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159 thoughts on “Breastfeeding Is Good but Maybe Not THAT Good

  1. Fifi says:

    Dr Hall – Why are you surprised that people don’t stick to discussing a study about a (possibly) controversial topic when your post is actually not really about the study? Are you aware that you’ve written this post using the study as the jumping off point but the way you’ve written it means it’s not actually the central focus of your text? The study’s authors may well have a bias of their own but if you just want to discuss the science there’s an incredibly simply way to make the discussion about the science – simply discuss the science.

    I said (possibly) controversial above because breastfeeding really only seems to be a big controversy in the US. It’s interesting to look at the roots of why women stopped breastfeeding and the cultural aspects. There’s most certainly an aspect directly related to class since in European cultures it was a sign of status to not have a wet nurse (and wet nurses came from the lower classes) or to look after one’s own children (that’s what nannies are for). It’s a bit like how steak, white bread and refined sugar were once a symbol of wealth since they were only easily affordable to the wealthy. Once these products became mass produced, they lost their use as status symbols and other rare/exclusive food items needed to be found to symbolize wealth. (The emergence of the suntan as a symbol of wealth and beauty is also tied to social changes, once the farmers moved into the factories the social meaning of a suntan changed.) There’s also a commercial aspect.

    So, there’s a class/social aspect to the breast vs bottle/wet nurse issue that also found its way into medicine and the history of breastfeeding in medicine. Medicine isn’t practiced in a vacuum, and medical ideas about women’s bodies and sex were particularly influenced by both social values (that are now obviously sexist, classist and scientifically ridiculous) and some pretty weird ideas about the body and sex (these puritanical ideas also influenced medical ideas about circumcision as a means to prevent masturbation, which was seen as bad when it’s actually very healthy). Well, pretty weird to those of us who didn’t grow up with religion defining what is natural and what isn’t instead of science!

    In many ways, since it was medicine that was responsible (within a social context that had pretty confused and oppressive religious ideas about biology, sex and gender) for convincing women that breastfeeding was less desirable than formula, it’s appropriate that it’s medicine that highlights the benefits of breastfeeding. It’s pretty ironic that in North America that it tends to be immigrant and upper middle class women who breastfeed. Now, clearly there are cultural aspects to this but I have to wonder if they don’t both actually also have access to more information on how to successfully breastfeed. There’s this myth that anything to do with mothering is instinctual and should just automatically happen with no learning or understanding on the mother’s part – it’s these kinds of myths that result in women feeling guilty and is they’re not good enough mothers. If one chooses not to breastfeed because they simply find it too inconvenient, then that’s a choice (if it is indeed a choice and not a result of having no choice but to put social or work considerations before maternal ones).

    And let’s not forget that there’s money to be made from selling formula and convincing women that breastfeeding really isn’t that good and is difficult and inconvenient. And, of course, breastfeeding doesn’t benefit anyone financially. Nestle and other formula manufacturers don’t care about your or anyone else’s baby or SBM, really they don’t – their primary raison d’etre is to make money (selling formula is just one more way to do this). Just as the manufacturers in China that put melamine in formula to boost the protein profile were obviously focused on profits. (Melamine has also been found in trace amounts in formula sold in the US and Canada, well below toxicity levels in rats but still something worth considering since we’re talking about infants. Nestle owns milk factories in China and had their baby formula products recalled in China due to too excess amounts of iodine, as well as melamine contamination in a separate case. They’re hardly responsible global citizens in other areas either!)

  2. edgar says:

    “One assumes, but the data-gathering is SO BAD it’s simply hard to know! I saw yet another article last week about how a “huge” number of women “suddenly stop breastfeeding” at six months and public health officials saying they don’t know why the drop in the statistics is so large or how to “educate” women to keep going, and I wanted to scream at the newspaper because while I’m sure there IS a drop — many women see six months as a relatively natural cut-off for breastfeeding — I know from being in these studies that a HUGE portion of the “drop off” is that you introduce solids at 4-6 months, and you FALL OUT OF THE BREASTFEEDING CATEGORY! So maybe their educational efforts are failing because THOSE WOMEN ARE STILL BREASTFEEDING and their data collection methods absolutely suck.

    I don’t think we can draw any conclusions until we have better data, cleaned up and depoliticized.”

    You know that data collection methods differ, right? So the categories that you mention may not be applicable to the article you cite.
    And this link http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm

    that you posted, there is no mention of solid. So the introduction of solids at 4-6 does NOT affect the BF rate. Supplementation with formula, however does.
    As for the categories themselves, I have no beef with them. I think trying to break it down further is inviting trouble because of poor recall and trouble estimating etc.
    Since they have been collecting data the same way, the method is reliable, as it does show a shift, so something is changing. You may not like it, but the measurement is consistent. Changing the methodology now would be harmful.

    I don’t think we can draw any conclusions until we have better data, cleaned up and depoliticized.”

    I think this would apply to your rants as well, you are unable to look at the data for what it is. Instead you lament what category you do not fall into.

  3. Fifi says:

    “There’s most certainly an aspect directly related to class since in European cultures it was a sign of status to not have a wet nurse (and wet nurses came from the lower classes) or to look after one’s own children (that’s what nannies are for).”

    Should have read…

    “There’s most certainly an aspect directly related to class since in European cultures it was a sign of status to not have to nurse and to have a wet nurse instead (and wet nurses came from the lower classes). It was also a sign of status to not have to look after one’s own children (that’s what nannies are for).

  4. Zoe237 says:

    @HH

    ” And it’s interesting that you estimated 40% whereas by my count it was less than 25%. Also that you expected most of the comments to be about that instead of expecting 60% of the comments to be about the science. It’s also interesting that the comments are largely about what society should do, rather than about what the scientific evidence actually shows and whether it is robust enough to inform societal responses.

    You seem to want us to keep all opinion out of our posts, but that isn’t possible or desirable. We try to evaluate and interpret scientific studies, not just report their findings without comment.”

    Maybe you’re right. I didn’t do a word count or anything, and counted everything after the comment as not a specific scientific criticism of the study, and noted it was a little less than half the post. It doesn’t really matter, but you brought up personal reasons for not bf and some anecdotal information and the whole “making women feel bad” argument, so it’s not suprising that many of the comments did as well, mine included. I’m guessing that nobody really read the study or bothered to double check your information. Like I said, I agree with your assesment of this specific study but not necessarily the conclusion: that bf is just slightly better than formula. It’s one study out of hundreds that have been done. Then many commenters who I’m guessing haven’t read the research are saying the data isn’t clear cut. Well, yeah it is. We know breastfeeding saves lives and money. The question is how many and how much.

    Again, if this study doesn’t show 900 infant lives saved by bf, what is a more realistic number? How many lives is worth it for an individual to bf or a doctor to encourage it?

    I do get the feeling that people think bf vs formula is like coke versus pepsi. Yes, a lot of it is a matter of perspective. To me, for example a 30% increase in respiratory infection requiring hospitalization from formula is HUGE, considering bf is FOR ME a relatively easy intervention. I admire women who stick with it through all kinds of problems; I probably would have given up after a certain point. Bf is great, but it’s not worth being miserable the first year of your child’s life. And I can’t imagine saying anything in public to a stranger about their feeding choice… good grief.

    Anyway, the bottom line is that risk/benefit analysis is a matter of personal perspective in this case. But for public health officials and medical organizations, their recommendations are the same across the board.

    Oh, Michelle, I wasn’t comparing bf and carseats. Somebody mentioned that the recco for rear was 12 months. I said soon it might even be more than that, speaking of infant safety/health reccos.

  5. magra178 says:

    The “900 deaths” makes me wonder how well they accounted for economic factors. The abstract didn’t mention anything about that, but there could be a large disparity. A low-income mother working full time formula feeding may be hesitant about taking off work and paying for a doctor’s visit, and wait until symptoms have lasted for days, and the child may likely be in a large daycare facility. While at the other end, a high income formula feeding mom working full time has the sick leave to take off at the first symptoms, doesn’t worry about doctor’s visits cost, and may even have a nanny for her child, or in a small in home facility where the likelihood of the child getting sick is less.

    On another note, more on topic with the discussion, I wish there was no stigma either way. A friend posted the discussed article on facebook, and someone posted “yuck.” And women get judged for pulling out a bottle; seeing a women breast feeding or bottle feeding her baby in public should be considered no different from seeing her give a child a fruit snack.

    oh, on another topic, I liked the free formula. even though I breastfed, I used it for the first month of giving cereal. I didn’t to use breastmilk, since my baby didn’t eat it all and didn’t want to waste that, but wanted something with more taste and substance than water to get her started!

  6. Fifi says:

    Interestingly, I’ve found that most often (but not always) the best posts about SBM by this collective often get the least comments and the least science-based often get the most comments. I suspect that this is because facts speak for themselves and a well made argument or observation – that at least seems not to be based in a personal bias – doesn’t leave much room for people to counter with an opinion. When a large part of a blog post is personal opinion/anecdote and the science is merely used as a device to discuss this personal opinion, then readers are naturally going to chime in with their personal opinions and anecdotes.

    There’s a big difference between using personal opinion and anecdotes in a blog and proffering a professional opinion that’s not biased by personal opinion and past actions. Personal (subjective) opinion and professional (theoretically, at least, objective) opinion should not be mistaken for each other. Mistaking one for the other or considering them the same is exactly how personal biases and religious/political ideologies creep into science and medicine unseen.

  7. AlexisT says:

    Kristen:

    Well Alexis, looks like you took one part of one sentence of my comment and used it to make yourself feel superior.

    It seems you didn’t read my post well either, because if you had, you would know that I did not breastfeed. I can hardly claim superiority. I just think the “I turned out fine” anecdote is irrelevant, pointless, and misleading. Our knowledge changes. There are many practices we could point out where the vast majority of people “turned out fine” but we would still not recommend people do them today.

    For that matter, I don’t like it when women like me are held up as examples of why we shouldn’t push breastfeeding.

  8. Zoe – “Oh, Michelle, I wasn’t comparing bf and carseats.”

    Sorry about that then. I seem to recall someone making the comparison upthread…(not the front, rear facing discussion) Thought it was you. My bad.

  9. Fifi says:

    I also wonder why using dead babies as an argument is acceptable when promoting c-sections but not when promoting breast feeding?

    A choice not to breast feed is a choice. Any guilt one feels is really one’s own responsibility to deal with – such is the nature of being an adult. When we make choices, we have to take responsibility for those choices. If we are forced to make a decision by circumstances beyond our current control, it’s not actually a choice. Once again, it sounds like yet another area of life where American women really have very little choice – certainly far fewer than most women in the developed world (though it’s obviously a family issue as well as simply a women’s one).

  10. Harriet Hall says:

    Some of the recent comments indicate a misunderstanding of the study and what I wrote about it.

    “It’s one study out of hundreds that have been done.”

    No, actually it’s based on a survey that reviewed hundreds of studies.

    “your post is actually not really about the study”

    Yes it is about the study. Read my post again. I added a personal anecdote to illustrate a fact and I offered an opinion that the conclusions of the study should not be used to browbeat women, but the post was about the study.

    “I also wonder why using dead babies as an argument is acceptable when promoting c-sections but not when promoting breast feeding?”

    There were no actual dead babies. There were just imaginary dead babies created by manipulating statistics.

    “Again, if this study doesn’t show 900 infant lives saved by bf, what is a more realistic number?”

    According to the survey the study was based on, the real number may well be close to zero. The AHRQ found NO clear correlation with mortality.

    “The “900 deaths” makes me wonder how well they accounted for economic factors.”

    They didn’t account for anything. They did not document actual deaths or study sick infants. They just took odds ratios and tried to guess how many deaths there “might” have been.

  11. edgar says:

    On the theme of totally ignoring Harriet’s posts about the data, I’ll tell you a little secret. I always wanted to try the breastmilk in the eyes thing. But my daughter never had an eye infection.
    Which I am glad of course. But my own little experiment would have been interesting.

    Flame away,.

  12. Fifi says:

    Dr Hall – “Yes it is about the study. Read my post again. I added a personal anecdote to illustrate a fact and I offered an opinion that the conclusions of the study should not be used to browbeat women, but the post was about the study.”

    Um, no, it uses the study as a device and discusses the study but your conclusion sums up what it’s really about for you (such is the nature of conclusions!). Your conclusion seems to indicate that this is a matter of choice and women’s autonomy for you and not actually about SBM. This conclusion – which indicates your main concern and wraps up what you’re writing about – has little to do with SBM and everything to do with “choice” and the social aspects of breast feeding and not really to do with the science. You also hail formula as being a responsible for giving women a choice. From a feminist perspective, it doesn’t really. True choice would include the option to do one’s job AND breastfeed, or take maternity leave, instead of having to choose between the two.

    “Breastfeeding is clearly better for babies, and I strongly support it, but I think the facts leave us room to support those women who make an informed choice not to breastfeed. Some women can’t produce enough milk or have health problems that interfere with breastfeeding. Some women know the benefits of breastfeeding but choose not to do it. We may not agree with their choice, but we can respect their autonomy. Thank goodness we now have safe, nutritious infant formulas that give us a choice.”

    Sorry Dr Hall but your personal anecdote does little than to do than to underline what your conclusion indicates is your main point of writing this blog post.

    As for the “dying babies” – you can claim your use is different than the use in this study but it really isn’t. Once again, kind of funny to see it used yet again in the context of “choice” (since c-sections were also being discussed in the context of choice, as were circumcisions).

    If you wanted to only discuss the science it would be very easy for you to do so by only discussing the science. It’s a bit silly to continually get upset that people respond to opinion laden blog posts about controversial topics with their opinions and anecdotes when you present anecdotes and your main conclusion is an opinion!

  13. Fifi says:

    Also, women who can’t lactate or produce enough milk aren’t making a choice – their biology has defined what is possible for them. Trying to make out that choosing not to breast feed and not being able to are the same thing makes no sense! One is a choice, the other isn’t. The same is equally true of women who are forced to use formula because of working conditions. They’re not actually making a choice unless there is an option to breast feed being presented (that doesn’t involve being fired and going on welfare so one can do what’s best for one’s infant).

  14. Harriet Hall says:

    I cannot possibly please Fifi and I’m not going to try.

    In my article on circumcision I did what Fifi seems to want. I did my utmost to simply present the science and not interject any opinion of my own, in fact I honestly didn’t have an opinion, yet I was still excoriated. When the topic is a controversial one, readers will insist on putting an opinion in the writer’s mouth. When I have an opinion, I would rather state it myself than have someone else try to tell me what my opinion is. :-)

    I will continue to use illustrative anecdotes and offer opinions when I think it’s appropriate. If Fifi objects, that’s just too bad.

  15. wales says:

    Perhaps this has been addressed already here, if so I apologize. A possible risk to be aware of with regard to infant formula: Clostridial spores in powdered infant formula. http://download.journals.elsevierhealth.com/pdfs/journals/0022-3476/PIIS0022347610000703.pdf

  16. wales says:

    I see the link I provided doesn’t give full access. The article is in The Journal of Pediatrics’ March issue.

    http://www.jpeds.com/issues/contents?issue_key=S0022-3476%2810%29X0003-8

  17. Surly Nymph says:

    I am not a scientist but I am a skeptic. I am by no means in the middle of the research regarding breastfeeding vs. not breastfeeding but when I had my child in August I fought to bf and failed. It really bothered me so I did some reading.

    Correct me if I am wrong but aren’t the majority of studies regarding the health benefits of breastfeeding survey/observation related?

    This is a far cry from actual experimental research. Research which would benefit if we could raise two groups of children, from birth with no other differing circumstances, as either breastfeeders or formula feeders.

    We can not ethically do this so we have to rely on surveys and observational studies correct?

    I know that a childs situation can vary greatly from mother to mother OUTSIDE of what they are fed. How can we come to a hard conclusion that breastfeeding is SO MUCH BETTER than formula based on studies with so many other variables?

  18. edgar, I’ve never heard of the breast milk in the eye thing. Someone recommends breast milk as eye drops for pink eye? Huh.

    Are you trolling on a dare? :)

  19. Zoe237 says:

    I make no claims as to the accuracy of these studies or the use of breastmilk to treat pink eye, but I figure it can’t hurt (uhoh, flame away here too!).

    Breastmilk and conjunctivitis:

    J Trop Pediatr. 2007 Feb;53(1):68-9. Epub 2006 Dec 6.

    Switch from antibiotic eye drops to instillation of mother’s milk drops as a treatment of infant epiphora.
    Verd S.

    Abstract
    In a paediatric practice, the management of patients with signs and symptoms of congenital nasolacrimal duct obstruction (CNLO) was switched from topical antibiotic to topical mother’s milk (MM) -based regimens. The conservative management of this condition includes frequent cleansing of the lids, digital lacrimal sac massage, and application of topical antibiotic drops when there is a mucopurulent discharge. The method for managing CNLO has evolved in our office of paediatrics during the past 7 years. This change was initiated by some mothers who have applied traditional therapy: MM eye drops. This evolution has been accompanied by a number of articles from the mid 1990s into the 2000s on safety of MM eye drops in case of neonatal conjunctivitis, and on the anti-inflammatory characteristics and antibacterial activity of topical MM.

    for chlamydia”
    J Reprod Immunol. 1998 Jul;38(2):155-67.

    The in vitro antimicrobial capacity of human colostrum against Chlamydia trachomatis.
    Ramsey KH, Poulsen CE, Motiu PP.

    Microbiology Department, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL 60515, USA. kramse@midwestern.edu

    Abstract
    We sought to assess the antimicrobial capacity of human colostrum against Chlamydia trachomatis. a common agent of ophthalmia neonatorum. Colostrum was collected from 13 post-partum females and tested in an in vitro assay of chlamydial growth inhibition using HeLa 229 cells as the host cell line. All samples significantly inhibited chlamydial growth in a dose-response manner. The percent inhibition ranged from 45.3 to 99.0 (mean=88.1+/-4.1). The chlamydial growth inhibition activity of colostrum was found to be: heat- and freezing-resistant: more concentrated in colostrum than breast milk; was not attributable to interferon or antibody activity; and, could not be attributed to host cell cytotoxicity. Additionally, chlamydial growth inhibition occurred in < or = 15 min and was effective only when colostrum was incubated with chlamydiae prior to addition to HeLa 229 monolayers. Lastly, centrifugal fractionation of the colostrum yielded similar activity in the lipid pellicle and in the lipid-free supernatant. These results indicate that topically applied colostrum may have efficacy in the prophylaxis of ophthalmia neonatorum of chlamydial etiology in the absence of conventional modalities.

  20. Dawn says:

    @micheleinmichigan: yeah, I’ve heard of the breastmilk to cure eye infections. Never tried it, though. Seems to go through the crunchy community often when pinkeye makes its rounds (I had a LOT of patients ask me about it; all I could do is tell them I didn’t know if it really worked and recommend they talk to their pediatrician!)

    @Fifi: sometimes a choice is dependent on physiology, sometimes psychology. A happy baby with a happy formula feeding mother is always better than a breastfed baby with a very unhappy mother (can you imagine being comfortable and happy when you feel your mother cringing away from you as you nurse? Besides the mental/physiological link between letdown and nursing).

    Economic factors lead to a choice. Work situations lead to a choice. Womankind has always had a choice – nursing their own baby, finding someone else to nurse them, or figuring out another way to feed the baby (cow, goat, water buffalo…whatever).

    Do I think the US can do better in encouraging breastfeeding? Yes. Do I think there will ever be a time when most women who physically can breastfeed will do so? No, because the physical ability is only one piece of the puzzle.

    (An aside…what with all the car seat nonsense, back to sleep, no this, no that, avoid, don’t let….I’m SO glad my children survived childhood when they did!)

  21. Cloud says:

    Wow, what a lot of arguing over a fairly measured post.

    micheleinmichigan- breast milk as eye drops for pink eye is a well known remedy, and in fact, it was recommended to me by my pediatrician. I think it works because breast milk includes some immune cells (maybe NK cells? Don’t quote me, I can’t remember the details). Anyway, Edgar is not trolling.

    I think we should set up our systems to give every woman a chance to make the choice about breastfeeding herself.

    This means at least 3 months of maternity leave, because your supply isn’t really stabilized by 6 weeks (and 6 weeks is a major growth spurt for most babies, and going back to work in the midst of a growth spurt is a surefire way to think you can’t produce enough milk). 6 months would be better, but I won’t get greedy.

    This means lactation rooms and breaks for all working women (now law for all women in companies >50 people, thanks to the health care reform bill). Most women only need 15-20 minutes 2-3 times/day to pump. My smoking coworkers take more break time than that.

    This means tweaking our care for immediately post-partum moms to include skin-to-skin contact, which has been shown to increase breastfeeding success.

    This means better support during those initial few weeks, which can really be difficult, and yes, painful.

    If we do all of this, and individual women make the choice to formula feed, fine. We absolutely should not make her feel bad about the choice. But they way things are set up right now, that choice is often not really the mother’s at all.

    Full disclosure- I breastfed my first child for 23 months. I’m currently breastfeeding my second child, and intend to do so until she is close to 2, as well. I went back to work when the baby was 3 months old both times.

    I want every mother to have the option of breastfeeding because it has been one of my favorite things about motherhood for reasons that I struggle to articulate. All I can say is that I am so very, very glad that I did not quit in the early weeks of breastfeeding my first daughter, when we struggled with her latch.

  22. edgar says:

    No, I have heard of it, it alt circles, but I cannot comment on efficacy, as, well, I didn’t get to perform my experiment!

  23. Harriet Hall,

    “I cannot possibly please Fifi and I’m not going to try.”

    I don’t know why you would care to please Fifi or me or anyone else. But the only person I actually see complaining on this thread is you.

    You complain that people don’t argue with you about the science of your post. Why would they? Your science was fine.

    You complain that your readers discuss the social and emotional contexts of breastfeeding among themselves. Well, more people have something to say about these things than care to critique your perfectly good takedown of the Pediatrics article. The social and emotional contexts of breastfeeding are even interesting enough that you digressed from the Pediatrics article to discuss them yourself in your original post.

    When people respond to your complaints by pointing out that you yourself care about the social and emotional context of breastfeeding (an objective observation) you complain that they aren’t happy.

    I’m not sure I understand what would please you.

  24. provaxmom says:

    Is all breastmilk really created equal? That one has always made me curious, and I’ve never seen anything written on it. Yes, I’ve seen the eye thing, but never a nutritional study on breastmilk. What if I live on cheetos and diet pepsi? What if I’m like that guy that ate like 25 bags of microwaved popcorn a day? Is bm really better then?

    I tried really hard, but as a new mom, and then with the second one–whew! You just eat on the fly.

  25. Harriet Hall says:

    Alison,

    Please look back. What I actually said was “My choice of topic has generated a lot of discussion.” That was an observation, not a “complaint that your readers discuss the social and emotional contexts of breastfeeding among themselves.” I have no objection to commenters discussing whatever they want. I enjoyed the discussion and I thought they brought up several worthwhile points.

    What I actually said was “I had hoped more attention would be paid to the poor methodology of the paper.”

    I had hoped that people more knowledgeable than I about statistics, research, peer-reviewing for major journals, etc. might be able to contribute to my critique of the study. If I got anything wrong, I want to know; and it would also be nice to get confirmation that I got it right.

    What would please me is if readers understood and responded to what I actually wrote rather than to their idiosyncratic interpretations of what I wrote – like your interpretation that I was complaining that people didn’t argue with me about the science. :-)

    “When people respond to your complaints by pointing out that you yourself care about the social and emotional context of breastfeeding” Was that what Fifi was doing? I may have misunderstood. I thought she was criticizing me for using anecdotes and opinions rather than limiting myself strictly to the science.

  26. Cloud says:

    Provaxmom- I am not aware of any careful studies on the impact of the mother’s nutrition on her breastmilk, but my understanding from the studies that I have read is that in most cases your body will prioritize putting the nutrients in the milk over giving them to you. For instance, your body will actually pull calcium from your bones to provide sufficient calcium in the milk.

    So I think the most important nutrients will be in your milk unless you are severely malnourished. I suspect some of the “lesser” nutrients might be missing- so for instance, I have been advised to take fish oil pills, both to ensure that I’m providing enough omega-3s to my baby and to ensure that I keep what I need.

    And the useful antibodies and other disease-fighting components will only be present if the milk-producer has been exposed to the same disease that the baby is being exposed to. So in that respect, the milk of the actual mother is indeed best.

  27. squirrelelite says:

    Thank you, Harriet, for pointing out how the recommendations in this article may have gone beyond what the data they were based on could reasonably support. Also, I appreciate your suggesting how a more pragmatic and less advocatory approach to helping new parents prepare to feed and raise their baby(s) might be more effective and beneficial for all concerned, especially the baby. (More on that later.)

    First, some thoughts on the article:

    I don’t know how much I can help with your critique of the article since I don’t have access to the whole article and my statistical expertise mainly comes from several math classes and some pragmatic experience trying to use the past to make an informed guess about the future.

    However, I noticed in the abstract the authors said “we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding:” The abstract does not mention any consideration of diseases for which the risk ratios were neutral or whatever diseases there might be for which the risk ratios could actually favor bottle-feeding. I am guessing they simply set those cases aside and analyzed the rest. Thus, even if the data they analyzed were excellent and fully supported their recommendations and even if they were 100% successful in getting people to follow their recommendations, we do not know what the overall balance of favorable versus unfavorable outcomes would be because they did not analyze that part of the question.

    When they went from data that showed no relationship or an unclear relationship between breastfeeding and some of the diseases they were analyzing to derive an implication that more breastfeeding could save 900 lives a year, it certainly looks like they reached beyond the bounds of what their data could support and engaged in what Dr Hall referred to as “statistical skullduggery”. Like Dr Hall, I hope that another doctor or researcher better access to the primary sources and more experience in this area could offer some insight.

    Since the AHRQ report that was a major data source for their analysis says that “one should not infer causality based on these findings”, I would have been very careful in trying to make definitive predictions or recommendations if I had been writing the report.

  28. Fifi says:

    Dr Hall – Actually, what I am saying is that you continue to write in a certain way and then complain about the outcome being the same when you write in a certain way. If you wanted a hardcore critique of your interpretation of the science by a statistician or other medical scientist – to tell you whether you’re on track or off, or right or wrong, from a researcher’s point of view, or just because you want to argue with someone who is a researcher – then you didn’t approach the topic in a way that invites this or indicates it’s what you’re seeking.

    The anecdotes and opinions make it appear you wrote this blog for the general public and that your main thrust is that people shouldn’t make women who choose not to breast feed feel bad by promoting the idea that bf is better because that may make them feel bad. You mention public policy but you didn’t actually address any real issues about public policy – just that it may make some women who choose not to breast feed feel bad and that this study doesn’t prove anything so should be ignored – even though you say you believe bf’s clearly better for babies (before lumping in women who can’t bf with women who decide they’d rather not, two totally different situations and one isn’t by choice while the other is).

    And, really, I’m not expecting you to please me Dr Hall. In fact, I find it kind of weird that you keep constantly going back to this kind of victim stance accusing me of being out to get you, or making it about being “pleasing” and so on. The fact that the last paragraph or concluding paragraphs are what sums up a text of this nature isn’t something I just made up, it’s standard literary form (it can be broken, of course, but if it’s not intentional it usually just confuses the reader in an unproductive way). But whatever…I certainly don’t take what you write personally since I’ve noticed that your reaction to anyone who critiques you is pretty much the same. I just don’t take your claims to want to discuss science very seriously anymore for a variety of reasons, the main one being that you keep using critiquing shoddy studies (a worthy thing in and of itself) into things to hang personal opinions backed by anecdote upon.

  29. squirrelelite says:

    Part II, a more personal response:

    Breast feeding or bottle feeding a baby affects each of us when we are born and if we have a child or children of our own it affects us again. Thus, many of the people who read this article will already have had to consider the issues and make a choice. This is reflected in the many comments that talk primarily about personal experience and choices. In this part I try to discuss my experience.

    My wife and I have raised four kids. The first three were adopted and bottle fed. Then, my wife got pregnant and we had a fourth child who was breast fed. Fortunately, they all turned out to be reasonably healthy so it is possible to raise a healthy child if you provide good nutrition, medical care (like vaccination and regular checkups) and other forms of nurturing.
    There are advantages to breast feeding, but it is not a make or break issue and should not be advocated as such.

    There are also advantages to bottle feeding. A big one is bonding. Because we shared feeding the first three, they were equally comfortable playing with either of us or accepting consoling from either of us when they were upset or hurt. The fourth child always went to Mom for food. She was fine playing with me, but when she was hurt or upset, She Wanted Mommy!

    It took 2 or 3 years and some dedicated special time together to work through that.

    Fortunately, we raised healthy children and I support efforts to help all parents do that.

  30. Harriet Hall says:

    Fifi said, “I just don’t take your claims to want to discuss science very seriously anymore”

    That’s OK. There are enough people who do take me seriously that I don’t think I’m in any danger of being “voted off the island.” :-)

    I’ll return the compliment and I won’t take your criticisms very seriously anymore either.

  31. provaxmom says:

    Well, I also have been accused of bringing emotions into this, in “we shouldn’t reseach for fear of hurting people’s feelings.” I think I’ve addressed that already.

    But I do think that we can and should promote BF, but why does it always have to be at the expense of hurting the feelings of FF? IMO, they are not overly sensitive to this, either. I’ve done both, I get to play for both teams. ;)

    I think that hurting people’s feelings is relevant here, as if you are hurting the feelings of formula feeders, that is the exact population whose minds you want to change, not alienate.

    And to be honest, I don’t read many of the studies that are linked here. That’s why I come here, to get the cliff notes version. Do students today even know what cliff notes are? Am I dating myself with that?

    And if we only discussed data, nothing but data, no opinions, this would probably be a fairly boring place. We’re human after all.

  32. provaxmom says:

    Oops, I had wanted to add–

    I think anecdotes do matter. In scientific research–of course not. But in life, they do matter. It’s what bonds us as people, sharing our stories.

    So while I wholeheartedly agree that they have no place in medicine or scientific research, they do have their place. And I don’t see why a discussion can’t be a place for an anecdote. If we were all ‘passionless drones’ ;) only reiterating scientific data, well………

  33. Fifi says:

    Dr Hall – Since you don’t generally respond to my actual criticisms but rather make dramatic claims regarding being victimized or refer to being “pleasing”, it’s pretty clear you don’t actually even consider or take any critique seriously. Since you respond the same way – a bit less dramatically – towards others you don’t find pleasing I don’t take it personally. I’ve noticed the only people you take seriously are research scientists or statisticians who reveal through their critique of your claims that you’re not actually a researcher and don’t quite understand what you’re critiquing.

    It’s why using language like “skullduggery” regarding researchers – which implies that the researcher is somehow being intentionally corrupt and even evil – is a rather unfortunate semantic device/manipulation (or strategy) to use when writing because it’s an appeal to emotion meant to incite a certain negative emotional response towards the researchers and their study. Maybe you’re just not conscious of this kind of thing as a writer but it makes it seem like you’ve got something personal against the researchers/research and are not just making a critical analysis of the actual study but to whip up an emotional response to prejudice readers. This vilifying language combined with your own anecdote combined with the (conscious or unconscious) inaccuracy of lumping together women who choose not to bf with women who simply can’t, is what moves your blog post from being an impartial analysis of science. Sorry you can’t see that for yourself! I doubt you’re consciously trying to manipulate readers – though I can’t rule that out, I think it’s more likely that you’re just being yourself and you assume your opinions must be scientific and more rational and common sense than other peoples’…we all tend to feel that way! Subjectivity, it’s what we’ve got to work with (even those of us who are subjectively convinced they’re very objective….a situation that means one becomes entirely blind to their own subjectivity and very defensive towards critique – be it a deferential/pleasing response to those who are perceived to have power or a hostile one to those who are seen as less powerful).

  34. This is probably predictable, but I like anecdotes, I like science. In my mind, the science helps me make a decision. The anecdotes help me see how that decision may possibly play out in everyday life and on an interpersonal level. In this case, I actually was reasonably clueless that people had had such a variety of experiences. I’ve heard about the social pressures of BF, but outside of one friend complaining about a co-workers comments, I’ve never really heard parent’s stories. So it was educational for me. If the topic comes up (and I have three pregnant friends, so it might), I feel better prepared.

    I also learned that mom’s who have their children in hospitals (instead of adopting) sometimes get free formula AND a free diaper bag. Damn, once again I miss out. On the other hand, I’m grateful that I got left off the mailing lists…probably broke even. :)

  35. magra178 says:

    provaxmom-

    from what I’m aware of breast milk is not created equally. viruses can be passed to child, and toxins. I think some overstate, and over worry, about the “toxins” in breast milk, but there are studies. Sandra Steingraber, an ecologist, went over some of this in her book “Having Faith.” She cited research in there (it was written in the 90′s) most about increased toxins in breast milk in mothers who are exposed to high levels at home/work. I didn’t look up any of the papers, or read anything more recent, but I was a bit skeptical, she came off as overly paranoid to me, but interesting still.

  36. Zoe237 says:

    Okay, so I’m reading AHRQ report right now. They whittled 9000 studies down to 43 on infant health and 29 metanalyses (as Dr. Hall mentioned, I just didn’t realize there were 9000 to begin with). Many of the studies specified that they compared ever bf to exclusive ff, which is the exact opposite of what a previous commenter asserted about any formula putting you in the formula column. Now, obviously there are problems in consistency- some studies were exclusive bf vs exclusive ff. I’m guessing that any meta will run into these issues and the usual caveats are in order. Of course, these are all epidemiological studies, as randomized is mostly impossible. At what point can causality be inferred from an epidemiological study, as a general matter? Is it possible?

    Now here’s what I don’t get. The review mentions that the risk of respiratory illness resulting in hospitalization is reduced 72% in breastfed infants. Obviously diseases like rsv can kill infants. So say we have a population of 4,000,000 infants, 100,000 (2.5%) infants are hospitalized for rsv and 100 (.1%) die. (completely made up numbers btw). What exactly would a 72% reduction mean in terms of numbers? Say 100% were ff. What if 100% were bf, how many would be saved with 72% less hospitalizations? And how would the NNT be calculated? Yes, I’m hopeless! Now, exactly what is wrong with this tactic? I’m assuming that’s exactly what the Pediatrics article authors did, why is it invalid?

    Likewise, it was a 64% reduction in gastroenteritis, SIDS 36% reduction average, childhood leukemia, 15%, and ear infections, 50%. Now, SIDS and leukemia kill. If there is indeed a protective benefit of bf, it follows that lives will be saved, probably more than by say the (in the U.S.) chickepox vaccine (100 lives) or rotavirus vaccine (less than 10). Dr. Hall asserts that the answer is possibly none. WHY?? Pediatrics says it’s 911 lives saved by bf/ year. I’m guessing the answer is somewhere in the middle of 0 and 911. I’d like to know the other side of this and perhaps learn something.

    Now, I agreed with Dr. Hall in the the first comment that 911 deaths was overreaching and agreed with many of her criticisms.

    From the report:

    There is a general consensus that
    breastfeeding protects against many infections, including AOM. Breast milk contains
    immunoglobulins with antibody activity against common bacteria such as Haemophilus
    influenzae and Streptococcus pneumoniae. It also contains components that interfere with the
    attachment of Haemophilus influenzae and Streptococcus pneumoniae to nasopharyngeal
    epithelial cells. The intermittent administration of milk with anti-adhesive substances into the
    nasopharynx of the nursing child may reduce the extent of colonization and protect against
    infection.27

    A previous review of diarrhea morbidity in both developed and
    developing countries reported that the risk of diarrhea in infants who did not receive breast milk
    were 3.5 to 4.9 times higher than infants who had exclusive breastfeeding in the first 6 months of
    life.42 Factors like secretory IgA, oligosaccharides, lactoferrin and others available in breast milk
    may protect the infant from various infections through passive immunity.1 In vitro and in vivo
    binding studies have demonstrated that fucosylated glycans in breast milk inhibit binding by
    campylobacter jejuni, stable toxin of enterotoxigenic Escherichia coli, and major strains of
    calciviruses (e.g., noroviruses (also known as Norwalk-like viruses)) to their target host cell
    receptors.

    Respiratory infection is the most common medical problem among infants and children. Each
    year in the United States, three percent of all infants are hospitalized with moderate to severe
    respiratory infection.47 Severe lower respiratory tract diseases may increase the risk of childhood
    asthma. Viral infections, especially respiratory syncytial virus (RSV) infection, are the most
    common cause of lower respiratory tract disease in developed countries. RSV infection occurs
    most frequently between 2 and 8 months of age.”

    http://www.ahrq.gov/clinic/tp/brfouttp.htm#Report

  37. Harriet Hall says:

    The AHRQ found no clear relationship between breastfeeding and mortality, and it cautioned that for its findings of relationships with disease incidence, causality should not be inferred. Therefore it is not acceptable to use that study’s likelihood ratios for disease incidence to calculate the number of excess deaths. As I said, it merely amounts to estimates based on estimates based on mixed data of varying quality.

  38. “you don’t actually even consider or take any critique seriously”

    I was taught that a critique was a discussion of the strength and weaknesses of a particular work in order to help the artist, author, actor, etc, improve on that work or their technique.

    The method of critique most often prescribed in art school is the pnp oreo, start out with the positive, point out various negatives or areas for improvement, then end on a positive. This may sound insincere, but actually, I have found when you really look at a piece of art (books, play) there is always something positive there.

    The reason for the pnp oreo is that most (if not all) people will react defensively when presented with all negatives AND they will not know where to start in improving the piece.

    So in the fine art and art/creative direction world a critique is very different from a criticism or a review. In a criticism or review an author is usual starting out with an opinion/analysis of the work and then offering supporting arguments as to why the work fits that analysis. ‘This article sucked, and this is why’ This review or criticism is usually addressed with the intention of convincing a broader audience, not with the intention of helping the artist, author, actor, etc improve.

    I do not think one or the other is inherently more valuable, only different. But, I believe, the later approach is much more likely to get a rise out of the author. The majority of people do react defensively to a purely negative review or criticism. (Until they’ve undergone Hollywood training and learned to just smile, wave and only say nice things in front of the camara.)

    Sorry to expound off topic, but an art school education is so seldom useful on SBM, I couldn’t resist.

  39. Fifi says:

    michele – In art school, it is the norm to say something positive first – it’s certainly something I do if mentoring someone and is how critique in an educational setting generally works. I probably would get better results by being “pleasing” and pandering to Dr Hall, that seems rather silly since she’s gone out of her way to construct an image of herself as tough, no nonsense and more rational than others (they may be biased and emotional but she’s sure she never is…it’s just that people are out to get her if they say anything that doesn’t please her and she’s being victimized! Particularly if someone isn’t buying into her anti-psychology or whatever posts that use emotional language to try to vilify researchers and sometimes even reveals a total lack of understanding of how research is conducted when a statistician or researcher calls her out (though there’s enough similarity between Dr Hall and Dr Tuteur that I may be confusing the particular incident and attributing one’s actions to the other). Sorry, I certainly don’t expect perfection of any kind from an SBM blogger, just not a vilifying of researchers by using terminology like “skullduggery” or religious ones like “not kosher” (who cares, science isn’t a religion!) when the person writing about it isn’t even a researcher themselves and throws anecdotes and opinion into the mix. Since some or many people who do come to SBM want some form of Coles Notes regarding the science being discussed they’re coming here for expertise – an expertize regarding research that Dr Hall doesn’t actually seem to have. This doesn’t mean her opinion and expertize as a doctor isn’t meaningful or worth considering, it just means that her expertize isn’t as a research scientist. Considering this and how she also throws folksy personal anecdotes into the mix, it starts to veer away from SBM and towards the kind of territory that SBM (quite rightly) critiques where science is bent into shapes that support personal opinions shaped by subjective experiences.

    I don’t disagree that this study probably shouldn’t be used to base public policy on and goes too far. However, I think Dr Hall is pretty clearly biased and this shows up in several ways.
    1. personal anecdote about how inconvenient bf was for her because she might end up leaking breast milk at work.

    2. she lumps in her kind of personal choice made for her own convenience with women who CAN’T bf for biological (or neurotic) reason – this is even more intellectually dishonest than the study she’s critiquing. Why does she try to make her conscious choice made (according to her) for her own convenience equivalent to women who have no choice? At the end of the day it makes this whole blog appear like she’s just justifying her personal choice (which she positions as being equivalent to that of a woman who has no choice and might want to breast feed).

    3. Obviously no one in their right mind can come out against breast feeding – particularly on an SBM blog – but the next best thing is to say it isn’t “that good” and thank god for formula that gives women “choice”. Of course, formula doesn’t give most women – particularly the women with the least options – more choice since American society is so far behind in regards family friendly policies like maternity and paternity leave. (Nice that Obama or someone managed to squeeze in a bit, maybe things will change in the US after all.)

    4. it could easily be argued that women who would lose their jobs if they bf don’t really face a choice and I’m very sympathetic to that, however Dr Hall was quite clear that she made a choice based upon personal desires and needs and wasn’t forced into not breast feeding because she had no option or by her superiors at work. However, since she does confuse her situation with that of women who want to bf and can’t, I’ve got to wonder if maybe she’s a bit confused about what choice actually is.

  40. FiFi – I think we read the article differently and it could be that we have different views on what is a parental choice, I’m not sure. I do believe it’s wrong for a researcher to try to encourage a particular parental choice by slanting the reading of the data. Even when that choice does have sufficient data to support it in some or many cases. To me that appears to be the case in this report.

    But, yes I can say that a mom who says “I chose to use formula because I had a child at an inopportune time in my demanding career and I don’t want to set aside my career to BF.” is different than a mom who can’t BF due to physiological issues.

    The question for the former mom is to what degree is BF better than FF. That mom may feel perfectly happy to set her career aside for a year for a truly compelling increased infant mortality rate caused by FF. But, they may not be willing to do the same to avoid 3 ear infections that will clear up in a week with antibiotics.

    This is why I keep harping on accuracy of the individual risk/cost/benefit analysis. Accurate research and interpretation may be useful to these moms. I believe for a researcher to put their thumb on the scale is a problem and I’m glad Dr. H pointed it out.

    There are other decision points here too. Some babies will not both FF and BF, once they FF they will reject BF (don’t know how often this occurs). A friend of mine had a child who was falling behind growthwise in the first 6 months. She was already pumping to stimulate more production without much increase. One recommendation was to FF so that the baby got more calories, but concern was that the baby would then reject MM. The other option was to “wait and see”. Accurate interpretation of data is important in this decision too. In this case, they chose wait and see with frequent ped checks and things turned out fine.

    But, mostly I posted because since you used the word critique, it reminded me that some people have not had the occasion to learn about the difference between critique or criticism/review. It is an awareness that’s I’ve found useful, so I thought I’d share.

  41. Fifi says:

    To be clear, I’m not trying to shut Dr Hall up or run her out of town (nor am I deluded enough to think I have the power to do so in the first place). I’m simply being as tough on her as she is on those she disagrees with (though I am not accusing her of skullduggery, just of doing some of the things she criticizes others for – I’m pretty sure this is a blind spot due to bias not any intentional ill intent or skullduggery).

    I think Dr Hall does have a lot to contribute here, she just seems to often overreach her actual expertize and insert personal opinion yet expects to treated like an expert offering a professional opinion. Research science being one area, psychiatry and cognitive science being another. I don’t care if she’s not an expert in these areas except when she acts like she is to grind some ax that has more to do with personal beliefs than science! I’d be quite interested in reading Dr Hall talk about her experience as a physician and I think she’d probably be great at doing a “Ask Dr Hall” kind of column where she gives the kind of common sense advice that GPs hand out to the general public. I wouldn’t expect her to keep anecdotes or even personal opinion separate in that kind of context because they’re not being presented as a scientific critique. Accusing research scientists of “skullduggery” and other nefarious intentions comes off as either paranoid or an intentional attempt to use an emotional smear to influence readers.

  42. Zoe237 says:

    “there is indeed a protective benefit of bf, it follows that lives will be saved, probably more than by say the (in the U.S.) chickepox vaccine (100 lives) or rotavirus vaccine (less than 10). ”

    I should add that I’m not trying to directly compare bf and vaccines, because one, it’s a lot easier to get a few shots rather than bf for a year, and two, I would hope that the absolute risk reduction of vaccines would approach one. However, bf does confer passive immunity. Vaccines are certainly more highly protective, but more children also die from things like rsv and SIDS.

    If breastfeeding is not ultimately found to be protective against disease (e.g., in the end it really was all due to confounders that we didn’t anticipate), or the data is unclear, there is something seriously wrong with epidemiological studies. It really sounds like methodolatry if people are trying to demand RCTs to show causality, considering the dose response relationship, biological plausibility, and highly significant odds ratios.

  43. I really like Catherina’s point: breast feeding has great efficacy; it is the effectiveness that is challenging. It is a challenge of how our society is arranged that makes one option, formula, much more feasible, for many women, in comparison to another option, breast feeding.

    Recognizing that, as Catherina says, the next agenda item is to figure out HOW to work with societal arrangements to suit what is clinically, developmentally preferred, all other things being equal.

    For me and my wife, we penciled out a strict budget, and became a one-income family. She di the breast-pump thing at her office, which was private enough, but she sure did not enjoy a minute of all of that hassle.

    In my field, my axe-to-grind, obviously, is why does the health care system overall provide medications for depression, anxiety, sleep disorders, and ptsd, when talk therapy has greater efficacy? The reasons are several, and most have to do something with the arrrangement of our health care delivery system, not with practitioners being bought with a logo pen and free lunch.

    Just a couple weeks ago, when addressing this, a physician lemanted how terrible it is that she really has no chance to guide a depressed client to a trusted counselor. Why? Behavioral health carve-out plans change, and change their affiliated/approved providers, all of the decent counselors are booked-up, we do not have co-location of mental health in medical care settings, reimbursement for psychotherapy is often challenged beyond the fifth appointment while reimbursement for off-lablel Rx is never challenged for years of treatment, et cetera.

    I say this to help us all realize that efficacy is one thing, and effectiveness- including the arrangement of our society, including family leave as well as health care financing, is another.

    Having just completed my taxes, I have to admit that the prominent 1040W lines where having each child drops my tax burden really helps us be a one-income family: the tax code is family-friendly, supporting a different kind of parenting arrangement, which, for the breastfeeding time span for our kids, included support of breast feeding. (Thanks to all of you employed people without kids who are transferring your wealth to me and mine!!)

    Some public places have changing tables, and even have those “family” bathrooms – those are awesome ways that our society can help us parents try to do the best we can, as we see fit, when it is time to nurse or change a diaper.

    We would be an awesome society if we could accomodate, amongst other things, a mom breastfeeding if she wants to, whether there is some slight clincal edge or not. Clinical edge, all the better.

  44. Kylara says:

    @edgar: “I think this would apply to your rants as well, you are unable to look at the data for what it is. Instead you lament what category you do not fall into.”

    I was pointing out that particular data as BETTER data that I did NOT have as big a beef with.

    However, I live in a city with a big “breastfeeding resource center” (which is pretty good) and three hospitals that all do research, so in the last 10 months I’ve participated in a LOT of studies/surveys on breastfeeding under the auspices of a LOT of different groups studying it. Many of these studies are appallingly designed — that’s obvious to me even as a layman — and that bothers me. I find it troublesome for the scientific claims that arise out of these studies that in most of them, I am given the “formula feeding” form and not the “breastfeeding” form because of my son’s minimal supplementation — not because I have a burning urge to be considered an exclusive breastfeeder, but because it seems problematic and dishonest and MUST affect the statistics. Many of the studies only have two categories: Breast exclusive, and everyone else.

    And, of course, the news media reporting takes even better-designed studies and reports them badly. And even the local public health officials mentioned above seemed unaware of the data collection practices in the studies they were using to deal with local breastfeeding education, and were confused as to why there was a drop-off in “exclusive” breastfeeding at 6 months in the (county-wide) study they were using. Well, I was in that study, and it’s because introducing solids kicked you out of the breastfeeding category on that one. So they’re devoting public health dollars to educating a problem that isn’t what they think it is, and frustrated that they’re not “reaching” the women who aren’t breastfeeding — they talked about how they were having trouble figuring out who they were to be able to reach them. Well, I think problems in study design and data interpretation have a lot to do with that!

  45. Enkidu says:

    micheleinmichigan: “Do we know that 90% of U.S. women (I’ll say mothers) is a realistic goal? So, we know that there are certain percentage of mother’s who physically can’t breastfeed. We have a certain number of infants who can’t or have a very difficult time breastfeeding. (I don’t know how realistic it is to feed a baby solely on pumping) We also have a certain percentage of infants that are placed with adoptive parents or foster parents within the first 6 months. Considering that, makes me wonder if 90% is achievable and if it is not, why suggest a creatively derived number of lives that could be saved based on 90%.”

    I don’t know where they pulled the 90% out of either, or if it is in any way realistic. The percentage of breastfeeding-capable mothers should have definately been addressed in a study like this one.

    One other thing, and yes there is emotion in this comment: I’ve noticed that a lot of the posters set aside mothers who are physically unable to breastfeed (such as myself) as not pertinant to this conversation. But we are. We have to look at crappy studies like this one, and every study that says our baby is going to be sicker, dumber, die of SIDS, etc. Just because we didn’t have a choice in whether to breastfeed or formula feed doesn’t mean that studies such as this one have no impact on us. The title of this paper might as well have been, “900 babies will die this year because they were fed formula… will yours be one of them?”

  46. “Research science being one area, psychiatry and cognitive science being another. I don’t care if she’s not an expert in these areas except when she acts like she is to grind some ax that has more to do with personal beliefs than science! I’d be quite interested in reading Dr Hall talk about her experience as a physician”

    But, FiFi – I’m sorry to be argumentative but I feel genuinely confused. First you referenced “dead babies” which I believe was Dr. Tuteur’s comment (regarding, what was it, waterbirth?) and then you referenced psychiatry, which I think was Dr. T’s post on the anti-depressants for mild, moderate depression report?

    I don’t recall Dr. H protesting a research scientist comment or correction. But I do recall it alot with Dr. T. Which is not to say I would remeber, but…? I know she has been a bit hard on Backer, PL and DanaUlman lately, but that’s a different story in my book (maybe not to other commentors, though.)

    As to research science, I do not expect Dr Hall to be a research science expert, but I do think every Doctor needs to have a critical thinking approach to reading research. That is all I see in this article. It’s what I would expect my doctor to do before presenting a research conclusion to me as valid.

    Am I missing something? Aside from her wordsmithing, “skullduggery” and her use of anecdote, do you see something wrong with her criticism of how the report arrived at their numbers? Or is it more the tone that you have a problem with?

  47. David Gorski says:

    Fifi, you clearly appear to be mixing up Dr. T with Harriet, and I do not appreciate it. If that is not the case, then from my perspective your comments appear to have gone over the top, far beyond what is warranted. I’m on my way to a meeting and am whipping this out on my iPhone. I may comment more later.

  48. Oh Dear, The thread has died. Probably, I’m the only one who’s wondering what Dr. G. may possibly whip out next.

  49. Zoe237 says:

    That didn’t sound too good Michele, especially on a breastfeeding thread… lol.

    I’ve said it before and I’ll say it now. I think fifi goes too far in her criticism and I’m also totally lost to the Dr. Tuteur comparisons.

  50. Meh. I don’t like it when people accuse other people of having unnamed biases or agendas instead of directly addressing what is said – Dr T did this to me a couple of times – but Fifi is not usually wrong. Impolitic, perseverating, perhaps; but not wrong.

    I actually think that Fifi goes to a fair amount of effort to be placating and to explain herself, often resulting in her comments being rather long.

  51. Gudrid says:

    Firstly I wanted to thank you for your article. In my case it is extremely timely as I have a 5 month old baby myself. With all of the rabid “breast is best” types that make hurtful and rude comments to someone who shakes up a bottle of formula in public, it’s nice to see an article on the topic. :)

    Due to breastfeeding issues with my son I switched to pumping and supplementing with formula at around 6 weeks. I pump about 3/4 of what my son needs, and supplement with the rest. But even so, its amazing how many people, strangers even, feel the need to criticize or comment about the nature of the food I feed my baby. I was told by a co-worker that “you don’t know what’s in that baby formula. I think it’s dangerous and harmful, and completely irresponsible to feed it to your kid, and I would never let my daughter have any.” I couldn’t believe what I was hearing! Now if my co-worker brings that up again, at least I have an article I can direct him to look at. :) Thanks again.

  52. # Zoe237on 15 Apr 2010 at 9:00 pm

    “That didn’t sound too good Michele, especially on a breastfeeding thread… lol.”

    Oh well, I’m not proud. It was like a penny just laying there in the street, waiting to be picked up. :)

  53. StatlerWaldorf says:

    edgar said, “I always wanted to try the breastmilk in the eyes thing. But my daughter never had an eye infection.”

    It does work, but too slowly for my tastes. I did breastmilk in the eye for 3 days and it was looking much better, though not completely resolved, so I got antibiotic drops to finish the infection off.

    Fifi said @ Harriet Hall, “The anecdotes and opinions make it appear you wrote this blog for the general public and that your main thrust is that people shouldn’t make women who choose not to breast feed feel bad by promoting the idea that bf is better because that may make them feel bad. You mention public policy but you didn’t actually address any real issues about public policy – just that it may make some women who choose not to breast feed feel bad and that this study doesn’t prove anything so should be ignored – even though you say you believe bf’s clearly better for babies (before lumping in women who can’t bf with women who decide they’d rather not, two totally different situations and one isn’t by choice while the other is).”

    I agree. While it does a disservice to everyone when research is poorly designed or research results are manipulated and misleading, it isn’t useful to use it as a jumping off point about how women who choose to formula feed instead of breastfeed from the beginning shouldn’t be pressured or feel guilty about not breastfeeding, because breastmilk isn’t that much more special anyway. I think we need better research on the subject, but I think there will always be a battle over breast vs bottle because of all of the surrounding factors that influence infant feeding.

  54. StatlerWaldorf says:

    MedsvsTherapy said, “Some public places have changing tables, and even have those “family” bathrooms – those are awesome ways that our society can help us parents try to do the best we can, as we see fit, when it is time to nurse or change a diaper.

    We would be an awesome society if we could accomodate, amongst other things, a mom breastfeeding if she wants to, whether there is some slight clincal edge or not. Clinical edge, all the better.”

    Well said! I feel that women and men should receive more consideration for family life, from family friendly facilities to work leave. Men should get approx 3 weeks paternity leave, and women should get a bare minimum of 6 months maternity leave, and they shouldn’t be financially penalized. Govt and workplace support should be given. It makes more sense to make society friendlier to raising families, than having families formula feed by default and leave their babies at daycare to get right back to work. If some parents choose this for their own personal preferences, that is fine, but I’m sure there are far more parents out there who would appreciate the time to breastfeed and be home with their infant. There is plenty of working time in everyone’s lives. Would it really be such a hardship in society to let people have paternity and maternity leave?

  55. StatlerWaldorf says:

    Timely16 said, “I hope every child has a happy and healthy upbringing, but I don’t see why taxpayers or private employers should pay for it. Your decision to have children is voluntary. If I decide to go on a voluntary, 3-month spiritual quest to Tibet, I shouldn’t expect my job to be waiting for me when I returned, much less to be paid 70% of my salary while I was gone.”

    I’d say, put your money where your mouth is. A society depends on the next generation, and you will still be working when some of those kids your tax money supported will also be working and contributing to taxes that benefit you.

    And in Europe many progressive companies offer both paid and unpaid sabbatical time for their employees to take leave to study or travel, or do some kind of social responsibility projects. Their jobs are still waiting for them when they get back. Workers also tend to get around five weeks of annual vacation time, compared to two or three weeks in North America.

  56. pepihl says:

    The author didn’t like to breastfeed her first baby. What does her personal taste to do with science-based medicine? Is breastfeeding not THAT good just because is time-consuming or we women don’t like it?

  57. Harriet Hall says:

    pepihl

    “Is breastfeeding not THAT good just because is time-consuming or we women don’t like it?”

    Of course not! I never suggested that. I only offered an example (a sort of “case report”) to illustrate my point that the claim that women could have “no” reason not to breastfeed was untrue.

    Breastfeeding is good but it is not as good as the Pediatrics article said, because they formed exaggerated estimates based on flawed statistics.

  58. WhatAWorld says:

    I realize I’m a little late to the party, but I’d like to thank Dr. Hall for looking into this. I’m sure she had to hide in a foxhole for a while after submitting/publishing her results given the heat around this topic.

    And I just don’t get that. In my field (personnel assessment/selection), my colleagues and I make it a personal pastime to rip into each others’ studies, to question the methodology, the shortcomings, the caveats of the outcomes. And that’s a GOOD thing.

    Why is it no one can question a breastfeeding study without the pitchforks and torches coming out? I LOVE to see that she’s critically looking at these studies and saying, ‘Hey, wait a minute…’

    I have tons of problems with the methodology used in breastfeeding studies I’ve seen, but the biggest problem of all is the studies seem to assume we all live in a vacuum, where the ONLY variable of interest is breastfeeding. Really? What about the effects of nature and nurture? Our environment? Our income/socio-economic-status? Our diet? Our stress levels? And so on. Someone please tell me the breastfeeding researchers are tying that all into their results as well – and they’re looking at them longitudinally as well, not just at a convenient snapshot of time. Because if not, I’m willing to bet good money that breastfeeding is nothing more than a mediating variable that’s plucked out of the wash.

    Either way, I’m just happy to see someone taking notice of sloppy research.

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