Formula industry watered down breast-milk campaign

WASHINGTON – In an attempt to raise the nation’s historically low rate of breast-feeding, federal health officials commissioned an attention-grabbing advertising campaign a few years ago to convince mothers that their babies faced real health risks if they did not breast-feed. It featured striking photos of insulin syringes and asthma inhalers topped with rubber nipples.

Plans to run these blunt ads infuriated the politically powerful infant formula industry, which hired a former chairman of the Republican National Committee and a former top regulatory official to lobby the Health and Human Services Department. Not long afterward, department political appointees toned down the campaign.

The ads ran instead with more friendly images of dandelions and cherry-topped ice cream scoops, to dramatize how breast-feeding could help avert respiratory problems and obesity. In a February 2004 letter, the lobbyists told then-HHS Secretary Tommy Thompson they were “grateful” for his staff’s intervention to stop health officials from “scaring expectant mothers into breast-feeding,” and asked for help in scaling back more of the ads.

The formula industry’s intervention – which did not block the ads but helped change their content – is being scrutinized by Congress in the wake of last month’s testimony by former Surgeon General Richard Carmona that the Bush administration repeatedly allowed political considerations to interfere with his efforts to promote public health.

Rep. Henry Waxman’s Committee on Oversight and Government Reform is investigating allegations from former officials that Carmona was blocked from participating in the breast-feeding advocacy effort and that those designing the ad campaign were overruled by superiors at the formula industry’s insistence.

“This is a credible allegation of political interference that might have had serious public health consequences,” said Waxman, a California Democrat.

The milder campaign HHS eventually used had no discernible impact on the nation’s breast-feeding rate, which lags behind the rate in many European countries.

Some senior HHS officials involved in the deliberations over the ad campaign defended the outcome, saying the final ads raised the profile of breast-feeding while following the scientific evidence available then – which they say did not fully support the claims of the original ad campaign.

But current and former HHS officials say the muting of the ads was not the only episode in which HHS missed a chance to try to raise the breast-feeding rate.

In April, according to officials and documents, the department chose not to promote a comprehensive analysis by its own Agency for Healthcare Research and Quality of multiple studies on breast-feeding, which generally found it was associated with fewer ear and gastrointestinal infections, as well as lower rates of diabetes, leukemia, obesity, asthma and sudden infant death syndrome.

A top HHS official said that at the time, Suzanne Haynes, an epidemiologist and senior science adviser for the department’s Office on Women’s Health, argued strongly in favor of promoting the new conclusions in the media and among medical professionals. But her office, which commissioned the report, was specifically instructed by political appointees not to disseminate a press release.

Both HHS and AHRQ ultimately sent out a few e-mail notices about it, but the report was generally ignored. Requests to speak with Haynes were turned down by other HHS officials.

Regarding the changes made to the earlier HHS ad campaign, Kevin Keane, then HHS assistant secretary for public affairs and now a spokesman for the American Beverage Association, said that formula companies lobbied hard, as did breast-feeding advocates.

“We took heat from the formula industry, who didn’t want to see a campaign like this. And we took some heat from the advocates who didn’t think it was strong enough,” Keane said. “At the end of the day, we had a ground-breaking campaign that goes further than any other administration ever went.”

But the campaign HHS used did not simply drop the disputed statistics in the draft ads. The initial idea was to startle women with images starkly warning that babies could become ill. Instead, the final ads cited how breast-feeding benefits babies – an approach that the ad company hired by HHS had advised would be ineffective.

During the 2003-05 period in which the HHS ads were aired, the proportion of mothers who breast-fed in the hospital after their babies were born dropped from 70 percent in 2002 to 63.6 percent in 2006, according to statistics collected in Abbott Nutrition’s Ross Mothers Survey, an industry-backed effort that has been measuring breast-feeding rates for more than 30 years.

In 2002, 33.2 percent of women were doing any breast-feeding at six months; by 2006, that rate had declined to 30 percent.

The World Health Organization recommends that, if at all possible, women breast-feed their infants exclusively for at least six months.

The campaign the industry mounted was a Washington classic – a full-court press to reach top political appointees at HHS, using influential former government officials, now working for the industry, to act as go-betweens.

Two of the those involved were Clayton Yeutter, an agriculture secretary under the first President Bush and a former chairman of the Republican National Committee, and Joseph Levitt, who four months earlier directed the Food and Drug Administration’s Center for Food Safety and Applied Nutrition safety center, which regulates infant formula.

A spokesman for the International Formula Council said both were paid by a formula manufacturer to arrange meetings at HHS.