Good Enough Mum

Do multiple vaccines overload the immune system? Apparently not.

One common claim of the anti-vaccine movement is that there are just too many vaccines these days, and that the sheer number given is overwhelming the immune systems of many children and leading to all sorts of potential ills specified or unspecified (autism is a biggie here, but there are others attributed as well).  Hence, the whole theory of 'selective vaccination', where you pick particular ones to give your children and leave the rest. 

I never found this theory terribly convincing.  After all, we're swimming in germs all the time - the vaccines we get are a tiny fraction of the bacteria and viruses that our immune systems have to deal with on a day-to-day basis, even before you take into account the fact that the germs in vaccines have been deliberately weakened or even killed off before being administered to people.  It always seemed to me like plain common sense that our immune systems wouldn't find it that much of a big deal to handle several vaccines at a time.  However, I never had anything more concrete than that to counter the claims about overloading of the immune system.

Then, I read Paul Offit's "Autism's False Prophets".  This is the book I have been hoping for years that somebody would write; a clear and simple account by a paediatric microbiologist of the whole story of the vaccine/autism controversy, giving the true stories behind the many frightening and plausible-sounding claims made by the anti-vaccine campaigners and explaining why the evidence does not support them.  The debunking of conspiracy claims was marvellously welcome; the scientific parts of it, of course, I already knew quite a bit about because of having access to medical journals. But I learned one particular piece of information that I actually hadn't known and that sounded so simple and obvious once it was explained that I still can't believe it isn't publicised far more by the pro-vaccine side of the argument; the scientific reason why the 'overloading the immune system' theory doesn't stand up.  I share it with you here in honour of National Vaccines Week.

You see, although we think of vaccines in terms of how many germs are vaccinated against (and thus it looks to us as though the list is getting longer and longer; and, while I don't see that as a problem for the reason given above, I can appreciate that to a lot of parents it does look daunting), that isn't how it works on the level of the immune system.  The immune system 'sees' things in terms of how many proteins it has to mount an antibody response to.  And this is not a simple one-to-one relationship; in fact, every germ that the immune system mounts defences against has multiple surface proteins against which antibodies need to be made.  The number of proteins involved (they're called antigens, by the way, if you want the technical term) depends partly on the size of the virus or bacterium being fought against; in the case of vaccines, I believe it also depends partly on the technique used to render the germ in question unable to cause full-blown infection so that it can be safely injected into the human body.  (When Offit made this point, I did in fact remember something I'd seen mentioned in passing during the huge controversy over the five-in-one vaccine that was brought in a few years ago; that it actually contained fewer of these proteins than the separate vaccines had, and was thus, if anything, going to present less of a challenge to the immune system than the vaccines given prior to that.)

Anyway, about a hundred years ago or thereabouts, the only vaccine children received was the smallpox vaccine; now, of course, they receive far more than that.  But, according to Offit, the number of foreign proteins presented to a child's immune system by the total vaccination schedule currently recommended for children in the United States today is actually substantially less than the number of foreign proteins that were contained in the smallpox vaccine alone.  (Here in the UK, of course, it will presumably be even fewer, as there are a couple of vaccines on the US schedule that we don't have on ours.)  The smallpox vaccine (which is no longer given) contained a grand total of 200 foreign proteins for the immune system to deal with in one go; the vaccines advised for a child in the US today contain a somewhat more petite total of 153 foreign proteins.  So, if overloading of children's immune systems from vaccines actually was the cause of autism or of whatever disease the anti-vaccine lobby happen to be currently claiming, we'd expect to see the rate of the disease in question dropping rather than rising. 

The logical conclusion?  No, the current vaccine schedule is not causing any sort of overload of children's immune systems.  Children's immune systems, in fact, have noticeably less to deal with than they did a hundred years ago.  153 proteins?  Luxury.

Edited to add: I've now submitted this post to a cool blogging mini-carnival that I recently stumbled across, going by the name of Controversunday.  If I do this properly, a badge should now appear that you can click on to lead you back to the host blog and thence the other submissions, and if I don't do it properly, you'll get a load of gobbledegook.

(Woo-HOO! It worked! I am the GREATEST! Ahem.)

Quick opinion poll on breastfeeding promotion methods

Thanks to everybody who's commented on my last post - I really appreciate the trouble, and, for once in my life, I'm actually going to try to write a reply to comments.  If you haven't read it yet, do please do so and give me your thoughts.

Meanwhile, something that one of the commenters said made me think of an issue on which I'd like the opinions of others.  There has been debate and contention, in the past, over whether public health announcements on breastfeeding should frame the differences between breastfeeding and formula feeding in terms of 'benefits of breastfeeding' or 'harms of formula'.  (So, for example, do you tell people that breastfeeding helps to protect babies against ear infections, or that formula feeding increases the chances of babies getting ear infections?  Which way round do you put it?) 

I would really like to know what kind of reaction people have to each of those two ways of phrasing things, and whether one would make you more likely than the other to try to breastfeed and/or try to seek help from others to overcome breastfeeding problems and/or persevere in the face of difficulties.  I'm not looking for intellectual arguments as to why you feel one way of phrasing things is better than another, but visceral reactions on your part as to how it makes you feel, and honest impressions of how it might inspire you to act as a result.  For reasons I hope will be obvious, I'd really like to get as many opinions as possible from people who are in what you might call the 'wavering would-be breastfeeders' camp - people who like the general idea of trying to breastfeed but have doubts or concerns or have tried it and had problems with it.

Thanks in advance.

The Bartick Study and Breastfeeding Disclaimer Syndrome

I had a blast from the past the other day.  I logged into Typepad to find a new comment (an actual, genuine comment, I mean, not a spam comment, which I get all the time), on my post from back in 2006 debunking the Stats.org anti-breastfeeding article.  (Do please check that post out if you've time and haven't yet read it, by the way - it's one I'm proud of.)  The reason this was a blast from the past is not just because I haven't read that post in a while, but because the commentator is one who not only commented on here several times in the past but also inspired a couple of my previous posts before dropping off the blogging scene a few years ago, to be sorely missed by many of us.  At least I'm assuming it's the same one - she has a different blog, but the personal details, expressed views, and thoughtful and intelligent writing style all match the Jamie I remember (female, by the way, and no connection to my son of the same name). 

So, not only does Jamie seem to be back (yay!) but she also had a request for a post from me, which I am also pleased about because I love getting post requests.  Jamie would like to know my response to the Bartick study. 

The Bartick study, for those who haven't heard, is the one that apparently worked out that $13 billion could be saved in healthcare costs in the USA if enough babies were breastfed.  My reaction to that was pretty much "Wow, that sounds good (um, must get round to reading it some time)."  Since even someone as wordy as I am can't get much of a blog post out of that, I've decided instead to write about my reaction to other people's reactions to the study. Jamie linked to an article from ABC News discussing the study, and it raised several points that I think are worthy of comment.

Firstly, Goldin seemed to be damning breastfeeding with faint praise when she described the research as showing 'some suggestions' that breastfeeding had benefits.  The evidence is, in fact, considerably stronger than Goldin is making it sound.  I wrote quite a bit more about this, but this point was only really meant to be an aside and I ended up writing so much about it I felt it was distracting attention from what I meant to be the focus of this post, so I snipped all of that and saved it for a potential future post, if anyone's interested.  Meanwhile, see this old post of Annie's at PhD in Parenting for a good layperson's summary of the best paper on the topic.  (The paper she describes, by the way, is the one that was used as the source for the figures used in the study that's causing all the current upset; so Bartick et al were in fact using fairly sound figures as to the rates of benefits from breastfeeding, despite what's been elsewhere alleged.)

Secondly, the article criticised the Bartick study on the grounds of not taking into account the costs to society of providing the support that would be needed to get breastfeeding rates up and subtracting that from the $13 billion.  True enough, but it seems to me to be missing the point.  I think the point of the study was not meant to be "Whoopee!  We just found a way to make $13 billion out of thin air without lifting a finger!" but "We can afford to invest a hell of a lot of money in providing support for breastfeeding mothers and making the necessary changes in maternity leave laws, and still come out ahead of the game financially."  Surely the real lesson of the study's findings is that investing money in breastfeeding support is a win-win situation?

Thirdly, the commenters' views seemed to carry a strong hint of what I once dubbed Science Myth 2 - the idea that it's well out of order for a researcher to (gasp! the nerve of them!) come up with findings you don't like.  Maybe I'm misinterpreting what was said there, because I'm only too aware of the risks of reading too much into quotes that may have been taken out of context, but Goldin's and Beard's comments did seem to be coming across as anger, not with any actual example of an interpretation of the study that they'd heard and disagreed with, but with the study itself.  (McKenna's attitude came across as rather more sensible.)  If the ABC article misrepresented Goldin and Beard in that regard, my apologies.  A much stronger example of this attitude came from Lenore Skenazy's 'Quit Picking On Moms Who Don't Breastfeed'.  Uh, Lenore?  Examining a legitimate research question is not the same as 'picking on' anyone, and - stop me if I'm wrong about this - I'm pretty sure no-one's used "Irresponsible Parents Continue To Formula Feed" as a headline either, outside your imagination.

(You know - now that I think about it, this whole phenomenon of taking research you don't like as a personal attack does seem to be something I cannot remember ever coming across before joining the mommyblogging world.  I used to spend a lot of time on an abortion rights debate group, and the members of that group would merrily ignore or misrepresent any research that didn't suit whatever their particular views happened to be, and occasionally a researcher who'd found something that other people didn't like would be accused of bias.  But I simply can't remember anyone on the group, or in other debates I've come across, displaying that same sense of being personally affronted by research they didn't like.  Am I wrong?)

The fourth point is the main one I wanted to write about, and is in fact something I've hoped for some time I'd eventually be able to get round to writing a post about; a phenomenon I've come to think of as 'Breastfeeding Disclaimer Syndrome'.

Breastfeeding Disclaimer Syndrome (I'm not wedded to the name, by the way - if you have a better idea, I'm quite open to suggestions) is my term for the way in which people seem to feel the need to follow up any positive statement about breastfeeding with immediate disclaimers about the importance of recognising that of course many women can't do it and they should not be made to feel guilty.  Sometimes this reaction comes from others; a surprising amount of the time, it comes from the person who made the initial positive statement, as though we can't say anything about the benefits of breastfeeding without immediately qualifying it with the disclaimers about it not being univerally possible.

What interests me about this is that I don't remember ever seeing this happen with any other public health issue.  I don't, for example, see reports of studies on the benefits of exercise being responded to with hasty defensiveness about the importance of remembering that some people are quadriplegic and can't exercise and some people have such long working hours it's just impossible for them to find time to exercise and some people just find it really really difficult and painful and that amount of stress can't be good for anyone either so we shouldn't blame people who find a sedentary lifestyle works better for them and it's important not to make anyone feel guilty about it.  People can accept both that exercise can be good for you and that there are various reasons why someone may not actually follow that advice, without the conflict between those two facts ever being any sort of particularly big deal.  So why the difference?

I can think of several reasons.  One, of course, is the whole "But think of the chiiiiiiiiildreeeeeeen!" factor that makes any debate about parenting decisions so particularly heated - nothing hits people's hot buttons quite as hard as any suggestion that you may have been doing less than the best for your children.  One is the all-or-nothing attitude of breastfeeding activists, which I really do think often shoots them in the foot; the overwhelming emphasis on six-months-of-exclusive-breastfeeding that so often obscures recognition of all the benefits you can get from any amount of breastfeeding from any length of time.  If you feel guilty about your lack of exercise, you can appease the guilt with relatively simple measures like walking to the shops instead of taking the car; if public health announcements about the importance of exercise were all focusing on the importance of going to the gym for a complete workout every day for six months, I suspect we'd get a lot more of the same sort of overt defensiveness about exercising as we do about breastfeeding.

A third, major, reason is that breastfeeding is unique among healthy lifestyle measures in another way; it's a one-shot deal.  With any other healthy lifestyle measure you care to think of - exercising more, drinking less, eating better, stopping smoking - we can appease our guilt over not doing as well as we know we should by picturing the hypothetical but will-definitely-happen-someday future in which we clean up our act and do things a lot better.  This may not get us very far in terms of here-and-now improvement, but it does at least ease any guilt we feel to the point where we don't feel the need to get freaked-out defensive over it.  But, in the case of breastfeeding - with the little-known and time-limited exception of relactation - we don't get do-overs.  Any child we didn't breastfeed when we had the chance is going to stay non-breastfed. And it is very, very difficult to accept the idea of having done things in a way that you not only wish you hadn't, but that you will never have the chance to go back and do right.  Of course, that's something every human living has to deal with at multiple points in their life for all kinds of reasons, but add in the think-of-the-chiiiiiiiiildreeeeeeen emotiveness factor and the guilt can become overpowering.  And I think that's why we get so much emphasis on the need to remember all the reasons why women may end up not breastfeeding despite really wanting to.  It's our way of wanting to ease that pain by (rightly) giving women credit for their good intentions and best efforts.

The trouble with that particular temporary ease-off of the painful emotions involved in not managing to breastfeed is that it doesn't look at how the whole thing could be made better for women struggling with the same problems in the future.  Sure, it's important to recognise that many women can't breastfeed.  You know what's even more important?  Recognising that a much larger number of women could breastfeed if they had proper support and help when they needed it and a more breastfeeding-friendly culture.  Instead of putting all that energy into disclaimers, why not put it into clamouring for the importance of making the changes that would help more women breastfeed?

The article linked to in that last sentence, by the way, is a piece by none other than Melissa Bartick, the lead author of the much-maligned study in question.  While she does have the occasional unfortunate tendency to meander off the point into unrelated thoughts of her own fantasy birthing experience (look, by all means get your partner to cut the cord if that's what you both want and by all means don't do that if it isn't what you want, but, either way, it's not going to make a blind bit of difference to your chances of breastfeeding successfully, so let's leave that decision in the realm of personal preference where it belongs and get back to the topic under question, please), she also raises a heck of a lot of good points.

So.  Work with me here, guys.  I'm throwing out these ideas as to why people react as defensively as they do to any kind of breastfeeding promotion, but I'd love further thoughts on where to go with this in terms of getting away from that attitude and, instead, seeing research like this as something we can use as a positive force for change.  Any thoughts?

The Sane Person In The Attic, Reprise (or: Not that I'm cheating or anything, but...)

Three weeks ago, one of the topics for the Writing Workshop was 'Tell me about somewhere you used to work'.  While I did not, strictly speaking, have time to write a post, I did have a post I really wanted to write; the story of the six months I spent in a live-in job in a psychiatric hospital, which was notable not so much for the job (though I enjoyed that too) as for what it was like to spend six months living as a lurker on the top floor of an enormous, near-empty, old psychiatric hospital.  This was not an experience I could resist having the chance to blog about and so I spent that week writing about how I came to move to that job and what it was like living there.  The only problem was that, due to unforeseen delays involving vomiting children, I ended up not getting it finished until after submissions had closed on Sunday, and thus finding myself in a position of having spent my non-existent spare time for that week on writing a post that no-one other than myself, my family, and Kirsten from Mansfield would ever be likely to read.  I was, as you can imagine, just a tad miffed.

This week, I still don't have time to write a post (as usual), but I checked the topics out anyway (as usual), and, lo and behold, the first one on the list was 'Tell me about a time when you decided to move house'.  Having moved house twelve times in my adult life, I have plenty of potential material there; but it just so happens that one of the times I decided to move house was the time I had to move to take up a new job in a new area in a psychiatric hospital where I would have to live in, and, guess what, I just happen to have this perfectly good pre-written post on the subject all ready.  There now - that worked out pretty well, didn't it? 

Admittedly I'm stretching the topic considerably, not only because only a small proportion of the post is about the reasons why I moved, but also because it's not terribly accurate to say that I 'decided' to move house; I had to move house (well, move residence, given that what I was moving into was not a house but a hospital) because I didn't have an available job to go to in the area where I was currently living.  What can I say?  I hate to let a good post, or for that matter even a mediocre post, go to waste.  If you have time, do please go and read it.