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MADELEINE BRAND, host:

And now to a familiar voice you hear on Day to Day.

Dr. SIDNEY SPIESEL: You can't say, all right, randomly, I'm going to flip a coin, and you're going to breastfeed or you're not going to breastfeed.

BRAND: That's Dr. Sidney Spiesel, our regular medical contributor. He's talking about how hard it is to conduct a scientific study on breastfeeding. He says it's not really ethical to tell patients whether or not to breastfeed. So, he says, scientists in a recent study did the next best thing.

Dr. SPIESEL: They went to country of Belarus, and they took a bunch of what were called clusters. They found local regions which had hospitals in it, things like that. And they randomly assigned some of those regions to actively promote breastfeeding and other regions to just do what they've been doing in the past. And then track and see if there's more breastfeeding as a result of the intervention and what happens in that case. That is sort of random in a way because you're comparing just very large differences in regions.

BRAND: So what they did was, they either actively encourage or didn't actively encourage women to breastfeed for the first six months of life?

Dr. SPIESEL: Well, ultimately that was what they concentrated on, was exclusive breastfeeding for the first six months of life. This is a big country, and they ultimately got about 17,000 mother child pairs to study who were breastfeeding.

BRAND: So that seems like a sizable study group. What did they find?

Dr. SPIESEL: This study, I think, is an ongoing study, so they keep finding new things. The only positive medical benefits they've really been able to identify, which are clear, are the benefit of protection against gastrointestinal disease like diarrhea and vomiting disease and things like that. It's clear that there is real benefit from breastfeeding from that. In addition, it was helpful at preventing eczema in kids. So those are the two medical benefits. But the most recent study was one that looked at the effect on child behavior and on maternal adjustment to children.

BRAND: And did they find, as lot of breastfeeding advocates promote, that there is, first of all, an increase in IQ for the babies and an increase in infant maternal bonding.

Dr. SPIESEL: Actually, no.

BRAND: No, on both?

Dr. SPIESEL: No on both. I mean, they were looking at not so much IQ, although there were a bunch of studies that were part of it, but they were just looking at the question of, what are behavioral effects on the child. Were their any risks or benefits for behavioral effects for the children. They were looking at - they weren't, as I say, measuring IQ so much as what children's strengths and difficulties, that was the sort of the standard method they used to look at, and they really found that there was no significant difference in behavioral strengths or difficulties in children who were randomized to a breastfeeding promotion intervention or not.

BRAND: So as a pediatrician, what do you take away from this? What will you tell new mothers?

Dr. SPIESEL: The question is, not so much what I tell new mothers, but what I tell myself. You know, I had always kind of assumed that one benefit of breastfeeding is, in fact, that kind of enforced closeness that would surely have long-term consequences in terms of relational benefit between the mother and child. And I can't say that anymore. Will it encourage me or discourage me from encouraging breastfeeding? I'm not discouraged from thinking that breastfeeding is a good thing, basically. It's a good thing.

BRAND: But women who don't shouldn't feel terrible?

Dr. SPIESEL: No. No, no absolutely. And, you know, for all the benefits that are touted around breastfeeding, it's actually, when you do a really good study, it's very hard to find the kind of tremendously powerful benefit that people have been claiming. I've always argued that breastfeeding is probably better only based on kind of a sense of nature. That humans surely know how to make milk for their own babies better than soys or cows do. But that may not necessarily be true. I just sort of think it is.

BRAND: Dr. Sydney Spiesel, thank you very much.

Dr. SPIESEL: Thank you.

BRAND: Dr. Sydney Spiesel is a practicing pediatrician. He is also a professor at the Yale medical school and he comes to us from the online magazine Slate.

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