Sara, I wrote a letter to the editor of the Lancet in November.  The Lancet
refused to publish it but they did send the letter on to Dr. Malcom Sears,
author of the study.  And he did write to me.  Here's a shortened version of
the letter to the editor(if anyone wants the full length version with
footnotes, I can send by attachment).  Valerie W. McClain, IBCLC

To the Editor:
     As an international board certified lactation consultant, I read with
interest the Sears et al. study on the long-term relationship between
breastfeeding and the development of atopy asthma.(1)  There is a long
history of observation and studies that suggest that breastfeeding,
particularly exclusive breastfeeding is protective agianst atopy and asthma.
I was therefore astounded to read this study that attempts to show
breastfeeding as a risk rather than a protective factor.

     The first problem I found with this research is there is no definition
of breastfeeding.  Studies that compare breastfeeding and infant formula
feeding without an operational definition of breastfeeding are seriously
flawed (2)  The authors' report that newborns classified as 'breastfed'
actually received nightly formula feeds while in the hospital.  Thus, these
newborns received doses of foreign proteins besides breast milk from the
beginning.  It is quite possible that it is these foreign proteins introduced
to an immature gut that is the trigger for atopy and asthma in these
children.

     The authors state, "No duration of exclusive breastfeeding had a
protective effect against development of atopy and asthma in later
childhood."  This research clearly did not test the effects of exclusive
breastfeeding, if newborns were given nightly formula feeds.  I believe that
it is next to impossible to be certain that a method of feeding is a risk or
protective, when the feeding method is mixed--particularly in the newborn
period.....

Casting  doubt about the protective factors in breastfeeding, could easily
mean that more women decide that breastfeeding is not worth the effort.  If
the study is wrong but influences enough women (it certainly got quite a bit
of media attention), we could easily end up with more atopic and asthmatic
children dependent on the pharmaceutical industry.  I am disturbed that this
study was published in The Lancet.
Sincerely,...........

I mentioned the Royal New Zealand Plunket Society (I stated the New Zealand
Plunket Nurse program might be biased--records maintained by them on infants
for the study) was founded by Truby King on the need to provide safe formulas
to infants.  Dr Sears states that the Medical Research Council (now called
the Health Research Council) funded the study.

I also mentioned a news release (June 18, 2002) from McMaster University that
states that GlaxoSmithKline Inc. was donating $1 million to establish a
McMaster University Research Chair in pediatric asthma at the Firestone
Institute for Respiratory Health St Joseph's Healthcare Hamilton Ontario
Canada (Malcolm Sears is from this Institute).  Dr. Sears in his letter to me
says, "Your statements regarding GlaxoSmithKline and the suggestion that our
study was biased because of pharmaceutical input are totally unfounded."  He
goes on to further state in his letter to me that, "There are many good
reasons for breastfeeding, and all that our study has done is to remove one
alleged reason which was based on short-term studies rather than adequate
long-term studies examing whether or not breastfeeding was protective against
atopy and asthma.  We have not suggested that women use formula feeding as a
means of reducing asthma and atopy."

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