Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood

6. Conclusion: Whither Breastfeeding?

139 6 Conclusion Whither Breastfeeding? F E W PE O PL E A R E against health. Or freedom. Or compassion. But when one person’s freedom to drive her car at any speed infringes on another’s freedom to travel safely, or when compassion for others leads to a loss of self, the meritsofrestrictionandselfishness beginto emerge.Ostensiblyunobjectionable ideals become controversial when advocates become myopic and lobby for their cause with a single-minded zeal that borders on monomania. Likewise, preventing risk, promoting health behavior, and providing for babies are, in theory, not terribly contentious agendas. They become problematic when proponents do not adequately consider the complex social environments in which they are pursued, as if their desirability could be challenged only by the ignorant or nefarious. Reducing risks to the environment raises manufacturing costs, which makes consumer goods more expensive and decreases buying power. For low-income families, marginal cost increases can wreak havoc on finances, so helping the environment might be virtuous but unaffordable. Advocating healthy choices can create social ostracization by exaggerating personal control and understating the influence of socioeconomic structures on well-being. Nurturing babies and children can lead to a loss of self, particularly when the burden for that care falls disproportionately on one family member. The problem, therefore, is not risk aversion, health promotion, or concern for children but the insular and unidimensional zealotry they often inspire. Science and Public Health In the United States, a veritable health mania has led to moral agendas predicated on limited science and to prescriptions for behavior that reflect a crucial misunderstanding of the methods with which scientific evidence is constructed.1 Among the most common practices across the sciences 140 Whither Breastfeeding? is the computation of statistical significance, which determines whether a relationship between two variables exists. For example, if the correlation between body fat and coronary disease, or breastfeeding and better health, is statistically significant, this means that an individual who is overweight runs a higher risk of developing heart disease and that children who are breastfed are more likely to be healthier. What statistical significance cannot determine is whether adipose tissue or breastfeeding causes particular outcomes. It is a useful calculation that can help scientists orient future research, but it cannot answer fundamental questions about what leads to better health. In an extended critique of contemporary science, Stephen Ziliak and Deidre McCloskey lament that a “cult of statistical significance” has “metastasized” throughout various sciences. “Existence, the question of whether, is interesting,” they contend, “but it is not scientific.” Rather, scientific questions ask about causal relationships, about “salience, adequacy , nonnegligibility, real error, an oomph that measures the practical difference something makes.”2 Because statistical significance cannot demonstrate how or why an association exists and whether or how much it matters, by itself it is a weak scientific tool. Scientists who answer the metaphysical question—is there a relationship?—but fail to tackle the scientific question—what does the relationship mean?—elide the difference between the statistical and social meaning of the word “significant” and can end up “causing damage with a broken statistical instrument.”3 Such damage results today when people change their behavior in response to the almost daily release of new research on how lifestyle affects health. If the practical meaning of a statistically significant association is limited, the medicalization of life has made clear that the conceptual terrain on which such relationships can be established is virtually limitless. Almost every dimension of a person’s life—from what she breathes, eats, and drives to her family and social networks—can somehow be quantified and measured in relation to various health outcomes, and the results of these analyses are often inconsistent. According to Barry Kramer, associate director for disease prevention at the National Institutes of Health, much of health research today amounts to “the cure of the week or the killer of the week, the danger of the week.” He likened it to treating people to “an endless regiment of whiplash.” Stan Young, a statistician at the National Institute of Statistical Sciences, stated that epidemiological research is so often wrong that it approaches “worthless.” “We spend a lot of money and we could make claims just as valid as a random number generator.”4 Whither Breastfeeding? 141 If not all scientists are quite so disparaging, many nonetheless recognize that the proliferation of epidemiological health studies has produced much confusion among and between...