This is a terrible idea. Infant digestive tracts are unable to accommodate a steady diet of Tim's coffee, maple syrup, and Labatt's. It would lead to gross malnutrition, deferential self-effacement, and a compulsion to apologize for everything.
I know not everything is about my thing, but this issue really seems like it would have been alleviated if Democrats could focus more on improving existing bureaucracy when in office rather than on just blasting more money into the machine.
If FDA had adequately consulted and informed other agencies about this decision and its impact, there are plenty of smart people in the admin who could have alleviated this before it became a crisis.
Fundamental competence was one of the top selling points for Biden & contrasts with Trump. It’s also something they could really accomplish even without congress. But I do think it requires serious focus from top levels of the executive to make it work.
This is essentially our situation. My wife and I accidentally each bought large quantities of formula (because it's expensive and you use a lot so it just makes sense to buy in bulk) at the same time right before the shortage really started. We recently ran out of that excess supply and decided since our kid was eleven months that we would just switch to cow's milk. I can't imagine how much more stressful this situation is for parents of younger babies.
I also just want to say this has been yet another instance where the "anything other than breast milk is ruining your kid's life" crowd are really annoying and destructive. Saying things just put in the effort to relactate is really anti-helpful and adding mental stress for parents that are already in an extremely difficult situation.
More broadly, is there some way the federal government could give overall reliability ratings to foreign regulatory agencies? Part of what makes this so sensible is it's a very reasonable bet the Canadian equivalent of the FDA more or less knows what they're doing. Ditto for most rich-world regulators on a lot of issues, and who knows, maybe some developing-country regulators as well. We obviously want to have our own regulatory agencies making their own determinations, but a government that says "here are some foreign agencies that are staffed by qualified professionals, and in a pinch, you're not going to get anybody killed following their instructions" would seem way more reasonable and normal. And if, like, the Swiss pharmaceuticals regulator (or whoever) is weirdly corrupt and incompetent for idiosyncratic reasons, that would be good to know too!
The FDA seems to stumble from failure to failure. Maybe food or drug regulation is especially challenging but it seem to have more problems than all the other federal agencies combined.
Seems like as good a place as any for me to yell into the void: The fact that the shutdown of *one* factory can put us in crisis mode is pants on head stupid.
* Do not shut down key infant formula production facilities on the basis of questionable safety issues.
* Allow foreign baby formula to be sold in the United States.
* Stop demonizing parents who feed their babies formula, it's a miracle of modern science whose production and quality needs to be treated as a source of national pride. In China they have no such scruples about breastfeeding vs. formula – formula is widely regarded as superior to breastfeeding and indeed American formula is massively sought after there. People buy pallets of it to ship back to China.
I do not have kids, but I’d be curious to know if anyone with young kids went to their pediatrician and inquired about feeding and received advice akin to “you can give them milk and some food” or if doctors (and parents) are mostly risk averse here and just stress finding formula since it is most nutrient-dense. Maybe age of the doctor would make certain answers about what is okay more or less common…
Personal anecdote my mother has told me in the past: I was a fat baby and cried a lot and when she went to the doctor they suspected I just still hungry often. She began putting cereal in my bottle way before her other kids. I suspect this was just practical advice/something the doctor suggested and I turned out fine and presumably stopped crying.
Again, I know nothing on how these things shake out in reality, but Emily Oster’s work is one fairly recent piece of analysis that shows we don’t have very good evidence that many existing parental guidelines make much of a difference in kid’s outcomes.
This isn’t the only example of the FDA being dumb about formula, it’s only the latest one. Anyone interested in the topic or in the topic of radical FDA procedural reform should check out Scott Alexander’s discussion of how our formula formulation was killing babies for 20 years while European formulations were not for very simple and well understood reasons: https://astralcodexten.substack.com/p/details-of-the-infant-fish-oil-story?s=r
We seem to be particularly bad at these kind of collective public health (or p.h. adjacent) issue.
I'm sure both social and bureaucrattc dysfunction is involved, but it seems like instead of basically saying something like 'There is a baby formula shortage, so if your child is over X months of age and otherwise healthy, please consider...' and trusting the enough of the public can understand and will try to comply, we get all kinds of tortured messaging in an attempt to achieve a similar result.
It closely parallels the 'masks aren't effective' guidance early in the pandemic.
They could have just come out and repeatedly said 'masks are somewhat effective, but we need to reserve them for front-line workers until supply improves.'
Instead of trying to manipulate the public, give an honest and straightforward message and let the chips fall where they may.
I hate to be “that mom” but I’m really tired of these “breast isn’t REALLY best so we should just feed formula and that’s valid and OK” and then this formula shortage happens and parents are left holding the butts. There are a lot of great things about formula except for the fact that it can’t be produced at point of use by an individual. Mothers are heavily encouraged by social pressure to completely switch babies onto formula if they even think they might not be able to breastfeed. It’s never really looked upon as a viable alternative to use alongside breastfeeding. This is in large part due to the mommy wars and “breast is best” mothers acting like you’re giving your child poison if a drop of formula ever passed baby’s lips.
If mom is mostly breastfeeding for the first 9 months to a year and something like a massive supply issue with formula occurs (but that will never happen!) she can simply work to increase her supply again short term, get through the crisis, and by then as Matt pointed out, the baby will be older and your options are much more flexible. This would also make it easier to supply babies and other people who absolutely DO need formula during a crisis.
In other words - sometimes there are better options than a hard line on infant feeding in either direction.
My daughter started going after solid foods and refusing any kind of infant cereal at 5 months, so we sat down with her doc and went over what would be necessary to ensure she got everything she needed. She breastfed about half the time at 7 months, tapering to nothing by 11 months.
So she got loads of cow’s milk and we made sure her solids included the rest. It was *odd* to have a 6 month-old child clamoring for lamb curry at dinner but she’s fine.
Oh dear. I think this article suffers from an excess of Reasonableness. This seems to be the key paragraph, and I think there might be a little hiccup:
“Under the current circumstances, I think advising parents of older babies that they can switch to animal milk would both give them peace of mind and also (more importantly) help resolve the underlying crisis. Consumption would rapidly fall by 10-30 percent, which would allow shelves to be restocked. That would reduce the incentive of parents with time and money to burn to stockpile or hoard formula, which would further alleviate shortages.“
If the FDA advises parents of older babies that they can switch to cow’s milk, is every parent going to listen? Formula consumption is not going to fall by 30%.
Really, with the exception of Slow Boring readers and Emily Oster fans, will anyone listen? Perhaps most parents will think “the FDA is advising this out of desperation [as indeed they are]. Cow’s milk is obviously second-best. I’ll keep buying formula whenever I can, just to be safe.”
Asking parents to turn on a dime and ignore years of child-rearing advice is a lot. Doing it after the public health community has spent two years lighting its credibility on fire is practically futile.
A straightforward solution to the formula crisis
"Adopt Canadian guidelines for older babies"
This is a terrible idea. Infant digestive tracts are unable to accommodate a steady diet of Tim's coffee, maple syrup, and Labatt's. It would lead to gross malnutrition, deferential self-effacement, and a compulsion to apologize for everything.
I know not everything is about my thing, but this issue really seems like it would have been alleviated if Democrats could focus more on improving existing bureaucracy when in office rather than on just blasting more money into the machine.
If FDA had adequately consulted and informed other agencies about this decision and its impact, there are plenty of smart people in the admin who could have alleviated this before it became a crisis.
Fundamental competence was one of the top selling points for Biden & contrasts with Trump. It’s also something they could really accomplish even without congress. But I do think it requires serious focus from top levels of the executive to make it work.
This is essentially our situation. My wife and I accidentally each bought large quantities of formula (because it's expensive and you use a lot so it just makes sense to buy in bulk) at the same time right before the shortage really started. We recently ran out of that excess supply and decided since our kid was eleven months that we would just switch to cow's milk. I can't imagine how much more stressful this situation is for parents of younger babies.
I also just want to say this has been yet another instance where the "anything other than breast milk is ruining your kid's life" crowd are really annoying and destructive. Saying things just put in the effort to relactate is really anti-helpful and adding mental stress for parents that are already in an extremely difficult situation.
More broadly, is there some way the federal government could give overall reliability ratings to foreign regulatory agencies? Part of what makes this so sensible is it's a very reasonable bet the Canadian equivalent of the FDA more or less knows what they're doing. Ditto for most rich-world regulators on a lot of issues, and who knows, maybe some developing-country regulators as well. We obviously want to have our own regulatory agencies making their own determinations, but a government that says "here are some foreign agencies that are staffed by qualified professionals, and in a pinch, you're not going to get anybody killed following their instructions" would seem way more reasonable and normal. And if, like, the Swiss pharmaceuticals regulator (or whoever) is weirdly corrupt and incompetent for idiosyncratic reasons, that would be good to know too!
The AAP has a bad habit of taking extreme dogmatic positions that go beyond the evidence. This is how we got a surge in peanut allergies.
The FDA seems to stumble from failure to failure. Maybe food or drug regulation is especially challenging but it seem to have more problems than all the other federal agencies combined.
Seems like as good a place as any for me to yell into the void: The fact that the shutdown of *one* factory can put us in crisis mode is pants on head stupid.
Great advice. I'd add:
* Do not shut down key infant formula production facilities on the basis of questionable safety issues.
* Allow foreign baby formula to be sold in the United States.
* Stop demonizing parents who feed their babies formula, it's a miracle of modern science whose production and quality needs to be treated as a source of national pride. In China they have no such scruples about breastfeeding vs. formula – formula is widely regarded as superior to breastfeeding and indeed American formula is massively sought after there. People buy pallets of it to ship back to China.
I do not have kids, but I’d be curious to know if anyone with young kids went to their pediatrician and inquired about feeding and received advice akin to “you can give them milk and some food” or if doctors (and parents) are mostly risk averse here and just stress finding formula since it is most nutrient-dense. Maybe age of the doctor would make certain answers about what is okay more or less common…
Personal anecdote my mother has told me in the past: I was a fat baby and cried a lot and when she went to the doctor they suspected I just still hungry often. She began putting cereal in my bottle way before her other kids. I suspect this was just practical advice/something the doctor suggested and I turned out fine and presumably stopped crying.
Again, I know nothing on how these things shake out in reality, but Emily Oster’s work is one fairly recent piece of analysis that shows we don’t have very good evidence that many existing parental guidelines make much of a difference in kid’s outcomes.
This isn’t the only example of the FDA being dumb about formula, it’s only the latest one. Anyone interested in the topic or in the topic of radical FDA procedural reform should check out Scott Alexander’s discussion of how our formula formulation was killing babies for 20 years while European formulations were not for very simple and well understood reasons: https://astralcodexten.substack.com/p/details-of-the-infant-fish-oil-story?s=r
We seem to be particularly bad at these kind of collective public health (or p.h. adjacent) issue.
I'm sure both social and bureaucrattc dysfunction is involved, but it seems like instead of basically saying something like 'There is a baby formula shortage, so if your child is over X months of age and otherwise healthy, please consider...' and trusting the enough of the public can understand and will try to comply, we get all kinds of tortured messaging in an attempt to achieve a similar result.
It closely parallels the 'masks aren't effective' guidance early in the pandemic.
They could have just come out and repeatedly said 'masks are somewhat effective, but we need to reserve them for front-line workers until supply improves.'
Instead of trying to manipulate the public, give an honest and straightforward message and let the chips fall where they may.
Reading about infant feeding supply chains is so much better than actually feeding infants.
Import Irish baby formula. Has extra Baileys Irish Crème, which helps babies sleep through the night.
I hate to be “that mom” but I’m really tired of these “breast isn’t REALLY best so we should just feed formula and that’s valid and OK” and then this formula shortage happens and parents are left holding the butts. There are a lot of great things about formula except for the fact that it can’t be produced at point of use by an individual. Mothers are heavily encouraged by social pressure to completely switch babies onto formula if they even think they might not be able to breastfeed. It’s never really looked upon as a viable alternative to use alongside breastfeeding. This is in large part due to the mommy wars and “breast is best” mothers acting like you’re giving your child poison if a drop of formula ever passed baby’s lips.
If mom is mostly breastfeeding for the first 9 months to a year and something like a massive supply issue with formula occurs (but that will never happen!) she can simply work to increase her supply again short term, get through the crisis, and by then as Matt pointed out, the baby will be older and your options are much more flexible. This would also make it easier to supply babies and other people who absolutely DO need formula during a crisis.
In other words - sometimes there are better options than a hard line on infant feeding in either direction.
My daughter started going after solid foods and refusing any kind of infant cereal at 5 months, so we sat down with her doc and went over what would be necessary to ensure she got everything she needed. She breastfed about half the time at 7 months, tapering to nothing by 11 months.
So she got loads of cow’s milk and we made sure her solids included the rest. It was *odd* to have a 6 month-old child clamoring for lamb curry at dinner but she’s fine.
Oh dear. I think this article suffers from an excess of Reasonableness. This seems to be the key paragraph, and I think there might be a little hiccup:
“Under the current circumstances, I think advising parents of older babies that they can switch to animal milk would both give them peace of mind and also (more importantly) help resolve the underlying crisis. Consumption would rapidly fall by 10-30 percent, which would allow shelves to be restocked. That would reduce the incentive of parents with time and money to burn to stockpile or hoard formula, which would further alleviate shortages.“
If the FDA advises parents of older babies that they can switch to cow’s milk, is every parent going to listen? Formula consumption is not going to fall by 30%.
Really, with the exception of Slow Boring readers and Emily Oster fans, will anyone listen? Perhaps most parents will think “the FDA is advising this out of desperation [as indeed they are]. Cow’s milk is obviously second-best. I’ll keep buying formula whenever I can, just to be safe.”
Asking parents to turn on a dime and ignore years of child-rearing advice is a lot. Doing it after the public health community has spent two years lighting its credibility on fire is practically futile.