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“Attachment Parenting Medicine”, Part II

In Part I of this series, I pointed out a bit of magical thinking on the part of Susan Markel, M.D. who calls herself the “Attachment Parenting Doctor”. As I pointed out, she seems not very keen on vaccination (though she doesn’t quite take a stand against it). I find that odd on the part of the doctor, but she certainly has a right to her own opinions. I presume that, as the “AP doctor”, she has a none-too-small contingent of non-vaccinators whom she feels the need to cater to. However, medical opinions need to be based upon facts, and some of the things she says here clearly contradict known facts. It fact, the stuff on that webpage sounds much like the usual pseudoscientific mumbo-jumbo you find on AP webpages. Somehow, I expect better from someone with a medical degree and board certification in pediatrics.

(Just for full disclosure: I have a few families in my practice who don’t vaccinate, usually for all the common junk-science reasons. Working in a country with socialized medicine, I don’t know that I have the right to throw them out of my patient base, nor would I; however, I make very sure that they know exactly and in great detail how unwise I think their decision not to vaccinate is, and do my best to convince them to rethink their position. Nobody has left my care as a result – I don’t harass them about it nor do I get nasty, and I’ve even managed to change one mother’s mind, I’m happy to say).

Markel suggests that good alternatives to vaccination are:

Giving your children the “best diet possible” – i.e, whole grains, “organic” foods, avoiding corn syrup and the like.

While this is good advice in general (well, except the “organic” foods. Plain conventionally grown produce is every bit as healthy for you, and usually, you can afford more of it), and while malnourished children are certainly more at risk from infectious diseases, there is no evidence that unvaccinated children on this “holistic” diet are any more protected from vaccine-preventable diseases, or even from complications of such diseases, than a child on a conventional Western diet – McDonalds and all. In fact, there have been rather bad cases of disease among unvaccinated “natural-parented” children. Here’s a description of whooping cough cases among children on Vashon Island, WA, whose parents thought as Dr. Markel suggests:

From 1995 to 1999, said Ms. Packard, the school nurse, an epidemic here of whooping cough, which can be fatal in infants, hospitalized some infants and left some children with chronic asthma. Ms. Forest’s grandson Deven had whooping cough two years ago and, she conceded, probably passed the disease to 10 other children, including an infant.

”Yeah, that bothered me,” Ms. Forest said. ”But I called everybody and we studied up on what you can do to build up the immune system.”

The baby ”did just fine,” she said. ”On Vashon Island, you have middle-class people who eat healthy and keep warm. If everyone was poor-poor, not breast-fed, not eating right — that might be a reason to vaccinate.” But she and her daughter remain steadfastly opposed.

Meg White, 45, though, now somewhat regrets not vaccinating. Three years ago, her whole family, including her infant son Julian, had whooping cough ”really, really bad” for more than three months.

”My son would turn all shades of purple,” she said. ”He stopped breathing several times and we took him to the hospital. My daughter was terrified of going to sleep because then it got worse. She would vomit all over the place. My husband cracked ribs from coughing.”

Here’s another description of a measles epidemic in an affluent town in Germany, egged on by some homeopathic “doctors” and the local Waldorf school.

Breastfeeding as a panacea.

Claims Dr. Markel: “Breastfed babies are immunized; children who are injected with viruses and bacteria are vaccinated. An endorsed campaign by the government to increase Americans’ breastfeeding rate would prevent more childhood diseases -and deaths- than all of the vaccination programs currently endorsed.

As I’ve pointed out before, I’m all for breastfeeding and the immunological properties of breastmilk. But it takes a good deal of ignorance – or plain intellectual dishonesty – to claim that breastfeeding confers better protection against severe childhood diseases and death than vaccines do. Despite Dr. Markel’s wish to cater to her patient base, a doctor’s job is to advise her patients honestly and in a fact-based manner.

Putting aside for a moment the issue of passive vs. active vaccination (breastfeeding mostly confers antibodies which are gone not long after the baby stops breastfeeding, whereas a vaccine helps the child produce antibodies on his own which are much longer lasting), let’s compare the two – giving the breastfeeding side all the breaks possible – and see for ourselves which is the more effective health measure.

The only large study I know of which attempted to estimate how many excess deaths occur in babies due to their not breastfeeding is the infamous Chen and Rogan study from 2004. The study’s authors estimated that about 720 lives of children 1 month – 1 year old would be saved in the US each year if all children were breastfed. Unfortunately for them the only statistically significant association between lack of breastfeeding and increased incidence of death was in the category of “accidental injuries”, suggesting that the effect was probably the result of confounding variables not tested for (unless someone can suggest a plausible mechanism by which a breastfeeding baby is better protected from falling off a changing table, say, than a formula-fed one). But what the heck, I said we’re giving Dr. Markel every break possible. So let’s assume that breastfeeding can really prevent 720 infant deaths per year.

Now let’s look at vaccines and their health impact. The CDC has a great article on its website titled “What Would Happen If We Stopped Vaccinations?“. As I said I’m going to give the breastfeeding side all the breaks possible, I won’t include morbidity from nonfatal vaccine preventable diseases (mumps and rubella), nor mortality that usually manifests itself in adulthood from a disease acquired when the subject was a child (hepatitis B). That doesn’t mean those diseases are not worth vaccinating for, or do not save lives (again, I’m not counting fetuses that are aborted as a result of congenital rubella syndrome as deaths, but if you happen to be pro-life, you might want to).

Polio: Before vaccines, there were 13-20,000 cases of paralytic polio in the United States annually, mostly among children. According to the CDC, the death rate for paralytic polio among children (usually as a result of permanent paralysis of the breathing muscles) is 2-5%. 2% of 13,000 is 260 deaths per year. Remember that’s taking the minimum numbers.

Measles: Measles has a death rate of 1-3/1000 in the developed world (in the developing world, the rate is much higher due to nutritional deficiencies, particularly Vitamin A; but that’s not what we’re discussing). According to the article, “An average of 450 measles-associated deaths were reported each year between 1953 and 1963.” Measles vaccine was first introduced in 1963; you can see what happened to measles rates once vaccination was introduced here.

Hemophilus influenzae type b (Hib): ” Hib meningitis once killed 600 children each year and left many survivors with deafness, seizures, or mental retardation.”

Pertussis (whooping cough):“In the U.S., prior to pertussis immunization, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.“. Even assuming that given better artificial respiration techniques, 95% of those 9000 children could have been saved (and I think I’m being optimistic here), that’s still some 450 deaths per year.

Penumococcus:“Before pneumococcal conjugate vaccine became available for children, pneumococcus caused 63,000 cases of invasive pneumococcal disease and 6,100 deaths in the U.S. each year. Many children who developed pneumococcal meningitis also developed long-term complications such as deafness or seizures. Since the vaccine was introduced, the incidence of invasive pneumococcal disease in children has been reduced by 75%.” That’s a reduction of 4575 cases/year.

Chickenpox: Caused mostly deaths in adults and vaccine uptake is relatively low. I would guess the vaccine prevented a few deaths in children from the previous level of 100-150 deaths per year overall, but it’s hard to estimate the exact number.

Diphtheria:“If we stopped immunization, the U.S. might experience a situation similar to the Newly Independent States of the former Soviet Union. With the breakdown of the public health services in this area, diphtheria epidemics began in 1990, fueled primarily by persons who were not properly vaccinated. From 1990-1999, more than 150,000 cases and 5,000 deaths were reported.” which makes some 500 deaths/year on average.

Tetanus:“From 1922-1926, there were an estimated 1,314 cases of tetanus per year in the U.S….approximately 20% of cases end in death”. Add another 260 fatalities per year.

I’ll leave you to do the adding-up, but it should be quite clear to anyone who can do basic math that vaccines are a far more effective health measure for children than breastfeeding is. There’s no reason you can’t do both, of course; but to pretend breastfeeding is in any way, shape or form as, or more, effective as vaccines in preventing severe childhood illness and/or death is something nobody, least of all someone with an MD, should contend.

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2 Responses

  1. Surely the main point here is that the only immunity transfered via breast milk is localized, that is gastrointestinal?

    My understanding ( Not a Dr., just a critically thinking mother ) is that immunity is primarily passed between mother and offspring via breastmilk in many animals – but NOT in primates. In primates immunity is passed through the placenta – so when a woman has a flu vaccination in pregnancy, her baby enjoys the same protection where as a nursing mother can’t pass along the benefits of a flu shot (just as a ‘for instance) to her breastfeeding baby.

    I have heard women argue that breastfeeding can substitute for vaccination. Now I know where they dot the notion. Even if this isn’t strickly speaking, what Dr. Markel argues, it’s pretty damn close and I think she has a lot to answer for.

  2. Nancy,

    There are probably factors in breastmilk which improve a baby’s humoral immunity as well – breastfed babies have been shown to develop a stronger immune response to vaccines given them, for example. And yes, most humoral (blood-transferred) immunity is still placenta-derived and lasts, at most, a few months past delivery.

    That doesn’t change the fact that whatever immune properties breastfeeding has, they stop almost immediately once a baby stops breastfeeding (and even if you plan to breastfeed until they’re 6 or 7 years old, the ‘dose’ of breastmilk per child’s body weight will still be going down as the child grows and breastmilk becomes a negligible part of his diet).

    Not to mention that even exclusive breastfeeding won’t provide immunity anywhere near strong enough to prevent your baby from getting polio, pertussis, tetanus, measles and other vaccine-preventable diseases.

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