WHAT PRICE A FREE DINNER?
On a wild wet windy evening in late June 2008 that made crossing the Auckland harbour bridge no mean feat, an event took place in the Spencer on Byron hotel in Takapuna that made even the most hardened cynics amongst us turn ashen-faced.
As the storm raged outside complete with thunder and lightning and a tornado or two waiting in the wings, inside it was all cosy and warm, with immaculately-clad waiters handing out free drinks and delectable nibbles as the guests drifted in and mingled with their colleagues.
The guests were nearly all GPs who at the end of May had received a letter from the drug company Bayer inviting them to a presentation by a senior paediatrician and a drug company representative, after which dinner would be served. The invitation was attractive enough to bring out over 100 GPs on such an inclement night.
The topic of what the letter described as “a dinner presentation” was Feeding Options for Women Not Fully Breast Feeding. After half an hour or so of “arrival drinks and canapé” we were ushered into a room and seated at tables set for dinner. Paediatrician Peter Nobbs was introduced and began his presentation on the history and politics of breastfeeding. He began setting the scene for the message he was there to give by focusing on an aspect of the environment that some new mothers in New Zealand 100 years ago were subjected to. The Plunket Society was put under the spotlight as Peter Nobbs described their staunch support for breastfeeding, their objections to an advertisement for an early version of what was then known as “humanised milk mixture” that appeared in the Otago Witness in the first decade of last century, and the two-faced behaviour of Plunket Nurses who, according to a letter that appeared in the Otago Daily Times in 1915, were telling mothers to breastfeed while they themselves were bringing up their babies on Glaxo.
We were told Plunket Society’s founder, Sir Truby King’s Melrose property in Wellington is listed as a category 1 Heritage Building, and that it was here that the earliest attempts to make “humanised milk mixture” or infant formula in New Zealand began. Vegetable oil, cod liver oil and dextrose were added to cows milk and this humanised milk mixture was marketed by the Plunket Society under the name of Karilac along with “Plunket cream” known as Kariol.
Following a bit more history Peter Nobbs showed a slide documenting the falling breastfeeding rates in the middle of last century – it was recorded as being 91.5% in 1939, 82.1% in 1945, and 74.4% in 1952.
By now it was clear that the message we were being given was that not fully breastfeeding was normal and natural, that health authorities were often hypocritical about the advice they were required to give to new mothers about breastfeeding and what they actually said and did, and that the pro-breastfeeding stance was just a lot of politically-correct behaviour. Along with this were some subtle and not so subtle messages about the problems and risks of breastfeeding.
Turning his attention to the politics of breastfeeding Peter Nobbs went on to talk about the WHO Code - the International Code of Marketing of Breast-Milk Substitutes - the advice given to new mothers in hospital, and the argument around whether complementary feeding with a bottle does have any affect on breastfeeding.
He referred to the erroneous perceptions of groups like La Leche League and quoted from one of the group’s 2007 newsletters in which the sentence “Formula companies’ only aim is to make money” appeared. He assured the audience that formula companies in New Zealand do comply with the WHO Code on the Marketing of Breastmilk Substitutes and therefore see themselves as providing a complementary service.
NZ Breastfeeding Authority
The next organisation to come under attack was the NZ Breastfeeding Authority. He described their website, their current proposals around the Baby Friendly Hospital Initiative, and the accreditation of the hospitals in the Auckland region in critical terms. The NZBA website refers to the benefits of breastfeeding but not the risks, and risks of infant formulas but not the benefits. He cited as an example the fact that the website mentioned bacterial contamination of infant formulas. He was very critical of how ridiculous this was when the incidence is less than one in a million.
Bottles and pacifiers
The issues surrounding the use of pacifiers and bottles featured next with Peter Nobbs referring to some of the evidence about their supposed effects on breastfeeding. Studies on the use of pacifiers show no consistent results, he said. The effects of supplementary bottle-feeding had been studied in two studies from the USA and one from Swizterland. One showed an effect on breastfeeding and one did not. The duration of breastfeeding in both groups was the same.
The lack of randomised controlled trials was something Peter referred to several times during his presentation.
Peter ended his presentation with a list of the five most common conditions that mothers and babies present with at the doctor’s office. They included reflux, colic, poor weight gain, allergies, and diarrhoea. As he talked about each condition he showed a slide with the image of the appropriate Bayer Infant Formula (brand name is Novalac) product – Novalac Reflux, Novalac Colic, Novalac Hypoallergenic, Novalac Diarrhoea. There was even a Novalac Sweet Dreams! With the exception of Novalac Diarrhoea, all products are suitable for use from birth onwards and are described as a “nutritionally complete formula suitable for long-term everyday use.” Given that each of these special formulas costs around $30 a tin (almost double that of ordinary infant formula), the statement that the aim of the drug company is to make money does not seem at all unreasonable.
Bayer Consumer Care
The presentation by Ayumi Uyeda, the young female drug company rep was unremarkable in that it was clearly her job to promote the wonders of the Novalac range of specialised infant formulas. She consistently described them as “premium products’, and the higher cost was simply “a price differential.”
Ayumi Uyeda referred to the EDEN study of 3.500 babies, “an observational study of what happens in private practice” that was firstly an epidemiological study on presenting problems, and secondly the effects of Novalac on the problem. However, there was no mention of RTCs!
Her slides showed the ”scientifically developed” range of specialised infant formulas and how they differed from each other. The slick marketing of solutions to “problems” such as reflux, colic and constipation, the expansion of the diagnostic criteria used to identify such commonplace events as spilling or spitting up, periods of prolonged crying and distress, and constipation and diarrhoea, along with the supply of free drinks and good food, was both impressive and incredibly dishonest.
Needless to say, I left after the presentations – before dinner was served – because I suddenly found I had completely lost my appetite. I went instead to the bar and bought a spiced tomato juice and sat mulling over what I had just witnessed with the health professional friend who had got me into the event.
RESULT OF COMPLAINT TO MOH COMPLIANCE PANEL
It is nearly two years since the complaint referred to above was sent to the Ministry of Health’s WHO Compliance Panel for implementing and monitoring the International Code on the Marketing of Breast-milk substitutes in New Zealand.
The complaint concerned the free dinners organised for GPs, Plunket and midwives by the drug company Bayer on 23 and 25 June 2008 and the pre-dinner presentations given by Auckland paediatrician Peter Nobbs on “Feeding options for women not fully breastfeeding” which was followed by a presentation by a Bayer employee promoting a range of specialised infant formulas manufactured by Bayer.
Bayer Consumer Care NZ
“Bayer Consumer Care NZ” responded to the letter of complaint in a letter to the Compliance Panel dated 25 August 2008. When advised by email that we were not satisfied with Bayer’s response, the matter was referred to the next meeting of the Compliance Panel which was held on 12 December 2008. The Compliance Panel considered there was a breach of several articles in the NZ Infant Formula Manufacturers Association (NZIFMA) Code of Practice, and Bayer was subsequently notified of this decision. Bayer lodged an appeal in March 2009 and the matter was referred to the Adjudicator.
In a decision dated 7 May 2009 the Adjudicator determined that Bayer had a legitimate ground for an appeal and the complaint was referred back to the Compliance Panel for redetermination.
The Compliance Panel considered the matter again provided its redetermination in a decision dated 11 September 2009, and advised that Bayer was in fact in breach of several articles in the NZIFMA Code of Practice. In a letter dated 9 October 2009 Bayer again appealed the decision of the Compliance Panel. The result was that the Panel’s decision and Bayer’s appeal was once again referred back to the Adjudicator.
The Adjudicator considered Bayer’s appeal and stated in the final paragraph of an 11-page document dated 25 March 2010 that it was her view “that none of the grounds of appeal have been established and the accordingly the Compliance Panel decision should be upheld.”
It was a very different story with Peter Nobbs. Peter hired a lawyer to deal with the complaint made about his presentation at the Bayer dinner. Although it was contrary to the Compliance Panel’s normal procedure, the lawyer requested the disclosure of the identity of the person/organisation who had made the complaint.
After getting a phone call from the Ministry of Health Lynda Williams agreed to have her name and that of the organisation she worked for released to the lawyer/Peter Nobbs.
In a letter dated 19 September 2008 the lawyer responded to the complaint on behalf of Peter Nobbs. The Compliance Panel was advised by email that we were not satisfied with the response provided. The lawyer then demanded a copy of the email but this time the request was declined.
The Compliance Panel considered the complaint at its meeting on 12 December 2008. Letters were then exchanged between the lawyer and the Panel. The secretariat of the Compliance Panel requested a copy of Peter Nobbs’ Powerpoint presentation and speaking notes and asked Mr Nobbs to disclose the sum that he was paid by way of an honorarium for his presentations.
The Panel met again on 11 August 2009 and subsequent to that meeting a draft decision letter was sent to the Chair and members of the Panel.
In a decision dated 11 September 2009 the majority of the Panel considered that there had been a breach of the Code.
On 7 October 2009 Peter Nobbs wrote that he had a number of concerns about the Panel’s decision and he appealed. The matter was then referred to the Adjudicator.
The Adjudicator considered Peter Nobb’s appeal and stated in the final paragraphs of an 15-page document dated 8 April 2010 that:
“In the context of this decision it is apparent that the Compliance Panel was in possession of all of the relevant information and that it had the opportunity to consider the facts are arguments advanced by the complainant and the health worker. Accordingly it is not appropriate for the matter to be referred back to the Compliance Panel for redetermination.
Accordingly it is my view that the Compliance Panel is quashed.”
Basically Peter Nobbs and his lawyer claimed:
· The Health Education presentations were organised by Bayer and covered an entirely legitimate and an important topic for health professionals dealing with breastfeeding and infant feeding issues
· The amount of the honorarium ($1125) Peter Nobbs received was not relevant because Peter was not promoting Bayer products
· The notes made by Lynda Williams at the presentation contained factual inaccuracies and misunderstandings
· Lynda Williams was not invited to the evening for which invitations had been sent out to GPs and nurses
The truth is that no-one attending these events (Bayer and Peter Nobbs continue to hold them) can be in any doubt that the free dinners provided by Bayer are part of a promotion pushing the range of Bayer’s infant formulas. There are stands and tables with tins of the various special formulas prominently displayed at these events, and the powerpoint presentations by both Peter Nobbs and the drug company rep contain slides with a photo of each of the infant formulas.
We have it on good authority that the “honorarium” was a great deal more than $1125.
Lynda Williams has 30 years experience of taking notes/minutes while attending meetings and is used to recording verbatim what is said by speakers. She was invited to attend by a midwife who asked the organisers if she could attend and bring a colleague.
Maternity Services Consumer Council Newsletter June 2010