I am surprised about Dr. Spiegel's article in which he discusses the immunology of breastfeeding. He presents himself as knowledgeable about immunology but has got it completely wrong. It is true that the antibodies in the milk are not absorbed into the baby's body. But that doesn't mean they are just useless bits of protein that the baby poops out. Antibodies from the breastmilk are only one of many components that protect the lining of the gut from invasion by dangerous bacteria, viruses and fungi. (And not only the gut, but antibodies are induced in the baby's urinary tract, for example, through factors in the breastmilk that cause the baby's immune system to mature more rapidly that the artificial baby's immune system). These antibodies attack dangerous organisms and kill them, and they do so together with a very complex system that assure that the breastfed baby does not get sick. This complex system includes also lactoferrin and lysozyme, which kill bacteria, other factors that prevent bacteria from using nutrients and thus prevent their growth, mucins which line the gut to prevent bacteria from invading and it would take a book to continue.

Even more amazing is that breastmilk antibodies and other factors kill these bugs without causing inflammation. Inflammation (the redness, pain and swellling you get when you have an infection, say of the throat), though part of the way the body fights infection, is also often what causes the damage of an infection. Breastmilk has many factors that decrease and even prevent the inflammation associated with the killing of the infective agents.

On top of that, Dr. Spiegel's insistance that studies don't prove definitively that breastmilk protects is putting things upside down. You don't have to prove that breastfeeding is better, since it is what is normal and physiologic. You have to prove that artificial feeding is as good as breastfeeding. And that's never been done.

It is most disheartening that a physician would not have done his homework properly before writing such an inaccurate story.

Jack Newman, MD, FRCPC