Intended for healthcare professionals

Letters

Baby milk companies accused of breaching code

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7083.830a (Published 15 March 1997) Cite this as: BMJ 1997;314:830
  1. C M A Campbell, Clinical medical officera
  1. a Community Paediatric Department, Foyle Health and Social Services Trust, Bridgeview House, Londonderry
  2. b MRC Childhood Nutrition Research Centre, University College London Medical School, London WC1N 1EH

    Code is often disregarded in the United Kingdom

    Editor-Violations of the World Health Organisation's code of marketing of breast milk substitutes by baby milk manufacturers have recently been reported from Thailand, Bangladesh, South Africa, and Poland.1 It is worth noting that the code is also frequently disregarded within the United Kingdom.

    Posters, parent information leaflets, and calendars marked with the trade names of baby milk companies are commonplace within health service premises; gifts such as pens and notebooks, with baby milk manufacturers' trade names and logos, are frequently presented to health workers. These provide tacit endorsement of the advertisers' products within the health service.

    The code requires that manufacturers' product information, including labels, should explain the benefits of breast feeding and the costs and hazards associated with artificial feeding. No more than a token attempt is made by any of the manufacturers to give this information to the public.

    There is now clear evidence that artificial feeding of infants is associated with substantial morbidity, some mortality, and much increased health service costs, even in the affluent countries of the West2 3 None the less, the present government has refused to legislate to make the advertising of baby milks illegal, apparently after pressure from within the baby milk industry.4

    The Indian Medical Association and the Pakistan Paediatric Association have managed to refuse financial support from the baby milk industry.5 It is a pity that the Royal College of Paediatrics and Child Health cannot provide a similar lead within the United Kingdom.1

    Here, only 29% of new mothers leave hospital breast feeding. As part of a joint breast feeding initiative our local hospital and community trusts have launched a breast feeding policy which includes the avoidance of all forms of advertising of breast milk substitutes within the premises of the trusts. A breast feeding training programme has also been initiated for all relevant staff, which includes information on the implementation of the WHO code.

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    Why scientists should not become divorced from baby milk companies

    1. Alan Lucas, Medical Research Council clinical research professorb
    1. a Community Paediatric Department, Foyle Health and Social Services Trust, Bridgeview House, Londonderry
    2. b MRC Childhood Nutrition Research Centre, University College London Medical School, London WC1N 1EH

      Editor-Jacqui Wise discusses a report criticising baby milk manufacturers for violating the international code on marketing breast milk substitutes1–a code developed to protect and promote breast feeding.2 Failure to breast feed has been linked to detrimental outcomes in babies3 and mothers4 and, in developing countries, to substantial infant mortality. Code violations are rightly offensive to health professionals and the public.

      The backlash against baby milk companies has, however, changed the climate for researchers collaborating with industry to advance infant nutritional care. Such scientists may be personally criticised, even though the international code recognises a place for baby milks. Some hospitals–for example, so called baby friendly hospitals–may inhibit clinically indicated research with formula milks. The International Board of Lactation Consultant Examiners recently moved to withhold continuing education credits from people attending lectures by speakers who have a relationship with manufacturers or retailers of products for the artificial feeding of infants. This could exclude lecturers who work with industry on materials to promote breast feeding.

      To foster a balanced view in this sensitive area I suggest four reasons why clinical scientists should not become divorced from the baby milk industry.

      Firstly, raw cows' milk is not recommended before 12 months. As most Western mothers stop breast feeding long before then, baby milk is generally the dominant food for Western infants even when they have been breast fed initially. Therefore its safety and efficacy requires careful industrial and scientific collaborative research.

      Secondly, products made by baby milk manufacturers may be clinically indicated when lactation fails; breast feeding is inadvisable as in maternal HIV infection, certain drug treatment, and rare inborn errors of metabolism in the infant–or breast milk alone is nutritionally inadequate, as in preterm infants. Research is complex and requires close liaison between industry and science.

      Thirdly, research on formula milks is fast moving. Manufacturers cannot and should not operate alone–they must be responsive to clinical scientists.

      Finally, the outcome of breast fed infants guides the design of baby milks. As breast and formula feeding cannot be randomly assigned, how a component of breast milk affects outcome is most robustly tested in non-breast fed infants by randomised comparison of formulas; one containing the relevant component. Collaboration between industry and science is essential.

      Recent evidence suggests that infant nutrition may have important programming effects on later health.5 Much of the world's scientific and technological expertise that underpins this rapidly developing field lies in industry. Much key research–including that on breast feeding–results from industrial grants to responsible clinical scientists, who should not be made uncomfortable for necessary contributions to infant care. Nevertheless, researchers should not miss opportunities to influence baby milk manufacturers to adhere to their important marketing code.

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      View Abstract