It's been so cold that I haven't been spending much time at my desk, preferring the warmth of the woodstove in our front room as temperatures remain far below freezing for the second week running.  But naturally the splash made by Professor Sven M. Carlsen, who is head of the Unit for Applied Clinical Research Institute for Cancer Research and Molecular Medicine in Trondheim, Norway, has required all of us who work with breastfeeding to spend far more time than we'd have preferred, doing damage control.  I'm going to be on a local radio broadcast today, along with another member in our local BF org chapter and I look forward to the chance to get some information into circulation, rather than sensationalized hooey.  I will be leaning VERY heavily on this statement from Baby Friendly UK which I recommend everyone read, print out and have at hand for all the questions you are likely to get in the aftermath of this media humbug. http://www.babyfriendly.org.uk/items/item_detail.asp?item=620  

Mr Carlsen was interviewed on the Norwegian national TV news on Tuesday, which was the first time I had ever heard his name. While the broadcast included not one word about where, or even whether, his own study was published nor about what the aim of his research was, he was given plenty of air time to accuse those who have worked to improve the maternity services' offerings to new mothers of being 'blinded' by their 'love' for breastfeeding, and this blindness, according to Carlsen, is what makes us all believe that the epidemiological evidence supports the idea that breastfeeding makes a difference to child health, when in fact child health is determined before birth, by maternal hormones, and diet after birth has no effect one way or the other.  His argument as he himself stated it, is that the epidemiological evidence ALL comes from studies that were poorly designed, but since we are blinded by love, we can't see that.  Then he said that he has carried out a proper, stringent analysis of the same evidence and can reassure us all that mothers who don't breastfeed can relax, because it makes no difference.  He cited Michael Kramer's PROBIT study and implied that the two of them see completely eye to eye, and indeed from a private e-mail I have seen from Carlsen's hand one could almost get the impression that they have collaborated on research, but there are no references listed in PubMed in which both of their names appear on the same article.  Carlsen himself mentions a reference to a Swedish tabloid headline from last fall, to show that he is not alone in his opinion of how overrated breastfeeding is - Marit Olanders will want to be sick when she hears this, the headline translates as 'Grew tired of all the lies about breastfeeding' and is about a non-scientist who got a lot of press coverage for her frontal attack on breastfeeding in Sweden's equivalent of the Daily Mail.  I am not aware of any other scientists who use this source as a reference in professional discussions, but I guess if love can blind one, so can hate, so perhaps that explains why he is willing to arm himself with such, er, 'untraditional' scientific references.  It does not explain how Carlsen managed to miss Kramer's statement of last summer, criticizing the sensational treatment given to his research and reiterating his belief that breastfeeding does indeed matter.

Fleur Bickford in an eloquent post writes: '...With a control group and an intervention group that include breastfed babies, naturally the results are bound to be weaker than if breastfed babies are being compared to formula fed babies, which was not the intent of the PROBIT trial. In other words, the researchers have a hypothesis based on a study that was not designed to look at the health of breastfed babies versus formula fed babies.
The newspaper articles suggest that the journalists either didn't read the actual research article, or they have no understanding of research. Either that or they're just looking to stir up controversy and sell more papers as usual. How sad that it is at the expense of mothers and babies.'

I'll add that it's likely that the journalists didn't read the original research article, AND if they did it wouldn't help because they, like most health professionals and other people, lack the skills and knowledge to read such articles critically, AND they are looking to stir up controversy and sell more papers.  IOW, all of the above :P

Baby-Friendly UK issued a very good statement in response to the ludicrous amount and nature of the coverage given to this tiny little study of 181 women (from Carlsen's abstract: 63 from a 'random sample' of pregnancies and 118 from 'a group with an increased risk of giving birth to a small-for-gestational-age newborn') in one Norwegian town.  

In the Baby-Friendly UK statement they remind us that a finding of small differences between groups may be a *strong* finding, if the research has been well done.  So, in the first paragraph from Fleur's post above, may I suggest that the word 'weaker' be replaced with the phrase 'less dramatic'?  The differences between the two groups are small, but the results are no weaker because of it.  Even a small difference between groups will have big implications if the difference concerns the prevalence of common illnesses such as gastroenteritis or respiratory infections, for which the effect of breastfeeding is extremely well established.  Why Carlsen chooses to ignore this is a mystery.

I have not had a chance to read more than the abstract yet, and I hope the article elaborates further on just how many of the 181 women were not breastfeeding or not fully breastfeeding at six weeks, three, and six months postpartum. We have no good national data on breastfeeding rates since 2000, because records are not kept about this in the primary care system, so we won't be able to compare their rates with any national average, but it may give us an indicator of just how many women are not succeeding at breastfeeding as long as the national targets of six months exclusive BF and 12 or more months total.  At the risk of offending my colleagues who work in Trondheim I will say that the hospital there did not earn its international reputation for its great BF support. The emphasis in Trondheim has long been fetal medicine and antenatal diagnostic techniques; they train all the obstetric ultrasonographers for the whole country there and do a great job of that, and they do a lot of very specialized intensive newborn care and infertility treatment as well.  But just a few years ago I had an uncomfortable confrontation with a former head of pediatrics there at a conference, who said 'We mustn't turn breastfeeding into a religion' and she went on to expound on her beliefs that breastfeeding made little difference to long term health, for mother or child.  Her concern about the safety of donor milk was also the main obstacle to the establishment of a donor milk system there, and Trondheim only got their milk bank going after she retired.

To their credit, the national broadcasting company invited breastfeeding expert Gro Nylander to the studio on Tuesday and asked her to comment on Carlsen's statements.  She said very clearly (I am paraphrasing from memory here) that 'Carlsen knows a lot about hormones in pregnancy, and he should stick to what he knows about, because he is far afield here - contrary to what he says, we are constantly learning more about the impact of breastfeeding on lifelong health.  All he has done is confirm that women with certain hormone disturbances, struggle a bit more with breastfeeding than average.' 

The way the story has played out is a prime example of dumbing down the news, and that is nothing new, especially not in our field.  I need to get out the door; writing this post has been good preparation for the radio piece!

Cheers
Rachel Myr
Kristiansand, Norway

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