Saturday, April 18, 2015

Typhoon Haiyan/Yolanda part-2: Rescuing Breastfeeding


Breastfeeding Expert Support Team with mobile Breastfeeding Tent-Philippines  from the "Final Report on Breastfeeding Action-Lifeskills 8Jan2014"

"Even in the best, most hygienic conditions, artificially-fed babies are five times more likely to suffer diarrhoeal diseases.  In an emergency situation, even where bottle feeding is not normally associated with increased mortality in a non-emergency setting, infant feeding methods can become an issue of life or death.  Unsanitary, crowded conditions, a lack of safe water and a lack of facilities to sterilize feeding bottles and prepare formula safely and correctly means that artificially fed infants are more than 20 times more likely to die from diarrhoea and other infectious diseases than infants who are exclusively breastfed."  
"Infant feeding in emergencies:  experiences from Lebanon," by Ali Maclaine
Humanitarian Exchange Magazine Issue 37 March 2007
http://www.odihpn.org/humanitarian-exchange-magazine/issue-37/infant-feeding-in-emergencies-experiences-from-lebanon

My previous post on Typhoon Haiyan/Yolanda was in my mind unfinished.  Why? Because there seemed to me to be much more that needed to be shared. How do you impart through words the work of these dedicated women to protect and promote breastfeeding in the aftermath of such devastation?  The Philippine Breastfeeding Expert Support Team (BEST) understood the barriers to promoting and protecting breastfeeding and created solutions through the use of their mobile breastfeeding tents.  One of the barriers is that in the aftermath of an emergency, there is a deluge of infant formula donations.  There is a lack of understanding that even under the best circumstances, infant formula has risks.  During an emergency those risks escalate.

One of the most challenging aspects in the aftermath of a disaster is how to manage formula-fed infants knowing that these babies are at higher risk for morbidity and mortality.  The Philippine BEST group used a variety of strategies to help moms relactate.   Peer counselors helped educate and inspire mothers to breastfeed.  Hand expression was taught, confidence was given that the milk was there.  Wet nursing was used to help fed babies while they were transitioning to the mother's breasts.  Donor human milk was used to help those babies who lost their mothers.

The following is 17 pictures and inspiring stories of breastfeeding mothers in the Philippines.  The first slide is of Velvet Escario-Roxas, who has trained many breastfeeding peer counselors, is Executive Deputy Director at Arugaan (means "to fully nurture with a lifetime commitment," in Filipino) Toddler Center in Quezon, and was very involved in the mobile Breastfeeding Tent after the typhoon.  Also in these pictures is Bing Guevara who was also very involved in mobile breastfeeding tent after Typhoon Yolanda.

https://ph.news.yahoo.com/photos/breast-is-best-moms-tell-their-inspiring-stories-slideshow/velvet-escario-roxas-life-by-imagine-nation-photography-photo-1376526863233.html

The founder of Arugaan in Quezon is Ma Ines Fernandez.  She is an inspiration to many.  She recently was made an Ashoka Fellow and I think the following video is helpful in understanding why she is such an inspiration.  Ashoka Fellows are "leading social entrepreneurs who are recognized for their innovative solutions to social problems...demonstrating unrivaled commitment to bold new ideas and prove that compassion, creativity and collaboration are tremendous forces for change."


I am inspired by this group of dedicated supporters and protectors of breastfeeding in the Philippines.  Hopefully, you will be, too!!  We need more programs like this around the world.  In heartfelt gratitude for the many people around the world who protect and promote breastfeeding.
Valerie W. McClain


Saturday, April 4, 2015

Typhoon Haiyan/Yolando: Protecting and Promoting Breastfeeding in the face of Disaster


"Breastfeeding serves to protect a child's right to food security and medicine.  Temporary lack of food and water in emergency conditions in a disaster-stricken area cannot be presumed to justify the prescription of formula for babies.  In such situations, the health risks to which the babies are already  exposed can only be exacerbated when panic sets in and authorities unjustifiably offer formula as an emergency response."
--"Vulnerability:  From Protection to Empowerment," by Leonardo D. de Castro and Ma. Ines Av. Fernandez, Asian Bioethics Review vol.6 no.4 (2014) 
http://asianbioethicsreview.com/journal/index.php?journal=abr_sbc1&page=index



Recently I had the privilege of being introduced through the email to some dynamic women who by their commitment and actions are making a difference in their communities.  Each of them using their different skills but recognizing the value of working together have created a blueprint for promoting and protecting breastfeeding during emergency situations.  They live in the Philippines, a country consisting of 7107 islands in the area geographically known as the "Ring of Fire."  The country is prone to earthquakes and typhoons.  Ma. Ines Fernandez is the founder of Arugaan, a non-governmental organization (NGO) that was instrumental in making Quezon City the first mother-baby friendly city in the Philippines. She created an innovative creche program that promotes and protects breastfeeding for working women.  In 1986 Ines co-authored and lobbied for the Philippine Milk Code (WHO Code--The Philippines is one of 37 countries in the world that fully implements the WHO Code).

Ines wrote a proposal that helped Arugaan receive funding from the World Health Organization to support breastfeeding in emergencies through the use of mobile breastfeeding tents. Mobile tents create a safe space for mothers and children with an opportunity to rest and recuperate from the trauma and struggles of survival after a disaster.   The tents also create an opportunity to educate moms about the importance of breastfeeding, the risks of infant formula, relactation, and the importance of nutritious, indigenous foods.  This education is combined with individual counseling or group counseling on breastfeeding, demonstrating positioning at the breast, breast massage to stimulate a milk supply, hand expression, wet-nursing/cross nursing. Healthy indigenous foods were provided for the moms as well as a creche for children.   In her email she mentioned that the Philippines encounter 21 typhoons yearly and that they "weather the storm with smiles."  This positive attitude shines forth in the pictures and papers that were shared with me regarding their work with supporting breastfeeding in the aftermath of Typhoon Haiyan/Yolanda, a category 5 typhoon that killed 6300 people and displaced 4 million people. 
From Jenny Ong's blog
http://www.chroniclesofanursingmom.com/2014/03/help-arugaan-mission-for-haiyan-victims.html

Such an endeavor takes the work of many people.  One person, one group, one organization cannot do this kind of work alone.  With the spirit of cooperation and collaboration, Arugaan BEST (Breastfeeding Emergency Support Team) lead by Ma. Ines Fernandez worked with the Breastfeeding Pinays-an online breastfeeding support group of 40,000 members administered by Velvet Escario-Roxas and her trained peer counselors and co-founder of the Facebook group Breastfeeding Pinays, Bing Guevara; LATCH (Lactation, Attachment, Training, Counseling, Help)-a breastfeeding support group with Jenny Ong who is a trained breastfeeding counselor and Dr. Lei Camiling-Alfonso,Dr. Donna Capili, Dr. Mianne Silvestre from Kalusugan ng Mag Ina (KMI) who are also promoting a program called First Embrace.   Jenny Ong with her organization LATCH helped get the money needed for transportation fares for community mothers so they could volunteer at the tents.  Donor breastmilk (no donor breastmilk from outside the Philippines was allowed) was collected and airlifted to evacuation centers and a hospital in areas impacted by the storm to help infants in need.  Infant formula donations were discouraged because the mixing of infant formula with contaminated water can cause gastrointestinal illnesses and can be fatal.

There were many people involved in this collaborative approach and there were many agencies like UNICEF and the WHO, the Philippine government agencies (DOH and others) and international non-profit organizations like Save the Children coordinating the approach to help the survivors of the typhoon.
 Mobile breastfeeding tents were used at evacuation centers in Manila.  Later they were able to use their mobile Breastfeeding Tents to make visits (and return visits to see how moms and babies were doing) to the villages in Leyte/Samar hard hit by the typhoon.  I was impressed by the documentation that was done by this Arugaan endeavor and that they did follow-up visits. The breastfeeding tents encouraged more breastfeeding among mothers and at the same time educated communities on the importance of breastfeeding. 

One of the things I know from the hurricanes I have witnessed in Florida is that the impact of a hurricane/typhoon is felt in a community for years.  Homes have to be rebuilt or repaired, jobs may be lost, food security may disappear for many families.  Many close-knit families have lost their loved ones and often have to move to new locations causing additional stress.   The stress of this instability and personal loss may be long-lasting for families impacted by such storms.   

Breastfeeding is a well-known safety net for mothers and babies against the damaging effect of poverty and/or natural disasters.  Infant formula is a known risk in such situations because the safety of water supplies are often questionable, access to fuel/electricity may not exist meaning that sterilization of bottles/nipples will be difficult putting infants at high risk for infections and death.

"Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies."
--"Donated breast milk substitutes and incidence of diarrhoea among infants and young children after the May 2006 earthquake in Yogyakarta and central Java," by DB Hipgrave et al., Public Health Nutr. 2012 Feb 15(2): 307-315
http://journals.cambridge.org/download.php?file=%2FPHN%2FPHN15_02%2FS1368980010003423a.pdf&code=9b2a7c9c144f4c9728e851f47f408cbf

"According to reports from the Philippines cases of gastroenteritis increased last year during Typhoon Yolanda because donated infant formula was mixed with contaminated water."
http://www.dairyreporter.com/Regulation-Safety/Infant-formula-donations-banned-at-Typhoon-Ruby-evacuation-centres

One of the things that happens during and after natural and man-made disasters is that good-hearted people believe that donating infant formula is the answer for babies during such emergencies.  What happens is that these donations often sabotage the breastfeeding mother, put more infants at risk for diarrhea and death, and are difficult to control and monitor. Not only that but once you have infants dependent on infant formula (an expensive product even in developed countries), then when all the free infant formula is no longer available, how will an infant survive? I remember years ago trying to talk to some missionaries regarding this issue.  They were collecting infant formula in our area to go to the survivors of an earthquake in Nicaragua who were living in tents in a landfill.  I could not convince these very kind-hearted people that it was a dangerous thing to do.  They assured me that they had water-filtering devices they were bringing as well as infant formula.  They did not understand that what they were creating is dependency upon a product that would not be available for free after the donations stopped.  Which meant that infants would be at increased risk for malnutrition and death, when families could no longer get free infant formula.  And by the time free formula ended, mothers would not have the information or help to relactate.

Hurricane Katrina was an eye-opening event for many of us here in the US.  The conditions were unbelievable for a country that is considered rich and modern.  I remember one night seeing the news in which it was stated that mothers with brand new babies in the New Orleans Superdome had run out of infant formula and water in which to keep their infants fed and hydrated.  I saw mothers giving people their babies to other people who were lucky enough to get a bus out of the brutal conditions of the Superdome.  They did this so that their infants could have food and water.  Watching those news clips and saying to myself, if only those mothers had some LLL leaders, IBCLCS or WIC breastfeeding peer counselors standing next to them to say that they could breastfeed their babies and here's how to do it.  Breastmilk will provide your infant with nutrition as well as keeping them hydrated.  Formula feeding mothers who have newborns still have milk in their breasts.  Relactation in the newborn period is much easier than relactating with an older baby (and that, too, can be done with knowledge and help).

Reading and seeing the pictures of what is being done by the breastfeeding organizations in the Philippines blows me away.  Why?  Because they are showing us a blueprint in how to protect and promote breastfeeding in emergencies.  I dearly wish that here in the USA we can follow their example. This can be done by any country (other countries are doing it) and it is a vital and dynamic way to help mothers and babies during emergencies.  The presence of such programs increases the knowledge in communities of the importance of breastfeeding.  I salute and applaud the efforts of this amazing group of women in the Philippines who are promoting and protecting breastfeeding.  May they stay safe as another typhoon heads their way--Typhoon Maysak.
Valerie W. McClain

Thursday, February 19, 2015

A 1950's infant formula patent: reflections and questions


"Following the termination of breastfeeding, there is evidence of ongoing protection against illness due to protective influences on the immune system mediated via human milk.  Industry continues to attempt to improve infant formula with the addition of compounds such as fatty acids, oligosaccharides, nucleotides and lactoferrin.  However, human milk has such far-reaching effects on the infant's immune response that optimal development depends heavily on its provision."  The Impact of Breastmilk on Infant and Child Health by Wendy H. Oddy BAppSc MPH PhD (Breastfeeding Review 2002; 10(3): 5-18)

Deja vu?  Remember the movie, Groundhog's Day, with actor Bill Murray?  I feel like I am living that movie and its rather hilarious and sad at the same time.  Frustrating, you bet it is frustrating.  What we know about breastmilk and infant formula is still well hidden in our society.  So reading papers from a decade ago, like Ms. Oddy's paper in Breastfeeding Review is...well its a Groundhog's Day moment.   I read the epidemiological evidence in the early 1990's and presumed or assumed that this evidence would take hold in our society.  Instead it seems we have had a media campaign for the past 3 years to convince people that infant formula is just as good as breastfeeding.  Ms. Oddy states boldly in the abstract of her paper, "Infant-formula-feeding is inferior to breastfeeding because human milk provides specific and non-specific factors that have long-term consequences for early metabolism and the devlopment of disease."

As I reread Ms. Oddy's paper, I found myself reflecting on why our society is so resistant to the information that infant formula has health risks.  Why is this information consistently buried in our society?  I remember as a La Leche League leader in the 80's and early 90's that the emphasis was on promoting breastfeeding, discussing the benefits.  Not much was said about the risks of infant formula.  It seemed to be an unspoken rule.  I remember reading, Breastfeeding Matters by Maureen Minchin in 1990 and being blown away by the information.  Then reading in the Journal of Human Lactation an article by Marsha Walker, IBCLC in 1993 entitled, "A Fresh Look at the Risks of Artificial Infant Feeding," JHL 9(2): 97-107 in which she states, "Declining breastfeeding rates and the aggressive marketing of breast milk substitutes has blurred the distinction between breast milk and formula."   Around the same time, I read, "The Politics of Breastfeeding," by Gabrielle Palmer.  These 3 publications influenced me enormously.  At the time I remember thinking that parents should know this information and they should know this information before their babies are born.  In fact all of society needs to know the risks of infant formula to better understand why infant formula advertising needs to be curtailed.  The reason for the establishment of the WHO Code in the 80's was the recognition that aggressive infant formula marketing was causing a decline in breastfeeding.  Now in recent years, we have seen the rise of breastfeeding initiation rates but continuation rates are poor.  Mixed feeding (breast and bottle feeding) is the predominant mode of feeding in the USA.  Infant formula advertising has changed to meet the challenge of increased breastfeeding initiation rates.  Current themes in advertising seem to be geared towards scapegoating breastfeeding advocates, trying to make advocacy appear to be aggressive and mean-spirited.  Yet there is still the repetitive advertising theme from the 1990s in which breastfeeding and infant formula feeding is promoted as a choice, a personal lifestyle choice.  The risks of infant formula do not exist while breastfeeding is put on a pedestal.  The pedestal in which most women, mere mortals, will admire but never truly obtain.  Countering such advertising is difficult.  It is not impossible, if the WHO Code was utilized to balance public information on infant feeding.

The other day I ran across an infant formula patent filed in 1952 and owned by American Home Products (which became Wyeth in 2002, which became Pfizer in 2009, which Pfizer sold to Nestle in 2012 for $11.85 billion--yes billion) invented by RM Tomarelli et al and entitled, "Infant feeding compositions."

This patent from the 1950s is about supporting the growth of Lactobacillus bifidus in baby formula.  The inventors found that a growth promoting factor that supports the growth of Lactobacillus bifidus in the infant intestinal tract in hog gastric mucin.  I had never heard of hog gastric mucin. While researching this I found an article entitled, "Pig stomach mucins are effective as anti-viral agents for consumer products," dated April 25, 2012.  One product that this current research suggested was to use pig stomach mucin in infant formula.
http://phys.org/news/2012-04-pig-stomach-mucins-effective-anti-viral.html

American Home Products (Wyeth) knew about hog gastric mucin (aka pig stomach mucin) in the 1950s.  Although they weren't trying to find an anti-viral component for infant formula but rather trying to promote the Lactobacillus bifidus (L. bifidus) factor for their infant formulas.  Their reasons for trying to promote L. bifidus were,

"Medical authorities are now in general agreement that many of the advantages which a breast-fed infant seems to have, in so far as its nutrition and resistance to certain diseases are concerned, are attributable, at least in part, to the predominance of L. bifidus in his intestinal tract."

and

"In any event, where the gram-positive bacillus L.bifidus is present in large numbers in the infant intestine, which is now found only when the infant is breast-fed, there is considerable less growth of other microorganisms, particularly of the gram-negative B. coli, the Clostridia, and of certain air born microorganisms such as the Sarcinae bacteria."

and 

"The fact that a stable L. bifiaus [misspelled? I believe they mean bifidus] flora is characteristic only of the intestinal tract of breast-fed infants is now fully understood and appreciated by pediatricians and other specialists in the medical, biological and nutritional sciences....the original observations of Tissier concerning the predominance of L. bifidus in nurslings stool have been amply confirmed is pointed out in the more recent publication of Norris, Flanders, Tomarelli and Gyorgy..."
http://www.goggle.com/patents/US2697663

Interesting to find this patent written so many years ago and find that the infant formula industry was trying to imitate human milk using hog gastric mucin.  And 60 years later, they are once again interested in hog gastric mucin (pig stomach mucins).  But more curious is that they knew that L. bifidus (what we now call a probiotic) created positive health effects in the breastfed baby.  They knew that there was a difference between the breastfed and the formula fed baby.

How far have we really come in our understanding?  We seem to be spinning our wheels, playing Groundhog's Day with information on the health effects of breastfeeding and not breastfeeding.  How far has the infant formula industry come in improving infant formula?  In the 1950's they would use hog gastric mucin and in 2012 they are back to thinking about using this component.  I imagine it will be genetically engineered because that is the current fad in our biotech world.  Have we gone forward in making a safer infant formula?  Or perhaps are we just spinning our wheels, in a circle of belief that somehow men and women of science have the god-like understanding of human milk and making a safer infant formula.
Copyright 2015  Valerie W. McClain

  

Saturday, February 7, 2015

Infant Formula Advertising in the USA, the WHO Code, and a profession


"Is breastfeeding 'worth the bother'?  The epidemiologic evidence is strongly affirmative.  Important protection against gastrointestinal infections in every setting has been confirmed and reconfirmed;  most clinicians now accept such observations.  Many clinicians, however, are surprised to learn that breast-feeding is associated with significant reductions in nongastrointestinal infections, including pneumonia, bacteremia, and meningitis, and with a reduced frequency of certain chronic diseases later in life.  Much of the important data concerning the health benefits of breastfeeding appeared in the last decade and are not widely known..."
--Breastfeeding and Health in the 1980's:  A Global Epidemiological Review, by Allan S. Cunningham, Derrick B. Jelliffe, E.F. Patrice Jelliffe
Journal of Pediatrics 118: 659-666 

I would venture to say that the epidemiological evidence regarding the value of breastfeeding to the health and well-being of babies and mothers are still relatively unknown.  The infant formula industry says, "Breastfeeding is Best." But ask a parent or even some health professionals why breastfeeding is best and listen to the response.  The answers are usually generalities nothing specific and never about the risks of infant formula.  There is a presumption that in developed countries like the US, that infants do not die from the way in which they are fed.  The belief is that infant formula is only a risk in developing countries, like countries in Africa.

Yet according to US infant mortality data, babies in the US die from pneumonia, gastrointestinal infections. bacteremia, meningitis and SIDs.  Would breastfeeding have prevented or reduced some of these deaths?  What do we really know about infant mortality statistics in the US and the relationship to how an infant is fed?  It would be easy to find out, if we required each infant death certificate to state how the infant was fed in the last 24 hours (or last 48 hours or last week) before death. 

I read "Breastfeeding and Health:  A Global Epidemiological Review," over a decade ago.  And the evidence from research done in the 80's is still relatively unknown to the general US population.  But now that evidence is being used to create novel and "improved" infant formulas, create patents, and monopolize those "inventions."  We see the advertisements that the new formula is closer to breast milk.  Are these formulas closer to breast milk because the industry has claimed the DNA (cDNA) of various breast milk components?   In US patents and patent applications, infant formula companies are creating novel ingredients through genetically engineering.  How much of those novel, genetically engineered ingredients are actually placed in infant formula is unknown.  The US infant formula industry does not have to label gmo ingredients because the FDA considers gmo and natural ingredients equivalent.

How much of our society's ignorance of what is in the can of infant formula and ignorance of risks regarding infant formula is orchestrated by industry?  How much of it is caused by an unwillingness to openly discuss risks of infant formula.  It seems that breastfeeding advocacy can only discuss the risks of not breastfeeding.  The risks of not breastfeeding is not the same statement as risks of infant formula.  The risks of not breastfeeding presumes that there are also risks in breastfeeding.  Is that true?  Risks of not breastfeeding is in reality an avoidance of discussing the risks of infant formula.  Its a word game to avoid offending infant formula feeding mothers but also results in letting an industry "off the hook."  

The consequences of letting an industry off the hook is that advertising/marketing gets more and more outrageous.  The recent Similac Ad, which some parents refuse to understand is an advertisement, is a prime example of how the internet not only impacts one country but the global community. With the rise of the internet and the multitude of devices that now connect to the internet, the infant formula industry has a global reach in advertising.  The wealth and power of an industry's marketing department has the ability to influence the hearts and minds of many, many people.  We have marketing that is so sophisticated that the audience does not even understand that what they are watching is an advertisement.  

Our society believes in choice, when it comes to infant feeding.  Yet making a choice presumes that that the person is making an "informed" choice.  Does direct advertising of infant formula to the public give parents an "informed" understanding of the benefit/risk ratios involved in their decision-making?  The infant formula industry has millions in which to advertise their products.  How much money does breastfeeding advocacy organizations have in their budgets to promote breastfeeding?  Not much in comparison.  Are parents around the world getting a balanced view in making their "choice" to breastfeed or not?  

Advertising directly to the public, gives the infant formula industry an unfair advantage.  When choices are made because of advertising, is it really choice?  We have had regulation of advertising in regard to the Tobacco Industry because of their unfair influence over young people to smoke.  Once a person starts to smoke it is very difficult to quit.  Likewise once a mother starts using infant formula, it becomes very difficult to reverse that decision.  Regulations on Tobacco advertising have not ended the industry, people are still smoking despite the known risks.  The curtailing of tobacco advertising and the use of extra sales tax on cigarettes to use in anti-smoking advertising campaigns has balanced public information.  Likewise we need balanced information regarding the choice of infant feeding.

So what is stopping us from using the WHO Code to balance the public information on infant feeding?  There are many reasons.  One reason I suppose is that in the US there is a belief in "free markets" and the rights of corporations (corporations are legally considered persons).  What this means politically is that any regulation of corporations is often dismissed by various political groups.  Although amazingly enough, our country started regulating the advertising of tobacco because more and more people understood the health risks of tobacco.  If more and more people understood the health risks of infant formula, I believe advertising of infant formula would be curtailed in the US.  We would then be abiding by at least one of the provisions of the WHO Code.
One of the provisions of the WHO Code is "No advertising of breastmilk substitutes."

Another thought I have is that IBCLCs request that the IBLCE re-institute the principle of ethical practice in which, "IBCLCs must adhere to those provisions of the International Cod of Marketing Breast-Milk Substitutes and subsequent resolutions which pertain to health workers." (#24)
 http://www.childbirthinternational.com/course/IBLCECodeofEthics.pdf

In 2011, the IBLCE (the certifying organization for IBCLCs) eliminated the Code of Ethics for IBCLCs and renamed it the Code of Professional Conduct for IBCLCs.  There is no principle regarding the need for IBCLCs to adhere to the WHO Code.  Although interestingly enough they did keep the principle of respecting intellectual property rights (which includes patents).  The WHO Code does appear briefly on the Code of Professional Conduct for IBCLCs prior to the Preamble but it is no longer a principle.
http://iblce.org/wp-content/uploads/2013/08/code-of-professional-conduct.pdf

I realize that people think that because the WHO Code is mentioned prior to the listing of principles that this is just as good as having it as a principle.  But I think that by removing this as a principle seems to imply that the WHO Code is really not an important principle.  And in the FAQ regarding the Code of Professional Conduct for IBCLCs, I find the statement regarding the question of whether it is unethical for an IBCLC to work for an infant formula company to be most illuminating.  "However, from a legal perspective IBLCE cannot prohibit, or pursue ethical sanctions against a certificant who chooses to work for an infant formula company."
http://iblce.org/wp-content/uploads/2013/08/code-of-professional-conduct-faqs.pdf

I have been rather astounded by this perspective by the IBLCE.  It's one of the reasons I let my IBCLC credential lapse.  I think if one believes as I do that breastfeeding is a health care decision not a personal lifestyle choice, then one of the principles of a profession that serves mothers and babies has to be the WHO Code.   

I think if we understand the history of the last 50 years regarding the epidemiology of breastfeeding, we would regard the WHO Code as vitally important.  If we continue to avoid the need for the Code, then we will continue to see more of the kind of advertising like the Similac Ad.  Scapegoating breastfeeding advocates will silence the willingness of parents to listen to breastfeeding advocates.  And it will also create advocates who are even less likely to discuss the risks of infant formula.
Copyright 2015 Valerie W. McClain




Saturday, January 31, 2015

The Similac Ad and the Tobacco Industry: Similar Marketing Strategies


"We think we should start not by raising barriers, but by lowering our voices.  We think smokers and non-smokers can work out their differences together in a spirit of tolerance and fairness and respect for each other's rights and feelings."
--RJ Reynolds 1986 from Strategies of the Tobacco Industry by Larry Breed
http://archive.tobacco.org/resources/history/strategieslb.html

and

"I was interested to read the descriptive names and phrases used to describe those involved in the anti-tobacco movement.  They are 'zealots,' 'anti-smoking agitators,' 'health campaigners,' 'tobacco prohibitionists,' 'overzealous do-gooders' and 'busybodies.'"  Strategies of the Tobacco Industry

"Tobacco's message is free choice."  Strategies of the Tobacco Industry


If the Similac Ad was instead an ad for a specific brand of cigarettes, what would we see and hear?  What music would be in the background?  I envision that it would be Michael Jackson's Billie Jean. My feet start tapping to the beat and the words drift through my mind..."Billie Jean is not my lover....be careful of who you love  and be careful of what you do cause the lie becomes the truth."

 I see the playground and the players:  the smokers, and then we see the zealots. The do-gooders pushing through the swings.  "Look,the Tobacco police are here!"  If only smokers and non-smokers would get along because after all this is about civil liberties and free choice.  It's not about health.  It's about choice.  There is no proof that cigarette smoke cause human disease.

All the smokers and non-smokers in my imagined ad start a verbal "rumble." Who's right and who's wrong?  Just as this verbal war reaches a crescendo to the tune of Billie Jean, a smoker accidently drops her lit cigarette into an overflowing trash can.  The trash can ignites and suddenly everyone races to the trash can and together they put the fire out.  See, simple if we would all get along, our problems would be solved!!  

Then across the screen our new mantra is unveiled and the soft soothing background music--the music we hear at the grocery store to keep us soothed and buying-buying.  "No matter what our beliefs, We are people first."   Yep...I believe I believe...we are people!!  

In stark black and white we see the "Brand," the cigarette product doctor's and hospital's recommend.  And then under the "Brand" is #Peoplehood Unite.  

Should we honestly believe that the infant formula industry has no strategy? They are playing the Tobacco Industry playbook.  The playbook that reinforces the self-esteem of the people who are using their product while scapegoating advocates who consider their product a health risk.  This particular ad establishes the credibility of the company as fair players.  Its a playbook we need to understand.  And it's why we absolutely need the WHO Code to regulate the marketing of infant formula.
Copyright 2015 Valerie W. McClain



 



Monday, January 26, 2015

Escaping MotherHood and joining the SisterHood


PATENT #8802650 "Methods of using human milk oligosaccharides for improving airway respiratory health."  filed in December 2011 owned by Abbott Laboratories. The patent states:

"The HMO [Human Milk Oligosaccharide] or HMOs may be isolated or enriched from milk(s) secreted by mammals including but not limited to human, bovine, ovine, porcine, or caprine species."  [also may be manufactured by microbial fermentation and/or chemical processes]

"Furthermore, the use of HMOs in nutritional compositions can reduce the growth of respiratory viruses (e.g. RSV, human parainfluenza virus type 2, and influenza A virus), and thus, reduce viral-induced upper respiratory infections.   As such, by utilizing HMOs, alone or in combination with other immune enhancing factors, in a nutritional product, such as an infant formula, it is now possible to provide infants with an alternative, or supplement, to breast milk that closely mimics the benefits thereof."  

Hm...should we ask Abbott Laboratories (manufacturer of Similac) how it is that Human Milk Oligosaccharides can be found in the milks of cows, chickens[correction sheep-ovine is sheep--sorry], pigs or monkeys?  Yes human milk oligosaccharides are found in human milk but how is human milk oligosaccharides produced by other mammals?  Genetic engineering?

This patent is almost as strange as the "Similac" Ad that some people are writing about and watching on you tube.  The ad is Abbott's promotion campaign called, "sisterhood of motherhood."  This is a you tube video to end the "Mommy Wars."  Ironic, if you believe as I do, that the Mommy Wars was a public relation campaign brought to you by Similac. 

As we watch the video, we find ourselves in the Hood, the realm of "mommies" and stay-at-home daddies.  The scene takes place at a playground.  We see mommies everywhere:  sitting on benches with their babies strapped to their bosoms, striding through the park pushing strollers like their are weapons of war, mothers bottlefeeding, mothers breastfeeding in their hooter hiders, lesbian mothers, working mothers, and stay-at-home fathers cooking hot dogs while taking care of their babies.  

We are in the Hood.  The music brings us back to the place we want to escape from--the Hood or is it MotherHood?  Like so many people stuck in the ghetto of lost desires, we subliminally accept this message.  We are at war with each other and ourselves.  Mothering has become a battleground in which we all struggle to escape. The battle fronts are clearly seen as mothers march through the park.  The first words spoken in this music video are from the formula feeding mothers, "Oh look the Breast Police have arrived."  We see the breastfeeding mothers pushing through the empty swings.  One breastfeeding mother angrily shakes her breast towards the formula feeding mothers.  One breastfeeding mom states that those who don't breastfeed are, "too lazy to breastfeed."  Who do we sympathize with in this video?  It appears to me that the breastfeeding moms are the bullies of this Hood.  Most women would hate to be perceived as bullies and most women are brought up to not be aggressive on our playground called life.  Will the audience sympathize with these breastfeeding moms?

The video ends with the name Similac against a black background and the slogan, "Sisterhood Unite."  Similac is a brand of formula, the company that manufactures this particular brand is Abbott Laboratories.  I have read comments by various moms who mix this up, believing that there is a Similac company who sells Similac formula.  After watching the video I understand why Abbott is doing this.  Using the brand name of the formula rather than the company name means that more product is sold.  The company name is not as important as the name of the product they are selling. Abbott Labs is a huge well-known pharmaceutical company with no need to keep their name in your brain. 

At the end of the video, the music becomes softer as everyone chases the baby in the runaway stroller.  They all save the baby, and they all start hugging each other.  What a creative and easy solution to the "supposed" mommy wars.  Life just isn't that simple.  Solutions to problems in real life take longer than a few minutes of running downhill.  The video ends with the mantra, "No matter what our beliefs, We are parents first."  What does this really mean?  I know a lot of religious parents who would say that their faith comes first, before their parenting.  Usually we start out with a set of beliefs about parenting prior to our first child and that is often refined and even changed once we actually parent.  The mantra Similac uses is really devoid of understanding of the complexity of human conflict.  Does parenting unite us?  Or, is it just as likely to divide us?

 I have begun to imagine a Father Similac, the parent figure to us all. He comes to our rescue, quoting scripture from the book of corporate values.  The price of going along with corporate values is to ignore some uncomfortable truths, to stay silent in order to keep the peace.  Peace at any price...where have I heard that before? 
Copyright 2015 Valerie W. McClain


Wednesday, January 7, 2015

Commercialization of Human Milk--Part 2


"Indigenous  peoples worldwide are now at the forefront of a new wave of scientific investigation:  the quest for monopoly control of genetic resources that will be useful in new pharmaceuticals, nutriceuticals and other bio-engineered products."  by Debra Harry, Executive Director of the Indigenous People's Council on Biocolonialism, in 2001.
http://www.ipcb.org/publications/other_art/globalization.html

THE TALE of LACTOBACILLUS REUTERI PROTECTIS

In 1990 Dr. Ivan Casas (who would later become Research Director of BioGaia of Sweden/USA- a company that markets and sells probiotics) went looking for a strain of Lactobacillus reuteri (L. reuteri) that could be commercialized.  It is quite probable that the interest in L. reuteri derived from the observation that this bacterium produced a substance called reuterin,a broad-spectrum antibiotic. With increasing antibiotic resistance, a natural occurring antibiotic, would be a great discovery, as well as of great financial interest.  In Peru he found the strain he was looking for in the breastmilk of Indians from villages high in the Andes.  He had examined breast milk from mothers in the USA as well as South American mothers in Lima Peru and had not found this particular strain.  Whether these Indian mothers from the Andes were direct descendents of the Inca or Arawak, I do not know.  But who would have believed that the milk that these women donated would contain a bacteria that would become very popular as a supplement for infants and children, as well as adults.  It would also become known as Lactobacillus reuteri Protectis, and BioGaia in 2012 would sell the rights of its patent for use in infant formula to Nestle.  "BioGaia received EUR 40 million up-front and a commitment to a further EUR 10.8 million during the period 2014 to 2017 upon achievement of certain milestones."
http://www.biogaia.com/press/biogaia-enters-new-extended-agreement-nestle

Initially this strain of bacteria from human milk was deposited at the American Type Culture Collection (ATCC) as Lactobacillus reuteri SD 2112 but later given the number ATCC 55730In 2007 it was replaced and became Lactobacillus reuteri DSM 17938.  According to Biogaia literature, the strains ATCC 55730 and DSM 17938 are "considered comparable in all aspects of probiotic function."  The only difference is that DSM 17938 no longer carries the two plasmids that carried resistance to tetracycline and lincomycin.  The original ATTC 55730 had these plasmids that carried antibiotic resistance.   
http://www.biogaia.com/history-lactobacillus-reuteri

According to the ATCC the Lactobacillus reuteri that was isolated from human milk is connected to patent #7344867,  This patent is entitled, "Selection and use of lactic acid bacteria for reducing inflammation in mammals." filed in 2005, invented by Eamonn Connolly who was the Senior VP for Research at BioGaia, and patent inventor to quite a few other patents owned by BioGaia.  Eamonn Connolly is now Head of Research and Development at Infant Bacterial Therapeutics AB of Sweden, a subsidiary of BioGaia.  He also is one of the authors of a recent paper published in The American Journal of Tropical Medicine and Hygiene entitled, "A Phase One Safety Study of Lactobaciluus reuteri Conducted in the Peruvian Amazon:  Observations from the Field,"  published 2/10/2014.  The was a phase one trial under the FDA Investigative New Drug program.  Forty-five healthy adults received either L.reuteri DSM 17938 or a placebo.
 http://www.ajtmh.org/content/90/4/777

Thus the bacterium from the breastmilk of Peruvian Indian mothers of the Andes lives on and on.   And breastfeeding mothers and infant formula feeding mothers around the world will use and benefit from the donated milk/bacterium of Peruvian Indian mothers.  And a few companies will financially benefit from "their invention."  And people will continue to believe that the commericalization of human milk has not happened yet.  I find it fascinating that one of those industries that benefits from this kind of invention is the infant formula industry and particularly that it is Nestle.  If moms make the choice to not breastfeed, then industry will make sure moms get the human milk component equivalent to the real thing.   Don't ask questions about these kind of inventions.  Don't ask about ethics regarding donating human milk (breastmilk is often called white blood-the collection of white or red blood is often about collecting DNA) for research. But the next time you dose your infant or child with this particular probiotic or give the infant formula with Lactobacillus reuteri Protectis, say a little prayer of thanks to the Indian women of the Andes!
Copyright 2015 Valerie W. McClain