Check your privilege

vaccines

I recently stumbled on an article published in Health Nut News that troubled me. Health Nut News, a website dedicated to tackling topics in health and wellness, takes a critical approach to assessing mainstream medicine. The article provocatively titled “CDC Advises Delayed Breastfeeding to Boost Vaccine Efficacy,” caught my eye as a public health professional and certified lactation educator, so I looked farther.

There’s no hiding that the Internet has dramatically changed how we seek, and interact with, health information. Prior to the Web 2.0, health information was kept in the hands of professionals, dolled out through one-directional communication. Now, patients and consumers can access health information on demand, but they can also generate and share their own content. Out is the old method of professional driven and supplied knowledge, replaced by a collaborative approach to information sharing, where health information is no longer hostage to work hours and geographic location.

But this online participatory approach to health information is not without its drawbacks. All information is easier to share and access. This includes accurate sources, as well as some questionable ones. To stifle this progress in interest of verifying all sources would arguably cause more harm than good, so the onus now lies on the shoulders of information consumers to vet their sources. In response to this need, the NIH generated a list of user-guided questions for consumers to use when assessing online health information. With this guide in mind, let’s look at how “CDC Advises Delayed Breastfeeding to Boost Vaccine Efficacy” stacks up.

  1. Who runs the website? Health Nut News is run by Erin Elizabeth, a self-identifying “health arts activist.” Elizabeth is active on social media and is affiliated with osteopathic physician, Dr. Joseph Mercola. Both Mercola and Elizabeth present themselves as critics to mainstream medicine.
  1. Who pays for the web site? What is the web site’s purpose? Health Nut News presents as a blog, featuring guest contributors in addition to Elizabeth’s own writing. There is no clear indication from the site itself who funds it, but the website does include advertisement banners available for purchase. More site traffic equates to increased ad exposure, and thus, more ad income. This has the potential to be a conflict of interest. The website also includes a “shop” where products are sold through Amazon. There is a lack of transparency about how these factors may impact content and purpose of the website. Without transparency, it seems that the purpose of this website is to provide information and sell related products, inviting potential bias.
  1. What is the original source of the web site’s information? How current is it? Health Nut News makes a practice of listing references. In this case, the article was originally posted to Food Renegade. Food Renegade and Health Nut News are sister sites. There is no evidence that Health Nut News critiqued or assessed the original source, or accompanying analysis, prior to cross posting the article. As a result, a write up riddled with errors slipped through, and the conversation failed to evolve. Here’s a few of the more grievous offenses:

First off, the original study, “Inhibitory effect of breastmilk on infectivity of live oral rotavirus vaccines,” referenced in the article was written in 2010. It’s outdated. Let’s take a look at subsequent research and recommendations, and then talk.

Secondly, in “CDC Advises Delayed Breastfeeding to Boost Vaccine Efficacy,” the author kicks off the article with the following statement: “Ten researchers from the CDC’s National Centers for Immunization and Respiratory Disease (NCIRD) released a paper…” This is an inaccurate representation of the affiliation of contributing authors. In reality, only four researchers were affiliated with the CDC’s National Centers for Immunization and Respiratory Disease Control and Prevention. The rest were connected with one of the following:

  • Division of Pediatric Infectious Disease, Emory University, Atlanta, GA
  • The National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
  • Department of Pediatrics, All India Institute of Medical Science, Delhi, India
  • Department of Pediatrics, Rhode Island Hospital, Providence, RI
  • Department of Microbiology, College of Medicine, Korea University, Seoul, South Korea
  • Fogarty International Center, National Institutes of Health, Rockville, MD

The author is trying to achieve something by associating the research, and subsequent recommendation, with the CDC. This is immensely relevant when we consider the implications of the article, perpetuating a sense of distrust in the CDC, and other health organization.

Finally, the author reasonably concludes that the original study illustrated that in a game of rock-paper-scissors, breast milk trumps the live oral rotavirus vaccine, as well as the virus itself, and that it’s ridiculous to recommend moms delay breastfeeding-surrounding immunization.

That might be true in the U.S. Here in the U.S., it is estimated that rotavirus accounts for 20 to 60 deaths each year, in U.S. children under the age of 5. But check your privilege. Here in the U.S., we generally have access to safe water (e.g. water that will not give you diarrhea). Here in the U.S., we also generally have access to supportive therapies in the event of diarrhea related dehydration. But rotavirus is also the leading cause of diarrhea in children in developing countries, and in India, it is estimated that 90000-153000 children die from rotavirus each year. And in many of these developing countries, safe water and supportive therapies are not so easy to come by.

Assuming that all infants in India were breastfed as recommended by the WHO, until two years of age, then it might be reasonable to say that breastfeeding should take precedence over immunization. But that’s not the case. A recent study examining infant feeding practices in India revealed that only 55.9% of infants were exclusively breastfed for six months, adding that children breastfed for less than two years had increased rates of diarrhea. While I agree that breastfeeding promotion or improved water quality would go along way to address many of these issues, until such goals are achieved, it is unreasonable to suggest we remove all supplementary supports, including the live oral rotavirus vaccine.

So, let’s have a conversation about this. But let’s make it an evidence-based one.

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