Oh, the irony!

Kate Tietje, Modern Alternative Mama, is furious that parents are sharing scary stories about their children injured by and dying from whooping cough, measles and chickenpox. How dare suffering parents spread fear of vaccine preventable diseases while Tietje is trying to spread fear of vaccines?

Her post, Dear Parents, Please Stop Sharing Scary Disease Stories, would be a hilarious example of cluelessness were it not about dead babies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]How dare suffering parents spread fear of vaccine preventable diseases while Tietje is trying to spread fear of vaccines?[/pullquote]

Tietje writes:

These stories are popping up almost weekly on social media. (I guess that isn’t that much, since we’re talking hundreds of millions of people in several different countries — something to keep in mind.) Whenever they do, tens of thousands will share them, and warn people. The media will pick them up, and plaster them all over the place, with dire warnings to “anti-vaxxers” to see what lies ahead of them if they don’t smarten up and vaccinate.

Weekly stories of children hospitalized for vaccine preventable diseases “isn’t that much”?

Wrong! When vaccine rate are high, those stories are virtually non-existent. During my entire 4 years of medical school and 4 years of residency, I never heard a single story about a young child with whooping cough. It became so rare that doctors had trouble diagnosing it at first because they had never seen it.

But now, in response to the fear mongering of Kate Tietje and her anti-vax compatriots those diseases have made a deadly comeback.

It feels like a “trump card” when your child has unfortunately been ‘the one’ to experience the illness or the complications. The proof that you were really right all along, and that people really must vaccinate. You hope that your story will reach the people who need to read it, and that you’ll convince more people to see things your way…and vaccinate their babies.

But you won’t.

It’s so predictable, every time. A mother (or father) shares her/his story, earnestly hoping that s/he will change peoples’ minds. Several friends and family members encourage her and tell her how brave she is and how sorry they are that her baby is sick. They tell her how needed her message is, and how people just don’t get how serious this stuff is, and how her story will make a difference. She feels justified in having shared it.

Sort of like the way Tietje shares stories of the “vaccine injured”:

I want to help you, mama. I want to give you and your child a voice. Your story deserves to be recognized. Other people need to know that vaccine injury isn’t silent, it isn’t pretend. It isn’t so rare that you’ll never know anyone who struggles with it. It’s real, and it’s a daily part of life.

If you have your story written up, mama, please share a link to it in the comments. I’ll add them throughout the day, so that we have a long list of stories that people can read. So that they can know the truth.

Tietje must be suffering from hyp-lash, an injury caused by hypocritically bouncing back and forth two utterly incompatible positions. Watching Tietje, who runs a business based on fear mongering, counsel others that fear mongering is ineffective would be very amusing if it weren’t literally a matter of life and death.

So please, please. Stop sharing these big, scary stories and these angry pronouncements. It only divides people, when we are all just trying to keep our kids healthy and safe.

Tietje obviously has no problem sharing big, scary stories about vaccines; she actually solicits them. So what’s the problem with sharing big, scary stories about vaccine preventable diseases? As far as I can determine, the problem is that the stories of vaccine preventable injuries and deaths make Tietje look like an unethical liar and interfere with her business model.

Anti-vaxxers like Tietje are cheats. They rely heavily on the fact that vaccines work in order to claim that they don’t. If children died of vaccine preventable illnesses at the same rate they died before vaccines, anti-vaxxers would be universally derided as fools. They can only operate their fear mongering businesses as long as vaccine preventable illnesses appear to be gone. Those big, scary stories of infants dying from whooping cough are bad for business since they demonstrate beyond a doubt that vaccine preventable illnesses are not gone.

Anti-vaxxers are liars. They claimed that it is merely coincidence that vaccine preventable diseases disappeared after the introduction of vaccines and therefore they insisted that vaccine preventable illnesses would not return if children weren’t vaccinated. Those big, scary stories of children injured or dying from vaccine preventable illness are bad for business since they demonstrate that the illnesses return and children die when we stop vaccinating,

Anti-vaxxers are unethical because rely on herd immunity to keep their own children safe. They ostentatiously refuse the burdens of vaccination while implicitly relying on its effectiveness. If everyone did what they did, people like Tietje would be out of business and some of her children might be dead. How many books and supplements would Tietje be able to sell on the backs of her unvaccinated children if those children die appalling deaths? Very, very few.

Tietje insists:

People who are already suspect of vaccines do not read these stories — especially if shared angrily, with name-calling directed towards “anti-vaxxers” (as is often the case) and say “You know what, I was clearly wrong.” No, it only makes them frustrated.

If no one reads the stories of small children suffering and dying from vaccine preventable diseases, why is Tietje railing against them? How does she even know about them if no one reads them?

Tietje is railing against these stories precisely because people DO read them and they ARE effective in debunking the lies that Tietje purveys, damaging her business and her credibility.

Tietje’s hypocrical post should offer comfort to the parents who have publicly shared their anguish when their babies are injured or die from vaccine preventable diseases. You might have wondered if you were making a difference, but when Tietje begs you to stop, you can be sure that you are.

Everything wrong with the breastfeeding industry can be summed up in the hashtag #everybreastfeedcounts.

It’s the motto of this week’s celebration of breastfeeding in the UK.

What’s wrong with #everybreastfeedcounts? A look at NHS Lothian’s breastfeeding page reveals the problems.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It betrays a focus on profit for the industry, not the wellbeing of babies.[/pullquote]

1. Counts for what?

In countries with clean water, the benefits of breastfeeding for term infants amount to 8% fewer colds and 8% fewer episodes of diarrheal illness across the entire population of infants in the first year. That’s the result of exclusive breastfeeding for months. There’s no evidence that this slight benefit even persists beyond the first year.

But the scientific evidence hasn’t stopped Baby Friendly UK from lying about the benefits. The claims that breastfeeding prevents obesity, diabetes and allergies have been debunked multiple times, but Baby Friendly UK insists on trotting out these discredited claims anyway.

2. It isn’t even true!

In order to demonstrate that every breastfeed counts, you would need to show a linear dose-response relationship between breastfeeding and the purported benefits on a granular level and that has never been shown. Moreover, there’s no reason to believe that it could be shown. Such assertions reflect an argument beloved of alternative health advocates that “if some is good, more must be better.”

Consider C-sections. Can you imagine the uproar if obstetrics adopted the motto “every C-section counts”? There’s no question that a minimum C-section rate (19% or higher) is necessary to achieve low perinatal and maternal mortality. But if we double the C-section rate we can’t expect that perinatal and maternal mortality will drop by half. Just because something is good (breastfeeding or C-sections), more of it is not necessarily better.

3. It reflects a belief that process is more important than outcome.

The truth, which ought to be obvious to anyone, is that every BABY counts. Every baby deserves whatever he or she needs to flourish and breast is NOT best for every baby.

The breastfeeding industry likes to claim that breastmilk is the perfect food. In order for breastmilk to be perfect, it would always be present in the perfect amounts, and all babies would be perfectly capable of extracting it from the breast. However, we know that 5-15% of women don’t make enough breastmilk to fully nourish a baby, and some babies have issues like low muscle tone that make it impossible for them to successfully breastfeed.

Go to any kindergarten class, of middle school class, or college class. Can you pick out the children who were breastfed from those that were bottle fed? And if the breastfed children were identified to you, could you tell who was breastfed longer? Of course not because breastfeeding simply isn’t that beneficial.

Look at child health parameters. Over the last 100 years, there have been wide-spread swings in breastfeeding rates from over 95% to a low of 24% (1973) back up to over 75% today. Despite these wide swings there has been no effect on infant mortality, life expectancy or IQ.

4. It betrays a focus on profit for the industry, not the wellbeing of babies.

The industry profits when it sells goods and services that aid breastfeeding. It does not profit from babies who are bottlefed so it has adopted a relentless focus on marketing breastfeeding itself, not on outcomes.

It’s no different from the oil industry that tries to convince everyone to heat their home with oil and not switch to natural gas, which is often cheaper and cleaner. The oil industry does not care what is better for you, your home and your environment. If it were it would acknowledge that natural gas is a better choice for some people, but to do that would undermine profits and profits come first.

5. It utterly ignores women’s fundamental right to control their own bodies.

The claim that every breastfeed counts isn’t merely untrue, but it is an ugly attempt at emotionally manipulating women into using their bodies in the industry approved way. Not every woman wants to breastfeed and the proven benefits of breastfeeding are so trivial that there is no reason to pressure or manipulate women into doing so.

The bottom line is that #everybreastfeedcounts is a marketing slogan not supported by the scientific evidence. The truth, though less profitable for the breastfeeding industry, is that every BABY counts and every MOTHER counts. If we truly care about babies and mothers we will stop crude efforts at emotional manipulation and promote an alternative motto:

HER baby, HER body, HER breasts, HER choice!

Opponents are clear about one thing; women don’t understand the risks. They aren’t giving informed consent because they aren’t fully informed. Sure, they may be counseled about the major risks, the ones that could kill you, but deaths are rare. The other complications are so much more common. If women only knew the myriad risks they faced, they’d never choose it in the first place.

Opponents recommend far more extensive counseling, preferably counseling that takes place long before the decision needs to be made. They helpfully offer books and websites as well as in person counseling about ALL the risks, not just the ones that doctors deign to mention. Doctors can’t be relied upon to provide truly informed consent since they have a conflict of interest. They’re the ones who make money if the woman elects the procedure.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s not a coincidence that natural childbirth advocates have taken a page from anti-choice activists.[/pullquote]

Inevitably there has been a backlash against the opponents but the opponents claim the high ground with the retort: “Are you saying that there are NO risks?” Everyone knows that there are risks and that comment exposes those in favor as being the lying, evil people that they are. Opponents are providing a valuable service by carefully and extensively counseling women about the risks. Once they know, they will turn down the procedure.

Think I’m talking about natural childbirth advocates and epidurals? Think again.

I’m talking about anti-choice advocates who work tirelessly to prevent women from choosing abortion.

It’s not a coincidence that natural childbirth advocates have taken a page from the playbook of anti-choice activists. They both have the same aim: to conceal their true purpose while pretending that they are concerned about informed consent, trying to place any and all obstacles to the procedure in the path of women who might choose it.

Neither group feels constrained by the truth. Reasoning that the ends justify the means, both groups routinely exaggerate and even fabricate “risks.” Seeking, above all else, validation of their personal philosophical beliefs, both groups struggle to convince women who would choose differently that those choices are wrong. Focussed entirely on preventing the procedure, both groups have zero regard for what happens to women once they reject the disapproved choice. They care about women up to the moment that they are forced into the “correct” decision; whatever happens afterward must simply be endured by the women they have duped.

Most of is can easily recognize the tactics of anti-choice activists for what they are, mendacious attempts to force women to make approved decisions. Most of us can easily recognize that the pregnancy “support” centers have no interest in supporting pregnancy and certainly have no interest in supporting the babies that result from those pregnancies. They are exclusively concerned with foisting their philosophical views on everyone else. Their pious bleating about “informed consent” masks their true motivation.

We should recognize the tactics of NCB advocates for what they are, mendacious attempt to force women to make approved childbirth decisions. We should recognize that NCB “education” has nothing to do with supporting women in finding the choice that is best for them. Advocates are exclusively concerned with foisting their philosophical views on everyone else. Their pious bleating about “informed consent” masks their true motivation.

This piece first appeared in June 2011.

Lactivists, both laypeople and professionals, have built a movement predicated on the claim that “breast is best.”

That claim that is at odds with everything we know about reproduction — there’s an incredible amount of wastage and death associated with producing the next generation — and the historical reality of cemeteries filled with the bodies of babies and mothers who died in childbirth or shortly thereafter.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]These injuries and deaths did not happen until hospitals and providers began aggressively promoting exclusive breastfeeding.[/pullquote]

For the past few decades, the reaction to this scientific and historical reality has been limited to denial, albeit a particularly ugly form of denial. Lactivists have propagated the lie that insufficient breastmilk is merely an excuse for not breastfeeding, since every woman can make adequate milk if she just breastfeeds harder.

This ugly edifice of denial is beginning to crumble under a large and growing body of scientific evidence that 5-15% of women (or more) can’t produce sufficient breastmilk and that nearly half of all babies might benefit from supplementation with formula at some point (generally in the first few days of breastfeeding). Even Kate Tietje, Modern Alternative Mama, has been forced to acknowledge the truth that insufficient supply really happens, and is relatively common. Don’t worry, though, she has come up with a more subtle way to blame others for their difficulties.

Tietje has read Dr. Christie del Castillo Hegyi’s presentation on the dangers of insufficient breastmilk that I referenced yesterday.

The author goes on to explore her own story … After four days, they discovered that baby was hungry and mom wasn’t producing well, and then that she wasn’t producing at all. By that time, baby had become severely hypoglycemic and dehydrated, and ended up suffering brain damage from it.

The tale is a cautionary one: the author states that up to 20% of newborns are vulnerable to under-feeding and the severe effects that can come from it, and that it happens almost only in exclusively breastfed babies. Therefore, she concludes that the current breastfeeding education is inadequate, monitoring of at-risk newborns in inadequate, and that the idea that exclusive breastfeeding is the best/healthiest way is based on a naturalistic, magical-thinking point of view.

Tietje reflects on these tragedies and decides … it’s the mothers’ fault!

This tiny study notes that hormonal issues may play a role. This study notes that obesity may cause milk production to be delayed or non-existent (which makes sense, since obesity is often hormonally-related)…

This study says that disruption of a mother’s circadian rhythm, which is related to hormonal disruptions, can delay milk supply.

This study notes that women who received pain medication in labor were approximately twice as likely to experience delayed lactation vs. women who had none, regardless of birth method. (Mothers with an emergency c-section with epidural and other medications were three times as likely to have delayed lactation.)

This study shows that up to 44% of mothers can experience delayed lactation — I believe this was cited in the author’s original post. What the author didn’t dive into was the causes, but the study does. Six factors are related to delayed lactation, including maternal age of 30 or older; being overweight or obese; larger-than-average baby weight (greater than 7.9 lbs); absence of nipple discomfort on days 0 – 3; and infant failing to breastfeed effectively at least twice in the first 24 hours.

See? It’s not breastfeeding; it’s those fat, lazy mothers who had pain relief in labor!

But those are not causes, they are risk factors. And what’s a mother supposed to do about her age, her baby’s weight, and being a first time mother? Tietje offers no solutions since there are none.

Moreover, Tietje neglects to draw the obvious conclusion: breastfeeding isn’t perfect; it’s subject to many factors beyond anyone’s control.

She writes:

I was turned off by the original author’s suggestion that we ought to be “alarmed” by this, and her refusal to take into consideration any risk factors that may have played a role in what happened…

Maybe Tietje doesn’t think that we should be alarmed by preventable infant injuries and deaths; I can’t imagine a better reason to be alarmed. These are IATROGENIC injuries and deaths. They would not have happened, and did not happen, when hospitals and providers were not aggressively promoting exclusive breastfeeding.

Tietje insists:

It’s important not to let information scare us. It’s important not to walk away with only “some” of the facts. We need a clear and more complete picture of what is happening, so that we can identify at-risk moms and babies, and take measured steps to prevent these outcomes, or to intervene if they occur anyway.

Preventable infant injuries and deaths SHOULD scare us, and we should be horrified that these are iatrogenic injuries and deaths. Breast is not best for all babies. Our insistence on promoting a process (breastfeeding) over outcomes (healthy babies) has led us to this point and we need a serious adjustment in the way we treat and counsel new mothers.

Instead of measuring breastfeeding rates (process), we should be measuring jaundice rates, dehydration rates, readmission rates, injury rates and death rates (all outcomes).

We should recognize that hospital readmissions for jaundice and dehydration, as well as brain injuries and deaths are iatrogenic injuries. We are CAUSING them and therefore, it is up to us to prevent them.

The job of health care providers is to nurture babies, NOT to promote breastfeeding, and the sooner we recognize and acknowledge that, the sooner we can put an end to preventable injuries and deaths.

The central conceit of natural parenting is that the key to healthy, happy babies is recapitulating what our “primitive” black and brown sisters did in nature.

That’s why natural childbirth advocates claim that the best birth is an unmedicated vaginal birth.

That’s why attachment parenting advocates claim that carrying an infant in a sling and sleeping in the same bed lead to a happy child.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Prelacteal feeding is practiced from Africa to Southeast Asia, to Central and South America.[/pullquote]

That’s why lactivists recommend prelacteal feeding, supplementing early breastfeeding with a variety of substances like water and honey.

Wait, what? For lactivists and breastfeeding professionals, supplements are absolute anathema.

It is an article of faith among them that formula supplementation interferes with breastfeeding, dooms exclusive breastfeeding and causes dangerous alterations to infant gut flora. What if they’re flat out wrong? And what if babies are being injured and even die because we aren’t recapitulating nature?

Prelacteal feeding occurs in nearly all cultures.

In Egypt:

Sixty per cent (89/149) of study infants were prelacteally fed sugar-water, teas, or both. Lack of milk in the mother’s breast (74 per cent), and maternal exhaustion or illness following labour (29 per cent) were the two most commonly stated reasons for prelacteal feeding.

In rural India:

A total of 44% of the mothers initiated breastfeeding within 30 minutes with home delivery and 38% with Caesarean section. There was a delay of 2 to 3 hrs in feeding. A total of 19% of the mothers in our study didn’t breastfeed even after 24 hours after the delivery. They were given pre lacteal feeds and discarded the colostrum. A total of 13% of the babies were fed with sugar water alone for more than 48 hours. Honey (6%) and ghee (3%) were also commonly used pre lacteal feeds.

In Ghana:

… [C]olostrum was referred to in Kusaal language as “ first milk, yellow milk, dirty milk or dense milk” interchangeably. During in-depth interviews, the similarity between colostrum and pus or blood was often noted. Breast milk only became pure or clean after it had changed from yellowish to the whiter color of mature milk. While waiting for “clean” milk to flow, women would use a wet nurse to provide breastmilk to their babies or give water with herbs…

Moreover:

Colostrum avoidance has been reported across the globe, in varied places such as India, Nepal, Bangladesh, Indonesia, West Java, the Philippines, Vietnam, Thailand, Bolivia, Guatemala, Guinea-Bissau, Nigeria and Tanzania. Using the term ‘delayed breast-feeding’, Morse et al. found that fifty of 120 cultures described in the Human Research Area Files ‘withheld’ colostrum.

In other words, our “primitive” black and brown sisters were convinced that colostrum was harmful and that supplementation was critical to ensure infant survival.

So why have lactivists discarded this “ancient wisdom”? I suspect it is for two reasons. First, it doesn’t comport with the belief in the near magical properties that lactivists accord to breastmilk and breastfeeding. Second, studies have demonstrated that prelacteal feeding is associated with higher infant mortality. That’s not surprising since the supplements are often contaminated with harmful bacteria, and therefore compare unfavorably with exclusive breastfeeding for women who produce enough breastmilk.

But as far as I can determine, no one has investigated why a practice that breastfeeding advocates see as harmful to both breastfeeding and infants gained such wide currency. Prelacteal feeding is practiced from Africa to Southeast Asia, to Central and South America, suggesting that a variety of peoples independently believed it to be beneficial.

Obviously we cannot know the original reasoning behind the practice, but odds are high that it reflects the fact that 5-15% of women (or more) have insufficient or delayed production of breastmilk. Without supplements, those babies would have died of dehydration. With pre-lacteal feeds, babies lived who would otherwise have died. Over time, that observation was transmuted into a belief that colostrum was harmful and supplements were lifesaving.

We’ve ignored those insights about supplementation, ascribing them to ignorance, in favor of our preferred belief that women in indigenous cultures breastfeed early, exclusively and for extended periods of time. But maybe we’re the ones who are doing it wrong.

We have a huge advantage over indigenous women. We have access to a clean, safe source of supplementation: infant formula. But instead of replacing contaminated prelacteal feeds with formula, we’ve banned prelacteal feeds and the results may be deadly.

Dr. Christie del Castillo-Hegyi has been working tirelessly to alert both women and healthcare providers to the dangers of insufficient and delayed breastmilk production. She has created an excellent presentation.

Dr. Castillo-Hegyi’s first child was profoundly injured by breastfeeding induced dehydration and hyperbilirubinemia. She started reading the scientific literature on breastfeeding and brain injury:

In the September, 2015 issue of Hospital Pediatrics, an article was published describing 11 exclusively breastfed newborn babies who developed profound hypoglycemia between the second and fifth day of life from insufficient breast milk intake…

They subsequently developed long-term neurological disabilities including seizure disorders, motor weakness, visual impairment and feeding difficulties requiring speech therapy.

As a result:

I believe we may be inducing hypoglycemic brain injury to many newborns by asking mothers who may not be producing sufficient milk for their newborn’s physiologic need to exclusively breastfeed. We are potentially putting ourselves at odds with the protective natural instinct to respond to a baby’s cry by telling mothers that their colostrum is enough (which for many it may not be) and by making them fear failure by giving their child supplementation when they need it.

Are we actively and aggressively ignoring what indigenous mothers have known for centuries, that a significant proportion of babies cannot survive without initial supplementation? Are we risking babies’ lives and brain function because lactivists and breastfeeding professionals have become obsessed with the process of breastfeeding, privileging it over the outcome of healthy babies?

I’m not aware of even a single term infant whose life was saved by exclusive breastfeeding, but I’ve read and heard about quite a few whose lives were destroyed by the emphasis on exclusive breastfeeding. At a minimum this obsession with process over outcome is causing terrible suffering for babies who are starving and their mothers who endure their cries of hunger.

Prelacteal feeding is common worldwide, but we’ve chosen to ignore that in favor of a fantasy created by lactivists that breastfeeding is always perfect for every baby. How ironic that lactivists invoke indigenous women as justification for banning supplementation while ignoring one of their central insights … that many babies need and benefit from supplementation.

Why wear a seat belt?

The average person, driving the average car on the average trip is not going to be involved in a major crash. If that’s the case, seat belts are a useless intervention that merely provide extra revenue for car manufacturers, right?

In fact, the average person, driving the average car is probably not going to get into a crash during the entire life of the car. If that’s the case, there’s no reason to put seat belts into every car when only a very small percentage will actually benefit from them. The majority of seat belts could be described as “unnecesseat belts,” right?

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]No need to routinely buckle your seat belt. You only need to buckle it if you’re going to be in an accident.[/perfectpullquote]

And what’s up with air bags? The average driver, driving the average car on the average strip will not need both a seat belt AND an airbag. If you want to understand why all cars have airbags, follow the money: air bags are really expensive so car companies install air bags into every car to justify jacking up the price by hundreds of dollars.

A woman should have complete autonomy over her body. If she wants to buy a car without unnecesseat belts and without airbags, that should be HER decision. She has the right to decide how she feels safest.

And anyway, if her intuition tells her that she is likely to be in a car accident, she can always transfer to a fully equipped rental car for a specific trip. Plus, the hospital is only ten minutes away!

So educated women who care about their quality of life, not just whether they live or die, don’t wear seat belts, right?

Wrong!

Any woman with a grain of common sense in her head wears a seat belt EVERY time she gets in a car. Why? Because she knows that it is foolhardy to trust averages. Just because the average person, driving the average car on the average trip won’t need a seat belt in retrospect does not change the fact that tens of thousands of lives are saved each and every year by routine use of seat belts.

Women who claim to “trust birth” are really trusting averages. It’s true that the average woman, carrying the average baby in the average position will have an uncomplicated labor and that any and all interventions can be deemed unnecessary in retrospect. But as in the case of seat belts, just because the average woman carrying the average baby in the average position won’t need those interventions does not change the fact that tens of thousands of lives are saved each and every year by the routine use of obstetric interventions.

Trusting birth is no different from trusting driving. The vast majority of people who refuse routine use of seat belts will not die in a car accident, but that hardly makes their choice safe or sensible. Similarly, the vast majority of women who refuse the routine use of the interventions of modern obstetrics will not have their babies die as a results, but that hardly makes their choice safe or sensible.

Most of us would be appalled if people took to referring to seat belts as “unnecesseat belts,” because we recognize that they are necessary, even if they are never needed. The same principle applies to the routine interventions of modern obstetrics. Anyone who understands the routine dangers of childbirth is appalled by those who refer to C-sections as “unecesareans,” because we recognize that they aren’t unnecessary even if they weren’t needed in retrospect.

The routine use of modern obstetric interventions rests on the same principle as the routine use of seat belts. Both save tens of thousands of lives each and every year, NOT because everyone needs them, but because “trusting” that you are average is nothing more than a foolhardy, and sometime deadly, mistake.

 

This piece first appeared in June 2011.

I’m the first to acknowledge that medicine is far from perfect. Members of my family have been victims of poor medical practice: failure of a doctor to listen, failure of a doctor to take the time to think about what’s really going on, failure of a doctor to believe what a patient is telling him or her, not to mention sheer incompetence.

Despite that, the most important medical advice I can give you is ignore anyone who tells you to ignore your doctor.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Modern medicine is the worst form of treatment except for all others that have ever been tried.[/pullquote]

It’s not that your doctor can’t be wrong; if you don’t agree with what a doctor has told you or you don’t like the way that a doctor cares for you, get a different doctor. But don’t listen to a layperson or a purveyor of alternative health.

To paraphrase Winston Churchill:

Modern medicine is the worst form of treatment except for all others that have ever been tried.

There is no system that has saved more lives, cured more diseases, performed more successful surgeries, invented more lifesaving drugs and devices than modern medicine. Nothing else even comes close.

Who might tell you to ignore your doctor? In my experience, there are two types of people who make that recommendation: those who are selling something they want you to buy and those who are desperate to boost their self-esteem to have their own choices mirrored back to them.

That’s especially true in the realm of natural parenting.

People have been parenting naturally for millions of years and during that entire time span the mortality rate of children (and mothers) has been astronomical.

How have we lowered the death rates of mothers and children to current levels?

1. Alternative health advocates like to claim that it is entirely due to clean water and sanitation. It’s true that those have saved millions of lives. What people fail to realize is that clean water and sanitation are MEDICAL advances. The rationale for both is the germ theory of disease and that was not proposed by laypeople.

2. Better nutrition has saved lots of lives, too, although the main component of better nutrition is simply adequate food. Children died because they were forced to live a subsistence existence. Sure, all the food was organic, but there wasn’t enough of it.

Moreover, everything we know about nutrition was discovered by doctors and scientists. No nutrition discoveries were made by advocates of alternative health, chiropractors, homeopaths, reiki masters and any of the other charlatans who claim to be practicing medicine when they are simply stealing your hard-earned money.

3. Antibiotics have saved millions of lives and continue to save millions of lives every year.

4. Prenatal care saves millions of lives and it was developed by doctors. No one besides obstetricians, not even midwives, have contributed a single life saving intervention to the care of pregnant women.

5. Infant formula has also been one of the greatest life saving discoveries of all time. It is estimated that 5-15% or more of women are biologically incapable of fully nourishing a child with breastmilk. In the past, those babies simply died of starvation or dehydration. Now they are easily saved.

6. Vaccination, after sanitation, is the greatest public health discovery of all time. Once we learned about the way the body fights off disease (by recognizing bacteria and viruses as foreign and killing them) and why it often fails (the bacteria and viruses act faster than the body can recognize and kill them), we used that knowledge to improve the odds. Now we teach our immune systems to recognize foreign invaders before they invade. We give the body’s natural defenses an enormous head start and that has led to the eradication (smallpox) and near eradication of many infectious scourges.

Who tells parents to ignore their obstetricians? Individuals and organizations who make money by convincing you to distrust the only people who can save your life. Midwives resent that obstetricians learned to do what they did better, more safely and with far less suffering. Midwives make money when they tell you to ignore your doctor despite the fact that THEY count on the SAME doctors to rescue you when they can’t. They tell you to ignore the preventive medicine that obstetricians offer since they can’t offer it themselves, but they’re more than happy to call the obstetrician to save your life when the disaster that the obstetrician might have prevented actually occurs.

Who tells parents to ignore their pediatricians? For a long time that distinction went to the anti-vax lobby, which makes money from books and supplements. Anti-vaxxers are the 21st Century flat-earthers. Doesn’t the world look flat to you? That makes it flat. Doesn’t it seem to Jenny McCarthy that vaccines cause autism? That makes vaccines the cause.

The ultimate irony is that anti-vaxxers rely entirely on vaccination in order to convince you not to vaccinate. If everyone rejected vaccines, millions of children would sicken and die. But if only a minority of people reject vaccines, their children will be protected by the herd immunity created when the majority vaccinate.

More recently, lactivists have climbed on the “ignore your doctor” bandwagon. Why? It is an article of faith among them that breastfeeding, uniquely among all bodily processes, is both perfect and never fails. Both claims are spectacularly wrong, and sadly, babies are dying preventable deaths because lactivists tell people to ignore life saving advice from pediatricians. Lactation consultants aren’t medical professionals; they are special interest marketers. They make money only when women breastfeed, and they make more money when women struggle unsuccessfully to breastfeed, paying for countless $100/hour sessions of LCs telling women with low supply to breastfeed harder.

To my knowledge, not a single term baby’s life has been saved by refusing to supplement breastfeeding with formula, but tens of thousands of babies lives are saved each and every year by formula itself.

Doctors aren’t perfect. No one knows that better than a doctor like me. But doctors are dramatically more knowledgeable than midwives and lactation consultants. They know infinitely more than quacks like chiropractors, cranio-sacral manipulators, homeopaths, and anti-vaccine fear mongers.

You should ALWAYS feel free to consult another doctor if you have doubts about what your doctor recommends. And if a second opinion does not address your concerns, get a third doctor’s opinion.

Your doctor may be wrong, but that does not make your midwife, lactation consultant or alternative health practitioner right.

Ignore anyone who tells you to ignore your doctor. To do anything else is to risk your baby’s life.

The National Review has a response to my piece in TIME, Not Discussing Down Syndrome Complications is Unethical and, as might have been expected, it utterly misses the point.

Writing about a woman who felt her doctor was pressuring her into termination of her Down Syndrome baby because he mentioned the option more than once, I noted:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Her baby, her body, her choice — whether we are talking about abortion or about breastfeeding.[/pullquote]

… [G]ood medical care always requires providing complete and accurate information—not merely the information that a patient wishes to hear.

In response, Matthew Hennessey complains about Doctors’ Double Standard on Complete and Accurate Information:

Amy Tuteur, an obstetrician-gynecologist, also took issue with Baker’s letter. Writing at Time.com, Tuteur said it would be unethical not to discuss possible medical treatments (i.e., abortion) with a pregnant woman carrying a child with Down syndrome — even if, like Baker and my wife, the patient had already said she wasn’t interested in “terminating” her pregnancy…

That got me thinking: How far should a doctor go when providing “information” about odds-based medical and social outcomes to an expectant mother? Life is risky. Life is dangerous. There’s a lot that can go wrong. Should a doctor list all that stuff out at baby’s first ultrasound? A 2003 study published in The Lancet found that children who grow up with one parent are at increased risks of psychiatric disease, suicide, and addiction. Maybe physicians like Tuteur should impress on their unmarried pregnant patients the risks to their quality of life should they decide to “continue with the pregnancy.”

How far should a doctor go? Far enough to provide all the information relevant to making the medical decision at hand:

What are the chances that a Down Syndrome child will be intellectually compromised? 100%.

What are the chances that a Down Syndrome child with have a congenital heart defect? Approximately 50%.

What are the chances that a child in a one parent family will develop psychiatric disease? Nowhere close to either of these two salient facts about Down Syndrome.

Hennessey illustrates the problem of starting with the conclusion and attempting to reason backward. It is incompatible with medical ethics which starts with principles (autonomy, justice, beneficence and non-maleficence) and leaves all possible conclusions open. In addition, starting with a predetermined conclusion often leads to tortured logic and intellectual incoherence. In particular, it often leads to censorship, muzzling health providers to prevent them from giving accurate information so as advantage the pre-determined conclusion.

Hennessey wants to muzzle providers so they cannot provide women with the facts about Down Syndrome. He believes that the ends, preventing abortion of Down Syndrome children, justifies violating ethical principles.

I suspect that most people working in obstetrics and pediatrics recognize just how unethical such “counseling” would be.

But there is another, equally unethical counseling program that enjoys wide favor among obstetricians and pediatricians. It’s call The Baby Friendly Hospital Initiative.

It starts with the conclusion that all babies and all mothers benefit from breastfeeding and that the benefits are so large that they justify violating the ethical principle of medical autonomy. The truth is that the benefits of breastfeeding in industrialized countries are trivial. There is no evidence that breastfeeding rates have any impact on population based health parameters like term infant mortality or life expectancy. Breastfeeding can be lifesaving for preemies, but the majority of babies are not born prematurely. So the purported empirical justification for the violations of medical autonomy simply don’t exist.

Even if they did exist, the central “steps” of The Baby Friendly Hospital Initiative would still be unethical. It is UNETHICAL to muzzle healthcare providers, whether the issue is abortion or breastfeeding. It is UNETHICAL to attempt to manipulate a patient’s choices, whether that means mandating vaginal ultrasounds for women who want terminations, or locking up infant formula and forcing women to sign consent forms acknowledging the “risks” of formula feeding. It is UNETHICAL (and unscientific) to ban formula supplementation or pacifiers.

In medicine, the ends do not justify the means. Sure we could save lives if we forced people to donate kidneys, but that’s unethical since the most fundamental medical right is the right to bodily autonomy. In medical ethics, we reason FROM principles, not TO predetermined conclusions.

Mr. Hennessey fails to understand that, but he’s just one individual attempting to convince others to make the same choice that he made.

The ethical failure that is The Baby Friendly Hospital Initiative is far more egregious. It is an effort by healthcare professionals to ignore women’s bodily autonomy while insisting that the ends justify the means. They never do.

Her baby, her body, her choice — whether we are talking about abortion or about breastfeeding.

I usually write for lay people, but this post is directed specifically to medical professionals including pediatricians, obstetricians, midwives, postpartum and neonatal nurses.

Whenever a medical professional dares to question the exaggerated benefits of breastfeeding, or attempts to discuss the deadly risks of aggressive breastfeeding promotion such as hypernatremic dehydration or infant falls from hospital beds, he or she is shouted down by appeals to authority. Specifically, lactivists point out that breastfeeding is considered the standard of care by a variety of professional organizations.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Medical recommendations, including recommendations from professional societies, have been wrong in the past.[/pullquote]

It’s happened to me and I’ve seen it happen to Christie del Castillo-Hegyi, MD who has been working tirelessly to alert both parents and professionals to the risks of aggressive breastfeeding recommendations. She’s consistently shouted down by the insistence that if the AAP or the WHO recommends something, it is beyond questioning.

That’s both dangerous and unethical.

Medical recommendations, including recommendations from professional societies, have been wrong in the past. That is why it is critical to be able to question medical recommendations.

When I finished my OB-GYN residency, the standard of care was giving hormone replacement therapy (HRT) to all women. It was going to prevent heart disease and osteoporosis, with virtually no side effects. When I practiced at a large HMO, HRT was considered evidence based medicine and whether or not all post menopausal women were placed on HRT was considered a parameter for evaluation of physician care.

HRT had become the standard of care despite the fact that even at the time there were many people who questioned whether the benefits had been thoroughly documented. I can remember discussing it with a colleague who was also just out of residency. We agreed that by the time we were menopausal, we would truly know about the risks and benefits of HRT, as opposed to merely accepting preliminary data. Moreover, there were some, including breast cancer surgeon Susan Love, MD, who worked at my institution, who warned that HRT would increase the risk of breast cancer; few people paid any attention since HRT was standard of care.

Everyone “knew” that HRT was a good thing and naysayers were shouted down and silenced. We now know that the naysayers were right. We will never know how many women we harmed despite our best intentions.

I learned something very valuable from that experience: we should not silence naysayers.

Why did HRT become a standard of care despite weak evidence of benefits and plausible suggestion of serious risks? There was another player that everyone ignored, manufacturers of HRT. They pushed very hard to publicize the benefits and ignore the risks.

Why is breastfeeding the standard of care despite weak evidence of benefits and plausible suggestions of serious risks? There’s another player operating here: the breastfeeding industry, which has lobbied aggressively to promote weak evidence of benefits and suppress evidence of risks.

There is no doubt in my mind that over the next decade breastfeeding recommendations will be modified extensively in light of the actual scientific evidence, instead of basing recommendations on wishful thinking on the part of the industry.

Censorship in science is incredibly harmful. Censoring those who criticize the current standard of care is unethical. The benefits of breastfeeding have been grossly exaggerated, and the risks suppressed.

I don’t agree with everything that Christie Castillo-del Hegyi and other critics claim, but I strongly support the need to listen to them and anyone else who has plausible reason to question the aggressive promotion of breastfeeding.

They physicians who promoted HRT for all post menopausal women believed they were doing the right thing. They believed it every bit as fervently as breastfeeding advocates believe in the promotion of breastfeeding. But we shouldn’t forget that they are wrong and that breastfeeding advocates may be wrong, too.

If I were in a more forgiving mood today, I might feel sorry for the Trump Hate Brigade, caught as they are on the horns of a dilemma. Should they be happy or sad about the massacre in Orlando?

Latino gay people were killed (hooray, they had it coming) by an assault weapon (hooray, every citizen has the right to buy military grade weapons to protect themselves from those they hate) by a Muslim pledging allegiance to ISIS (hideous, all Muslims are terrorists). How is the Trump Hate Brigade supposed to feel when the people they hate are killed by other people they hate? See what I mean about the dilemma?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]A dilemma for the Trump Hate Brigade: how should they feel when people they hate are killed by other people they hate?[/pullquote]

The Trump Hate Brigade should figure it out now, since in the United States of Hate, promoted by Hater-in-Chief Donald Trump, such dilemmas will become more commonplace. If you’re supposed to hate the Muslims, and the Jews, and the Latinos, and the disabled, and anyone who isn’t exactly like you, it’s inevitable that people you hate will kill other people you hate before you get around to doing it (or condone doing it).

That’s what happens when people give power to those who rule by stoking fear. The motto of rational thought was issued by Descartes hundreds of years ago: “I think, therefore I am.” The motto of The Hater-in-Chief and his followers ought to be: “I hate, therefore I am.”

The ultimate irony, of course, it that the Trump Hate Brigade has far more in common with the Muslim terrorist they condemn than they do with the Latino gay people who were killed. The club-goers were simply trying to live their lives while allowing others to live theirs. The Muslim terrorist hated gay people because they offended his religious sensibilities, so he killed them. How is that any different from the North Carolina legislators who hate transgender people because they offend their religious sensibilities? It isn’t.

The Trump Hate Brigade hate Latinos whom they suspect of stealing their jobs so they want to build a wall and keep them out; they hate Muslims as terrorists so they want to keep them out; some of the men hate women so they mock them in the crudest possible terms; they hate Jews whom they suspect as being more successful than themselves so they threaten them with pictures of ovens. Make no mistake, building a wall is not the same thing as murdering people, but we must never forget that murdering people often follows building walls to keep them out.

Hate leads to murder as night follows day. That’s why it’s critical to confront hate wherever and whenever we see it. That’s why it is crucial to ban discrimination on the basis of race, religion, ethnicity, gender or sexual preference. That is why it is imperative that we DON’T built walls, and we DON’T keep people out of this country on the basis of race or religious belief.

The United States of America was built on the principle that ALL men (and now women) are created equal and all are endowed by their Creator with certain inalienable rights. The Declaration of Independence deliberately does not specify the race, religion or sexual preference of citizens; anyone can be a citizen.

If Trump has his way The United States of America will die, to be replaced by The United States of Hate where straight, white men are full citizens and everyone else has fewer rights or no rights at all.

Trump claims that he is not a racist, not a misogynist, not homophobic. I wouldn’t be surprised if that were true; his emotional range seems to extend only from unmerited self-regard all the way to full-blown narcissism. It may be that he has no emotional band width left for any other hateful “-isms.” But he is well aware that his chief appeal for many of his followers reflects his effort to make the US safe for hate again; he plays to that, deliberately praising violence and refusing to condemn the ugly behavior of his followers.

Trump used this tragedy to praise himself for recognizing the threat of Islamic terrorism, as if the rest of us hadn’t noticed or cared about the deaths of those who died on 9/11 and in subsequent terror attacks. But he has far more in common with the terrorists than he would ever understand. When you encourage hate, you encourage terrorism.

Today gay people were murdered. True, it happened at the hands of a Muslim terrorist, but it wasn’t the fact that he was Muslim or declared allegiance to ISIS that made him attack gay people. It was hate officially sanctioned by religious authorities, Christian as well as Muslim, American as well as Arab.

Tomorrow it could be another despised group, and hate will be the cause.

This election is going to be a referendum on whether we want to continue to base our country on the values of healers like Washington and Lincoln or haters like Joe McCarthy. I love the United States of America precisely because our principles are the highest moral principles of freedom and justice. It would be a tragedy of extraordinary proportions if we allow Donald Trump to create The United States of Hate.