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Highlighting Risks Of Not Breast-Feeding 'Toned Down'

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HHS campaign that aired advertisements promoting breast-feeding from 2003 to 2005 was "toned down" after formula industry representatives hired lobbyists to influence the department.Breast-Feeding

An HHS campaign thataired advertisements promoting breast-feeding from 2003 to 2005 was"toned down" after formula industry representatives hired lobbyists toinfluence the department, the Washington Post reports.

At the request of HHS' Office of Women's Health the not-for-profit Ad Councilagreed to donate $30 million in air time for ads based off formerSurgeon General David Satcher's 2000 report titled, "Blueprint forAction on Breast-feeding," according to the Post. The women's health office hired the ad agency McKinney + Silver to work with scientists from NIH, CDCand elsewhere on the campaign. After officials met with dozens of focusgroups, they decided the most effective way to urge women tobreast-feed was to "delineate in graphic terms the risks of notbreast-feeding," the Post reports. One of the ads createdfor the campaign featured a nipple-tipped insulin bottle and said,"Babies who aren't breast-fed are 40% more likely to suffer Type 1diabetes." According to the Post, some ads also featured photos of asthma inhalers topped with rubber nipples.

According to the Post,the formula industry's involvement in the ad campaign is being"scrutinized" by Congress after Carmona's testimony last month at ahearing with the House Committee on Oversight and Government Reform (Kaufman/Lee, Washington Post,8/31). Carmona said the Bush administration routinely blocked him fromspeaking out or issuing reports on human embryonic stem cell research,abstinence-only sex education, emergency contraception and othersensitive public health issues. He also said the administration oftenedited his speeches for politically controversial content andencouraged him to attend internal political meetings (Kaiser Daily Women's Health Policy Report, 7/16).

TheHouse government reform committee is investigating whether Carmona wasbarred from participating in the breast-feeding advocacy project and ifpeople working on the campaign were overruled by superiors. "This is acredible allegation of political interference that might have hadserious public health consequences," Rep. Henry Waxman (D-Calif.),chair of the committee said.

Lobbying by Formula Industry

The International Formula Counsel hired Clayton Yeutter -- former agriculture secretary and former chair of the Republican National Committee -- and Joseph Levitt, former director of the FDA Center for Food Safety and Applied Nutrition's food safety center, to arrange meetings with HHS, according to an IFC spokesperson. According to the Post, formula company officials also approached Carden Johnston, then president of the American Academy of Pediatrics.Afterward, Johnston wrote a letter to then HHS Secretary Tommy Thompsonstating that AAP had "some concerns about this negative approach andhow it will be received by the general public." Lawrence Gartner, headof AAP's section on breast-feeding, wrote to Thompson saying that the800 members of the section did not know about Johnston's letter and didnot share his concerns.

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In a Feb. 17, 2004, letter to Thompson,Yeutter wrote that IFC wanted to meet with Thompson because the draftbreast-feeding ad campaign was inappropriately "implying that motherswho use infant formula are placing their babies at risk," which couldlead to class action lawsuits, the Post reports. Yeutteralso wrote that McKinney + Silver might "well be correct" in concludingthat a toned-down ad campaign would be less effective, but the campaigncould give "guilty feelings" to the women who cannot or choose not tobreast-feed. He asked, "Does the U.S. government really want to engagein an ad campaign that will magnify that guilt?" Yeutter lauded thenHHS Assistant Secretary for Public Affairs Kevin Keane for making"helpful changes" to the ad campaign but asked that more be done.Yeutter two months later wrote to Thompson thanking him for meetingwith a group that included Levitt and another official.

Change in Ad Campaign

Gina Ciagne, the women's health office's public affairs specialist forthe campaign, said, "We were ready to go with our risk-based campaign-- making breast-feeding a real public health issue, when the formulacompanies learned about it and came in to complain. Before long, wewere told we had to water things down, get rid of the hard-hitting adsand generally make sure we didn't somehow offend." According to the Post,the campaign ran ads that showed images of dandelions and cherry-toppedice cream scoops to highlight how breast-feeding could help preventrespiratory conditions and obesity.

Current andformer HHS officials said Cristina Beato, then an acting assistantsecretary at HHS, was key in changing the ads, telling associates to"be fair" to formula companies, the Post reports. Beatoand Christina Pearson, an HHS press officer, also told then SurgeonGeneral Richard Carmona that they did not want him involved in thecampaign's launch or in promoting its themes, according to current andformer agency officials. Beato and Pearson said they do not recallgiving Carmona that advice.

Beato said that complaints fromformula companies did not play a role in her decisions, adding, "Ibrought together our top public health people to examine the healthclaims, and they examined the science and concluded what should be inand what should be out." Keane said, "We took heat from the formulaindustry, who didn't want to see a campaign like this. And we took someheat from the advocates who didn't think it was strong enough."

A spokesperson for McKinney + Silver, which withdrew from the campaign after the changes were ordered, declined to comment, the Post reports.

AHRQ Document

According to the HHS officials and documents, the department in Aprilchose not to promote an analysis of breast-feeding studies conducted byits Agency for Healthcare Research and Quality.The report did not say if there is a direct cause and effect ofbreast-feeding but said it is associated with fewer ear andgastrointestinal infections, and lower rates of diabetes, leukemia,obesity, asthma and sudden infant death syndrome.

According to the Post,a top HHS official said Suzanne Haynes, a senior science adviser forthe women's health office, called for the department to promote thereport to the media and medical professionals. Current and formerdepartment officials said that Rebecca Ayer, HHS press officer, toldHaynes and others in July that there should be "no media outreach" onthe report. According to the Post, HHS and AHRQ sent out e-mail notices about the report, but it was "generally ignored" (Washington Post, 8/31).


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