Marketing infant formula at the expense of breastfeeding: Updates in the conflict between the pharmaceutical industry and the public interest

About 80% of infant formula currently sold in the US is made by 2 large pharmaceutical companies. Their premier marketing technique is distribution of commercial discharge packs to all new mothers via the birthing hospital. Packs typically contain formula samples or coupons, and other company-sponsored material, and are packaged in an attractive "diaper" bag with the company logo. Research shows that commercial packs decrease exclusive breastfeeding, even when the samples are removed. The practice succeeds because it implies that the hospital and/or clinician endorse the use of formula in general, and of that brand in particular. Sales representatives from formula subsidiaries have been able to enjoy access to hospitals and hospital personnel because hospitals have long allowed access to sales representatives from their parent pharmaceutical companies. Formula representatives, like pharmaceutical representatives, supply free meals and gifts to hospital staff to foster a cooperative relationship with medical personnel that may result in increased sales of formula, particularly with cooperation of staff in giving out the discharge packs to new mothers. Recent US efforts to combat the hospital distribution of commercial discharge packs stemmed in part from backlash in Massachusetts, where former governor Mitt Romney, courted by Bristol-Myers Squibb, quashed proposed regulations to ban hospital distribution of formula discharge packs. These events have fueled US efforts to eliminate hospital marketing of formula, and growing numbers of hospitals are eliminating this practice. These successes derive from increased public awareness of the unethical tactics, and of medical staff awareness of data showing that the practice undermines medical recommendations to breastfeed exclusively. However, formula companies are broadening their tactics. In recent years, they are claiming that newer untested additives make formula so close to breastmilk that many women have indicated that they believe there is now no difference. The industry is also redirecting sample packs to obstetricians' offices, sending "supplementation kits" to pediatric and ultrasound offices, and the workplace. Other tactics include a workplace support toolkit aimed at undermining the confidence of low-income hourly workers, spa-giveaways in the packs, and use of unisex stylish black bags. Conclusion: Despite some successes in combating marketing of infant formula in the health care setting, ongoing efforts will be needed to keep up with the evolving practices of industry.