Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Concern over Breastfeeding
- Mark Hollinsworth (16 March 2001)
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Humans are primates -- designed to breastfeed for YEARS not months
- Katherine A Dettwyler (16 March 2001)
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Footnotes say it all
- Emily (19 March 2001)
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Unethical research
- Marie Tyndall (20 March 2001)
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BMJ to promote future research refuting findings
- Denise Headrick (21 March 2001)
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Re: Unethical research or reader bias
- Andrew Mimnagh (21 March 2001)
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Ethics and Credibility
- David (22 March 2001)
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Re: Footnotes say it all
- Timothy James (22 March 2001)
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Breastfeeding data must be collected prospectively
- Wendy H Oddy (24 March 2001)
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Let humans remain humans
- Farzana Ishrat (27 March 2001)
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Is all medical research done on such small sample sizes?
- Sarah Hung (2 April 2001)
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Mark Hollinsworth, Statistical Support Officer ISD (Scotland)
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Dear Editor, I read with interest the article by Leeson et al and am concerned that this study, and the publicity it receives, may discourage women from breastfeeding. This is a relatively small study (331 individuals) and may be biased by some population effect in the Cambridge area. Further, I suspect that the mother’s diet while she is breastfeeding plays a more important role in outcome than the length of time the infant was breastfed. Caution must be used with this study because of the small numbers involved and a larger, national study undertaken to investigate the issue further. I suggest that, if possible, information about maternal diet during breastfeeding be collected. Yours sincerely, Mark Hollinsworth |
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Katherine A Dettwyler, Associate Professor of Anthropology and Nutrition Texas A&M University
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Of course the duration of breastfeeding matters -- the longer the better. Humans are animals, mammals, and primates. Research on correlates of weaning age in non-human primates, such as adult body size, length of gestation, timing of permanent tooth eruption, timing of sexual maturity and growth rates during childhood, predict that modern humans should be breastfed for between 2.5 years and 7 years (Dettwyler, 1995 and 1999). Humans have slightly longer durations of all stages of the life span than our nearest relatives, chimpanzees. We have slightly longer gestation, later dental eruption, later sexual maturity, and therefore would expect slight later ages of weaning. Chimpanzees breastfeed for 4-5 years. Around the world, many children are breastfed for 2.5 to 7.0 years, including some in the US, Canada, and Great Britain. It may be the case that a healthy start in life of several-to-many years of breastfeeding should be followed by a life-long diet low in animal protein and fat and high in physical exercise, in order to maximize heart health in adulthood. But until researchers study the effects on blood vessel flexibility of NORMAL durations of breastfeeding (2.5-7.0 years), and of the combination of NORMAL durations of breastfeeding with different post-weaning diets and amounts of exercise, we won't know. I find it appalling that researchers would suggest that more than 4 months of breastfeeding could be harmful to children, when research shows that 2.5 to 7.0 years is clearly the normal and natural duration for our species. On a final note, it is always good advice to question the credibility of research and researchers funded by the infant formula companies. Dettwyler, K.A. 1995 A Time to Wean: The Hominid Blueprint for the Natural Age of Weaning In Modern Human Populations. In Breastfeeding: Biocultural Perspectives, edited by Patricia Stuart-Macadam and Katherine A. Dettwyler, pp. 39-73. New York: Aldine de Gruyter. Dettwyler, K.A. 1999 Evolutionary Medicine and Breastfeeding: Implications for Research and Pediatric Advice. The 1998- 99 David Skomp Distinguished Lecture in Anthropology, Department of Anthropology, Indiana University, Bloomington, IN, 47405. |
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Emily , Proud Mommy Breastfeeding on Demand
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Dear Editor: I read this article with increasing dismay, until I saw the footnote "IWB received a contribution from Mead Johnson, Nutricia, and SHS towards attending the Indian Society for Parenteral and Enteral Nutrition meeting." Why in the world would a formula company want to fund a study that supports their most direct competition? Answer: they wouldn't. Personally, I believe it is irresponsible to publish an article based on such a small study; especially considering how many people will not go through the trouble to verify the information, but will take it for its face value and stop breastfeeding. We breastfeeding moms have a hard enough time with "society" being so prudish about a baby at the breast in public--not to mention receiving opinions on how long is appropriate for ME to breastfeed MY child. Also, while this article provided a link to the study it was based on, it did NOT make clear that this study was based on only 331 mothers with children born at Cambridge Hospital. With the advent of Internet publishing, it is indeed possible for someone with less than a doctorate to read your journal, and make their judgements based on this article while not even reading the footnotes, much less the study on which it is based. (Hence my response--I am a stay-at-home breastfeeding mother in the Southeastern US.) Had I not known to follow through this depressingly negative article by reading the footnotes and other reference points, this information would have completely escaped me. While I am not suggesting that you "dumb down" your articles for the general population, I am suggesting that this information be made more clear. We (breastfeeding mothers) are always looking for positive information that supports breastfeeding and this article fails miserably. Sincerely, Emily Florida, US |
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Marie Tyndall, Anthropologist, Midwife, Lecturer University of Costa Rica
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This study provides no evidence to suggest that babies should not be breastfed for more than four months or less than several years. The fact that it is funded by formula companies implies that it is unethical and is not serious enough to deserve the publicity of finding itself amongst BMJ publications. Sorry to find it. Hope that other readers will be able to see through it. Katherine Dettwyler´s response explains very well not only why breastfeeding in humans should continue to be recommended, but also why it is necesary. |
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Denise Headrick, IBCLC, College Instructor, Michigan, USA
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Although this very unfortunate article will cause years of needless and annoying media sensationalism (predictably the sponsors' purpose), I would rather focus positively on proving it irreplicable as quickly as possible. And I haven't a flicker of doubt it will easily be done. My three teenage children, each breastfeed beyond her/his fourth birthday, will willing enroll in the future research. The ethical follow- up will be for the BMJ to publish up-coming enrollment information for those studies. Denise Headrick B. |
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Andrew Mimnagh, General Practitioner United Kingdom Crosby Merseyside U.K
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Whilst agreeing entirely within the editorial that Breastfeeding advice should not be changed I am concerned at the call to ban company sponsored research as unethical. I agree the finding is couterintuitive but so are many "proven Facts" that are found in the natural world. |
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David , IBCLC
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While I understand that research depends on funding as it does not generate income, I find it amazing that research funded by companies that produce baby formula, with working hypotheses that are against our biological norm (you're starting out trying to prove that breastfeeding causes disease?!)are validated by an editorial trying to convince us that the study is a genuine attempt to further our knowledge base. Until I read that the writer of the editorial also accepts funding from formula manufacturers. This research was based on a very small, self selected sample group in one town in England. The abitrary division of the group into 'ever breastfed' and 'never breastfed' is confusing, as is the time frame of the study, relying on remembered information and considering that babies were often given formula without parental consent or knowledge. The conclusion takes a quantum leap from a finding of stiffer arteries to "an urgent need to study further (read "gimme more funding")the possible influence of a longer peiod of breastfeeding on the evolution of arterial DISEASE" when did 'stiff' become diseased, especially when there was no other evidence of more cardiovascular disease in the 'ever breastfed' group. A serious study would go back to our basic biological norm and consider children breastfed exclusively for 6 - 12 months and weaned gradually to a healthy diet over the next 2-5 years. They would be chosen from a large sample group in every country of the world - but you couldn't get funding for that, could you? There is a lot of ADVERTISING money going into "research" |
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Timothy James, Senior lecturer University of Central England
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I am disturbed at the low level of logic in the responses to Booth's article. In particular, the final remark by Emily is revealing: "We (breastfeeding mothers) are always looking for positive information that supports breastfeeding and this article fails miserably." In other words, the answer has been predetermined and only evidence which supports that answer is acceptable. This is contrary to the entire scientific approach to truth-seeking, which demands that we go wherever the evidence takes us, whether it was where we wanted to go or not. Booth's article is carefully balanced in its conclusions, attempting explicitly to exclude the more obviously fallacious or self-serving conclusions which unscrupulous or negligent people might seek to draw. This is admirable; for Tyndall to accuse the research of being unethical because a formula-milk company paid for him to go to a conference is shocking. In fact, it is Booth's care in stating the conclusions which can validly be drawn from the research findings which leads to Dettwyler's valuable observation in her response, that the interaction with diet in later life requires investigation. Any evolutionary survival benefit from prolonged breast feeding of human infants presumably accrued in an environment of low-protein and low-fat diets in adult life, high infant mortality and relatively short total life expectancy (though not as short as in crowded agricultural communities). How to draw conclusions for our own environment is a complex multi-factorial matter, which can not be summed up in a simple slogan like "breast is best" - however unethical the behaviour of sellers of breast-milk substitutes. |
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Wendy H Oddy, NHMRC Public Health Research Fellow Curtin University of Technology & Institute for Child Health Research, Perth, Western Australia
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Dear Editor Leeson et al have reached the conclusions of their publication based on flawed methodology, even though a reference to this methodology is given (Kark JD et al, 1984). There are criteria for the measurement of breastfeeding in breastfeeding research. The prospective collection of breastfeeding data at the very minimum of one year following birth, must be recommended. Leeson et al have collected infant feeding data some 20 to 28 years following the feeding period. Although this data was collected from the mothers of participants, the retrospective nature of the breastfeeding data calls into question the findings of their study. Yours Sincerely Dr WH Oddy |
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Farzana Ishrat, Health & Nutrition worker Bangladesh
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The very fact that the study was sponsored by a formula producing company questions the reliability of the study. Nature has created mammals to be fed on their mother's milk in early life. Just because technology has advanced and opportunists have made profit-making their prime goal, we must not forget that from the beginning of the human race infants have been breastfed, without any adverse effcts. Otherwise the race would not have survived to date. When nature has provided the perfect food why are innocent people made to spend hard earned money for company manufactured inferior quality food? That the study was sponsored with an ulterior motive, there is no doubt in the intelligent man's mind. If we look at the present disease pattern and the causes of death, at no other times have there been more complicated illnesses and deaths due to dietary pattern. Had we not given in to technology, rather stuck to natural foods, then many of the present day illnesses could have been avoided. After years of hypnotism by the formula producers when the world is going back on the age-old method of infant feeding publication of such dubious study reports is appalling. We don't want to feed our babies animal milk so that they grow up with animal characteristics. Let us vow to make this world such a place that all future human babies will be exclusively fed only their mother's milk and then continue breastfeeding at least till the age of two, thus creating a loving bond between mother and child, between the child and the rest of the family, and allowing children to grow up to build a happier world to live in. |
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Sarah Hung, Accredited Mother Support Volunteer
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I am a mother support volunteer and have been asked many questions by mothers about this article. So I was very happy to find both it and the editorial available on this web site. I have no professional medical training but I do have one question, is all medical research done on such small sample sizes? The study included 331 people, of whom 149 received some breastmilk as a baby. It is not clear whether they were fully breastfed or just received partial breastfeeding. Of these 149 people the average length of time breastfed was 3.33 months (within the 4 months that the study said there was no difference between being breastfed or formula fed). The longest time to brestfeed was 18 months - not that long when compared to the 2.5 to 7 years Katherine Dettwyler talks about in her response. I would like to know just how many people where in each of the catagories, 4-5 months breastfed, 6-7 months breastfed, 8-9 months breastfed and >10 months breastfed. Is it usual in medial research to draw conclusions from such small sample sizes? When I worked professional, as a transport planner, I would never have recommended building roads on such a small sample and it worries me that doctors would even consider it. Yours faithfully, Sarah Hung
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