Most readers of my blog will know that in the UK infant formula (first stage,
or from birth formula) cannot be marketed to parents, or be discounted or
promoted in shops. Manufacturers use follow-on formula to get around these
advertising restrictions, but there are still rules that they must follow and they
can be pulled up by the Advertising Standards Agency for breaking them. When shops
break the rules on infant formula promotion – by discounting it, or positioning
it in premium spots in store – they can be reported to Trading Standards. It’s
far from a perfect system; no prosecutions have been brought, and companies are
not fined nor have to apologise for infringing the rules, but the principle of
challenging misleading marketing does at least exist. Baby Milk Action, with
the help of its members and the public, monitors advertising to parents and
compiles a report ‘Look What They’re Doing in the UK’ to expose the companies' tactics.
When it comes to advertising aimed at health professionals,
however, the situation is very different. Many people don’t know that breastmilk
substitutes can be marketed to healthcare
professionals: in journals and magazines, on professional websites and at
conferences and study days. Although the Department of Health has regulations
stating that this advertising must be ‘scientific and factual’, there is no
monitoring and no mechanism for reporting marketing that breaks the rules,
other than to complain directly to the Department of Health.
First Steps Nutrition Trust’s recently published resource ‘Scientific and Factual – a review of breastmilk substitute advertising to health professionals’ looks more
closely at the science used to back up the claims made in advertising in
professional journals and magazines. We know from research that advertising is
effective – why else would the companies spend vast sums on advertising space? –
and that adverts that carry simple, easy-to-understand messages relating to the
reader’s own scientific knowledge are very ‘believable’. The companies know
this too, and they also know that few health workers will have the time or
resources to investigate the references given in tiny print at the bottom of
carefully crafted adverts. Graphs, charts and statistics create the appearance
of ‘a scientific basis’, even when what they show is not scientifically correct
or objective.
The resource looks in detail at adverts that appear in publications
including the Journal of Family Health,
the Journal of Health Visiting and Dietetics Today, but the same and
similar adverts appear in many other publications aimed at health professionals
in a wide range of fields. When the references given to support the claims made
in the adverts are scrutinised, the findings are often shocking.
An advert for Cow & Gate Comfort milk, marketed as
relieving colic, which shows an emotive image of an exhausted mother, appeared in
the Journal of Health Visiting in
March 2016. The main claim, in red type, is that ‘95% of paediatricians
reported an improvement in common infant feeding problems with a formula like Cow & Gate Comfort1’
[italics added]. Closer reading of the reference given reveals that the study,
funded by Numico (Danone) did not use
Cow & Gate Comfort milk; the test formula had different energy, protein,
carbohydrate and mineral content. NHS Choices says that there is no evidence
for any treatment that is beneficial for colic, which resolves itself. The
conclusion that the advert is deliberately misleading is inescapable.
SMA, now owned by Nestle, has been rolling out a new product,
SMA PRO, and many stores have illegally cleared stock of the previous formula
by marking it down in price to make way for the new product (lots of examples have been posted on the Baby Milk Action Facebook page). An extensive advertising campaign to health
professionals has accompanied the roll-out. Dietetics
Today carried two adverts for SMA PRO in March 2016, a shorter one-page ad
and then a longer, more ‘scientific-looking’ ad – this in itself is a tactic
designed to reassure the reader that the information given in the simpler
advert is supported by the ‘science’ given in the more complex version. The
main claim in the simpler advert is that SMA PRO is ‘Clinically proven1’.
This is supported by one reference to a poster presentation given by Nestle
employees at a conference – not a peer-reviewed publication as required by the
Department of Health regulations. The poster reports a meta-analysis of four
studies looking at infants fed with Nan milk (another Nestle product). It is
not clear whether this Nan formula is the same as SMA PRO. It is impossible to
know how the manufacturers can use this evidence to claim that SMA PRO is
clinically proven, or what it is ‘clinically proven’ to do. That such shaky
evidence can be used to support a headline claim on a new product shows just
how confident the companies are that they will not be challenged.
There is much, much more detail in the resource, which has
painstakingly reviewed all the scientific papers the companies have cited to
support their claims. If, having read it, you’re outraged by how misleading these adverts are, there are plenty of suggestions
for action on the First Steps Nutrition Trust website. Health professionals can
demand change, by complaining to the journals and professional bodies that
carry advertising and allow it at events, and writing to the Department of
Health regulators. The Royal College of Paediatrics and Child Health voted at
its AGM in April to ‘decline any commercial transactions or any other kind of funding or support from all companies that market products within the scope of the WHO Code on the marketing of breast milk substitutes’ – other professional organisations can be lobbied
to pass similar resolutions. For more information, and links to further
reading, see the campaign pages on the First Steps Nutrition Trust website.
Baby Milk Action is urging the UK parliament to enforce marketing restrictions
on the promotion of formula to parents too – see more on their website here or
make a donation to support their work.
