At least Sears appeared to be heading for anointment — even giving himself the title “America’s pediatrician” on his recently launched, full-service parenting Web site — until recently. These days Sears is under attack by some of his previously worshipful fans, as well as members of the international lactation science and pediatric communities.

Why? It turns out that Sears, known for his advocacy of what he calls the “Baby Bs” — birth-bonding, breast-feeding, bed-sharing, baby-wearing and “belief in the signal value of an infant’s cry” — appears to have previously undisclosed financial ties to the infant-formula industry.

During the 1990s, Sears established himself as the most visible spokesperson for the cause of breast-feeding promotion in the United States. In his books, he strongly supports breast-feeding as the truly optimal choice for parents and babies, and he has made the case countless times through the years in major magazines and on television. (He is the medical advisor to Parenting magazine.)

Sears also has been a vocal critic of the tactics used by infant-formula companies to ingratiate themselves with pediatricians. In “The Breastfeeding Book,” as part of a three-page sidebar titled “For Professionals: How You Can Help,” Sears wrote: “Beware of formula reps bearing gifts. Be discerning about posters, pamphlets and educational materials from formula companies. Having the name of a formula manufacturer on information you hand your patients about breast-feeding conveys the message that bottle-feeding is the norm, as does having cans of formula around your office.”

Because of his outspoken support of mother’s milk and his apparent stand against infant-formula marketing, Sears has shared warm and longstanding ties to La Leche League International, a UNICEF-recognized nongovernmental organization that strongly opposes medical collusion with the pharmaceutical companies that sell formula. Sears serves on their prestigious professional advisory board and is a frequent speaker at their regional and international conferences. La Leche League’s catalogues and libraries heavily promote what Sears’ publisher has recently repackaged as “The Sears Parenting Library.”

So loyal fans and followers of Sears (I include myself here. Full disclosure: He wrote the foreword to my book about attachment parenting) were shocked to find that his site featured prominent banner ads promoting infant formula. Perhaps more surprising was the fact that Sears actually hyperlinked directly to the Store Brand Infant Formula site within the body of his advice to bottle-feeding parents, saying, “That’s why I tell my bottle-feeding mothers to consider Store Brand Formulas. They are approved by the FDA, recognized by Good Housekeeping, available at most national retailers under the store’s own label, and they cost up to 40 percent less than the expensive national brands. The best source of information about store brand baby formulas is www.StoreBrandFormulas.com.”

AskDrSears.com, which debuted in November, represents Sears’ bid to expand his media presence to the Internet. According to Sears, the site received 41,000 hits on the first day it went live. Sears had hopes that it would become “the premier parenting site on the Web.” Instead the site has become the target of an angry letter-writing campaign by pro-breast-feeding parents, medical professionals and “lactivists” all over the world, as well as the subject of considerable ethical controversy.

Advertising directly to consumers by companies that manufacture or sell infant formula is strictly prohibited by the World Health Organization’s Code on the Marketing of Breastmilk Substitutes, an international agreement intended to prevent the billion-dollar infant formula industry from making further inroads into declining worldwide breast-feeding rates. Furthermore, the code includes an important clause stating that “no financial or material inducements should be offered by [infant formula] manufacturers or distributors to health workers, or members of their families, nor should these be accepted.”

Although infant-formula companies (and most parenting magazines, Web sites and other media) in the U.S. pretty much ignore the code, American medical professionals who support breast-feeding, groups such as La Leche League International and UNICEF, as well as many informed breast-feeding parents, generally take it very seriously. All indications prior to the launch of AskDrSears.com were that the beloved “Dr. Breastfeeding,” as Sears is known to attachment fans, felt the same way.

Last week, AskDrSears.com posted an open letter from Sears in which he addressed his critics and explained his decision to allow ads for StoreBrandFormulas.com on the Web site. The letter noted that running a site of that size is very expensive. Since AskDrSears.com was donating banner ads to nonprofit groups such as La Leche League and Attachment Parenting International, Sears rationalized, his acceptance of paying ads from StoreBrandFormulas.com should be understandable.

(According to a representative for La Leche League, the group’s ads on AskDrSears.com did not represent a “donation” by Sears, but rather a reciprocal banner ad exchange in which an ad for “The Sears Parenting Library” received placement on the extremely popular La Leche League International site.)

In his open letter, Sears wrote, “Initially, I was leery of allowing formula advertising to be included … we needed financial support. It’s a reality that very few dot-coms are profitable. Consequently, many fail. And, the days of aggressive venture funding are over. To be successful today, dot-coms must generate revenue and cover their expenses. In order to offer free access to our site, we have to accept advertising from all reputable organizations and institutions.”

Rather than calming the controversy, Sears’ open letter prompted WHO code-watchers all over the Internet to dig a little deeper. It soon became public knowledge, via various parenting and breastfeeding e-mail lists and newsgroups, that AskDrSears.com shared the same small Virginia hosting server as PBM Products, the company that markets Wyeth Nutritionals — the company that makes store-brand infant formulas.

It also was revealed that Sears, a longtime vocal advocate of adding the controversial supplement DHA to infant formulas in the United States, serves as a paid medical advisor to Martek Biosciences, the company currently lobbying the FDA to require DHA supplementation in all infant formula sold in this country.

Despite his stated positions at AskDrSears.com advising parents on the use of generic infant formulas (when formula is required) and DHA, Sears did not offer any disclosure statement on the site informing readers of his fiduciary ties to PBM or Martek.

In a telephone interview Sunday, Dr. Sears readily admitted that PBM Products/StoreBrandFormulas.com underwrote the cost of designing and launching AskDrSears.com, as well as the cost of a full-page ad promoting the site in this month’s BabyTalk magazine. Sears also answered affirmatively when asked if he is a Martek stockholder.

It was apparently an employee of PBM Products who contacted La Leche League’s public relations director, Kim Cavaliero, in order to inquire about a banner exchange between LLLI and AskDrSears.com. Cavaliero says that she “obviously” had no idea that she was dealing with a representative of a formula-marketing company rather than an employee of AskDrSears.com.

Cavaliero says that she specifically asked the individual who contacted her whether there would be any infant-formula ads on the site, since LLLI policy prohibits League ads from running on sites with such advertising. The PBM employee assured her that there would not. (La Leche League has since removed all its ads from AskDrSears.com. PBM Products did not return calls or e-mails asking for comment on this matter.)

In the interview, Sears claimed that, despite the fact that PBM Products designed much of his site and paid to advertise on it, he too was unaware that actual banner advertisements for PBM’s product line would run on his site until after he began receiving e-mails from what he has described as “mad mommies.”

“I made a mistake in allowing the ads for infant formula to appear on my site,” said Sears, who has since removed the link to the StoreBrands site. “I accept responsibility for that mistake and I plan to correct it.”

According to Sears, he first became acquainted with PBM Products while visiting Wal-Mart headquarters in Arkansas to discuss placing his parenting products, such as books and baby carriers, in Wal-Mart’s recently launched “breastfeeding collection.” PBM, in cooperation with Wyeth Nutritionals, provides Wal-Mart with its own “Parents’ Choice” brand infant formula.

Sears recalls that after meeting representatives of PBM through Wal-Mart, he came up with the idea to partner with the formula company in his already-planned AskDrSears.com Web venture in order to both fund the site and “reach out to bottle-feeding mothers who would not otherwise hear our attachment parenting message.”

Sears notes that it is his opinion that his parenting books are merely “preaching to the choir,” and that he is extremely eager to find a way to promote the benefits of baby bonding to parents who aren’t breast-feeding. He says that he has recently explored a number of ideas to get his message out, including holding discussions with Wyeth Nutritionals about putting brochures promoting attachment parenting (and presumably AskDrSears.com) inside 30 million cans of infant formula. Since coming under fire for his ties to PBM Products, Sears says that he is no longer considering this idea.

According to Sears, he was completely unaware — and was at the time of this interview still not convinced — that his relationship with PBM violates the WHO Code, which he says he supports “100 percent.” He says that he is in discussions with PBM Products now to recraft the site so that it is in total compliance with the code, even if this means severing his ties to PBM. However, when asked, Sears says that he has no plans to end his relationship with Martek Biosciences or his advocacy for DHA supplementation because he believes in the product so strongly.

Sears reports that the banner ads for infant formula will be removed from AskDrSears.com this week. (They disappeared from the site Tuesday.) He now wants to challenge his core audience to come up with creative ways to connect with bottle-feeding parents who might be interested in attachment parenting.

“Bottle-feeding mothers should be encouraged to practice all the other aspects of attachment parenting, and I want to figure out how to remedy that,” said Sears.

However, from the discussions raging all over Internet parenting forums at the moment, it remains to be seen whether Dr. Sears’ core audience will stick around to help him figure this one out.

As a highly accomplished freelance writer, Spike Gillespie’s work has
appeared in Cosmopolitan, Playboy, Texas Monthly and other national
publications. But it is in the world of online journalism where she has made
her greatest mark. Gillespie came online at the urging of writer friends who
encouraged her to become “the Madonna of the Infobahn.” Immediately seduced by the false intimacy of
online communication, Gillespie — always prone to long, soul-baring
personal correspondence and essays — began writing an e-mail column, soon
syndicated worldwide by Prodigy, in which, as one reviewer noted, she
“pioneered the art of the online confessional.” Her Web work has also
appeared in Word, Tripod, Salon and Bust. As her column subscriber numbers grew during the latter half of the ’90s, so did her acclaim, leading USA Today to dub her one of the first “cyber-celebrities.” In her weekly
chronicles of both the ordinary and extraordinary happenings of her life
– everything from the death of her son’s guinea pig to the termination of her
own pregnancy — she developed a loyal fan base of readers, mostly women,
who follow her to this day. Although Prodigy eventually canceled her
column, it was these essays that formed the seed material for her
autobiography.

In the book, Gillespie recounts her personal history in an unflinching
straight line — starting with her childhood as the daughter of working-class
New Jersey Catholics, moving on to her teenage summers at the gritty, 1970s
Atlantic seashore of Bruce Springsteen and finally wrapping up with her
current status as one of the arty elite in arty Austin, Texas.

The theme running throughout the entire narrative is the writer’s search for
the love and attention she never received from her remote, cold father.
Unlike so many other modern tales of dysfunctional families, this
isn’t one of overt abuse. Gillespie wasn’t beaten, molested or starved by
her parents. Instead she paints a picture of a severe, oddball father — a man
who required that his children peel his sweaty socks off his feet each
evening and who drove his brood of eight mortified offspring around
town in a huge clunker of a car plastered with crudely hand-lettered
pro-life slogans. Gillespie’s father was apparently never willing and
perhaps unable to demonstrate any love for his child, or to accept the mouthy,
tattooed, literary feminista she became.

At 18, never having left the greater New Jersey area,
Gillespie fled south to Florida for college, becoming the first member of
her family to seek a university education. Free from her father’s iron
grasp, Gillespie shaved her Breck-girl hair into one of the first spiky punk
coiffures at the University of South Florida (hence the nickname “Spike”)
and began a lifetime of looking for love with “all the wrong men.” Over the years, Gillespie worked her way across the country by involving herself — usually intimately — with a parade of literally dozens of guys.

And a more motley crew was likely never assembled. From the college honey who assaulted her to her son’s father — a man with a drinking problem so severe that he suffers repeated grand mal seizures — Gillespie’s penchant for hooking up with inappropriate and
unavailable lovers takes on epic proportions. In the book, she refers to
many of her problems being “penis-related” — a deadly accurate assessment. Near the end of the book, Gillespie chronicles perhaps the very worst of her entanglements: a brief, destructive marriage to a man she met via e-mail. In the course of only a year, her semi-sociopathic bridegroom manages to reduce Gillespie to a depressed, insecure, unemployed
shadow of her former self.

Despite the bleak specifics of Gillespie’s story, at its heart it is both
uplifting and inspiring. This is because Gillespie’s retelling of the
redemptive experience of mothering her only child, Henry — her “perfect boy”
– serves as a powerful counterpoint to the chaos swirling around her. Her
unfettered joy in her son and in her relationship with him shines through on
every page.

In typically dramatic Gillespie fashion, Henry entered the world
in a violent homebirth (this will probably be the only book you
will ever read in which a woman refers to the “blood-spattered walls” of the
room in which she gives birth). His early years were spent in a variety of
seedy apartments with a mother who was waitressing by day and writing term
papers for students at the University of Texas by night. Those with
preconceived notions about how a young child should be parented may find
themselves disturbed reading about Henry Mowgli Gillespie’s unconventional
early home life. But parents from all walks will relate to Spike Gillespie’s
powerful struggle to effectively mother her child with no model upon which
to base her own parenting. Her recounting of her failures and successes as a
mother is graphically honest and very moving. In one passage she
describes feeling out of sync with the other young mothers at her local
playground:

Compared to the vast majority of the other mothers — with their snappy diaper bags, clean clothes, and healthy snacks — I felt like an alien. I was
disheveled at all times, hung over often enough, my son rarely clad in more
than a drooping diaper.

Gillespie does eventually encounter another mother at the park with whom she
becomes fast friends, but in the beginning of their relationship, she is
frightened to reveal the realities of her daily life — a filthy apartment,
alcoholic partner and unstable finances. For months she will only meet her
new pal at the park or a restaurant. Eventually, however, the two women grow
close enough that Gillespie opens up, and begins the process of creating the
chosen family of close friends that she and Henry enjoy today.

Gillespie must have been tempted to end her book with a tidy, “I’m all better now” wrap-up in which she admits having learned from her mistakes and vows never to repeat them. In fact, the book ends on an ambiguous note. Gillespie still drinks, still dates some of the wrong men and still struggles with depression. While her growth as a person, an artist and a mother is
self-evident, she doesn’t shrink from the clear fact that she has miles yet
to go before she shakes the pain that has driven her to flights of terrible
judgment all her life. At a recent reading of her work, Gillespie suggested
that her book serve as a sort of apology to her son, as well as an
explanation for what she has done. Although the highly sexual nature of much
of the material in this memoir means that Henry — now a self-assured,
articulate third-grader with a mop of hair he has recently dyed green —
likely won’t read it for years, when he does he will have something that few
children can claim — a deep, searing glimpse into the soul of his mother.

The failure of many medical professionals to fully inform their patients of the impact of infant feeding choices is due in large part to their own ignorance of the facts. Most obstetricians, pediatricians and nurses graduate from their professional training having had little or no exposure to the most up-to-date literature or clinical practice in this area. In fact, a recent AAP survey revealed that 45 percent of pediatrician respondents stated that they see formula-feeding and breast-feeding as equally acceptable methods for feeding an infant. The survey further noted that “nearly equal proportions of pediatricians agree and disagree as to whether formula-fed babies are just as healthy in the long run as breast-fed babies (34 percent vs. 38 percent); 27 percent are undecided.” These statistics reveal a shocking unfamiliarity with the large and growing body of current research on this topic.

In many cases, health care providers’ views on infant feeding are based on their own, highly personal experiences. A nurse who chose to formula-feed her own children or a doctor whose wife weaned her baby at three weeks is unlikely to be an effective advocate for breast-feeding. A large-scale study of physicians’ knowledge of human lactation in a 1995 issue of the Journal of the American Medical Association reported that the most important factor influencing the effectiveness and accuracy of a doctor’s breast-feeding advice to patients was whether the doctor herself, or the doctor’s wife, had breast-fed her children. In a March 1999 report on breast-feeding promotion efforts by American doctors, Pediatrics magazine concluded, “A majority of pediatricians believe that breast-feeding and formula-feeding are equally acceptable methods for feeding infants. Furthermore, reasons given for not recommending breast-feeding include medical conditions such as mastitis, nipple problems, low milk supply, jaundice, and low weight gain, which have recognized therapeutic approaches that generally do not preclude breast-feeding.”

“Doctors need to do better in giving their patients good information and support regarding infant feeding,” says Dr. Gartner, who has traveled the country offering lactation training to physicians and hospitals. “But it takes a great deal more education to do this. It’s easy to explain to parents why they should put their baby in a car seat, but human lactation is much more complex. Many, if not most doctors are carrying around a lot of wrong information about breast-feeding versus bottle-feeding. In order to be effective, they have to unlearn those misconceptions.”

Infant formula companies have traditionally targeted health-care professionals as the quickest route to convincing mothers that formula-feeding represents a safe, nourishing option for their babies. Physicians and nurses in the U.S. routinely receive gifts, office supplies, meals, a year’s supply of free infant formula for themselves or a relative and even pricey vacations from the infant-formula marketing representatives who haunt their offices. According to Dr. Dettwyler, some pediatric residency programs are largely underwritten by infant-formula manufacturers, an allegation verified by the National Association of Breastfeeding Advocacy and the International Lactation Consultants Association. Not surprisingly, more than 70 percent of surveyed pediatricians recently reported to the AAP that they recommend a particular brand of infant formula to their patients. (In contrast, Pediatrics reported that only 65 percent of pediatricians surveyed recommend exclusive breastfeeding for the first month after birth; only 37 percent recommend breastfeeding for the first year, as recommended last year by the AAP.)

The 1996 annual report from Abbott Laboratories, makers of Similac infant formula, took note of this cozy tie between the medical community and infant-formula manufacturers, stating that, “Abbott’s close relationship with pediatricians and other health-care providers serves as the foundation for the company’s solid market position in the United States. Pediatricians are also key to the success of the consumer education programs, such as the Welcome Addition Club … a program that provides new and expectant parents with a broad range of information, from nutrition and breast-feeding tips to basic parenting skills.”

In 1994, after years of stalling by Republican administrations that opposed it, the United States joined every other developed nation in the world as a signatory to the “WHO Code,” an international agreement that, among other things, calls for an end to formula promotion and giveaways through the health-care system and includes a clause stating that “no financial or material inducements should be offered by [infant formula] manufacturers or distributors to health workers, or members of their families, nor should these be accepted.” Despite the WHO Code, virtually all hospitals in the United States offering maternity services — as well as the majority of individual obstetricians and pediatricians — continue to provide massive free advertising from the huge pharmaceutical companies that produce and market formula in the United States. Such promotional material comes in the form of formula giveaways, patient “educational literature” produced by the formula companies and even free baby equipment such as diaper bags.

Obviously, marketing and product giveaways on this scale cost infant-formula companies millions and millions of dollars each year. But it pays off. Their own market research, as well as medical literature and anecdotal observations by lactation professionals, have demonstrated that these tactics make it statistically less likely that a women will breast-feed without supplementation or breast-feed at all. And once a woman stops nursing and begins feeding infant formula, these companies know that they likely have her “hooked” on their product, since even a brief interruption in the nursing relationship can cause a woman’s own milk supply to dwindle or the baby to begin refusing breast in favor of bottle.

American hospitals have largely shrugged off the idea that accepting free formula and large cash “donations” in return for a particular formula company’s right to market directly to its patients represents an ethical problem. Around the world, thousands of hospitals have become certified by the World Health Organization as “Baby-Friendly” by agreeing to aggressively and accurately promote breast-feeding and to end the practice of allowing infant-formula companies to offer freebies to personnel or patients. In the United States, however, fewer than 20 hospitals and birthing centers have received the Baby-Friendly designation.

“Hospitals should not be accepting free infant formula from these companies. They know that if they didn’t accept it, they would have a reduced sense of obligation to promote formula. Their continued acceptance of this practice says something important,” notes Dr. Cunningham.

Because the WHO Code hasn’t been incorporated into federal law in the United States as it has in some other countries, it is impossible to enforce. And although American infant formula companies claim to voluntarily adhere to the code’s provisions, including no direct marketing of infant formula to consumers, they openly flout the code and their own assurances of compliance. This can be made clear by flipping through any popular parenting magazine or watching any television program geared toward women in which appealing ads for infant formula are abundant. Nestli, the notorious maker of Carnation brand formulas, is perhaps most disingenuous when it comes to adherence to the WHO Code. On its Carnation Baby Web site, parents who live in other countries are asked to read a statement in which Nestli makes a feeble attempt to comply with the code by warning against bottle-feeding. American parents entering the site receive no such statement from Nestli.

Many breast-feeding advocates believe that infant-formula manufacturers are now attempting to influence parents through product placement in the entertainment industry. During the 1998-1999 television season, particular brands of infant formula were displayed on episodes of the television programs “Mad About You” and “Chicago Hope.” In one notable episode of “Chicago Hope” from last season entitled “The Breast and the Brightest,” the plot revolved around the death of a breast-fed infant due to malnutrition. Woven throughout the episode were inaccurate statements regarding the Baby-Friendly Hospital Initiative (BFHI) and breast-feeding in general. BFHI and La Leche League International, as well as Medela, a leading manufacturer of breast pumps, felt compelled to issue formal responses to the content of the program, characterizing it as a “gross misrepresentation.”

Interestingly, the entire last season of “Chicago Hope” was sponsored by the Pharmaceutical Research and Manufacturers of America (PhRMA), whose membership is made up of pharmaceutical companies, including those that manufacture and market infant formula. According to a PhRMA press release, sponsorship of “Chicago Hope” was part of a collaborative effort between Johns Hopkins Medicine, PhRMA, CBS Television stations and 20th Century Fox, “to relate to viewers on medical concerns at a time when their awareness is heightened on such issues.” PR Newswire reported in September 1998 that the PhRMA-sponsored episodes would “educate viewers” on “issues such as … the risks associated with breast-feeding.”

The reasons behind these marketing efforts are crystal-clear: The manufacture and sale of commercial infant formula is an unbelievably profitable enterprise. U.S. infant-formula sales reached approximately $2.59 billion in 1993, representing a 6-percent increase over 1992. Today that figure is estimated to be at $3 billion and climbing. Since 1989, when formula companies lifted their previous voluntary ban on marketing directly to consumers, the market has grown by 54 percent. The average bottle-feeding family in the United States spends between $800 and $2000 per year on infant formula. With such a lucrative product to promote, corporations have wisely enlisted the assistance of new parents’ most trusted advisors — health-care providers — in order to retain and increase their markets.

Infant-formula manufacturers attempt to hide behind the empty-sounding “breast is best, but …” disclaimer that most of them include with their advertising (although even this statement appears to be slowly disappearing from infant-formula advertising). However, the simple fact is that breast-feeding itself is the most dangerous and formidable competitor formula companies have. Every time a woman chooses to breast-feed instead of bottle-feed her baby, the pharmaceutical companies lose approximately $1,000 in sales. Because the companies that produce formula also develop and market medications and medical supplies, they must be acutely aware that the higher rates of illness suffered by formula-fed children as a group also affects their bottom line, possibly even more than the sale of the formula itself. For example, Abbott Laboratories, aside from making Similac and Isomil, also produces Pediasure, an oral rehydrating solution for infants and young children with diarrheal disease. The company also produces antibiotics widely used to treat infant infections, as well as products for diabetics.

Experts agree that there is a role for the appropriate use of commercial infant formula. It should always be used for infants under 12 months in lieu of any type of homemade formula or whole cow, goat, or soy milk. The problem, they say, is with the way it is marketed and represented to parents.

“Infant formula should be seen for what it is: a pharmaceutical product, not for routine use,” says Dr. Dettwyler. “The way these companies market it as equivalent to breast milk and just one equal choice among several is wrong.”

While commercial infant formulas are commonly perceived to be the medically recommended second-choice infant food after breast-feeding, the World Health Organization (WHO) actually states: “The second choice is the mother’s own milk expressed and given to the infant in some way. The third choice is the milk of another human mother. The fourth and last choice is artificial baby milk.” For mothers who are unable to breast-feed their own babies, a small network of human milk banks exists in the United States. The informal sharing of breast milk and wet nursing has been common throughout human history; the first U.S. milk bank opened in Boston in 1911. Today, the seven regional milk banks belonging to the Human Milk Banking Association of North America (HMBANA) follow strict health and safety guidelines — similar to that of a blood bank — for the collection, processing and distribution of milk donated by breast-feeding mothers. According to Andrea Morgan, Executive Director of the Mothers’ Milk Bank at Austin, Texas, and HMBANA vice president, banked human milk is currently available by prescription only, and as more people seek an option other than infant formula for their infants, the demand continues to be greater than the supply.

“The limiting factor really is the amount of milk on hand,” explains Morgan. “Healthy newborns have lowest priority, regardless of the status of the mother. There is simply too much demand from sick and premature babies and other gravely ill children, where mothers’ milk represents survival and a decent shot at good health, with no real good alternative. More publicity helps to generate more donors. People call me all the time and say they’ve been dumping breast-milk because they didn’t have room in the freezer and didn’t realize there was an alternative. It also helps to spread the word to more physicians, who become interested in having this milk available to their sick patients.”

Currently, the small scale on which human milk is processed and distributed makes it prohibitively expensive for most families compared to infant formula. It costs about $2.50 to purchase one ounce of processed, banked human milk. Infant formula, while still expensive — costing between $75 and $175 per month for an exclusively formula-fed infant — is based on abundantly available and cheap agricultural products such as cow’s milk or soybeans.

“Some insurers pay [for banked human milk] if they realize that these patients will have lower overall health-care costs. Medicaid also pays in some states,” says Morgan. “The processing fee that we charge covers only about half the cost to process the milk. And all milk banks exist because of some other type of support: Either they are located in a hospital that provides a substantial operating subsidy or, as in our case, a community-based, not hospital-based bank. We must constantly work to raise funds. But no medically needy recipient is denied milk for inability to pay.”

With the current high cost and limited availability of banked human milk, commercially produced infant formula generally remains the only available alternative for those mothers who are truly unable to breast-feed their babies due to adoption, maternal HIV infection or other factors. And unfortunately, in the United States, because of inflexible work schedules, a lack of societal support and an epidemic of medical mismanagement, nursing is often made extraordinarily difficult for even the vast majority of women who are physically capable of breast-feeding their children. But Dr. Gartner believes that if more parents understood the stark realities of the risks inherent in artificial feeding, they would no longer stand for a situation in which they are literally forced by external circumstances to feed their babies an expensive, potentially hazardous product in lieu of a safe, available one — their own breast milk.

“Women are simply not getting informed on this issue,” says Gartner. “In many cases, advertising and promotion have led parents to believe that there is no substantive difference between breast-feeding and formula-feeding in the United States and of course, this is far from being the case. I urge parents to read and learn as much as they can about relative health outcomes in children before they decide how they will feed their baby. Studies have shown that when women are educated on this issue — even when they then decide not to breast-feed — they don’t feel guilty. But most women, when they find out all the facts, do feel cheated and very, very angry.”

In virtually all of the reported cases each year in which a breast-fed baby becomes seriously ill as a result of her mother’s feeding choice, the problem is actually one of not breast-feeding — meaning that, as in the Walrond and Cheeks cases, some uninformed and unsupported nursing mothers are not aware that they aren’t effectively transferring milk from their breasts to their babies. In sharp contrast, however, routine formula feeding — even when done properly by parents — is itself a contributor to overall rates of infant morbidity and mortality in the United States. This is because — despite what manufacturers’ advertising would have parents believe — today’s commercial infant formulas, while a marked improvement over the homemade concoctions of years past, still represent a flawed and highly inferior imitation of our own, species-specific milk.

According to the American Academy of Pediatrics’ most recent member survey, a majority of baby doctors see slightly more formula-fed babies than breast-fed babies admitted to the hospital for instances of malnutrition and failure to thrive. But this represents only the tip of the iceberg when it comes to the differences in rates of morbidity and mortality between formula-fed and breast-fed infants in this country. When the overall health of formula-fed infants in the U.S. is compared to that of breast-fed infants — even after controlling for variables such as parents’ socioeconomic backgrounds — it becomes clear that formula-fed babies are sicker, sick more often, and are more likely to die in infancy or childhood. However, parents often lack access to this information, and in fact, are often the recipients of misinformation, thus denied the ability to make truly informed choices regarding how they will feed their babies. Although the phrase “breast-feeding is best” is tossed around so liberally as to have been rendered almost meaningless, many Americans are under the mistaken impression that today’s commercial infant formulas are nearly identical to human milk. And because of this, parents who routinely approach other important infant health and safety issues in a thoughtful, deliberate way are largely unaware that in epidemiological terms, the decision to formula-feed when breast-feeding is an option places their child at demonstrably higher risk for a wide variety of ailments.

“Parents are not adequately informed regarding the real risks of artificial milks [infant formula],” says Nancy Wight, MD, FAAP, IBCLC, and a neonatologist at Children’s Hospital in San Diego. She says that she considers it part of her job to strongly encourage the parents of her patients to breast-feed. “Doctors never worry about making parents feel guilty when we discuss childhood immunizations, car seats, seatbelts, bicycle helmets or fencing around pools. I have an obligation to my patients to give them correct information — not formula marketing slogans — and let them make the choice.”

Dr. Lawrence Gartner, MD, FAAP is a respected medical authority on infant feeding who has played a role in drafting policy statements for the AAP regarding this issue. He agrees that parents today aren’t fully aware that the breast-or-bottle decision is more than just another neutral lifestyle choice.”Compared to other equally important child safety issues like car seat use or babies’ sleep position, parents should understand that the decision whether to breast- or bottle-feed ranks right up on top when it comes to protecting babies. The AAP certainly puts it in that category.”

In fact, the AAP explicitly states that encouraging breast-feeding among parents is “as important to preventive pediatric health care as promoting immunizations, car seat use, and proper infant sleep position.”

Katherine Dettwyler, Ph.D., associate professor of anthropology at Texas A&M University and an internationally recognized expert on infant nutrition, agrees with Gartner’s assessment of the relative risks of “artificial feeding” for American children. “I would rank the decision of how to feed your baby as the No. 1 infant safety issue in this country,” says Dettwyler.

Despite the widespread misperception that aggressive promotion of breast-feeding has had a major impact on how we feed our babies, more than 70% of infants in the United States are fed infant formula as their primary source of nutrition for most of their critical first year of life. According to a recent report in the Washington Post, although a federal survey in 1995 found that 58% of American mothers start off breast-feeding their babies — the same percentage as a decade earlier — 20% fewer mothers today are still breast-feeding after three months. While it is certainly true that many individual formula-fed infants will do “just fine” (as will most unvaccinated individuals in the United States), the research clearly indicates that, as a population, America’s formula-fed babies are not “fine” at all.

“Sure, you can speak of the benefits of breast-feeding,” explains Dr. Gartner. “But it’s really just as accurate — maybe more accurate — to speak of the risks of formula-feeding. Unfortunately, the large volume of medical literature we now have that demonstrates this is written from the perspective of proving the ‘advantages’ of breast-feeding — as if formula-feeding were the gold standard. But when you read the literature the other way around — as it should be read, really — the results are rather startling.”

These “startling” results were crystallized in the AAP’s exhaustively researched 1998 Policy Statement on Breast-feeding and the Use of Human Milk. For the first time, parents can easily access a readable, comprehensive overview of all the most current medical literature related to infant feeding. Summarizing the results of their study, the AAP Policy Statement notes that infants who are not breast-fed “in the United States, Canada, Europe, and other developed countries, among predominantly middle-class populations” see an increased incidence and severity of such diseases as diarrhea (a malady from which approximately 500 American children aged 4 and under lose their lives each year), lower respiratory infection, otitis media (ear infections), bacteremia, bacterial meningitis, botulism, urinary tract infection, and necrotizing enterocolitis. The AAP goes on to say that a number of studies now indicate that breast milk may lower babies’ risk for sudden infant death syndrome, insulin-dependent diabetes mellitus, Crohn’s disease, ulcerative colitis, lymphoma (cancer), allergic diseases, and other chronic digestive diseases.

“More than 1,000 childhood deaths per year in the United States could be prevented through breast-feeding,” says Dr. Allan Cunningham, associate professor of pediatrics at the State University of New York Health Science Center, Syracuse and the author of scholarly articles on the mortality risks of bottle-fed babies in the United States. “This includes infants who die from a wide variety of illnesses such as diarrheal diseases like rotavirus, as well as pneumonia and bacterial meningitis. Although the ‘Back to Sleep’ campaign has made a large dent in the number of babies who die each year from crib death, my estimate is that you roughly double the statistical risk of a baby dying of SIDS if you formula-feed. This is something parents just aren’t made aware of.”

Dr. Cunningham has published research in leading pediatric journals indicating that for every 1,000 bottle-fed infants in the United States, 77 hospital admissions would result. The comparable figure for breast-fed infants was determined to be five hospital admissions. And Naomi Baumslag, M.D., MPH and Dia Michels note in their book, “Milk, Money and Madness” (Bergin and Garvey, 1995): “Even where bacterial contamination can be minimized, the risks of bottle-feeding are not inconsequential. Bottle-fed infants raised by educated women in clean environments, to this day, have significantly greater rates of illness and even death … In a study that analyzed hospitalization patterns for a homogeneous, middle-class, white American population, bottle-fed infants were 14 times more likely to be hospitalized than breast-fed infants.”

A May 1995 study reported in the Journal of Pediatrics, “Differences in Morbidity Between Breast-fed and Formula-fed Infants,” examined “whether breast-feeding is protective against infection in relatively affluent populations.” The study followed two groups of babies, each of whom was either breast-fed or formula-fed exclusively for the entire first year of life. The babies were matched for characteristics such as birth weight and parental socioeconomic status, and the study was controlled for the use of daycare. The results of this research revealed that, in the first year of life, the incidence of diarrheal illness among formula-fed infants was twice that of breast-fed infants and the number of prolonged ear infections (more than ten days in duration) was 80% higher in formula-fed infants. Breast-fed infants experienced 19% fewer ear infections overall.

In a study reported in the April 1999 issue of Pediatrics, researchers looked at the frequency of only three illnesses during the first year of life: lower respiratory tract illnesses, otitis media, and gastrointestinal illness. Infants in the study were healthy at birth and were classified as never breast-fed, partially breast-fed, or exclusively breast-fed, based on their mother’s feeding choice during the first three months of life. According to the study’s authors, “Frequency of office visits and hospitalizations for the three illnesses was adjusted for maternal education and maternal smoking, using analysis of variance.” The results of the research revealed that there were 2,033 excess office visits, 212 excess days of hospitalization and 609 excess prescriptions for these three illnesses alone per 1,000 bottle-fed infants compared with 1,000 exclusively breast-fed infants.

To Dr. Dettwyler, more familiar illnesses, such as ear infections, represent an important aspect of the risks of formula-feeding which shouldn’t be overlooked. “In this country we have just become accustomed to repeated ear infections in our babies. Although we can treat these problems with antibiotics, we should be asking ourselves how this affects our babies’ quality of life,” says Dettwyler.

Dr. Wight agrees. “We are accepting as normal, abnormal amounts of unnecessary illnesses such as otitis media, lower respiratory illness, gastroenteritis, diabetes and allergies, among others.”

Despite the fact that the medical literature clearly supports the contention that formula-feeding represents a statistically riskier enterprise for American babies than does breast-feeding, this isn’t a message parents often hear in the media. It’s hard to imagine headlines proclaiming: “Mother’s choice to formula-feed leads to preemie dying of necrotizing enterocolitis!” (Necrotizing enterocolitis is an inflammation of the large and small intestines, which carries a mortality rate of 20-40 percent for the 5-12 percent of all very premature infants who become ill with it. Formula-fed preemies are up to 10 times more likely to experience this serious complication, and of those infants who develop the illness, infants who aren’t receiving breast milk are significantly more likely to require surgery and to die.) Individual health-care providers across the country are able to relate specific instances in which babies experienced less favorable health and developmental outcomes attributable to artificial feeding. But no one from the Wall Street Journal is calling to put these cases on the front page as evidence of the potential hazards of infant formula.

Dr. Linda Shaw, M.D., FAAP, is a practicing pediatrician in Altoona, Penn. who says that she sees “plenty of babies with formula problems … Just a few months ago, I had a formula-fed infant I had to admit to the hospital for failure to thrive. I have also cared for infants with cow’s milk protein allergies leading to gross rectal bleeding. I’ve seen lots of infants hospitalized with gastroenteritis or RSV [Respiratory Syncytial Virus, the single most common cause of lung infections in infants] that was worse because they weren’t getting the maternal antibodies found in breast milk,” says Shaw.

Catherine Bargar, RN, IBCLC is a lactation consultant in private practice in Ithaca, N.Y. She says that in her previous positions as Obstetrics Discharge Coordinator at an Ithaca hospital and as a staff member with a local office of the Women Infants and Children (WIC) supplemental nutrition program for low-income families, she saw “many babies who experienced significant negative health effects from formula.” In some instances, these illnesses were actually due to improper formula-feeding, such as patients preparing formula with water from unclean wells, leading to babies with severe diarrhea requiring hospitalization. In many other cases, however, the problems Bargar observed were directly attributable to the risks inherent in any formula feeding.

“I saw countless babies suffering through numerous unsuccessful formula changes in an attempt to find one that the baby could tolerate. Details varied somewhat as to which formula had what negative effect, but the story was always the same: The mom had stopped breast-feeding or never even started and tried formula Brand X. The baby then vomited, got serious rashes, failed to gain weight appropriately, developed asthma, etc. They then switched formula numerous times with varying negative health effects and ended up with a sickly baby or toddler,” recalls Bargar. “These children ended up on expensive and only marginally-tolerated formula. Often these babies were diagnosed with gastric esophageal reflux following expensive testing. This scenario was one I encountered at least daily.”

Although commercial infant formulas are better than synthetic human milk substitutes of the past, the simple fact is that they can never duplicate the living, anti-infective and unique hormonal properties of real breast milk. “It has become increasingly apparent that infant formula can never duplicate human milk,” wrote John D. Benson, Ph.D., and Mark L. Masor, Ph.D., in the March 1994 issue of the medical journal Endocrine Regulations. “Human milk contains living cells, hormones, active enzymes, immunoglobulins and compounds with unique structures that cannot be replicated in infant formula.” Benson and Masor, both researchers for infant formula manufacturing giant Abbott Labs, went on to note that they believe that creating an infant formula that replicates human milk would be impossible.

This may come as a surprise to parents who see and hear frequent advertisements from infant formula companies touting their products as “a miracle” and “most like breast milk.” In fact, formula manufacturers have no idea exactly how close their product is to breast milk because new ingredients and properties of breast milk are discovered every year. And even among those elements of human milk of which science is already aware, today’s infant formula still doesn’t measure up. Breast milk contains hundreds of known ingredients and elements which have not been — or cannot be — added to infant formula at this time.

“Modern formulas are only superficially similar to breast milk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally they are inexact copies based on outdated and incomplete knowledge of what breast milk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium and iron than breast milk. They contain significantly more protein than breast milk. The proteins and fats are fundamentally different from those in breast milk,” says Dr. Jack Newman, a Canadian pediatrician who has been a UNICEF infant nutrition consultant in Africa, and has published articles on the subject of breast-feeding in Scientific American and several medical journals

Dr. Martha Neuringer, a research associate professor of clinical nutrition at Oregon Health Sciences University in Portland was quoted in 1994 by New York Times science writer Natalie Angier as saying that, “Human milk is an incredibly complicated substance. It contains proteins we haven’t even identified yet, much less know the function of.”

In the June 1999 issue of Discover Magazine, it was reported that Swedish and British immunologists working with a grant from the American Cancer Society have discovered that one identified protein in breast milk, alpha-lactalbumin, literally destroys every cancer cell with which it comes into contact. According to lead scientist Catharina Svanborg, her team pursued this exciting research in an attempt to determine why “the relative risk of childhood lymphoma is nine times higher in bottle-fed infants, and the risk for carcinoma is also elevated.”

“This [alpha-lactalbumin] is a substance that kills lots of tumor cells, every cancer we test it against. Lung cancer, throat cancer, kidney cancer, colon cancer, bladder cancer, lymphoma, leukemia, and pneumococcus bacteria too,” explained Svanborg in Discover.

One new tack taken by infant-formula manufacturers has been to attempt to match the body chemistry of the breast-fed infant rather than the chemical makeup of breast milk itself. Abbott Labs researchers have stated, “A better goal is to match the performance of the breast-fed infant. Performance is measured by the infant’s growth, absorption of nutrients, gastrointestinal tolerance and reactions in blood.”

Yet even using this standard of measurement, bottle-feeding falls short. Levels of long-chain fatty acids — a critical component of brain development in humans — are markedly lower in the blood chemistry of artificially-fed infants. Additionally, certain hormones, minerals and amino acids are found at very different levels in breast- and bottle-fed babies. “Formulas succeed only at making babies grow well, usually, but there is more to breast-feeding than getting the baby to grow quickly,” explains Dr. Newman.

In addition to the health risks inherent in feeding an inferior substitute for mother’s milk — formula-feeding can also be hazardous due to parental misuse or manufacturing error. Child health advocates, particularly those associated with the WIC program, report that some parents dilute their babies’ bottles of formula in an attempt to make the expensive product last longer. This can cause malnutrition, or a condition known as “water intoxication,” leading to brain swelling and seizures. Additionally, parents who do not have access to a safe water supply place their babies at risk of bacterial contamination when they prepare bottles of formula.

Formula manufacturing errors are also far more common than most American parents are aware. In fact, the federal Infant Formula Act, which aimed to improve the safety and effectiveness of infant formula, was passed after a manufacturing error allowed a large quantity of chloride-deficient formula to enter the U.S. marketplace, causing documented health problems in a number of babies.

According to information on a company Web site from “Qualicon, Inc.,” a new DuPont subsidiary that describes itself as providing commercial diagnostics in food, pharmaceutical and personal-care products, an unnamed infant formula manufacturer recently discovered that “its finished product was consistently contaminated with low levels of Enterobacter sakazakii.” Although Qualicon’s report of this incident states that this substance is not a known pathogen, in fact strains of Enterobacter sakazakii are known to cause deadly illnesses such as meningitis in infants fed infected formula. In this case, Qualicon describes having isolated Enterobacter sakazakii “frequently in products from two (infant formula) factories and infrequently in products from a third.” Qualicon found several hundred samples and more than 30 different strains of the bacteria in both raw materials and the environment at each site. This widespread problem was found to be caused by cross-contamination due to cleaning methods and personnel movement. As this information came from a Web site advertising Qualicon’s services to the food industry and not from any infant formula manufacturer, parents are unlikely to have been aware of this potentially life-threatening infectious hazard.

In early June 1999, Mead Johnson, makers of infant formula brands including Enfamil and Prosobee, reported that 120,000 cans of infant formula shipped to stores late last year were being recalled due to a labeling mistake that could lead to “severe medical problems” in some babies. Company officials said the cans labeled as infant formula could actually contain the “adult nutritional supplement” Vanilla Sustacal. No public explanation was offered for the time lapse between discovery of the problem and the recall being issued. In another recent incident, a memo released by the Georgia WIC program on May 6, 1999 announced that in April of this year, Abbott Labs initiated a voluntary recall of its Ready-to-Feed (RTF) Isomil, an iron-fortified soy-based infant formula. The memo fails to mention exactly why the formula is being recalled. In April of this year, 75,000 32-ounce cans of Nestle’s Carnation Good Start brand infant formula were recalled due to the product’s having “curdled.” No mention of this recall was made on Carnation’s promotional Web site for parents.

In fact, between 1982 and 1994 alone, there were 22 significant infant formula recalls in the United States. At least seven of these were classified by the Food and Drug Administration as Class I, meaning health problems could be life-threatening to babies who were fed the tainted formula. In many cases, parents never become aware that their child’s primary food source has been recalled because this would require checking with the FDA Enforcement Report every week to find out about any new problems with various brands.

Just as I was feeling most defeated by my sorry excuse for a day, the phone rang. It was my literary agent, calling from New York to give me the good news: A major publisher had just acquired my second parenting book — on the joys of raising a larger family. It was 3 p.m. and things were looking up.

Soon after, a friend unexpectedly dropped by. I answered the door still dressed in my tattered flannel bathrobe. I invited her in and excitedly related the details of the new book deal to her. She immediately began to giggle uncontrollably.

“What?! What’s so funny?” I asked with some annoyance while frantically trying to keep my 15-month-old from struggling out of my arms. He was intent on heading back to the cat-food bowl for a few more bites of what had lately become his favorite unauthorized snack.

“Well … um … just look at yourself,” she said, bemusedly eyeing my sticky bathrobe, and probably the dishes in my sink, and the Legos and headless Barbies covering the dining room table. “You don’t exactly look like some kind of ‘parenting expert.’”

It’s true. I really don’t. Even fully dressed without the glitter in my hair. For one thing, many, if not most, writers of parenting books — Dr. Benjamin Spock, John Rosemond, T. Berry Brazelton, Richard Ferber, James Dobson and Burton White, to name but a few — are men. There are some female writers on the topic of child-care issues, including the wonderful Penelope Leach and Eda LeShan, but they constitute a distinct minority. Additionally, most of these pundits — be they male or female — are well past their own time in the parenting trenches. When these folks offer child-care guidance, it’s through the rosy glow of memory, or based on solely academic observations.

By contrast, I wrote my first book, “Attachment Parenting: Instinctive Care for Your Baby and Young Child,” while actually living what I was writing about. When I penned the chapter explaining how parents can successfully “wear” their baby, it was with my own infant comfortably nestled in a sling on my chest as I typed. Writing the section on long-term breast-feeding was slow going, since I had the pleasant task of taking regular nursing breaks with both my toddler and her baby brother. I wrote my book not as a Ph.D. in child development or a world-renowned pediatric researcher, but as a 31-year-old mother and writer who wanted to offer parents information on a nurturing style that was really working for my own family and many others.

Despite the fact that I clearly don’t fit the mold of the conventional parenting expert (and in fact don’t think of myself as such), by virtue of having written rather extensively on child-care topics for newspapers and magazines, as well as being the author of two upcoming parenting books, that label is starting to stick. But the disconnect between being thought of as an authority on this subject and the normal ups and downs of my day-to-day life as a parent can be somewhat jarring at times. Although I believe sincerely and passionately in the topics about which I write, the fact is that I am a flesh-and-blood mama with real, live children. For this reason, I am not always able to measure up to the expectations that other people — and even I myself — sometimes have for me and my family.

One unsettling phenomenon I have encountered is that when some other mothers become aware of my work, they seem to feel the need to explain and even defend their own parenting choices to me ad nauseam — either that or they avoid me. For instance, I’ve noticed that bottle-feeding acquaintances at my neighborhood playground either won’t come within 10 feet of me or immediately plop down beside me to offer an unsolicited stream-of-consciousness commentary on the myriad reasons why they simply couldn’t breast-feed. I’m never sure how to respond to these encounters. These women aren’t asking for my opinion; instead they just seem to want to be absolved of their guilty feelings by having someone they perceive to be an “expert” validate their decisions. Needless to say, I would never presume to comment to them on their child-rearing practices, which are none of my business. After all, I go to the park to play with my kids, not to render some sort of all-knowing judgment on other parents.

I’ve also noticed that friends and acquaintances seem to presume that the progeny of someone who has written a book on the topic of child-rearing will always behave perfectly. Lately, when my
children do something predictably childlike, such as collapse in a crying heap at a restaurant after being kept out too late, other adults who know of my vocation seem to revel in the supposed irony of the situation. They are sure to say something they believe to be cleverly amusing, such as: “Gee, is that what I’ll get if I follow the advice in your book?”

My first-grader, Henry, has even taken to occasionally comparing his real mom with “parenting expert” mom. Henry is proud of my work as a writer and likes to offer his input on my advice to parents. He knows from our discussions and his own experience that I am an advocate of gentle, respectful discipline for children. But it took me by surprise recently when, after I totally lost it and yelled at him, Henry burst into tears and announced: “I’m going to tell all the mommies who buy your book that you scream at me all the time!“

I don’t scream at Henry all the time, or even very much of the time. But the idea that he might tell people that I do bothered me more than I wanted to admit. After all, why would anyone want to buy a book on parenting from someone who allegedly verbally abuses her own small children?

“I’ll bet those people who wrote ‘What to Expect When You’re Expecting’ never yelled at their children,” I thought to myself glumly.

I am not proud to confess that since writing my book, this isn’t the only instance in which I have allowed myself to succumb to somewhat absurd expectations regarding my family life. For example, I decided that my children should have the opportunity to be included in the publicity photo for my book. They seemed enthusiastic about the idea and we all had a great time getting dressed up and going to the photo shoot. I was certain that the photographer had captured a variety of wonderful shots of my adorable, well-adjusted children. Unfortunately, this was not the case. When the proofs arrived, I discovered row after row of pictures of what looked to me like unhappy, sullen-looking children.

“How did this happen?” I shrieked at my husband. “We can’t use these! Everyone will think I’m a terrible mother and that attachment parenting turns children into depressed malcontents!”

He finally persuaded me to calm down, and after days of poring over the contact sheets with a magnifying glass, I managed to choose the shot in which my children looked the cheeriest. Still, although I knew it was silly, I continued to harbor a secret wish that we could just crop them out of the photo altogether.

All of this baggage associated with my relatively new status as a parenting pundit was really starting to get me down. Then I happened to run across an interview with Dr. Benjamin Spock, in which he spoke honestly of his own struggles to effectively parent his stepdaughter, Ginger. In the piece, he admitted to being so angry with Ginger on one occasion that he “became purple in the face and shouted at her furiously.” I couldn’t believe it. The one and only Dr. Spock — the mother of all parenting experts — yelling! With a purple face even! I read the passage several times, feeling better by the moment. Suddenly my own foibles seemed acceptable, even inconsequential. Although I still don’t think I look like “some kind of parenting expert,” I have realized that I do look and act like something even more credible: a real parent.