Lynette Hafken asks about how to deal with the assertion that the NNT for
breastfeeding is astronomically high for the scary diseases.  Her musings
seem to me to be right on target.  How about reminding everyone that
breastfeeding is not a treatment, it is simply adherence to the normal diet
for infants and young children?

Obviously, if you want to introduce a drug for universal prophylactic use,
you will need to argue heavily that the numbers of people who need to take
the drug in order to avoid a single case of Scary Disease X, are justified
by the great benefit to that person who will be spared the dreadful fate.
Also, you will have to show that it doesn't really matter that for every one
of them, ten thousand people are taking the drug needlessly, because your
drug, unlike every other medication ever invented, has NO UNTOWARD SIDE
EFFECTS and it costs almost nothing.

If, on the other hand, all you want to do is restore normalcy to early child
nutrition, why should you have to prove that your so-called intervention has
a good cost-benefit relationship?  I know we aren't in Lactopia yet, and
here in its first outpost on Earth where I live, even most of the foremost
experts are still talking about the 'advantages' and 'benefits' of
breastfeeding, but honestly, there is no reason to compare the act of
breastfeeding to public health interventions such as screening for sickle
cell anemia or fluoridation of water or routine immunizations of children.
Please note I am not discussing these interventions in terms of being for or
against them, only listing them as examples of public health measures for
which it is entirely legitimate to debate the NNT before instituting them,
in contrast to breastfeeding, which is more comparable to sweating or
peeing: all bodily functions that wouldn't exist if they weren't necessary.
What is the NNT for perspiration, anyway?  Wonder what diseases it prevents
besides idiopathic hypothermia?

Anyway, breastfeeding deficiency on a societal level leads to such increased
rates of a huge array of diseases, that what is really of interest is the
NNT in order to avoid the cumulative ill health burden where breastfeeding
is not the cultural norm.  (A vicarious measure of this is the costs to the
health services of not breastfeeding, and those numbers are available.)  But
have any of you ever heard of a mother who was disinclined to breastfeed
despite everything we know about the significance of breastfeeding, who
changed her mind when she heard about the relationship between not
breastfeeding and lymphoma in the child?  'OOOOHH! Why didn't you MENTION
that right away?  Of COURSE I'll breastfeed!'   Right.

Rachel Myr
Kristiansand, Norway   

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