Author Archives: Karen Hall

08 Oct

Trick or Treatment

Trick or Treatment: Alternative Medicine on Trial
By Simon Singh and Edzard Ernst


Cheekily dedicated to HRH The Prince of Wales, Trick or Treatment is an investigation of alternative therapies, using scientific methods to determine whether any of them work.

Between them the authors have medical and scientific backgrounds, and Prof. Ernst has also practised homeopathy and other alternative treatments. They argue that this places them in a strong, objective position from which to investigate these therapies.

The book specifically examines over 40 complementary therapies, from aromatherapy to yoga. The authors have critically reviewed the available research, and drawn conclusions about whether the therapies are effective, and for what sort of conditions they might be beneficial.

Whole chapters are devoted to four of the therapies: acupuncture, homeopathy, chiropractic and herbal medicine. Within these chapters, the authors give detailed descriptions of the history and development of the therapies, and discuss the theories behind them. In valuable addition to the discussion of the therapies themselves, these chapters include colourful explanations of research methodology, and concepts such as bias. For this reason I strongly recommend the book to anyone who wishes to understand how clinical trials are conducted, and what factors can affect the results.

The chapter devoted to the placebo effect considers the ethics of promoting ineffective treatments for conditions that might respond to conventional medicine.

Singh and Ernst conclude that homeopathy and acupuncture are at best benign placebos, but can in fact be dangerous quackery. Chiropractic treatment is shown to work for a limited number of conditions, but the financial and physical risks to patients are high, and it is no more effective than conventional treatment. Some herbal medicine is shown to be effective, but the paucity of the research leaves a muddied picture.

The conclusions reached about most of the other therapies are that they are largely ineffective, although some, such as yoga, may have a short-term calming or de-stressing effect. Most are shown to be expensive, not founded in actual scientific knowledge, and may be dangerous, particularly when used instead of an effective conventional treatment.

The book is extremely readable, with hundreds of memorable examples, such as the death of George Washington being caused by his doctors’ practice of bloodletting. The tone is amusingly scathing, occasionally strident, and the authors pull no punches. The book would not be enjoyed by believers in or practitioners of alternative medicine but ought to be required reading for anyone considering using it, for their own good.

03 Oct

Closest to breastmilk

While it’s no longer legal in this country for the milk manufacturers to claim that their infant formula is “closest to” or “inspired by” or (yes, this has happened) “better than” breastmilk, the idea that these companies are beavering away trying so hard to come up with the perfect infant food has a fairly strong hold. As long as they are seen to be competing to be the best infant formula, they can hope that we will overlook the fact that they are all nutritionally inadequate in different ways. This makes their claim to be the best yet more irresponsible, as bottlefeeding mothers tend to stick to one brand.

It is simply impossible to support a claim to be “close to breastmilk,” because the components of breastmilk change constantly. They change from day to day, from feed to feed, according to the age of the child, the needs of the child, and even the weather. Seriously. On a hot day, babies drink thinner, more thirst-quenching milk. If formula manufacturers cannot identify all the ingredients, and cannot establish the function of many of those ingredients that they have identified, and cannot synthesise many of those whose function they do understand, and cannot balance the synthetic ingredients to achieve the same nutritional end result, then how can they possibly be selling something that is supposed, in some way, to be equivalent to human milk?

On top of that, there is the slightest teeny tiny suspicion that sometimes, some of the changes made to the formula might not be entirely attributable to amazing new discoveries about the contents of human milk, but in fact can be attributed to amazing new discoveries about what parents will buy if it is suggested to them that a particular product contains “essential” ingredients for brain growth, prebiotics, or the wonderful immunofortis. And no-one ever calls them to account for the fact that these essential ingredients were missing in the previous formula. Infant formulae are revised over 100 times a year, and each one is more perfect than the last, just as each Mars Bar is the biggest ever.

The bioavailability of nutrients in human breastmilk is high for its human consumers, because of the interaction between the ingredients of the milk, and the body’s mechanism for processing them. If one element is needed to process another, but is not available, then something else will be used, and the balance is upset. For example, too much iron causes a zinc deficiency; yet artificial milk contains twenty times the concentration of iron found in human milk, because cow’s milk lacks human lactoferrin, and therefore the iron in cow’s milk cannot be as easily absorbed by the human infant. Human iron is all absorbed, but the iron added to artificial milk is not, resulting in more waste for the newborn’s body to process, and encouraging the growth of harmful bacteria such as salmonella and candida in the gut. The guts of artificially fed children are already at more risk from such pathogenic bacteria, because they have a higher pH, because the lactose in human milk encourages the growth of friendly bacteria which keeps the pH naturally low. You see? As soon as one domino clicks down, the others start to tumble.

Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine. – Frank Oski, M.D., retired editor, Journal of Pediatrics

Today’s post once again owes a lot to Maureen Minchin – Breastfeeding Matters: What we need to know about infant feeding and the ever-factual Royal College of Midwives’ Successful Breastfeeding. Other sources were Kellymom, and Gabrielle Palmer – The Politics of Breastfeeding.

Originally posted elsewhere on 14th May 2008

21 Sep

No Big Deal

The thing about breastfeeding is that the milk production system is dynamically stable, provided you don’t mess with it, and you ensure it’s operating effectively. The system has all these different elements that facilitate its stability and effectiveness, and when these elements are undermined or misunderstood, that’s when it goes wrong. Sadly the culture we live in is big on the undermining and misunderstanding of breastfeeding, and that’s why the majority of women stop doing it before they feel ready.

Here are some of the indredients in the recipe for no-big-deal breastfeeding.

  1. A newborn baby has a stomach capacity of around 5ml. A teaspoon of colostrum (the kind of milk you have when your baby is first born) is therefore big enough to fill it. It is likely that the tiny tummy will both fill and empty quickly, and therefore need to refill frequently. (Undermined by the idea that colostrum is insufficient therefore artificial milk needs to be given, therefore breastmilk production system insufficiently stimulated).
  2. Short frequent feeds stimulate the milk to change from colostrum to mature milk, which happens over the next days. (Undermined by the idea that baby’s frequent demand for the breast indicates a problem with breastfeeding, when in fact it may be normal, or it may indeed indicate some problem that could be dealt with. Offering artificial milk does not deal with this problem).
  3. Newborn humans are highly dependent and inherently appealing. In cultures where ‘lying in’ is practiced, the newborn’s needs to be close with his or her parents are naturally fulfilled. (In cultures where governments spend 14 pence per baby on promoting breastfeeding, and baby milk manufacturers spend £20 per baby on promoting formula, such as the UK, we have tended to forget about the baby as a person with needs, and started to cast it as a demanding creature that makes its mother’s life difficult). A baby who is kept close to his or her mother is likely to feed little and often, stimulating the milk supply and growing well.
  4. When the change in the milk occurs, around day 4, there will be a lot of milk in the breasts. This is called engorgement. It is what it sounds like. It is important to get this milk moving out of the breasts, using baby or pump as necessary. That’s because milk contains something called Lactation Inhibitor, and if the milk remains in the breast then the LI informs the body that milk is no longer needed. Milk production then decreases or ceases. It’s also because the baby needs to feed on the milk.
  5. Breastfeeding should not be painful. Pain indicates a problem. The majority of the time, the problem is something to do with the way the baby is held, or the way the baby attaches at the breast. The majority of the time, such a problem can be dealt with by giving careful attention to these things, finding a way to make mother and baby more comfortable. If the baby is well-attached, the mother should feel no pain. If the baby is well-attached, then he or she can feed effectively, giving the correct level of stimulation to the milk supply, keeping mum from getting engorged, and consuming enough milk to sustain his or her own growth and development. (Undermined by the phrase of course it hurts, what did you expect? leading mothers to persevere through pain and misery to the point at which it becomes unbearable, and they stop.
  6. Newborn humans may be highly dependent and helpless, but they do have the ability to signal when they are hungry (see above), and stop feeding when they are full. Therefore it should be possible to feed the baby on cue, for as long as he or she needs to feed, without pain, and for breastfeeding to work. (Undermined by pressure from ourselves or others to be in control of the chaos, to get back to normal, to have a life, etc etc etc).

I see a big circular diagram with lots of arrows connecting all these things together. The challenge for me is to convey to pregnant couples that for breastfeeding to work well and fit easily into one’s life (an oft-stated aim), it is necessary to optimise all of these elements. I fear that what this comes across as is an edict that you have to Give In To Your Baby, otherwise you are a Bad Mother Who Never Really Wanted to Breastfeed Anyway. Our modern culture clashes horribly with the needs of a breastfeeding mother&baby. I can understand how hard it is for so many of the women I meet, coming from Important Jobs and busy lifestyles where they are used to having control and predictability. Many work until very shortly before the baby is born, and it seems to me when I meet them in classes that the baby is still very abstract, and their idea of what life is going to be like is unrealistic. Perhaps we should be encouraged to stop working a good month or more before the due date, and spend that time hanging out with new mums (Hm, isn’t that what NCT Bumps and Babies groups are for?). Initially this would be disastrous because all they would hear is the horror stories, but perhaps slowly an understanding of the necessarily fuzzy boundaries of new motherhood might develop.

09 Aug

Breastfeeding: A dad’s guide

I responded on twitter to a recent post by DaddyBeGood about breastfeeding, ostensibly about how dads can get involved so they don’t feel like a spare limb. Now, there is substantial research literature about the impact on breastfeeding of a supportive and informed partner, including the paper I studied earlier this year. I am absolutely behind helping dads to help mums to breastfeed, but I think it’s a complex subject, and get frustrated by that lowest common denominator, the suggestion that dad can only help by giving baby a bottle of expressed milk.

I don’t wish to be harshly critical of the original post, but I would like to add some more ideas, and to explain why giving a bottle might not actually be that helpful.

I also want to put out there the suggestion that babies might benefit from their different carers loving them in different ways; a parent who does not feed the baby is giving love that is not associated with food. Might this be healthy for the child’s emotional development, and helpful for someone who wants to be able to settle and comfort the child without the assistance of lactating breasts?

Not a lot of bottle
Antenatally, I hear both mums- and dads-to-be ask about expressing milk, so that dad can give a bottle. I suspect that the dads are not always as enthusiastic about doing that 2am feed as their partners want them to be. I suspect also that mums are anxious about the responsibility of being the sole feeder, especially if breastfeeding is as difficult as they have heard it is. There’s also that survival thing where new mums are unconsciously determined to bond dad to baby so as not to be abandoned. And yes, of course some mums don’t want to breastfeed, and that’s their right.

But is it really so straightforward: Dad gives bottle, dad and baby bond, mum gets much-needed break?

Expressing is a chore. If breastfeeding is straightforward, then expressing is not going to be an easier option. Parents of newborn babies are usually experiencing a period of flux and uncertainty, and finding time to express a bottle of milk can be a challenge. Night-time breastfeeding can be less disruptive to everyone’s sleep than getting up to fetch and warm a bottle (and there’s no guarantee mum won’t wake anyway, either because baby cries while waiting for the bottle, or because the longer gap between feeds means, ironically, that she has to express some milk). Expressing milk is less efficient than breastfeeding, and it can knock mums’ confidence to find that it’s hard to pump large volumes of milk. It is not necessarily any quicker to bottle-feed a newborn than to breastfeed. And in those early days when mum’s milk supply is regulating to meet her baby’s need, expressing milk can upset the balance.

So what else can dad do?
To me, the idea that any carer must give a bottle in order to bond with a baby is one of the biggest booby traps of all.

When I meet new families to provide breastfeeding support, I see dads who are totally immersed in the experience of feeding their babies, and their focus is 100% on getting breastfeeding to work so that they can get away from the tyranny of expressing milk. Yes, men feel like a spare limb when they see their partner and child struggling with something as essential as feeding, but they are also learning very quickly what their part in the team is. There’s plenty of research on the benefits of skin to skin contact, and this does not just apply to mothers. Babies get comfort from being close to their fathers, from his familiar smell, the sound of his heartbeat, the rhythm of his breathing, the rumble of his voice. They get antibodies from his immune system. They get social stimulus from him making faces, amusement from him singing to them, security from his arms.

Bonding has the same chemical basis as falling in love: oxytocin and endorphins. If you listened in your antenatal class then you know how to increase levels of these hormones: through relaxation, laughter, touch, eye contact. So any interaction with your child that involves responding to their need for comfort will facilitate bonding. Responding to your baby’s needs helps them to trust you and to feel safe. You don’t have to be armed with a bottle of expressed milk to achieve this.

Dads can give mum a break not by interrupting the flow of breastfeeding, but by interacting with baby at other times. They can carry a colicky baby around in a sling or a baby carrier, bath baby (or bath with the baby), give the baby a massage. They can keep mum company during periods of intense feeding, help her to get comfortable, keep her fed and watered, and give her a hug when it’s needed.

Above everything else, dads can help their partners by getting informed about breastfeeding, and enabling them to access help if they need it.

01 Aug

Nestle Box Top Scheme

Ms Head Teacher
My child’s school

9th February 2011

Dear Ms Teacher

Nestlé box top scheme

I was sorry to read in the most recent newsletter a plea to parents to collect Nestlé box tops, and I wish to register my opposition to the Nestlé box-top scheme.

As the NCT Breastfeeding Counsellor for this area, I support the Nestlé boycott and I do not wish my son to be encouraged to ask for Nestlé products. Nestlé is the target of a boycott in 20 countries because of its unethical and irresponsible marketing of breastmilk substitutes.

According to the United Nations Children’s Fund (UNICEF):

“Marketing practices that undermine breastfeeding are potentially hazardous wherever they are pursued: in the developing world, WHO estimates that some 1.5 million children die each year because they are not adequately breastfed. These facts are not in dispute.”

Monitoring conducted by the International Baby Food Action Network (IBFAN) shows Nestlé to be responsible for more violations of the marketing requirements than any other company. Nestlé is excluded from the relevant ethical investment lists produced by FTSE4Good because of these activities, which contribute to the unnecessary death and suffering of infants. Instead of making the required changes to its marketing policies and practices, Nestlé embarks on public relations exercises, attempting to improve its image. The box-top scheme fits this pattern.

If Nestlé really did care for children, it would stop its aggressive marketing of baby foods. And it would stop promoting unhealthy cereals to children. Nestlé makes much of its Shredded Wheat, even advertising it claiming “You’d never add salt. Neither would we.” But most Nestlé’s cereals do have high levels of added salt, according to Food Standards Agency definitions. The sugar content has also been criticised. It is not appropriate on health grounds for the school to encourage children to consume these products by promoting the box-top scheme, and goes against the school’s healthy eating policy, whereby you explicitly discourage unhealthy snacks, crisps and chocolate in the children’s lunches.

I would like to think that the school will look at the wider picture: what does a commercial relationship with the world’s most boycotted company teach the children? Nestlé’s generosity amounts to a penny per serving (much less than this in practice as many box tops will not be redeemed), so you could ask children to put by a penny each breakfast to send to the school, whether the breakfast is cereal or something healthier.

I for one would be more than willing to donate a book each term, rather than have Nestlé benefit from this free advertising directly at our children, and I feel confident that if other parents were aware of the global and local effects of their unethical practices, they would probably agree.

I have enclosed some further information. You can also look at http://www.babymilkaction.org/, and finally, I would be more than happy to come in and talk to you about this interesting subject!

Yours sincerely

Karen
NCT Breastfeeding Counsellor

Views expressed here do not represent the views of NCT.