Introduction
Index to violations featured
Conclusions

The Tip of the Iceberg - Volume 2

January 1998 to June 1998

Company responses to January 98 violations

Thank you for your E-mail message about Nestlé and baby milk which has been passed to me to reply to. Nestlé has always believed that breast-feeding is the best way to feed a baby, and we continue to fully support that view. We are committed to helping to promote breast-feeding, for example by the production of leaflets, posters and videos; by clear statements on our packs and any educational materials about the benefits of breast-feeding; and by co-operation with other parties in educational programmes. [ * Many of these activities are violations of the International Code - see examples on these sheets.] We market baby milk ethically, within the guidelines of the World Health Organisations (WHO) Code and within any national laws. For example in all developing countries we do not advertise baby milk to mothers or to the public, we do not use pictures of babies on our packs and we do not give free supplies to mothers . [ * See evidence to the contrary on these action sheets and in monitoring reports such as Breaking the Rules, Stretching the Rules 1998 and Cracking the Code] [ * Comments on the situation in Sri Lanka that follow refer to violation ref. 98/05] The allegations made by Baby Milk Action that we are "failing to honour our stated commitments in Sri Lanka" is misquoted and out of context. Nestlé fully supports legislation to implement the WHO Code, but the legislation must be clear, unambiguous, effective and must be implemented and monitored co-operatively by all concerned parties. [ * It is Nestlé which is refusing to co-operate. Does this mean the law has to be changed to suit Nestlé?]. Our dealings with the Sri Lankan authorities were to ensure effective legislation for the benefit of breast-feeding and for the provision of information to ensure safe and adequate nutrition for infants when breast-feeding is not possible or when thenutritional needs cannot be met by breast-milk alone (as required by the WHO Code). The allegations made against us in Pakistan are similar to the situation in Sri Lanka, and the above comments apply. We are not trying to weaken legislation, but in fact the opposite - to have effective law which will be enforceable for the benefit of child health. Our policy on marketing of infant formula in developing countries can be found on our website at: www.nestle.com/html/a2c.html/#charter [ * Our leaflet Nice design - shame about the text reveals the loopholes in Nestlé's "Charter"] Nestlé is extremely proud of its record of achievement in developing countries, where we have a long term commitment to working with local communities. We believe that it is through co-operation and sensitivity to the needs and cultures of these communities that real benefit can be brought to these countries, for example through the creation of employment, education and training, and environmental projects. We would be happy to send you further information by post if you wish. Yours sincerely Nestlé UK Limited Corporate Affairs Department Denise Briggs, BSC (Hons), SRD Specialist in Dietetics

Baby Milk Action's evaluation: The Code calls on companies to collaborate with government monitoring schemes Nestlé suggests that this means it must be part of the enforcement process This is not the normal situation regarding laws - the independence of enforcers is of paramount importance

For comments on Sri Lanka see violation ref. 98/05. Nestlé's demand for co-operation between all parties sounds rather hollow when it violates the International Code and Resolutions, even in the face of government requests for it to change its practices. The paper Engineering of Consent: Uncovering Corporate PR (available from Baby Milk Action) explores how companies, including Nestlé, call for co-operation most loudly when regulations are proposed. The report Feeding Fiasco (also available from Baby Milk Action) documents the activities of the baby food industry in Pakistan following monitoring in 1997. It demonstrates the need for legislation to stop practices such as paying doctors substantial sums of money to recommend a particular brand of infant formula. The International Code limits companies to providing scientific and factual information to health workers and gives health workers the responsibility for advising parents. Nestlé attacks this principle in an attempt to gain access to parents to promote its products. For example, Nestlé's submission to the Pakistan Government criticises the ban on advertising and states: "The right of families to informed choice is severely restricted - unless they can spare the time to consult a health worker each and every time they want information on infant and young child feeding - this goes beyond anything seen in the most authoritarian totalitarian state and will do nothing to promote improved health." The International Code does not give Nestlé the right to be included in a government monitoring scheme as Nestlé's response suggests. Article 11.2 gives responsibility for monitoring application of the Code to governments and states: "The manufacturers and distributors of products within the scope of this Code, and appropriate nongovernmental organizations, professional groups, and consumer organizations should collaborate with governments to this end." Nestlé interpretes this article to suggest it must be part of the enforcement process. This is not the normal situation regarding laws - the independence of the enforcers is of paramount importance. Article 11.3 makes it clear that: "Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them." Article 11.4 gives NGOs such as Baby Milk Action and the International Baby Food Action Network (IBFAN) a mandate for monitoring the industry and reporting violations. It also gives a role to individuals such as the Campaign for Ethical Marketing letter writers. It states, "Nongovernmental organizations, professional groups, institutions, and individuals concerned should have the responsibility of drawing the attention of the manufacturers or distributors to activities which are incompatible with the principles and aim of this Code, so that appropriate action can be taken. The appropriate government authority should also be informed." If Nestlé wishes to collaborate with governments in the monitoring of the law, it should be "proactive and more responsible to monitor its own marketing practices and respond promptly to correct all violations that are reported" as the World Health Organisation's Executive Director of Family and Reproductive Health requested at the 1998 World Health Assembly.

Wyeth (SMA) attempts to take over from health professionals (Ref: 98/02)

Wyeth, a subsidiary of American Home Products, and manufacturer of the SMA range of baby milks, is seeking direct contact with mothers to promote its products. SMA's round-the-clock "Careline" is being widely promoted in the UK on product labels and elsewhere. The International Code bans marketing personnel from seeking direct or indirect contact with pregnant women and mothers (Article 5.5). Wyeth responded to a letter writer in February 1998 as follows [Baby Milk Action comments in bold after the * symbol]:

Your January letter addressed to Mr. J. R. Stafford [ * Wyeth CEO] regarding the Careline in the United Kingdom has been referred to me for a reply. We are pleased to provide you with the following information. The UK Careline service was set up to respond to the increasing number of calls and letters from parents requesting information about Wyeth's products [ * The slogan for the "Careline" is "For more baby and toddler information call...". Companies should not seek direct or indirect contact with mothers.] The Careline service complies with the Infant Formula and Follow-on Formula Regulations of 1995 which are based on the European Commission Directive 91/321/EEC. This legislation was developed to support the aims and principles of the WHO Code taking into consideration the specific needs of the UK. [ * The Directive is weaker than the International Code. Wyeth denies its responsibility to abide by the International Code "independently of any other measures taken for implementation..." as required by Article 11.3] The Careline number is provided to parents but the phone calls are initiated by the parents who choose to use the service. The UK Government Guidelines for handling informational material allow for telephone contact between manufacturers and consumers. Wyeth did not send any Careline leaflets to Kenya which you mentioned in your letter. Thank you for the opportunity to address your concerns. Sincerely, Beverly Halchak Director Maternal-Child Health

Baby Milk Action's evaluation: Wyeth's "Careline" is banned by the International Code Companies are called on to abide by the International Code "independently of any other measures"

Wyeth's response raises several important issues. It demonstrates how Wyeth misrepresents the "Careline". Clearly Wyeth is attempting to solicit calls from parents, yet this is banned by Article 5.5 of the International Code states: "Marketing personnel, in their business capacity, should not seek direct or indirect contact of any kind with pregnant women or with mothers of infants and young children." Baby Milk Action believes it is important that companies give full information on labels. For example, a vegetarian may wish to know whether substances such as LCPs (long-chain polyunsaturated fatty acids) come from animal origins. Article 10.2 of the International Code refers to applicable standards of the Codex Alimentarius Commission, which generally require products to display company details. If a mother wishes to make contact she can do so without being prompted by Wyeth's "Careline" promotion. The International Code requires a warning notice on products stating "that the product should be used only on the advice of a health worker" and this is reflected in the UK law. Wyeth undermines this requirement in an under-lid leaflet by adding, "Or you can call us on the special Careline number." This case also demonstrates that baby food companies are prepared to ignore the provisions of the International Code despite the provisions of Article 11.3. It demonstrates the failure of the British Government and the European Union to impelement the International Code as required by World Health Assembly Resolution WHA34.22 under which the Code was adopted in 1981. This Resolution states that the International Code is a "minimum requirement" and urges all Member States: "to give full and unanimous support to the implementation of the recommendations made by the joint WHO/UNICEF Meeting on Infant and Young Child Feeding and of the provisions of the International Code in its entirety as an expression of the collective will of the membership of the World Health Organization; "to translate the International Code into national legislation, regulations or other suitable measures..." (emphasis added). Wyeth's inability to control distribution of its products and materials, which were found in Kenya, demonstrates the importance of following minimum international requirements such as the International Code and Resolutions. Baby Milk Action and UK health worker organisations continue to work for the full implementation of the International Code and Resolutions in the UK.

Wyeth (SMA) promotes genetically engineered soya to mothers (Ref: 98/03)

This violation concerned an information leaflet on soya, which refers to soya-based infant foods, but does not include required information. Wyeth responded to a letter writer in March 1998 as follows [Baby Milk Action comments in bold after the * symbol]:

Your January 30 letter addressed to Mr. J.R. Stafford Your January letter addressed to Mr. J. R. Stafford [ * Wyeth CEO] regarding the soy leaflet available in the United Kingdom has been referred to me for a reply. This particular leaflet was produced in response to general questions from parents regarding the soy beans which could be used as an ingredient in soy based products. The leaflet did not specifically focus on infant feeding Your January letter addressed to Mr. J. R. Stafford [ * Then why does the leaflet include a promotion of SMA "Careline" and the slogan "For more baby and toddler information call..."] It complies with the literature requirements of the EC Infant Formula Directive as implemented by the UK government (Infant Formula Regulations of 1995). [ * It does not comply with Article 5.5 of the International Code which is a "minimum requirement" companies should follow "independently of any other measures taken for implementation" (Article 11.3)] Your letter mentioned the UK Department of Health "concern" about phytoestrogens. The UK government has called for additional research on the phytoestrogen content of foods and milks fed to babies. All parties agree on the need for further research in this area. The current UK position (July 1996 Message from the Chief Medical Officer) is that soy based infant formulas should be used on the advice of health professionals and that those parents who have been advised to use soy products for their babies should continue to do so [ * the guidelines state that soy based formulas should only be used on the advice of health professionals - the leaflet does not mention this] All of our labels for our soy infant formulas state that the products should be used on professional advice [ * again, they should be used only on professional advice] and all the labels include the statement that breast milk is best for babies [ * the labels also promote the SMA "Careline" to be telephoned for advice. See violation ref. 98/02 "SMA attempts to take over from health professionals"] Your letter also mentions aluminium. Because aluminium is a naturally occurring substance, small amounts are inherently present in the materials used for infant formulas. The levels are low and the average baby would ingest less than the Provisional Tolerable Weekly Intake which was established by the Food and Agriculture Organization and the World Health Organization of the United Nations. No reports concerning adverse effects have occurred with respect to Wyeth infant formulas. We carefully monitor the aluminium levels present in our infant formulas and the UK Department of Health also routinely monitors all infant formulas available in the market. Over the years, we have worked with the suppliers of raw materials to reduce the levels even further. The leaflet did not cover the risks of allergy or the management of allergies because that was not its intended purpose. The leaflet was about soybeans. Use of the leaflet complies with the UK Government's Infant Formula Regulations of 1995. We wish to assure you that we view our responsibilities under the UK's Infant Formula Regulations very seriously and we remain committed to providing high quality products for those babies requiring special nutrition. We appreciate the opportunity to share this information with you and to respond to your concerns. Sincerely, Beverly Halchak Director Maternal-Child Health.

Baby Milk Action's evaluation: Higher levels of weedkiller in foods may follow use of genetically engineered soya if company lobbying is effective

The leaflet promotes Wyeth's SMA logo (SMA is the brand name for its infant foods) and so is subject to the restrictions of the International Code and so should include the information required by Article 4.2. Wyeth's argument in this response is exposed by the inclusion of its "Careline" logo and slogan "For more baby and toddler feeding information call.." It is interesting to note that the leaflet makes great claims for the environmental benefits of genetically modified soya. Yet soya is genetically modified to make it more resistant to weedkiller so that higher doses can be used. In Australia, where genetically modified soya is being used in formulas, the biotech company Monsanto has applied for a 200-fold increase in the allowable levels of its Roundup weedkiller in foodstuffs. Genetically modified organisms are controversial because of other possible risks to both health and the environment. Many UK NGOs are calling for a five-year ban while further research is conducted.

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Company responses to February 98 violations

A tangled web in West Africa (Ref: 98/04) A consultant acting for US Foods & Pharmaceuticals attempted to get the Ghanaian Government to support plans for launching an infantformula in Africa through free supplies

In September 1997 the consultancy firm Sar International wrote to the Ghanaian Ministry of Health on behalf of the company US Foods & Pharmaceuticals with a proposal for "launching My Baby infant formula in Ghana." Sar suggested that the Ministry identify non-profit organisations to solicit free supplies of the product. According to the letter, aid donors would then be asked to fund the supplies. Sar stated that My Baby formula would be for "distribution free of charge to the childrens hospitals, clinics and women clinics hospitals [sic]," and suggested that non-profit organisations "should express an interest in the products and that it will be responsible to distribute the products, nationally, free of charge." Sar indicated that US Foods & Pharmaceuticals would sponsor and conduct seminars on infant nutrition as part of the project. The IBFAN group, Ghana Infant Nutrition Action Network (GINAN), worked on the case nationally, sent a letter of complaint to Sar and alerted the IBFAN network. Sar claimed to have similar schemes planned for Cote d'Ivoire, Guinea, Liberia and Senegal. Baby Milk Action contacted both Sar and US Foods & Pharmaceuticals and informed them that free supplies are banned by the International Code and Resolutions. The case was featured on the Campaign for Ethical Marketing February 1998 action sheet. Sar subsequently demanded an apology, stating its project had been misrepresented. Baby Milk Action's solicitor responded. Sar apologised for any "misunderstanding" and announced that the project had been dropped. An international aid organisation, which Sar implied endorsed the project, also sent a solicitor's letter to the consultancy and received an apology for misuse of its name. Mr. Rajan Vembu, President of US Food & Pharmaceuticals, failed to respond to Baby Milk Action's telephone calls or letters. However, he did respond to a campaign supporter who complained about the project. Mr Vembu's letter, from the end of February 1998 follows:

I want to thank you for taking the time to write to me about "My Baby" infant formula for sale in Ghana. I personally appreciate your concerns. On behalf of USF & P, I can assure you that we never offered to provide any free products for distribution. However, we understand that a voluntary agency approached us to purchase our formula for needy persons, and USF & P is not involved in the distribution process. We only sell products at commercial prices. Our seminars if provided, are general in nature covering mostly health, sanitation, and preventative health care for professionals only. We do not promote our products in those seminars. Given my background and experience, we are very conscious about commercialism of infant formula in the third world countries. Our company in all aspects promote breast feeding along with good nutrition but we do not want to leave behind the ones that have no opportunity for breast feeding. Our formula meets FDA and WHO standards and is considered to be one of the best products in the market and our marketing practices comply with WHO regulations. We also encourage education in nutrition, sanitation and health care. We also encourage people such as yourself to become an active member in supporting programs in developing countries through UNICEF, WHO and other bonafide, beneficial organizations whose people dedicate their lives to service, volunteerism, and to improve the lives of people world wide. One such organisation is Africare located in Washington, D.C. who do a great service in Africa especially Ghana. I very strongly urge you to take a greater role in supporting this organization in Ghana. They are involved in drinking water issues, health care, low investment technological development to meet locals needs. A generous contribution from you will help them solve some of the basic necessities of the living poor. You may also want to consider volunteering with either Africare or the Peace Corps. I would be most enthusiastic to hear from you about your participation in any one of these programs. Once again I thank you for taking the time to write to me. Sincerely, Rajan Vembu President

Baby Milk Action's evaluation:

Mr. Vembu's response does not give an accurate presentation of the project as propsed to the Ghanaian Governement. To do this we have reproduced the letter Sar International sent to the Ministry of Health, Ghana (dated 19th September 1997) on the following pages. It is understood that the author is from Liberia and possibly not writing in his first language.

Reference: A None [ * sic] Profit Project for Selected West African Countries. I appreciate the opportunity to meet with you at your office in late June of this year, regarding the subject matter of launching "My Baby" Infant Formula in Ghana. I am pleased to introduce my client, US Foods and Pharmaceuticals, Inc. (USF & P) with Headquarters based in Madison, Wisconsin. Equally too, we solicit your cooperation in launching this non profit project, which respond to certain specific needs of child nutrition in Africa. Overview Background US Foods and Pharmaceuticals Inc., is an innovative company in research and development and focuses on products formulated to benefit the population in various parts of the developing world. USF & P has developed one of the most advanced nutritional formulae for infants from birth to one year and other follow-on formulas. The products, "My Baby" Infant Formula. We are putting together a non profit project for "My Baby" Infant Formula products, to be funded by an international funding foundation that has accepted to fund this project. The countries that the project is packaged for are listed herein. As manufacturer of it's Reference: A None [ * sic] products, USF & P will offer technical assistance to the non profit organization in this framework. USF & P's technical expertise is enhanced by the company is owned mostly by more than 150 medical doctors. Many of whom are members of the professional international organization, "Physicians without Boarders" who have an input formulation and testing of the products. Reference: A None [ * This organisation is not known, though it bears such a close resemblance to the organisation "Doctors without Borders" (the name of Medecin Sans Frontiers in the United States) that Sar issued an apology to the organisation after we brought the matter to their attention] USF & P products comply with the standards of the United States Food and Drug Administration (FDA) and the World Health Organization. USF & P is affiliated with Land O'Lakes Cooperative based in Minnesota, USA, in the manufacturing of the products. [ * Baby Milk Action wrote to Land O'Lakes about the project, but received no reply. Sar received a copy of our letter and wrote a strongly worded response to us claiming Land O'Lakes had no connection with the project and that we should issue an apology for suggesting they did. Our solicitor responded, pointing out that we contacted Land O'Lakes because they were referred to first by Sar.] Land O'Lakes does over 3.8 billion dollars business world-wide. The products come in powder form: "MY-BABY" INFANT FORMULA This is a registered trade name in the United States for the products for USF & P. It comes with low Iron and with Iron - Two products. The labels are in English, French or Arabic. Special labels are written in Chinese and Japanese for those markets. There are five infant formula manufacturers based in the United States. They are: 1.) Similac. It is manufactured by Ross Laboratories for distribution in the United States. 2.) Enfamil. It is manufactured by Mead Johnson for distribution in the United States. 3.) Good Start. Is manufactured by Carnation Nestle for distribution in the United States. 4.) SMA. Is manufactured by Wyeth Nutritional and is no longer marketed in the United States. 5.) "My Baby". Is manufactured by US Foods & Pharmaceuticals for world wide distribution. The Non Profit Project and Project Countries A Washington DC based international foundation, is prepared to consider funding containers of "My Baby" Infant Formula to a non profit charitable organizations in Africa. This non profit group should be pro women, pro children, pro national Government, one that is acceptable to the current National Government. This charitable organization once approved, would be send [ * sic] two twenty foot containers per year (every other six months) of "By Baby" [ * sic] Infant Formula, for distribution free of charge to the children hospitals, clinics and women clinics-hospitals. They will not be for resale. US Foods and Pharmaceuticals will visit in-country, with Physicians to discuss with the National Government's Ministry of Health, the non profit organization handling this project, nutritionists and doctors about childcare nutrition benefits. A one to two days seminar on this subject matter will be held, sponsored by US Foods and Pharmaceuticals. The seminar will be conducted by USF & P. This is a two year project to be funded by this foundation, for the following countries. Republic of Ghana Republic of Senegal Republic of Liberia Guinea, Conakry Republic of Cote d'Ivoire The Foundation is currently funding a five years project for the construction of Ten (10) schools and Two (2) hospitals in the Republic of South Africa. Amongst other recipients of funds from the foundation is Africare Inc. It funds Africare, Inc., the single largest African American none [ * sic] profit organization in the world that. [ * Baby Milk Action contacted Africare which confirmed it had no connection with the project]. Africare only place of business is Africa where it focuses and does business. Africare is in Forty Two (42) African countries and with it own offices. The foundation funds some of Africare's projects. Should an organization based in country be interested in this project please let that organization fax me directly and mail the original copy to me. The letter should be addressed directly to me. It should respond to the following subject matters: 1.) Introduce the organization and indicate when it was established. Discuss about it current organization activities. Give names of the officials of the organization. It should discuss some of the charitable works it is now undertaking. It should express and interest in the products and that it will be responsible to distribute the products nationally, free of charge. 2.) The capacity and resources to properly distribute the products effectively. 3.) Request and indicate the fact that it does not have funds available to finance the procurement of the products and a grant or funding request of the products would be highly appreciative. This will only be for two twenty foot container(s) 4.) Indicate that is has the capacity to properly warehouse the products securely. We will appreciate if you can facilitate this project by identifying a credible charitable group interested in cooperating with us on this project. Please accept that we anticipate your continuous cooperation with us to launch this project in Africa. I am enclosing herewith, a brochure on "My Baby" Infant Formula products. Best regards, Sar A. L. McClain, Sr.

Sar claimed that the request for free supplies of infant formula came from non-profit organisations Yet, Sar's letter to the Ministry of Health asks for help in identifying organisations to request free supplies The project was stopped following Baby Milk Action's campaign

Sar McClain was contacted by Baby Milk Action by telephone and asked to clarify aspects of the project. From this conversation Baby Milk Action understood that the product would be distributed under the project for general use and that USF & P had a long-term aim of manufacturing "My Baby" formula in Africa. We suggested that Sar and USF & P contact UNICEF or WHO to better understand the provisions of the International Code and Resolutions. Resolution WHA47.5 calls on Member States "to ensure that there are no donations of free or subsidized supplies of breast-milk substitutes and other products covered by the International Code of Marketing of Breastmilk Substitutes in any part of the health care system." Sar wrote to Baby Milk Action on 10th February 1998 and explained the origin of the project as follows: "...as a result of visits to Africa on business, and request from credible African charitable non profit organizations, Sar International was independently responding to specific needs of these organizations. And, in fact, the products were not for free." This contradicts the contents of the letter Sar wrote to the Ministry of Health soliciting requests for free supplies and our subsequent telephone discussions. We sent a solicitor's letter refusing to issue the apology Sar demanded. Sar subsequently apologised for any "misunderstanding" and announced that the project was not going ahead. The most interesting aspect of this case is the insight it gives into so-called humanitarian aid which companies often claim is only being supplied following a request for assistance. Perhaps it would be wise to question what efforts have been made by companies to secure those requests in the first place. See the report on Infant Feeding in Emergencies on the resource list for information on guidelines adopted by UK NGOs.

Nestlé attempts to weaken Sri Lanka's revised law (Ref: 98/05)

This violation concerned Nestlé's lobbying of the Government to weaken the Sri Lanka Code for the Promotion and Protection of Breast Feeding and Marketing of Infant Formulae and Related Products Nestlé's response to an e-mail complaint has been reproduced in the report on Pakistan's proposed law, ref: 98/01. See Baby Milk Action's evaluation for that violation as well as the comments here.

Baby Milk Action's evaluation: Nestlé attacks provisions in Sri Lanka's draft law which implement specific articles of the International Code and Resolutions Nestlé labels products in its home country of Switzerland in three languages, but complains when Sri Lanka proposes the same requirement

There are a number of interesting specific aspects to Nestlé's attempt at undermining the Sri Lanka Code. Nestlé said in its submission to the Government: "Article 7.8 [of the Sri Lanka Code] says that manufacturers should establish a monitoring system. It would make more sense to have a government monitoring system in which industry participates." Article 11.2 states that "Monitoring the application of this Code lies with governments..." While companies, along with NGOs and others, are called on to collaborate with governments this does not give them a right to be included in the government's monitoring system. In general laws are monitored by independent enforcers. In calling for manufacturers' to set up their own monitoring system, the government is implementing Article 11.3 states: "Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them." Nestlé also objected to the Government's implementation of World Health Assembly Resolution WHA49.15 which calls on governments "to ensure that the financial support for professionals working in infant and young child health does not create conflicts of interest." Nestlé complained: "Articles 5.4-5.6 [of the Sri Lanka Code] prohibit industry from providing any support to health professionals or medical researchers." Finally it is worth repeating that Nestlé complained: "Article 2.3 [of the Sri Lanka Code] requires that the label be printed in three languages." The same requirement is made in Nestlé's home country of Switzerland. It is ironic that Nestlé Public Relations materials claim it respects other cultures when it holds double-standards such as this.

Your January letter addressed to Mr. J. R. Stafford [ * Wyeth CEO] regarding the Careline in the United Kingdom has been referred to me for a reply. We are pleased to provide you with the following information. The UK Careline service was set up to respond to the increasing number of calls and letters from parents requesting information about Wyeth's products [ * The slogan for the "Careline" is "For more baby and toddler information call...". Companies should not seek direct or indirect contact with mothers.] The Careline service complies with the Infant Formula and Follow-on Formula Regulations of 1995 which are based on the European Commission Directive 91/321/EEC. This legislation was developed to support the aims and principles of the WHO Code taking into consideration the specific needs of the UK. [ * The Directive is weaker than the International Code. Wyeth denies its responsibility to abide by the International Code "independently of any other measures taken for implementation..." as required by Article 11.3] The Careline number is provided to parents but the phone calls are initiated by the parents who choose to use the service. The UK Government Guidelines for handling informational material allow for telephone contact between manufacturers and consumers. Wyeth did not send any Careline leaflets to Kenya which you mentioned in your letter. Thank you for the opportunity to address your concerns. Sincerely, Beverly Halchak Director Maternal-Child Health

Baby Milk Action's evaluation: Wyeth's "Careline" is banned by the International Code Companies are called on to abide by the International Code "independently of any other measures"

Wyeth's response raises several important issues. It demonstrates how Wyeth misrepresents the "Careline". Clearly Wyeth is attempting to solicit calls from parents, yet this is banned by Article 5.5 of the International Code states: "Marketing personnel, in their business capacity, should not seek direct or indirect contact of any kind with pregnant women or with mothers of infants and young children." Baby Milk Action believes it is important that companies give full information on labels. For example, a vegetarian may wish to know whether substances such as LCPs (long-chain polyunsaturated fatty acids) come from animal origins. Article 10.2 of the International Code refers to applicable standards of the Codex Alimentarius Commission, which generally require products to display company details. If a mother wishes to make contact she can do so without being prompted by Wyeth's "Careline" promotion. The International Code requires a warning notice on products stating "that the product should be used only on the advice of a health worker" and this is reflected in the UK law. Wyeth undermines this requirement in an under-lid leaflet by adding, "Or you can call us on the special Careline number." This case also demonstrates that baby food companies are prepared to ignore the provisions of the International Code despite the provisions of Article 11.3. It demonstrates the failure of the British Government and the European Union to impelement the International Code as required by World Health Assembly Resolution WHA34.22 under which the Code was adopted in 1981. This Resolution states that the International Code is a "minimum requirement" and urges all Member States: "to give full and unanimous support to the implementation of the recommendations made by the joint WHO/UNICEF Meeting on Infant and Young Child Feeding and of the provisions of the International Code in its entirety as an expression of the collective will of the membership of the World Health Organization; "to translate the International Code into national legislation, regulations or other suitable measures..." (emphasis added). Wyeth's inability to control distribution of its products and materials, which were found in Kenya, demonstrates the importance of following minimum international requirements such as the International Code and Resolutions. Baby Milk Action and UK health worker organisations continue to work for the full implementation of the International Code and Resolutions in the UK.

Company responses to March 98 violations

What Nestlé is trying to hide in the Philippines (Ref: 98/04)

Nestlé has been exposed in the Philippines for employing nurses as "Health Educators" who promote Nestogen infant formula to new mothers in the community. This violation has been highlighted by Baby Milk Action and our IBFAN partners for a number of years. On the March action sheet we published a photograph of a "Health Educator" at work taken from the 1998 IBFAN Philippines monitoring report. Nestlé responded to a letter writing campaign initiated by the Swiss Nestlé boycott group, Aktionsgruppe Nestlé. The translation provided to us is as follows: [Baby Milk Action comments in bold after the * symbol]:

On behalf of Mr. P. Brabeck [ * Nestlé CEO] we would like to comment on the points you raised. 1. Philippines It is possible that on behalf of Nestlé, qualified nurses or nutrition advisers in the Philippines have contacts with various persons in the health sector and discuss with them correct infant feeding practices - including breastfeeding. However, a direct contact of these persons with pregnant women or mothers is explicitly forbidden - because it does not conform to the Code - and Nestlé verifies that these restrictions are strictly followed. This applies, of course, also to all other countries. The only exception are direct replies to consumer questions or complaints. On behalf of Mr. P. Brabeck [ * The rest of the letter responds to violation refs: 98/01 and 98/05] Yours sincerely Daniel Herrera Head of PR Nestlé Suisse S.A.

Baby Milk Action's evaluation:

Nestlé's assurance is false. Baby Milk Action continues to gather evidence and publicise this violation. The "Health Educators" in the Philippines featured on the French TV programme Vrai Journal in March 1999. See the June 1998 action sheet, ref 98/17 for the next stage in this saga.

Nestlé in South Africa (Ref: 98/07)

Nestlé lobbied the Government of South Africa for a meeting to discuss marketing of baby foods. The action sheet called for letters to be sent to the Ministry of Health in South Africa supporting independent, transparent and effective controls on the marketing of the baby feeding industry. See the reports on violation refs. 98/01 and 98/05 for further information on Nestlé's rationale for attempting to weaken government measures. Nestlé continues its attempts to weaken government measures in South Africa.

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Company responses to April 98 violations

Mead Johnson in Russia (Ref: 98/08)

The violation concerns promotion of EnfaMama milk for mothers and promotion of infant formulas to health professionals at conferences and to mothers through posters. Health professionals have also been funded to attend conferences. In one case the health professional endorsed EnfaMama from the rostrum. Mead Johnson responded to a letter writer in July 1998 [Baby Milk Action comments in bold after the * symbol]:

Your recent letter to Peter R. Dolan On behalf of Mr. P. Brabeck [ * CEO of Bristol-Myers Squibb, the parent company] regarding the marketing of infant formula and the WHO Code was forwarded to my attention. Mead Johnson supports the aim of the WHO Code, and in 1983 became the first US infant formula manufacturer to adopt the Code in developing countries, including standards for product integrity, labeling, distribution and promotion. Our policy is to follow the WHO Code in developing countries, [ * but the International Code applies to all countries] as well as the laws and regulations put in place by those countries' governments. As a company, we pride ourselves in our commitment to responsible marketing of infant formula products. With regard to EnfaMama, we are very proud of this product and disagree with you that the promotion of it in Russia is unethical or scandalous. On the contrary, EnfaMama is an adult nutritional product developed to help strengthen and maintain the health of expectant and lactating mothers. It is designed to do precisely what the WHO Code was established to do: promote breast feeding and prolong the breast feeding period. In addition, the use of EnfaMama is supported by the Russian Academy of Medical Sciences, the country's leading institution of nutrition. With regard to Article 7.3 of the Code, we monitor our marketing practices throughout the world, and take all suggestions of violations very seriously. We have reviewed our practices relating to this article and are confident that we are meeting the letter and spirit of the WHO Code, government laws and regulations, and our own policies and procedures. Peter J. Paradossi Associate Director, Public Affairs and Communications

Baby Milk Action's evaluation:

As the campaign sheet indicates, this product is a subtle way of sowing seeds of doubt in a mother's mind about her ability to breastfeed. It also creates the idea that expensive artificial foods are necessary for successful infant feeding, whether fed directly to the child or via the mother's body. In reality it is the mother's body which produces the perfect infant food, not Mead Johnson.

Nestlé threatens to "pull out investment in Zimbabwe" (Ref: 98/09)

The violation concerns Zimbabwe's moves to implement the International Code and Resolutions in national measures. Nestlé reportedly threatened to pull out of Zimbabwe if the law was passed. Letter writers were asked to write to Nestlé for confirmation of whether this was true and to appeal to Nestlé to do nothing to undermine adoption of the law. Nestlé wrote to a letter writer in July 1998 [Baby Milk Action comments in bold after the * symbol]:

Thank you for your letter to Mr Brabeck and Mr Blackburn, which have been passed to me to reply to. The draft Zimbabwe regulations seek to ban any advertising or promotion, not only of breast-milk substitutes, but of any beverage, milk product, or other food consumed by babies and young children under the age of 5 years. Such a regulation would make it impossible for consumers to make informed choices about feeding their children. Your recent letter to Peter R. Dolan On behalf of Mr. P. Brabeck [ * advertising is promotion not information] It contradicts the aim and principles of the WHO Code, which emphasise the importance of "adequate information" and "appropriate marketing and distribution". In a letter to the Ministry of Industry and Commerce the Chairman of Nestlé Zimbabwe pointed out that the prevention of legitimate marketing activity for almost the entire range of products manufactured locally by Nestlé would inevitably lead to the closure of our factory. This would result in job losses for about 200 people and an extremely negative economic impact on local farmers who supply us with milk, wheat, maize and sugar. The Food Manufacturers' Association of Zimbabwe has submitted proposed amendments to the Ministry of Health which will protect the interests of consumer and producer alike, and have our full support. [paragraph on violation ref: 98/10 given below] Yours sincerely Denise Briggs, Bsc (Hons), SRD Specialist in Dietetics

Baby Milk Action's evaluation: The law has gone ahead and Nestlé's factory is still operating

Nestlé implies that the law prevents the "legitimate marketing activity for almost the entire range of products manufactured locally by Nestlé." Yet, Nestlé has claimed that its infant food business is a few percent of its turnover. Nestlé is generally known for confectionery, convenience food and coffee. In Zimbabwe Nestlé's best known product is reportedly a breakfast cereal. While governments may have to make a choice between foreign investment and infant health when introducing legislation, it appears that this is simply a case of Nestlé flexing its muscles. The law came into effect on 1st March 1998 and Nestlé's factory is still operating in Zimbabwe.

Nestlé's empty promise (Ref: 98/10)

The violation concerns Nestlé's promotion of bottle feeding in advertisements for Valvert water in Russia. In December 1997 (see Tip of the Iceberg Volume 1) Nestlé assured a letter writer that it would end this practice, but in April 1998 the advertisements were still appearing. Nestlé wrote to a letter writer in July 1998 [Baby Milk Action comments in bold after the * symbol]:

[ * The bulk of this letter is quoted in the report on violation ref: 98/09] In line with our previously stated commitment, we instructed Perrier Vittel to stop advertising Valvert as appropriate for bottle-feeding. We have asked them to explain why these instructions have not yet been implemented. Yours sincerely Denise Briggs, Bsc (Hons), SRD Specialist in Dietetics.

Baby Milk Action's evaluation: The law has gone ahead and Nestlé's factory is still operating

In the past Denise Briggs has given the assurance that no Nestlé employee has ever broken the International Code. One cannot help wondering how it is possible for Nestlé to give such assurances when its internal monitoring and enforcement structures are so evidently flawed. We will continue to monitor the situation. (This case was featured again on the Campaign for Ethical Marketing action sheet in November 1998. The company response to complaints prompted by that campaign will appear in Tip of the Iceberg Volume 3).

Company responses to May 98 violations

Nestlé and self-regulation in the USA (Ref: 98/11)

The violation concerned an advertisement for Nestlé Carnation Good Start infant formula which idealised artificial infant feeding and included the slogan "Bring out the best in your baby." Nestlé wrote to a letter writer in October 1998 [Baby Milk Action comments in bold after the * symbol]:

[ * The bulk of this included the standard claims as appear in the response to violation ref. 98/01 and the response to violation ref. 98/09] In regards to Nestlé's infant formula marketing practices in the US, the US is not a signatory to the WHO Code. [ * this is incorrect - see below] However, in the US, Nestlé abides by the aim of the Code and our advertising states that breast milk is best. Nestlé has always believed that breast milk is the best way to feed your baby and Nestlé does not market infant formula as a superior alternative to breast milk. The US's decision not to sign the WHO Code is based upon the belief that the WHO Code infringes upon their basic constituional rights of free speech. Marketing and advertising benefit the market place and consumers by increasing competition, lowering prices and helping to educate consumers on product choices. In addition, the US believes that women and parents have a right to information on infant feeding options in order to make an informed choice on how best to feed their baby. Yours sincerely Denise Briggs, Bsc (Hons), SRD Specialist in Dietetics.

Baby Milk Action's evaluation: Nestlé flagrantly violates the International Code in the United States Nestlé argues that its advertising benefits consumers by increasing competition Mothers don't have millions to spend boasting how the milk they produce really is the best for babies Nestlé should follow the Code independently of any other measures Nestlé's refusal to do so demonstrates that it cannot be trusted to regulate itself

This letter provides an intriguing insight into Nestlé's approach to the International Code and Resolutions and the marketing of baby foods. Nestlé claims it is abiding by the aim of the International Code in the US and presents the inclusion of a breastmilk is best message in the advertisement as evidence of this. This ignores the fact that the aim of the International Code includes the protection of breastfeeding, which the advertisement undermines with text suchas: "The Nestlé Carnation Baby. Loves to sleep. Loves to smile. Never heard of fussy... And Good Start digests more like breastmilk in a baby's tummy than the leading formula. No wonder Kim's so happy. Not to mention mom & dad!" Nestlé offers no excuse for violating the International Code so blatantly - Article 5.1 bans the advertising of breastmilk substitutes. Even Nestlé's "Charter" claims that Nestlé does not advertise infant formula. Closer inspection reveals that the "Charter" only applies to so-called "developing countries" - one of its loopholes. Nestlé's justification for advertising infant formula in the US does not acknowledge the fact that the International Code was adopted because "the marketing of breastmilk substitutes requires special treatment, which makes usual marketing practices unsuitable for these products" (from the preamble). Nestlé claims the customer benefits by increased competition. Yet Nestlé is not only competing with other manufacturers of breastmilk substitutes, it is competing with mothers who do not spend millions of dollars boasting how the breastmilk they produce really is the very best for their babies. It is partly because the resources for promoting breastfeeding are so limited that the International Code seeks to ban the promotion of breastmilk substitutes and calls on health workers to advise mothers. Yet Nestlé suggests its biased and emotive advertising assists mothers "to make an informed choice on how best to feed their baby." It is significant that Nestlé claims that the US is not a signatory to the International Code. The US supported Resolution WHA47.5 at the 1994 World Health Assembly which noted all previous relevant Resolutions, including WHA34.22 under which the International Code was adopted, and stated that the Assembly was "reaffirming its support for all these resolutions and reiterating the recommendations to member states contained therein." Article 11.3 of the International Code calls on companies to follow it "independently of any other measures" Nestlé's attitude to international requirements such as the International Code is particularly worrying when one considers Nestlé's influence on bodies pushing the free trade agenda. Nestlé Chair, Helmut Maucher, is the President of the International Chamber of Commerce which is lobbying for closer involvement in the World Trade Organisation. Nestlé's Peter Brabeck chairs the European Round Table, which consists of the Chief Executives of a number of European transnationals and gives them formal and informal access to government and European Union policy makers.

Wyeth - scary isn't it (Ref: 98/12)

The violation concerns an advertisement for Wyeth's Parent's Choice infant formula. Wyeth, a subsidiary of American Home Products and the manufacturer of SMA baby foods, responded to a letter writer in June 1998 as follows:

This is in response to your recent fax about an ad for Parent's Choice infant formula. Wyeth is not involved with the marketing of this product or with any other formula sold in the United States. Wyeth manufactures infant formula for several retailers sold under a private label. Product-related marketing activities are the responsibility of the distributor and retailer. Sincerely Beverly Halchak Director Maternal Child-Health

Baby Milk Action's evaluation: Wyeth saysParents' Choice is sold under a private label and it has no responsibility for the advertisement Yet the advertisement states "Parents' Choice is a product of Wyeth Nutritionals"

"Scary isn't it" was the headline of the advertisement which suggested advice on infant feeding was confusing. Wyeth's response adds to the confusion and gives even more cause for concern. The advertisement states: "(C)1998 Parents' Choice is a product of Wyeth Nutritionals Inc. Georgia. VT 800-272 5095." and: "Look for it at Wal-Mart." Article 11.5 of the International Code states: "Manufacturers and primary distributors of products within the scope of this Code should appraise each member of their marketing personnel of the Code and their responsibilities under it." Wyeth has chosen to associate its name with this product, making the claim that it is "sold under a private label" seem contradictory. Wyeth should take responsibility to ensure that whoever conducts the marketing is aware of the Code and its requirements.

Nestlé lobbies the Government of Uruguay (Ref: 98/13)

Nestlé lobbied the Government of Uruguay for a meeting to discuss strategy for the forthcoming World Health Assembly. Nestlé called for implementation of the International Code, but made no reference to the subsequent Resolutions. The Resolutions have been adopted by the World Health Assembly to resolve questions of interpretation and to address new marketing strategies and scientific knowledge. Supporters were asked to write to the Government of Uruguay supporting independent, transparent and effective controls on the marketing of the baby feeding industry and to write to Nestlé asking it to support implementation of the International Code and Resolutions. No specific comment of Nestlé's has been received. See the reports on violation refs. 98/01 and 98/05 for further information on Nestlé's rationale for attempting to weaken government measures.

Dumex uncovered (Ref: 98/14)

We exposed a confidential internal newsletter from Dumex, a brand owned by the Danish East Asiatic Company, which presented ideas for marketing staff to achieve "impressive growth in the increasingly challenging industry." As far as we are aware no letter writers received a response from the company, but we understand that there have been changes in the top management responsible for the newsletter following the publicity surrounding this case.

Company responses to June 98 violations

Nestlé piles on the pressure in Pakistan (Ref: 98/15)

Nestlé continued its lobbying of the Government of Pakistan as it developed a law implementing the International Code and Resolutions. We called on supporters to write to the Government in support of independent, transparent and effective controls on the marketing of the baby feeding industry. See the reports on violation ref. 98/01 for further information on Nestlé's rationale for attempting to weaken the Pakistan government's measures.

Mead Johnson promises to reduce crying in the UK (Ref: 98/16)

The violation concerns a leaflet on Nutramigen infant formula which Mead Johnson encourages health professionals to hand out to parents. Baby Milk Action took this issue up with Mead Johnson directly. The spokesperson said the leaflets were to assist health professionals who advised mothers to use the product and would assist pharmacies to identify or order the product. The spokesperson denied the information was idealising because a "breast feeding is best for the health of your baby" message appeared on the leaflet.

Baby Milk Action's evaluation: The 'breast is best' message is undermined by the rest of the text

The International Code demanda that companies only provide scientific and factual information to health workers (Article 7.2) and should not seek direct or indirect contact with mothers or pregnant women (Article 5.5). Information for health workers "should not imply or create a belief that bottle-feeding is equivalent or superior to breastfeeding." Yet the promotional pamphlet and leaflet suggest that Nutramigen reduces crying and using it will "relieve parental anxiety and distress in 48 hours." Comparisons are only made with infants fed on cow's milk formula and not with breastfed infants. The materials do not reveal that Nutramigen is also based on cow's milk.

Conclusions