How to make a simple morality tale out of a complex public health issue

After years of being hated by advocates of breastfeeding, Nestlé and the rest of the baby food industry must have wept with delight at articles in the Wall Street Journal last month.

Their early Christmas present came in the form of a front page, lead news story (5 December) and an accompanying editorial in the European edition (6 December), which painted the baby food manufacturers as heroes poised to save African children from certain death.

What was the nature of their heroism? "One major formula maker," said the article, "Wyeth-Ayerst Laboratories Inc, says it stands ready to donate tons of free formula to HIV-infected women. No.1-ranked Nestlé SA says it too would donate, if asked." Such donations, argued the reporters, would stop the transmission of HIV from mothers to their children via infected breast milk, halting the spread of AIDS through sub-Saharan Africa.

All heroic tales need a villain, and this one was no exception. "Unicef," said the paper, "refuses to greenlight the gifts, because it doesn't want to endorse an industry it has long accused of abusive practices in the Third World."

If there was any doubt in readers' minds about the goodies and baddies in this epic struggle for infant health, the headline hit the message home: "African Babies Fall Ill as Unicef Fights Formula Makers." The editorial went further still, blaming Unicef's "feud against the industry" for "killing millions of children."

Formula fever soon spread west across the US, reaching the pages of the Houston Chronicle (December 10). Michelle Malkin, a nationally syndicated columnist, cited the Wall Street Journal report and accused Unicef's "breast feeding crusade" of "killing the children it's supposed to protect." She also offered her advice to the agency: "There is a very simple solution: feed the babies formula."

A simple battle
In six days, the American dailies had taken a highly contentious health issuethe merits of breast and bottle feeding in the era of AIDSand turned it into a simple battle between the benevolent corporations and a seemingly malicious international health agency.

View larger version (61K): [in this window] [in a new window]   Was vilifying Unicef the easy option?

Accepting donations sparks controversy
Accepting donations from the formula industry seems to be tearing apart the UN health agencies, adding fuel to the paper's condemnation of Unicef.

Is the industry cashing in on the crisis?
Many breastfeeding activists say that the formula industry is capitalising on the HIV epidemic to promote its products in the developing worldand the US papers have interpreted this as a charitable mission. Alison Linnear, coordinator of the International Baby Food Network, said, "It would seem that the manufacturers of breastmilk substitutes are seeking to exploit the dilemma posed by HIV/AIDS."

A missing voice
One voice that was remarkably absent from the Wall Street Journal story was that of the World Health Organization. Was it playing hard to get, after recent claims that it has a close relationship with industry? (BMJ 2000;320:1362).

No apologies from Wall Street
The Wall Street Journal rejects the powerful criticisms it has received from the international health community. It makes no apologies whatsoever for the story and the hard hitting editorial, nor for suggesting that donating milk substitutes is the answer to the HIV epidemic. Dick Tofel, a spokesman for the paper, said, "Our view is that these are the facts. If there was more formula available, babies would not be dying."