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Tossing the Formula (Along With the Facts): Fact-Checking the Breastfeeding Media

Posted Oct 16 2012 5:06pm
The benefits of breastfeeding are beyond question these days. In a front page article in today's New York Times Science section, Pam Belluck's Tossing the Formula reports on the formula crack-down in hospitals across the country. Public health officials claim such programs like New York City's  Latch On Odyssey  and all its Baby Friendly manifestations represent an attempt to promote breastfeeding and not discourage formula use per se, cough cough. Now today's article wasn't really about the benefits but I didn't have to read very far into it for confirmation breast milk has reached near iconic status:
The debate over formula samples isn’t about whether breast-feeding is healthier. Even formula companies acknowledge that “breast milk is the gold standard; it’s the best for babies,” said Christopher Perille, a spokesman for Mead Johnson, which makes Enfamil formula.
The debate over formula samples isn’t about whether breast-feeding is healthier. 

How true. I could not agree more. 

Few discussions of breastfeeding ever critically examine the benefits. Given the free pass granted breastfeeding, most people would probably be surprised to learn the relatively modest size of the benefits.  Or less than rigorous surveys and methods involved. However instead of any serious or meaningful inquiry we get the standard line or two about the bountiful good of the breast and its output:
Breast-feeding decreases babies’ risk of ear infections, diarrhea , asthma and other diseases, and may reduce risk of obesity and slightly improve I.Q., experts say. The question is whether samples tempt mothers who could breast-feed exclusively for the recommended six months to use formula when they’re exhausted or discouraged if nursing proves difficult. Tossing the Formula, New York Times

Decreases the risk. This wording gives the impression of causation without stooping to explicit causation. It's technically inaccurate but still carries the ring of scientific credibility.   

The reduced risks. Ear infections. Diarrhea.  Honestly, how many bouts does the average infant or toddler have a year? These are the most "robust" of the benefits meaning the most consistent and largest. Then there's the rest of the lot. Asthma, not especially well-established (i.e. inconclusive, lots of mixed results).  IQ. Shouldn't even spend another second thinking about it. Obesity? Please. Fine but how to explain the span of several years (if  not decade) in which it is utterly unknown what the kids in the study actually ate. Researchers don't generally ask (i.e. weren't so interested).  If only we could peek inside the breastfeeding lab in the Department of Maternal and Child Health
Hey, look at these chubby kids. I wonder why they're so heavy.  Maybe they weren't breastfed? Hhhmm. Instead of asking about their diets over the last few years, it's just such a pain, let's focus on what went in their mouths when they were babies. Hey. Wow. A significant difference! Breastfeeding reduces the risk of obesity. Cool. We can so publish this.   

As if the researchers didn't start with the premise breast-feeding was superior. As if the researchers didn't start with a big pile of data and run every outcome every which way through the statistical software until a significant breast-feeding benefit popped out.  How dare I? Frankly the formula article gave me fresh insight into the compromised nature of at least one breastfeeding study. If only I were making this up:
We’re not anti-formula,” said Dr. Melissa Bartick, a founder of Ban the Bags, a breast-feeding advocacy group, which reports that one-fifth of the country’s nearly 3,300 birthing programs have taken more comprehensive steps of banning samples and logo-emblazoned bags for all mothers. “If a woman makes an informed choice to formula-feed, the hospital should provide that formula. But hospitals shouldn’t be marketing it. Tossing the Formula, New York Times

Informed choice.  

This comes from Melissa Bartick, M.D., Harvard researcher and lead author of  The Burden of Suboptimal Breastfeeding or as I like to call, The Dead Babies Study .  Bartick and her co-author Arnold Reinhold argue 900 babies die a year in the United States because they don't sucked down enough breast milk. That estimate comes from babies who died from a variety of illnesses such as childhood leukemia, SIDS, obesity and asthma. As if more breast milk could have saved them. The level of ridiculousness in that claim, the study and its subsequent media attention including a shout out by the Surgeon General motivated me to nominate it as one of the most memorable studies of the year and by that I really mean most infamous.

But hey, let's hear it for informed choice. If only women had accurate, nuanced information free of bias they could make one as opposed to wading through the rhetoric that's come to characterize too many public health recommendations and policies to say nothing of the parenting media.
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