Breastfeeding medicine research in context: a relational evolutionary process
Research as an evolutionary process
If we knew what we were doing, it would not be called research, would it? Albert Einstein
Albert Einstein wrote those words before his death in 1955, not long before I was born in 1960, and well before the arrival in the 1980s of evidence-based medicine with the work of clinical epidemiologists Professors Sackett and Guyatt at McMaster University, Canada.
It’s true that research remains all about inquiry into the unknown. The drive to research is driven by our extraordinary human capacity for awe, wonder, and hunger to know more and more about each other and the marvellous world we are born into. We humans are a uniquely biocultural lifeform. We accumulate, store, and transmit knowledge intergenerationally through our breathtaking capacity for cultural heredity, ever building upon each other’s intelligence and cultural expressions.
We have in the space of my life-time radically systematised the process of research across all areas of science. Our Homo sapiens capacity to grow this collective intelligence and develop tools which support our adaptations and flourishing around the planet, including through the collective tool of research, is currently in a phase of staggering acceleration. Now, you could say that our planet is wrapped in an envelope of collective human intelligence. In an extraordinary evolutionary leap, Homeo sapiens spp has become like a geological force (similar in power to the lithosphere or atmosphere or biosphere), since we control the evolution of all other lifeforms on earth. Research has been fundamental to this evolution.
You and I are two tiny nodes or bodies in the great network of human intelligence spanning the past 300,000 years. Our efforts to contribute intellectually and clinically only make sense within this vast network of ancestral human intelligence. Each of us develops within the unfolding power of evolution, bringing us to the roiling edge of human knowledge in this moment of time. Every research paper I read engages me in a whole team’s endeavour to better understand. All my writing arises out of my synergistic participation in human and planetary life, and the collective intelligence of research. My own contributions are also fundamentally informed by my interactions with mothers and babies - parents and infants - in the clinic, attending to their particular and intimate needs day after day for decades.
Relationship is fundamental to research, whether between researchers (through our published studies), in opportunities to share with others at conferences and gatherings, or in relation to the subjects or objects we are researching. Because of this radical relationality, there is no genuinely neutral or entirely objective science. We humans need to understand the dynamic nature of context, always.
Lactation medicine is currently compromised in its capacity to evolve quickly, relative to other areas of medicine
Lactation medicine is currently compromised in its capacity to evolve, relative to other areas of science and medicine, for a number of reasons including
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Gendered under-investment in clinical lactation science
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Ideology which is not science-based (that is, the ideology does not result in positive outcomes for breastfeeding families) yet which is structured into the world's dominant lactation non-profits, filtering and constraining the amount of research-based education health professionals receive.
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Research-based debate and dissent are either not encouraged, or actively silenced, though debate and dissent are fundamental to the evolution of research-based clinical practice. This occurs for ideological reasons. Dissent is a vital part of the development of collective human intelligence, in health and in any other field.
Many years ago I formed the view that lactation medicine needs to be more deeply engaged in
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Interdisciplinary research (which critically analyses mechanistic or medicalised or reductionist lenses)
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Unsettled infant behaviour research (which fundamentally interacts with breastfeeding and lactation)
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Perinatal and infant mental health perspectives
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Politics and sociology of breastfeeding (awareness of ideology, evolving beyond ideology).
This is how I've approached breastfeeding and lactation medicine in the development of Neuroprotective Developmental Care.
I worry that breastfeeding medicine as a standalone discipline is fraught with risk, including of overmedicalisation and fragmentation of mother-baby and family care. Is it appropriate for lactation medicine to aim to co-opt expertise in management of unsettled infants, infant development, perinatal and infant mental health, when lactation medicine is defined by the exclusion of those infants who don't receive breast milk? Is it in families' interests that management of early life challenges is fragmented across these domains? I believe a genuinely integrative lactation medicine is required, which sits at the heart of, but is not the title of, neuroprotective developmental care of mothers and babies. So that no family is excluded.
... Which is my vision for NDC.
Recommended resources
Busting myths about evolutionary biology and infant care generally
Breastfeeding durations in ancestral environments. A little extra something - part 3
Busting myths about evolutionary biology and breastfeeding
A timeline of relevant evolutionary events for health professionals who care for parents and infants
Selected references
Ghadimi M, Guyatt G, Zaror C, et al. Trustworthiness of treatment clinical practice guidelines has modestly improved since the introduction of Institute of Medicine standards: a systematic survey. J Clin Epidemiol. 2025;187:111962. doi:10.1016/j.jclinepi.2025.111962
Nilsen P, Sundemo D, Heintz F, et al. Towards evidence-based practice 2.0: leveraging artificial intelligence in healthcare. Front Health Serv. 2024;4:1368030. Published 2024 Jun 11. doi:10.3389/frhs.2024.1368030
S. D.Shapiro, I.Logvinov, and R. M.Thomas, “Redefining Evidence-Based Practice Through Patient Values: A Theoretical Innovation for Person-Centered, Value-Based Care,” Journal of Evaluation in Clinical Practice32 (2026): e70344. https://doi.org/10.1111/jep.70344.
W.Qi, “Rethinking Evidence in Contemporary Evidence-Based Medicine: A Critical Examination Into Emerging Forms of Clinical Practice,” Journal of Evaluation in Clinical Practice32 (2026): 1-9. https://doi.org/10.1111/jep.70369.