The Economic Burden of NOT Breastfeeding
Vaccination with the full CDC-endorsed schedule of vaccines is presented as our absolute best choice to protect and nurture the health of our precious children. Vaccines are believed to be so important that they are mandated , subsidized , and protected by a special court .
Recently, we published an article  that discussed the widely promoted claim that vaccines save society billions of dollar every year. Are there other measures that could save society a few billion bucks, and significantly reduce infant and child mortality, morbidity, and related health costs?
In April 2010, Pediatrics published an article, The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis . This analysis was a review of some of the findings contained in an exceptionally comprehensive report  that was published in 2007 by the Agency for Healthcare Research and Quality (AHRQ). The Pediatrics paper determined that if:
“90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess of 911 deaths, nearly all of which would be infants…”
Almost 1,000 excess infant deaths every year, and a cumulative total of $130 billion in costs in 10 years. Low breastfeeding rates in the US should obviously be cause for serious concern. Note that the authors only considered three diseases, none of which are communicable or have vaccines available; necrotizing enterocolitis, otitis media, and gastroenteritis. Pediatrics did not publish new evidence, but simply analyzed data contained in the AHRQ report, which cited numerous studies favoring breastfeeding.
The AHRQ report looked closely at asthma (an interesting omission in the Pediatrics paper) and found that:
“Meta-analysis of the 12 studies [of 8183 term infants] with follow up of 2 or more years reported a summary odds ratio of 0.70 (95% CI 0.60 – 0.81), suggesting an association of breastfeeding and a reduction in the risk of the development of asthma.”
Published journal articles which show that breastfed babies have a significantly reduced risk of developing asthma include:
Asthma appears to be the leading chronic illness of childhood, and those afflicted need more prescriptions, more ambulatory visits, and are hospitalized 3.5 times more than their non-asthmatic peers. And the economic burden? The estimated annual cost for treating this condition in children younger than 18 is $3.2 billion. Asthma is the cause of almost 5 million physician visits, and 200,000 hospitalizations per year.  It would be safe to say that the figures put out by both Bartick et. al and the AHRQ are conservative. If breastfeeding might be associated with the reduction of health care costs of this magnitude with regard to simply one disease – where are the initiatives supporting this free, preventive measure?
Kull et. al, 2004 ,  found a statistically significant association favoring breastfeeding reducing asthma, proposing that the preventive effect of breastfeeding can be mostly explained by the decreased risk of respiratory infection. An Australian study from 2002 , which looked at gastrointestinal illnesses, respiratory infection, otitis media, eczema and necrotising enterocolitis only, suggested that higher rates of breastfeeding would save the Australian Capital Territory health budget $A60 – 120 million a year. A newer study  suggests that if approximately 80% of Australian babies were breastfed without any solids or supplements to at least 6 months, this would result in a reduction just in childhood chronic illnesses of between 4 – 18%.
Less than 500 deaths annually from measles in the U.S. was enough for public health officials to embark on a campaign to eradicate measles, yet there remains a persistent level of denial when it comes to actions to create an environment that promotes breastfeeding. Where are the subsidies, the mandates, the ad campaigns , the training programs for maternity personnel so they’ll push breastfeeding on new mothers the same way they push the Hepatitis B vaccine?
One conspicuous gap in the evidence usually presented on the benefits of breastfeeding is its effect on the outcome of infectious illnesses in childhood. Stay tuned as insidevaccines digs further into the remarkable science around breastfeeding.
 Immunization Action Coalition, State Information, State mandates on immunization and vaccine-preventable diseases, accessed on August 7, 2010. http://www.immunize.org/laws/
 A Multitude of Vaccine Benefits, Yet Controversy Persists, Donald G. McNeil, Jr., New York Times, published 3/28/08, accessed on August 7, 2010. http://health.nytimes.com/ref/health/healthguide/esn-vaccinations-ess.html Referring specifically to this passage:
Health insurers pay for most vaccines, and public clinics offer them free to the uninsured, the cost paid by the federal government under the Vaccines for Children Program of 1994.
 US Department of Health and Human Services, Health Resources and Services Administration, National Vaccine Injury Compensation Program, Accessed on August 7, 2010. http://www.hrsa.gov/vaccinecompensation/
 Insidevaccines, Vaccine Sleight of Hand, published July 18, 2010, accessed August 7, 2010. http://insidevaccines.com/wordpress/2010/07/18/vaccine-sleight-of-hand/
 Bartick, et. al., The burden of suboptimal breast-feeding in the United States: a pediatric analysis. Pediatrics. 2010 May;125(5):e1048-56. PMID: 20368314 http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1616v1
 Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153 (Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022). AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality. April 2007. http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1616v1
[6a] Wendy H. Oddy et al, “The Relation of Breastfeeding and Body Mass Index to Asthma and Atopy in Children: A Prospective Cohort Study to Age 6 Years”, American Journal of Public Health, 94(9); 1531-1537, 2004. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448489/pdf/0941531.pdf
[6b] Wendy H. Oddy and Jennifer K. Peat, “Breastfeeding, Asthma, and Atopic Disease: An Epidemiological Review of the Literature”, Journal of Human Lactation, 19(3); 250-261, 2003. http://jhl.sagepub.com/content/19/3/250.abstract
[6c] Wendy H. Oddy, “Breastfeeding and Childhood Asthma”, Thorax, 64(7); 558-559, 2009. http://thorax.bmj.com/content/64/7/558.extract
 Weiss KB, Sullivan SD, Lyttle CS. “Trends in the cost of illness for asthma in the United States, 1985-1994.” Journal of Allergy and Clinical Immunology, 106(3): 493-499, 2000. http://www.ncbi.nlm.nih.gov/pubmed/10984369
 Akinbami LJ. “State of Childhood Asthma, United States, 1980-2005.” Advance Data from Health and Vital Statistics, 381: 1-24, December 2006.
 Kull, I, 2004, “Breast-feeding reduces the risk of asthma during the first 4 years of life”; J Allergy Clin Immunol 2004 Oct;114(4):755-60 – PMID: 15480312. http://www.ncbi.nlm.nih.gov/pubmed/15480312
 Smith J P et al, 2002 “Hospital system costs of artificial infant feeding; estimates for the Australian capital Territory” Australian and New Zealand Journal of Public Health, , vol 26, no 6, pgs 543 – 551. http://www3.interscience.wiley.com/journal/118960695/abstract
 Smith JP et al 2010. “chronic disease and infant nutrition; is it significant to public health?” Public Health Nutr. Jul 13 1-11 – PMID: 12530799. http://www.ncbi.nlm.nih.gov/pubmed/12530799
 Kaufman, Marc and Lee, Christopher, HHS Toned Down Breast-Feeding Ads: Formula Industry Urged Softer Campaign, The Washington Post, published August 31, 2007, accessed August 7, 2010. http://www.washingtonpost.com/wp-dyn/content/article/2007/08/30/AR2007083002198.html Would like to highlight this:
But other current and former HHS officials say the muting of the ads was not the only episode in which HHS missed a chance to try to raise the breast-feeding rate. In April, according to officials and documents, the department chose not to promote a comprehensive analysis by its own Agency for Healthcare Research and Quality (AHRQ) of multiple studies on breast-feeding, which generally found it was associated with fewer ear and gastrointestinal infections, as well as lower rates of diabetes, leukemia, obesity, asthma and sudden infant death syndrome.
The report did not assert a direct cause and effect, because doing so would require studies in which some women are told not to breast-feed their infants — a request considered unethical, given the obvious health benefits of the practice.
A top HHS official said that at the time, Suzanne Haynes, an epidemiologist and senior science adviser for the department’s Office on Women’s Health, argued strongly in favor of promoting the new conclusions in the media and among medical professionals. But her office, which commissioned the report, was specifically instructed by political appointees not to disseminate a news release.
Wanda K. Jones, director of the women’s health office, said agency media officials have “all been hammering me” about getting Haynes to stop trying to draw attention to the AHRQ report. HHS press officer Rebecca Ayer emphatically told Haynes and others in mid-July that there should be “no media outreach to anyone” on that topic, current and former officials said.