Nestlé attempts to defend its health claims...
“Improved breastfeeding practices and reduction of artificial feeding could save an estimated 1.5 million children a year”
According to the World Health Organisation:
“infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.”
So how can Nestlé justify claiming on its labels that its formula ‘protects’ babies and has ‘new active immunity’?
Below we give the defence provided by Nestlé’s Global Public Affairs Manager, Dr. Gayle Crozier-Willi, in a letter dated 2 November 2010, the latest in a long series. Dr. Crozier-Willi has also received thousands of emails from boycott supporters.
‘Gold Standard’ refers ‘to the Gold colour of the labels’
“The use of the term “Gold Standard” refers to the fact that this advanced formula is, in our view, the Gold Standard for formulas, in comparison to other less innovative infant formulas. The statement was made in product literature for the exclusive use of health care professionals and referred to the Gold colour of the labels. It was not in any sense meant to make a comparison with breast milk and the brochure was not available to mothers or to the general public. Yours is the only complaint that we have seen about this since the launch of the product, and in any case since that time, the brochure has been discontinued.”
‘Protect’ logo ‘is backed by scientific evidence’
“The ‘Protect’ logo is used on a new generation of sophisticated infant formula with a unique combination of specific strains of probiotics, long-chain polyunsaturated fatty acids, immune-nutrients and selected proteins. This unique combination has positive effects on the infant’s physiology and metabolism with other formula without these ingredients. However, we in no way suggest that the formula is equal to or superior to breastmilk.”
Are these claims of ‘positive effects’ true? See our crowdsourcing experiment to explore the 'research' that Nestlé cites.
The ‘protect’ logo is shown here on a tin from the display in rural Malawi and appears in many other developing countries. No mention is made of comparison with other formulas.
Article 9.2 of the International Code of Marketing of Breastmilk Substitutes states:
“Neither the container nor the label should have pictures of infants, nor should they have other pictures or text which may idealise the use of infant formula.” [emphasis added]
...but finally admits added LCPs have no benefit
The Cochrane Library has reviewed research on ingredients that Nestlé and other companies highlight such as DHA and ARA Long Chain Polyunsaturated Fatty Acids (LCPUFAs) and concluded:
“It has been suggested that low levels of long chain polyunsaturated fatty acids (LCPUFA) found in formula milk may contribute to lower IQ levels and vision skills in term infants. Some milk formulas with added LCPUFA are commercially available. This review found that feeding term infants with milk formula enriched with LCPUFA had no proven benefit regarding vision, cognition or physical growth.”
Similarly, Cochrane Library reviews have found no benefit from adding prebiotics and probiotics. Nestlé has finally acknowledged the Cochrane Library findings, but says: “we do not make any claim on product labels that contradicts the Cochrane Library’s reviews”.
How can basing the global marketing campaign around the added ingredients be reconciled with the acknowledgement that there is no proven benefit from adding them to formula, a totally different environment to breastmilk? Dr. Crozier-Willi sees no contradiction, stating:
“Our statement is that DHA and ARA are ‘two special fatty acids found in breast milk, which are important for your baby’s defence system, and contribute to the development of brain and vision.’”
So Nestlé’s defence is it is talking about the benefits of breastmilk, not its formula!
Crowdsourcing - your chance to unpick Nestlé’s argument
It is disingenuous for Nestlé to pretend it is not claiming benefits for its formula. Its materials and arguments need close scrutiny and we would like you to help. Click here for full details of Nestlé’s defence of its claims, dig into the research and give us your analysis.
Here’s an example of what to expect. In earlier correspondence about a ‘Brain Building Blocks’ claim Nestlé used about LCPs, Dr. Crozier-Willi referenced research to support it, without giving the title of the study. Perhaps because this was: “The role of polyunsaturated fatty acids in term and preterm infants and breastfeeding mothers.” This states: “many studies have demonstrated advantages of breastfeeding versus formula-feeding on subsequent cognitive and visual function.” Regarding the supposed benefits of adding LCPs to formula, the paper urges caution over studies suggesting some early effects: “Although one logically may assume that these early effects may have long-term effects, this assumption is not warranted by the available data.”
So the best study Nestlé could cite actually contradicts the theory that adding LCPs to formula brings benefits. After many letters - and thousands of emails from members of the public - it is welcome that Nestlé now accepts the Cochrane Library reviews and admits this. But it still refuses to remove the logos and stop the aggressive marketing. More pressure is clearly needed - click here to send an email to Nestlé.
The latest global monitoring report from the International Baby Food Action Network (IBFAN), called Breaking the Rules, Stretching the Rules (page 9) shows that the ‘root and branch review’ Danone promised after taking over the NUMICO companies (Nutricia, Milupa and Cow & Gate) has resulted in practices becoming worse, not better. Danone is rivalling Nestlé in the extent of its violations, and has its own version of the Nestlé ‘protect’ logo.
Danone has added shields to products around the world making claims that its added ingredient, Immunofortis builds the immune system. The UK Advertising Standards Authority and European Food Safety Authority are amongst those who have ruled that there is no evidence to substantiate this claim. Danone targets parents with baby clubs and offers free gifts to mothers and health workers, while providing misleading information.
Danone has promised to send us details of the changes it made as a result of its ‘root and branch review.’ We will read this with interest, but we want the company to drop its Immunofortis claims immediately and stop other violations or we will call a boycott of its key consumer brands. Watch for an announcement at the World Health Assembly in May 2011.
Pfizer/Wyeth breaks Saudi law
Pfizer/Wyeth ‘Breastfeeding Educators’ continue to turn up at breastfeeding events in Saudi Arabia distributing booklets containing bad information which have not been approved. Saudi law states: “The health care institutes are prohibited from using the employees of the producers, importers and distributors for mother’s milk substitutes and their staff to work in the field of child and maternity care.”
Nestlé’s Creating Shared Value forum in London on 27 May, aimed to reposition the company as a leader in sustainability, healthy food and education. Niels Christiansen was in full flow:
“We now reach about five million children...and we’re going to be expanding this to about eighty countries...We’ve started a programme to educate teenage girls on good nutrition before they get married and become pregnant, because that’s where we think we have to start, really - before the woman even becomes pregnant.”
No mention of the International Code or that this is a conflict of interest. Our questions to the online event were ignored but a vote at the end showed that less people believed sustainability was embedded in business than at the beginning!
• Nestlé also sponsored the Women’s Forum Global Meeting in France in October. Nestlé CEO, Paul Bulcke, spoke on global health and malnutrition and overcoming “political, social, environmental and ethical obstacles” in Africa. Urban Jonsson, a former chief of nutrition at UNICEF, commented:
"The business of Nestlé is to make money, selling processed foods, notably infant formula, weaning products, and products for young children. It is absurd that they should now be acting as if they are in the business of saving Africa. Public health is the responsibility of the public sector, including the UN system."
www.wphna.org/doorrevolves_nov2010.asp
For coming events see: http://info.babymilkaction.org/diarydates
Tacking Obesity: How companies use Education to build Trust:
http://info.babymilkaction.org/news/policyblog120310
GAIN pushes a market-led approach at Codex
In November, we joined IBFAN Africa and Infact Canada at the 2010 Codex meeting on Nutrition in Santiago, Chile. The Codex Alimentarius Commission sets global food standards and industry delegates can outnumber government delegates at meetings. It took us over a decade to bring the baby food and formula standards into line with the International Code and Resolutions - not least because the Chair, Prof. Grossklaus, was consistently biased towards industry. He famously threatened us with a “Red Card” (Update 37) for calling for independently funded science and declarations of conflicts of interest. Grossklaus retired in 2009, and the new chair Pia Noble, is somewhat fairer.
However the big power blocks of the US and EU still have disproportionate power. For example, in the debate about India’s proposals for a standard for baby foods for underweight children, Basil Mathioudakis, speaking for the European Commission, tried to weaken wording protecting 6 months exclusive breastfeeding - perhaps because the EU baby food Directive still allows labelling from 4 months.
The Global Alliance for Improved Nutrition (GAIN) (see Update 42) hovered behind the scenes pushing its market-led approach to development - the idea that ‘formulated’ baby foods and supplements should be promoted to the general public for the prevention of malnutrition. Such marketing is dangerous. It can create dependency on imported foods and undermine breastfeeding and traditional healthy feeding habits and skills.
Codex report: ftp://ftp.fao.org/codex/Reports_2011/REP11_NFe.pdf
(We attend as IACFO - the International Association of Consumer Food Organisations)
Among the many promotions for imported fortified milks in the Philippines, this one is appalling.
A notice in a Manila supermarket aisle beside S26 Progress toddler milks (1-3 yrs) and S26 Promil Gold (6 -12months) says: “A toddler can learn anywhere - even in this aisle. Teach him what these items are and help him write them on this paper. Help him make better Progress”
Photo: Karleen Gribble
Breastfeeding promotion: a good idea? If so, who pays?
Follow this link to a 4-minute film where passers by are interviewed about a Save the Children breastfeeding advertising campaign in China in September:
http://v.youku.com/v_show/id_XMjE5OTMyODg4.html?referral=ebulletin&date=wk8-12nov
SCF China breastfeeding ad. 2010
Advertising may help change attitudes, but it can also soak up funds and divert attention away from less noticed, but essential interventions such as health-worker training, peer counselling or marketing controls. It can also attract unhealthy sponsors - see below. Tell us what you think.
Below: In India it is illegal to advertise products for children under 2. Nestlé gets round this by promoting World Breastfeeding Week with the Nestle logo!
All health claims in Europe are covered by the European Nutrition and Health Claims Regulations (1924/2006) and before being approved must be analysed by the European Food Safety Authority (EFSA) - (Update 41 & Update 42).
In examining the thousands of claims submitted, EFSA has deemed the scientific basis for vast majority of formula claims for Immunofortis, prebiotics etc to be unsubstantiated, but considers that there is evidence to support 4 claims that DHA/ALA contributes to brain and eye development in infants and children. EU Member States (MS) will vote on whether these 4 claims should be permitted at the Standing Committee on Food Chain and Animal Health (SCoFCAH) meeting on 6th December.
While the benefits of Long Chain Polyunsaturated fatty acids (LCPs) in breastmilk are proven, the case for adding synthetic LCPs to the different environment of infant formula has not been, something Nestlé, for one, has finally admitted (pg 15). The case for adding LCPs to follow-on milks, which are part of a mixed diet, and then to make promotional claims is weaker still. We believe that EFSA gave bad advice in this case because it is not required to look at independently-funded research or reviews or to look at ‘risk’ - task that is left to Member States and the EU Commission. So the Cochrane Review, the 98 reports of adverse reactions to the US FDA, the banning of DHA fatty acids in products with the US federal organic label, and the calls for warnings rather than claims, seem to have been ignored.
Since July, responsibility for claims has been transferred from the Food Standards Agency to the Department of Health (DH) who will now attend the EU meetings which take place behind closed doors in Brussels. We have been calling for years for these procedures to be more transparent, accountable and democratic. (See Time to change the Rules?) The DH notes of the meeting are cryptic, but they do indicate that several Member States share our concerns about the lack of evidence to support the claims, how industry will use them and the impact the claims will have on public health messages - not just in the EU but globally. If passed, follow-on milks and any food meeting the criteria could carry these highly promotional claims, further undermining the role of unprocessed family foods. Infant formulas can carry only ‘nutrition’ claims (stating the presence of DHA) not a ‘health’ claim. Illogical when the DH position is that follow-on milks confer no health advantage. Applying ‘Conditions of Use’ guidance would work only if these excluded all foods, milk and drinks for infants and young children.
“The evidence for effectiveness of DHA addition to formula for term babies in terms of improved long-term mental development is weak at best ... until stronger data are available I would opt for a view that the effects of DHA on mental development are not sufficiently documented to establish public health policy.”
Ricardo Uauy. London Sch. of Hygiene & Tropical Medicine. June 2010.
“We find the case for labelling infant formula or follow on formula with health or nutrition claims entirely unsupportable. If an ingredient is unequivocally beneficial as demonstrated by independent review of scientific data it would be unethical to withhold it for commercial reasons. Rather it should be made a required ingredient of infant formula in order to reduce existing risks associated with artificial feeding.”
UK Government’s Scientific Advisory Committee on Nutrition (SACN) 2007
See Policy Blog for links to EFSA’s rejected claims and more.
Whatever next?
Cow Colostrum for infants. On sale in Vietnam, with DHA claim, supposedly collected within two hours of delivery. Imported from New Zealand.
Photo: Claire Champion
The most common questions asked by parents and carers who intend to use infant formula are probably, ‘Which formula is the best?’ and ‘How do I make a bottle?’ A new film for health workers developed by Baby Milk Action with Mark-It TV and the Baby Feeding Law Group, aims to equip health workers with the information they need to answer these questions and others.
Why is Baby Milk Action venturing into this area? As we campaign to stop company promotion, a question often raised is, ‘Where will health workers and mothers find the information they need?’
We interviewed various experts from the Baby Feeding Law Group to provide objective, independent information for health workers. There is a companion short film that health workers can use with parents and carers who intend to use formula to explain the differences between products on the market and how to reconstitute powdered formula in line with World Health Organisation and UK Department of Health guidance.
So which is the best formula? Look at the information baby food companies put on their websites and in information for health workers and you would believe that their particular brand is the best. Graphs show the company’s product is not only closer to breastmilk than competing brands but not far off being equivalent. They can’t all be telling the truth and closer analysis finds that none of them are. Indeed, by law all formulas on the market have to contain all ingredients known to be necessary.
Companies base their marketing campaigns on ‘optional’ added ingredients, but as the experts explain, there is no proven benefit from these. Indeed, one company (Danone) fell foul of the Advertising Standards Authority in 2009 for claiming its formula is the best when there is no basis for the claim. Companies violate the International Code by targeting healthworkers, offering gifts and money to meet if the health facilities don’t allow it. Danone has even been offering midwives grants branded with its Aptamil formula name. Companies know how important it is to reach health workers. So do we.
Ordering the Infant Formula Explained films
The films are available under licence and can be packaged with other popular Mark-It Television titles on breastfeeding and baby-led weaning. The licence allows a hospital, primary care trust, children’s centre or teaching establishment to use the health worker film with staff and show parents and carers the film developed for them. The films can be provided on multiple DVDs, or electronically for use on an establishment’s intranet. Click here to request a quote.
In focus groups with health workers, virtually all said they would like the DVD to be used in their facilities and half said they would modify their responses to the question ‘Which is the best formula’ after seeing the health worker film, or be more confident about their answers. One comment was, “Brilliant, opinions from a varied group and very factual, a real eye-opener for health workers.”
Infant Formula Explained includes interviews with: Dr. Wendy Jones (Pharmacist), Dr. Colin Michie (RCPCH), Gabrielle Palmer (Nutritionist), Sally Marchant (MIDIRS), Gillian Weaver (UKAMB), Mike Brady (BFLG), Rosie Dodds (NCT), Vicky Carne (MIDIRS), Shel Banks (IFIT), Liz Schofield (Midwife).
• Contact us if you would like to receive a review copy of the DVD for your publication.
Breaking the Rules - Stretching the Rules 2010 (BTR) is published by IBFAN’s International Code Documentation Centre (ICDC) in Penang, Malaysia. BTR examines the marketing activities of the major infant feeding companies using the International Code and subsequent relevant resolutions (the International Code) as benchmarks. Unlike industry funded analyses, BTR looks at real labels and promotion - not just what companies SAY they do. Some companies will dismiss this report out of hand but anyone wishing to understand how marketing undermines infant health should buy a copy.
The global market:
The baby food market exceeds US$24 billion per year according to global marketing reports. Double-digit growth is forecast for several regions up to US$38.7 billion by 2015. So the pressure to increase market share is intense - even by governments (see New Zealand story below).
Although 77% of countries have taken some action to implement the Code, monitoring and enforcement are still inadequate, particularly when laws and legal systems are weak. Only effective national legislation, properly enforced and monitored - independently from the companies - can protect child health.
Health facilities especially those not Baby Friendly, are still the preferred avenue for promotion, providing much sought after ‘medical endorsement.’ Prescription pads with formula pack shots to tick are used all over the Middle East. Free formula donations are still provided - in secret - to private clinics and hospitals along with offers of services, sponsorship and gifts.
Branding: “Premiumization”. “Gold” and “Premium” logos are used to suggest a higher grade and more expensive formula. In Singapore, ‘premium’ cereals are all the rage. Toddler/Growing-Up Milks are also on the rise.
Online marketing is much less costly than print advertising and keeps mothers’ attention for longer. Baby Clubs build brand loyalty with personalised sequencing of gifts, baby record booklets and samples. Wyeth (now owned by Pfizer) gets mothers to confirm they have read the ‘breast is best’ message before moving to promotional sites.
Claims Galore for prebiotics, probiotics, bifidus, lutein, DHA, ARA, Immunofortis - scientific sounding terms used to baffle and mislead parents.
Sponsorship and conflicts of interest: The majority of national paediatric associations are dependent on the largesse of companies - four are even endorsing products. Sponsorship of infant feeding programmes is a conflict of interest and is not allowed by WHA resolutions.
Incentive schemes: For the first time in years, incentive schemes, prohibited by the Code, are used by Wyeth-Pfizer and Dumex-Danone.
New Zealand Government sees profit in formula market
New Zealand’s Economic Development Minister Gerry Brownlee stated in October:
“A kilo of infant formula is worth ten times the value of a kilo of milk powder, so it’s obvious which product New Zealand should be selling.”
New Zealand earned more than $750 million from milk formula exports in 2009.
Source: Radio New Zealand News 29 October 2010.
http://www.radionz.co.nz/news/rural/60638/processed-foods-key-to-nz-earnings-rise-report
Despite progress 42 million infants are sub-optimally fed
As a Global Advocacy Task Force Coordinator, we joined the World Alliance for Breastfeeding Action (WABA) Global Partners Forum in Penang, Malaysia in October where an important new report (and website) was launched by IBFAN Asia.
From the left: Anwar Fazal, Dr Arun Gupta, Dr Raj Anand and Sarah Amin celebrate the release of IBFAN’s WBTi Report at the WABA Conference in Penang, October 2010.
The WBTi State of Breastfeeding in 33 Countries: 2010, Tracking Infant and Young Child Feeding Polices and Programmes Worldwide is packed with useful charts which highlight gaps in policy which lead to babies missing out on their foundation for development and protection from disease. Printed copies are available in Baby Milk Action's on-line Virtual Shop.
Millions of newborns in the 3 continents studied (so far only developing countries) are still not receiving any breastmilk at all and fewer still are breastfed for six months of life.
The ten areas of action highlighted in the Global Strategy for Infant and Young Child Feeding are used to score the policies and programmes of 33 countries RED (worst) YELLOW, BLUE or GREEN (best).
Although much progress has been made, NO country has yet achieved a GREEN rating and only 9 received a BLUE rating. Most have not raised exclusive breastfeeding rates because of weak or un-coordinated action on three of the most important interventions: having a national plan of action with a budget; good health care support facilities and adequate maternity protection. Bridging these gaps could help achieve one of the aims of the UN Secretary General’s new Global Strategy for Women’s and Children’s Health, that 21.9 million more infants are exclusively breastfed for first six months by 2015. It would also contribute towards the UN’s Countdown to 2015, Maternal Newborn and Child Survival Report.
Dr Arun Gupta, the creator of WBTi and IBFAN’s Regional Coordinator for Asia explains:
“What does this mean? Over 78 million babies are born in the 33 countries featured in the report - more than half of the babies born in the world. Yet only about 36 million of these are exclusively breastfed for the first six months. Over 42 million children are still sub-optimally fed. If you look at the booming economy block of Brazil, India, China - despite their progress and the important steps taken to protect health - there are key gaps which mean that infants and children are losing out on the benefits. It’s vital that policy makers ensure that the drive to expand economies does not take precedence over the health of children.”
World Breastfeeding Trends Initiative (WBTi) is part of the IBFAN/WABA Breastfeeding Initiative for Child Survival (gBICS).
The Revolving Door, WHO and the World Economic Forum
In Update 42 we reported our concern about the presence of the World Economic Forum (WEF) on the International Advisory Council (IAC) of WHO’s new Global Network for Non-Communicable Diseases (NCDnet). Peter Brabeck, Nestlé’s CEO, is on the Board of WEF.
NCDnet was masterminded by Janet Voûte, who, with no cooling off period, has moved from WHO to Nestlé as Vice-President responsible for global public affairs policies and strategies. We are not sure if WEF remains on the IAC. Other notable revolving door examples are Derek Yach - WHO’s Executive Director for Chronic Disease, now Pepsi-Co’s Senior Vice President, and Gro Harlem Brundtland, WHO’s Director General (1998-2003) who joined the Pepsi Blue Ribbon Advisory Board. See The Door Revolves Again. World Public Health Nutrition: www.wphna.org/doorrevolves_nov2010.asp
IBFAN and the BFLG wrote to Mead Johnson (MJ) and the Philippine Government about Alactagrow for one-year olds and above. MJ’s promotions, labels and gifts (right) claim that Alactagrow boosts brain, bones and immunity. However, Alactagrow was deemed substandard by the FDA because of its low fat level and MJ distributors had to recall the product in September 2010. We are worried that MJ may pressure the Philippines Government for permission to donate the recalled cans to the Department of Social Welfare and Development!
Abbott Laboratories waited a week after discovering beetle contamination before issuing a recall of 5 million units of Similac infant formula in September.
www.ibfan.org/fact-contaminants.html
www.ibfan.org/art/Written_Submission_by_IBFAN_stakeholder_meeting_WHO_FAO.pdf
The dramatic pictures and stories illustrating flood-affected Pakistan prompted UNICEF to write to the Guardian:
”Unicef would like to express its concern about the potential impact of this story on the emergency response and the health and survival of young children in Pakistan – a concern shared by many other humanitarian agencies.....Bottle-feeding in Pakistan is now even more dangerous than it ever was. The 6 September article highlights the extremely poor conditions of sanitation and hygiene in Reza’s home: the sewage, flies everywhere, the filthy flood waters. How is Reza’s mother going to sterilise that bottle? In addition, donations of milk are likely to be fed – and pose most risk of diarrhoea, malnutrition and death – to the youngest and most vulnerable infants who could be breastfed.“
www.guardian.co.uk/world/2010/sep/22/unicef-bottle-feeding-fears-pakistan
A new Indonesian law stipulates that anyone who stands in the way of babies being exclusively breastfed for the first six months of life will be fined and sentenced to up to a year in prison.
World Health Assembly adopts two landmark Resolutions on the promotion of junk foods and baby foods
Twenty nine years after the adoption of the landmark International Code of Marketing of Breastmilk Substitutes, the World Health Assembly adopted two new historic Resolutions which may have a long-lasting impact on child health.
First, a Resolution (WHA 63.14) proposed by Norway, calls for Member States to implement a set of Recommendations (which we had input into) on the Marketing of foods and Non-alcoholic Beverages to Children - referred to by many as the ‘Junk Food Code’. These call on governments to take a lead in policy setting and to restrict marketing, including in ‘settings where children gather’ (e.g. schools) and to ‘avoid conflicts of interest.’
A new Resolution on Infant and Young Child Nutrition (WHA 63.23) highlighted the damaging impact of the commercial promotion of baby foods on the health and survival of children and on childhood obesity. The Resolution, initially proposed by Peru, aims to raise the profile of nutrition in public health policy setting - a double-edged sword which can create opportunities for market-led solutions to development (see page 12) so we were on guard. After three days of discussion with many developing countries highlighting industry’s continued irresponsible promotion, the Resolution was adopted with several key amendments.
(Left: Briefing the US Surgeon General, Vice- Admiral Regina Benjamin, at the World Health Assembly).
Infant and Young Child Nutrition Resolution (WHA 63.23) key points:
The importance of breastfeeding in reducing child mortality was highlighted in Resolutions on the Prevention of Pneumonia (WHA 63.24, 1.5.c) proposed by the UK and the Millennium Development Goals (WHA 63.15, 1.6).
Warning: Nestlé is lobbying policy makers in Africa to be included as partners in health policy setting. WHA Resolutions 49.15, 58.32, 61.20. call for Conflicts of Interest to be avoided.