Formula wars

PINOY KASI

Formula wars
By Michael Tan

Inquirer
Last updated 02:13am (Mla time) 06/27/2007

It’s almost formulaic, the way the drug companies argue their case for advertising and promotions, whether for medicines or for breast-milk substitutes (milk formula). I’m saying formulaic because they use the same scripts over and over again, whenever there are attempts by governments to regulate their advertising and marketing strategies: “People need access to information, and we’re providing it through our advertising and marketing campaigns.”

The current battle over milk formula started last year when the Department of Health issued new and stricter regulations on the promotion of milk formulas. There were already existing rules and regulations under a Milk Code, but the provisions were frequently being violated, with the Bureau of Food and Drugs handling 63 reported violations of the code between July 2001 and December 2004. After the government issued the new regulations, the drug industry took it to court on grounds that this violated their right to free trade. As the case dragged on in the Supreme Court, the industry shifted its focus, arguing now that the new rules will prevent the companies from providing information about child nutrition and impeding free choice among mothers.

Let consumers decide, industry will argue. They should add, caveat emptor (let the buyer beware). The playing field here is just too skewed. Advertising is powerful because it uses mass media, taking on a semblance of expert authority and finding its way into our subconscious because of its frequency. Think of some of the drug ads you’ve seen, and their claims. I can hear “Ako pa,” a macho guy attributing his virility to a vitamin. And from way back in childhood, I can still hear the catchy tune for Tiki Tiki vitamins. (See? You’re humming it now, aren’t you?)

A 2006 report of the Philippine Center for Investigative Journalism (pcij.org/i-report/2006/breastfeeding.html) cited AC Nielsen figures showing that P2.3 billion was spent for advertising infant formula during the first half of 2006 alone. Note that's half a year, and only for advertising in the media. The health department’s entire budget for one year is only P13 billion, so there’s hardly anything for education on infant and child nutrition.

During the last few days, local media have been featuring a clinical professor from the Ohio State University, who argues in behalf of the companies that many mothers will find themselves in situations where they choose not to breastfeed, or cannot breastfeed, and that they will need access to information, provided by the companies, to make the right choices.

Informed choices

I can accept that many mothers will indeed find that they cannot breastfeed, not so much for physiological reasons than because of having to return to office work. But the question for the drug companies is simple: Is their information really going to help mothers make informed choices? If, for example, a mother has to return to work, are the drug companies actually providing information about the options for the mother besides infant formula -- for example, using a breast pump to get the milk and storing this in the refrigerator?

The industry’s “information” is just too skewed toward promoting milk formula, from infant booklets given in hospitals to new mothers, with advertisements for milk formulas and weaning foods, to the packaging itself. My own son is on formula simply because I’m solo parenting (yes, I know there are claims that men can induce themselves to lactate but...). But even as I use formula, I do resent the way the manufacturers still attempt to drum up their ludicrous IQ messages in the packaging. I have a can of Gain in front of me and it has “IQ” written all over the can. Psychologists can tell you this is insidious, almost a way of saying: if you shift, you might be taking away all this IQ-enhancing milk from your child.

I’d trust industry more if it would stop playing with the facts. On television the other night, I heard claims that breastfeeding continues to be widespread anyway in the Philippines, so why regulate the formulas. I heard a figure as high as 85 percent cited, but that refers to mothers who initiate breastfeeding, and that could be even for one day alone.

What are the figures that matter? First, only 16 percent of mothers will use exclusive breastfeeding for six months, which is the recommendation of the World Health Organization -- a small minority. Second, the last National Demographic and Health Survey found that the median period of breastfeeding nationwide was only 0.8 months. Yes, the decimal point comes before the 8, meaning it’s less than a month.

Industry spokesmen have also challenged, sometimes with indignation, Unicef’s figures about milk formulas being related to some 16,000 infant deaths in the Philippines. They want proof, but again that’s all so formulaic, making them sound too much like the tobacco companies who continue to insist that there is no direct proof showing that smoking kills. It reflects a lack of understanding of scientific medical research, which can show only correlations rather than direct causation. With such poor scientific sense, industry’s claims to being able to provide sound medical information become highly suspect.

Wish list

If the formula manufacturers are serious about their claims to providing information, then let them expand on the initiative of Nestlé’s Wellness Campaign, which has included a categorical statement that there is no scientific evidence to support IQ improvement from one of the infant formulas. Nestlé was the main target of consumer groups many years ago because of its aggressive marketing of milk formula and it seems to be learning that public relations can pay off.

Just a wish list for the companies to prove that they’re interested in medical information for better maternal and child health:

How about launching, in their own offices and factories, facilities for mothers to breastfeed and to store breast milk? How about spearheading a campaign with other corporations on the value of breast milk? (Using the language of profits, we could argue that breastfed children are healthier, which means less absenteeism from mothers who would otherwise have to stay home to care for a sick child.) How about more programs on TV, with media-wise doctors and nutritionists, explaining good child nutrition in general, to include, I’m willing to concede, a role for milk formulas? (Sure, maybe even tackle the question about breastfeeding men.) Finally, how about sponsoring medical experts to talk about how long a child should be on milk formula? (Some of my pediatrician friends say I can shift to regular milk after the child turns 2. Others say 1. Still others, including the late Benjamin Spock, suggest a total shift away from cow’s milk and the use of soya instead.)

There are enough opportunities out there, to be funded from the industry’s P21-billion annual revenues, for the companies to prove they’re genuinely interested in promoting infant and child nutrition.