On Expertise and Advocacy

Coffee apparently causes cancer.  Or does it?  Pending appeal, everyone in California may have to be warned about the risk every time they grab a cup.  The scientific community seems to be pushing back on what appears to be a silly overreaction, and a media corrective is in progress.  The source of the controversy is a study purporting to show that exposure to a compound released in the process of roasting coffee beans increased the odds of lab animals developing cancer.  It seems that the classification of the substance as a carcinogen isn’t controversial among scientists.  However, whether or not and how this study applies to humans remains hypothetical, and inconclusive.  Nevertheless, public policy has stepped in half-cocked due to the misleading use of science by advocates in a court system often ill-equipped to understand it.

Seeing the news reports around the dubious coffee-cancer connection reminded me of an incident, or rather series of incidents, in the first week of my son’s life.  The birth was tough for my wife.  There was a long induction, a lot of labor, and finally a C section.  I won’t go into additional detail.  That’s her story to tell, not mine.

During my wife’s pregnancy, I became vaguely aware that there is a bitter dispute around the efficacy of feeding babies formula, as opposed to breastfeeding them.  Thankfully, as a man, the mommy wars and similar inter-female conflicts are far away from me.  I don’t have much at stake in the cultural arms race that seems to plague modern motherhood, but I do want to be a good dad, and a supportive husband.  I tried to do my part to prepare, along with my wife, for what to expect in delivery and with a new baby.  One thing we didn’t learn until too late is that a delivery like the one my wife went through can screw up the hormones and other processes that cause the female body to produce milk.

For those who aren’t parents, the first days with a new baby are a parade of doctors, nurses, technicians, shepherds, kings from the orient, and various relatives, all poking and prodding mother and child.  In our case, among the visitors was a woman described to us as a “lactation consultant.”  My wife had planned to breastfeed, at least initially, and the consultant told her she was doing a great job.  According to her the latch was great, the baby was eating, and everything was going splendidly.  Like most new parents, we took every positive statement as a good sign.  However, the day before we were supposed to leave the hospital, we were told that our son had started to lose weight at a rate bordering on dangerous, and was becoming jaundiced.  After an intense night of an extremely hungry baby, we asked for some formula, which temporarily calmed him down.

At first things seemed to be improving, and my wife and son were discharged from the hospital.  Unfortunately, upon returning home, the feeding issues resumed.  Every free second was spent frantically googling for solutions.  The internet is teeming with wild-eyed claims about babies and feeding them.  Many fiercely oppose feeding baby formula to infants.  Children fed formula are, according to these sources, much more likely to have all manner of health and developmental problems.  There are of course countervailing opinions, which say that the benefits are overstated, and complicated by demographics and socio-economic status.  Deciding which of these narratives to believe feels more like an act of faith than a rational decision.

At the baby’s first doctor’s appointment, our son had lost more weight.  My wife went to the “lactation consultant” referred by our pediatrician’s office seeking advice.  She went to that appointment alone (looking back I regret not going).  This is where things got really weird.  The consultant told her that the baby was severely tongue-tied.  We would need to see a specialist, and corrective surgery was necessary for the baby to eat.  Further, my wife would be required to go through an intense pumping regimen for hours every day in hopes of maybe, at some point, producing sufficient milk.  Needless to say, we were both quite upset by this news.

We made a follow-up appointment with the pediatrician to verify that what the consultant said was true.  In the process of explaining the situation to my son’s doctor, my wife said she was open to abandoning breastfeeding.  Suddenly there was a sea change, and everything was A-OK.  Our pediatrician said she saw no reason to seek a specialist.  Relieved, we went to Costco, bought a tub of formula the size of a smartcar, and have had no feeding issues since.  This episode quickly faded into the chaos of the first few months of having a kid.  At 6 months, my son eats constantly and is generally large and in charge.

Things ended well for us, but it’s strange to me that these consultants are permitted to embed with the actual caregivers.  In retrospect, it’s clear that they are advocates, not clinicians.  There are no circumstances where one would have told my wife that breastfeeding probably wasn’t going to work out for her.  Worse, the assumption that my wife was hell-bent on feeding the baby this way had colored the behavior of the actual experts.  Had we (and my wife in particular) not kept some semblance of wits, we could’ve ended up pursuing an unnecessary surgery and made my wife spend her maternity leave hooked up to something from the dungeon of Madame Van Der Sexxx.  All that for what amounts to uncompromising pursuit of a lifestyle choice despite an abundance of reasonable alternatives.

A dangerous combination of statistical data, poorly understood scientific study, and media designed for short attention spans seems to plague society.  We are constantly bombarded with information we’re assured is “scientific,” but rarely does that information come with critical context or caveat.  On top of that, well-meaning entities and institutions deploy scientifically informed advocates along with their experts in ways that aren’t clearly distinguishable to the average person.  I see this as a problem, but I have no idea how to resolve it.

Data from the scientific method has been used to produce outcomes even our relatively recent ancestors would have seen as miraculous.  However, people trying to navigate day-to-day decision making can’t scrutinize every nugget of information on which they rely.  How do we as individuals use information to our benefit but avoid overreactions?  Where do we temper facts with concepts like diminishing returns and making the perfect the enemy of the good enough?  How do we avoid crafting policy based on the possible but highly improbable, when it isn’t always easy to tell the experts from the advocates?   I don’t believe in censorship or official information filters, but I’m also not sure it’s realistic to expect everyone to become coldly rational and well-informed on everything.

Maybe breast milk is marginally better than formula, even if it isn’t worth risking malnutrition or a medical procedure (I demur regarding the kinky pumping devices).  According to Dr. Google, for families like mine the science is a wash, but I don’t have the expertise to truly know.  What I do know is that something you do every day, among many other factors, is statistically increasing the odds of you developing cancer, your kids being delinquents, and complete catastrophe for you and everyone you love.  There’s also an army of people out there using that information to support some agenda.  Somehow we need to find a way to benefit from our knowledge, but without using it capriciously.  On top of that, we must be vigilant to avoid manipulation by those who would use data as a cudgel.  There’s a coffee on me for the first person who figures this one out.

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