Hi everyone.  I have comments on three topics today:

(1) doctor bashing -- I did not, in any way, mean to suggest that ALL
pediatricians are greedy bastards in league with the formula companies to
make babies sick.  I was suggesting a number of reasons for why SOME doctors
never tell their patients about any of the benefits of breastfeeding or
dangers of infant formula.  This was in response to a comment on misc.kids
that "If all of these claims about breastfeeding being better than formula
were true, then pediatricians would be telling us about it."  I was trying
to explain why that was not necessarily the case.  Of course, many doctors
DO tell their patients about the benefits of breastfeeding and the dangers
of infant formula.  Other doctors don't, but not because of the "greed"
reason, rather because of the other reasons I stated, which if I recall
correctly included that a) they were never taught anything about nutrition
in general, or bf in particular, in medical school, and b) they don't keep
up with the research journals where much of the research on the benefits of
breastfeeding has been published, just in the last decade, and c) they have
read the research but remain unconvinced (and many many doctors fall into
this category -- they want to wait and see the pronouncements from the AAP,
rather than judge the research on their own, or they wait for review
articles).  If you take away all the WONDERFUL doctors out there who are
supportive, and who are informed, *and* take away all the doctors who are
MERELY uninformed, *and* take away all the doctors who are MERELY
unconvinced still because the AAP hasn't made an official statement about
it, then you are left with those doctors who MAY be responding to the
pressures and benefits they get from the infant formula companies, and who
realize that those in private practice (not the HMO or capitated care docs)
make money only when people are sick.  I know many wonderful, caring,
informed, doctors, and never made a blanket generalization about *all*
pediatricians, though that is clearly the way my statement has been
interpreted.  And the discussions that my medical school mentee had with her
fellow students made it clear that they had been strongly influenced by the
formula company representatives who came to their campus or whom they met
during their preceptorships at the local clinic, and they also felt that "a
few more ear infections, or bouts of diarrhea weren't really harmful to
children."  I don't think they realized/accepted the magnitude of difference
in health between breastfed babies and formula-fed ones, and never thought
that their support of infant formula would lead to infant deaths -- just a
few more illnesses on average, which they could "cure" with antibiotics, and
the child was no worse off.

(2) regulating intake -- there was a wonderful post on the last digest (I
didn't write down the poster's name) about imagining what it would be like
if an adult were told how much to eat and at what times, and it might be
just enough, or too much, or too little.  This was partly in response to the
awful advice given in the parents magazaine about letting the baby cry it
out sometimes, and not letting the baby get "used to" small snacks all the
time, but training it to eat big meals on a widely spaced schedule.  I am
awaiting a copy of the original article from the magazine (someone from
parent-l said they would send it to me), but I *do* plan to respond, both to
the doctor and to the magazine.  There is plenty of evidence from the
composition of human milk that humans are designed to be fed often, around
the clock.  If we were a "cache" species, like deer, who leave their fawns
cached in a nest on the forest floor for hours at a time while they forage,
and nurse only a few times a day, then we would have concentrated, high
protein, high fat, high calorie milk, as a species.  Instead, we have milk
similar to the milk of other animals that have continuous contact and
frequent nursing around the clock.  It might be better for *all* of us if we
ate numerous small meals during the day, instead of only 1, 2, or 3 large
meals.  Dr. Samuel Fomon, who is a highly respected researcher in infant
nutrition, gave a talk at A&M several years ago in which he said that
infants should be taken off the breast at each feeding "as soon as they show
any indication of willingness to stop."  This is supposedly to "teach" them
to eat in moderation.  Of course, we all know that if the baby isn't allowed
to get the hind milk then they don't grow as they should and remain fussy
and unsettled after a feed, and that babies are wonderfully efficient as
self-regulating their caloric intake if allowed to.  Sigh.  This attitude
also reveals the assumption that breastfeeding is strictly a
"nutrient-transfer process" and ignores everything else that is going on
during a breastfeeding session.

(3)  I was driving down the street the other day and saw a woman step out
from a bus stop shelter toward the street and hold her arm out pointing
something out into the street.  I looked more closely, and saw that it was a
baby bottle.  She was shaking it, and then pointing it away from her as it
spewed dark brown liquid out into the street.  Obviously something
carbonated -- Coke, Pepsi, Guiness Stout?  I didn't get a chance to see the
child with her, so I don't know how old it was, but I was appalled.  Sigh,
again.




Katherine A. Dettwyler
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