Changes to paper served to stifle debate

EDITOR—As the author of the paper on strengthening the international code of marketing of breast milk substitutes for the meeting on infant feeding held by the World Health Organization and Unicef, I applaud Ferriman for bringing this matter to the attention of the public.1 One cannot help but wonder about the driving force behind the WHO's last minute cuts to papers prepared for the meeting.

The WHO asked me to write about successes for and obstacles to the implementation of the international code since its adoption in 1981, and to suggest a way forward. Before the meeting, the paper went through several drafts, and I had incorporated changes suggested by both the WHO and Unicef. Yet, at the meeting itself, the WHO cut nearly a third of the paper and did not circulate it to participants until the third day.

One of the big obstacles to implementation of the code identified in the paper related to the marketing practices of infant food companies. The WHO deleted nearly all descriptions and criticisms of such practices as they have evolved over the 19 years since the code was adopted.

At the meeting, the WHO staff blamed the cuts on the organisation's legal department. I await a response to my request for a written legal rationale for each deletion in the paper. The explanation offered in the article by the WHO spokesperson, that the paper did not meet a high standard of scientific objectivity and balance, is new to me. It is difficult to see how objectivity and balance could be better achieved through omitting all discussion of marketing practices, which I described as one of the major obstacles to achieving the code's primary aim to protect and promote breast feeding.

The WHO and Unicef invited me to write this paper on …