Reason # 13 Why Breastfeeding is the NUMBER ONE Public Health Issue - Breast Cancer
September
24 ,
2009
I know that some readers might think that my claim is a bit preposterous. I mean, maybe breastfeeding is an important public health issue, but number one? Isn’t that a little extreme?
Well, I hope that the skeptical one’s among you are still reading, because I will convince you, so hang in there and read on.
I am now going to focus on the benefits of breastfeeding to the Mom, and my first topic is breast cancer.
According to Cancer.org, there were 178,848 cases of breast cancer diagnosed in 2007. Around 40,000 women die each year in the US from breast cancer. What kind of effect would increasing the rate of breastfeeding have on this incredibly large number of women who suffer from this terrible disease?
According to an article in the Lancet in July 2002, it was estimated that if the average women would have as many children as they did in previous centuries (around 6+ children), and they breastfed for 24 months as they did in previous centuries, that the incidence of breast cancer would be decreased by around half!
Now I don’t suppose anyone would expect us to encourage women to have 6+ children or breastfeed for 24 months these days, so let's assume that if we could increase the breastfeeding rate from 60% to 95 % that we could reduce the rate of breast cancer by only 10%.
That's 17,000 cases of breast cancer saved, and 4,000 liver saved per year!
Are you convinced yet? If not, stay tuned for the next reason, # 14, cardiovascular disease.
A Short Break to Talk About Pressuring Moms to Breastfeed
September
23 ,
2009
I was referred by some of my readers to some lively articles and blogs regarding the pressure that some Mom's get to breastfeed, and the guilt that many who decide not to breastfeed are forced to experience by the "pro-breastfeeding" crowd.
Check out this article in the Atlantic entitled, "The Case Against Breastfeeding", and this great blog discussion on postpartum progress. These are just some examples, and I'm sure that any of you that are interested can find thousands of similar discussions, both online and in other venues, and I think it is very important for me to say something about it.
It is my job as a physician to evaluate the medical evidence, and to present it to my patients in as unbiased and non judgemental way as possible. My patients depend ion me to be honest with them. If I prescribe a medication, a treatment course, or a surgery, it is my responsibility to be as honest as i can about the possible risks,side effects, benefits, and alternatives.
If I purposely withheld information from my patients because I was afraid of their reaction, they would be rightly upset at me, for I would not be doing my duty as a physician.
I fully understand that there are SOME women who have legitimate reasons for not breastfeeding their baby. I never judge my patients or anyone, nor do I ever want to make someone feel guilty about their decision.
However, I do sincerely believe that if more women really understood the health benefits of breastfeeding, that many many more would make the extra effort to do it.
I also believe that as a society we should make the effort to make breastfeeding more socially acceptable and easier to do. I have been saying all along in this blog that I want to increase the breastfeeding rate from 60% to 95%. That leaves out 5% for those people with legitimate reasons for bottle feeding their baby.
95% is my own statistical goal, but I think it is reasonable. If we all got together to help our Moms breastfeed (that includes Dads!), and we were all supportive, we would make a culture that breastfeeds their babies, and a healthier culture overall.
Those few Moms who can't, should be supported in their reasonable decision, guilt doesn't help anyone be a better mother. But their decision should be an informed decision, based on the scientific facts. This is what this blog is for. I am trying to inform my readers of the true benefits of breastfeeding.
Next post I will resume my quest to prove why breastfeeding is the number ONE public health issue of our time. We are only half way there, so hang on!
Reasons # 9,10,11 & 12 Why Breastfeeding is the NUMBER 1 Public Health Issue
September
18 ,
2009
So we continue with our quest to prove our contention that breastfeeding is the number one public health issue of our time. Today I will complete the discussion of the infant benefits of breastfeeding with a number of benefits that the child gets from breastfeeding. Like my last post, there aren’t good numbers and statistics for me to analyze, and these are only slight associations and some remain a little controversial. Still, keep in mind that even only a small benefit can have a major public health impact if you multiply that small impact by the millions of babies that are fed by their mother’s formula every year.
So let's start.
Reason # 9 - Cognitive development. Several studies have confirmed that babies that breastfed are on average more intelligent then babies that are formula fed. Now this of course does not mean that formula fed babies are not smart. Please do not misunderstand this finding. It just means that on average, when analyzing thousands of people, the breastfed children are slightly more intelligent. I must admit that some studies have questioned this finding; however, there is enough evidence available to at least concede that there is a good chance that it is true.
Just think about the impact of an increase in the average IQ of the population of the US!
Reason # 10 - Visual function. At least in preterm infants, it has been proven that visual function is improved and retinopathy (a disease if the retina of the eye that preterm infants can get) is decreased. This may not extend to full term infants. However, considering the increase in preterm birth in recent years, this can also have a significant impact on public health.
Reason # 11 - Future cancer risk. Breastfeeding has been associated with a reduction in the overall risk of childhood cancer as well as lymphoma and leukemia. Additional studies have demonstrated reduced risk of all childhood cancers in children that have been breastfed. This benefit of breastfeeding should be enough on its own to convince anyone to breastfeed their child. It is science, not propaganda.
Reason # 12 - Hearing function. At least in preterm infants, hearing function matures faster in breastfed infants.
Although I could continue with more benefits to the child of breastfeeding, I would like to move on to the myriad of MATERNAL benefits in my next group of posts, so stay tuned for Reason # 13 - reduction of breast cancer risk.
Reasons # 7,8 Why Breastfeeding is THE number one public health issue of our time - Urinary Infections & sepsis
September
16 ,
2009
Today we continue with our series, and I will group a few advantages of breastfeeding into one blog post. These are all problems with a low incidence to begin with, and the evidence is not extensive enough to "run the numbers' as I have attemtpted to do in my previous posts. Nonetheless, the evidence is there, and these simply add more reasons to the accumultaiong body of evidence to convince you that breastfeeding is the number one public health issue of our time.
Reason # 7 - Studies support the findings that breastfed babies are less likely to have urinary infections than babies that are formula fed.
Reason # 8 - Incidence of infection in the blood (sepsis) is less among babies that are breastfed
If you are still not convinced, wait for the next post for reasons # 9,10, 11, and 12. Cognitive development, visual function, future cancer risk, and hearing function. I hope the crowd of skeptics is diminishing rapidly, but I haven't even started listing the maternal benefits of breastfeeding yet!
Reason # 6 Why Breastfeeding is the NUMBER ONE Public Health Issue - Ear Infections!
September
11 ,
2009
Acute otitis media, otherwise known as "ear infections" is the most frequent diagnosis in sick children visiting physicians' offices. In 2000, it was estimated that annual expenditures for the diagnosis of otitis media totaled approximately $5 billion in the United States; 40 percent of these costs were for care of children between the ages of one and three years. Analysis of data from a 1992 national survey indicated that 30 percent of all antibiotic prescriptions for children were for the treatment of otitis media.
Between 60 and 80 percent of infants have at least one episode of an ear infection by one year of age, and 80 to 90 percent by two to three years. The highest incidence of ear infections occur between 6 and 24 months of age in the United States. It is estimated that there are about 24 million visits each year for this diagnosis!
It has been shown that the incidence of ear infections can be reduced by about 20% in children that are breastfed. So let's go with our crude mathematics again.
If we increase the number of children breastfed from 60% to 95%, that's a 35% increase. 35% of the 5 billion dollars spent is 1.75 billion dollars. 20% of that is 350 million dollars saved! Take that to the bank! And it's free!
That same math applied to doctors visits amounts to 1.68 million doctors visits saved!
If you are still not convinced that breastfeeding is THE most important public health issue of our time, stay tuned for tommorrow's reason # 7 - Urinary infections!
Reason # 5 Why Breastfeeding is the NUMBER 1 public health issue - Respiratory Illness
September
09 ,
2009
So, we move on to reason # 5 today. We are now discussing the benefits to the breastfed infant that are beneficial while he/she is being breastfed, and the illnesses that can be prevented by breastfeeding.
The following are the findings of several scientific studies:
Breastfed infants have 26% risk of developing respiratory illness during the first 3 months of life, compared to 37% for formula fed infants
Wheezing is reduced in breastfeeding infants (see our previous discussion on asthma)
Breastfed infants are .6 times as likely (close to HALF as likely) to be hospitalized for respiratory illnesss over formula fed babies in the first year of life.
I for some reason am having a very hard time finding good statistics for the number of hospitalizations per year for children with respiratory disease. So I can't impress you with my questionable but impressive mathematics today. However, look at the statistcis I just wrote, and just imagine the public health impact of 11% less infants with respiratory disease under 3 months old, and almost HALF as many hospitalizations under one year of age.
Add that to the stats you've already seen on this blog, then tell me you're not yet convinced that breastfeeding is the NUMBER ONE public health issue? If you're still a skeptic, hang on for tommorrow's reason # 6: ear infections (otitis media)!
Reason # 4 Why Breastfeeding is the Most Important Public Health Issue - Gastroenteritis
September
08 ,
2009
Today we continue explaining why breastfeeding is the single most important public health issue of our time.If there are still skeptics out there, keep reading this blog. Today i will start speaking about aan entire constellation of benefits that all fall under the category of prevention of illness during breastfeeding. This is different from the previous three reasons which concentrated on long term benefits to the child who is breastfed.
It is a well established scientific fact, that babies that are breastfed are less likely to get ill, less likely to be hospitalized, and when they are hospitalized, it is generally less severe, and they stay less time in the hospital. This includes everal different types of health problems, and we will review some of the main onesover the next few days, starting with gastroenteritis.
According to recent data, gastroenteritis in children accounts for approximately 1.5 million outpatient vists each year; 200,000 hospitalizations; 300 deaths, and 9% of all hospitalizations in children < 5 years old. The evidence is solid that breastfeeding protects babies from this disease. One study showed that rates of gastroenteritis were reduced from 16% to 3%, another showed that days of diarrhea in the first year of life were reduced from an average of 7 to 3 days in breasfed babies, another showed a reduction in hospitaliizations for gastroenteritisat approximately HALF of the rates for formula fed children.
Now let's do some admittedly very crude math, I don't know how many of those 200K hospitalizations were babies of breasfeeding ag, but let's just say for arguments sake that it is about one fifth. That makes about 40,000 hospitalizations, if we increased the breasfeeding rate from 60% to 95%, that would mean 14,000 more breastfed babies in that group. If the risk reduction is about half, that saves 7,000 hospitalizations per year! No small feat! And this says nothing of 1.5 million outpatient visits! And doesn;t include the decreased length of stay forthe breastfed babies who are admitted!
Tommorrow we will continue with the illnesses in babies that can be prevented by breasfeeding, and we willtalk about reason # 5 why breastfeeding is THE MOST IMPORTANT PUBLIC HEALTH ISSUE - Respiratory disease. Please skeptics, if you are still out there, hang on for the ride, you will be convinced.
Reason # 3 Why Breasfeeding is the Most Important Public Health Issue - Allergic Diseases and Breastfeeding -
September
06 ,
2009
Today we venture into reason # 3, but I must apologize in advance to those readers who like numbers and statistics. Today I cannot provide you with such statistics, because the studies relating to these topics don't give many reliable numbers to work with. However, that doesn't make today's point any less valid.
We've already shown what kind of public health impact higher rates of breastfeeding would have by decreasing the rates of childhood obesity and diabetes. Now it is time to move on to the allergic diseases. These include an entire collection of disorders that are characterized by hypersensitivity reactions to various allergens to be found in the environment. These include food allergies, asthma, and atopic dermatitis (skin sensitivity to various skin irritants).
The evidence is pretty solid that exclusive breastfeeding for at least three or four months reduces the risk that the child will develop the following problems; atopic dermatitis (skin allergies), recurrent wheezing in first six years of life (often diagnosed as asthma), and the incidence of allergy to cow's milk.
Other problems, such as food allergies in general and asthma beyond six years is still a bit controversial.
So let's just add this fact to the statistics we have been quoting the last two days for diabetes and obesity. I don;t have good numbers to play with when it comes to the true incidence of these problems and how much we could reduce it with breastfeeding. But the fact still remains that LOTS of kids and families would be saved LOTS of aggravation if only we could increase the breastfeeding rates.
Tomorrow's Reason # 4 - Multiple Illness Prevention while breastfeeding.
Breastfeeding and Public Health Reason # 2 - Diabetes
September
04 ,
2009
Let's continue with the reasons why breastfeeding should be the number one public health issue of our time. We are taking apart the infant benefits first, and then we will analyze the maternal benefits second.
Yesterday we spoke about what could be gained by increasing the rate of breastfeeding in terms of childhood obesity. It is well known that obesity increases the risk of developing Type 2 diabetes. So it should come as no surprise that if we increased the rate of breastfeeding in the US, we would decrease the rate of type 2 diabetes.
However, the following may surprise you. There is another type of diabetes that has nothing to do with obesity at all, and that is type 1 diabetes. This is caused by an autoimmune disorder which attacks the cells in the pancreas that make insulin. So what does this have to do with breastfeeding?
Hold on to your seats! Studies demonstrate that the risk of developing type 1 diabetes is decreased as well in children who breastfeed! The exact mechanism is unclear, but the relationship has been established. According to several of these studies a breastfed baby is about HALF as likely to get type 1 diabetes as a baby who is not breastfed.
About 2 out of every 1,000 children under the age of 19 in the US have type 1 diabetes. That means that out of 61,000,000 children in the US about 122,000 children have type 1 diabetes. If we increased the breastfeeding rate from 60% to about 95%, according to my crude mathematics, we could prevent about 25,000 cases of Type 1 diabetes. And that doesn't even include the Type 2 diabetes that we're preventing as well!
How many public health interventions do you know of that could prevent 25,000 kids from getting diabetes?
Are you still not convinced that breastfeeding should be THE number one public health issue in the US? If not, stay tuned and READ ON!
Tomorrow’s topic: Allergic Benefits of breastfeeding
Breastfeeding and Public Health - why is it not the BIG issue?
September
03 ,
2009
So I think I've found my big issue to discuss this month, and I will follow a similar format to last month when I discussed the reasons for the rising c-section rate in the US.
I must give credit to my twitter followers for this idea, but I will tell you right away that I have always had this idea brewing in my mind to make my case for it. The topic is breastfeeding and public health. Now breastfeeding is of course a very personal decision, and something that every woman needs to decide on her own whether to do it, how long, and what resources she will use to help her out. I strongly support the decision of virtually every woman, with VETY few exceptions, because it is very clear that breastfeeding is healthier for Mom, baby, and society at large. That is indisputable.
However, I would like to take a different angle, and that is the incredible impact breastfeeding has on general public health. In this month's series, I will argue, that very possibly, the single most important public health issue of our time could very well be the promotion of breastfeeding. The only possible exception that I could think of, is maybe smoking prevention as a public health issue.
So maybe you think I am a nut, well, you have two choices. You can ignore the rest of this month's blog, and go on thinking I am a nut. Or you can read this month’s blog, and maybe you will learn some incredible things and find out that I am on to something.
So take a deep breath, get ready, and let's go!
Here goes reason # 1 why breastfeeding is an important public health issue:
Reduction of childhood obesity.
According to the National Health and Nutrition Examination Surveys; 17% of children aged 6-11, and 18% of children aged 12-18 were considered obese in the years 2003-2006. This compares with 4-5% in the years 1963-1970. It is an established fact that the risk of adult obesity is much higher when a child is obese. Exactly what percentage of obese children go on to becoming obese adults is not clear, but the high risk is well established.
The relationship between obesity and diabetes, hypertension, and numerous health disorders including cancers like breast cancer is also well known, and it is beyond the scope of this blog post to go into the details.
So if we could reduce the rate of childhood obesity, it would follow then that we could reduce the rate of adult obesity and all of these health problems, right?
If we found a simple intervention that could reduce the childhood obesity rate, what kind of repercussions would that have for the health of our entire society? I am not talking about a mass exercise program, and I am not talking about an anti snack machine in school program, I am talking about breastfeeding, yes, breastfeeding.
Numerous studies have confirmed that children who are breastfed are less likely to be obese than children who are not breastfed. I will not list them here, but feel free to ask me privately if you want references. If you analyze most of the studies in layman's terms, you will find that a reduction of approximately 5-10% in childhood obesity could be obtained if all children were breastfed. I admit that this is a crude analysis, but if you look through the numbers, you will find that this is pretty accurate.
Now let's assume that you can increase the breastfeeding rate from 60% of women to 95%. Would it be an exaggeration to assume that we could reduce the childhood obesity rate by let's say 3-4%. How many children would that be? There are approximately 61 million children in the US. That means that there is about 10,370,000 obese children, based on a 17% obesity rate. If we could reduce that by 3%, that's 311,000 less obese children! Not bad, that's about the entire population of the city of Cincinnati Ohio!
Now I am not a mathematician, and if I am all wrong please correct me, but at least you must concede that I am on to something. And we've only just started! We have a whole month to go of reasons why breastfeeding should be a number one public health priority! Trust me, if you're not convinced yet, you will be.
The Gardisil Controversy - To Vaccinate or not to Vaccinate?
September
01 ,
2009
So, welcome to the new month of September. We are now moving on to a new topic, in fact this month I think I will be dealing with several new topics. I must thank my twitter followers (to follow me, click www.twitter.com/askmyobgyn) for suggesting this topic. The big question is, Gardisil, good idea or not a good idea.
Those of you that know me and that have been reading this blog, already know that I am decidedly NOT a conspiracy theorist. I believe, naively, that the people involved in the Gardisil controversy are all well meaning, and they all think they are right. I do not, and I will not ever, start accusing people of cover-ups, nor will I start talking about the nefarious motives of those money hungry pharmaceutical companies. I won't do it. So if that is what you are looking for, read some other blog, there's plenty out there.
On the other hand, I would like to discuss with you some real medical debate about risks, benefits, and good vs. bad ideas.
So here goes. Gardisil, most people agree, is a good idea. Charlotte Haug, M.D., PhD one of the leading gardisil critics (and you'll hear more about her criticisms in a minute) writes, "The theory behind the vaccine is sound: if HPV infection can be prevented, cancer will not occur".
Gardisil also works, the evidence is very good that the overwhelming majority of those vaccinated are protected from the four HPV types that the vaccine was designed to prevent,.
So what could be the problem.
First let's discuss adverse events, so that we can place this in context. Adverse events will happen with any and every intervention that has ever been invented, and probably will always occur with every future discovery as well. So the fact that adverse events can occur, should not be a deterrent from trying to discover and promote a new drug. The question is though, How many adverse events, and how severe will they be, and conversely, how much benefit is there to the drug that outweighs that risk? This is the bottom line. Not whether or not adverse events happen, but what are the costs versus the benefits.
So what is the data about adverse events? Well, according to the US Vaccine Adverse Events Reporting System (VAERS), 12, 424 adverse events were re[ported between June 2006 and December 2008. Of these 772 events were reported as serious, and 32 were reports of death. This is out of 23 million doses given. There is no place here to review the exact details, but let's just use these numbers for now.
Depending on how you look at it, these numbers can be seen as verifying the safety of the vaccine or otherwise, but let;s look at risk vs. benefit. If we can prove that for those 32 million doses of the vaccine, that more than 32 cancer deaths would be prevented, then we could say, that the vaccine in general, as public policy, was a success. Even an individual could tell themselves that there is a greater likelihood of having your life saved by the vaccine than there is to have your life lost due to the vaccine.
So how many cases of cervical cancer will be prevented by Gardisil? Well, there is simply no way to prove that, because we won;t know this answer for at least thirty years! many of those cases we are preventing, would not have happened for quite some time. So we don't know just how the vaccine will effect death rates from cervical cancer for a long time. However, advocates of the vaccine will say that 70% of cervical cancers are caused by HPV 16 & 18, and about 4,000 women die of this cancer every year. If 70% of these deaths were eliminated by the vaccine, that is a savings of 2,800 lives every year, for only a small number of vaccine related deaths!
So it sounds like the vaccine is a great idea. The only problem is as follows. Women that get the vaccine still need cervical screening with pap smears because of the other types of HPV that are not included in the vaccine. It is well known that pap screening has been very effective in reducing the rates of cervical cancer. By simply improving the pap screening that we NEED TO DO ANYWAY, we can probably save those lives without the vaccine. Remember that even women that got the vaccine still need pap smears, so its not like we are saving them from getting pap smears by giving them the vaccine. So the counter argument is, why bother with the vaccine?
I hope I made this argument clear to you, I admit that it can get a bit confusing, but it is very important. Let me end today's discussion by telling you that I personally do strongly recommend the vaccine to my patients, simply because it does vaccinate them against HPV and it could save their lives. It also protects you from genital warts, a nice added benefit. But I do recognize that this debate has some good arguments on all sides. By ALL means, remember to get regular pap screening. If you argue that you shouldn;t get the vaccine, and then you don't show up for pap smears, your life is in your own hands.
If you want to see a great article about this debate, check this link on Medscape.
