A formula to put babies at risk

What science the Bush administration chooses to stifle or promote seems to be a matter of politics and economics. According to a recent story in the Washington Post, the multibillion-dollar baby formula industry pressured the Department of Health and Human Services to weaken a 2004 public-service campaign promoting breast-feeding -- and it worked, even though the science supported the other side.

Numerous studies suggest that breast milk protects infants from developing certain illnesses and that formula-feeding increases their health risks.

The ad campaign was designed to drive home that point. Now the health of millions of infants is at risk because mothers don’t have the scientific knowledge the ads would have conveyed to make an informed choice between breast- or formula-feeding.

According to the Post, a recent report by an agency within the Health and Human Services Department makes the same point as the canceled ads but has also been downplayed by the government because of pressure from the formula industry.

The original ad campaign was sponsored by the department’s Office on Women’s Health and developed by the Ad Council, a nonprofit group that produces public-service TV commercials. One spot shows a pregnant woman riding a mechanical bull while a voice-over says, “You wouldn’t take such risks while you were pregnant -- why take them afterward? Babies were born to be breast-fed.” Another ad features a hypodermic needle lying alongside a nipple-topped insulin bottle -- and states that formula-fed infants are 40% more likely to develop Type 1 diabetes. The ads aimed to shock women into an awareness that the risks of not breast-feeding their infants were real.

According to Gina Ciagne, a former public affairs specialist in the women’s health office who worked on the campaign: “Very soft campaigns had always been used for breast-feeding. These weren’t resonating. We needed something to break through the clutter.”

Formula companies got wind of the ads on the Ad Council’s website and immediately tried to kill them. Powerful economic interests were at stake. For Abbott Laboratories, Mead Johnson Nutritionals, Wyeth Nutrition and Nestle Nutrition, feeding babies is big business. For instance, in 2006, according to public filings with the Securities and Exchange Commission, Abbott Nutrition, a division of Abbort Laboratories and the industry leader, sold more than $1 billion worth of these products in the United States alone.

At the 2004 meeting of the American Academy of Pediatrics, formula industry lobbyists buttonholed Dr. Carden Johnston, the academy’s new president, and persuaded him to write a letter to Tommy G. Thompson, then-secretary of Health and Human Services, protesting the “negative” tone of the pro-breast-feeding ads. “I support the ad campaign being very positive. Breast-feeding should be a nurturing sort of experience; we should not use guilt,” Johnston says now.

Johnston’s letter outraged Dr. Lawrence M. Gartner, then-head of the academy’s committee on breast-feeding. “The formula companies wanted to get the ad campaign killed [because] of the strong financial relationship between the formula companies and the [American Academy of Pediatrics],” he told me.

Johnston’s letter had an immediate effect at the Health and Human Services Department, Ciagne says. So did the lobbyists hired by the International Formula Council: Clayton Yeutter and Joseph Levitt. Yeutter, a former secretary of Agriculture, had been instrumental in setting up the Women, Infants and Children program in 1972. Low-income mothers eligible for this food program buy more than half the formula sold in the United States, and the formula industry partly subsidizes it through rebates. The rebate program alone subsidizes about 2 million families.

In his letter to Thompson, Yeutter complained that “the [breast-feeding] ad campaign . . . is clearly inconsistent with the approach taken by the USDA over the past three decades.” In order words, the ads threatened the Women, Infants and Children program’s heavy dependence on the formula companies.

At the same time, Wanda Jones, the director of the women’s health office, recalled that she and others “began to doubt” the science behind the public-service ads. “The science in these frontier areas was really rather immature,” she told me.

But how questionable was the science?

Jones concedes that even in 2004, research showed that Type 1, or insulin-dependent, diabetes occurs at significantly lower rates -- the percentage ranges from 19% to 40% -- among breast-fed babies. Because the data on formula-feeding and Type 2 diabetes are more equivocal, Jones says, the ad with the syringe and nipple-topped insulin bottle was dropped. “Most people don’t know the difference between Type 1 and Type 2 diabetes [which seldom involves insulin injections], so we felt it would be confusing,” Jones said.

Although the science supporting a link between childhood leukemia (15% to 19% lower in children who were breast-fed, according to studies) and asthma (27% to 40% lower in breast-fed children) is strong, the ads on these illnesses were also scratched.

Pressure from the formula companies and the American Academy of Pediatrics trumped the science: Instead of nipple-topped syringes and inhalers, new, soft ads featured dandelion puffs and ice cream sundaes vaguely evoking breasts. The entire campaign, shown in only 17 states, quietly expired in 2006.

The report released in April by the Agency for Healthcare Research and Quality, a unit within the Health and Human Services Department, supports the claims made in the original ad campaign -- and then some. It assessed the research designs, methods and results of 9,000 studies, dating from 1966 to May 2006, on the health implications of breast- versus formula-feeding. The report concluded that there is a substantially greater risk of severe lower respiratory (72% higher), intestinal (64% higher) and middle-ear infections (23% to 50% higher) for formula-fed babies. Sudden infant death is 36% more likely among formula-fed babies.

“The problem with the formula companies is that they’re marketing a product clearly inferior to breast milk,” Gartner said. No formula can compete, nutritionally or immunologically, with something produced by eons of natural selection and tailored to the precise needs of human infants and their mothers. Women who do not breast-feed put their babies at risk.

Sadly, many of these mothers are in the Women, Infants and Children program. By law, according to Kate Houston, a deputy undersecretary in the Agriculture Department, any participant who wants formula must be given it, and almost half of all infants born in the U.S. receive assistance from the food program. For many reasons, not least that work environments are seldom supportive of breast-feeding, most of these mothers choose formula.

“It’s really personal choice,” said Mardi Mountford, executive vice president of the International Formula Council. “There are lots of different circumstances that factor in. The mom is the one to make the choice.”

Mountford also refuses to acknowledge that the Agency for Healthcare Research and Quality report has any validity. “I don’t accept the science,” she says flatly.

It’s a neat trick. The formula companies and their supporters have deftly reframed the debate. The science is invalid. So the debate isn’t about science anymore, it’s just about choice, and mothers shouldn’t be made to feel guilty about their preferences.

“If a formula-fed child gets leukemia, we don’t want the mother to feel guilt over it, on top of everything else,” Johnston said.

No such mother should feel guilty. But she should feel angry that she wasn’t told, in some clear, graphic and unmistakable way, what the health risks of formula-feeding are. The terrible thing is that our government had the information and for political and economic reasons chose -- and still chooses -- to keep that knowledge to itself.