Whooping cough, also known as pertussis, is a bacterial respiratory tract infection. It begins looking like most other upper respiratory illnesses:

There may be nothing more than a runny nose and sneezing, often with little or no fever. The first coughs can look like a common cold. After 1-2 weeks, this may progress to a stage characterized by bursts of numerous rapid coughs (paroxysms, a “machine gun” cough) followed by a loud “whooping” inhalation, which gives Bordetella Pertussis the alternative name of “whooping cough.” That “whoop,” however is not an invariable part of the illness. A final recovery stage with coughing may last weeks or months. It’s a nasty illness which the Chinese call the “100 day cough” and their number is not far off. In most cases, whooping cough is a truly miserable cough that can ruin a family’s summer plans and mean a lot of missed days of work and school. In very rare cases, it can lead to much more serious conditions. The risk is highest for infants in the first six weeks of life who can get very sick and even die from it.

At the present time, I’m aware of two families in my practice who I believe have pertussis. I have no laboratory confirmation and in neither case has anyone in the family required hospital care.

The media and many official medical organizations get the discussion of “epidemics” wrong as often as they get it right and when they finally have something to talk about in the press it’s hard to sort out the truth. Before you read any further, have a look at this New York Times article about the whooping cough “epidemic that wasn’t.”

This time, unlike the H1N1 “pandemic” scare, the avian flu hype, the measles epidemic of 132 cases, the Jewish mumps scare and the West Nile Virus fear posters at every trail head, the pertussis outbreak information might be real and might be a reason to consider getting your child vaccinated. Whooping cough is not easy to diagnose with lab tests and doctors and parents often must rely on their clinical impression the cough and the pattern of disease spread. According to the official website of Children’s Hospital of Philadelphia, an article reviewed by Dr, Paul Offit estimates that there are between “600,000 to 900,000″ cases of pertussis each year in adults and adolescents alone. This stands at odds with official data from the CDC which puts that number at 5000-10,000. This type of disparity makes the discussion of pertussis outbreaks and vaccination just a little more difficult.

I think the DTaP vaccine is the shot with the best risk/benefit ratio and it’s the vaccine I use the most often in my office week. The official schedule includes far too many shots for six-week-old babies. A lot of harm and confusion could be alleviated by vaccinating later and not giving five or six vaccines at the same time.

This “acellular” vaccine does not contain mercury (almost no vaccines still do) and has been in use for nearly fifteen years in the United States and for quite a few years before that in other countries.

DTaP vaccine prevents whooping cough and may even prevent illness or lessen the severity of illness after the first vaccine. The routine schedule includes three doses in the first six months of life, a fourth at eighteen months of age, a fifth at age five years and booster doses of a new adolescent/adult vaccine. I don’t think your babies under a year of age should be given any vaccines, including this one. The CDC and most doctors, including my colleagues in this office, disagree.

Erythromycin, Zithromax and similar antibiotics can shorten the contagious phase of pertussis and can stop the spread of the illness in a family or a school. Our office has DTaP vaccine for infants and young children and another for older children, adolescents and adults. I do not recommend this vaccine for infants unless there are unusual risk factors in a baby’s life. Again, the vast majority of experts disagree, and I understand the need for public health considerations and preservation of herd immunity but still would rather vaccinate only after 12-24 months of age and feel comfortable, in most cases, giving no vaccine at all.

Ultimately this is a parents’ decision. Do not expect the media to let up on this issue in the near future.

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Tylenol Recall Update

Since the April recall, Children’s Tylenol, Benadryl, Motrin and other McNeil Pharmaceutical products are still unavailable for purchase. The latest report says we should not expect a return of these products until 2011. You can receive updates from the makers of Tylenol on their website. In the meantime, I recommend generic brands of diphenhydramine (Benadryl) for allergies and generic acetaminophen and ibuprofen for fever control when you need it.

Here is a resource to help you determine the proper amount of acetaminophen to give your child.

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Some of you have expressed interest in Senator Barbara Boxer and my support for her advocacy for children. My wife and I are co-hosting an afternoon with Senator Boxer at a private home in Santa Monica this Sunday, June 27th and also will be co-hosting an event with Senator Boxer and Vice President Biden in July. If you are interested in either of these fund raising events, please email Sheila Creal at SHEILATCREAL@AOL.COM

Jay Gordon, MD, FAAP

Jay

A few days ago, Ms.McMahon emailed me to tell me that the decision had been made to omit my interview from the show. There would not be one word from me. She didn’t tell me that she had also omitted 100% of Dr. Robert Sears’ interview. And that any other comments from physicians supporting the parents on the show in their ambivalence about vaccines or their decision to refuse all vaccines would also be omitted.

She left this as a show with many doctors commenting very negatively, very frighteningly and often disdainfully and dismissively about vaccine “hesitation” as they called it.

Below is my email response to Kate McMahon.

Dear Kate,

The “Frontline” show was disgraceful. You didn’t even have the courtesy to put my interview or any part of the two hours we spent taping on your web site.

You created a pseudo-documentary with a preconceived set of conclusions: “Irresponsible moms against science” was an easy takeaway from the show.

Did you happen to notice that Vanessa, the child critically ill with pertussis, was not intubated nor on a respirator in the ER? She had nasal “prongs” delivering oxygen. I’m sorry for her parents’ anxiety and very happy that she was cured of pertussis. But to use anecdotal reports like this as science is irresponsible and merely served the needs of the doctor you wanted to feature.

No one pursued Dr. Offit’s response about becoming rich from the vaccine he invented. He was allowed to slide right by that question without any follow up. Dr. Paul Offit did not go into vaccine research to get rich. He is a scientist motivated by his desire to help children. But his profiting tens of millions of dollars from the creation of this vaccine and the pursuit of sales of this and other vaccines is definitely not what he says it is. His many millions “don’t matter” he says. And you let it go.

Jenny McCarthy resumed being a “former Playboy” person and was not acknowledged as a successful author, actress and mother exploring every possible avenue to treating her own son and the children of tens of thousands of other families.

I trusted you by giving you two or three hours of my time for an interview and multiple background discussions. I expressed my heartfelt reservations about both vaccines and the polarizing of this issue into “pro-vaccine” and “anti-vaccine” camps. I told you that there was at least a third “camp.” There are many doctors and even more parents who would like a more judicious approach to immunization. Give vaccines later, slower and with an individualized approach as we do in every other area of medicine.

What did you create instead?

“The Vaccine War.”

A war. Not a discussion or a disagreement over facts and opinions, but a war. This show was unintelligent, dangerous and completely lacking in the balance that you promised me–and your viewers–when you produced and advertised this piece of biased unscientific journalism. “Tabloid journalism” I believe is the epithet often used. Even a good tabloid journalist could see through the screed you’ve presented.

You interviewed me, you spent hours with Dr. Robert Sears of the deservedly-illustrious Sears family and you spoke to other doctors who support parents in their desire to find out what went wrong and why it’s going wrong and what we might do to prevent this true epidemic.

Not a measles epidemic, not whooping cough. Autism. An epidemic caused by environmental triggers acting on genetic predisposition. The science is there and the evidence of harm is there. Proof will come over the next decade. The National Children’s Study will, perhaps by accident, become a prospective look at many children with and without vaccines. But we don’t have time to wait for the results of this twenty-one year research study: We know that certain pesticides cause cancer and we know that flame retardants in children’s pajamas are dangerous. We are cleaning up our air and water slowly and parents know which paint to buy and which to leave on the shelves when they paint their babies’ bedrooms.

The information parents and doctors don’t have is contained in the huge question mark about the number of vaccines, the way we vaccinate and the dramatic increase in autism, ADD/ADHD, childhood depression and more. We pretend to have proof of harm or proof of no harm when what we really have is a large series of very important unanswered questions.

In case you were wondering, as I practice pediatrics every day of my career, I base nothing I do on Dr. Wakefield’s research or on Jenny McCarthy’s opinions. I respect what they both have done and respectfully disagree with them at times. I don’t think that Dr. Wakefield’s study proved anything except that we need to look harder at his hypothesis. I don’t think that Jenny McCarthy has all the answers to treating or preventing autism, but there are tens of thousands of parents who have long needed her strong high-profile voice to draw attention to their families’ needs: Most families with autism get inadequate reimbursement for their huge annual expenses and very little respect from the insurance industry, the government or the medical community. Jenny has demanded that a brighter light be shone on their circumstances, their frustration and their needs.

I base everything I do on my reading of CDC and World Health Organization statistics about disease incidence in the United States and elsewhere. I base everything I do on having spent the past thirty years in pediatric practice watching tens of thousands of children get vaccines, not get vaccines and the differences I see.

Vaccines change children.

Most experts would argue that the changes are unequivocally good. My experience and three decades of observation and study tell me otherwise. Vaccines are neither all good–as this biased, miserable PBS treacle would have you believe–nor all bad as the strident anti-vaccine camp argues.

You say the decisions to edit 100% of my interview from your show (and omit my comments from your website) “were purely based on what’s best for the show, not personal or political, and the others who didn’t make it came from both sides of the vaccine debate.” You are not telling the truth. You had a point to prove and removed material from your show which made the narrative balanced. “Distraught, confused moms against important, well-spoken calm doctors” was your narrative with a deep sure voice to, literally, narrate the entire artifice.

You should be ashamed of yourself, Kate. You knew what you put on the air was slanted and you cheated the viewers out of an opportunity for education and information. You cheated me out of hours of time, betrayed my trust and then you wasted an hour of PBS airtime. Shame on you.

The way vaccines are manufactured and administered right now in 2010 makes vaccines and their ingredients part of the group of toxins which have led to a huge increase in childhood diseases including autism. Your show made parents’ decisions harder and did nothing except regurgitate old news.

Parents and children deserve far better from PBS.

Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.

Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.

In 1918, it appears that influenza A (an H1N1, by the way) did this globe-trotting mutation and killed millions. The times and state of medical care are not comparable, but a milder parallel occurrence is possible. Perhaps this happens every 100 years or so, perhaps every three million.

Whenever possible, we should form antibodies against viruses at the right stage of their existence and at the right stage of our lives (For example, chickenpox in childhood and EBV/mono in early childhood. There are many other examples.) Getting many viral illnesses confers lifetime immunity, and very few vaccines do.

Tamiflu is a very powerful drug with little proven efficacy against this bug, and with its major side effect being tummy upset. I’m not using it at all. Psychiatric side effects are also possible.

I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.

I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry. Yes, one can measure antibodies against a certain bacterium or virus in the blood and it may be associated with someone not getting sick, but there are very few illnesses common enough or enough ethics committees willing enough to do the right tests. That is, give 1000 people the real vaccine and 1000 placebo shots, expose all of them to the disease and see who gets sick. Seriously. I know it sounds terrible.

This is, obviously, a difficult public discussion because it touches on the concept of benefits and risks, again, of morbidity and mortality. Few public officials have the courage or inclination to present all facets of this difficult decision. I give vaccines to my patients every single day, but I always err on the side of caution. Implying that this is a dangerous new shot is not scientifically or statistically correct and represents hyperbole and even dishonesty on the part of the so-called “anti-vaccine” camp.

It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.

I just think that giving this new H1N1 vaccine is not the cautious nor best thing to do.

Best,

Jay Gordon, MD, FAAP

Interestingly, the AAP may actually have dramatically increased integrity under Dr. David Tayloe, our new president, but someone else violated the first rule of publicity: Don’t complain when some one makes you look a lot better than you really are. Even if he does it on April First!!

Dr. Susan E.Burger is one of the world’s foremost experts on international nutrition and epidemiology who shared with me her submission to the New York Times. The Times did not publish this excellent article and I asked her permission to post it here. Thank you very much, Dr. Burger

JNGMD

Goliath and the Gnats:

The resuscitation of an April fools’ joke that should have been allowed to die.
by Susan E. Burger, MHS, PhD, IBCLC, RLC

Increasingly, professional medical associations are evaluating their ethical standards and setting the bar higher. The American Psychological Association responded to a grassroots effort of their membership base by placing moratorium on psychologists participating in the interrogation of detainees. The International Lactation Consultant Association, of which I am a member, recently decided to stop accepting sponsorship from a company that is no longer complying with the International Code of Marketing of Breast-milk Substitutes. On April 1st, the Journal of the American Medical Association published a proposal for controlling conflicts of interest (and it was NOT a hoax).

As a parent, I would expect a professional medical association that declares itself to be “dedicated to the health of all children” to uphold standards at least as high if not higher than others. Unfortunately, it seems as if the American Academy of Pediatrics (AAP) has become distracted by the urge to protect its reputation through silencing one of its critics, rather than clarifying and improving its ethical standards.

The AAP’s protectionist response was triggered when one of its own members posted on Lactnet, a listserve frequented by members of my profession. The pediatrician in question posted a fake press release from the President of the AAP. It does not take a neonatal surgeon to realize that the prominent display ofApril 1st and the poster’s own name suggests this was an April fools’ joke. Just in case anyone missed these obvious clues, the pediatrician clarified that the press release was a fake within several hours of his original post.

What was the essence of the spoof?

The fake press release stated that the AAP would end the ethical problem of receiving money and sponsorships from the pharmaceutical industry.

It apologized for the AAP’s role in watering down a national breastfeeding campaign and allowing a formula company logo to be printed on the Academy’s book on breastfeeding.

It finished with the assurance that the AAP would seek to comply with the International Code on the Marketing of Breast-milk Substitutes, a code published by the World Health Organization (WHO) and endorsed by the United States.

What is true in the fake press release is that the AAP does receive money and sponsorships from the pharmaceutical and formula industry; it did play a role in watering down the breastfeeding campaign; the front cover of its breastfeeding book is imprinted with a formula company logo; and it does not meet its obligations under the International Code of Marketing of Breast-milk Substitutes. What is not true in the fake press release is that the President of the AAP wrote it, apologized about the conflicts of interest, and made assurances about code compliance.

For a day, the false press release provided mild amusement and sighs of “wouldn’t it be great if this were true”. By the next day, the spoof had leaked into online forums and gone global!

A frequent blogger on issues of breastfeeding advocacy who goes by the username of Lauredhel, investigated the resulting chatter in the blogosphere and concluded, “no one who’s paying attention believes it is real”. Like many an April fools’ joke, this spoof should then have quickly disappeared into obscurity.

Unfortunately, the AAP itself resuscitated the discussion. On April 15th, the moderators of Lactnet posted a letter from Nicole Finitzo, attorney for the AAP, to ensure that members of the listserve understood the AAP’s position on the fake press release. The letter from Ms. Finitzo claimed that the fake press release “contains patent misstatements of fact and misrepresents the AAP’s position, and it is defamatory.” The breastfeeding advocacy blogger, Lauredhel, commented,“I do believe this is the very first time I’ve seen someone accused by a lawyer of defamation for claiming that an organization was more ethical than it actually is.”

Ms Finitzo also demanded of the listserve moderators that, “it will be essential for the original items and all copies on your server, wherever located, to be immediately taken out of circulation immediately.” Since the AAP has over 60,000 members and the Lactnet listserve merely comprises a few thousand members, this heavy-handed letter seems like Goliath swatting at gnats. Unfazed by the demand to remove the original items, the moderators of the listserve offered to post a statement on behalf of the AAP if they wish to further illuminate their stance on financial relationships with industry. The AAP has not yet replied.
I’m hoping that the AAP will come to its senses and realize swatting at gnats is a futile endeavor unlikely to earn anyone’s respect. I think the AAP would earn more respect if they chose to set higher standards to control the conflicts of interests that influence policies for children’s health.

Susan E. Burger, MHS, PhD, IBCLC, RLC

Proud member of the International Lactation Consultant Association, the United States Lactation Consultant Association, and the New York Lactation Consultant Association.

Excellent Follow up at HOYDEN ABOUT TOWN

I think the immune system, like every other system of the body, matures slowly, and that it can better tolerate viral infection at older ages and better tolerate one virus at a time. The other thing is that vaccines all contain other ingredients. They contain aluminum, they contain tiny bits of formalin [an aqueous solution of formaldahyde]. So I recommend waiting as long as parents are comfortable, and vaccinating very, very slowly. I also ask parents to wait at least six months before the first vaccine. I prefer to wait a year. I have patients who choose to get no vaccines at all, and I support that. I have patients who choose to get almost no vaccines at all, and I support that. I have patients who choose every vaccine except this one or that one; I support that.

What do you think are the risks of vaccinating a newborn or 1-month-old?
The first part of my answer is: I don’t know. And that bothers me. [In my practice] I have a natural orientation, but when I give medication, I can usually explain the side effects and what causes them. What bothers me is that when I give vaccines and I see side effects, I don’t know what causes them. I think that there is a so-called neuro-immune response, where the immune system and the central nervous system have complex interactions, and I think that there can be problems.

What are some of the side effects you’ve seen besides fever and bruises?
I’ve seen kids who developed autism shortly after vaccination. When I first went into practice in the ’80s, I would get a lot of phone calls from moms, and they would say, “You know, after the shots, she’s just acting a little different. Is that normal?” And I’d say, “Yes it is.” And they’d call back a week later and say, “He’s still a little bit off. I can’t quite describe it.” That scared me.

Now, many people would argue that vaccines are only for the better. I would say that there’s no free lunch; it is lovely to be immune to whooping cough, but if I have to diminish your health a little bit to do that, I have to hesitate. Integrity demands that I tell you other parts of the story: I saw one child who developed seizures two days after her two-month appointment, and she didn’t get any shots. It’s true that the onset of autism often coincides with the time that kids are getting their shots. But the vast majority of times that I see a temporal relationship, I’m assuming it’s not a coincidence.

I am 100 percent convinced that vaccines, while creating some excellent public health benefits, also create problems. I’ve been doing this for 29 years. I’ve watched it really closely, and I’ve seen kids who get shots undergo changes.

Why is there so much controversy specifically about the MMR vaccination?
It’s a live-virus vaccine. A live-virus vaccine, in order to work, creates a little bit of an infection. And when you get measles, you get it through your nose and your throat, [which triggers a very specific immune response.] When we inject measles, we are bypassing that system and going right into the bloodstream. And we’re finding that yes, there can be some impact on the intestinal tract and to the brain from the measles vaccine. And it’s a vaccine of almost no benefit to American children, one by one. Now, in terms of public health, I don’t want to be the guy who said, “Boy, this vaccine stinks.” It doesn’t stink. It works very, very well. The reason we don’t have measles in America is because the vaccine works great. But sit down, please. Let’s talk about the fact that your cousin and your other cousin both have autism. Or that your son has some questionable neurological issues, he seems to be speaking or walking a little later. I don’t want to mess with him.

What about the ethyl mercury compound thimerasol in vaccines?
Here’s what people are saying in America: “Look, we took all the mercury out of the vaccines. And there’s still a rise in autism.” But they didn’t take the mercury out of the vaccines. The flu shot recommended for your 6-month child on up? It has 25 micrograms of mercury. The tetanus booster that your 7-year-old gets for a rusty nail? 26 micrograms of mercury. So, they’re lying. [Note: Go to fda.gov to see current amounts of thimerasol in vaccines; most are thimerasol-free.]

What does it mean to “green our vaccines”?
Right now we’re creating vaccines using ingredients that are cheap preservatives, but it could be done better. It means, let’s see if we can get the aluminum out of them. Let’s see if we can get the formaldehyde out of them. Let’s see if we can produce them in a way that makes a little more sense for safety.

What do you say about reports that in a certain subset of people who have a genetic disposition, vaccines and other environmental factors might trigger autism?
I am 100 percent certain. The NIH child health division has a poster that says, “Genetics load the gun, but environment pulls the trigger.” And that was invented mostly for pesticides and cleaning fluids underneath your sink. But we know that there is a genetic predisposition for diabetes, but you need a trigger. They’ve done identical-twin studies, one gets it one doesn’t. What the hell happened? We know there’s a genetic predisposition to autism, but I don’t think that accounts for all cases.

How do you reconcile the notion of not vaccinating with the public health benefit that you mentioned earlier?
I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.

In June 2000, a group of top government scientists and health officials gathered for a meeting at the isolated Simpsonwood conference center in Norcross, Georgia. Convened by the Centers for Disease Control and Prevention, the meeting was held at this Methodist retreat center, nestled in wooded farmland next to the Chattahoochee River, to ensure complete secrecy. The agency had issued no public announcement of the session — only private invitations to fifty-two attendees. There were high-level officials from the CDC and the Food and Drug Administration, the top vaccine specialist from the World Health Organization in Geneva and representatives of every major vaccine manufacturer, including GlaxoSmithKline, Merck, Wyeth and Aventis Pasteur. All of the scientific data under discussion, CDC officials repeatedly reminded the participants, was strictly “embargoed.” There would be no making photocopies of documents, no taking papers with them when they left.

The federal officials and industry representatives had assembled to discuss a disturbing new study that raised alarming questions about the safety of a host of common childhood vaccines administered to infants and young children. According to a CDC epidemiologist named Tom Verstraeten, who had analyzed the agency’s massive database containing the medical records of 100,000 children, a mercury-based preservative in the vaccines — thimerosal — appeared to be responsible for a dramatic increase in autism and a host of other neurological disorders among children. “I was actually stunned by what I saw,” Verstraeten told those assembled at Simpsonwood, citing the staggering number of earlier studies that indicate a link between thimerosal and speech delays, attention-deficit disorder, hyperactivity and autism. Since 1991, when the CDC and the FDA had recommended that three additional vaccines laced with the preservative be given to extremely young infants — in one case, within hours of birth — the estimated number of cases of autism had increased fifteenfold, from one in every 2,500 children to one in 166 children.

Even for scientists and doctors accustomed to confronting issues of life and death, the findings were frightening. “You can play with this all you want,” Dr. Bill Weil, a consultant for the American Academy of Pediatrics, told the group. The results “are statistically significant.” Dr. Richard Johnston, an immunologist and pediatrician from the University of Colorado whose grandson had been born early on the morning of the meeting’s first day, was even more alarmed. “My gut feeling?” he said. “Forgive this personal comment — I do not want my grandson to get a thimerosal-containing vaccine until we know better what is going on.”

But instead of taking immediate steps to alert the public and rid the vaccine supply of thimerosal, the officials and executives at Simpsonwood spent most of the next two days discussing how to cover up the damaging data. According to transcripts obtained under the Freedom of Information Act, many at the meeting were concerned about how the damaging revelations about thimerosal would affect the vaccine industry’s bottom line. “We are in a bad position from the standpoint of defending any lawsuits,” said Dr. Robert Brent, a pediatrician at the Alfred I. duPont Hospital for Children in Delaware. “This will be a resource to our very busy plaintiff attorneys in this country.” Dr. Bob Chen, head of vaccine safety for the CDC, expressed relief that “given the sensitivity of the information, we have been able to keep it out of the hands of, let’s say, less responsible hands.” Dr. John Clements, vaccines advisor at the World Health Organization, declared that “perhaps this study should not have been done at all.” He added that “the research results have to be handled,” warning that the study “will be taken by others and will be used in other ways beyond the control of this group.”

In fact, the government has proved to be far more adept at handling the damage than at protecting children’s health. The CDC paid the Institute of Medicine to conduct a new study to whitewash the risks of thimerosal, ordering researchers to “rule out” the chemical’s link to autism. It withheld Verstraeten’s findings, even though they had been slated for immediate publication, and told other scientists that his original data had been “lost” and could not be replicated. And to thwart the Freedom of Information Act, it handed its giant database of vaccine records over to a private company, declaring it off-limits to researchers. By the time Verstraeten finally published his study in 2003, he had gone to work for GlaxoSmithKline and reworked his data to bury the link between thimerosal and autism.

Vaccine manufacturers had already begun to phase thimerosal out of injections given to American infants — but they continued to sell off their mercury-based supplies of vaccines until last year. The CDC and FDA gave them a hand, buying up the tainted vaccines for export to developing countries and allowing drug companies to continue using the preservative in some American vaccines — including several pediatric flu shots as well as tetanus boosters routinely given to eleven-year-olds.

The drug companies are also getting help from powerful lawmakers in Washington. Senate Majority Leader Bill Frist, who has received $873,000 in contributions from the pharmaceutical industry, has been working to immunize vaccine makers from liability in 4,200 lawsuits that have been filed by the parents of injured children. On five separate occasions, Frist has tried to seal all of the government’s vaccine-related documents — including the Simpsonwood transcripts — and shield Eli Lilly, the developer of thimerosal, from subpoenas. In 2002, the day after Frist quietly slipped a rider known as the “Eli Lilly Protection Act” into a homeland security bill, the company contributed $10,000 to his campaign and bought 5,000 copies of his book on bioterrorism. The measure was repealed by Congress in 2003 — but earlier this year, Frist slipped another provision into an anti-terrorism bill that would deny compensation to children suffering from vaccine-related brain disorders. “The lawsuits are of such magnitude that they could put vaccine producers out of business and limit our capacity to deal with a biological attack by terrorists,” says Dean Rosen, health policy adviser to Frist.

Even many conservatives are shocked by the government’s effort to cover up the dangers of thimerosal. Rep. Dan Burton, a Republican from Indiana, oversaw a three-year investigation of thimerosal after his grandson was diagnosed with autism. “Thimerosal used as a preservative in vaccines is directly related to the autism epidemic,” his House Government Reform Committee concluded in its final report. “This epidemic in all probability may have been prevented or curtailed had the FDA not been asleep at the switch regarding a lack of safety data regarding injected thimerosal, a known neurotoxin.” The FDA and other public-health agencies failed to act, the committee added, out of “institutional malfeasance for self protection” and “misplaced protectionism of the pharmaceutical industry.”

The story of how government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public is a chilling case study of institutional arrogance, power and greed. I was drawn into the controversy only reluctantly. As an attorney and environmentalist who has spent years working on issues of mercury toxicity, I frequently met mothers of autistic children who were absolutely convinced that their kids had been injured by vaccines. Privately, I was skeptical.

I doubted that autism could be blamed on a single source, and I certainly understood the government’s need to reassure parents that vaccinations are safe; the eradication of deadly childhood diseases depends on it. I tended to agree with skeptics like Rep. Henry Waxman, a Democrat from California, who criticized his colleagues on the House Government Reform Committee for leaping to conclusions about autism and vaccinations. “Why should we scare people about immunization,” Waxman pointed out at one hearing, “until we know the facts?”

It was only after reading the Simpsonwood transcripts, studying the leading scientific research and talking with many of the nation’s pre-eminent authorities on mercury that I became convinced that the link between thimerosal and the epidemic of childhood neurological disorders is real. Five of my own children are members of the Thimerosal Generation — those born between 1989 and 2003 — who received heavy doses of mercury from vaccines. “The elementary grades are overwhelmed with children who have symptoms of neurological or immune-system damage,” Patti White, a school nurse, told the House Government Reform Committee in 1999. “Vaccines are supposed to be making us healthier; however, in twenty-five years of nursing I have never seen so many damaged, sick kids. Something very, very wrong is happening to our children.”
More than 500,000 kids currently suffer from autism, and pediatricians diagnose more than 40,000 new cases every year. The disease was unknown until 1943, when it was identified and diagnosed among eleven children born in the months after thimerosal was first added to baby vaccines in 1931.

Some skeptics dispute that the rise in autism is caused by thimerosal-tainted vaccinations. They argue that the increase is a result of better diagnosis — a theory that seems questionable at best, given that most of the new cases of autism are clustered within a single generation of children. “If the epidemic is truly an artifact of poor diagnosis,” scoffs Dr. Boyd Haley, one of the world’s authorities on mercury toxicity, “then where are all the twenty-year-old autistics?” Other researchers point out that Americans are exposed to a greater cumulative “load” of mercury than ever before, from contaminated fish to dental fillings, and suggest that thimerosal in vaccines may be only part of a much larger problem. It’s a concern that certainly deserves far more attention than it has received — but it overlooks the fact that the mercury concentrations in vaccines dwarf other sources of exposure to our children.

What is most striking is the lengths to which many of the leading detectives have gone to ignore — and cover up — the evidence against thimerosal. From the very beginning, the scientific case against the mercury additive has been overwhelming. The preservative, which is used to stem fungi and bacterial growth in vaccines, contains ethylmercury, a potent neurotoxin. Truckloads of studies have shown that mercury tends to accumulate in the brains of primates and other animals after they are injected with vaccines — and that the developing brains of infants are particularly susceptible. In 1977, a Russian study found that adults exposed to much lower concentrations of ethylmercury than those given to American children still suffered brain damage years later. Russia banned thimerosal from children’s vaccines twenty years ago, and Denmark, Austria, Japan, Great Britain and all the Scandinavian countries have since followed suit.

“You couldn’t even construct a study that shows thimerosal is safe,” says Haley, who heads the chemistry department at the University of Kentucky. “It’s just too darn toxic. If you inject thimerosal into an animal, its brain will sicken. If you apply it to living tissue, the cells die. If you put it in a petri dish, the culture dies. Knowing these things, it would be shocking if one could inject it into an infant without causing damage.”

Internal documents reveal that Eli Lilly, which first developed thimerosal, knew from the start that its product could cause damage — and even death — in both animals and humans. In 1930, the company tested thimerosal by administering it to twenty-two patients with terminal meningitis, all of whom died within weeks of being injected — a fact Lilly didn’t bother to report in its study declaring thimerosal safe. In 1935, researchers at another vaccine manufacturer, Pittman-Moore, warned Lilly that its claims about thimerosal’s safety “did not check with ours.” Half the dogs Pittman injected with thimerosal-based vaccines became sick, leading researchers there to declare the preservative “unsatisfactory as a serum intended for use on dogs.”

In the decades that followed, the evidence against thimerosal continued to mount. During the Second World War, when the Department of Defense used the preservative in vaccines on soldiers, it required Lilly to label it “poison.” In 1967, a study in Applied Microbiology found that thimerosal killed mice when added to injected vaccines. Four years later, Lilly’s own studies discerned that thimerosal was “toxic to tissue cells” in concentrations as low as one part per million — 100 times weaker than the concentration in a typical vaccine. Even so, the company continued to promote thimerosal as “nontoxic” and also incorporated it into topical disinfectants. In 1977, ten babies at a Toronto hospital died when an antiseptic preserved with thimerosal was dabbed onto their umbilical cords.

In 1982, the FDA proposed a ban on over-the-counter products that contained thimerosal, and in 1991 the agency considered banning it from animal vaccines. But tragically, that same year, the CDC recommended that infants be injected with a series of mercury-laced vaccines. Newborns would be vaccinated for hepatitis B within twenty-four hours of birth, and two-month-old infants would be immunized for haemophilus influenzae B and diphtheria-tetanus-pertussis.
The drug industry knew the additional vaccines posed a danger. The same year that the CDC approved the new vaccines, Dr. Maurice Hilleman, one of the fathers of Merck’s vaccine programs, warned the company that six-month-olds who were administered the shots would suffer dangerous exposure to mercury. He recommended that thimerosal be discontinued, “especially when used on infants and children,” noting that the industry knew of nontoxic alternatives. “The best way to go,” he added, “is to switch to dispensing the actual vaccines without adding preservatives.”

For Merck and other drug companies, however, the obstacle was money. Thimerosal enables the pharmaceutical industry to package vaccines in vials that contain multiple doses, which require additional protection because they are more easily contaminated by multiple needle entries. The larger vials cost half as much to produce as smaller, single-dose vials, making it cheaper for international agencies to distribute them to impoverished regions at risk of epidemics. Faced with this “cost consideration,” Merck ignored Hilleman’s warnings, and government officials continued to push more and more thimerosal-based vaccines for children. Before 1989, American preschoolers received eleven vaccinations — for polio, diphtheria-tetanus-pertussis and measles-mumps-rubella. A decade later, thanks to federal recommendations, children were receiving a total of twenty-two immunizations by the time they reached first grade.

As the number of vaccines increased, the rate of autism among children exploded. During the 1990s, 40 million children were injected with thimerosal-based vaccines, receiving unprecedented levels of mercury during a period critical for brain development. Despite the well-documented dangers of thimerosal, it appears that no one bothered to add up the cumulative dose of mercury that children would receive from the mandated vaccines. “What took the FDA so long to do the calculations?” Peter Patriarca, director of viral products for the agency, asked in an e-mail to the CDC in 1999. “Why didn’t CDC and the advisory bodies do these calculations when they rapidly expanded the childhood immunization schedule?”

But by that time, the damage was done. At two months, when the infant brain is still at a critical stage of development, infants routinely received three inoculations that contained a total of 62.5 micrograms of ethylmercury — a level 99 times greater than the EPA’s limit for daily exposure to methylmercury, a related neurotoxin. Although the vaccine industry insists that ethylmercury poses little danger because it breaks down rapidly and is removed by the body, several studies — including one published in April by the National Institutes of Health — suggest that ethylmercury is actually more toxic to developing brains and stays in the brain longer than methylmercury.

Officials responsible for childhood immunizations insist that the additional vaccines were necessary to protect infants from disease and that thimerosal is still essential in developing nations, which, they often claim, cannot afford the single-dose vials that don’t require a preservative. Dr. Paul Offit, one of CDC’s top vaccine advisers, told me, “I think if we really have an influenza pandemic — and certainly we will in the next twenty years, because we always do — there’s no way on God’s earth that we immunize 280 million people with single-dose vials. There has to be multidose vials.”

But while public-health officials may have been well-intentioned, many of those on the CDC advisory committee who backed the additional vaccines had close ties to the industry. Dr. Sam Katz, the committee’s chair, was a paid consultant for most of the major vaccine makers and was part of a team that developed the measles vaccine and brought it to licensure in 1963. Dr. Neal Halsey, another committee member, worked as a researcher for the vaccine companies and received honoraria from Abbott Labs for his research on the hepatitis B vaccine.
Indeed, in the tight circle of scientists who work on vaccines, such conflicts of interest are common. Rep. Burton says that the CDC “routinely allows scientists with blatant conflicts of interest to serve on intellectual advisory committees that make recommendations on new vaccines,” even though they have “interests in the products and companies for which they are supposed to be providing unbiased oversight.” The House Government Reform Committee discovered that four of the eight CDC advisers who approved guidelines for a rotavirus vaccine “had financial ties to the pharmaceutical companies that were developing different versions of the vaccine.”

Offit, who shares a patent on one of the vaccines, acknowledged to me that he “would make money” if his vote eventually leads to a marketable product. But he dismissed my suggestion that a scientist’s direct financial stake in CDC approval might bias his judgment. “It provides no conflict for me,” he insists. “I have simply been informed by the process, not corrupted by it. When I sat around that table, my sole intent was trying to make recommendations that best benefited the children in this country. It’s offensive to say that physicians and public-health people are in the pocket of industry and thus are making decisions that they know are unsafe for children. It’s just not the way it works.”

Other vaccine scientists and regulators gave me similar assurances. Like Offit, they view themselves as enlightened guardians of children’s health, proud of their “partnerships” with pharmaceutical companies, immune to the seductions of personal profit, besieged by irrational activists whose anti-vaccine campaigns are endangering children’s health. They are often resentful of questioning. “Science,” says Offit, “is best left to scientists.”

Still, some government officials were alarmed by the apparent conflicts of interest. In his e-mail to CDC administrators in 1999, Paul Patriarca of the FDA blasted federal regulators for failing to adequately scrutinize the danger posed by the added baby vaccines. “I’m not sure there will be an easy way out of the potential perception that the FDA, CDC and immunization-policy bodies may have been asleep at the switch re: thimerosal until now,” Patriarca wrote. The close ties between regulatory officials and the pharmaceutical industry, he added, “will also raise questions about various advisory bodies regarding aggressive recommendations for use” of thimerosal in child vaccines.

If federal regulators and government scientists failed to grasp the potential risks of thimerosal over the years, no one could claim ignorance after the secret meeting at Simpsonwood. But rather than conduct more studies to test the link to autism and other forms of brain damage, the CDC placed politics over science. The agency turned its database on childhood vaccines — which had been developed largely at taxpayer expense — over to a private agency, America’s Health Insurance Plans, ensuring that it could not be used for additional research. It also instructed the Institute of Medicine, an advisory organization that is part of the National Academy of Sciences, to produce a study debunking the link between thimerosal and brain disorders. The CDC “wants us to declare, well, that these things are pretty safe,” Dr. Marie McCormick, who chaired the IOM’s Immunization Safety Review Committee, told her fellow researchers when they first met in January 2001. “We are not ever going to come down that [autism] is a true side effect” of thimerosal exposure. According to transcripts of the meeting, the committee’s chief staffer, Kathleen Stratton, predicted that the IOM would conclude that the evidence was “inadequate to accept or reject a causal relation” between thimerosal and autism. That, she added, was the result “Walt wants” — a reference to Dr. Walter Orenstein, director of the National Immunization Program for the CDC.
For those who had devoted their lives to promoting vaccination, the revelations about thimerosal threatened to undermine everything they had worked for. “We’ve got a dragon by the tail here,” said Dr. Michael Kaback, another committee member. “The more negative that [our] presentation is, the less likely people are to use vaccination, immunization — and we know what the results of that will be. We are kind of caught in a trap. How we work our way out of the trap, I think is the charge.”

Even in public, federal officials made it clear that their primary goal in studying thimerosal was to dispel doubts about vaccines. “Four current studies are taking place to rule out the proposed link between autism and thimerosal,” Dr. Gordon Douglas, then-director of strategic planning for vaccine research at the National Institutes of Health, assured a Princeton University gathering in May 2001. “In order to undo the harmful effects of research claiming to link the [measles] vaccine to an elevated risk of autism, we need to conduct and publicize additional studies to assure parents of safety.” Douglas formerly served as president of vaccinations for Merck, where he ignored warnings about thimerosal’s risks.

In May of last year, the Institute of Medicine issued its final report. Its conclusion: There is no proven link between autism and thimerosal in vaccines. Rather than reviewing the large body of literature describing the toxicity of thimerosal, the report relied on four disastrously flawed epidemiological studies examining European countries, where children received much smaller doses of thimerosal than American kids. It also cited a new version of the Verstraeten study, published in the journal Pediatrics, that had been reworked to reduce the link between thimerosal and autism. The new study included children too young to have been diagnosed with autism and overlooked others who showed signs of the disease. The IOM declared the case closed and — in a startling position for a scientific body — recommended that no further research be conducted.

The report may have satisfied the CDC, but it convinced no one. Rep. David Weldon, a Republican physician from Florida who serves on the House Government Reform Committee, attacked the Institute of Medicine, saying it relied on a handful of studies that were “fatally flawed” by “poor design” and failed to represent “all the available scientific and medical research.” CDC officials are not interested in an honest search for the truth, Weldon told me, because “an association between vaccines and autism would force them to admit that their policies irreparably damaged thousands of children. Who would want to make that conclusion about themselves?”

Under pressure from Congress and parents, the Institute of Medicine convened another panel to address continuing concerns about the Vaccine Safety Datalink Data Sharing program. In February, the new panel, composed of different scientists, criticized the way the VSD had been used in the Verstraeten study, and urged the CDC to make its vaccine database available to the public.

So far, though, only two scientists have managed to gain access. Dr. Mark Geier, president of the Genetics Center of America, and his son, David, spent a year battling to obtain the medical records from the CDC. Since August 2002, when members of Congress pressured the agency to turn over the data, the Geiers have completed six studies that demonstrate a powerful correlation between thimerosal and neurological damage in children. One study, which compares the cumulative dose of mercury received by children born between 1981 and 1985 with those born between 1990 and 1996, found a “very significant relationship” between autism and vaccines. Another study of educational performance found that kids who received higher doses of thimerosal in vaccines were nearly three times as likely to be diagnosed with autism and more than three times as likely to suffer from speech disorders and mental retardation. Another soon-to-be published study shows that autism rates are in decline following the recent elimination of thimerosal from most vaccines.

As the federal government worked to prevent scientists from studying vaccines, others have stepped in to study the link to autism. In April, reporter Dan Olmsted of UPI undertook one of the more interesting studies himself. Searching for children who had not been exposed to mercury in vaccines — the kind of population that scientists typically use as a “control” in experiments — Olmsted scoured the Amish of Lancaster County, Pennsylvania, who refuse to immunize their infants. Given the national rate of autism, Olmsted calculated that there should be 130 autistics among the Amish. He found only four. One had been exposed to high levels of mercury from a power plant. The other three — including one child adopted from outside the Amish community — had received their vaccines.

At the state level, many officials have also conducted in-depth reviews of thimerosal. While the Institute of Medicine was busy whitewashing the risks, the Iowa legislature was carefully combing through all of the available scientific and biological data. “After three years of review, I became convinced there was sufficient credible research to show a link between mercury and the increased incidences in autism,” says state Sen. Ken Veenstra, a Republican who oversaw the investigation. “The fact that Iowa’s 700 percent increase in autism began in the 1990s, right after more and more vaccines were added to the children’s vaccine schedules, is solid evidence alone.” Last year, Iowa became the first state to ban mercury in vaccines, followed by California. Similar bans are now under consideration in thirty-two other states.

But instead of following suit, the FDA continues to allow manufacturers to include thimerosal in scores of over-the-counter medications as well as steroids and injected collagen. Even more alarming, the government continues to ship vaccines preserved with thimerosal to developing countries — some of which are now experiencing a sudden explosion in autism rates. In China, where the disease was virtually unknown prior to the introduction of thimerosal by U.S. drug manufacturers in 1999, news reports indicate that there are now more than 1.8 million autistics. Although reliable numbers are hard to come by, autistic disorders also appear to be soaring in India, Argentina, Nicaragua and other developing countries that are now using thimerosal-laced vaccines. The World Health Organization continues to insist thimerosal is safe, but it promises to keep the possibility that it is linked to neurological disorders “under review.”

I devoted time to study this issue because I believe that this is a moral crisis that must be addressed. If, as the evidence suggests, our public-health authorities knowingly allowed the pharmaceutical industry to poison an entire generation of American children, their actions arguably constitute one of the biggest scandals in the annals of American medicine. “The CDC is guilty of incompetence and gross negligence,” says Mark Blaxill, vice president of Safe Minds, a nonprofit organization concerned about the role of mercury in medicines. “The damage caused by vaccine exposure is massive. It’s bigger than asbestos, bigger than tobacco, bigger than anything you’ve ever seen.”

It’s hard to calculate the damage to our country — and to the international efforts to eradicate epidemic diseases — if Third World nations come to believe that America’s most heralded foreign-aid initiative is poisoning their children. It’s not difficult to predict how this scenario will be interpreted by America’s enemies abroad. The scientists and researchers — many of them sincere, even idealistic — who are participating in efforts to hide the science on thimerosal claim that they are trying to advance the lofty goal of protecting children in developing nations from disease pandemics. They are badly misguided. Their failure to come clean on thimerosal will come back horribly to haunt our country and the world’s poorest populations.

NOTE: This story has been updated to correct several inaccuracies in the original, published version. As originally reported, American preschoolers received only three vaccinations before 1989, but the article failed to note that they were innoculated a total of eleven times with those vaccines, including boosters. The article also misstated the level of ethylmercury received by infants injected with all their shots by the age of six months. It was 187 micrograms – an amount forty percent, not 187 times, greater than the EPA’s limit for daily exposure to methylmercury. Finally, because of an editing error, the article misstated the contents of the rotavirus vaccine approved by the CDC. It did not contain thimerosal. Salon and Rolling Stone regret the errors.

An earlier version of this story stated that the Institute of Medicine convened a second panel to review the work of the Immunization Safety Review Committee that had found no evidence of a link between thimerosal and autism. In fact, the IOM convened the second panel to address continuing concerns about the Vaccine Safety Datalink Data Sharing program, including those raised by critics of the IOM’s earlier work. But the panel was not charged with reviewing the committee’s findings. The story also inadvertently omitted a word and transposed two sentences in a quote by Dr. John Clements, and incorrectly stated that Dr. Sam Katz held a patent with Merck on the measles vaccine. In fact, Dr. Katz was part of a team that developed the vaccine and brought it to licensure, but he never held the patent. Salon and Rolling Stone regret the errors.

CLARIFICATION: After publication of this story, Salon and Rolling Stone corrected an error that misstated the level of ethylmercury received by infants injected with all their shots by the age of six months. It was 187 micrograms ? an amount forty percent, not 187 times, greater than the EPA’s limit for daily exposure to methylmercury. At the time of the correction, we were aware that the comparison itself was flawed, but as journalists we considered it more appropriate to state the correct figure rather than replace it with another number entirely.

Since that earlier correction, however, it has become clear from responses to the article that the forty-percent number, while accurate, is misleading. It measures the total mercury load an infant received from vaccines during the first six months, calculates the daily average received based on average body weight, and then compares that number to the EPA daily limit. But infants did not receive the vaccines as a ?daily average? ? they received massive doses on a single day, through multiple shots. As the story states, these single-day doses exceeded the EPA limit by as much as 99 times. Based on the misunderstanding, and to avoid further confusion, we have amended the story to eliminate the forty-percent figure.

Correction: The story misattributed a quote to Andy Olson, former legislative counsel to Senator Bill Frist. The comment was made by Dean Rosen, health policy adviser to the senator. Rolling Stone and Salon.com regret the error.

Kennedy Report Sparks Controversy

November 3rd, 2003 was a big day for Alabama emergency room pediatrician, Dr. Carden Johnston. On that date last month, he was installed as the new President of the 66,000 member American Academy of Pediatrics (AAP) at the prestigious organization’s annual meeting in New Orleans. It was also the date that he sparked what has emerged as a major ethical controversy by inadvertently pulling back the curtains on the powerful influence that a particular corporate interest appears to have in shaping AAP policy and action.

“I have to admit that I never imagined that my presidency would start off with such a bang,” Dr. Johnston says, acknowledging the debate now taking place within his organization.

At issue is a letter dated November 3rd that Dr. Johnston sent to Secretary of the Department of Health and Human Services (DHHS), Tommy G. Thompson, officially expressing the AAP’s concern over the “negative approach” of the federal agency’s soon-to-be-released, pro-breastfeeding advertising campaign. What Dr. Johnston didn’t mention in his letter, however, was that he had developed this sudden and seemingly urgent interest in this issue not via a last minute clinical review of the scientific literature, or even after consulting with the AAP’s own recognized lactation science experts.

In fact, his concern came immediately after aggressive, personal lobbying by representatives of one of the AAP’s biggest financial contributors, the $3 billion U.S. infant formula industry. Within days of a New Orleans meeting with worried formula industry reps, Johnston hurled the considerable credibility and persuasive impact of the esteemed American Academy of Pediatrics into an explicit effort to stifle the most ambitious initiative ever undertaken to promote breastfeeding in the United States.

“Some of us within the AAP have long suspected that the infant formula companies had this sort of direct access to AAP leadership,” explains Dr. Lawrence Gartner, a founding member of the Academy of Breastfeeding Medicine and chairman of the AAP’s Professional Section on Breastfeeding. “Dr. Johnston’s actions have revealed the extent of this influence more clearly than anything else I’ve seen. Many doctors within the AAP are very disturbed by this.”

Reflecting the strong opinions of a number of AAP members interviewed in the past week, Dr. Jay Gordon, a pediatrician and best-selling author of several parenting books, says that his opinion on the AAP leadership’s actions in this matter go beyond “disturbed.”

Dr. Gordon reports that, that in his view, the AAP leadership has “weakened and emasculated (the ads) to suit the manufacturers of formula,” and “as a result of their craven disregard for America’s babies and families, more infants will get sick and die each year. I wish that this greedy, immoral, reprehensible act could be met with criminal charges,” explains Gordon.

The ad campaign currently inspiring such passion among the nation’s pediatric health care providers is funded within the DHHS Office on Women’s Health (OWH), and has been in the works since 2000. Officially dubbed the “National Breastfeeding Awareness Campaign,” the creative end of the OWH project has been handled by Raleigh, North Carolina advertising agency McKinney+Silver, while the entire project is overseen by The Ad Council, the private, non-profit organization that produces, distributes, and promotes public service campaigns on behalf of charitable organizations and government agencies.

In 2002, DHHS described the upcoming breastfeeding initiative as a three-year, multimedia social marketing blitz worth as much as $40 million in advertising dollars. It is alleged by a variety of organizations representing lactation consultants, physicians, nurses, midwives, and public health activists that the AAP’s last-minute appeal to DHHS prevented the much-anticipated campaign launch from taking place as scheduled this month. Additionally, it appears that representatives of the infant formula industry – with the benefit of prematurely leaked information about the specifics of the ad campaign- have been quietly lobbying federal and Ad Council officials to change the ads’ content and tone.

According to the AAP’s own Breastfeeding Section, at least one thousand new scientific and medical papers on topics related to breast and bottle feeding have been published in just the past four years. Taken as a whole, this mounting body of research revealsdramatically different health outcomes for populations of breast and formula-fed babies, even when controlling for socioeconomic and other factors. The new ad campaign was designed to reflect this research and to catapult the issue of breastfeeding into the same category of public health concerns as smoking, carseat use, childhood vaccinations, and SIDS prevention.

While critics of Dr. Johnston’s action strongly disagree that the tone of the DHHS ads is “negative,” they concede that the new campaign does offer a fundamentally different way of looking at the breast-bottle issue. They hasten to add, however, that this new approach was completely intentional. According to those medical professionals who played a role in creating the actual content of the new campaign, the ads utilize a market-oriented and evidence-based approach to the issue, relying for the first time on the proven communications strategies that have successfully impacted other public health behaviors in recent years.

According to those who have viewed them, the ads feature catchy slogans meant to become memorable such as “Breastfeed: It’s too important not to,” and “Babies are born to be breastfed.” Some of the ads also use humor to make their points, including TV spots showing a pregnant woman participating in roller derby and riding a mechanical bull. These absurdist images are used to make the point that, just as no woman would take those sorts of risks while pregnant, mothers of infants should avoid the quantifiable risks to their babies’ health that come with not breastfeeding.

“As I understood it, this was to be the first national advertising campaign that focused on the risks of not breastfeeding as opposed to the benefits of choosing to breastfeed,” explains Dr. Audrey Naylor, a San Diego pediatrician and Executive Director ofWellstart International, as well as a member of the AAP’s Breastfeeding Professional Section, and a past consultant to the World Health Organization on infant nutrition issues. “This would definitely mark a significant change in the way this issue would be presented to the general public. It’s a change to promote breastfeeding as a public health issue rather than simply as a personal parenting choice.”

The area of the website of The Ad Council devoted to a brief discussion of the planned DHHS breastfeeding campaign offers a glimpse into this very different, market-oriented way of viewing the issue of breast vs. bottle, stating that, “Babies who are not exclusively breastfed for at least 6 months will be more likely to contract asthma, allergies, and cancer.” In previous breastfeeding promotion campaigns, this statement would have certainly read “Babies who are breastfed will be less likely to contract asthma, allergies, and cancer.”

In a presentation sponsored by the Breastfeeding Task Force of Greater Los Angeles on the planned campaign, McKinney+Silver was quoted as seeking to move from creating awareness to creating conversion with the ads.

“Shift the language from ‘If you breastfeed, your baby will be healthier,’ to ‘If you don’t breastfeed, your baby will be more prone to…,” noted McKinney+Silver in describing the campaign’s approach. The presentation went on to note that, while most American women seemed informed of the benefits of breastfeeding, few seemed aware of the potential consequences of not nursing their babies. “(There is) no perceived disadvantage if you don’t breastfeed. Many think breastfeeding is like supplementing a ‘standard diet’ with vitamins. Formula, by default, is credited with the status of being ‘the standard.’”

In much of the rest of the world, ads for infant formula directed at consumers are verboten in much the same way that television ads for cigarettes and liquor are no longer acceptable in the United States. This global aversion to infant formula advertising is due to the widespread adoption by governments and private industries outside the United States of the World Health Organization’s Code on the Marketing of Breastmilk Substitutes – known as the WHO Code.

In this country, however, there is only minimal adherance to the WHO Code by public or private entities and as a result, advertisements for different brands of infant formula are a ubiquitous part of the U.S. media landscape.

In years past, various individual government agencies, hospitals, and private organizations such as La Leche League International have attempted to counter the advertising sledgehammer wielded by the well-heeled infant formula industry via a patchwork of relatively low-budget, smaller-scale ads focusing on the “the benefits of breastfeeding.” However, the DHHS breastfeeding campaign to which the AAP leadership has now objected was to be the first national effort to utilize high-end, commercial-quality production values to position the “breast is best” public health message to go head-to-head with even the slickest Madison Avenue-produced infant formula ads.

Clearly, this was not a campaign that was going to play well with the infant formula industry, which has until now managed to create a uniquely advantageous situation in which it has positioned itself as the primary spokesman for its chief competitor in the marketplace, breastfeeding. And this new message is assuredly not the one they want projected into public consciousness.

“Ironically, infant formula companies in this country can honestly say they spend more on what they call ‘breastfeeding education’ than any other single entity,” explains Amy Spangler, a nurse and lactation consultant who currently chairs the United States Breastfeeding Committee, an umbrella consortia of health care organizations interested in breastfeeding that was intimately involved in developing the new DHHS campaign. “They also underwrite much of the research into infant feeding issues. The pay-off for them is that they then get to manipulate the message, which is always “Breastfeeding is best, but… There is always a ‘but,’ and breastfeeding is suggested as a type of ‘bonus feature’ for parenting rather than the norm.”

According to a number of sources within the medical community who were included in meetings during the planning process for the breastfeeding campaign, DHHS officials repeatedly stressed to participants that the specific messages of the ads –which were clearly shaping up to be potentially controversial- needed to be “embargoed” until their official release.

Amy Spangler attended several meetings with DHHS and OWH officials to discuss the Breastfeeding Awareness Campaign and she says that federal and Ad Council officials encouraged participants to avoid speaking publicly about the content of the planned ads before their release.

“It was never said specifically that the need for keeping the ads under wraps until release was due to anything having to do with infant formula companies, but I think we would have been naïve to assume that this was not one of the reasons why,” explains Spangler.

Despite the warnings, however, the infant formula industry did apparently gain access to much of the content of the ads, allowing them to begin an intensive and targeted lobbying effort against their release. DHHS officials are reluctant to discuss the circumstances surrounding the premature leak of the ads, saying only that “a small amount” of information about the campaign was accidentally released on The Ad Council website at some point in November. Hipmama.com has learned, however, that DHHS and Ad Council officials voluntarily met with formula industry representatives at several points during the fall, even as pro-breastfeeding stakeholders were being instructed by the same officials to keep mum in order to preserve the integrity of the ad campaign’s message.

Additionally, most or all of the actual ads were shown to dozens of attendees at a North Carolina medical conference in October, something that Office on Women’s Health spokesperson Christina Pearson says the agency didn’t authorize or even know about until after the event.

According to a variety of sources, members of Congress began hearing complaints about the pending ad campaign from infant formula manufacturers as early as the first week of October, but it was at the AAP convention in November that the industry was able to aim what is arguably the biggest weapon in its lobbying arsenal –the clout of the American Academy of Pediatrics – directly at the breastfeeding campaign.

“The reason why the infant formula industry is so successful is because they have managed to manipulate health care providers into providing them with a cloak of credibility,” explains Amy Spangler. “The bottom line here is that the president of (an infant formula company) doesn’t have to send a letter directly to a federal official when he can get the President of the American Academy of Pediatrics to do it for him.”

Public health advocates and many individual physicians, nurses, midwives, and lactation consultants have long criticized the cozy financial ties between infant formula manufacturers and major medical organizations such as the AAP, the American Medical Association, the American Academy of Family Physicians, and the American College of Obstetrics and Gynecology. The infant formula industry – part of the larger pharmaceutical industry lobby – is also recognized as one of the most effective and powerful lobbies on Capitol Hill.

Critics of this relationship between baby doctors and formula makers note that because the U.S. infant formula industry –with sales of $3 billion annually – clearly has a commercial interest in impacting parents’ infant feeding choices, the industry should not play any role in crafting public health messages relating to the industry’s clear competitor in the marketplace, breastfeeding.

“It is simply not appropriate for these companies to have a say in how publicly-funded health education campaigns present breastfeeding issues,” argues Marsha Walker, RN, IBCLC, and Executive Director of the National Alliance for Breastfeeding Advocacy (NABA), a non-profit group promoting breastfeeding. “It would be like inviting a cigarette manufacturer to have a say in the message of a government sponsored anti-smoking campaign.”

OWH spokesperson Christina Pearson disagrees, however, insisting that DHHS has made it clear all along that the agency wanted to hear from “all sides” on the issue.

While it may be reasonably asked what “sides” exist when speaking of a public health campaign promoting a free or low-cost, healthy alternative over another, expensive and less healthy alternative, the AAP leadership decided that their organization was going to take sides. In a phone interview with Hipmama.com on December 3rd, AAP President Dr. Johnston readily admitted that he was approached by representatives of infant formula companies during the annual AAP convention in the first week of November, and asked to attend a “private,” “not on the agenda” meeting to discuss some concerns that the industry had with the planned DHHS breastfeeding campaign. He says that he and the three other members of the American Academy of Pediatrics Executive Committee, Dr. Joe Sanders, Dr. Carol Berkowitz, and Dr. E. Stephen Edwards, immediate past president of the AAP, met for approximately 45 minutes with “two or three” representatives of Ross Products “and maybe one other company” to hear their concerns.

“This was the first I had heard about this planned breastfeeding promotion campaign,” says Dr. Johnston. “Sad, but true. I didn’t know it was in development until after these folks told us about it.”

Dr. Johnston’s account of his interest in and knowledge of the DHHS ad campaign differs from the version reported in the December 4th edition of the New York Times. In a story entitled “Breastfeeding Ads Delayed In Dispute Over Content,” reporter Melody Peterson writes that Dr. Johnston and Dr. Sanders “…said that they had decided to send their letter before (infant formula company) executives expressed their concerns at the Academy’s national conference, held last month in New Orleans.”

In his interview with Hipmama.com, Dr. Johnston said that he became alarmed at the tone and message of the ads after viewing samples shown to him by the infant formula company reps in New Orleans.

“They showed us more than ten but fewer than twenty printouts of something that looked like ads. It was my impression these were copies of some of the ads,” says Dr. Johnston. “A lot of the ads looked fine to me, but I shared their concerns about the negative approach overall. It worried me, as it did them, that parents whose kids got cancer or grew up dumb might feel guilty if they did not breastfeed.”

Dr. Johnston says that he did not find it inappropriate or even remarkable that a commercial interest would have advance advertising copy from a planned multi-million dollar federal public health campaign designed to convince Americans to buy less of their products.

“I never asked them where they got this stuff,” says Dr. Johnston. “I just had the feeling that their relationships within Health and Human Services were better than ours at the Academy. I was actually embarrassed that this was the first time I was being made aware of the problems with this advertising campaign. Of course, they have to be concerned about issues that impact their shareholders.”

Dr. Carol Berkowitz, who will become AAP President in 2004-2005, confirms that she also attended this meeting, however in a phone interview on December 3rd, she told Hipmama.com that the meeting was noted on her personal conference schedule when she arrived in New Orleans.

“The meeting was on my own schedule that they handed me when I arrived,” says Dr. Berkowitz. “I assumed it had been set up in advance at AAP headquarters. I saw nothing remarkable about it; I attended many such meetings while I was there and I’ve been friends with many infant formula representatives for years.”

Dr. Berkowitz says that she too was concerned about the tone of the ads based on what formula industry representatives told her when she met with them at the AAP Convention.

“At the end of the meeting, Dr. Edwards asked what they wanted us to do and they told us that they had just wanted to make us aware of the situation, ” remembers Berkowitz.

Apparently, the AAP leadership’s freshly heightened awareness led to almost immediate action on behalf on the formula industry. In a letter dated November 3rd –- while the AAP convention was still underway in New Orleans and on the very same day he was installed as President — Dr. Johnston signed off on a strongly worded statement to DHHS objecting to the ostensibly still-under-wraps breastfeeding advertising campaign, based solely on what he had been shown and told by infant formula company lobbyists.

In the letter, Johnston notes that it has “come to his attention” that an ad campaign is about to be launched, and that he formed his opinions “after reviewing the Web Page of The Ad Council.” He does not mention that his concern was, in fact, prompted by a private meeting he had just concluded with representatives from the infant formula industry. Dr. Johnston told Hipmama.com that, despite the wording in his letter to Secretary Thompson, he is not certain that he personally viewed The Ad Council webpage before signing the letter, and that he didn’t actually draft the letter himself; staff at AAP offices near Chicago did. But he says that he was comfortable signing his name to it.

“I felt that we needed to send a letter immediately because the people we met with told me that these ads were about to be released,” explains Dr. Johnston. “They conveyed a sense of urgency to me and I shared their concerns. I thought many of our members would be disturbed if these ads were released in that format. I felt we needed to act.”

Meanwhile, members of the U.S. Breastfeeding Committee and other medical professionals with an interest in the DHHS advertising campaign had no idea that the new President of the AAP had taken such an action. Within a week of the AAP convention, however, sympathetic sources within DHHS began contacting interested medical professionals around the country and quietly reporting that “something was up” with the breastfeeding campaign.

“We started hearing from people that the infant formula companies had begun an intense lobbying campaign against the ads within DHHS and other government offices, including Senator Bill Frist’s,” says Marsha Walker of NABA. “They were saying that they were unhappy with ads that told of consequences of not breastfeeding as opposed to stating the benefits.”

By mid-November, Dr. Lawrence Gartner had been alerted by a DHHS staffer to the existence of the Johnston letter sent on behalf of the AAP. Gartner says that he was very disturbed that the AAP’s own Breastfeeding Section had not been consulted or even notified about the contents of Dr. Johnston’s letter to Secretary Thompson, even though he and his colleagues in the AAP’s Breastfeeding Section had also attended the AAP Convention earlier in the month. After investigating the matter, Dr. Gartner felt compelled to send his own letters to Secretary Thompson, as well as to other AAP members.

In his letter to fellow pediatricians across the country, Dr. Gartner wrote that, “ There is every reason to believe that (the infant formula companies) are pulling out all the stops to get this ad campaign buried, or, at least, modified to be less effective… This entire affair is a very serious matter, which raises many questions about the leadership of the AAP and the influence of the formula industry on AAP activities.”

Mardi K. Mountford, Executive Director of the International Formula Council, a trade group representing the interests of infant formula manufacturers takes issue with Dr. Gartner’s assertion that her industry is seeking to discredit or delay the DHHS campaign.

“We strongly encourage mothers to breastfeed if they can, but we don’t believe that women need to be subjected to scare tactics like the ones that are in these ads,” explains Mountford. “Our only interest in reviewing the scientific claims in the ads is that they be accurate so that parents have the information they need to make their own decisions about what’s best for their families”

Mountford’s remarks highlight something that public health advocates have long noted; namely, that the infant formula industry’s tactics in lobbying against initiatives such as FDA regulation of their product, standardization of ingredients in their product, and now, the DHHS breastfeeding campaign are remarkably similar to the strategies employed by tobacco companies in the early years of the anti-smoking public health movement.

According to PRWatch.org, the tobacco industry created what eventually became known as the Council for Tobacco Research(CTR) in 1953, claiming that the organization’s mission was to ”find out whether smoking was dangerous…’” During the 1980s, internal CTR memos revealed that “ the CTR actually worked at “promoting cigarettes and protecting them from these and other attacks,” by “creating doubt about the health charge without actually denying it, and advocating the public’s right to smoke, without actually urging them to take up the practice.” Just as the infant formula industry currently pays for much of the research into breastfeeding in the U.S, for many years the CTR funded most research into tobacco health issues and attempted to insert itself as a “concerned” corporate citizen into the government’s earliest anti-smoking campaigns.

While Dr. Johnston’s letter to DHHS referred only to a “negative tone” in the ads, infant formula industry lobbyists had been contacting DHHS and Ad Council officials since Spring, 2003 and insisting that the specific scientific research upon which some of the language of the ads were based was faulty. OWH spokesperson Christina Pearson confirms that the infant formula industry raised these concerns with DHHS officials, and concedes that the ads have now been modified to remove references to specific statistics that quantify the higher risks for certain diseases. However, she says that this change was in no way the result of pressure from the infant formula industry.

Several sources within the Ad Council, which relies heavily on funding by pharmaceutical companies that also produce infant formula – such as Mead Johnson – claim otherwise. They say that Mead Johnson threatened to pull its millions from The Ad Council’s budget if the references to specific risk numbers were not removed from the ads. The Ad Council declined to comment on this report, instead referring all inquiries to Christina Pearson at OWH, who says her agency can neither confirm or deny this alleged incident.

According to Dr. Gartner, the industry’s complaints about a “negative” tone in the ads, as well as its questioning of the science behind the campaign are just red herrings designed to delay and water down the campaign for as long as possible.

“As far as a negative tone goes, most successful public health campaigns rely heavily on making the public aware of negative consequences of certain behaviors. While it may be a new way to approach breastfeeding promotion, it’s a common advertising device.” says Dr. Gartner. “We don’t tell parents about the ‘benefits’ of carseats. We tell them that studies indicate that if they do not use a carseat, their baby has a greater risk for being injured or killed in an accident. And telling them this has worked. Thousands of lives are saved every year because this message works.”

Dr. Johnston admits that he now regrets not having discussed the letter he sent to Secretary Thompson with his own “breastfeeding experts” within the AAP, including Dr. Gartner. But notification is as far as it should have gone, says Johnson. He stands by his concerns about the ad campaign.

“I rely on the breastfeeding experts to help me learn more about breastfeeding issues, but some of the science behind these breastfeeding claims is shaky. It’s just not solid yet, and you know how some of these breastfeeding enthusiasts can lack objectivity,” noted Dr. Johnston.

When asked whether this lack of scientific objectivity he has observed extends to members of the AAP breastfeeding section, he replied “some, not all.”

Dr. Gartner says that he finds Dr. Johnston’s statement about objectivity among the physicians in the AAP’s Breastfeeding Section “outrageous.”

“I’ve read thousands of scientific papers on breastfeeding and formula feeding in just the past few years and so have my colleagues in the Breastfeeding Section within the AAP,” notes Dr. Gartner. “I challenge Dr. Johnston to discuss the hard science behind this issue with me any time. I would welcome the opportunity. Frankly, I do not believe he is qualified to comment on the research because I doubt he’s read much of it except –it appears – possibly what the infant formula companies have shown him.”

According to many lactation consultants and physicians who have played a consulting role in crafting the DHHS ad campaign, an earlier release date offered by DHHS officials was to be in October, 2003, to correspond with World Breastfeeding Week. That date came and went and participants were next told that the date for the campaign’s official roll-out would December 3rd, to correspond with a meeting of breastfeeding and infant health experts that was scheduled to take place in Washington. In its December 4th edition, the New York Times cited an Ad Council newsletter that named a December, 2003 release date for the campaign.

Christina Pearson of OWH disputes the claim that there has ever been a true release date set for the ads and emphatically denies that any changes have been made to the campaign’s message as a result of pressure from the AAP or infant formula industry representatives.

“The campaign is still on the drawing board and as far as we are concerned it has never come off the drawing board,” explains Pearson. “Anyone who thought we were about to release the ads was simply mistaken. We will continue our review of the message and the content until everyone feels comfortable that we have it right.”

Katie Allison Granju is the author of “Attachment Parenting: Instinctive Care for Your Baby and Young Child” and her essays can be viewed on her website at Loco Parentis.

The allergen in poison ivy is a substance called urushiol. What urushiol does, to people who are allergic to it, is bind with the skin cells and produce a rash. In order to treat a reaction to the poison ivy what you essentially need to do is “neutralize” the urushiol.

There are several herbs, when applied topically, that can do this. Jewelweed is one of the best. You can also combine this with any herb that contains a significant amount of saponins such as Soapwort, Horse Chestnut, Licorice, or Rose Leaves. Please remember that these are for topical use only as saponins shouldn’t be taken internally while pregnant or nursing, but are perfectly safe when used externally. Some things to help control the itching are aloe vera or plantain. Also, cool baths with powdered colloidal oatmeal can be extremely soothing.

It’s no wonder that the pharmaceutical industry has made a huge effort to market drugs for ADHD and that a large and intelligent backlash has developed against the widespread use of these powerful chemicals.

I have been a pediatrician for twenty years and for fifteen of those years I completely disdained the use of Ritalin and the other psychopharmaceuticals for ADHD kids. I was probably wrong to “throw out the baby with the bath water.” Denying that a small percentage of children receiving Ritalin actually benefited from the drug was not fair to them. We don’t know enough about brain chemistry to completely understand ADHD, but we do know the impact of untreated ADHD on children: a much more difficult childhood and adolescence with school and social problems which can be nonstop.

I now try “everything else” before resorting to prescription medication, but I no longer rule out that possibility.

Deficiency in central nervous system dopamine probably causes many, if not most, of the problems associated with ADHD. Nutritional problems can cause or exacerbate this deficiency: supplemental tyrosine, B vitamins, vitamin C and copper have all shown a positive influence on improving the school performance of children with ADHD. These can all be combined with conventional therapy with no adverse interactions. Ritalin and similar drugs act by directly increasing brain dopamine levels.

Before I consider anything else, I try to persuade the family to put their child and themselves on an excellent diet. The standard American diet filled with sugar, artificial sweeteners, colors, preservatives, saturated fats, low levels of vitamins and minerals, and too much protein is not good for brain health or health in general. Mainstream medical journals have debated this topic for decades and most medical practitioners don’t like to consider nutritional alternatives in the treatment of any disease because it takes too long to discuss it with their patients.

I recommend whole foods as the backbone of the nutritional regimen. As obvious as this sounds, most children get the bulk of their food in an over-processed form. Whole grain cereals and breads and lots of fresh fruit and vegetables and beans and pasta make for meals which interest children and adults. Counsel your patients to avoid sugar!! Reading labels closely will show parents just how many artificial additives have worked their way into kids’ daily diets. Many chemicals mimic brain neurotransmitters and even conventionally published research admits that sugar has a negative impact on the behavior of ADHD children. Processed cereals and high-fructose corn syrup sweetened drinks add huge amounts of sugar to a child’s day. Even regular unsweetened apple juice in the quantities some children like can be a large source of extra sugar.

There are many alternative remedies which can be used to treat children with ADHD and learning disorders. We must help the families in our practices find these and guide them in their usage.

Ginkgo Biloba dilates blood vessels and improves circulation to the brain. Researchers have shown it’s utility in Alzheimer’s Disease.

Variations are to be expected, and are in no way to be considered a defect.

– Hang tag from Madras shirt

Statistics reflect this confusion. Depending on who you read, some experts say we have about eight hundred-thousand learning disabled children in the country. Others put the figure as high as eight million.

In 1963, when “learning disabilities” were first described, we found very few students with the problem and thought the problem was rare.

Some take a very conservative view and say that 30 – 50% of us will outgrow it, but a growing body of experts think we just learn to cope with it. There’s a certain brain development that takes place at puberty that sometimes makes ADD much easier to live with. I think the jury’s still out but my guess that most of learn to live with it, not outgrow it.

For anxiety, a mix of Kava and Siberian Ginseng is good.

For depression, Gingko Biloba or Borage. There has been a good amount of success with a combination of the two as well.

Keep in mind when combining herbs to treat one symptom or illness to use a proportional dosage. (i.e., two herbs would be half dosage of each, three herbs would be one-third dosage, etc.)

Here is a link that goes into homeopathic remedies for depression. The info given is on postpartum depression simply because all of these are safe while nursing. They are all used to treat general depression as well, so they’re not specific for use for PPD.

Homeopathic Remedies for Postpartum Depression – MotherNature.com Health Encyclopedia

The usual speech applies here. When looking into using herbal or homeopathic remedies, make sure you’re getting them from a good health food store. Avoid commercial places like GNC. Get out the yellow pages and look under health food stores, then call around until you find one with a certified herbalist on staff. This is the store you want to go to.

Exercise should not be forgotten when dealing with depression. It has been shown that regular exercise is the best remedy for depression. There have been patients who’ve suffered repeated bouts of depression who have been able to go off meds completely after starting and maintaining a regular exercise program.

The dosage for regenerating cartilage is 1500 mg of glucosamine a day and 1200 mg of chondroitin a day. Take this dosage until you start feeling a relief from the pain. Then drop down to 1000mg of glucosamine and 800 mg of chondroitin until pain disappears. From that point on, take a daily dose of 500 mg glucosamine and 400 mg chondroitin daily to prevent future degeneration.

Patients using glucosamine for osteoarthritis should take 1500 mg per day. It can take up to 4 – 8 weeks to relieve pain. Therefore, continuing on a NSAID during this time period may be necessary.

Patients with type II diabetes should monitor their blood sugar carefully due to concerns that glucosamine might increase insulin resistance.

In considering which supplements will assist you best with joint pain, it may be helpful to know that the absorption rate for chondroitin is 0 to 8% while the glucosamine sulfate is 98%. Glucosamine sulfate is the best source. It is possible to get the relief you are looking are with glucosamine alone.

Here are some natural treatments for colds that can be used in children and are also safe while nursing. When using herbs with children you can usually find a product made specifically for infants and children. If you can’t here’s how to determine the dosage. You take the child’s weight and divide it by 150. The resulting fraction is the portion of the adult dose to administer.

The first thing you’ll want to do is boost your body’s immune system. Echinacea, 2 capsules 3 times per day, and Colloidal Silver are great immune system boosters. You may also want to boost your intake of vitamin C, up to 500mg 4 times per day, and eat foods with plenty of fresh garlic.

Anise and Mullein, in tea form and taken as needed, are both natural expectorants. Elderberry, 10ml 2 times per day, is the best antiviral product on the market, natural or otherwise. It is most effective in fighting the flu virus, but is also very effective against cold viruses.

Aromatherapy can be a great tool as well. Lavender and Clary Sage in your bath are what you’ll want to use. Lavender works to relax muscles and can help soothe coughs and Clary Sage helps alleviate the grumpiness that tends to accompany colds. What you’ll need to look for is an essential oil. It is the oils of these plants that work, so something that merely contains a fragrance is going to be useless. Then what you do is take some unscented liquid soap and add five drops Clary Sage oil and ten drops Lavender oil and use your finger to mix the oil with the soap. This emulsifies the oils so that they mix with your bath water.

Nettle, 2ml 2-5 times per day, is a natural antihistamine. Nettle is also wonderful for treating seasonal allergies. It’s a great alternative to artificial antihistamines that can affect milk supply.

Some recipes:

Vapor Rub
1/2 teaspoon eucalyptus essential oil
1/8 teaspoon peppermint essential oil
1/8 teaspoon rosemary essential oil
1/8 teaspoon clary sage essential oil
1/4 cup olive oil

Mix ingredients together in a glass bottle (not plastic as the essential oils will bleed into it making the rub less effective) and shake well. Massage onto chest as often as needed.

Cough Syrup
1 tablespoon anise
1 tablespoon mullein leaves
1 tablespoon thyme leaves
1 tablespoon rose hips
1 tablespoon slippery elm bark
1 tablespoon lemongrass leaves
1 quart water
½ cup rice syrup

Place herbs and water in a large saucepan. Bring to a boil, uncovered. Remove from heat, cover and let herbs steep for 45 minutes. Strain out the herbs. Return liquid, uncovered, to low heat and simmer for 15 minutes. Turn off heat and slowly stir in syrup. Let cool completely. Store in a glass container in the refrigerator for up to 12 months.

Dosage: Up to 20 lbs.=1/4 teaspoon, 21-40lbs.=1/2 teaspoon, 41-60lbs.=1 teaspoon, 61 lbs. and over= 2 teaspoons, taken every 4 hours.

I think that many infections, including otitis media (middle ear infections) respond faster or better to antibiotic treatment but I also think that the negative impact of those medicines is underestimated by doctors and patients alike. Everything from yeast overgrowth in the intestines, oral thrush, vaginal or diaper area yeast infections to diarrhea result from antibiotics. Additionally, some people have allergic reactions to these medicines. Perhaps the most underestimated problem is the breeding of bacteria which are resistant to the very drugs we count on to kill them.

For all of these reasons, it’s a great idea to save antibiotics for the times when infections threaten health and safety and/or when other therapy modalities have been exhausted.

I treat ear infections with prevention (anti-allergy measures such as dairy avoidance, dust reduction and getting rid of feather pillows and quilts) and with herbal and homeopathic remedies. I have some formal training in these methods but nowhere near enough to call myself an authority. I have been trained by my patients’ actions and by years of experience watching the way children respond to gentler methods of healing otitis media and other infections.

I like to put mullein/garlic oil in the ears hourly for a day or two and give pulsatilla 6X or 12C (homeopathic strength–the range I have given indicates homeopathic ignorance… but it works) or lachesis homeopathically hourly for two days.

Elderberry is an herbal preparation which interferes with viral growth and I use the extract for younger children and the lozenges (hourly again… tough day for moms) for the toddlers and older kids. The doses can be calculated from the bottle you buy.

I also give extra vitamin C (500 mg/year of age/day to a maximum of 5000 for ten year olds to adults) and 5-15 mg of zinc/day to help immune function.

Echinacea is another good herb for stimulating immune function and I use it for any child without bad allergies or other autoimmune problems.

Dairy avoidance is crucial to treat or prevent ear infections and many people like to replace the lost calcium either with fortified drinks (soy, rice, orange juice) or with supplemental calcium.

Pain control can be done either herbally or with Tylenol-type meds. Hot compresses on the ear will increase blood flow and speed up healing.

2. Don’t be thrown by growth spurts. They are normal and short lived. The only accurate way to gauge how much the baby is taking in is by counting wet and dirty diapers.

3. Buy yourself a tube of Lansinoh.

4. Get through the first 2 to 3 weeks. After that it is SO much easier!!

5. Have phone numbers of breastfeeding-friendly people to help you.

6. Remember that your breasts are never truly empty of milk. You make milk as your baby nurses.

7. Always let the baby end the feeding himself. That way, he will get all of the hindmilk he needs.

8. If you feel discouraged or like throwing in the towel, read this list or 101 Reasons to Breastfeed. It has always helped me and I could never quit after being reminded of why I was breastfeeding.

9. Check to see if you have inverted or flat nipples while pregnant, because you can start correcting them before the baby is born.

10. The first few days till milk comes in, colostrum is really all a baby needs. Nurse often on each side (every 90 minutes) to make sure baby gets enough colostrum and to ensure milk will come in soon.

11. Watching the clock, timing nursing sessions, and switching breasts after x amount of minutes might just drive you and baby crazy. Don’t worry so much about the time, and feed baby on one breast till she’s satisfied before offering the other, which she may or may not take at the same feeding.

12. It is not supposed to hurt to breastfeed. If it hurts, you have one of two things happening, most likely:
a) A bad latch. Work on that first.
b) Thrush.

13. In the beginning and any time you have sore nipples, use Lansinoh (USP modified lanolin, ultrapure medical grade) in the purple tube from the pharmacy. If you have a sore or cracked nipple, keep nursing on it and it will get better.

14. If it hurts for the first 30 seconds to a minute after latching on and goes away, you are not doing anything wrong. It will get better in a couple of weeks and be gone by 6 weeks. Sometimes let-down can be painful in the beginning. That, too, goes away. Severe or long-lasting pain, however, needs to be looked into; it’s probably very solvable.

15. A newborn who is pulling back and crying at the breast is not rejecting you. It could be a growth spurt, forceful letdown, thrush or just a tired or gassy baby. All can be dealt with.

16. A baby, especially newborn, is SUPPOSED to nurse all the time (even every hour or two). That it is normal and does not mean that your milk supply is low.

17. If a baby, especially newborn, is sleepy; she is growing. Don’t let a sleepy baby scare you into thinking she isn’t getting her nutrition. Jaundice might be a reason that baby is sleepy; keep a close eye on her and contact your pediatrician if you suspect that (see next tip). If she goes a long time without nursing, try using a wet cloth or undress baby to wake her up during feedings.

18. Jaundice is not a reason to substitute formula for breastmilk, no matter what the doctor wants you to think. A baby with a bilirubin level of less than 20 is perfectly fine. Breastfeeding MORE during jaundice, not less, is beneficial. Question anyone who tells you differently and do your own research.

19. Nursing a newborn at least 10 to 12 times a day is a good rule of thumb, and that doesn’t mean the feedings will all be evenly spaced. The number of feedings will decrease as baby gets older. Also look for 6 to 8 wet diapers to ensure baby is getting enough to eat. Some babies have BMs more often than others, but when they do occur, they should be mustard yellow and a bit seedy and loose.

20. Putting a baby, especially newborn, on a schedule may decrease your milk supply, ending breastfeeding altogether. Feed on baby’s cue (sucking hand, quietly fussing, etc.), even if you think she just ate and can’t be hungry. She is growing, needs the comfort and nutrition, and you need the milk stimulation in the early weeks.

21. Some newborns will cluster nurse: feeding often for a few hours then resting for several more. This is normal.

22. A baby being “big” does not mean he needs to be supplemented. Your milk supply will be more than enough for him. Simply nurse him as often as he wants to in the beginning, but don’t think that this “constant nursing” will last forever. He’ll become more efficient and your milk supply will increase to appease him.

23. There are things you can do to increase your supply if need be. Drink plenty of water. Rest. Take fenugreek or another herbal supplement if the problem is serious.

24. Get a sling. It’s a lifesaver. Maya Wrap slings and Over The Shoulder Baby Holder slings are great ones!

25. Leaking: If you leak a lot, don’t worry; this will subside over time. If you don’t leak much, don’t worry; this is NOT an indication of low milk supply.

26. Know when and what to expect during a growth spurt. (10 days, 3 weeks, 6 weeks, etc.) Baby may pull off breast, be a little fussier, and/or nurse more often, building up your milk supply. Nursing more often does not mean you aren’t making enough milk and baby needs formula; just the opposite — baby is increasing your milk supply for you by nursing more often.)

27. After 6 weeks, your breasts may not feel as full. This is not an indication that you aren’t making enough milk, just that your body has adjusted to your milk supply. Around this time, baby may nurse more because of a growth spurt. Don’t let the feel of your breasts and the increase in nursing make you worry.

28. Pumping is not a good indicator of how much milk you normally make. Baby sucks more efficiently and differently than a pump. Also, all pumps are NOT created equal.

29. Every bottle of formula given to a baby can:

a) decrease your milk supply, making one think that further supplementing is needed since mom isn’t “making enough milk”.
b) increase the risk of nipple confusion.
c) even kill forever many of the immunities breastmilk offers, once foreign substances enter the body.

30. Using a pacifier instead of nursing a baby may hinder your milk supply.

31. Unless they have “IBCLC” after the “MD”, NEVER take accept as accurate ANYTHING a physician or nurse tells you about breastfeeding; that is not required training for a pediatrician or OB. Hear them out, but find a qualified lactation consultant, excellent reference materials and a support group (online or in real life) of breastfeeding women to get second, third and fourth opinions.

32. If your baby is choking or throwing up during and after eating, it could be you have a forceful letdown. The best way to fix this is to nurse leaning back. This letdown will ease up over time, and your baby will also get used to it.

33. Nurse laying down whenever possible, even if you don’t want to cosleep. Baby gets fed, you get rest.

34. Mom eating dairy might cause a baby discomfort in the early weeks and months.

35. Dads can bond in every other way with the baby other than feeding. Offering a bottle early on for dad to bond may interfere with the nursing routine and risk ending it altogether.

36. Regardless of any problem you might encounter, there is a solution that does NOT involve formula. If you hit a road block it’s merely a matter of getting accurate help. Talk to an Internationally Board Certified Lactation Consultant (IBCLC) if you need serious help. Only 3% of women medically CANNOT breastfeed; that means 97% of women can do it quite successfully, even if there are initial problems.

37. Regardless of what one might think, formula, too, has its downfalls and inconveniences that may not show up till later, including inferior nutrition, increased health problems and cost. Best to get the rough stuff out of the way now and have an easy breastfeeding relationship later on.

38. Surround yourself with supportive people (and good books and online help) and ignore the well-meaning non-supportive ones.

39. When pumping at work, always pump at least as often as your baby would nurse. Add an extra pumping session early in the morning, not at the end of the day, to increase supply.

40. Just because you are young does not mean you can’t make the best choices for your child — and breastmilk is the best choice. Don’t let anyone try to tell you that you’re too young to make enough milk, or make nutritious milk. You WILL make enough, and it will always be more nutritious than formula.

41. Trust yourself. Other people may try to tell you that you are feeding your baby too often or that you should be feeding solids or formula, but you will know what is best for your baby.

42. Educate yourself. This is the best way to know when you are given bad advice from doctors or well-meaning family members. Read as much as possible before baby is born.

43. Drink at least 64 oz. of water a day.

44. Eating peanut products while nursing can lead to potentially fatal peanut allergies later in baby’s life.

45. When pumping and working you will need to drink at least 80 oz. of water per day. This does not include sodas or caffeinated drinks. If you drink these you need to drink even more water.

46. When pumping and working, your baby can make your work day his longest stretch without nursing, up to 6 hours, as long as you feed every 2 hours during the night.

47. When working, if at all possible, go to your baby for your lunch hour to nurse.

48. If you sleep with your baby you can nurse and sleep at the same time if you do it lying on your side. You may not want to do this in the beginning just to make sure you are awake enough to see that he is eating enough. After 6 or 8 weeks you should have a good breastfeeding relationship and can feed while sleeping.

49. Never hesitate to get help, even if you are not sure that your problems are feeding related.

50. Feeding on demand is the best way to relieve or avoid engorgement. It “teaches” your body to make the right amount for your baby.

51. Enjoy breastfeeding. He will only be a baby for such a short amount of time. Let yourself love it!

52. If the situation arises where you lose your milk, know that you have the possibility to relactate. If women who have never lactated can induce lactation for adopted children, a formerly nursing mom can relactate!

53. You may come across some well-meaning, but unsupportive people who try to give advice and possible misinformation. There are many myths about breastfeeding which most people still believe. Just be prepared to smile, nod and get your own information.

54. Take a class or go to a support group to get yourself ready before the baby is here.

55. Keep in mind that although you have heard stories of women who were “unable” to breastfeed, almost all women can. We know more about breastfeeding now than ever before, and have learned that there is a solution to almost all breastfeeding problems.

56. Pump first thing in the morning because this is when you have the most milk.

57. Remember that the evening is when you have the least amount of milk. This doesn’t mean that you are losing your supply.

58. Before a growth spurt your baby will want to nurse more often because he will be signaling your body to make more in order to accommodate his growth spurt. Feeding on demand is the only way to weather a growth spurt. This is the time when it is most important to not supplement because that will signal your body to make less.

59. During growth spurts baby may sleep a lot, become fussy and pull away from the breast crying (especially in the evening.) Don’t be alarmed, this is normal. The best thing to do is provide a lot of skin-to-skin contact and nurse, nurse, nurse.

60. Once you get past the first few months it will become second nature to you, and you will find that it is so easy to breastfeed. You never have to give feedings a thought because the food is always right there, ready when baby is.

61. When you nurse in public it is helpful to have a sling because the baby feels safe and it is totally discrete. Or you can nurse and do housework at the same time!

62. It is very rare for a breastfed baby to “need” supplements. If someone tells you he does, do your own research before believing them.

The mothers from the Breastfeeding and Breastfeeding Support boards on AOL have contributed some things that they found helpful when they were new to NIP. We hope that it will provide you with tips for making the transition to NIP an easier one for you.

Most of all, remember, that nursing your baby is completely normal and natural to do, regardless of where you are when your baby is hungry. It’s how our bodies were designed to nurture our precious children. It’s just that some folks haven’t figured that out yet. Set a good example for another new mom that may be watching you and just nurse your baby.

- Cherri

2. Get completely physically comfortable before latching on. There’s nothing worse than having to hold a bad pose because the baby isn’t finished.

3. I like crossing my legs to lift the baby up a bit.

4. Chairs with arms are nice when you have to support the baby’s weight for a longish nursing session.

5. Learn to NIP without special nursing clothes. That way you’ll never have to worry about what you’re wearing when you leave the house. I recommend a loose top worn on the outside of your pants.

- Sharon

Choose where to sit carefully. If you try to go away from other people, you will be sitting alone in a sea of empty tables, drawing attention to yourself. If you sit more with a crowd, the activity going on around you will distract any onlookers from what you’re really doing.

By placing a diaper bag or large purse on the table, you can block the view of your chest without a blanket. Think about lines of sight. If someone seems inappropriately curious, place the bag between him and you.

Keep doing what you’re doing. If you’re talking to friends, eating lunch, or what-have-you, you will look normal and inconspicuous.

- Ivy

- Jane

2. If you sit at a booth in a restaurant make sure it is roomy enough to accommodate the baby in front of you without him being smashed up against the table. That being said, booths are more private than tables.

3. If the weather is nice, go to a park. I used to stroll him and sling him on the walking paths and then sit down on a park bench. This gave me exercise and I began to sit closer and closer to other people as my confidence grew.

4. Invest in a cassette tape that does progressive relaxation (I had one for childbirth.) Listen to it at night before bed. Use the techniques you learn from the tape to relax when you are all nervous, the baby is crying, and you think everyone is looking.

5. Don’t let family members tell you that you can’t nurse somewhere. My mother said I couldn’t nurse in church so I told myself, “watch me”, and practically begged the baby to fuss.

6. It is all in your attitude and determination to do what is best for your child. This is one of your first chances to be your child’s biggest advocate. He will get the best nutrition available and you will not be a wimp!

- Claire

- Nicole from PA

- Christine Cosmo

- Jennifer

In the beginning, try to find a dressing room in department stores. The mirrors are usually large and make it easy to see how much you are really showing.

I sometimes use a lightweight blanket/shawl type thing just for latching since my son likes to “play” for a bit before getting down to business.

There are usually at least a few benches that are kind of in secluded areas in most malls, not to hide, but usually quieter and less traffic.

- Min

- Sarah J.

I thought all was great, until a few minutes into the feeding. Three 40ish aged men turned around and kept staring at me. They were acting like I had whipped my boob out and was showing it to the crowd, then the one guy said so that I could hear it, “That poor kid is going to be confused when he grows up. I would die if my mother had done that to me.”

My heart sank and out of reaction I ended the feeding immediately. I sat for a few minutes with a confused son on my lap. He had no clue what was going on. Then I realized what an idiot I was being by stopping the feeding. I started getting mad and I realized how ridiculous that it is that I keep running to the car or to a dressing room when my son gets hungry in public. Jerks like these guys are in the wrong, not me! So I started over, and this time. I was LOUD about it. “Ooohhhh honey, are you hungry! I bet that tastes good Aidan.”

The guys were, like… so grossed out, and for the rest of the game we were having to deal with them looking back to see if I was nursing, and I nursed two more times during the game. It was a truly liberating experience — no more hiding for me. If I can nurse at a football game with 13,000 people there, I can do it anywhere!

- Shaye

So I asked my husband to sort of block the view with his body while I latched our daughter. He was so reassuring, “Jo, you can’t really see anything from this angle.” After that, I was able to NIP with or without him present to block the view.

As my father-in-law said while I nursed at the airport, “If anyone looks, all they are going to see is a mama loving her baby the way nature intended!”

- Jo

- “Lactalina “

I have always enjoyed scanning medical databases for new breastfeeding articles but this collection was gathered by Ginna Wall, MN, IBCLC and Jon Ahrendsen, MD, FAAFP who have given their kind permission for its presentation here.

For a frank discussion with your dentist, skip right to the dental caries articles. Families with premies need to look hard at the RSV research and the NEC articles among others. Neonatologists need them, too.

The brain grows better with breastmilk as has been shown over and over again in research about IQ, motor development and vision.

The articles about decreased incidence of malignancy and diabetes are worth a read in their entirety when you have a chance to get to MEDLINE or Pubmed.

View the entire contents of this report by clicking here:

Outcomes of Breastfeeding Versus Formula Feeding

Diarrhea
An episode of diarrhea was significantly less likely to last for six or more days if an infant was breastfed for three or more months.  Baker D et al.  “Inequality in infant morbidity: causes and consequences in England in the 1990s.”  J Epidemiol Community Health 1998 Jul;52(7):451-8

The risk of developing diarrhea increases as the amount of breastmilk an infant receives decreases.  When compared with exclusively breastfed infants, infants who were exclusively formula-fed had an 80% increase in their risk of developing diarrhea.  Scariati PD et al.  “A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States.”  Pediatrics 1997 Jun;99(6):E5

Among babies born at more than 30 weeks gestation, confirmed necrotizing enterocolitis was rare in those whose diet included breastmilk; it was 20 times more common in those fed formula only. Lucas, A., Cole, T.J., “Breast Milk and Neonatal Necrotizing Enteral Colitis”. Lancet 1990; 336:1519-23

Significantly increased risk for acute otitis media as well as prolonged duration of middle ear effusion were associated with male gender, sibling history of ear infection and not being breast fed. Teele, D.W., Epidemiology of Otitis Media During the First Seven Years of Life in Greater Boston: A prospective, Cohort Study”. J of INFEC DIS.1989.

In infants who were breast fed until at least 12 months of age, the percentage of any otitis media was 19% lower, and of prolonged episodes (> 10 days) was 80% lower than formula-fed infants.  The mean duration of episodes of otitis media was longer in formula-fed than breastfed infants (8.8 vs 5.9 days, respectively).  Dewey KG et al.  “Differences in morbidity between breast-fed and formula-fed infants.”  J Pediatr 1995 May;126(5 Pt 1):696-702

The risk of developing an ear infection increases as the amount of breastmilk an infant receives decreases.  When compared with exclusively breastfed infants, infants who were exclusively formula-fed had a 70% increase in their risk of developing an ear infection.  Scariati PD et al.  “A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States.”  Pediatrics 1997 Jun;99(6):E5

Infants who were not being breast fed were 17 times more likely than those being breast fed exclusively to be admitted to hospital for pneumonia.  Cesar JA et al.  “Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study.  BMJ 1999 May 15;318(7194):1316-1320

Odds of respiratory illness with maternal smoking were 7 times higher among children who were never breastfed then among those who were breastfed.  Woodward A et al.  “Acute Respiratory Illness in Adelaide Children: BreastFeeding Modifies the Effect of Passive Smoking”.  J Epidemiol Community Health 1990 Sep;44(3):224-30

A birth cohort was followed-up to age 4 years.  By age 4 years, 27% of the children had symptoms of allergic disease.  Family history of atopy was the single most important risk factor for atopy in children.  Sibling atopy was a stronger predictor of clinical disease than maternal or paternal atopy.  Formula-feeding before 3 months of age predisposed to asthma at age 4 years (OR: 1.8). Tariq SM, et al.  The prevalence of and risk factors for atopy in early childhood: a whole population birth cohort study.  J Allergy Clin Immunol. 1998 May;101(5):587-93.

Eczema was less common and milder in babies who were breast fed (22%) and whose mothers were on a restricted diet (48%). In infants fed casein hydrolysate, soymilk or cows milk, 21%, 63%, and 70% respectively, developed atopic eczema.  Chandra R.K., “Influence of Maternal Diet During Lactation and the Use of Formula Feed and Development of Atopic Eczema in the High Risk Infants”. Br Med J. 1989

Children who had consumed mother’s milk by tube in early weeks of life had a significantly higher IQ at 7.5 to 8 years, than those who received no maternal milk, even after adjustment for differences between groups and mothers’ educational and social class.  Lucas, A., “Breast Milk and Subsequent Intelligence Quotient in Children Born Preterm”. Lancet 1992;339:261-62

PKU IQ
School-age phenylketonuric children who had, as infants, been breastfed 20-40 days prior to dietary intervention scored significantly better (IQ advantage of 14.0 points, p = 0.01) than children who had been formula fed.  A 12.9 point advantage persisted also after adjusting for social and maternal education status.  Riva E et al.  “Early breastfeeding is linked to higher intelligence quotient scores in dietary treated phenylketonuric children.  Acta Paediatr 1996 Jan;85(1):56-8

In 771 low birth weight infants, babies whose mothers chose to provide breastmilk had an 8 point advantage in mean Bayley’s mental developmental index over infants of mother choosing not to do so. Morley, R., “Mothers Choice to provide Breast Milk and Developmental Outcome”. Arch Dis Child, 1988

Erythropoietin stimulates production of red blood cells and is used in the treatment of anemia of prematurity.  Human milk contains considerable amounts of erythropoietin which resist degradation after exposure to gastric juices at physiologic pH levels. Kling PJ et al.  “Human milk as a potential enteral source of erythropoietin.”  Pediatr Res 1998 Feb;43(2):216-21

Preterm infants demonstrated a higher oxygen saturation and a higher temperature during breastfeeding than during bottle feeding, and were less likely to desaturate to <90% oxygen during breastfeeding. Blaymore Bier JA et al.  “Breastfeeding infants who were extremely low birth weight.  Pediatrics 1997 Dec;100(6):E3

In this study of 330 8-year-old children from Southern Tasmania, those who werebreastfed had higher bone mineral density at the femoral neck, lumbar spine and total body compared with those who were bottle-fed.  This association remained significant after adjustment for size, lifestyle factors and socioeconomic factors.  Breastfeeding for less than 3 months was not associated with increased bone mass at any site.  Jones G, Riley M, Dwyer T.  Breastfeeding in early life and bone mass in prepubertal children: a longitudinal study.  Osteoporos Int 2000;11(2):146-52

Women who were breastfed as infants, even if only for a short time, showed an approximate 25% lower risk of developing premenopausal or postmenopausal breast cancer, compared to women who were bottle-fed as an infant. Freudenheim, J. “Exposure to breastmilk in infancy and the risk of breast cancer.” Epidemiology 1994 5:324-331

Children who are artificially fed or breastfed for only 6 months or less, are at an increased risk of developing cancer before age 15. The risk of artificially-fed children was 1-8 times that of long-term breastfed children, and the risk for short term feeders was 1-9 times that of long term breast feeders. Davis, M.K. “Infant Feeding and Childhood Cancer.” Lancet 1988 13;2(8607):365-8.

A statistically significant protective effect against Hodgkin’s disease among children who are breastfed at least 8 months compared with children who were breastfed no more than 2 months.  Schwartzbaum, J. “An Exploratory Study of Environmental and Medical Factors Potentially Related to Childhood Cancer.” Medical & Pediatric Oncology, 1991; 19 (2):115-21.

A total of 1744 children with acute lymphoblastic leukemia (ALL) and 1879matched control subjects, aged 1-14 years, and 456 children with acute myeloid leukemia (AML) and 539 matched control subjects, aged 1-17 years, were studied.  Ever having breast-fed was found to be associated with a 21% reduction in risk of childhood acute leukemias.  The inverse associations were stronger with longer duration of breast-feeding.  Shu XO etal, “Breast-feeding and risk of childhood acute leukemia.  J Natl Cancer Inst 1999 Oct 20;91(20):1765-72

In interviews with the mothers of 2,200 children affected by either acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), the infant-feeding history of each of these children was compared with that of over 2,400 healthy controls.  The investigators found that a history of breastfeeding was associated with a reduction in risk of childhood acute leukemias.  Babies who are breast-fed for as little as one month have a 20% lower risk of childhood leukemia than bottle-fed babies, and babies breast-fed for more than 6 months have an even lower risk — 30% less. Robison L et al.  Journal of the National Cancer Institute 1999;91:1765-1772.

This study estimated the prevalence of early childhood caries and related behavioral risk factors in a population of low-income, Mexican-American children in Stockton, California.  Data was collected on 220 children ages six years or less using a parent-completed questionnaire and clinical dental examinations.  Mean age at weaning from breast-or bottle-feeding and patterns of bottle use during sleep did not differ significantly between children with caries and those without. Ramos-Gomez-FJ et al.  “Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California.”  Journal-Of-Dentistry-For-Children 1999; 66 (6): 395-403, 366

This in-vivo and in-vitro study showed that human breastmilk is not cariogenic.  Erickson PR, Mazhari E.  “Investigation of the role of human breastmilk in caries development.”  Pediatr Dent 1999 Mar-Apr;21(2):86-90

Children who were either never breast-fed or only until 3 months exhibited a significantly higher caries prevalence than those breast-fed for a longer time.  Mattos-Graner RO et al.  “Association between caries prevalence and clinical, microbiological and dietary variables in 1.0 to 2.5-year-old Brazilian children.  Caries Res 1998;32(5):319-23

A strong association was found between exclusive bottle-feeding and anteroposterior malocclusion.  Davis DW, Bell PA.  “Infant feeding practices and occlusal outcomes: a longitudinal study.”  J Can Dent Assoc 1991 Jul;57(7):593-4

Among breastfed infants, the longer the duration of nursing the lower the incidence of malocclusion. Labbok, M.H. “Does Breast Feeding Protect against Malocclusion? An Analysis of the 1981 Child Health Supplement to the National Health Interview Survey”. American Journal of Preventive Medicine, 1987.

Children who developed IDDM in New South Wales, Australia, were compared to healthy children of the same sex and age. Those who were exclusively breastfed during their first three months of life had a 34% lower risk of developing diabetes than those who were not breastfed. Children given cow’s-milk-based formula in their first three months were 52% more likely to develop IDDM than those not given cow’s milk formula. Diabetes Care 1994;17:1381-1389, 1488-1490.

The breastfed group had significantly higher antibody levels than two formula-fed groups together. Breastfed infants thus showed better serum and secretory responses to perioral and parenteral vaccines than the formula fed, whether with a conventional or low-protein content.  Van-Coric, M. “Antibody Responses to Parental & Oral Vaccines Where Impaired by Conventional and Low-Protein Formulas as Compared to Breast Feeding”. Acta Paediatr Scand 1990; 79: 1137-42

Osteoporosis
The odds ratio that a woman with osteoporosis did not breastfeed her baby was4 times higher than for a control woman.  Blaauw, R. et al. “Risk factors for development of osteoporosis in a South African population.” SAMJ 1994; 84:328-32.

Whether or not women had ever breastfed, total duration of breastfeeding and duration of breastfeeding per child were not associated with reduced bone mineral, but breastfeeding for more than 8 months was associated with greater bone mineral at some sites.  Melton L et al.  “Influence of breastfeeding and other reproductive factors on bone mass later in life.”  Osteoporos Int 1993 Mar;3(2):76-83

Mothers who breastfed exclusively or partially had significantly larger reductions in hip circumference and were less above their prepregnancy weights at 1 month postpartum than mothers who fed formula exclusively.  Kramer, F., “Breastfeeding reduces maternal lower body fat.” J Am Diet Assoc 1993;93(4):429-33

A retrospective review of 800 pregnancies at one family practice revealed an association between lack of breastfeeding and physical and sexual abuse of the mother and/or her children.  This anecdotal association has not been previously reported, is worth further study using more rigorous methods.  Acheson, L., “Family Violence and Breast-feeding” Arch Fam Med July 1995; Vol 4,pp 650-652

Food Expense
The cost to supply artificial baby milk (ABM) to one child is between $1,160 and $3,915 per year depending on the brand.  Even mothers on WIC need to buy approximately 200 cans of concentrate to feed her infant in the first year.  Breastfeeding Support Consultants, Information on Infant Feeding Costs, April 1998  (based on Illinois and North Carolina suburban supermarket prices).

Compared with formula-feeding, breast-feeding each infant enrolled in WIC saved $478 in WIC costs and Medicaid expenditures during the first 6 months of the infant’s life.  Montgomery DL, Splett PL.  “Economic benefit of breast-feeding infants enrolled in WIC.”  J Am Diet Assoc 1997 Apr;97(4):379-85

If women breast-fed each child for at least 6 months, the total projected savings over a 7.5-year period ranges from $3,442 to $6,096 per family.  This translates into an estimated yearly savings of between $459 and $808 per family.  Savings were calculated based on estimates of the resulting decrease in infant morbidity, maternal fertility, and formula purchases.  Tuttle CR, Dewey KG.  “Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California.  J Am Diet Assoc 1996 Sep;96(9):885-90

View the entire contents of this report by clicking here:
Outcomes of Breastfeeding Versus Formula Feeding

Infections of the breast present themselves typically in two manners. Mastitis is a bacterial infection in the breast, typically involving a considerable quantity of mammary tissue. A plugged duct is an individual duct that is blocked, swollen and often presents as a hard knot in the breast. A plugged duct can lead to mastitis, but the two are not always presented together. The treatment for both includes many of the same measures. The differentiation is often seen in the level of a fever and length it sustains. If a woman is familiar with the symptoms of either, and begins treatment immediately upon noticing the first symptoms, it can almost always be resolved before antibiotics are necessary. I encourage all breastfeeding moms to become familiar with the symptoms, so as to be in a position to catch the first signs and avert a long and painful battle.

Symptoms

1. Tender, aching breast
2. Hard knot in breast
3. Skin hot and red, often in a spot right above a knot
4. Flu-like body aches
5. Fever
6. Red line visible on breast
7. A blister on the nipple is often associated with a plugged duct

Treatment

1. Increase nursings on the affected breast.
2. Point baby’s chin at any red, hot spot you may have.
3. Prior to nursing, immerse breast in very hot water and massage toward the nipple. As often as possible, do this in a bathtub to get excellent immersion. If needed, a sink can be used with washcloths to assist.
4. After nursing, ice the breast. You can use a bag of frozen peas set aside for this purpose and wrap it in a thin dishcloth.
5. Massage toward the nipple while nursing.
6. Go to bed with baby and rest and nurse if at all possible.
7. If your entire breast is sore, alternate nursing positions to rotate baby’s chin around the breast.
8. Take ibuprofen to assist with pain and reduce inflammation.
9. While nursing, use a hot rice pack on your breast. A simple rice pack is to take a tube sock, place rice in it and tie a knot at the end. This can be heated in the microwave.
10. Stop wearing a bra while fighting mastitis.
11. Keep track of your temperature and watch for a red streak on your breast. If your fever goes up considerably or if you feel very weak, you may need to consider antibiotics.
12. Make sure you are drinking 64 oz. water a day!
13. If you have a blister on your nipple, it can be opened with a sterile needle. Be gentle and don’t tear the skin, merely open it. Then massage toward the nipple and the “plug” is often discharged in the form of a thickened milk that has been backed up in that duct.

Prevention

1. Take Lecithin 1200mg three or four times a day.
2. Wear a comfortable, loose nursing bra. Avoid underwire styles. Make sure you have plenty of room in your nursing bra to expand as various times of the day according to how long it’s been since nursing.
3. Eat a diet low in saturated fats.
4. Rest with baby every day. Resting is vital to keeping your body healthy and producing milk easily.
5. Limit the length of time spent doing errands in a day. Resist heading out the door with a detailed map of how you’re going to accomplish a dozen tasks in speedy fashion. You will inevitably come home exhausted and that state of exhaustion has the potential for setting you up to have a breast infection.
6. Drink 64 oz. of water daily.
7. Be careful regarding sleeping positions.  A sleeping position that puts pressure on your breasts is likely to contribute to plugged ducts. If you are a tummy sleeper, try sleeping on your side and put a bed pillow between your knees — it helps to keep you from flipping over onto your stomach.
8. Be aware of how your seatbelt fits across your chest and adjust it as needed to alleviate pressure on the breast itself.  Many vehicles have adjustable heights, but if yours does not you may want to use a folded washcloth or cloth diaper to place underneath where a belt presses against your breast to redistribute the pressure.  Another obvious solution is to limit how long you are out in the car, whenever possible, and nurse well while massaging that area when you are through driving.

Recommended Reading:

• Blocked Ducts and Mastitis
• Articles from LEAVEN: Mastitis–Plugged Ducts and Breast Infections
• The Womanly Art of Breastfeeding by LLL

If there is a rule that would help moms survive growth spurts with a smile, it would have to be, “Don’t Watch The Clock!” Don’t watch the clock for how long baby has been nursing. Don’t watch the clock for how long it’s been since baby last wanted to nurse. Don’t watch the clock for how many times you’ve been awakened that night to nurse.

Growth spurts happen. They happen with all nursing dyads. Some babies protest more about them and others seem to sail through them with the greatest of ease. Some books will tell you they happen at so many weeks or months. They may tend to, but the truth is, they can happen anytime.

Signs of a Growth Spurt

• Baby is nursing often or almost nonstop
• A baby who was previously sleeping through the night is now waking to nurse several times
• Baby will latch and unlatch, fussing in between

These signs are all signals to the mom’s body to “MAKE MORE MILK NOW!” Our bodies listen very well if we will merely respond to the baby’s needs. The extra suckling will stimulate your body to make more milk.

Often Observed After a Growth Spurt

• Baby sleeps extra for a day or two
• Mom is a bit fuller than usual for a day or so
• Baby calms down at the breast
• You may see an increase in wettings with the increased supply baby is drinking

Growth spurts seem to throw new moms for a loop. Just when they thought they were beginning to understand their baby’s signals, they abruptly changed. The frequent requests to nurse can be confusing as well as the frequency with which growth spurts happen within the first few months. The key is purely and simply to go with the flow (pun intended!) If you respond to your baby’s signals to nurse during a growth spurt and do not interfere with them in any manner, your body will quickly respond and increase supply. Typically it happens within 24 to 48 hours. Sometimes growth spurts seem to drag on for a week. This would be a good time to make sure you’re drinking plenty water.

Don’t allow a growth spurt to rob you of your confidence in nursing. Instead, allow it to instill confidence in your ability to read your baby’s cues. Your confidence will be further rewarded as your supply increases and your baby settles back down into a happy breastfeeding baby again, with a smart mommy who knew that sometimes baby really does know best and our job is to listen.