On 11/05/2012 14:02, Nikki Lee wrote:
> Dear Lactnet Friends:
>
> The WHO says it best for feeding options: #1 is fresh from mom. #2, frozen
> from mom.  #3 from a donor milk bank or a wet nurse.  #4 nonhuman milks.

Actually, they seem to have abandoned that hierarchy years ago, from 
what I can see (presumably in recognition of risk of HIV transmission 
complicating matters).  The 'Global Strategy for Infant and Young Child 
Feeding' from 2003 now says that the best choice of alternative 'depends 
on individual circumstances'.

>
> As with any food, best is fresh whether it be strawberries or chicken or
> human milk.

Probably, although not altogether helpful in decisions about milk 
donation where most donated milk is going to be frozen rather than 
fresh.  However, the point I was making about opportunity costs in my 
previous e-mail is that decisions don't (or shouldn't) boil down to a 
single factor taken in isolation of all others.

Let's say that you and I both agree that, say, fresh strawberries are 
better from the health point of view than synthetic fruit bars.  
However, they're also more expensive and not available at the shop up 
the road where we do our shopping, so they require extra time to go and 
get them - so, getting fresh strawberries rather than a synthetic 
variant is going to take money and time away from what we could be using 
for the health of our families in other ways.  What should we do in that 
situation?  My opinion would be that there isn't a 'should' - there 
isn't a single obvious 'best' way to do things when weighing up those 
competing considerations.  You and I might make different decisions 
according to our resources, responsibilities, and priorities.  That 
wouldn't be about 'greed', or about one of us making 'better' decisions 
- it would simply reflect the complexities of life and the fact that 
sometimes different options are better for different people in different 
circumstances.

Thus it is for donated milk vs. formula.  Donated milk probably has some 
advantages over formula even for healthy term babies, but it also has 
various drawbacks in terms of cost, risk, and practicality (the precise 
drawbacks depend on the route taken to distribute and acquire the 
milk).  You are assuming that the benefits are always going to outweigh 
the drawbacks and that it is therefore appropriate to impose this choice 
on all mothers who do not supply their babies' needs entirely with their 
own breastmilk.  I do not share this assumption, for reasons that I've 
already spent some time explaining.  I think you and I just don't see 
eye-to-eye on this and may have to agree to differ.  All I ask is that 
you recognise that, when others reach different conclusions to you on 
this issue, it is not necessarily due to greed or ignorance but may well 
be due to the fact that different people, in weighing up pros and cons 
of different decisions, may quite legitimately arrive at different 
conclusions as to appropriate courses of action.


Best wishes,

Dr Sarah Vaughan
MBChB MRCGP

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