FROM THE SUBSTACK OF “A MIDWESTERN DOCTOR” TITLED: THE FORGOTTEN SIDE OF MEDICINE
The History of Formula Feeding
While I strongly believe in the value of breastfeeding, throughout history and cultures, there are many references of mothers who could not sufficiently nourish their children with breastmilk who then sought out milk from other mothers or other supplemental sources of infant nutrition (which unfortunately were often not nutritionally adequate or contaminated with microorganisms).
Note: I believe that one of the primary causes of insufficient milk production from the mother was poor nutrition or malnutrition (something which was addressed in many early societies by having mothers eat specific diets).
This led to a variety of attempts to create a milk substitute that more accurately matched the safety and efficacy of human breastmilk (starting in 1865), a process which was revolutionized through the discovery of evaporated milk powder and its adaptation into infant formulas in the early 1900s. That was followed by various other attempts to produce more nutritionally adequate formulas.
As infant formulas improved in the 1920s, manufacturers began targeting physicians with their advertising. By 1929, the American Medical Association (AMA) established a committee to evaluate the safety and quality of formula compositions, leading many companies to seek the AMA’s “Seal of Acceptance,” bringing physicians closer to formula manufacturers. By the 1940s and 1950s, formula use became widely accepted as a safe alternative to breastmilk, and with the help of aggressive marketing and the inappropriate medicalization of childbirth, successfully displaced breastfeeding.
Note: the AMA’s seal of approval was created in 1905, and was designed to be a source of revenue to keep the struggling organization afloat (as it was given in return for advertising dollars rather than any assurance of safety—for instance the AMA widely promoted the benefits of smoking their sponsor’s cigarette brand). Sadly, once this funding allowed the AMA to begin establishing a foothold in the medical market, the organization then switched to blacklisting every competing therapy which would not sell out to the AMA (which is essentially why there are so many remarkable forgotten medical therapies exist from the early 1900s).
Many recognized this shift was harmful to both mothers and children. Hence, various groups (particularly the La Leche League, which was founded in 1956) mobilized the public to support breastfeeding mothers. In the 1970s, they finally reached the public (due to both scientific data emerging in support of breastfeeding and a growing societal dissatisfaction with the paternalistic and insensitive attitude medicine had to women). This shift began with middle-class mothers returning to natural breastfeeding, and gradually, governments eventually recognized the value of breastfeeding too (although it was not until 1984 that indecency laws against public breastfeeding began being updated). The decline in breastfeeding was, at last, reversed.
One of the key events that catalyzed this shift away from formula was the Nestlé formula scandal (which began in 1973), which began after the public learned Nestlé was aggressively targeting poor women in undeveloped countries for infant formula sales. This was accomplish by paying hospitals to give free samples to mothers after delivery and telling mothers (frequently via sales reps impersonating nurses) that they would not be able to produce enough milk for their babies, which in turn let to the impoverished mothers frequently not only switching to infant formula but diluting it (as they could not afford standard doses). Millions of infants diedas a result of these practices, and Nestlé eventually came under widespread public scrutiny (e.g., boycotts, celebrity protests, government investigations, and some of its predatory marketing practices being banned). The fact that Nestlé was able to convince millions of mothers to starve their babies to death again illustrates how predatory many of these marketing tactics were (particularly since some of those now outlawed practices still continue in the poorer nations).
Formula Marketing
During each pediatric “well-child” visit, in addition to pushing the currently scheduled vaccines on the child, the child will also be weighed and often told that, according to the growth chart, they are underweight, strongly encouraged to consume infant formula, and sent home with a free sample. One of the particularly concerning things for me about doctors pushing these products on children was that the ingredients in the most common brands were fairly unhealthy:
Additionally, because of how frequently the “underweight” diagnosis came up, I naturally became quite suspicious of it.
Note: somewhat analogously, patients will routinely be told that due to their blood pressure and cholesterol, they are at a high risk of having a heart attack in the next few years, so they must start a statin to prevent it. Given that almost everyone ended up being “high risk,” I was not surprised to learn that in 2016, Kaiser completed an extensive study which determined this calculator overestimated the rate of these events by 600%. Sadly, that has not deterred doctors from using this calculator (e.g., medical students are still tested on it for their board examinations).
Read More in Part 3 of Mother’s Milk.
