Big Formula's influence over the AAP

My wife and I are big propoenents of breast-feeding our children, partly for religious reasons and also because of medical ones. It's essentially politically incorrect to question why it's "okay" for parents to "choose" to formula-feed their children.

Now it turns out that the infant formula industry has been dominating the debate - to their financial interest - and have even recruited the American Academy of Pediatricians as lobbyists to the Bush Administration's FDA for their cause. The issue is a new ad campaign that intends to educate women about the health risks of not breastfeeding, rather than the tame approach until now of trying to tell women the benefits of breastfeeding. And this new aggressive stance has really galvanized the formula industry to try and intervene:

November 3rd, 2003 was a big day for Alabama emergency room pediatrician, Dr. Carden Johnston. On that date last month, he was installed as the new President of the 66,000 member American Academy of Pediatrics (AAP) at the prestigious organization�s annual meeting in New Orleans. It was also the date that he sparked what has emerged as a major ethical controversy by inadvertently pulling back the curtains on the powerful influence that a particular corporate interest appears to have in shaping AAP policy and action.

�I have to admit that I never imagined that my presidency would start off with such a bang,� Dr. Johnston says, acknowledging the debate now taking place within his organization.

At issue is a letter dated November 3rd that Dr. Johnston sent to Secretary of the Department of Health and Human Services (DHHS), Tommy G. Thompson, officially expressing the AAP�s concern over the �negative approach� of the federal agency�s soon-to-be-released, pro-breastfeeding advertising campaign. What Dr. Johnston didn�t mention in his letter, however, was that he had developed this sudden and seemingly urgent interest in this issue not via a last minute clinical review of the scientific literature, or even after consulting with the AAP�s own recognized lactation science experts.

In fact, his concern came immediately after aggressive, personal lobbying by representatives of one of the AAP�s biggest financial contributors, the $3 billion U.S. infant formula industry. Within days of a New Orleans meeting with worried formula industry reps, Johnston hurled the considerable credibility and persuasive impact of the esteemed American Academy of Pediatrics into an explicit effort to stifle the most ambitious initiative ever undertaken to promote breastfeeding in the United States.

�Some of us within the AAP have long suspected that the infant formula companies had this sort of direct access to AAP leadership,� explains Dr. Lawrence Gartner, a founding member of the Academy of Breastfeeding Medicine and chairman of the AAP�s Professional Section on Breastfeeding. �Dr. Johnston�s actions have revealed the extent of this influence more clearly than anything else I�ve seen. Many doctors within the AAP are very disturbed by this.�
[...]
In 2002, DHHS described the upcoming breastfeeding initiative as a three-year, multimedia social marketing blitz worth as much as $40 million in advertising dollars. It is alleged by a variety of organizations representing lactation consultants, physicians, nurses, midwives, and public health activists that the AAP�s last-minute appeal to DHHS prevented the much-anticipated campaign launch from taking place as scheduled this month. Additionally, it appears that representatives of the infant formula industry - with the benefit of prematurely leaked information about the specifics of the ad campaign- have been quietly lobbying federal and Ad Council officials to change the ads� content and tone.

According to the AAP�s own Breastfeeding Section, at least one thousand new scientific and medical papers on topics related to breast and bottle feeding have been published in just the past four years. Taken as a whole, this mounting body of research reveals dramatically different health outcomes for populations of breast and formula-fed babies, even when controlling for socioeconomic and other factors. The new ad campaign was designed to reflect this research and to catapult the issue of breastfeeding into the same category of public health concerns as smoking, carseat use, childhood vaccinations, and SIDS prevention.

(emphasis mine) The article is a great one because it really explores the issue from the analogy of smoking risk - and questions the role of the big formula companies over public health policy in those terms:

According to a variety of sources, members of Congress began hearing complaints about the pending ad campaign from infant formula manufacturers as early as the first week of October, but it was at the AAP convention in November that the industry was able to aim what is arguably the biggest weapon in its lobbying arsenal �the clout of the American Academy of Pediatrics - directly at the the breastfeeding campaign.

�The reason why the infant formula industry is so successful is because they have managed to manipulate health care providers into providing them with a cloak of credibility,� explains Amy Spangler. �The bottom line here is that the president of (an infant formula company) doesn�t have to send a letter directly to a federal official when he can get the President of the American Academy of Pediatrics to do it for him.�

Public health advocates and many individual physicians, nurses, midwives, and lactation consultants have long criticized the cozy financial ties between infant formula manufacturers and major medical organizations such as the AAP, the American Medical Association, the American Academy of Family Physicians, and the American College of Obstetrics and Gynecology. The infant formula industry � part of the larger pharmaceutical industry lobby - is also recognized as one of the most effective and powerful lobbies on Capitol Hill.

Critics of this relationship between baby doctors and formula makers note that because the U.S. infant formula industry �with sales of $3 billion annually � clearly has a commercial interest in impacting parents� infant feeding choices, the industry should not play any role in crafting public health messages relating to the industry�s clear competitor in the marketplace, breastfeeding.

�It is simply not appropriate for these companies to have a say in how publicly-funded health education campaigns present breastfeeding issues,� argues Marsha Walker, RN, IBCLC, and Executive Director of the National Alliance for Breastfeeding Advocacy (NABA), a non-profit group promoting breastfeeding. �It would be like inviting a cigarette manufacturer to have a say in the message of a government sponsored anti-smoking campaign.�

OWH spokesperson Christina Pearson disagrees, however, insisting that DHHS has made it clear all along that the agency wanted to hear from �all sides� on the issue.

While it may be reasonably asked what �sides� exist when speaking of a public health campaign promoting a free or low-cost, healthy alternative over another, expensive and less healthy alternative, the AAP leadership decided that their organization was going to take sides.
[...]
Mardi K. Mountford, Executive Director of the the International Formula Council, a trade group representing the interests of infant formula manufacturers takes issue with Dr. Gartner�s assertion that her industry is seeking to discredit or delay the DHHS campaign.

�We strongly encourage mothers to breastfeed if they can, but we don�t believe that women need to be subjected to scare tactics like the ones that are in these ads,� explains Mountford. �Our only interest in reviewing the scientific claims in the ads is that they be accurate so that parents have the information they need to make their own decisions about what�s best for their families�

Mountford�s remarks highlight something that public health advocates have long noted; namely, that the infant formula industry�s tactics in lobbying against initiatives such as FDA regulation of their product, standardization of ingredients in their product, and now, the DHHS breastfeeding campaign are remarkably similar to the strategies employed by tobacco companies in the early years of the anti-smoking public health movement.

According to PRWatch.org, the tobacco industry created what eventually became known as the Council for Tobacco Research (CTR) in 1953, claiming that the organization�s mission was to �find out whether smoking was dangerous��� During the 1980s, internal CTR memos revealed that � the CTR actually worked at "promoting cigarettes and protecting them from these and other attacks," by "creating doubt about the health charge without actually denying it, and advocating the public's right to smoke, without actually urging them to take up the practice." Just as the infant formula industry currently pays for much of the research into breastfeeding in the U.S, for many years the CTR funded most research into tobacco health issues and attempted to insert itself as a �concerned� corporate citizen into the government�s earliest anti-smoking campaigns.

It's a lengthy article and well worth reading in full if you are interested in the topic - I'm of the persuasion that we should regulate direct advertising by the formula companies in much teh same way we regulate tobacco, for almost the same reasons.