Innovations in infant milk feeding: from the past to the future.

Innovation is important for life science and economy, but the value of innovation for public health depends on its impact on promoting health. Breastfeeding is not innovative but evolved slowly over 250-300 million years, yet its total benefits are not surpassed by more innovative ways of infant feeding. Until the 19th century, infants fed inadequate breast milk substitutes suffered from high mortality. In 1865 a major improvement was von Liebig's 'soup for infants', the first breast milk substitute based on chemical human milk analysis, soon followed by commercial applications. Other early innovations include whey protein-dominant formula, addition of specific carbohydrates to promote bifidobacteria ('prebiotic') and of live bacteria ('probiotic'), predecessors of apparently recent innovations. Opportunities for innovations exist since many outcomes in formula-fed infants do not match those in breastfed populations. Of concern, expected economic benefits through innovations may override scientific arguments. Business and marketing desires must be counterbalanced by independent pediatric and scientific evaluation. Developing innovations with relevant outcome effects is complex, costly and cannot be expected to occur every few years. Cooperation between academic investigators, small and medium enterprises with high innovative potential, and large industries promotes progress and should be facilitated, e.g. by public research funding.