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Breastfeeding improves IQ – now have we got your attention?

Research published in JAMA Pediatrics this week shows a causal relationship between breastfeeding and higher IQ by the time a child is seven years old. Put simply, longer breastfeeding appears to make…

New research shows breastfeeding leads to improved language receptiveness at age three. Tom & Katrien/Flickr

Research published in JAMA Pediatrics this week shows a causal relationship between breastfeeding and higher IQ by the time a child is seven years old. Put simply, longer breastfeeding appears to make for smarter children.

This is just another piece of scientific proof of the wonders of breastfeeding. Its benefits for gut development and immunity have been widely reported, but studies looking at breastfeeding’s effects on brain development have so far been poorly designed, showing only weak positive effects.

The new research shows breastfeeding leads to improved language receptiveness at age three. And higher verbal and non-verbal IQ at school age.

The research

This is a well-designed observational study and the latest in a line of countless other studies showing benefits for the “long-term” breastfed baby, compared to formula feeding or short-term breastfeeding.

And it’s a vast improvement on previous studies because the authors have adjusted their results for factors that are known to influence child intelligence. Maternal intelligence, for instance, and the developmental stimulation received in the home environment. In other words, the authors have independently examined the effects of breastfeeding on child intelligence.

The study didn’t simply compare babies who were “ever” breastfed to those who were “never” breastfed. The author asked whether babies were being breastfed at six months and 12 months, thereby accounting for the effects of partial versus exclusive breastfeeding.

At age three, the children had a 0.58-point increase in language comprehension (listening and understanding what is communicated) tests for every additional month of breastfeeding.

By the age of seven, every additional month of breastfeeding resulted in a 0.35-point increase in verbal intelligence (ability to analyse information and solve problems using language-based reasoning) score and a 0.29-point increase in non-verbal intelligence (ability to analyse information and solve problems using visual, or hands-on reasoning) score.

Definitely worthwhile

It may seem obvious that providing our young with the nutrition that has evolved over thousands of years to support their growth and development will result in greater brain function, immune function, and so on.

But studies like these are important because the majority of the population is not heeding their results. In the latest Australian Bureau of Statistics Report (2003) – 87% of infants were breastfed at birth, but this had fallen to 48% six months later and 23% by the time they were a year old.

The National Health and Medical Research Council recommends exclusive breastfeeding for six months and for it to continue until at least 12 months.

The World Health Organization also recommends exclusive breastfeeding for up to six months and for it to continue alongside appropriate complementary foods until the child is two years old and beyond.

Our closest genetic relatives, primates (apes and chimpanzees), spend about 12% of their lifespan breastfeeding their young. That’s around four and a half years. If we spent the same proportion of our time breastfeeding, we would do so for nine years!

The average time we spend breastfeeding now is one year or about 1.5% of lifespan, which is comparable to what rodents do, even though their brains are significantly less evolved than ours.

One of the reasons women may not be breastfeeding for very long (even though they physically can) is because it is stigmatised. Breastfeeding is discouraged in some public places and some mothers fear the nosey citizen offended by the sight of it, who decides to comment.

Perhaps it’s time to replace television advertisements for infant formula with a national advertising campaign showing women breastfeeding to “normalise” the natural way to feed babies and toddlers.

Breastfeeding represents an incredible opportunity for the human brain (and the body, in general) to reach its full potential. Let’s give our young the best start in life that we can.

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120 Comments sorted by

  1. Thomas Duff

    Postdoctoral Fellow, Forest and Ecosystem Science at University of Melbourne

    Interesting article. JAMA study seems to show a positive association between breastfeeding & IQ - though being a bit of a statistics nerd; their use of the word 'causal' sits a bit uncomfortably with an observational study.

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  2. Sue Ieraci

    Public hospital clinician

    There are many good things about breast feeding, but its benefits, in wealthy societies, are frequently exaggerated. The good studies in developed societies show a small decrease in gastro and respiratory infection in the first year from exclusive breast feeding for six months or more. Other factors - like smoking in the household, exposure to child care or other siblings, have a greater effect than the type of feeding.

    The story is different in the impoverished world, where lack of clean water…

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    1. Valerie Kay

      PhD candidate, public health

      In reply to Sue Ieraci

      Sue Ieraci, I don't know what hospital or health service you work in, but if it has resources and guidelines on breastfeeding I think you should consult them. Otherwise consult the UNICEF baby friendly initiative at http://www.unicef.org.uk/babyfriendly/
      As a health professional, you have responsibilities not to misinform the public, either by presenting untrue evidence, or as you do on breastfeeding, by trying to downplay and undermine the evidence. I also suggest you look at code of marketing of breast milk substitutes ( available on the UNICEF link).
      I'm sorry if I appear heavy-handed about this, as I think your contribution to debates is often interesting (although I don't necessarily always agree with it) however in this case I think your conduct raises real ethical issues.
      There's been a lot of comment on this site about people who oppose vaccination but seems to be less about people who oppose (or in this case subtly undermine) breastfeeding.

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    2. Chris Saunders

      retired

      In reply to Valerie Kay

      Here we go again, attacking the person and not the argument. Sue actually states she encourages breast feeding. You surely must notice she raises some very valid points. If you are going to encourage (sell) women to breastfeed than it should surely be backed up by validated research and the research cited in this article is generally agreed to not quite make the mark. I also doubt the need for women to be sold on breastfeeding. The NHS’ 87% figure for women who begin breastfeeding upon return…

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    3. Genevieve Heard

      Research fellow, Centre for Population and Urban Research at Monash University

      In reply to Sue Ieraci

      Thanks Sue. I think the critical and nuanced approach you offer is just what the discussion around breastfeeding needs. Unfortunately it's such an emotive issue, both for breastfeeding advocates (as comments to this article show) and for mothers. I have been lucky to breastfeed my babies to 12m+ myself but know many mums who have tried very hard without 'success'--and are made to feel terribly guilty by the 'breast is best' message.

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Valerie Kay

      What an extraordinary response, Valerie Kay.

      If you read my post, you will see that I have read the actual research looking at the effects of breastfeeding on infant health - have you?

      You say ''As a health professional, you have responsibilities not to misinform the public.'' I agree. It is for this reason that I take the time to present accurate information, especially in response to an article that is more hype and ideology than evidence.

      I don't feel it is ethical to exaggerate or misrepresent the benefits of any particular approach to health. Do you?

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Genevieve Heard

      Thanks, Genevieve

      I also felt strongly that ''breast is best'' until I read the actual studies, looking at the methodology and data. As I said, breast feeding has some health outcome advantages, all other things being equal, but they aren't large.

      Parenting should not be a contest driven by ideology, competition and guilt. Most people with good intentions are able to be ''the adequate parent'' - which is what most children need to thrive. The fine detail about how to improve on common sense should come from evidence, not ideology.

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    6. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      Ah, the hubris of the clinician who thinks they're a scientist. I'll work on a reply over the next couple of days detailing the 5 or 6 instances in which your lack understanding has led you into error, and explore the possible reasons behind your position, which you quite clearly have.

      Just one obvious (and typical of clinicans) example: you don't understand what standard error is.

      And another, in logic: why would you use the fact that no increase was found in Visual Motor Abilities and Memory and Learning to gainsay the study or the article? That's like crtiticizing a drug which helps only one or 2 symptoms of a multisymptom disease.

      And why the irrelevant discussion of changes over time in IQ analysis?

      Heaven forbid: biological determinism!!

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    7. Sue Ieraci

      Public hospital clinician

      In reply to David Clancy

      Why the relevant discussion about gradual increases in IQ over time? Because this does not correlate with breast feeding trends, and reflects an improving response to testing rather than an objective gradual increase in ''intelligence''.

      Heaven forbid: two !! from the biomedical scientist who pontificates about clinical outcomes.

      If you intend to return, please review the actual studies and leave your ideology and !! behind.

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    8. Peter Elepfandt

      Medical Doctor

      In reply to David Clancy

      Not entirely sure how a "Stats Specialist" can support a observational study being portrayed as proof for causation.

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    9. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Peter Elepfandt

      I would have thought that, as medical doctors, you would know that, in epidemiology and in interventional and case-control studies of this sort, a dose response strongly suggests causation. It cannot prove, because that level of proof is impossible to provide.

      This is exactly the type of evidence that links smoking and lung cancer, and is why tobacco companies used to claim there was no proof of a link. In their case it was meretricious. In your case it's probably just ignorance. But whatever it is, you don't want to be like tobacco company PR men, do you?

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    10. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      "In the study cited, for example, the reported IQ difference for a full twelve months of breast feeding, when the child reaches seven years, is reported as 4.2 verbal IQ points. However, no difference was found in the two other tests that were done: one on Visual Motor Abilities and one on Memory and Learning. In addition, we know that the standard error (margin of error) of IQ tests is about 3.8 - which accounts for almost all of the single difference they found. In addition to that, a large percentage…

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    11. Lewis Rassaby

      logged in via Facebook

      In reply to Chris Saunders

      If you were to rate the need for evidence for breast feeding against the need for evidence to justify formula feeding, what would be your answer? Forget for a moment that the subversion of breast feeding has cost millions of lives world wide or that botulinus has recently infected a batch of formula in Australia. Do you seriously think that breast feeding needs to be justified ?

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    12. Sue Ieraci

      Public hospital clinician

      In reply to David Clancy

      ''This is exactly the type of evidence that links smoking and lung cancer''

      Another misleading statement, David Clancy. The TYPE of study (observational) may be similar, but the quality and quantity of the data are vastly different - as I suspect you know.

      The evidence linking smoking with vascular disease, emphysema and lung cancer is enormous, dramatic, and collected over many years, in all parts of the world.

      The study being touted as convincing in this article showed a dubious, non-clinically-significant result.

      Returning again with only rhetoric and no evidence, it seems to be your post that shows more characteristics of the PR man than the scientist.

      Have you reviewed a lot of the evidence around clinical outcomes from breast feeing?

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    13. Sue Ieraci

      Public hospital clinician

      In reply to David Clancy

      As I suspected, David Clancy, it appears that you haven't read the literature on clinical outcomes relating to infant feeding.

      There's no point analysing just the specific words I used in my post. Why not read the actual literature, including the study that is the subject of this article, and come back with an informed argument rather than just a rant?

      In case you aren't aware, I'm not the only person who thinks that this study has been hyped beyond its actual evidence. Perhaps you also don't realise that evidence is cumulative'.

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    14. Sue Ieraci

      Public hospital clinician

      In reply to Lewis Rassaby

      ''subversion of breast feeding has cost millions of lives world wide''

      This is true in the impoverished world - as I discussed above - but not in our society.

      The objective risks of using formula in impoverished conditions occur in two main ways: lack of clean water means that the solution can be infected, and poverty may lead to dilution and thereby, malnutrition.

      Neither of these issues occur in our society.

      Conversely, in impoverished societies, breast milk can be linked with iron…

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    15. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      Since it is only your 'specific words' that are available to me as an indication of the way you think, they are the things I choose to address. If there is fault with your specific words it is your fault, not mine. If you’d prefer us to work with the vibe instead, state that up front.

      And I choose to address them not out of any sort of righteous indignation, simply out of a sense of outrage at the clear mismatch between the level of pontification in your posts and the intellectual rigour and clarity…

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    16. Sue Ieraci

      Public hospital clinician

      In reply to David Clancy

      David Clancy - if you have, as you say, ''read most of the literature on cognition and breastfeeding'' then please, PLEASE discuss it here, rather than questioning my motivations and tone.

      Contrary to your assertion, cognition IS a clinical outcome. As I discussed above, the best-constructed studies on the clinical outcomes of various methods of baby feeding in developed societies show a modest benefit in the number of minor infectious diseases in the first year of life.

      It's worth quoting…

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    17. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      yet you failed, in your original post, to mention any specific work, along with the other errors you included.

      Nor in your subsequent posts, in the interests of presenting a complete picture, did you feel the need to mention

      http://archpsyc.jamanetwork.com/article.aspx?articleid=482695

      which I'm sure you are aware was a large randomized trial run in Belarus.

      As I'm sure you are also aware, but serially failed to point out, it is impossible practically to run a perfect study in this area, as is well known. However the Belarus study and the one which is the subject of the Coversation article and getting closer and are in this context very good efforts and should not be dismissed, especially by you with your demonstrably tenuous grasp of scientific methodology and analysis.

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    18. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      and you steadfastly ignore the issue of dose response in this study.

      I am happy to acknowledge the limitations of previous studies and that overall they show a small effect or no effect. But they are all limited in a number of serious ways, which is always commented upon. What is interesting in meta-analysis terms is that you almost never see negative effects, which, if there were truly no effect, you would expect to see more often.

      Anyway, once we have acounted for all the obvious possible confounders, what is left? Are breastfeeding mothers just more effective nurturers?

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    19. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Karen Marshall

      Yes, sure. This one is instructive.

      The problem with the prospective studies, which is basically all of them, is that they follow or study women and their offspring who are (or were) either breastfeeders or not and have, for want of a better term, chosen that status. Because breastfeeding is known to be beneficial in a range of areas and therefore the converse, formula feeding is potentially harmful, it is unethical to grab a bunch of soon-to-be-mums and allocate them randomly into BF and non-BF…

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    20. Sue Ieraci

      Public hospital clinician

      In reply to David Clancy

      Great - this is the sort of discussion we should be having - about the nature of the evidence and what it shows.

      "The very well read Dr Sue Ieraci'' has read this study also - not just the abstract copied above, but the actual paper. The authors themselves discuss the limitations of the study:

      ''High interpediatrician variability in the WASI IQ results, however, led to wide CIs around the observed IQ differences (and thus to considerable uncertainty about the true magnitude of the observed…

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    21. Karen Marshall

      Parent

      In reply to Sue Ieraci

      Thanks for the information David Clancy and Sue Ieraci.

      Would I be correct in interpreting the study from Belarus as showing a small correlation in increased language development, but no statistical difference in other tested areas of intelligence? And that this study may also add to the one in the article above whereby the abstract and subsequent media reporting overstates the actual results found?

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    22. Sue Ieraci

      Public hospital clinician

      In reply to Karen Marshall

      That sums it up, Karen Marshall.

      There is also a good summary in the WHO document ''Long-term effects of breastfeeding: SYSTEMATIC REVIEW" 2013 - which can be accessed at http://apps.who.int/iris/bitstream/10665/79198/1/9789241505307_eng.pdf

      Chapter 9 covers ''Performance in Intelligence Tests''. The chapter covers 34 references, discusses the methodological issues, and concludes that

      "This meta-analysis suggests that breastfeeding is associated with increased performance in intelligence tests in childhood and adolescence, of 3.5 points on average. Maternal IQ is an important
      confounder, but it accounts for only part of this association – even among those studies that adjusted for maternal intelligence, breastfeeding was associated with an additional 2.19 IQ points.''

      As I outlined before, the standard error of the tests that make up what we know as ''IQ tests'' is about 3 points.

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    23. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      You just don't listen, do you? Not standard error, standard deviation.

      And this is important, because one standard deviation from the mean encompasses 68% of the population. 2 standard deviations cover 95% and three s.d. cover 99.7%. So an improvement of 3.8 points, or one standard deviation, can take a person from 68% of the population up to 95%.

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    24. Valerie Kay

      PhD candidate, public health

      In reply to Sue Ieraci

      I haven't been able to access this website for some time Sue which is why I haven't replied. I spent ten years researching maternity and breastfeeding, however my research now is on broader topics. However you can get the latest research summaries and guidelines from the WHO and the NHRMC. You obviously feel that you are superior to those bodies, but I don't agree that you are. I also don't understand why you understand why you have this desire to misinform people.
      Just for one example, it is simply…

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    25. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Valerie Kay

      seconded.

      If it looks like a bully and smells like a bully, it is one. Online or wherever.

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    26. Sue Ieraci

      Public hospital clinician

      In reply to David Clancy

      No, David, please stop ranting. Calm down and try to understand.

      I'm not talking about standard deviation, I'm talking about standard ERROR.

      From a paper on psychological tests:
      ''The standard error of measurement (SEm) estimates how repeated measures of a person on the same instrument tend to be distributed around his or her “true” score. The true score is always an unknown because no measure can be constructed that provides a perfect reflection of the true score. SEm is directly related…

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    27. Sue Ieraci

      Public hospital clinician

      In reply to Valerie Kay

      Ms Kay - you seem to have misunderstood again.

      My position is contrary to what you suggest - I don't feel I am superior to anyone - I'm just clarifying what the research of others has shown. The WHO summary is just one of the reviews I have quoted.

      Your alarmist statement that a baby in our society could ''die from lack of breastfeeding'' just serves to illustrate what I am trying to say. Babies don't die from ''lack of breastfeeding'' - they die from infection, dehydration, or, in impoverished…

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    28. Chris Saunders

      retired

      In reply to Valerie Kay

      Kay you return to attack the person, not the issue. Sue has said all along that in the first year of life breast fed babies show a better immunity to respiratory and gastric infections by 2% than bottle fed ones. Even I who am a believer in Gillespie’s sugar poison can get that much. If you really have some facts, some proof, dish them up, otherwise the umpire’s decision will have to be with Sue no matter how many medals you have won; medals impress, but they just don’t register as truth with the…

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    29. Chris Saunders

      retired

      In reply to David Clancy

      Well David from where I stand it seems you mean to do a job on Sue, and tell Sue and the rest of us just how clever you are, but nowhere have I received an indication of just what point you are trying to make, except that Richard of Doll and Peto lung cancer study fame, would probably say the JAMA team are right, the editorial team are right and Sue is wrong, but all without any explanation as to why this is so. For the women like me of no particular quality any new information we receive we take on faith until proven otherwise, and as we grow, as long as it jells with the accumulation of what we have already learnt and experienced and does not outrage that unduly, but at this juncture after a number of exchanges with Sue you have told me nothing. If I sound like a bully, it's because I have a thirst for knowledge, not semantics or a new way to sledge.

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    30. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Chris Saunders

      They're all there to read. I'll recap:

      What is interesting in meta-analysis terms is that you almost never see negative effects, which, if there were truly no effect, you would expect to see more often.

      Anyway, once we have acounted for all the obvious possible confounders, what is left? Are breastfeeding mothers just more effective nurturers?

      Then there's the Kramer study, which I won't re-post, then there's the list of immune modulatory components known as at 2005.

      The appeal about…

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    31. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Chris Saunders

      In general, if you piss a lot of people off regularly, it's not them, it's you.

      Unless you're right all the time. I am not clever and I get things wrong all the time, l but I have some relavant training, and I can tell from Sue's writing where she doesn't understand. And it's not infrequent.

      Go look at her posts in general. Try to find the examples where she acknowledges her errors, or even addresses them. Those that are pointed out as obvious, she ignores.

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    32. Chris Saunders

      retired

      In reply to David Clancy

      I would not attempt to argue your points as it seems to me, Sue has already done so. I am not at all sure why you would be left with the question “Are breastfeeding mothers just more effective nurturers?” Nurture means bringing up, training and fostering. If in this case you mean intelligence in offspring the whole criticism of the article was that this was not a valid finding of the study. Needless to say, I won’t go to all of Sue’s posts, it seems like a fools error as I have come across her from time to time and I do recall a consistency of approach in that she always demanded evidence based medicine along with a willingness to engage which may not have influenced me to her opinion, but certainly influenced me to respect her input. I certainly agree that' In general, if you piss a lot of people off regularly, it's not them, it's you'. By the same token such behaviour judged at its lowest level is a challenge to us to do our best, judged at its highest it compels us to learn.

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    33. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Chris Saunders

      It was a valid finding. Nothing is certain and proof in epidemiology is near impossible. Nowhere did Sue Ieraci acknowledge my repeated point that a dose response is usually sufficient evidence of a causal link.

      A dispassionate approach would have included, even through gritted teeth i suspect in Sue's case, something like "although in this case theere was a dose response so it is an improvement upon previous studies".

      Once you control for all the confounders you can control for (maternal IQ, socioeconomic status, maternal education), what is there left to claim as a possible confounder to explain the positive results instead of breastfeeding? Is it just that breastfeeding mothers are more effective nurturers? And if this is a confounder, then it almost doesn't matter because the effect is the same i.e. improved cognitive development.

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    34. Chris Saunders

      retired

      In reply to David Clancy

      I'm not sure that breastfeeding mothers equates with more effective nurturers. I’m also not at all sure whether we have been all talking about the same thing. But the following is the objective of the study referred to in paragraph one of the article. “Objectives To examine relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years and to evaluate the extent to which maternal fish intake during lactation modifies associations of infant feeding with later…

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    35. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Chris Saunders

      They did the fish part because of another study where the cognition effect of breastfeeding was strongly influenced by a fatty-acid metabolism gene (oily fish have high levels of the fatty acid in question).

      I was going to mention this study as it is very strong evidence that the breastmilk has biological effect in regard to cognitive development. This is because it is hard to imagine an as yet unidentified environmental confounder which would interact with genotype in this way. Sue Ieraci also overlooked this one, but then she was not trying to be dispassionate about this issue, as evidenced by this statement of hers:

      One might wonder why it is worth questioning the value of something as good as ''mothers' milk''. The reason is that women who are unable to, or choose not to, breast feed, should not be made to feel that they are somehow harming their children.

      Good job evidence trumped guilt when designing anti-smoking campaigns.

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    36. Karen Marshall

      Parent

      In reply to David Clancy

      Sorry David Clancy, I'm not understanding your correction of Sue Ieraci here. Was the study showing an improvement of 3.8 IQ points in a part of an IQ test on language or was it showing an improvement of one whole standard deviation? Is improving an IQ score by 3.8 points improving someone's IQ score by a whole standard deviation? I know very little about IQ scores but I thought they have more range then that.

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    37. Karen Marshall

      Parent

      In reply to David Clancy

      They didn't control for paternal IQ? I wonder why?

      Also I'm curious, did the studies you've listed show a dose response? That would mean that the more breastmilk someone receives the higher their IQ wouldn't it? I wonder why the article above didn't discuss that too since it would be a more convincing argument for some sort of causation.

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    38. Valerie Kay

      PhD candidate, public health

      In reply to Chris Saunders

      Because as I said Chris, this is not the focus of my current research, which is why I suggested Sue should respond to the current research summaries. Even if it were my current focus, I wouldn't necessarily have enough time to spend in discussions like this. If you read Sue's latest response to me, you will see that she actually admits there is a significantly increased risk for formula fed infants from gastro- enteritis, even in wealthy countries. Fortunately - for those of us living in such countries…

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    39. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Karen Marshall

      Sorry yes you're quite right. A standard deviation is 15 points so the effect size is modest although the Belarus study measured 7.5 point advantage in verbal IQ, which is a fair bit. Could in theory take someone from the 65th percentile to the (roughly) 75th.

      And in that study, that advantage was for women who had the intensive BF counselling, whether they did end up breastfeeding or not (43% did), so the likelihood is that, if anything, it may be an underestimate.

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    40. Chris Saunders

      retired

      In reply to David Clancy

      So you don't know the fate of the fish either? Apart from the old oily fish/fatty acid ‘thing’ being the miracle ingredient of the day, I have no idea what you mean when you say “Good job evidence trumped guilt when designing anti-smoking campaigns." Quite apart from the fact that anti smoking campaigns were designed to invoke fear, guilt has to do with having committed an offense. I guess you could skew smoking as an offense against yourself, but it is normally perceived as harm against another. To suggest that feeding children formula milk is akin to smoking is a long stretch.

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    41. Chris Saunders

      retired

      In reply to Valerie Kay

      Thanks for your answer Valerie. I can't help thinking you keep getting off the main point. Is the research finding valid as the author claims or is it not as others including Sue counterclaim? That is the issue which is of general interest to this conversation.

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    42. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Chris Saunders

      On the sides of cig packets, from memory, it said 'smoking harms your unborn child' and 'your smoking harms others'

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    43. Valerie Kay

      PhD candidate, public health

      In reply to Sue Ieraci

      Sue from what I can make out here you are suggesting that because test/ retest results for any individual can vary by 2.8, that a difference of 4.2 points between the breastfeed and non-breastfeed children is not significant. As far as I can work out, you are confusing issues about measurement error with issues about statistical significance. The measurement error you are talking about here would not make any difference to the overall results because we would expect the error to be randomly distributed…

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    44. Sue Ieraci

      Public hospital clinician

      In reply to Valerie Kay

      I hadn't intended to continue dragging this out, but Susanne Starke below has asked that I provide a response to this post.

      Let's go back to the paper.

      First, about a third of cases were lost to follow-up, so excluded from the analysis.

      Then the maximum reported test gain was in one small subgroup - seven year olds who had been breast fed for an entire year showed improvement of 4.2 points on a single test within the cognitive tests that make up ''IQ" (the other tests showed no significant…

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    45. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      This is what you were asked to reply to:
      " you are confusing issues about measurement error with issues about statistical significance. The measurement error you are talking about here would not make any difference to the overall results because we would expect the error to be randomly distributed across the whole test population of formula fed and breastfeed infants."

      Please stop ignoring and obfuscating legitimate criticisms of the substance of your posts. In the interests of clarity and education, if those are your primary aims.

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    46. Joy Johnston

      midwife

      In reply to David Clancy

      It is true that the quantum of harm is greater with smoking than with not breast feeding. But the harm of smoking is (usually) to the adult who smokes. Even if there is only a small amount of harm with not breastfeeding surely the onus is on the midwives, and the health system, to do all it can to promote, protect and support breastfeeding. The baby is the innocent recipient of whatever the mother chooses to feed him or her. I reject any notion that a wealthy society can accept a standard that would put poorer people groups at an increased risk of harm.

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  3. Sue Ieraci

    Public hospital clinician

    And here is a different analysis of the same paper:

    http://pediatricinsider.wordpress.com/2013/07/31/does-breastfeeding-improve-the-intelligence-of-babies/
    US Paediatrician Roy Benaroch:
    '' 2 of the 8 tests were positive; but 6 of 8 were not. In the aggregate, this study may provide some support for increased intelligence among breastfed children – none of the tests showed decreased intelligence – but the support isn’t strong, and it isn’t even consistent among the tests.

    But that kind of…

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    1. David Collett

      Sales at https://aussiebuilder.com

      In reply to Sue Ieraci

      That was a well argued comment Sue (and very interesting! ).

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    2. Chris Saunders

      retired

      In reply to Sue Ieraci

      Thanks for your comments Sue. The slant of the article is somewhat hard to cop quite apart from the dubious nature of the research findings it describes. The article implies that women who are perfectly able to breastfeed just plain refuse to in the absence of good reasons. So here’s another even better reason. I find this, probably unintended, message insulting to not only the non-breastfeeding mother’s intelligence, but also her goodwill towards her child. To induce the non breastfeeding mum to feel guilty about something that is usually due to circumstances out of her control is very unfair and as guilt is a very nonconstructive emotion inducing it is not about to encourage good relations with perceived judgmental birthing staff and condemning society. My money was on the iodine in the fish, until I read the result.

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    3. Valerie Kay

      PhD candidate, public health

      In reply to Sue Ieraci

      Sue I have debated this with you before. I seriously do not understand why you persist with these ill-informed and outdated arguments. What can you possibly get out of it? I simply don't understand why you do it. I'm not going to get into debates with you. If you looked at the evidence fairly you would see that there is clear evidence that breastfeeding has multiple benefits for mother and child. Nearly all women are able to breastfeed but many do not get the information and support they need and the sort of misinformation you put forward contributes to that situation. I am seriously disappointed and upset by your behaviour.

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    4. Michel Syna Rahme

      logged in via email @hotmail.com

      In reply to Valerie Kay

      Breast feeding is one of the most beautiful sights, if not the most beautiful. And although that is my opinion, I cannot find in thought any reason why any one could be opposed. In a recent documentary the doctor was explaining how when giving birth the child passes through an area where the bacteria essential for health is delivered to the baby - more so than Caesarian - and that the same essential bacterias were present in breast milk. Although there are no doubt other factors contributing to the overall IQ of each child, I find that the foundations of Sue's argument - which is to devalue the benefits of breastfeeding - comes from a strange place.

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    5. Michel Syna Rahme

      logged in via email @hotmail.com

      In reply to Michel Syna Rahme

      So what should be done Sue: what one would you choose?

      1. Promote the benefits of breast feeding
      2. Promote formula feeding over breast feeding
      3. Promote to mothers that there are no benefits of breast feeding over formula feeding
      4. Do not promote or share any information or research about breast feeding babies because that might upset the small percentage of mothers who cannot breast feed

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    6. Michel Syna Rahme

      logged in via email @hotmail.com

      In reply to Sue Ieraci

      So what should be done Sue: what one would you choose?

      1. Promote the benefits of breast feeding
      2. Promote formula feeding over breast feeding
      3. Promote to mothers that there are no benefits of breast feeding over formula feeding
      4. Do not promote or share any information or research about breast feeding babies because that might upset the small percentage of mothers who cannot breast feed

      less than a minute ago reportReply

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    7. Gordon Smith

      Private citizen

      In reply to Valerie Kay

      Val - I do not think that Sue is arguing against the fact that breast feeding has multiple benefits for mother and child. My understanding is that she is critiqueing the research and suggesting that the conclusion from the study may not be supported by the actual data.
      I have serious misgivings about advocacy research where the conclusion is pre determined and the data is worked in such a way to support it.
      This is very damaging for science and it seems many are happy with bad science if it is for a good cause. This will ultimately damage science and its reputation and trust with the public and I thank Sue for pointing out the potential flaws in this paper.

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    8. Gordon Smith

      Private citizen

      In reply to Michel Syna Rahme

      I would do option 1 - promote the benefits of breast feeding. I havent seen anyone say we should not.
      Given the range and complexity of issues that can affect both the physical and psychological health of a child I would place breat feeding in the "promote it but dont get too hung up on it" (how is that for a scientific term).
      The counter risk of making those who for what ever reason can not or choose not, suffer unecesary guilt should also be factored in.
      Unproven claims such as if I dont breast feed my child will not be as smart risk reinforcing guilt that may negatively impact on psychological bonding.

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    9. Karen Marshall

      Parent

      In reply to Gordon Smith

      Option 5 - give parents all the information on feeding choices and let them decide based upon their and their baby's needs.

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    10. Sue Ieraci

      Public hospital clinician

      In reply to Valerie Kay

      Valerie Kay - you have never really debated this with me, because you either haven;t read the research yourself, or are not prepared to discuss it.

      It is your attitude that appears to be ''ill-informed and outdated.''

      If you are ''seriously disappointed and upset'' by reading about what the actual data show, perhaps you should re-think your values.

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Michel Syna Rahme

      '' I find that the foundations of Sue's argument - which is to devalue the benefits of breastfeeding - comes from a strange place.''

      Sue's explanation comes directly from the evidence found in well-constructed studies in developed countries. That may be a ''strange place'' to some.

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    12. Sue Ieraci

      Public hospital clinician

      In reply to Karen Marshall

      Karen Marshall has it in one. Present the real information.

      In the midst of all this righteous indignation, that's what I am attempting to do.

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    13. Joy Johnston

      midwife

      In reply to Sue Ieraci

      A point that I want to record in this context is that no matter how 'wealthy' our society is, no matter how difficult it is to demonstrate through research an advantage for a breastfed child over the non-breastfed child, breast feeding is the biological norm. No technology or man-made substance has, or will, be developed to replace that norm.

      Another point that is clear to me is that, if it is truly dangerous (as we know it is) for a baby in the developing world to be denied his or her mother's…

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  4. Michael Dwyer

    Misanthropist

    The article reads like it was largely motivated reasoning. I don't know if comparing our breastfeeding habits with apes, primates and rodents is really a great way to reach an informed conclusion.

    To say that a rodent's brain is much less evolved than our's falls into the trap of assuming humans are the pinnacle and end goal of evolution, and is quite naive for someone working in the biological sciences.

    A rodent's physiology is no less evolved than ours; it is merely evolved to different ends…

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  5. Lyndal Breen

    logged in via Facebook

    It saddens me that a positive article about breastfeeding is greeted with so many negative comments. As a mother who breastfed 4 of five children and a grandmother with six grandchildren who were breastfed at least six months, I wouldn't like to claim that there were particular increases in IQ for my children (who have had a range of 'successes' and 'failures' in adult life).
    But if you believe that close contact and maternal focus matter, you will find that the breastfed child will enjoy this this for much longer than the bottle-fed one. Simply by being physically attached, breastfed children are going to hear more adult conversation.
    My non-breastfed child was slipping off my lap and heading off with her bottle by nine months even though I wanted to mimic breastfed attachment as much as possible.

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    1. Gordon Smith

      Private citizen

      In reply to Lyndal Breen

      Lyndal - I dont think people have argued negatively against breast feeding.
      They have argued that this paper may have flaws and these are two completely different things - see my reply to Val above.

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    2. Thomas Duff

      Postdoctoral Fellow, Forest and Ecosystem Science at University of Melbourne

      In reply to Gordon Smith

      Hi Lyndal - I think the comments actually highlight how difficult it is to do this kind of research rather than making any negative statement about breastfeeding itself. You provide a good example; in the study, it is essentially impossible to separate the effects of breastfeeding, maternal focus and being in close proximity to adult conversation (so we can't say which is the true cause of the IQ increase). It would be interesting to follow up to find out why people decided to stop breast feeding at particular times.

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    3. Karen Marshall

      Parent

      In reply to Thomas Duff

      I agree that it would be interesting to know why women are giving up breastfeeding. I know my own reasons and that of other mothers I know, but I haven't really seen them addressed realistically. I would also like to see the discrepancy between the expectations of breastfeeding groups and the WHO (to exclusively breastfeed for 6 months) and that of the advice given to new parents by paediatricians (which is to introduce solid foods between 4-6 months) explained in terms of breastfeeding rates. I wonder whether exclusive rates of breastfeeding are much higher then reported due to this discrepancy (assuming the paediatricians are correct in their recommendation).

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    4. Chris Saunders

      retired

      In reply to Karen Marshall

      Thomas and Karen, in the 8th last paragraph of the article, there is a link to the ABS report 2003 and it shows NHS results for why women stop breast feeding, just scroll down. As mentioned in my previous post, they are largely due to difficulty with the actual process of breastfeeding.

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    5. Thomas Duff

      Postdoctoral Fellow, Forest and Ecosystem Science at University of Melbourne

      In reply to Karen Marshall

      I agree - It would be fascinating to see whether reporting (as opposed to behavior) is influenced by people's perceptions of what they should have done (i.e. expert advice).

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  6. alan freeman

    insurance man

    If I wish to increase my I - is it too late to start?

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  7. Joy Johnston

    midwife

    There are many compelling reasons today for health professionals to promote, protect and support breastfeeding. We have a duty of care to do no harm. Promoting breastfeeding is, to my mind, a no-brainer. (and I don't really care if my IQ would have been higher if my mother had breastfed me longer)

    Almost everyone in our society accepts that 'breast is best' for babies and their mothers.

    The dilemma that midwives face in the brief period of birth and postnatal care in which we are directly…

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  8. Michelle Skurr

    Health practitioner

    I don't understand:

    Why people are so surprised and resistant to this information?

    Why people fight so strongly against parents having access to accurate information about the risks of formula?

    And most particularly
    Why are we stil reporting breastfeeding as the experimental condition and formula feeding as the control?

    The correct interpretation of this data is that babies fed formula have lower IQ than their biologically 'normal' peers (who have been breast-fed).

    Criticism of formula and its effects is NOT criticism of parents who choose, for whatever reason, to use formula. Stop protecting corporation profits and start giving parents accurate information on which to base their decision on how to feed.

    Oh and real, useful support in those early weeks and beyond from health professionals and others who really understand etc. wouldn't go amiss either.

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    1. Chris Saunders

      retired

      In reply to Michelle Skurr

      Michelle, I remember in England in the sixties, a visiting nurse went out to all new mums. It was a difficult exercise fraught by the real perception of threat by the mums and walking on egg shells for the nurse.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Michelle Skurr

      Michelle Skurr - why are you so resistant to discussion of what the data actually show about the effects of feeding type in our society? Is it because it threatens your ideology? And what, exactly, do you consider the ''risks of formula'' to be (in our wealthy society)?

      Families should be encouraged to choose breast feeding and, if they choose it, the mother should be assisted to make it work - so long as the harms of continuing do not become greater than the benefts.

      The benefits are these: a modest reduction in the number of respiratory and gastro infections in the first year of life (for six months or more exclusive BF).

      None of the other purported benefits are supported by good evidence.

      IN particular, the study that is promoted in this article doesn;t show what the author claims it does.

      If you disagree, please tell me which of these statements is wrong, backed up with better evidence.

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    3. Michelle Skurr

      Health practitioner

      In reply to Sue Ieraci

      Hi Sue,
      You seem to be getting a little personal - is that because I threaten your ideology?

      I have read the research, and disagree with your interpretation, probably based in your ideology of course, considering we're only human.

      I'm not actually arguing that families should be encouraged to choose breastfeeding. I believe in true informed consent, parents should have access to accurate information about the potential risks and benefits of each option, personalised to their situation, and…

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    4. Chris Saunders

      retired

      In reply to Michelle Skurr

      Your post confuses me because you say you believe in 'true informed consent' for parents. Breastfeeding is the universal obvious first choice. And one which most women try to make work and only when they fail then turn to formula milk. Your post implies, along with the article, that women are making choices about a favoured feeding source before the event. If that is true, and I sincerely doubt it, one can assume these women in Australia have good reason for that. The fact that the statistics cited by the article state 87% of mothers try to beastfeed, surely points to this being the case?

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    5. Michelle Skurr

      Health practitioner

      In reply to Chris Saunders

      Chris,

      Breastfeeding is the universal first choice because its the ideal. And who wouldn't aspire to be the best parent they can be. But then reality hits, its a learnt skill for mother and baby, and there are many social pressures and lack of support that negatively impact the breastfeeding relationship, expectations and so chance of success. Not least of which is the felt pressure from HPs to see every baby on the 50th percentile of the growth chart and the answer to every breastfeeding hiccup…

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Michelle Skurr

      Michelle Skurr - if you really believe that families should be informed, why do you keep arguing rhetoric rather than evidence?

      I don't see any evidence - and particularly not in my comments, that formula feeding is some sort of ''norm''. What we are discussing is what the relative health outcomes are, and whether the study discussed in this article actually says what the author claims it says. You haven't presented anything that supports any point of view - except your own assertions.

      And any agenda of mine? I think breast feeding is great for both mother and baby, if it works well and both are happy. It's just that I've now read beyond the ''breast is best'' slogans to find that the type of milk doesn;t make a great deal of difference to health outcomes of babies in our society. It makes a bit of difference, but not a lot.

      In impoverished societies, it makes a huge difference. I expect that's why the WHO is so committed.

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  9. Michelle Skurr

    Health practitioner

    I'm going to stop commenting after this, but to use the link provided by Sue Leraci, an alternative interpretation of the study concludes that you could have 3 possible headlines.

    The authors in their conclusion, the JAMA editorialist, and the news outlets are saying that this study is very supportive of the association with increased IQ. They could have chosen any of these headlines:
    1. Tests show improved intelligence in breastfed babies.
    2. Some tests show improved intelligence in breastfed…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Michelle Skurr

      You're missing the most crucial point, Michelle Skurr. The study was not conducted well, and the results don;t show what the author claims they show - no matter what way you try to spin it.

      The only accurate headline would be ''study fails to make significant finding.''

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    2. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to Sue Ieraci

      The title could be something like: "IQ improvements with breastfeeding are likely due to benefits in language development"

      Or more accurately: "IQ deficits with formula feeding are likely due to deficits in language development"

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    3. David Clancy

      Lecturer, Biomedical Science at Lancaster University

      In reply to David Clancy

      These are just the immune modulatory components known as at 2005. But I'm sure they, and all the non-immune-relevant components have no developmental, and therefore possibly lasting, biological effects whatsoever. Sue.

      Anti-microbial compounds
          Immunoglobulins: sIgA, SIgG, SIgM
          Lactoferrin, lactoferricin B and H
          Lysozyme
          Lactoperoxidase
          Nucleotide-hydrolyzing antibodies

          κ-Casein and α-lactalbumin
          Haptocorrin
          Mucins
          Lactadherin
          Free secretatory…

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    4. Sue Ieraci

      Public hospital clinician

      In reply to David Clancy

      David Clancy - you still haven't read the literature on health outcomes, have you?

      Yes - breast milk contains all that stuff. Does that mean that children who are breast fed have much better health outcomes than those who aren't.

      In the impoverished world - yes, certainly.

      In our wealthy society, not much.

      And that's the difference between patient-based outcomes and test-based outcomes.

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  10. Lewis Rassaby

    logged in via Facebook

    When someone says something like 'we are only interested in results' (Sue Leraci)' I always smell a rat. If it were possible to guide public policy and personal decision making by recourse to evidence, life would be simple and rational. It isn't. Evidence is never value free. Not even in the Cochrane library. We need to know where we, as researchers, debators of research, public intellectuals or private commentators are coming from. Thats why contributors to the Conversation make their disclosure…

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    1. David Collett

      Sales at https://aussiebuilder.com

      In reply to Lewis Rassaby

      When someone opens with "Ah, the hubris of the clinician who thinks they're a scientist." I feel uncomfortable they are going to focus on the individual, not the argument. There is no safety in argument to presume the knowledge of the person you are engaging with based on their current title.

      As for the paper in question, I don't have a subscription to JAMA Pediatrics so I will not be able to read it. If Sue is getting something wrong with her discussion of the paper I am sure Hayley would be happy to point out the error.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Lewis Rassaby

      Smiling about the ''prickly conservatism'', Lewis. I haven't had that one levelled at me before.

      Your comment, like David Clancy's, adds to the long list of people expressing righteous indignation without backing up their argument.

      I've read the studies that assess health outcomes in infants in wealthy societies - have you?

      If you've read them, and come up with different conclusions, tell us that studies they are and why your conclusions are different to mine.

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  11. Olivia Hibbitt

    Medical Writer

    I am really disappointed in this article. Since when does observational data show causation? I know that the authors of the JAMA article also assert this, however, I would have expected someone writing for the conversation to be able to read through a rather cynical attempt to make the abstract more appealing.

    This sort of stuff actually harms the good public health message, that breastfeeding is the natural and normal way to nourish an infant. It's studies, and articles about studies, that misinterrpret and overstate results that makes many people turn off. At best the article quoted shows a weak correlation between breastfeeding and certain measured of IQ, falsly trumping up the results achieves nothing.

    Sue Leraci.... you seriously deserve a medal for sticking up so eloquently for evidence based medicine!

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    1. Lewis Rassaby

      logged in via Facebook

      In reply to Olivia Hibbitt

      Are we arguing the merits of the JAMA study or the article by Hayley Dickinson in the Conversation or the value of breastfeeding as opposed to formula feeding generally? This blog is confused. What do you think should be the appropriate public message Olivia? I think it should be that breast feeding should be unequivocally promoted as the desirable norm. You would have to be blind and daffy not to know that the whole question is highly contested by corporates who do not care about health; they…

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    2. Lewis Rassaby

      logged in via Facebook

      In reply to Olivia Hibbitt

      Further:

      Why is it that no one gets a lather up when the most ridiculous claims are made for all kinds of supplements, medicines and the like yet when a modest study even suggests confirmation of what we already know, the knives are out?

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    3. Dan Costa

      Lecturer and Researcher in Psychology at University of Sydney

      In reply to Olivia Hibbitt

      Disclosure: I know little about the effects of breast-feeding (except for the passion the issue arouses), so have no strong feelings one way or the other. I do, however, get slightly het up when claims about research go beyond the evidence upon which they are supposed to be based. This article has an abundance of such claims:
      “shows a causal relationship”; “scientific proof”; “breastfeeding LEADS TO improved language receptiveness”

      And so on.

      Not one of these statements is justified by the results of the research. Perhaps this debate would have been less heated had the author avoided extreme terms that do not accurately represent the research. Then again, the sensationalist title suggests the intention to ignite debate. Personally, I find statements such as “there is evidence to suggest” more compelling, because, unlike absolute claims about causality and proof, there is a real possibility that they are true.

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    4. David Collett

      Sales at https://aussiebuilder.com

      In reply to Lewis Rassaby

      Because we are not at the supermarket discussing a marketing label on some placebo product :)

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Lewis Rassaby

      Lewis Rassaby - you must not be reading very widely.

      The ridiculous claims made for all sorts of supplements and sham therapies is one of the main subjects of my written output. There are many examples on this very site.

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Dan Costa

      Well said, Dan.

      There is also the issue of the way that scientific evidence accumulates. Our understanding of a complex area is rarely changed by a single study - particularly one with evidence as weak as the one that is hyped in this discussion.

      The paper discussed should be summarised by ''more research is needed.'' If a meta-analysis is ever done, this paper might either be thrown out of the analysis, or listed under ''weakly positive'' results.

      One thing at fault here is the tendency for media outlets to pick up and either titles and/or press releases about newly published papers and present them as if they contain concrete evidence. As I said, science doesn't work that way.

      This is yet another example of the advantages of data registries - where all studies with positive or negative results could be accessed.

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    7. Karen Marshall

      Parent

      In reply to Olivia Hibbitt

      Olivia, I agree it is off-putting. The message of breast is best is fine, most new mothers I know are being saturated with this message. For the first child we are putting in extraordinary efforts - constant breastfeeding, lactation consultants, pumping, special nursing lines, shields etc to try and maintain breastfeeding (and I'm not the only one that did ALL of that lot..). It becomes tiring very quickly for those of us that have difficulties with breastfeeding and these efforts quickly become…

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    8. Dan Costa

      Lecturer and Researcher in Psychology at University of Sydney

      In reply to Lewis Rassaby

      Except I wonder how many people read the title of this article and clicked on the link expecting to read about a "modest" study that merely "suggests" anything.

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    9. Olivia Hibbitt

      Medical Writer

      In reply to Lewis Rassaby

      Umm, if you read what I wrote I believe I said that the public health message that breastfeeding is the natural and normal way to nourish an infant is good....but perhaps I am just being daffy, I was adopted so not a drop of breastmilk passed these poor lips!

      I know there are ads for formula, but are you seriously trying to tell me that mothers are so stupid and impressionable that they will see an add for formula and stop breastfeeding? Please.

      Tell me...what should I have fed my twins on when, after a car crash birth, I failed to produce milk for EIGHT days, and when it did come in it was woefully inadequate to feed two hungry babies both of whom had to spend time in special care AND subsequently lost around 15% of their body weight while we were trying to get breastfeeding established...hmmm...perhaps I should have gotten the milk fairies to come by?

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    10. Olivia Hibbitt

      Medical Writer

      In reply to Lewis Rassaby

      Welcome to this website called The Conversation...there are plenty of lathers on here about complementary medicine.

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    11. Lewis Rassaby

      logged in via Facebook

      In reply to Olivia Hibbitt

      I absolutely respect your opinion grounded in those terrible experiences. I meet many people whose experiences are less difficult and respect their decisions about breastfeeding as well. As a GP it is not my job to tell people what to do but having been around in that capacity for thirty years I have not seen much in the way of public health resistance to the messages of the corporates. Parallel to to this has been a withdrawal of funding from organizations like Breastfeeding Australia (the old…

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    12. Lewis Rassaby

      logged in via Facebook

      In reply to Sue Ieraci

      I have no idea whether I read "widely" or not. But if I need to read widely in order to have a sound opinion about breast feeding please tell me. And how widely should I read? I have a feeling that it would never be wide enough!

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    13. Lewis Rassaby

      logged in via Facebook

      In reply to Olivia Hibbitt

      I certainly don't think mothers are stupid or impressionable but neither do I think the advertising industry throws their money away. The ads are smart and seductive. You can see where the talent is on television ( apart from Madmen, Walking Dead and Trueblood); its in the ads. Its a middle class conceit to think we are immune to the effects of ads. They work.

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    14. Sue Ieraci

      Public hospital clinician

      In reply to Lewis Rassaby

      ''Sue Leraci's appeal to evidenced based medicine in this context strikes me as equivocation.''

      I don't get what you mean by this, Lewis (presuming you meant to refer to me - I'm Ieraci not Leraci).

      How is an appeal to evidence any kind of equivocation? To me, the steadfast tendency to ignore the evidence is an equivocation to ideology.

      As clinicians, I agree that it's not our job to tell people what to do, It IS out job, however, to use our expertise to interpret the evidence for people, where it exists. The evidence just doesn't show what some people would like it to show.

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    15. Sue Ieraci

      Public hospital clinician

      In reply to Lewis Rassaby

      Lewis - I said that in response to your assertion that ''no one gets a lather up when the most ridiculous claims are made for all kinds of supplements''. IN fact, many people do.

      How widely should you read about infant health outcomes in relation to feeding? Do a good search on this topic in the developed world, read how the studies were done and what they showed.

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    16. Lewis Rassaby

      logged in via Facebook

      In reply to Sue Ieraci

      Thanks for your advice as to how to read widely! I had no idea.

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    17. Lewis Rassaby

      logged in via Facebook

      In reply to Olivia Hibbitt

      I would like to stick up for EBM. But it is not the Final Arbiter of public policy or clinical practice. I wish it were. Then I could retire and be replaced by a medical version of an ATM. Unfortunately for EBM there is often a problem with 'data in'. Have a look at the HYVET study on hypertension in the very elderly and try and figure if it is a good or bad study. They have been arguing about it for years. It has taken that long to find the flaws in the methodology which the authors managed to opacify in their study. So too with many other studies. Deciding what constitutes good public policy and clinical practice is about bringing together information from clean studies, the caring heart, the sensitive intuition and the lived experience of real people and common sense. These qualities (of knowing) are all deeply intellectual and are not to be surrendered to Cochrane, PubMed or Google.

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    18. Lewis Rassaby

      logged in via Facebook

      In reply to Sue Ieraci

      Wrong!. Its not our job to interpret the evidence, although its in our interest to do so where we can. Epidemiologists and statisticians can do this better. Our job is to care for the sick. That role is informed by EBM but not determined by it. In this argument about breastfeeding it is abandoning common sense to demand the same level of evidence for breastfeeding as for formula feeding.

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    19. Sue Ieraci

      Public hospital clinician

      In reply to Lewis Rassaby

      Lewis - I expect we have the same aims, although we are talking at cross purposes.

      Imagine you were looking after a mother who was exhausted from attempts to breast feed, had added some formula as a supplement, and had found a routine that suited herself and baby, who appeared to be thriving.

      The mother tells you tearfully that she feels terribly guilty that she has failed top exclusively breast feed, as she has been told she may not be giving her baby the best chance. She is devastated with…

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    20. Chris Saunders

      retired

      In reply to Olivia Hibbitt

      My thoughts are with you here Olivia and the 15% loss in body weight for your beautiful twins an unbearable thought and what it must have meant to you trying to do your best by them. I suppose one must accept that the people who were helping you were doing their best, but would it be too unjust to put the arguments of breast feeding advocates into a perspective where they seem to think it ok to starve a child into submission where a mother did not face your particular hardship, had a straight forward…

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  12. Lyndal Breen

    logged in via Facebook

    What a lot of comments on how hard it is for some Mums to breastfeed. It was hard for me too, with my first baby I was told I was 'too highly strung' to breastfeed, encouraged to complementary feed and within 4 weeks, I had no milk at all.The baby had also been 'cot nursed' (introduced to the bottle) for 24 hours before I even held her after a difficult birth. What I am saying is that both my baby and I were primed to the bottle before we even went home from hospital.
    I was fortunate that my second…

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    1. Karen Marshall

      Parent

      In reply to Lyndal Breen

      I thought that there was some research about formula feeding correlating to a slightly higher rate of infections. My youngest spent a night in hospital under observation as an 8 week old with bronchiolitis. He was my formula fed baby. Although admittedly he fared better then the other babies at playgroup (some of which where breastfed and some bottle fed) in that he was only there for observation, never needed oxygen and it was only for one night.

      Your experience matches that of my parents generation…

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  13. Lisa Simpson

    Procrastinator

    Sue Leraci you are one of my favourite people ever!! I love your comments whenever they come up and in this particular conversation you have been at peak performance. Your comments here demonstrate not only careful study and clear understanding of the science but also a huge level of care and understanding towards patients and their needs.
    Your incredible patience in continuing to politely but firmly and persistently rebut the 'hypers' must be so helpful for the well-being of new mothers struggling to breast feed and being scared into believing they are failures cursing their children for life.
    Thankyou for taking the hours from your day to do this!

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Lisa Simpson

      Thanks for your comments, Lisa, and thanks for understanding my motivation.

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    2. Susanne Starke

      logged in via Facebook

      In reply to Sue Ieraci

      I agree with Lisa 100%. I know it's tiring, but would you mind answering to Valerie Kays last post?

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