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Subject:
From:
"Nice, Frank" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 5 Nov 1997 15:35:34 -0500
Content-Type:
text/plain
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Would like to share my response to Jack Newman.
Frank J. Nice, DPA, CPHP
----------
From:   Nice, Frank
Sent:   Wednesday, November 05, 1997 3:31 PM
To:     [log in to unmask]
Subject:        RE: Frank Nice's questions

Dear Jack:
I agree with you on what you state below.
The purpose of my questions was to draw your thoughts out on this
subject further, and obviously you did. While I may not agree with your
answer to the second question 100%, it is almost always my philosophy
when I counsel also. The risks of not breastfeeding must always be
considered or at least counseled about.
In my counseling I often quote you and your positions on these matters
to make my counseling advice as complete as I can.
The truth is that I very, very rarely counsel a mother who must take a
specific drug with really no alternatives that she shouldn't breastfeed.
I can probably count those cases in the past 20 years on one hand.
Thanks for responding.
Take care.
Frank J. Nice
PS: Of course, if a drug increased juvenile diabetes 3%, it would not be
on the market, while a possible increase of 25% by not breastfeeding is
not given the time of day.  We run into such cases with our epilepsy
drug research, and that is why I am involved in research trying to show
that overall improvement of Quality of Life (evaluated by the patient,
not the physician) must be a part of the decision to approve a drug for
marketing, not just adverse effects.

----------
From:   newman[SMTP:[log in to unmask]]
Sent:   Wednesday, November 05, 1997 3:11 PM
To:     Lactnet
Cc:     Nice, Frank
Subject:        Frank Nice's questions

No, obviously the fact that one mother takes a drug with no *apparent*
effect on the baby means nothing.  That is not the issue.  The issue
is: is breastmilk with a given quantity of drug more hazardous than
infant formula?  The answer in my opinion, is rarely yes.  According
to Dr. Allan Cunningham, not breastfeeding increases the risk of
juvenile diabetes by 3-25%, depending on what you read.  Okay, Frank,
I ask you:  If a drug increased a child's chances of getting juvenile
diabetes by 3%, would that drug still be on the market in the US?

Jack Newman, MD, FRCPC

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