News article

JAMA article advises severing of industry ties

April 13, 2009

Eleven leading US physicians have published a special article in the April 1 issue of the Journal of the American Medical Association (JAMA) recommending that all professional medical associations sever their ties with pharmaceutical and device manufacturers. The statement may have broad implications for the infant formula industry, even though infant formula is not specifically mentioned. The eleven authors of the proposal include Dr. Catherine DeAngelis, editor-in-chief of the JAMA, and Dr. Carol Berkowitz, past president of the American Academy of Pediatrics (AAP).

The statement recommends that professional medical associations (PMAs), start by limiting their budgets to 25% industry funding, and work toward with the goal of “$0.” Many PMAs, which are defined as physicians’ organizations, have gotten funding for activities ranging from conferences and annual meetings, to funding the development of practice guidelines, as well as unrestricted grants, often totaling millions of dollars. The statement recognizes that some valuable activities may need to be curtailed, and recommends that all funding come from membership dues and advertising sales in their journals and vendor fees at conferences. The authors of the proposal stipulated that they are writing as individuals, not as representatives of their own medical organizations.

For some time, breastfeeding advocates have cited conflicts of interest between the American Academy of Pediatrics and the infant formula industry, which is largely controlled by pharmaceutical companies. The AAP has engaged in many of the practices specifically condemned by the JAMA statement. These relationships with industry have been commonplace in many professional medical organizations, not just the AAP, and arguably have compromised practice guidelines and policy in many areas of medicine. Members of the AAP’s Section on Breastfeeding have repeatedly tried to get the organization to sever its ties with the formula industry, but so far without success.

The relationship with the formula industry has arguably influenced AAP’s medical policies. The AAP has been relatively silent in advocating for the WHO/UNICEF Baby-Friendly Hospital Initiative, which eliminates marketing of infant formula by hospitals and substantially increases breastfeeding rates at the expense of infant formula. The AAP committee on nutrition recommends only 4-6 months of exclusive breastfeeding, in contrast to the AAP Section on Breastfeeding and all other major medical organizations in the world, which recommend exclusive breastfeeding for 6 months.

According to Naomi Baumslag and Dia Michels in their 1995 book Milk, Money, and Madness, the formula industry contributed $3 million to the building of AAP’s headquarters, and had been giving annual $1 million grants to the organization.

Overwhelming evidence exists to show that aggressive marketing of infant formula undermines breastfeeding duration and exclusivity. The formula industry competes with breastfeeding for market share of infant nutrition. Its profits go down when breastfeeding goes up.

The JAMA statement, “Professional Medical Associations and their Relationships with Industry,” is available at http://jama.ama-assn.org/cgi/reprint/301/13/1367.