Director Fine, the Lt. Governor as well as the First Lady spoke of their commitment to breastfeeding families and their support of the hospitals’ efforts in this giant step forward in removing the commercial barriers to breastfeeding. State health officials noted that studies link giveaways to decreased breastfeeding rates, which is not in keeping with their efforts to promote optimal health for mothers and infants in Rhode Island.

For more information, see coverage in USA Today.

The toolkit provides an excellent illustration of what happens when well-meaning organizations partner with the formula industry, potentially tarnishing their own credibility and hard-earned reputation. Research has already shown that when formula companies provide information on breastfeeding, mothers who use that material are more likely to use formula.

Yet, in its most egregious flaw, the toolkit repeatedly refers users to Abbott’s materials on breastfeeding, including a pamphlet they produced, their hotline and their website. There is also plenty of inaccurate information in their other materials in the toolkit.

The influence of the formula industry may be too subtle to be readily apparent to the average user, including editorial staff at Corporate Voices.

What is most notable about the toolkit are the many things that it doesn’t say. For example, the toolkit contains long lists of resources, many of which are well respected, but nowhere does it mention the federal government’s Business Case For Breastfeeding, a competing worksite toolkit that is evidence-based and has no commercial bias. It also does not highlight the National Business Group on Health’s worksite material, which is also well respected.

In its main brochure, the Corporate Voices toolkit describes the health benefits to infants such as reduced ear infections, diarrhea and colic. But it fails to mention any more scary or serious conditions such as hospitalization for lower respiratory tract infection, Sudden Infant Death Syndrome, obesity, and diabetes. There is little risk to the formula industry to concede milder diseases of infancy that most of the public knows about anyway.

When the toolkit’s main brochure discusses the “benefits” of maternal health, it mentions only breast cancer, cervical cancer, and weight loss. These latter two conditions are without a strong evidence base, and are not included the 2007 Agency for Health Care Research and Quality analysis of breastfeeding data. Other serious maternal diseases that are in the AHRQ report go unmentioned: ovarian cancer and type 2 diabetes, for example.

The toolkit features many common but subtle problems often seen when the formula industry produces materials on breastfeeding such as:

• Repeatedly describing only the “benefits” of breastfeeding, and never referring to the risks of not breastfeeding. Breastfeeding is the biologically normal way babies are fed; to describe the “benefits” of breastfeeding implies that formula is the normal way babies are fed.
• Using superlative language to describe breastfeeding or breastmilk such as “best” or “optimal,” knowing that most people will settle for “good enough” or “average” and the ideal or optimal products are often beyond the reach or desire of the average person.
• Overemphasizing how difficult breastfeeding can be—focusing on mothers’ struggles, pain, guilt, leaky breasts, etc. Included in this category are materials that emphasize the different kinds of equipment a mother “needs” in order to breastfeed: creams, pads, cover-ups, pumps, special clothing, etc.
• Using language above the reading level recommended for health literacy when producing educational materials for the general public. Health literacy experts recommend that materials be written at a sixth grade level. Materials written at sixth grade reading level have short simple sentences, without the need for commas.
• Using subtle language to ensure formula feeding mothers are included in all breastfeeding initiatives, as was illustrated in a letter from an Ohio representative to the Surgeon General included in the toolkit, predating the Surgeon General’s release of her Call to Action to Support Breastfeeding. The representative asks that the Call to Action be “balanced and supportive of all mothers,” and “improve the nutritional well being of all infants in this nation.”
• Failure to mention more serious diseases associated with early cessation of breastfeeding, and only mentioning more minor risks that are already commonly known.

Aside from referring mothers and providers to Abbott materials, the toolkit includes many videos purporting to give tips on breastfeeding. Again, what is important is what is not included. Many of the videos are amateur productions by ordinary mothers with no particular expertise in breastfeeding, and they have little practical information about how to pump at work, or how to breastfeed and some even have overt misinformation. It is concerning that an organization with such resources as Corporate Voices would ignore any number of well-made professional resources in favor of amateur videos that provide little actual support.

Finally, there is almost no mention of the effect of introduction of formula on mother’s milk supply or her ability to breastfeed. Readers may be especially confused because well-respected material is included with obvious formula marketing material, making the entire package appear more credible than it really is.

Conflicts of interest are rife in the health care field, and that is why a growing number of academic medical centers are minimizing their faculties’ relationships with pharmaceutical and device makers. Increasingly, well-meaning doctors and administrators are learning that there is “No Free Lunch”. It is time that well-meaning non-profits learn the same lesson.

Non-profit organizations must be careful not to enter into agreements with any corporation whose activities compromise their own mission and policies. A non-profit interested in children’s health should not be entering into financial relationships with tobacco companies or makers of sugar-sweetened beverages, for example.

These corporations cannot be expected to compromise their bottom line for a good cause—their own shareholders would not stand for it. Thus, true promotion of breastfeeding will only hurt Abbott’s sales. However, a skillful manipulation of a worksite lactation program may actually help its sales, or at least ensure the sales are not negatively impacted. Abbott is well aware that the only way to sell more formula is to sell less breastfeeding. Corporate Voices has partnered with them at its own peril.

Abbott’s support of the Corporate Voices toolkit is not “generosity,” but a sensible marketing investment for its formula products. The result: Corporate Voices appears to be no more than a foolish pawn in Abbott’s greater marketing scheme, and not a good citizen legitimately trying to help working mothers and their employers.

Mead Johnson uses aggressive marketing tactics, such as hospital marketing, to convince families to purchase its high-priced formula. Mead Johnson’s product costs twice as much as the PBM products sold at Sam’s Club, Target, Kroger and Walgreen’s, the company told the associated press.

Mead Johnson recently drew fire from breastfeeding advocates for marketing Lipil as “The Breast Milk Formula”, despite evidence that the long chain polyunsaturated fatty acids added to infant formula have no beneficial effect for healthy infants.

Mothers continue to receive uninvited coupons and samples mailed to their homes — according to a recent CDC study, nearly 2/3 of first-time mothers received a free sample of infant formula in the mail .  

Industry marketers continue to reach mothers through mailing lists sold by baby product manufacturers or maternity retailers. In the hospitals, some mothers have reported that baby photo companies are providing addresses to the formula industry to pitch their products to moms.

The industry seems to be extending that strategy to small businesses: we’ve had reports that businesses catering to young families, such as baby photo studios, are handing out formula samples and coupons to clients. In one case, the owner of a photo studio confirmed that a formula representative had approached her about distributing their marketing materials. In another case, a photo company that takes newborn photos in the hospital was connecting with at least one formula manufacturer to share contact information of new parents.

Where have you seen formula handouts in your community? And what can we do to educate businesses about the financial costs and health risks of marketing branded formula to new mothers?  

Mead Johnson hit new lows this past week, calling Lipil “The Breast Milk Formula” on its web site. The title to the web page was changed to “Enfamil – Lipil” following a concerted campaign by breastfeeding activists to contact the Federal Trade Commission.

Mead Johnson’s advertising is already under review by the FTC for overstating the health benefits from added fatty acids DHA/ARA. With the recent “breast milk formula” ploy, Mead Johnson sank to new lows, essentially claiming that infant formula is the same thing as human milk.

Breastfeeding listservs sent out alerts starting June 12, urging advocates to write to the Federal Trade Commission and file a complaint about this deceptive advertising. The web site still listed “The Breastmilk Formula” on June 13, but within days, Enfamil had replaced the title.

Nevertheless, the rest of the web page continues to mislead families with spurious claims that their formula is equivalent to human milk. The page combines colorful graphics with claims that babies fed with DHA/ARA supplemented formula are smarter and have better vision than those fed other types of formula.

In fact, a study by the widely-respected Cochrane Review found that adding artificial long chain polyunsaturated fatty acids (LCPUFA’s) such as DHA and ARA to infant formula had no beneficial effect for healthy infants. In their summary, they write:

This review found that feeding term infants with milk formula enriched with LCPUFA had no proven benefit regarding vision, cognition or physical growth.

In fact, supplementation with LCPUFA’s may cause dangerous side-effects. A recent report by the National Alliance for Breastfeeding Advocacy (NABA) and the Cornucopia Institute found that some infants fed formula with DHA and ARA supplements developed diarrhea, vomiting and dehydration. In an alert to parents, they write:

DHA and ARA in infant formula have been linked to severe diarrhea, vomiting, dehydration, and gastrointestinal pain in some infants. Since these additives are relatively new in infant formula, not all pediatricians are aware of their possible side effects.

It’s time to let the FTC know that continued misleading advertising of “breast milk formula” is unacceptable. Act now to file a complaint on the FTC web site. A sample letter of complaint follows below.

Sample Letter
I wish to register a complaint regarding text contained at the following Mead Johnson website:

http://www.enfamil.com/app/iwp/enfamil/productDetail.do?dm=enf&id=-10733&iwpst=B2C&ls=0&csred=1&r

Mead Johnson manufactures infant formula and markets it in a manner that is false and misleading to consumers. This deceptive text could lead consumers to believe that Enfamil formula is the same as breastmilk and cause them to purchase this product thinking that it will produce the same health outcomes breastfeeding. Enfamil formula contains fungal and algal sources of DHA and ARA. These sources of DHA and ARA are metabolized differently from the long chain fatty acids naturally present in breast milk. Mead Johnson has been cautioned by the FTC to refrain from overstating the health benefits from these fatty acids, yet the company has escalated its claims to the point that it represents its product as “the breast milk formula,” suggesting it is equivalent to human milk.

The National Alliance for Breastfeeding Advocacy (NABA) and the Cornucopia Institute jointly filed a petition with the FTC on January 24, 2008 requesting the investigation into false and misleading claims by formula manufacturers regarding these fatty acids as possible violations of the law (15 USC 45). This particular ad is misleading, because a Cochrane review of randomized trials has shown that there is no evidence for a beneficial effect of LCPUFAs in infant formula. Such misleading information may lead consumers to make ill-informed decisions about infant feeding.

Of note, The US Department of Health and Human Services targets exclusive breastfeeding in the Health People 2010 goals. Public health groups on the state and federal level invest millions of dollars to support breastfeeding. Advertisements such as this one directly undermine those efforts by misleading parents into thinking that infant formula is equivalent to breastmilk.

The FTC is legally obligated to end misleading advertisements under Section 5 of the Federal Trade Commission Act, 15 USC 45. The FTC has described a misleading advertisement as a representation, omission, or practice that is likely to mislead the consumer. In the case of DHA/ARA as advertised on this website, there is a high likelihood that consumers will be mislead into believing that this formula offers benefits to their infant’s development and is equivalent to breastfeeding. This deception can cause harm to both mother and infant leading to premature formula supplementation or cessation of breastfeeding.

I urge the FTC to thoroughly investigate this matter pursuant to your authority, including but not limited to the issuance of a civil investigative demand. We must ensure that consumers have accurate information regarding the health consequences of artificial breast milk substitutes.