My father died in the wake of a medical mistake.

He died in the hospital where I had trained and was on staff. It was nine months after his doctors neglected to inform him that a routine pre-operative chest X-ray had shown a small cancerous tumor in his lung. When he showed up seven months later coughing blood, the tumor was the size of his fist, filling the middle of his chest. He died 8 weeks to the day after the diagnosis despite aggressive treatment.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Nearly all of those who died were going to die anyway. Had they refused conventional medical care, they probably would have died sooner.[/pullquote]

He was only 60 years old.

The medical mistake that preceded my father’s death was egregious, inexcusable and fatal. I am as outraged as anyone about the number of medical mistakes that occur. But — and this is the critical point — had he never had the fateful chest X-ray and had he never interacted with the conventional medical system he would have died anyway and possibly sooner.

That’s why, though I abhor medical mistakes more than most, I’m not remotely persuaded to abandon conventional medicine by the rallying cry of many alternative health advocates, “medical mistakes are the third leading cause of death in the US.” That’s because most medical mistakes are “failure to rescue.”

My father’s case is a perfect example. He died because of a cancer that was so aggressive that at the time he was diagnosed its origin could not be determined. It could have been lung cancer; it could have been cancer arising in a lymph node in the chest; it could have been a metastasis from a distant organ. It was no longer possible to tell.

He died of a cancer that was so aggressive that, in the space of 7 months, had grown from the size of his fingertip to the size of his fist. But — and this is the critical point — had he never had the fateful chest X-ray, he would have died anyway and in exactly the same way since he had no symptoms until he started coughing up blood. The chest X-ray offered an opportunity to rescue him from the disease he already had and because his doctors never communicated with him or each other, he was denied that opportunity.

That’s a tragedy but it also shows why it’s absurd to use medical mistakes as justification for shunning conventional medical care like vaccinations, hospital birth and just about any treatment you can name.

The claim that medical mistakes are the third leading cause of death US ignores the fact that nearly all of those who died were going to die anyway. Had they refused conventional medical care, they probably would have died sooner.

In 2016, Dr. Aaron Carroll provided an analysis why the claim that medical errors cause 98,000 deaths per year dramatically overstates the impact of medical errors.

They focused on the study from which the 98,000 was extrapolated. It involved an observational analysis of 7,743 “high-severity” patients in a New York hospital admissions database, which found that 13.6 percent had died, at least in part, because of an adverse event.

But this didn’t account for the baseline rate of death. Using New York State Health Department data, and applying the calculated death rate for in-hospital acute care admissions, they found that about 13.8 percent of patients in the “high-severity” group should have been expected to die over all.

This means that the death rate in the group with medical errors was probably similar to the death rate in a group without medical errors, casting doubt on those errors as being the cause of death. (my emphasis)

Subsequent studies claiming that the incidence of deadly medical errors is even higher, 250,000-400,000 deaths per year, suffer from the same problem.

As Dr. David Gorski noted earlier this year:

[T]he authors conflated unavoidable complications with medical errors, didn’t consider very well whether the deaths were potentially preventable, and extrapolated from small numbers. Many of these studies also used administrative databases, which are primarily designed for insurance billing and thus not very good for other purposes.

A more recent study, using more sensitive methodology, has found that the rate of death from medical errors is only a tiny fraction of the massive numbers originally claimed.

…First, it uses a database designed to estimate the prevalence of different causes of death, rather than for insurance billing. Second, it used rigorous methodology to identify deaths that were primarily due to AEMTs (adverse effects of medical treatment). One thing about this study that makes sense comes from its observation that AEMT is a contributing cause for 20 additional deaths for each death for which it is the underlying cause. For 5,180 deaths in the most recent year, that means 108,780 deaths had an AEMT as a contributing or primary cause that year, which is in line with the IOM estimates. It’s also in line with my assertions that one major issue with previous studies is that the unspoken underlying assumption behind them is that that if a patient had an AEMT during his hospital course it was the AEMT that killed him.

So “adverse medical events” ARE common, but most are NOT medical errors and are NOT the primary cause of death in any case.

What is the practical significance of these findings?

Let’s use an analogy. Imagine if firefighters were found to have made mistakes in fighting major fires. Perhaps they took too long to arrive, had a hose with a hole in it, or attacked the fire in the wrong way. People might even have died in the wake of the mistakes. But that doesn’t mean it was the mistakes that killed them; the fire killed them and the mistakes possibly impeded their rescue. It is also possible that they could never have been saved at all, even if the fire fighters had responded flawlessly.

Moreover, any mistakes made by the firefighters wouldn’t have made it a reasonable strategy to refuse to call the fire department. The death and destruction would have been worse, not better. Fire fighters who make mistakes fail to rescue people who might have been rescued, but not calling them ensures that everyone who is trapped will die.

Similarly, refusing conventional medical care prevents medical errors but it doesn’t protect patients from disease and it is the disease that kills them. Therefore, it makes no sense at all to shun conventional medical care because of fear of mistakes.

If I had to guess, I would say that the folks at the World Health Organization are afraid.

They’re afraid that if women in industrialized countries knew the truth about how trivial the benefits of breastfeeding really are, they might not feel pressured to breastfeed. I don’t know why that would be a bad thing — since the benefits truly are trivial and have no measurable impact on infant health — but they seem to think it is.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The WHO admits that their own data do NOT justify causal inference … then proceeds to draw a causal inference.[/pullquote]

Hence this latest effort to mislead women by claiming again — falsely — that breastfeeding prevents obesity.

They even made a meme! Too bad it isn’t true.

A 2018 comprehensive review of the breastfeeding literature had this to say about breastfeeding and obesity:

The relationship between breastfeeding and obesity later in life is debatable. A large, systematic 2014 review of 15 cohort and 10 cross-sectional studies found a significantly reduced risk of childhood obesity among children who were breastfed (adjusted OR=0.78; 95% CI, 0.74- 0.81). However, the review included studies that controlled for different confounders, and smaller effects were found in studies in which more confounders were taken into account.

The 2013 WHO meta-analysis found a small (approximately 10%) reduction in the prevalence of overweight or obese children, but cautioned that residual confounding and publication bias were likely. At 6.5 and 11.5 years of follow-up, PROBIT failed to demonstrate a protective effect for exclusively or “ever” breastfed infants. Sibling analysis similarly fails to demonstrate a statistically significant relationship.

A 2015 meta-analysis of 23 high-quality studies with a sample size >1500 children and controlled for important confounders showed a pooled reduction in the prevalence of overweight or obesity of 13% (95% CI, 6-19).57 The protection in this meta-analysis showed a dilution of the effect as the participants aged and an inverse relationship of the effect with sample size.

Breastfeeding is, therefore, unlikely to play a significant, if any, role in combating the obesity epidemic. (my emphasis)

But the WHO itself has published a new paper that found … the same thing that is already known about breastfeeding and obesity: the link is tenuous to non-existent.

The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16–1.28] and 1.12 [1.07–1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17–1.36] and 1.05 [0.99–1.12], respectively).

There are three major problems with this paper:

1. The authors didn’t correct for the most important confounding variable, maternal BMI.
2. Even if the results don’t disappear when adjusted for confounding, they are so small as to be clinically meaningless.
3. Correlation does not prove causation.

The authors themselves acknowledge that they haven’t adjusted for all relevant confounders.

…[T]here was no information about the maternal BMI at the time of her child’s birth, which has been shown to be amongst the determinants of birth outcomes and childhood overweight, reflecting the contributions of shared genes and the environment.

So the results themselves could be illusory and might very well disappear if maternal BMI — a known determinant of childhood weight — were taken into account.

But even if the link between breastfeeding and obesity didn’t disappear, its effect is so small as to be meaningless.

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?.

…[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?

He answers:

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…

In this study, as in multiple previous studies, the association is small, in the range of tens of percent. And that means it isn’t clinically relevant, having only minor effects or no effect on overall health or risk of disease.

The WHO claims about this study aren’t merely misleading, though, they are outright lies.

The authors themselves acknowledge that they have NOT proved that breastfeeding reduces the risk of obesity:

…[T]he data come from cross-sectional studies, which can detect an association between exposure and outcome but do not justify causal inference.

It’s hard to be clearer than that. They admit that their own data DO NOT justify causal inference … and then proceed to IGNORE what they just admitted.

The present work confirms the beneficial effect of breastfeeding with regard to the odds of becoming obese…

It doesn’t and it can’t because the data DO NOT justify causal inference!

Why would the WHO mislead the public about what their research on breastfeeding and obesity actually shows?

Here’s a clue in an interview with one of the researchers:

World Health Organisation (WHO) experts who led the Europe-wide research are calling for more help and encouragement to women to breastfeed, as well as curbs on the marketing of formula milk which, said senior author Dr João Breda, misled women into thinking breast was not necessarily better.

But breastfeeding ISN’T necessarily better, the actual benefits is industrialized countries are trivial, and there are very real risks to breastfeeding promotion — measured in tens of thousands of newborn hospital readmissions per year.

No amount of misleading claims from the WHO and its researchers changes the fact that breast is NOT best for every mother and every baby!

Imagine an idyllic village nestled in a jungle clearing.

The people are prospering because they have easy access to animals for meat, copious river fish, and abundant roots and nuts. There’s just one problem: the same land that feeds them so generously is filled with predators who attack them. Lions and tigers eat the villagers, elephants stampede and even small animals drag their children away, never to be seen again.

The villagers’ first thought is to create better weapons with which to kill marauders. They keep their spears that kill at close range, but add bows and arrows to kill predators long before they can get close enough to harm anyone. It’s not perfect, but it works well … in the daytime. Eventually the villagers have to sleep and nearly every night, someone, often a child, is eaten.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers foolishly fear the fence more than the predators.[/pullquote]

Then they decide to built a wooden wall complete with wooden watch towers. Powerful or determined predators can scale the wall, but the watchers alert the villagers who use their weapons to kill them. This turns out to be an excellent solution. As each new home is built in the village, the owner is required to expand the fence.

It’s not a perfect system, of course. Every now and then a predator manages to scale or breach the fence, but the watchtowers allow for advance warning so the villagers invariably meet the predator with immediate and deadly force.

Several generations pass and one day a villager has the terrible misfortune to watch as his child suffers a serious injury and dies when one of the heavy timbers being used to construct a new watchtower falls over and crushes her. He grieves deeply.

“Why,” he asks, “are we repeatedly extending the fence as the village grows and building new watchtowers? No one has been killed by a predator in several generations. My daughter died because of a fence no one needs. Let’s stop extending the fence and building watchtowers. Don’t let another child die like my daughter did!”

All the villagers feel sorry for the grieving father, but most recognize that the reason that that no one has been killed by a predator for several generations is because of the fence and watchtowers, not in spite of them.

A few of the father’s friends, however, worry that what happened to his child might happen to one of their children. They decide that when they build their new houses, they will not extend the fence around it; they will simply leave it open. Others caution them about the risk, but they point out that they are well armed and can simply shoot any predators that make it through the gap.

Those who are afraid insists that the predators aren’t as dangerous as they used to be, and, in any case, they now have better weapons they can use to protect themselves.

Some even insist that the fence never worked at all and the fact that no one has been attacked in 20 years means that the predators have disappeared.

At first it seems that the father was right. Leaving a few segments of the fence open appears to make no difference. The fence perimeter is nearly a mile around and the scattered openings represent only a few feet. Every now and then the child of parents who refused to extend the fence is dragged away and eaten, but those grieving parents bear the horrible result of their personal decision. And, as they are quick to point out, none of their children are ever crushed by fence timbers.

Gradually the number of homeowners who leave their portion of the fence open slowly increases. Then something strange starts to happen. Villagers who live inside the fence are attacked by wild animals. An alligator drags off the child of a villager who had faithfully extended his fence and built a watchtower to go with it.

Why are people well protected by the fence being killed by predators?

The reason isn’t hard to fathom. A few small gaps in a large fence offered great protection even if it wasn’t perfect protection. A predator would only be able to gain access to the village if it found an opening by chance. As the number of gaps grew, the chance that a predator would stumble upon one and then enter the village also grew. The predators now had access to the entire population of the village and didn’t necessarily stop after killing someone near the gap. The fact that those living closest to the gap have powerful weapons wasn’t as helpful as they imagined it would be. They aren’t constantly standing guard so they can easily be caught unawares.

What does that have to do with vaccination?

Bacteria and viruses are the predators and our children are the prey. Vaccines are the fence and watchtowers. Vaccination is an early warning that allows the immune system to meet any threat with immediate and deadly force in the form of antibodies. Yes, you can fight an infection without having been vaccinated just as you can fight a predator as it is dragging off your child. But forewarned is forearmed in infectious disease just as it is in mortal combat.

Anti-vaxxers are like the grieving father and his friends. They are more frightened of falling fence timbers than of lions and tigers. They no longer see lions and tigers as a threat because they’ve been kept out of the village, but predators are deadly whether you have seen them recently or not.

Anti-vaxxers create holes in the immune fence that protects all of us. They risk the health of everyone, not just their own children.

When you understand that vaccines function as the fence you can see the absurdity of anti-vax claims:

Insisting that unvaccinated don’t threaten the vaccinated is like insisting that no one needs to fear a few gaps in the fence that keeps out the lions and tigers so long as the gaps are only near those who don’t like the fence. The reality is that once the predators get through the fence they can attack anyone and typically kill the most vulnerable no matter how desperately their parents try to protect them. Similarly, once bacteria and viruses get through the immune fence created by vaccination, they can attack anyone and typically kill the most vulnerable no matter how desperately their own parents try to protect them.

Leaving gaps in the fence is an invitation to predators. Leaving gaps in vaccine immunity is an invitation to predators, too. Pertussis and measles may not look as harmful as lions and tigers, but they are every bit as deadly.

Anti-vaxxers have created now so many gaps in the fence that vaccine preventable diseases have come roaring back.

All our children will pay the price.

 

Adapted from a piece that first appeared in September 2016.

Breastfeeding research keeps veering into pseudoscience.

It’s not merely that breastfeeding research like most pseudoscience research starts with the conclusion — breastfeeding is beneficial — and then works backwards to find data to support it. That has led to persistently massive exaggeration of the benefits and utterly ignoring the risks.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]No substance treats multiple conditions and diseases that have vastly different causes. That’s pseudoscience, not science.[/pullquote]

The chief indicator that much of breastfeeding “science” is largely pseudoscience is that breastmilk is touted as the cure for everything.

For example, a physician asked other physicians on Twitter:

Drs of Twitter! If your child had developed a mild superficial fungal infection over the weekend, would you buy some Canesten 1% (available from a pharmacist without prescription) or would you feel you needed to take your child to a walk-in centre for a formal diagnosis & script?

And Dr. Natalie Shenker, MD, PhD replied:

Hey, hope the little one is ok. Have you tried putting breastmilk on? Contains fungicide components (probably for just this sort of thing)

Let’s leave aside for the moment the unwarranted assumption that every mother has breastmilk on hand. Why is Dr. Shenker recommending it?

She sent a variety of tweets in explanation:

It’s has fungistatic effects!

There are presumably multiple factors that also combat pathogenic fungi!

It promotes the seeding of helpful fungi!

She offered citations to support her claims but as another individual noted:

The first paper is a study of isolates from human saliva being used on fungal samples (not infections on actual people). Do you have any data that supports the topical use of human milk on fungal infections in actual humans?

That’s a classic pseudoscience tactic: citing research that has nothing to do with the issue under discussion.

And Dr. Shenker responded with another pseudoscience dodge:

I did say data was scanty but as I’m sure you know, historically lab studies seldom get rolled into clinical trials in this field.

Well, yes. That’s because the results of in vitro studies rarely translate to effective treatment for humans.

Lots of things — like orange juice, for example — have fungistatic properties properties in vitro, but we don’t recommended treating fungal dermatitis by bathing in orange juice.

Sadly, however, breastmilk has become the miracle cure for everything.

As Dr. Steve Novella has written on Science Based Medicine:

One common feature of pseudoscience is that proponents of a specific belief tend to exaggerate its scope and implications over time…

How does that happen?

[T]here is a tendency for dubious treatments to undergo indication creep over time. A treatment that starts out being used for one specific indication has a growing list of conditions it can treat or cure, even conditions with very different real underlying causes.

This happens because the process that is being used to determine if the treatment works is flawed in the first place. Typically unscientific treatments are based upon anecdotal evidence, which is susceptible to placebo effects. Proponents are not being skeptical, nor are they conducting the kinds of studies that are capable of showing that the treatment does not work.

In fact the process they use is designed to show that the treatment does work. Therefore, no matter what they try it for, it will seem to work. They may naively come to believe that it works for everything. In some cases they may then backfill an explanation for why it works for everything …

Breastmilk might be helpful in treating certain kinds of dermatitis. In vitro studies do sometimes yield treatments that work in human beings. But no substance treats multiple conditions and diseases that have vastly different causes. That’s pseudoscience, not science.

Why insist that breastmilk is a miracle cure for everything? Marketing!

…If you have a product to sell, you want that product to have as wide a market as possible. In medicine this means as many indications for your treatment as possible. In fact, why limit your market at all? If your treatment works for every indication in every population, then you have maximized your potential customer base.

This does not necessarily mean that those selling panaceas are always knowingly lying … There is a powerful motivation to believe that your treatment has wide-ranging implications. If you discover a treatment that is effective for some cases of athletes foot, that is an achievement and might even be highly profitable. But if you discover the treatment for all infections, or all cancers, or all human disease, then you should become world famous and fabulously wealthy. This is a powerful motivation to believe.

Even legitimate scientists fall prey to the allure of believing their discovery is bigger than it actually was. They have the rest of the scientific community to give them a reality check.

Marketing has led lactation professionals to label colostrum or even breastmilk itself as “liquid gold.” Marketing has led lactation researchers to make outsize claims about the benefits of breastmilk for infants. And marketing has led these same researchers to imagine that there isn’t a medical problem that can’t be improved by squirting breastmilk on it.

Breastmilk is food. It has some benefits, but when people have access to clean water to prepare formula those benefits are trivial.

It’s not a cure-all and if breastfeeding researchers wish to be taken seriously, they must stop pretending that it is.

If its customers are to be believed, the reason the alternative health industry exists is because of how poorly doctors treat patients.

Yet when it comes to poor treatment, the medical industry can’t hold a candle to the airlines. So why is there no alternative airline industry?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why is there a alternative health sucker born every minute, but no customers for an alternative airline industry?[/pullquote]

Why aren’t people paying random individuals they read about on the internet to fly them to their destinations in the same way they pay random individuals they read about on the internet to “treat” them with various nonsensical methods like homeopathy and cranio-sacral therapy?

Why are they so practical when it comes to airline travel, choosing only government certified purveyors, recognizing that they will have to compromise to get where they want, but so gullible when it comes to healthcare, sure that there must be an easier, less uncomfortable way to get treated for or cured of a serious illness?

If they (falsely) criticize the medical industry for merely treating their chronic diseases instead of curing them, why don’t they complain that the airline industry never teaches them how to fly but forces them to come back over and over again whenever they want to go somewhere?

And why do they trust that airlines take them where they want to go rather than imagine that the airlines are drugging them with hallucinogens to make them think they have flown somewhere else when they’ve never left the ground? After all, if you are foolish enough to believe that vaccines are an elaborate government conspiracy to give the population autism, you will believe anything.

Consider the many unflattering similarities between the Big Air and Big Medicine:

Both the airline industry and the medical industry are effectively monopolies.

If the average person wants to fly, he or she has no choice but to deal with the airline industry. If the average person wants to treat, cure or even prevent many serious illnesses, he or she has no choice but to deal with the medical industry.

Because they are monopolies, neither devotes serious effort to customer service.

The airlines cancel flights, bump passengers for no better reason than because it suits them. In addition, they have no compunction about delaying flights by hours just to have mechanics check to be sure everything is working right. Don’t like waiting? Too bad for you! Similarly, doctors make patients wait for hours in their offices and that’s nothing compared to the hours you will wait if you visit an emergency room. Don’t like waiting? Too bad for you!

They don’t listen.

Pilots have zero interest in how you think they should navigate to your destination. They don’t care what you believe you know after reading about flight on the internet; they won’t even talk to you about it. Doctors aren’t especially interested in what your Facebook mommy friends told you about your child’s symptoms. They might talk to you about it but even then, they will probably ignore your views on the subject and offer their own.

They don’t care about your comfort.

Leg room in airline seats; I rest my case! Hospital johnnies; another indisputable sign of lack of concern.

They have high barriers to entry.

If you are dissatisfied with your treatment by airlines, you can’t simply set up your own and you are not free to use airlines started up by individuals if they fail to meet the elaborate government standards for commercial flight. Similarly, you can’t simply call yourself a medical doctor if you haven’t graduated from medical school and you can’t obtain a license to practice unless you’ve completed additional years of training.

They make mistakes.

Mistakes by the airline industry are remarkably rare, but when they do happen they are often spectacular disasters that lead to the loss of many lives. Doctors and nurses make mistakes, too. They are far more common, though fortunately most do not lead permanent injury or death.

Given all the similarities, why is there a alternative health sucker born every minute, but no customers for an alternative airline industry?

I suspect the reason is simple: air travel is much more accessible to the senses than medical care.

You can hear the airplane engines.
You can feel the plane take off and land sometime later.
You can see that you are in a very different place when the plane arrives at its destination.

What do your senses tell you when you are being treated for or cured of a disease?

Not much, since most treatment occurs over days, weeks or even months so gradual change is not appreciated.

And your senses tell you nothing at all in the case of preventive care. You didn’t have measles before vaccination, for example, and you don’t have measles afterwards.

Indeed, when treatment or cure occurs over a relatively short period or can be easily perceived, there is no alternative health analogue. You don’t find many “natural” orthopedic surgeons for example, since people feel the acute pain of a fracture, feel the relief that pharmaceuticals offer, see the difference that splinting or casting makes, and feel the difference when the bone is healed.

The bottom line is that alternative health exists because you can trick people into believing you are treating them even when you are merely lightening their wallets, but you can’t trick people into believing that you have flown them to another place if you’ve never left the ground. The customer has to be a lot smarter to understand healthcare treatment than to understand airplane travel.

It has nothing to do with how you treat people and everything to do with their ability to understand something they cannot sense directly and immediately.

In the wake of the Charlottesville rally of white supremacists in 2017, resulting in the murder of a counter-protester, Donald Trump uttered these immortal words:

You also had some very fine people on both sides.

With that ugly claim, Trump signaled his sympathy with racists. Is Trump a racist? As Sen. Cory Booker recently pointed out, “The racists think he’s a racist.” That, of course, is the point. He is pandering to racists because he values their support above their immoral views and harmful acts.

But make no mistake, there are not very fine people on both sides of the white supremacy debate. There are only racists — whose racism hurts others — and everyone else.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Is La Leche League anti-vax? Anti-vaxxers think it is.[/pullquote]

In the wake of an blog post asking if La Leche League is anti-vax, I found this statement on their website:

La Leche League does not have a stance on vaccinations …

Really? LLL doesn’t have a stance on the greatest public health advance of the past century, an advance that has saved more lives than breastfeeding ever could? Apparently, there are some very fine people on both sides of this issue. LLL is eager to pander to them because it values the support of anti-vaxxers above their unscientific, unethical views and harmful refusal of vaccines.

Make no mistake, there aren’t two sides to the vaccine debate. There are only conspiracy monetizing, pseudoscience peddling charlatans — whose fear mongering represents the greatest public health threat in this century to children in industrialized countries — and nearly all doctors, scientists and public health officials in the world.

Is LLL anti-vax? The anti-vaxxers think it is.

This list comes from the National Vaccine Information Center (NVIC), possibly the premier anti-vax organization.

La Leche League can be found nestled among the major purveyors of pseudoscience like Mercola.com and Dr. Bob Sears. There is no indication that this endorsement was solicited, but it is an endorsement nonetheless.

Speaking of anti-vax charlatan Bob Sears, recently disciplined by the Board of Medicine of California for giving out vaccine exemptions, he is a regular speaker at LLL conferences, including the LLL International Conference in 2007. Indeed, he was scheduled to speak at this LLL conference that took place months after he had been placed on probation.

The topic? How to evade California’s recently strengthened vaccine mandate.

All of which raises the question: if La Leche League is willing to twist and ignore scientific evidence on vaccination — arguably the single most important protection of the health of children — can they be trusted to accurately represent the scientific evidence on breastfeeding?

The answer is an emphatic, “No!”

What does the truth matter when your goal is to promote breastfeeding even above the health and safety of babies?

It doesn’t matter enough to warn mothers about the dangers of breastfeeding itself. Breastfeeding is now the leading risk factor for newborn readmission to the hospital; literally tens of thousands of babies are being readmitted each year for iatrogenic problems caused by aggressive breastfeeding promotion. You might think that the readmission of tens of thousands of newborns each year merits a discussion on the LLL website, but you would be wrong.

What does the truth matter when your goal is to promote breastfeeding even above the health and safety of babies?

Fully one third of cases of Sudden Infant Death Syndrome (SIDS) are associated with bedsharing and the American Academy of Pediatrics is quite clear that bedsharing is unsafe for babies and should be avoided. LLL mentions the AAP recommendation only to disparage it.

The American Academy of Pediatrics (AAP) says, “Infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep.” Easy to say… Eventually, many mothers find that bedsharing is a low-risk, long-term solution for sleep deprivation and an unhappy baby…

What does the truth matter when your goal is to promote breastfeeding even above the health and safety of babies?

La Leche League is no longer an organization devoted to science (if it ever was). It is a special interest group devoted to advancing the fortunes of itself and its members, regardless of whether children are harmed as a result.

There are not “fine people” on both sides of the anti-vax debate. There are only conspiracy monetizing, pseudoscience peddling charlatans and nearly all doctors, scientists and public health officials in the world. Going forward, medical professionals and medical organizations should either convince LLL to adhere to the scientific evidence or sever ties with them.

If La Leche League doesn’t stand on the side of doctors, scientists and public health officials, then doctors, scientists and public health officials should not stand by LLL’s side.

The statistics are staggering. Up to 1 in 3 American women experience sexual violence during their lifetime. Nearly 20% of adult women recall an episode of childhood sexual abuse or assault.

These women often have different needs around childbirth and breastfeeding and those needs are routinely ignored by natural childbirth and lactation professionals.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Isn’t it a provider’s obligation to support WOMEN, not to promote their preferred method of birth or infant feeding?[/pullquote]

As the paper Responding to Prenatal Disclosure of Past Sexual Abuse explains:

…[T]he perinatal period can be especially challenging for abuse survivors. During pregnancy, bodily sensations resembling disturbing elements of past abuse may lead patients to experience four categories of posttraumatic stress symptoms:

recurrent and intrusive memories;
avoidance of thoughts, activities, and other reminders of the traumatic event;
heightened irritability and other manifestations of autonomic arousal;
and negative changes in mood and cognition.

… Soet and colleagues demonstrated that sexual trauma survivors were 12 times more likely to perceive their childbirth experiences as psychologically traumatic compared to women without this history…

Inter-relationships between sexual abuse, female sexual function and childbirth provides further detail:

Sexual abuse (SA) survivors have been found to potentially experience triggering flashbacks and/or ‘body memories’ of the SA trauma during childbirth. This recalling/re-experiencing of the sexual trauma may be due to a variety of factors such as the similarity in the anatomy involved and the exposure of sexual body parts. Clinical procedures and labour sensations have like-wise been shown to be experienced by SA survivors as triggers, reminding them of the abuse …

Nearly every paper on the topic emphasizes that a subjective sense of lack of control is particularly triggering.

Control/lack of control has also been reported as the main underlying factors influencing SA survivors’ subjective evaluation of the birthing experience in a study by Parratt. Moreover, feelings of powerlessness, betrayal and humiliation have been cited as potential adverse experiences of SA ‘birthing survivors’ – as detailed in a study by Parratt…

Abuse survivors report similar feelings around breastfeeding.

For example:

Some survivors worry that if they choose to breastfeed that breastfeeding advisors will need to touch them when teaching them how to breastfeed their baby…

Certainly no advisor should touch your breasts in any situation without seeking your permission first…

And others find night feedings particularly triggering:

Some survivors mention that they find night time feeds more difficult and are more likely to be triggered and have an unpleasant experience. Obviously, this is more likely if you were abused at night…

Survivors often struggle with feelings of failure that can be exacerbated by breastfeeding difficulties:

…[S]urvivors who breast feed may find themselves saying “My baby lost weight when breastfeeding. I’m useless”. You baby losing weight is not your failure… There are some medical reasons why occasionally a woman may not produce enough milk, or a baby may not take enough milk – and if this is the case then a health care professional will be able to suggest ways forward. It does not mean you have failed…..it is unfortunately one of those things that happens through no fault of your own.

The theme that is repeated over and over again among survivors is a loss of control is especially debilitating for them. Yet natural childbirth and lactation professionals consistently pressure women to give up control to “nature.” They are dismissive when women request epidurals and routinely demean the idea of C-section on maternal request. This despite the fact that women who make these choices are often protecting themselves from sensations they cannot bear and memories that haunt them.

Should women have to reveal a history of sexual violence just to receive the care they need? I always appreciated and felt honored by being taken into my patients’ confidence about past trauma and tried to do anything in my power to make their childbirth experience more bearable. But not every provider is supportive.

… When talking to one midwife about the fact that I would chose not to breastfeed if I had a baby, she replied “Well, you don’t deserve to be a mother then!” – without exploring any of the reasons with me that I may have come to this conclusion. Unfortunately, this attitude is not totally unheard of within the hospital environment, and rather than perhaps supporting survivors to be able to overcome their fears, this attitude can close a survivor down and prevent them from getting the support which may prove helpful to them.

Moreover, if up to one third of women experience sexual violence during their lifetime, shouldn’t ALL providers offer ALL women the option of taking control of their birth experiences by choosing epidural or C-section on maternal request? Shouldn’t ALL providers offer ALL women the opportunity to formula feed if they think that is the best way to protect their mental health.

Why do natural childbirth and breastfeeding professionals routinely ignore the needs of survivors of sexual violence?

Isn’t it a provider’s obligation to support WOMEN, not to promote their preferred method of birth or infant feeding?

It could be the motto of Andrew Wakefield and other anti-vax medical professionals:

Chaos is a ladder.

It’s one of the most memorable of the many memorable Game of Thrones quotes, first uttered by Littlefinger, Lord Petyr Baelish, in a conversation with Varys (season 3, episode 6).

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers continue to be unwitting dupes, while anti-vax professionals climb ever higher on the ladder of deliberately created chaos.[/pullquote]

While Varys bemoans chaos as disrupting his plans (“a gaping pit, waiting to swallow us all”), Littlefinger reveals that chaos is essential to his plans.

Chaos isn’t a pit. Chaos is a ladder. Many who try to climb it fail and never get to try it again. The fall breaks them. And some are given a chance to climb. They refuse. They cling to the realm or the gods or love. Illusions. Only the ladder is real. The climb is all there is.

What does he mean?

For Littlefinger, creating chaos is a way to achieve his own goals. He uses chaos as an instrument for his own gain… Chaos can be used as an opportunity with anyone who: either creates chaos or uses it for their own gain, or, once in the chaos, can keep their cool and make something of it.

Anti-vax medical professionals and former professionals have created chaos among parents of young children in order to use it for their own ends:

• They have incited a completely groundless fear of vaccines that has led to a dramatic decrease in vaccination rates and an equally dramatic rise in illness and death from vaccine preventable diseases.
• They have single handedly brought back scourges that had not been seen for many decades.
• They promote and monetize a variety of useless supplements and “immune boosters,” as well as books that promulgate their nonsense.
• They have recently begun to specialize in victimizing isolated communities like Somali refugees in Minnesota and certain sects of ultra-Orthodox Jews in New York, playing on their fears of government.

They know vaccines work. As Dr. Bob Sears famously wrote in The Vaccine Book: Making the Right Decision for Your Child:

I also warn [parents] not to share their fears with their neighbors because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.

In other words, Sears implicitly acknowledges that vaccines are highly effective and that their effectiveness is dependent on herd immunity.

But Andrew Wakefield is the true Littlefinger of the anti-vax movement.

Although it takes multiple seasons for it to be revealed, Littlefinger directly instigated the events that led to nearly everything that has happened on the series. GOT fans may remember that it is the death of Jon Arryn, purportedly at the behest of the Lannisters, that leads Robert Baratheon to appoint Ned Stark as his Hand. That very quickly results in the judicial murder of Ned Stark by Cersei Lannister convulsing the entire kingdom in war. We have been watching the horrors of that war ever since.

But the Lannisters, evil as they are, did not kill Jon Arryn. Littlefinger arranged for him to be poisoned, made sure he died, and sent a letter claiming that the Lannisters were responsible. Why did he do it? Because he was denied the opportunity to rise to power in the existing structure of the kingdom and saw his chance to rise by climbing the bodies of those killed in the chaos he unleashed. Things did not play out quite as he expected, but by keeping a cool head he managed to exploit every development. He almost got away with it.

Andrew Wakefield nearly single handedly unleashed the anti-vax movement by fabricating “research” that purportedly showed that the MMR (measles, mumps, rubella) vaccine caused autism. At no point did Wakefield believe that vaccines causes autism. If he had, he would not have needed to deliberately fake his research.

His motive was banal; he wanted to get rich. He was developing a vaccine to replace the MMR and sought to increase demand and market share for his new vaccine by discrediting the old one. He ended up creating chaos and then exploiting that chaos to enrich himself.

The similarity with Littlefinger doesn’t end there. Littlefinger was able to convince everyone that the Lannisters had murdered Jon Arryn because many people (correctly) distrusted the Lannisters. It had always been clear that they were out to improve their own fortunes so it was not a stretch to imagine that they had murdered a political rival. But those who believed were not sophisticated analysts of the Westerosi political scene; they were unsuspecting dupes of Littlefinger.

Wakefield was able to convince parents that vaccines cause autism because many people (correctly) distrust large industries like Big Pharma. There have been so many examples of deadly corporate malfeasance by Big Pharma that it was not a stretch to imagine that they were marketing a harmful vaccine. But those who believe vaccines are harmful are not sophisticated analysts of corporate misconduct; they are unsuspecting dupes of Andrew Wakefield and his ilk.

Littlefinger created chaos because he calculated that he could exploit to ensure his rise. He would have gotten away with it, too, if it weren’t for the fact that the all-knowing Three Eyed Raven Bran, has seen the past and exposed him.

Wakefield and other medical professionals like Bob Sears create chaos and bring back deadly diseases, because they calculate that they can profit from it. Sadly, we don’t have an all-knowing Three Eyed Raven whom anti-vaxxers will believe. So they continue to be unwitting dupes while anti-vax professionals climb ever higher on the ladder of deliberately created chaos.

As anyone who has been a victim or bystander to bullying can attest, bullies enjoy bullying as a solitary pursuit, but absolutely adore bullying as a group activity. Having an audience apparently makes bullying more enjoyable, having minions makes it easier, and having those who admire you more because you are a bully makes it positively addictive.

Group bullying has sadly become one of the defining features of contemporary natural childbirth advocacy and lactivism. Both started to offer women choices but eventually hardened into groups that offer one choice each and bully those who make different choices.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Having an audience apparently makes bullying more enjoyable, having minions makes it easier, and having those who admire you more because you are a bully makes it positively addictive. [/pullquote]

Now Seána Talbot, head of the UK Natural Childbirth Trust (NCT), has resigned over being forced to stop group bullying. Apparently, if the NCT can’t bully women who don’t mirror her own choices back to her, the job has lost its appeal.

In her resignation letter, Talbot wrote:

In the face of overwhelming opposition from most fellow trustees and NCT’s executive, I have tried my best to steer the charity back towards its core mission, and its longstanding values…

…[T]he executive team, with the support of most of the board, have already taken the charity away from our core mission of birth and breastfeeding, and towards more generic ‘parent support’ with an emphasis on postnatal mental health.

It’s almost as if Talbot thinks supporting all parents, regardless of their choices, is a bad thing.

How dare anyone consider women’s mental health more important than unmedicated vaginal birth and breastfeeding? How dare anyone imagine that the wellbeing of the bullied is more important than the enjoyment of the bullies?

As an article in The Guardian elaborated:

[Talbot] said the charity was shying away from publicly supporting breastfeeding in media debates and on social media, because its top priority was to be popular with new parents, including those who formula feed …

But no one has stopped supporting breastfeeding. They’ve merely stopped supporting breastfeeding to the exclusion of other choices. And, in particular, they’ve stopped supporting bullying parents into breastfeeding and shaming them for not breastfeeding.

Why? Because UK parents have made it clear that they won’t accept bullying anymore:

Since 2016, the charity has seen a 55% decrease in its membership from 110,000 to 50,000. It also suffered a 10% drop in its income over the same period, from £17.3m to £15.6m. A raft of competitors to the NCT have sprung up online and in cities like London, offering “non-preachy” practical courses which aim to help expectant parents feel confident and happy about their decisions, regardless of how they birth or feed their baby.

As Zoe Williams explains in The ‘breast is best’ lobby has left women feeling judged and unworthy:

…[F]or years the trust has been known for its fierce views on the “medicalisation” of childbirth. Women came away with the idea that epidurals were for wimps, caesarean sections meant you had failed, and the Syntocinon injection was only for the kind of weakling who couldn’t eject a placenta with the power of her mind.

It’s position on breastfeeding has been particularly harmful:

…[W]hen your position is that breastfeeding is the only real choice of the responsible mother, it’s difficult to claim a meaningful, simultaneous care for her mental health, and often this orthodoxy works actively against her confidence and mental wellbeing.

…Crucially, breastfeeding advocates react very badly to any notion of coexistence – that mothers who bottle-feed can enter the same conversations, forums, Instagram feeds, on the same terms. They will always be suboptimal mothers, though it won’t be their fault – rather, they didn’t get enough “support” to do the right thing.

Bullying has become a feature of lactivism, not a bug.

And Talbot and her supporters simply adore bullying and don’t want to give it up. From the article on Talbot’s resignation:

A breastfeeding counsellor and NCT practitioner, who did not want to be named, said she had been repeatedly concerned by posts by the NCT on Instagram regarding infant feeding. For example, social media influencer Naomi Courts, who lists baby bottle brand Tommee Tippee as a partner on her Instagram homepage, was given the opportunity to ‘take over’ the charity’s Instagram feed on Friday. Other posts have shown a mother with her head cropped off breastfeeding, immediately followed by a smiling mother formula feeding her baby.

A mother who enjoys formula feeding? The horror!

“Promoting bottle-feeding as equal to breastfeeding goes against our infant feeding policy, which says we should talk to parents about informed decision-making and not compare breast and bottle as equal – because it isn’t an equal choice.”

Except that formula feeding IS an equal choice and in some cases the better choice for individual babies and mothers. Why? Because exclusive breastfeeding has risks as well as benefits and most of the claimed benefits have been debunked.

As the current spokesperson for the National Childbirth Trust explained:

“If we’re making any change it’s about [wanting] to be here for all parents… Anybody who is either about to have a baby or has had a baby can come to NCT and get support and be welcomed. If that is a shift, then I think that is a really positive shift.”

Talbot and her supporters may not like it, but the truth is that there is no benefit of breastfeeding [or unmedicated vaginal birth] worth risking a mother’s mental health. That puts bullying off limits for natural childbirth and breastfeeding advocates.

Bullies won’t be happy and leaders of organizations that have enjoyed group bullying may resign, but the many, many women who have been bullied will be better off.

Since time out of mind human beings and microorganisms have been engaged in an accelerating arms race. Diseases have found novel ways to infect us and we have found novel ways to fight back. First we evolved genes that help us resist disease; much later we learned to use natural antibiotics produced by other living things and then to synthesize entirely new ones; ultimately we engineered vaccines to prevent diseases before they even happened.

Microorganisms have fought back. They evolved antibiotic resistance and they evolved to pass the genes that confer antibiotic resistance among themselves so they don’t have to wait for evolution to protect them. They might ultimately evolve to evade vaccination, but in the meantime they’ve found a short cut. By presenting a mild face, they’ve tricked some people into helping them propagate.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There’s a name for those who advance the interests of disease causing microorganisms; we call them anti-vaxxers.[/pullquote]

There’s a name for those who advance the interests of disease causing microorganisms — like measles, pertussis and influenza — over the interests of human beings; we call them anti-vaxxers.

Can microorganisms control human behavior? Why not? Plants and animals already do it.

In the book The Botany of Desire, Michael Pollan asked an intriguing question:

What existential difference is there between the human being’s role in [a] garden and the bumblebee’s?

Don’t both act to improve the wellbeing of plants?

He observes:

Gardeners like me tend to think such choices are our sovereign prerogative: in the space of this garden, I tell myself, I alone determine which species will thrive and which will disappear…

What if that grammar is all wrong? What if it’s really nothing more than a self-serving conceit? A bumblebee would probably also regard himself as a subject in the garden and the bloom he’s plundering for its drop of nectar as an object. But we know that this is just a failure of his imagination. The truth of the matter is that the flower has cleverly manipulated the bee into hauling its pollen from blossom to blossom…

And we’re being manipulated by plants, too.

The fact that one of us has evolved to become intermittently aware of its desires makes no difference whatsoever to the flower … All those plants care about is what every being cares about on the most basic genetic level: making more copies of itself. Through trial and error these plant species have found that the best way to do that is to induce animals — bees or people, it hardly matters — to spread their genes. How? By playing on the animals’ desires, conscious and otherwise…

The book tells the story of four plants — apples, tulips, marijuana, potatoes — and the traits they have evolved to trick human beings into propagating them by fulfilling human desires for sweetness, beauty and altered consciousness, etc.

Animals manipulate us in similar ways. The dog offers loyalty, the cow offers milk and the chicken offers meat and eggs. In return, we propagate them — in far greater numbers and to a much wider geographical extent — than they could ever have managed on their own.

Arguably, no plant or animal been more successful in manipulating us into promoting its own interests than the microorganism yeast. In exchange for the intoxication and leavening properties it offers, we propagate yeast in industrial quantities.

Yeasts can be considered man’s oldest industrial microorganism. It’s likely that man used yeast before the development of a written language. Hieroglyphics suggest that that ancient Egyptians were using yeast and the process of fermentation to produce alcoholic beverages and to leaven bread over 5,000 years ago…

It is believed that these early fermentation systems for alcohol production and bread making were formed by natural microbial contaminants of flour, other milled grains and from fruit or other juices containing sugar… Over the course of time, the use of these starter cultures helped to select for improved yeasts by saving a “good” batch of wine, beer or dough for inoculating the next batch…

Human beings commercially produce three million tons of baker’s yeast alone each year. That’s a pretty big accomplishment for a pretty small organism.

At no point is there any intentionality on the part of the yeast or any of these plants and animals. But by offering us something we want, these organisms have convinced us to do their bidding.

Anti-vaxxers are now doing the bidding of disease causing microorganisms such as those that cause measles, whooping cough and influenza. If dogs offer loyalty, apples offer sweetness and yeast offers intoxication, what do the vaccine preventable organisms offer human beings? In the case of anti-vaxxers, it is the the unmerited ego boost that anti-vax belief provides. Anti-vaxxers imagine themselves as smart enough to see the truth that others miss, cynical enough to recognize the corporate self-dealing that others ignore, and powerful enough to control their health in the face of government efforts to harm them.

How do vaccine preventable bacteria and viruses aid anti-vaxxers in their delusions? By presenting a mild appearance in a substantial proportion of cases.

Why don’t we ever see anyone holding Ebola parties, seeking to have their children acquire natural immunity? Ebola is obviously so debilitating and deadly that even the most delusional anti-vaxxer cannot imagine that prevention is worse than the disease. No one is rushing to bring back polio, either, for the same reason, although it is only a matter of time before it returns.

But diseases like measles, whooping cough and influenza often present a mild face, lulling anti-vaxxers into the complacent belief that they aren’t harmful at all. If the diseases aren’t harmful then the risks of vaccination (real or imagined) seem unjustified. Therefore, anti-vaxxers are doing everything in their power to allow the unrestrained propagation of these diseases. Measles, whooping cough and influenza don’t have many friends, but they have enough anti-vax friends to allow them to come roaring back.

It’s too late for smallpox. Even anti-vaxxers couldn’t convince people that the vaccine was worse than the disease because smallpox was rarely mild. As a result, the disease was wiped from the face of the earth. If measles, whooping cough and influenza were to become more virulent, anti-vaxxers would be relegated to the dustbin of history, quickly recognized as the foolish, ignorant conspiracy mongers that they are. Then we would be free to extirpate measles and whooping cough, too, (though probably not influenza because it mutates too quickly).

The bottom line is that anti-vaxxers are doing the bidding of deadly pathogens because those pathogens present a mild face often enough to fool them. Anti-vaxxers aren’t educated; they’re gullible … and bacteria and viruses are taking advantage of that fact.