How Big Formula Bought China

Another day, another news item that paints some of the Academy of Nutrition and Dietetics’ industry pals in a not-so-positive light.

Today, Reuters released a special investigative report titled “How Big Formula Bought China”, starring Academy friend Nestlé (which is approved to provide continuing education to dietitians) and corporate sponsor Abbott Nutrition. Here are some of the highlights:

• “In the two days after Lucy Yang gave birth at Peking University Third Hospital in August 2012, doctors and nurses told the 33-year-old technology executive that while breast milk was the best food for her son, she hadn’t produced enough. They advised her instead to start him on infant formula made by Nestlé. “They support only this brand, and they don’t let your baby drink other brands,” Yang recalled. “The nurses told us not to use our own formula. They told us if we did, and something happened to the child, they wouldn’t take any responsibility.”

• “For Nestlé and other infant formula producers, there is one significant complication for their China business: a 1995 Chinese regulation designed to ensure the impartiality of physicians and protect the health of newborns. A Reuters examination reveals that global infant formula companies have found ways to skirt and violate the 1995 code, which they support publicly.”

• “Under China’s 1995 code, companies may not distribute free formula or samples to pregnant women, their families and hospitals. They can’t sell products at a discount. Nor may they offer hospitals funding, equipment or information in order to promote their product. The regulation bars hospitals and academic institutions from accepting gifts or help from formula companies or promoting infant formula products. It requires medical institutions to “actively advocate” the advantages of breastfeeding. Penalties for violations, however, are lenient – the maximum fine is 30,000 yuan ($4,900). Enforcement is complicated by its division across several government bodies: the National Health and Family Planning Commission (NHFPC), the State Administration for Industry and Commerce, the State Administration of Radio, Film and Television, and the General Administration of Press and Publication.”

• “Reuters found formula company advertising and promotion commonplace inside hospitals. In August, visitors to the maternity ward at Hangzhou Tianmushan Hospital in eastern China were greeted with banners from Mead Johnson that read: “Healthy babies, happy mothers” and “Give baby the best start in life!”

• “Mothers whom Reuters interviewed said formula was pushed to them in myriad ways: doctors gave them discount cards for infant formula during prenatal checkups; hospital staff strapped identity bands branded by formula companies to their babies’ limbs; formula representatives entered their hospital rooms to distribute samples as they recovered from giving birth.”

• “At Beijing Tiantan Hospital, representatives from companies, including Nestlé and Wyeth, visited with formula samples for mothers and presents for doctors, said Dr. Yang, who worked as an obstetrician there until 2009. “We weren’t given a commission, just small gifts.”

• “A former Nestlé sales representative said she brought samples to doctors and took them to dinner. A former Nestlé marketing executive said it was standard industry practice in China to provide financial incentives to doctors to recommend a certain brand of formula. Chinese doctors, she said, expect it.”

• “Most of the major infant formula companies have cultivated ties with the government in China — including departments affiliated with the National Health and Family Planning Commission (NHFPC), one of the agencies tasked with enforcing the 1995 regulation on formula marketing. Companies fund hospital research and awards for doctors, sponsor conferences and train state medical personnel – the same medical professionals who are supposed to be actively advocating breastfeeding.

• “Nestlé and other foreign formula companies also enjoy direct access to Chinese policymakers. During discussions about revising the 1995 regulation that began in December 2011, the Ministry of Health (now the NHFPC) solicited opinions from big foreign formula brands as well as global health and children’s organizations. Nestlé sought to weaken some of the proposed provisions, some of which were more stringent than the 1995 regulation and would have brought China closer in line with WHO regulations, according to a copy of its submission obtained by Reuters. Despite publicly supporting the WHO code, Nestle objected to a proposed rule that formula packaging should display in a conspicuous way the wording “breastfeeding is recommended”. The WHO code says formula containers should clearly and conspicuously display a statement on the superiority of breastfeeding.”

This is why we recommend that the corporate behavior of industry partners and allies be scrutinized and evaluated. It doesn’t reflect well on a health organization when the companies it associates with and trusts with its constituents are consistently called out for questionable behavior. It also makes it difficult for a health organization to publicly opine on said behavior when it is bound by financial ties.