Dear all:

I haven't piped up because there has been some really excellent posts on the reverse 
causality of blaming breastfeeding for failure to thrive.  This "myth" persists even in my 
own international nutrition circles.  I was astounded to hear one friend comment on 
another friends small daughter and that the reason why she was small was that she was 
still breastfeeding at age three.  Both women were from developing countries and worked 
for UNICEF on nutrition programs.

I'm doing a talk for Cornell Medical Students and my reverse causality example was how 
the formula industry used to try to deflect the evidence on not breastfeeding  and 
increased infant mortality by claiming "reverse causality" --- that infants who are ill or 
dying are more likely to be given formula and the fact that they were ill or dying is the 
real cause of the death (and specifically mentioned that powdered infant formula was the 
same as any other home-based concoctions that are often given the finger as the reason 
for the high mortality.  This was debunked in a now oldie (mid1980s) but goodie study 
using a large data set in Malaysia on infant mortality --- the same data set that also 
debunked the notion that the much higher infant death rates from use of formula in 
developing countries was due to poorly designed studies.  Within the Malaysia sample 
there was enough economic diversity and data to do some nice epidemiology to nail down 
the fact that breast milk substitutes are even more risky when you a) don't have a toilet, 
b) don't have enough water, and c) don't have clean water:  a) is higher risk than b) 
which is higher risk than c).  Hence the explanation for the fact that infant mortality rates 
really were that much higher among those who were using breastmilk substitutes in 
developing areas of the world.

I was also going to use the reverse causality issue on blaming the bottle --- and the fact 
that the underlying problem that caused the mom to use the bottle (assuming a mom 
wants to breastfeed) never gets dealt with because you are ignoring the feeding problem 
--- and hence setting up the infant for later eating disorders.


Best 

Susan Burger, MHS, PhD, IBCLC, RLC

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