FLRF/Medela Post

My previous post, Friends of the WHO Code? set out the facts re the Family Larsson Rosenquist Foundation as I understand them, and I have had no contradictions or corrections. (I will report any, of course, in public posts, as I believe strongly that private groups discussing this issue misleads good people, and creates needless confusion and dissension.)   

To recap briefly. FLRF is the Swiss charitable foundation that is the single largest independent source globally of funds for breastfeeding research, mostly given as large grants to universities to set up targeted centres of excellence in aspects of breastfeeding and lactation. Funding for FLRF comes from a group of companies that includes Medela. Its Board of Directors includes one Larsson Family member, not involved in any of the family businesses. This is common practice, and the charity is professionally run and audited. FLRF is not Medela, does not own Medela, and is not owned by or in any way linked to by Medela. Basic fact. No matter how many times people get it wrong. 

What does this second post address?

The Medela AG issue I discuss is twofold.

Firstly, does this pioneering breastpump company violate the International Code of Marketing of Breastmilk Substitutes (the Code, WHO Code)?  

Secondly, whether Medela is or is not a Code violator, is it morally justified, and beneficial to the cause of optimal breastfeeding, to blacklist or de-platform anyone who has any dealings with them – whether for financial gain or not? 

(Note for the uninitiated: At present Medela and those who speak for them are shunned by some breastfeeding groups such as ILCA, LLLI, and ABA. (And some extend this shunning to FLRF as well.) Medela is prevented from sponsoring or exhibiting at conferences, and thus prevented from reaching health professionals to market and educate about their products. Sponsorship from some lesser/newer companies may be accepted, in order to keep professional education affordable.

The overall issue of the uncontrolled industry sponsorship of health professional conferences is currently being debated quite widely, but that is not the issue here. Nor is infant formula industry marketing.) 

But first: do I have any conflict of interest here? None, though some people have active imaginations, which reveals something about them, nothing about me.

I have publicly broadcast that I spoke at one Medela conference in 2018, for which I was paid an honorarium that I donated to charity –  even though as a single aged pensioner with an income below the poverty line, I am currently unable to afford recommended dental care.  Neither Medela nor its critics determine what I think or do: I weigh all available evidence and reach conclusions that I believe are in the best interests of mothers and children. 

 (NB: I asked to speak at that Medela conference because I was sure it would attract some people less likely to know about infant formula harms, people who needed to read Milk Matters: infant Feeding and Immune Disorder. And the talk I gave is summarised in my online poster: https://infantfeedingmatters.com/the-milk-hypothesis-illustrated/  Anyone who perceives any conflict of interest in that is welcome to comment.) 

 Additionally, I contributed a strongly revisionist chapter on the history of infant feeding to the scientific and factual FLRF textbook  Breastfeeding and Breast milk: from biochemistry to impact. You can read that online at https://infantfeedingmatters.com/infant-feeding-history-revised/ and judge for yourselves about potential conflict of interest. The payment for the chapter came from Thieme, its German publisher, and went towards the cost of attending the 2018 ISRHML conference in Japan. 

I chose to do both these things despite being told that to do so would mean certain people would try to reduce the speaking invitations I would receive globally.  As they have since. Not only for me, but for other notable authors and researchers. 

Firstly, is Medela a WHO Code violator? 

Why is Medela alleged to be? What recent actions can justify selective refusal to allow this particular pump company to be present at, or sponsor, key breastfeeding organisation conferences? This ban on sponsorship has led, as might be predicted, to Medela creating its own Asia Pacific conferences, to reach the key health professionals who largely determine the relative market share of pump companies. Medela conferences are high quality and relatively low cost. And so banning Medela from paying to exhibit probably reduces income for breastfeeding organisations runnng conferences, which lose their sponsorship, and also possibly lose registrants to their better-funded competition. Good outcomes?  

Why all this? It’s hard to get concrete answers from critics, some of whom have what would appear to be vested interests themselves, to a critical eye like mine. I will discuss the answers I had been given as justification before drafting this post. I asked  on my Facebook for further evidence, and no other actions were noted. Individuals simply expressed their opinion that Medela marketing breached the Code, as they understand the Code. Some asserted that the Code prevents breastpump companies from providing information to families if they also make bottles to feed expressed breastmilk, and that the Code mandates that health professionals are the only people who should receive any information. 

Reason 1. Medela refuses to take out of their pump kits, the bottle and teat for feeding expressed breastmilk. In my opinion, quite rightly. Were they to take out bottle or even teat, mothers buying Medela pumps would need to find items that fit, separately, from hospital or after they get the pump home. Another good outcome? Of course not. It would be irresponsible – and very bad customer service – to impose another task and cost on stressed new mothers, some of very small or sick babies.  

Reason 2. Additionally, in photos of the Medela pump kit, the bottle is visible. That is a problem?? The Code does not prohibit images of bottles in breast pump pictures; these imply that breastmilk will flow from the bottle. Such pictures imply the (for many) attractive idea that mothers do not have to be present 24/7 for their babies to be exclusively fed mothers’ milk. Is this such a bad thing in societies where  breastfeeding is often portrayed as life-limiting for women?  In the Code, bottle and teats are mentioned as the feeding equipment for infant formula, which at the time of Code development, 1981, was only the first 4-6 months of infant life. Subsequent World Health Assembly resolutions have dealt with later formula use and toddler formulas as well, and WHO has given guidance on the preparation of infant formula, and cup feeding because of the dangers of bottles in conditions of poverty. But nowhere that I can see is the feeding of breastmilk from a bottle denounced, nor is the actual marketing/sale of such products forbidden by WHO or anyone.

Bottle feeding is, regrettably, a western norm. Medela naturally makes these teats and bottles to suit its pump equipment, and so is a manufacturer under the Code, which permits the provision of scientific and factual information to health professionals. Some other lactation-related equipment is sold separately from the pump kits, but in general feeding breastmilk is the purpose of Medela’s range (explicitly stated in 2012 when their new teat was released. It is not intended for formula feeding.) Medela say they are publicly committed to marketing their bottles and teats only in the context of breastmilk feeding. 

On the other hand, Ardo does manage to show bottles in the images of their pumps kits without attracting any criticism. But they do go much further in avoiding the sight of a teat. And their glass bottles have to be bought separately. 

But personally, I can’t see much Medela wickedness so far. Mothers buy online; they need to know what they’re buying, so the ‘no advertising at all’ dictat simply won’t work. What else has Medela done to be singled out from other pump companies? 

Reason 3. Some allege that Medela breaches the Code by advertising its new teat, the innovation-prize-winning Calma teat and the mini Calmita, developed in original research done with Medela (not FLRF) research funds. This teat works differently from previous teats, in that it requires the infant to create suction pressure before milk will flow from the teat into the mouth. This ensures that the baby does not have to keep swallowing or else bite down on the teat to stop flow, in order to breathe and swallow, but can pause, as with breastfeeding. Because of this need to create vacuum, it is claimed that this vacuum release teat is more akin to breastfeeding, and so less likely to result in bottle teat preference, than conventional flow through teats, or teats that are squeezed to extract milk.

And so, Medela claims, it “supports an easy transition from the breast to the feeding solution and back to the breast.” That, say some, is a breach because not a scientific and factual statement. Is it? How do they know? No research evidence is given, so I assume that’s simply their opinion. 

In Australia the Therapeutic Goods Administration requires products to justify therapeutic claims. All marketing is covered by consumer protection laws that prohibit false and misleading advertising, while permitting the development and marketing of new products. WHO Code and WHA resolutions are not binding on any sovereign nation, but are recommendations for governments to implement in accord with their circumstances and legal systems.   

If the Medela claims about their teat are not true, they are false and misleading. For which there are multi-million dollar penalties in Australian law. Yet competing teat manufacturers did not fund comparative trials to disprove what Medela was claiming (which suggested to me that they knew their products would compare badly.) Such competitors have not alleged breaches of any laws, though they ought, if this was the case (which suggested to me that they couldn’t prove a case.)   

In reality, Medela’s teat competitors are making therapeutic claims that go way beyond anything Medela says. After being astounded to be told that one American company was Code compliant, I checked out the internet for multiple brands of teats, bottles and breastpumps. It turned out that what the speaker was referring to was some undated period in the past when Evenflo was said to have been Code compliant, although it certainly is not now. [helps prevent colic gas and fussines, prevents mouth fatigue: Evenflo] [“Anti-reflux & anti-colic latch to help support & control the feed. Avoids nipple-confusion. Unique teats for proper breastfeeding latch & correct feeding action” says Minbie. Yet I am not aware of anyone diligently searching out and creating an online blacklist of all persons associated with all these companies. Only Medela, which is constantly and wrongly conflated with FLRF.) Is that just? And is it worthwhile?

Advocates can’t fund research studies. But if they really want to know whether advertising is false and misleading, they could focus their efforts on getting existing consumer law enforced. To prosecute a company for telling lies in marketing will not create the backlash against breastfeeding advocacy that creating a crusade against bottle and teats certainly will. And has.

But is that Medela claim of enabling an easy transition between breast and bottle untrue? As I read it, that statement does not encourage breastfeeding reduction or cessation, but merely recognises the reality of many women’s lives. To me, it clearly refers to current mixed feeding practices (some breast, some bottle, but all breastmilk, as complex lives dictate) that have become common wherever women return to the paid workplace and cannot keep their baby with them to breastfeed. It has been shown in studies with regular teats that infants can develop a preference for the more predictable bottle, despite this requiring different and greater muscular effort, and negatively affecting their orthodontic development.  We might prefer that women solely breastfeed, and see bottles as an additional needless risk, but not every busy mother would agree that cup feeding is the ideal method of getting breastmilk into a small baby.  

Unlike some, I didn’t rely on my utter ignorance of the new-design teat to form an opinion about it. In the absence of published comparative research on teats, I wanted to see this different teat in action. So I visited the UWA research centre where all the developmental industry research had been done, and watched videos of infants feeding via the Calma teat. It was visually clear that – as the researchers claim – milk flow occurred when the mouth seal had been created, and the infant’s jaw dropped, forming a stronger vacuum. Backwash of milk into the breast was also visible. That convinced me. 

So I was not surprised later to see a randomised controlled trial of the two different types of teats, in which use of the the smaller Calma teat  (Calmita) was associated with significantly more preterm babies fully breastfeeding at discharge,  and still breastfeeding at 3 months (Breastfeeding in the sense of getting maternal breastmilk at least, as the researchers carefully noted that they could not specify how much milk came direct from the breast. However, in the supportive WA context, it’s pretty certain that these babies were directly breastfeeding at least some of the time. And no sane person considers the supplementary use of bottles means a woman is not in truth a breastfeeding mother, when her breast is supplying her baby’s food!) [Perrella SL, Nancarrow K, Trevenen M, Murray K, Geddes DT, Simmer KN (2019) Effect of vacuum–release teat versus standard teat use on feeding milestones and breastfeeding outcomes in very preterm infants: a RCT. PLoS ONE 14(3): e0214091 https://doi.org/ 10.1371/journal.pone.0214091] Follow up studies of these children’s orthodontic history should be interesting, especially if those still breastfeeding at three months are compared with infants fully bottle fed from birth who progressed to formula feeding, with its different viscosity, composition, and feeding patterns.

That was published after IBFAN’s post, discussed below.  So Medela’s claims are possibly true, certainly for many women I know as well, and no one has disproved them although they have $$ motive to do so.

Then surely it is important for Medela to be able to advertise a teat less likely to cause problems for breastfeeding? Parents of preterm  babies especially need to know. Healthworkers need to know. And as noted above, provision of scientific and factual information is explicitly permitted in the International Code. Such advertising is therefore not, in my opinion, a Code violation, nor a breach of consumer law. Until it s proven to be false.

IBFAN’s opinion An IBFANer myself since 1981, I pay attention to what they say. (But I also know they, like me, are fallible.) IBFAN claimed that Calma marketing was  “confusing mothers by leading them to think switching back and forth between breast and bottle is acceptable, when it is in fact a practice that means the end of breastfeeding!”  https://www.ibfan-icdc.org/medela-a-notorious-code-violator-2/   The studies which show such an outcome were discussing conventional teats. It is precisely because conventional teats can lead to the demise of breastfeeding that a teat which more closely simulates the action of breastfeeding needed to be created and then to be marketed.

The vacuum release of milk is a physiological reality. And so the new teat is an innovation which makes bottle feeding a little more like breastfeeding. And has been recognized as an innovation by awards.

However, IBFAN was not telling the whole story. (Perhaps because those writing the opinion were not clinicians working with women?)  It is also true that motivated mothers continue to breastfeed longer as a result of being able to express their milk while at work, and their babies receive more breast milk, less formula, because pumps exist. Good outcome.

And true that many women express enough to donate milk to other less fortunate mothers, thanks to effective and efficient breast pumps. Another good outcome.  

To be opposed to the development and marketing of a better pump or teat is not in the best interests of all those women who cannot breastfeed exclusively for the recommended six months of life, and who wish to continue into the second year and beyond, as WHO recommends, and many in Australia do. Breast pumps have introduced more flexibility and are valued by mothers, not only of small sick babies but of toddlers  and older children. Though the IBFAN authors may not know it, ‘switching back and forward’ is routine for many experienced mums who understand how to regulate their supply up or down. Increased workforce participation makes a pump necessary for many mothers in communities like Australia with longer duration breastfeeding.  

Marketed to whom?

But one step back. Should the teat be advertised to the general public? Or only to health professionals? This is 2020 and the internet exists and every mother with a phone uses it. Literate mothers would react strongly against the idea that information should NOT be available to guide their choice of teat or bottle, and that they should always ask health professionals for recommendations. Quite rightly in my view. That reeks of the old paternalist and self-serving mentality that saw the AMA refuse to recommend formulas which included preparation instructions on the tin, thus ensuring that parents had to pay doctor’s fees to get the information.  It did not seem to trouble doctors that poor families could not afford to do so, and had to guess. And it does not seem to trouble some Code activists, for that matter. They talk as if all mothers everywhere can freely access such professional help, which of course they are happy to provide. This is nonsense. Intelligent and literate women are perfectly capable of making good decisions about infant feeding issues without such patronizing bullshit. What matters is that they are not being lied to in any information they can resource for themselves. And their prime resource is the internet, not health professionals’ offices.

The internet has changed the whole concept of marketing. It seriously does need to be regulated and policed to punish the false and misleading advertising that abounds on it. But the idea that WEIRD parents should not have access to information directly, when they choose to access it, is nowadays simply ludicrous, and it’s not going to happen. To say it should, helps no one – except those who want to depict breastfeeding advocates as extremist nutcases making life difficult for bottle feeding parents.  

So too is the idea that companies should not provide advice about the use of their products, or that information provided by those with medical degrees after their name is inherently more reliable. I see mistakes about infant feeding from both groups. The Code was written in the era when doctors were god, and men told women what to do with their babies. IMO, companies have a moral obligation to provide as much information as possible, and a legal obligation to ensure that what they provide is clear and accurate.  

It is of course true that in an ideal world there would be no need for breast pumps or teats, as lactating mothers would be better supported to be close to their infants, and the provision of breast milk for those who could not breastfeed would be seen as a community responsibility. That is not the WEIRD world we live in.

 Optimal infant feeding in weird societies often involves both breast and bottle feeding, as those of us who work with mothers are well aware. And few are more aware of that than Professor Amy Brown of Swansea University, who summarised those societal constraints in a great chapter in the FLRF professional textbook Breastfeeding and Breast Milk: from biochemistry to impact, and discusses them in her own books, Breastfeeding Uncovered: who really decides how we feed our babiesThe Positive Breastfeeding Book: ; Informed is Best and others. Just as I did in 1985 in Breastfeeding Matters: what we need to know about infant feeding. I’ve lived through the time before, and after, effective breast pumps. I know they are useful, albeit over-used.

So, here’s my (fallible) answer to the questions:

1. Can Medela fairly be singled out as a violator of the International Code?  On the evidence I have, I would say no, they should not be singled out. While Code article 5.1 does forbid advertising to parents and seeking contact with them, online marketing is not confined to Medela, and press releases will always highlight new developments. In fact, it is often a Medela press release, or reportage based on one, that is criticized: are companies not supposed to tell the world about their innovative products?

So yes, when it’s a Code breach to advertise the products at all (but  not to have them on the market)…then, every single company, not just Medela, is breaking the Code, and in far more obvious ways. Even those that avoid showing teats are showing bottles. Certainly others use weasel words and careful language to try to disguise the health claims they have no proof to support.

But that doesn’t answer the important second part of the Medela issue. Which is: 

2. Is it morally right, or beneficial to the cause of optimal breastfeeding, to blacklist or de-platform anyone who has any dealings with them? 

And here I hope all my readers would agree. Absolutely not. I think it is morally reprehensible, irresponsible, and harmful, not to mention unscientific, undemocratic and anti-feminist. A waste of time and energy, and divisive in the advocacy movement. It plays into the hands of those Bridget McGann has rightly called “breastfeeding science deniers”. it is counter-productive and alienates many.

 Recommendations for all organisations currently refusing Medela sponsorship while accepting other sponsors.

I am aware that at least one major breastfeeding organisation has already been asked by a fellow pioneer lactation consultant to reconsider its position on Medela as a Code violator.  Many breastfeeding groups – LLLI, ILCA, LCGB, ELACTA, LCANZ, WABA, NCT, ABM, ABA, the whole alphabet soup of advocacy – need to take this seriously, basing their decisions on the evidence. Not on the opinions of virtue-signallers gaining credibility as passionate Code supporters by condemning and excluding their critics. Personally, I dislike condemning even them, for I am sure they mean well, and may be great with mothers.

But I have believed for a long time that they are doing harm; I have tried to reason within private groups, and for my pains been excluded and then uninvited as a result of their actions. I ignored even that, as age and income mean that I am cutting back on travel anyway.  But stop and think about what it means if you are to shun those with any industry connections.

Far better to have two things, I think: 

1. Breastfeeding association conference policies that require:

  • organisers: to include a diverse range of experience and ethnicity and social class in choice of speakers, and wide access to the latest relevant information from all sources;
  • sponsors: to bring only Code compliant materials – that is scientific and factual information – with any breaches to be confiscated and destroyed. (Booksellers should be exempted as registrants need to see the wide range of books influencing families and researchers. )
  • speakers: to declare their past and present commercial links in print in the conference brochure and before presenting, and to be open to questions in a dedicated timeslot 
  • attendees: to observe the rules of civility and avoid slander and rash allegations on pain of expulsion from the conference without refund, if unwilling to apologise in person and in public  

2. No conferences for health professionals solely organised by industry.

At all. Ever. If industry can reach health professionals by sponsoring their conferences, there is no need for them to set up competing conferences.

And above all, far better to ignore breast pump marketing unless outrageous, and use every bit of activist energy to focus on the facts that in North America and elsewhere, infant formula marketing still targets mothers with free samples; hospitals still routinely use formula to alter the infant microbiome; doctors still advise mothers not to breastfeed when taking safe medications; allergists still advise using formula instead of changing maternal diet…and mothers and babies are still dying and suffering needlessly.

Ignoring Tom Hale’s book or mine because we attempt to educate any place we get an invitation is not helping change any of those deeply damaging facts. Being judgmental about other people’s ethical decisions is utterly unattractive, and dogmatists that invoke any document from anywhere as if they are the Ten Commandments are people I despair of.  The Code’s aims and objectives are what we should all be working to realise.

Let’s support one another to do the best we can to that end where we are. And for me – not you, that’s your business – that absolutely means I will attend industry conferences, speak at industry conferences, read industry books, talk to industry people – and interpret the information for people who need to know much more than they currently do about industry’s products.  If that means anyone blacklists me, or anyone else, they should be bloody ashamed, frankly.   

Why do I take the time to write about this? Not because I want to promote Medela or its products. I don’t care about Medela or its market share, and I don’t endorse any company’s products without good evidence that they are better than others. On the other hand, I give credit where it’s due, because I remember the breastpumps available in 1976! 

But because truth matters, always. And justice is important when dealing with anyone, including commercial entities.  

Partly because I believe challenging this black ban is long overdue. It is not just the company which is being affected. I am tired of a situation in which the integrity of good people is implicitly or even openly questioned, on the basis of no evidence. For years there have been damaging global slurs and inferences about those who are prepared to work with industry in any way shape or form.   

Researchers are well able to deal with controversy, but expect disagreement to be rational and civil, and based on what they have said, rather than their funding sources.  I know one young researcher who has left the field of breastfeeding precisely because of nasty confrontations witnessed, and others distressed by such behaviour. Mental health issues are not confined to the families we care for. It makes me angry. 

But it’s not only because I feel for the researchers and authors whose reputations have been smeared by gossip and innuendo, and sales limited by prejudice. (And let’s not pretend that doesn’t happen.)  As I’ve mentioned, Code cultists have got to the stage of blacklisting as conference speakers those who have interacted with industry or even written a  chapter in the FLRF book, Breastfeeding and Breastmilk: from Biochemistry to Impact – from which some were pressured to withdraw, and others chose to boycott, although doing both made the book less powerful in the cause of breastfeeding. (The planned chapter on feeding in emergencies being given to policy makers would have been useful, wouldn’t it? Proposed speakers thought their ethics more important. Frankly, I don’t. ) 

The cause of breastfeeding needs people to speak truth to industry and to those willing to attend industry-funded meetings.  There will be few first class speakers on offer if every single person with any association, however slight or secondhand, with a  Code-related entity cannot be permitted to speak at health professional conferences. The list would be a very very long one indeed. Perhaps Code activists will it to all those who publish in journals supported by Code-breakers and eliminate all scientists from the speaking circuit as well?

Why am I doing it? Ultimately, because I can, and others can’t.  As a person with a well-documented record of working for WHO Code compliance from 1981 till now, I hope organisations might listen to the author of Milk Matters: infant feeding and immune disorder, and have a rethink.

I assure them, and all readers, it does not help the cause of breastfeeding advocacy to insult and offend the very people we most need to hear our grassroots experience and perspective. Criticise the research if you will. DO not imply that any defects are due to funding sources unless there is evidence that this is indeed the case. It is unfair and cowardly to pick on people you know are not going to fight back. (not a problem for me! I expect this post will result in much time wasting as it already has.) 

 I am saying plainly to the world at large, that to me, this whole Medela/FLRF brouhaha is just plain daft – justify it publicly, or just stop it, and expel from your membership those who shout down anyone with a different opinion. Breastfeeding organisations, make ethical and pragmatic decisions based on your purpose, to help women successfully breastfeed their children, not police other professionals’ consciences. 

Bottom line: Medela is not a formula company. If women don’t lactate, Medela loses. 

But if good information is not available because organisations lack sponsorship or speakers are blacklisted, others lose. Babies and their mothers. Organisations educating health professionals. Health professionals who can’t afford more expensive education (and that means many LCs). 

And finally, an overdue thank you to the Larsson Rosenquists… 

As I understand the history, they got into breast pumps because way back in the 1980s, they valued breastfeeding personally, were in the industrial  vacuum technology game, saw the need for better breast pumps and lactation-related gadgets, and got on with making a profit from the growing market of women wanting to breastfeed.  

Good on them for making better products in the 1980s and funding serious product research (and if their competitors can make a better product and share better research, good on them as well!) 

So blessings on you all, Larssons and Rosenquists, for seeing the need to provide research funds because of the importance of breastfeeding and breastmilk. Good on you for endowing the independent Swiss charity, the Family Larsson-Rosenquist Foundation. Few families have done as much for global public health, and seen so little gratitude from those who should care and be thankful. Well, for what little it’s worth, I am! 

Maureen Minchin IBCLC 1985-2010 Mother of 3, and grandmother of 5   Historian who studied at University of Melbourne and Oxford University Founding member of ILCA and ALCA  Only Australian involved in the creation of IBLCE and BFHI  Editorial Board member, International Breastfeeding Journal Member of DOHaD and ISRHML  

Addendum: Am I credible about the WHO Code?  Just who do I think I am to challenge this? What are my Code credentials?  It’s a long term commitment. My books since Food for Thought in 1982 have all explained and referenced the International Code. Breastfeeding Matters (1985) was a catalyst for a great deal of Code work. I ensured that ILCA and IBLCE and ALCA and BFHI Australia all enshrined Code compliance as fundamental. I proposed and later chaired the ILCA Code Committee which created strategies for policing compliance in conferences. I persuaded (not easily!) notable IBFANers to work with ILCA and become Directors. I was a founder member and International Delegate on the ILCA Board myself. I taught hundreds of healthworkers about the Code for 20 years, providing every student wth a copy of the ICDC Health Workers Guide. Courses created – lots of those – have always included it, in Australia and even in Malaysia as part of a formal WHO Code Workshop there, and in Hong Kong for BFHI. My intervention ensured that in Australia the agreed marketing code covered infants up to 12 months of age, not just 6, as everywhere else in the world at that time. I was for three years a Community representative on APMAIF, the official Australian Advisory Panel on the marketing of Infant Formula. (which did good work initially and then was captured by industry after a more conservative government came to power.)  Milk Matters: infant feeding and Immune disorder, my latest book, brought political issues up to date. And I am proud to say that some former students In Australia, New Zealand, the UK and elswhere have carried on that concern and awareness of Code issues, together with a keen sense of the importance of implementation within their societal context to protect, promote and support breastfeeding. More recently I have been involved (unpaid as usual) in a global consultation in Frankfurt, and with the UK Save the Children Report, Don’t Push It! Why the formula industry must clean up its act. (2018) https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf  as well as the IBFAN Asia conference in Malaysia.  (Yet I have the distinction of being blacklisted by a small coterie working to ensure that I am not invited to speak at conferences. With friends like that, who needs enemies?)