Surgeon General Botches Breastfeeding Call to Action: A Suboptimal Study in the National Spotlight

Surgeon General Regina Benjamin (courtesy AP)

“I believe that we as a nation are beginning to see a shift in how we think and talk about breastfeeding,” said Dr. Benjamin. “With this ‘Call to Action,’ I am urging everyone to help make breastfeeding easier.”

A shift!  Amen! It’s about time we change our talk about breastfeeding.   

Bless dear Dr. Benjamin, the Surgeon General, Her Health Excellency who declared breastfeeding a national priority in a press release last week. 

Yes, let’s please talk it out, Dr. Bennie.

We can agree breast milk is the best choice for building tiny brains and bodies, even the formula makers admit it.  I breastfed all three of my babies and would do it again in that hypothetical younger-me universe where I spend a couple years in Paris eating baguettes and painting large canvases. 

However, the top doc and I would disagree over the degree of these health bennies, especially those loose links involving the health outcomes years if not decades past the actual “laying on of the lips” so to speak.

I can forgive a lapse or two here and there but Dr. Bennie highlights a particularly poor piece of what I can only describe as propaganda “research” in her press release, uses it as evidence of the high health care costs attached to not breastfeeding enough. 

In fact, it’s the only study she cites in the press release (The Burden of Suboptimal Breastfeeding in the United States): 

A study published last year in the journal Pediatrics estimated that the nation would save $13 billion per year in health care and other costs if 90 percent of U.S. babies were exclusively breastfed for six months. Dr. Benjamin added that, by providing accommodations for nursing mothers, employers can reduce their company’s health care costs and lower their absenteeism and turnover rates.

Now I don’t know if Dr. Bennie’s read the actual journal article but if she had she’d find this:

The authors, Bartick and Reinhold, relied on a 2007 government report reviewing research on the health benefits.  We can debate the accuracy of the review – it was based on data from the 80s and 90s – but let’s excuse that for now.  We’ll ignore the accuracy of the findings linking 10 health conditions to (not!) breastfeeding.  While we’re in a forgiving mood we’ll also ignore the authors’ ridiculous assumption that 90% of mothers can and want to breastfeed exclusively for 6 months.

Bartick and Reinhold then computed the health care costs for treating these conditions ranging from the  minor and fleeting like ear infections and stomach upset (the strongest links) to the more serious like childhood obesity, Type 1 diabetes even SIDS.  We’ll not quibble too much there, we got a  bigger battle ahead.  Fine. We’ll accept all those estimates. Whatever you say, Bart and Reiny!

Here’s the rub, the ruse really.  It’s the 900 dead babies.

If you remember the headlines this study captured you’ll recall the dead babies.  The authors concluded over 900 baby deaths a year could be prevented if their mommas complied with the breastfeeding recommendations. 

900 dead babies!!!  Really?

Do we know breastfeeding actually prevents “premature death?” Good question.  The answer is pretty much no, no we don’t know if babies actually die from “suboptimal breastfeeding”.   

Nor is there much in the way of empirical numbers to help us figure that out.  But that didn’t stop the researchers.  Somehow they computed how many babies die each year due to a variety of conditions, in fact, this was the first study to do so – in a peer-reviewed journal, the premiere Pediatrics journal – and reported “premature deaths” for a variety of conditions.  So it was an important study not only because it was the first large-scale analysis of the health costs associated with not breastfeeding – but also because it estimated baby deaths.

Despite setting a precedent for future research – not to mention future government Calls to Action, the authors never revealed how they calculated the annual baby deaths.  This is a very large hole.  Huge. 

This omission makes me very suspicious and very irritated.  The journal editors and reviewers should have demanded to see these calculations and it’s anyone’s guess why they didn’t insist on them in the actual text.  Me suspects the estimates are jerry-rigged.  In other words highly speculative and thus inaccurate.  It’s not only aggravating and sloppy but disingenuous.

And that’s not the worst of it. 

The authors took those 900 annual deaths and estimated the cost of their premature deaths.  Basically how much those dead babies would have earned over their lifetimes, roughly $10 million each.  That’s 9 billion a year.  Then Bartick and Reinhold rolled that 9 billion into their big fat estimate of how much not breastfeeding costs us each year. 

The whopping $13 billion in the headlines last spring and the Surgeon General’s press release – over 70% of it isn’t even a health care cost.  Most of it involves the lifetime earnings of all those dead babies Bartick and Reinhold somehow calculated die each year from not enough breast milk. 

 Forgive me for thinking we were talking about the medical costs of not breastfeeding.  When most of us hear about health care costs we imagine doctor bills, prescription medication, etc.  Not forgone earnings.

Bartick and Reinhold seriously inflated the numbers and did so in a very deceptive manner.  Not only did they not reveal how they computed the actual number of annual dead babies but they vaguely refer to the costs of premature death that I naively assumed meant the colossal end-of-life bills.  They include a line or two of economic mumbo-jumbo that I only realized meant lost lifetime earnings after I’d read the paper they cited.  Now that’s pretty darned ballsy.  You claim 13 billion and hundreds of dead babies but somehow never spell out how you got that many deaths or that you’ve included not only true health costs but lost earnings of the deceased.  Remarkable. 

I’m not sure I’ve read anything this disappointing in years – at least not in a prominent journal from researchers at a prominent institution (Harvard).  

I expect a little braggadocio, the speculations in the conclusions, the exaggerations.  I know researchers have to make a good argument for their data, they gotta have a good “story” and stretch the results from time to time. We all know they sometimes poke around in the data for those significant results.  I get it, been there, done that.

But this study, “The Burden of Suboptimal Breastfeeding” is not only suboptimal but sneaky, deceptive, disingenuous and it’s got the weight of Harvard and the US Surgeon General behind it. 

When I first read it a few months back I worried it would become the bench mark for health authorities.  So much so I named it one of the year’s worst pieces of research in my column Naked Data at Parent Dish.  Voila, now the suboptimal study officially entered into the public health canon and will haunt me for years to come. It’s there, folks, taken as matter of scientific fact.

With no questions asked.  Amazing.

Sweet Jesus, just when I thought I could finally stop writing and thinking about breast milk.  

Was Dr. Bennie aware of these lifetime wages snuck into that 13 billion? In her press release she refers to the $13 billion as “health care costs and other costs” – so if she did know, how sneaky of the Surgeon General. If she didn’t, why the hell isn’t our top doc doing her homework?  
So yes, Dr. Bennie, a shift is needed.  Let’s start talking honestly about breastfeeding for a change.