Iraq death toll

Wise Babies

Study shows breast-fed children are smarter

About half the 14,000 babies were randomly assigned to a group in which prolonged and exclusive breast-feeding by the mother was encouraged at Belarussian hospitals and clinics. The mothers of the other babies received no special encouragement.

Those in the breast-feeding encouragement group were, on average, breast-fed longer than the others and were less likely to have been given formula in a bottle.

At 3 months, 73 percent of the babies in the breast-feeding encouragement group were breast-fed, compared to 60 percent of the other group. At 6 months, it was 50 percent versus 36 percent.

In addition, the group given encouragement was far more likely to give their children only breast milk. The rate was seven times higher, for example, at 3 months.

The children were monitored for about 6 1/2 years.

The children in the group where breast-feeding was encouraged scored about 5 percent higher in IQ tests and did better academically, the researchers found.

Previous studies had indicated brain development and intelligence benefits for breast-fed children.

But researchers have sought to determine whether it was the breast-feeding that did it, or that mothers who prefer to breast-feed their babies may differ from those who do not.

The design of the study -- randomly assigning babies to two groups regardless of the mothers' characteristics -- was intended to eliminate the confusion.

'MOTHERS WHO BREAST-FEED ... ARE DIFFERENT'

"Mothers who breast-feed or those who breast-feed longer or most exclusively are different from the mothers who don't," Dr. Michael Kramer of McGill University in Montreal and the Montreal Children's Hospital said in a telephone interview.

"They tend to be smarter. They tend to be more invested in their babies. They tend to interact with them more closely. They may be the kind of mothers who read to their kids more, who spend more time with their kids, who play with them more," added Kramer, who led the study published in the journal Archives of General Psychiatry.

The researchers measured the differences between the two groups using IQ tests administered by the children's pediatricians and by ratings by their teachers of their school performance in reading, writing, math and other subjects.

Both sets of scores were significantly higher in the children from the breast-feeding promotion group.

The study was launched in the mid-1990s. Kramer said the initial idea was to do it in the United States and Canada, but many hospitals in those countries by that time had begun strongly encouraging breast-feeding as a matter of routine.

The situation was different in Belarus at the time, he said, with less routine encouragement for the practice.

Kramer said how breast-feeding may make children more intelligent is unclear.

"It could even be that because breast-feeding takes longer, the mother is interacting more with the baby, talking with the baby, soothing the baby," he said. "It could be an emotional thing. It could be a physical thing. Or it could be a hormone or something else in the milk that's absorbed by the baby."

Previous studies have shown babies whose mothers breast-fed them enjoy many health advantages over formula-fed babies.

These include fewer ear, stomach or intestinal infections, digestive problems, skin diseases and allergies, and less risk of developing high blood pressure, diabetes and obesity.

The American Academy of Pediatrics recommends that women who do not have health problems exclusively breast-feed their infants for at least the first six months, with it continuing at least through the first year as other foods are introduced.

(Editing by Maggie Fox and Stacey Joyce)

Picked To Die

Who should MDs let die in a pandemic? Report offers answers

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that "this is the most detailed one I have seen from a professional group."

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list "was emotionally difficult for everyone."

That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

"You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."