Earlier this year, doctors across the country opened the pages of the official journal of the Canadian Paediatric Society and found a six-page insert touting baby formula.
The ad was designed to look like a journal article, with a list of scientific advisers on the front page and the words "Expert Discussion Forum" included in bold. On the last page, underneath a long list of references and small fine print, only an adept reader would notice the piece was "made possible under an unrestricted educational grant from Mead Johnson Nutrition [Canada] Co." And that the piece wasn't peer-reviewed by the journal's editorial board.
The CPS officially recommends infants be exclusively breastfed for the first six months of their lives. But after reading the ad in the March edition of Paediatrics and Child Health, one could be mistaken for thinking the CPS also unofficially supports the idea formula is just as good, if not better, than breast milk.
The piece focuses on docosahexaenoic acid (DHA), a type of fatty acid that has been popping up in more and more brands of formula in recent years. Unsurprisingly, the expert panel concludes that DHA is vital to developing babies and that doctors across the country should educate their patients about the need for it.
DHA is a polyunsaturated fatty acid found in breast milk. Infants can also produce it from other fatty acids in their diet. Some research suggests infants who directly consume high amounts of DHA from breast milk or formula see a modest benefit in brain and eye development.
That explains why so many formula companies have jumped on the DHA bandwagon, adding it to their products and then creating labels that tout how DHA supports brain and eye development.
The problem? Most of the research on this subject is mixed and many experts, including the World Health Organization, say there is not enough proof that formula supplemented with DHA actually benefits infants. A comprehensive review of the research published by the Cochrane Neonatal Review Group in 2011 concluded that supplementing formula with DHA and other fatty acids "cannot be recommended" because the evidence doesn't show it helps.
Reading the insert in the Paediatrics and Child Health journal gives an entirely different impression of the wonders of DHA: "Long-term data suggest that the neurocognitive benefits of DHA supplementation extend beyond infancy," reads one large, bolded phrase from the ad. A bulleted list states that DHA-supplemented formula has been linked to improved attention, problem solving, mental development and visual acuity.
Although it is careful to point out breastfeeding is the optimal choice, the piece states, repeatedly, that North American women have low levels of DHA intake. There is a subtle suggestion that formula is the superior choice in the line that states, "Despite the fact that DHA-enriched infant formulas have been available in Canada since 2003, all infants are not routinely fed DHA-enriched formula."
The ad even goes so far as to say the World Health Organization recommends all pregnant and lactating women get a certain amount of DHA and other fatty acids a day, and that a report from the organization found that DHA supplementation benefits infants.
The World Health Organization does not agree with the advertisement's conclusions.
"We explicitly state that further research is needed before specific recommendations can be made," Laurence Grummer-Strawn, WHO's technical officer in nutrition for health and development, wrote in response to questions from The Globe and Mail. "Even if there were such a recommendation, it is not logical to assume that supplementation of women would translate into a need for inclusion in infant formula. They are separate issues."
Katie Olsen, media relations co-ordinator with Canadian Paediatric Society, said the advertisement was clearly marked as such and that the formula company provided fees to the journal publisher.
"As with any other advertisement, we expect that our health-professional readers will use their judgment and discretion when interpreting the material."
In other words, the national organization representing pediatricians does not think it's a problem its journal published a major ad paid for by a formula company to make dubious claims about the benefits of DHA-supplemented formula.
Doctors understand the importance of breast milk and viewing an ad isn't likely to change that. But advertisements do influence doctors, even if they don't realize it. A 2010 article in the journal PLoS Medicine found that doctors who received information from drug companies, including journal ads or visits by salespeople, were more likely to prescribe that company's drug. So it's not outrageous to think the advertisement in Paediatrics and Child Health could influence doctors' opinions on the benefits of formula. Maybe they will become less likely to encourage mothers to breastfeed, or allow advertisements for formula in their offices.
While the vast majority of Canadian mothers – 89 per cent in 2011-2012, according to Statistics Canada – choose to breastfeed their newborns at the start, only one in four is still exclusively breastfeeding at the six-month mark. According to Statistics Canada, most women say they stop breastfeeding because they don't have enough milk or because of problems with technique.
We live in a country that likes to tell women to breastfeed, or even make them feel bad if they can't, or won't. Women should be free to make the choice over infant feeding without any guilt. But if we pretend formula advertising and marketing has nothing to do with stubbornly low breastfeeding rates, we are kidding ourselves.
Apparently someone needs to tell this to the Canadian Paediatric Society.
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