Tuesday, May 26, 2015

"IN THE BEGINNING THERE WAS BREAST MILK..."


"You cannot insert a gene you took from a bacteria into a seed and call it life.  You haven't created life, instead you have polluted it."--Vandana Shiva


"In the beginning there was breast milk," says the sweet voice of the narrator as she describes the history of breastfeeding.  As I watched the 4-minute video  by the WK Kellogg Foundation, I was rather taken aback by their version of the history of breastfeeding, particularly since the first sentence is, "in the beginning there was breast milk."  I am fascinated by that statement and that point of view.  I always imagined that in the beginning there was breastfeeding not breast milk.  But maybe I am caught up in the game of who came first the chicken or the egg?  As I watch the historic timeline presented by this video, I was struck by what this video considered important.  The only infant formula mentioned was Nestle and their Lactogen.  Why didn't they mention Mead Johnson or Abbot, more common infant formulas in the USA?  Why did they mention the Innocenti Declaration but no mention of the WHO Code in their timeline. Show Nestle formula but not talk about Nestle as a violator of the WHO Code? History or hiding history? Why did the soothing voice of the narrator state, "Enough this isn't natural (regarding formula feeding), yet the visual focus is of the breastfeeding mother with the statement, "Enough this isn't natural?"  Subliminal messages?  Do we remember more of what we see than what we hear?  Why did this timeline state that infant formula improved over the years and visually we see the #1 improved quality?  Why did they state that nurseries in hospitals, the separation of mothers and babies, was because of the need to protect babies from bacteria/germs; without bringing up that infant formula companies often funded and designed hospital nurseries to increase mother-baby separation? One of the last signs to read on this history timeline is a home made poster that says, "Mother's Milk Fresh, Local, Sustainable."  Kinda makes one wonder what is this video promoting?  Breastfeeding? Or Breast Milk?

The video by WF Kellogg Foundation is entitled, "Growing a first food movement," appears to me to be rather slanted.  It shouldn't be, should it?  Afterall, thanks was provided to the Academy of Breastfeeding Medicine, Best for Babes, Black Mother's Breastfeeding Association, US Breastfeeding Committee, among other organizations that should know alot about breastfeeding history.  Both the Academy of Breastfeeding Medicine and the US Breastfeeding Committe have been either supported or funded by the WK Kellogg Foundation.

"The foundation receives its income primarily from the WK Kellogg Foundation Trust, which was set up by WK Kellogg.  In addition to its diversified portfolio, the trust continues to own substantive equity in the Kellogg company."  
http://www.wkkf.org/who-we-are/overview

Celeste A. Clark who was previously employed by Kellogg as a nutritonist and later became involved in Kellogg's worldwide communications, nutrition and regulatory programs, active in the Institute of Medicine Food Forum as well as WHO Industry Group. She is on the BOD of Mead Johnson as well as the food company, Diamond.  Another Board member of Mead Johnson, Anna C. Catalano is on the Global Advisory Board for the Kellogg Innovation Network.
http://www.meadjohnson.com/company/board-of-directors

A few years ago in a previous post to this blog, I have written about Kellogg's being considered a stakeholder in the infant formula industry.
http://vwmcclain.blogspot.com/2012/06/troubled-shores-of-breastfeeding.html

So should we be particularly surprised that this video has a slant to it?  Should we be surprised that there is no mention of the WHO Code?  Should we be surprised about some of the visual points on the timeline don't match with the narrative? The surprise is that breastfeeding organizations are financially involved with this company's foundation.  
Copyright 2015 Valerie W. McClain

the video
https://www.youtube.com/watch?v=Zhx-R6p1xAQ 

Kellogg and the National WIC Association, business partners
https://www.nwica.org/business-partners/kelloggs

National WIC Association, voting member of US Breastfeeding Committee
http://www.usbreastfeeding.org/p/cm/ld/fid=17

Companies fighting GMO labeling and monies spent on stopping labeling
http://www.inspirationgreen.com/vote-yes-on-37.html



Tuesday, May 12, 2015

BREASTFEEDING: PROTECTING OUR GENETIC & BIOLOGICAL DIVERSITY


"Cultivating and conserving diversity is no luxury in our times:  it is a survival imperative."--Vandana Shiva

Breastfeeding is the sacred and timeless dance of love between a mother and her baby.  It is at its basic level;  a gift of food and water, warmth and safety.  Mothers and babies have been dancing to this melody of love and communion for centuries.   It is a dance that is truly unique and specific between a mother and her baby.  A mother must surrender her own needs for the survival of her infant.   In societies, like the USA, where this mother-baby dance is of little or no value, it is very difficult for a woman to sustain this kind of relationship.  

The commercialization of human milk and growth of milk banking (both for-profit and non-profit) is the marketing of the antithesis of the sacred dance of breastfeeding.  It is the isolation of mothering into being a producer of a product for consumption.  It is about the separation of a mother and her baby and the presumption by society that the product, the milk, is equivalent to breastfeeding.  Preserving the milk takes priority over preserving the breastfeeding. 

But is breast-milk-feeding equivalent to breastfeeding? The loss of breastfeeding goes unrecognized.  Mothers recognize the loss.  But in a society that places value on things and products not relationships, the preservation of breastfeeding is not often considered of prime importance.  Instead our society believes that the milk is the priority. But mothers feel the loss.  How much of the postpartum depression epidemic is related to mothers feeling this loss?  How much is about a society that believes that mothers should "man-up" and go back to being a "productive" member of society?  How much of our rising preterm births and c-section rate in the USA are the result of pregnant women having to work up until they give birth?  Our society creates an enormous economic stress on women.  Instead of protecting future generations, our society seems hell-bent on destroying it.

Breastfeeding preserves diversity in a society.  The milk that is produced by one mother is never identical to another mother's milk.  The milk carries the genetic blueprint, the mother's DNA, as well as protective antibodies against all the pathogens and toxins in the mother's environment.  The milk varies from hour to hour but from day to day, month to month.  Preterm milk is very different from term milk and seems specifically geared to the premature infant.  This individualization is the basis of human survival on this earth.  We jettison this individualization at great risk to the survival of the human species.

Yet we now have an industry willing to create human milk-based infant formulas derived from heat-treated and pooled donor milks.  The pooling and pasteurization of donor milks is similar in principle to the vast development of monocultures in agriculture.   Instead of preserving breastfeeding, valued because of its diversity;  our corporations and institutions are creating the need for greater and greater use of a manufactured breast milk. By destroying its uniqueness, the product, breast milk no longer has many of the genetic and biological properties that make it a life-protecting substance.  

What fascinates me is that the companies that will profit from creating human milk-based formulas, believe that they have a scientific understanding of human milk.  The patents describe the uniqueness of human milk and then go on to describe their various heat treatments to make their pooled donor milks"sterile" (safe for many consumers), freezing and refreezing the product, as well as extraction methods to filter out various components of the milk and then putting it all back together again only in different combinations. Depending on the product the addition of fortification is also part of this picture. Will this product create the same health benefits that are derived from a baby breastfeeding?  Will all this handling create better health for infants?  Isn't there a much more cost effective and simpler way to feed and protect our infants?  How about preserving and protecting breastfeeding?

One of the most interesting aspects of the creation of a large network of milk banking systems is the relationship between milk banking and human milk researchers who are often funded by the infant formula industry.  Over the years that I have looked at patents on human milk components, I have noted how often human milk researchers seem associated with various milk banks.  And surprisingly enough it isn't just Prolacta or Medolac, the for-profit "milk banks."  But in many cases human milk researchers seem very involved in the non-profit milk banks-HMBANA (Human Milk Banking Association of North America).  For instance human milk researcher, David Newburg, is new board member/director of HMBANA.  
https://www.hmbana.org/sites/default/files/images/mar2015.pdf 

He owns a variety of patents on human milk components (to be genetically engineered)and is the co-founder of a company called Glycosyn.
http://www.glycosyninc.com/home,1.html 

Products that his company are working on are oligosaccharides to be used as supplements in infant formulas. Probiotics/prebiotics for use in infant formulas. Anti-obesity agents (human milk adiponectin--patent) for use in formulas.  And a diagnostic derived from a human milk component that identifies the risk of necrotizing enterocolitis in preterm infants.

He has over the years received funding from Mead Johnson and Wyeth (which became Pfizer and is now Nestle).  Helped edit an article of prebiotics in infant formula for Mead Johnson
https://www.meadjohnson.com/pediatrics/us-en/sites/hcp-usa/files/LB2329-Prebiotics.pdf

It is highly understandable why human milk researchers want to be involved with milk banks.  But why do milk banks want to have human milk researchers involved with their organization?  Particularly when most human milk researchers receive funding from the infant formula industry.    It is also must peculiar in that HMBANA wants the FDA to regulate internet milk sharing/selling.  But it sees no problem in giving access to and/or influence to their organizations to human milk researchers who have ties to the infant formula industry?

Are non- profit milk banks like HMBANA protecting breastfeeding from commercialization, protecting the genetic and biological diversity of breastfeeding?  Or are they part of the problem?  Where are we going as a society, when the answer to feeding infants is more about a culture of breast-milk feeding rather than breastfeeding?  Where are we going when milk banks believe the same mantra as the infant formula industry that there is the need for more and more supplies of milk because "some" women can't or won't breastfed?  Is that the truth or just a self-fulfilling prophecy?
Copyright 2015 Valerie W. McClain










Wednesday, May 6, 2015

The Business of Human Milk-Based Products and the Destruction of Breastfeeding


"Hunger and malnutrition are man-made.  They are hardwired in the design of the industrial, chemical model of agriculture." --Vandana Shiva
http://climateandcapitalism.com/2012/08/28/vandana-shiva-industrial-agriculture-causes-hunger/

Yesterday morning was just like any other morning.  I cruise the web, looking for news. Scanning the headlines I feel a sense of deja vu, a memory of being a pre-teen in the 60's sneaking a peak at a supermarket tabloid story in which a woman gives birth to an alien or finds out her husband is the Alien.  Well, I found some news yesterday that wasn't tabloid news.  But it sure had an alien feel.  It was Medolac Labs launching of "the first ever direct-to-consumer offering of human donor milk."  According to the article the product is, "commercially sterile, shelf-stable human donor milk, and easy-to-use as formula."
http://finance.yahoo.com/news/medolac-laboratories-launches-donormilk-com-135700374.html

So now it will be possible for, "more babies to receive 100% human milk protein instead of bovine or soy protein formula."  Should we be calling this "human donor milk" or might the correct term be "human milk-based infant formula?"  Prolacta uses the term for its human milk-based infant formula and its products are registered at the FDA as Exempt Infant Formulas.
http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/InfantFormula/ucm106456.htm 

While Medolac Labs are using human milk, can we call it "donor milk?"  Like Prolacta, they pay for it, at a $1/ounce.  So it isn't donated.  And it has to be a highly processed product in order to be shelf-stable for 3 years!  The press statement says that "it is as easy to use as formula."  Huh?  I have never believed that infant formula is easy to use.  Since this is a ready-to-feed product, the presumption is that it is quite simple.  Well, let's see, even with ready-to-feed formulas, bottles and nipples have to be cleaned/sterilized.  After opening, one has to know how long it can be kept in a refrigerator or whether it should be tossed after sitting out at room temperature.  There is time that must be devoted to this kind of feeding as well as knowledge of how to use the product safely.  There is often a time delay in bottlefeeding, babies may be hungry but mom has to prepare the bottle or at least go get the bottle. Breastfeeding, on the other hand, is quite simple in comparison (once a mother gets over the early weeks, when difficulties are the most prevalent).  There are no need for bottles or pacifiers.  A breastfed baby gets an immediate response for its hunger cues.  There is no need for storage space for a product because a breastfeeding mother makes milk depending on infant demand (the more the baby nurses, the more milk is made).  There is no need for money for a product (making a mother independent of market forces).  And breastfeeding, gives the mother a number of physical gifts:  less breast and ovarian cancers, child spacing, no period for months, sometimes stretching into several years.  Infants receive the benefit of suckling at the breast:  appropriate jaw development and with that better dental health, less airway restrictions lowering the possible SIDs risk and actual physical contact with the mother (a biological norm--why we are called mammals).

Will our society buy into human milk-based products rather than the human commitment of breastfeeding?  We live in a technological money-driven world in which human commitment is into acquiring things.  Our importance in this world is dependent upon the house we live in, the car we drive, the jobs we have, our degrees/titles we accumulate and the clothes we wear.   Watching any TV ads or internet ads, creates the illusion that life without these things, these products isn't worth living.  We are judged and found wanting, if we don't have the latest cell phone or newest techno-gadget available.

How do we collect all these worldly goods?  We either have top-of-the-line jobs or we get ourselves into debt.  Look at the university student who graduates into the workforce with thousands of dollars of debt for their education.  Will their new job (if they get one) help them quickly pay off that debt?  Or will they find themselves in ever increasing debt and servitude with the need for a place to live and a car to drive?  Women get paid less than men for the same kinds of jobs.  Yet women who have college/university debt have the same amount of debt as men who have educational debt.  So paying off debt is far more difficult for women.  How many women nowadays can afford to stay home with their babies?  Between educational debt and medical debt (having a baby in the US can be a huge medical debt despite insurance), women are caught in a lose-lose situation.

There is the belief that the next best thing to breastfeeding is breast-milk feeding.  It is understood that when a mom pumps and gives that to her infant that it is better than infant formula.  But are human milk-based products equivalent to fresh, expressed milk?  Or as they claim, equivalent to pasteurized donor milks? Do we have the research that these products that have become sterile due to industrial processing are equivalent to the donor milk that is just simply pasteurized?  Obviously the product cannot be the same as the milk that is created in a woman's breast.  Yet we are to believe that a sterile, 3-year shelf stable human milk is a necessity?  Isn't breastfeeding the necessity?

Will this human milk industry be satisfied with just a few customers?  Or will this industry have a need for more and more customers?  Will this industry find more and more ways to curtail private milk sharing?  Will this industry eventual sabotage breastfeeding, in its need for profits?  And will the current economic and political climate that has made women second class citizens, create the need for these products? 

Women feel that their self-worth is tied to being employed, to making money.   Self-worth is not tied to mothering our babies.  Our society has created a world in which most of us are indentured to our employers because of our accumulated debts.  I am not sure how human milk-based products will play out in the years to come but I am pretty darn sure that breastfeeding will become lost in the sea of need for profits.

"The disclosure provides sterile human milk protein compositions.  In one embodiment the sterile human milk protein composition is prepared by a method comprising sterile filtering skim human milk through at least two successively smaller submicron filters to obtain a human milk protein composition, lyophilizing* the human milk composition, and applying a viral inactivation step and/or sterilizing process to the lyophilized human milk composition."
--WIPO** patent application WO/2012/030764, owned by Neolac, Inc. USA, inventor:  Elena Medo, entitled:  HUMAN MILK PREPARATION

*lyophilized-"freeze drying, the creation of a stable preparation of a biological substance by rapid freezing and dehydration of the frozen product under high vacuum."  from Medical Dictionary

**WIPO (World Intellectual Property Organization)-agency of the United Nations.

Will these patented products safeguard breastfeeding or become a waste of resources in which breastfeeding is sabotaged?  
Copyright 2015 Valerie W. McClain







Saturday, April 18, 2015

Typhoon Haiyan/Yolanda part-2: Rescuing Breastfeeding


Breastfeeding Expert Support Team with mobile Breastfeeding Tent-Philippines  from the "Final Report on Breastfeeding Action-Lifeskills 8Jan2014"

"Even in the best, most hygienic conditions, artificially-fed babies are five times more likely to suffer diarrhoeal diseases.  In an emergency situation, even where bottle feeding is not normally associated with increased mortality in a non-emergency setting, infant feeding methods can become an issue of life or death.  Unsanitary, crowded conditions, a lack of safe water and a lack of facilities to sterilize feeding bottles and prepare formula safely and correctly means that artificially fed infants are more than 20 times more likely to die from diarrhoea and other infectious diseases than infants who are exclusively breastfed."  
"Infant feeding in emergencies:  experiences from Lebanon," by Ali Maclaine
Humanitarian Exchange Magazine Issue 37 March 2007
http://www.odihpn.org/humanitarian-exchange-magazine/issue-37/infant-feeding-in-emergencies-experiences-from-lebanon

My previous post on Typhoon Haiyan/Yolanda was in my mind unfinished.  Why? Because there seemed to me to be much more that needed to be shared. How do you impart through words the work of these dedicated women to protect and promote breastfeeding in the aftermath of such devastation?  The Philippine Breastfeeding Expert Support Team (BEST) understood the barriers to promoting and protecting breastfeeding and created solutions through the use of their mobile breastfeeding tents.  One of the barriers is that in the aftermath of an emergency, there is a deluge of infant formula donations.  There is a lack of understanding that even under the best circumstances, infant formula has risks.  During an emergency those risks escalate.

One of the most challenging aspects in the aftermath of a disaster is how to manage formula-fed infants knowing that these babies are at higher risk for morbidity and mortality.  The Philippine BEST group used a variety of strategies to help moms relactate.   Peer counselors helped educate and inspire mothers to breastfeed.  Hand expression was taught, confidence was given that the milk was there.  Wet nursing was used to help fed babies while they were transitioning to the mother's breasts.  Donor human milk was used to help those babies who lost their mothers.

The following is 17 pictures and inspiring stories of breastfeeding mothers in the Philippines.  The first slide is of Velvet Escario-Roxas, who has trained many breastfeeding peer counselors, is Executive Deputy Director at Arugaan (means "to fully nurture with a lifetime commitment," in Filipino) Toddler Center in Quezon, and was very involved in the mobile Breastfeeding Tent after the typhoon.  Also in these pictures is Bing Guevara who was also very involved in mobile breastfeeding tent after Typhoon Yolanda.

https://ph.news.yahoo.com/photos/breast-is-best-moms-tell-their-inspiring-stories-slideshow/velvet-escario-roxas-life-by-imagine-nation-photography-photo-1376526863233.html

The founder of Arugaan in Quezon is Ma Ines Fernandez.  She is an inspiration to many.  She recently was made an Ashoka Fellow and I think the following video is helpful in understanding why she is such an inspiration.  Ashoka Fellows are "leading social entrepreneurs who are recognized for their innovative solutions to social problems...demonstrating unrivaled commitment to bold new ideas and prove that compassion, creativity and collaboration are tremendous forces for change."


I am inspired by this group of dedicated supporters and protectors of breastfeeding in the Philippines.  Hopefully, you will be, too!!  We need more programs like this around the world.  In heartfelt gratitude for the many people around the world who protect and promote breastfeeding.
Valerie W. McClain


Saturday, April 4, 2015

Typhoon Haiyan/Yolando: Protecting and Promoting Breastfeeding in the face of Disaster


"Breastfeeding serves to protect a child's right to food security and medicine.  Temporary lack of food and water in emergency conditions in a disaster-stricken area cannot be presumed to justify the prescription of formula for babies.  In such situations, the health risks to which the babies are already  exposed can only be exacerbated when panic sets in and authorities unjustifiably offer formula as an emergency response."
--"Vulnerability:  From Protection to Empowerment," by Leonardo D. de Castro and Ma. Ines Av. Fernandez, Asian Bioethics Review vol.6 no.4 (2014) 
http://asianbioethicsreview.com/journal/index.php?journal=abr_sbc1&page=index



Recently I had the privilege of being introduced through the email to some dynamic women who by their commitment and actions are making a difference in their communities.  Each of them using their different skills but recognizing the value of working together have created a blueprint for promoting and protecting breastfeeding during emergency situations.  They live in the Philippines, a country consisting of 7107 islands in the area geographically known as the "Ring of Fire."  The country is prone to earthquakes and typhoons.  Ma. Ines Fernandez is the founder of Arugaan, a non-governmental organization (NGO) that was instrumental in making Quezon City the first mother-baby friendly city in the Philippines. She created an innovative creche program that promotes and protects breastfeeding for working women.  In 1986 Ines co-authored and lobbied for the Philippine Milk Code (WHO Code--The Philippines is one of 37 countries in the world that fully implements the WHO Code).

Ines wrote a proposal that helped Arugaan receive funding from the World Health Organization to support breastfeeding in emergencies through the use of mobile breastfeeding tents. Mobile tents create a safe space for mothers and children with an opportunity to rest and recuperate from the trauma and struggles of survival after a disaster.   The tents also create an opportunity to educate moms about the importance of breastfeeding, the risks of infant formula, relactation, and the importance of nutritious, indigenous foods.  This education is combined with individual counseling or group counseling on breastfeeding, demonstrating positioning at the breast, breast massage to stimulate a milk supply, hand expression, wet-nursing/cross nursing. Healthy indigenous foods were provided for the moms as well as a creche for children.   In her email she mentioned that the Philippines encounter 21 typhoons yearly and that they "weather the storm with smiles."  This positive attitude shines forth in the pictures and papers that were shared with me regarding their work with supporting breastfeeding in the aftermath of Typhoon Haiyan/Yolanda, a category 5 typhoon that killed 6300 people and displaced 4 million people. 
From Jenny Ong's blog
http://www.chroniclesofanursingmom.com/2014/03/help-arugaan-mission-for-haiyan-victims.html

Such an endeavor takes the work of many people.  One person, one group, one organization cannot do this kind of work alone.  With the spirit of cooperation and collaboration, Arugaan BEST (Breastfeeding Emergency Support Team) lead by Ma. Ines Fernandez worked with the Breastfeeding Pinays-an online breastfeeding support group of 40,000 members administered by Velvet Escario-Roxas and her trained peer counselors and co-founder of the Facebook group Breastfeeding Pinays, Bing Guevara; LATCH (Lactation, Attachment, Training, Counseling, Help)-a breastfeeding support group with Jenny Ong who is a trained breastfeeding counselor and Dr. Lei Camiling-Alfonso,Dr. Donna Capili, Dr. Mianne Silvestre from Kalusugan ng Mag Ina (KMI) who are also promoting a program called First Embrace.   Jenny Ong with her organization LATCH helped get the money needed for transportation fares for community mothers so they could volunteer at the tents.  Donor breastmilk (no donor breastmilk from outside the Philippines was allowed) was collected and airlifted to evacuation centers and a hospital in areas impacted by the storm to help infants in need.  Infant formula donations were discouraged because the mixing of infant formula with contaminated water can cause gastrointestinal illnesses and can be fatal.

There were many people involved in this collaborative approach and there were many agencies like UNICEF and the WHO, the Philippine government agencies (DOH and others) and international non-profit organizations like Save the Children coordinating the approach to help the survivors of the typhoon.
 Mobile breastfeeding tents were used at evacuation centers in Manila.  Later they were able to use their mobile Breastfeeding Tents to make visits (and return visits to see how moms and babies were doing) to the villages in Leyte/Samar hard hit by the typhoon.  I was impressed by the documentation that was done by this Arugaan endeavor and that they did follow-up visits. The breastfeeding tents encouraged more breastfeeding among mothers and at the same time educated communities on the importance of breastfeeding. 

One of the things I know from the hurricanes I have witnessed in Florida is that the impact of a hurricane/typhoon is felt in a community for years.  Homes have to be rebuilt or repaired, jobs may be lost, food security may disappear for many families.  Many close-knit families have lost their loved ones and often have to move to new locations causing additional stress.   The stress of this instability and personal loss may be long-lasting for families impacted by such storms.   

Breastfeeding is a well-known safety net for mothers and babies against the damaging effect of poverty and/or natural disasters.  Infant formula is a known risk in such situations because the safety of water supplies are often questionable, access to fuel/electricity may not exist meaning that sterilization of bottles/nipples will be difficult putting infants at high risk for infections and death.

"Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies."
--"Donated breast milk substitutes and incidence of diarrhoea among infants and young children after the May 2006 earthquake in Yogyakarta and central Java," by DB Hipgrave et al., Public Health Nutr. 2012 Feb 15(2): 307-315
http://journals.cambridge.org/download.php?file=%2FPHN%2FPHN15_02%2FS1368980010003423a.pdf&code=9b2a7c9c144f4c9728e851f47f408cbf

"According to reports from the Philippines cases of gastroenteritis increased last year during Typhoon Yolanda because donated infant formula was mixed with contaminated water."
http://www.dairyreporter.com/Regulation-Safety/Infant-formula-donations-banned-at-Typhoon-Ruby-evacuation-centres

One of the things that happens during and after natural and man-made disasters is that good-hearted people believe that donating infant formula is the answer for babies during such emergencies.  What happens is that these donations often sabotage the breastfeeding mother, put more infants at risk for diarrhea and death, and are difficult to control and monitor. Not only that but once you have infants dependent on infant formula (an expensive product even in developed countries), then when all the free infant formula is no longer available, how will an infant survive? I remember years ago trying to talk to some missionaries regarding this issue.  They were collecting infant formula in our area to go to the survivors of an earthquake in Nicaragua who were living in tents in a landfill.  I could not convince these very kind-hearted people that it was a dangerous thing to do.  They assured me that they had water-filtering devices they were bringing as well as infant formula.  They did not understand that what they were creating is dependency upon a product that would not be available for free after the donations stopped.  Which meant that infants would be at increased risk for malnutrition and death, when families could no longer get free infant formula.  And by the time free formula ended, mothers would not have the information or help to relactate.

Hurricane Katrina was an eye-opening event for many of us here in the US.  The conditions were unbelievable for a country that is considered rich and modern.  I remember one night seeing the news in which it was stated that mothers with brand new babies in the New Orleans Superdome had run out of infant formula and water in which to keep their infants fed and hydrated.  I saw mothers giving people their babies to other people who were lucky enough to get a bus out of the brutal conditions of the Superdome.  They did this so that their infants could have food and water.  Watching those news clips and saying to myself, if only those mothers had some LLL leaders, IBCLCS or WIC breastfeeding peer counselors standing next to them to say that they could breastfeed their babies and here's how to do it.  Breastmilk will provide your infant with nutrition as well as keeping them hydrated.  Formula feeding mothers who have newborns still have milk in their breasts.  Relactation in the newborn period is much easier than relactating with an older baby (and that, too, can be done with knowledge and help).

Reading and seeing the pictures of what is being done by the breastfeeding organizations in the Philippines blows me away.  Why?  Because they are showing us a blueprint in how to protect and promote breastfeeding in emergencies.  I dearly wish that here in the USA we can follow their example. This can be done by any country (other countries are doing it) and it is a vital and dynamic way to help mothers and babies during emergencies.  The presence of such programs increases the knowledge in communities of the importance of breastfeeding.  I salute and applaud the efforts of this amazing group of women in the Philippines who are promoting and protecting breastfeeding.  May they stay safe as another typhoon heads their way--Typhoon Maysak.
Valerie W. McClain

Thursday, February 19, 2015

A 1950's infant formula patent: reflections and questions


"Following the termination of breastfeeding, there is evidence of ongoing protection against illness due to protective influences on the immune system mediated via human milk.  Industry continues to attempt to improve infant formula with the addition of compounds such as fatty acids, oligosaccharides, nucleotides and lactoferrin.  However, human milk has such far-reaching effects on the infant's immune response that optimal development depends heavily on its provision."  The Impact of Breastmilk on Infant and Child Health by Wendy H. Oddy BAppSc MPH PhD (Breastfeeding Review 2002; 10(3): 5-18)

Deja vu?  Remember the movie, Groundhog's Day, with actor Bill Murray?  I feel like I am living that movie and its rather hilarious and sad at the same time.  Frustrating, you bet it is frustrating.  What we know about breastmilk and infant formula is still well hidden in our society.  So reading papers from a decade ago, like Ms. Oddy's paper in Breastfeeding Review is...well its a Groundhog's Day moment.   I read the epidemiological evidence in the early 1990's and presumed or assumed that this evidence would take hold in our society.  Instead it seems we have had a media campaign for the past 3 years to convince people that infant formula is just as good as breastfeeding.  Ms. Oddy states boldly in the abstract of her paper, "Infant-formula-feeding is inferior to breastfeeding because human milk provides specific and non-specific factors that have long-term consequences for early metabolism and the devlopment of disease."

As I reread Ms. Oddy's paper, I found myself reflecting on why our society is so resistant to the information that infant formula has health risks.  Why is this information consistently buried in our society?  I remember as a La Leche League leader in the 80's and early 90's that the emphasis was on promoting breastfeeding, discussing the benefits.  Not much was said about the risks of infant formula.  It seemed to be an unspoken rule.  I remember reading, Breastfeeding Matters by Maureen Minchin in 1990 and being blown away by the information.  Then reading in the Journal of Human Lactation an article by Marsha Walker, IBCLC in 1993 entitled, "A Fresh Look at the Risks of Artificial Infant Feeding," JHL 9(2): 97-107 in which she states, "Declining breastfeeding rates and the aggressive marketing of breast milk substitutes has blurred the distinction between breast milk and formula."   Around the same time, I read, "The Politics of Breastfeeding," by Gabrielle Palmer.  These 3 publications influenced me enormously.  At the time I remember thinking that parents should know this information and they should know this information before their babies are born.  In fact all of society needs to know the risks of infant formula to better understand why infant formula advertising needs to be curtailed.  The reason for the establishment of the WHO Code in the 80's was the recognition that aggressive infant formula marketing was causing a decline in breastfeeding.  Now in recent years, we have seen the rise of breastfeeding initiation rates but continuation rates are poor.  Mixed feeding (breast and bottle feeding) is the predominant mode of feeding in the USA.  Infant formula advertising has changed to meet the challenge of increased breastfeeding initiation rates.  Current themes in advertising seem to be geared towards scapegoating breastfeeding advocates, trying to make advocacy appear to be aggressive and mean-spirited.  Yet there is still the repetitive advertising theme from the 1990s in which breastfeeding and infant formula feeding is promoted as a choice, a personal lifestyle choice.  The risks of infant formula do not exist while breastfeeding is put on a pedestal.  The pedestal in which most women, mere mortals, will admire but never truly obtain.  Countering such advertising is difficult.  It is not impossible, if the WHO Code was utilized to balance public information on infant feeding.

The other day I ran across an infant formula patent filed in 1952 and owned by American Home Products (which became Wyeth in 2002, which became Pfizer in 2009, which Pfizer sold to Nestle in 2012 for $11.85 billion--yes billion) invented by RM Tomarelli et al and entitled, "Infant feeding compositions."

This patent from the 1950s is about supporting the growth of Lactobacillus bifidus in baby formula.  The inventors found that a growth promoting factor that supports the growth of Lactobacillus bifidus in the infant intestinal tract in hog gastric mucin.  I had never heard of hog gastric mucin. While researching this I found an article entitled, "Pig stomach mucins are effective as anti-viral agents for consumer products," dated April 25, 2012.  One product that this current research suggested was to use pig stomach mucin in infant formula.
http://phys.org/news/2012-04-pig-stomach-mucins-effective-anti-viral.html

American Home Products (Wyeth) knew about hog gastric mucin (aka pig stomach mucin) in the 1950s.  Although they weren't trying to find an anti-viral component for infant formula but rather trying to promote the Lactobacillus bifidus (L. bifidus) factor for their infant formulas.  Their reasons for trying to promote L. bifidus were,

"Medical authorities are now in general agreement that many of the advantages which a breast-fed infant seems to have, in so far as its nutrition and resistance to certain diseases are concerned, are attributable, at least in part, to the predominance of L. bifidus in his intestinal tract."

and

"In any event, where the gram-positive bacillus L.bifidus is present in large numbers in the infant intestine, which is now found only when the infant is breast-fed, there is considerable less growth of other microorganisms, particularly of the gram-negative B. coli, the Clostridia, and of certain air born microorganisms such as the Sarcinae bacteria."

and 

"The fact that a stable L. bifiaus [misspelled? I believe they mean bifidus] flora is characteristic only of the intestinal tract of breast-fed infants is now fully understood and appreciated by pediatricians and other specialists in the medical, biological and nutritional sciences....the original observations of Tissier concerning the predominance of L. bifidus in nurslings stool have been amply confirmed is pointed out in the more recent publication of Norris, Flanders, Tomarelli and Gyorgy..."
http://www.goggle.com/patents/US2697663

Interesting to find this patent written so many years ago and find that the infant formula industry was trying to imitate human milk using hog gastric mucin.  And 60 years later, they are once again interested in hog gastric mucin (pig stomach mucins).  But more curious is that they knew that L. bifidus (what we now call a probiotic) created positive health effects in the breastfed baby.  They knew that there was a difference between the breastfed and the formula fed baby.

How far have we really come in our understanding?  We seem to be spinning our wheels, playing Groundhog's Day with information on the health effects of breastfeeding and not breastfeeding.  How far has the infant formula industry come in improving infant formula?  In the 1950's they would use hog gastric mucin and in 2012 they are back to thinking about using this component.  I imagine it will be genetically engineered because that is the current fad in our biotech world.  Have we gone forward in making a safer infant formula?  Or perhaps are we just spinning our wheels, in a circle of belief that somehow men and women of science have the god-like understanding of human milk and making a safer infant formula.
Copyright 2015  Valerie W. McClain

  

Saturday, February 7, 2015

Infant Formula Advertising in the USA, the WHO Code, and a profession


"Is breastfeeding 'worth the bother'?  The epidemiologic evidence is strongly affirmative.  Important protection against gastrointestinal infections in every setting has been confirmed and reconfirmed;  most clinicians now accept such observations.  Many clinicians, however, are surprised to learn that breast-feeding is associated with significant reductions in nongastrointestinal infections, including pneumonia, bacteremia, and meningitis, and with a reduced frequency of certain chronic diseases later in life.  Much of the important data concerning the health benefits of breastfeeding appeared in the last decade and are not widely known..."
--Breastfeeding and Health in the 1980's:  A Global Epidemiological Review, by Allan S. Cunningham, Derrick B. Jelliffe, E.F. Patrice Jelliffe
Journal of Pediatrics 118: 659-666 

I would venture to say that the epidemiological evidence regarding the value of breastfeeding to the health and well-being of babies and mothers are still relatively unknown.  The infant formula industry says, "Breastfeeding is Best." But ask a parent or even some health professionals why breastfeeding is best and listen to the response.  The answers are usually generalities nothing specific and never about the risks of infant formula.  There is a presumption that in developed countries like the US, that infants do not die from the way in which they are fed.  The belief is that infant formula is only a risk in developing countries, like countries in Africa.

Yet according to US infant mortality data, babies in the US die from pneumonia, gastrointestinal infections. bacteremia, meningitis and SIDs.  Would breastfeeding have prevented or reduced some of these deaths?  What do we really know about infant mortality statistics in the US and the relationship to how an infant is fed?  It would be easy to find out, if we required each infant death certificate to state how the infant was fed in the last 24 hours (or last 48 hours or last week) before death. 

I read "Breastfeeding and Health:  A Global Epidemiological Review," over a decade ago.  And the evidence from research done in the 80's is still relatively unknown to the general US population.  But now that evidence is being used to create novel and "improved" infant formulas, create patents, and monopolize those "inventions."  We see the advertisements that the new formula is closer to breast milk.  Are these formulas closer to breast milk because the industry has claimed the DNA (cDNA) of various breast milk components?   In US patents and patent applications, infant formula companies are creating novel ingredients through genetically engineering.  How much of those novel, genetically engineered ingredients are actually placed in infant formula is unknown.  The US infant formula industry does not have to label gmo ingredients because the FDA considers gmo and natural ingredients equivalent.

How much of our society's ignorance of what is in the can of infant formula and ignorance of risks regarding infant formula is orchestrated by industry?  How much of it is caused by an unwillingness to openly discuss risks of infant formula.  It seems that breastfeeding advocacy can only discuss the risks of not breastfeeding.  The risks of not breastfeeding is not the same statement as risks of infant formula.  The risks of not breastfeeding presumes that there are also risks in breastfeeding.  Is that true?  Risks of not breastfeeding is in reality an avoidance of discussing the risks of infant formula.  Its a word game to avoid offending infant formula feeding mothers but also results in letting an industry "off the hook."  

The consequences of letting an industry off the hook is that advertising/marketing gets more and more outrageous.  The recent Similac Ad, which some parents refuse to understand is an advertisement, is a prime example of how the internet not only impacts one country but the global community. With the rise of the internet and the multitude of devices that now connect to the internet, the infant formula industry has a global reach in advertising.  The wealth and power of an industry's marketing department has the ability to influence the hearts and minds of many, many people.  We have marketing that is so sophisticated that the audience does not even understand that what they are watching is an advertisement.  

Our society believes in choice, when it comes to infant feeding.  Yet making a choice presumes that that the person is making an "informed" choice.  Does direct advertising of infant formula to the public give parents an "informed" understanding of the benefit/risk ratios involved in their decision-making?  The infant formula industry has millions in which to advertise their products.  How much money does breastfeeding advocacy organizations have in their budgets to promote breastfeeding?  Not much in comparison.  Are parents around the world getting a balanced view in making their "choice" to breastfeed or not?  

Advertising directly to the public, gives the infant formula industry an unfair advantage.  When choices are made because of advertising, is it really choice?  We have had regulation of advertising in regard to the Tobacco Industry because of their unfair influence over young people to smoke.  Once a person starts to smoke it is very difficult to quit.  Likewise once a mother starts using infant formula, it becomes very difficult to reverse that decision.  Regulations on Tobacco advertising have not ended the industry, people are still smoking despite the known risks.  The curtailing of tobacco advertising and the use of extra sales tax on cigarettes to use in anti-smoking advertising campaigns has balanced public information.  Likewise we need balanced information regarding the choice of infant feeding.

So what is stopping us from using the WHO Code to balance the public information on infant feeding?  There are many reasons.  One reason I suppose is that in the US there is a belief in "free markets" and the rights of corporations (corporations are legally considered persons).  What this means politically is that any regulation of corporations is often dismissed by various political groups.  Although amazingly enough, our country started regulating the advertising of tobacco because more and more people understood the health risks of tobacco.  If more and more people understood the health risks of infant formula, I believe advertising of infant formula would be curtailed in the US.  We would then be abiding by at least one of the provisions of the WHO Code.
One of the provisions of the WHO Code is "No advertising of breastmilk substitutes."

Another thought I have is that IBCLCs request that the IBLCE re-institute the principle of ethical practice in which, "IBCLCs must adhere to those provisions of the International Cod of Marketing Breast-Milk Substitutes and subsequent resolutions which pertain to health workers." (#24)
 http://www.childbirthinternational.com/course/IBLCECodeofEthics.pdf

In 2011, the IBLCE (the certifying organization for IBCLCs) eliminated the Code of Ethics for IBCLCs and renamed it the Code of Professional Conduct for IBCLCs.  There is no principle regarding the need for IBCLCs to adhere to the WHO Code.  Although interestingly enough they did keep the principle of respecting intellectual property rights (which includes patents).  The WHO Code does appear briefly on the Code of Professional Conduct for IBCLCs prior to the Preamble but it is no longer a principle.
http://iblce.org/wp-content/uploads/2013/08/code-of-professional-conduct.pdf

I realize that people think that because the WHO Code is mentioned prior to the listing of principles that this is just as good as having it as a principle.  But I think that by removing this as a principle seems to imply that the WHO Code is really not an important principle.  And in the FAQ regarding the Code of Professional Conduct for IBCLCs, I find the statement regarding the question of whether it is unethical for an IBCLC to work for an infant formula company to be most illuminating.  "However, from a legal perspective IBLCE cannot prohibit, or pursue ethical sanctions against a certificant who chooses to work for an infant formula company."
http://iblce.org/wp-content/uploads/2013/08/code-of-professional-conduct-faqs.pdf

I have been rather astounded by this perspective by the IBLCE.  It's one of the reasons I let my IBCLC credential lapse.  I think if one believes as I do that breastfeeding is a health care decision not a personal lifestyle choice, then one of the principles of a profession that serves mothers and babies has to be the WHO Code.   

I think if we understand the history of the last 50 years regarding the epidemiology of breastfeeding, we would regard the WHO Code as vitally important.  If we continue to avoid the need for the Code, then we will continue to see more of the kind of advertising like the Similac Ad.  Scapegoating breastfeeding advocates will silence the willingness of parents to listen to breastfeeding advocates.  And it will also create advocates who are even less likely to discuss the risks of infant formula.
Copyright 2015 Valerie W. McClain