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Healthy Skepticism International News

September 2008

Is the American Academy of Pediatrics Helping Babies R Us Promote Formula?

By .(JavaScript must be enabled to view this email address)

(Originally published at The Social Medicine Portal, a project by faculty members of the Department of Family and Social Medicine of the Albert Einstein College of Medicine, Yeshiva University, New York.)

It was the attractive young couple sitting on the brownstone that drew my eye. It looked like a patient education brochure for expectant parents. After all, it was sitting in the clinic hallway outside the office of our busiest obstetrics provider, advertising itself as a “comprehensive resource guide for getting ready for baby.” But there was something wrong here.

I was initially struck by the title: “Becoming Us,” which seemed to imply that the advent of the baby was uniting the couple. Then I noticed that the brochure was sponsored by “Babies R Us” and suddenly the implication changed: Did having a baby somehow make one part of the “Babies R Us” family?

Although the pamphlet stated that it was a “comprehensive resource guide to getting ready for baby”, it seemed that getting ready for baby primarily involved buying products available at BRU. Some of these products appeared in ads. But others appeared in infomercials, sitting alongside apparently neutral advice. In short, like much of the so-called patient education materials, this guide was simply advertising.

There was, however, something particularly disturbing about this catalog. On the cover it stated “Editorial content reviewed by the American Academy of Pediatrics” giving a medical endorsement of the information in the catalog. This impression is, undoubtedly, reinforced by being distributed in a clinic where prenatal care is provided. In case a reader missed the point, the first page contains the stamp of the AAP along with a little disclaimer that the AAP is not endorsing “any product or service or the claims made for any product or service by any advertiser.” But in an infomercial, where does the advertising stop and the content start? (The Babies R Us webpage on Buying Guides and Advice also comes with a prominent AAP endorsement and again creates the same confusion.)

This endorsement is particularly troubling given the prominent role played by baby formula in the pamphlet. Before entering into the specifics, it is important to remember that the promotion of breast-feeding is one of the key maternal, infant, and child health goals of the Healthy People 2010. Current HP2010 goals call for 75% of mom’s to initiate breast-feeding, 50% to continue at 3 months (40% exclusively breastfeeding), 17% to exclusively breastfeed at 6 months and 25% to continue breastfeeding at 12 months. As we have posted previously, breast-feeding has multiple health benefits for mother and child. And regrettably we do not have a single baby-friendly hospital in New York City.

Back to our “comprehensive resource guide”: There is one overt ad for “Nestle’s Good Start Supreme” which can “support Baby’s Healthy Immune System.” This comes in the middle of the section on “Mealtime” which opens with a beautiful two-page spread of Dad bottle-feeding an infant. The mealtime section is divided into 3 parts. The first is about breast-feeding and two 1/4 page pictures of breast-feeding Mom’s compete with a 1/2 page of bottle paraphernalia. “Mealtime: Bottles” has our “editorial content” on bottles next to a picture containing two types of “Earth’s Best” powder, a can of Similac and a bottle of Similac “Organic.” Finally, the “Big Eaters” shows us a baby starting solids “between four and six months.” Not exclusively breast feeding. Finally, the “changing tables” section reminds us not to forget “bottle and formula.”

Companies are, of course, free to advertise what they will (although one often wishes that Congress would do the right thing by babies and just outlaw advertising of formula). A study published in Obstetrics and Gynecology in 2000 by Howard et. al. concluded that: “Although breast-feeding initiation and longterm duration were not affected, exposure to formula promotion materials increased significantly breast-feeding cessation in the first 2 weeks.” So why should the AAP endorse commercial advertising which not so subtly gives expectant mothers the message that formula feeding is a normal choice, just like breast feeding. And one wonders how these pamphlets made their way into our clinic which is, in theory, closed to advertising of this type?

The answer for us is that we are deluged with such advertising. Sometimes it comes in boxes of magazines and pamphlets that look like legitimate publications coming from legitimate organizations, but are really vehicles for pharmaceutical advertising. (Some of this is even endorsed by professional associations!) It comes to the physicians and staff in envelopes with handouts or CME offers or “patient education” DVD’s or pamphlets. It comes in the form of pre-packaged television such as CNN’s Accent Health. Or patient education billboards such as those produced by EURO RSCG. It comes in the pads and pens that somehow manage to find their ways into our pockets and desks. Getting rid of this is a bit like exterminating cockroaches. It’s a never ending job.

Why does AAP endorse such infomercials? It violates the spirit of their own policy on breast feeding which states that pediatricians should:

• Promote, support, and protect breastfeeding enthusiastically. In consideration of the extensively published evidence for improved health and developmental outcomes in breastfed infants and their mothers, a strong position on behalf of breastfeeding is warranted.
• Promote breastfeeding as a cultural norm and encourage family and societal support for breastfeeding.

And this endorsement of Babies R Us seems to undermine the work of the the AAP Section on Breastfeeding, and specifically contradicts their advice to doctors that they:

• Provide noncommercial educational materials on breastfeeding.
• Remove commercial logos and other indirect formula endorsements (eg, note pads and pens with brand names, decorative logos, calendars), and store formula supplies out of view.

Unfortunately, AAP’s main Continuing Medical Education Publication, Pediatrics in Review, is sponsored by Abbott Nutrition, makers of Similac. And presumably the AAP does not endorse BRU “editorial content” for free. But there is a price to pay for dancing with the devil.

We hope the AAP will amend their policy and no longer endorse content for commercial publications which advertise and feature formula. This could be an important step in achieving their own objective of establishing breastfeeding as a cultural norm.



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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963