social distancing measures used today were well known and implemented with mixed severity and mixed outcomes in 1918. Total isolation, if implemented early, is effective…

The effectiveness of social distancing … is considered to depend on how well and how soon it implemented. In 1918, St Louis implemented these early and well, but Philadelphia did not, including allowing a WWI parade. Philadelphia had a greater rate of infection. However, when St Louis later started cutting back on social distancing restrictions, influenza cases spiked, and the city had to reinstate the measures.

But people chafed at the restrictions and suffered from the resulting economic devastation. Cases and deaths were dropping and politicians were declaring that the worst was over. Sound familiar?

There was tremendous political pressure to lift the restrictions. At first the predictions of the protesters seemed to be confirmed. Cases of the flu continued to drop and it nearly disappeared during the summer months. But it hadn’t been eliminated because social distancing measures were ended too soon. In the fall, it came roaring back.

Lifting control measures when a population is still in the exponential part of the curve, and before any external factors that can limit a wave take effect (eg, a vaccine or antiviral), allows that population to regress to the point before controls were implemented. However, by that time, a much higher number of individuals will be infected. If doubling time reaches 3 days early in the wave, 10 infected persons will increase to 20 in 3 days. If the doubling time when controls are lifted is still 3 days, but the number of infected persons is 1000, then the number will go from 1000 to 2000 infected persons in 3 days, and then to 4000 in another 3 days.

This is especially true when, as in the case of COVID-19, the virus can spread asymptomatically. Moreover, the virus can continue to mutate as it spreads, possibly becoming more virulent.

When the Spanish flu returned in the fall, cases and death rates exploded. Ultimately 675,000 American died of the flu and — as the graph demonstrates — the majority of deaths occurred in the second wave.

There are a lot of reasons to believe that COVID-19 may behave like the Spanish flu and similar pandemics. Indeed, nearly every prediction made by doctors and scientists about the COVID-19 pandemic has come to pass; those predictions were based directly on the Spanish flu experience. That means that the worst of this pandemic still lies ahead.

Where are we now? I added the green arrow to the graph to show that we appear to be cresting the first wave. It seems to those who are protesting the restrictions that there is no reason to continue them. That’s what those who protested the 1918 restrictions thought, too.

They were dead wrong! For every person who died in the first wave of the Spanish flu, up to 10 died in the second and third waves. That means that if 60,000 Americans have died thus far, we can expect as many as 600,000 more to die in the coming 12-18 months if we lift restrictions prematurely.

That doesn’t have to happen. We can keep restrictions in place, only gradually easing them to be sure that the disease does not come roaring back. If the graph convinces politicians to move slowly, hundreds of thousands of lives (including YOURS!) may be saved. Even if politicians choose to behave irresponsibly, you can still heed the lessons of the graph and keep practicing social distancing as far as you are able, continuing to wear masks and avoiding large gatherings of people as much as you can.

Those who refuse to learn from the past are condemned to repeat it. Just because the protesters are determined to ignore the lessons of 1918 and kill themselves, their relatives and their friends doesn’t mean the rest of us have to follow them into the abyss.

Remember this graph; it could save your life and the lives of those you love.

Faced with the pandemic of COVID-19 the Trump administration has done everything wrong and tens of thousands of people have died as a result.

• Trump suppressed information about the threat of the pandemic.
• He lied about the dangers of the virus.
• He refused to allow use of the test that would have identified early cases.
• He failed to provide protective equipment for medical staff.
• He seized tools states had ordered to fight the disease.
• He promotes ineffective and dangerous treatments.
• He is inciting his followers to resist the only measures that have protected them: social distancing, masks and economic shutdowns.

Every action Trump has taken has killed or will kill more people. So why is he doing it? Because Trump doesn’t care about the threat of the virus; he only cares about the perception of the virus. Given the choice between preventing people from getting sick or falsely assuring people they won’t get sick he picks lying every time.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]I OPPOSE any effort to develop a vaccine “at warp speed.”[/perfectpullquote]

But all that may pale in comparison to the next effort Trump is touting — developing a vaccine “at warp speed.” We could develop a safe vaccine for COVID-19 slowly or we could quickly develop a vaccine that might be deadly.

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.

Sound familiar?

I am a passionate advocate of vaccines and I know that the only solution to the current pandemic is a vaccine. Nonetheless, I OPPOSE any effort to develop a vaccine “at warp speed.” We MUST ensure the vaccine is safe and the ONLY way to do that is to test it over time.

We can have a safe vaccine or a rapidly developed vaccine. We can’t have both. We must demand a safe vaccine!

Anti-elitism killed John McDaniel.

On social media McDaniel publicly disparaged efforts to slow the spread of COVID-19.

One screenshot of a post dated March 13 included an accusation that the virus was a “political ploy.”

“If you’re paranoid about getting sick, just don’t go out,” another post allegedly said. “It shouldn’t keep those of us from Living Our Lives. The Madness has to stop.”

A month later he was dead. The proximate cause was coronavirus. The real cause was anti-elitism.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Do Trump supporters love themselves as much as they hate elites?[/perfectpullquote]

I’m old enough to remember when doctors and scientists were respected. That was before a political party weaponized anti-elitism in the effort to win elections.

It started by encouraging distrust of government. President Ronald Reagan famously declared:

The nine most terrifying words in the English language are: I’m from the Government, and I’m here to help.

Over time it expanded to include the people who might support activist government, the “elites.” Instead of responding to the threats identified by “elites” in science and medicine, anti-elitists began condemning those who brought them any news they didn’t want to hear.

Anti-vaxxers didn’t like vaccines so they publicly vilified the doctors and scientists who created them. They attack any effort to maintain one of the greatest public health advances of all time.

Oil and coal interests didn’t want to hear about climate change so they publicly vilified the scientists who raised the alarm. They and their followers attack any effort to protect us from the environmental tragedy that we have been racing toward.

Our current President and his followers didn’t want to hear about the dangers of coronavirus so they publicly vilified the “elitist” doctors who warned about it.

Instead of taking measures to head off the pandemic, Trump and his supporters discounted the frantic calls to action of “elitist” epidemiologists and insisted it wouldn’t arrive.

Instead of quickly mobilizing social distancing to prevent spread of the virus, they derided those measures (they were recommended by elitists!) and insisted they were unnecessary efforts designed to socially control populations for nefarious ends.

Instead of quickly implementing the testing developed by the hated elitists at the World Health Organization, the Federal government insisted on developing its own test that was an embarrassing failure.

Instead of providing protective equipment for “elitist” health professionals, they have instead confiscated protective equipment that states managed to source for doctors and nurses.

At every step of the way, the Federal government has openly disparaged “elitist” scientists and callously risked the lives of “elitist” doctors and nurses.

Anti-elitism has become such a knee jerk reaction that instead of doing everything possible to avert economic disaster, Trump supporters including Senate Majority Leader Mitch McConnell have labeled rescue measures as “Blue State bailouts” designed to protect hated Democratic elites.

Anti-elitism has become such a reflexive response that instead of staying far away from others who might be carrying the virus, Trump supporters are holding rallies to show their contempt for safety measures.

But the anti-elitists have a big problem: the hated elites could have reduced the scale of this massive tragedy and they are the ONLY people who can bring it to an end.

Thus far nearly every prediction that “elites” have made about COVID-19 has come to pass. Nearly every prediction made by anti-elitists has been wrong, often spectacularly wrong.

So there’s only one question left for anti-elitists:

Do they love themselves and their families more or, like John McDaniel, do they hate “elites” so much that they’re willing to die for no better reason than to demonstrate their contempt?

In the last 30 years we have engaged in a huge public health campaign to increase the use of car seats. Not only have we spent millions, we’ve enacted laws that actually make it illegal for parents to drive infants without buckling them into car seats.

The campaign has been spectacularly successful. According to the Insurance Institute for Highway Safety, from 1975 to 2013, infant fatalities fell from 6/100,000 to 1.3/100,000 while car seat use rose to 99% of children under age 1. Of course car seat use is the not the only reason why infant fatalities dropped; cars themselves are safer, but the use of car seats has played an important role.

[perfectpullquote align=”right” color=””]Out of hospital birth has a death rate more than 50X higher than failing to put an infant in a car seat.[/perfectpullquote]

Forgoing car seat use for infants is not merely illegal, it is social anathema. Who would defend a mother who chooses not to use a car seat for her infant. No one, right? Who would claim that the risk of not using a car seat is so small that it should be left to the mother’s choice? No one, right?

Yet, many home birth midwives defend it as a reasonable choice because the risk of death is small. But small is a relative term. That’s why it is instructive to compare the risk of refusing to use a car seat with the risk of giving birth outside a hospital.

I’ve attempted to do that in the graph below:

The graph reflects information from the Insurance Institute for Highway Safety and the data from a 2016 paper in The New England Journal on out of hospital birth suggested that the increased risk of giving birth outside a hospital was small.

Even a cursory glance reveals an inconvenient truth (inconvenient for natural childbirth advocates that is). Childbirth, even for low risk women with singleton term babies in the head first position is inherently dangerous. Infants who are unrestrained had a death rate of 4.6/100,000 whereas the infants of low risk women faced a death rate of 106/100,000 even in a hospital. Childbirth is 100X more dangerous than failing to restrain an infant in a car seat.

The graph actually dramatically understates the risk. The automobile fatality data reflects deaths per 100,000 children, most of whom rode in cars multiple times. The per trip mortality rate is substantially lower. Furthermore, the birth data is from low risk women. The true gulf between automobile infant deaths and deaths from childbirth is probably another order of magnitude.

The graph also shows that the risk of death for an infant riding in a car is actually very small, whether riding in a car seat or not (1.3/100,000 vs. 4.6/100,000). Nonetheless, we value the lives of our infants so much that we are willing to spend millions of dollars and enact laws in all 50 states to protect them from this small increase.

In contrast, there’s a much larger difference between delivering a baby outside a hospital vs. in a hospital (258/100,000 vs. 106/100,000). If 100,000 mothers of infants chose to drive with their infants unrestrained, there would be an absolute increased risk of 3 infant deaths per year. If 100,000 low risk women chose to give birth outside the hospital, however, there would be an absolute increased risk of 152 deaths!

That doesn’t change the fact that it is up to each woman to decide for herself where to give birth. But it does suggest that the increased risk of death at out of hospital birth isn’t small after all.

Simply put, no one could call the failure to buckle an infant into a car seat a safe choice. If no one would call that choice safe, no one should call the choice to deliver outside a hospital, which has an absolute increased risk of death that is 50X higher, a safe choice.

It’s difficult to imagine anything more soul searing for a mother than the thought that her baby died as a result of her choice.

People Magazine reported:

Kara Keough Bosworth and her husband Kyle Bosworth are mourning the loss of their newborn son, McCoy Casey.

In an emotional Instagram post on Tuesday, the daughter of Real Housewives of Orange County star Jeana Keough revealed the tragic news that her son had died after experiencing “shoulder dystocia and a compressed umbilical cord” during the course of his birth.

What they didn’t mention was that his death was very likely preventable. It happened because Keough chose homebirth.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Low risk is never no risk.[/perfectpullquote]

As she explained to members of a shoulder dystocia Facebook group:

This has been the worst and hardest time of my life, and I can’t even wrap my brain around how we missed an 11 lb+ baby … I’m experiencing a lot of sell-blame and guilt. How did I not know? Would the outcome have been different in a hospital? Would he have been saved?

Why did Keough choose to risk her baby’s life in this way?

Once hospital rules changed and I learned my doula wouldn’t be allowed to attend and there were rumors that husbands might not even be allowed by the time I delivered due to COVID-19, I made the decision to switch to a home birth with a certified nurse midwife, her student midwife assistant and my doula.

After all, she had a completely normal pregnancy and had had a previous vaginal birth. She believed she was low risk. She was told her baby was “on the bigger side of the normal range.”

But low risk is never no risk and when emergencies happen at home babies die for lack of access to high tech medical care.

Crowning hurt but head came out in 2 effective pushes. I expected the body to slither out from there … But instead …midwife told me to get on all fours and I knew instantly – shoulder dystocia.

… [W]e did McRoberts, Gaskin maneuver, standing, supra public pressure, running start, Wood’s screw maneuver, she attempted to release the anterior shoulder, posterior shoulder, reach an arm/hand and break a clavicle. We ran through the maneuvers about 3 times each.

And during that entire time, Keough’s baby was deprived of oxygen. Once the head is born, the umbilical cord is trapped between the baby and the pelvis until the rest of the body is born.

It took so long to release the baby that EMTs had time to arrive and enter the house.

Baby McCoy had no heartbeat.

[H]e was immediately “bagged” to help him breathe and they were doing chest compressions. My husband followed him to the hospital – 4 blocks away (another reason we felt safe making the decision to birth at home) and they did manual compressions for 45 minutes – and they got him back with 3 shots of epinephrine… [He] was 11 lbs 4 oz.

They got his heart restarted, but his brain had suffered massive injury.

After 72 hours of cooling blanket and an MRI we were given the devastating news that our son’s brain was severely damaged from severe HIE (hypoxic ischemic encephalopathy)…

We had to make the decision to withdraw care and let his body join his soul after 6 days and we held him as he made the transition to heaven.

There are a variety of reasons that the outcome would almost certainly have been different in a hospital. Most importantly, there would have been physicians more experienced in managing shoulder dystocia and neonatologists who could have intubated the baby immediately. A Zavanelli maneuver (pushing the baby back up and performing and immediate C-section) might have been possible.

Another possibility is that an ultrasound might have revealed that the baby was extremely large and Keough might have been offered a C-section. Had that happened, baby McCoy would have survived and Keough would be mourning the loss of a vaginal birth, not the loss of her son.

Yet despite everything she has endured and lost, Keough is thinking about avoiding a C-section for her next baby.

My brain can’t help but jump ahead to my next pregnancy and the PTSD and how I would totally WANT a natural vaginal birth again … but I would no longer be a good candidate for a home birth (despite the fact that I really loved every minute until he was stuck)…

It’s shocking. It was her concern for her experience that cost her son his life; yet he hasn’t been dead for a week and she’s already worried about her future experiences.

Dead babies can’t breastfeed. I would have thought that even the most ardent lactivist understands that. Apparently not.

The editorial, Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm, by Alison Stuebe, MD, the new president of the Academy of Breastfeeding Medicine is deeply troubling for its willingness to sacrifice the lives babies whose mothers are infected with COVID-19. Why sacrifice their lives? For no better reason than to promote breastfeeding.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Like gun rights activists, lactivists reject even the most common sense restrictions.[/perfectpullquote]

I guess I shouldn’t be surprised. We’ve already seen lactivists like Melissa Bartick, MD cheerfully do the same, promoting bedsharing despite the fact that it is the single biggest risk factor for SIDS.

But equally troubling to me is Dr. Stuebe’s willingness to use “arguments” typically associated with anti-vaxxers and gun rights activists.

Dr. Stuebe starts by acknowledging that separating newborns from COVID-19 infected mothers can save their lives:

The benefit of separation is that it minimizes the risk of transmission of SARS-CoV-2 from mother to infant during the hospital stay.

But then follows with this absurdity:

However, if the goal is the health and well-being of mother and child in the months following birth, there are additional considerations.

That makes her invocation of the phrase “first do no harm,” especially inappropriate. As Wikipedia explains:

Primum non nocere is a Latin phrase that means “first, do no harm.”…

It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

Immediate contact between a newborn and a mother infected with COVID-19 carries the obvious risk of the infant’s death. The chance of benefit of immediate contact is not merely less certain, but non-existent. The purported need for immediate skin-to-skin contact was invented less than 50 years ago and reflects religious and cultural beliefs, NOT medical evidence.

In other words, like gun rights activists who reflexively reject even the most common sense gun restrictions designed to save lives, breastfeeding activists reject even the most common sense restrictions designed to save babies lives. Why? For the exact same reason. Once people see that restrictions DO save lives and DON’T cause harm, they will no longer believe the expansive claims of activists. Better that some should die to preserve the “freedom” of others to claim what they want.

Let’s analyze the rest of Stuebe’s arguments.

1.“Separation may not prevent infection.”

This is a classic anti-vax argument: if it’s not 100% effective it’s not worth doing.

2.”Interruption of skin-to-skin care disrupts newborn physiology.”

That’s nonsense. Three generations of American babies were born to mothers who did not have contact with them for hours after birth. No one has ever documented even a single instance of harm to those millions of infants and mothers, let alone widespread harm.

3.“Separation stresses mothers.”

You know what stresses mothers far more? Their babies contracting a deadly illness and requiring painful interventions, NICU stays and possible death.

4.”Breastfeeding is a baby’s first vaccine.”

Breastfeeding is NOT a vaccine. Vaccines provide ACTIVE immunity; they teach the baby’s immune system to make antibodies to specific bacteria and viruses; babies make more of those antibodies whenever threatened, providing years or even lifetimes of protection. Breastfeeding provides PASSIVE immunity to a few bacteria and viruses; babies do not learn to produce their own antibodies. Therefore, the protection lasts weeks at most.

5.”Early separation disrupts breastfeeding, and not breastfeeding increases the risk of infant hospitalization for pneumonia.”

This is perhaps the most ridiculous of Dr. Stuebe’s ridiculous arguments. Early separation of babies from infected mothers is designed to prevent COVID-19 pneumonia. It is highly effective. Are we supposed to believe that letting babies get COVID-19 pneumonia is an effective strategy for preventing future pneumonia?

6.”Separate isolation doubles the burden on the health system.”

So? Is the fact that saving babies’ lives cost money supposed to be an argument for letting babies die?

The bottom line is that the risks of COVID-19 transmission from infected mothers to infants is real, documented and deadly. The “risks” of maternal newborn separation are purely theoretical and never seen over millions of babies born in the US over 50 years of experience.

Better dead than not breastfed immediately? Maybe to lactivists Dr. Stuebe, but not to mothers and certainly not to babies.

According to scientist and author David Brin:

[S]elf-righteousness can also be heady, seductive, and even … well … addictive. Any truly honest person will admit that the state feels good. The pleasure of knowing, with subjective certainty, that you are right and your opponents are deeply, despicably wrong. Or, that your method of helping others is so purely motivated and correct that all criticism can be dismissed with a shrug, along with any contradicting evidence.

Sanctimony, or a sense of righteous outrage, can feel so intense and delicious that many people actively seek to return to it, again and again.

Breastfeeding activists are outraged. They are lactimonious!

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]In a moment of national crisis, supporting women does NOT involve referring those who use formula as ignorant fuckers.[/perfectpullquote]

They are lactimonious about breastfeeding rates:

A Swansea University academic has said that breastfeeding levels in the UK are the lowest in the world. She is placing much of the blame on the social pressures and attitudes that many women face and is calling for greater support for new mothers to start and continue breastfeeding.

Dr Amy Brown of the Department of Public Health, Policy and Social Sciences discusses this in her forthcoming book, Breastfeeding Uncovered. She says that breastfeeding has a whole host of benefits, including protecting the health of mothers and babies. Increasing breastfeeding rates would therefore save the UK millions of pounds each year.

Yet there is NO correlation between breastfeeding rates and healthcare costs. Indeed the UK — where lactivists are indignant about the breastfeeding rate — has one of the lowest rates of infant mortality in the world.

They’re lactimonious about formula. Oops! I mean artificial baby milk.

They’re lactimonious when anyone dares suggest that breastfeeding has risks as well benefits.

But most of all, they’re lactimonious that anyone dares criticize their self-righteousness.

Consider this exquisite example of lactimony from the Facebook page Raw Reality with Sarah.

Like all who run lactimonious pages and blogs, Sarah starts with those delicious feelings of outrage:

If I see any of you “fed is best” mother fuckers encouraging a mother to use formula right now, we’re going to have a problem!

Sarah helpfully illustrates a sentinel feature of lactimoniousness: the delusion that anyone cares about what she thinks.

A second feature of lactimony is the irresistible urge to lie:

We are in the middle of a national emergency. We are facing quarantines and a shortage on food in general. There is a formula shortage!!!

Yes, we are in the middle of a national emergency, a pandemic of a disease that can be fatal and has already killed thousands in the US including some babies. But there is NO shortage of food in general and there is NO formula shortage. No matter, lactimoniousness depends on fabricating threats.

Sarah, like all every other lactimonious blogger, misrepresents the fed is best movement.

Do not, unless medically necessary, encourage a mother to get caught in the formula feeding, top-up effect trap. For fucks sake, especially if they have not used formula yet, or their baby was just born.

But the fed is best movement is not about encouraging women to use formula. It is about encouraging women to do what works best for them, especially important at a moment of national — and for many women, personal — crisis.

In the ultimate irony, Sarah the lactimonious, who makes money “advising” women on unassisted birth, declares:

The fucking ignorance.

Ask yourself, Sarah, if you are lactimonious.

Is it pleasureable to know with certainty, that you are right and your those lazy morons who formula feed are deeply, despicably wrong? Do you feel proud that that your method of helping others is so purely motivated that calling women “fuckers” is justified? Why? Because they dare to choose an excellent method of nourishing their babies, or – horror — they combine two equally excellent methods, formula and breastmilk?

Sarah, your lactimoniousness has nothing to do with breastfeeding and everything to do with your addiction to self-righteousness, that delightful hit of dopamine you get every time you refer to a formula feeder as a fucker.

The truth, however, is that the benefits of breastfeeding are trivial. Insufficient breastmilk is common and exclusive breastfeeding is the leading cause of newborn hospital readmission. There is no formula shortage, and the fed is best movement is about supporting women, not promoting formula.

And — pro-tip — in a moment of national crisis, supporting women NEVER involves referring to those who use formula ignorant fuckers.

As Dr. Anthony Fauci explained last week:

What we do is that every time we get more data, you feed it back in and relook at the model. Is the model really telling you what is actually going on?Models are as good as the assumptions you put into them, and as we get more data, then you put it in and that might change.

Consider a model that predicts the number of lives lost to COVID-19 in the US each day. According to the Washington Post article that quoted Dr. Fauci:

One bit of data added to the … models was the actual number of deaths over the past few days. The graph presented on Monday, for example, included an estimate that there would be about 850 deaths on April 1. Data … indicates that the number was closer to 890 — though even that figure includes some uncertainty. The model released on Wednesday night estimated there would be 899 deaths on April 1.

The accuracy of the model is validated by how closely it approximates what happens in the real world. Models make predictions and if those predictions fail to occur, the model is revised so it more closely complies with reality.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Mathematical models must be revised regularly by incorporating real world data.[/perfectpullquote]

That’s how mathematical modeling works. The model should be revised regularly based on real world information.

That’s why it’s a very serious problem that the mathematical modeling of the benefits of breastfeeding is NEVER revised to incorporate real world data.

For years breastfeeding researchers like Melissa Bartick, MD have constructed mathematical models to predict how we would decrease infant mortality, severe morbidity and healthcare expenditures if more women would breastfeeding. Back in 2010, Dr. Bartick published The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis.

She claimed:

If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance).

Bartick notes that the model was based on at least 14 separate assumptions about associations between breastfeeding and various conditions and illnesses. It is not unreasonable to make assumptions, but it is indefensible to refuse to revisit those assumptions when predictions are not confirmed by real world evidence.

For example, the latest coronavirus predictions of new cases and deaths have been recently revised downward based on the fact that cases and deaths are decreasing faster than the earlier models predicted. Earlier models, like all mathematical models, were based on assumptions. That’s okay as long as you revise those assumptions based on what actually happens.

But breastfeeding researchers NEVER revise their assumptions, even when they are demonstrably false.

In the past 10 years, Dr. Bartick and other breastfeeding researchers have been unable to show that even one term infant death has been prevented by increasing breastfeeding rates, let alone hundreds. They have been unable to show that even a single dollar has been saved by increased breastfeeding rates, let alone billions of dollars per year.

Did they revise their models?

No, they actually doubled down.

In September 2017, they released a “Breastfeeding Savings Calculator” based on the 2010 model. As far as I can determine, they didn’t revise a single aspect of that original model. This despite the fact that there were 7 years of data to work with, 7 years that had FAILED to produce the benefits the model predicted in 2010. That’s inexcusable.

Nearly every claim on the benefits of breastfeeding circulating today is still based on the 2010 model. It’s the equivalent of continuing to use the coronavirus projections from November 2019 even though they did not accurately capture what is currently happening in April 2020.

As Dr. Fauci noted, mathematical models must be continually revised so they accurately reflect what is actually happening. Breastfeeding researchers never revise their models; that’s why they are completely wrong.

Pregnant women and new mothers are terrified that they might pass COVID-19 to their infants. It’s a justified fear; if they are infected at the time of birth, they might need to be separated from their infants until they recover.

Sadly, pregnant women and new mothers have also been terrorized into believing that any separation from their infants will interfere with their ability to bond to the baby and the babies’ ability to bond to them. That fear is wholly UNjustified! Bonding is a natural process that happens spontaneously and does not require ritualized timed, time-sensitive behaviors.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Bonding happens naturally, spontaneously and does not require ritualized time-sensitive behaviors.[/perfectpullquote]

How ironic!

If there’s one thing that natural childbirth advocates are sure of, it’s that women and babies are “designed” for birth. It happens spontaneously and if they simply trust in the process, it will turn out fine.

If there’s one thing that lactivists are sure of, it’s that women and babies are “designed” for breastfeeding. It happens spontaneously and if they simply trust in the process, they will be able to nourish their babies completely.

If there’s one thing that attachment parenting advocates are sure of, it’s that bonding … DOESN’T happen spontaneously and requires elaborate rituals, timed and time-sensitive.

Ironically, given that attachment parenting is promoted as “natural,” the idea that maternal-infant attachment occurs naturally, that mother and child might love each other simply because they belong to each other, is rejected out of hand. Instead, ritualized practices must be employed, supervised by an army of experts including parenting gurus, midwives, and lactation consultants, among others.

As Charlotte Faircloth notes in the essay “The Problem of ‘Attachment’: the ‘Detached’ Parent” in the book Parenting Culture Studies:

It hardly seems controversial to say that, today, we have a cultural concern with how ‘attached’ parents are to their children. Midwives encourage mothers to try ‘skin-to-skin’ contact with their babies to improve ‘bonding’ after childbirth, a wealth of experts advocate ‘natural’ parenting styles which encourage ‘attachment’ with infants…

Previously a mother’s love for her child had been romanticized and ascribed to inherent characteristics of women, mother love has now been medicalized, requiring participation in rituals prescribed by experts.

As I’ve noted repeatedly over the years, attachment parenting is not based on Attachment Theory, which tells us that the “good enough” mother is all that any child needs. So where did it come from? It certainly did not come from an epidemic of “detached” children. Until recently it was accepted as obvious that children remained unattached only in the most severe cases of abuse and neglect.

It came not from the study of humans, but of non-primate animals. Animals like ducklings had been shown to “imprint” on whatever caretaker they saw first during an “attachment window.” Attachment parenting theorists simply extrapolated, theorizing that infants “bonded” to their mothers during an attachment window around birth.

Faircloth explains:

Initially, the focus was on the critical period immediately after birth, though this later expanded to the period around birth as a whole. The argument was that a child’s first hours, weeks, and months of life had a lasting impact on the entire course of the child’s development. Birth, in particular, was singled out as one of the ‘critical moments’ for bonding to take place. After birth, new mothers were told to look into the eyes of their infant, hold their naked child, preferably with skin-to-skin contact, and breastfeed for optimal bonding…

This belief is the result of medicalizing and pathologizing bonding.

…[C]oncern with detachment as part of a broader trend in the twentieth century towards the medicalization of parenthood: in particular, the medicalization of maternal emotion and mother love itself…

The truth is that bonding is not contingent and happens SPONTANEOUSLY over time (as any father or adoptive parent could tell you). It does not depend on a formalized set of behaviors; indeed, it has NOTHING to do with those behaviors at all (as anyone who has adopted a child beyond infancy can tell you).

Vitually all children will bond to their mothers in the absence of abuse or neglect. Indeed, three entire generations of Americans were raised by mothers who were unconscious at the moment of birth and didn’t see their babies for hours afterward. There is no evidence that maternal infant bonding was harmed in any way.

Unfortunately, attachment parenting advocates have medicalized and pathologized bonding. They promote a fear-based view, hinting at dire consequences if you don’t follow their advice. And that leads to a lot of unnecessary guilt on the part of mothers who did not or could not follow attachment parenting prescriptions.

There is NO EVIDENCE that immediate contact (let alone mandated periods of skin-to-skin contact) are necessary for bonding. That has always been true, but in the age of COVID-19 it is even more important to acknowledge that truth.

It has happened again.

Another major breastfeeding professional has been forced to acknowledge what I have been writing about for more than a decade: breastfeeding has a significant failure rate!

Indeed, the language Dr. Alison Stuebe uses almost perfectly mirrors what I have written repeatedly in the past.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]On breastfeeding, I told you so![/perfectpullquote]

In Breastfeeding, Like Every Other Organ System, Is Not Invincible, Dr. Stuebe finally admits it:

As physicians, we should not be surprised that the breast is not invincible. After all, there are >1 million children and young adults worldwide with type 1 diabetes—if pancreatic islet cells can fail, why would lactocytes be invulnerable? …

I have repeatedly used the example of the pancreas and diabetes to illustrate why claims of the “perfection” of breastfeeding must be wrong, why insufficient milk supply is not “misperceived” and why the recommended treatments (like brutal pumping regimens) often don’t work.

Dr. Stuebe admits that the need for supplementation is so common that it was described in some of the first extant works of writing produced nearly four thousands years ago.

Throughout human history, if a mother was not able to produce enough milk, she could turn to another lactating woman in her community for help. Wet nursing is referenced in the Law Code of Hammurabi, and one of the earliest medical encyclopedias, The Papyrus Ebers, includes a prescription for lactation failure.

Dr. Stuebe acknowledges that aggressive breastfeeding promotion is causing major health problems:

That is a significant public health problem, because more families than ever are following evidence-based recommendations to breastfeeding exclusively. In the past half century, breastfeeding initiation rates in the United States have climbed from a nadir of 22% in 1972 to 84% in 2016. Nearly half of infants are exclusively breastfed through the first 3 months of life.

When mothers are encouraged to breastfeed exclusively even though a significant proportion of women are physically incapable of producing enough breastmilk, babies suffer major health problems and risk disability and death.

Referring to a comprehensive review I wrote about last month, Stuebe notes:

… [W]e synthesize evidence published over the past 10 years regarding early infant feeding and growth, as well as management of hypoglycemia and hyperbilirubinemia. We further integrate recommendations for maternal and infant risk factors and management, recognizing that breastfeeding is a two-person organ system; evaluation and management require a dyadic approach.

She is referring to the just published Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥ 35 Weeks.

As I noted:

Breastfeeding researchers admitted that everything the Fed Is Best Foundation and I have been writing for years is true:

-Insufficient breastmilk is common
-Serious, life threatening dehydration can result
-Wet diapers are NOT a reliable indicator of hydration status
-Insufficient breastmilk is not “misperceived”
-Low blood sugar can threaten babies’ brain function
-Serious, life threatening jaundice can result from insufficient breastmilk
-Judicious formula supplementation does not harm breastfeeding
-Pacifiers bans have no basis in science
-The Baby Friendly Hospital Initiative has led to babies harmed by falling from or being smothered in mothers‘ hospital beds

There’s only one glaring omission from the paper: an apology to the Fed Is Best Foundation and myself. We’ve been desperately trying to gain attention for the tens of thousands of babies who suffer and are re-hospitalized each year because breastfeeding professionals such as Dr. Stuebe refused to admit that breastfeeding — like every other organ system — has a significant failure rate.

Had they admitted the obvious in 2010 instead of in 2020, Dr. Christie del Castillo—Hegyi’s son might not have suffered a permanent brain injury as a result of insufficient breastmilk. Jillian Johnson’s son Landon would almost certainly still be alive, not a victim of neonatal hypernatremic dehydration.

I wonder when it will finally occur to breastfeeding professionals that they have caused untold suffering for babies and mothers. Maybe then they will feel remorse.