Thursday, August 08, 2013

The Dangerous Breastfeeding Advocates Network

"A little learning is a dangerous thing;
drink deep, or taste not the Pierian spring:
there shallow draughts intoxicate the brain,
and drinking largely sobers us again."

Alexander Pope

I first found out about The Breastfeeding Advocates Network (TBAN) when I saw their poster, a collage of happy baby faces, hanging in one of the maternity wards in the hospital I work in. "Neat," I thought. Trying to get parents to breastfeed can be quite a challenge sometimes but if the general public wants to take up the cause, crusade away, I say! One of the cornerstones of modern Paediatrics and Obstetrics is that infants should be fed exclusively on breastmilk for the first six months of their lives and the benefits are numerous - I would tell you what they are but this is not a post about the manifold wonderfulness of breastmilk.

When my pregnant wife told me that she had just joined the group, I joined as well and for weeks, I was contented with just observing the buzz of activity within the group. A lot of new mothers are posting what are termed in-house as "SOS'es" - mothers seeking advice from other more experienced mothers to troubleshoot breastfeeding issues. One of the more common cries for help there is are mothers not producing enough breastmilk after giving birth. The mothers there rightly advice that often, the supply of milk will appear low in the first few days after a child's birth and that mothers should keep allowing their babies to latch on and suckle regardless. I mean, that is the same advice I give to encourage new mothers! Damn, this is a great place for new moms!

However, after spending some time there, I noticed that there are also mothers who post there asking for medical advice when their babies fall ill and often, they receive large volumes of opinions that are anecdotal and sometimes contradictory. This is where I started taking notice of the more questionable side of TBAN that operates beyond the boundaries of breastfeeding. What is worse, there are mothers who post about advice given by doctors that they aren't sure about, and the response these posts generate were generally abusive, like "That doctor's an idiot!" or incredibly cocksure, like "That doctor is obviously wrong!"

As an insider in the medical field, I know better than most people about the number of nincompoops that managed to escape through the graduation end of med schools, but on the web, I will never dream of making such statements on any specific case when I myself have not acquainted myself with all the details of a patient, including giving said patient a proper physical exam and getting an eyeball of some investigations. One thing that any medico would quickly learn right out of med school is that all patients are different and they sometimes warrant different advice for the same condition. However, these highly-empowered mothers are not limited by that same prudence. They think that if something applies to their few offspring, it should apply for all mothers and all babies. I suppose that this is what they mean when they say that a little knowledge is a dangerous thing.

Here's an example of a thread that demonstrates the ignorance and arrogance that is endemic and encouraged in TBAN:

Persistent Ignorance
It's someone asking "What is your favourite colour" right AFTER someone said that their favourite colour is purple.

The first commenter above, Ong Chiew Ping, immediately disputed and disparaged a doctor's diagnosis of iron deficiency anemia, betting that that doctor didn't do the required test and merely guessed it by looking at another blood test (she was referring to the complete or full blood count). See what I mean about an immediate knee-jerk distrust towards licensed, respectable medical professionals even when they know nothing about the patient discussed?

The second mother, Hui Hoon who started the thread, clarified that the test also included iron level and the total iron binding capacity (TIBC), which was what she meant by the protein that binds iron being low. The rub is that she also proved the doubtful mother above her wrong.

The really funny bit is the third mother, Xe Hui, who advised that the second mother seek a second opinion to ensure that a proper iron study is done, right after the second mother told everyone that the proper iron study was indeed done. This may seem innocuous to anyone else but to anyone in the medical line, it is obvious that the mothers offering advice only know about the medical stuff they talk about superficially, but any real depth eludes them (I mean, they didn't even recognise an iron study when it flew right into their faces flapping its wings). These are mothers who call doctors stupid, by the way. Would you take medical advice from them?

You have seen nothing yet. Here is another mother whose immediate automatic reaction is to assume incompetence on the part of the doctor,

Egg Allergy Vitriol
I wonder if these people really think replacing "fuck" with "fish" makes it okay.

The thread-starting mother, Hui Hoon, clearly stated that her child is 15 months old but in her righteous anger to threaten ballistic harm on the doctor and her eagerness to show how much smarter Mandy thinks she was compared to him, she missed the fact that the child in question was older than her stipulated age below which infants shouldn't be fed eggs. These mothers even fail to take account of a patient's details that are available on the page, let alone spend any time to consider the details that aren't available to them like physical examination findings and blood works. Would you take medical advice from them?

Here is how that exchange continued. Notice how reserved and polite I was trying to be in contrast to my usual belligerent online persona,

This is what we refer to in med school as 'digging one's own grave'.
Doubling down.

As you can see above, the mother trying to justify her position have obvious trouble telling the difference between early exposure of allergens to prevent the development of allergies versus exposing a child with egg allergies to eggs to treat said allergies. You might want to read that last sentence again. Medicine is rife with subtleties demonstrated above and this further underlines the importance of knowing one's patients thoroughly before advising anything. Would you take medical advice from mothers who don't understand those subtleties?

Anyway, the mother was basing her advice (directly or indirectly) on the old 2000 feeding guideline by the American Academy of Pediatrics (AAP), which the AAP retracted in 2008 due to lack of evidence for its efficacy. Would you take medical advice from mothers who do not bother themselves with the latest evidence? In fact, based on the latest news in the world of allergies, Mandy Chee's advice may actually cause more children to develop allergies. Thanks Mandy, for making other people's babies sick!

But after I was banned from TBAN (more on that later), the same mother who doesn't understand those subtleties was seen bragging about how she knew better than I do,


See the fire-breathing pomposity of someone who still cannot tell the difference between preventing the development of allergies and treating children who are already allergic? How the fuck does someone prevent allergies in an already allergic child anyway? She can type an entire sentence of complete nonsense and not even realise it.

Of course, this kind of behaviour is fostered and nurtured by the admins who run the group - admins who claims to be certified Breastfeeding Peer Counselors but nevertheless, does not shy away from giving advice unrelated to breastfeeding. They have many quacky beliefs, but one of the worst of them is this,

Dangerous Quacks
Okay, I may or may not have baited them into saying those things, but I was gathering evidence.

Now, for a bit of background. Sudden Infant Death Syndrome (SIDS) is a nebulous entity and a boogie man of all new parents everywhere. According to the AAP, there are many things that reduce its risk and many that increase it based on countless studies over the years. Now, one of the latest, largest study and analysis into the phonomenon turned up a startling find: co-sleeping, when it takes the form of bed-sharing, increases the risk of SIDS in infants below 3 months old by 5 times. It was estimated that 81% of SIDS cases with no other risk factors could have been prevented if parents choose to sleep on different surfaces than their babies.

Yes, these Breastfeeding Peer Counselors are dispensing medical advice that increases the risk of babies dying suddenly. I wonder if their certification can be stripped away for doing that.

Their justification? "Other studies" which they have not exerted themselves to provide and that it helps them sleep better. Gina, the founder of the group, even wondered if the researchers are parents - as if that somehow changes the numbers and stats those researchers found. By her logic, shouldn't you avoid all male obstetricians because they have never given birth themselves? Most practicing oncologists are not suffering from cancer, so does that mean that they don't know how to treat cancer?

While doctors have yet to determine the exact cause of SIDS, the medical community have observed it for decades, learning what we could about it. In 1994, there was a huge campaign called Back to Sleep which exhort parents to place their babies on their backs to sleep, and it resulted in more than 50% decrease in SIDS. That recommendation too was based on pesky "research" and "studies".

Some of them cited Dr Sears who advised co-sleeping but he did not make the important distinction between bed-sharing and room-sharing - which was irresponsible. Just to be clear, bed-sharing is bad while room-sharing is good. You'd notice that in his article, he recommends sleeping with babies on different surfaces. He also talked about his two books as evidence of his expertise, but they were written in 1996 and 2005. The latest and largest study on bed-sharing was published in 2012, evidence not available to Dr Sears when he wrote those books.

An admin of TBAN, however, does make that distinction and proudly announced that she bed-shared and endorses the practice,

Queen of Woo
If there are identifiable underlying issues, it wouldn't be called SIDS, lady.

The admin Daphne Lee-Yang is also the admin of another group which is part of of the anti-vaccination movement,

Anti-Vaxxer Advocate
That's because your unvaccinated babies are being protected by the herd immunity created by other parents who decided to vaccinate, you bloody parasites.

Talking about how the anti-vaccination movement have made ill and even killed countless babies, children and vulnerable adults would require a ten-hour long lecture and a 200 slides presentation on its own, but needless to say, this woman is using her positions of influence to give dangerous advice to other parents. I feel that as someone who witnessed such harmful unscientific ideologies being sold to so many trusting parents, I have a responsibility to say something against this breastfeeding advocacy group that clearly oversteps their boundaries of expertise.

Now on my banning, I have always stayed completely polite when I was in TBAN. I never said anything I couldn't back up with evidence and I have never used my qualifications to bully others into agreeing with me, preferring instead to refer to respectable medical organisations and medical studies. My profession is irrelevant. I could have been a plumber or a rubbish collector but if what I said came from reputable sources, they can stand on their own. This stood in stark contrast to how I had been treated there in turn. The mothers who disagree with me prefer instead to attack me, pointing out that my profile picture is boo-hoo-hoo scary and that I, as a medical doctor, should be out saving lives instead of posting in a Facebook group. Their abusive behaviour had not gone unnoticed,

Voice of Reason
Finally, a voice of reason!

I had also received private messages from lurking members who wanted to know more about the information I was sharing in TBAN, but they did it quietly because they didn't want to appear to be supporting me for fear of drawing the ire of other moms and the admins, which is yet another indication that TBAN is intolerant of anything that deviates from their orthodoxy.

I was banned because too many mothers disagreed with me. And what is even more baffling is that my wife too was banned from the group as well, even though she wasn't "guilty" of the crimes they executed me on. When my wife asked an admin regarding the reason for her banning, that admin couldn't give her one. Maybe they just didn't like the fact that she's married to me.

A couple of those messages sums up the environment in TBAN quite well,

Private Message 2

Private Message 1

Last I checked, they were calling me a "quack" after I had been banned. That is libel, of course, and I can sue them for it. I was also accused of being a House Officer in Sabah when I am actually living in Sarawak. According to them, I was also guilty of the heinous crimes of taking time off from saving lives, reading from a Kindle and blogging about my cats. Ho boy.

Actually, I do have an answer for one of those accusations. I didn't take time off from saving lives. I used my free time to try and save the lives that they were inadvertently harming.

And if they kicked me out for calmly explaining my case (and my wife for being married to me), why then do the admins allow such vitriolic, abusive speech in the group? They talked about me giving off negative vibes and undermining the supportive atmosphere in the group but seriously, what the others were saying were far more mean spirited than anything I would dream of saying - yet they get to stay on. Why?

Because they agree with the admins. They are the echo chambers that insulate them from ever learning anything that doesn't sit well with their personal biases.

In summary, The Breastfeeding Advocates Network is a good peer resource for breastfeeding. Full stop. Take everything there with a sackful of salt. Aside from that, it is nesting site for arrogant mothers who would bully people with views that are different from theirs and while dispensing often misguided medical advice themselves of their own to trusting parents in need. The admins there encourage such imprudence while recommending dangerous medical practices of their own. They also remove anyone who share opinions that upset their monopoly on the minds of their members there.

Needless to say, I'll be directing my patients to safer, more civil and ethical breastfeeding groups in the future.

P.S. Don't take my word (and screen caps) for it, go visit them and see for yourself!

Milking it,
k0k s3n w4i