Saturday, January 15, 2011

Breastfeeding Bubble Burst?

Pediatricians challenging exclusive breastfeeding.

What next? Gisele Bundchen turning to formula. Gwyneth Paltrow forgoing her kids'  daily dose of lemon-flavored flax oil (yes, read about her hectic day at HuffPo).

A group of British pediatricians bring to the table some evidence exclusive breastfeeding for 6 months (i.e. not introducing solids or any formula or other liquids such as soymilk, cow's milks, etc. until 6 months) may have, eek, several downsides - like higher risks of allergies, iron deficiency anemia, and celiac disease.  They speculate further about possible limited food preferences and nutritional deficiencies.

Remarkable article in the British Medical Journal.  Refreshing, someone has done their homework.  I particularly appreciate their reasonable tone. 

Not only do the docs question exclusive breastfeeding, and thus the American Academy of Pediatrics and the behemoth breastfeeding-is-best lobby but also provide a glimpse at the faulty foundation beneath the exclusive breastfeeding recommendations set down by the World Health Organization in 2001.  According to these daring docs out of University College London, "the evidence base supporting a major, population-wide change in public health policy underwent surprisingly little scrutiny."

Hmm.  How faulty was the evidence? 

The WHO edict rested largely on one published review of international studies authored by Kramer and Kakuma, the former who published one of the most methodologically-messed up pseudo scientific hatchet jobs (on breast-feeding and IQ!) I've laid eyes on outside of undergraduate pysch courses.  Here's how the London baby doctors see it:
The review included 16 eligible studies, seven of which were from developing countries. Apart from two randomised trials in Honduras, the studies were observational, precluding proof of causation for the outcomes examined, since residual or unidentified confounding may remain even after adjusting for potential confounders. The study’s conclusions (box 1) included evidence for the efficacy of six months’ exclusive breast feeding (notably reduced infection rate) but also potential risk (iron deficiency anaemia, with its associated adverse neurodevelopmental outcomes).
Okay, so what about the "developed" countries, you know, like the US? There must have been lots of evidence, right?
"One study from Belarus showing a lower risk of gastroenteritis. "
In other words, stomach flu.  The WHO seemed to ignore another large review of 33 studies that basically concluded there was no basis for the 6 months-clause.

So there you have it.  By the way, the British peds are very much pro breast-feeding and would readily agree to exclusive breast-feeding for 4 not 6 months.  The evidence for 4 months is slightly less suspect.

9 comments:

Anonymous said...

Does this mean there is a glimmer of hope for more balanced research is on the horizon?! That people are starting to see that weak studies are being used as "undeniable evidence?" Only one can hope!

Polly Palumbo, Ph.D. said...

Fingers crossed, Anony, our New Year's wish!

TherExtras said...

I could live with 4 months being the general recommendation, if the mother chose.

Finally! I was able to copy this from a billboard while Hubby was driving:
www.breastmilkcounts.com

Barbara

Polly Palumbo, Ph.D. said...

Hey Barbara! As usual, well-said! I'm fine with 4 months too, especially since I don't have to do it again! Cannot wait to check out the bill board - what you don't point and click while driving?

Polly Palumbo, Ph.D. said...

Yikes! Have you seen the website? Adorable babies, future "brain surgeons", "rocket scientists", "world class athletes" - all because "breastmilk makes kids stronger", "healthier" and "smarter". Much worse than I anticipated...now I'm supposed to go to sleep? By the way, did you hear the music? Breastmilk prevents SIDS, diabetes, etc.....wow. Barbara, how do you do it? Do you avert your gaze when passing this propaganda?

TherExtras said...

Sincere apologies for the sleep-depriving propaganda. Did you notice who the site sponsor is? State WIC program.

(I can't quite come up with the words to describe the particular placement of the billboard in this town.)

I did it for you, Polly. ;)

So what do we do now?

Barbara

Polly Palumbo, Ph.D. said...

And I thank you! So I'm assuming it's not exactly in the high-rent district where mommies have lots of paid help and breast pumps?

Just when I think I should drop the topic...just got Joan Wolf's new book - Is Breast Best...cannot wait to read it!

Emily said...

From Knight Science Journalism tracker:

http://ksjtracker.mit.edu/2011/01/20/breastfeeding-study-a-case-study-in-bad-headlines/

From that piece: "And, the kicker: According to the study’s disclosure, three of its four authors 'have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past 3 years.'"

Polly Palumbo, Ph.D. said...

Good eye, Emily! But their claims can be readily verified, the research considered by the WHO (I have read it) - still is lame. But still, something to consider.