In one of the weekly literature updates that I subscribe to, I saw an abstract that caught my eye. The authors argue that there's inadequate evidence for the WHO recommendation for six months of exclusive breastfeeding. They say there might be a sensitive window in which babies need exposure to complementary foods, and that exclusive breastfeeding for six months could increase a baby's risk of developing allergies later. They also contend that babies exclusively breastfed for six months may be more vulnerable to micronutrient deficiencies.
At this point I detected the unmistakable aroma of a rat in the room. A rat with deep pockets, though whether it was a rat named Nestle or Mead Johnson or Wyeth or Abbott was not clear to me. I pulled up the full text and looked for a declaration of competing interests. There was none.
Five minutes of googling, however, confirmed my suspicions. The first author, Susan L. Prescott, has taken money from Mead Johnson and sits on Nestle's Scientific Advisory Board. (That's a .pdf link, if you've got a slow connection. Google will give it to you in HTML if you prefer.) At the same link, we learn that Ralf Heine has taken money from Nestle and Nutricia. Maria Makrides and Robert Gibson seem to have a Wyeth gig going, though they've also lent Nestle a hand (scroll down to the bottom of that page).
Why aren't these affiliations mentioned in their most recent article?
Some breastfeeding advocates assume that industry-funded research must be untrustworthy. I think that's an extreme position -- Alan Lucas, for instance, has done some work I'm happy to talk about even though I am mindful of his cozy relationship with the infant formula industry. But if you want me to take you seriously, you have to tell me that you're taking money from an entity with an enormous financial stake in the issue at hand. Industry flung back its collective head and howled when the WHO recommended six months of exclusive breastfeeding in 2001, and it sounds like they're still sulking.
Did you know that if you wait until six months to introduce complementary foods, most babies can handle fork-mashed table food without difficulty? What would the shareholders say about widespread recognition that commercially prepared baby food is mostly unnecessary?
If you're interested in truth and scientific accuracy, it seems to me that when you cite an article endorsing six months of exclusive breastfeeding, you should mention its conclusion even if you disagree with it. If you omit the conclusion, saying only that some breastfed babies have lower hemoglobin and failing to address the clinical significance of the difference, I have to wonder about your agenda. And I wonder, too: why wouldn't you touch on the conflicting reports in the literature about iron status after long-term exclusive breastfeeding? I am also going to be deeply skeptical about your article if you don't mention the tendency for allergic babies to reject solids. This creates a chicken-and-egg question: are they slow to accept solid food because of a predisposition to food allergies, or does the late introduction of solids cause food allergies? You are welcome, of course, to favor the latter hypothesis; in my view it is irresponsible to suggest only one possible causal mechanism when a plausible alternative exists.
Anyone who says unequivocally that breastfeeding will protect a baby against atopy isn't telling you the full story. Right now there are conflicting findings in the literature and we don't fully understand what's going on. But anyone who says that exclusive breastfeeding might be responsible for the marked rise in food allergies --well, you'll have to excuse me while I hold my nose.
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