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Interestingly, the entire last season of "Chicago Hope" was sponsored by the Pharmaceutical Research and Manufacturers of America (PhRMA), whose membership is made up of pharmaceutical companies, including those that manufacture and market infant formula. According to a PhRMA press release, sponsorship of "Chicago Hope" was part of a collaborative effort between Johns Hopkins Medicine, PhRMA, CBS Television stations and 20th Century Fox, "to relate to viewers on medical concerns at a time when their awareness is heightened on such issues." PR Newswire reported in September 1998 that the PhRMA-sponsored episodes would "educate viewers" on "issues such as ... the risks associated with breast-feeding."

The reasons behind these marketing efforts are crystal-clear: The manufacture and sale of commercial infant formula is an unbelievably profitable enterprise. U.S. infant-formula sales reached approximately $2.59 billion in 1993, representing a 6-percent increase over 1992. Today that figure is estimated to be at $3 billion and climbing. Since 1989, when formula companies lifted their previous voluntary ban on marketing directly to consumers, the market has grown by 54 percent. The average bottle-feeding family in the United States spends between $800 and $2000 per year on infant formula. With such a lucrative product to promote, corporations have wisely enlisted the assistance of new parents' most trusted advisors -- health-care providers -- in order to retain and increase their markets.

Infant-formula manufacturers attempt to hide behind the empty-sounding "breast is best, but ..." disclaimer that most of them include with their advertising (although even this statement appears to be slowly disappearing from infant-formula advertising). However, the simple fact is that breast-feeding itself is the most dangerous and formidable competitor formula companies have. Every time a woman chooses to breast-feed instead of bottle-feed her baby, the pharmaceutical companies lose approximately $1,000 in sales. Because the companies that produce formula also develop and market medications and medical supplies, they must be acutely aware that the higher rates of illness suffered by formula-fed children as a group also affects their bottom line, possibly even more than the sale of the formula itself. For example, Abbott Laboratories, aside from making Similac and Isomil, also produces Pediasure, an oral rehydrating solution for infants and young children with diarrheal disease. The company also produces antibiotics widely used to treat infant infections, as well as products for diabetics.

Experts agree that there is a role for the appropriate use of commercial infant formula. It should always be used for infants under 12 months in lieu of any type of homemade formula or whole cow, goat, or soy milk. The problem, they say, is with the way it is marketed and represented to parents.

"Infant formula should be seen for what it is: a pharmaceutical product, not for routine use," says Dr. Dettwyler. "The way these companies market it as equivalent to breast milk and just one equal choice among several is wrong."

While commercial infant formulas are commonly perceived to be the medically recommended second-choice infant food after breast-feeding, the World Health Organization (WHO) actually states: "The second choice is the mother's own milk expressed and given to the infant in some way. The third choice is the milk of another human mother. The fourth and last choice is artificial baby milk." For mothers who are unable to breast-feed their own babies, a small network of human milk banks exists in the United States. The informal sharing of breast milk and wet nursing has been common throughout human history; the first U.S. milk bank opened in Boston in 1911. Today, the seven regional milk banks belonging to the Human Milk Banking Association of North America (HMBANA) follow strict health and safety guidelines -- similar to that of a blood bank -- for the collection, processing and distribution of milk donated by breast-feeding mothers. According to Andrea Morgan, Executive Director of the Mothers' Milk Bank at Austin, Texas, and HMBANA vice president, banked human milk is currently available by prescription only, and as more people seek an option other than infant formula for their infants, the demand continues to be greater than the supply.

"The limiting factor really is the amount of milk on hand," explains Morgan. "Healthy newborns have lowest priority, regardless of the status of the mother. There is simply too much demand from sick and premature babies and other gravely ill children, where mothers' milk represents survival and a decent shot at good health, with no real good alternative. More publicity helps to generate more donors. People call me all the time and say they've been dumping breast-milk because they didn't have room in the freezer and didn't realize there was an alternative. It also helps to spread the word to more physicians, who become interested in having this milk available to their sick patients."

Currently, the small scale on which human milk is processed and distributed makes it prohibitively expensive for most families compared to infant formula. It costs about $2.50 to purchase one ounce of processed, banked human milk. Infant formula, while still expensive -- costing between $75 and $175 per month for an exclusively formula-fed infant -- is based on abundantly available and cheap agricultural products such as cow's milk or soybeans.

"Some insurers pay [for banked human milk] if they realize that these patients will have lower overall health-care costs. Medicaid also pays in some states," says Morgan. "The processing fee that we charge covers only about half the cost to process the milk. And all milk banks exist because of some other type of support: Either they are located in a hospital that provides a substantial operating subsidy or, as in our case, a community-based, not hospital-based bank. We must constantly work to raise funds. But no medically needy recipient is denied milk for inability to pay."

With the current high cost and limited availability of banked human milk, commercially produced infant formula generally remains the only available alternative for those mothers who are truly unable to breast-feed their babies due to adoption, maternal HIV infection or other factors. And unfortunately, in the United States, because of inflexible work schedules, a lack of societal support and an epidemic of medical mismanagement, nursing is often made extraordinarily difficult for even the vast majority of women who are physically capable of breast-feeding their children. But Dr. Gartner believes that if more parents understood the stark realities of the risks inherent in artificial feeding, they would no longer stand for a situation in which they are literally forced by external circumstances to feed their babies an expensive, potentially hazardous product in lieu of a safe, available one -- their own breast milk.

"Women are simply not getting informed on this issue," says Gartner. "In many cases, advertising and promotion have led parents to believe that there is no substantive difference between breast-feeding and formula-feeding in the United States and of course, this is far from being the case. I urge parents to read and learn as much as they can about relative health outcomes in children before they decide how they will feed their baby. Studies have shown that when women are educated on this issue -- even when they then decide not to breast-feed -- they don't feel guilty. But most women, when they find out all the facts, do feel cheated and very, very angry."
salon.com | July 20, 1999

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