The organized crusade for Twilight Sleep was relatively short, but the damage to women and the birth process was done. The change in how obstetricians were perceived, how they treated the birth process, and how American women experienced birth were dramatic. It accelerated the trend to hospital birth, where, with newly elevated status, doctors gained control of the birthing room. Ironically, women were the catalysts for this change, showing the power of the consumer to shape medical practice. Doctors also saw the profitable side of birthing, and, even though Twilight Sleep wasn’t the answer, they continued to look for safer ways to have a medicated birth—from ether to epidurals. The desire for painless childbirth continued and led to more assembly-line, hospital-based programs of heavy sedation. This created a symbiotic relationship between the medical field and the pharmaceutical industry, which supplied the sedatives.
As births moved from the home to the hospital, something else happened—the practice and sensibility of obstetricians changed. Instead of sitting at a woman’s beside in her home for hours, they were shuttling between patients in a hospital, moving one along to deal with the next. They lost familiarity with and concern for the rhythms and nuances of labor and the needs of the mother. Prior to this cultural shift, comfort and reassurance was often the most necessary or only “treatment” needed during birth. Now medical interventions were created to interfere with a natural process. Chemically inducing labor, heavily drugging laboring women, and separating mothers and newborns became commonplace—all of these are counterproductive to breastfeeding. In 1971, the year I was born, only 24.7 percent of babies were ever breastfed.
Even this brief look into the development of the practices of the physicians who guide us through pregnancy, birth, and infant health shows the close influence of consumer demands and commercial interests regardless of health implications. Pediatrics and obstetrics grew larger and more popular at the expense of women. As pediatrics cozied up to the infant formula industry, obstetricians began to rely on pharmaceuticals to enhance credibility. So the two medical practices that women rely on at one of their most vulnerable periods have earned their reputation by presuming the female reproductive system is so wrought with problems it needs constant monitoring, sedatives, and frequent medical intervention. In 1996, the C-section rate in the U.S. was 21 percent; in 2015 it was 32.7 percent, a 53 percent increase well above the “medically necessary” target of 10–15 percent WHO recommends. The disturbing trend of a male-dominated field controlling where and how women give birth and how women feed should concern all women. How these practices impact lactation were never considered. As lactation became the least appreciated and least understood reproductive function by the very physicians who should’ve understood it best, it became the function most dispensable, the easiest to cast aside. Human milk substitutes, however, became indispensable. And therefore, unbelievably profitable.
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Milk Money: The Big Business of Bodies, Breasts, and Babies
Soda companies, infant formula makers—these are not social service agencies. They are businesses whose primary job is to produce dividends for investors. Once that is understood, corporate marketing becomes understandable.
—MARION NESTLE, AUTHOR AND PROFESSOR OF NUTRITION AT NEW YORK UNIVERSITY
Before there was industrial agriculture, processed foods, McDonald’s, high fructose corn syrup, and TV dinners, people ate real food. Those people included infants and toddlers. Babies ate breast milk until they moved on to homemade baby foods. If a baby could not be breastfed by its own mother or another mother, he or she was fed breast milk substitutes made according to recipes shared between mothers or published in the common household advice manuals. “If the [cow’s] milk cannot be obtained,” said Joseph B. Lyman and Laura E. Lyman, in their Philosophy of House-Keeping (1869), “water in which cracker or good wheat bread has been soaked with sugar added to it is very nutritive and digestible.” In the 1920s and 1930s, evaporated milk became widely available at low prices, evolving into the number one ingredient in homemade infant formula. While crackers and evaporated milk weren’t ideal food options for infants—and many babies who ate those substitutes developed diet-related illnesses—they were used as emergency solutions for the rare occurrences when a baby couldn’t be breastfed.
What began as a homemade product used rarely, for preterm infants who were too ill to nurse or when a mother’s milk was not available, grew into a mass-produced, worldwide product meant to replace mother’s milk even when it was available. By the end of World War II, bottle feeding had become the standard method of infant feeding in the United States and, to a lesser extent, in Europe as well. The shift from occasional use of formula to the ubiquitous use of formula was driven by the profit-making potential of infant formula, not the nutritional needs of babies. The important shift from thinking of formula as a second-rate, backup product that should be used only when needed to considering it on par with mother’s milk and using it as the first option forever changed infant feeding patterns across the globe—and, therefore, our collective health trajectory.
All of the science says that a baby’s best interests are met when they receive the nutritional, developmental, and immunological benefits of breastfeeding. On the other hand, the goal of the formula industry and its bumper crop of ancillary bottle-feeding products is to maximize market size by increasing the number of mothers who buy these products and the length of time they use them. Infant formulas are the only source of nutrition for many infants during the first months of life. They are critical to infant health since they must safely support proper growth and development during a period when the consequences of inadequate nutrition are most severe. Ultimately, public health and private profit are at odds because the formula industry profits from the failure of breastfeeding. And the failure of breastfeeding among a generation of women is a fatal blow to the health and wellness of future generations.
Few products other than infant formula undermine a normal bodily function in order to create a physical need for a commercial product in order to replace it. Formula samples cause the mother to need formula: once formula feeding starts, the lactation process, which slows with less frequent nursing, actually begins to dry up. When the free sample of formula is used, and there has been less nursing at the breast, there is an actual need to buy more formula.
It’s not an accident that big business is interested in what we eat on the very first day of life. The collision of medical needs, parenting trends, and the historical undermining of women provided business and marketing opportunities. By the mid-nineteenth century, formula companies saw a commercial opportunity and seized it. Processed infant food reduced parental anxieties about nutrition (which was fanned by male physicians) and later, offered women entering the workforce the appearance of an irresistible convenience. Manufactured and well-advertised, infant formula was admired by doctors and health professionals and welcomed by mothers. Fueled by changing ideas about infant feeding and a budding advertising industry, infant formula grew in popularity.
Commercially made milk emerged as an ideal industrial product: a standardized creation with predictable tastes, textures, and qualities. But because formula is easy to mass manufacture doesn’t necessarily make it the healthiest option for babies. Food is programming. What we eat every day, good and bad, sends messages to our body. That makes our earliest diet especially critical. Introducing babies to minimally nutritious, calorie-dense products, laden with sugar and salt, lays the groundwork for a lifetime of overeating processed foods since our sensory preferences for tastes are developing in infancy.
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It’s a clear brisk day when I meet with Dr. Julie Mennella of the Monell Chemical Senses Center, a nonprofit research center in Philadelphia. Mennella, a biopsychologist and researcher, has produced a large body of work examining the genetic influences and sensory development of taste preferences in utero and the early months of life. Mennella’s work found that babies born to mothers who eat
a diverse and varied diet while pregnant and breastfeeding are more open to a wide range of flavors. She’s also found that babies who follow that diet after weaning carry those preferences into childhood and adulthood. Researchers believe that the taste preferences that develop at crucial periods in infancy have lasting effects for life and actually predict what they’ll eat later. In fact, changing food preferences beyond toddlerhood appears to be extremely difficult. “Where you start is where you end up,” Mennella says.
The Monell researchers identified three key periods for developing taste preferences: in utero; in early infancy, before three and a half months of age; and at weaning, which makes what the mother eats during pregnancy and breastfeeding critically important. The flavors we are exposed to in mother’s milk are the flavors we find acceptable as we grow up. Studies show that breastfed babies are more likely to try new foods later on in life because, unlike formula, which tastes the same every time, breast milk varies daily in flavor and taste. “Infants exposed to a variety of flavors in infancy are more willing to accept a variety of flavors, including flavors that are associated with various vegetables and so forth and that might lead to a healthier eating style later on,” says Gary Beauchamp, the director of the Monell Center.
This work has profound implications for understanding how critical early food experiences are to our future health. It also explains why there is profit potential for pharmaceutical companies in determining an infant’s diet and future health trajectory. Take sugar intake, for example. Independent laboratory testing has found alarmingly high levels of corn syrup and sugar in popular infant formula brands. The formula companies aren’t required by law to disclose sugar levels, but some independent studies have found shocking results. One independent analysis by an NBC news affiliate in Chicago and Deibel Laboratories found as many as 13.5 grams of sugar per serving in some infant formula brands, including Enfamil Premium. That’s about the same amount of sugar as an eight-ounce Vitamin Water and about half the sugar in an eight-ounce Red Bull, but a newborn baby is consuming that serving three to six times a day. That amounts to roughly fifty-four grams of sugar per day with only four feedings—almost the same amount of sugar in one twenty-ounce Coke. Imagine giving your newborn a bottle of Coke or two Red Bulls every day. When I eat sugary snacks, I can balance my diet by drinking more water, eating more vegetables later, or consuming less sugar for the rest of the week, but for infants, formula is their sole diet—their only source of nutrition. This makes the ingredients in what they eat every day, several times a day, worthy of even deeper scrutiny. Instead, we have the opposite.
Deibel’s analysis found Similac Advance Organic Complete Nutrition to have 3.5 grams per serving of sucrose—the most potent and addictive form of sugar. Because of its potency, sucrose has already been banned from infant formula in Europe in conjunction with antiobesity efforts. The top five ingredients listed for Similac Sensitive Formula for Fussiness and Gas are corn syrup solids, sugar (sucrose), milk protein isolate, high oleic safflower oil, and soy oil. Enfamil’s Soy Toddler formula also lists corn syrup solids as the initial ingredient, followed by vegetable oil (palm olein, coconut, soy and high oleic sunflower oils), soy protein isolate and calcium phosphate. These dangerous sugars, including sucrose, remain in infant formula in the United States. The Infant Nutrition Council, the trade association for the infant formula manufacturers, says the ingredients are safe: “All of these carbohydrates have been shown in clinical studies and many years of consumer use to be safe and support normal growth development in infants.” Infant formula makers conduct their own research and then, in effect, road test it on babies and wait for adverse results. They are automatically considered safe until proven otherwise. Meanwhile, for years, scientific journals on nutrition, going back to a 1995 study in the American Journal of Clinical Nutrition, have published ongoing findings linking the consumption of large quantities of sugar and high fructose corn syrup to behavioral disorders such as ADD as well as anxiety, hyperactivity, distractibility, and nighttime insomnia. An infant diet that is high in sugar and corn syrup also increases the risk for a wide spectrum of other health problems ranging from dental cavities to nutritional deficiencies, according to published studies. The American Academy of Pediatrics has published multiple health warnings about the dangers of sugar-sweetened sodas, sports drinks, and fruit juices. In her groundbreaking book Soda Politics: Taking on Big Soda and Winning, Marion Nestle, a nutrition professor and founder of the food studies program at New York University, deconstructs the impact of soda drinking on public health. “Soda is sugars, water, and nothing else of redeeming nutritional value. They account for between a third and half of all sugar intake. Substantial research indicates an association between habitual soda drinking and obesity, type 2 diabetes, and other chronic conditions,” Nestle noted in an interview. While sodas have come under intense scrutiny for their dangerous sugar content, most parents are unaware of the sugar content of infant formula. The health impact of a generation of infants being fed a high-sugar diet is hard to ignore. According to a 2000 report by the American Diabetes Association, type 2 diabetes, which used to largely affect adults, is the “new epidemic” in the American pediatric population, with a 33 percent increase in incidence and prevalence among young children and adolescents. A decade before the study, this disease was rare in the American youth population. According to a report by Dr. Francine Ratner Kaufman, much of the increased prevalence is attributed to excess caloric intake and childhood obesity. There is no question that consuming high levels of sugar from birth is woefully dangerous. Yet consumers are unaware of the true content of sugar in formula, and manufacturers are not required by the government to disclose it. In the meantime, formula feeding primes millions of infants for a lifetime of unhealthy taste preferences.
As a result, big pharma is shaping and controlling America’s eating habits from birth. That means they ultimately influence everyone’s health, priming our population for diet-related diseases, like diabetes. Simultaneously, they are selling the drugs that treat those diseases. Healthy infant nutrition, it turns out, is ultimately a form of preventive medicine, and that is at odds with the profit-driven model of big pharma. They will make less money down the line if people don’t need their medications. In other words, it is in their commercial interest to directly and indirectly create the conditions that generate demand for their products in later years. To fully achieve that objective, their work begins at birth, in an all-out profit battle to be every newborn’s first food.
An industry accomplishment of this scale is the stuff of business-school case studies. Imagine this MBA project: invent a product that will compete with another product already in worldwide use, a product that is perfectly designed, impossible to replicate, responds directly to the needs of its recipients, is convenient, and mostly enjoyable to use. Then add this humdinger: this product is also free. Not only should your invention compete with this established product (and cost a lot), but it should also push the perfect, established, free product out of the market, making it unnecessary and obsolete. In fact, users of the established product should be ridiculed or treated like weirdos or fanatics. This is the story behind the business of infant formula.
While agribusiness behemoths like Monsanto dominate the commercial food industry with mass-production must-haves such as genetically modified seeds and bovine growth hormones in cows, pharmaceutical companies dominate the market for liquid nutritional supplements and infant formula. Today, infant formula is a global industry with $11 billion in annual sales and represents the largest segment of the baby food market. Wall Street analysts estimate that the total worldwide market for infant formula could reach as high as $80 billion. Therefore, the current estimated world sales of formula of $11 billion represents only 14 percent of the total potential sales. For drug companies, infant formula is the cash cow of pediatric “drugs.” No other product has such profit potential and guaranteed supply of potential users. While adult drugs make mill
ions, big pharma doesn’t have any incredibly lucrative drugs in the pediatric arena. Many analysts say the market for expensive pediatric ADHD drugs has peaked with more than 4.5 million children diagnosed. But with infant formula, the potential market is replenished daily, justifying an annual marketing budget of $500 million to $1 billion.
Two pharma giants, Abbott Laboratories (whose drug portfolio includes Humira for rheumatoid arthritis and the HIV drug, Norvir) and Bristol-Myers Squibb dominate the infant formula industry, creating a virtual oligopoly. In addition to their large stake in Mead Johnson, Bristol-Myers Squibb’s portfolio includes the blockbuster drugs Plavix, a blood thinner; and Abilify, for schizophrenia; and Reyataz, for HIV. The largest formula maker, with 50 percent of the market share, is Ross Labs, a unit of Abbott that makes Similac (named for being “similar to lactation”) and Isomil, a soy-based formula. Infant formula sales account for up to 50 percent of the total profit of Abbott. Second, with about 35 percent of the market, is Mead Johnson, maker of Enfamil. And while Bristol-Myers Squibb sold Mead Johnson back in 2008 in an initial public offering that raised over $560 million, it still owns over 150 million shares of the company, valued at over $14.5 billion. Carnation, maker of Good Start formula, the third largest player, has been a subsidiary of Nestlé since the Swiss giant purchased it in 1988.
The Big Letdown Page 4
