Breast Dogma

By Jim McVeagh 17/01/2011

There’s a bit of a rumpus going on at the moment in the world of Midwifery. It seems that some brave doctors, paediatrician Dr Mary Fewtrell, of University College London and her colleagues, have published a paper challenging the WHO dogma of six months of breast feeding. The Midwives are all frothing at the mouth already:

Britain’s College of Midwives challenged the suggestion the country should reconsider its official advice on breastfeeding.

“I believe this is a retrograde step and plays into the hands of the baby food industry,” said the college’s professional policy adviser, Janet Fyle.

She said that if earlier introduction of solids was encouraged, many parents would offer sugar-based foods to their babies, potentially nurturing a sweet tooth.

Help, help! It’s the evil baby food industry behind this! Except that none of the authors of the paper nor any of the numerous studies they cite have any connection to the baby food industry. It would have been nice to have some sort of counter-argument citing dissenting studies, but I guess that is too much to expect from the dogma-ridden UK college of midwives (and I doubt ours will be any different)

At least the Ministry will take the time to study the evidence. Essentially, the authors have pointed out that the WHO dogma of 6 months of exclusive breast feeding is based on epidemiological evidence mostly from third-world countries. There is no doubt that, in third world situations, this is a good policy. Unfortunately, its extrapolation to first world situations is essentially pure supposition. Fewtrell, and her colleagues, point out that there is evidence that children not placed on solids between the ages of 4 and 6 months may develop iron deficiency anaemia, food sensitivities and coeliac disease. The evidence for these things is also quite weak, as the authors observe, but there is sufficient evidence to question the dogma of WHO and of the college of Midwives. At the very least we should be looking urgently at whether there are disadvantages to late weaning in first-world communities.

Interestingly, the paper mentions the possibility that late introduction of solids predisposes children to dislike bitter things like green leafy vegetables when they are older. This is interesting because the Midwives response above says almost the opposite; that babies may develop a sweet tooth. I note that the paper merely suggests this as an area of further research, whilst the Midwives state their theory (for which there is no evidence) as a gospel truth. Therein is the problem in a nutshell.

It is about time that the dogma surrounding breast feeding is dispelled. There is no doubt that breastfeeding is the best way to start feeding a baby, but mothers should not be made to feel like they are inadequate when they choose to use formula milks. There is no reason at all that babies should come to any harm if they are weaned off the breast starting at four months instead of six. There is also no reason why mothers should not use mashed vegetables and similar foods, rather than expensive baby preparations. On the other hand, those preparations are extremely handy when going out to visit friends and there is no reason why mums should be made to feel guilty if they want to use them.

Where there is no hard evidence there should be latitude. Where there is doubt, there should be grace and humility. Medicine should always be based on evidence and reason rather than supposition and dogma.


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0 Responses to “Breast Dogma”

  • Hi Jim

    I haven’t read the paper so am not in a position to comment on the authors conclusions, but I did notice the following statement in the footnotes:

    “MF, AL, and DCW have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past 3 years”

    So to say the authors of the paper have no connection to the baby food industry is a little misleading.


  • Hi Siouxsie

    Not really. “Consultancy work” usually means giving a specialist opinion on something. It does not imply endorsement or involvement in company doings. An unfavourable opinion or study will not lose you consultancies, because the company is genuinely looking for an unbiased opinion, not an endorsement. What they need is specialised information and they can’t get it from anywhere else.

    Mary Fewtrell and her colleagues are paediatricians specialised in infant nutrition. It is not surprising therefore that they commonly get funding for their studies from the infant food industry. Almost all major clinical research is funded by an interested industry. There is little funded by government’s directly and that is mostly social studies rather than medicine per se. In other words, if one disallows industry funding on the grounds that the results are somehow “tainted” (a dubious unproven notion) virtually all clinical research would come to a standstill.

    The BMJ insists that all associations are declared and clearly they find these insignificant. They are common associations and make no difference to the paper.

    Significant associations would be product endorsements, employee or contractor status or a near family member involved with these. This is what I mean by “no connection” – the same as everyone else in clinical research would mean.

    All of this is quite irrelevant, of course. Instead of trying to see connections between authors of the paper and the baby food industry, the various commentators would be better off commenting on the academic merits of the paper and its conclusions. So far, all I have heard are ad hominem attacks and diatribes on the wonders of breastfeeding. This despite the fact that the paper is not about breastfeeding, which is acknowledged as the best way to go, but about the timing of weaning.

  • The evidence for these things is also quite weak, as the authors observe, but there is sufficient evidence to question the dogma of WHO and of the college of Midwives. At the very least we should be looking urgently at whether there are disadvantages to late weaning in first-world communities.

    Taking nothing away from your overall thesis (I haven’t read the paper either) but if the downside isn’t overly serious and there is only weak evidence for concern, where’s your urgency coming from?

    Regards your comment on the conflict of interest (COI) statement:

    Almost all major clinical research is funded by an interested industry.

    Hmm. Do you have numbers to back that? For larger-scale clinical trials of drugs I can imagine this might be true (the costs are pretty high, so a vested interest might invest into it, etc.), but I wonder how true it is of projects with more modest costs.

    Also, is the work in question really clinical research:- wouldn’t it be public health?

    Personally I would have liked the COI to be more explicit: given that they acknowledge a COI, to explain better just what it is. It’d reduce the uncertainly. As it stands I agree with Siouxsie that it deserves a degree of caution. Not rejecting what they have to say, just adding a degree of caution. To my initial reading this is in essence this is what BMJ is doing in printing the COI, noting a caution. Just as you argue that the COI doesn’t mean the work is definitely tainted, you also can’t argue that there definitely is no issue either—it plays both ways. As you know, it’s one reason why COIs are such a nuisance: they leave an open question.

  • Grant:

    I did not say the downside wasn’t serious, only that there is insufficient evidence to be definitive. Therefore it would be a matter of some urgency to find out if the suggested concerns are verifiable. Iron deficiency anaemia in babies, for instance, can cause serious permanent intellectual handicaps. This is not a trivial problem.

    I don’t have figures with me but I recall being told at a conference presentation on study design and creation that less than 10% of research in the western world is State funded. The rest is from industries and private foundations.

    I haven’t read Fewtrell’s other papers so I can’t comment on the “public health” aspect.

    Agree about the CoI being more explicit – it would save a lot of ad hominem innuendo and perhaps lead folk to debate the paper rather than the people.