Tuesday, October 16, 2012

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

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 New York 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 of the breast 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 of these 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 if it weren't for 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 didn't suck 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.

UPDATE: I'll be posting soon on the other claims in the article. Stay tuned. Thanks for all the emails. The comments on the New York Times website seem rather tame compared to usual vicious fare surrounding breastfeeding. People appear concerned about banning formula. Check them out, see if you can find me in the Reader Picks.  There goes my chance at being invited to the Harvard Symposium on Breastfeeding. 

9 comments:

Julie said...

I generally agree with your skepticism, however, I do agree that if formula were available, I would have been much more tempted to give up on breastfeeding. My baby wasn't getting enough milk and I was exhausted. The only reason i continued was my husband who was determined to give any and all support to me to make it work. He basically took over the house for 2-3 weeks. Who has a husband who can do that? It certainly wasn't worth a lost job or something similar.

Polly Palumbo, Ph.D. said...

Hi Julie, yes, good points. I felt very much the same way in the early days. Did you read the article? Belluck brought up the question of whether the free formula deters breastfeeding. The studies are mixed and I suspect quite shoddy and sparse.

Anyhow, I breastfed and took home the samples. I eventually used them too with all three of my kids though much sooner with the younger ones. In fact, I think just having them in the house, just knowing they were there, might have eased my worries, especially with the second two kids because I'd struggled so much the first time.

I think supplementing with a bottle of formula actually helped me breastfeed longer for a several reasons including the peace that I wasn't the sole food source and also with getting more sleep (hubby could feed) and in the early days, give my bleeding nipples some relief.

Julie said...

Since I didn't do that I guess I wouldn't know.

I would just be afraid supplementing would affect my milk supply somehow- I would not produce enough.

I was having this problem anyway. For some reason none of the women in my family produce very much breast milk.

Polly Palumbo, Ph.D. said...

My friend who had problems with low milk supply would tell people she made only skim milk. Anyhow I was lucky to avoid that issue.

Polly Palumbo, Ph.D. said...

Hey Julie, love your blog by the way. Any hints on how to make my girls realize science is fun? My 4th grader refused to believe cooking is really an experiment, baking chemistry.

andrea said...

I don't understand. Can't hospitals give moms a piece of paper where they can check yes I want a formula sample or no I don't, not unlike filling out your preference for lunch?

I also want to hear what your take is on this: "Health experts warn that even small amounts of formula dilute breast-feeding’s benefits by altering intestinal micro-organisms..."

Polly Palumbo, Ph.D. said...

Great idea. If it were only that simple. Frankly I could have used a box to check asking the lactation specialist not to pester me so much.

Oh Andrea, you so know what I was doing this afternoon, checking up on the other expert claims in the piece! I'll have to do a follow-up soon. I do remember reading a study or two on beneficial gut bacteria etc. in breastfed babies. I assume this is what that statement references. Also there's that pesky claim about endangered milk supply. I'll let you know!

PS I also couldn't resist peeking at Ban the Bags, the "pro-breastfeeding" group ridding hospitals of free formula.

Clare said...

Dear Polly

You might want to check out this report just out from UNICEF

http://www.unicef.org.uk/
Latest/News/breastfeeding-report-nhs-savings/

Polly Palumbo, Ph.D. said...

Thanks, Clare. Your thoughts on it? Looks like it's in the vein of the Suboptimal Breastfeeding report. Will have to read up and include it in my follow-up.