Friday, July 28, 2006

Why the constant call for infant formula in emergencies, the most dangerous setting for its use?

I just read “For him, combat zone is office-Relief worker from Capital Region says human needs outweigh dangers in Lebanon" By PAUL GRONDAHL, Staff writer Albany Times Union, Thursday, July 27, 2006 in which he covers the good works of the Catholic Relief Services/Caritas in Lebanon.
While noting that "Suffering civilians are suffering civilians, and we intend to help them'' he notes, “The need is acute for water, food, infant formula, medical supplies and sanitary products” and that “The logistics of distributing relief supplies in a country whose infrastructure has been reduced to rubble and where trucks face the danger of being bombed [is] an ongoing challenge.”
So I wrote to the fine reporter who covered this humanitarian activity as follows:

Dear Paul:
I am startled and concerned about the constant call for infant formula whenever there is an emergency. The use of infant formula in emergency settings is a high risk activity, where fuel and cleanliness are rare and diseases rampant. These are times when the anti-infection components of human milk are even more important, and associated with increased survival.

While I do not have the data for Lebanon, the data from surrounding countries show that the vast majority of infants are breastfed throughout the first year. In an emergency, the mother can produce more milk as the child needs, if she is protected and fed - which should be a priority. It is cheaper, easier and safer to feed the mom, and breastfeed the infant, for the health and survival of them both.

Please let me know if there is any way to get this message out to the readership.

Best wishes,
Miriam

Monday, July 10, 2006

10 July 2006
Open letter to:
Sen. George McGovern
Stevensville, MT

Dear Sen. McGovern:

With great respect for you, and for the causes you have defended, I was surprised to read your letter to the New York Times entitled, “Breast Milk and AIDS” 6 July 2006. You are well known for your support for women's issues, so perhaps it has not been brought to your attention that breastfeeding is an emerging women’s issue.

Human milk is the best nutrition, as you note, but it is much more than nutrition alone. Breastfeeding is probably saving more than 5 million lives today, and could save at least 1.3 million more lives every year. What other healthcare intervention can say the same?

There are so many breastfeeding-associated factors that protect infants and young children against disease and chronic ailments that it would be impossible to list them here. The result is that, in some settings, the risk of dying from not breastfeeding is greater than the risk of contracting AIDS from breastfeeding. In the United States as well, breastfeeding saves lives and, due to its immunological components, reduces disease significantly when compared to formula feeding.

Why is this a women’s issue? The common sense approach would be free choice. But, to make it truly possible for women to choose and to succeed with breastfeed in the United States-- without having to make significant socio-economic sacrifices or to fight their health care providers – we should level the playing field. This is do-able -- many northern European countries have accomplished this years ago -- with four actions: full, information on feeding options without commercial bias; social and political support for paid maternity leave; health worker education and standards of care that support breastfeeding; and third party payment for lactation support and care. Countries and societies have supported these changes so that women and families could freely choose what they know to be best for their children.

We claim to be the nation that supports “motherhood and apple pie”. Once we really begin to offer women and families a free and informed choice in this manner, only then can we claim that we are supporting their nurturance of the next generation, and taking a balanced, “middle of the road” approach.

Thank you for your ongoing support of women, and for all Americans who aspire to be all that they can be.

Sincerely,

Miriam H Labbok, MD, MPH

Friday, July 07, 2006

State offering new formula

Richmond, Va.

"The Virginia Department of Health says a new company is being used to provide formula for the program. Under the new contract, the program will receive more than 24-point-five (m) million dollars a year in rebates on cans of formula purchased through the program... More than 30,000 infants in the program use the formula..." http://www.wjla.com/news/stories/0706/342098.html Copyright 2006 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Please, someone, tell me how the formula companies can afford these multi-million dollar "rebates", which are, of course, tax deductible for them, if the state were really getting the lowest possible pricing?

And how could be this massive over-pricing be occurring if the industry is not colluding on pricing?

I’m not sure, but I think that this means that Virginia residents’ tax dollars are being overspent by at least $24.5 million, and, then, on top of this, our federal tax dollars are paying for the tax deduction claimed by the company against this gift/rebate to the state.

As a result, Virginian tax payers are paying twice, and the formula companies are earning twice.

And the formula companies are getting richer – just read the market news...


Monday, July 03, 2006

New York Times Editorial Apologist for Breastfeeding

The New York Times editorial on breastfeeding: “About Breast-Feeding...” Week in Review, p.9, 2 July 2006, http://www.nytimes.com/2006/07/02/opinion/02sun2.html, reduces the important public health implications of breastfeeding to something to consider only in a situation with “all things being equal” and then purports to support a middle ground. This editorial comments on a proven public health intervention - breastfeeding - as though it were one of two equal viewpoints, the other being formula feeding, and provides the casual observation that folks are doing okay without it, dismissing its value. To this reader, this does not appear to be a “middle of the road” stance, and, simply put, it is irresponsible. The issue that was originally raised was one of misplaced guilt and responsibility surrounding breastfeeding, but this editorial reduces this editorial reduces the issue of breastfeeding to something to consider only in a situation with “all things being equal”.

This editorial expresses scientific opinion that can impact negatively on the health of its readership and that is, at best, ill-informed and misleading. If a "middle of the road" option were defined in this piece, it certainly is not supported by the final sentence: "Millions of Americans have thrived on [infant formula] and are doing quite nicely as far as we can see." This sort of statement would be similar to saying that "millions of Americans have smoked and are doing quite nicely". As a medical epidemiologist, I concur that both of these statements are true, but each one belies the importance of the preventive health message.

In epidemiology, it is common that not every study, or every individual's anecdotal observation, will reveal the marked impact of an important intervention. Rather, reporters and scientists, alike, should rely on the evidence. When there is "biological plausibility" and the majority of the evidence points in the same direction, even if some studies do not achieve statistical significance, there is indeed cause for concern. Every person who smokes does not get heart disease or lung cancer, and yet we strongly discourage smoking because we have studied the consequences. Every non-breastfed child does not become ill, and every non-breastfeeding mother does not get breast cancer, but we know that the probable risks of these consequences for the mother and the child are increased, and therefore we should strongly support breastfeeding.

Why do we see these differences in health outcomes, despite agreement that formula is generally nutritious? Because breastfeeding is not nutrition alone. Every baby is born deficient in terms of its immunological maturity, and the milk from its mother carries the necessary immune factors needed until the baby's system can mature. And every baby is born with susceptibilities, and breastfeeding can lessen the risks for many, or delay onset until the child is old enough to handle it. In addition, there are many additional factors that help the infant adapt to the world outside, and that change with the child's needs over time, that are only found in mother's milk.

We who were not breastfed may well be among the "millions of Americans doing quite nicely", but what would our situations have been if we had been breastfed? There is a wealth of scientific evidence that we could have been healthier in many ways: perhaps brighter, perhaps thinner, with better vision and straighter teeth and, perhaps, less likely to have a chronic disease such as cancer. We can only decry that our mothers were not supported to feed us in the manner that is proven to reduce the risks of childhood illnesses, and which would have had, according to most studies, long term consequences for both her and for us.

Why didn’t our mothers and grandmothers breastfeed? There were many social pressures on women to work during the war. And in the 1950s, when women were encouraged to stay home, the commercial pressures may have taken over. For example, my infant formula-sponsored baby book, the one that my mother was given when I was born, stated, more or less: Congratulations on your new baby. Your hormones are going wild, and you may feel like doing something bizarre, like putting your baby to your breast. Resist. Your doctor knows better.

The commercial sector no longer makes such statements, but we are the progeny and the students of the generations of well-meaning women who received this sort of counsel from the medical profession and media, alike. Any woman who succeeds with optimal infant feeding in our society is deserving of respect and applause.

To return to the editorial, what is the "middle of the road" on this issue, anyway? Perhaps a middle ground might emerge where there is a situation in which women were enabled to truly make a choice. What would that look like? To make a fully informed choice, a woman and family would have ready access to accurate information, free of commercial bias, and, if she chooses the healthful option, she is enabled to breastfeed by a society that supports women by providing third party payment for breastfeeding support, training all healthcare workers in the basics of breastfeeding health, ensuring maternity leave and/or workplace support for continued breastfeeding, and offering constant encouragement in giving every infant the best start on life.

When our society has achieved this support for women of all circumstances, dedicating at least as much in the way of resources to breastfeeding support as the commercial sector provides for advertising the nutrition-only breastmilk substitute, then, perhaps, we will be able to define a "middle of the road."