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1 Introduction Just a few decades ago, the notion that human milk contains immuneprotective qualities was routinely dismissed by medical experts, even referred to as the stuff of “wives’ tales and folklore.”1 Now the American Academy of Family Physicians states in a position paper that “not breastfeeding is associated with increased risks of common conditions including acute otitis media, gastroenteritis, atopic dermatitis, and life-threatening conditions including severe lower respiratory infections, necrotizing enterocolitis, and sudden infant death syndrome.”2 In conjunction with this shift regarding what counts as scientific truth about human milk’s immune-protective qualities, during the last few decades we have seen a profound shift in some of the medical recommendations on infant feeding and a less tangible, but equally profound, shift in popular understandings of what it means to make an infant-feeding choice. Whereas the phrase breast or bottle might have once implied a choice between two relative equals, each with its own benefits and drawbacks, we increasingly live in a world in which human milk is portrayed as possessing unique qualities that might be emulated but will never be replicated in an artificial substitute. As the American Academy of Pediatrics (AAP) proclaims in its current policy statement on infant feeding, breastfeeding is “the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes.”3 It is tempting to view this recent shift in beliefs as a typical example of science doing what it is supposed to do—increasing our knowledge and understanding of phenomena in the natural world—and medicine doing what it is supposed to do—changing its practices and recommendations in response 2 Breast or Bottle? to relevant scientific advances. I argue in this book, however, that such a progress-based interpretation leads to an incomplete understanding of the recent shift in scientific facts and medical recommendations with regard to infant feeding. Of course, the amount of epidemiologic evidence that demonstrates human milk’s health benefits has increased in recent years, and so has the amount of evidence that helps us scientifically understand the mechanisms that lead to these benefits. But the story of why these forms of evidence have increased so dramatically in the last few decades is not just a story of new scientific discoveries . Rather, it is a story about individuals, coalitions, and organizational entities who have engaged in relentless rhetorical efforts to improve our scientific explanations and cultural appreciation of human milk, lactation, and breastfeeding in the context of a decades-long historical tendency to devalue and denigrate these uniquely female capabilities of the human body. Experts and advocates arguing in favor of human milk have gained important rhetorical ground since the 1970s when a shift in the dominant metaphor for the human immune system enabled medical researchers to start seeing human milk as part of this gender-neutral system instead of just an element of female reproduction. Prior to this important change in the rhetorical framework of the breast–bottle debate, researchers in pediatrics, immunology, and other medical specialties viewed human milk and breastfeeding as uniquely female capacities, and they were quite successful in accumulating evidence to argue against the idea that human milk provides any health benefits that cannot be duplicated in formula. When we acknowledge these important rhetorical shifts, events, and initiatives , it becomes clear that science should be understood as an important and ever-shifting frame for the breast–bottle controversy, but not as its final arbiter. If we take seriously the excerpt from Plato’s dialogue Gorgias that appears as an epigraph to this book, then considering the rhetorical aspects of a phenomenon such as infant feeding is crucial to developing a complete understanding of it. In fact, if we believe Plato’s dialogue, those rhetorical dimensions might be even more important than the strictly scientific or medical dimensions at times and, in any case, hard to separate from them. Rhetoric has been defined, most simply and elegantly, as the capacity “to see the available means of persuasion in each case.”4 But the simplicity of this definition belies its true power. As suggested by Gorgias’ reply to Socrates’ question, Western culture has long acknowledged the mystical force of rhetoric and has even treated it as supernatural. As has been shown to be the case for the language that is used to talk about fertility, migraines, depression, and a variety of other health-related topics...

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