Wednesday, July 21, 2010

Kids, Cancer, IVF, and Infant Formula: A Logic Puzzle Not on Your Kid's SAT

IVF is to ______: Baby Formula is to ______

No, I'm not prepping for the logic section of the SAT, but I've got a puzzling logic problem of my own after reading about kids and cancer.  Yes, kids with cancer. Pretty much a parent's worst nightmare.  Something the media could really milk. If I'm being cynical, I'd expect the media to run away with the new study out of Sweden showing children conceived in vitro face slightly higher cancer risks.   Pump up the fear, forget to tell us why we shouldn't be so scared.  After reading the journal article I was prepared for the embellishment of the rather undramatic results that IVF children have slightly elevated risks of childhood and early adulthood cancers for uncertain reasons.   

So I was pleasantly surprised to read Time's finely nuanced piece on the IVF study published in this month's Pediatrics (see the Times article, Study: Why IVF is Linked with Cancer Risk):

The article delves into the details like the number of cancer cases in IVF young adults (56) versus others (38) in the sample of 2.4 million births, including over 26,000 IVF babies.   The reporter could have merely told us the risk increases by 42%, then we'd be worried, right?  But we learn these cancers are very rare and that in plain English, the risk translates to just one more case of cancer per 1,000 IVF babies.  Phewww.  And there's discussion of why it's so hard to study the issue, complicated by the tangle of factors that might contribute to a higher risk - something about the infertile mothers, something to do with the specifics of invitro fertilization, or those of preterm birth in general, like the child's birth weight, birth size, breathing issues, Apgar scores, etc.  

Interesting, refreshing in nuance.  But then this little nugget stuck out:
Even if the study had confirmed IVF as a risk factor, experts say the level of increased risk is not enough to deter parents from undergoing the treatment. While IVF may bump up a tiny risk of childhood cancer, without it, many infertile couples may not have a baby at all.
All good.  The way it should be. 

Basically the lead researchers and the reporter bent over backwards to assure IVF parents and children they should not sit around worrying about cancer. And potential IVF parents certainly should not NOT do IVF just because of this slightly elevated cancer risk.

But I couldn't stop thinking about the parallels to other parenting issues.  Say breastfeeding.  Can you imagine if we treated the negligible health risks of infant formula like those of IVF?

 And in the latter we're talking respiratory infections and diarrhea - nothing compared to cancer for goodness sakes.  Why is it the parenting industry downplays the risks of invitro fertilization (as well they should) but not infant formula?  Both are excellent examples in which parents generally are limited in their options -  one by fertility, the other, by complications making breastfeeding difficult or impossible.  They come to the alternative method not completely by choice.

It is particularly striking when you consider the ongoing stigmatization of infant formula...  

Remember the public service ads likening not breastfeeding to riding a mechanical bull or smoking while pregnant? Imagine a public health campaign comparing IVF to child abuse.  Maybe it's a test tube emblazoned with the words CANCER.  It's absurd.  Simply crazy.  But why do we accept, even endorse at times, this criminalization of moms who use formula?

Why the respect for IVF parents and perhaps families and children struggling with cancer but not the same for women who simply feed their babies infant formula, hardly a known carcinogen.  It's an odd thing, the public battle over how and what we feed babies.   I bet part of it is our perception of personal choice.  Women don't chose to be infertile but they do choose not to breastfeed.  Or so goes our stereotypical thinking - though I know, I know, infertile parents do choose IVF and some do not and many women do not "choose" formula so much as they cannot breastfeed.  If I were to do a little survey I think people would perceive more choice on the part of women who don't breastfeed.   The formula moms would fare poorly compared to women who saddled with infertility choose to use invitro. We stigmatize those who we perceive to have choices. 

Speaking of choices, let's face it, there's not much difference between child health outcomes when it comes to breast milk or formula.  The risks/benefits are relatively small so we need to justify our choices.  Turns out we're good at employing psychological means to justify our decisions, a little trick called cognitive dissonance that makes our foregone choices less appealing and thus less tantalizing and bothersome according to legendary psychologist Leon Festinger.  Be it the guy we didn't marry, the house we didn't buy, the career we left to stay home with the kids, the preschool our kids didn't attend, the substances we didn't feed our babies - we devalue, degrade, otherwise trash the choices we didn't choose.  It makes life less stressful, at least for our own selves if not the rest of humanity who did not make or have the ability to make the same choices.  In the case of breastfeeding, it's arduous, often thankless work.  All the more reason to seek out justification, especially in light of not so perceptible differences between the health outcomes of breast milk and formula kids. 

So this week let's try to remember the genius of Mr. Festinger, a chain smoker par excellence who might very well have invented the theory of cognitive dissonance to justify his addiction - had he, the son of Russian Jews who came of age during the Holocaust, not been eager to understand atrocities of human behavior, especially those involving group dynamics and the justification of social beliefs and behavior. 

So have you solved the logic problem at the top of the page?

If only we could so easily reduce the justification of our own often illogical beliefs and behaviors.

CORRECTION: OOwww I love reading these in the Sunday edition!  Anyhow, I reversed the numbers for the cancer cases in an earlier edition.  Me culpa.  Sorry!  Kids were hungry, me hurrying....

16 comments:

StandardSpicyWhatnot said...

I do think it is important to note that no one makes a dollar on intercourse conception or breastfeeding...really. I'm not implying that it is a big conspiracy or anything just that we have a very consumerist culture and spend a lot of money on formula and reproductive tech. You failed to mention the health benifits breastfeeding give the mother...... and the risks to the mother from reproductive tech. It is much more complicated this this post delves into...SAT comparison or not.

Polly Palumbo, Ph.D. said...

Hi SSW. So I take it you're against assisted reproductive technology? Can I also assume the breastfeeding industry - i.e. lactation consultants, boppies, breast pumps too? I get you on our too much consumerism culture. As for breastfeeding, I don't deny the health benefits exist for mom though they are relatively small too. This post focused on children's health - so that's for another time. I'm not really up on the maternal risks of reproductive technology but I can gander they include all the risks of multiple births plus a few others, right? The media's focused much more on the children than mommas. Yes, it is a complicated phenomenon to study so all the more reason to focus attention on the crucial aspects - which often get left out of the media reports not to mention the public discourse. I couldn't agree more about the complexity!

Natalie said...

"Speaking of choices, let's face it, there's not much difference between child health outcomes when it comes to breast milk or formula. The risks/benefits are relatively small so we need to justify our choices."
This goes against scientific evidence from EVERY medical organization out there: WHO, AAP, ABM, you name it. This is science, not opinion. Denying evidence and spreading inaccurate information is wrong.

Anonymous said...

Are you seriously trying to compare the "breastfeeding industry" of pillows and the occassional lactation consultant to the multi *billion* dollar formula industry? Seriously?

There have been thousands of studies around the world showing the superiority of breastfeeding on a baby's health - including their health later in life. This is very different than an IVF study about a very low risk of cancer.

Sure, it's OK to bottle feed, your child won't DIE ... but there is something much much better. They're both a white tinged liquid, but otherwise, they're very different substances.

Polly Palumbo, Ph.D. said...

Hi Natalie,

Yes, I agree, spreading inaccurate info is wrong - that is why I say again and again - if you read the actual scientific evidence of breastmilk (or breastfeeding) you will find that there are many studies finding benefits though - and this something the medical community RARELY states - the benefits are relatively small and short-lived. I don't dispute that - I breastfeed all 3 of my kids for between 3 and 5 months bc I believed the benefits existed. BUT I think it is a disservice to women, kids, and MEN everywhere to portray breastmilk as the ONLY or as an infinitely better choice. It simply isn't true if you take the entire body of research and look at the NUANCES. BTW, there are even studies that find NO BENEFIT but we don't hear about them. And I can assure you plenty of researchers look at those outcomes and when they don't find it - they don't get published.

Polly Palumbo, Ph.D. said...

I did not compare the breastfeeding industry to the lactation industry or the formula industry - you'll see Spicy above objected to consumerism involved in the parenting and baby industry. I simply asked if she objected to the range of consumer products and services in each.

As for formula-feeding vs IVF, I agree it's hard to compare the two - I am simply making the point that we spend inordinate amounts of time pressuring women into breastfeeding when we have yes, plenty of studies, but ones that don't show a huge benefit. Why we exaggerate the so-called "risks" of formula and downplay, quite rightly, the risks of IVF, which include cancer, I just don't get.

Again, I am a breastfeeding advocate, been there, done it with all my kids. But I refuse to disregard the science and it does not show a large benefit for breastfeeding on any outcomes.

Jem said...

In your entry you say (with regards to formula) that "we're talking respiratory infections and diarrhea - nothing compared to cancer for goodness sakes." but this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/ claims that not breastfeeding puts infants at an increased risk of leukemia, which obviously is a cancer.

How accurate is this study? (I am not a scientific sort, just a breastfeeding mother with an interest in lactation/etc)

Thanks in advance.

Polly Palumbo, Ph.D. said...

Hey Jem, I've never read anything about a cancer link but I will take a look at the study. My gut instinct is that this is a retrospective study in which adults or young adults were asked to recall if they were breastfed. That means it is not most likely a well-controlled one and if these subjects were babies back at least twenty years or so the breastfeeding rates were less and there were no doubt important differences between moms who b'fed and those who didn't. So we can't attribute cancer rates to bf - especially with the longspan with uncontrolled differences between these families. But I could be wrong - thanks and I will take a look see this weekend!

Polly Palumbo, Ph.D. said...

In response to Jem's reference to studies showing a link between bf'ing and childhood leukemia - I've read a few meta-analyses (that look at a large # of studies) in addition to some of the newer studies on the topic. It's a mixed bag for sure. The problem with the meta-analyses, though they give an overall picture so to speak, the studies tend to be older. The author of the 2004 meta-analsis finding a link later published a tighter study finding no link. This UC Berkeley researcher, Kwan, reports 14 case-controlled studies find no link and 5 do. Overall in the literature less than half seem to show a link.

It's a difficult topic to study. Most have originated in cancer centers then matched cancer cases to controls in the general population. All of them thus, are retrospective, asking mothers (and some fathers) to recall bf'ing back years. BTW, the studies that do find a link report only slightly higher risks. Experts remind us childhood leukemia is very rare - affecting like 30 children out of 1 million. Anyhow, thanks for the prodding, Jem. As one of the researchers pointed out, we shouldn't make women who don't breastfeed feel guilty about it based on this research.

Polly Palumbo, Ph.D. said...

BTW, I "misspoke" earlier in my comments, or perhaps could be misinterpreted - it's not that I never read about a possible cancer link to bf'ing - I read the reports about leukemia several years back and don't include cancer in one of the established benefts - it is very much an iffy finding unlike other benefits. I recalled the body of work as inconclusive so I don't consider it good evidence of a link - that in combination that there are many intervening variables between bf'ing and the illness plus a whole host of factors that differ between women who breastfeed and those who don't. May it be true? Maybe but as yet we don't have that evidence. Maybe it's not true? Maybe.

Jem said...

Thanks for taking a look and sharing your thoughts.

"As one of the researchers pointed out, we shouldn't make women who don't breastfeed feel guilty about it based on this research."

Agreed.

TherExtras said...

Ack! Sorry I'm so late weighing-in, Polly. Aha! Your did not tweet this post!

"trash the choices we didn't choose" Sums-up your (and mine) reasons for expecting the media to make a run with this particular study.

Perfect logic - comparing this to the formula/breastfeeding issue.

Well, now to read the other comments...Barbara

Polly Palumbo, Ph.D. said...

Seemed perfect logic to me! Do you think we're becoming too skeptical and stepping into cynicism? I know you will have a good answer for that one....now, if you'll excuse me, I must tweet my post nearly a week later...not exactly what Twitter envisioned for the whole new instant information, etc.

TherExtras said...

Cynicism logically follows understanding research better than the media. We are not cynical about bf or ivf.

Someone must've caught you between here and twitter...;)

Barbara

The Fearless Formula Feeder said...

Don't know how I missed this one - and it's over a year old. Geesh. But you hit on one of my biggest pet peeves, here. You are absolutely right that there is a parallel to be drawn. Before I say what I am about to say, I want to make it clear that both my kids were conceived w/the help of a reproductive specialist; we only needed monitoring/hormone therapy but it was assisted all the same. I have absolutely nothing against RT and think it is a fantastic thing. But that said - in many cases, infertility is partly, if not solely, the result of waiting too long to have a child; this is very often a choice (I was by far the youngest person in that specialist's waiting room and I was in my early 30's, so far from "prine" childbearing age, myself...if we did what was 'natural' and the "biological norm", the majority of my friends would not be mothers). A choice I support, but still a choice. So I actually think it is a PERFECT parallel to formula feeding; both involve a personal risk/benefit assessment; both allow people to parent who will be incredible parents and bring great kids into the world; people who may not have been able to reproduce and sustain their children, otherwise.

In other words - fabulous analogy.

Polly Palumbo, Ph.D. said...

Better late than never! Forgot what I said last week but kinda sorta remember this one bc I've always been amused by the selective "natural" mothering imperatives.