Tuteur debate: Minchin 2

Tuteur debate: Minchin 2  is a two part reply for the historical record. It is in two parts.

The first annotates what  Amy Tuteur posted online on her Facebook page.  The second part is a  critique of her reply (Tuteur 1)  to Minchin 1.   Get a cuppa or a glass of wine and read on. See if you agree that I have uncovered an absolute howler of a mistake.

If in any doubt as to who says what, or whether my redaction alters the meaning of her reply, check the original. Some Michael Tuteur (son?husband?) shared the Dropbox folder, and the unilateral process maximises traffic to her site. Probably the reason for the “debate”.

Part 1. MM’s annotation of Amy Tuteur’s false and misleading waffle on Facebook.

My reply to that her post (Tuteur 1) follows on after this.

AT: Reply to Maureen Minchin’s non-responsive piece June 18, 2019

MM: This description is in itself a complete lie. The process we are engaged in, of sequential posts, (just not on your FB page where you can play to the audience) is the one you unilaterally moved the debate to (and I considered refusing) after I had initially agreed to a moderated verbal debate. You then challenged me to answer your question in a series of alternating posts. That is what I have done. MY ‘piece’ is a very responsive reply to your question. I expect you to reply to it. Then you changed the rules again unilaterally, or tried to. You claimed to want to apply the Oxford rules of verbal debate (check WIKI) to a written discussion. I kept telling you that I was committed to an impartial and documented debate, accepted your sequential posting, gave you times and dates and process to consider, and you kept ignoring  and refusing to respond in any way to my posts.  You were at all times well aware of my public posts. You had been told that I refused to visit your website (until now, being forced to in order to search out your multiple posts, in multiple places, which constitute not so much a reply, as a campaign of lies and misrepresentation and disparagement.)

AT: Maureen Minchin has refused to abide by impartial debate rules so she has forfeited.

MM: Another complete lie. See above. it is quite clear to me that you were counting on my not knowing that you were setting ultimata via memes. You, a contestant, appointed yourself judge (!), and declared that the other contestant had forfeited, while all along YOU KNEW that I was getting a process set up.  That seems to have been what spooked you into tossing me out. Ever since I accepted your behaviour it has seemed to me to have had the one purpose of getting me to walk away.  (As most people would have, and I was being advised to because this type of manipulation of the truth was expected of you.) Again, I think the record will show that. And I just went on doing methodically and carefully and fairly what I had said I would do.

AT: She’s still forging ahead any way, posting what amounts to an opening statement.

MM: No, it is exactly what I said it is, an answer to the question YOU set and challenged me to answer. To call it the opening statement in a debate is complete misrepresentation of my answer to the question. Your question was the opening statement in that debate, and it lacked any justification or argument. So my reply asked you, who proposed it, to justify it. You need to distort history like this because you know you were caught out trying an underhanded tactic, disguising your statement as a question, to put the burden of proof on me. In fact you are the one who needs to prove your deviant case. Just as flat earthers need to, when we have so much evidence that the world is round. Doesn’t stop them believing it’s flat, though.

AT: At no point does she provide any evidence that breastfeeding has been shown to actually have the benefits claimed; she simply repeats the claims.

MM: Not claims. The findings of world recognised bodies 1) who have appointed expert committees with specialist epidemiological training 2) to assess the clinical evidence found in multiple studies, and 3) on that basis published statements that I have read. That is evidence in any court room, in any government consultation. So it is evidence in a  written debate by two non-epidemiologists or other people on the subject. I can cite their findings, that’s my evidence. And in my book I do. I read what the experts write and think them credible. You read what the same experts write and dismiss it because it doesn’t fit your beliefs. That’s cognitive dissonance.

And I do more than repeat the claims. I tell people where they can go to find the evidence that convinced me. And since I have spent years putting that evidence into a printed book, I tell them where to find that book, even what page to check.  I give them the book. That’s a wee bit more than making claims. As you do, based on appalling misunderstanding of history and science alike, and perhaps a need to ensure your “six figure advance” was justified. Of course it’s not self-promotion or self-interest for you to make posts on, and put links to, the website for that specious book…

AT: On her Facebook page she reports that writing the piece was “a lot of work and great fun, too.”

MM: An author enjoying writing, that must be bad? Why wouldn’t I enjoy an intellectual challenge?  Perhaps you don’t, and that’s why your book is so badly researched, referenced and written.

AT: Maureen Minchin’s piece — verbose and self-promoting — is non-responsive. She has yet to show that breastfeeding has the benefits claimed; she simply repeats the claims.

MM: Cheap insults don’t deserve a response. And you are repeating the claim that I repeat the claims…. Try answering the questions in Minchin 1, which was my answer to your statement-disguised-as-a -question.

The above was the first part of Minchin 2.

What follows is my official reply to Tuteur 1 (in which she was supposed to reply to Minchin 1 and does not. Instead she puts forward an argument that in some ways is the argument for her own question, and in other ways is… well read it for yourself.)

This is an annotated version of Amy’s response to my answer to her opening quatement (statement masquerading as a question).


Q. Are the benefits of breastfeeding real and clinically relevant or merely theoretical and not reproducible in large populations?

AT: Here’s my response:
Public health initiatives, by definition, are meant to improve public health. They are usually based on solid scientific evidence, their implementation saves thousands if not millions of lives, and they pay for themselves many times over in lives saved, earnings preserved and medical expenditures averted.

MM:  Truism to set the scene for what follows. Nothing new there. Then we have more (which being utterly irrelevant I’ll delete) about the drop in vaccine-preventable disease and smoking, all unexceptional, and totally simplistic too. Epidemiologists would certainly agree that these were public health successes, but would add in many other factors contributing to the change. Still, I’ll ignore all that, and stick to the debate topic of breastfeeding. Except to say that where both those public health strategies are concerned, WEIRD nations have done much more than  “promoting”. They have altered societal conditions that make it now less likely that people will get sick, less likely that they will smoke, and spent billions to promote the desired outcome. And yes, we all  agree that “it has paid off in both lives and money saved”(AT)

MM: And so does breastfeeding: the economists can calculate it, and they know their job far better than any retired SOb. The World Bank says “Support for breastfeeding is one of the smartest investments in any country can make” and talks of its “critical importance to national development.” https://blogs.worldbank.org/health/breastfeeding-smart-investment-reaching-sustainable-development-goals 

MM: so some pages of waffle later, let’s get to the topic. 

AT: How about breastfeeding? An entire industry, the lactation industry, has arisen to promote and profit from efforts to increase breastfeeding rates.

MM: in typical fashion, this is Amy the non-historian putting the cart before the horse. It was an interactive mix of the increasing realisation of the risks and harms of formula feeding that led advantaged women to want to breastfeed, that led to a greater awareness of the need for better informed health professionals, better all round, better hospital practices, better information and equipment to facilitate breastfeeding in postwar WEIRD nations.. Breast pumps multiplied incredibly fast in 1980s USA where women had no decent maternity leave. Other countries followed suit at varying paces. Of course in capitalist societies it is inevitable that businesses of all kinds would see opportunities and create goods and services, most of which would be completely unnecessary, in a differently organised society.  One of the few things I agree with Amy about is that in the Unites States this has reached obscene levels, an added unnecessary expense, making breastfeeding seem like the province of the affluent.  I think only America would see giving a breast pump to every woman as a way of enabling breastfeeding. However some items are useful, and indeed some of the profits from at least one breast pump company are being fed back into trying to resolve the problems that employed breastfeeding women face.  But it isn’t breastfeeding advocates who own most shares in those companies; it wouldn’t surprise me if people like obstetricians did!

Only Amy has created a lactation industry out of small and large businesses making items that range from the useful to the bizarre. What items could we include in a definition of the infant formula industry if all the ancillaries needed for feeding formula and by formula fed babies were to be classified as one large industry?  the scale of the industry is of course is not comparable. Since 1980 infant formula industry has expanded from a global figure of 2 billion to closer to US$70 billion. 25% of that initially was funded by the US taxpayer, and it’s debatable whether the industry could have come so far so fast without that enabling.

What did the World Bank say about costs and benefits from this “industry”. “Our research shows that efforts to promote and protect breastfeeding cost an estimated $0.6 billion per year globally, with potential economic returns of about $30 billion per year over the next ten years. This is a return of about $35 for each $1 invested in breastfeeding promotion and protection. There are very few other best buys in development that can match these returns https://blogs.worldbank.org/health/breastfeeding-foundational-investment-human-capital And by the way, Amy’s book contains blatant untruths arising from either extreme ignorance or extreme malice or both,  about lactivists and money, which I’ll detail in the review of her book to be published separately.

AT: They’ve claimed a myriad of benefits for breastfeeding and predicted that an increase in breastfeeding rates would produce a decrease in infant mortality as well as reductions in a variety of diseases and conditions. Breastfeeding initiation rates have risen in response. They have nearly quadrupled since 1970 rising from 22% to over 83% today.

MM:  Who exactly claimed what exactly when?   Amy here is talking about breastfeeding initiation rates; she does not mention either breastfeeding duration rates or breastfeed feeding exclusivity rates. Nor does she mention rates of exposure to bovine protein in American hospitals over that same time. A recent audit of hospitals in one state of Australia found that around 70% of “breastfed” infants in one private hospital were given formula; public hospitals had reduced it to around 40%. As my book goes to considerable lengths to discuss and document, all those factors have an impact on outcomes both for morbidity and mortality, i.e. sickness and death.

AT: But the breastfeeding rate appears to have had no impact on the infant mortality rate. The graph below [source please I can’t read this] illustrates the steep drop in infant mortality over the course of the 20th Century. I’ve added markers for the breastfeeding rate at various points. As you can see, the precipitous drop in breastfeeding rates did not have an impact on infant mortality and the rising rate of breastfeeding initiation does not seem to have an impact, either.

MM:  What a howler! First, I can’t believe Amy can be so ignorant as to use these correlations, which she condemns as irrelevant when others make them! And surely she realizes that the 20th century was the period in which urban sanitation, antibiotics, better housing and cheaper food and dozens of other factors came together to lower infant mortality. 

Secondly, the USA still has a shameful infant mortality rate for such a wealthy nation. (Why is US and UK data collection being de-funded just when it might show these impacts because the significance of exclusive breastfeeding is being realized by scientists such as Professor Meghan Azad, including epidemiologists like Dr Maria Quigley?) The USA is about 51st in the world, with 50% more deaths than the average for comparable developed nations. 

Thirdly, she is wrong. A CDC discussion of US infant mortality rates shows that in fact there has continued to be a decline, but a slowdown in the rate of decline due to an increase in the number of premature and preterm births. (In short, there has been a drop since BFHI got going, despite worsening of preterm rates.) US data on infant mortality from 2005-2014 exists. Run through the whole free slide show online, from the Kaiser Family Foundation. https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/#item-postneonatal-mortality-2005-2014 A slide shows the ongoing decline and the fact that the rates are highest in non-Hispanic black infants. And that the lowest rates are NOT advantaged white women but Pacific Islanders…. what are the respective breastfeeding initiation and DURATION rates I wonder? I have no time now to research this properly, but clearly Amy Tuteur hasn’t a clue about doing even basic research. That took me 3 minutes to find.  

The science suggests that there is likely to be a significant decrease in infant, and maybe even, under 5 mortality if WHO recommendations about breastfeeding were ever to be implemented. (That is, exclusive breastfeeding from birth to around six months of age and then  continued breastfeeding with appropriate supplementation, into the second year and beyond.)  Where breastfeeding and the use of breastmilk has become exclusive (as in some neonatal units) the rates of sepsis, meningitis, and death have in fact dropped substantially. However, this is very recent and still rare, and there is always a lag in data collection and analysis. 

Recent studies –  the kind Amy rejects, the only kind that can be done without huge government funding – have shown that formula feeding doubles or even quadruples the risk of sudden  unexpected death in infancy (SUDI) compared with exclusive breastfeeding for two months. The dose, the duration, and the exclusivity of breastfeeding are all significant in rates of sickness and death in childhood in every nation. But they are not being researched, recorded, or analyzed on a national scale. So if we exclude all smaller studies, there will never be any data that Amy would consider real and relevant. Unless she likes the outcomes they produce, of course! (Btw, Amy’s elite white privilege shows up all the time, and is discussed in my review of her book, soon to be published.)

AT: Breastfeeding was supposed to prevent obesity, but obesity rates continue to rise.

MM:  data? age group? reference?  Amy creates straw men and never references her statements, so no one can see if she is quoting accurately, or know who she is quoting. Then sweeps in to say How absurd! Yep. She is. I don’t think anyone ever thought that breastfeeding was going to end obesity in humans on a SAD, what Nestlé calls the Standard American Diet. There is, as she said, a lag factor: a rise in 50 year olds might relate to feeding in 1970. Any rise in 5 year olds in Australia might relate to newer formulas on the market with 18grams of protein per liter. I know in the 1970s I checked formula amounts on cans, and assumed that  more would be better. (because “They wouldn’t let them sell it if it wasn’t perfect, would they?” I know more about composition and regulation of infant formula now!) Breastfeeding is being shown in studies  to reduce the risk and degree of obesity in infancy. In some follow-up studies that benefit persists, in others it doesn’t. Because the problem is multi-factorial. It is many other factors – including the parents’ lifelong diet, and the food the child is given to supplement breastmilk and then after weaning, that will determine the outcome for individuals. 

However people have a better chance of avoiding obesity as an adult, if in fact they do not start life obese, or are not programmed towards obesity by gut microbes that prefer obesogenic foods. Or their parents weren’t. Read Milk Matters about this. Check the references or read them for yourself. Don’t trust my reading and above all, don’t trust Amy’s sweeping generalisations. It’s quite clear that the early microbiome can program child development towards obesity. And that gut is affected by exposure to infant formula, even among children subsequently breastfed after hospital discharge. More recent Canadian studies (google the major Canadian CHILD study and author Meghan Azad) have shown differences at 12 months even between exclusively- and partially-breastfed, breastmilk fed, and formula fed infants. Interestingly, if we listened to mothers talking about formula, we might learn a lot about what grows fatter/taller  babies. 1980s Vietnamese mothers in Melbourne valued chunky babies as a sign of health -which it is in traditional cultures. Their strongly preferred brand was the one with the highest protein levels at the time. 

As I said in Minchin 1, my answer to AT’s original question, the infant formula industry understands this better than anyone, and is working to reduce protein and total calorie levels in infant formula now that causative pathways are being revealed (by yet more small short-term infant studies Amy doesn’t believe in). Every reformulation is an enormously complicated task and runs the risk of creating new problems of excess or deficiency, as the testimony of long-time Ross/Abbott expert Duane Benton described in the USFDA’s Food Advisory Committee meeting on Infant Formula, November 18,2002… (And problems can only be identified after the fact, when many thousands of children have been fed on the formula, for the problem to have become obvious. One famous B6 deficiency problem was the result of a simple error in processing temperature, and might not have been damaged US children’s brains if the child was not exclusively fed SMA from that faulty production line. But as Benton said in that meeting, a colleague had “spent his whole career going into court cases in relationship to that.”) [Parent alert here: it’s probably safest NOT to buy a lot of the same brand and batch of one formula, but  buy smaller quantities and different brands. That was the advice of Formula Inc, a group of parents whose children were harmed by the absence of chloride.] 

But obesity is a vertically communicated problem. Even breastfed infants are affected by obesity in their parents. Both parents. Mothers get the blame and shame all through pregnancy by obstetricians and nurses and dietitians if they are overweight, but micro RNAs in sperm can affect gene expression, and gene expression affects development.) All this stuff is in Milk Matters if people are genuinely interested in learning.

AT: It was supposed to prevents (sic) asthma but rates have continued to rise.

MM: again, who said that? and what did they say precisely? Nothing will prevent asthma where there is inherited airway hypersensitivity, and enough diesel particulate or pollen or volatile organic compounds in the air. There have been multiple environmental factors that affect outcomes here. Infant feeding is only one. But a significant  one. Breastfeeding, by creating a healthy normal immune system, may reduce the severity, delay the incidence, and limit the damage caused by asthma. Studies of the kind Amy dismisses as worthless show that. Changes in the microbiome affect the immune system,  and all human development, have been brought about by deviant infant feeding over a century will not vanish overnight. It has taken some generations to breed these problems in, In the 1930s, eczema was seven times more likely in children not breastfed.  but those children survived with their altered immune systems and created and gestated the next generation.  Within two generations, eczema once rare,  has become common even in breastfed children, although it emerges later, and is usually less severe, than in formula-fed children, and responds well to maternal dietary changes. It is unlikely that one generation of breastfeeding or even two, will breed out the altered gene expression, if the experience in other mammals holds true for humans. 

AT: In fact, nearly all the predictions that flow from claims about the benefits of breastfeeding have failed to come to pass. 

MM: another sweeping generalisation with no evidence, no documentation of source, no awareness of the limitations of what was looked for, or what could be looked for. Are we really supposed just to believe that if Amy says it, it must be true? Effectively this woman is saying, ignore the authorities and the scientists. I am doctor god – believe me! Where is the evidence? the reference to the evidence?  does AT really believe that the American Academy of Pediatrics put some of those diseases on its list just for the heck of it and despite serious opposition? Does she not realise that the AAP must have had valid documented evidence that infants had been sick or died as a consequence? Which makes the evidence clinical and it makes it real. All too real for the parents, some of whom may have formula-fed because of piffle like this. Amy is truly saying that infant feeding doesn’t matter  in a country where as far as Amy is concerned, the water is always clean, people are always able to afford enough of the food, and babies always get it mixed right and perfectly delivered. And of course the product itself, the ultra-processed multi-mix of foods that is infant formula, never has problems – though the affordable powder cannot, of its nature, even be sterile. (While the additionally heat-treated ready-to-feed liquid, that people like Amy can afford, will carry more of the AGEs associated with harm – see  below.)

AT: That raises the question: Are the benefits of breastfeeding real? It also raises a follow up question. If the benefits of breastfeeding are shown to be real, are they clinically relevant?

MM: next we get  a lot of rhetorical and simplistic blah [edited out] to say a few very basic things: (talk about verbose!) I am prolix, not verbose, Amy, because there is a lot of information to convey to people who might be glad to have it. Defacing my posts with coloring pencils might be stress-relieving for you, but it is pointless. There are people who will check whether what we say is true, and you have given them NOTHING. Next revelatory point you make follows:

AT: “We can’t consider results real unless the same results occur repeatedly” and “have been corrected for confounding variables”.

MM: Oh duh. Yes, true, no one denies any of that. Tick, you might pass Stats 101. And virtually all studies nowadays are getting better at that. Except, as yet, where it comes to getting true detail of infant feeding: that is still rare, despite being a potent confounder. We should even be getting brand and batch of formulas, as these can vary widely and there are no independent  data on which, for example predisposes most to obesity, or eczema which often precedes asthma, or which results in the biggest difference in brain white matter.  Formulas are not all the same; they are all different, and they will have different effects. One of the things that makes it hard to measure the impact of infant formula is the lack of comparative data. The reality is that parents can make a more informed choice about an appliance they want to buy than they can about the food that will build their child’s bodies, and affect the health of the grandchildren. Did you, dear reader, realise that the so-called low allergenic formulas touted to reduce allergy outcomes have just been shown to increase them in one study?  And this is biologically plausible, because the more processed the product, the higher the level of what are known as advanced glycation end  products (AGEs). If you doubt the truth of that statement you really do need to read Milk Matters.  And look up AGE’s. https://www.researchgate.net/publication/263581993_Advanced_glycation_end_products_in_infant_formulas

AT: “Even if it were a real result (reproducible and corrected for confounding variables), it isn’t a clinically relevant result.”

MM: not necessarily true. Might well be clinically very relevant to some people.

AT: I’m asking whether they [the benefits] have been reproduced, whether they have been corrected for all confounding variables and whether they make a meaningful difference to the health of babies and mothers.

MM: Fair question, no problem with that. Pity you don’t check what the detail in the studies could tell you about all that. What follows is a lot of dramatic gestures and very little content, so I’ll compress this next bit down to what is being said, by taking out irrelevant rhetorical flourishes. I think that reading what she says next, most scientists’ jaws would drop. She goes on to say:

AT:  What won’t answer the questions? The statements of authority figures or organizations, scientific citations of studies that found effects in small groups, the naturalistic fallacy (“if it’s natural it must be good”), personal beliefs and personal anecdotes, mathematical models based on extrapolation of small studies.

MM:  I didn’t invent that. She really said it. Well, that’s the end of most medical and pharmaceutical research. Out goes all infant formula research, which often consists of groups of 40-100 children at most. There goes our beliefs about how food works in bodies, which are based heavily on animal studies -as I said, pigs and rats for formula. This is such an incredibly ignorant comment. How did scientists and society find out about smoking causing cancer? individual case histories, small studies, animal experiments, mathematical models, basic biology which suggested that lungs clear of tar might work better (but that’s the naturalistic fallacy) – all played a role. The accumulation of evidence took forever because of denialists, and people died because commonsense was rejected, basic biology ignored, and expensive lawyers created doubt. They did it deliberately, and knowingly killed people. It took societies decades to make the needed changes actively to reduce smoking, because of the vocal opposition of a minority of denialists. That’s how they work, to ensure no sudden changes threaten what is benefitting those wealthy enough to have shares in lucrative products. 

Amy Tuteur is following in a great tradition – the tradition of the industry company lawyers, whose tactics are beautifully described in David Michael’s exceptional book Doubt is their Product: how industry’s assault on science threatens your health which you can look inside at Amazon https://www.amazon.com/dp/019530067X/ref=rdr_ext_tmb  and another book, Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming  https://en.wikipedia.org/wiki/Merchants_of_Doubt  I can only hope she would have enough integrity to disclose any potential conflicts of interest she and her whole family might have by benefitting from such companies. But I  don’t think that’s necessary to explain her views, and I also think no infant formula company would want to be publicly associated with her. Their marketing is much less abrasive, far more clever.

Let’s be clear here. If that scientific consensus is right, lives will be lost and harms created if we do not act as fast as we can. Wealthy white women like Amy who oppose those changes are not immune, but most of the misery they cause is felt by the most vulnerable. The data collection and graphs come later, when we can assess outcomes of public health measures put in place usually by more ‘democratic socialist’ parties. It is not a coincidence that the most conservative parties (read funded by the richest industries) de-fund data collection as a waste of money – as a response to inconvenient truths data could reveal. 

AT: What would answer the questions? As with any public health measure, the proof of the pudding is in the eating. In other words, the benefits must be measurable. [more pointless rhetorical flourishes re smoking and vaccination removed ] Should we believe that breastfeeding has a myriad health benefits for term babies including saving lives if no one can show that any lives have been saved? No.

MM:  But that of course is where Amy is revealing her ignorance. The mortality rates cited above say so. Lower rates of necrotising enterocolitis in preterms she accepts as real, in her book anyway. What about the studies showing higher rates of cot death for the formula-fed? Not to mention higher rates of death and many other disease in children right across the world.  As I have said repeatedly, infant mortality data has never recorded or reflected the detail of infant feeding as it should. A senior pediatrician at the Royal Children’s Hospital in Melbourne told me,  “Each summer we have a wave of formula fed kids with gastro, in the winter it’s bronchiolitis, and the really sick ones are all formula fed. Any breastfed kids are well enough to stay home, it’s the bottle fed ones we have to admit.”  There’s no money in it for a public hospital, and budgets are always stretched, so they keep kids out of hospital if at all possible. But they don’t accurately chart and write reports on the detailed feeding status of the children, or the world would know what a difference it makes to infants. Why not? Does the fact that formula companies support them financially affect their willingness to expose this, or is it the vocal elite women screeching that they would only be doing it to upset and shame the mothers? The fact is that most formula feeding parents do not even realize that formula cannot be sterile, and can contain nasty microbes like Salmonella, Enterobacter, Cronobacter, Klebsiella, causing serious illnesses like meningitis and sepsis as well as diarrhoea and vomiting needing intravenous rehydration. 

The cause of sickness or death in such a child will not be listed as contaminated formula. It will be diarrhea, or respiratory disease, as the case may be. And to try and prevent it after just one such case in Australia, supermarkets will offer hand wipes. Why? because a mother alleged that it must have been the trolley, because the child hadn’t eaten anything but formula after being discharged from the hospital the first time, but had sat in the supermarket trolley, gripping the handle, on the way home. Parents are often blamed for contaminated formula, when the bugs could well have been in the tin before they opened it. And if you think that’s alarmist, you really need to read the second book within Milk Matters. 

AT: Should we believe that breastfeeding has a myriad of health benefits if incidence of the diseases that breastfeeding was supposed to prevent remained unchanged or even rose? No.

MM: After being offensive again, the equally prolix AT concludes by saying that MM  “couldn’t find any data• that shows that the benefits claimed for breastfeeding term infants are real or clinically relevant.”

MM: I did find the mortality data she overlooked! But has the woman no common sense? I did not go looking for DATA other than that.  Locating the data – and there is a lot of it – was the job of expert consultations, conferences, organisations, committees. They then examined the data and wrote the statements. 

It’s simple. AT chooses not to believe them. She is a denialist. She chooses to believe that all of those highly intelligent people – most of them even doctors, wow! – were incapable of thinking the very simple thoughts that she has about what makes a reliable study and produces good data.  The Oxford Perinatal Epidemiology Unit and similar research groups provide the data to experts capable of assessing it. They would be laugh at what Amy says above abut what is valuable research. AT seems to think that unless the world already has the relevant charts and graphs published where she can easily find them, that data does not exist. 

It does exist. How else would the World Bank be convinced to find the tiny amounts of money it does for breastfeeding work, compared with the billions spent on encouraging the cows milk industry globally? Or are World Bank experts also  “lactivists” whose sole purpose in life is to make money by cruelly shaming elite women who choose to bottle feed formula? Yes, that’s what all those breastfeeding advocates are and do, the ones who spend a lifetime helping women. Including the still voluntary, still free, LLLI which Amy defames in every legal sense of the word. Read more about the great global lactivist conspiracy (as Amy construes it) in my review of her book, which will be posted on my website as soon as possible. Go to www.infantfeedingmatters.com and search for Tuteur. Search button is top right.

Maureen Minchin to Amy Tuteur and indefatigable readers

A  final comment on your reply (Tuteur 1) to my answer (Minchin 1) to the question you set. 

(Tuteur 1) fails to address even one of the questions I asked in Minchin 1. Saying “I don’t agree” and providing no proof is not addressing the question. That is enough for me to say you have breached the basic rules I agreed to debate under. As promised in that public document, and for the record, I plan to highlight the questions you failed to answer, and re-post Minchin 1 on my website. Failing to address any point a second time is seen as one of two things. 1. you accept their validity; or 2. the debate is over, because you are not engaging with the questions I have asked you, in an effort to get you to provide some evidence for a monumentally stupid question. 

Amy Tuteur, you are saying, in essence, I know more than anyone in the world; that everyone who disagrees with me is venal or stupid. Take Amy’s word for it, ignore the global consensus of expert intelligent humans that MM calls on. Since it’s possible to monetise divisiveness and conflict from fake news, in the USA I guess you can continue to look forward to the next six figure advance that you boasted of online.

I formally demand that you cease and desist from posting my blog on your site and instead post the link to this website where it can be read, or my Facebook page.

• Certainly not in the three weeks I had, much of which was spent trying to get you to make some common arrangements that were impartial and would provide a permanent record of the conversation we would have. [You may well have spent months preparing this spiel and graphs, though it seems strangely familiar and I think I’ve seen this elsewhere, or much of it. I told you in March that I could not consider even the arrangements for the debate before the end of May. Some of us breastfeeding advocates are busy helping women and educating health professionals!