Friday

Pandora's Box-part 3-


                          "Breastfeeding promises significant cost savings
                            compared to formula feeding:  according to the
                            US Department of Agriculture, the USA would
                            save a minimum of $3.6 billion per year in health
                            care and indirect costs if at least 75% of mothers
                            initiated breastfeeding and 50% breastfed until
                            the infant is at least 6 months old."
                            "Marketing Breastfeeding--Reversing Corporate Influence
                              on Infant Feeding Practices," by DL Kaplan & KM Graff
                              published in 2008
                              http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443254

According to the CDC Breastfeeding Report Card of 2013, nationally we have reached or almost reached those goals.  Although nationally, exclusive breastfeeding is only 16.4%.  Individual states in the US have varied statistics.  In Florida, we have 71.8% "ever breastfed," 40.9% breastfeeding at 6 months and only 10.6% exclusively breastfeeding at 6 months.  This data is taken from national immunizations survey and I believe there may be some inaccuracies.  
http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf 
   
When I worked in the WIC Program, the "ever breastfed" statistic was based on a mother's recall of "ever" making an attempt to breastfeed.  That could mean that a mother made one attempt and then quit breastfeeding but would be included in the ever breastfed category.  The most important figures in terms of cost savings and health is the duration of breastfeeding and how many mothers are exclusively breastfeeding (which creates the most cost savings and health benefits).  We can deduce from this data that most women in the USA are doing both breast and infant formula feeding--exclusivity being a rare practice.  Anyway saving $3.6 billion is quite a savings in health care and indirect costs. 
The savings would probably be a lot more, if exclusive breastfeeding was practiced. 


What is the problem with mothers doing both breastfeeding and infant formula feeding?  What we do know is that the introduction of infant formula usally means less time at the breast, lowered milk production, triggering the use of more infant formula.  It becomes a spiraling circle and before too long the mother is no longer breastfeeding or barely breastfeeding.  The statistics show this quite plainly--very few mothers exclusively breastfed.  So the question has to be why?  What is happening that is creating this situation?  There are many reasons--employment is one, short maternity leaves, misinformation, etc.  But high on my least is the marketing of infant formula.  The targeting of the new breastfeeding mothers with information and free samples of infant formula that makes it seem like you can do both and there are no consequences to doing both.  Weaning from the breast is a direct consequence of the introduction of infant formula.  Most mothers do not understand the impact of infant formula on breastfeeding.  Nor do they understand how infant formula changes the gut flora of the infant which in turn impacts the infants immune system.  Thus the hospital gift bags of free infant formula to breastfeeding mothers is a trojan horse, the pandora's box.  It is marketing that works well as we can see by the CDC statistics.

To understand the marketing influence of an industry on medical institutions and physicians, one might take a journey back in time and see how physicians were used to market cigarettes. [corrected by author, VWM] A 1930 ad for Lucky Strike's (a cigarette brand) states, "20,679 Physicians say "LUCKIES are less irritating." Another brand, Philip Morris, declared in their ads in the 30's, "Men and women with irritation of the nose and throat due to smoking were instructed to change to Philip Morris Cigarettes."  
http://www.ncbi.nih.gov/pmc/articles/PMC1470496

The title of the article regarding marketing of cigarettes is aptly called, '"The Doctors' Choice Is America's Choice"  The physician in US Cigarette Advertisments, 1930-1953,' by Gardner and Brandt.  They say, "For the tobacco companies physicians' approval of their product could prove to be essential..."  and, "Physicians became, through this process, an increasingly important conduit in the marketing process."  Maybe marketing of infant formula is not this bad (dependent upon your point of view), it still has undertones that imply approval by pediatricians and hospitals with free gift bags only part of the marketing endeavor.

In 1999 in the USA Mead Johnson sued Abbott in the US Distric Court of Indiana.  Why?  Because Abbott advertised Similac under the banner, "First Choice of Doctors."  Mead Johnson believed that claim as false and misleading and violated the Lanham Act.  They sought an injunction to stop Abbott from advertising, "1st Choice of Doctors" claim.  Not sure how this all turned out.  I think Mead Johnson won this court battle and got an injunction against Abbott.  Because Abbott no longer makes that claim.  Their claim now is "#1 Brand Fed in Hospitals."  And Mead Johnson's claim is, "#1 Pediatrician Recommended Brand."  Rather funny,  since Mead Johnson in the court case in 1999, used the argument that "most doctors do not have a preference between the two leading brands and there is no evidence that one product is medically superior to the other."  

So I think we can understand that marketing through physicians and through medical institutions is important to industry, and in this case to the infant formula industry.  It gives a product a validity, a respectability, and a belief in the scientific basis for a product.  But like cigarettes, the science is bought by the industry.  It took a long time for people to recognize that cigarettes were hazardous to health.  Partly because of the merging of mutual interests between industry and medical institutions/health care providers.  Advertising works or industry would not use it.  Advertising in which consumers believe that hospitals or doctors recommend a product, works even better.  There is enormous faith placed on health care professionals and their institutions. 

In an article by the George Washington law review dated in 2010 on, "Medical Marketing in the United States:  A Prescription for Reform," the author, Joshua Weiss states, "On average, the drug and medical device industries spend over $20,000 per doctor each year on marketing efforts that include gifts, meals, travel, consultancy fees and continuing medical education programs.  The reach of medical marketing has grown so broad that one recent survey reported that ninety-four per cent of physicians have received some form of benefit or payment from the drug and device industries."  [Many of the infant formula companies are part of the pharmaceutical industry].  
http://groups.law/gwu.edu/LR/ArticlePDF/79-1-Weiss.pdf 

We know that breastfeeding saves billions of dollars in health care costs.  We have stopped the Tobacco Industry from marketing directly to consumers and no doctor or health care facility would promote smoking now.  So why are we reluctant to regulate the marketing of infant formula to the public?  Particularly when these companies are making claims that they are supported by the health care institutions and profession.  Why?  What do we believe? 
Copyright 2013 Valerie W. McClain

for further information:  Mead Johnson & co. v. Abbott Laboratories 1999
http://www.leagle.com/decision/199992041FSupp2d879_1829 



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