Tuteur debate: Minchin 3

Maureen MinchinBook Reviews, Bottle Feeding, breastmilk, Child Health, Commentary, debate, epigenetics, General News, Immunology, Infant Formula, Infant Health, Lactation, Lactivism, Maternal Health, Microbiome, Milk Hypothesis, Milk Matters

TUTEUR MINCHIN DEBATE

 MINCHIN 3: A REPLY TO TUTEUR 2

 Thanks to an onlooker, I received a copy of Amy Tuteur MD’s latest reply, which I discovered online at 12.30pm today June 21. It is not a reply addressed to me, but to her supporters. It is they who matter. 

  And to them I say that in my opinion,  AT has given up any pretence that this is a serious intellectual debate. In that, posts are secured from tampering and  promptly shared, each party understands and addresses what the other says, and the whole debate can be accessed easily and read by those on both sides, with no advantage to one party accruing from the location of posting.

That was what I envisaged, with professional help wrote procedures for, and attempted to negotiate with AT. Who refused to engage, and then worked to her own rules, which include changing the mode of the debate, insult, harassment,  theft of intellectual property, petty tricks to prevent posts  being available freely on any other site but hers, misrepresentation of what was posted, and encouraging her supporters not to read the other party’s post. She is conducting a shameless political campaign to discredit important information that directly affects the lives of all involved. She has been for years, and she has harassed and harmed many people in the process. Just how many I am only now learning as more people tell me their stories of online trolling.

Gloves are off, people. After Amy’s last post, I feel free to enjoy gently scoffing, and speaking very plainly, sometimes to you, and sometimes to her, as part of an appropriate response. Which will also include useful information and links, and an invitation to my Facebook page. Get yourselves a cuppa or a long drink.  This has to be long to cover important issues. Don’t read it if you don’t want to learn. And vice versa.

What follows is an annotated version of that unedited posting (Tuteur 2 for the record.) by retired obstetrician, Amy Tuteur. This document  is thus Minchin 3. Italics for Amy’s words.

 Reply (Minchin 3) to Tuteur 2 (italics)

AT: Maureen Minchin uses 6000 words to say “no,” she can’t show the benefits of breastfeeding are real.

MM: Those 6000 words do a great many things, but not that. As by the end of this readers may realise.  Among other things, they expose one of Tuteur’s glaring mistakes; and she hasn’t even tried to explain it away, but tries to get her followers not to look at it. (Acknowledging a mistake was never a choice for Infallible Amy.)

What was that mistake? In Tuteur 1, AT used a daft correlation with what she said were not-declining US mortality rates, to ‘prove’(Ha!) that the increase in breastfeeding initiation has had no effect, prevented no deaths of term infants. As I pointed out to her in Minchin 2, that correlation is absurd, one way or the other, when so many factors influence the outcome. (Like the higher incidence of preterm births, for example.)

And I also pointed out to her that, in just three minutes of Google searching, I had discovered two facts of interest.

  1. That she was WRONG: US infant mortality has declined in the period that BFHI has begun to be implemented. The link to the data is in Minchin 2. And a declining infant mortality rate proves nothing, but suggests the need for research, while the correlation suggests rising breastfeeding rates could be part of the reason.
  2. That the group of US citizens with the lowest infant mortality rate was not advantaged white women, Amy’s demographic; they came second. The lowest infant mortality rate is among Pacific Islanders resident in United States, who come from a culture supportive of breastfeeding.  Coincidentally or not, I can’t say without further research. The correlation proves nothing. For Amy or me.

To assert that IM rates are not declining was a total blunder by AT. Which by itself is not important, but says a lot about her research skills and care in citation. 

No wonder AT has failed to post Minchin 2 on her FB page (after posting an unreadable defaced Minchin 1 – to drive web traffic to her site, and keep her followers away from mine.)

AT might claim that she has not posted Minchin 2 because I requested her to cease and desist from stealing my intellectual property. But I had told her exactly that in writing many times before, and it had not stopped her doing so. After all, this is a person who with her lawyer husband’s help has even fought a court case over her stealing and defacing other people’s work. https://www.casemine.com/judgement/us/59145ed2add7b0493420f9f2

So I was not surprised when AT ignored my request to stop stealing. I was surprised by the juvenile colouring-in tactic though. I had thought I was debating an intelligent (possibly psychologically challenged) adult.

And I was not surprised that she did not post Minchin 2 on her website!

AT: Those who are following the debate between Maureen Minchin and myself may recall that in my response to her opening statement I noted:
The widely touted benefits of breastfeeding are based on extrapolations of small studies riddled with confounders. The impact of increased breastfeeding rates predicted by lactation researchers have failed to occur. There has been no measurable impact on mortality of term babies or anything else. That’s in direct contrast to the benefits for extremely premature babies where increased use of breastmilk has led to a decreased risk of necrotizing enterocolitis and death. 

I pointed out that Maureen, despite putting a lot of words on paper, had not demonstrated that breastfeeding had saved any term babies’ lives, prevented any diseases or saved any money. I asked once again if Maureen could find any real world, population based evidence that breastfeeding has the benefits claimed.

MM: And I responded in some detail, which you can read for yourselves, as autonomous intelligent adults capable of rational thought,  in the file Minchin 2 at https://infantfeedingmatters.com/tuteur-debate-minchin-2/  My reply to Amy’s starting question, Minchin 1 (Amy’s Dropbox colouring-in project) is at https://infantfeedingmatters.com/tuteur-debate-minchin-1/ Those are the links Amy didn’t want to give you, to keep everyone reading on her FB page. And by the way, are  preterm babies’ lives unimportant?  If breastmilk can save their lives, why would it not save others, sick term babes for example? Immune factors in breastmilk don’t stop working when baby reaches term.

AT: You can find her bizarre, meandering response on her website. I read it so you don’t have to.

MM: OMG! She really says that!  The god-doctor can be trusted  to give you an accurate detailed account like this one. She really doesn’t want you to go there and find out just her bad her research has been.  That is such an insult to you all. If you were not offended you should have been.

And again she uses insulting emotive adjectives to describe what other people find to be coherent and informative narrative. There is a huge amount in what I write that she doesn’t want you to know. And I have this annoying habit of telling you where you can find it, and making it easy for you to check the truth of what I say. While she leaves you to search for a site she could have given the link to. Tactics, Amy, that do you no credit at all, and proclaim that this is political debate, where dirty tricks and insults and imputations and cartoons are usual. [Btw, Amy,I’m not bothered by being less computer savvy than you or Michael.  I’m in my 70s and can do enough to get things written. In fact, I loved your cartoon of a child not being able to see something. After reading Tuteur 1 and Tuteur 2, I felt it was a really good portrait of you.]

Amy-fans, there couldn’t be a greater contrast between the way I treat my followers and the way she is treating hers. Essentially she is saying to you, “believe me”.  Don’t believe global authorities – many of them doctors – who have studied the matter, looked at all the evidence, and made careful statements.  You can’t trust them, from the World Health Organisation to the American Academy of Pediatrics to the American College of Obstetrics and Gynecology to the CDC to UNICEF to national governments everywhere. All evil lactivists, and not credible. You can trust me, the 16 years-retired obstetrician.  I know better than all those experts. I reject the very evidence that convinces them. I define evidence as I want it to be, not as internationally recognised epidemiologists declare it to be. “Trust me, I’m a doctor.” She’s always made much of that, and used it to dismiss others who are not. Yet many of the people who reviewed that evidence and made those statements are doctors. Such as Dr.Alison Steube MD, MSc, FACOG, FABM USA; Associate Professor for the Division of Maternal Fetal Medicine at the University of North Carolina School of Medicine, Brigham and Harvard educated. Or a PhD doctor, like Larry Grummer-Strawn of WHO, former head of the US Centers for Disease Control Nutrition Unit …whom she has harassed, who was involved in drafting WHO’s statements. Don’t trust a man who has risen to the top in both the US and the global health community, necessarily the epitome of moderation and caution in language. Trust DrAmy5@aol.com (someone just shared that email with me) who boasts that she got “a six-figure advance” for writing the rubbish she does? If you choose to put all your faith in her,  and not listen to others, you are part of a cult,not part of an intelligent group of people wanting to know the truth.  AT is powerful in an era of fake facts. I think she is a sad joke in the world of research.

AT: Maureen Minchin uses 6000 words (??!!) to say “no,” she can’t show that the benefits of breastfeeding are real or clinically relevant.  She couldn’t show evidence of lives saved. She couldn’t show evidence of disease incidence reduced. She couldn’t show evidence of money saved, either. 

MM: Didn’t try. Minchin 2 was once again asking Amy Tuteur to prove her case, since she is the one who started this whole process by posting as a question an evidence -free statement. No point posting individual studies when the consensus arose from not one, but meta-analyses of a multitude of studies, all of which Amy deems inadmissible evidence!

 AT: Moreover, she admitted why there is such a massive disjunction between benefits claimed and benefits realized.  About 4000 words in, she first quotes me:  “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.” Then responds: 

“…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.”

Thank you for admitting that, Maureen. The widely touted benefits of breastfeeding are based on small studies with tiny sample sizes and animal studies. I’m not sure she even realizes that she has conceded my point. 

[MM: I don’t have to explain to any scientist how silly that comment is. Or anyone with basic logic or comprehension skills. Read what I wrote in context. I am saying that the whole research enterprise has many facets, and we always rely on exactly the types of study that Amy refuses to accept, in just about every other field. Perhaps above all in clinical medicine, and infant feeding! where small studies allow a product to be marketed well ahead of any proof of safety and efficacy, and the population level trial consists of the infants who use the product… but that unsupervised trial is not actively monitored or reported on. In a very real sense, with each new formulation, the infants who drink the product are the guinea pigs. [Oh yes, the FDA asks for post-market surveillance reports – and  none exist.]

AT: She then goes on to say:
“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.”

MM: Yes, I did say that. And yes, they did play a role.  Hypotheses and science all arise in multiple ways. The natural fallacy made people suspicious; the animal studies looked and proved the suspicion was plausible, indeed provably real n mammals; clinicians noted the link in small human studies; then bigger studies; and causative evidence accumulated. The number of smoking hamsters or rats or dogs sacrificed to seeing if smoking was the causative agent would run into thousands, I expect. The carcinogenic compounds were identified in laboratories. Large scale epidemiological investigations followed all that, and produced the statistical links to a degree of certainty. Still not to everyone’s satisfaction. And all the time the tobacco industry funded prominent denialists, AT analogues, to say “Not proven to MY satisfaction. And (often) I’m a doctor.”  Read the books cited in Minchin 2. The denialists funded biassed studies; contested  studies showing the link as not being big enough to be anything more than coincidence; claimed that the disease had other causes;  claimed confounders were not considered; said it was a false correlation….(all the things that AT does about breastfeeding, in fact. And the flat-earthers do when someone suggests the earth is round.) So it took a long time for what is now-accepted-truth to emerge and for societies to start to change.

And all that time, people were needlessly dying.  As they are now, mothers and children, from failure to breastfeed and lack of breastfeeding and from exposure to formula at an unsafe age, before the gut microbiome and immune tolerance is established, before infant bodies can handle foods other than breastmilk. (As a complex processed food and part of the diet of an older child, formula is not really an issue, though fresh foods and water can do the job better than any highly processed food.)

AT: But scientists were spurred to investigate the link between cigarettes and smoking because of clinical evidence — real world, population based data; the incidence of lung cancer was rising and people who smoked had a much higher risk of lung cancer than those who didn’t.  

MM: as noted above, global epidemiology done by epidemiologists follows, not begins a process of discovery. Because the data has to be produced before it can be analysed.  And massive research projects on a national or global scale are not done on speculation, but as a result of concern arising from smaller studies, animal data, laboratory studies, and all the rest… It all starts with an hypothesis. And that is often generated by observation by a layperson. Judy Graham springs to mind, a woman who changed the outcome of MS for many thousands of people by ignoring a gloomy prognosis and becoming an expert who taught doctors. https://overcomingms.org/latest/managing-multiple-sclerosis-naturally-book-review 

AT: In the intervening 55 years since the publication of the Surgeon General’s Report on smoking and lung cancer, the predictions made have come true. Physicians and scientists predicted that the rate of lung cancer would drop if fewer people smoked. That’s exactly what happened. 

MM: Ka Ching!  at last, a true statement!

AT: That’s a stark contrast with breastfeeding. Nearly all of the predictions made by smoking researchers have come to pass, nearly none of the predictions made by breastfeeding researchers have come true.

MM: oh dear, back to unsupported assertions. Suddenly we go to “nearly all”, a sweeping generalisation when only the most obvious prediction has been described. What were the others? (Not that it matters. The change is for the public good. we don’t need to prove what commonsense knew in the era of badges saying “Your rights end where my nose begins”.)

But the sweeping generalisation, “nearly none”  – of what predictions by which breastfeeding researchers? Again, obfuscation and blether. In fact, if she is referring to excellent statistical work projecting massive savings in lives and societal costs, by Melissa Bartick, the World Bank, UNICEF and WHO, or the Oxford Perinatal Epidemiology Unit, we could not expect the predictions to have been proved true. Why? Because the clearly-stated conditions for the projections – the extent  of breastfeeding in practice and its duration – have not been met. Ta da! You don’t have to be a genius to know that you can’t discover the effects of what hasn’t yet happened.

AT: The bottom line is that Maureen has acknowledged that she can’t show that the benefits of breastfeeding aren’t real or clinically relevant. 

MM: ANOTHER true statement, hallelujah!  I, MM,  absolutely “can’t show that they aren’t real or clinically relevant,” Infallible Amy.  Because they are real. Double negatives there make a genuine positive. Do I now assert that you have agred with me and the debate is over??? What a hoot. Oh, and don’t take that first phrase and sentence and misuse it, petal. That would really show you up as a fraud.

AT: That’s not surprising. Over the years I’ve asked real breastfeeding researchers from Melissa Bartick to Amy Brown to Jack Newman to demonstrate that the benefits of breastfeeding are real. They haven’t been able to do it, either. 

MM: Fanfare for Amy! She has badgered and bullied these incredibly helpful and useful humans,  people who are actually helping mothers breastfeed, to the point where they have given up trying to communicate with her. They still have to endure stressful online abuse from time-wasting AT-linked trolls. Some people find that not only takes valuable time, but messes with their minds, and causes severe harm. It silences many others: they won’t say what they think or they’ll have to deal with that stuff. What a win for truth and knowledge such nastiness is. That will really save lives and healthcare costs. Not.

At least my friends Melissa, Amy, and Jack are “real breastfeeding researchers”.  Which implies that I am not. Oh golly gosh, how hurt I am – an expert like Amy doesn’t recognise me as a researcher.  A medical historian whose job it is to make the history and science intelligible, and I’m not really a researcher. Scientists seem to think I am a useful researcher, and commend my writing, but I am just devastated that a Denialist Obstetrician doesn’t. NOT.

AT: The only remaining question is whether anyone should continue to believe that the benefits of breastfeeding are real when its strongest proponents CAN’T show that increased breastfeeding rates have had a meaningful impact on the health of term babies.

MM: I just love people who ‘should’ others. “Should” you continue to believe that the benefits of breastfeeding are real? AT thinks you shouldn’t. She can tell you what to think, don’t bother reading for yourself.

But even if AT was right, and she is not, “a meaningful impact on the health of term babies” is not the only reason to think that breastfeeding matters. Note once again, how much AT cares about the lives of women and families. Dr. Mike Woolridge has rightly pointed out that her advice is selfishly putting other women at risk of reproductive cancers, after lowering her own risk by breastfeeding four children. It’s not only that risk though, which is now widely accepted fact.

https://www.nytimes.com/2018/10/26/well/family/breast-feeding-is-good-for-the-mother-and-not-just-the-baby.html? 

Studies show many other maternal risks are increased by not breastfeeding. diabetes, heart disease for starters. https://health.usnews.com/health-news/health-wellness/articles/2014/09/12/why-breast-feeding-is-important-for-moms-heart-health? Those can be based on big studies because the diseases are so common. There are many other health effects, as for instance in multiple sclerosis, where the small numbers with the disease mean that pooling small studies is necessary to assess risk. Tuteur would dismiss all that information. To what end? And only 1 in 6 women are told any of that. Check out this 2018 link. https://doi.org/10.1089/bfm.2018.0170 A quick google ( I am short of time here) reveals that one of the breast cancer studies published 17 years ago was a collaborative re-analysis of data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96973 women without the disease. (Lancet. 2002 Jul 20;360(9328):187-95.) There have been others since.

What is the only remaining question?

I disagree strongly with AT about the only remaining question. For me the only remaining question is, Why on earth would this affluent white American set herself up in opposition to this particular global consensus?  There simply is no question that not-breastfeeding creates additional risks and harms. To women and children. Those risks and harms would be less if we lived in a society where breastfeeding was not so much promoted as protected and enabled. Promoting breastfeeding without protecting and enabling it puts the responsibility onto individual women. Many are not going to be able to breastfeed for any length of time due to circumstances over which they have no control. Many more will attempt to breastfeed, and for lack of support and good clinical knowledge will be unable to nurture their babies fully at their breasts. Not because those breasts would be unable to feed the baby, not that that woman’s body is defective, not that that mother does not want to breastfeed. But because the early stages of breastfeeding are hard for many women in any society where it is not taken for granted and the skills learned from childhood by observing mothers feed their babies. And when that early stage is hard, telling women that it doesn’t matter, (because there is a second good choice that makes no difference to outcomes) undermines motivation to continue. And so many women are robbed not only of health benefits, they never reach the stage when breastfeeding is a comfort to both parties, a unique form of intimacy, a perfect pacifier, an absolute joy, a validation of your worth as a mother and a human being. (And I say that as someone who experienced 3 months of excruciating nipple pain en route to that experience, pain that was gone in 48 hours after accurate diagnosis and appropriate treatment. Which I discovered for myself in a book by a 1950s UK obstetrician that my 1970s doctors had not read.)

And of course,  breastfeeding benefits the planet as well as the participants. It is not simply a question of health. This debate did not include any mention of the serious environmental consequences of artificial feeding of infants. Those concerned about the environment and about climate change and about the world’s diminishing water supplies should all be concerned about the massive expansion of formula use around the world. in which the example of elite women like AT plays a big part.

Which, for me,  all adds up to this.

For any educated person to be actively involved in undermining the idea that breastfeeding is critically important in today’s world seems to me utterly irresponsible.  Which is one of the reasons why, when challenged to this debate, I did not walk away.  And I refused to walk away despite being goaded to do so multiple times by both Amy and her cronies.  Despite being told that I had forfeited by the contestant turned judge and jury. Despite knowing that it could only be an unpleasant and wearing experience (but being an optimist, hoping that it might not be).

In fact it has been a great deal more entertaining and easier than I had feared it might be.  And once again, I am feeling very happy that I took the decision, when challenged, to stand up to a bully.

PS. Whoever it was that made a $500 bet that I could not possibly face the doctor has lost it –  sorry, but I hope you pay up!  You should have known a little more about me,  before you risked that amount. And so we come to the signature. Amy Tuteur, MD 

MM: Yes, don’t ever forget the MD,  my poor Muddled Denialist. We are all sooo impressed by the fact that years ago you could afford to become a doctor, even specialise in obstetrics until 2003. Why ever did you give it up? Surely the internet is not a satisfactory substitute?

Now, here I am tempted just to say, as Australians do, FFS Amy Tuteur, please stop being an internet troll and get some help to break your addiction to grandstanding and trolling. History will not judge you kindly. All your contributions to this debate will be archived online, together with mine, and any other relevant material, in a website where even your followers will be able to access it all and read it sequentially. I believe your followers are intelligent humans capable of making sensible judgements about issues. I suspect they are mostly women who have been hurt by the standard medical system obstetricians are very much part of. They are welcome on my FB page; all I ask is that they behave civilly. Disagree all they like, but listen and learn too. And read my book, and think for themselves.

And there I will stop. In the hope that it might convince a few still doubtful, I will post not only this on my website, but also a brief summary of the streams of evidence that have created the global consensus that breastfeeding is a major public health issue.

Maureen Minchin

www.infantfeedingmatters.com/

 

  1. Apologies to all for typos and glitches that I spot once things are posted. These gems are being produced under time constraints without editorial or computer assistance. So far none that I’ve seen have affected understanding or changed meaning.