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)

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.

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."

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

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