Most recent news stories

JAMA article advises severing of industry ties

April 13, 2009

Eleven leading US physicians have published a special article in the April 1 issue of the Journal of the American Medical Association (JAMA) recommending that all professional medical associations sever their ties with pharmaceutical and device manufacturers. The statement may have broad implications for the infant formula industry, even though infant formula is not specifically mentioned. The eleven authors of the proposal include Dr. Catherine DeAngelis, editor-in-chief of the JAMA, and Dr. Carol Berkowitz, past president of the American Academy of Pediatrics (AAP).

The statement recommends that professional medical associations (PMAs), start by limiting their budgets to 25% industry funding, and work toward with the goal of “$0.” Many PMAs, which are defined as physicians’ organizations, have gotten funding for activities ranging from conferences and annual meetings, to funding the development of practice guidelines, as well as unrestricted grants, often totaling millions of dollars. The statement recognizes that some valuable activities may need to be curtailed, and recommends that all funding come from membership dues and advertising sales in their journals and vendor fees at conferences. The authors of the proposal stipulated that they are writing as individuals, not as representatives of their own medical organizations.

For some time, breastfeeding advocates have cited conflicts of interest between the American Academy of Pediatrics and the infant formula industry, which is largely controlled by pharmaceutical companies. The AAP has engaged in many of the practices specifically condemned by the JAMA statement. These relationships with industry have been commonplace in many professional medical organizations, not just the AAP, and arguably have compromised practice guidelines and policy in many areas of medicine. Members of the AAP’s Section on Breastfeeding have repeatedly tried to get the organization to sever its ties with the formula industry, but so far without success.

The relationship with the formula industry has arguably influenced AAP’s medical policies. The AAP has been relatively silent in advocating for the WHO/UNICEF Baby-Friendly Hospital Initiative, which eliminates marketing of infant formula by hospitals and substantially increases breastfeeding rates at the expense of infant formula. The AAP committee on nutrition recommends only 4-6 months of exclusive breastfeeding, in contrast to the AAP Section on Breastfeeding and all other major medical organizations in the world, which recommend exclusive breastfeeding for 6 months.

According to Naomi Baumslag and Dia Michels in their 1995 book Milk, Money, and Madness, the formula industry contributed $3 million to the building of AAP’s headquarters, and had been giving annual $1 million grants to the organization.

Overwhelming evidence exists to show that aggressive marketing of infant formula undermines breastfeeding duration and exclusivity. The formula industry competes with breastfeeding for market share of infant nutrition. Its profits go down when breastfeeding goes up.

The JAMA statement, “Professional Medical Associations and their Relationships with Industry,” is available at http://jama.ama-assn.org/cgi/reprint/301/13/1367.

Atlantic article sparks breastfeeding storm

March 16, 2009

A storm is brewing against breastfeeding with tomorrow’s publication of Hanna Rosin’s The Case Against Breastfeeding. Rosin was also featured on the Today show this morning, along with Dr. Nancy Snyderman deriding the medical research on breastfeeding. Their discussion points to a much bigger issue: it can be very challenging to breastfeed in the United States.

The CDC recently found that 60% of women do not even meet their own breastfeeding goals, and even fewer meet the universal medical recommendation to breastfeed exclusively for 6 months with continued breastfeeding for the first 1-2 years of life. These recommendations are for all women and babies, including the waitresses and bus drivers whom Rosin discusses. The US is the only developed country in the world without paid maternity leave. In the few states where they are in place, worksite breastfeeding laws help mothers in all kinds of jobs, but in most states, women must do without any support, and currently most women can’t afford just to stay home.

Both the Atlantic and the Today Show focus solely on breastfeeding as something mothers feel pressured into doing for the good of the child. Neither source notes that breastfeeding is important for a mother’s health as well: early cessation of breastfeeding is linked with increased rates of breast cancer, ovarian cancer, diabetes type 2, and coronary artery disease.

Rosin’s selective citing of the scientific literature suffers from a serious lack of fact-checking from the Atlantic editorial staff. The most recent comprehensive, objective analysis on the risks of not breastfeeding comes from the Agency of Healthcare Quality Research (2007). This report conclusively links early weaning to increased risks of maternal and childhood disease, including childhood obesity. “With an epidemic of obesity in this country threatening our collective health and our economy, now is not the time to make the case against an effective preventative measure,” says Dr. Melissa Bartick, an internist and chair of the Massachusetts Breastfeeding Coalition (MBC).

The expert scientists of all major medical organizations recommend breastfeeding based on their organizations’ review of the literature. Says Marsha Walker, a nurse and Board member of MBC: “These folks are the MD’s and the PhD’s who know their way around meta-analyses, Odds Ratios, Hazard Ratios, p-values, and Relative Risks, and who can tell us a lot more than one ‘paranoid sleep-deprived mother of a newborn’” which is how Rosin describes herself in the article. “Medical authorities aren’t always right about everything,” says Bartick, “but for now, the best information we have about breastfeeding suggests that the US needs to do a whole lot more to support it than we currently offer,” says Bartick. “Instead of pitting women against each other, we should be using that energy to advocate for giving all families meaningful support, from the hospital to the worksite.”

Visit here to write to the Atlantic.

Visit here to contact the Today Show.

Formula company sponsors mediocre lactation toolkit

February 20, 2009

With a formula company logo on the bottom of every page of materials, a trio of sponsors has released a new “Workplace Lactation Program.” As one of the sponsors, Abbott Nutritionals, manufacturer of Similac infant formula, features prominently in all the materials. The program’s release comes on the heels of the of the federal government’s new program, “The Business Case for Breastfeeding.”

The other sponsors of the toolkit are Corporate Voices for Working Families, and Working Mother Media, which publishes Working Mother magazine. While the sponsors say the toolkit is specifically aimed at low-wage hourly workers, its employee materials are written at at a least a twelfth grade reading level. Health literacy experts recommend using a sixth grade reading level for the general public. The materials refer mothers to the Abbott website for tips on breastfeeding.

The poor graphic layout of the employee materials make them difficult to read and not user-friendly. The employee materials are dense with text, and light on visuals and open space. The employee materials have large highlighted sections on breastfeeding problems, making breastfeeding appear fraught with difficulties. Although the materials list various resources around breastfeeding, including the formula company website, they make no mention of the government’s Business Case for Breastfeeding.

Previous research on materials from formula companies have shown they undermine confidence in nursing mothers, particularly first-time mothers, women of color, and those with lower educational levels.

Because breastfeeding and infant formula directly compete with each other for market share of infant nutrition, any effective breastfeeding strategy may cut into formula sales and profits. “The only way to sell more formula is to sell less breastfeeding,” says Dr. Melissa Bartick, chair of the Massachusetts Breastfeeding Coalition. Numerous resources are already available that do not have an inherent conflict of interest.

Marsha Walker, head of the National Alliance of Breastfeeding Advocacy and an MBC Board member, says, “Companies who want to burnish their corporate image by using this mediocre material are not showing good corporate citizenship.” If employers truly want to support their lactating employees, they should use the government’s Business Case for Breastfeeding, adds Walker, noting that this program is also designed to include low-wage hourly workers.

Walker also suggests that members of the public also contact Corporate Voices and Working Mother Media to express their concerns.

• Donna Klein, dklein@cvworkingfamilies.org, President of Corporate Voices.
• Carol Evans, carol.evans@workingmother.com, President/CEO of Working Mother Media.

See the Corporate Voice press release here.

Breastfeeding linked with lower risk of maternal heart attacks

February 14, 2009

Lifetime breastfeeding of at least 2 years is associated with a reduced risk of heart attacks and coronary artery disease, according to a new large study published in this month’s issue of the American Journal of Obstetrics and Gynecology. Using data from over 89,000 women from the Nurses’ Health Study, the study found that mothers who had total of at least 2 years of lifetime breastfeeding had 37% lower risk of heart attacks from coronary artery disease (CAD) compared to mothers who had never breastfed, even adjusting for common potentially confounding risks.

Even when the study’s findings were adjusted for potentially confounding factors of obesity, parental history, and lifestyle factors such as smoking, these women still had 23% lower risk of CAD compared to mothers who had never breastfed. CAD, also known as coronary heart disease, consists of atherosclerosis of the arteries that nourish the heart muscle, and it is the most common cause of heart attacks and angina.

Dr. Alison Stuebe, assistant professor of Obstetrics and Gynecology at the University of North Carolina, led the study. Stuebe, formerly of Brigham and Women’s Hospital in Boston, has served on the board of the Massachusetts Breastfeeding Coalition. She is also lead author of a 2006 study that showed longer duration of breastfeeding is associated with decreased risk of maternal type 2 diabetes.

“Breastfeeding is good for mothers and babies,” Stuebe said. “This study provides additional evidence that successful breastfeeding impacts health risks across two generations.”

Previous research on humans and animals suggested that breastfeeding may affect the metabolism of the lipids implicated in atherosclerosis. Breastfeeding women are known to have higher levels of HDL cholesterol (the so-called “good cholesterol”) and higher levels of triglycerides, which can be harmful. Other data has found that breastfeeding reduces blood pressure and heart rate. Elevated blood pressure also contributes to atherosclerosis and CAD.

The American Academy of Pediatrics recommends breastfeeding for at least the first year of an infant’s life, and most other major medical organizations recommend breastfeeding for the first two years. The finding imply a substantial public health benefit if more mothers breastfed according to recommendations. Currently, only about 21% of US infants are still breastfeeding at 1 year, according to the Centers for Disease Control and Prevention.

The abstract of the study is available on the PubMed web site, and the article is available on the AJOG website (with an accompanying editorial).

Governor signs breastfeeding bill

January 9, 2009

In a victory for families in Massachusetts, Gov. Deval Patrick today signed An Act to Promote Breastfeeding. The bill explicitly protects a mother’s right to nurse her baby in public.

“This is a major step forward for public health,” said Dr. Melissa Bartick, and internist and chair of the Massachusetts Breastfeeding Coalition. “This law establishes that breastfeeding is the normal way to feed infants, and it will protect mothers from harassment for following medical advice.” All medical organizations recommend that babies receive only breast milk for the first 6 months of life. Infants who are not breastfed face higher rates of ear infections, diarrhea, pneumonia, asthma and obesity, and mothers who do not breastfeed face higher rates of breast cancer, ovarian cancer and diabetes.

Despite the well-documented health risks of not breastfeeding, multiple Massachusetts mothers have faced opposition to breastfeeding. In one highly publicized case, a mother visiting a Victoria’s Secret was told she couldn’t breastfeed there because it was “inappropriate.” Another mother was expelled from a party supply store for nursing her infant. Recently, a mother returning to Massachusetts on an Amtrak train was told she couldn’t breastfeed on board.

Once the new law takes effect, individuals who harass a nursing mother will face a $500 fine, giving mothers who have been embarrassed or humiliated a recourse. In other states with similar legislation, advocates have created a printed “license to breastfeed” for mothers to carry in case they encounter opposition. The Massachusetts Breastfeeding Coalition plans to distribute similar licenses with the details of the new law, and how to report violations, later this year.

“This law empowers mothers to follow medical recommendations and breastfeed their babies,” Bartick said. “Mothers who may be afraid to breastfeed for fear of being humiliated will know they have a legal recourse.”

The Massachusetts Breastfeeding Coalition actively supported the bill, organizing a lobby day at the state house in May 2007 and encouraging members to visit their legislators, write letters, and mail photographs of breastfed babies to the state house.

The new legislation comes after eight years of advocacy, with key leadership from Senator Susan Fargo, who first introduced a breastfeeding legislation several sessions ago. “For something that’s so healthy and so natural and supported by so many health groups, it just makes so much sense” to pass the protections for breastfeeding, Fargo was quoted in the Boston Globe on December 31.

“No longer will mothers be forced to feed their children in the restroom of a restaurant or mall. … Women who nurse should not be treated as second-class citizens,” Representative David P. Linsky, a Framingham Democrat who pushed for the bill in the House, said in a statement also quoted by the Globe.