Thursday, April 10, 2008

NPR: where do you find your health experts?

Dear Day to Day:

I am disappointed in your presentation yesterday on Michael Kramer’s epidemiological study of a community breastfeeding intervention.Dr. Speisel misrepresented the study and its findings. The study he mentions was not designed to study the impact of breastfeeding per se; the study is examining the long-term impact of a hospital based intervention to increase breastfeeding. In other words, the results do not reflect breastfed children vs non-breastfed children, but rather looks at populations whose mothers were exposed to breastfeeding support in the maternity vs those whose mothers did not receive breastfeeding support in the maternity. In the areas with support, infants were more likely to breastfeed (19.7% vs 11.4% at 12 months, exclusively breastfed at 3 months, 43.3% vs 6.4%; and at 6 months, 7.9% vs 0.6%). With this small but significant increase in breastfeeding, the group with the maternity intervention were less likely to experience 1 or more gastrointestinal tract infections (9.1% vs 13.2%) and atopic eczema (3.3% vs 6.3%).

In Dr Michael Kramer’s earlier finding on this study, when the children were younger, a clear difference was found in the health impacts in the regions with and without breastfeeding support, but Michael does not compare breastfed vs not breastfed, he compares areas that had a maternity-based intervention and areas that did not. However, given that the breastfeeding rates in the two groups were different but by no means a comparison of breastfeeding vs not breastfeeding, it is not surprising that findings may be muted or confusing when the children are more than 5 or 6 years old. There are many other studies that do so.

Dr. Speisel’s contention that it is impossible to use epidemiological techniques to compare breastfed to non-breastfed children shows a lack of understanding of epidemiology. Good methodology is not limited, as he suggests, to randomized case-control studies.

If you were truly interested in reporting on this study, it would have been appropriate to interview the author.

Downplaying the importance of breastfeeding for health and survival in the US is in contrast to the AHRQ meta-analysis on this subject, HHS Health Goals for the Nation, and the wealth of studies on this subject. I consider the choice to give a non-expert air time to express an opinion that can damage public health practices is, frankly, somewhat irresponsible.

Incidentally, I am not able to find a single peer-reviewed publication in a PubMed Search under his name, nor am I able to find Dr. Speisel’s name listed in the Yale Medical Faculty directory.

As a contributor to NPR I expect better reporting and accuracy.

Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM
Professor of the Practice of Public Health,
Director, Center for Infant and Young Child Feeding and Care
Department of MCH, School of Public Health
The University of North Carolina at Chapel Hill
former UNICEF Senior Advisor on Infant and Young Child Feeding and Care
former Division Chief at USAID in charge of Nutrition and Maternal Health
former Director of Breastfeeding Research at IRH, Georgetown University Medical School


rainbowzinnias said...

Thank you for your excellent post, Dr. Labbok.

Rebecca said...

It really is alarming that an NPR show could have gotten this story so wrong ... and now that I know that they interviewed a non-expert whose credentials appear, at best, to be shaky, I really have to wonder if this interview wasn't planted by the formula industry. The IFC never misses an opportunity to twist some study's findings into "news" that breastfeeding somehow isn't all that great after all.

*Diana* said...

This is a fabulous letter -- thank you so much for articulating what so many of us are feeling about this issue.

Harry Torney said...

A really excellent rebuttal, Miriam, and very level-headed with no sign of going over the top. Well done!

Rebecca said...

Slate and Dr. Speisel revisit the study, in a video interview, with (IMHO) mixed results. (Oh, and this interview again identifies Dr. Speisel as a faculty member at Yale's medical school.)

He has stopped bashing the methodology and seems to grasp that the difference between the populations is the presence of a breastfeeding education intervention in one group. However, the reporter again tries hard to get him to say that women needn't feel guilty if breastfeeding isn't working, and instead of making the obvious (to us!) recommendation that such mothers should seek support, he meanders through something garbled about it being best for baby only if mom is enjoying it -- which the reporter strangely calls "very reassuring advice." ???