Product information to health professionals
Companies are breaking the rules by ...
providing health professionals with materials that violate Article 7.2. Companies equate product information with an opportunity to advertise. The materials they provide to health workers more often than not consist of nothing more than product promotion. Scientific and factual information is sometimes included but few, if any, of the materials are restricted to such matters. In addition, many of the materials favourably compare bottle feeding to breastfeeding and few contain the points required by Article 4.2.
Information provided to health professionals regarding products within the scope of the Code should be restricted to scientific and factual matters. Such information should not imply or create a belief that bottle feeding is equivalent or superior to breastfeeding, and it should comply with Article 4.2.
Chart 6 shows countries where companies provides health professionals with materials that violate Article 7.2..
|Infant Formula||Follow-up Formula||Complementary Food|
|ABBOTT ROSS||Brazil · Colombia · Spain · Guatemala · México · Nicaragua · Perú · Uruguay||Colombia · Guatemala|
|DANONE / DIEPAL||Cote dIvoire||Cote dIvoire||Benín|
|GERBER||Colombia · Guatemala · México · Uruguay · Venezuela|
|MEAD JOHNSON||Argentina · Colombia · Costa Rica · Guatemala · México · Nicaragua · Thailand||Nicaragua|
|MILUPA||Germany · Argentina · Bolivia · Croatia|
|NESTLE||Germany · Argentina · Bolivia · Brazil · Colombia · Costa Rica · Spain · Gabón · Hungary · Indonesia · México · Perú · Dominican Rep. · Senegal · Uruguay · Venezuela||Argentina · Bolivia · Brazil · Colombia · Gabón · Hungría · Indonesia||Bolivia · Colombia · Côte dIvoire · Guatemala · Senegal · Uruguay · Venezuela|
COW & GATE
|Argentina · Costa Rica · Spain · Dominican Rep.||Argentina · Costa Rica · Spain · Indonesia|
|SANDOZ / WANDER||Spain|
|WYETH||Argentina · Bolivia · Brazil · Colombia · Costa Rica · Guatemala · México · Nicaragua · Uruguay · Venezuela||Bolivia · Indonesia · Uruguay · Venezuela|
Other companies that violate Article 7.2 include Alter (Spain), Aponti (Germany), Hero (Spain), Lederle (Guatemala), Ordesa (Spain), Sancor (Argentina) and Watties (Western Samoa)
Some materials collected do not contain any scientific or factual information, such as this Abbott Ross leaflet for health workers in Brazil which shows only a picture of a baby on the cover. The company uses the inside text to create anticipation about a new formula by praising its characteristics yet never mentioning the product by name.
Nestlé produces a glossy colour leaflet for Lactogen 1 and 2 for health workers in Indonesia. The leaflet advertises Lactogen 1 and 2 economy packs. Although the "Important Notice" complies with Article 4.2, it is in very small print and mentioned only at the end.
Information or Promotion ?
Most company produced materials add some scientific and factual information to the product promotion. In Croatia, a brochure for Pikomil 1 has a large colour picture of two tins of Pikomil 1 and a feeding bottle on the cover. The drawing of a bottle is used as an icon for each sub-heading inside the brochure. The Pikomil 2 brochure is similarly designed.
Pikomil brochures in Croatia..
In Pakistan, Lyempf brochures for Bebelac EC claim that it is a "fully adapted infant formula for healthy babies requiring Extra Care". It is recommended for use from birth onwards. Other Bebelac products are mentioned within as being "perfectly interchangeable". The glossy brochure with a picture of a healthy baby is more an advertisement for Bebelac than scientific or factual material.
Wyeths S-26 and Promil booklets distributed to health professionals in Colombia are 2-dimensional copies of the real tins. The S-26 "building blocks" logo is displayed on every other page of the S-26 booklet, and the formula is repeatedly compared favourably to breastmilk. The Promil booklet features its own logo on every other page.
large, glossy, colour S-26 and Nursoy brochures
containing minimal scientific information, if any, given to health workers in Colombia.
In Brazil, Nestlé provides paediatricians with a little manual "Medicamentos Habitualmente Usados Em Pediatria" (Frequently Used Drugs in Paediatrics). The Nestlé name and logo are prominent on the front and back covers. The inside cover advertises Nan HA under the caption " the Nestlé solution for prevention of cows milk allergies".
Another Nestlé publication, the Manual de Gastroenterologia Pediatrica, also advertises Nan HA on the inside front cover and other special formulas on the inside back cover as "the Nestlé solution for special diets".
Health professionals in Brazil also receive regular mailings from Nestlés Scientific Information Service in colourful customised Nestlé envelopes. A typical mailing in July 1997 included an announcement about the new ingredients in Nestogeno 1, which simultaneously promoted Nestogeno 2 and Nestogeno Soy. There was also a glossy booklet about the minerals and vitamins in Nestlé Mom, a formula for pregnant women and lactating mothers, and, conveniently, a copy of the Nestlé Annals with scientific information on "vitamins during pregnancy and infancy".
The Nestlé Beba leaflet in Hungary shows packshots of Beba 1, Beba 2 and Beba H.A. on the cover page and again on the inside. Only one page is dedicated to information about the constituents of the formulae. The back of the leaflet advertises the range of Nestlé infant cereals starting at four months. At the bottom of this page is the "important notice" which, ironically, is in the smallest print of the whole leaflet.
Ross folder containing some scientific information is given
to health workers in Brazil.
The folder itself and each section divider advertise Similac Advance 1 and 2..
In Argentina, Bago/Nutricias pamphlet for health workers advertises Nutrilon products. Separate pastel-coloured cardboard cut-outs of cartoon figures also advertise each product individually.
Some cartoon cut-outs from Bago/Nutricias promotional material for Nutrilon in Argentina.
This Nestlé brochure for Lactogen 1 in Indonesia opens up to read " The ratio of micronutrients in breastmilk is ideal ..." on one page, and "New, Lactogen 1 with improved ratio of micronutrients" on the facing page. The illustration under the first caption shows drawings of children with mineral deficiencies, while the facing page promotes Lactogen 1 as the answer to adequate micronutrient intake. Such material is misleading and unethical.
Pictures or text idealizing the use of formula
Pictures of healthy happy babies have always been used to idealize the use of breastmilk substitutes. Mead Johnson, Nestlé, Abbott Ross, Wyeth and Snow Brand are among the many companies which use such pictures in their product-related materials.
In Argentina, Nestlés leaflet for Nan 2 which promotes other Nan formulas such as Nan 1, Pre-Nan, Nan HA and lactose-free Nan uses a baby picture to idealize the use of its formulas. So does Dumexs leaflet for Mamex in Thailand.
In Spain, Milupa brochures for GEA, SOM 1, SOM 2 with the picture of a baby and the caption "Youll always find a solution in Milupa" are given to health workers, and are freely available to mothers in health care centres.
A Nestlé brochure used by Nestlé Health Educator nurses in the Philippines promotes Nestogen 2 as "the nutritionally complete, good-value-for-money follow-up formula". The material also uses the phrase "If breastfeeding is not possible, ..." which implies that it is common for mothers not to be able to breastfeed.
The Nestlé Nidina leaflet in Argentina shows the picture of a happy couple with their baby, and the product. Similar family pictures or mother and child pictures, cartoon baby animal characters, flowers and the like are used to idealize the use of formula.
Pictures idealizing the use of breastmilk substitutes.
Advertisements in healt worker's publication
Advertisements to health workers in professional journals rarely comply with Article 7.2. A few examples include the following: The Journal of Paediatrics, Obstetrics and Gynaecology in Indonesia carries a full page advertisement for Nestlés Lactogen 1 and 2. The sentence beginning with "If breastfeeding is not possible for any reason ..." immediately conjures the possibility of mothers not being able to breastfeed for various reasons. Lactogen is then recommended as the best choice. The same Journal advertises Nutricias Follow-on formula, Nutrilon.
In Spain, Abbott Ross advertises Similac in the Pediatria Rural y Extrahospitalaria . The full page advertisement consists of a photo of a baby surrounded by stars with the caption "A new age in infant nutrition". A similar advertisement for Similac Advance appears in professional journals in Colombia.
Wyeth advertises SMA in at least nine professionals journals in New Zealand using the slogan "And heres your old favorite SMA."
Advertising is found even in the professional associations own publications. A special supplement to the monthly publication of the Pakistan Paediatric Association, on the occasion of the 8th National Paediatric Conference carried a front page advertisement for Nestlés Lactogen 1, recommended from birth, with the "Important Notice" in very tiny, almost impossible to read, print.
Implying that formula is equivalent to breastmilk
A brochure for Nestlés Nan 1 in Colombia boldly promotes Nan 1 as the best alternative to mothers milk. It compares the percentage constituents of two elements of breastmilk and formula and show it to be equal. Another Nestlé brochure advertises another of its brands, Nestogen 1, as the best alternative.
A good alternative ...
The best alternative...
Promotion in Health Care
Free samples and supplies | Posters, calendars and other displays | Gifts to healthworkers
Gift to mothers in healt care facilities | Informational and educational materials for mothers