Drs. Bartick and Stuebe, please withdraw the fallacious Breastfeeding Savings Calculator

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You have to give Drs. Melissa Bartick and Alison Stuebe credit for brazenness. Not only do they still insist that increasing breastfeeding rates saves money, despite a complete lack of evidence, they have created a “calculator” to estimate the fallacious savings.

Using current literature on the associations between breastfeeding and maternal and pediatric health, we modeled the costs of health outcomes for a US cohort of mothers and their infants born in 2002 and followed to age 70 years… The 9 pediatric conditions considered in this model were: acute lymphoblastic leukemia (ALL), acute otitis media (AOM), Crohn’s disease, ulcerative colitis, gastrointestinal infection (GII), hospitalization for lower respiratory tract infection (LRTI), obesity in non-Hispanic whites to age 4, necrotizing enterocolitis (NEC), and Sudden Infant Death Syndrome (SIDS). The 5 maternal conditions modeled were breast cancer, pre-menopausal ovarian cancer, type 2 diabetes mellitus, hypertension, and myocardial infarction…

Only lactivists would dare to “calculate” future savings from increasing the breastfeeding rate when they can’t manage to demonstrate past savings although the breastfeeding rate has tripled in the last 40 years. Barticle and Stuebe did not use “current literature,” they used only papers published by themselves. Moreover, they neglected to include the costs of breastfeeding such as hospitalizations for dehydration, jaundice, long term therapy for brain injury and deaths as a result of insufficient breast milk.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Rates of lymphoma, inflammatory bowel disease and breast cancer have been rising NOT falling as breastfeeding rates have climbed.[/pullquote]

To put the problem in context, we know that vaccines save money because we have seen dramatic decreases in the rate of vaccine preventable diseases and their associated costs. We know that ending cigarette smoking saves money because we have seen dramatic decreases in lung cancer rates and their associated costs. In contrast, we have seen almost NO decreases in the rates of diseases supposedly prevented by breastfeeding despite the fact that breastfeeding rates have increased from 24% in the early 1970’s to over 76% in the past few years.

What has happened to the rate of diseases supposedly prevented by breastfeeding?

Pediatric acute lymphoblastic leukemia

According to the National Cancer Insitute: “Cancer in children and adolescents is rare, although the overall incidence of childhood cancer, including ALL, has been slowly increasing since 1975. (my emphasis).

Crohn’s disease and ulcerative colitis

According to the paper Epidemiology of Pediatric Inflammatory Bowel Disease: A Systematic Review of International Trends:

Globally rising rates of pediatric IBD (due primarily to the rising incidence of CD) was demonstrated in both developed and developing nations … (my emphasis)

Breast cancer

This graph comes from the United States Preventive Services Task Force:

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New cases of both invasive and non-invasive breast cancer have risen since 1975.

I have confronted Dr. Bartick in print about the fact that she is unable to demonstrate past savings from rising breastfeeding rates; and she couldn’t rebut it. Over 2 years ago I wrote this comment on an Academy of Breastfeeding Medicine post:

Breastfeeding rates have tripled in the past 50 years. Where is the evidence that term babies lives has been saved? Where is the evidence that the diseases you insist are decreased by breastfeeding are actually decreasing as a result of breastfeeding? Where are the billions of healthcare dollars you claimed would be saved as the breastfeeding rates rose? Where is the return on investment of the millions of dollars spent to promote breastfeeding?

Here’s how Dr. Bartick responded:

I have given you the evidence on NEC and SIDS. You can dig up the evidence on the other diseases. To my knowledge, no one has actually dug it up yet. It’s not fair to say “it doesn’t exist.” It would be wonderful if you gather your team of statisticians and experts, and did the research yourself and published your own paper on it, Dr. Tuteur, instead of saying the evidence doesn’t exist…

My reply:

Sorry, Dr. Bartick, that’s a cop out. You’ve given no evidence that the decreases in SIDS and NEC are caused by breastfeeding. You’ve given no population evidence of any kind for any of your other contentions.

Don’t tell me that I can dig it up on my own. If it were available, you would have already posted it…

So Drs. Bartick and Stuebe have created a fanciful calculator that “models” future savings from increasing breastfeeding rates despite the fact that they are utterly unable to demonstrate the central assumptions of their model. They insist that breastfeeding saves lives in theory even though there is no evidence that it saves lives of term babies or mothers in practice.

I don’t doubt that Drs. Bartick and Stuebe believe deeply that breastfeeding saves money, but wishing doesn’t make it so. The existing population data shows that increasing breastfeeding rates does not save money or lives of term babies or mothers. That’s not surprising since breastmilk is just one of two excellent ways to nourish a baby. In first world countries, it’s benefits are trivial.

Dr. Bartick and Stuebe ought to immediately withdraw their fallacious breastfeeding “calculator.” It is based on easily disproven assumptions, provides erroneous data, and reflects ideology instead of science.

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  • Ramon Amoedo

    Indeed something isn’t adding up. Breastfeeding worldwide is growing for some time but many diseases and conditions it was supposed to reduce are, in fact, growing. Chron, obesity, asthma and many others seem to be on the rise despite successful breastfeeding promotion… It begs the question of WHY this is happening

  • CSN0116

    My institution just did a praising spread on this today, as a faculty member is co author on Bartick’s Monte Carlo paper and this “calculator.” So guess what we’re going to pick apart in my epi class tomorrow (for which Jung’s “Lactivism” is supplemental reading)?! Grrrrrr.

  • JSterritt

    So basically Bartick and Stuebe have shifted the burden of proof for their grand claims onto anyone who challenges them!? This is analogous to a “savings calculator” that assumes an annual rate of return of 20% on investment. When you ask which wonderful investments provide such prodigious returns, the designers say: “well, you have to find them yourself.”

  • MaineJen

    Ugh. I can’t see myself not working. I get bored staying home!! And I like my job. Come to think of it, the “like my job” thing carries a lot of weight. I’m not domestically oriented (I hate cooking and cleaning, I’m not crafty, I forgot picture day at the kids school this year, you get the picture).

    I can totally see my husband staying home, if we didn’t need his income still 🙂

  • Sue

    How does their data stack up post-pneumococcal and Rotavirus vaccination?

    • moto_librarian

      My wager is that the modest reduction of GI illnesses in year one (8% on a population level) has disappeared thanks to the Rotavirus vaccine.

      • Young CC Prof

        When the rotavirus vaccine was introduced, total hospital admissions for diarrhea in young children dropped by about 50%, immediately. There are other bugs that can be nasty, norovirus, etc, but rotavirus was the single worst form of viral gastroenteritis, which is why it was target for vaccine development in the first place.

        • Roadstergal

          The vaccine-induced savings to both overall dollars and scarce hospital resources is just eye-opening. I still can’t get over how opposed people can get to the things – as _policy_.

  • Sue

    SIDS/SUDI? Have they totally ignored the Back to Sleep campaign? Now THAT is a huge healthcare/life/saving strategy, at essentially NO cost.

    People who are interested in child health will promote those strategies that improve it. People who are interested in a particular ideology just promote that ideology.

    • moto_librarian

      Back to Sleep is a pretty big confounder, isn’t it?

      • Sarah

        When you’re researching breastfeeding, confounders are not a thing.

    • yugaya

      Bartick actively promotes bedsharing in adult bed. Over 50% of all sleep-related infant deaths happen while baby is sleeping in adult bed and/or bedsharing. Can someone calculate how much over 2000 dead babies each year cost and send her and other lactavists the bill?

  • Anion

    OT:

    I just wanted to say thanks again to all who offered me advice last month. Sadly, the fact that the positive result I got on my pregnancy test was extremely faint turned out to be an indicator that something was wrong; it was actually a blighted ovum. I started bleeding a couple of days later.

    I’m okay. Sad, but since it didn’t seem “real” anyway, I think I’m probably doing a little better than I might have otherwise. And physically I’m okay now, too; the doc (at a local clinic, I hadn’t found a regular doc yet) and I both figure my age had a lot to do with it.

    Anyway. I wanted to give an update and say thank you again to all who were so kind and helpful. I really appreciate it.

    No need to reply–I’m sure you’re all sympathetic and everything and I appreciate it, I just don’t want to derail the comments. So, you know, as you were. 🙂 Thanks.

    • Empress of the Iguana People

      hugs

    • Roadstergal

      Thanks for coming back and giving an update! That must have been quite the roller-coaster of emotions.

    • moto_librarian

      I am sorry to hear this, but glad that you are coping relatively well. Hugs.

  • A pumping mom

    So I can buy a big tub of generic formula for $21. I would need to consume approximately 18,000 calories to make that much milk. That is 9 days of 2k calories per day, which is probably a bit more than I actually eat. I certainly spend more than $21 on food for me every week!

    I am currently combo feeding since it is working, but we will see how long I go.

    • A pumping mom

      This is of course assuming I’m doing the math correctly. Maybe it is 9k calories? At work and not looking at container. Still would take more to feed me! I think the break even was if it was more than 2.5 days worth of food for me. And there was definitely more in the container than that!

    • CSN0116

      Nothing, NOTHING about the cost/benefit analysis has ever made sense to me. Generic formula is CHEAP. And a baby only “needs” but 1-2 bottles. Tap water in most areas of a developed country will suffice and can be boiled if not adequate. Even if there are more colds, GI infections, cancers — breast feeding is:

      -20% more daily calories to the nursing mother
      -The nursing mother’s time
      -Pump break times that get added to the work day for wage workers
      -Pumps
      -Pump parts
      -Time and resources (water, soap, dishwasher) spent washing parts several times per day
      -Refrigeration to store pumped milk
      -Nursing bras
      -Nursing pillows
      -Baby vitamin supplements
      -Supplements, teas, cookies, etc.
      -Nipple creams
      -Extra weight checks for baby
      -Lactation consultations (in hospital and out)
      -Prescriptions
      -Mastitis treatment
      -Thrush treatment for mom and baby
      -NICU/PICU stays for FTT, hyperbilirubinemia, dehydration, hypernatremia (all multiple times more likely in BF babies)
      -Lifelong treatment for brain injury suffered from the above ^^
      -Maternal mental health complications for perceived failure

      Even if you had zero BF complications and never used a pump — the extra food consumed alone (and money and pollution spent to manufacture, transport and prepare it) will top formula feeding costs.

      I EFF for less than $500 per year, ALL costs factored in. I just don’t see how in any world BF is more economical. And not that it has to be, but c’mon with the bullshit argument. Have these people never dabbled into the beautiful world of formula feeding? It’s fucking blissful! 😀

      • a pumping mom

        20% more calories? More like 45-50% for me. Prepregnancy, I was eating 1300-1500 calories per day. I usually pump 600-800 calories of breastmilk daily, not including the energy it takes to convert food to milk ( only pumping, so I actually know how much is made). I had trouble at first figuring out how to keep from losing to much weight.

        Your other stuff is also true. We did have an extra appointment for jaundice/weight but both mom and dad had jaundice so that could have as easily been genetic as boob food.

        • Kq

          I didn’t keep track of how much more I ate but I was ravenous all the time while breastfeeding. And as for the mythical magical weight loss from nursing – I didn’t lose any until he weaned.

      • Krista

        And of course the cost benefit analysis will be different for everyone. I was lucky in that breastfeeding came relatively easily, no supply issues, baby latched, but when I went back to work/school I found pumping to be beyond tedious. I was as supported as I possibly could be, I just didn’t like it, so it was no longer worth it for me. Formula during the day and nursing mornings and evenings.

        Not everyone needs extras so for some it may really be cheaper, but as soon as you start factoring special equipment, consultations, herbs/supplements, etc., pretty sure that balance tips in favor of formula.

        Of course whatever works best for you is fine as long as baby is fed.

  • J.B.

    semi-OT: wowowowow this one gets way too close to eugenics for me: http://www.jpeds.com/article/S0022-3476(16)31096-4/abstract
    (Maybe this paper is the underpinnings of the calculator that is the subject of this post?)

    Because non white people breastfeed less, bad things? And, um, if they account for differences in birthweight and maternal age did they do even the slightest looking at INCOME?

    Edit: and why would you simulate instead of pulling up real data???

    • CSN0116

      Oh this paper is total shit.

    • Sarah

      I’ll give you one reason..

  • guest

    If they did a little more digging, they would find that the “links” between all of those pediatric conditions and breastfeeding practices have been completely debunked. Linking SIDS (now thought to be caused by a congenital defect that changes the structure of the brain, skull, and inner ear) with a lack of breastfeeding is particularly cruel.

    Funny, I developed Crohn’s disease and frequently have to contend with GI infections. All this time, I thought my gut troubles were genetic and a result of complex environmental factors (and I even test positive in genetic screenings for Crohn’s disease!). I could have been spared years of pain and suffering, if only my mother had breastfed me…

    Oh, wait. She did. My mom was a crunchy-granola hippy who ate a totally organic, mostly vegetarian diet and breastfed my siblings and I exclusively.

    Also, in spite of all that breastmilk and fresh air and ginger tea, we lost my brother to leukemia, so #$%* you, Bartrick and Stuebe.

    • fiftyfifty1

      ” #$%* you, Bartrick and Stuebe.”

      I second that. To blame mothers for outcomes like Crohns and Leukemia when THERE IS NO GOOD EVIDENCE is beyond low.

      • Gæst

        I’ve said this here before, but others have claimed breastfeeding prevents asthma. Except it doesn’t. My great grandmother had asthma – I’ve no idea how she was fed. My mother has asthma. I also don’t know how she was fed, but maybe I’ll ask some time. I have asthma. I was formula fed. My son has asthma, but OOPS: he had only breast milk until 7 months, and he was already demonstrating intermittent wheezing by that age (though not diagnosed with asthma until much later, as it’s difficult to identify the cause of wheezing in infants). It’s fucking genetic. Environment plays a role. There can be food triggers for it. But there is no good evidence that breastfeeding helps it at all.

        • BeatriceC

          Your son’s asthma is clearly the vaccine damage he got from you vaccinating and undoing all the good from the magical tit juice.

          • Gæst

            I guess I shouldn’t be taking him for a flu shot today!

          • Empress of the Iguana People

            too late, he’s already damaged. Better get a new kid and start over
            /s

          • Gæst

            Darn!

        • Platos_Redhaired_Stepchild

          Hell yeah its genetics! My family had a long history severe debilitating chronic disorders before formula was invented….and they stopped killing us because of vaccines & modern medicine & formula (malnutrition can kill too). Hip hip hooray for science!

    • Anion

      I am so sorry for your loss.

      (And wow, I didn’t know that about the latest SIDS research! How interesting!)

      • mabelcruet

        The problem with SIDS (in the UK we tend to use the term SUDI, SIDS is more commonly used in USA) is that its a cover-all term for what is probably going to turn out to be a range of conditions/anomalies/reactions to a variety of different insults/stressors/agents. In a percentage of cases, there may be structural or functional anomalies in the brain that modify an infants response to stress/illness or modify how the infant reacts to being in a sub-optimal environment and that can lead to unexpected death. But the way SUDI research is reported in the media isn’t helpful-its often paraded as ‘we’ve found the cause of SUDI’, when actually it’s ‘we’ve found an anomaly which may lead to compromise in a certain percentage of infants who have underlying vulnerabilities and which could potentially lead to unexpected death’. And its highly misleading for Bartick and Steube to proclaim that breast feeding prevents SIDS. There is an epidemiological link when you look at large populations, and its possibly to do with the reduced infection risk in breast fed infants, but the way they’ve presented it, it reads as though breast feeding guarantees your baby isn’t going to be at risk of SUDI/SIDS, which isn’t correct.

        • CSN0116

          The strong SES factor that has always accompanied SIDS rates – and SES, as we know, acting as a huge moderator variable for breast feeding rates – makes me beyond skeptical of the purported breast feeding-SIDS link. SES is so inextricably intertwined in things like the decision to breast feed, prenatal conditions, home living conditions, infant care practices, and even biological conditions. I don’t know how one could ever sort it all out and accurately “call it.” And I don’t really know why people are even trying…

          • Sarah

            I do!

          • mabelcruet

            I completely agree. Bartick and Steube are presenting it as a very black and white issue, and it absolutely isn’t, its far more nuanced. But by being so dogmatic and so prescriptive (essentially they are saying ‘you must breast feed or your baby will die of SIDS) that prevents parents from making an informed decision. For example, we know that under certain circumstances, there is an increased risk of SUDI with bed-sharing, but parents can mitigate that risk and on balance, considering all factors, they may decide to bed-share as that is more suited to their family. Telling them ‘you must never bed share under any circumstance’ isn’t helpful-for them, maybe bed sharing helps maternal and infant sleep, or facilitates feeding or whatever, and that needs to be considered in a broader context-demonising mothers who co-sleep (or who don’t breast feed) isn’t fair.

          • Azuran

            It’s like their blanket recommendation that babies should sleep in their parents room until they are 1. They won’t stop talking about the reduced risk of SIDS (even though no one could come up with a plausible explanation as to why it does)
            They don’t mention how room sharing can negatively affect sleep for both parents and the baby. Or how much it can affect intimacy in the couple. Because mothers are completely asexual being. How dare I wish to have sex in my own bed, or just make small talk (or tickle wars) with my SO as we get ready to go to bed.
            You must have baby in your room, or else it will die of SIDS.

          • mabelcruet

            But that’s the recurring motif in all of these ‘baby-centred’ issues. Breast feeding, co-sleeping, baby-wearing, attachment parenting-its all presented as the ideal with absolutely no consideration given to whether this fits with the parents wishes, needs, ideas or preferences.

          • CSN0116

            It’s also complete inability (not just refusal, literal inability) to explain population vs individual risk, which are two totally different things.

            I am exceedingly familiar with the SIDS literature, because I scoured the hell out of it when my first borns (twins) would not rest well using the current sleep recommendations, but slept oh-so-peacefully on their bellies. But alas, belly sleeping was sure to “kill” them, much like bed-sharing. So I reviewed the evidence, weighed the pros and cons, and ultimately allowed them to belly sleep — alone, in cribs, on flat mattresses, unswaddled, with no blankets, with pacifiers, and with a fan on. Their subsequent three siblings were belly sleepers from birth. This is beyond frowned upon.

          • EmbraceYourInnerCrone

            When my kid was born(1994) was near the start of the Back to Sleep campaign, and we did follow the recommendations..except I had a very limber newborn who apparently learned to inchworm very quickly. I would put her down on her back and by the time she was a couple of weeks, she would flip to her belly. We even got this contraption that was supposed to keep her on her back…so she inched herself out of it and flipped on her belly. We put her in the second bedroom because the hall between was about 2 feet wide and with both doors open it was almost like having her in the same room (I tried having her in the same room right next to the bed and every tiny noise woke me up)

          • Empress of the Iguana People

            My sister used to sleep on her front but with her knees tucked up and her butt in the air. My parents thought it was hysterical (which is how I know about it)

          • yugaya

            It’s stupid as fuck and science denialism. Not what one expects to see among SOB regulars. 🙁

          • Eater of Worlds

            If it helps complicate things, they found that babies sleep better in their own rooms after 4 months. http://www.npr.org/sections/health-shots/2017/06/05/531582634/babies-sleep-better-in-their-own-rooms-after-4-months-study-finds

          • Roadstergal

            ” And I don’t really know why people are even trying…”

            The message of “It’s great to be rich” is true, but people get tired of hearing it, I guess. And “Just do what works best for you, it’s not your fault you’re not fuckin’ rich” doesn’t make women feel guilty enough.

  • BeatriceC

    Hell, those first few tries they use more calories trying to eat than they actually consume. None of my kids came off the NG tube until they could bottle/breast feed efficiently. The first few days (at least) they didn’t get any substantiative nutrition from the oral feeds and they weren’t expected to. They were just expected to learn how to do it. They got everything they needed through a tube.

  • CSN0116

    I work at the same institution and sit on a random committee with Barticks’s right-hand girl. This woman is obnoxious and vile in real life too. All the gag.

  • kilda

    I love how she says no one has “dug up” the evidence. Like it’s there, just no one has had the time yet to compile it. And Dr Amy totally could, but she’s too lazy.

    As opposed to what she really means, which is that no one has done studies that show any evidence for the other conditions.

    • Roadstergal

      Nobody has dug up the evidence, so let’s base policy on speculation.

    • Russell Jones

      Life is much easier when you just make stuff up from whole cloth, then get righteously indignant when others won’t do your work.

      “No one has yet dug up the evidence proving my pontifications true. The evidence is totes there, though. Believe me. It’s there and it’s really, really good evidence. The best, in fact. Please don’t be jealous of how spectacularly good my as-yet undiscovered evidence is. And besides, when you think it through, the fact that this outstanding evidence remains undiscovered is really your fault, seeing as how you discourteously failed to discharge the burden of proof that I assumed. BTW, why do you hate babies?”

      lol

      • ForeverMe

        Russell Jones, OT: OMG. That last paragraph is very Trumpian. Except a few sentences were a bit long for him, I think.

  • Angharad

    It looks like the majority of their 95% confidence intervals include zero (aside from ear infections and gastrointestinal illness). Doesn’t that usually mean you don’t have any evidence of an effect?

    • Casual Verbosity

      That is exactly what it means. If the confidence interval includes zero it means that a possible value of the difference between the groups is zero.
      Or it means that they used a critical constant that’s incongruent with their F critical value. I did that the other day and it stood out like a sore thumb. I didn’t just say ‘Lol, chuck it in the thesis anyway!’

  • attitude devant

    Only slightly OT: I am seeing a pattern in my colleagues that concerns me. We have several partners who have wanted to work less after having children. All well and fine, because I’m a mom too and I get that it’s a juggling act. So, because we value them as physicians and part of our practice we let them set a reduced schedule. A VERY reduced schedule. Kind of a pain from several angles, not the least of which that it makes our practice less economically efficient, but ok, because we value them. Yet as time goes on, these same people are less and less satisfied with the accommodation we have given them and usually behave very badly over some basic stuff (like being asked to see someone else’s patient on an urgent basis if they have an opening, something partners do for each other) and then ultimately they end up quitting, often without giving proper notice. I’m dealing with the third instance of this. The rest of us women who had kids are fine. Any ideas what’s going on here? The only constant seems to be that each of these had a partner making good money so the family didn’t really need their income.

    • EmbraceYourInnerCrone

      I’m in IT and have dealt with similar instances. I have a kid myself, now an adult but she was a child when I faced this situation. I am completely guessing but it always felt like, since the person’s family could afford to do without their paycheck, they felt(maybe subconsciously?) they were somehow doing the rest of us a favor by continuing to work after they had kids.
      Having been the single person and also the married person with no kids it does sometimes seem that some(certainly not all) parents expect accommodations while making NONE of their own. They also seem to be the parents who act like no one else ever had to deal with being a working parent before in the history of the world…

      • attitude devant

        Well, I had tiny kids before some of these people ever spawned their own, and you’d better believe they cut me no slack. When they had kids I tried to make it better for them than it was for me,but they don’t get it, I guess. Your comment also reminds me that when my parents died someone took my call so I could go to the funeral and then asked me when I was leaving for the airport when I could pay them back. (Which I intended to do, but seriously?)

        • EmbraceYourInnerCrone

          Wow! talk about not an appropriate time to ask!? Is there an empathy gene missing!

        • Roadstergal

          It’s one of those things where if you weren’t, well, emotionally wrecked from going to your parents’ funeral, you could make the response, “When _your_ parents die.”

          (Losing a parent is an unutterably shitty situation, and that comment’s timing makes my blood boil.)

          • Sue

            “When _your_ parents die.” EXACTLY. Or, “when you need me to, at short notice, for something really important to you.”

    • fiftyfifty1

      “like being asked to see someone else’s patient on an urgent basis if they have an opening, something partners do for each other”

      Lame. Super lame. They should be covering those patients and not just “if they have an opening.” Patients come first, and if these docs don’t think so, they are not the docs I would value. Bye bye.

      • attitude devant

        I think that’s where we’re headed. Again.

      • Merrie

        That jumped out at me. I would wonder what the time frame was on that. If they were already there and asked to see someone else’s patient and they got upset… not good. If they were asked to come in extra/stay extra, when they maybe didn’t have child care arranged… understandable for them to be frustrated. Juggling two working parents when your spouse’s job is not flexible is really challenging, and getting asked to work extra at the last minute can really throw a monkey wrench.

    • Who?

      Work becomes an irritation to them. They blame work when things in their perfect life are not so perfect. Clearly the high earning spouse is far to busy to ‘help out’ (ahem, take responsibility) so their beady eye falls on their work colleagues.

      Work isn’t about love, it’s a transaction, so they don’t see the harm in leaning on work colleagues, who can ultimately be cut loose if things get uncomfortable.

      Bad for patients, though and by extension the entire practice.

      Colleagues like this need to be former colleagues, sooner than later.

      • attitude devant

        Yep. Thanks.

    • Sarah

      To be honest they just sound like they don’t want to be there. The parent thing is a bit of a red herring. Although kids plus sufficiently earning spouse is probably the reason they don’t want to be there, so it;s relevant in that respect, that’s the way people sometimes behave when they’re not feeling it. Whether that’s down to kids or something else.
      I’ve seen people do this both with and without children. And to be honest, did it a little bit myself with one job (though my employer was much less nice than you sound). I had a child myself at that time, but that’s not why I felt as I did.

      • attitude devant

        You’re right. I think the children issue is a red herring

    • Sue

      When I used to be a Head of Department, that sort of behaviour really challenged my feminist principles. Of course I wanted our Department (ED) to be family-friendly, but I wanted everyone to have a work-life balance, not only the parents of young kids. It worked best for people who recognised they had rights AND responsibilities – I would happily adapt the schedule to suit them if they were able to make allowances for other people’s needs in other ways.

      • attitude devant

        This is really helpful. They keep casting it as a feminist issue but I realize now that that’s just the window dressing.

      • Charybdis

        You had an erectile dysfunction department? 😛

    • The Computer Ate My Nym

      I can’t remember where you work (US or outside of the US), but I quit clinical practice with two middle fingers up and a manuscript of a book making fun of a fictional hospital that might have some remote similarity to the hospital I worked at last a couple of years ago. I simply couldn’t take being told that I was a bad doctor because I didn’t make enough money any more. There are so many frustrations involved in practicing medicine that any excuse to get out seems like a good one.

    • Amazed

      They want to have the fame of being a “doc” but the obligations part is too much for them, IMO. With the high earning partner in the picture, they feel secure enough to let their irritation on mean old obligations whiners like you show. This – and perhaps feeling that they deserve all accommodations in the world because they are mothers.

      I am reminded of a colleague that is now in harsh financial state (and complaining of it still). She drove me mad with her, “Help me! Recommend me! Help me find clients!” after her kids grew up somewhat and she realized that her onetime clients had moved to other translators because in this business, no one is waiting for you to become ready. There is always someone else willing to take the text and you sink into oblivion. OK, I offered her a big text that would go with a nice sum at the end. Her answer? “OK, I’ll take it and if the kids leave me alone, I’ll do it!” Nice, eh? I still can’t explain HER. Her husband doesn’t even make this much.

      OT: During the last month or so, we’ve been juggling Amazing Niece like a hot potato because we all have to work. If she isn’t with her mom, dad, or grandma, she is with me because Mom, Dad, and Grandma have to work; if she isn’t with me, this is because I have to work. We hadn’t had a normal visit with going and leaving in many weeks – they come, we have dinner, and then they leave and she stays with us. Sometimes, they just hand her over and leave. The result is that she starts cryng the moment she sees us – she thinks we’re taking her away from her parents. Well, no one pays the Intruder to take care of his kid, so she will be juggled around some more. Such is life. THese partners of yours seem to have forgotten this fact.

  • Tori

    I had a discussion a few weeks ago about ‘paced bottle feeding’ in context of low supply. That’s all well and good, but it was being pushed so as when you are mixed feeding you “waste less formula”. I actually I don’t care if I waste formula. There is plenty more of that where it came from from the grocery store.. now that is plentiful and cheap.

    • Azuran

      Lactivists would be outraged by me. I actually wasted breastmilk when I was combo feeding that first week before my milk finally came in.
      I could barely pump 5mls and my baby usually drank 25-30ml of formula after each breastfeeding session.
      I found adding up all those small amount (which ended up only being enough for 1 supplementation each day) and then heating it up and sterilizing the pump and the bottles etc to be way too much trouble. So I wasn’t careful with it and basically just let it sat in the fridge for a few days and then dumped it.

      • Heidi_storage

        Whenever I dumped breastmilk for awhile, I had phantom voices screaming “LIQUID GOLD!” in my ear. (These days, my older kids take care of any excess.)

    • CSN0116

      I have never seen paced bottle feeding used except to rationalize minimally starving a baby so that she becomes as close to accustomed to mom’s undersupply as possible. Of course that’s not how it’s described, but it’s the reality of the practice. Can’t have baby becoming quickly and conveniently nutritionally satisfied… if mom’s breasts can’t do that then a bottle and formula sure as hell can’t either.

      • BeatriceC

        Paced feeding is a great thing when you’re teaching a preemie (or other medically needy newborn) who hasn’t yet learned how to manage the suck/swallow/breathe cycle how to do oral feeds. That’s what it was designed to do. Otherwise, it’s a bunch of bullshit.

        • Gæst

          One of my preemies would just fall asleep before she really ate enough, so rather than slowing her feeding down, we were looking to make it faster/easier. She needed the bottle nipple that took the least amount of work. Although before she came home, the NICU nurses were adamant about limiting both babies to a small amount of milk per feed. I don’t know why.

          • BeatriceC

            That’s another issue a lot of preemies have, but one they don’t get to until they master the suck/swallow/breathe thing. Pace feeding is a teaching tool, not a long term feeding method. Once the baby has learned to eat and breathe at the same time, it’s no longer useful.

          • Gæst

            Yeah, mine were late pre-term and didn’t need to be taught to suck. But she was also a bit SGA, so she got tired easily.

      • Young CC Prof

        “Paced feeding” has been used to describe two different things, one fine, the other not fine.

        The first definition is literally slowing down the feeding, the second is limiting the baby’s intake arbitrarily, for example, one ounce per hour.

      • Tori

        The idea was not to restrict the amount but to ‘slow down the feed’ so baby didn’t choke on the flow of milk from the bottle and over eat. I don’t know what bottles they are using, because that sure didn’t happen with my son when he was drinking from bottles… he was pretty good at stopping when he wanted.

        • CSN0116

          They’re full of shit. (Almost) no baby will choke on a Level 1/Slow nipple flow. That is extremely rare and if it does occur, is remedied by switching bottle brands to one more conducive to your baby’s suck.

          They obsess over the “over eating” part and that’s where the intentional calorie restriction practice comes it. Makes me furious.

          • Tori

            Yes, exactly. I acknowledge my son first struggled with slow flow teats because even they were so much faster than he was getting from me. But after a few days he got the idea, and he never choked on this supposedly uncontrollable flow even those first days. I find it so frustrating. And pointed out the one time I tried paced bottle feeding with him he got upset so quickly abandoned it, and that you can just buy another tin of formula at the grocery store so who really cares if you putsome down the drain.

          • Azuran

            My baby used to choke regularly on the breast for the first 3 months. I was told this was normal, frequent and not something to worry about.
            To them, if it happens with a bottle it’s automatically bad, if it happens on the breast it’s alright.

    • Roadstergal

      Extended Barker hypothesis, bitches! Sure, it’s speculative, but it’s no more speculative than any of the lactivist stuff.

  • Sarah

    Not that I really need to ask, but when calculating their ovarian cancer stats, did they consider that some of the women not breastfeeding will have gone straight back onto the combined Pill, which also reduces the risk of ovarian cancer? I feel confident they’ve taken this into account. Just like the costs of treating mastitis…

    • Casual Verbosity

      And the cost of private lactation consultants. And the numerous paraphernalia that are not “necessary”, but make breastfeeding easier/more comfortable/more convenient/more manageable as a working mother. Surely they factored that in…

  • MI Dawn

    My fully breastfed daughters had as many ear infections as their bottlefed father (with the infections starting when they were still fully breastfed) – gee, do you think genetics *might* have had something to do with that? They didn’t get as many illnesses, thanks to things like vaccines. They never were obese, even when changed to fully formula fed by 7 months. One developed allergies, needed a T&A and has exercise-induced asthma – she was breastfed nearly 2 months longer than her sister with no health issues.

    So, tell me where the savings for these kids were? As babies and children, most of the MD visits were either routine checkups or injury related. Can’t say there was any savings due to breastfeeding.

    • The Bofa on the Sofa

      Our older son was EBF for about 3 months, and after that he was combo fed until about 9 months, after which he weaned.

      He only had one cold before he was 14 mos old, at 1 mo, while he was EBF. No other illnesses of any sort.

      And then, he went to daycare, and spent the next four months basically on a continuous dose of antibiotics. He’d get over one, catch another cold, which turned into another ear infection. Repeat.

      Our younger guy has been regularly sick since he has been a month old, one cold after another. He has another one now. But very few few ear infections.

      • Sue

        Which goes to confirm that the biggest influence in getting viral infections is EXPOSURE.

        • The Bofa on the Sofa

          Yes, that’s the point. No breastfeeding study that claims anything about illness is worth squat unless it controls for daycare, because that’s where kids get sick

    • Azuran

      My BF baby still hasn’t been sick so far. However, I’ve never been as sick as I’ve been since I’ve started breastfeeding.
      Since my daughter was born 6 months ago, I’ve been sick multiple times
      I’ve had a generic unknown disease causing a fever for 3 days and a general crappyness feeling for a week.
      A very severe laryngitis that lasted 2 weeks where both my tonsils where basically 50% pus (one of them now as a notch in it due to the massive damages.)
      I’ve developed benign paroxysmal positionnal vertigo.
      I’ve just got over another episode where I has a fever for a day and half my tongue basically became a huge ulcer that took about 2 weeks to heal completely.

      I’m gonna blame all this on breastfeeding :p
      Because you don’t need proofs when it’s about breastfeeding.

      • MI Dawn

        LIked for the last sentence. Sorry you’ve been feeling lousy!

      • Merrie

        I was sick every other week, seemingly, when my second kid was a baby… because my first kid had just started in group care and was bringing every bug under the sun home. Smh.

    • Steph858

      I’m sure Lactivists can find a way to Data Dredge till they can show that breastfeeding prevents accidents. There may be no correlation between breastfeeding and accidents in general, but what if you focus on RTCs, trips/slips, broken legs, sprained wrists, broken ribs, broken ribs caused by RTCs, broken ankles caused by 8-10 year-olds playing football in November …

      • Roadstergal

        I’m sure you could dredge the data that way. I’m just thinking about low-SES kids playing in crappy parks and not-built-to-be-kids’-play-areas type places, and high-SES kids playing on parks that are all kid-proofed and have the recycled tire ground. Bingo, breastfeeding leads to fewer injuries at play!

      • BeatriceC

        An old stats book that’s been out of print for who knows how long had an introductory blurb for the correlation/causation unit that was quite memorable. The author dredged up data to show that pickles caused car accidents. He did a whole write up showing that at least one of the drivers in car accidents had eaten pickles within x amount of time prior to the crash and so on and so forth. Then he went on to explain that this particular example was ridiculous, but it highlighted the correlation doesn’t equal causation thing. I forget how he manipulated the data. I want to say it only looked at car crashes that happened within so many feet of the entrance of fast food places or something like that, but it’s been so long since I’ve read that blurb that I can no longer remember.

        • EmbraceYourInnerCrone

          The Skepchick.org website has a funny weekly column in the same vein called Bad Chart Thursday, this was one of my favorites:

          http://skepchick.net/2015/10/throwback-bad-chart-thursday-sugar-could-make-us-immortal/

          Sugar consumption has been steadily rising since the early 19th century, life expectancy has been steadily rising since the early 19th century. So if we eat MORE SUGAR we will live forever! Science!!

    • Casual Verbosity

      I was fully breastfed, and until a few years ago, my life consisted of tonsillitis, head-cold, ear-infection, repeat, up to 6 times a year! The copious amounts of breast milk I received as an infant couldn’t spare me from that… getting my tonsils out was ultimately the solution. No ear-infections in the three years since and I’ve halved the number of colds I get. Crazy!

      • Roadstergal

        I got ear infections like clockwork at the beginning of winter every year until they yanked my tonsils as a young girl. Not a single one afterwards, and I’m otherwise healthy as a horse – no chronic diseases, allergies, obesity, any of it. I must have gotten the good batch of formula?

        • Casual Verbosity

          You’re right. It’s probably the food you ate for the first 6-8 months of your life, rather than removing a malfunctioning part of your immune system.

    • Azuran

      Genetics could also play a significant role in all this. My SO’s family does appear to have pretty weak lungs. My SO had pneumonia many times as a kid and was hospitalized a few times. His niece (5) and nephew (3) also had like 7 pneumonia between the two and multiple trips to the hospital. Last year, both his sisters and his mom had to be hospitalized for pneumonia as well (and yes, both the kids also had pneumonia at the same time).
      And all this merry bunch was exclusively breastfeed.

    • moto_librarian

      Yup. Both of our sons had very little breastmilk, and I spent a lot of time feeling guilty that son number one had constant ear infections. This child also failed his newborn hearing screen twice, got tubes at ten months (the surgeon discovered a pocket of infection in his left ear that had been there for quite some time, despite regular antibiotics), and ultimately had a left ruptured ear drum at age 6 that required a tympanoplasty. Despite this, I never fully got over the guilt until his younger brother was born and had no more than one ear infection through infancy and toddlerhood. It’s pretty clear that something structural (e.g., genetic) was the real cause of our older child’s problems, and no amount of breastmilk would have changed that.

  • Roadstergal

    Can I just point out that the initials of the authors of this calculator are “BS”?

    Hey, if Flanders can do it…

  • Emilie Bishop

    Pretty sure my son’s readmissions, LC appointments, breast pump, nipple shields, fenugreek, breast pads, nursing bras, cream for my aching nipples, and my therapy appointments brought on by feelings of failure for not exclusively breastfeeding have amounted to a net cost for the healthcare sectors providing all of these. We barely saw his doctor after we switched to only formula. Funny how the stupid “calculator” doesn’t have boxes for any of that.

    • Roadstergal

      It’s been said before, but breastfeeding is only free if mom’s time is worthless. Which doesn’t mean it’s not worth doing, but that needs to be acknowledged – and I bet as much money as B & S claim we’re saving that they didn’t account for that.

    • Young CC Prof

      Heck, they didn’t even include the costs of providing basic lactation support, much less treating difficult nursing relationships.