Sunday, January 15, 2017
The Fallacies of "Fed Is Best" and "I Support You" PR Campaigns
"When I came back to the United States, I decided that if you could use propaganda for war, you could certainly use it for peace. And "propaganda" got to be a bad word because of the Germans using it, so what I did was to try and find some other words so we found the words "public relations." by Edward Bernays, the father of public relations
The falling star streaked across the sky; and my brain wondered whether I had really seen it or was I just looking for magic in the night sky? Did my neighbor see the falling star? Or was this just a moment in time that I, alone, observed it? I thought of the night sky in Arizona, where falling stars were part of the night-time landscape. But here in Florida, falling stars are a treat, not a common occurrence. Night-time lighting which blocks our view of the sky has certainly changed our world and our perceptions of life on this planet. Years ago, my brother told me about his summer job of camp counselor for inner city boys and girls of Philadelphia. The camp was out in the woods, far away from city lights and traffic. He said he was amazed that many of the very street-wise and tough-acting children of the inner city were full of fear of the darkness at nightfall. I was amazed as he was, because my brother and I had so much fun camping and our family even lived in the middle of the woods in Northern Ontario for a few years. So our experience and our fears as children were so different from the children living in a inner city environment.
It is hard to understand other people whose experience and fears are different from our own. Their fears are not our fears. Their experiences give them a different reality from ours. We can scorn and ridicule their fears but that doesn't give us a bridge to further understanding of other human beings on this planet. There are many examples in our lives of how divisive society can be, when our reality clashes with other people's reality.
Infant feeding decisions is one of those examples of a clash of realities. We are a society of conflicting opinions and realities regarding breastfeeding and bottlefeeding. But what is of concern to me is the use of propaganda, PR and social marketing techniques in this clash of realities. Is this just an ideological battle or is an industry using its power and monies to promote their reality?
This appears to me to be both an ideological battle of different viewpoints and the PR work of the infant formula industry. We have media campaigns pushing back against the "breastfeeding is best" slogan used in the social marketing of breastfeeding. "Fed is best" is the slogan used to counter "breastfeeding is best." We also have another campaign slogan called, "I support you." The intent of the "I Support You," campaign is about giving support to both breastfeeding and infant formula feeding mothers. Yet the criticism of the I Support You campaign appears to be only directed at breastfeeding advocacy.
The "I Support You" campaign was founded by Suzanne Barstow, the Fearless Formula Feeder blogger, who is also a CLC (Certified Lactation Counselor- a week long educational course on breastfeeding with a final exam at end). My impression is that Suzanne Barstow is a supporter and promoter of infant formula and I have written about her promoting the use of Similac coupons, etc.
Her campaign got support from some breastfeeding advocates. The Best for Babes Foundation seemed somewhat supportive of this campaign. One of their credos is, "All moms deserve to make a truly informed feeding decision and to be cheered on, coached ad celebrated without pressure, judgment or guilt." The presumption of this credo is that it is possible to have a "truly informed feeding decision" in our society. And the other presumption is that breastfeeding advocacy spreads guilt, judgment and pressure to breastfeed. The Best for Babes Foundation is also very supportive of breastfeeding but they do accept a belief that "informed feeding decisions" can be made in our society. I, on the other hand, have to question that premise because the infant formula industry through propaganda and advertising has created a bottlefeeding reality. Its influence in the medical professions and in infant feeding research is legendary. After all the bottle has been the symbolic representation of baby or babyhood. Escape from the societal mindset that infant formula is the default feeding program and that breastfeeding can be regimented like bottlefeeding is next to impossible. The infant formula industry through its patents shows us that the industry has been selling an inferior product over the years. They recognize the problems of their formulas and will solve the problems with various human milk components. The public usually hasn't a clue about what the industry is doing other than the smoke and mirrors of the industry's PR. So while many breastfeeding advocates may believe that informed choice exists in the US, the reality is that even breastfeeding advocates are clueless about what is in that can of formula. So informed choice exists in what world? Here is a few patents to look at that are owned by different formula companies. What do we really know as consumers and what does the industry know?
For example, Abbott Labs patent #9539269 filed in 2011 entitled, "Methods for decreasing the incidence of necrotizing entercolitis in infants, toddlers or children using human milk oligosaccharides." Abbott will use human milk oligosaccharides (a prebiotic) in their formulas to decrease the risk of necrotizing entercolitis (NEC) which can be a deadly infection in infants, particularly premature infants. NEC is a risk factor when infants/preterm infants are given infant formula.
A Nestle patent (#9498502) filed in 2010 called, "Prevention and treatment of allergic diarrhea." From the patent, "...the present inventors have discovered that a particular strain of Bifidobacterium breve originally isolated from human milk, B. breve CNCMI-3865 (NCC2950) is highly effective in the prevention and treatment of allergic diarrhoea." In the patent the inventors state that diarrhea is the second most common cause of infant mortality worldwide and that it causes 5 million deaths worldwide to children under 5 years of age.
How about a Mead Johnson patent (#9089157) filed in 2013 using human milk oligosaccharides (prebiotics) to inactivate Cronobacter sakazakii entitled, "Adherence inhibition of pathogens by prebiotic oligosaccharides." A quote from the patent,
"Cronobacter sakazakii(also called Enterobacter sakazakii) is a motile, petrichious, non-sporeforming, gram negative facultative anaerobe. It is an opportunistic pathogen that has been implicated in severe forms of meningitis, necrotizing entercolitis and sepsis in infants. Although the environmental source of the microorganism in unknown, powdered infant formula has been implicated in several outbreaks...Of particular concern are reports of the organism being isolated from powdered milk processing plants and hospital utensils such as spoons and other implements used to prepare infant formula."
The fatality rate for infants that contract a Cronobacter Sakazakii infection has been estimated to be between 40-80 per cent. And the CDC estimates that we have an average of 6 cases per year and this maybe an underestimation since there is only one state in the USA that has made this infection a reportable disease. Yet the public believes that infant formula is only a risk in developing nations?
Meanwhile I read in the blog, Momivist, that exclusive breastfeeding can cause life long disabilities. The blog is written by Jody Segrave-Daly RN, MS, IBCLC, one of the founders of Fed is Best Foundation. She states, "Every year in the US, approximately 60,000 newborns are readmitted back to the hospital for unforeseen complications from exclusive breastfeeding and insufficient intake." No footnote of where this statistic comes from other than 2 references at the end of the article. Both references lead back the Fed Is Best Foundation. With the last reference having a paper written in the Journal of Pediatrics entitled, "Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children," published in 2015. I found no mention of exclusive breastfeeding in this paper and this paper had a chart entitled, "Recognizing and managing neonates at increased risk for a persistent hypoglycemia disorder." No mention of exclusive breastfeeding as a risk factor nor any statement about the 60,000 newborns readmitted due to exclusive breastfeeding and insufficient intake.
The mission of Fed is Best Foundation is laudable. Who would argue against saving babies from brain damage caused by insufficient intake (hypoglycemia)?
The question is where is the research behind the belief that exclusive breastfeeding is the cause of insufficient intake? No published research that I have seen. So this appears to me to be a hypothesis by the founders of this private Foundation.
Both founders of this Foundation are or were employed in hospitals. Jody Segrave-Daly is an RN and IBCLC working in a NICU (neonatal nurse specialist) and Dr. del Castillo-Hegyi is adjunct faculty member in the Department of Emergency Medicine in the University of Arkansas and a practicing American Board of Emergency Medicine-certified physician. She states she has a background in newborn brain injury research at Brown University. And she states that her child has autism due to newborn jaundice due to insufficient milk intake from delayed milk production.
They both have a medical perspective of this issue. What they see is through the eye of a medical system that has very little faith in breastfeeding which cannot be measured and seen. Jody Segrave-Daly states in her Momivist blog, "As a veteran NICU, nursery nurse and IBCLC, I have taken care of and fed thousands of babies over the years." Feeding babies is what a nursery nurse does because babies are separated from their mothers. This task maybe a requirement of the job in a NICU but it is not part of the task of an IBCLC. And expertise in feeding babies other than our own, helps in a NICU job but it is an endeavor that changes a person's vision of the reality of breastfeeding. Jody Segrave-Daly supports pre-lacteal feedings as "usual and customary all over the world." She asks, "how can supplementation destroy breastfeeding?" And then answers that it doesn't. She seems unaware of evidence to the contrary or that this behavior may not destroy breastfeeding but it certainly changes the newborn's gut and with that impacts an infant's immune system.
Only seeing bottlefeeding and only seeing the worse case scenarios in hospitals impacts what a person believes to be true. It's why labor and delivery nurses (in general) have the most difficult births and complications. And even midwives have more difficult births. I remember reading a medical book on symptoms of disease and by the time I finished the book I was sure I had every disease in that book. The sad state of affairs in the USA is that most OB/Gyns have never seen a normal birth. And I would say that the same could be said about breastfeeding and that doctors and IBCLCs who are medically trained rarely see normal breastfeeding in the early days in which babies do fine with exclusive breastfeeding.
The biggest fear that new breastfeeding mothers have is that they cannot produce enough milk. This FEAR has created the very low percentage of women exclusively breastfeeding their babies. How many women are actually exclusively breastfeeding their babies in the newborn period? Where is the data? How do we define exclusive breastfeeding? What is the impact of "mandatory"IVs for laboring moms on newborn weight loss? New studies now believe that IVs cause significant weight loss in newborns (dependent on amount and timing of IVs). How do these dextrose and salt solutions given to mom impact the baby in utero in the stages of being born? Readmittance to hospitals is more common in preterm infants for feeding problems and jaundice. Why? Do we send home preterm babies with mothers who want to breastfeed without ever having put the baby to breast? Separation of mothers and babies, even preterm infants, creates enormous physical stress on both babies and mothers. Sometimes this cannot be avoided, but often policies in hospitals and the lack of vision regarding breastfeeding creates the side effect of insufficient milk in mothers. Should we blame exclusive breastfeeding? Or is a viewpoint distorted?
I see the falling star, who else sees it? The darkness of the night sky does not scare me. I am embraced by it. It is my memory of my childhood. The city streets at night are far more scary. If we are isolated from the reality of exclusive breastfeeding, how can we support and protect it?
Copyright 2017 Valerie W. McClain