Malpractice Liability Concerns for Doctors who Advise Patients Regarding Infant Feeding
Doctors have been widely recommending breastfeeding to patients without mentioning the frequent presence of developmental toxins in contemporary human milk. That should be of concern because of, among other things, the potential for malpractice suits alleging failure to inform the patient about possible risks of an infants’ consuming the recommended feeding. According to authoritative sources (mostly EPA and U.S. ATSDR), there are four different developmental toxins typically present in human milk, each in doses well above established safe levels, and each in concentrations many times higher than in infant formula. (details below) Experts on the subject of toxins in breast milk (P. Grandjean and A. A. Jensen) pointed out in 2004 that “these substances have caused contamination of human milk only during the last half century, and long-term health impacts are now being discovered.”(a)
The World Health Organization and three U.S. physicians’ associations, AAP, ACOG and AAFP, also promote breastfeeding while saying nothing about developmental toxins in human milk; but they do not deny the hazardous presence of those toxins when asked about them.(a1) The presence of developmental toxins in human milk in concentrations well above established safe levels is based on authoritative sources,(9, 10, 11, 11a) and apparently nobody disputes that evidence. In addition, it seems to be widely and authoritatively acknowledged that toxins such as these contribute to developmental disabilities. According to a 2008 consensus statement signed by 57 scientists, health professionals and researchers (with 49 doctoral degrees among them), “Recognition of the contribution of chemical contaminants to learning and developmental disabilities has increased substantially in recent years as new evidence has emerged both about the ability of neurotoxic chemicals to interfere with brain development and the susceptibility of the brain to chemicals.” (a2)
If physicians unreservedly advise parents to feed their infants a substance that the parents only later find out contains multiple significant developmental toxins, there is potential for malpractice suits. That could become more likely if a child were to become impaired with one of the several chronic disorders that have become more widely diagnosed in recent years as breastfeeding rates have been increasing: asthma, diabetes, allergies, ADHD or autism. (These increases, following the rapid increases in U.S. breastfeeding rates, are indicated in considerable historical data from the CDC.(c)) Although various studies have found that breastfeeding reduces these disorders, there have also been over 60 scientific studies that have found that these disorders are actually increased by breastfeeding, especially when children are studied past early childhood.(b) Given (a) the evidence from those studies, (b) the authoritatively recognized high levels of developmental toxins in human milk, and (c) the increases in unexplained childhood disorders that have occurred since breastfeeding started increasing, malpractice suits in this area are real possibilities. Since the total lifetime cost of having autism has been estimated to run into millions of dollars per individual, there is strong reason for many parents to become motivated to seek financial remedies, if they feel they were given advice that failed to mention significant risks of the specific infant feeding that was being recommended.
Among other relevant scientific studies that are not well known: A 2011 study by a highly published American scientist, investigating data from all 50 states and 51 U.S. counties, found that "exclusive breast-feeding shows a direct epidemiological relationship to autism," and also, "the longer the duration of exclusive breast-feeding, the greater the correlation with autism."(d) A dose-response relationship between an exposure and a health outcome (such as was found in that study) is considered to be especially significant evidence to support a finding of cause and effect. Additional support for a causal connection between breastfeeding and autism was provided by three other studies since 2009, one conducted in the U.S., one in the U.K., and one in Canada(e), (f), (g) The combination of the latter three studies, each looking at different levels of exposure and finding corresponding different degrees of association with autism prevalence, revealed another dose-response relationship.
Although a physician’s legal duty to inform the patient might be thought of mainly with regard to risks of surgery or medications, it is not limited to that. The Supreme Court of Washington, citing two earlier cases, and referring to decisions involved in "nontreatment situations in which medical care is given,” stated that “These decisions must all be taken with the full knowledge and participation of the patient. The physician's duty is to tell the patient what he or she needs to know in order to make them” (the decisions).(1) Infant feeding decisions are clearly heavily affected by advice of a physician.
A Wisconsin Supreme Court 2012 review quoted an earlier decision as follows: "a growing number of courts require physicians to disclose what a reasonable person in the patient's position would want to know."(emphasis added) (2) Providing an update on this ongoing increase, a 2016 article in the Journal of the American Medical Association reported that "in the United States, approximately half of the states have adopted the reasonable-patient standard." The authors went on to explain that this standard "requires physicians and other health care practitioners to disclose all relevant information... that an objective patient would find material in making an intelligent decision...." A 2015 decision by the U.K. Supreme Court also adopted this standard.2a
The District of Columbia Circuit Court, in what is often referred to as a landmark case (Canterbury v. Spence), held that the test for determining whether a particular peril must be disclosed to the patient is "its materiality to the patient's decision: all risks potentially affecting the decision must be unmasked."(3)
A publication of an Atlanta law firm, citing two Georgia cases, states, “Where a person sustains toward another a relation of trust and confidence, his silence when he should speak or his failure to disclose what he ought to disclose is as much a fraud in law as an actual affirmative false representation.” (4)
In the AMA’s Code of Medical Ethics, Section 8.082, it states, “Withholding medical information from patients without their knowledge or consent is ethically unacceptable.”(5) Courts in different states, including the Supreme Court of Indiana and the Court of Appeals of Georgia, have relied at least in part on the AMA code of ethics in arriving at decisions.(6)
In a Utah decision, the court stated, "If a reasonable person in the position of the plaintiff would consider the information important in choosing a course of treatment, then the information is material and disclosure required." (7) As mentioned, treatments are not limited to surgery or medicines: The American Heritage Medical Dictionary (2007) includes "regimens" such as exercise among examples of treatments; breastfeeding is obviously a regimen. According to Mosby's Medical Dictionary (9th Ed.), medical treatment is "the care and management of a patient to combat, ameliorate, or prevent a disease, disorder, or injury." A doctor's advice about breastfeeding is clearly a part of patient care and management, and the physicians' associations promote breastfeeding substantially on the basis of its presumed prevention of various diseases and disorders.(6a)
Some doctors may feel protected by what is customary belief or advice among physicians, but that apparently provides little real protection. The Washington Supreme Court, quoting from an earlier decision regarding a physician’s duty to inform, noted, “The usual conduct of doctors in this matter is not relevant to the establishment of the liability which is imposed by law.”(8)
Given the obligation of physicians to disclose what somebody in the patient's position “would want to know" when making a decision in a matter discussed with the physician, it would seem to be reasonable to consider the following question:
Do most doctors disclose the relevant negative information to patients when they recommend breastfeeding?
Bear in mind the following, all of which appears to be highly relevant to a parent’s decision whether to breastfeed, all of which is based on authoritative sources (as cited), but none of which parents normally hear about when doctors advise them to breastfeed their infants:
(a) dioxins are present in human milk in average concentrations exceeding the EPA’s Reference Dose (estimated reasonably safe dose, or RfD) by scores to hundreds of times;(9)
(b) PBDEs have been found in human milk in concentrations normally ranging from well above to over 20 times the EPA’s RfD;(10)
(c) mercury is typically present in human milk at four times the maximum allowed by U.S. law in bottled water, but often higher.(11) and
(d) PCBs are present in human milk in concentrations about 20 times the maximum allowed by law in U.S. public water supplies.(11a)
All four of the above developmental toxins are present in infant formula in average concentrations no more than 7% as high, and usually less than 1% as high, as their concentrations in human milk.(12)
(As mentioned, when points such as the above were presented in multiple letters to the American physicians’ associations that promote breastfeeding and to WHO, none of those organizations has ever replied.)
Scientific studies that indicate adverse effects of those toxins on children:
PCBs: A large team of German scientists and doctors, studying 171 healthy mother-infant pairs, found "negative associations between (human) milk PCB and mental/motor development ... at all ages, becoming significant from 30 months onwards." In addition, "negative associations with PCB increased with age."12f Also according to a German scientist, “Several prospective cohort studies - including our Düsseldorf study - have demonstrated that pre- and early postnatal exposure to PCBs is associated with deficit or retardation of mental and/or motor development.”12n
PBDEs: A Spanish study assessed PBDE levels in mothers and found that gestational exposure had no significant adverse effect on 4-year-olds, but exposure to those same mothers' PBDE levels via breastfeeding did have a substantial effect, including an 80% increase in relative risk of attention-deficit problems and a 160% increased relative risk of poor social competence.12c (“Poor social competence” is a way of describing typical characteristics of people with autism spectrum disorders, or ASD.) Note that this study was carried out in Europe, where PBDE levels have been found to be one-tenth (or less) as high as in the United States.12d
Mercury: At least ten published studies have found high levels of mercury in those diagnosed with autism.12e There are many ways in which specific known effects of mercury exposure resemble traits of autism, and the known latency of effect of mercury is very compatible with the surprising regressions and late emergence of autism traits.12m
Dioxins: A study by an international research team found that learning disability and attention deficit disorder were 133% and 202% higher among 12-to-15-year-old children with higher levels of dioxins -- that is, over two and three times the risk compared with children who had lower dioxin levels.12a The elevated levels of dioxins associated with such dramatic increases in risk of neurological disorders were quite common -- found in 27% to 31% of children -- not at all exceptional exposures. And these elevated levels of dioxins more than likely originated from breastfeeding, given the children’s ages combined with the following: the ratio of dioxin accumulations, comparing breastfed with formula-fed children, has been authoritatively calculated to be 6-to-1 after the first year for infants breastfed 6 months or more, and still 2-to-1 even a decade later.12b
Other things related to “what a reasonable person in the patient's position would want to know” about this subject: Breastfeeding was unusual in the mid-20th-century U.S., according to the American Academy of Family Physicians,(13) and something can be learned from health data comparisons that include that extended period of low breastfeeding rates. Comparisons of that generation’s health outcomes with those of earlier generations are not meaningful for various reasons.(14) But it is revealing to make comparisons with the generation that followed the mid-century generation: As mentioned, there have been several childhood epidemics and disease increases that started during the 1970’s to early 1980’s, after breastfeeding rates started increasing rapidly (after 1971), and the causes of these epidemics and increases have not been determined: diabetes, asthma, allergies, obesity, ADHD, and possibly autism.(15) Those childhood increases have in the last decade or so been continuing into adulthood.(15a) Considering that these epidemics and increases began only after a rapid increase in a type of infant feeding that is undisputedly high in developmental toxins, and considering the specific apparent effects of those toxins that have been found in scientific studies as indicated above, many people might see a causal relation between the increases in the disorders and the increases in breastfeeding.
The four toxins that have been widely reaching developing brains in concentrations well above established safe levels have all been found to do so via the avenue of breastfeeding, and are apparently ingested by infants in such concentrations only via the avenue of breastfeeding. The author of this article has written to seven different scientists involved in the field of pediatric neurological disorders, inquiring whether they could suggest any environmental toxins to which developing brains are widely exposed in concentrations exceeding established safe doses, other than the four mentioned above;17 three replies have been received as of several months later, and none have suggested any other such toxins. This distinctive trait of lactation of mobilizing a mother’s toxins stored in body fat, and then excreting those toxins to the infant in highly concentrated form, is something that most reasonable people “would want to know" about when receiving medical advice concerning feeding their infants.
Physicians and their insurers should also be aware that doctors’ obligations to inform patients in such areas are affirmative and possibly even retroactive, according to a legal scholar: “By requiring physicians to seek out former patients to disclose newly discovered medical risks, these decisions emphasize that physicians have a relatively extensive affirmative obligation linked to their fiduciary duties to their patients -- one that does not automatically cease when the physician-patient relationship ends and that does not depend on a patient requesting this information. “(16)
Comments or questions are invited. At the link below are comments and questions from readers, including a number of doctors, as well as a link for sending your own comments or questions: www.pollutionaction.org/comments.htm
*To read about Pollution Action and the author of this article, go to www.pollutionaction.org/
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a) Grandjean and Jensen, Breastfeeding and the Weanling’s Dilemma Am J Public Health. 2004 July; 94(7): 1075. PMCID: PMC1448391 at www.ncbi.nlm.nih.gov/pmc/articles/PMC1448391/
a1) None of those organizations has responded to any of three or more letters sent to each organization by the author of this article, concerning the apparently serious levels of those toxins in human milk. All readers are invited to see if they can get a response from any of those organizations in reply to inquiry about the serious presence of those toxins in human milk, including the evidence that is provided here.
a2) Collaborative on Health and the Environment’s Learning and Developmental Disabilities Initiative, Scientific Consensus Statement on Environmental Agents Associated with Neurodevelopmental Disorders, at http://www.healthandenvironment.org/?module=uploads&func=download&fileId=618
b) See www.breastfeeding-studies.info/.
c) for considerable historical health data for the period concerned, citing authoritative sources, see www.breastfeedingprosandcons.info.
d) Shamberger, R.J., Autism rates associated with nutrition and the WIC program, J Am Coll Nutr. 2011 Oct;30(5):348-53. Abstract at www.ncbi.nlm.nih.gov/pubmed/22081621
e) Breastfeeding and Autism P. G. Williams, MD, Pediatrics, University of Louisville, and L. L. Sears, MD, presented at International Meeting for Autism Research, May 22, 2010, Philadelphia Marriot, found at https://imfar.confex.com/imfar/2010/webprogram/Paper6362.html) This study found that 35% of autism cases had been breastfed for a certain period, compared with 13% and 14% in the control group and in the same state.
f) Trends in Developmental, Behavioral and Somatic Factors by Diagnostic Sub-group in Pervasive Developmental Disorders: A Follow-up Analysis, pp. 10, 14 Paul Whiteley (Faculty of Applied Sciences, University of Sunderland, UK), et al. Autism Insights 2009:1 3-17 at www.la-press.com/trends-in-developmental-behavioral-and-somatic-factors-by-diagnostic-s-article-a1725) This study found that 65% of autism cases had been breastfed for a certain period; the authors looked at a comparison figure of 54%, but that figure was unrealistically high, since it came from a study (Pontin et al.) of breastfeeding by mothers largely from “more affluent families”, who breastfeed at unusually high rates in the U.K. For breastfeeding prevalence data that would apply to the general U.K. population, the authors of the Pontin study referred the reader to Infant Feeding 1995 (Foster et al.); examination of the data in that book reveals that a figure in the upper 20%’s would apply for the equivalent period (just after four weeks). That is also as was found in the U.K. Infant Feeding Survey - UK, 2010 Publication date: November 20, 2012, Chapter 2, at http://www.hscic.gov.uk/catalogue/PUB08694/ifs-uk-2010-chap2-inc-prev-dur.pdf
g) Dodds et al., The Role of Prenatal, Obstetric and Neonatal Factors in the Development of Autism, J Autism Dev Disord (2011) 41:891–902 DOI 10.1007/s10803-010-1114-8, Table 6, at http://autism.medicine.dal.ca/research/documents/2011DoddsetalJAutDevDisord.pdf This 2010 Canadian study, drawing data from a population-based “clinically-rich perinatal database,” investigated a very large population, nearly 130,000 births. Data from almost 127,000 of those children (those without identified genetic risk of autism) went into the study’s finding that there was a 25% increased risk of autism among children who were breastfed at discharge from the hospital.
(1) Gates v. Jensen, 92 Wn.2d 246 (1979), 595 P.2d 919, item (1), at https://casetext.com/case/gates-v-jensen-1. The Court referred to two earlier cases in support of its “application of the doctrine of informed consent to circumstances other than treatment of a diagnosed disease.”
(2) Jandre and Jandre v. Wisconsin Injured Patients and Families Compensation Fund, 2012 WI 39, Supreme Court of Wisconsin, Case No.: 2008AP1972 , in par. 25, at http://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=81164)
(2a) Spatz et al., The New Era of Informed Consent: Getting to a Reasonable-Patient Standard Through Shared Decision Making, Journal of the American Medical Assn., Viewpoint | May 17, 2016, at http://jama.jamanetwork.com/article.aspx?articleID=2516469
(3) Canterbury v. Spence, 464 F.2d 772, cert. denied, 409 U.S. 1064, 93 S.Ct. 560, 34 L.Ed.2d 518 (D.C.Cir. 1972) at http://biotech.law.lsu.edu/cases/consent/canterbury_v_spence.htm
(4) Philip C. Henry, Esq. et al., What’s the Difference Between Informed Consent, Failure to Warn, and Fiduciary Duty? Henry, Spiegel, Fried & Milling, LLP, Atlanta, GA , in “Fiduciary Duty” section, at http://www.hsm-law.com/wp-content/themes/henryspiegelmilling/inc/pch_seminar_paper-informed_consent.pdf
(5) at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8082.page
(6) See Culbertson v. Mernitz, 602 NE2d 98 (Ind. 1992) at http://www.leagle.com/decision/1992700602NE2d98_1700.xml/CULBERTSON%20v.%20MERNITZ, and Court of Appeals of Georgia, Ketchup V. Howard. No. A00A0987. Decided: November 29, 2000, at http://law.justia.com/cases/georgia/court-of-appeals/2001/a00a0987-0.html
(6a) This can be confirmed on the websites of the AAP, AAFP, and ACOG, searching for their position statements on breastfeeding.
(7) Nixdorf v. Hicken, 612 P.2d 348, 354 n.19 (Utah 1980), quoted in Thomas L. Hafemeister; Ph.D. ,J.D. in Washington University Law Review, Sept. 1, 2009: Lean on me: a physician's fiduciary duty to disclose an emergent medical risk to the patient, downloadable at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1443469
(8) Smith V. Shannon, No. 49142-9, 100 Wn.2d 26 (1983), 666 P.2d 351, Washington Supreme Court, at https://www.courtlistener.com/opinion/1142486/smith-v-shannon/
9) Re: EPA’s RfD for dioxin: At http://www.epa.gov/iris/supdocs/dioxinv1sup.pdf in section 4.3.5, at end of that section, "...the resulting RfD in standard units is 7 × 10−10 mg/kg-day." (that is, O.7 pg of TEQ/kg-d)
Re: breastfed infants’ exposures to dioxins: Infant Exposure to Dioxin-like Compounds in Breast Milk Lorber (Senior Scientist at EPA) et al., VOL. 110 No. 6 June 2002, Environmental Health Perspectives http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54708#Download
10) Re: PBDEs ingested by breastfed infants:
-Table 5-4 of EPA (2010) An exposure assessment of polybrominated diphenyl ethers. National Center for Environmental Assessment, Washington, DC; EPA/600/R-08/086F. http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=210404, Schechter study in first page of table. Also Section 5.6.2, near end of section, of above.
- Costa et al.,Developmental Neurotoxicity Of Polybrominated Diphenyl Ether (PBDE) Flame Retardants, Neurotoxicology. 2007 November; 28(6): 1047–1067. PMCID: PMC2118052 NIHMSID:
- RFD for PBDEs: EPA Technical Fact Sheet on Polybrominitated Diphenyl Eithers (PBDEs) and PBBs, re RfD of 1 x 10-4 mg/kg/day (100 ng/kg-d) for BDE-47 and BDE 99 at www2.epa.gov/sites/production/files/2014-03/documents/ffrrofactsheet_contaminant_perchlorate_january2014_final_0.pdf Regarding prevalence of tetraBDEs, see Costa LG, et al., Polybrominated diphenyl ether (PBDE) flame retardants: environmental contamination, human body burden and potential adverse health effects. Acta Biomed. 2008 Dec;79(3):172-83 at www.ncbi.nlm.nih.gov/pubmed/19260376.
11) Re: Mercury levels in breast milk:
- U.S. ATSDR document on mercury at www.atsdr.cdc.gov/toxprofiles/tp46-c5.pdf, p. 443
- Code of Federal Regulations, Title 21, Chapter 1, Subchapter B, Part 165, Subpart B, Sec. 165-110 at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=165.110
11a) Re: PCB levels in breast milk:
U.S. Agency for Toxic Substances and Disease Registry, Toxicological Profile for Polychlorinated Biphenyls (PCBs), 2000, at www.atsdr.cdc.gov/toxprofiles/tp17.pdf This ATSDR report (year 2000) quotes a range of concentrations of PCBs in human milk as from 238 to 271 ng/g lipid weight. 1 g lipid weight = about 25g whole weight (assuming 4% fat in human milk). So the concentrations found in the studies were about 250 ng/25g whole weight, which = 10ng/g whole weight. 1 g (gram) = 1 ml of water, so the 10 ng/g whole weight is about the same as 10ng/ml. That is the same as 10,000 ng per liter, which is the same as .01 mg/liter. So the levels of PCBs in human milk seem to be about .01 mg/liter, compared with .0005 mg/liter, the maximum allowed by law in U.S. public water systems. That is, about 20 times the concentration that would be allowed in public water systems. (U.S.EPA, Drinking Water Contaminants, National Primary Drinking Water Regulations, at http://water.epa.gov/drink/contaminants/index.cfm#Organic)
12) Re: dioxins in formula less than 1% of dioxins in breast milk:
- U.K. Food Standards Agency Food Survey Information Sheet 49/04 MARCH 2004, Dioxins and Dioxin-Like PCBs in Infant Formulae, found at http://www.food.gov.uk/multimedia/pdfs/fsis4904dioxinsinfantformula.pdf
- Compatible figures were found in Weijs PJ, et al., Dioxin and dioxin-like PCB exposure of non-breastfed Dutch infants. Chemosphere. 2006 Aug;64(9):1521-5. Epub 2006 Jan 25 at http://www.ncbi.nlm.nih.gov/pubmed/16442144
Re: PBDEs in formula less than 2% of concentration in breast milk:
-Section 4.7 , 2nd paragraph (citing Schechter et al.) of U.S. EPA (2010) An exposure assessment of polybrominated diphenyl ethers. http:/cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=210404
-Section 5.6.2 of above, 2nd paragraph. The EPA states the figure as "44.1 ng/g lwt" (44.1 ng = 44,100 pg). For comparison purposes, the lipid (fat) weight indicated here needs to be converted to whole weight, which can be done as follows: The EPA here assumes a fat content of 4%. Using that figure, 44,100 pg/g lwt becomes 1760 pg/g wwt.
Re: Mercury in formula less than 1% as high as in human milk:
- Food Additives & Contaminants: Part B: Surveillance Vol. 5, Issue 1, 2012 Robert W. Dabeka et al., Survey of total mercury in infant formulae and oral electrolytes sold in Canada DOI: 10.1080/19393210.2012.658087 at www.tandfonline.com/doi/full/10.1080/19393210.2012.658087#tabModule
Re: PCBs in infant formula typically less than 1% but up to about 4% as high as in human milk:
- In breast milk: About 250 ng/g lipid weight. In soy-based formula: about 10 ng/g lipid weight. U.S. Agency for Toxic Substances and Disease Registry, Toxicological Profile for Polychlorinated Biphenyls (PCBs), 2000, pp. 560, 573, at http://www.atsdr.cdc.gov/toxprofiles/tp17.pdf Data does not appear to be available for PCBs in cow’s-milk-based infant formula, but data for whole milk could give an approximation, as follows: adding together the figures for the two kinds of PCBs in this study provides a range of 52 to 2455 ng/kg fat, which equals .05 to 2.45 ng/g fat (lipid) (Krokos et al., Levels of selected ortho and non-ortho polychlorinated biphenyls in UK retail milk, Chemosphere. 1996 Feb;32(4):667-73. at www.ncbi.nlm.nih.gov/pubmed/8867147)
12a) Lee et al., Association of serum concentrations of persistent organic pollutants with the prevalence of learning disability and attention deficit disorder, J Epidemiol Community Health 2007;61:591–596. doi: 10.1136/jech.2006.054700 at http://jech.bmj.com/content/61/7/591.full.pdf+html.
12b) Infant Exposure to Dioxin-like Compounds in Breast Milk Lorber (Senior Scientist at EPA) and Phillips Vol. 110., No. 6 June 2002 • Environmental Health Perspectives at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240886/pdf/ehp0110-a00325.pdf, 242 pg at initiation; this should be compared with data from following: U.K. Food Standards Agency Food Survey Information Sheet 49/04 Mar. 2004, Dioxins and Dioxin-Like PCBs in Infant Formulae, found at www.food.gov.uk/multimedia/pdfs/fsis4904dioxinsinfantformula.pdf
Compatible figures were found in Weijs PJ, et al., Dioxin and dioxin-like PCB exposure of non-breastfed Dutch infants, Chemosphere 2006 Aug;64(9):1521-5. Epub 2006 Jan 25 at www.ncbi.nlm.nih.gov/pubmed/16442144
12c) Gascon M. et al., Effects of pre and postnatal exposure to low levels of polybromodiphenyl ethers on neurodevelopment and thyroid hormone levels at 4 years of age Environ Int. 2011 Apr;37(3):605-11. doi: 10.1016/j.envint.2010.12.005. Epub 2011 Jan 14 found at www.ncbi.nlm.nih.gov/pubmed/21237513)
12d) Giordano et al., Developmental Neurotoxicity: Some Old and New Issues, ISRN Toxicol. 2012; 2012: 814795, PMCID: PMC3658697 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658697
12e) See footnotes 6, 15, 16, and 29 in D. Austin, An epidemiological analysis of the ‘autism as mercury poisoning’ hypothesis’, International Journal of Risk and Safety in Medicine, 20 (2008) 135-142 at http://researchbank.swinburne.edu.au/vital/access/manager/Repository/swin:9302
Also Adams JB et al., Biol Trace Elem Res. 2013 Feb;151(2):171-80. doi: 10.1007/s12011-012-9551-1. Epub 2012 Nov 29.Toxicological status of children with autism vs. neurotypical children and the association with autism severity. at http://www.ncbi.nlm.nih.gov/pubmed/23192845
Also Geier DA et al., Blood mercury levels in autism spectrum disorder: Is there a threshold level? Acta Neurobiol Exp (Wars). 2010;70(2):177-86, http://www.ncbi.nlm.nih.gov/pubmed/20628441
Also Priya et al., 2011, 1999a. Toxicological Profile for Mercury Level of trace elements (copper, zinc, magnesium and selenium) and toxic elements (lead and mercury) in the hair and nail of children with autism. Biol Trace Elem Res. 2011;142:148–158;
Also Hassanien et al., Environmental Heavy Metals and Mental Disorders of Children in Developing Countries. Environm Risk. 2011;1:1–25.;.
Also El-Baz et al., Hair Mercury Measurement in Egyptian Autistic Children. Egypt J Med Human Gen. 2010;11:135–141;
Also Al-Farsi et al., Levels of heavy metals and essential minerals in hair samples of children with autism in Oman: a case-control study (2013)
12f) Jens Walkowiak et al., Environmental exposure to polychlorinated biphenyls and quality of the home environment: effects on psychodevelopment in early childhood. Lancet 2001: 358: 1602-07 Abstract at www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)06654-5/abstract
12g) Shamberger, R.J., Autism rates associated with nutrition and the WIC program, J Am Coll Nutr. 2011 Oct;30(5):348-53. Abstract at www.ncbi.nlm.nih.gov/pubmed/22081621
12h) Breastfeeding and Autism P. G. Williams, MD, Pediatrics, University of Louisville, and L. L. Sears, MD, presented at International Meeting for Autism Research, May 22, 2010, Philadelphia Marriot, found at https://imfar.confex.com/imfar/2010/webprogram/Paper6362.html)
Trends in Developmental, Behavioral and Somatic Factors by Diagnostic Sub-group in Pervasive Developmental Disorders: A Follow-up Analysis, pp. 10, 14 Paul Whiteley (Faculty of Applied Sciences, University of Sunderland, UK), et al. Autism Insights 2009:1 3-17 at www.la-press.com/trends-in-developmental-behavioral-and-somatic-factors-by-diagnostic-s-article-a1725) Whitely et al. looked at a comparison figure of 54%, but that figure was unrealistically high, since it came from a study (Pontin et al.) of breastfeeding by mothers largely from “more affluent families”, who breastfeed at unusually high rates in the U.K. For breastfeeding prevalence data that would apply to the general U.K. population, the authors of the Pontin study referred the reader to Infant Feeding 1995 (Foster et al.); examination of the data in that book reveals that a figure in the upper 20%’s would apply at just after four weeks. That is also as was found in the U.K. Infant Feeding Survey - UK, 2010 Publication date: November 20, 2012, Chapter 2, at http://www.hscic.gov.uk/catalogue/PUB08694/ifs-uk-2010-chap2-inc-prev-dur.pdf
12m) See www.autism-correlations.info for much more on these matters, including citations of authoritative sources.
12n) Winneke, Developmental aspects of environmental neurotoxicology: lessons from lead and polychlorinated biphenyls, J Neurol Sci. 2011 Sep 15; Epub 2011 Jun 15. at http://www.ncbi.nlm.nih.gov/pubmed/21679971
(13) Breastfeeding, Family Physicians Supporting (Position Paper), American Academy of Family Physicians, at http://www.aafp.org/about/policies/all/breastfeeding-support.html
(14) Complications that tend to preclude meaningful health-vs.-breastfeeding-rate comparisons for earlier generations:
(a) The mid-century generation contains a large percentage of people who would have already died at an early age if they had been born a generation earlier; average estimated life expectancy for Americans born during the 1950’s is 7½ years greater than that of people born during the 1930’s and 11 years greater than that of people born in the 1920’s. (U.S. CDC, National Vital Statistics Reports, Vol. 62, No. 7, United States Life Tables, 2009, at http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_07.pdf, p. 45, Table 19).
(b) The percentage reporting no regular physical activity (52%) is three times as high for the mid-century generation as it was for the previous generation. (King et al., The Status of Baby Boomers’ Health in the United States: The Healthiest Generation? JAMA Intern Med/Vol 173 (No. 5), Mar 11, 2013, American Medical Assn., at http://archinte.jamanetwork.com. ) The decline in physical activity is largely connected with the major decline of jobs in agriculture and manufacturing that took place after 1955 (per U.S. Bureau of Labor Statistics).
(c) There does not appear to be data available regarding breastfeeding rates in the decades preceding the birth of the mid-century generation.
(15), (15a) See considerable historical public health data, mainly from the U.S. CDC, summarized with references to authoritative sources at www.breastfeeding-health-effects.info).
(16) Thomas L. Hafemeister; Ph.D., J.D. in Washington University Law Review, Sept. 1, 2009: Lean on me: a physician's fiduciary duty to disclose an emergent medical risk to the patient, p. 1191, citing an article by an associate professor of medical jurisprudence, at http://openscholarship.wustl.edu/cgi/viewcontent.cgi?article=1134&context=law_lawreview
(17) Those scientists were the members of the science team at the organization, Autism speaks, to whom letters with this inquiry were individually mailed in the summer of 2014. See footnotes 9 through 12 (above) for sources regarding hazardous levels of the toxins discussed, including comparison with levels in the principal alternative feeding type.
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