Dear Angela,
The real problem is not lack of evidence of benefits of breastfeeding, or detriments of formula feeding, it's the lack of good research about breastfeeding. There are many literature reviews and observational studies that clearly show increased morbidity and mortality in infants and their mothers due to lack of breastfeeding. However, especially in developing countries it's difficult to find large randomized, double-blind, cause and effect studies. Partly because of the low rates of exclusive breastfeeding in these countries and because it's hard to control for all the variables that may affect health outcomes. Also, many women may intend to exclusively breastfeed during the study, but then that changes and they drop out of the studies. Mostly, we only have observational studies and literature reviews, and one million years of evolution at this point, to go on. But my question for her would be, if that's not enough for her, what research is she
 planning to use as her evidence that formula is adequate? No observational studies or systemic literature reviews to support her assertion that this method of infant nutrition that deviates from what humans have eaten since the dawn of time will be comparable to human milk. If she is planning to deviate from the physiological norm of humans, it's her responsibility to provide proof of it's adequacy, it's not our responsibility to defend human milk for human beings. And I would challenge HER to find large scale, cause and effect studies that show that formula is as healthy for infants as human milk. When you talk to her, also I would be sure to use the term "human milk" not breast milk, as a reminder that what we are talking about is human milk for human beings. I know for us, it's seems silly to even have to study this. It's like having a study as to whether or not oxygen is good for human beings.
 
I also have to say, I find it extra sad when it's a woman MD saying this, especially when we understand how formula feeding increases a woman's risk of breast cancer and other health problems for women. Secondly, I don't know if this incorrect information is her idea, or something she erroneously picked up in Med school, either way as a Physician, she is ultimately responsible for the content of the information that she passes along to her patients. Next, as a new MD, I think she should be especially careful about passing along advice that conflicts with information provided by the AAP, ACOG, the Surgeon General, the AAFP, WHO and Unicef. I would call her out on the word game she is playing with you too - "Most studies either portray breastmilk advantageous in some areas but not all." If studies show that breastmilk is advantageous even in some areas, then by definition it is beneficial. I think she is trying to play semantics with you. Where are her
 large, cause and effect studies to make her case? Where are her studies showing human milk is detrimental?
 
Human milk should be the baseline standard that we compare formula against. We would never feed another species milk from a different species, such as feeding puppies milk from a mother pig and expect their growth to be the same. If we did, we would need large studies showing it's adequacy for the puppies, not large studies showing the adequacy of the mother dog's milk for her own puppies! In one way, she's probably right that there are no benefits of breastfeeding, when we see that babies are sicker on formula, that means that there are detriments of formula feeding. Because human milk is meant to be the physiologic norm for human babies.
 
Often, we have a hard time with research in this country because there are so few exclusively breastfed babies. The recent recommendation by AAP that breastfed babies may need iron supplementation at 4 months was based on one study that started with about 130 babies, but so many dropped out, stopped breastfeeding or started solids early that by the end of the study only 3 were exclusively breastfed to 6 months, but still they based a policy change on this study. And I'm sure your MD is probably using this in her repertoire of studies to show that human milk may be insufficient.
 
That's why at this point, until there is more research, the best evidence comes from systemic reviews of many different observational studies, and across the board those reviews show at least some benefits to breastfeeding, so until she has large-scale studies to refute that, she should probably recommend the milk that humans were intended to grow on. Systemic literature reviews showing benefits of breastfeeding are easy to find.
 
Here's one that shows that in developed countries like USA, infants die from lack of breastfeeding. It's hard to find a bigger disadvantage of formula than death.
 
http://www.urmc.rochester.edu/flrpp/provider-materials/documents/Bartick2010TheburdenofsuboptimalBFintheUS-costanalysis.pdf
 
 "If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80%compliance)."
 
And if even she could prove they were comparable, how about the waste of money or the damage to the environment?
 
And on cancer prevention:
 
http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Breast-cancer/Landmark-report-recommends-breastfeeding-to-prevent-cancer/
 
 
Good luck to you, I'm coming up against the same thing in the hospital where I work.
 
Tricia Shamblin, RN, IBCLC

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