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From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 22 Dec 2011 07:41:58 -0500
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Dear all:

The pharmaceutical and nutritional supplement industry would feel like they died and had gone to heaven if the criteria for lack of harm was "no case reports" and "we would have heard about it by now".  As an epidemiologist, I am aghast that this can be used as criteria for "lack of harm".   There are many things that "we would have heard about by now" that have been hidden for considerable amounts of time that are harmful.  

Cigarettes were a prime example.  It takes a very long time for cancer and heart disease to develop.  These are multifactoral conditions.  So you can always blame it on something else.  If you look at my father I could claim "see, my father has been smoking for 65 of his 85 years and he has not developed lung cancer or heart disease.  When I was young both my parents pointed to their good health at the time to claim that cigarettes were not harmful.  Yet, my mother had her first heart attack at age 52.  She died of a stroke at age 62, two weeks before my son's birth because she never could give up the cigarettes she started smoking at age 14 --- at a time when the lack of immediate harm of smoking went completley unnoticed.  The tobacco industry suppressed evidence for many years and it took much more sophisticated epidemiology than the "case control studies" that you can use for acute illnesses to prove that there were links between smoking and cancer.  You can't give one group a cigarette for a few weeks, a few months or a few years and give another group a placebo cigarette and learn anything about the disease pathology of cigarettes.  The timeline is too long.  The late Abraham Lillienfeld was one of the pioneers in this area of epidemiology.  It astounds me to this day that much of medicine is still stuck in the case-control studies that do not work as well for multicausal diseases that take a long time to emerge.

As for the impact on the brain -- it is a very very challenging arena.  The tests of cognition are not nearly as consistent as one would believe.  You have test and retest bias because humans of any age (and even animals) learn by taking the test.  So any sort of before after improvements could merely be due to taking the test a second time.  There are many many factors that can make it APPEAR that there was no impact when in fact there WAS AN IMPACT.  A small sample size, a badly constructed test of cognition, confounding factors can all muddy the waters so that a very real impact is not revealed.  This is why I truly believe that formula does reduce cognition.  The metaanalyses show that formula may not be significantly lower -- but it is never better and some of the studies show it is worse for cognition.  If we had better designed studies we would probably be able to tease out the impact.  

Now, it is one thing to reassure a mother who drinks an ocassional glass of wine.  It is another thing to say whole populations who drink commonly do not include a contingent of more heavy drinkers that may very well be having a negative impact on their infants by drinking too much.  Poor cognition might be blamed on the interactions between the alcoholic parent and the infant, the socioeconomic status of the parent (which might be lower due to alcoholism) and the infant. One can think of many many reasons why one might not notice that there may also be an impact of routinely drinking milk with a high alchohol content.

The problem with blanket statements that minimize the potential harm of drinking while caring for your baby is that it is precisely those who are most inclined to drink heavily who will latch onto such statements to excuse their heavy drinking.  Some studies suggest that women are more likely to hide their alcoholism more effectively than men.  Carefully disguising it as light social drinking.  

The problem is not about breastfeeding per se -- it is more about recognizing that we are dealing with populations in which some mothers will be alcoholics and heavy drinkers and this DOES impact the care of their infant and I really do believe that heavy duty alcohol infused milk cannot help but have an impact on cognitive development.  Designing a study to detect and then follow closet alcoholic mothers would be quite a trick.  Larger scale general studies asking mothers how much they drank are highly unlikely to pick up such an impact.

And while I am all for minimizing all the reasons why we don't want to scare mothers away from breastfeeding, I am not in favor of doing so with the same type of logic that is used by others to attack breastfeeding.  Many people use the same sort of logic to excuse the harmful impact of formula.  And how many times have drugs been recalled that were supposedly tested only to find that they have a harmful impact in a tiny proportion of the population that is so devastating that they need to be recalled?   Do you really want to find out later that false reassurance really did cause harm among women who were drinking more heavily than they told you? 

Sincerely,

Susan Burger

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