Janis, one of the characters in Mean Girls, says:

There are two kinds of evil people in this world. Those who do evil stuff and those who see evil stuff being done and don’t try to stop it.

There’s actually a third kind: those who see good stuff being done and harrass those who do it.

That’s what came to mind when I saw this mea culpa written by a midwifery student, desperately trying to survive in a profession dominated by lactivist bullies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists subject one of their own to a re-education campaign.[/pullquote]

According to 19 year old Sophie, she had posted her support for the #FedIsBest campaign on her Instagram account:

Originally, I had understood that ‘Fed is Best’ was a concept about babies receiving correct nutrition and perhaps if you didn’t support the campaign, then you were implying you didn’t care about the feeding of babies.

That IS the concept of the Fed Is Best campaign. It rests on the premise that being fully fed with formula is much better, healthier, and safer for babies and mothers than starving on breastmilk. If you don’t support it, you care more about the promotion of breastfeeding than the promotion of infant and maternal health.

Poor Sophie didn’t realize that on Wednesday all the followers of the mean girls wear pink and she dared to wear a different color.

The mean girls subjected her to a re-education campaign and she is apologizing as frantically as she can:

Following my original post, some of my followers contacted me directly with links to articles and information which gave other viewpoints on #FedisBest. I am so grateful that these messages were sent to me with respect and kindness. I was not belittled, or sent hateful comments, even though I’m sure I offended many of my followers. A positive of this situation has shown me how social media can be used in a kind way – I have learnt so much, and if I hadn’t posted about the campaign, I would probably still be in my naïve bubble of confusion and misconceptions. I am the first to admit that as I am so new to midwifery, there are huge gaps in my knowledge and skills. I have so far to go, but we all must start somewhere. This is what my blog is about – sharing honestly about each step in my journey, whether it’s forwards or backwards.

Who was responsible for her re-education? Prof. Amy Brown, the Regina George of lactivism.

The article that really helped me learn was written by Professor Amy Brown; ‘Why Fed Will Never Be Best: The FIB Letting Our New Mothers Down’…

Amy’s article also made me realise that at no other point in our lives do we accept fed as best, rather than an absolute minimum.

See? Fed is minimal! That’s what all the mean girls say and Sophie desperately wants to be part of the in crowd, not on the outside getting bullied by the mean girls. And if there is one thing that the mean girls are absolutely, positively sure of is that anyone outside their group deserves to be bullied.

Rosalind Wiseman, author of the book Queen Bees and Wannabees on which Mean Girls is loosely based had this to say on the topic of mean girls:

The hazing experience and then the subsequent participation in the group forces its members to maintain the status quo and traditions at all costs. It demands mindlessness and unquestioned loyalty, resulting in boring people who have little ability to think for themselves or have an opposing viewpoint from those who have the most social power.

Sadly, that seems to be true for lactation professionals. They demand mindless, unquestioned loyalty and bullying of anyone who disagrees.

And it’s hard to protect yourself. As Wiseman notes:

Sometimes bullies are your friends and very rarely do bullying prevention tips acknowledge this fact or what to do about it.

And poor Sophie is exquisitely anxious that her “friends” within the midwifery and lactation professions consider her one of the group.

She can’t prostrate herself enough!

Although I feel embarrassed about publicly sharing my misunderstandings and may have led to others unintentionally being misinformed too, I’ve learnt lots in a positive way, thanks to social media and my followers. I plan to do more reading of articles and research about infant feeding. I will also investigate what the organisation where I work does to support infant feeding and I’ve got Amy Brown’s ‘The Positive Breastfeeding Book’ on my must-read list!

Hopefully Regina George Amy Brown has been pacified.

But Sophie, if you read this, I want you to consider something else:

You should NEVER apologize for being compassionate! You should NEVER apologize for refusing to take part in bullying! You should NEVER apologize for thinking for yourself and reaching your own conclusions!

Only mean girls would expect that from you.

As someone who endured my share of hazing during medical training, I know how very, very hard it is to maintain compassion for patients within a system that encourages treating them shabbily. I don’t expect you to resist the pressure now; you have no choice but to go along to get along.

But be assured that your first impulse — to be kind and respectful toward women and babies suffering from pressure to breastfeed — was correct. Don’t let the mean girls bully the compassion out of you.

Anti-vaxxers preen to themselves and each other that they are educated, empowered protectors of their children’s well being. They’re not; they are social parasites.

I’ve written before about the fact that privilege is the sine qua non of the contemporary anti-vax movement. Vaccine preventable diseases have to become rare before it is possible to imagine that the “risks” of vaccines outweigh the risks of diseases themselves.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Social parasites take their share of  the benefits of society while refusing to shoulder their share of the burdens.[/pullquote]

Furthermore, anti-vax is unethical. It only becomes a realistic option in societies where most parents behave morally and follow the admonition to get their children vaccinated. Most people, understanding the importance herd immunity, vaccinate their children. In contrast anti-vaxxers assume that they will be protected from diseases like measles because everyone else is vaccinating, and — privileged as they are — they imagine they are entitled to keep their own children unvaccinated.

In other words, they are social parasites.

Social parasitism is a phenomenon that occurs among social insects.

Social parasitism is a condition where a parasitizing ant species depends upon the labour provided by a host ant species within the context of a mixed-species colony.

They are the freeloaders of the insect world:

…Social parasite species evolve from seemingly typical, social species but have evolved mechanisms which shortcut the usual social formalities like building your own nest and raising your own brood. In this sense, they are receiving all of the benefits of social organisation while giving little in the form of social costs…

Among humans:

Social parasitism is a pejorative that is leveled against a group or class which is considered to be detrimental to society. The term comes from the ancient Greek παράσιτος (parásitos), “one who lives at another’s expense, person who eats at the table of another,” used to label the social offender.

Anti-vaxxers are most certainly detrimental to society as demonstrated by the recent resurgence of vaccine preventable diseases that had become extremely rare. Anti-vaxxers and their children survive and thrive at the expense of others mothers’ children. How? Children who are younger, more fragile and less immune competent (due to chemotherapy or immunologic disease) are both more likely to be susceptible to vaccine preventable diseases and less likely to recover from them.

Imagine an ancient agrarian community facing famine restricting each individual to only two meals a day in order to extend the food supply as long as possible before the next harvest. Now imagine that a few individuals take enough food from the community supply in order to provide their own children with three meals a day. Not only will the food for the whole community run out earlier, but when the whole town is starving, it is the weakest among them who will succumb long before those who took more than their share. Those who took extra (and their children) will survive at the expense of the rest of the community. That makes them social parasites.

Immunity to disease, like a communal food supply, is a benefit that is only possible within a community. The ancient agrarian community pooled their food to maximize the survival of everyone, even the young and the weak who could never have fought for a fair share on their own. As long as you are dependent on the benefits of that society (that’s what you are doing if you eat from the communal supply), you must contribute to preserving that supply by taking only what everyone else is taking. Otherwise you are a social parasite.

Contemporary society “pools” immunity in order to maximize the survival of everyone, even the young and the weak. As long as you are dependent on the benefits of that society (and you are if your children face minimal risk because other children are vaccinated), you must contribute to preserving that supply by having your own children vaccinated. Otherwise you are a social parasite.

Notice that it doesn’t matter whether or not vaccination has risks (there is a real, but tiny risk of brain damage or death) or what those risks are (autism, autoimmune diseases, vaccine “injuries” or whatever non-existent risks you choose to imagine). Arcane discussions about the scientific literature are irrelevant. Regardless of the risks, everyone must share them, just as in the case of the dwindling food supply. Insisting that you don’t have to vaccinate your children because you are afraid vaccines raise the risk autism is like insisting that you can take more than your share from the communal food supply because two meals a day instead of three raises the risks of malnutrition. It doesn’t matter even if it’s true.

Once you choose to share the communal benefits of society, you are morally obligated to share the burdens as well. Otherwise, you are a social parasite and the community will have a right — indeed an obligation — to punish you for putting the entire community, particularly the young and the weak, at risk.

Many years ago I received an urgent gynecology question at 11 PM. I was the OB-GYN Chief Resident on call that night so any outside calls came to me.

The middle aged woman on the phone told me she was desperate for help. She needed to know if her son’s girlfriend had come to the hospital to have an abortion. I repeatedly explained to her that I didn’t know, wouldn’t find out and was constrained by patient confidentiality from telling her in any case. I thought we were having a conversation about abortion and patient privacy. But then she said something that changed everything:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Laysplainers don’t merely overestimate their own knowledge; they can’t tell the difference between real knowledge and impossible knowledge.[/pullquote]

Please, you must let me know if she had an abortion at your hospital, because I hear the baby calling to me from a jar: Grandma, Grandma, come get me!

I realized then that we were having a conversation about mental illness.

I didn’t understand what was going on until the moment the woman offered impossible knowledge. Impossible knowledge is what people believe they know but couldn’t possibly be true because it is literally impossible (as in this case) or because it doesn’t exist.

Many people with mental illness believe they are in possession of impossible knowledge. The woman I spoke with believed with every fiber of her being that her putative aborted grandchild was telling her to come get him. But you don’t have to have to be mentally ill to claim you have impossible knowledge. Laysplainers offer it all the time to “prove” whatever it is they believe.

As I wrote last week, a laysplainer is a layperson (typically an anti-vaxxer or alternative health advocate) who “explains” disease, prevention or treatment to a medical professional in a condescending, overconfident, oversimplified and inaccurate way. And they don’t restrict themselves to false claims. They freely (and irritatingly) offer impossible knowledge.

In 2015, Dr. David Dunning, of the Dunning Kruger effect, published a paper on impossible knowledge.

At times, people even claim knowledge they cannot possibly have, because the object of their knowledge does not exist, a phenomenon known as overclaiming. For example, in the late 1970s, nearly a third of American respondents expressed an opinion about the “1975 Public Affairs Act” when asked about it directly, even though the act was a complete fiction. Approximately a fifth of consumers report having used products that are actually nonexistent …

Impossible knowledge looms large in the anti-vaccine movement. Many rabid anti-vaxxers assert confidently that there is a secret world-wide conspiracy of nearly all doctors, immunologists and public health officials to promote vaccines that don’t work and actually cause injuries to innocent children. That’s impossible knowledge because there is no such conspiracy and it couldn’t possibly be secret if you learned about it from a YouTube video.

The shill gambit, beloved of anti-vaxxers and lactivists, is often a form of impossible knowledge. Accusing me of being a shill for big Pharma or Big Formula is definitely impossible knowledge since I don’t get paid by any pharmaceutical or formula company. It is also impossible knowledge since you can’t possibly know it unless you have examined my finances and/or the finances of drug and formula companies.

Claiming that I “hate” breastfeeding is another variation of impossible knowledge since I breastfed my four children and both I and they enjoyed it and thrived.

So why do people claim knowledge they couldn’t possible have because it didn’t happen or it isn’t true?

According to Dunning and colleagues:

A sizable body of work on how people evaluate their own knowledge suggests that they rely not only on a direct examination of their mental contents but also on a feeling of knowing. Notably, a feeling of knowing is often only weakly predictive of actual knowledge and appears to be informed, at least in part, by top-down inferences about what should be or probably is known. We theorized that such inferences are drawn from people’s preconceived notions about their expertise, inducing a feeling of knowing that then prompts overclaiming.

In other words, anti-vaxxers and other alt-health aficianados don’t merely overestimate their own knowledge as the Dunning Kruger effect predicts (those with the least knowledge tend to think they know the most). They aren’t capable of telling the difference between real knowledge and a “feeling” of knowing.

The authors note:

It is easy to imagine how a tendency to overclaim, especially in self-perceived experts, could have adverse consequences. Self-perceived experts may give bad counsel when they should give none. For instance, an individual considering a financial decision may consult a friend who expresses confidence in her financial knowledge. That friend may provide inappropriate advice because she fails to recognize her insufficient familiarity with the question. Further, a tendency to overclaim may discourage individuals from educating themselves in precisely those areas in which they consider themselves knowledgeable and that may be important to them. In other words, over-claiming may hinder people from truly achieving a valuable level of genuine knowledge.

Similarly, self-perceived vaccine experts (anti-vaxxers) give bad counsel when they should give none. The typical anti-vaxxer provides inappropriate advice because she fails to recognize her insufficient knowledge. Moreover, because she “feels” like she knows all she needs to know, she doesn’t seek education in immunology, science and statistics. Offering impossible knowledge marks her not as knowledgeable, but as ignorant and gullible.

So, laysplainers, spare me your impossible knowledge!

Don’t tell me what doctors do or don’t learn in medical school; I went to medical school and you didn’t.

Don’t tell me how many “unhindered” vaginal births obstetricians have seen; I’m an obstetrician and you’re not.

Don’t tell me vaccines cause autism; I’ve read the vaccine literature and you haven’t.

Don’t tell me the Fed Is Best Foundation is shilling for formula companies; their financial forms make it clear that they aren’t.

When you assert impossible knowledge you are like the woman who told me she heard her aborted grandchild calling her. You indicate that you have lost touch with both knowledge and reality.

What if we’ve been approaching the anti-vaccine phenomenon the wrong way?

We’ve been operating under the assumption that anti-vax is fundamentally a misunderstanding, reflecting lack of knowledge of immunology and statistics. But what if it is actually a culturally mediated phobia like triskaidekaphobia, fear of the number 13?

That would explain why fear of vaccines has continued to metastasize even though in the entire 200+ years of the movement, anti-vaxxers have never been right even once. It would explain why attempts to educate anti-vaxxers have been utter failures. It would explain why anti-vaxxers huddle together on social media; only another sufferer of the irrational fear can understand it. And it would explain why anti-vaxxers keep moving the goal posts — It’s mercury! It’s aluminum! It’s autism! It’s vaccine “injuries”! — to justify their irrational fear.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What does fear of vaccines have in common with fear of the number 13? Both are culturally mediated phobias.[/pullquote]

What is a phobia?

According to Wikipedia:

A phobia is a type of anxiety disorder, defined by a persistent and excessive fear of an object or situation… The affected person goes to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the feared object or situation cannot be avoided, the affected person experiences significant distress…

Phobias can be divided into generalized fears like agoraphobia (fear of leaving home), social phobias (fear of being judged by others) and specific phobias involving fear of specific objects and situations, like fear of heights (acrophobia) and fear of enclosed spaces (claustrophobia).

A specific phobia can reflect a previous bad experience. For example, getting bitten by a dog can lead to a paralyzing phobia of dogs, not merely a rational fear of aggressive dogs.

Specific phobias can be the result of watching others have a bad experience, such seeing another person bitten by a dog.

Phobias can also be taught, and therefore be culturally mediated. That’s how people become afflicted with fear of specific numbers like triskaidekaphobia, fear of the number 13.

Although it may seem trivial, triskaidekaphobia is an issue that affects western societies economically. Because of the superstition, some people delay doing business on the 13th of any month, while statistically there are more people who do not go to work on the 13th day of any month …

Friday is also considered to be an unlucky day in western culture…

The term for the fear of Friday the 13th is paraskevidekatriaphobia.

It is estimated that the United States loses about $900,000,000 in productivity every year because of Friday the 13th as some people are so superstitious about it that they wouldn’t even get out of bed.

Different numbers are the source of phobias in different cultures. These include:

Tetraphobia, fear of the number 4. In China, Taiwan, Singapore, Japan, Korea and Vietnam, as well as in some other East Asian and South East Asian countries, it is not uncommon for buildings (including offices, apartments, hotels) to omit floors with numbers that include the digit 4 … This originates from Classical Chinese, in which the pronunciation of the word for “four” is very similar to that of the word for “death,” and remains so in the other countries’

17 is an unlucky number in Italy, perhaps because in Roman numerals 17 is written XVII, which can be rearranged to “VIXI”, which in Latin means “I have lived” but can be a euphemism for “I am dead.” In Italy, some planes have no row 17 and some hotels have no room 17…

Obviously there is nothing inherently dangerous or harmful about these numbers, or any numbers, yet many people are very afraid of them and some people are so afraid that it affects their life in significant ways.

What would it mean if vaccine hesitancy were not a rational fear, but rather a phobia, vaxophobia? It would mean that we must change our entire approach to people who refuse vaccines.

First, we would stop spending so much time educating people about the real risks of vaccine preventable diseases and focus instead on the irrational fear of vaccines itself. When treating a person who suffers from claustrophobia, we don’t spend much time explaining why the chances of being trapped for long periods inside an elevator is low. A phobia is not a rational fear, so it’s not amenable to rational explanations. Instead we try to trace the origins of the fear and help people to desensitize themselves by controlled exposure to the fear.

As this Mayo Clinic website explains:

The best treatment for specific phobias is a form of psychotherapy called exposure therapy. Sometimes your doctor may also recommend other therapies or medication. Understanding the cause of a phobia is actually less important than focusing on how to treat the avoidance behavior that has developed over time.

Second, we would spend more time and effort in understanding how this specific, culturally mediated phobia is transmitted from affected to unaffected individuals. It is an urgent question. While triskaidekaphobia may be harmful to the American economy, vaxophobia is very harmful to the health and wellbeing of babies and children. It puts them at risk of illness, serious injury and even death. And that doesn’t even count the economic impact of wages and productivity lost to vaccine preventable diseases.

Third, we would recognize that anti-vax physicians, naturopaths, chiropractors, etc. are not empowering their patients, they are reinforcing their enslavement to the phobia. The “service” an anti-vax doctor like Bob Sears provides by writing vaccine medical exemptions is no different than the “service” of providing a medical exemption for working on Friday the 13th. Both are abuses of the medical system.

Finally, we would stop arguing with and pandering to vaxophobes. We don’t excuse people from working on the 13th of every month simply because they are phobic about the number 13. Similarly, we should not allow philosophical exemptions for vaccination. There’s no philosophy involved here, just an irrational fear, and pandering won’t fix it; it will only make it worse.

It’s always the mother’s fault.

There is a long and storied history of mother blame extending back millennia. Women who couldn’t conceive were labeled “barren” even though infertility is caused by male factors 20% of the time. Women who had only daughters and no sons were blamed for the sex of their children, even though it is sperm that determine gender, not ova. For hundreds of years of recent history, women were told that their dreams could affect the outcome of pregnancy; dream of something frightening and the baby might be deformed. Within the past century, “refrigerator mothers” were blamed for autism even though there was never any evidence to support such a link.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We must “discover” ever more arcane “benefits” so we can continue to shame, blame and humiliate women who can’t or don’t breastfeed.[/pullquote]

The latest recruit to the deeply satisfying pastime of mother blame is the microbiome. For the past few years it has been used to chastise women who can’t or don’t breastfeed. Recently, it has offered an a new opportunity to chastise women who pump breastmilk because — duh! — women who give up career and livelihood to breastfeed supposedly represent the apogee of contemporary motherhood.

On the face of it, there’s no reason why breastfeeding, which in industrialized countries has only trivial benefits, has become a public health cause celebre.

There are so many, many issues that have a much greater impact on child health that are being ignored, while breastfeeding advocacy benefits from millions of dollars of public and private funds, extensive public health campaigns, and redesign of hospital policies. We have public health campaigns against smoking because that costs millions of lives; we have public health campaigns to promote vaccination because vaccines save millions of lives; we have public health campaigns to promote breastfeeding … which has never been shown to save even a single term baby.

If you want to see how trivial the impact of breastfeeding is on public health you need only look at the impact of breastfeeding on infant mortality in the US during the 20th Century when breastfeeding rates fluctuated dramatically from a high of over 75% to a low of 25% and back up to 75%. Breastfeeding rates had ZERO impact on infant mortality.

While breastfeeding advocates breathlessly promote studies that show trivial benefits within tiny groups of carefully selected individuals, we’ve already done the largest public health experiment possible and it shows that breastfeeding is NOT a public health issue since it has no impact on public health.

Why then do we continue to justify a multimillion dollar effort to promote breastfeeding rates in the absence of public health benefits?

Frist, breastfeeding advocacy is a huge business. While individual professional breastfeeding advocates don’t make large sums of money, 100% of the income of lactation consultant derives from breastfeeding promotion, and 100% of the income of lactivist organizations like the Orwellian-named Baby Friendly Hospital Initiative comes from the more than $11,000 they charge each hospital for the privilege of being designated lactivist baby friendly.

Second, breastfeeding promotion, which has its modern incarnation in La Leche League as an effort to keep women in the home and out of the workforce, is a response to the profound social disclocation of women’s emancipation. The political right has retreated into religious fundamentalism and the political left has retreated into mindless worship of “nature.” Simply put, aggressive promotion of breastfeeding is deeply retrograde and anti-feminist.

So we must “discover” ever more arcane “benefits” so we can continue to shame, blame and humiliate women who can’t or don’t breastfeed or — don’t breastfeed the “right” way by staying home with their infants 24/7/365.

It’s part of the effort to maintain a traditionally misogynistic “blame the mother” culture.

As Phyllis Rippeyoung explained in her paper, Governing Motherhood: Who Pays and Who Profits? published by the Canadian Centre for Policy Alternatives:

This individualizing of responsibility for child welfare has also been seen among breastfeeding proponents, as most explicitly illustrated in an editorial by Dr. Ruth Lawrence, a founder of the Academy of Breastfeeding Medicine. In her essay, “The Elimination of Poverty One Child at a Time,” she argues that breastfeeding is the panacea for health and cognitive inequalities between poor and non-poor children. She ends the piece by writing that breastfeeding may be the only gift that poor mothers have to offer their children.

… I have been unable to find any research assessing whether breastfeeding … will actually reduce either poverty or the consequences of growing up poor, one child at a time or otherwise. In research I have recently completed, I assessed the relative impact of breastfeeding versus the family educational environment on reducing gaps in child verbal IQ between the poor, the near poor, and the non-poor … This research indicates that individual solutions to low test scores will not solve the problems of inequalities in school readiness.

It is hardly a coincidence that the women who are targets for shaming by breastfeeding advocates are more likely to be poor, non-white and under-educated. It’s so much easier and cheaper (not to mention politically gratifying) to chastise these mothers for not breastfeeding than to address the terrible environments in which many are forced to raise their children.

The ugly truth is that money spent on breastfeeding advocacy benefits only the advocates — the very people who write and promote research that continually “discovers” new “benefits” — not mothers or children.

We should stop spending money on public health campaigns to promote breastfeeding and divert that wasted money to initiatives that we know will help ALL mothers and ALL children, not just those who breastfeed or are breastfed.

But is so much more satisfying to shame mothers for not breastfeeding — and blame them for everything!

Imagine a study that compared the mouth microbiome of men and women and found that up to 1/3 of the common mouth bacteria differed between men and women. Plausible, right, since male and female hormones are different and might exert some impact on the bacteria that live inside mouths?

Now imagine that the researchers concluded that women are inferior to men because their mouth microbiome differs.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]This is not science; it’s misogyny. And that sucks![/perfectpullquote]

Outrageous, right?

How do the researchers know which microbiome is better? Why do they take men as a the standard? Why do they assume that any differences between women and men are “proof” that women are inferior? Where is the evidence that the mouth microbiome has anything to tell us about the relative value of men and women?

It’s outrageous because the researchers obviously started with the assumption that men are the standard against which women ought to be judged. Furthermore, they engaged in motivated reasoning; to the extent that any differences between men and women exist, they are assumed (without any scientific evidence) to support the pre-determined conclusion that men are “better” than women.

If you understand why the above imaginary study would be junk science, you now understand why the new study, Composition and Variation of the Human Milk Microbiota Are Influenced by Maternal and Early-Life Factors, comparing breastmilk to pumped breastmilk is also junk science.

It starts with the unwarranted assumption that breastmilk taken from women who breastfeed exclusively is some sort of standard. It assumes that any differences detected in the microbiome of women who pumped are “proof” that pumped breastmilk is inferior. And it demonstrates that the conclusion to which the authors were committed a priori was that fresh breastmilk is better than pumped.

According to the MedicalXpress:

A large-scale analysis in humans reveals that indirect breastfeeding using pumped milk is associated with the depletion of oral bacteria and a higher abundance of potential pathogens compared with direct breastfeeding at the breast…

Specifically, indirect breastfeeding (defined as at least one serving of pumped milk in the preceding two weeks) was associated with a higher abundance of potential opportunistic pathogens, such as Stenotrophomonas and Pseudomonadaceae.”Increased exposure to potential pathogens in breastmilk could pose a risk of respiratory infection in the infant, potentially explaining why infants fed pumped milk are at increased risk for pediatric asthma compared to those fed exclusively at the breast,” says first author Shirin Moossavi of the University of Manitoba. To determine if this is the case, there will need to be additional research into how changes in the milk microbiota affect colonization of the infant gut microbiome, which influences health.

There is so much wrong with these claims that it’s difficult to know where to start:

Potential pathogens?

Could pose a risk?

“Indirect” breastfeeding, implying it’s not real breastfeeding?

Let’s look at the actual scientific findings.

What did the authors set out to explore?

Two main pathways have been proposed to explain the origin of milk microbiota: entero-mammary translocation of the maternal gut microbiota and retrograde inoculation by the infant’s oral microbiota. The fact that colostrum collected even before the first infant feeding already contains a microbial community supports the entero-mammary pathway, while the similarity of infant oral microbiota to breastmilk microbiota supports the retrograde pathway. It is plausible that both pathways are contributing to the bacterial content of human milk.

What did they find?

To identify potential inherent patterns in the milk microbiota, hierarchical clustering was performed on the core microbiota…

Milk Microbiota Diversity Is Associated with Mode of Breastfeeding, Method of Milk Expression, and Other Maternal Factors

Overall, milk samples had a mean ± SD richness (observed ASVs) of 147 ± 44 and diversity (inverse Simpson index) of 15.8 ± 8.7. We explored the association of α diversity with multiple maternal and infant factors. In multivariable linear regression adjusting for infant sex, mode of feeding, mode of delivery, and parity (number of older siblings), indirect breastfeeding was independently associated with lower milk bacterial richness (adjusted Math Eq–18.9, 95% CI, −27.9, −9.9, p < 0.001) and diversity (adjusted Math Eq−2.08, 95% CI, −3.91, −0.25, p < 0.05; Table 1). In a subset with data on milk expression method, pump versus manual expression was associated with significantly lower bacterial richness (Math Eq = −39.6, 95% CI, −60.5, −18.7, p < 0.001)…

In addition:

Milk Microbiota Composition Is Associated with Breastfeeding Practices, Multiparity, and Other Maternal Factors in a Sex-Specific Manner

Indeed:

We observed intriguing differences in milk microbiota α diversity and overall community structure according to infant sex. There was a trend in direct association of infant sex with milk microbiota in our SEM analysis, and we also found sex-dependent associations of breastfeeding mode, exclusivity, and lactation stage (higher R2 in males), as well as parity, mode of delivery, and maternal BMI (significant in females only) with milk microbiota in RDA…

Overall:

Notably, however, the many factors we evaluated collectively explained less than a third of the total variation observed in milk microbiota composition, indicating that other unmeasured factors are contributing to the large inter-individual variation in milk microbiota profiles.

The study has some serious limitations:

The main limitation of our study is that milk samples were pooled from multiple feeds and were not collected aseptically.

In summary:

1. The authors found wide variation in the microbiome of pooled samples of of breastmilk that were not collected aseptically.
2. More than two thirds of the variation was unexplained.
3. Less than one third of the variation could be attributed either to the gender of the infant or a history of pumping breastmilk.
4. There is no evidence that any of these differences are clinically relevant.

So why did the authors blare their “conclusion” that pumping changes the milk microbiome? It certainly wasn’t because the findings have ANY implication for mothers or babies.

This paper, like nearly every aspect of professional lactivism from the inception of La Leche League in the 1950’s, isn’t about what is good for babies. It is about controlling women’s behavior through guilt. That’s why I have a handy rule of thumb for breastfeeding “science”:

Any paper that concludes or implies that giving up career and livelihood to stay home and breastfeed is “better” is deserving of special scrutiny.

More often than not, such papers are not science, but exercises in motivated reasoning.

Most people are unaware that La Leche League, the first and still the most influential lactivist organization was founded specifically to convince women to stay home with young children.

In the book La Leche League: At the Crossroads of Medicine, Feminism, and Religion, Jule DeJager Ward explains:

[A] central characteristic of La Leche League’s ideology is that it was born of Catholic moral discourse on family life … The League has very strong convictions about the needs of families. These convictions are the normative heart of its narrative… The League’s presentations and literature carry a strong suggestion that breast feeding is obligatory. Their message is simple: Nature intended mothers to nurse their babies; therefore, mothers ought to nurse…

In 2019 you can no longer tell women that it is “better” for babies to have a stay at home mother. It’s easy to recognize the misogyny in that claim. Therefore, lactivist tactics have switched to convincing women that breastfeeding is better for babies. They’ve spent the past 30+ years promoting an expanding list of health benefits … that have nearly all been debunked.

So the search is on for ever more arcane “benefits” and investigations of the breastmilk microbiome are part of that effort. Our understanding of microbiomes is primitive. We have literally no idea what a “normal” microbiome looks like. We have literally no idea whether variations among individuals are clinically relevant or merely incidental. That hasn’t stopped breastfeeding researchers from drawing junk science “conclusions.” And those conclusions always rest on the assumption that a mother breastfeeding directly and exclusively is the standard against which any variations should be assumed inferior.

That reflects the patriarchal belief a woman’s place is in the home and nowhere else. It also reflects the patriarchal belief that women should be judged by the function of their reproductive organs, not their intellect, talents or character. That’s not science; it’s misogyny. And that sucks!

It’s been nearly 20 years since I was diagnosed with a benign brain tumor, a meningioma. At the time the Gamma Knife (stereotactic radiosurgery, which is radiation not surgery) was relatively new, but as my brain tumor was deep inside my brain it offered an opportunity to avoid potentially destructive brain surgery.

Nonetheless, I sought a second opinion from a prominent neurosurgeon who aggressively recommended surgery, although he warned me that I would almost certainly lose my hearing on that side of my head as well as sensation in my face.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The women and babies for whom I advocate are entitled to expect Dr. Jack Newman to answer the question I posed.[/pullquote]

So I asked him how brain surgery compared with the Gamma Knife for successful outcomes. He told me surgery had an 85% success rate and the Gamma Knife had a 95% success rate.

Then I asked him about the risk of complications. He answered that I would definitely have complications from the surgery (hearing loss, etc.) but that the complication rate for the Gamma Knife was extremely low.

So then I asked whether if I was one of the rare failures of Gamma Knife treatment, would that compromise a surgeon’s ability to remove the tumor. He assured me that it would make no difference.

Finally I asked if the Gamma Knife had a higher success rate, a lower complication rate, and did not prevent using surgery in the case of failure, why hadn’t he recommended the Gamma Knife. He didn’t miss a beat, acknowledging that he didn’t recommend it, because he didn’t have one.

I was reminded of that episode when I was recently deleted and banned from Dr. Jack Newman’s Facebook page for daring to ask a question that he didn’t want to answer:

[C]an you please show us any impact that changing breastfeeding rates have had on term infant mortality or any metrics of major term infant morbidity.

He’s hardly the only lactation professional to delete, ban or block me on social media. Although the phrase “what doctors don’t want you to know” is overused among the alternative health community, the tactic of hiding health information is alive and well in the lactation community.

Dr. Newman is afraid of me because, like the neurosurgeon who didn’t recommend the Gamma Knife because he couldn’t profit from it, he can’t answer a simple question because he won’t profit from the answer. And so it is very, very important to make sure not merely to ignore me, but to prevent others from even hearing my question. Who knows what might happen to the income of lactation professionals if women learn the truth that breastfeeding DOESN’T have the benefits they claim and has risks that they would prefer to ignore?

That’s why you must never, ever listen to Dr. Amy.

As a public service, I’ve gathered some of the most common reasons why you shouldn’t listen to me, complete with the English to English translations.

“Don’t listen to Dr. Amy because she’s biased.”

English to English translation:

Dr. Amy is biased toward presenting complete information. She won’t exclude the mass of data that we feel compelled to conceal.

“Don’t listen to Dr. Amy because she cherry picks the data.”

English to English translation:

Dr. Amy does not merely quote the data, but she breaks it down so you can understand it too. That means that instead of merely accepting what we tell you about breastfeeding, you will be armed with the actual statistics that show that the benefits of breastfeeding term infants in industrialized countries are so trivial that they cannot be detected in large populations.

“Don’t listen to Dr. Amy because she’s crazy.”

Only a crazy person would take the time to present the data, show you where you can find it yourself, and explain how even you can understand and analyze it. That’s dangerous. Listen to us and you won’t have to use your own intelligence and reach your own conclusions. Just accept what we tell you.

“Don’t listen to Dr. Amy because she hates breastfeeding.”

English to English translation:

Ignore the fact that she breastfed her own four children happily and with little difficulty. Don’t listen to Dr. Amy because she hates the fact that the only metrics that breastfeeding has managed to change in large populations is the increased rate of complications, brain injuries and deaths of newborns. Exclusive breastfeeding on discharge is now the leading risk factor for newborn hospital readmission. Those who “love” breastfeeding are willing to lie about; since Dr. Amy is not willing to lie, she must “hate” it.

The women and babies for whom I advocate are entitled to expect Jack Newman to answer the question that I posed. To that end, I have petitioned him on Change.org. Please sign the petition if you, too, would like to see Dr. Newman answer the question!

In the meantime, keep in mind what’s really going on when someone tells you “Don’t listen to Dr. Amy,” or deletes my questions and bans me for asking. What they’re really telling you is don’t read, don’t learn, don’t think. If you do, you are bound to conclude that they are telling you is false, and they can’t have that, can they?

Ask yourself: Are you brave?

Are you brave enough to read what I say, review the papers that I cite, analyze the data for yourself, and reach your own conclusions?

I’m not afraid of that, but apparently lactation professionals are. That should tell you all you need to know about the purported benefits of breastfeeding.

Just as it was wrong when the neurosurgeon recommended surgery to me because he couldn’t profit from the safer radiation treatment, it’s wrong when lactation professionals claim that breast is best — and delete, ban and block anyone who can demonstrate otherwise — simply because they can’t profit from formula feeding.

Biological warfare offers an unparalleled opportunity for enemies of the US to terrorize and kill Americans.

According to Wikipedia:

Biological warfare (BW) — also known as germ warfare — is the use of biological toxins or infectious agents such as bacteria, viruses, and fungi with the intent to kill or incapacitate humans, animals or plants as an act of war.

The use of biological weapons is prohibited under customary international humanitarian law, as well as a variety of international treaties. The use of biological agents in armed conflict is a war crime.

The limiting factor in biological warfare is not the number of agents; there are many excellent candidates that could be used to wipe out our population. To date the limiting factor has been the ability to weaponize those agents.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers, Russia is trying to Make America Sick Again. Don’t help them![/pullquote]

The primary difficulty is not the production of the biological agent, as many biological agents used in weapons can often be manufactured relatively quickly, cheaply and easily. Rather, it is the weaponization, storage and delivery in an effective vehicle to a vulnerable target that pose significant problems.

But what if it were much, much easier? What if you didn’t need to manufacture the agent, weaponize it, store it and find an appropriate method of dispersal? What if all you needed to do was convince Americans not to vaccinate against it?

Unless you have been living under a rock, you are undoubtedly aware that Russia under Vladimir Putin has been engaged in a multi-faceted disinformation campaign designed to cause chaos in the American political system, enable the election of Russia friendly politicians, and sow discord in the international alliances that restrict Russian aggression. It has been successful beyond Putin’s wildest imagination, with the election of Donald Trump — Russia’s candidate — to the Presidency. And it was all done without firing a shot. All it took was the theft of private information, weaponized by mastery of Facebook and Twitter.

But what if you wanted to go beyond a wholesale takeover of the political system of the US and actually kill Americans? All you’d need is the weaponization of misinformation about vaccines and disease, and scourges believed controlled in the US would come roaring back.

What if anti-vaxxers — so desperate to believe that their ignorance and conspiracy theories mark them as enpowered, independent thinkers — are nothing more than easily controlled pawns in an effort to weaken the US? It’s not as unlikely as you might think.

Indeed, US Defense Advanced Research Projects Agency (DARPA) has been investigating it. The paper Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate was published in the American Journal of Public Health in October 2018:

We report the results of a retrospective observational study assessing the impact of bots and trolls on online vaccine discourse on Twitter. Using a set of 1 793 690 tweets collected from July 14, 2014, through September 26, 2017, we quantified the impact of known and suspected Twitter bots and trolls on amplifying polarizing and antivaccine messages.

This analysis is supplemented by a qualitative study of #VaccinateUS — a Twitter hashtag designed to promote discord using vaccination as a political wedge issue. #VaccinateUS tweets were uniquely identified with Russian troll accounts linked to the Internet Research Agency — a company backed by the Russian government specializing in online influence operations.

Thus, health communications have become “weaponized”: public health issues, such as vaccination, are included in attempts to spread misinformation and disinformation by foreign powers. In addition, Twitter bots distributing malware and commercial content (i.e., spam) masquerade as human users to distribute antivaccine messages. A full 93% of tweets about vaccines are generated by accounts whose provenance can be verified as neither bots nor human users yet who exhibit malicious behaviors. These unidentified accounts preferentially tweet antivaccine misinformation.

They found:

Russian trolls and sophisticated Twitter bots post content about vaccination at significantly higher rates than does the average user. Content from these sources gives equal attention to pro- and antivaccination arguments. This is consistent with a strategy of promoting discord across a range of contro- versial topics — a known tactic employed by Russian troll accounts. Such strategies may undermine the public health: normalizing these debates may lead the public to question long-standing scientific consensus regarding vaccine efficacy… We recently found that this strategy was effective for propagating news articles through social media in the context of the 2015 Disneyland measles outbreak.

This is not Russia’s first foray into disinformation campaigns about disease. As the accompanying editorial in the American Journal of Public Health notes:

Consider, for example, Russia’s active measures campaign in the mid-1980s to disseminate propaganda that the AIDS virus was unleashed on the world by the United States as a biological weapon. As an individual campaign, it successfully spread thousands of false stories; its reach was limited only by a lack of human resources to conduct active measures. Today, new communication channels, tested strategies, and established preferences among the online public allow the propagation of false information in viral fashion.

The Russian effort to weaponize measles by sowing misinformation about vaccination has important implications both for anti-vaxxers and for medical professionals fighting to save the lives anti-vaxxers put at risk.

Anti-vaxxers need to understand that they are the target of a highly sophisticated disinformation campaign designed to weaken our country. They are not brave, independent thinkers. They are dupes. What more do you need to know about the safety and efficacy of vaccination than the fact that the Russians, our mortal enemies, are trying to convince you of the opposite?

And the stakes are far higher than they realize. It isn’t just a matter of wasting money on the books and supplements peddled by anti-vax celebrities. It isn’t just a matter of putting the lives of your own children and other people’s infants and immunocompromised children at risk. It’s a matter of putting the safety of our country at risk.

Anti-vaxxers, you are NOT the victims of a massive conspiracy of all the doctors, public health officials and pharmaceutical companies in the world. You ARE a victim of a Russian conspiracy targeting you specifically, understanding that your lack of knowledge of science and statistics makes you the weak link in the effort to protect the health of individual Americans and American itself.

Russia is trying to Make America Sick Again. Don’t help them!

Pro-tip: Don’t bother telling me what doctors do or don’t learn in medical school; I went to medical school and you didn’t.

Don’t bother telling me how many “unhindered” vaginal births obstetricians have seen; I’m an obstetrician and you’re not.

And for the love of all that is holy, stop laysplaining vaccination to me!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Your belief you know more than physicians reflects your ignorance of science coupled to your extreme gullibility, fortified by your utter lack of self-awareness.[/pullquote]

What’s laysplaining? It’s my new term for the annnoying behavior of a layperson (typically an anti-vaxxer or alternative health advocate) who “explains” disease, prevention or treatment to a medical professional in a condescending, overconfident, oversimplified and inaccurate way.

Not to put too fine a point on it, but your treasured belief that you know more about vaccination than physicians reflects your ignorance of science coupled to your extreme gullibility, fortified by your utter lack of self-awareness.

You’re like the second grader who having mastered addition and subtraction declares that calculus is a plot by math professors to oppress students. There is no possible way for a second grader to understand the substance, utility and necessity of calculus; he or she must accept the word of those with expertise in higher math.

Similarly, there is no possible way for a layperson — EVEN YOU — to fully understand the substance, utility and necessity of vaccination; most adults, being more mature and self-aware than second graders, understand that they have to accept the word of those with expertise in medicine, immunology and epidemiology.

No, you’re not Galileo or Darwin, who ushered in great paradigm shifts in science and neither are the quacks you follow on Facebook. Both Galileo and Darwin were scientists, fully trained and completely up to date with contemporary scientific literature.

Both were engaged in basic scientific research and made extensive, mind-numbingly detailed observations of the natural world before articulating their theories.

Both PUBLISHED their findings so that other scientists could critique them and potentially reject them.

They didn’t declare the result of their research and expect anyone to blindly accept it. They understood that extraordinary claims require extraordinary evidence and they provided it.

They did not “trust” their intuition and they didn’t expect you to trust yours.

And critically, they didn’t attempt to monetize their findings.

To my knowledge — feel free to correct me — in the entire history of medical science there has never been a lay person who caused a paradigm shift. You’re not going to be the first one and neither is the quack you follow on Facebook.

But wait! Doctors can be wrong, so maybe they’re wrong about vaccination.

Yes, doctors can be wrong, and other doctors — not laypeople — might subsequently correct them.

Prior to the germ theory of disease, doctors were unaware that they could transmit microscopic pathogens from cadavers to live patients. Semmelweis, through careful observation and experimentation, proved they could. Laypeople did not make that discovery, nor did they adopt Semmelweis’ recommendations until the medical profession as a whole had done so.

How about the debacle that was thalidomide? Doctors prescribed it to pregnant women, not understanding that the medication could cross the placenta, and children suffered severe limb defects as a result. But the connection between thalidomide and limb defects was not discovered and explained by laypeople. It was discovered by Frances Kelsey one of the first female physicians (also a pharmacologist) at the FDA.

So don’t tell me how measles was “disappearing” before the vaccine was licensed; I studied epidemiology and you didn’t.

Don’t tell me adjuvants are toxic; I studied both immunology and toxicology and you studied neither.

Don’t tell me that Dr. Bob Sears agrees with you; I read the scientific literature and didn’t see his name accompanying his published findings.

Don’t tell me vaccines “shed” or herd immunity doesn’t exist; I’ve practiced medicine and you haven’t.

Please, please stop laysplaining vaccination to me! You aren’t dazzling me with your knowledge; you’re merely confirming what I knew about you already: you are deeply ignorant of science, thoroughly baffled by statistics, and setting a new standard for both gullibility and lack of insight.

They meant well.

It was a social movement to improve the health of children, women and families. Its leaders emphasized the negative effects of making different choices. It promoted intensive education as well as policies restricting access. And it was a resounding failure, causing more harm than good.

I’m talking about Prohibition, but I could just as easily be talking about contemporary lactivism.

As Wikipedia explains:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Both are resounding failures, causing more harm than good.[/pullquote]

Temperance proponents saw the alcohol problem as the most crucial problem of Western civilization. Alcoholism was seen to cause poverty, and all types of social problems … They believed that abstinence would help decrease crime, make families stronger, and improve society as a whole. Although the temperance movement was non-denominational in principle, the movement consisted mostly of church-goers. Temperance advocates tended to use scientific arguments to back up their views, although at the core the temperance philosophy was moral-religious in nature.

Similarly, lactivists — particularly lactation professionals — see breastfeeding rates as a crucial problem of contemporary society. They claim or imply that formula feeding decreases IQ, decreases job prospects, and decreases adult incomes (without ever taking into account that breastfeeding itself is socio-economically patterned). They believe that pressuring women to breastfeed will make children healthier, families stronger and improve society as a whole. Although lactivism is non-denominational, it’s origins are in religious attempts to force women back into the home. Although lactivists tend to use scientific arguments to support their views, at the core, the philosophy is moral-religious in nature; it’s primarily concerned, NOT with the well-being of babies, but with the control of women.

Temperance advocates were so supremely self-confident in the rightness — both scientific and moral — of their position that they were able to convince the US government to completely prohibit the sale of alcohol. Lactation professionals are so supremely self-confident in the rightness — both scientific and moral — of their position that they have been able to convince hospitals to allow the Baby Friendly Hospital Initiative to be the only private organization to operate within them. They have created a system of formula prohibition within hospitals, emphasizing mandatory “education” and draconian restriction of formula access.

When passage of the 18th Amendment ushered in Prohibition, temperance advocates settle down to watch the benefits unfold. Instead of the success they had envisioned, their movement was a disaster.

Both federal and local government struggled to enforce Prohibition over the course of the 1920s. … Despite very early signs of success, including a decline in arrests for drunkenness and a reported 30 percent drop in alcohol consumption, those who wanted to keep drinking found ever-more inventive ways to do it. The illegal manufacturing and sale of liquor (known as “bootlegging”) went on throughout the decade, along with the operation of “speakeasies” (stores or nightclubs selling alcohol), the smuggling of alcohol across state lines and the informal production of liquor (“moonshine” or “bathtub gin”) in private homes.

In addition, the Prohibition era encouraged the rise of criminal activity associated with bootlegging… Such illegal operations fueled a corresponding rise in gang violence, including the St. Valentine’s Day Massacre in Chicago in 1929, in which several men dressed as policemen (and believed to be have associated with Capone) shot and killed a group of men in an enemy gang.

Lactation professionals have been struggling mightily to enforce formula prohibition within hospitals. Despite early signs of success, including a rise in breastfeeding rates, the BFHI has precipitated a health crisis. It isn’t merely that NONE of the predicted benefits of term babies have materialized. Lactivism in general, and the BFHI in particular, has led to a dramatic increase in newborn hyponatremic dehydration, hypoglycemia and severe jaundice with resulting brain injuries and deaths. Lactivism in general and the BFHI in particular has been responsible for an explosion of newborn hospital readmissions amounting to tens of thousands of readmissions EACH YEAR at the cost of hundreds of millions of dollars. Indeed, exclusive breastfeeding on discharge (the central goal of the BFHI) has become the LEADING risk factor for newborn hospital readmission.

But lactation professionals, like temperance advocates, have met repeated failures with ever greater determination, abandoning scientific evidence and logical thinking in the process.

Consider this recent declaration by professional lactivist Dr. Jack Newman, responding to a articles in the mainstream media about the dangers of aggressive breastfeeding promotion:

It is a big jump to conclude that … because there is no rock-solid evidence for breastfeeding being better, that means breastfeeding is not better.

No, Dr. Newman, it’s not a big jump. It’s SCIENCE! With no solid evidence for breastfeeding being better than formula feeding, we must conclude it ISN’T better.

I left this comment on his Facebook page:

Dr. Newman, since you are so sure breastfeeding has substantial benefits, can you please show us any impact that changing breastfeeding rates have had on term infant mortality or any metrics of major term infant morbidity. To my knowledge, the only impact breastfeeding has had on these parameters is a dramatic increase in the rate of neonatal hospital readmission. Indeed exclusive breastfeeding is now the leading risk factor for readmission. So I see the risks, but I can’t find the benefits. Can you show us the population data that supports your claims?

It’s been over 24 hours and he hasn’t responded. That’s not surprising since he has no data to rebut my claims.

Sadly lactivism in general, and the BFHI in particular, are the equivalent of Prohibition.

Why did Prohibition fail? Because advocates failed to take reality — people would always want to drink alcohol — into account and, obsessed with the promised benefits, they never even considered let alone anticipated the risks.

Why is the BFHI a failure? Because lactivists failed to take reality — that some babies and some mothers would ALWAYS need formula — into account. Obsessed with the promised benefits of breastfeeding, they never even considered let alone anticipated the risks of aggressive breastfeeding promotion.

Prohibition was relegated to the dust heap of history. That’s exactly where aggressive breastfeeding promotion and the Baby Friendly Hospital Initiative also belong!