Donor breast milk banking

I find this editorial wanting on numerous grounds, including first and foremost its guilty-until-proved-innocent bias and its arch attitude as much toward Mother Nature as to all those "committed individuals" whose "altruism is undeniable".

I'm also exercised by its sloppy logical leaps, for example statements like:

"Unregulated expansion [of donor breast-milk banking] requires evidence of benefit" (does that imply that "regulated expansion" wouldn't require such evidence?);

"Donor human milk is not the optimal food for preterm growth" (so, in the absence of the milk of mothers delivering preterm, what's the optimal synthetic alternative then?);

"[increasing the protein and mineral content of donor milk] is an imprecise science as the composition of human milk is very variable" (Mother Nature screws up again and thank goodness we have those nice folks in long lab coats to provide us with "precise science");

"milk banks in the UK vary in size and operating procedures and are unregulated" (is this not an invitation for said banks to pull up their individual and collective socks rather than an indictment of their existence or the use of their "product"?);

"What evidence is there to support the use of donor breast milk?" (how much more evidence do we need of the risks involved in managing the nutritional needs of such kids any other way?);

"infant growth was slower" (uh, we're quite sure that slower is bad, right?);

"the role of donor milk remains to be established" (whereas we're of course entirely satisfied that the role of a synthetic alternative has been clearly established):

"donor milk is expensive" (managing a case of necrotizing enterocolitis is cheap, right?);

"These uncertainties are reflected in the divergent attitudes of clinicians towards the use of donor milk", which is an unreferenced quasi- non sequitur generalization followed by "and compounded by variations in acceptability by different communities", which - in an editorial whose primary focus is the UK - is backed by a single reference to research undertaken in north-central Nigeria.

By all means, let the research continue and may the relevant clinical guidelines always reflect objective evidence. But, sadly, the editorial's tentative either/or concluding recommendation - that "NHS resources might be better directed towards supporting mothers' own lactation" - automatically excludes a significant group of infants born preterm whose own mothers' milk is not available.

Collective experience confirms that any method of feeding these babies other than by using breast milk as the base ingredient is risky until shown otherwise. The burden of proof continues to rest on those who would suggest otherwise.

James Akre

Geneva, Switzerland

akrej@yahoo.com

Competing interests: None declared