Briefing paper for RCPCH members responding to the survey on sponsorship by formula milk manufacturers
A group of College members proposed the motion recently passed at the AGM arguing that the College should in future decline all kinds of funding from formula milk manufacturers (FMMs). This briefing paper sets out the evidence and policies that led them to take this position
For the first time in May 2016, the World Health Assembly[ii] recommended
“…health professional associations and non-governmental organizations should not:>
• accept gifts or incentives from such (FMM) companies;
• allow such companies to sponsor meetings of health professionals and scientific meetings”
Which companies are we concerned about?
This guidance applies to companies who make and market breast milk substitutes (BMS), feeding bottles or teats for healthy infants anywhere in the world, even if the specific funding refers to one of their specialist BMS products. It also applies to indirect funding from trusts or organizations that are funded by companies marketing BMS. Of course, this does not prohibit use of specialist BMS products for recognised medical indications[iv]. Whilst individuals may need to work with FMMs to undertake research on specialist formulas, it is vital to maintain the College’s independent status by avoiding this source of income and the resulting institutional conflict of interest.
What are the key arguments in favour of this approach?
- Around 80% of UK mothers start breastfeeding, but the rate drops away sharply after birth and we now have one of the lowest continued breastfeeding rates in the world. This is strongly associated with the use of ‘supplementary’ formula feeding, which displaces breastmilk and inhibits breastmilk production, increasing the risk of early cessation of breast feeding 13-24 fold.
- There are significant health consequences within the UK. A recent Lancet series summarised 28 systematic reviews and meta-analyses and found that in high-income countries, even after fully allowing for socioeconomic confounding, the impact of not breast feeding on child morbidity and mortality is substantial, while the impact on maternal health is actually higher than in resource poor settings .
- The question is not whether individual formula manufacturers are behaving ‘ethically’. All FMMs have a responsibility to their shareholders to maximise sales of a product that by its very nature displaces breastmilk. While FMMs also produce therapeutic products, the great majority of their profits come from products marketed to parents of healthy children and this market is growing rapidly worldwide
- The College ended formula milk funding for core activities about fifteen years ago, after the previous AGM vote on this topic, but recently this policy has been reversed. The College now accepts core funding from Mead Johnson, a major producer of formula milk worldwide, accepted a research grant from an unnamed manufacturer and has also been in discussions with both Nestle and Danone.
- Unlike other potential donors, this income is not charitable giving. Rather, it allows FMMs to portray their products as safe and scientific by associating themselves with paediatricians .
- Institutional conflict of interest is manifest when a strategic or financial influence has the potential to undermine that institution’s collective purpose. We suggest that a financial relationship with FMMs has potential to create bias within the institution that threatens public trust in the College as an independent source of guidance upon infant and young child feeding. This therefore is a probity issue.
- This income is at most no more than 1% of the College turnover, so is not necessary for the College to function.
- This is not about a mother’s right to choose how she feeds her baby; it is about her right to access unbiased information on which to base that choice. We can easily afford not to have the money; we cannot afford the loss of reputation.