Breastfeeding Medicine

Physicians blogging about breastfeeding

Full disclosure

with 11 comments

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.

Written by astuebe

May 18, 2010 at 9:50 pm

11 Responses

Subscribe to comments with RSS.

  1. While I agree there is an unquestionable bias when there is industry-sponsored research, I think the criticism given to Medela is a bit harsh. Yes feeding the baby at the breast is best, no doubt. However, in the event of premature birth or mothers who have to go back to work, isn’t it the best alternative for those mothers to pump their milk? Premature, sick and impaired babies often have trouble feeding altogether, especially at the breast, so don’t we want to give them the mother’s expressed milk whether via feeding tube or bottle?

    Jennifer San Nicolas

    May 18, 2010 at 10:29 pm

    • while i agree with you that it’s in the interest of some mothers to have industry research for a better pump, one must still take into account that they’re in the business of making pumps, not having mothers breastfeed. hope this makes sense!

      ilse

      May 19, 2010 at 8:44 am

    • I don’t think the author is saying that breast pumps are not useful. We all know they can be life-savers when they are needed. What Best for Babes sees as a problem, though, is mothers who end up exclusively pumping who didn’t want to and didn’t have to, whose confidence in their ability to direct breastfeed was undermined, or who encountered so many boobytraps that breastfeeding got off to an unnecessarily bad start and pumping becomes the only option.

      Best for Babes

      May 19, 2010 at 9:06 am

    • Most mothers who pump their milk because of going back to work or because they have a premature baby also feed at the breast. It’s rarely an “either or” situation because it is fairly difficult to keep a full milk supply up with pumping alone. No pump like a baby!
      Also, studies have shown that bottle feeding is actually more difficult for babies than feeding at the breast. More difficult, meaning more stressful – the suck,swallow,breathe rhythm that a baby uses to breastfeed means the milk is gotten in small, manageable amounts. With a bottle, they often have to clamp down to stop the flow of milk so they can manage it – their heart rate increases and they show other signs of stress.
      I’m more interested in the new pumps made by Hygeia and Simplisse. Medela can’t even be bothered to be WHO Code compliant (even though it doesn’t take that much effort).

      Donna

      May 19, 2010 at 9:40 am

    • Yes, there are babies who genuinely need artificial assistance to get enough milk…but we can use so many other ways to measure their intake. Simply enough we could use a Medela scale to weigh a baby before & after he/she nurses. Why the big study about creating another way? Well, a machine you can sell to pediatricians makes more money. A pump for moms makes more money. Bottles & paraphernalia makes more money.

      Most babies who are not being breastfed are not missing out because they are sickly or premature. Most of them miss out on nursing because moms are being sold on all these other products…this is just another way to sneak those products into people’s homes.

      Dianna

      May 19, 2010 at 9:54 am

      • My comment is about the usefulness of a before/after pump. After much trial and error – measuring the weight of various items before adding milk and after adding milk (Bottles, balloons etc) we (the other nurses I work with in the NICU) have determined that the scale is not as accurate as it would need to be – and more often then not it causes a mother to stop breastfeeding b/c she believes her baby isn’t getting enough despite regular (over a 24/48 hour period)weight gain.

        Sarah

        May 19, 2010 at 5:53 pm

  2. Excellently put. We can’t totally discount industry research – their deep pockets allow for funding that government and universities may not be able to afford. But, we must evaluate study design critically and scrutinize conclusions, and beware of soundbite interpretations, particularly those which support the sale of a product.

    Shannon Tierney
    Breast surgeon
    Swedish Cancer Institute

    Shannon Tierney, MD, MS

    May 18, 2010 at 10:43 pm

  3. Whittlestone of Australia or New Zealand told us in the late 80s that the only suction in breastfeeding occurred in the swallow phase of the breastfeeding action, and that this suction pulled milk from the back of the breast.
    Yes, Medela does probably have a vested interest in selling more pumps. Their pumps are more effective than others that are available. And if I am working with a mother who needs help with milk supply, I will tteach her the mechanics of breastfeeding and a gentle latch and position, then look for help from Medela’s products if they are necessary as the best option available.

    Linda Cheston,IBCLC

    May 19, 2010 at 6:22 am

  4. I don’t know how expert New Scientist Bumpology contributor Linda Geddes is, but I get the sense that Linda Geddes is NOT the most reliable interpreter of Dr. Donna Geddes’ research on this topic.

    It’s inaccurate for writer Linda Geddes to say, “… suction, and not the infant’s tongue, is the key to milk transfer during feeding,” since there’d be no suction without the tongue action! Ditto to say, “… 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.”

    To say this is a misinterpretation of researcher Donna Geddes statement, “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.”

    Where’s the conflict in her statement? So what if significant breast milk removal does not involve compression of the nipple when creating the suction DOES involve that compression – that wave-like or “milking”-appearing action of the tongue? Having seen some of Dr. Geddes ultrasound evidence, I must say it’s more than a bit compelling. Is it important for the wave-like action of the infant’s tongue, which compresses the nipple against the palate, to actually result in milk transfer? Isn’t it enough that the wave-like compression “sets up” the drop of the tongue, which creates the suction that does result in transfer? Can’t have one without the other.

    And just because suction results in most of milk transfer, it doesn’t negate the importance of contact. Just as evidence may find suction key to drawing milk out of the breast, evidence also finds more milk is obtained via pumping when a mother has more skin-to-skin contact with her baby and when she uses “hands-on” techniques with pumping.

    I’ve not been wild about and am definitely not a fan of Medela’s marketing strategies in the last few years, but neither do I want to dismiss evidence that moves us forward in our understanding of how babies effectively transfer milk – or how mothers can obtain the most milk when pumping is needed. As for Medela’s future plans, I’ll wait until the company states its intentions rather than depend on the Bumpology contributor. Since infant sucking ability can change with time, a reliable test seems unlikely. In the meantime, check out:
    Geddes DT, Kent JC, Mitoulas LR & Hartmann PE (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Hum Dev, 84(7), 471-477.

    KKG

    Karen Gromada

    May 23, 2010 at 10:22 pm

  5. [...] why?  We challenged readers not to believe every study they see, and in an excellent piece called Full Disclosure on the Academy of Breastfeeding Medicine’s blog, Dr. Alison Stuebe takes it a step further, [...]


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 571 other followers

%d bloggers like this: