Case study: 'cancelling' an evidence-based primary care innovation which offers alternatives to low value care for management of breastfeeding problems and unsettled infant behaviour
The NDC or Possums programs have been developed as a response to the high levels of overmedicalisation and paramedicalisation in early life care
Over the past two decades, in direct response to the growing problem of low value care of common breastfeeding and infant care problems, I have developed Neuroprotective Developmental Care (NDC or the Possums programs) as a primary health care (or community-based) clinical innovation developed by applying the principles of implementation science.
I've developed these programs using implementation science, addressing concerns about mother-baby overtreatments on multiple fronts. My approach to development has aligned with the principles articulated by Armstrong 2018:
“There is growing recognition within healthcare improvement research of the gains to be had from ensuring that the design and execution of improvement efforts are appropriately theoretically informed, and [articulate] a clear theory of change, an account of how and why the planned activities are credible as a means through which the desired outcomes can be achieved. It’s also important to ensure robust evaluation of efforts to tackle the problem.”1
The NDC or Possums programs are a multi-component suite of clinical interventions which address the domains of breastfeeding, feeds, sleep, cry-fuss problems, infant sensory motor needs and development, and perinatal and infant mental health, based on acknowledgement of the interrelated complexity of each of these domains. The NDC interventions are clinical translations of theoretical frameworks established in about 20 systematic or narrative theoretical framing reviews, and have been refined in response to 10 peer-reviewed published evaluations which demonstrated the programs’ efficacy, as well as ongoing feedback from clinical practice. Education pathways for health professionals include NDC Accreditation and a high level Lactation Fellowship.
You can find here the scientific publications contributing to the development of NDC which have raised the alarm about overtreatment and unintended outcomes in management of breastfeeding problems and unsettled infant behaviour.
Breastfeeding and lactation non-profits use commercial levers to ‘cancel’ the Possums or NDC innovations in clinical breastfeeding and lactation support
The International Board of Lactation Consultant Examiners (IBLCE) currently operates a global monopoly on breastfeeding education for International Board Certified Lactation Consultants (IBCLCs), of whom there are about 38,000 worldwide. It is not necessary to be a registered health professional in their own country to qualify as an IBCLC. Two associated non-profits endorse various lactation courses, towards which IBLCE directs participants.
The IBCLE has withdrawn attribution of Continuing Professional Development points from the Possums programs and my related presentations anywhere in the world, in response to my publication of two research articles which challenge bodywork- and frenotomy-dominated approaches to breastfeeding problems, and which offer alternative evidence-based clinical strategies. Withdrawal of CPD attribution ‘cancels’ this innovative suite of evidence-based interventions from visibility amongst IBCLCs and breastfeeding medicine doctors internationally. You can find out more about this here.
Unfortunately, this has become a widespread problem, affecting dozens or more of the world's leading researchers in the field of breastfeeding and lactation, and has the affect of seriously skewing the kind of education received by breastfeeding medicine doctors and other health professionals, including IBCLCs.
In other local examples
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The Board Directors of the Breastfeeding Medicine Network of Australia and New Zealand declines to allow mention the NDC or Possums programs, Lactation Fellowship in their newsletters informing members of news and initiatives in the field of breastfeeding medicine, including our program of international guest speakers - even though the newsletter features and raises the profile of other small business breastfeeding medicine educators and clinicians, and even though I'm a network member. This decision was upheld by the Board in 2025 when I made a courteous written appeal.
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The Australian Breastfeeding Association (ABA) declined to allow NDC or the Possums programs to pay for advertisements to parents in their parent magazine in 2025, stating that to do so would not align with their goals, even though the ABA accepted, at the time and subsequently, paid advertisements from a wide range of businesses which offer low value health care, including from baby expos which extensively promote low value health care interventions.
These are just two small examples of the globally powerful ways in which commercial levers, driven by breastfeeding ideologies rather than commitment to quality and genuinely evidence-based health care, are currently used by the world's dominant single-issue breastfeeding non-profits to ‘cancel’ genuinely evidence-based primary health care initiatives in the fields of breastfeeding and unsettled infant behaviour. This is a major issue for those who care about the ethics of breastfeeding medicine, and the wellbeing of breastfeeding mothers, their infants, and their families.
Related resources
Groundbreaking research is 'cancelled' by single-issue breastfeeding non-profits
Selected references
Armstrong N. Overdiagnosis and overtreatment as a quality problem: insights from healthcare improvement research. BMJ Quality and Safety. 2018;27:571-574.
Azad MB, C NN, Bode L. Breastfeeding and the origins of health: interdisciplinary perspectives and priorities. Maternal and Child Nutrition. 2020;17:e13109.
Chetwynd E. From censorship to conversation: agnotology, market infuence, and the ethics of breastfeeding research. Journal of Human Lactation. 2025;4(3):303-305.
Kendall-Tackett K. Have we returned to the Dark Ages: Excommunication and its chilling effect on science. Clinical Lactation. 2020;November:DOI: 10.1891/CLINLACT-D-1820-00024.