Monday, April 17, 2017

Exaggerated Benefits of Breastfeeding

“There are countless medical, emotional, and economic benefits of breastfeeding…”
The American Academy of Pediatrics, April 2017

The benefits of breastfeeding are so plentiful they can’t be counted. Countless. Do not fall for this spin in the new clinical report issued this month by the American Academy of Pediatrics. Although “countless” the AAP still managed to rattle off a list of purported breastfeeding benefits to try to dazzle pediatricians into believing the benefits are stronger and better than they truly are.

The AAP experts are no longer interested, if they ever were, in quantifying the purported benefits. They certainly don’t like to take measure of the size of the benefits. Like telling you the number of ear infections you can prevent by breastfeeding for 6 months. They do not want moms to know it is less than one. As it turns out, breastfeeding benefits are relatively moderate and short-term. But that does not make anyone want to breastfeed let alone for one year, exclusively for 6 months.

I won’t even comment today on the other questionable language and claims in the new AAP report, including “optimal cognitive development.” 

Parents deserve better information. They don’t deserve “countless” benefits of breastfeeding. A respected pediatric organization should not spin health information. Period. 

6 comments:

Cheryl M. said...

This is pretty bad. What else are they exaggerating?

Polly Palumbo, Ph.D. said...

Hi Cheryl,

Yes, that is an issue.

As it turns out, a number of official guidelines that seem like they are based on water-tight, rock-solid data are not. Yes they are "evidenced-based" in that there is some research behind them. Generally the policy makers go by the existing evidence but it often does not provide specific cut offs or numbers, for instance, that there is anything "magic" about breastfeeding for one year. If you recall, they changed the early screen recommendations from birth to 18 months recently - from zero tv to almost zero tv bc although studies suggest early tv and screens are not particularly helpful (and in extreme cases hinder language development), there is not hard evidence.

Deuce Mom said...
This comment has been removed by a blog administrator.
Anonymous said...

Just for the avoidance of doubt... Can you do a quick rundown of absolute risks for outcomes associated with BF (vs FF) - including only those causally known to be linked, (I think that is, diarrhoea, otitis media, upper resp tract infections, NEC in preterms). Frustratingly, it's very hard to get these "actual data" expressed as absolute risks (which are the most meaningful) - generally most research papers or other presentations give relative risks or odds ratios only which are really hard to interpret. but absolute risks actually give info that is meaningful to parents.

eg:

100 babies optimally BF (6mo exclusive then partial BF plus solids)
100 exclusively FF (plus solids after 6mo)

number that would experience each outcome, for each group of babies, for the 1st year

You almost *never* see this actual data presented this way, but it's the easiest way to actually see the benefits of BF. If you know of papers which give these stats, it would be sooo helpful if you could add here. Thanks.

Polly Palumbo, Ph.D. said...

Hi - You are so on point here!! almost never. Wish I had these numbers. I have rarely seen this data and have been asking this same question for years. Rarely are the benefits discussed as absolutes, and I cannot think of a single time I have seen an effect size. Part of the problem as you said, a lot of the research is older and the effect sizes are not reported. Part of me also suspects they are not reported (but also calculated by public health minds) due to a lack of will to do so - that is, to put the numbers into a meaningful context. - bc I think people would be far less impressed if they saw them.

I have often thought about doing it myself - but the issue is, which studies to include. The AHRQ report, that collected a lot of research, is now rather dated. Have you looked at the SIDS meta study? It is even hard to know how they arrived at those numbers, actually, the studies that were used in the first place. OF COURSE this doesn't even get at the issue of confounding factors involved.


Anyhow, the study I have been wanting to see are those breastfeeding effect sizes compared to those for other parental behavior measures, for instance, childhood vaccines, prenatal visits, diet in first few years, etc. I recall a guy at Princeton did a comparison of risk for autism that I have been wanting to replicate for breastfeeding. He reported it, an informal chart, in the NY Times.

You aren't a statistician by any chance? If you're interested in pursing, give me a shout on email. If you have any ideas about how to do this study, would love to hear.

Thanks.

Polly Palumbo, Ph.D. said...

Sorry - thought I'd published your comment last week, thanks