Breastfeeding Doesn’t Provide Cognitive Benefits After All, Study Finds

But doctors still recommend it.


While breastfeeding is often recommended by doctors to help protect newborns from infections and diseases, the question of whether breastfeeding actually leads to cognitive benefits for infants isn’t so well settled.

Despite previous studies indicating that breastfeeding has a positive impact on children’s intelligence – which researchers say could be due to nutrients in breast milk – a new study now suggests that there are no long-term cognitive benefits to breastfeeding.

 Using data from the Growing Up in Ireland longitudinal study, a team from University College Dublin studied 7,478 children, whose cognitive abilities were assessed at ages three and five.

During the assessments, children were tested on their problem-solving and vocabulary skills, and were also evaluated in terms of their behaviour, including assessing their emotional symptoms, hyperactivity, and relationships with others.

The researchers found that after accounting for socio-economic variables such as parents’ education and income, there was no strong evidence to suggest that children who had been breastfed as babies demonstrated cognitive benefits over babies who hadn’t.

“[W]e didn’t find any statistically significant differences between children who were breastfed and those who weren’t, in terms of their cognitive ability and language,” one of the researchers, Lisa-Christine Girard, told Katie Forster at The Independent.

But on one measure, the results did show a contrast.

“We did find direct effect of breastfeeding on a reduction in hyperactive behaviours when the children were three years old,” says Girard. “This wasn’t found at five years, suggesting there may be other factors that are more influential as children develop.”

 In other words, it’s possible that the notion that breastfeeding confers a benefit to children’s intelligence hasn’t successfully accounted for all the parental, lifestyle, and other socio-economic factors that can also influence a child’s development and upbringing.

“I think [the study] fits well in the body of literature that long-term benefits of breastfeeding look a whole lot smaller or non-existent if you properly control for your confounding variables,” statistician Brooke Orosz from Essex County College in New Jersey, who was not involved with the study, told CNN.

“The easy question – do kids who are breastfed have better outcomes? The answer is yes. The difficult question is: is it breast milk that improves their brain, or is it that growing up with parents who are better educated and have better incomes makes a difference?”

While the new study might not be able to provide a definitive answer on that issue, the results do seem to suggest that socioeconomic factors could have played a part in skewing previous data – but Girard’s team doesn’t expect this to be the end of the discussion.

“This has been a debate for over 100 years, and we’re working hard to understand the complete picture,” she told Allison Aubrey at NPR.

In any case, while researchers will continue to investigate the link – if any – between breastfeeding and developmental benefits, scientists say the new study shouldn’t dissuade anybody who wants to breastfeed from doing so, given the commonly accepted health and nutrition advantages.

Of course, not every mother is able to breastfeed, due to a range of conditionsthat make breastfeeding difficult or impossible for some – but for women who don’t experience those complications, the advice from physicians is firm.

“There’s a strong body of evidence to support that breastfeeding is one of the healthiest things we can do to support children’s immune systems,” paediatrician Ellie Erickson from Duke University, who wasn’t involved with the study, told NPR.

On that issue, at least, it’s a point that the study authors are in complete agreement with.

“The medical benefits of breastfeeding for both mother and child are considered numerous and well documented,” the researchers write in their paper.

“[T]hese findings do not contradict the many medical benefits afforded to both mother and child as a result of breastfeeding.”


Hospital Readmission Not a Good Quality Measure for Children.

Preventable readmission rates for children are lower than all-cause readmission rates, according to a new study.

“The concern that many of us have is that there is much less to be gained from a major effort to reduce pediatric readmissions because so many are due to an unpredictable disease process,” James Gay, MD, from Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, Tennessee, told Medscape Medical News.

“Pediatricians try very hard to keep their patients out of the hospital in the first place,” he explained, “so a large investment of time, energy, and funds to reduce pediatric admissions may not be very beneficial overall, and it might actually distract from efforts in other areas, such as concentrating on patient safety.”

Dr. Gay presented the results here at the American Academy of Pediatrics 2013 National Conference and Exhibition.

Pressure is on at hospitals to reduce 30-day readmissions, which are considered by some regulators to be a metric of patient safety and quality care. The Affordable Care Act requires a hospital readmission reduction program for facilities that treat Medicare patients and imposes penalties for institutions with high rates.


A large investment of time, energy, and funds to reduce pediatric admissions may not be very beneficial overall.


Hospital administrators are therefore keen to identify preventable readmissions. Some state Medicaid programs use the 3M Potentially Preventable Readmissions grouping software; however, data on its use in pediatric readmissions are lacking, said Dr. Gay.

His team assessed 1,749,747 hospitalizations in 58 Children’s Hospital Association member hospitals. They used the 3M software to calculate all-cause readmission rates with the company’s proprietary list of 314 All Patient Refined Diagnostic Related Groups.

The software flagged 80% or more of all-cause readmissions as potentially preventable for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy. In contrast, the software suggested that more than 40% of 30-day readmissions were not preventable, including those for seizures, gastroenteritis, central line infections, urinary tract infections, and failure to thrive.

For the 20 leading patient diagnostic groups for all-cause readmissions, the software algorithm removed chemotherapy, acute leukemia, and cystic fibrosis from the list of potentially preventable reasons.

Table. All-Cause vs Preventable Pediatric Readmissions


All-Cause Readmissions (%)

Preventable Readmissions (%)











“There are many fewer pediatric than adult hospitalizations in the first place, and the numbers and rates of readmissions are lower in children,” Dr. Gay pointed out. According to Medicare estimates, “older adults have readmission rates of about 20% at 30 days. The overall pediatric rates are closer to 6% to 10%,” he added.

Conditions that drive hospital readmission in children, or lead to admission in the first place, are very different from those in adults, Dr. Gay said. For example, adults are more likely to be readmitted within 30 days because of a high prevalence of chronic conditions, like congestive heart failure and chronic obstructive pulmonary disease, whereas children have more acute illnesses, such as pneumonia, bronchiolitis, and asthma.

“Because of these issues, many hospital pediatricians believe that readmission rates are not a good quality measure for pediatrics,” Dr. Gay said.

Asked by Medscape Medical News to comment on this study, Mark Shen, MD, from Dell Children’s Medical Center in Austin, Texas, noted that “in this study, the single most common reason for readmission was chemotherapy. We expect these kids to come back — we’ve wiped out their immune system.”

Other children are discharged with the expectation they will return as well, he added. “Sometimes we know they’re coming back. We’re just giving them a break at home, such as children with sickle cell disease or ventricular shunts.”

This study is useful because it indicates that the rate of 30-day hospital readmission is lower for children than for adults. Further research could focus on key chronic conditions associated with more readmissions in children, which so far only have been identified in adults. “But we’re getting closer in pediatrics,” Dr. Shen added.

The study authors caution that the 3M software might not completely reflect the reasons for pediatric readmissions, and future studies are warranted to validate its use in this population. The broader issue is whether efforts to track and reduce adult hospital readmissions apply equally to pediatric patients, Dr. Gay said.

Narrow-Spectrum Antibiotics Effective for Pediatric Pneumonia.

Narrow-spectrum antibiotics have similar efficacy and cost-effectiveness as broad-spectrum antibiotics in the treatment of pediatric community-acquired pneumonia (CAP), according to the findings of a retrospective study.

Derek J Williams, MD, MPH, from Vanderbilt University School of Medicine in Nashville, Tennessee, and colleagues published their findings online October 28 in Pediatrics.

“The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America…guideline for the management of children with [CAP] recommends narrow-spectrum antimicrobial therapy for most hospitalized children,” the authors write. “Nevertheless, few studies have directly compared the effectiveness of narrow-spectrum agents to the broader spectrum third-generation cephalosporins commonly used among hospitalized children with CAP.”

Therefore, the researchers used the Pediatric Health Information System database to assess the hospital length of stay (LOS) and associated healthcare costs of children aged 6 months to 18 years who were diagnosed with pneumonia between July 2005 and June 2011 and treated with either narrow-spectrum or broad-spectrum antibiotics. The authors excluded children with potentially severe pneumonia, those at risk for healthcare-associated infections, and those with mild disease requiring less than 2 days of hospitalization.

Narrow-spectrum therapy consisted of the exclusive use of penicillin or ampicillin, whereas broad-spectrum treatment was defined as the exclusive use of parenteral ceftriaxone or cefotaxime.

The median LOS for the entire study population (n = 15,564) was 3 days (interquartile range, 3 – 4 days), and LOS was not significantly different between the narrow-spectrum and broad-spectrum treatment groups (adjusted difference [aD], 0.12 days; P = .11), after adjustments for covariates including age, sex, and ethnicity.

Similarly, the investigators found no differences in the proportion of children requiring intensive care unit admission in the first 2 days of hospitalization (adjusted odds ratio [aOR], 0.85; 95% CI, 0.25 – 2.73) or hospital readmission within 14 days (aOR, 0.85; 95% CI, 0.45 – 1.63) were noted between the groups.

Narrow-spectrum treatment was also linked to a similar cost of hospitalization (aD, −$14.4; 95% CI, −$177.1 to $148.3) and cost per episode of illness (aD, −$18.6; 95% CI, −$194 to $156.9) as broad-spectrum therapy.

The researchers note that the limitations of the study were mostly related to its retrospective nature, including potential confounding by indication, the absence of etiologic and other clinical data, and a relative lack of objective outcome measures.

“Clinical outcomes and costs for children hospitalized with CAP are not different when empirical treatment is with narrow-spectrum compared with broad-spectrum therapy,” the authors write. “Programs promoting guideline implementation and targeting judicious antibiotic selection for CAP are needed to optimize management of childhood CAP in the United States.”

Active Cooling Improves Transport of Infants With Hypoxic-Ischemic Encephalopathy.

Newborns with hypoxic-ischemic encephalopathy (HIE) do better with active cooling during transport, a new paper says.

Servo-controlled active cooling during transport of full-term infants with HIE improved their temperature stability and reduced their transfer time in comparison to passive cooling, researchers said October 21 in Pediatrics.

All babies cooled using the active approach were within the target temperature range when they arrived at the regional unit for treatment, versus 39% of the passively controlled infants, Dr. Topun Austin of Rosie Hospital in Cambridge, UK, and his colleagues found.

HIE occurs in two of every 1,000 newborns in developed countries, and in 10-20 per 1,000 babies in the developing world, Dr. Austin explained in an interview with Reuters Health. Therapeutic hypothermia, which involves cooling babies from their normal temperature of 37 degrees C to 33.5 degrees C, has been shown to help prevent brain damage in these infants.

“If you cool them by just a few degrees, a lot of these babies will have a normal neurological outcome at 18 months,” the investigator said. “It’s quite a dramatic improvement with quite an inexpensive treatment.”

One approach to cooling babies with HIE is to simply remove their clothes, Dr. Austin added, but this “passive cooling” approach can lead to overcooling. With active cooling, the baby is placed on a fluid-filled mattress. A rectal probe monitors the infant’s temperature, and the mattress is automatically heated or cooled to ensure that the target temperature is maintained.

Until now, no studies have compared outcomes with passive vs active cooling. To do so, Dr. Austin and his team reviewed data from a regional neonatal transfer team for 134 infants. The first 64 were treated with passive cooling; the other 70 infants were treated with active cooling after the purchase of a servo-controlled mattress.

Cooling started at an average of 46 minutes of age for the active group, vs 120 minutes for the control group. Median stabilization time was 153 minutes for the control group versus 133 minutes for the active group, while age at arrival was 504 minutes for the control group and 452 for the active group.

Dr. Austin and his colleagues are now investigating strategies for identifying infants with HIE as early as possible.

“It is important for the policy maker to make active cooling available during transport and maybe in the areas at medium and far distance from the referral centers,” said Dr. Mohamed Tagin, a neonatal fellow at the Hospital for Sick Children in Toronto, in email to Reuters Health. Dr. Tagin did not participate in the new study.

“I do agree that the active cooling process should be monitored at a tertiary care facility where appropriate monitoring and expertise are available for such complicated management,” Dr. Tagin added. “It is however very important to commence cooling as soon as the criteria for moderate to severe HIE have been fulfilled, given the available evidence about the improvement of the long-term outcome for those newborns.”

Dr. Tagin continued, “It is important when we discuss the issue of cooling to highlight that patient identification and early management is the most important step and often times it is done by a midwife or a family physician far away from further support. As the situation is stressful enough to those individuals, I believe there should be a system in place to give clear advice over the phone and maybe this already should be preceded with some training to different scenarios.”

But while active cooling should be the standard of care, he said, in the meantime “cooling should not be delayed, and passive cooling with frequent / continuous monitoring should be commenced once the patient has been identified.”

Doctors Asked to Counsel Teens About the Dangers of Smoking.

Doctors already have a hefty checklist of topics to go over with their patients. Will they be able to squeeze in discussions about the health hazards of tobacco during office visits?

The recommendation, published in the Annals of Internal Medicine and Pediatrics, that primary-care physicians start counseling younger patients about tobacco updates the U.S. Preventive Services Task Force (USPSTF) advice from 2003. At that time, the task force of experts could not find enough evidence to ask physicians to intervene with talks about tobacco during checkups with teens and adolescents. Since then, however, the panel says more studies have shown that conversations with physicians can have an impact in reducing smoking and other tobacco use among teens.


The members analyzed trials that were designed to either prevent smoking among adolescents or to encourage them to quit. Youngsters who were told about antitobacco programs by their primary-care physicians were 19% less likely to start smoking than peers who were not provided with such information. Compared with other methods such as group sessions to discuss the health risks of tobacco; videos and pamphlets that provided information on tobacco; or even prescription forms preprinted with antitobacco messages, having conversations with health care professionals, either in the doctors’ office or over the phone, appeared to be the most effective.

That’s encouraging for physicians who have long struggled to help adult smokers to quit. “We now know that the smokers that have the most difficulty quitting are the smokers that start in their teenage years and smoke into young adulthood. Those are the smokers that may never be able to quit smoking, and that’s recent data,” says Dr. Len Horovitz, an internist and pulmonary specialist at Lenox Hill Hospital in New York City, who was not on the panel. “It seems incumbent upon pediatricians and internists who have experience with these patients to counsel those patients at exactly that time.”

Rates of cigarette smoking among teens have stalled, but that doesn’t mean they aren’t still using tobacco. Some have switched to cigars, which are less expensive, often flavored, and even crafted to look like cigarettes. While teen tobacco use dropped significantly in the U.S. between the years 1997 and 2003, beginning in the early 2000s, these declines started to reverse as states cut funding for tobacco-control programs. From 2009 to ’11, tobacco use remained steady, with about 1 in 5 high school students using some form of tobacco.

(MORE: Secondhand Smoke Is More Damaging for Teen Girls Than Boys)

Will the USPSTF recommendation help bring tobacco use down again? Already pressured to cover a significant amount of health information in a short office visit, Horovitz says doctors may find it difficult to throw another important health issue into the mix. “There’s counseling on diet, exercise, fastening your seat belt [and] nutrition; and smoking cessation measures are a part of the annual physical too,” he says. To make time for discussions about such lifestyle factors and how they affect their health, Horovitz says he allots an hour for each such visit.

Discussing such lifestyle behaviors, including tobacco use, is easier if doctors and patients have a long-standing relationship that is built on trust and familiarity. “All patients will talk about stress, and I ask questions that are pointed enough that they will volunteer that information. When you take care of a patient over a few years, there is trust and confidence in the doctor-patient relationship, and the patient will be more spontaneous in giving you facts that they might not give a doctor at first or if they don’t have a consistency in who they see,” says Horovitz.

Since not all patients have such interactions with their doctors, the task force also identified some other strategies that could help physicians to help their teen tobacco users to quit. For instance, some cessation programs send reminder text messages to teens’ smartphones, while some states, including New York and Rhode Island, have gone after their wallets by increasing the price of cigarettes. Mass-media antismoking campaigns and laws that target retailers selling cigarettes to underage customers are also effective. In an editorial accompanying the new recommendations, Dr. Michael Steinberg of Robert Wood Johnson University Hospital and Cristine Delnevo of the Rutgers School of Public Health also argue for raising the smoking age from 18 to 21, since that would make it much harder for younger people to purchase tobacco products and therefore discourage them from smoking regularly.

With the new recommendation, doctors are being asked to join antitobacco efforts for teens, based on the latest data that suggests they can have a significant impact on whether or not their young patients smoke. It’s just a matter of finding the time to discuss how smoking and tobacco can affect teens’ health, and making such conversations a priority during the office visit.


Soda Linked to Aggression, Attention Problems, and Social Withdrawal in Young Children.

Soda has already been blamed for making kids obese. New research blames the sugary drinks for behavioral problems in children too.

Analyzing data from 2,929 families, researchers linked soda consumption to aggression, attention problems and social withdrawal in 5-year-olds. They published their findings in the Journal of Pediatrics on Friday.

Although earlier studies have shown an association between soft-drink consumption and aggression in teens, none had investigated whether a similar relationship existed in younger children.

To that end, Columbia University epidemiologist Shakira Suglia and her colleagues examined data from the Fragile Families and Child Wellbeing Study, which followed 2,929 mother-child pairs in 20 large U.S. cities from the time the children were born. The study, run by Columbia and Princeton University, collected information through surveys the mothers completed periodically over several years.

In one survey, mothers answered questions about behavior problems in their children. They also reported how much soda their kids drank on a typical day.

Suglia and her colleagues found that even at the young age of 5, 43% of the kids consumed at least one serving of soda per day, and 4% drank four servings or more.

The more soda kids drank, the more likely their mothers were to report that the kids had problems with aggression, withdrawal and staying focused on a task. For instance, children who downed four or more servings of soda per day were more than twice as likely to destroy others’ belongings, get into fights and physically attack people, compared with kids who didn’t drink soda at all.


Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States.


Objective  To assess the prevalence and patterns of exposure to drugs and therapeutic agents among hospitalized pediatric patients.

Design  Retrospective cohort study.

Setting  A total of 411 general hospitals and 52 children’s hospitals throughout the United States.

Patients  A total of 587 427 patients younger than 18 years, excluding healthy newborns, hospitalized in 2006, representing one-fifth of all pediatric admissions in the United States.

Main Outcome Measures  Daily and cumulative exposure to drugs and therapeutic agents.

Results  The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol, various antibiotics, fentanyl, heparin, ibuprofen, morphine, ondansetron, propofol, and ranitidine being among the most prevalent exposures. A considerable fraction of patients were exposed to numerous medications: in children’s hospitals, on the first day of hospitalization, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs, and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By hospital day 7, in children’s hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. Patients with less common conditions were more likely to be exposed to more drugs (P = .001).

Conclusion  A large fraction of hospitalized pediatric patients are exposed to substantial polypharmacy, especially patients with rare conditions.

In the United States, for persons young and old, exposure to medications is essentially universal.1Over the past decade, the relatively neglected area of pediatric drug effectiveness and safety has received increasing attention. The 2002 Best Pharmaceuticals for Children Act (BPCA),2 building on the 1997 US Food and Drug Administration Modernization Act,3– 4 set forth the goal of reducing pharmaceutical errors in the dispensing of drugs to hospitalized children. In the hospital setting, the efficacy and safety of many pediatric medications have not been well established5; much of the use of medications is for off-label indications6; and medication errors occur.5,7– 10 Both the BPCA and the complementary Pediatric Research Equity Act of 200311 have underscored the need for pediatric studies regarding both on- and off-label drug treatments12– 14 and for improvements in pediatric drug labeling.15– 16

To advance this agenda, we need to refine our knowledge of the overall patterns of pediatric inpatient drug and therapeutic agent use, including what drugs and therapeutic agents are used most commonly, the number of different drugs and therapeutic agents that hospitalized children receive, and potential differences in drug and therapeutic agent exposures across different types of hospitals. This knowledge, especially if based on population-level data, would enhance efforts to prioritize and design research studies regarding the effectiveness and safety of pediatric inpatient medications.17– 19

To address these objectives, we combined hospital medication use data from 2 large databases, the first of which comprises data exclusively from children’s hospitals while the second data set comprises data from mostly general hospitals; together these data sets represent approximately 19.9% of all pediatric inpatient hospitalizations in the United States. In this report, we examine drug and therapeutic agent use patterns among hospitalized pediatric patients (excluding healthy newborns) evident in the combined data, focusing on exposure to polypharmacy, which has been shown to be associated with an increased risk of adverse drug reactions in adult patients in intensive care units and other settings.20– 21

Source: JAMA


Physical Punishment of Children Linked to Obesity, Arthritis in Adulthood.

Harsh physical punishment in childhood is associated with adverse physical health outcomes in adulthood, according to a cross-sectional study in Pediatrics.

Researchers surveyed over 30,000 U.S. adults about whether they had experienced harsh physical punishment (e.g., pushing, grabbing, shoving, slapping, or hitting) as children. After adjusting for education, family history of dysfunction and mental disorders, and other variables, adults who reported receiving harsh physical punishment as children were at increased risk for having arthritis (adjusted odds ratio, 1.25) and obesity (OR, 1.20). The risk for cardiovascular disease was of borderline significance. Past studies have found that childhood mistreatment is linked to dysregulation of the body’s stress response system.

For physicians advising parents about discipline, the authors write: “It is recommended that physical punishment not be used with children of any age.” They instead recommend “positive parenting approaches and nonphysical means of discipline.”

Source: Pediatrics

Metreleptin improved metabolic parameters in children with lipodystrophy.

Positive results from an NIH-supported analysis indicate an investigational recombinant analogue of human leptin has potential as a therapy for pediatric lipodystrophy, according to data presented at the 2013 Pediatric Academic Societies Annual Meeting.

The literature has established that lipodystrophy is known to cause metabolic abnormalities (ie, hypertriglyceridemia, insulin resistance, diabetes andsteatohepatitis), which tend to become severe through childhood and adolescence, and may be resistant to current treatment options.

Rebecca Brown, MD, assistant clinical investigator of the diabetes, endocrinology and obesity branch at the National Institute of Diabetes and Digestive and Kidney Diseases, and colleagues included pediatric patients in an ongoing, open-label study at the NIH (2000 to present).

According to abstract data, patients included in the study (n=39; nine male and 30 female; mean age, 11.9 years) had four subtypes of the disease: congenital generalized lipodystrophy (n=26, 67%), acquired generalized lipodystrophy (n=9, 23%), familial partial lipodystrophy (n=2, 5%), and acquired partial lipodystrophy (n=2, 5%).

On average, the researchers administered metreleptin 4.4 mg (Bristol-Myers Squibb and AstraZeneca) subcutaneously once or twice daily for a mean duration of 3.9 years.

Data indicate that baseline HbA1c (9.8%) decreased significantly to 7.7% after 12 months (–2.3; 95% CI, –3.2 to –1.4) in adolescent patients aged 12 to 18 years.

Triglycerides were notably high in the same group at baseline (1,378 mg/dL), but improved significantly to 385 mg/dL after 12 months (–44; 95% CI, –73 to –15), according to data.

Both age groups displayed significantly elevated mean alanine aminotransferase (ALT; ≤12 years: 193 U/L; adolescents: 105 U/L) and aspartate aminotransferase (AST; ≤12 years: 119 U/L; adolescents: 87 U/L) at baseline. However, ALT (≤12 years: 155 U/L; adolescents: 59 U/L) and AST (≤12 years: 90 U/L; adolescents: 57 U/L) decreased after metreleptin therapy, according to data.

“Metabolic disorders resulting from lipodystrophy can develop in childhood and adolescence and are exacerbated over time,” Brown said in a press release. “This new analysis supports the continued study of investigational metreleptin as a potential treatment option for pediatric patients with lipodystrophy.”

Overall, metreleptin was well tolerated, and the most common adverse events reported were decreased weight (n=3, 7.7%) and hypoglycemia (n=3, 7.7%), followed by fatigue (n=2, 5.1%) and nausea (n=2, 5.1%), the researchers wrote.

According to the press release, metreleptin has acquired orphan designation from the FDA, and the European Medicines Agency is evaluating the agent.

For more information:

Brown R. #3490.3. Presented at: Pediatric Academic Societies Annual Meeting; May 4-7, 2013; Washington.

Source: Endocrine today




Robert Lustig: The no candy man.

A man who declares that sugar is a toxin in the same league as cocaine and alcohol, and one that must be regulated in the same manner as tobacco, is apt to draw public attention. But Robert Lustig, professor of clinical paediatrics at the University of California, San Fransisco, is not camera shy. Indeed, he revels in the attention, even when it is not always flattering. Where other academics might feel uncomfortable, he exploits his fame to full effect. For example, at a recent symposium in London he argued that sugar was an addictive and dangerous substance, singularly responsible for the soaring rates of obesity and diabetes around the world. He began his speech with a quotation from Gandhi and concluded by declaring a war against the sugar industry. The audience responded with rapture and enthusiasm.

Lustig, a paediatric endocrinologist specialising in neuroendocrinology, owes his fame predominantly to a lecture, posted on YouTube, entitled “Sugar: The Bitter Truth” ( At the time of writing, it had had more than 3.3 million views. Not bad for a 90 minute lecture, the bulk of which is devoted to complex biochemical reactions that happen in the liver. But Lustig is an engaging and passionate speaker, prone to rhetorical flourishes and dramatic pronouncements, which keeps his audience, virtual and real, interested.

Source: BMJ