Friends of the WHO Code?

Maureen MinchinBottle Feeding, breastmilk, Commentary, debate, General News, Infant Formula, Infant Health, Lactivism, Marketing, Marketing, Milk Matters, Reviews by MM

I sometimes wonder why good sense is called common sense, when it seems to be relatively rare in some places. 

Take for example some of that minority who insist that no one should, for example,  

  • read literature created or published by commercial interests (other than their own, or their friends);
  • attend or speak at conferences organised by any related commercial interest (other than their own, or those they approve); or
  • contribute useful perspectives to a text that will be distributed freely around the world to key policymakers, funded by an independent Swiss group foundationally endowed by a family whose income derived from related products.

Some such people are apparently unable to deal with divergent views in an open public forum  such as a conference: they ensure that speakers who disagree with them are not invited, or are even dis-invited.  They cannot deal with civil disagreement in private Facebook pages, and so arbitrarily exclude anyone who persists in politely challenging the self-appointed administrators. They then feel free to slander and defame, to encourage others to make snide comments based on what seems to me too little knowledge and far too much malice. 
They presumably rejoice when within committees their objections result in speakers being rejected, invitations being withdrawn, and scarce funds and precious time being wasted.
They may even publish blacklists of reputable researchers and educators to target for exclusion: they boast of their ability to prevent or reduce such invitations. (Most committees strive for consensus about invited speakers. And many committee members are gentle folk, who can be bullied by the loudest voices, or are trusting souls who believe defamatory remarks – because they themselves would never say such things without substantial foundation. Which regrettably they fail to demand from bullies.)

Consumer advocates who actively conspire to suppress ideas that conflict with their own, I see as unprofessional and inadequate , both undemocratic and profoundly anti-feminist. 

Are such folk right to see a breast pump company as being as much of a problem as an infant formula company? Is it rational to focus on the one such company that had the courtesy to respond to a letter sent to many? Should other companies which simply ignored their letter, and which do not sponsor or fund much independent research, be seen as suitable donors and welcomed to their conferences? 

By their fruits ye shall know them…

So just what do such people achieve? How many more babies will be breast-fed as a result of their suppressive actions? How many mothers helped and precious time saved by insistence that a teat should not be packaged with a breastpump? How many premature babies survive?

Perhaps most importantly, what new academic research will be done, or powerful scientific information be produced, to sway policymakers to establish breastfeeding as the norm in WEIRD nations that pioneered artificial feeding, their most damaging export? 

Let’s take an example of literature that such persons think should not be read. It was published by an infant formula company, written by an eminent researcher recently the target of what seemed to me like snide dismissal. Read the excerpts below about human milk oligosaccharides, HMOs (sugars) found in human milk. Synthetic -but not identical – analogues of some of these sugars can be produced by genetically-modified organisms, and the formula industry is trialling the addition of two to their products; while breastmilk contains around 200, all bioactive:

“In some cases, individual HMOs exert a certain effect and, while there might be some redundancy, the effects are often highly structure-specific. In other cases the combination of different HMOs in specific ratios to each other is required to be effective, and future research needs to assess whether or not the administration of individual HMOs alone may be counterproductive and potentially harmful to the infant’s short and long-term health. Overall, the personalized complexity of HMOs cannot be mimicked in artificial infant formula and provides yet another powerful reason to protect promote and support breast feeding.” HMOs are “the first prebiotics that humans are exposed to in life – when the infant is breast-fed…. The composition of microbial communities isolated from infant fecal samples and cultured under anaerobic conditions changes over time, depending on what specific HMOs are added to the culture. For example, the composition of a microbial community looks very different when exposed to either a mixture of the HMOs that were isolated from pooled human milk, or to individual HMOs. Since the differential composition and activity of microbial communities has been linked to diseases like obesity, diabetes, inflammatory bowel disease, or autism, exposing infants to individual HMOs in formula instead of a complex HMO mixture in human milk may increase disease risks. Long-term follow-up studies are required to rule out this potential risk and avoid potential harms to the infant’s short and long-term health….. HMOs can be seen as another example of personalized nutrition early on in life which comes in addition to other personalized components of human milk like antibodies, milk microbiota, immune cells, and progenitor cells. In fact the personalized complexity of HMOs provides yet another powerful reason to protect promote and support breastfeeding.” Professor Lars Bode 2019 Nestle Nutrition Institute Workshop.

To me, this is a useful statement to counter likely misleading marketing of those synthetic analogues of human milk oligosaccharides, SAHMOs, not HMOs at all. The fact that Nestle produced this, means it cannot be seen as advocacy propaganda or exaggeration.  

Why would anyone not use this? Why would anyone suggest anything wrong with Professor Lars Bode doing research to reduce NEC in an academic centre endowed by independent Swiss funding?  or giving such a talk in an industry symposium streamed globally?

Of course there are many valid ethical and practical questions about whether, and who, and how, to read or attend or speak at industry-funded resources.  

Yes, industry-funded resources should all be unnecessary in that future utopia where national resources are applied equitably for the benefit of all citizens, and industry products and marketing are tightly regulated (and the US government does not apply huge pressures to WHO and other governments to protect its industries – hasten the day!).

Yes, it is important to avoid real conflicts of interest, and for those who can afford the luxury, to avoid personal benefit from industry interactions (as I always have), even while knowing that no one can control others’ perceptions of conflicts of interest, and scientists need to be employed to do research.

Yes, as the Code said, all such interactions and potential conflicts of interest should be declared (as I have and do.)

Yes, the gullible, those incapable of critical appraisal, or just those who don’t want to be suspected of supporting a $70 billion industry that undermines breastfeeding, might well avoid all industry contact. Good for them. Adults are free to make their own judgments, and it is not for others to judge them without full knowledge of what was involved in their decisions and the outcomes. 

Meanwhile back in that real world where women struggle to feed babies as best they can in their pressured lives, a vast infant feeding-related industry exists and creates products now necessary in cultures when mothers and babies are routinely separated. Breast-feeding advocacy needs to make real change and healthy choices possible for all women, especially the disadvantaged.

What that world doesn’t need is division within the chronically under-funded breastfeeding advocacy movement, together with ignorance of what industry is doing, and is saying to many more health professionals than advocacy and independent education can ever reach. Marketing can and should be regulated, so that the worst do not gain market share but lose it. The International Code of Marketing of Breastmilk Substitutes allows scientific and factual information to be shared, and much consumer law prohibits false and misleading information. But without objective and impartial policing, those are empty concepts.

And above all, that breastfeeding advocacy movement  doesn’t need suppression of ideas and information, on the say-so of what I see as self-appointed vigilantes who overlook the aims and objectives of the International Code, and focus on their own interpretation of its details and later World Health Assembly resolutions. The cause of public health is harmed by their refusal to respect and engage with fellow workers. 

Unlike any self-appointed gatekeeper, I am not listing names here; but I will, if and when I think that necessary. Those with a need to know may enquire privately. 

My hope is that in this year 2020 I will see:

  • a lot more 20/20 vision, common sense, and unity in breastfeeding advocacy
  • intelligent prioritising of the real enemies of breastfeeding – not simply the formula industry or feeding products industry.
  • vigorous and overdue fightback against what I see as virtue signalling and bullying, that – in my opinion and experience – limits the availability of important information, disheartens some academic researchers, and leaves health professionals ignorant of what they need to know to advise parents.

Let’s focus on what matters most, keeping the goal of optimal feeding for ALL infants in mind even as we accept the pragmatic reality that this will take time to achieve, together with societal investment on the scale that has so normalised artificial feeding in WEIRD nations. Above all we need to support academic research and researchers. I believe that Professor Peter Hartmann was right when he said in the 1990s, that “Infant formula will be the tobacco of the 21st century”. Change will be rapid once a critical mass of research has accumulated. That day is closer because of the blocks of funding provided by the Family Larsson Rosenquist Foundation to researchers around the world. But active advocacy is needed to change societal norms and structures. There we can all help, in large and small ways, and we can’t afford to waste time and energy on blacklists and bluster. I am responding now only because I think the harm being done requires me to address it. And because anyone who’s read my writing knows that I see the big picture and speak the truth – as I see it- as plainly as I can to anyone, while welcoming civil criticism from anyone. In a time of deceit, telling the truth is a revolutionary act.” I hope George Orwell was right!