A Conflict of Interest

We are suppose to be able to trust our governments.  Trust the medical professionals that give us information and recommendations about our health and trust the major associations that advise the public and our governing bodies when they are making decisions and statements.  I know that the vast majority of the John and Jane Doe's are perfectly happy to blindly follow the professionals that supposedly have our best interests at heart, but there are still a few thinking humans out there and we are seriously concerned.  


When you read the fine print and do your homework it becomes blatantly clear that such faith in the assumed omnipotence of these professionals and their associations is questionable at best.  "Conflict of  Interest" is rife in our governments and professional associations.  So much so that the question becomes "Who do you trust?"


CBC and other news agencies have spent months tracking down the truth about Tamiflu, the Be-all, End-all for dealing with the H1N1 flu virus..... or so they tried to convince us. The Canadian government stockpiled nearly $180 MILLION dollars worth of anti-viral drugs (mostly Tamiflu), and now a good portion of it is about to expire. Yep, Millions of dollars are about to be thrown out.  Why do we have these stockpiles of drugs and are they even worth it is the question the CBC and other media reporters are asking.  Why? Because the truth is that there is a HUGE conflict of interest that is deeply rooted at the centre of all this.


The CBC reports:

A CBC documentary, which was broadcast on The National on Monday night, reports that certain other researchers in Canada, Italy, Britain and the U.S. are now challenging the claims by Roche that Tamiflu can significantly reduce complications or hospitalizations due to the flu.
The documentary also raises concerns about possible side effects surrounding the drug — strange behaviours and psychiatric delusions — that some countries, Japan in particular, have reported.
Using freedom of information requests, the investigation found hundreds of similar cases in Canada and the U.S., which were reported to health authorities but have not been made public.
It’s often difficult to establish a clear causal link between a drug and rare adverse reactions. Roche says its research suggests that these side effects result from the flu itself and high fevers, not the medication.
In the course of the CBC investigation, Zalac also reported that three of Canada's most prominent flu experts — Dr. Donald Low and Dr. Allison McGeer of Mount Sinai Hospital in Toronto, and Dr. Fred Aoki of the University of Manitoba — had received research funding or acted as a consultant or speaker for Roche during the period when Tamiflu was being promoted....
...But these relationships were rarely reported in broader public forums, in the media or even when some of these individuals would appear in marketing videos or flu-warning commercials on television produced by Roche.

Conflict of Interest is a disease that riddles our entire government and the decision makers that we presume are looking out for the best interests of the people they are advising: Us. I have written several articles about the various xxxx that have been reported in the media, yet ignored by the public for the most part:

- "Conflict of Interest Much? Here a swine, there a swine"

-"WHO "Mr Swine Flu" investigated for gross Conflict of interest"

-"WHO warns of corruption in Pharmaceutical companies"

But Conflict of Interest isn't just about the flu, it happens in all aspects of the health industry!  WHO and UNICEF have both been targeted as having undisclosed conflicts of interest. As a matter of fact just recently  Ann Veneman, Unicef executive director from 2005 to 2010, joined forces with the evil Nestlé board of directors. This LINK  shows the implications of her shocking career move from an organisation that supports breastfeeding to one that undermines breastfeeding.

And then there is the recent call for submissions from the Health Canada Committee in charge of rewriting the guidelines "Nutrition for Healthy Term Infants: Birth to Six Months". Appalled by the fact that Health Canada left us with less than one month for the public and stakeholder groups to write their response to their draft document, we scrambled to gather our information and to petition HC for an extension of the deadline (which we did successfully).  While writing their response, Elizabeth Sterkin of INFACT Canada uncovered the committees dirty laundry: 3 of the members of the committee have ties to Infant formula and infant food companies.  Yet nowhere in their draft document or the information about the members of the committee does Health Canada reveal these conflicts of interest to the public or to stakeholder groups.  To not disclose this information when HC tries to make statements that if a mother is unable to breastfeed, commercial infant formula is her only option: ""Commercial infant formulas are the only acceptable alternative to breastmilk.".... hmmmmm.... no mention of donor milk or banked breastmilk.  Just formula.  Still think that conflicts of interest like this don't shape policies?

We need to stand up for our rights to have full disclosure and to have access to information to make informed choices that are not influenced by people that are motivated by financial gain.  We need to tell our governments that these conflicts of interest need to be fully disclosed to the public so that they KNOW where the information  is coming from and how commercialism and the mighty dollar might be twisting that information for their own gain.  

Accountability is not just an empty word.  It must be followed by action. 

AIM submission to Health Canada on Infant Nutrition

A group of mothers on Facebook have formed the Association of Informed Mothers - AIM. This group was initially created to write a submission to Health Canada in response to their draft document "Nutrition for Healty Term Infants: birth to 6 months". This document will replace the current Canadian Guidelines that are in place, and while they have made some excelent changes, some areas of the draft document were very poorly worded, or incorrect. The following is AIM's submission to Health Canada and we would like to invite everyone who agrees with our document to sign your name to the bottom of it as an interested member of the public. If you wish to have your name added to the submission please  go to the facebook note HERE  and comment with your name, city and province. this document will only be open for signatures till 9pm this evening. so please feel free to share it out on your groups etc to spread the word!

A huge thank you to all the moms who poured their heart and soul into this document!
Dani

********************************************

The Association of Informed Mothers (hereafter called AIM) is a stakeholder group of mothers who support and advocate for mothers' rights to make fully informed choices for the health and well-being of both themselves and their families. To do this, mothers need access to information that is in the spirit of full disclosure and is provided free of influence by organizations, third parties, or persons that hold a conflict of interest. It is AIM's belief that Health Canada is responsible to provide information to the citizens of Canada that comply with these points.

AIM fully supports INFACT Canada's submission to Health Canada's Committee reviewing the guidelines for "Nutrition for Healthy Term Infants". AIM strongly believes that INFACT Canada's submission is of great value to the Health Canada Committee, as the information it provides is accurate, does not create a conflict of interest and is well researched. (A copy of INFACT Canada's submission is included at the end of this document).

AIM also fully supports UNICEF's submission to the Health Canada Committee. Health Canada has agreed to follow the World Health Organization's (WHO) infant feeding recommendations, and therefore any statement made by Health Canada should be aligned with UNICEF's submission (A copy of UNICEF's submission is included at the end of this document).

The following is a list of AIM's key concerns with Health Canada's draft document "Nutrition for Healthy Term Infants - birth to six months". AIM has specified a list of changes to be made to the document. These changes are required for the draft document, in order to provide the information parents need to make fully informed decisions for their family.


1. The language of the Health Canada draft document needs to be changed to reflect the normalcy of breastfeeding. Statements such as "the benefits of breastfeeding" should be changed to "risks of artificial feeding methods" or "the importance of breastfeeding". Breastfeeding is the biological norm for all human children, referring to its outcome as "benefits" implies it is outside and/or above the norm. For further information of the use of language and its effects on normalizing breastfeeding, please refer to the article "Watch your Language", written by Diane Weissinger, Journal of Human Lactation, Vol. 12, No. 1, 1996.

2. It is legally and ethically advisable for Health Canada to omit statement #5: "Commercial infant formulas are the only acceptable alternative to breastmilk." from these guidelines. To make such statements is unethical, inadvisable, and untrue. The inclusion of statement 5 directly contradicts Health Canada's acknowledgement and public acceptance of the WHO Infant feeding guidelines, which state that "For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup,which is a safer method than a feeding bottle and teat – depending on individual circumstances."apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf

Statement #5 is also contrary to UNICEF's recommendations for infant feeding, and undermines the use of donated and banked breastmilk. 

Currently, several provinces are researching the creation of milk banks, and the Canadian Paediatric Society is calling for the development of milk banks across Canada. The use of donor milk, whether through formal or informal channels, is vitally important to the health of infants whose mothers are not able to exclusively breastfeed, and is fully supported by WHO. It is the recommendation of AIM that Health Canada develop guidelines to address the use of donor milk, outlining the risks and benefits of using donor milk vs infant formula, and provide the information necessary for parents to make fully informed decisions about feeding their infants.

3. Health Canada should remove all sections in the draft document that discuss the use of artificial breastmilk substitutes. Those sections addressing commercial infant formulas should be made into a separate document or included in an appendix on the use of artificial feeding methods and products. Full disclosure of information about the risks of using commercial infant formulas and safe feeding methods is imperative in order for parents to be fully informed when making infant feeding decisions. By placing nutritional information about infant formulas side by side with breastfeeding, Health Canada is creating the false impression that they are equal and interchangeable methods for feeding infants. This is untrue, misleading, and does not meet the principle of full disclosure, nor does it give parents the proper information upon which to base their decisions. 

4. We submit that Health Canada should make its stance clear by making an official statement affirming that Canada is both a signatory to, and is compliant with, the World Health Organization International Code of Marketing Breastmilk Substitutes and subsequent resolutions. 

The Government of Canada is a signatory to the International Code for the Marketing of Artificial Breastmilk Substitutes and as such is required to pass legislation which provides for the enforcement of all provisions of the Code. Health Canada not only has a responsibility to remind all levels of government of this requirement, but also to ensure that all health care and related facilities within Canada are compliant with the Code. To ensure this compliance, Health Canada must immediately inform all physicians, nurses and health care facility administrators of the full range of provisions of the Code. Upon completion of dissemination of this information Health Canada must ensure that all professionals and facilities in Canada meet the requirements of the Code. INFACT can assist in this matter through the provision of information and resources.

On May 21st, 2011 it will be 30 years since Canada and 118 other countries signed the WHO Code, yet the Canadian government continues to refuse to pass legislation to protect and enforce the Code. 


5. The Baby Friendly Hospital Initiative (BFHI) is integral to ensuring mothers and babies are provided with the minimal support and information needed to begin their breastfeeding relationship at birth. The Baby Friendly Hospital Initiative (BFHI) should be fully endorsed by Health Canada. All Canadian hospitals should be informed of all BFHI recommendations and should be striving to attain BFHI status by a set date. BFHI should be recognized by Health Canada as the minimum requirement, not a luxury.

6. The Health Canada draft document should focus on the need for better breastfeeding and lactation education for all medical professionals (doctors, nurses, midwives etc.), and any personnel that come into regular contact with new mothers (social workers, etc). Health Canada should also advise provincial and territorial health policy makers that breastfeeding support and education at these levels are seriously lacking, and that this lack of education negatively impacts the ability of medical professionals to support mother and baby dyads. Health professionals who are unable to provide educated lactation support should be advised that mothers must be referred to professionals that are fully trained, rather than giving misleading and/or inaccurate advice that is detrimental to breastfeeding success.

7. The statement made in the draft document: "4. In Canada, all infants need supplemental vitamin D. " is incorrect and misleading. Health Canada cannot accurately state that ALL infants need to be supplemented with Vitamin D. Instead, AIM recommends that Health Canada set up prenatal maternal testing for Vitamin D levels. If mothers are shown to be deficient in Vitamin D, prenatal supplementation has been shown to optimize vitamin D levels in infants. Canadian mothers are at higher risk of being Vitamin D deficient due to northern latitude and long winters with little sun exposure. Therefore, it is the recommendation of AIM that Canadian mothers be advised by Health Canada to take a Vitamin D supplement along with folic acid to ensure infant health after birth.

8. AIM does not agree with the current American Academy of Paediatrics recommendation that breastfed infants should be supplemented with iron. Breastmilk has been proven to contain adequate iron to support infant health, except in cases of severe maternal anemia. It is AIM's recommendation that Health Canada encourage prenatal testing to address maternal anemia before birth. 

9. The statement by Health Canada in section 2.7: "The impact of cesarean birth on breastfeeding appears to have changed over time. In most cases today, cesarean birth does not impede breastfeeding" is incorrect and needs to be removed. There is no evidence to support this statement, and strong evidence to contradict it. Health Canada needs to set up separate guidelines that examine and make recommendations about medical interventions during pregnancy and childbirth such as chemical inductions, the routine use of IVs, epidurals, invasive testing and pain medications during labour, the use of surgical interventions, such as forceps/vacuum extractions and cesarean sections, and early cord clamping and their effect on maternal and fetal outcomes, with special attention given to breastfeeding initiation and longevity . Perinatal practices are one of the most powerful indicators of long term breastfeeding success and are therefore vitally important considerations.

10. In section 9 the Draft Document states that "9. At six months, infants need complementary foods along with continued breastfeeding to meet their nutrient needs". This statement gives the impression that breastmilk is no longer adequate after 6 months and that it suddenly loses it's ability to nourish an infant at this time. This is inaccurate. It should also be noted that not all infants are ready for or require complementary foods at a set age, i.e. 6 months. A statement that "Infants should not be given complementary foods before 6 months, but after that time introduction solids may begin" would be preferable.

It is the opinion of AIM that the committee responsible for these guidelines is lacking oversight by the public and should include members that are involved in stakeholder groups or members of the general public who are interested in the outcomes of the draft document and Health Canada's new guidelines. 

Currently breastfeeding initiation rates in Canada are excellent. However, by 3-6 months the percentage of mothers exclusively breastfeeding their babies drops radically. This extreme drop in breastfeeding rates directly affects the health and wellbeing of mother-baby dyads and is an accurate indicator of the lack of information and lactation support currently available to families across Canada. It should be noted that the recommendation of exclusive breastfeeding to six months is often undermined or outright ignored by health care professionals who encourage or recommend or demand supplementation with infant formula before the baby has even been released from hospital. Evidence-based information and education provided to parents and health-care professionals is integral to the increase of long-term breastfeeding rates in Canada. As members of AIM, and as mothers, we have a vested interest in increasing breastfeeding information and education available to healthcare providers and families across Canada. We therefore respectfully request that Health Canada review our submission and make the changes necessary to bring Canada in line with the World Health Organization, and to maintain its place as a key player in the forefront of worldwide health.

We thank you for the opportunity to provide our recommendations. We would like to be included as a stakeholder in any future consultation on these or similar guidelines. 

Association of Informed Mothers

Danielle Arnold
Brantford ON

What formula is NOT.

I just discovered this blog tonight and immediately had to share it with all of you.  This article is brilliantly well written, it outlines everything in a way that is non-confrontational, and most importantly does not gloss over the facts. I have a sick baby tonight so don't have time to really get into my thoughts here, but rest assured I'll be looking forward to reading more from "The Babe and the Breast" blog!

What Formula Is Not 

Ah, the hot button issue. There has been a large kerfuffle of attention lately over the start-up of a new milk-sharing network on Facebook called Eats On Feets (http://www.eatsonfeets.org). The brainchild of Arizona midwife Shell Walker and fierce Montreal lactivist Emma Kwasnica, Eats On Feets is a network run by merit of individual state, province, and country pages where moms or families who are having difficulty with milk supply can turn to other lactating mothers for donated milk to supplement or feed their children. Moms with oversupply provide the milk, and Eats on Feets provides the space. It is a good setup, with Eats On Feets administrators and creators putting emphasis on the need for informed choice. The FAQ on their page is thorough and provides information on flash-pasteurization, disease transmission, and obtaining medical history from potential donors. Soon after Eats On Feets emerged as a major player (and a major threat to the formula industry), many medical groups jumped to issue vehement statements to the media, with their focus being less about informed choice and more on fear-mongering. The response from Health Canada and the Canadian Paediatric Society has been extremely cautionary, focusing on the risks of breast-milk sharing and calling the practice "very dangerous". The Calgary Herald.   Health Canada states that “unprocessed human milk should not be shared.” (see Health Canada’s statement HERE)





Considering the rapid rise of popularity for informed milk sharing, it should come as no surprise that this month Health Canada chose to revise and rewrite its existing infant feeding recommendations. What is shocking however, if that the new recommendations state that “Commercial infant formulas are the only acceptable alternative to breastmilk” (See full draft statement HERE). There is no mention of donor breastmilk, either through a milk bank or via less formal channels. In fact, not only is the option of donor breast milk completely ignored, but the make-up and risks of formula feeding are also completely absent. Instead a huge portion of the document focuses on what formula is, what it contains, what types are available, and how it should be prepared.





WHAT???





Not only are the risks of formula feeding skated over, but Health Canada spends more time discussing the benefits of bovine-based formula over soy-based formula than it does on the Ten Steps from the Baby-Friendly Hospital Initiative, an Initiative that is essential to boost and maintain breastfeeding rates in maternity wards.





Come on Health Canada! Doctors receive little to no breastfeeding training during their time in med school. If you are lucky like me, you find a doctor who did his residency in a breastfeeding clinic (and still needs some of the finer points explained to him). Doctors and nurses in Canada turn to Health Canada for their information on infant nutrition, and aside from people in my lucky situation, most doctors still believe that formula is an equal alternative to mommy milk, and shoddy documents like this do nothing to inform them of risks and facts about formula, which can then be passed to new moms. So, in light of this ridiculous oversight of real formula facts, and the (very mild) explanation of what formula is, I will give you an exposition on what formula is NOT. Much of the credit for this list goes to several lovely ladies from the facebook page, “Hey Facebook, Breastfeeding Is Not Obscene!” (namely, Elizabeth Anthes, Stephanie Knapp Muir, Jo Slamen, Emma Locker, Karen Coffman, Murielle Bourbao, Jennifer Dunston Lane, Kasey-Louise Traynor, Nicky Lawrence, Cheryl Giovenco, Barbara Rail, Lucy Fensom, and the lovely Alison Kennedy. Thanks ladies!)



1. Formula is not sterile.



Ever heard E. Sakazakii? It’s a pathogen commonly found in infant formula that can cause major illness for the baby if formula is not prepared properly. It is essential that all bottles, nipples, and equipment be sterilized before every feed, and that boiling water is used to make the infant formula. It’s not enough that the water be “sterile”, like the companies who make those huge containers of sterile water would lead you to believe. The water needs to be hot enough at the time you prepare the bottle to kill off potential pathogens like E. Sakazakii. This leads us to point two.



2. Formula is not convenient



For those of us breastfeeding moms who have supplemented or used formula at any point, we fully understand the truth of this statement. It is a million times easier to NOT have to get up, walk to the kitchen, boil the water (to kill the E. Sakazakii), prepare the formula, and then rush back to the baby, while all the while he is shrieking at the top of his lungs to be fed. Nor is it easier to haul all the paraphernalia associated with formula-feeding. The bottles, the sterilizer, the container of powder (oh damn, it spilled AGAIN), not to mention where oh where in this stupid mall can I find a place to boil my water? Oh shoot, we’ve been here for 7 hours, and the pre-mixed formula I made is only good for 30 minutes at room temperature! I forgot my miniature cooler! (http://www.nestle.ca/en/FAQ/baby_nutrition_faqs.htm) It is so much easier, once the initial bumps of learning are past, to just roll over, pop out a breast, and go back to sleep, or to find a seat (or stand, if you are talented), lift your shirt slightly, and latch baby.

To read the entire article click HERE
 

INFACT Canada- Online Petition to Health Canada

Attention Canadians! Please take a moment and read and sign the petition to Health Canada linked below!!  This is very important as Health Canada has not given enough time to the public to respond to the changes they are making to the draft nutritional guidelines for children from birth to six months.  The public needs a chance to review these changes and make their voices heard by Health Canada!!

Sign the online petition to Health Canada to broaden consultation on infant nutrition recommendations

As of course you know, Health Canada has opened up its draft nutritional guidelines for children from birth to six months in an online consultation. The period of time for response is very short, Feb 3 is the deadline. There are no cross-country consultations or opportunities for input beyond this online consultation.
A letter has been drafted asking Health Canada to extend the deadline for the online consultation and to implement cross-country consultation meetings as they have done recently for revisions to Canada's Food Guide and Canada's Physical Activity Guideline.
Please consider signing this letter personally or on behalf of your organization.

Sign the petiton letter online now at:
http://www.gopetition.com/petition/42101.html.

Thanks,

Jodine Chase

Help INFACT Canada to promote, protect and support breastfeeding.

INFACT Canada- Health Canada revises their recommendations for feeding Infants

Attn: Canadian Parents- please take the time to read this message from INFACT Canada and respond to Health Canada's request for submissions and comments about their revision of Nutrition for Healthy Term Infants: Recommendations from birth to six months.  It is vitally important that parents exercise their Right to tell the government that we have expectations that they must live up to.  Please Read and share this widely!

Health Canada revision of Nutrition for Healthy Term Infants: Recommendations from birth to six months

Health Canada is planning the revision of Canada’s infant and young child feeding policy statement: Nutrition for Healthy Term Infants.

The first draft revision makes recommendations for infants from birth to six months.
It is critical that Canada’s revision reflect the evidence based, optimal feeding practices as recommend by the World Health Organization (WHO), and the WHO/UNICEF Global Strategy on Infant and Young Child Feeding.
INFACT Canada urges all those working with infants and young children to respond to the on-line request for comment. The time line to respond is very short: January 6 to February 3, 2011.
INFACT Canada has prepared general comment on the overall draft revision and also specific comment to the proposed principles and the recommendations.
You may wish to use the INFACT Canada comment or add to it, or prepare your own comment. Any way, we urge you to submit your comment to ensure that optimal infant feeding recommendations are protected. “As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal, growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to two years or beyond.” (WHO/UNICEF Global Strategy for Infant and Young Child Feeding, 2003)
The proposed draft revisions and comment form can be accessed at: http://www.hc-sc.gc.ca/fn-an/consult/infant-nourrisson/index-eng.php.

INFACT Canada’s General Comments on the Proposed Draft

January 2011

Prepared by Elisabeth Sterken, BSc,MSc,Dt

1. Conflict of Interest declarations provided by the Expert Advisory Group

   INFACT Canada’s position is that those with conflicts of interest should not be working on infant and young child public nutrition policies and should not be participating in this process.
   The list of the members of the Infant Feeding Expert Advisory Group can be seen at: http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/eag-gce-inf-nour-membership-membres-eng.php.
   
   James Friel: Serves on the advisory boards of Heinz and Danone (Both Heinz and Danone are manufacturers of complementary food products and infant formulas and are in serious violation of the International Code of Marketing of Breast-milk Substitutes and relevant resolutions of the World Health Assembly).
   Sheila Innis: Researcher in infant feeding and infant formulas. Receives research funding from infant formula manufacturers Mead Johnson, Abbott Laboratories and the from Martek Biosciences the maker of fungi and algae sourced fatty acids, DHA and ARA. (All three industries are in serious violation of the International Code of Marketing of Breast-milk Substitutes and relevant resolutions of the WHA).
   Daniel Roth: Is a researcher in vitamin D and has received a travel grant to attend the International Congress of Nutrition from the Organizing Committee sponsored by Coca Cola.
   The remaining five members of the Advisory Group have no competing interests.
   

2. Breastfeeding is the normative way to feed infants

   Industrially manufactured infant formulas differ very significantly in nutritional and chemical content as well as the means of feeding. The lumping these two into one document creates a flawed impression that breastfeeding and formula feeding are similar and interchangeable.
   INFACT Canada recommends that Canada’s Nutrition for Health Term Infants should make recommendations about the biologically normal way to feed infants.
   The feeding of other manufactured “milks” should be dealt with as an intervention and the conditions for the use of these products should be addressed either in an appendix or in a separate document on the use of artificial feeding methods and products. Full information about the risks of the use of these products and the feeding methods needs to be stated. Parents should be fully informed when making infant feeding decisions.
   

3. The International Code and WHA

   Canada’s government through its delegations to the World Health Assembly have endorsed the International Code of Marketing of Breast-milk Substitutes and all the relevant WHA resolutions on Infant and Young Child Nutrition. It is vital that Health Canada take responsibility and leadership in realizing the implementation of the WHO provisions they have endorsed.
   The International Code and WHA resolution measures are critical to protect the ability of mothers to fully breastfeed their children as recommended. The undermining interference on optimal breastfeeding practices resulting from the continued violations of the provisions of the International Code and resolutions, are extremely costly in personal loss, in health outcomes and in health costs. We all benefit when our children are breastfed.
   

For INFACT Canada’s detailed, formal comments on the proposed draft see: http://infactcanada.ca/nutrition-healthy-term-infants-new.html#comment.

For more information contact:

Elisabeth Sterken, MSc, Dt
Director INFACT Canada
esterken@infactcanada.ca
Telephone: 416 595-9819

Help INFACT Canada to promote, protect and support breastfeeding.

Position Statement: Ontario Breastfeeding Committee

The Ontario Breastfeeding Committee
Position Statement on the Use of Donor Human Milk

The Ontario Breastfeeding Committee is the provincial contact for the Breastfeeding Committee for Canada: The National Authority for the WHO/UNICEF Baby- Friendly Hospital Initiative. In partnership with the Breastfeeding Committee for Canada, the Ontario Breastfeeding Committee is responsible for the implementation of the WHO/UNICEF Baby-Friendly Initiative in Ontario and partners with hospitals and community health services to assist and support them to achieve Baby-Friendly designation.

The Ontario Breastfeeding Committee recognizes that:

• human milk is the food for babies
• women should make informed decisions on the use of donor human milk based on accurate and evidenced – based information

The Ontario Breastfeeding Committee recommends that:

• Government facilitate and accelerate the establishment of donor human milk banks in Ontario
• Government provides safe, evidence-based guidelines for human milk sharing.

The Executive of the Ontario Breastfeeding Committee December 15th. 2010

INFACT Canada: Health Canada's advisory lacks scientific basis

Mother’s milk and safe milk sharing: Health Canada’s advisory lacks scientific basis

December 7, 2010

The recent media focus on the mothers’ movement Eats on Feets has resulted in a Health Canada advisory warning mothers against the use of another mother’s milk unless it comes from a donor milk bank.

Health Canada’s advisory raises some important questions about the lack of scientific basis for their claims regarding the “risks” of human milk sharing.
The Health Canada advisory flies in the face of the recommendations by both UNICEF and the World Health Organization, that when a mother is unable to provide her own breastmilk, the milk of another mother is safer than the use of an infant formula. These principles are outlined in the World Health Organization and UNICEF Global Strategy on Infant and Young Child Feeding and the Baby-Friendly Initiative. Although these initiatives were endorsed by Health Canada, why are these important principles now deemed “risky”?

Health Canada claims

There is a potential risk that the milk may be contaminated with viruses such as HIV or bacteria which can cause food poisoning, such as Staphylococcus aureus. In addition, traces of substances such as prescription and non-prescription drugs can be transmitted through human milk. Improper hygiene when extracting the milk, as well as improper storage and handling, could also cause the milk to spoil or be contaminated with bacteria and/or viruses that may cause illness.

When mothers need a breastmilk replacement how does Health Canada consider the use of commercial infant formula products to be safer that the use of peer-to-peer informed milk sharing?
INFACT Canada is concerned that the Health Canada warning will dissuade mothers from providing human milk for their infants and encourage the use of commercial infant formula. The other alternative when mothers need a replacement for their own milk is the use of commercially produced infant formula. The risks associated with the use of infant formula products have been well documented. Mothers aware of these risks do not wish to expose their infants to such risks. These include increased prevalence of a range of infectious diseases and health conditions – ear infections, gastrointestinal infections respiratory infections, necrotizing enterocolitis, sepsis, meningitis, diabetes, childhood cancers, obesity, allergies – formula fed infants grow and develop differently from breastmilk fed infants, including cognitive and neural development.
While implying that formula is a preferable alternative to shared human milk, Health Canada fails to inform mothers that the risk of contamination by lethal and dangerous bacteria may exist in all powdered infant formula currently marketed in Canada. Has Health Canada warned parents that tins of powdered infant formula are not sterile and may contain Enterobacter sakazakii, a virulent and highly pathogenic contaminant that can lead to serious infections causing meningitis, necrotizing enterocolitis, sepsis and even death? Has Health Canada mandated that infant formula labels have warnings about the lack of sterility and that products must be carefully reconstituted at 70 degrees C to destroy the lethal Enterobacter sakazakii as recommended by the World Health Organization?
Additionally the Health Canada warning does not address the presence of the bacterium Salmonella species, a major cause for gastrointestinal infections, present in powdered infant formula. Should parents not be informed of the rather frequent recalls of infant formula products – the most recent for the presence of beetle parts in the formula? Furthermore there are many industrial contaminants found in infant formula such as heavy metals, plasticizers, including the plastic BPS present in concentrated formula.
Infant formula does not have the immunological constituents to alleviate against the risk of the built-in microbiological contaminants and the bacterial and viral contaminants related to formula preparation, handling, storage and feeding.
Health Canada’s advisory does not provide mothers with the information needed about the safe peer-to-peer informed sharing of milk. Nor does Health Canada provide access for mothers to the donor milk from milk banks that it deems safe and acceptable.
Currently there is only one milk bank in Canada at the BC Women’s Hospital and Health Centre in Vancouver. Donor milk from the BC Milk Bank has very limited access and is available on prescription only for high needs infants.
Although Health Canada’s policy statements recommend that infants be exclusively breastfed for the first six months of life and sustained breastfeeding to two years and beyond, adequate support systems need to be in place for mothers to achieve optimal breastfeeding practices. Mothers need to be able to access supplementary human milk for their infants for the full recommended time that infants and young children require human milk for optimal health, growth and development. A variety of social, cultural, health or economic reasons may necessitate that mothers have access to human milk in order to achieve this.
Mothers who wish to provide only human milk for their infants have no other means to access human milk than to establish their own method of safe milk sharing. Eats on Feets is a community-based movement of mothers meeting the needs of their infants based on a health screened and informed decision making process. Importantly many women have more than enough milk and have a deep desire to share with mothers and infants needing their milk.

Conclusions

Assessing and analyzing the risks (see ANNEX) of peer-to-peer informed milk sharing demonstrates the risks to be negligible. Peer-to-peer informed milk sharing is by far the safer means to provide replacement feeding when mothers own milk is unavailable.

However the risks of feeding infant formula to infants are well documented. Many mothers do not wish to expose their infants to the increased risks of infectious diseases, chronic diseases and growth and development anomalies, which have lifelong implications.
INFACT Canada urges Health Canada to provide guidelines to address the need for mothers who wish to donate their life giving milk to mothers who know this to be critically important for the health and well-being of their infants. Health Canada must recognize that informed milk sharing is not “dangerous” and must recognize that the alternative of using infant formula comes with a long list of documented negative consequences.
INFACT Canada urges Health Canada to facilitate a milk banking system across Canada that will provide full access for all mothers who wish to donate their milk and to mothers who need to make use of donated milk beyond the current limited “on prescription only.”
INFACT Canada urges Health Canada to establish centres where mothers can go to have their milk screened so they can feel comfortable and confident sharing their milk. As well Health Canada should review the capacity of blood banks to also screen human milk.
INFACT Canada urges Health Canada to provide the necessary funding and programme leadership to improve support systems for the establishment of lactation in the early weeks and months to help mothers overcome difficulties they may encounter.
Mothers need effective support systems to achieve the Health Canada recommendations for exclusive and sustained breastfeeding to ensure the highest attainable standard of health for their children. We will all benefit.

Elisabeth Sterken, MSc, RD
Executive Director
INFACT Canada
esterken@infactcanada.ca

With thanks to:
Jennifer Abbass Dick RN, BNSc, MN, PhD student, IBCLC, RLC
Linda Smith, BSE, FACCE, IBCLC, FILCA for their helpful comments.

ANNEX

It is important to compare the perceived risks and dangers of peer-to-peers informed milk sharing to the risks of providing infant formula as a replacement for a mothers own milk.

Peer-to-peer informed milk sharing

Viral and microbiological risks

• Mothers are screened and share their health data.
• The numbers of Canadian women of child bearing age who are HIV+ are few.
• The probability of an HIV+ mother, who has given birth, breastfeeds and donates her milk, is highly improbable. Moreover HIV+ mothers receive anti-retro-virals which significantly reduce the viral count.
• Human milk contains a multitude of complex antiviral and immune substances demonstrated to inactivate viruses such as HIV and reduce microbiological contaminants.
• Providing human milk exclusively is the best protection against viral and bacterial contaminants passing via the infant gut. Human milk provides a protective layer in the infant gut. It is in fact the introduction of infant formula into the infant gut that creates the risk of transmission. Mixed feeding of formula and human milk has been shown to be the greatest risk for viral transmission. The cow’s milk proteins in infant formula are a cause of gut damage providing a passage for viral (HIV, hepatitis B and C, HTLV 1 and 2, syphilus) and bacterial contaminants.
• Mothers can flash pasteurize donated milk to ensure that there are no viral or bacterial contaminants.(ref: Israel-Ballard K, Donovan R, Chantry C, Coutsoudis A, Sheppard H, Sibeko L, Abrams B. (2007). Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries. J Acquir Immun Defic Syndr. 45: 318-23.)

Passage of prescription and non prescription drugs

• There are very few drugs that are contra-indicated during lactation. Most drugs do not enter her milk.
• Eats on Feets advises mothers on how to screens donors for prescription and non prescription substances.
• If a mother is breastfeeding her own child she will be aware of any contra-indicated substances. If her milk is safe for her own child it will be safe for the child she is donating her milk to.

Improper hygiene, storage and handling

• Human milk is the most effective and efficient protection against microbial contaminants. It contains, IgA, IgM, IgG, IgE, IgD factors, lactoferrins, lysozymes, oligosaccharides, immunoglobulins, interferon, mucins, bifidus factors, to name a few and many as yet undiscovered factors. It takes a lot to “spoil” human milk.
• Mothers are aware of the normal principles of hygiene, storage and handling.
• INFACT Canada • info@infactcanada.ca

Concern Raised by Health Canada's Press release- Milk Sharing

Concerns raised by Health Canada’s press release (issued Nov. 25, 2010)

by Emma Kwasnica on Friday, 26 November 2010 at 17:48

Health Canada Press Release can be found here: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_202-eng.php


Health Canada is not supporting Canadian mothers in its recommendations issued yesterday. The question is raised as to why Health Canada is advising women to use only processed breastmilk from a milk bank, especially when there is only one milk bank for all of Canada, and that the milk there is reserved for only the sickest premature babies. Health Canada has not, and is not, offering women guidelines and information that support milk sharing, and overtly states in the press release that Canadian women should not share their breastmilk.

Furthermore, the press release issued yesterday contradicts Health Canada's current policy. In 2004, Health Canada recommended exclusive breastfeeding until 6 months of age, and specifically refers to their goal of aligning with the WHO's policy on infant health. The Health Canada recommendation defines exclusive breastfeeding as: "Exclusive breastfeeding, based on the WHO definition [5], refers to the practice of feeding only breast milk (including expressed breast milk) and allows the baby to receive vitamins, minerals or medicine. Water, breast milk substitutes, other liquids and solid foods are excluded."
Exclusive Breastfeeding Duration - 2004 Health Canada Recommendation
ISBN: 0-662-37809-1Cat. No.: H44-73/2004E-HTMLHC Pub. No.: 4824© Her Majesty the Queen in Right of Canada 2004

The WHO's definition of exclusive breastfeeding includes wet-nursing and using expressed (unprocessed) donor milk from another woman (when a woman's own breastmilk is not available). Therefore, Canadian mothers using other mothers' milk should not only be an acceptable option to Health Canada, but the preferred option over using infant formula.

From page 10 of the WHO document entitled 'Global Strategy for Infant and Young Child Feeding' (http://whqlibdoc.who.int/publications/2003/9241562218.pdf), under the heading "Exercising other feeding options", it states:

18. The vast majority of mothers can and should breastfeed, just as the
vast majority of infants can and should be breastfed. Only under
exceptional circumstances can a mother’s milk be considered unsuitablefor her infant. For those few health situations where infantscannot, or should not, be breastfed, the choice of the bestalternative – expressed breast milk from an infant’s own mother,breast milk from a healthy wet-nurse or a human-milk bank, or abreast-milk substitute fed with a cup, which is a safer method thana feeding bottle and teat – depends on individual circumstances.

19. For infants who do not receive breast milk, feeding with a suitable
breast-milk substitute – for example an infant formula prepared in
accordance with applicable Codex Alimentarius standards, or a
home-prepared formula with micronutrient supplements – should
be demonstrated only by health workers, or other community workers
if necessary, and only to the mothers and other family members
who need to use it; and the information given should include adequate
instructions for appropriate preparation and the health hazards
of inappropriate preparation and use. Infants who are not
breastfed, for whatever reason, should receive special attention from
the health and social welfare system since they constitute a risk
group.


Since banked (processed) human milk is not available to the vast majority of Canadian mothers, and the press release issued yesterday recommends against using another woman's breastmilk, one is left to infer that Health Canada is recommending formula as the next best option to a mother's own breastmilk. This is unacceptable and completely contravenes the WHO recommendations, as well as Health Canada’s own policy on infant feeding.

Yesterday's press release also included concern over pharmaceuticals in breastmilk; this warning is also in direct contrast with Health Canada's own statement on pharmaceuticals and breastfeeding, here:

(i) Drugs. Most prescription and over-the-counter drugs are minimally excreted through breast milk and are pharmacokinetically benign to the infant. 

http://www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_3-eng.php


Finally, the press release refers to concerns about food poisoning related to pathogens that might be introduced to breastmilk while being expressed or after it has been expressed. This aspect of your advisory needs to be clarified immediately. Tens of thousands of women in Canada express breastmilk from their breasts and place it in containers and store it in coolers and refrigerators and freezers for later consumption by their own babies. Are you now recommending against this practice?

Health Canada says it is committed to food safety. Every year recommendations for Canadians on preparing turkey for safe consumption are issued.
http://www.hc-sc.gc.ca/fn-an/securit/kitchen-cuisine/turkey-dinde-eng.php
You do not recommend that Canadians not share their turkey. You provide Canadians with safe turkey preparation guidelines in order to help ensure the safety of the people consuming their turkey dinners.

If you must recommend anything to Canadian woman about the practice of sharing milk, which is a food, please recommend evidence-based procedures for them to follow for the safe sharing of human milk. Do not hesitate to contact me should you require further information on this topic.

Sincerely,
Emma Kwasnica, in Montreal