Monday, July 8, 2013

The Art of Denouncing Breastfeeding

“Whole World Deceived... Except the Very Select”.
“Australia Not Down Under”.
“Sun Is a Light 32 Miles Across”.
“The Earth Has No Motion”.
“Science Insults Your Intelligence”.
“World IS Flat, and That's That”.
“The Earth Is Not a Ball; Gravity Does Not Exist".
“Breast is NOT Best”.
“The Breastfeeding Police Are Wrong About Formula”.

What do all these sentences have in common? Two things: They are all genuine newspaper headlines. They are all examples of Denialism:

“Denialism is choosing to deny reality as a way to avoid an uncomfortable truth. It is the refusal to accept an empirically verifiable reality. It has been proposed that the various forms of denialism have the common feature of the rejection of overwhelming evidence and the generation of a controversy through attempts to deny that a consensus exists” (Wikipedia).

In the breastfeeding domain, the people who write such denialist headlines know that science has a persistent habit of going against the relativistic, "whatever feels right for you is therefore right" modern mindset. Consequently such science becomes taboo in order to protect the numbers of people whose feelings may be hurt, and who might feel guilty because of the implications. But unfortunately for these people, hurt feelings and guilt do not disprove the findings. Biology is non-negotiable, and does not bend to relativism.

Hence, formula feeders (normally those with more-militant leanings) pacify their emotions by denouncing the very breastfeeding studies that offend them. Click here to see a good example of such denouncing in action. Typically, the denouncer uses a range of cognitive gymnastics to meet their goal. They employ distortions, half-truths, misrepresentation of the scientific position, asymmetric standards of reason and expedient shifts of premises and logic. No matter how large scale the research or how reputable the research team, they will fabricate fault with it. Above all, they prioritize their own sense of defensiveness over truth. Back to the Wikipedia definition of Denialism:

“Individuals or groups who reject propositions on which a scientific or scholarly consensus exists can engage in denialism when they use rhetorical tactics to give the appearance of argument or legitimate debate, when in actuality there is none.”

So for example, formula feeders will argue that the benefits of breastfeeding are exaggerated or non-existent, and therefore by formula feeding they have not put their child at any disadvantage. It is a form of denial, a face-saving technique. As social psychologist Dr Benoit puts it, “if the injury from the act is not as significant as first believed, the damage to the image of the accused should be limited as well”.

Thus, formula feeders fart out the assertion that “the benefits of breastfeeding are small”. I say ‘fart’ because not much, if any, thought is given to the assertion. It’s merely a by-product of ignorance, lack of creativity, and argumentative laziness. For instance, who defines ‘small’? Is it a value judgement rather than a scientific one? A 21% drop in postneonatal mortality doesn’t sound “small” to me.

Joan Wolf is one such denouncer. She has described herself as “taking on the experts” against “the public obsession with health”. When all else fails, she reverts to a very common denouncing strategy – she throws this chicken and egg curveball:

“Breast-feeding, in other words, cannot be distinguished from the decision to breast-feed, which, irrespective of socioeconomic status or education, could represent an orientation toward parenting that is itself likely to have a positive impact on children’s health.”

In other words:

Because breast is best > the best kind of parents are more likely to chose it > therefore, their children achieve the best in life.

Ask yourself: what comes first in the above chain?

Also ask yourself: can ‘parenting style’ account for this:

Click for a larger view.

Finally, ask yourself: In many Asian countries mothers who breastfeed their children tend to have lower educational attainment and come from lower income households, yet despite this, their breastfed children have better psychosocial and cognitive development than their more affluent formula-fed peers (Duazo et al 2010; Daniels and Adair 2005).

Perfect Science is a Perfect Illusion

Denouncers, or ‘Merchants of Doubt’ as some have called them, get excited by the inescapable indeterminacy of figures and statistics. When I discussed this with Dr Jack Newman, the renowned Canadian physician who specializes in breastfeeding support and advocacy, he told me:

“Well, the furious formula feeders don’t know what they are talking about. Admittedly, clinical studies are fraught with possible misinterpretations and poor design (the worst being that people doing studies often don’t know how breastfeeding works), but you don’t have to prove that the normal, physiological is better than the artificial.  That’s turning the world on its head.  Also consider that those studies that show “equality” of feeding methods are just as prone to error as those showing breastfeeding is better.  The furious formula feeders cannot have it both ways.

Prudence requires that we don’t accept the artificial as “equal” just because studies are not perfect.  But boy there are an awful lot of studies out there showing breastfeeding is better.  And for many, as in protection against infectious diseases, protection against overweight and improved cognitive function, as well as others, there are theoretical reasons too that breastfeeding is better.”

The problem is that adequate 'proof' for any possible assertion almost always leaves a space for unreasonable doubt. Absolute certainty is not possible in most spheres of human knowledge. As Stephen Jay Gould, an American paleontologist, evolutionary biologist, and historian of science, put it: "In science, 'fact' can only mean 'confirmed to such a degree that it would be perverse to withhold provisional assent'. I suppose that apples might start to rise tomorrow, but the possibility does not merit equal time in physics classrooms".

It should be obvious that no facts about the risks of formula can ever be proved beyond all doubt whatsoever, and that assertion is equally applicable to all facts about the world. What some formula feeders latch onto however, is that despite the facts of formula's risks having overwhelming evidence, they do not have quite as much as most well-established scientific truths (the existence gravity for instance). This behaviour can be likened to the tobacco industry's assertion that although there is very strong evidence that smoking is a major cause of lung cancer, there is wiggle-room available for them to demand a higher standard of proof and claim science has not met it. As illustration, take a look at this quote direct from Imperial Tobacco legal documents:

"Cigarette smoking has not been scientifically established as a cause of lung cancer. The cause or causes of lung cancer are unknown" (The Observer 2003).

Does that rhetoric sound familiar? That's because it's the same strategy formula feeders use when referring to the risks of formula:

"Formula feeding has not been scientifically established as a cause of SIDS. The cause or causes of SIDS are unknown".

Science is by its nature fallible and to demand infallibility from it is to disobey Aristotle's wise injunction to expect only as much precision as the subject matter allows. Like the connoisseur of good vodka, the truth seeker should not demand 100 per cent proof. We have to live with a small measure of uncertainty. Proof requires us to move only beyond reasonable doubt. It cannot require us to remove all possibility of doubt whatsoever.

Here are some other strategies you may have witnessed formula feeders using to denounce breastfeeding science:

  • Conspiracy theories — Dismissing the data by suggesting the scientist or those presenting the data are involved in "a conspiracy to suppress the truth" (more on this bellow).
  • Cherry picking — Selecting an anomalous critical paper supporting their idea, or using outdated, flawed, and discredited papers in order to make their opponents look as though they base their ideas on weak research.
  • False experts — Enlisting an ‘expert’ in the field, or another field, to lend supporting evidence or credibility (think: Alison Scott-Wright, Clare Byam-Cook, Gina Ford, et al).
  • Moving the goalpost — Dismissing evidence presented in response to a specific claim by continually demanding some other (often unfulfillable) piece of evidence.
  • Other logical fallacies —for instance, enlisting the help of a straw man, or red herring.

For comedic entertainment, let’s take a closer look at the first strategy on the list: conspiracy theories. Denouncers view scientific studies which extol the superiority of breastfeeding or highlight the risks of formula as the result of a secret plot by exceptionally powerful and cunning conspirators to make formula feeders feel bad. In doing so, the formula feeder places their own idiosyncratic worldview above mainstream science. They present themselves as special, holding secret knowledge unknown or unappreciated by the scientific community. In their opinion, all those who appreciate the risks of formula are simply part of a brainwashed herd, while the formula feeder can congratulate themselves on penetrating the deception. This behaviour is, of course, delusional and self-deceptive, but it serves them well.

Such conspiracism often contains a particular narrative form of scapegoating that frames demonized enemies (The World Health Organisation, government health departments, scientists, lactivists, etc) as part of a vast insidious plot against their ‘truth’, while also valorizing the scapegoater as a fearless hero for sounding the alarm. In this sense, denouncing breastfeeding science is a strategic utility. It identifies elites (“the increased IQ of breastfed babies is simply because they have privileged, middle class parents”), blames them for social harm (“they make us feel guilty with their holier than thou attitude”), and assumes that things will be better once mainstream action can reform (“give formula feeding mothers a break”). Denouncers view themselves as a small group of freedom-fighters who set out to save mothers by doing battle with overly-risk-adverse health organisations. The self-waged war is framed as David vs. Goliath political activism. Yet the irony is that Goliath is not The World Health Organisation nor the government health department, as these establishments are in relative poverty compared to the true Goliath: The billion dollar corporations whom enjoy a grossly unregulated existence thanks to so-called free-market capitalist principles. Tragically, David has got into bed with Goliath.

The Denouncers' Motives

So why do formula feeders fight such a fruitless cause, even at the risk of looking absurd?  The irony is that, as I explained in my book, however much they deny, distort or misconstrue evidence, it continues to matter them - enormously. In fact, they deny, distort and misconstrue evidence because it matters to them. I continue to be impressed by how much time and effort they put into attempting to debunk Mother Nature, and I’m not alone. James Akre, member of the Scientific Advisory Committee for La Leche League and project officer for Unicef has a theory as to why formula feeders go to such lengths. He told me:

“In my 30+ years as an observer of this line of "reasoning" I don't recall ever seeing a single example of the case against breastfeeding that was written by a male (which is not to suggests that men are not using other avenues to subvert Mother Nature's market share). This suggests that the writers are doing their best to justify, or at least seriously minimize the risks associated with, routine - as opposed to emergency - artificial feeding. On a personal level, I'm left to conclude that this could well be based on their own experience as children ("I wasn't breastfed, but I turned out all right") or the choices they may have made as mothers.

No amount of scientific or epidemiological evidence will ever satisfy The Denouncers; the primary reason being that this is not an intellectual but essentially an emotional debate for them. In fact, the very word "debate" seems out of place. It's rather a variation on the classic "Don't bother me with the facts; I've already made up my mind!" outlook. But even that sounds too cerebral. We're talking exclusively gut-level stuff here. My feeling after hanging around the topic these past four decades is that based on the collective knowledge that is readily available to anyone with a keyboard and a broadband connection, if you don’t understand the facts today, you're very unlikely to understand them tomorrow.

I suggest referring to this particularly virulent variety of obstinate critic as charter members of the Flat Earth Society. I’m not joking, at least not in terms of the implications of their brand of reality that is being bandied about. We are mammals; this is what we do, or at least what we should be doing. To suggest, imply or otherwise posit that, alone among the 5200 or so mammalian species that have been evolving for the past 200+ million years, we are able to willy-nilly forsake our mammalian imperative with impunity would be risible if it were not so serious in its individual and public health dimensions.”

Like James, breastfeeding advocate ‘The Analytical Armadillo’ IBCLC believes the roots of denouncing lye in self-serving emotional safeguarding:

“It's very difficult for a mother to begin to contemplate negative implications that may relate to her own child - believing it's rubbish is an inherently more comfortable position.”

In other words, denouncing breastfeeding studies helps to justify the denouncer’s use of formula, masking it as an ‘equal alternative’.

Anthropology professor Katherine Dettwyler is another breastfeeding advocate that is dismayed by this strategy. She has observed:

“Of course, the reality is that for many children in the US, bottle-feeding doesn’t represent a ‘miniscule or poorly understood risk’ – it represents a well-established higher risk of many different diseases both in infancy and throughout life, as well as a risk of a lower cognitive functioning. And for some children, their mother’s choice to bottle-feed will result, directly or indirectly, in their death.”

The very notion of formula feeding entailing a degree of risk is unsettling to the formula feeder. It conflicts with their understanding of themselves as good parents. Faced with such disconfirming evidence, they will find a counterfactual way to criticize, distort or dismiss it in order to maintain or even bolster their existing beliefs (psychologists calls this cognitive dissonance). Logic is compromised in an effort to recoup lost esteem, so much so that the absence of evidence is even taken as evidence of formula’s risk-free status. So for instance, because a SIDS death cannot be attributed to formula feeding alone, they maintain that formula feeding has no part to play in SIDS.

Denouncing is not just about personal self-deception; it also acts as self-deception at a group level, insofar as many people believe the same falsehood. If a significant amount of the population can be raised on the same false narrative, for instance the belief that formula is similar to breast milk, this becomes a powerful force to reinforce and reproduce breastfeeding failure on a societal scale. Indeed, false narrative is infectious. One mother’s false narrative is another’s deeply personal group identity (“I’m a fearless formula feeder”). False narratives are often forcefully defended, and they provide a strong underlying system of easily biased logic for interpreting unfortunate social trends. Deception is involved in their construction. That is, people consciously lie to create them, but once created, false narratives breed via self-deception at group level.

Does something smell fishy to you?

Here’s the ultimate crux of it all: the denouncers’ focus on breastfeeding science is a red herring. By channelling attention to denouncing breastfeeding studies, denouncers strategically divert attention from, and obscure, an important reality: the *complete* lack of studies which show formula is as good as. Shouldn’t the burden be upon formula, a food that has been around for a very, very, very short evolutionary period of time, to prove it holds no risks for human babies?

To conclude: Those who denounce breastfeeding science are merely the exhaust fumes of the internet. They are an unfortunate and unavoidable result of our information age. Whilst emotionally satisfying for the denouncer, their pseudoskepticism has reckless consequences for the rest of society. Denouncers hold moral and political responsibility for selfishly promulgating misinformation to advance their own interests while knowingly damaging the work of organisations whose main focus is improving all our health. We need to reframe breastfeeding, not as some sort of ideology to be defended; but rather as a universal act of allegiance to our children and to ourselves.

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