Should Baby Formula Be Advertised?

When Carnation Co. entered the $1.6-billion baby formula market last year with two new products, Good Start H. A. and Good Nature, it drew instant flak. The FDA and nine state attorneys general pounced on Good Start, questioning whether it was really, as advertised, “hypoallergenic.” The American Academy of Pediatrics pounced on Carnation for advertising formula to consumers at all.

Often linked, these are two separate issues. One is a matter of truth in advertising, appropriately questioned, relatively easily settled. The other, seeking to silence Carnation, is more complicated, calling into question the whole business of baby food marketing.

The hypoallergenic claim for Good Start for newborns ran afoul of the law when the attorneys general heard of some infants having allergic reactions to it, found that scientific studies cited didn’t actually support claims and noted that Carnation obscured its sponsorship of endorsing physicians.

The company also ran up against the Food and Drug Administration when the regulators questioned the hypoallergenic claims and requested more data--not just from Good Start but from Ross Laboratories for its hypoallergenic claims for Alimentum and Bristol-Myers for its claims for Nutramagen and Pregestimil.

As for the advertising, the Good Nature ad seemed innocuous, offering a wholesome “follow-up formula for older, active babies”--those more than six months old and eating solid foods. The Good Start ad was an “informational” piece, naming no product, but suggesting that babies who were sleepless, colicky and often sick might be on “the wrong formula,” and parents should “tell your doctor about it.”

Decades-Old Tradition

Unfortunately, formula makers must speak only to doctors and only doctors can speak to parents--a tradition that goes back decades, readily accepted by the drug companies that dominate the market with the help of doctors. Pediatricians consider breast-feeding “the optimal form of infant nutrition,” says Dr. Joe Sanders, associate director of the Academy, and are “opposed to anything that would lead to a decline in breast-feeding, like advertising (formula) direct to the public.”

The usual recommendation is for at least three to six months of breast-feeding, but it’s not unanimous. “The greatest immunological benefit of breast-feeding comes during the first month or so,” says Harvard pediatrician Ronald Kleinman, chair of the Academy’s committee on nutrition, and in fact, “the consensus now is do it as long as you’re comfortable with it.”

But doctors had another concern--interference in the “doctor-patient relationship.” Although the 1980 Infant Formula Act requires that all baby formulas marketed domestically provide needed levels of certain nutrients for growth and development, pediatricians believe that all nutritional decisions “should be reached,” said a recent Academy policy statement, “by discussion between the physician and the family,” with no communication between the manufacturer and “the lay public.”

Formulas, unlike prescription drugs, are sold off the shelves, but “advertising of infant formulas, like advertising of prescription drugs,” said Academy director James Strain, “should be limited to health professionals.”

Instead, the drug companies that make formula promote it through medical channels, their “detail” men passing out free samples to doctors and hospitals, the companies cementing the bonds with financial support for clinical studies, doctors meetings and conventions. Doctors and hospitals in turn give the samples to new mothers.

But “sampling” calls up other questions, particularly in the Third World, where it has precipitated the second boycott of Nestle products in a decade, led by Minneapolis-based Action for Corporate Accountability. Nestle and other manufacturers call it charity; critics say they take advantage of poor people, crowded hospitals and desperate staff, providing free formula to maternity patients who would otherwise breast-feed. As a result, women who have no money, no plumbing, no running water and no way of sterilizing bottles may be forced to buy--and perhaps mishandle--formula when they leave.

There’s evidence that “sampling” in American hospitals also works against breast-feeding, if less tragically. It conveys “an implicit approval,” says Jim Lovejoy, spokesman for Gerber Products, which is also introducing a formula. Carnation, which does no sampling, cites several academic papers indicating that formula samples (as one said) “shorten the duration of breast-feeding,” and that hospital gift packs are a “potent predictor” (says another) of the ultimate formula choice.

If the concern is breast-feeding, there’s some question whether sampling, advertising or even pediatricians are as powerful as argued. There have been “cyclical trends in breast-feeding,” says Susan Finn, director of nutrition services at Ross Labs (Similac, Isomil) in Columbus, Ohio, probably tied more to social changes than to formula marketing.

“We’re seeing a slight dip because of women working,” says Finn. “Women breast-feed while on maternity leave and then turn to formula.” Although an estimated 60% or 70% babies are nursing when they leave the hospital, fewer than a third are still breast-fed at six months.

Clearly the horse is out of the barn. Doctors might as well consider new ways of marketing baby nutrition--breast and formula.

Discussion, prodded by advertising, is one possibility. Newcomers Gerber and Carnation are full of good intentions. Carnation’s Good Nature bears labels saying “Not to Replace Breast Milk” and “Your Doctor is the Best Source of Advice,” and Gerber’s baby formula, coming next fall, “will say the ideal food is mother’s milk,” says Lovejoy. “Particularly in the lower incomes, some people don’t know breast-feeding is best, and we’re trying to tell the Academy we’re getting the message out in the most efficient way.”

They have opponents, of course, who think it unlikely that companies eager to sell product will whole-heartedly promote breast-feeding. And while the Academy wants more “public education through television, newspapers, magazines and radio” on behalf of breast-feeding, it doesn’t want airing of other views, particularly one that might suggest, says Sanders, “that there’s a formula that’s really just as good.”

The swift challenge to Good Start’s health claims might be some comfort, proving that free speech invites truth to surface. Debate can be both the risk and the advantage of open advertising.