To Dr. Jack Newman, pediatrician and professional lactivist:

Dr. Newman,

How dare you?

I just read your execrable piece on Huffington Post and I’m angry. The title is Do Mothers Really Have The Choice To Breastfeed? but it’s the subtitle that’s the greatest outrage: “Breastfeeding is not just about breast milk. It is a relationship.”

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]How dare you imply that a woman who breastfeeds has better relationship with her baby than a woman who bottle feeds?[/pullquote]

How dare you imply that a woman who breastfeeds has a different and better relationship with her baby than a woman who bottle feeds?

When did you ever breastfeed a baby?

For that matter, did you ever mother a child?

What precisely qualifies you to opine on what breastfeeding means to women and babies?

Wait, what? Doctor knows best? Where have I heard that before? Oh, right, from lots of other men telling women just how they ought to use their reproductive organs.

I am a mother of four adult children. From the moment each was born I loved him or her more than life itself and I still do. To this day, I would cut off my right arm to spare any of them pain. I love them for who they are and how I fed them has NOTHING to do with my feelings for them.

How dare you imply that I would love them less had I not breastfed them?

How dare you imply that I would have a different, inferior, relationship with them had I not breastfed them?

Do you think I love my children more than my friends who bottle fed or became mothers through adoption love theirs?

Do you understand just how vicious your statement is or do you simply not care how it impacts women and babies?

Let’s be honest. We’ve read the same research and we both know that the scientific evidence shows that benefits of breastfeeding in first world countries are trivial. We both know that the outlandish claims of lactivists are based on research that is weak, conflicting and riddled with confounders. We both know that breast milk isn’t magic, merely one of two excellent ways to nourish and infant.

But I know what it’s like to breastfeed and you haven’t a clue. That’s why I know that your claim that women who don’t breastfeed haven’t been given the choice to do so is ugly and untrue.

You write:

Often, in fact, mothers do not seem to have the right to breastfeed and are forced, by health professionals, judges and child protective agencies to bottle feed.

Often? Really? I’ve cared for thousands of women and I’ve never seen a single one forced by a health professional, judge or child protective agency to bottle feed against her will. You’ve made an empirical claim; where’s your empirical evidence?

From our experience with many thousands of mothers having come to our breastfeeding clinic during the past 32 years, I can say that in many such cases, with a little good help, the mother could carry on breastfeeding exclusively.

This may come as a shock to you, but women who come to your breastfeeding clinic WANT to breastfeed. They are not in any way representative of women who DON’T want to breastfeed or lack the socio-economic advantages that make breastfeeding easier for privileged women.

You simply ignore those women, a substantial proportion of mothers.

You insult your neonatology colleagues by implying that neonatal hypernatremic dehydration, malnutrition, hypoglycemia, and hyperbilirubinemia either don’t exist or aren’t dangerous even though we all know they can lead to brain damage and death; preventing them is of critical importance.

You treat women as if they are nothing more than cows, reducing them to the milk their breasts might produce, without any regard to their pain, needs and desires … and then you insult them on top of that.

Women have the right to control their own bodies. It is no more your business whether a woman breastfeeds than whether she terminates a pregnancy. She doesn’t have to justify herself to you and you have no way to know what motivates her unless she tells you.

Don’t you dare imply that women who bottle feed are lesser mothers than those who breastfeed. You’ve never breastfed; you’ve never been a mother. You have no idea what you are talking about.

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, nuts and tubers. 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.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Once predators get through the fence they can attack anyone and typically kill the most vulnerable.[/pullquote]

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.

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 his child die 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, fear 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.

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.

Over several years 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 isn’t particularly helpful. 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 we are the prey. What are vaccines? They 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 no one who is vaccinated needs to fear the unvaccinated 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. 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 can be every bit as deadly.

Vaccination is one the greatest public health advances of all time.

It has saved, and continues to save, literally millions of lives each year, yet many well meaning parents have become convinced that vaccines are harmful and there is no amount of scientific evidence that can convince them otherwise.

As Rachel Burke reports in The Olympian, We’re hard-wired not to change our minds:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Vaccine injuries are the demonic possession of our own time.[/pullquote]

The clearest example may be [the] work around the popularly held belief that the measles-mumps-rubella (MMR) vaccine is linked to autism, a claim made by a single, long-discredited study. Nyhan, Riefler, and their research partners surveyed over 2,000 parents; most received one of the following: (1) materials from the Centers for Disease Control (CDC) correcting the falsehood; (2) a pamphlet describing the dangers of measles, mumps, and rubella; (3) pictures of children who have these illnesses; or (4) a mother’s firsthand story about how her baby almost died from measles. A control group received no materials.

The results: None of these approaches made parents who were opposed to vaccines more likely to vaccinate their kids… (my emphasis)

Why are anti-vax parents evidence resistant?

Nyhan and Riefler speculate that “we’re even more inclined to hold on to a false belief if it threatens our sense of self.”

There’s no doubt that ego is a large part of anti-vax belief. As I’ve written before, anti-vaccine parents view themselves as smarter than others. They see their combination of self-education and defiance of authority as an empowering form of rugged individualism, marking out their own superiority from those pathetic “sheeple” who aren’t self-educated and who follow authority. Psychologically, they cannot tolerate the reality that they are both ignorant and gullible.

But fear of vaccines is hardly new. It’s been around for 200 years, nearly as long as vaccines themselves. Anti-vax advocates has amassed a perfect record; they’ve never been right even once!

Why, in the face of the scientific evidence of vaccines’ safety and efficacy and the historical evidence that anti-vaxxers have never been right about anything, do anti-vaxxers cling so desperately to their beliefs?

Perhaps it is a form of mass hysteria.

According to Wikipedia:

… [M]ass hysteria … is a phenomenon that transmits collective delusions of threats, whether real or imaginary, through a population in society as a result of rumors and fear…

A common type of mass hysteria occurs when a group of people believe they are suffering from a similar disease or ailment, sometimes referred to as mass psychogenic illness or epidemic hysteria.

Fear of vaccines is a collective delusion transmitted through a population as a result of rumor and fear. Yet there’s no doubt that those in the grip of anti-vax hysteria fervently believe that children, including their children, have been harmed by vaccines.

But there was no doubt in the minds of the citizens of 1690’s Salem, Massachusetts that members of their communities were being harmed by demonic possession. Just like contemporary anti-vaccine parents who fervently believe in vaccine injuries, not merely in theory, but in practice in their own children, Salem resident fervently believed in demonic possession, not merely in theory, but in practice in their own neighbors.

Adolescent girls … began to have fits that were described by a minister as “beyond the power of Epileptic Fits or natural disease to effect.” The events resulted in the Salem witch trials, a series of hearings and executions of 25 citizens of Salem and nearby towns accused of witchcraft. The episode is one of America’s most notorious cases of mass hysteria, and has been used in political rhetoric and popular literature as a vivid cautionary tale about the dangers of isolationism, religious extremism, false accusations and lapses in due process.

There’s no such thing as demonic possession and there never was, so why were Salem residents so sure they were witnessing it?

1. Someone had a “fit.” That really happened.
2. It was interpreted in light of religious beliefs and irrational fears.
3. Other people also had “fits.” They and those around them were not making it up; they fervently believed it had happened.
4. The population was gripped by the collective delusion of a threat and transmitted that fear through rumor, aided and abetted by those who stood to benefit from convincing others demonic possession was real.

Sound familiar? It should. It bears a striking resemblance to anti-vaccine advocacy.

1. Someone had a bad reaction after vaccination. That really happened.
2. It was interpreted in light of scientific ignorance and irrational fears about vaccines.
3. Other people also had “bad reactions.” They and those around them were not making it up; they fervently believed it had happened.
4. The population was gripped by the collective delusion of a threat and transmitted that fear through rumor, aided and abetted by those who stand to benefit from convincing others that vaccines injuries are real.

The key point, which cannot be overemphasized, is that many anti-vaxxers honestly believe that they have witnessed the evidence with their own eyes and they aren’t lying. But then the Salem residents who feared demonic possession also believed they had witnessed the evidence with their own eyes and they weren’t lying, either.

That’s why anti-vaxxers are evidence resistant. It’s not merely that they can’t understand the evidence because they lack scientific knowledge; it’s not merely that view themselves as “educated,” “empowered” and transgressive. It’s that they are in the grip of mass hysteria.

Vaccine injuries are the demonic possession of our own time. They are a collective delusion, fueled by fear and rumor, fanned by those who stand to benefit from the delusion.

Charlie Rae Young of Barefoot Birth has allegedly presided over a preventable homebirth disaster and preventable homebirth death in a little more than a year.

You may remember Charlie Rae from this debacle, What kind of mother claims she “rocked” a birth that nearly killed her baby?

…I totally rocked by HBAC with my cesarean baby by my side and then about an hour later, my new love began having breathing issues. He has meconium aspiration syndrome and we have been admitted to the nicu. We are likely to be here for a week or more so he can fully recover…

I will share the birth story once we’re home again. It was so amazing and empowering!

The homebirth midwife boasted about her handling of the disaster:

A hypoxic event in utero, Charlie Rae? Ya think? How is it that you had no idea of the hypoxic event until after he was born? It was your responsibility to prevent it.

In July Charlie Rae presided over the death of a baby from shoulder dystocia. Allegedly, according to a source:

She was 42w and wouldn’t go to the hospital even though her husband and parents wanted her to. Baby was 10lbs 14oz, had shoulder dystocia and paramedics were called. It took 8 minutes for the paramedics to arrive. Baby was not breathing when hey got there, but they ripped him out and worked on him and he was breathing/alive. I don’t know exactly how long he was alive before he passed, at least a couple of hours though. She had to have 3.5 hours of surgery to repair everything. They even considered a hysterectomy because of the extent of soft tissue damage, but they were able to save her uterus.

Astoundingly, Charlie Rae took to social media to whine about how hard the birth was for her!

Being a #midwife is hard. No one is ever guaranteed a baby to bring home. The impact that leaves in a community happens in waves. While it is heavy and sad and leaves you searching for answers where there often are none, it is also a reminder that none of us are doing life alone. Paxton is a boy who was only here for a short while – he is so loved and so missed. He brought so many people together, so much light into a dark place and left so many people with such a palpable impact. We walk with families through so much joy but also so much sorrow – and THAT is what #midwifery is. It is being with families and holding space for whatever unfolds. I am honored every day I am able to do this work – no matter how unfair it can seem sometimes…

It’s unfair, Charlie Rae, but not for you. It’s unfair for the babies who suffer from your hubris, ignorance and lack of skill. Paxton did not have to die. He would probably be alive today had his mother not attempted a homebirth.

Does Paxton’s mother blame Charlie Rae or herself for this utterly preventable horror?

Surely you’re joking!

…Thank you for being willing to be vulnerable and honest. Thank you for honoring Paxton’s birth and life in this way. I am so thankful for you. Thank you for loving him and for loving us. I don’t want to imagine walking through this with anyone else …

But she didn’t have to go through this. It was HER decision to give birth at home far from expert medical assistance, HER decision to hire a poorly educated, poorly trained pretend “midwife,” HER decision to ignore her husband and family to risk Paxton’s life.

Ironically, Paxton’s mother was apparently willing to accept high tech medical care for HERSELF to save her perineum and uterus in the wake of the shoulder dystocia, though she denied Paxton the very same level of care that could have saved his life.

Florida, could you please investigate this homebirth midwife. At a minimum, she needs extra education and training in managing high risk situations and referring high risk patients to hospitals.

Exactly how many babies have to suffer serious injuries or die before we make the substandard homebirth midwifery credential illegal and require that all midwives meet the international standards of education and training met by US certified nurse midwives and midwives in all other first world countries?

If Charlie Rae Young isn’t considered qualified to practice midwifery in the Netherlands, the UK, Canada or Australia, why is she considered qualified by the State of Florida?

 

 

 

 

 

 

 

 

The 20th Century was the century of genocide. The wholesale slaughter of ethnic groups and other populations was brought to a high art by the Turks who attempted to exterminate the Armenians, the Nazis who attempted to exterminate the Jews, and Stalin and Mao who attempted to exterminate substantial proportions of their own peoples.

The 21st Century is shaping up to be the century of factocide, a wholesale assault on a distinction that has stood for thousands of years: the difference between fact and opinion.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Facts, far from being the tools of the powerful, are the last refuge of the oppressed.[/pullquote]

Donald Trump represents the apotheosis of factocide. He makes no distinction between factual information and personal belief. Indeed, in his mind, his belief in something, no matter how outrageous, makes it a fact. And in the minds of his followers, Trump’s tweet of something, no matter how absurd or obviously false, makes it true.

But Trump is not responsible for factocide; he’s merely its beneficiary. Factocide has been manifest for many years as Republican Party dogma, as pseudoscience enabler and as a driving force in cable news and Internet communities.

Who is responsible? The list is long and varied

Academics: We are all postmodernists now. Postmodernism, previously relegated to the dusty corners of academia, has been unleashed into the world and the result has been an unmitigated disaster for facts. Postmodernism is a complex philosophical viewpoint that relies in large part on relativism:

Postmodernists deny that there are aspects of reality that are objective; that there are statements about reality that are objectively true or false; that it is possible to have knowledge of such statements … Reality, knowledge, and value are constructed by discourses; hence they can vary with them…

If nothing is objectively true — if there are no facts — how did we come to believe that there are facts and that those facts can be ascertained by human beings?

… [T]he prevailing discourses in any society reflect the interests and values, broadly speaking, of dominant or elite groups.

In other words, “facts” are what the powerful agree upon as needful in order to continue to hold their power.

The powerful had agreed on the “fact” that black people were intellectually inferior, women were weak and gay people were mentally ill. Those empirical claims had never been facts; they had been instituted as “facts” to protect the power of hetero-sexual, white men. The truth of the powerless was every bit as true as the “truth” of the powerful.

To the extent that postmodernism alerted us to the voices of the powerless and the tactics of the powerful, it provided a valuable corrective to prejudices that had been accepted as fact. To the extent that it has made facts themselves impossible, it has been (in my view) an unmitigated disaster. The radicals in the academy failed to anticipate factocide — that relativism can be employed just as easily by the far Right as by the disenfranchised of the Left.

Politicians: Politicians have always had a fraught relationship with the truth, brandishing it when it served their purposes and burying it when it did not. But Ronald Reagan was a politician with a difference. He understood Franklin Roosevelt had shaped an enduring Democratic political coalition by demonstrating not merely that government could be a force for good in the lives of its citizens, but by insisting that it should be a force for good.

This was anathema to conservative Republicans who believed that less government was better government. For forty years that had been a tough sell as a basis for a political campaign. Reagan set out to do something different. Instead of railing that Big Government wasn’t good for its citizens (flying in the face of people who knew Big Government had been good to them), he deliberately endeavored to ensure that Big Government couldn’t be good by defunding it and then blaming it for being unable to provide what citizens had come to expect.

Reagan famously declared:

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

It wasn’t true at the time he said it, but Reagan and other conservatives set out to make it true.

As Professor Douglas Amy explains:

The answer the Republicans found is to attack these programs indirectly. The weapon of choice? Tax cuts. The idea is simple: if we keep cutting taxes, eventually there won’t be enough money to spend on these programs and they will have to be reduced… Conservatives call this tactic “starving the beast.” Taxes are what nourish government. Take that source of nourishment away and government must inevitably shrink. For anti-tax advocates like Grover Norquist, this is the ultimate purpose of tax cuts: “The goal is reducing the size and scope of government by draining its lifeblood.”

Reagan knew that government helped people and therefore people liked government. He wanted them to hate government so he lied about it — factocide — while working constantly to make sure government couldn’t help people. He understood the facts, lied about them, but also worked to change them.

In contrast, President George W. Bush felt he could dispense with facts altogether. His philosophy, was famously summarized by an aide (believed to be Karl Rove) in speaking to a journalist:

The aide said that guys like me were “in what we call the reality-based community,” which he defined as people who “believe that solutions emerge from your judicious study of discernible reality.” … “That’s not the way the world really works anymore,” he continued. “We’re an empire now, and when we act, we create our own reality. And while you’re studying that reality—judiciously, as you will—we’ll act again, creating other new realities, which you can study too, and that’s how things will sort out. We’re history’s actors…and you, all of you, will be left to just study what we do.

Pseudoscience advocates: There have always been groups that have lied about scientists. Climate change denialists are the lineal descendants of both those who persecuted Galileo and those who ran tobacco companies. When your business is based on a lie, you must continue to tout that lie. But tradionally those who lie about science created the product first (religion, tobacco) and were forced into lying when the truth was revealed. In contrast, we now have entire industries — the anti-vax industry, the detox industry, homeopathy, homebirth — that started with the lie and built the industry around it.

How do they justify ignoring scientific facts? They use a bastardization of postmodernism: there is no such thing as scientific fact; there is only personal experience.  Jenny McCarthy “knows” vaccines caused her son’s “autism” and she cured it. Modern Alternative Mama, Kate Tietje, knows that people can “detoxify” from vaccines and other supposed environmental insults. Homeopaths believe that water has memory and that’s enough. Homebirth midwives “know” that birth is safe, and the babies who died at their hands aren’t proof that they’re wrong; they were “meant” to die.

Scientific facts are presented as the tools of powerful industries like Big Pharma who deploy them in order to maintain their power; the fraudsters and charlatans of pseudoscience portray themselves as powerless and guardians of their own “truth,” that vaccines cause autism, coffee enemas remove toxins, water has memory and childbirth is safe.

Sadly, those who are truly powerless, by dint of their lack of basic science knowledge, are repeatedly victimized by scientific factocide.

Cable news:It is fitting that cable news, which has no respect for facts, was born during the OJ Simpson trial when ignoring facts became a national obsession. Everyone (including the people who wanted a black man to be found innocent of killing a white woman) knew that Simpson had murdered his wife Nicole. The facts were beside the point. Many who hoped fervently for a not guilty verdict viewed it as recompense for centuries of judicial violence against black men. Emmet Till had been killed for talking to a white woman; it was payback to free a black man for actually killing a white woman.

It was also a rating bonanza to declare that Simpson was innocent despite the fact that everyone believed him to be guilty. It was an even bigger ratings bonanza to pretend that President Bill Clinton had violated the Constitution by having consensual oral sex with a young woman who worked in the White House. Some of the most powerful men who impeached Clinton were having consensual sexual affairs and lying about it while piously denouncing a political enemy for doing the exact same thing.

Cable executives noticed that facts did not matter at all when presenting the “news.” Indeed, gleefully ignoring facts was the key to the popularity popularity of Fox News — the flagship of factocide — with a viewership that feels, like the disenfranchised postmodernists of the Left, that they too are powerless. But that viewership is poor, uneducated and bigoted. That segment of the population, the same group that backs Trump in large numbers, rails against “political correctness” as the expression of a powerful elite that simply wants to maintain power.

The powerful of the Left claim that black people are NOT intellectually inferior, women are NOT weak and gay people are NOT mentally ill. But, wait! Isn’t the truth of the powerless every bit as true and the “truth” of the powerful?

That, of course, it the ultimate irony of factocide. The academics disparaged facts as the tools of the powerful (straight, white men) in order to help the historically oppressed. But when you insist that facts are merely the preferences of the powerful, you have no intellectual ground to stand on when poor, uneducated and bigoted white men insist on the right to discriminate and harass those who are not straight, white men.

We have learned that facts, far from being the tools of the powerful, are truly the last refuge of the oppressed. Hopefully it is not too late to prevent the utter annihilation of facts.

It is a curious fact, seldom remarked upon, that all diseases purportedly caused by vaccination share certain common characteristics. Chief among these characteristics is that the cause of the disease purportedly caused by vaccuses is presently unknown.

Anti-vaxxers never claim that a particular vaccine causes heart disease, gall bladder disease, bone abnormalities or any of the myriad diseases for which causes are already known. They always insist that vaccines cause autism, vague “damage to the immune system” or unspecified neurologic injury.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The seduction of anti-vax belief[/pullquote]

The characteristics of the vaccines themselves may vary (live attenuated, killed), the route of administration may vary (oral, injection), the characteristics of the diseases that they are designed to prevent may vary (everything from smallpox, to polio, to pertussis), but the characteristics of the diseases they supposedly cause are always the same.

Even the purported active agent may vary. The harmful ingredient might be the vaccine itself, the preservative, a contaminant, combinations of vaccines, the list is endless. But the purported harms always idiopathic, are particular dreaded, are typically diagnosed within years of childhood vaccinations, and are perceived to be on the increase.

In “All manner of ills”: The features of serious diseases attributed to vaccination, authors Leask, Chapman and Robbins explain:

The anti-vaccination movement claim many negative consequences from vaccination. High profile controversies have promoted hypotheses that vaccines were responsible for serious and dreaded diseases or disabilities with uncertain causes. Examples include encephalopathy from the pertussis vaccine in the UK in the 1970s and, more recently in the UK, autism from the measles-mumps-rubella (MMR) vaccine and, in France, multiple sclerosis from the hepatitis B vaccine…
Parental anxieties about fearful, mysterious diseases that threaten children foment receptive audiences for such claims. These causal attributions do not rely on the strength of evidence for asserting causal association but share a number of epidemiological and societal features in addition to the uncertain or idiopathic origin of the named diseases…

What are these characteristics?

Idiopathic nature (unknown cause):

Anti-vaccination writings tend to attribute causal connections between vaccination and diseases with idiopathic origin. Autism, asthma, multiple sclerosis, cancers, diabetes and Gulf War Syndrome have all baffled science and draw intense media interest when new claims about their origin arise. Their power comes from the suggestion that danger lurks in the familiar, with the sub-text that vaccines are modern day Trojan horses, promising prevention but disguising hidden threats.

Apparent rise in incidence:

Along with having idiopathic origin, diseases like autism and asthma appear to have increased in incidence in recent decades. Anti-vaccinationists allege this increase coincides with more vaccination.

… [C]onditions like autism lack concrete biochemical or clinical parameters, making them more prone to shifts in diagnostic criteria. The ongoing reappraisal of the diagnostic criteria for the autistic spectrum of disorders over recent decades has led to substantial uncertainty over whether a true increase in incidence exists or whether such diagnostic shifts represent an artifactual increase.

Dreaded outcomes:

Many of the ills attributed to vaccination have lethal, insidious or dreaded consequences. SIDS, autoimmune disorders and developmental disability are a few examples. Such qualitative components of dreaded diseases reduce the acceptability of even minute risks. Anti-vaccine groups or individuals appear to select fearful diseases for attribution to vaccines because of the potential impact of these messages. Dreaded diseases attract news media attention thus increasing the opportunity for the amplifications of the claims…

Temporal relationship to vaccination:

Some of the diseases most often attributed to vaccines become apparent in early childhood when many vaccines are given. In such cases, parents understandably search for an agent of blame, scouring their memories for events shortly before the illness. When parents apply post hoc ergo propter hoc (after therefore because of) reasoning, vaccination can become a compelling causal candidate. Reassurances exonerating vaccines are often met with dismay by those committed to their theory. For parents who may feel guilt, albeit unwarranted, about their child’s problem, vaccination is a graspable external cause…

These features are intuitively appealing to anti-vaxxers because they do not rely on scientific understanding, but appeal to “common sense.” In the words of sociologist Peter Bearman, writing in Just-so Stories: Vaccines, Autism, and the Single-bullet Disorder, anti-vaxxers tell “just so stories,” stories with simple explanations for complex phenomena.

This explains in part why anti-vaxxers are evidence-resistant. It seems not to matter how many studies disprove the purported link between vaccines and diseases like autism. Autism is a dread disease, with unknown and complex causes and an apparently rising incidence. It is far more reassuring to pretend that autism has a simple and easily addressed cause, than to acknowledge that it can strike any child, cannot be prevented and cannot be cured.

These findings have implications for the way in which we as a society address anti-vaxxers. The most straightforward course is to provide more education on vaccination and the science underlying vaccination. When people truly understand immunology, they do not invoke spurious relationships between vaccines and dread diseases.

Unfortunately, not everyone will respond to scientific information. Given the seductive nature of anti-vax belief, physicians and public health officials should also address the underlying errors of thought that occur among anti-vaxxers. Complex diseases do not have simple causes, just because the incidence of a disease is rising and vaccination has risen does not mean that vaccines cause autism, just because a disease is diagnosed after vaccination does not mean that vaccination caused the disease.

Anti-vaxxers need to heed H.L. Menken’s famous dictum: For every complex problem there is an answer that is clear, simple, and wrong.

For the complex problem of autism and similar diseases, vaccination is the answer that is clear, simple … and tragically wrong.

Another day, another misogynistic effort to pressure women to breastfeed. Today it is The Guardian piece Low UK breastfeeding rates down to social pressures over routine and sleep.

Speaking at the British Science Festival, Amy Brown of Swansea University said:

“We are told by so-called experts that you should get your baby in a feeding routine and your baby should not wake up at nights,” said Brown. “But that is really incompatible for breastfeeding. If you try and feed them less, you make less milk. You need to feed at night to make enough milk.”

Why do women stop breastfeeding?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Right puts women into religious purdah. The Left puts women in the purdah of biological essentialism.[/pullquote]

Speaking ahead of the publication of her book, Breastfeeding Uncovered, Brown said that while a large proportion of mothers struggle to breastfeed, few of them have underlying conditions that prevent the process.

Surveying around 300 women who had stopped breastfeeding in the first six months, Brown found that around 80% cited pain and difficulty as contributing, while 40% referenced public attitudes, 60% lack of support from others and 20% blamed embarrassment. (my emphasis)

Brown then proceeds to ignore her findings that 80% women stop because breastfeeding because of pain and difficulty! Apparently that’s just the price that “Nature” wants women to pay.

She speaks disparagingly of women’s exhaustion and desire for a life besides mothering:

We are told by so-called experts that you should get your baby in a feeding routine and your baby should not wake up at nights,” said Brown. “But that is really incompatible for breastfeeding. If you try and feed them less, you make less milk. You need to feed at night to make enough milk…

Not to be outdone:

Elizabeth Duff, senior policy adviser at the National Childbirth Trust, agreed that frequent feeding is necessary. “It is obviously easier for everyone if they begin to sleep more during the night, but if you are fully breastfeeding you will have to feed for at least once and probably two or three times during the night,” she said. “The daily patterns will come, but it won’t be in the first few days or the very first weeks.”

Exhaustion and inability to do anything besides breastfeeding is just another price that “Nature” demands.

Lactivists have fallen back on the racist, eugenics argument first advanced by Grantly Dick-Read to promote natural childbirth: Over-civilized white women have been socialized to betray their biological purpose.

Grantly Dick-Read believed that pain in labor was all in women’s heads. White women of the “better” classes had been socialized to believe that childbirth was painful, while primitive (read: black) women understood that their purpose was to produce and nurture babies and therefore had painless labors.

Grantly Dick-Read made up his theory to counter what he perceived as women’s failure to achieve their “biological purpose,” agitating for political and economic rights instead.

In other words, get back home, get pregnant, and stay there. Your needs, desires, intellect and talents don’t matter.

Lactivists are saying something similar: Get back home and breastfeed. Your needs, desires, intellect and talents don’t matter.

Why do lactivists and other natural parenting advocate seek to imprison women in their reproductive biology?

One of the greatest achievements of the 20th Century was the political and economic emancipation of women.

Of course, it only occurred for some women in some countries, but it was a milestone, nonetheless. For the first time in human history, women were finally judged for something other than the function of their breasts, uteri and vaginas.

Seismic change is rarely accomplished without backlash and the emancipation of women is no different. On the Right, there has been a retreat into religious fundamentalism, forcibly preventing women from taking their place in the wider world by convincing them that God intends for them to stay home bearing and raising children.

On the Left, there has been a retreat into “natural parenting,” attempting to force women back into the home by appealing to biological essentialism, hectoring women that “Nature” intends for them to stay home bearing and raising children.

The Right puts women into religious purdah, restricted to the home. The natural parenting advocates on the Left put women in the purdah of biological essentialism.

Forcing women back into the home to breastfeed is justified by appeals to “science,” but the science on breastfeeding benefits is weak, conflicting and riddled by confounding variables. That includes the “science” of the oft cited Lancet paper that claimed that exclusive breastfeeding could save 800,000 infant lives per year.

Really?

The overwhelming majority of infant deaths occur in the poorest countries where breastfeeding rates approach 100%. How exactly is enforced, exclusive, extended breastfeeding going to save lives in the UK or the US where vanishingly few infants die of non-accidental causes of death? The lactivists don’t say.

In truth, the health benefits of breastfeeding in countries like the UK and the US are trivial, limited to 8% fewer colds and 8% fewer episodes of diarrheal illness across the entire population of infants in the first year. In other words, the majority of infants will experience NO health benefit from breastfeeding.

No matter. The “science” is merely the cudgel used to force women back into their biological purdah.

The way forward is that we need a complete societal change to how we look at breastfeeding, how we accept it, but also how we accept and value mothering in general,” said Brown …

No, the way forward is that we need a complete societal change to how we look at WOMEN. They are more than their breasts, uteri and vaginas.

HER baby, HER body, HER breasts, HER choice.

Anything else is misogyny masquerading as concern for babies.

We live in Dunning Kruger nation.

What do I mean?

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

Where did they get that idea?

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

I’ll let Dr. David Dunning explain it:

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

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

Indeed:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here’s the LA Times:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

The challenge is both simple and straightforward:

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

What have we learned:

No one objected to the details of the challenge.

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

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

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

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

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

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

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

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

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

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

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

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

Why did I offer the anti-vax challenge?

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

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