Joan:  Congrats on your Baby Friendly cert!  Wow...I only wish we were even
in the same ball park (fortunately I don't work at a hospital).

You raised some very excellent research points.  I need to clarify that I
never said that Relative Risk equals causality.  Clearly, it is an
association; however, we can make the association and plausible direction of
causality stronger by using stratification in our two by two tables and by
using multiple logistic regression for calculations.  These techniques allow
us to "control" for other plausible factors that might be contributing to
the attributable risk.  If anyone would like to have a methodology
discussion, I'm game.  I used to teach Health Services Research Methodology
and a separate class in Health Data Analysis.  We never randomized people
into smoking and nonsmoking groups (forcing them to do either against their
will) and then looked at the results to conclude that smoking causes lung
cancer (among other things).  At some point, it is the vast amount of
studies first showing <<merely>> uncontrolled associations, then controlled
analyses that tilted the scales in the direction of "smoking causes lung
cancer" instead of "smoking is associate with lung cancer."  We are
certainly not going to randomize babies into nursing and formula fed.  WHY
would this be unethical?  For one, we believe moms need choice, but also as
is stated in the ILCA SUMMARY OF THE HAZARDS OF INFANT FORMULA "For every
1000 babies born in the US each year, four die because they are not
breastfed."  (Rogan, 1989).

Until more of us are willing to perform, read, talk about & formally
critique lots of the orginal research and then openly state what the
consequences are of that research (such as formula increasing the risk of
xyz disease) we will continue to "dance around" this issue of "Breastfeeding
benefits...." instead of "formula causes..."  Remember...breastfeeding is
the BIOLOGIC NORM and formula is the deviation from it (yes, it's really
truly necessary in a small percentage of cases--so make that available
without advertising or better yet by prescription).  We would  not say that
an alternative "lifestyle" or view is to "choose" to not put your kid in an
infant carseat, would we?   Do we wander around saying that "water benefits
human beings in this way and in that way, but Not drinking Draino (lye)
prevents esophageal burns too."  That is a ridiculous statement because of
the extreme end of the spectrum that Draino is on, but sometimes we need to
become extreme to move the discussion in the direction of progress.

Why are we so afraid to have an open discussion about this?  If this is
supposed to be a "safe" environment especially when science is provided to
back up statements, then I should be able to say these things without fear
of flames, but even on Lactnet we all have been exposed to the pervasive
forces of formula marketing and the so-called normalcy of substitute milks
across the age spectrum (for infants, children and adults).  So we seem to
feel like we must apologize for promoting (yes, actively promoting) what
<<should be>> the standard to which all other infant nurtition is compared.
There, I've said it.  Shoot away, I've got my umbrella out!
--
--Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC    [log in to unmask]
INFANT CUISINE AND MOTHER CARE: Lactation Consulting, Perinatal Health
Education and Attachment Parenting Classes for parents and practitioners

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