Sounds like Ginger did a great job of representing breastfeeding at this
presentation. It is always interesting to see how data can be manipulated! In Dr.
McLean's lecture he compares how babies who received formula with smaller
amounts of the added fatty acids (as in Similac Advance, a Ross product) did
"better" than those babies given formula with higher amounts, like Enfamil Lipil
(from Mead Johnson) with twice the amount of DHA than Similac Advance! Yes,
clinical studies are expensive which is why formula companies are working so hard
to make sure that the rules about clinical studies do not change. The FDA is
looking at criteria for clinical studies when a formula maker wants to change
or add ingredients.

As to breastfeeding rates in the US going up, a look at  Ross's data shows
more manipulation. Ross defines total breastfeeding as exclusive plus partial.
That is the 69.5% rate often quoted which makes it seem like breastfeeding
rates are improving. However, if you look at the rates for exclusive breastfeeding
which is 46.3% you can see the these rates have gone down and drop to 17.2%
at 6 months. "More mothers than ever before are supplementing." This is a
direct quote from an article by Ross: Ryan AS, et al. Breastfeeding continues to
increase into the new millennium. Pediatrics 2002; 110:1103-1109. One reason
exclusive breastfeeding rates continue to drop is the crushing commercial
pressure for supplementation that formula makers put on mothers and health care
providers.

Trying to improve formulas is simply part of doing business, not beneficence
on the part of formula makers. There is a concept called the "diffusion of
innovation" that is explained as once an innovative technology or concept reaches
a certain level of market penetration, it becomes as irresistible force, a
must-have item in the minds of the consumer and a must-offer product in the
minds of industry. Ross hesitated to put these fatty acids in formula but did so
after it saw Mead Johnson capturing more market share and heard mothers asking
for the formula that would make their babies smarter!

Grand Rounds presentations like these function to position formula makers as
good guys and make peddling their product more palatable to physicians and
nurses whom they depend on to model formula feeding as equivalent to
breastfeeding.

You did a good job Ginger in a very difficult situation. I am glad we have
you within the breastfeeding community!

Marsha Walker, RN, IBCLC
Weston, MA

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