Truth or Dare: Vitamin D and breastfeeding

The current recommendation from the AAP on breastfeeding and vitamin D is that "all infants, including those who are exclusively breastfed, have a minimum intake of 200 IU of vitamin D per day beginning during the first two months of life." When an organization like the AAP makes such recommendations/policies there are winners and losers. Who are the winners and do we really want to know the losers? Winners, of course, should be our babies, our children; since this impacts their health. Are they the winners? Does supplementation of vitamin D in the exclusively breastfed infant helpful or hurtful? Is it needed? Is it needed for all or selectively? Frankly, its hard to get a good picture on this because like anything decided in the US, economic motivation is of prime consideration. The economic winners in this policy are companies that make vitamins but also the infant formula industry. (Mead Johnson/Abbott also make vitamin drops for infants)

In 2000, a study was published in the Journal of Pediatrics by researcher Shelley R. Kreiter called, "Nutritional rickets in African American breast fed infants." It made alot of headlines around the country. I remember reading the study because I had been a WIC Breastfeeding Peer Counselor Coordinator in a Florida county from 1994-1998. Breastfeeding rates for African American women in my area were very, very low. Those who did breastfeed, most often were also using infant formula. Most did not breastfeed for long. So I was very interested in how this study defined breastfeeding. The definition of breastfeeding in research is crucial in making decisions of causation. How can researchers know that breastfeeding is the cause of the rise in rickets, if the mothers were also using infant formula, water supplementation, or foods or other drinks? In this particular study, if memory serves me there was no definition of breastfeeding. So we, the readers, do not know if breastmilk was the only source of nutrition for these infants. I would suspect NOT, because initiation rates in North Carolina for African American infants in the WIC Program ranged from 18% - 30% from the years 1993-1999. Duration rates at 6 months for the WIC Program during those years hovered at around 10%. With such low duration rates, I would believe that there was alot of supplementation going on (supplementation of formula/foods cause milk supplies to drop and is often instrumental in mother's weaning because of low supply of breastmilk). If there is no definition of breastfeeding in research, then how can we believe that the rickets were caused by African American women breastfeeding their babies? We might suspect this is a cause but until we have determined that the only food or drink these babies got was breastmilk, then how can we logically, scientifically say that their is a deficiency in breastmilk? The definition of breastfeeding is critical to the understanding of causation and in this study like the studies on hiv, the researchers saw no reason to define breastfeeding. Even WIC does not define breastfeeding in its data. Breastfeeding initiation is "ever" breastfed. Ever breastfed is dependent on the accuracy of the mother's memory and the accuracy of the WIC clerk. One might assume that breastfeeding mothers who get the "full" breastfeeding packet are exclusively breastfeeding but I learned quite quickly that often clients on the WIC full breastfeeding packets would also have infant formula (either gifted to them from the hospital/doc's office, friends/family, or bought out of pocket). So reading WIC stats does not give people outside the system a real understanding of what is going on regarding infant feeding and particularly if they aren't aware of differences in breastfeeding practices, the need for definitions. One of the authors of this study, Dr. Robert P. Schwartz (funded in other studies by Mead Johnson, Genentech) is interviewed about this study and he tells the story of how he obtained the WIC statistics--a WIC Representative gave him the breastfeeding data for part of the study (not the cases themselves but the data regarding the rise of breastfeeding rates in the North Carolina WIC population). I am somewhat amazed that WIC gave away their data. I think that is somewhat unusal.

http://www.ahrq.gov/about/evaluations/pharmportfolio/pharmportfolio3d.htm

The editorial in the Journal of Pediatrics 2000 in that particular issue of the Kreiter et al study was "Vitamin D-deficient rickets: The reemergence of a once-conquered disease." At one point it states, "The reappearance of rickets may be an unintended consequence of an admirable health initiative the promotion of human milk feeding." I find the sentence rather jarring, admirable? human milk feeding? Interesting spin....There were 3 authors to this editorial and one, Reginald C. Tsang was the author of a book called, "Vitamin & Mineral Requirements in preterm infants published by Mead Johnson.

In 2001, the CDC convened a Vitamin D Expert Panel meeting to determine the CDCs final report on vitamin D supplementation of breastfeeding infants. Some of the experts/researchers have industry funding or patents that would suggest to me that vested interests may have had a part in the conclusions that were drawn. Michael F. Holick was listed as a professor at Boston University School of Medicine. No mention of his inventions to patents on vitamin D compounds or test kits to determine vitamin D levels. (patents 4661,294, 6455714, 6291693) His test kits are based on ELISA antibody tests (remember antibody tests???? false positives). Another expert was Bruce W. Hollis, who just also happens to have a patent on a test kit for vitamin D (patent # 5821020). He was listed at this CDC panel meeting as a professor of Pediatrics at the Medical School of the University of South Carolina. Frank R. Greer, CDC expert panel member, has represented the National Dairy Association's 3-A-Day for stronger bones program. He is also the secretary/treasurer to the ISRHML (International Society of Researchers of Human Milk and Lactation). He was listed as a professor of pediatrics at Meriter Hospital, Wisconsin. Bonny L. Specker, another expert, has been funded in her research by Carnation/Nestle, on Mead Jonson Advisory Board 2004, National Dairy Council. Nancy F. Krebs has had her research funded by Mead Johnson. Of note is some very thoughtful statements made by Ruth Lawrence regarding the situation of vitamin D use for exclusively breastfed infants. (how will the gut of the exclusively breastfed infants respond) But the decision was made to supplement all breastfeeding infants.

http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/Vitamin_D_Expert_Panel_Meeting.pdf

I thought it of interest that a patent published in 1981 by Abbott Labbs (patent #4308264) on vitamin D(calcitriol 1.alpha.,25-dihydroxycholecalciferol) makes some interesting statments.

"Approximately one-third of premature infants, one-third of infants with birth asphyxia and one-half infants of insulin-dependent diabetic mothers have neonatal hypocalcemia."

"Late neonatal hypocalcemia usually occurs in full term of premature infants who have been started on feedings and show signs or symptoms of hypocalcemia only after several days or weeks of feedings."

An infant formula company describes low calcium problems and patents a vitamin D to solve the problem. But they don't blame the infant formula, calcium problems are the result of birth asphyxia, prematurity, and mostly diabetic mothers. Funny, how this all gets turned around 30 years later and the reasoning becomes that breastfeeding is one of the causes of rickets in African American infants.

Copyright 2008 Valerie W. McClain

Copyright, plagarism, IPRs

According to the IBLCE(International Board of Lactation Consultant Examiners), the purpose of IBCLCs tenet #25 on intellectual property rights was the need to prevent copyright infringement. Yet copyright laws are in place and vary from country to country. IBCLCs have copyright protections already without the need to acknowledge, respect, recognize, and understand IPRs (Intellectual Property Rights). So that reasoning does not make sense when looking at the legal picture around the world. Copyright (IPRS) does not protect writers from plagiarism (definition from Random House dictionary-"the appropriation or imitiation of the language, ideas, and thoughts of another author, and representation of them as one's original work.") Universities/schools frown upon plagiarism and a student or teacher can get into alot of trouble for plagiarism. But in a court of law in the US, plagiarism is not a crime. It is frowned upon, but one cannot bring someone to court for plagarism only for copyright violations. On the otherhand, copyright enfringement is against the law and punishable. Copyright enfringement effects mostly the publisher and not the author unless the author is the publisher. While anything written is considered copyrighted (even emails), in order to collect damages in a court of law one must have paid for the copyright. Thus copyright laws do not truly protect writers unless they have paid into the system. IPR lawyers are very expensive lawyers, even in the backwaters of Florida where I live, their hourly fee is higher than what I make working for 40 hours. As someone who has felt the sting of plagarism, seeing my long hours of research put up by others as their original work, I think copyright law does not touch the real problem. IPRs are a blessing for lawyers and courts...bringing in money and keeping people busy. They do not truly protect writers or inventors. They only protect the wealthy, well-educated people of society, keeping them in business. And keeping certain information away from the poor and undereducated. It is a system that has little reward for those with little power and/or money in society. So why are IBCLCs supportive of tenet #25?

Copyright 2008 Valerie W. McClain

Monopolies on human milk and its components

The ultimate result of our ethics code (tenet #25), is that IBCLCs must respect, understand, recognize, and acknowledge the monopolization of human milk and its components. While in my previous post on "Patents and Breastfeeding," I wrote that patenting does not restrict breastfeeding. Yet, monopolization eventually creates restrictions. For instance, the rise of our new human milk industry (Prolacta Bioscience) seems to have coincided with media discussions of the dangers of private persons milk sharing over the internet. This has coincided with IBCLC discussions of the dangers of wet-nursing [cross nursing, etc]. Not that these discussions shouldn't take place but the timing of these discussions makes one wonder. An industry arises that will monopolize a "standardized' human milk based on "donor" human milk. Women who share their milk rather than donate it to Prolacta are circumventing the monopoly. In fact the non-profit milk banks (HMBANA) are a threat to Prolacta's claims. Although I am not sure what restricts a non-profit milk bank from selling its milk to Prolacta as a way to keep their doors open. So Prolacta may not be such a threat to HMBANA milk banks.

We will be hearing more about the dangers of sharing human milk among friends or on the internet. And we will hear more about the dangers of cross nursing/wet nursing. Eventually, men and women will perceive that the only safe way to share human milk is through the authorized milk banking system and that it is not safe to cross nurse. What is the reality? Wet nursing has occurred throughout human history. Was it safe? One can suppose it was safe, infants survived. But we can be assured that now it will be considered dangerous because we have a monopoly to protect.

Like the infant formula industry, the human milk industry benefits from the belief that human milk transmits some diseases and some toxins. It also benefits (like the infant formula industry) from the belief that premature infants need fortification. I realize the response is that scientific research has proven that hiv is transmitted through breastfeeding and that certain environmental toxins are transmitted through human milk. And scientific research has proven that premies need fortification. Most of that scientifc research, the basis of our knowledge of human milk is funded by the infant formula industry. Anytime research is funded by industry, reality becomes distorted by the wants and needs of that particular industry. Most of that research lacks clear definitions of "breastfeeding." Thus the clarity of the picture of what is happening is shrouded by mixed feeding.

Does a new industry arise out of true need for a product or the need for a profit? Certainly, there is a mixture of needs. But what is the real driving force? Ultimately, in our society the reality is that often the real need is lost in the drive to obtain a profit.

Copyright 2008 Valerie W. McClain

Patents and Breastfeeding

There was a comment/questions to my last blog entry that I felt needed to be addressed.

"Laws here in Europe would not prevent a mother from breastfeeding due to any intelectual issues. Is the United States more restrictive? Do mothers be stopped from breastfeeding if research makes new findings and if involved in patented."

Patenting of human milk and/or its components do not restrict or prevent a mother from breastfeeding in the US or for that matter any place in the world. Patenting of human milk is restricting knowledge. A well-functioning democratic society needs information to implement policies/laws that benefit society. Patenting of human milk, means that information that is necessary for a community or the medical establishment to make good decisions about infant feeding is limited or virtually non-existent. Many health care professionals do not know that human milk is a prebiotic and probiotic substance. (the infant formula and dairy industry holds patents on the components) Many health care professionals think that the breastfed infant should be given a supplement--a probiotic or prebiotic. Interrupting an exclusively breastfed infant with a prebiotic or probiotic is rather odd, when the scientific basis of prebiotics and probiotics is human milk. Nestle/Danone have quite a few patents on probiotics, all derived from research on the breastfed infant. Consumers have no clue as to how these companies obtain the organisms that make a prebiotic or probiotic. They do not realize that basis for these supposed "health foods" is human milk, the breastfed infant. The dairy and infant formula industry know the value of human milk/breastfeeding...they have a more vigorous scientific understanding than advocates for breastfeeding. That knowledge is withheld not only from consumers but from the very people who need that information the most--advocates of breastfeeding.

For instance, let's look at the information on hiv and breastfeeding. There are patents on human milk components to treat and inactivate hiv. They are owned by the infant formula industry, the US Government, and the drug, supplement industries. Policy in the US medical institutions stops most hiv positive mothers from breastfeeding. There are well-known hiv researchers that call hiv/aids an oxidative stress disease and are involved with the supplement industry that makes supplements for hiv/aids patients. The supplements are derived from human milk research and use human lactoferrin in a synthetic form (human lactoferrin derived from transgenic cows or human lactoferrin genetically engineered from cultures). I need some sort of rational explanation regarding why a hiv-positive mother cannot breastfeed her baby while industries sell products based on human milk research to treat and inactivate hiv. If breastfeeding is a natural "vaccination" against diseases in the mother's environment, won't it seem logical that hiv positive mothers should be encouraged to breastfeed? Infectious hiv has never been found in samples of human milk. Some researchers believe the reason is because components in human milk quickly inactivate the virus. (of course an alternative view would be that since hiv has never been isolated, we would not see it in human milk). So what is the real story? Will we ever really know, when patents/products exist? When the infant formula industry owns the patents to inactivate hiv with human lactoferrin, do we suppose that they will support breastfeeding? Will they give us all the information they have on how human lactoferrin inactivates hiv? I think not. Hiv/aids has been a great money-maker for the infant formula industry. Why would they give this information out? It is very helpful to the infant formula industry to have people believe in the yuckiness of breastmilk--it is diseased, it is toxic. The media broadcasts this on a regular basis, backed by scientists who often have ties to industries that make money when breastfeeding is ditched. Even many breastfeeding advocates believe without question that hiv is transmitted through breastmilk. Research has never proven this but this premise is now written in books like a fact. Why? What industries win because of this belief? Knowledge is what is lost with intellectual property rights.

Patenting does not stop breastfeeding but the knowledge restriction that is and has occurred means that in the US there is little understanding of the value of breastfeeding and human milk. The infant formula/pharmaceutical industries (almost one and the same) understand fully the value of breastfeeding and own alot of the patents on human milk (synthetically produced through genetic engineering). That information becomes a closely guarded secret. Thus hiv-postive mothers will use infant formula with human lactoferrin and take supplements with human lactoferrin in treatment of hiv/aids. They will never know that the component used in the formula and in the supplements are based on human milk research. They won't ever question why they were told they couldn't breastfeed their infants. And neither does the breastfeeding community because there are patents/products/profits to be made. Knowledge empowers people, secrecy creates a manipulated society.

Copyright 2008 Valerie W. McClain

****************************************

After rereading this post from 5 years ago, I feel the need to clarify the US Government Patent and Trademark's definition of a patent, "A patent is an intellectual property right granted by the Government of the United States of America to an inventor, 'to exclude others from making, using, offering for sale, or selling the invention throughout the United States or importing the invention into the United States,' for a limited time in exchange for public disclosure of the invention when the patent is granted."
http://www.uspto.gov/patents/index.jsp

A trade is made.  The inventors and/or owners of the patent obtain a monopoly in exchange for public disclosure.  Very few people in the general public read patents The patents are legally complex, and require a knowledge of science in various disciplines.  Large sums of money are needed to maintain and legally defend the patent.  A system of monopolization, particular when it pertains to patents on life, impacts society in many ways.  Secrecy is easy when the legal and scientific language is incomprehensible to the average citizen,  It is a secret because we can only understand it through the guidance of the experts.  And the experts are usually those who stand to financially benefit.  Patents on life destroy traditional knowledge and values and replace it with a commercialism that benefits a select few.
Copyright 2013  Valerie W. McClain

IBCLCs & intellectual property rights

photo by Jessie McClain

Like all professions, international board certified lactation consultants (IBCLCs) have a code of ethics. The 25th and last tenet states, "Understand, recognize, respect, and acknowledge intellectual property rights, including but not limited to copyrights (which apply to written material, photographs, slides, illustrations, etc), trademarks, service marks, and patents." I am fascinated by this tenet. Why is it a necessary ethical code for this profession? Who proposed this tenet? We already have copyright laws. Why intellectual property rights (IPRs)? Whose IPR's do we acknowledge? USA? Australia? Japan? European? Canadian? World? Why is an international organization asking its profession to respect the monopolization of ideas? Breastfeeding is about preserving a tradition, our human heritage. Yet, a profession devoted to preserving breastfeeding, is requiring its members to acknowledge the monopoly rights of companies like Prolacta, who are placing claims on a "standardized" form of human milk or Medela's claim to a human milk fortifier. Even worse, our code of ethics means we must respect Nestle's claims to components of human milk. There is a long list of various companies and various claims on human milk and/or its genetic constructs. What ethical right do corporations have making such claims of ownership? And how are we to understand the rights of the US government making similiar claims?

Where are the educational courses or Breastfeeding Conferences on this subject? The topic of human milk patenting was banned on a professional listserve. So we are to acknowlege patents but not discuss them. How does one recognize and respect something, when one is ignorant of their existence? It is the catch-22 of a profession.

There are some people who believe that IPRs are a "coercive tool," the "privatization of knowledge," and a way for "corporations to control food and health." [well-known activist, Vandana Shiva of India] Breastfeeding is independence, a tradition, our inheritance. It is about feeding a baby without dependence upon the baby milk industry and less dependence on the medical industry. Yet as the claims on human milk stack up, breastfeeding is becoming a lost tradition. We value human milk but not breastfeeding. We value the product because it can make money. But not the human connection. The excitement about the patenting of human milk should be tempered with the reality that this is about control of a natural resouce, breastfeeding. Control means keeping people ignorant of the corporate interest in human milk.

Copyright 2008 Valerie W. McClain :)

HIV & Breastfeeding--part 8

photo by Jessie McClain

"Although humans are at continuous risk of infection by microbial pathogens, most survive these repeated onslaughts by mounting rapid responses that utilize a variety of antimicrobial proteins and small polypeptides."

This quote is from a patent filed by Agennix, a company in Texas that genetically engineers human lactoferrin (a component of human milk) for use as an antibiotic. The patent was filed in 2002 and called "Antimicrobial/endotoxin neutralizing polypeptide." Those who synthetically manufacture or genetically engineer what is made naturally in the body, seem to have lost hope that nature will resolve the infection. In fact we seem to live in a society that believes that nature doesn't work right or fast enough to suit the needs of a modern world. We imitate a small component of the natural world and make lots of it. Of course, nature does not work that way, so there is always repercussions.

For centuries prior to the manufacturing of baby milks, breastfeeding meant survival. We have always lived in a world teeming with microbes/pathogens and the survival of our young was dependent upon a mother's ability to breastfeed her babies. With the manufacturing of baby milks, the need for a sterile environment becomes critical for the survival of the infant. Baby milks have to be sterile liquids--without life. Survival of humanity becomes dependent on a world without living microbes/pathogens. And there are repercussions. The human body was designed to survive among microbes. Sterile environments mean that the human body does not work optimally. Prebiotics and probiotics are now being marketed because antibiotics in the body create a sterile environment ripe for the next pathogen. Medical science has begun to realize that it is the beneficial microbes that create health. When we sterilize our environment, we kill the pathogens but we also kill the beneficial microbes. Breastfeeding is designed to selectively target the pathogens in the mother/baby environment while building a beneficial microbial environment in the gut of the infant. There is no sterility, no lack of life. The use of infant formula is premised on the belief that man can create something as good or better than human milk and that breastfeeding is unnecessary in a wealthy world. We will liberate women from being slaves to their bodies. Interestingly, men are never interested in being liberated from the slavery of their bodies. But we, women, need to be liberated from our bodies--from birth, from breastfeeding. We will let men design and create birth and nutrition for infants. We will let institutions bring up those infants and this will create a better world. Let's look around us and see the ramifications of this belief (few births in the US are without interventions, few babies are exclusively breastfed and more and more children spend enormous chunks of time without either parent). I see alot of mentally and physically unhealthy children. What do you see?

Our society believes that we can do without breastfeeding and that we can export that viewpoint to other countries around the world. Medical science thinks the solution to pathogen/hiv transmission from mother-to-child is to prevent breastfeeding. Should we be surprised about the number of infants of hiv-positive mothers in Africa who died while being formula-fed versus the survival of infants exclusively breastfed? We believe that if we could eradicate poverty, then formula feeding would be safe. But is that a truth?

Copyright 2008 Valerie W. McClain

HIV & Breastfeeding--Part 7

I thought I'd dedicate this post to a couple of websites that give alternative views on hiv/aids. These websites have a wealth of information, lots to read and digest. I will be happy to add websites on alternative views. These two websites will keep you busy for months. One can read a variety of articles, listen to authors-podcasts. David Crowe's website has a fascinating clip from Oprah's TV talk show (from early 90's). The show was on several people who had been misdiagnosed as having hiv/aids. There lives were turned upsidedown. One man despite the knowledge that he was hiv negative continued to take hiv meds. Oprah talked about the power of belief. I think she was looking at it from a different perspective than I. But the power of belief has enormous effect on one's behavior. The man believed his initial diagnosis because he had all the supposed risk factors. When he started his meds, he got very sick. The meds he took to save him from a disease he didn't have, damaged his body. His sickness developed because of the drugs not a disease. Mentally, he believed the first diagnosis. He believed he was going to die because he was told by the health profession to prepare to die. Belief can kill. Like voodoo.

His story reminded me of a health professional who told me that they knew by looking at someone whether they had hiv/aids. They didn't need the test, they could tell by looking at them. This is someone I considered to be compassionate and a well-trained professional in the health care field. I was shocked by this admission. Science? Knowledge? We know your disease by looking at you and we know that you are going to die---well, yeah that's right on, we are all going to die, we are born to die. But health care professionals know when?? I guess its like the when regarding birth. If ya manipulate birth enough, you know when because you have the knife and the drugs. Same holds for disease and death, give someone enough drugs they usually get sick and die sooner than later.

Here's two informative websites on alternative views to hiv/aids:

http://aras.ab.ca

http://rethinkingaids.com