Sunday, April 03, 2011

McDougall, SIDS, and Breast-Feeding

To follow up on Macon's comment on my post concerning McDougall's views on breastfeeding, I searched the newsletter archives at McDougall's website. That search lights up quite a few discussions, but this one, from the May 2004 newsletter, gives a reference:

Bottle-feeding Kills Babies

Breastfeeding and the risk of postneonatal death in the United States by Aimin Chen in the May 2004 issue of the journal Pediatrics found children who were breast-fed had a 21% reduced risk of death in the first year after birth compared to bottle-fed children. Longer breast-feeding was associated with lower risk of death. Even the risk of crib death (SIDS) was reduced by 16% with breast-feeding.

In underdeveloped countries where sanitation is lacking, bottle-feeding a child is equated to a “death sentence.” In modern societies with more cleanliness and modern medical facilities the adverse consequences of bottle-feeding are less dramatic, but still too real. The US is ranked 16th in infant deaths in the first few months following birth and the prevalence of breast-feeding is 22% at 6 months. Finland is ranked first, worldwide, with the fewest deaths for infants, with 60% of babies breast-fed at six months, and Sweden is second with 50% of babies breast-fed at this time.

Remember from previous newsletters, my first act when I become Surgeon General will be to make formula available by prescription only. See my January 2004 newsletter Favorite Five article, “Formula (Bottle) Feeding Causes Infant Brain Damage.”

Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics. 2004 May;113(5):e435-9.

(As you can see, I have taken McDougall's reference and linked it to the publicly available article itself.)

McDougall is "take-no-prisoners" when it comes to breast-feeding.


Macon said...

Good stuff! I read it, and will still push back very hard on the "causes" SIDS. The relevant piece of the research is here (my emphasis):

"Is it plausible that breastfeeding protects not only against infectious disease mortality, through familiar immune enhancing mechanisms, but also against SIDS, accidental death, and others? Although a satisfactory mechanism has not yet been proposed, the protection from SIDS has been seen in several studies and is under investigation. For accidental death, Carpenter also observed lower risk, and although the association may represent something as simple as physical proximity, it deserves additional study, having been seen both in his data and in ours.

To some extent, the policy implications of demonstrating benefits of breastfeeding depend on whether the benefits will be achieved by persuading a mother to breastfeed when she otherwise might not have. Strictly, though, causality is difficult to demonstrate for any specific part of the interaction between the breastfeeding mother and her child. It may be that breastfeeding represents a package of skills, abilities, and emotional attachments that mark families whose infants survive and that it is these factors that produce the benefits seen, rather than breastfeeding or breast milk per se. We cannot randomize breastfeeding, although it is possible to randomize breast milk: Lucas et al23 conducted an ingenious study in which premature infants who were fed their mother's milk from a bottle did better on follow-up testing than children who were fed formula.

Reverse causality, produced by the motivation or enthusiasm that marks a healthier child who can breastfeed or by specific characteristics of the child's illness, such as cleft palate and breathlessness during sucking, that prevent breastfeeding might produce an artificial benefit of breastfeeding. Eliminating deaths in the first month and deaths from congenital anomaly or malignant tumor, where infants who are unable to breastfeed are concentrated, and using the initial feeding method to categorize feeding should diminish but perhaps not eliminate this problem. However, excluding these deaths also excludes the chance to examine whether breastfeeding has any effects on these deaths, especially those who are not fatally ill at birth. In a prospective study, it might be possible to include neonatal deaths if careful attention were paid to the reason that a child was breastfed or not. We do not have such data; however, we can eliminate from the analysis any child, case or control, who was admitted to the neonatal intensive care unit. This yields a similar but less precisely estimated OR of 0.83 (95% CI: 0.67–1.03)."

In other words, we are a LONG way from "causes SIDS".

I would have been totally fine if McDougal had said something softer than "causes." This is why I like Dr. Campbell's China Study. He presents a ton of evidence, but does not push on the "causes," except where he can produce both stats and a possible mechanism.

We can say together, though, that breastfeeding is the best thing for babies, unequivocally. And every effort ought to be made to do so, trumping just about everything.

Paul said...

I think you are absolutely right here, Macon. We have correlation but that does not mean causality. I think there is a lot of this sort of thing in "medical research" - and sometimes simply showing correlatoin is the best science can do at the time. For example, did we always know the mechanism by which cigarette smoke "caused" cancer? (Assuming that we know something definitive now.) So, then,there is always the need for good judgment. As to McDougall, he is someone who wants to push people to a healthy decision, and his rhetoric may get overheated. But I must say he has been consistent on the advantages of breastfeeding. Thanks for engaging on this.