Friday, September 28, 2007
I would like to thank everyone involved for their help with it. In providing reports about baby food company marketing practices to our monitoring project, for expert input, for proof reading, for gaining the official support of your organisation. Just about all health professional and mother support groups are backing the call for implementation of the World Health Assembly marketing requirements in the UK.
Whether the Government will act remains to be seen. Our aim and that of our partners is to protect all mothers and infants, whether breastfeeding or formula-feeding, by ensuring information is accurate and independent, support for mothers for breastfeeding and support for those who use formula to reduce the risks.
Our report is called: Protecting breastfeeding. Protecting babies fed on formula.
There will be an official launch in due course. You can read the report and obtain a printed copy via the Baby Milk Action website.
Unfortunately, this is only the beginning.
We have to see if the Food Standards Agency will take on board the views of the health experts and implement the international standards. As in every country, it will be up against the lobbying of the baby food industry. And, as I reported earlier this week, our Minister for Public Health was sharing a platform with Nestlé at a Nestlé-sponsored event at the Labour Party Conference. The event was about obesity. Ironically, if the government took action to protect breastfeeding, it would have an impact on obesity. Nestlé is not a big player in the UK formula market - its attempts to break in have gone disasterously wrong. But the companies that are here also have a record of aggression against legislaton that may hamper their growth in sales. For example, Wyeth/SMA is involved in a legal battle in the Philippines to have regulations struck down.
The draft UK regulations put out for consultation were not good. We now have to see what will be presented to the Parliament. Then we will have to campaign to ensure a weak law is strengthened or a strong law is not sabotaged. So much to do. But having worked on the report through the past few weekends, it is time for a rest.
One thing to finish. I had to check one of the statistics I have been using. This came from the Government Infant Feeding Survey 2005, which states : "Nine in ten mothers who gave up breastfeeding within six months would have preferred to breastfeed for longer, this level declining as breastfeeding duration increased. Although even among those who breastfed for at least six months, 40% would have liked to continue longer."
It's on page 221 of the report, but it is wrong as one of the experts working on the submission pointed out.
These are the actual findings in graphical form. This shows the proportion of mothers who stopped breastfeeding who would have liked to breastfeed longer:
Elsewhere in the report it states 9 out of 10 mothers who stopped breastfeeding by 6 weeks (not months) said they wanted to breastfeed for longer.
All the same, 40% of mothers who breastfed for at least 6 months said they wanted to breastfeed for longer.
Something is wrong if so many mothers are not able to breastfeed for as long as they wish.
Stopping the aggressive formula marketing practices is only the part of the story, of course. Mothers experiencing difficulties with breastfeeding need support.
An integrated approach can work. This is a graph from a Brazilian paper by Dr. Marina Rea, showing how median breastfeeding rates have recovered from less than 3 months in the 1970s to more than 10 months today.
The text refers to various initiatives to support mothers, including introducing progressively stronger legislation. I've written about this previously at:
When I saw the UK government survey report had this error with the 90% figure, I thought of making a flippant comment about not being able to trust the government.
But we do have to trust they will put infant health and mothers rights first (saving a fortune at the same time) by strengthening the law.
We can set out the evidence. We can campaign - and we will need your help to lobby your Member of Parliament if you are in the UK.
But at the end of the day, it is the politicians who hold the power to decide what is written into legislation.
Thursday, September 27, 2007
Though first remember that NUMICO, the transnational corporation behind the Cow & Gate brand, has been told by the Food Standards Agency that only claims permitted by the law can be used on labels of infant formula. The LACORS (Local Authorities Coordinators of Regulatory Services) guidance to Tradng Standards officers states that claims such as "Prebiotics supporting baby's natural defences" are non-compliant with the legislation. See:
There is also an Advertising Standards Authority ruling against prebiotics claims in a Cow & Gate follow-on milk advertisement which stated: "Our range of follow-on milks all contain a bunch of goodies called prebiotics to help build natural defences. Prebiotics are the special ingredients naturally found in breast milk, which of course is the best form of nutrition you can give your baby. But if you're not breastfeeding, our follow-on milks can still help your baby build strong defences." The evidence provided did not substantiate the claim. See:
Okay, so now to the reports we are receiving of Cow & Gate representatives in Tesco supermarkets pushing their formulas at customers, with stands, vouchers and prominent shelf talkers. Here is one:
If you are a regular reader of this blog it will come as now surprise to learn that despite all the above this includes the claim that Cow & Gate is 'with Prebiotic Care to support your baby's natural immune system'.
Is the law in the UK really so toothless? Yes, I'm afraid it is. If you look closely at this shelf talker you will see the small print says 'from 6 months to 3 years'. This enables the company to claim it is for follow-on milks not infant formula - though that is with it on the shelves. The UK law prohibits promotion of infant formula, but allows it for follow-on milks. Although the ASA has ruled against the claim in a follow-on formula advertisement it means nothing to the company.
The representatives are also handing out and displaying money off coupons with the claim that the formula helps 'support you baby's natural immune system throughout their early years'.
So the law is an ass and the draft revision of it prepared by the Food Standards Agency is little better.
With partners in the Baby Feeding Law Group and Breastfeeding Manifesto coalition, we are calling for the law to be strengthened. The Telegraph newspaper reports on this today. See:
Tomorrow is the deadline for submitting comments. See:
Wednesday, September 26, 2007
Here's how Nestlé strategy works. Last year Nestlé was due in court in the US as the International Labour Rights Fund brought a legal action over its failure to implement a 5-year plan to erradicate child slavery on the cocoa farms in Ivory Coast that supply it. Nestlé refused to attend a meeting hosted by the Senator who had developed the plan it had signed up to, but was happy to sponsor and attend a public meeting at the Labour Party Conference in the UK about slavery. We did manage to mobilise some leafleters and my colleague, Patti, attended the event to raise questions from the floor. See our press release from the time which links to an audio interview with the Director of the International Labour Rights Fund at:
This year, as well as the baby food issue, Nestlé has been trying to shake off criticisms of its unhealthy foods, which are implicated in the epidemic of obesity, and its illegal water extraction in São Lourenço in Brazil.
So guess the theme of the two meetings it has sponsored at this year's Conference?
On Monday it was on obesity with the New Statesman Magazine. See:
The Public Health Minister was on the panel and someone raised form the audience raised the question of the current consultation on the UK baby food law and questioned how the government can claim to be independent of the baby food industry.
Today it was on water, hosted by the Foreign Policy Centre, under the title: "Water: how can we better manage our most precious resource?" See the pdf downloadable by clicking:
I've written here previously about the ten-year campaign to stop Nestlé's illegal exploitation of water in São Lourenço, Brazil. After meeting the water campaigners at other events, we shared our experiences and helped to organised a meeting in the UK in March last year about their efforts to stop the illegal extraction and demineralisation of water from the historic water park. Nestlé's pumping has affected the natural springs and the tourism on which the town depends.
In 2005 I visited São Lourenço and spoke to the Public Prosecutor who had taken Nestlé to court after the citizens of the town raised a petition. Under the legal system he had to investigate the allegations in the petition and, finding a case to answer, had filed what is called a civil public action. I also met the Congressman, Dr. Rosinha, in Brasilia who had organised a public hearing into Nestlé's operations and found they not only contravened Federal Law, but their attempted justification for continued pumping was totally invalid.
I compiled documents, including a legal opinion from a Federal Prosecutor which again found the activities were against the law and suggested an investigation into possible corruption amongst officials who had allowed it to continue. I also spoke with a hydrologist in the park and collated official test results and investigations into what had happened. This evidence can be made available for journalists and others in the UK interested in this case.
Finally, earlier this year, the Public Prosecutor and Nestlé signed an agreement that pumping had to stop and the park be renovated otherwise Nestlé would be liable for daily fines. Recently pumping did indeed stop, over ten years after it began. Nestlé is now the world's biggest bottled water company and there are similar complaints about its treatment of communities and the environmental impact of its activities in other countries. Including the UK (see the 2005 news report here).
There wasn't time for my colleague Patti Rundall in the fringe meeting audience to raise all this today, but she did question Nestlé's presence there when it is the target of the boycott over its baby food marketing, its illegal water activities and the fact that its own audit, conducted by Bureau Veritas, was being used by Nestlé when it so blatantly failed to give the facts. Nestlé refers to the Bureau Veritas audit in a Public Relations publication on its activities in Latin America. See:
That press release links to supporting documents substantiating the allegations against Nestlé.
Nestlé's Hilary Parsons was on the panel and came out with various claims that she knows to be untrue, saying Nestlé abides by the baby food marketing requirements and that it had done nothing wrong in São Lourenço, citing the Bureau Veritas audit.
I have discussed the audit with the Bureau Veritas investigators. My view is they were either incompetent or part of the misrepresentation of the facts. When I encountered them at the launch of Nestlé's PR report on Latin America they seemed to be unaware of the civil public action, despite having visited São Lourenço and being shown around by Nestlé. Eventually Bureau Veritas admitted: "our work did not constitute a legal audit as such, nor did it include a review of the on-going civil action".
Nestlé's use of a report produced by auditors who apparently didn't even know it was fighting a legal battle over its operations shows just how duplicitous the company is.
You can see some of the evidence yourself by following the links from the press release referred to above. Here's a flavour - the map showing a new wall and expanded bottling plant was built in an area of maximum environmental vulnerability, for which Nestlé did not have permission.
You can also read the transcript of a radio programme recorded by the BBC and broadcast in 2005, and listen to it on line. See:
Those who have taken Nestlé's money for these fringe events and shared a platform with it as it boasts of its 'good works' and brushes aside criticism are in a poor position to hold it to account. They are unlikely to be familiar enough with the evidence to respond to the demonstrably untrue claims made by Nestlé and they would appear rude and ungrateful if they did.
I wish they would think a little more about how they appear involving themselves in Nestlé Public Relations strategy in this way.
For Nestlé it is money well spent. Nestlé loves the image transfer it gains from such events. No doubt, its cheque book is at the ready to book up events for next year.
Tuesday, September 25, 2007
It is a broad coalition, including Baby Milk Action (which is the secretariat for the Baby Feeding Law Group), the Breastfeeding Manifesto Coalition and individual members of these coalitions: Midwives Information & Resource Services, National Childbirth Trust, Save the Children and Unicef UK and the Mother and Infant Research Unit, University of York.
We are calling for the Government to implement the International Code of Marketing of Breastmilk Substitutes (which should be read together with the subsequent, relevant Resolutions of the Assembly which address changes in scientific knowledge and marketing practices and questions of interpretation).
This includes a ban on advertising and other forms of promotion of breastmilk substitutes. It is for health workers to provide accurate and independent information to parents and carers.
It also includes the right to accurate and independent information on use of formula for parents and carers who use it.
The consultation period comes to an end on Friday. See:
Monday, September 24, 2007
There was a great deal of controversy in 2005 when Chief Executive Officer, Peter Brabeck-Letmathé, had himself declared Chairman of the Board of Directors as well. A shareholder rebellion over this outright breaking of corporate-governance best practice got only 36% of the vote.
Shareholder democracy is compromised as Nestlé makes it difficult for share owners to register their shares. Indeed, so few are registered that it makes it statistically impossible to change some aspects of the articles of association of the company. Nestlé refused to let me register my one share, which the broker I used found unusual. It meant I couldn’t use it as intended to attend the shareholder meeting and had to go by other means. Nestlé claims that more than a third 'have elected' not to register their shares, meaning the two-thirds majority required for some changes is impossible.
There is a further obstacle to holding Nestlé to account through shareholder democracy. As I reported in April, it was a shock to see how shareholders hissed and booed anyone standing up to question Mr. Brabeck’s management practices. See:
With even institutional investors voicing concern when Mr. Brabeck's wanted to take on a dual role, only a third of votes represented at the shareholder meeting could be mustered. In an attempt to show sensitivity to shareholder concerns, however, Mr. Brabeck said he would stand down and Chief Executive in 2008, with his successor being identified in September 2007.
That process has now completed. And the winner is….
Mr. Paul Bulcke, currently Executive Vice President and Zone Director for United States of America, Canada, Latin America, Caribbean.
He is not yet a member of the Board. The Board is proposing that he be elected and appointed Chief Executive at the shareholder meeting in April 2008. This is being treated by Nestlé as a done deal and Mr. Bulcke will shortly begin the process of restructuring the Executive Board as CEO-designate.
So will Mr. Bulcke be any different from Mr. Brabeck when it comes to respecting the World Health Assembly marketing requirements for baby foods (or any of the other issues where Mr. Brabeck has attracted criticism and charges of abusing human rights and the environment)?
Well, we will give him a chance and ask him to accept the four-point plan aimed at saving infant lives and ultimately ending the international boycott. Mr. Brabeck rejected the plan and also rejected an invitation to attend an independent expert tribunal where he would have had the opportunity to show whether the claim that Nestlé markets infant formula ethically and responsibly is true. His reluctance to attend the tribunal is perhaps not surprising, as he knows we can demonstrate the claim is not true. Indeed, we have already done so before the UK Advertising Standards Authority after Nestlé made the claim in an anti-boycott advertisement.
Whether Mr. Bulcke will continue the strategy of denials and deception pursued by Mr. Brabeck in a failed attempt to undermine the boycott, while continuing with aggressive baby food marketing practices, remains to be seen. Nestlé’s Global Public Affairs Manager, Gayle Crozier Willi, admitted earlier this year that Nestlé is ‘widely boycotted’ so perhaps a new leader will face up to this and respond to the four-point plan.
Mr. Brabeck’s regime has been beset with public relations disasters on the boycott, from the ruling against the anti-boycott advertisement and his response to it (which generated headlines like “Mr. Nestlé gets angry") and his big book of letters from governments (which it turned out was not all it seemed). Perhaps his unsafe pair of hands when it comes to responding to the boycott will not be missed. See
Mr. Brabeck has been successful in delivering on the so-called Nestlé model. This involves aggressively pursuing growth in sales and unceremoniously dumping any business which does not achieve 5-6% annual growth.
This is where the signals about what to expect from Mr. Bulcke do not look good. As head of Latin America he has been successful in exceeding this growth target, with infant nutrition being one of the key growth areas.
He is already on the record saying that the recent acquisition of Gerber baby foods will be a motor for growth. As we exposed last year, Gerber violates the World Health Assembly marketing requirements in a systematic manner and there is little hope of this changing if it is fundamental to growth plans.
Mr. Bulcke has also stated that he sees China and India as key growth markets. The company has a poor record in both when it comes to baby food marketing. In China, for example, it provoked a boycott for refusing to remove from sale formula with levels of iodine outside permitted levels and then tried to recover its image by putting health workers into supermarkets in ‘nutrition corners’ where pregnant and lactating women were targeted. In India it has targeted medical students and workers with sponsorship in breach of national legislation and has distributed promotional leaflets to parents. See past reports in our Campaign for Ethical Marketing.
Will the new boss be the same as the old boss?
It remains to be seen. But Mr. Brabeck will remain the Chairman of the Board so setting strategic direction, which can't be good.
Some years ago, before he became Chairman, we wrote to all board members asking them to investigate Mr. Brabeck’s baby food marketing policies. We did not receive one reply. Since he became Chairman there has been little point complaining to him about himself and there will be little point complaining to him if Mr. Bulcke follows the same approach of putting profits before infant health and the rights of mothers.
All the same, we will write to Mr. Bulcke when he takes up his post and would like to raise questions at the shareholder meeting, if possible. Why not buy a share yourself and come along, or send us a donation to help us attend. See:
Friday, September 21, 2007
According to the UK Government’s national infant feeding survey (page 221), 90% of mothers who stopped breastfeeding by 6 months said they had wanted to breastfeed for longer. If obstacles were removed and better support given, then we could expect them to have their wish. Breastfeeding rates are higher in almost all European countries, markedly so in Scandinavia where the aggressive marketing of formula that occurs in the UK is absent. In Brazil breastfeeding rates have recovered from median duration of less than 3 months to ten months because of government action.
According to the UK Department of Health, breastfed infants are less likely to develop gastric, respiratory and urinary tract infections, obesity in later childhood, juvenile-onset insulin-dependent diabetes and atopic disease.
And as I have been hearing at the International Milk Bank Conference in Chester these past two days, premature infants receiving breastmilk (either from their mother or donor milk from a bank, should they be fortunate to have that opportunity in our current postcode lottery of coverage) are less likely to develop Necrotising Enterocolitis and less likely to die from it if they do develop it.
This reduction in illness and death equates not only to less suffering, but savings for the economy.
A paper cited by the UNICEF Baby Friendly Hospital training for policy makers (Powerpoint presentation) states the following:
This preliminary analysis of breastfeeding and formula feeding indicates that a minimum of $3.6 billion would be saved if the prevalence of exclusive breastfeeding increased from current rates (64 percent in-hospital, 29 percent at 6 months) to those recommended by the Surgeon General (75 and 50 percent, respectively).
This figure reflects approximately $3.1 billion attributable to preventing premature deaths, and an additional $0.5 billion annual savings associated with reducing traditional medical expenditures (for example, office or hospital visits, laboratory tests, etc.) and indirect costs such as forgone earnings of parents, among others.
This figure probably underestimates the total savings likely. This figure represents only cost savings due to reduced costs to treat three childhood illness; it excludes the cost of purchases for over-the-counter medications for treatment of OM and gastroenteritis symptoms, physician charges related to the treatment of NEC, and cost savings due to reductions in long-term morbidity.
Ref: Weimer. The economic benefits of breastfeeding: A review and analysis, Food Assistance & Nutrition Research Report No. 13. Wash.D.C., USDA, 2001.
As it says, this is probably an underestimate because only the costs of treating three illnesses in the first year are considered. As infants who are not breastfed are more likely to be sick in the longer term, these treatment costs could also be reduced.
Another factor missing from the equation is the treatment costs due to companies not providing preparation instructions in line with Food Standards Agency and World Health Organisation guidance for parents. Powdered infant formula is not sterile, but only one company in the UK warns parents of this fact (Hipp) and it directly contradicts the expert advice on how to reduce the risks of possible contamination. If companies were forced to provide correct information to parents who use formula, as we are demanding, then there could be a reduction in illness attributable to intrinsic contamination of powdered formula with Enterobacter Sakazakii, Salmonella and other pathogens, which is worryingly common (Enterobacter Sakazakii contamination was found in 14% of tins in a survey referenced by the US Food and Drug Administration). Fortunately the steps required to reduce the risks are simple. Unfortunately the industry is loathe to say anything about the risks associated with formula feeding and so does not communicate this. See:
If we scale the U$3.6 billion possible savings cited in the US study by the differences in population to gain a crude indication of possible savings for the UK, we arrive at a figure of £360 million for each year of breastfeeding rates at a higher level. A more accurate figure could be arrived at by comparing the assumptions in the paper with the UK situation.
Gordon Brown built his political reputation through being a ‘prudent’ Chancellor of Exchequer. Let us hope he will demand the Food Standards Agency conduct a proper cost-benefit analysis of bringing World Health Assembly marketing requirements into UK law so the enormous potential financial benefit is offset against any fears the government may have to spend a bit of money on lawyers to see off any challenge from the baby food industry wanting to continue aggressive marketing.
Thursday, September 20, 2007
I've written previously how this sometimes is missed in media coverage of our work, which can end up with a call for regulation of baby food companies being portrayed as an attack on mothers who use formula. See my blog on learning from the furore over the Wyeth/SMA promotion in OK! magazine linked to the celebrity Jordan at:
I said then that our call for accurate, independent information is to benefit mothers who use formula, for whatever reason, as well as to protect breastfeeding. Given the heat that can arise in discussions, we have launched a 'safer formula' campaign which we are inviting those who use formula to support and sign up to for updates on what is going on.
There are various blog entries here that are tagged with the 'safer formula', which can be called up by selecting the link at the side panel or the bottom of this entry.
I've added a separate Baby Milk Action group onto Facebook for those interested in keeping updated and discussing this aspect of our work, which can be accessed at:
Here is the description for it:
Baby Milk Action is a not-for-profit organisation that works to protect breastfeeding and to ensure breastmilk substitutes are used safely if necessary.
It is a mother's decision how to feed her child and she has a right to accurate, independent information free from commercial pressure, in line with marketing standards adopted by the World Health Assembly.
We monitor companies and work for the WHA measures to be implemented in legislation and enforced.
We attend the Codex Alimentarius Commission which sets composition and labelling standards for infant formula and other baby foods.
We and our partners campaign for companies to make permanent price cuts to what they charge for formula - it is one of the products with the highest mark ups. In Italy an illegal price-fixing cartel was broken by government action.
We campaign for governments to improve independent sources of information on formula. Monitoring shows that companies do not provide objective information on their products. Nor is their information and instructions on preparation in line with World Health Organisation guidance to parents.
You can find information on our work to make formula-feeding safer at:
This group is intended for parents and carers who use formula and for health workers and provides links to where to find independent information and our campaigns.
Search for Baby Milk Action for our group on wider aspects of our work, such as protecting breastfeeding and the Nestlé boycott.
Wednesday, September 19, 2007
If you have pictures of our merchandise in action and would like them to appear on our Baby Milk Action Virtual Shop comments blog, please send them to me.
Some new merchandise is in the pipeline. We are thinking baby bibs and adult aprons. What do you think? What images or slogans would you prefer?
Merchandise income helps to keep us operating and independent.
Tuesday, September 18, 2007
Infants who are not breastfed, for whatever reason, are at greater risk of short and long-term illness and we want to see those risks reduced. We have been working on this for years - as well as protecting breastfeeding - and recently launched a 'making formula safer' campaign to make it clearer that the regulations we want to see implemented and enforced are there to protect all mothers and babies.
Our main focus at the moment is on responding to a UK government consultation on proposed regulations for the marketing of formula. As they stand, these would allow companies to introduce new ingredients into formula and launch them onto the market without seeking any approval, without registering any evidence on the safety or need for the new ingredients, without any independent review of evidence and without an independent monitoring system for health workers and others to report concerns. All companies will have to do is present a model label of their new product to the Food Standards Agency. In theory they have to have studies that demonstrate the safety of the ingredients, but there is no requirement to present this or for the ingredients to be approved before being put on the market. You can help us achieve better controls by supporting our safer formula campaign and our work (why not become a member of Baby Milk Action?)
The forthcoming added-insulin formulas I wrote about yesterday have prompted me to do a little more digging for this blog.
The patent awarded to the company and Dr. Naim Shehadeh (who appeared in the media report cited yesterday) for the proposed formula is No. 6399090. You can find it here:
In presenting the possible benefits of the invention, this states: "exposure to bovine insulin present in fresh cow milk, which differs from human insulin only by three amino acids, may break the tolerance to insulin and lead to autoimmune diabetes."
Autoimmune diabetes or type-1 diabetes is also known as insulin-dependent diabetes mellitus (IDDM). This is where the pancreas is damaged and so cannot produce the insulin needed to control blood sugar levels. Damage may occur due to a virus or it can be because the immune system attacks the cells in the pancreas. This type of diabetes can affect children.
The other type of diabetes, type-2 or non insulin-dependent diabetes (NIDDM), is more common and is associated with adults and their lifestyles.
Both are on the increase. The annual conference of Diabetes UK earlier this year heard about a new study on the increase of type-1 diabetes, as reported by the BBC. See:
Lead researcher Professor Polly Bingley said the rate of childhood Type 1 diabetes was increasing all over Europe, particularly in the very young.
She said the increase was too steep to be put down to genetic factors alone.
"So it must be due to changes in our environment.
"This could either mean that we are being exposed to something new, or that we now have reduced exposure to something that was previously controlling our immune responses."
She suggested that fewer mums opting to breastfeed their babies might be a factor.
Another possibility is that children are being exposed to fewer germs, affecting the development of their immune systems.
Dr. Shehadeh's patent suggests that exposure to bovine insulin in cow's milk, the primary ingredient of most infant formula, may provoke an immune response in the child. In other words, the suggestion is the child's body sees the bovine insulin as an infection and produces antibodies to attack it. This reaction may prompt the immune system to go on to attack insulin-producing cells in the pancreas, so causing type-1 diabetes.
While the patent talks of fresh milk, the reference cited is actually for infant formula. I find this a little curious.
It is this study: Vaarala O, Paronen J, Otonkoski T, Akerblom H K. Cow milk feeding induces antibodies to insulin in children--A link between cow milk and Insulin-Dependent Diabetes Mellitus?. Scand J Immunol 47:131-135, 1998.
You can find it here:
Exposure to cow milk (CM)-based formulas in early infancy has been associated with an increased risk of insulin-dependent diabetes mellitus (IDDM), but studies on the possible pathogenic mechanism(s) linking CM and IDDM are contradicting. We hypothesized that if CM formulas contained bovine insulin (BI), exposure to them could lead to immunization against insulin, which is the only known β-cell-specific autoantigen in IDDM.
They did find higher incidence of antibodies in infants fed on cow's milk formula than infants fed on hydrolised formula (where the protein has been broken down) or breastmilk.
They suggest: "The high incidence of insulin-binding antibodies in young children with IDDM may be explained by oral immunization to BI present in CM. Exposure to BI, which differs from HI only by three amino acids, may break the tolerance to insulin."
So the higher incidence of type-1 diabetes in formula-fed infants, and the increase in this in recent years (now affecting 20,000 school-age children, notes the BBC report) may have something to do with this reaction to bovine insulin in formula. Though, as the study says, the evidence on the mechanism has been contradicting.
Dr. Shehadeh has published a paper in which he proposes the mechanism by which insulin in breastmilk protects against type-1 diabetes. The reference is: Shehadeh N, Shamir R, Berant M, Etzioni A. Insulin in human milk and the prevention of type 1 diabetes. Pediatr Diabetes. 2001 Dec;2(4):175-7.
You can find it here:
This is the abstract:
Although controversial, exclusive breast milk feeding was shown to exert a protective effect in preventing type 1 diabetes. In contrast, an early introduction of cow's milk-based formula in young infants may enhance the risk of disease, especially in genetically susceptible children, presumably by an increase of intestinal permeability to macromolecules such as bovine serum albumin and beta-casein, which may arouse autoimmunity.
We have shown that human milk contains insulin in substantial concentrations, while insulin is barely detectable (if at all) in infant formulas. Orally administered insulin was demonstrated to promote gut maturation and to reduce intestinal permeability to macromolecules.
Furthermore, oral insulin may induce tolerance to insulin and protect against the development of type 1 diabetes. We herewith raise a hypothesis that human milk is protective against the development of type 1 diabetes by virtue of the effects of its substantial content of insulin.
So the study suggests that the relatively high levels of insulin in breastmilk help the development of the gut, so preventing substances entering the blood stream to provoke an immune response. And at the same time, exposure to the insulin in breastmilk may induce tolerance to insulin, rather than an immune response.
The patent is a little more definite in its claimed benefits:
Addition of insulin to infant formula leads for the following beneficial effects. First, it renders the infant formula more similar to human milk. Second, it protects from the development of Type-1 diabetes. Third, it improve the development and maturation of infants intestine. The addition of insulin to infant formula is safe for at least two reasons. First, the concentration of insulin is selected similar to that found in human milk. Second, oral insulin administration is already used in several human trials
As I wrote yesterday, expect 'closer to breastmilk' claims and the suggestion the formula helps prevent diabetes.
The proposed UK law would allow this product onto the market. All the company has to do is send a label to the Food Standards Agency. That's all. The authorities don't have to check the science or evaluate the safety of the product. A product that will be the sole food for a child in its most critical phase of development outside of the womb can be launched without prior authorisation.
It may well be that adding insulin will mean that formula-fed infants are less at risk - but it may put them at greater risk. While the patent covers the possibility of adding insulin with the same amino acid sequence as human insulin, it covers other possibilities too. If it is true that bovine insulin, which has only three amino acids different, can provoke an immune response, what of the synthetic insulin this patent allows for?
Though the patent glosses over the fact by referring to fresh cow's milk, the study cited to show that bovine insulin may provoke type-1 diabetes is for infant formula. Is it certain that added insulin will protect against the bovine insulin in the formula that carries it?
A few years ago Dr. Shehadeh responded to a study on giving insulin to premature infants published in the British Medical Journal. See:
We suggest to add human insulin to infant formulas in a concentration similar to insulin concentration present in human milk. This addition may lead to the following beneficial effects: It will make infant formula similar to human milk; it may fasten gut maturation; and it may protect from the development of type 1 diabetes.
The lead researcher, Robert J. Shulman M.D., responded:
I am familiar with the work of Dr Shehadeh et al. There may indeed be a place for insulin in infant formula. However, before such a step is taken, I believe that it is imperative that appropriate prospective studies be done, including safety monitoring. Although our human pilot study and animal studies suggest there may be a benefical effect of oral insulin, much more work needs to be done and recommending its use now is, to my mind, not appropriate.
There needs to be more research, something the company plans to do. However, there are a whole host of ethical issues about how to do research on new-born infants and the role that companies wishing to bring a product to market should have in them.
I hope to return to this topic with more information on current thinking on whether adding insulin will reduce the health risks of formula feeding and the ethical concerns about research.
The more pressing task is working to ensure the UK law will only allow products onto the market with new ingredients if they are safe and necessary. You can support our campaign for safer formula at:
Monday, September 17, 2007
In my representation of the race (which you can hear by clicking here), the different formulas are jostling for position, diverting attention from breastmilk, way out in front. Not only does breastmilk have many times the number of 'prebiotics' (oligosaccharides) than formulas that boast of them, they are those a child needs. Breastmilk has Long Chain Polyunsaturated Fatty Acids and, unlike those in formula, they do actually appear to benefit brain and eye development. While powdered infant formula is not sterile and may contain pathogens such as Enterobacter Sakazakii and Salmonella (requiring care in preparation), breastmilk is not sterile because it is a living substance containing anti-infective properties produced by the mother in response to infections in the environment. Breastmilk is like a dose of medicine every time the child is fed.
But that is not all. Breastmilk contains factor X. Something not yet identified, but is perhaps important for the benefits breastfed children gain. Then there is factor Y, which has been identified, but cannot yet be simulated in the laboratory or in a cost-effective way to add to formula. Then we have factor Z, which can be simulated and added to formula, but does not have the same effect in the different environment of formula. LCPs are one example, but there are others, such as iron. Formula has far higher levels of iron because most of it is not absorbed by the child from formula. Virtually all of the iron in breastmilk is absorbed.
So breastmilk is way out in front in the race, but all the shouting is being done by the companies with their products in the pack behind. Which is the best? Which is the closest? They want to keep the attention focused on that part of the race.
If breastfeeding is not an option, if expressed or donor milk is not available, if wet-nursing is not culturally acceptable or discounted for safety reasons, then formula is the next best option. It is a legitimate product and we are not saying it should be banned. But it should be seen as what it is. An artificial substitute for a natural substance. The aggressive marketing generates a different perception. It suggests formula is hot on the heels of breastmilk and we should be cheering for it. "Love the milk you give" is the slogan of one of the companies in the UK.
I can imagine a diabetic using artificial insulin may love the fact it is available if he or she cannot produce his or her own. But I wouldn't want to see artificial insulin promoted on television and in celebrity magazines with a 'love the insulin you give' slogan and pictures of happy people and cuddly toys. I wouldn't want company produced materials causing me to doubt if I am producing enough insulin myself, suggesting symptoms that could indicate my insulin isn't up to the job and suggesting a little insulin supplementation may be a good idea. I wouldn't want a vocal advertising war over which artificial insulin is 'the closest to real insulin'. Certainly, I'd be grateful if it was available if I needed it, but I'd rather have my own insulin production system well checked out and medical advice before deciding I did need it or which brand to use.
Insulin is very relevant to this topic, because it is a missing factor in formula according to a recent report. This is from Israel21c:
In the first 24 hours of life, a nursing baby gets a big zing of power from its mother's milk. "This is a mother's first gift to her child," says Professor Naim Shehadeh, head of the Pediatric Diabetes Clinic at the Rambam Medical Center in Haifa, describing the nutrients and vitamins that mother's milk provides the newborn.
"Insulin is 100 times more concentrated in the first milk a mother gives her baby than in the blood. Nature must have a reason for enriching the first milk and helping the newborn get over the shock of the first 24 hours," explains Shehadeh, who specializes in pediatrics and endocrinology, and is also on the faculty of the Technion Institute Medical School.
Now get this:
Formula does not contain insulin.
Infants who are formula-fed are more likely to suffer from diabetes in later life.
These facts may be totally unconnected, but you can see they would make a great marketing campaign for a 'new improved' infant formula.
I've not looked into this thoroughly yet, but a microbiologist tells me that insulin-type growth factors in breastmilk are thought to be important for gut development and could be part of the reason why infants not fed breastmilk, particularly premature babies, are at greater risk of necrotising enterocolitis, an illness where the gut does not develop the blood vessels it needs, meaning the child cannot absorb food properly. NEC, as it is known, can be deadly, but it is a more immediate problem than diabetes.
All the same, the report goes on:
An expert in juvenile diabetes, Shehadeh and others observed the higher incidence of the disease among children who had not been breastfed.
"An alarm went off in my head," he told ISRAEL21c, and the first seed was planted for an idea for a formula for non-breast-fed babies that would come closer to the benefits of mother's milk - specifically the massive amounts of natural insulin found in mother's nectar.
So guess what may be just around the corner. Infant formula with insulin: "The result of that alarm is InsuMeal, a bioactive insulin protein that can be added to commercial infant formulas to make them closer to mother's milk."
Remember what market analysts Hambrecht and Quist said about Formulaid, the concoction of Long Chain Polyunsaturated Fatty Acids put on the market in the 1990s:
The history of infant formula has shown that virtually all similar examples have led to wide-scale introduction of such additives into infant formula, even if there was no evidence that the additives were important. Infant formula is currently a commodity market with all products being almost identical and marketers competing intensely to differentiate their product. Even if Formulaid had no benefit we think that it would be widely incorporated into most formulas as a marketing tool and to allow companies to promote their formula as 'closest to human milk.'
Things could go the same way with InsuMeal.
There is a problem, however, as the article explains:
"We looked on the market and we did not find any baby formula with insulin. It was lacking in all," said Shehadeh. "The reason insulin is not in formula, is because it is very sensitive to heat and mechanical stress, and usually destroyed in formulas. We developed a new technology to keep the insulin bioactive. We also have a usage patent."
You may recall that most companies are failing to warn parents that powdered infant formula is not sterile and the need for a high temperature step in reconstituting it to kill any pathogens. Some companies directly contradict the expert guidance to parents from the World Health Organisation. See:
We believe part of the reluctance is that new additives just around the corner, such as so-called probiotics and perhaps this insulin supplement, may be damaged by high temperatures. Perhaps the companies don't want parents to get used to using water above 70 deg. C to kill possible bacteria contamination because it would undermine their marketing claims about these new additives when they come if they would also be damaged.
There is a debate to be had over whether the benefits of new additives is greater than the risk from pathogens. For that there needs to be careful research.
Unfortunately, the proposed regulations currently out for consultation in the UK will allow companies to add new ingredients and launch new products onto the market without proving the safety or necessity of new ingredients.
In the government's proposals, companies simply have to submit a model of the label they plan to use to be held on file. That's it.
We are saying companies should submit research studies, much of it independently funded and conducted, and that these should be independently reviewed. If new ingredients are found to be safe and necessary for infant development, then they should be a legal requirement in all formulas.
For infants who are not breastfed, we are talking about the sole food during the most important phase of development outside the womb. Formula should be as good and as safe as possible.
You can support our campaign to make formula safer and sign up for updates at:
At the moment the claims around InsuMeal are hype, based on a study of 8 infants. The report continues:
"We believe that InsuMeal is a vital nutritional supplement. When the results of the forthcoming clinical trials are published, and the health benefits demonstrated, we will need a manufacturing base ready to meet the demand," said Shehadeh. China and India - where formula growth has been particularly high - are expected to be big demand markets.
The global wholesale market for infant formula is valued at US$8.5 to 9.5 billion in the article.
So what have we learned?
These 'closer to breastmilk' formulas on the market are now revealed to be missing insulin, according to this report. Why wasn't that mentioned in the company promotions?
What about factors X, Y and Z.
We have also seen that jumps in logic are made without real basis. Breastmilk has insulin. Breastfed babies are less likely to suffer from diabetes. Ergo, alarm goes off and potential big demand is spotted. The trials to show safety and health benefits are still to be done and the company is seeking investors to pay for these and the marketing, creating a conflict of interest.
In the race between formulas to appear the best and closest to breastmilk, look out for a new slogans in the years to come.
"Love the insulin you give", perhaps.
Friday, September 14, 2007
There are several groups on Facebook discussing the boycott. I've added a Baby Milk Action one as a place to provide information on our campaigns. See:
Meanwhile in North Carolina, students have been protesting over a total of $450,000 in grants from Mead Johnson being made to the school during the next three years for research and speaker fees. The Mead Johnson Center for Excellence in Children's Nutrition has been established at the school.
Brook Colgan, a second-year graduate student in the Department of Maternal and Child Health, told the Daily Tar Heel student newspaper: "I really feel that had there been a thorough investigation of the track record of Mead Johnson, they would feel differently."
The paper also reports: Nutrition professor Linda Adair said the protesting students have not properly researched the company's background, basing their evidence on studies that lack support. "Our understanding is that Mead Johnson is conducting itself in a very ethical way."
I posted the following comment:
This article only scratches the surface. Mead Johnson promotes its formulas around the world with idealizing claims that are not substantiated by independent reviews of the evidence. See details on my blog about the Nestlé boycott and other baby food companies:
Mead Johnson is a member of the Pharmaceutical and Health Care Association of the Philippines (PHAP) which has taken the Ministry of Health to court to try to have regulations for the marketing of baby foods struck down. It promotes its formula Alacta in the Philippines. Although the biggest ingredient in Mead Johnson's infant formula, Alacta, is corn syrup solids, it claims to contain 'FibreCal' and 'DHA precursor with Brain nutrients'. See:
For a film from UNICEF Philippines showing the impact of promotion by Mead Johnson and others (which can be viewed on line) see:
The PHAP has advertised in the Philippines in support of its attack on the law. The United Nations Special Rapporteur on the Right to Food has called these advertisements: "misleading, deceptive, and malicious in intent". See:
I work for Baby Milk Action which, as part of the International Baby Food Action Network (IBFAN), monitors the baby food industry around the world against marketing standards adopted by the World Health Assembly.
Let's hope those who make the decisions will click on a few links.
Thursday, September 13, 2007
Boots was running a promotion on baby foods. Quite rightly the promotional information on this pointed out that infant formula was not included in the promotion. This is because the UK law prohibits point-of-sale promotion of infant formula. The International Code of Marketing of Breastmilk Substitutes, which Boots should abide by independently of government measures, prohibits promotion of all breastmilk substitutes, feeding bottles and teats, but Boots does not care about this and breaches the wider provisions with impunity because they are not covered by our narrow law. Even so, Boots has repeatedly over-stepped the line and broken the narrow law, without once being prosecuted. See examples at:
The promotion in August did exclude infant formula. As well as pointing this out on promotional information, there were rather curious shelf talkers with the infant formula, like this:
Click on it for a larger version. It states:
"We're really sorry the Infant Formula and Follow-on Milk Regulations do not allow us to offer you price reductions or promotional offers on infant formula. Baby milks up to 6 months."
This struck me and others as a little odd. It is one thing to highlight exclusions from a promotion, another to regret the constraints of a law intended to protect infant health.
I should point out here that we are not against permanent price cuts for infant formula. In fact we campaign for companies to reduce their profit margins on formula. The mark up on formula is greater than most other products on the shelves. It is a real money spinner. We think companies should stop profiteering from mothers who use formula and cut their prices - not as a promotional strategy to gain more customers, but as a permanent change. In Italy in 2005 a successful action was brought by competition authorities against the companies for effectively forming a cartel to keep the price of their formula high, upto 3 times the price in some other European countries. The companies fined over 9 million Euros were: Heinz, Plada, Nestlé, Nutricia, Milupa, Humana and Milte (details in this report from law firm DLA piper avaialable as a pdf).
Okay, back to Boots. I wrote to the company about this shelf talker:
I find it curious that you feel the need to go beyond informing shoppers that infant formula is not included in the promotion on baby goods by making a prominent attack on a law which is intended to protect infant health. May I ask why you are ‘really sorry’ at the provisions of these regulations and why you wish to highlight your sadness to shoppers? It seems to me unprecedented that Boots should advertise its dislike for regulations in this way and you may wish to reconsider your wording.
Boots responded in part:
---Extract from Boots' response begins
The signs were displayed to explain to our customers' that we could not offer them any promotional offers on these products. I'm sorry that you are unhappy that we used the words 'we are really sorry..., but they are words that are commonly used in store marketing messages where we are not able to meet our customers' expectations. At no time were they ever intended to 'make a prominent attack on a law which is intended to protect infant health'. The sign was merely meant to be a warm and friendly message informing customers that we are not able to deliver what they wanted.
So Boots suggests the law denies customers what they wanted. I dispute this. Many customers, I am sure, want to see Boots respect the International Code and Resolutions. Otherwise why would they complain to us about violations?
I believe that parents that use formula would rather have an end to profiteering than promotions. As well as accurate information on how to reduce the risks of formula. Boots, however, sells formula with labels that contradict the guidance for parents on mixing up formula from the Food Standards Agency and the World Health Organisation. I raised this in my letter:
Boots shows continued contempt for the International Code and subsequent, relevant Resolutions of the World Health Assembly. Your contempt for the Code and Resolutions has helped lead to the low breastfeeding rates in the UK and the lack of objective information for parents who use formula. As you are no doubt aware, you are currently selling powdered infant formula that directly contradicts government and World Health Organisation guidelines for parents that formula should be reconstituted with water of at least 70 Deg. C. This endangers babies, abuses the rights of parents who use formula and is irresponsible. I suggest it is more appropriate that you should be ‘really sorry’ for these actions and correct them.
Boots responded as follows:
---Extract from Boots' letter
With regard to the other comments in the last paragraph of your letter, the products that Boots sells are products which comply with the requirements and provisions of the current infant formula law and if you have issues with respect to those requirements, we would respectfully suggest that you take that up with both the manufacturers and the legislators responsible for the law in Europe.
This is untrue. Boots has been selling and continues to sell formula that the authorities say is non-compliant with the UK Infant Formula and Follow-on Formula Regulations 1995.
We do indeed raise these issues with manufacturers and legislators and, as a result, the Food Standards Agency wrote to companies telling them to remove non-compliant claims from their labels. Boots continues to sell non-compliant products as they work through the system. See:
Regarding the instructions on preparation, the Food Standards Agency issued its guidance for parents in November 2005 following concerns over the deaths of infants in Belgium and France due to intrinsic contamination of powdered infant formula. Parents have a right to know that powdered infant formula is not sterile and the simple steps to be followed to reduce the risks. All companies have issue new labels since then, but do not give the clear information and warnings. One company, Hipp, directly contradicts the FSA guidance. See:
The important lesson from Boots response is that it requires legislation to hold manufacturers and retailers to account. Boots is happy to push things to the limit of the law - and sometimes beyond, as our monitoring evidence shows - regardless of its responsibilities to abide by the Code and Resolutions independently of government measures.
So please do help the campaign to protect breastfeeding and make formula feeding safer. The consultation being run by the government ends this month. See:
With your help we can strengthen the law, even if it will make Boots 'really sorry'.
Wednesday, September 12, 2007
It is going to be a great event, with speakers from around the world. You can find out more about the programme on the website of the UK Association of Milk Banks at:
It says: "UKAMB invites everyone with an interest in human milk banking to attend this important conference. These two days offer the opportunity to meet and share information with professionals from the fields of human milk banking, neonatal nursing, midwifery, medicine and microbiology. Accreditation for CME points has been applied for."
Here's the poster for it - click on it for a larger version (this is a link to it on their server so it will update if it changes, but it may also disappear once the conference is over):
The UK Association of Milk Banks are doing great work in building the UK network of donor human milk banks and promoting professionalism and robust quality control and safety procedures.I attended an international milk bank conference in Brasilia two years ago, speaking on the marketing requirements for baby foods. Brazil has a large and growing network of milk banks and, as you know, my wife Sonia used to coordinate the milk bank in São José dos Campos, São Paulo. She will be with me on the stall to share her experiences.
So I hope to see you there. You can obtain a booking form at:
Attendance starts at £60/day for students.
When you mention milk banking in Brazil, many people remember the news piece on the fire workers who support the milk banks by collecting donor milk.
You can watch the realplayer clip by clicking here.
Tuesday, September 11, 2007
I never met Dame Anita. Before my time at Baby Milk Action, she had given support to the campaign in distributing some of our leaflets through the Body Shop. My contact with her began in March 2006 when I woke to hear on the radio that she was planning to sell Body Shop to L'Oreal. This gave me two immediate campaign objectives: to ensure future media reports flagged up that L'Oreal is part-owned by Nestlé, the target of a boycott as it breaks the marketing requirements for baby foods more than any other company, and to contact Dame Anita to raise these concerns with her. It seemed unlikely I would be able to convince her to think again, but I did hope for a statement on the Nestlé link. It took a long time to prompt a response. See:
Nestlé, with its 28.8% shareholding in L'Oreal, profits from its sales and so profits from Body Shop too. This seemed to have been ignored in Dame Anita's public statements defending the deal with the argument that Body Shop would be a Trojan horse, changing L'Oreal from within. As a company from which Nestlé profits, we added Body Shop to our boycott list. A survey of boycott supporters via our website found that literally 99% said they would add Body Shop to their personal boycott, which focuses on Nestlé's leading brand, Nescafé coffee. We have since assisted supporters in leafleting to expose Nestlé malpractice outside Body Shop outlets.
It was our announcement of leafleting in May 2006, to coincide with the annual demonstration at Nestlé (UK) HQ, that finally prompted a response from Dame Anita, stating: "I object to the way Nestlé behaves. I am all too aware of their track record on baby milk, GMOs and Ethiopia, you have to have been living in space to not know their reputation." See:
This generated another round of media coverage and was the sort of strong comment that we had been looking for, even if Dame Anita did step back from Body Shop's stated support for boycotts by saying: "Boycotts rarely work and the people you hurt are primarily the weak and frail." And I was disappointed that in subsequent interviews she tried to downplay the impact of the boycott:
In its report on her passing, the Financial Times recalls some of this controversy and notes that Body Shop has continued to grow despite being added to the Nestlé boycott list. That does not mean boycott supporters who said they would avoid Body Shop for independent, ethical alternatives have not done so. It reflects the expenditure L'Oreal has made in promoting the brand and expanding it in new countries. Nestlé's aggressive business strategy also grows its sales, but it takes notice of the boycott because it affects its ability to grow, its profits and its image. See:
I had contact with Dame Anita twice more on this issue.
Someone flagged up to me that Body Shop was a part-owner of Day Chocolate company, producer of Fairtrade brands such as Divine and Co-op home-brand. This ownership had been included in the sale to L'Oreal. I contacted Dame Anita and Day about this, pointing out the all-too-likely scenario that the shareholding would pass to Nestlé. The Chief Executive of Nestlé is on the board of L'Oreal and I could see him making the suggestion. Why on earth hadn't this been anticipated? Why hadn't the other shareholders been given a buy-out option? It would create a disasterous situation for co-owners Twin Trading and the Ghanaian farmers cooperative that provides the cocoa. The Day Chocolate company also has links with Comic Relief and Christian Aid.
In campaigning there is a time to shout and a time to do things quietly.
This could have been another round of controversy, which had already generated prominent coverage for the Nestlé boycott, including a front-page story in The Independent. But the message that came back to me was to keep quiet because things were afoot to rectify the situation. So I went along with this, seeing that if we shouted about the risk of the Fairtrade-chocolate company falling into Nestlé hands, then Chief Executive, Peter Brabeck-Letmathé, could, out of obstinancy, make a grab for the shareholding. Better to give some time for Dame Anita to get the shareholding back if she could.
Fortunately she succeeded, as we reported in our Update newsletter. The shareholding was transferred not to Nestlé, but to Kuapa Kokoo, the Ghanaian farmers cooperative that part-owned Day. This gives the farmers a 47% holding. Also see the Day Chocolate company website. It was a perfect solution to my mind.
A few months ago Dame Anita phoned Baby Milk Action in a rush. She had a meeting with Nestlé - perhaps as an advisor to L'Oreal, she was going to encounter Peter Brabeck-Letmathé at a board meeting - and wanted a briefing on current concerns. So I ran through some of the cases of aggressive marketing we were targeting and how Nestle's policies are not in line with international standards.
I didn't expect she would make a breakthrough as experience shows Nestlé only changes its baby food marketing policies and practices when forced to by legislation or campaigning pressure, but having a call for change from another direction could be helpful if handled correctly. Sometimes such intiatives can be counter-productive - the Methodist Church Central Finance Board is pursuing a strategy of 'engaging' with Nestlé while refusing to 'engage' with Baby Milk Action to inform its discussions. The Board recently made a naive and potentially damaging report to the Methodist Conference.
I never heard back from Dame Anita about what happened with her meeting. We certainly haven't seen any great change of heart from Mr. Brabeck.
I guess it was Dame Anita trying to change things from within. As The Financial Times mentions she has : "passed away before what she had called her "Trojan Horse" strategy at L'Oréal could unfold."
Channel 4 television news tonight had an interview with Mark Constantine who worked with Dame Anita and had apparently offered to buy the company as an alternative to the L'Oreal deal. He is co-founder of a competing chain with an 'ethical' business approach. He recalls his time working with Dame Anita here:
He made an excellent point on the news about the 'Trojan Horse' strategy. To paraphrase: every day a Chief Executive wakes up, there are decisions to be made. It doesn't take buying a company to bring an ethical dimension. The Chief Executive can simply start taking different decisions.
In itself, looking for ethical business leaders is not the solution - it is for society through its laws to set the boundaries on what is and what is not acceptable as business practice - and we should not be taken in by well-sounding promises that mean little or only produce token changes. But the more business leaders who start their day thinking about the impact of decisions on people throughout their supply chain and the wider environment, the better.
With Body Shop (at least until it was floated as a public company, something she said she regretted) Dame Anita did demonstrate that business leaders can consider more than the profit motive.
Monday, September 10, 2007
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Friday, September 07, 2007
Claims that formulas with added LCPUFAs benefit brain and eye development are widespread. We have exposed how Nestlé promotes its formula with the claim it contains 'brain building blocks' and yesterday I was looking at Mead Johnson promotion for its Enfamil Lipil formula in the US and UK.
We receive monitoring reports from the US from time-to-time from mothers who have received a crate of formula at home from a company without any request for it. Samples and free supplies are prohibited by the International Code of Marketing of Breastmilk Substitutes. They undermine breastfeeding.
Imagine if you are at home with your new child of two or three weeks. You have sore nipples and your child who isn't latching on well is hungry and crying. You are in pain, frustrated and concerned that your child is not getting the sustenance needed. You're about to reach for the phone book to find a lactation consultant who you hope can help you through this difficult period when there is a knock at the door. It's a crate of formula. Not only does the thought of switching to formula offer immediate relief and an end to your baby's crying, a quick check into the formula shows you it claims it will actually help the brain and eye development of your child. You know 'breast is best', but the formula claims to be based on breastmilk and close to breastmilk. You may well take the totally understandable decision to believe what the company says and forget about calling the lactation consultant.
It is for a mother how to decide how to feed her child. However, a mother has the right to make that decision based on accurate information free from pressure from companies who have a vested interest in selling their product. The first crate of formula may be free, but once the child is on formula and a mother's milk has dried up, she is a captive consumer, unless she can obtain help with relactating.
We don't want to see mothers being forced to suffer if they experience difficulties with breastfeeding, but nor do we want to see companies targeting mothers, particularly during the time when breastfeeding is being established. We want there to be better support for mothers and, if she decides to use formula, accurate, independent information on the differences between the brands on the market and how to reduce the risks of formula feeding. That is achieved in part through implementing and enforcing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly.
Now, how could the crate of formula have magically appeared on the doorstep at the time when a mother is feeling most vulnerable? Well, in some cases it could have come from the health worker calling the company to register the birth.
In 2002 Mead Johnson ran a promotion for babies born on Labour Day. See:
---Extract from Mead Johnson promotional information
For every woman giving birth on Labor Day 2002, Mead Johnson Nutritionals will provide them with a FREE case of its new infant formula, Enfamil(R) LIPIL(R) with Iron. Enfamil LIPIL is the only infant formula in the United States that contains DHA and ARA - important building blocks of a baby's brains and eyes that are found naturally in breast milk - at levels clinically demonstrated to support brain and eye development in infants vs. the same formula without DHA or ARA. LIPIL is Enfamil's unique blend of DHA and ARA.
"We are committed to helping all infants get the best possible start nutritionally," said J. Roberto Moran, MD, Vice President and Medical Director for Mead Johnson Nutritionals, "We fully believe that breastfeeding is ideal for babies - breast-fed babies receive the benefits of DHA and ARA from their mother's milk. For moms who choose to use formula - either right from birth, following weaning from breast milk or as a supplement to breastfeeding -- Enfamil LIPIL is a great option."
Studies Show Benefits of LIPIL
Mothers could register themselves or: "Healthcare professionals can also call **** or send a fax to **** to provide the baby's birth date (it must be September 2, 2002) and provide shipping information. Mead Johnson will send a case of free Enfamil LIPIL formula right to parents' doorsteps."Generous, huh?
But what about the studies that Mead Johnson claims prove the benefit of its formula?
According to the Cochrane Library review of studies, quoted at the start, there is little evidence of any benefit.
Let me just say if there was a benefit then we would want to see LCPUFAs in every tin of formula. Why should the health of infants fed with formula be compromised further by denying essential ingredients? But when the European Scientific Committee examined whether LCPUFAs should be made essential ingredients it concluded there was no need to do so as there was no apparent benefit from adding them. We defer to the independent experts.
So what about the research referred to by Mead Johnson? This is what is says in the promotional information:
Enfamil LIPIL has been shown in some studies to support infant brain and eye development when compared to the same formula without DHA and ARA. One study led by Eileen Birch, PhD, of the Retina Foundation of the Southwest and funded by the National Institute of Child Health and Human Development found that infants fed Enfamil LIPIL from birth to four months scored an average of seven points higher (on a 100-point scale) on a test of mental development at 18-months compared to infants fed the same formula without DHA and ARA. The study also showed improved visual acuity equal to about one line on a standard eye chart in the one-year-old infants fed Enfamil LIPIL.---quote ends
Wow! Branier kids with better eye sight, if this can be believed.
Interesting, but presumably one of the studies considered in the Cochrane Review. Mead Johnson's use of the phrasing 'shown in some studies' reveals that the research is not conclusive.
But what about this study? It was, so it says, funded by the National Institute of Child Health and Human Development.
It seems it is this study: "Eileen E Birch et al. A randomized controlled trial of early dietary supply of longchain polyunsaturated fatty acids and mental development in term infants. Developmental Medicine & Child Neurology 2000, 42: 174–181."
I am not going to attempt a critical appraisal of it here. I defer to the Cochrane Library review on the benefits, or otherwise, of LCPUFA supplementation.
But I note a few very interesting points in the study not mentioned in the Mead Johnson promotional information.
Firstly, "Milk-based infant formulas were generously provided by the Mead Johnson Nutritional Center".
Okay, perhaps we can say that was nice of them and would have no influence. It was, after all, funded independently other than this wasn't it?
"This project was supported by NIH grant HD22380 and supplementary funding was provided by the Mead Johnson Nutritional Center."
Okay, so Mead Johnson was a funder, but they couldn't have had any influence on the reseach could they?
"A blocked randomization schedule was developed by the Mead Johnson Research Center (Evansville, IN) and provided in sealed envelopes to the study site."
Okay, so they provided the formula, some funding and the schedule for the study.
But, all the same, it could be a good study. It's just not independent, is it?
I am not about to question the work the Foundation does. I am happy to presume there are committed people doing their best to make a positive difference in this area.
But I will examine the claim to be independent by looking at the list of funders.
I guess you can see what is coming?
There in the Year Report 2006 is Mead Johnson.
Draw this all together and we have claims made by a company to promote its product that are not substantiated by an independent review of the evidence. A study that does appear to support the company's claims was provided with free formula by the company, part-funded by the company and provided with schedule data by the company. It was conducted by an organisation that receives other financial support from the company.
My conclusion is this: this is not the way to provide information to parents and health workers.
There needs to be independent and accurate information. Any claims should be based on independent science.
That is not only my point of view. The World Health Assembly has adopted Resolutions calling for care over conflicts of interest for health workers in the area of infant feeding. See the May 2005 Resolution WHA 58.32.
I think we would be wise to avoid conflicts of interest and should call on our policy makers to implement the International Code and Resolutions in independently monitored and enforced legislation.
What do you think?
If you want to defend a mother's right to independent and accurate information in the UK, please support our 'Making formula feeding safer' campaign: