Full disclosure

When industry sponsors science, can you trust the results? It’s a timely question these days, as press releases about two recent industry-sponsored breastfeeding studies  are making the rounds online.

One study,  funded by the formula giant Mead-Johnson, measured activation of genes in the intestines of breastfed vs. formula-fed babies, and found tremendous differences. The other, funded by breastpump manufacturer Medela, asserts that suction, and not the infant’s tongue, is the key to milk transfer during feeding.

So what’s in it for the corporate sponsors?
At first glance, the Mead-Johnson study looks like a boon for breastfeeding. Says study author Sharon Donovan, a University of Illinois professor of nutrition:

For the first time, we can see that breast milk induces genetic pathways that are quite different from those in formula-fed infants. Although formula makers have tried to develop a product that’s as much like breast milk as possible, hundreds of genes were expressed differently in the breast-fed and formula-fed groups

But the press release goes on to predict that Donovan’s approach will be the key to a new, better breastmilk substitute:

Understanding those differences should help formula makers develop a product that is more like the real thing, she said.

Best for Babes blogged about the study last week —  as I told Bettina Forbes, it’s not clear that this strategy  makes scientific sense. Even if a formula company can show that their “new, improved” formula is 50% similar to breastmilk, we won’t know if that 50% is what matters — or, for that matter, if turning on some, but not all, of the normal genes expressed in early development is even worse than turning on none of them.

Think of the baby’s gut as a complex machine, such as an automobile. A breastfed baby turns on all the systems in the car so that it can operate safely. Suppose that a “new, more like breast milk” formula can turn on some of those systems — such as the accelerator — but not the brakes or the airbag. The “new” formula turns on more genes, but it’s not giving you a safer car, or a healthier baby.

Complicating matters is the fact that the study itself is not yet published, so there’s no way for reporters or other researchers to put the press release in context. For marketing purposes, however, that may be deliberate. Without any science to vet, the press release becomes a conversation about how a formula company is trying to create a product that’s “more like breast milk.”

Medela’s study similarly isn’t published yet — the results were presented at the company’s own “5th International Breastfeeding and Lactation Symposium.” But the report in the New Scientist describes new evidence that it’s suction, not the infant’s tongue, that transfers milk from breast to baby. Here’s researcher Donna Geddes:

What we see is that when the tongue is lowered and the vacuum is applied, that’s when the milk is coming out of the breast, and that doesn’t involve any compression of the nipple… It’s not a milking action at all.

Why is Medela so interested in breastfeeding mechanics? Read on:

The next step is to devise a simple and universal test that could be used to assess babies’ ability to suck. This could reassure mothers whose infants are struggling to feed that it’s not their fault. “Currently there are no measurements to assure the mother or the clinician that things [in the breast] are working,” says Geddes.

It appears that one of the world’s leading producers of breast pumps is working on a “universal test” to determine which babies can’t suck — presumably so that mothers can skip over any efforts to breastfeed and go ahead and buy a Medela pump.

The statement, “currently there are no measurements to assure the mother or the clinician that things are working” feels to me like a smack in the face of any mothers’s confidence in the ability of her body and her baby to breastfeed successfully. In fact, clinicians and mothers can listen to an infant’s swallow, watch for the blissed-out “drunk face” that follows a full feed, and keep a count of wet and dirty diapers. If — and only if — those signs are faltering — a skilled pediatrician or lactation consultant can place a gloved finger in an infant’s mouth and assess for a dysfunctional or weak suck. What we don’t need is a  Medela-manufactured device to “diagnose” babies with suck dysfunction in order to sell more breast pumps.

Now, let me be clear. It is entirely possible that earlier assumptions about the mechanics of lactation are incorrect. I look forward to Geddes’ published, peer-reviewed study so that we can evaluate the merits of the science. But in the meantime, the media coverage sounds suspiciously like a pitch to sell more Medela merchandise — and in the process, shake the confidence of nursing mothers.

So, when industry sponsors science, can you trust the results? In these two cases, there isn’t any actual peer-reviewed science to evaluate, because the papers aren’t out yet. We’ll see what the science shows. And what about press releases on industry-sponsored science? You can be sure they’ll promote the sponsoring industry’s interests — booby traps and all.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.