‘Voldemort’ and health professional knowledge of risks of not breastfeeding; Poster presentation

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THE UNIVERSITY OF
WESTERN AUSTRALIA
J.P. Smith
1
, M.D. Dunstone, M.E. Elliott-Rudder
3
1. Australian Centre for Economic Research on Health, Australian National University, ACT, Australia.
3. Rural Clinical School, University of New South Wales, NSW Australia.
Background
Effective promotion of breastfeeding, and informed choice
by mothers, is constrained if health professionals'
knowledge on its importance is deficient. For many, training
is inadequate and personal experience or passive learning is
the main source of knowledge on breastfeeding.
1,2
Published
research is important to health professionals’ ongoing
learning about breastfeeding.
‘Voldemort’ and health professional knowledge of risks of
not breastfeeding?
†
Classification of titles of journal articles finding that
formula feeding increases health risk
Objectives
We ask: do titles and abstracts of relevant
journal articles clearly state their findings in
studies where formula-fed infants are shown to
have poorer health and development outcomes
than breastfed infants? Or, alternatively, is
formula feeding treated as a risk exposure that
— like the hazardous “Voldemort” in the famous
Harry Potter
books —‘Shall Not Be Named’?
3
Method and data
We conducted a systematic analysis of the
information content of titles and abstracts of the
78 journal articles that the American Academy of
Pediatrics cites as evidence of poorer health of
formula fed infants (see Box 1). We classified
each of the articles as ‘misleading’, ‘neutral or
silent’, or ‘naming’, depending on the information
conveyed in the titles. For abstracts, we used a
slightly different categorization. There was a
good to excellent level of agreement between
the three pairs of assessments of titles (weighted
Kappa statistic
k
= 0.87). Agreement between
assessments on abstracts was fair (
k
= 0.68).
Discussion and conclusion
A cultural reluctance to clearly state the health impacts of
premature weaning from breastfeeding may hinder health
professional learning and effective support of breastfeeding,
and present a barrier to informed choice by mothers.
In our analysis of a structured sample of scientific articles,
titles and abstracts systematically fail to state findings in
language that clearly and directly linked formula feeding to
the observed higher morbidity risk. Many even conveyed the
inaccurate message that breastfeeding was the risk exposure
for the illness or disease.
We conclude that a ‘Voldemort’ effect may exist. Further
research on larger samples drawn from a wider range of
media and in different cultural settings is needed to establish
if this ‘Voldemort’ effect is pervasive in information available
to health professionals.
† Study funded by Australian Research Council, Discovery Grant and APD Fellowship
1. Brodribb W, Fallon T. Health professionals and breastfeeding. LRC
Topics in Breastfeeding
Set XVII, Nov 2005.
2. Renfrew MJ, McFadden A,
et al.
‘Addressing the learning deficit in breastfeeding’.
Matern Child Nutr
2006; 2:239-44.
3 Rowling, J (1997)
Harry Potter and the Philosopher's Stone
. Bloombury Publishing Co, London
4 Smith J, Dunstone M, Elliott-Rudder M. ‘Health Professional Knowledge of Breastfeeding’,
J Hum Lact
2009;25(3):350-358.
5 Smith J, Dunstone M, Elliott-Rudder M. -- ‘Voldemort’ and health professional knowledge of breastfeeding ACERH WP 4; 2008
6 American Academy of Pediatrics. Breastfeeding Policy.
Pediatrics
2005;100(6, Dec):1035-1039.
7 Rao MR, Hediger ML,
et al.
Effect of breastfeeding on cognitive development of infants born SGA.
Acta Paediatr
2002;91(3):267-74.
8 Chen A, Rogan WJ. Breastfeeding and the risk of post neonatal death in the United States.
Pediatrics
2004;113(5):e435-9.
BOX 1:
Health
impacts
cited in AAP
2005
Policy
Statement
6
bacterial meningitis
bacteraemia
diarrhoea
respiratory tract
infection
necrotizing
enterocolitis
otitis media
urinary tract
infection
sepsis
sudden infant death
syndrome
Type 1 & Type 2
diabetes mellitus
lymphoma, leukemia,
& Hodgkin disease
overweight & obesity
hypercholesterolemia
asthma
cognitive
development
Actual text of findings in abstracts
7,8
‘Children who were ever breastfed had
0.79 times the risk of never breastfed
children for dying in the post neonatal
period. Longer breastfeeding was
associated with lower risk...promoting
breastfeeding has the potential to save or
delay approximately 720 post-neonatal
deaths in the United States each year.’
‘The salutary effect of exclusive
breastfeeding on cognitive development
was greater for children born small for
gestational age (SGA) than those born
appropriate for gestational age
(AGA). Based on a linear association
between duration of exclusive
breastfeeding and intelligence quotient
(IQ), children born SGA and exclusively
breastfed for 24 weeks were predicted to
have a 11-point IQ advantage over those
breastfed for 12 weeks, as opposed to a
3-point advantage for children born AGA
with similar durations of breastfeeding.’
An alternative statement of findings
‘Children who were formula fed had 1.27
times the risk of ever breastfed children for
dying in the post neonatal period. Longer
formula feeding was associated with higher
risk...reducing formula feeding has the
potential to save or delay approximately 720
post-neonatal deaths in the United States
each year.’
‘The deleterious effect of formula feeding on
cognitive development was greater for
children born small for gestational age (SGA)
than those born appropriate for gestational
age (AGA). Based on a linear association
between the age of first exposure to formula
feeding and intelligence quotient (IQ),
children born SGA and fed formula from 12
weeks of age were predicted to have a 11-
point IQ disadvantage over those formula fed
from 24 weeks, as opposed to a 3-point
disadvantage for children born AGA with
similar exposure to formula feeding.’
‘Naming’ the exposure variable; examples
Results
Formula was rarely named as an exposure
increasing health risk in the titles, or abstracts. In
a third of cases, titles implied misleadingly that
breastfeeding raised health risk (see table). Only
11 per cent of abstracts clearly identified formula
feeding as the health risk exposure variable.
4,5