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Politics, science and marketing

As the debate about the global policy on exclusive breastfeeding reached its peak, several new studies were published which appeared to raise doubts about its value. Valid research should never be suppressed, but here we take a look at these studies and the way they were covered in the media and understood by the public.As the debate about the global policy on exclusive breastfeeding reached its peak, several new studies were published which appeared to raise doubts about its value. Valid research should never be suppressed, but here we take a look at these studies and the way they were covered in the media and understood by the public.

Heart disease

A study about heart disease was published in the British Medical Journal (BMJ) in March, accompanied by 2 press releases and a leader article (Leeson et al, (2001) Duration of breastfeeding and arterial distensibility in early adult life: population based study, BMJ, Vol. 322, (643-647))

It received worldwide media coverage including at least 5 reports in India the following day - all suggesting that breastfeeding after 4 months actually causes heart disease. In the UK many women stopped breastfeeding immediately.

Although the study was funded by the Medical Research Council, one of its authors, Prof Alan Lucas, regularly collaborates with the baby food industry on other research and has designed several infant formulas. Prof Lucas vigorously defends both industry funding and his independence.

Certain salient points, failed to appear in either the summary or the press releases and few read the actual text which stated that the data did not "establish a causal relationship between the length of breastfeeding and cardiovascular disease."

There was no mention of the beneficial effect of breastfeeding on blood pressure and obesity, and Alan Lucas later admitted that if there is a problem it is likely to relate more to the Western diet that follows than to breastfeeding itself. Even though the study was based on 20-30 year recall and did not contain details of infant diets, the text referred specifically to participants as being "exclusively breastfed for less than four months."

The paper generated a large number of critical responses which can be found on the BMJ website.

Peanut allergy

Soon after, front page headlines in Canada stated "Breastfeeding can spur peanut allergy, study says"

The study, published in April in the Journal of the American Medical Association (Valdas et al, (2001) Detection of Peanut Allergens in Breast Milk of Lactating Women. JAMA 285:1746-1748), was partially funded by Nestlé.

The researchers gave 23 mothers half a cup of peanuts after a fast. Peanut proteins appeared in the breastmilk of 11 mothers but cleared after two hours. There was no evidence that breastfeeding was in any way linked to increased allergies.

It is clearly vital that research is done into these important issues, but it must be independent and must use sound methodology.

HIV, patents and human breastmilk

Some of the companies which are undermining breastfeeding and marketing their products as the solution to HIV transmission have taken out patents on certain components of breastmilk, including lactoferrin - known to have anti-viral properties which denature HIV. In recent years even more discoveries have been made about the rich make-up of breastmilk. For example, it is now known that breastmilk contains proteins (called lysozymes) which destroy HIV.

See article by Baby Milk Action published in International Health Exchange (April 2001) called "Saviours or culprits? HIV, infant feeding and commercial interest."

HIV - relative risks for babies

It is a common misconception that all women diagnosed as being infected with HIV will pass the virus to their infants. This is not the case.

Of 100 women in a community with 20% HIV prevalence among women at delivery:

1.7 million babies might have contracted HIV through breastmilk in the last 20 years. Over 30 million babies will have died from lack of breastfeeding in the same period.

(adapted from UNICEF 2000, Linkages 2001)

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HIV and breastfeeding - unethical research on maternal deaths?

As health services in Southern African countries struggle to cope with the HIV pandemic, two starkly different reports are raising the temperature of the debate and creating more confusion about HIV and breastfeeding. One is the follow-up study from South Africa showing the protective effect of exclusive breastfeeding, the other is from Kenya and suggests that breastfeeding is linked to higher maternal mortality. Meanwhile baby food companies step up visits to hospitals.

The official UN position is to support exclusive breastfeeding when safe access and conditionalities for artificial feeding cannot be assured. Despite this some governments and NGOs now distribute free formula to all women who are infected with HIV regardless of their social and economic situation. There is growing evidence that this is having a detrimental effect on infant health and on support for breastfeeding, not only for those affected by HIV, but also in the population at large.

The follow-up paper by Anna Coutsoudis in South Africa (see below) gives evidence of an encouraging outcome for babies and mothers who exclusively breastfed with no evidence of association between increased mortality or clinical problems and breastfeeding for either group.

In stark contrast a 2-year follow-up study by Ruth Nduati in Kenya, was published in the Lancet on 25 May. (Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial. The Lancet, Vol 357, May 26, 2001). This was accompanied by a Lancet press release with the alarmist headline: "Three-fold increased risk of death among HIV-1 infected breastfeeding mothers" and a commentary by Dr Marie-Louise Newell of the Institute of Child Health. The commentary seriously questioned the study's ethics, protocol and lack of clarity, and drew attention to Coutsoudis' very different findings.

Numerous concerns have been expressed about the Nduati study, including by WHO. For example, the breastfeeding mothers had higher viral loads at the outset, their babies had double the risk of transmission at birth, and no information was available on the quality of care given to both groups of mothers.

Many UK papers dropped the story as a result of Dr Newell's critical analysis but Reuters went ahead, mentioning only a few of Dr Newell's reservations at the very end. This was further cropped and distorted by the New York Times (25th May) which implied that Dr Newell accepts the findings: "more research is needed to confirm the findings and to understand exactly how breast-feeding raises the risk of death in HIV-positive women."

Ruth Nduati herself accepts that there are drawbacks in her study yet, unlike Dr Coutsoudis, who has consistently urged caution, Dr Nduati hastily concludes that the results "have important implications for public health policy" and that "Counselling...should include discussion of potential risks to the mother's health from breastfeeding..."

Coutsoudis is criticised because hers is the only study of its kind and its original focus was HIV and vitamin A supplementation. Yet Ruth Nduati set out to look at outcomes in babies not the impact of breastfeeding on maternal mortality (and the study on heart disease originally set out to look at infant weight! - see above)

Stop press: WHO has issued a statement in response to the study. Read it on the IBFAN Website

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The President of Botswana meets NGOs

The President of Botswana met NGOs from the UK NGO Aids Consortium in London in March to ask for help and advice in the fight against AIDS. Botswana has one of the highest rates of HIV infection (17%) but even with its revenue from diamonds, is facing a chronic lack of human resources.

Baby Milk Action reported on the concerns about the impact of the provision of formula, the lack of follow-up and the way breastfeeding was being undermined. In some cases, mothers were reported to have been offered free anti-retrovirals only on condition they agree to formula feed from birth. The President denied the last point but said that the provision of formula was on the advice of NGOs among whom there seems to be no consensus about breastfeeding. We expressed our concerns about partnerships with and involvement of for-profit industries.

After the meeting we were challenged by a representative of one of the companies involved in the legal battle against South Africa over drug patents - GlaxoSmithKline - who had gained access to the meeting. GSK is considering a $1.5b merger with the US babyfood giant Abbott Ross.

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International policy

Codex says no health claims on foods for infants and young children

Along with GM labelling, health claims, the validity of 'science' and the need for independent funding for research were hot topics at the Codex Alimentarius meeting on labelling in Ottowa in May. Codex is the body which sets global food standards which are used for world trade. Baby Milk Action joined INFACT Canada, Consumers International and other NGOs in calling for a ban on health claims, especially for breastmilk substitutes. We also called for better nutrition labelling and warnings on bottled waters. Many countries shared our concerns about the way the food industry uses health claims and dubious science to market unnecessary and sometimes unhealthy foods, often undermining national nutrition policies.

Claims such as this on Abbott-Ross's Similac, would no longer be allowed (as shown in IBFAN new international monitoring report Breaking the Rules)

After years of lobbying IBFAN's proposals were accepted and Codex recommended that health claims on foods for infants and young children should not be used.

It will be important to protect this provision through the remaining steps in the process. Meanwhile this new draft standard should be used in trade disputes.

Legally binding framework - or voluntary controls?

At a meeting the day after the EU Parliamentary Hearing in November (see Boycott News 29) Baby Milk Action asked the EU Trade Commissioner, Pascal Lamy, for his views on the EU Parliament's proposals for a legally binding framework which would be independently monitored and would call transnational companies to account. Disappointingly, Commissioner Lamy said that the guidelines for Multinational Enterprises drawn up by the Organisation for Economic Co-operation and Development (OECD) took precedence. The OECD guidelines are voluntary and companies are merely 'invited' to respect minimum principles and standards of behaviour. They are not seen as an obligation imposed from above.

We have also raised concerns about the need to assess the extent of influence of sponsorship in health and education services. The official position is that national governments must decide these issues. We asked whether the EU would consider controls, such as an EU-wide ban on marketing in schools, to ensure that health and education services, especially in the developing world, are not damaged by market interests. The representative for the services industries responded and said quite simply: if the controls are too strict companies won't like it. The bottom line is they have to make a profit.

Perspectives on education

(including quotes about our education pack on corporate sponsorship, Seeing through the Spin, which you can download or purchase from our Virtual Shop)

"Seeing Through The Spin is a powerful piece of corporate counter-spin, a crucial and trustworthy tool for teachers to help their students understand the barrage of public relations disguised as education"

Naomi Klein, author No Logo

"The corporate takeover of schools is one of the most terrifying aspects of the domination of public life by big business. Seeing through the Spin is an invaluable guide to the transformation of young people in the UK into marketable commodities."

George Monbiot, author of Captive State: the corporate takeover of Britain

"I have spent many hours studying your fascinating education pack. It is a marvellous production, thought provoking and well constructed to facilitate debate and awareness on critically important issues...the summary descriptions of each of major world corporations do justice to the claims and achievements of the corporations themselves, while also raising legitmate concerns about each one... That is what education is about, encouraging thought and discussion, not stuffing students' minds with the conclusions of partisan adults."

Dr Walter Barker, Director, Early Childhood Development Centre, Bristol

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Commercialisation of schools

Companies move in to schools - UK Teachers say no to commercialisation

Why would a company selling high-fat, high-salt, high-sugar foods and baby foods want to fund nutrition education in Russia? As British teachers and NGOs take action to protect the independence of our health and education services, the companies use more spin to cover up.

At its conference in April, attended by 980 delegates, the National Union of Teachers - representing 50% of British teachers - voted unanimously against the privatisation of the British education system and the distortion of the curriculum by commercialisation. The NUT will be mounting a national campaign to push this forward.

As teachers are coming under increasing pressure to accept schemes which push junk foods in exchange for cash or books - UK health and consumer groups are calling for a ban of advertising to children, including marketing in schools. The UK Food Standards Agency (FSA) has commissioned research into parental attitudes to promotion to children, including the school sponsorship schemes. The FSA will also try to find out what has an effect on eating patterns. But it is not looking into the health impact.

Aware of the concern, companies are developing new materials - Coca Cola's Corporate Citizen in the Community, and its literacy programmes for the under-privileged, Nestlé's new worksheets and brochure, Nestlé in the Community, - talk about 'sustainable development', 'Rio' and 'Kyoto' etc. But is this just a more professional gloss on what is still essentially marketing?

Perhaps Seeing Through the Spin, Baby Milk Action's education pack, which is designed to encourage people to think through these issues without promoting a particular ideology, will help us decide.

in Russian schools...

A mixed economy may be a good thing but where should the line be drawn? By the end of the year Nestlé's Good Nutrition programs will have reached 120,000 children in 2,000 schools in 17 regions in Russia. Education or branding?

in British schools...

Nestlé promotion in Harvard Public School, Delhi, in April. Nestlé distributed Kit-Kat and Milo free to the children. Photos: BPNI, April 2001

Teachers BEWARE - bogus history

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Breaking the Rules 2001

The IBFAN report Breaking the Rules 2001 was launched to coincide with the 20th anniversary of the Code in May 2001. The report is based on a survey of 14 countries, and the examples below demonstrate the range of companies and violations cited. Since the last report (in 1998) there has been an increase in company malpractices such as donating free supplies, Internet advertising and direct promotion to mothers. Significantly, in countries where there are no laws and no monitoring, it is a free-for-all for company marketing. A copy of the report Breaking the Rules 2001 can be ordered from Baby Milk Action's Virtual Shop or downloaded from the IBFAN website. Also available are the new State of the Code Charts 2001 detailing Code implementation by country and company. Some examples of violations detected are given below.

WHOÕs Director-General, Dr Gro Harlem Brundtland (left), joined IBFAN to celebrate 20 years of the Code. She congratulated IBFAN on their vital role in developing the Code. She asked Annelies Allain whether Breaking the Rulesis Ôevidence basedÕ. "I would not be so exhausted if it was not!Ó said Annelies. Photo: Baby Milk Action

1 Nestlé in Cote d'Ivoire

contacts mothers in health facilities and at home to promote products and give free samples such as Nativa and Cerelac. (Nestlé continue to be the worst violators of the Code, see Boycott News 29)

2 Milupa in Hong Kong

donates unsolicited supplies of Aptamil to health facilities.

3 Wyeth in Uruguay

have point-of-sale promotion in shops with customer discounts for Promil and S-26.

4 Abbott-Ross in Canada

places Isomil gift bags in a municipal family practice unit for distribution to mothers.

5 Mead Johnson in Taiwan

pays hospitals US$25-30 per infant in return for exclusive rights over certain periods.

6 Heinz in Italy

distributes free samples of Dieterba and Vivena AR 1 to mothers in health facilities. In some facilities they also hand out samples of complementary foods.

7 Cow & Gate (Nutricia) in Russia

send reps to visit a health care facility 3 times a week to advise mothers about infant feeding.

8 Hipp in the United Arab Emirates

have infant formula labels only in English - not in the local language.

9 Gerber in the USA

offers a 24-hour free helpline that is said to respond to over 650,000 calls each year from parents asking how to feed and care for their babies.

10 Danone in Ghana

gives gifts to health workers such as notepads, pens and deskpads advertising Blédina and Phosphatine.

Bottles and teats

These continue to be marketed in ways which undermine breastfeeding. For example, an Italian company called Mister Baby has a teat which makes claims such as: "Small and soft like mother's breast"; "particularly recommended for the first months" and "for natural uninterrupted feeding".

Internet

Companies are increasingly using the web to promote their products. Mead Johnson sponsors a paediatric nutrition information website. It is difficult to access this site without going via Mead Johnson's formula pages. (See also Nestlé's website in Boycott News 29)