Pamela Morrison wrote:
<People often shrink in 
horror at the thought of milk donors not being screened, particularly 
when the risk of transmittable diseases like HIV is factored in, but 
I've never understood why, unless it's actually anticipated that milk 
banks will make mistakes to inadvertently allow some raw milk into 
the supply chain.>

Yes, that's it exactly. Human beings are fallible; I anticipate that they're sometimes going to make mistakes. Processes such as pasteurisation probably aren't 100% perfect either when it comes to killing off the bugs. So, while pasteurisation is an important step in ensuring the safety of milk (both human and dairy) I don't think it should ever be the only step or a substitute for screening. After all, dairy milk is also pasteurised, but that doesn't mean I want dairies to give up TB testing the cattle, and it definitely doesn't mean I want them obtaining unscreened milk from a herd known to have high rates of TB and selling that to drink on the basis that pasteurisation will kill off all the nasties.

Great suggestion about buying the milk from Africa, and I wish I could see a way to make it work since it certainly does have advantages, but I do see a bunch of problems:

1. Wouldn't refrigeration and collection be a logistical nightmare? I mean, surely the kind of places we're talking about are likely to be without electricity in the village and often quite a ways off the beaten track?

2. The need to exclude HIV-positive mothers could mean stigma for mothers who want to keep their HIV-positive status secret, if the neighbours notice they're not selling their milk and put two and two together.

3. High incidence rate of HIV in many areas from unfaithful husbands, so a lot of cases could potentially slip through the testing.

4. Wouldn't you have to keep the milk from different ages of infant separate as the infant milk and the milk composition are different? Would that be feasible?

5. The changes in milk composition with time since birth, and with the infants' needs - how would that work out? Would it be feasible to collect the milk in three different lots (0 - 6 months, 6 - 12 months, and >12 months) to sell for children in that age group? Maybe that one could be managed - but then, you've got financial incentive to create a large and dubious market for 'toddler milk' in the way that formula companies currently do.

So I think that's probably too many insurmountable problems for that one ever to be viable, unless someone can think of clever solutions I'm missing. Shame...


Best wishes,

Dr Sarah Vaughan, imagination excited but ultimately disappointed
MBChB MRCGP

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