We live in Dunning Kruger nation.

What do I mean?

A variety of very loud “confident idiots” — anti-vaxxers, homebirth advocates, climate change deniers — actually think they know more than the experts in the respective fields.

Where did they get that idea?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”The incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.”[/pullquote]

I’ll let Dr. David Dunning explain it:

In 1999, in the Journal of Personality and Social Psychology, my then graduate student Justin Kruger and I published a paper that documented how, in many areas of life, incompetent people do not recognize — scratch that, cannot recognize — just how incompetent they are, a phenomenon that has come to be known as the Dunning-Kruger effect. Logic itself almost demands this lack of self-insight: For poor performers to recognize their ineptitude would require them to possess the very expertise they lack…

In other words, those who know the least about a particular topic — vaccines, childbirth, climate change — actually believe they know the most. They simply don’t know what they don’t know.

Indeed:

What’s curious is that, in many cases, incompetence does not leave people disoriented, perplexed, or cautious. Instead, the incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.

The expertise of immunologists, obstetricians and climate scientists is disparaged by confident idiots who believe their ability to use Google is the equivalent of any PhD.

If you’ve ever tangled with an anti-vaxxer, you know that it’s very difficult to argue with him or her. You can’t reason confident idiots out of a position that they didn’t reason themselves into in the first place. They often don’t understand the terms of the specific scientific discipline, the principles of scientific inquiry or even the rudiments of logic.

And yet they think they are experts, scorning the expertise of real experts.

Why are so many anti-vaxxers, homebirth advocates and climate change deniers “confident idiots”?

Some of our most stubborn misbeliefs arise … from the very values and philosophies that define who we are as individuals. Each of us possesses certain foundational beliefs — narratives about the self, ideas about the social order—that essentially cannot be violated: To contradict them would call into question our very self-worth. As such, these views demand fealty from other opinions. And any information that we glean from the world is amended, distorted, diminished, or forgotten in order to make sure that these sacrosanct beliefs remain whole and unharmed.

In some cases those cherished beliefs are that “corporations are evil,” “natural is always best,” or “government is the enemy.” In many cases the cherished belief is that the confident idiot is both smarter and less gullible than the rest of us poor “sheeple.”

How can the rest of us protect ourselves from confident idiots who parachute into websites, Facebook pages and message boards in order to “educate” the rest of us?

1. The first step is to recognize that those who know the least often think they know the most. That’s why professional qualifications are so important. That doesn’t mean that experts know everything, or that they are always right, but it does mean that they have a strong foundation from which to assess claims about vaccines, childbirth or climate change.

2. Be wary of anyone who claims that formal education is unnecessary, or that experts ignore the evidence of cherry picked scientific papers that don’t represent the consensus of knowledge on the subject.

3. Be wary of anyone who lacks formal education in the topic but nevertheless makes claims about vaccines, childbirth or climate.

4. Don’t “trust” any natural process simply because it is natural.

5. On the web, ignore anyone who cannot tolerate dissent and deletes comments that call their claims into question.

6. Resist the temptation to succumb to flattery. Don’t let the desire to feel superior to other people make susceptible to Internet propaganda.

We live in Dunning Kruger nation. The disparagement of expertise may boost the self esteem of its promoters, but often harms everyone else. What confident idiots know rarely represents the sum total of all knowledge on the subject; that’s why real expertise is worthy of respect.

Those who wish to be acknowledged as “educated” can’t take a short cut of an internet connection. They have to do the hard work of learning science, statistics and the actual subject under discussion, whether it is immunology, obstetrics or climate science; without that formal education, they are merely confident idiots.

The mainstream media is buzzing with the news that C-sections purportedly increase the risk of obesity in offspring by 15%.

Here’s the LA Times:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There’s just one problem. An increase of 15% is essentially nothing.[/pullquote]

Your very first moments of life can influence your risk of obesity for years, a new study shows.

Babies delivered via cesarean section were 15% more likely to be obese as kids, teens and young adults than were babies who made the trip through the birth canal, according to the report in JAMA Pediatrics…

Nutritional epidemiologist Changzheng Yuan of the Harvard T.H. Chan School of Public Health and her study coauthors had good reason to suspect that a C-section put a baby on the path to obesity. Two recent reports that pooled data from other studies found that cesarean birth was associated with a 22% increased risk of obesity.

There’s just one problem. An increase of 15% is essentially nothing.

The study is Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood, and appears to be methodologically excellent, correcting appropriately for confounding variables like maternal weight.

The problem is the importance they place on a very tiny difference that may be no difference at all.

Consider a different relationship, smoking and lung cancer. Smoking increases the risk of lung cancer by more than 2000%.

How about homebirths? Homebirth advocates are fond of claiming that the increased risk of neonatal death at homebirth is trivial, but CDC statistics indicate that it is in the range of 200% and the most definitive statistics, from Oregon, show that homebirth increases the risk of perinatal death by 800%.

Several years ago Gary Taubes wrote a piece for the New York Times Magazine explaining how lay people can judge the results of epidemiological studies, Do We Really Know What Makes Us Healthy? He was writing in the wake of new revelations about estrogen replacement therapy that showed that the benefits of estrogen had been vastly overstated. He pointed out that the estrogen fiasco was a foreseeable result of using weak epidemiological data to make sweeping pronouncements. It was a cautionary tale similar to many cautionary tales in epidemiology, particularly those concerning lifestyle behaviors.

…[T]he perception of what epidemiologic research can legitimately accomplish — by the public, the press and perhaps by many epidemiologists themselves — may have run far ahead of the reality. The case of hormone-replacement therapy for post-menopausal women is just one of the cautionary tales in the annals of epidemiology. It’s a particularly glaring example of the difficulties of trying to establish reliable knowledge in any scientific field with research tools that themselves may be unreliable.

Taubes offered lay people rules of thumb for evaluating claims based on epidemiological data.

…[H]ow should we respond the next time we’re asked to believe that an association implies a cause and effect, that some medication or some facet of our diet or lifestyle is either killing us or making us healthier? We can fall back on several guiding principles, these skeptical epidemiologists say. One is to assume that the first report of an association is incorrect or meaningless, no matter how big that association might be… Only after that report is made public will the authors have the opportunity to be informed by their peers of all the many ways that they might have simply misinterpreted what they saw…

If the association appears consistently in study after study, population after population, but is small — in the range of tens of percent — then doubt it. For the individual, such small associations, even if real, will have only minor effects or no effect on overall health or risk of disease. They can have enormous public-health implications, but they’re also small enough to be treated with suspicion until a clinical trial demonstrates their validity (my emphasis).

The authors of the C-section paper acknowledge that similar studies have found no difference in obesity rates, or small differences, and many studies that claimed to find differences in obesity rates did not correct for confounding variables:

Despite inconsistent findings from individual studies, two recent meta-analyses reported a 22% increased odds of adult obesity associated with cesarean delivery. However, many of the studies included in these meta-analyses—particularly in the meta-analyses for adult obesity—failed to account for important potential confounders, most importantly for maternal prepregnancy BMI.

Let’s apply Taubes’ principles to the claim that C-section increases the risk of obesity in offspring by 15%.

1. Assume that the first report of an association is incorrect or meaningless: This is not the first report of an association.

2. If the association appears consistently in study after study, population after population: This finding does not appear consistently. A number of studies have found no association between C-section and obesity

3. If the association appears … small — in the range of tens of percent — then doubt it: An increase of only 15% is very small, essentially no difference at all.

C-sections increase the risk of obesity in offspring by 15%?

May so, maybe no, but either way the difference is so small that it doesn’t tell us whether C-sections have any impact on obesity at all.

 

Addendum: Here’s the relevant chart from the paper.

I threw down the anti-vax gauntlet yesterday and offered a relatively simple challenge to those who believe passionately that vaccines are dangerous, ineffective or both. It’s been seen by nearly 75,000 people so far and not a single one has taken it, let alone passed it.

I’m not surprised since passing the challenge requires being truly educated about vaccines and anti-vaxxers recognize that they’re not.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]When asked to demonstrate their knowledge, anti-vaxxers run and hide.[/pullquote]

Let’s look at the challenge again and what we’ve learned from the fact that anti-vaxxers don’t dare take it.

The challenge is both simple and straightforward:

1. Make a claim
2. Provide 3 citations from peer review journals to support it
3. Provide relevant quotes from the papers (not the abstracts)
4. Situate the studies within the preponderance of the scientific evidence
5. Explain why your citations take precedence over scientific consensus

What have we learned:

No one objected to the details of the challenge.

Even anti-vaxxers recognize that the requirements — 3 citations from peer review journals, actually reading those citations, comparing those citations to the existing literature and explaining why we ought to believe the offered citations as opposed to the existing literature — are eminently reasonable. No one suggested that the requirements are too stringent or too difficult to accomplish by people who are actually knowledgeable about vaccines.

So what’s the problem? It’s not the ability to provide citations. Anti-vaxxers typically litter their comments with citations.

The apparently insurmountable threshold problem is likely the requirement to READ the citations; that’s the only way to provide relevant quotes from the bodies of these papers.

The truth is that anti-vaxxers don’t read the literature they cite. In many cases they couldn’t understand that literature even if they read it; they lack the basic education required.

So how do they find the relevant citations? They copy them from a professional anti-vaxxer who runs a website or wrote a book. In other words, they don’t know what the scientific literature shows; they are forced to rely on someone to spoon feed them the bite sized pieces of the literature that they are able to swallow. Hence the papers they cite may have titles that seem impressive to anti-vaxxers, but fail to prove their purported claims or ignore their claims altogether.

Even if anti-vaxxers were capable of reading and quoting the relevant papers, they can’t possibly situate them within the bulk of the scientific literature on the topic.

It isn’t merely that they are completely ignorant of the bulk of the scientific literature on a particular claim (e.g. vaccines purportedly cause autism, vaccines purportedly don’t work), although they are ignorant. It’s that they don’t understand that a scientific paper is not in and of itself “proof” of anything.

Science — real science, not the stripped down version of the anti-vaxxer’s imagination — is about placing findings within context. To do that, you have to master the bulk of the literature. It doesn’t mean that you are required to read every paper on the particular area, just that you have an understanding of what is in the most cited papers within that area.

How do you find those papers? If you are truly educated in the topic, you will know them because you’ve read them and seen them cited repeatedly.

If you aren’t educated on the topic, the Science Citation Index will be a useful guide. The SCI reports which later articles have cited any particular earlier article, or have been cited most frequently. The fact that a particular paper has been cited by other scientists the most does not make that paper true. It merely makes it possible for the uninitiated to determine the current consensus of opinion on a particular claim.

The most difficult part of the anti-vax challenge is to explain why your chosen citations take precedence over the consensus understanding.

That requires not simply basic familiarity with the literature on the topic, but a deep understanding of the scientific principles at issue.

Why did I offer the anti-vax challenge?

Because I wanted to illustrate the difference between really being educated and doing your research, as opposed to reading and repeating propaganda written by some anti-vax quack.

Anti-vaxxers like to preen that they are ever so much more educated than the rest of us sheeple, but when asked to demonstrate their knowledge, they run and hide. They recognize their own claims for what they are — nonsense that they can neither quote nor defend.

I don’t know about the rest of the pro-science community, but I’m getting mighty tired of anti-vaxxers swooping in to websites and Facebook pages, defecating all over them with absurd claims about the dangers of vaccines or their components, vomiting random scientific citations they haven’t even read and then declaring they’ve “proved” their claims.

Therefore, I’m offer the Dr. Amy Anti-vax Challenge.

I’m asking for the same standard of proof that any scientists would consider the minimum to support an extraordinary scientific claim.

It’s pretty simple really:

1. Make a claim
2. Provide 3 citations from peer review journals to support it
3. Provide relevant quotes from the papers (not the abstracts)
4. Situate the studies within the preponderance of the scientific evidence
5. Explain why your citations take precedence over scientific consensus

Anti-vaxxers are desperate to be taken seriously by the rest of the world. Here’s the perfect opportunity to show that their claims have scientific merit.

If they’re truly “educated” and have done their “research,” it shouldn’t be hard at all.

I can’t wait to see what they’ve got!

Imagine if I wrote the following:

I cannot sufficiently describe the profound sadness and disappointment I feel upon hearing that the State of California has banned drunk driving. I wanted to write to you to express my thoughts on the matter. It is my sincere hope that you will reflect seriously on my comments, as the consequences of this decision are grave and impactful far beyond the catchment area of your state.

You’d think I was nuts, right? Drunk driving has a terrible death toll and results in tremendous human suffering. Moreover, the person who chooses to drive drunk might not be the person who bears the burden of the injuries and death. Innocent bystanders are often the victims.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breech vaginal birth has a HIGHER death rate than drunk driving.[/pullquote]

The words above were not written about drunk driving. They were written about breech vaginal birth, a practice that has a HIGHER death rate than drunk driving. I paraphrased a public letter posted by Dr. Emiliano Chavira, of ImprovingBirth.org. Dr. Chavira is objecting to the decision by Glendale Adventist Medical Center banning elective breech vaginal birth. ImprovingBirth.org is planning a demonstration in front of the hospital next Wednesday to protest this change in policy.

But drunk driving doesn’t kill that many people. And driving drunk after partying is a long standing tradition.

Continuing the paraphrase:

To begin with, a brief word about drunk driving. This used to be a standard procedure in which all young people (and many older people) routinely indulged. As is also true with sober driving, drunk driving was on occasion, fraught and serious injury or death occurred. A landmark study shows that in 2014 drunk driving accounted for only 4/1000 US deaths each year. Moreover, the majority of auto accident deaths (over two thirds!) involve no drunkenness. Nonetheless, officials in many states banned drunk driving. To this day, the option of drunk driving is denied to all individuals.

But 4/1000 deaths each year is more than enough to justify banning drunk driving. Are we supposed to believe that the HIGHER death toll of breech vaginal birth is trivial?

Dr. Chavira emphasizes that this is an issue of personal autonomy:

[ACOG has] expressed in explicit language that in honor of the ethical principle of patient autonomy, the mother is the ultimate decision maker in the setting of childbirth. They have stated explicitly that competent individuals have the right to accept higher degrees of personal risk. They have also stated that decisionally competent individuals have the right to refuse recommended care, even when needed to maintain life…

But we don’t accept that reasoning when it comes to drunk driving. Why? Because others may be harmed. In the case of vaginal breech birth everyone participating faces the potential harm that comes from losing a baby to a preventable cause. They and the hospital face legal liability. Moreover, society faces the harm that comes from the massive expense of raising a brain injured child.

But medical autonomy is extremely precious, so I have a proposal for how we can preserve women’s autonomy to choose breech birth while simultaneously protecting others.

The obstetricians that choose to offer elective breech vaginal birth should agree to a rider attached to their malpractice insurance. Malpractice insurers set rates by calculating potential financial exposure. That’s why obstetricians have much higher malpractice rates than internists. The insurer could therefore calculate the additional financial exposure posed by breech vaginal birth, divide by the number of obstetricians offering the procedure and charge those doctors more.

Wait, what? That would cost Dr. Chavira and like minded obstetricians hundreds of thousands of dollars? Correct! And that’s where organizations like ImprovingBirth.org come in. Instead of holding rallies and threatening hospitals that refuse to participate in unsafe care, they could indemnify those same hospitals, giving them the financial freedom to accede to ImprovingBirth.org’s demands.

It’s a win-win!

Wait, what? Dr. Chavira and ImprovingBirth.org don’t want to pay. They want hospitals to pay to insure procedures that are unsafe? They want all obstetricians to pay more for malpractice insurance even though most obstetricians think breech vaginal births are unsafe and would not perform them? That doesn’t seem fair, does it?

I believe deeply in women’s medical autonomy. Women most certainly have the right to refuse medical treatment, even life saving treatment. That’s a negative right; the right to be left alone. But they DON’T have the positive right to demand unsafe treatment.

Don’t want a C-section for a breech baby? Fine, don’t come to the hospital for a breech vaginal birth or transfer to the hospital when the baby’s head gets stuck at a homebirth. Doctors and hospitals also have rights; they aren’t required to provide unsafe care.

Freedom comes with responsibility.

Freedom does not mean that you are free to drive drunk and vaginal breech birth is MORE dangerous than drunk driving.

Those who demand the freedom for breech vaginal birth have a responsibility to pay for it. Let’s see them put their money where their mouths are.

It is axiomatic among quacktivists — anti-vaccine activists, organic food devotees, natural parenting advocates — that our world is filled with toxins.

But toxicophobia, fear of toxins, is really just another form of privilege. Only those in wealthy, industrialized societies who have access to copious food and clean water, and are protected from epidemics of infectious disease have the leisure time and financial resources to indulge in internet fantasies of being poisoned by toxins.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Only the privileged have the leisure time and financial resources to indulge in internet fantasies of being poisoned by toxins.[/pullquote]

Sadly, the people who are at highest risk of actually being poisoned by toxins — industrial toxins, lead in paint and water, or simple environmental pollution — tend to be poor, non-white, and too busy trying to survive to have the time, energy or money to indulge in toxicophobia.

What do privileged toxicophobes believe?

Toxins are everywhere. Sometimes these toxins are named; often they are not. In all cases, though, there is no evidence that anyone is actually being harmed by “toxins,” but, of course, proof is not a requirement in the fantasy world inhabited by devotees of quacktivism.

Vaccines supposedly contain “toxins” that cause autism. (N.B. Toxins always and only cause diseases and syndromes whose etiology is still unknown. No one ever claims that toxins cause strep throat, or sickle cell anemia, or gallstones.) Our food supply is purportedly contaminated by toxins too numerous to even bother mentioning by name. Our water supply is supposedly contaminated by the toxins in pesticides. If that weren’t bad enough, Big Farma now wants to flood our food supply with … genetically modified food. And, of course, all medications produced by Big Pharma have myriad secret and toxic side effects.

Poor people have no patience for this nonsense. Consider Whole Foods Market venture into Detroit.

Amanda Musilli, a white, well off Whole Foods employee, lectured a group of poor, black Detroit residents:

I do want to start this talk about what’s different here, because when comparing prices of things, it’s only fair to compare apples to apples,” Musilli said at the August class, standing at the front of the room. “It’s not a fair comparison to compare our grass-fed, organic beef to factory-farmed beef.” … Musilli listed the ingredients Whole Foods prohibits in food it sells: high fructose corn syrup; artificial colors, flavors, and preservatives; irradiated foods; MSG. Whole Foods’ 365 brand didn’t contain GMOs, either, she added, deftly introducing the store’s private label. “Now I don’t know if you guys know that genetically modified organisms are a concern,” she said. “We can talk about that. By 2018 … every product will be labeled and it’s going to be similar to a cigarette label, that this product may contain genetically modified organisms.”

Participants like Toyoda Ruff seemed unimpressed:

While Ruff wanted her family to eat a healthy diet, she wasn’t buying the premise that lies at the heart of Whole Foods’ ideology and marketing: that organic, non-GMO, and corn-syrup-free foods are inherently healthier than the alternative. When it came to grocery shopping, [she] subscribed to basic nutrition guidelines that haven’t changed much in generations: less fat, sugar, and salt, more fruits and vegetables.

“To just go completely organic seems crazy to me,” said Ruff. “If it was a little cheaper, if it was the same price as the other stuff, maybe. But to me, it’s overpriced.” Her usual rule of thumb for determining quality was more pragmatic than the criteria listed by Musilli: “As long as it’s not spoiled, molded, or expired, I’m good with it.”

Food isn’t the only difference. Poor people are not anti-vaxxers. Their children may be behind on their vaccinations because they can’t afford healthcare or couldn’t get to the pediatrician, but not because they fear the vaccines themselves.

Poor people aren’t buying colon cleanses and detoxes; they aren’t spending time steaming their vaginas as recommended by Gwyneth Paltrow. They’re too busy trying to feed and care for their children and themselves.

The ultimate irony is that it is the less privileged who are truly threaten by toxins. Consider the epidemic of lead poisoning as a result of Flint, Michigan’s contaminated water supply. Or contemplate the poor citizens of East Chicago, Indiana where the very soil is contaminated with massive amounts of lead.

Lead is a real poison, with real consequences including the intellectual impairment of children. Hundreds, perhaps thousands of poor children have been harmed whereas no wealthy children have been harmed by the plethora of purported toxins that so agitate their parents.

In truth, toxicophobia is an affectation by which the upper middle class distinguishes itself from the poor. Toxicophobes like to imagine that their effort to avoid toxins marks them as “educated,” when it simply marks them as privileged.

Hey, anti-vaxxers, help me out here!

You’re big fans of vaccine package inserts, right? You’re constantly waving them in parents’ faces insisting that they “reveal” the “truth” about vaccine dangers, right?

So why do you ignore the package insert when it talks about the benefits, efficacy and safety of vaccines?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]You’re big fans of vaccine package inserts, right? So why do you ignore the package insert when it talks about the benefits, efficacy and safety of vaccines?[/pullquote]

According to Stop Mandatory Vaccination:

The risks for each vaccine are stated right on the vaccine package inserts but these inserts are not given to parents or even to adults considering the suggested vaccines for them. It is also doubtful that the doctor or nurse dispensing the vaccine has fully read the product insert…

A full list of contraindications and adverse events listed in the package inserts is available on the Immunization Action Coalition website. While the incidence of any particular adverse reaction listed on the insert may not be unacceptable in the eyes of the manufacturer or the CDC, every parent has both the duty and right to know what they are so that they can decide whether the benefit outweighs the risk for their child or themselves. (my emphasis)

The folks at Stop Manadatory Vaccination, seem to believe that package inserts are so important because they are:

• Accurate
• Filled with valuable information
• Scrupulously honest

Let’s take a look at the package insert for the MMR (mumps, measles, rubella) vaccine. It includes nearly two pages of possible vaccine side effects. Nothing is too small or too rare to be listed.

Looks scary, right?

But there’s more!

According to the package insert, the MMR is highly effective!

Clinical studies of 284 triple seronegative children, 11 months to 7 years of age, demonstrated that M-M-R II is highly immunogenic and generally well tolerated. In these studies, a single injection of the vaccine induced measles hemagglutination-inhibition (HI) antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of susceptible persons.

According to the package insert, the MMR has been extensively tested!

Efficacy of measles, mumps, and rubella vaccines was established in a series of double-blind controlled field trials which demonstrated a high degree of protective efficacy afforded by the individual vaccine components. These studies also established that seroconversion in response to vaccination against measles, mumps, and rubella paralleled protection from these diseases.

According to the package insert, the MMR dramatically improves public health!

The impact of measles, mumps, and rubella vaccination on the natural history of each disease in the United States can be quantified by comparing the maximum number of measles, mumps, and rubella cases reported in a given year prior to vaccine use to the number of cases of each disease reported in 1995. For measles, 894,134 cases reported in 1941 compared to 288 cases reported in 1995 resulted in a 99.97% decrease in reported cases; for mumps, 152,209 cases reported in 1968 compared to 840 cases reported in 1995 resulted in a 99.45% decrease in reported cases; and for rubella, 57,686 cases reported in 1969 compared to 200 cases reported in 1995 resulted in a 99.65% decrease.

The package insert mandates scrupulous attention to safety, acknowledges risks, emphasizes informed consent and asks for detailed explanations of any adverse reactions:

The health-care provider should inform the patient, parent, or guardian of the benefits and risks associated with vaccination. For risks associated with vaccination see WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS.

Patients, parents, or guardians should be instructed to report any serious adverse reactions to their health-care provider who in turn should report such events to the U.S. Department of Health and Human Services through the Vaccine Adverse Event Reporting System …

In fact, if you read the entire package insert, you would almost certainly opt to vaccinate your child!

See the paradox?

You claim that package inserts offer vital, scrupulously honest information about vaccines. They do.

So why aren’t you vaccinating?

Finally, a step in the right direction!

After several years of mounting evidence that the Baby Friendly Hospital Initiative (BFHI), designed to promote breastfeeding, leads to preventable deaths of babies being smothered in or falling from their mothers hospital beds, the American Academy of Pediatrics has finally weighed in. Their Clinical Report, written by members of the AAP’s Committee on Fetus and Newborn, Task Force on Sudden Infant Death, is entitled Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is no evidence that promoting breastfeeding saves the lives of term infants. Therefore it makes no sense to risk the lives of term infants to promote breastfeeding.[/pullquote]

Buried within the oh-so-careful language and grossly exaggerated benefits of breastfeeding is a simple truth:

The Baby Friendly Hospital Initiative mandates practices that kill babies.

And that’s before we address the further deadly impact of restrictions on formula supplementation.

Two of the tenets of the BFHI, the encouragement of long periods of skin to skin contact (SSC) between mothers and babies, and the virtual mandate on 24 hour rooming in are in direct violation of everything we know about infant suffocation and death.

The biggest risk to babies appears to be the risk of smothering. We know that there are multiple modifiable risks for infant suffocation: co-sleeping, prone position, soft bedding, and maternal impairment by opiates. Despite this, the BFHI encourages mothers to co-sleep amid soft bedding and during maternal impairment by opiates, as well as placing babies in the prone position during skin to skin contact.

Why are such obviously deadly behaviors encouraged? It is a misguided effort to promote breastfeeding. The evidence that skin to skin contact and rooming in promote breastfeeding is weak to non-existent. Yet even the AAP cannot resist false claims:

SCC has been researched extensively as a method to provide improved physiologic stability for newborns and potential benefits for mothers. SSC immediately after birth stabilizes the newborn body temperature and can help prevent hypothermia. SSC also helps stabilize blood glucose concentrations, decreases crying, and provides cardiorespiratory stability, especially in late preterm newborns. SSC has been shown in numerous studies as a method to decrease pain in newborns being held by mothers and fathers. In preterm infants, SSC has been shown to result in improved autonomic and neurobehavioral maturation and gastrointestinal adaptation, more restful sleep patterns, less crying, and better growth. Although not specifically studied in full-term infants, it is likely that these infants also benefit in similar ways. (my emphasis)

Of the eleven papers cited in support of this claim, NOT EVEN ONE demonstrates SCC causes benefits for term infants. That’s hardly surprising since the needs of preterm infants are dramatically different than those of term infants and there is NO REASON to suppose that both benefit from SSC in similar ways.

The purported benefits of SSC for mothers are even more tenuous, and based on papers from less rigorous nursing, midwifery and lactation journals.

Even worse, the AAP unforgivably repeats a favorite lactivist canard:

Rooming-in … may avoid newborn abductions …

Really AAP, how could you support such crackpot nonsense?

The truth is that claim that SSC leads improved increased breastfeeding is based on the same “evidence” that vaccines “cause” autism: temporal association, observation and wishful thinking. The rest of the Hill criteria for causation are not fulfilled, especially the mechanism of action and the utter lack of consideration of alternative explanations for the observations.

The sad reality is that tenets of the BFHI are not based on science; they reflect the preferences of lactivists elevated to requirements for other mothers.

This insistence on invoking spurious benefits of SSC and rooming in prevents the American Academy of Pediatrics from recommending the obvious: stop promoting extended skin to skin contact and stop mandating 24 hour rooming in.

Instead the AAP recommends steps that are entirely incompatible with the functioning of contemporary postpartum wards.

… [H]ave no more than 3 dyads assigned to 1 nurse to avoid situations in which nursing staff are not immediately available and able to regularly monitor the mother-infant dyads throughout the postpartum period.

But it takes two nurses per shift to staff a well baby nursery of 30 babies or more, and hospitals are abandoning well baby nurseries in order to save money on those two nurses’ salaries. It defies common sense to imagine that the same hospital is going to double or triple the number of postpartum floor nurses per shift in order to intensively monitor babies in mothers’ rooms.

Reality check:

There is NO EVIDENCE that promoting breastfeeding saves the lives of term infants. Therefore it makes NO SENSE to risk the lives of term infants to promote breastfeeding.

The AAP has taken a long overdue first step in acknowledging that the tenets of the BFHI lead to preventable infant deaths … But they still have a long way to go in explaining why a punitive program designed by lactivists to force other women to mirror their own choices back to them has any place in a facility devoted to promoting infant and maternal health.

I, I, me, me, my birth, my VBAC, my experience, just me, always me!

On Wednesday, I wrote about Dr. Brad Bootstaylor and See Baby Midwifery. DeKalb Medical Center restricted Dr. Bootstaylor’s privileges allegedly in the wake of a profoundly injured baby resulting from an attempted homebirth after two previous C-sections.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What about the babies who have been harmed? Who gives a shit?[/pullquote]

Apparently that was one injured baby too far, and DeKalb moved to protect mothers and infants (and itself) from a doctor who allegedly violated evidence based standards of care in obstetrics and demonstrated lack of clinical judgment and skill; even his supporters acknowledge that “forceps are not his strong suit.”

How dare the hospital try to protect babies and mothers from allegedly incompetent and dangerous providers? Who gives a shit about injured babies and heartbroken mothers? Certainly not the narcissists in the protest group organized to oppose the dastardly requirement for clinical competence.

They got a lawyer, the husband of one of See Baby’s pregnant clients, Zawn Villines, and began threatening the hospital.

She explains:

By Sunday, we were prepared to begin writing letters. Jeff [Filipovits] sent his first lawyerly letter to the hospital, and many group members began doing the same. This letter-writing campaign continued, and group members began sharing their letters. Jeff had numerous communications with the hospital, was threatening a lawsuit, and knew the specific causes of action under which he could file one.

Then, like a bad penny, Dawn Thompson from ImprovingBirth.org turns up counseling more intimidation:

Dawn Thompson of ImprovingBirth. org got in on things to offer us behind-the-scenes help. She suggested the second protest on Labor Day that we began using as a threat. Many other birth advocates and professionals also got involved early to lend resources. They include, but are not limited, to Brenda Sanders Parrish, Debbie Pulley, Kim Baxley Wilson, and so many more.

Then they met with the hospital to threaten them with a barrage of lawsuits:

Wednesday, we met with the hospital. Jeff made various legal threats. We all made threats. It was not at all a friendly meeting. In fact, I would say that members of our group were more hostile, more aggressive, and more demanding than I have ever seen anyone be in any other negotiation. They were also smart. We didn’t go in and yell. We went in prepared to ask legal questions, to accuse their lawyer of practicing medicine without a license, to threaten lawsuits over forced episiotomies, and so much more.

What about the profoundly injured HBA2C baby and other babies who have been harmed? Who gives a shit? Certainly not the “birth warriors” threatening the hospital.

They were planning their next protest when the hospital’s lawyer called, offering:

*Reinstatement of Dr. B’s VBAC and vaginal breech delivery privileges (except for VBAC3)
*Agreement to provide us with full details about the water birth vote on Monday, as well as agreement that we will get full details about future actions well before October 31.
*Reinstatement of vaginal breech delivery (Dr. B is still the only physician currently providing it)…
*Relaxation of IV and eating rules–please note they’re still saying it’s “hospital policy,” so you will need to be prepare to give a firm no.

What about the babies who have been harmed? Who gives a shit?

There was some sort of quid pro quo:

We canceled the protest for legal reasons we cannot disclose here. This is not an attempt at secrecy, but a recognition of the challenging realities of threatened litigation and hospital politics.

Please understand that if we still had the protest, it is very likely we would lose every single gain we made. That affects real laboring women right now. Their lives are different and better because of this movement. No one’s life has been made worse because of this movement.

What’s next for these intrepid birth warriors?

*Targeted protests against problematic birth policies; we could be like a birth strike force.

*Targeted lawsuits against birth policies, forced interventions, and medical malpractice.

*Working to end the water birth and VBA3C ban …

And, of course:

A new, moderated group that requires a signed commitment to confidentiality to avoid being infiltrated by the Skeptical OB and others (please note anything you say here is effectively public, since the media is here, as well as people who wish to make this group look foolish).

Hey, that’s not right! I’m not trying to make you look foolish. I’m trying to make you look like people who don’t give a shit about dead or injured babies, and you’re helping me do it.

No one has suggested that the hospital is acting for any reason other than to protect babies and mothers. Zawn Villines, Dawn Thompson et al. are threatening to sue the hospital to force them to STOP protecting babies and mothers.

It may be legal, but it is both ugly and unethical.

 

Update: See Baby Midwifery supporters are attempting to pitch NPR a story that DeKalb Medical Center is threatening women with with physical force.

Here’s how they intend to make the case:

***URGENT EMERGENCY POST PLEASE READ***

Some of you received emails for Joel Schuessler stating that women who refuse to exist the water birth tub would be “gently removed.” WE NEED THOSE RIGHT NOW.

…This is VITAL for our news coverage and our legal strategizing. NPR wants to know.

I need this NOW.

L: … Here’s what mine said: “In the event that waterbirths are discontinued permanently, policies and procedures will be in place to safely removed mothers who wish to labor in water to another setting for delivery.”

Zawn: you may have just won this for us

But ACOG and the AAP have clinical guidelines that say waterbirth is dangerous for babies.

Who gives a shit about the babies?

Where does Dr. Bootstaylor stand on what has been happening?

“THANK YOU” everyone from my inner core to outer sanctum in the spirit of honoring birth, choices, and shared decision making.

I’m truly humbled and honored to be in alignment with all Mothers and Families

Bring Birth Back!

What about the babies that have been harmed or will be harmed?

All together now: Who gives a shit about the babies?

Is Dr. Brad Bootstaylor another Dr. Wonderful?

Long time readers may remember the story of the original Dr. Wonderful, Robert Biter, MD. Back in 2010 Dr. Biter had his obstetric privileges at Scripps Encinitas suspended. Natural childbirth advocates held marches, conducted a letter writing campaign, and blogged in support, all without having any idea of the charges against him.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s almost as if they don’t care about the babies harmed at their hands.[/pullquote]

It turned out that he was facing multiple malpractice suits for having harmed multiple patients. His behavior was so egregious that he was eventually stripped of his medical license.

At least in that case, Dr. Biter’s supporters did not know why privileges were revoked and simply assumed that is was because of his support for homebirth, waterbirth, etc.

In the case of Dr. Brad Bootstaylor, his supporters profess surprise and anger that his privileges have been restricted. His practice, See Baby Midwifery, is organizing a rally in support and has contacted multiple media outlets to express their outrage.

There’s just one problem. They KNOW that many babies have been injured and harmed by Dr. Bootstaylor and the midwifery practice; they’re simply lying about it to the public.

On August 21, See Baby Midwifery posted the following:

To our amazement and disappointment, See Baby Midwifery was advised by DeKalb Medical on 8/17/16 (Wednesday) that we can no longer support birth options for mothers to include VBAC, water birth and vaginal breech births. This sudden and unexpected lack of support brings great concern to us and our community.

Temporarily, all VBAC eligible and breech presenting patients will be birthing at Emory Midtown with Brad Bootstaylor, MD.

Water birth has also been discontinued however water labor, of which the majority of patients benefit most, is still supported and available to you (birthing pool, shower, tub, etc.).

Midwifery services will continue at Dekalb Medical for all other patients…

Having this type of news come out of nowhere, is something we are empathetic to, and we share in that frustration wholeheartedly… (my emphasis)

But, in truth, they’ve known all along that multiple babies have been harmed by their practice.

In a private group planning the protest, a supporter acknowledges:

… I saw some information about this whole policy change being due to a bad outcome with a VBA2C birth this week…

Indeed:

There was no loss. There was a transfer [from home] that resulted in a rupture but mom and baby are alive… This was a significant complication. Catastrophic.

Evidently there are problems with Dr. Bootstaylor’s use of forceps, too, which elicited this chilling acknowledgement:

I am a bit biased and I truly love Dr. B but forceps are not his strong suit.

But wait! There’s more!

…[T]here have been many bad outcomes over the months regarding water birth. She said there have been more babies being sent to the NICU since See Baby [Midwifery] was there than ever before…

There was an emergency meeting of the DeKalb OB department last night. A doula reports that Dr. Bootstaylor told her:

30 OBs at the meeting. Many felt waterbirth was forced upon them. See Baby [Midwifery] was invited there in the beginning… He says it feels that they are now being uninvited…

Could it be because their obstetrician presided over a homebirth disaster, is so unskilled with forceps that the support staff has noticed, and an unusually high proportion of babies from their practice is ending up in the NICU?

The OB department wants to restrict Dr. Bootstaylor’privileges:

Was forced to sign the VBAC and breech and forceps or lose privileges. Voluntary refrainment of these practices.

The restrictions on Dr. Bootstaylor and See Baby Midwifery have been put in place in the wake of bad outcomes that represent real babies who have been harmed, possibly grievously, possibly permanently.

Has See Baby Midwifery been honest with its patients and other members of the community about what has happened. Of course not!

See Baby Midwifery shared that Dr. Bootstaylor’s privileges have been restricted, but not why they have been restricted. It’s almost as if they don’t care about the babies harmed at their hands, only about the ones that they can still profit from.

What did See Baby Midwifery do about their bad outcomes? Did they perform root-cause analyses? Did they modify their practice to prevent further outcomes? Of did they just bury them, hoping no one would notice about the trail of damaged babies they left in their wake?

The outrage here is NOT that DeKalb Medical Center moved to restrict Dr. Bootstaylor’s practice. They are legally and ethically required to act. But Dr. Bootstaylor and the midwives of See Baby are ALSO legally and ethically required to act. Instead, they tried to rally support for their harmful practices and figuratively bury the babies that have been injured at their hands.

They should be ashamed of themselves.