Feeding (and manipulating) the masses, part 1

Some of the manipulation we’ve talked about in the past has been fairly innocuous – a larger nozzle for soap, or a manipulation of yellow light that switches faster than expected to catch speeders.  But manipulation can be a lot more… dangerous.

Milk Manufacturers Manipulation

Delicious milk. As an aside, you’d be surprised what a Google search for breast milk can turn up…

Take the food supply, for example. Eating is fairly important for us humans, and when manipulations affect what we do (or do not eat), they can have serious ramifications. One of the seminal stories in that domain, of course, is the Nestle milk scandal.

Nestle (and many other companies, but Nestle was the largest, and quickly became the lightning rod for the issue as a whole) sells baby milk formula. This is not an easy product to sell, if you think about it – it’s a product that most mothers sort of make on their own when they become mothers.  But Nestle and a number of other companies did make it, and in the 1970s they started to give serious thought as to how to best sell it. In the Western world, manufacturers had managed to get a significant proportion of women off breastfeeding and onto formula, but the numbers had started to stagnate, and there were some disturbing hints of reversal . So formula makers looked abroad – specifically, at developing countries – for their growth.

So Nestle and others began to market formula aggressively in Africa and Asia and S. America.

Lactogen Milk Feeding

Lactogen: it’s good for you!

The issue, of course, is that while the mothers in those markets didn’t really know that formula was a lot less healthy than breastmilk, they still had to be convinced to spend what little income they had on a product that was completely superfluous (to most mothers). So how did the manufacturers get around that problem?

– The manufacturers started massive marketing campaigns aimed towards mother. The key message was that powdered milk was “like mother’s own milk”, and that it was the progressive way to feed your child. Some showed white women feeding their babies formula, others showed local women in relatively wealthy surroundings giving their babies bottled milk. The images showed well-fed babies, and they were hammered home – in August 1974, as an example, there were 135 30-seconds ads by Nestle for Lactogen in Sierra Leone.

Free Mlik Bottle Manipulation

– The manufacturers like Nestle and Unigate also started to distribute free milk samples on a massive scale. This milk went to physicians, maternity wards, hospitals, and essentially everyone and anyone who was likely to come into contact with a young mother. This was a very smart manipulation given the nature of breastfeeding: if a young mother doesn’t breastfeed relatively quickly, her milk dries up, and she becomes completely dependent on  formula. So if you could get enough samples (maybe as little as a couple of week’s worth) into the hands of a young mother, you guaranteed yourself a client for more than a year. It was a global example of the ‘first one is always free’ technique.

– Foreshadowing decades of pharmaceutical activities, the manufacturers began to reach out to doctors and midwives and technicians. Through a system of donations and education, the manufacturers ensured that an entire generation of health care professionals in Africa, South America, and Asia essentially grew up believing that formula was the way to feed babies.

The saddest expression of this came through the idea of ‘milk nurses’.

Milk Nurse

These were women that wore lab coats, red crosses, and all the uniform of nurses and helped mothers get and use powdered milk. The issue, of course, was that they were not real nurses – they were hired by the milk manufacturers to promote their formula.  If challenged by real doctors, or international organizations, the ‘milk nurses’ explained that their function was purely marketing and educational, but of course none of the mothers who listened to their advice knew that.

All these techniques worked, largely. Rates of breastfeeding tumbled around the developing world over the next few years, dropping by 30% and more in countries like Chile and many countries in Africa. Entire countries went from breastfeeding to formula over little more than a decade, putting around $1-2 B of revenues into the coffers of Nestle, Unigate, Bristol Myers, etc…  This was truly an epic ‘victory’ for the manufacturers – the daily cost of formula represented 20% or more of the wages for the families that were generating that cash flow to the manufacturers.

Beyond this transfer of wealth, though, these manipulations had other consequences. Formula requires water, and relatively clean bottles. Outside of the maternity wards and the ‘milk nurses’ stand, conditions were hardly ideal – millions of women (who couldn’t read) started to mix formula with what water they could find, which was often unsanitary. Bottles were not washed, formula was not kept sterile, and babies got hit with a double whammy: they were not getting the nutrients of breastmilk, including the immune system boosters that a mother passes on to her child, and the milk that they were consuming became increasingly contaminated with bacteria and other contaminants. Hundreds of thousands, perhaps millions of babies died of malnutrition as a result.

By the late 1970s, new studies were coming out in the Western world about this issue, as more and more folks began to understand the manipulations of the formula makers. South African journalist Mike Muller published a scathing article called “The Baby Killers” [Warning – PDF], which detailed some of these practices, and UNICEF and the WHO got involved.

Manufacturers moved into a defensive stance. Formula, they claimed, was never meant to compete with breast feeding – it was just targeted to women who could not, or would not, breastfeed. Studies after studies were published by the manufacturers, claiming that their clients were well-to-do women in those regions who couldn’t spare the time to breastfeed.

Most of those defenses failed, simply because of the huge numbers involved. By the early 1980s, millions of women in the developing world were on formula, well beyond the 1% or so that could not medically breastfeed, or the even smaller proportion of wealthy women who lacked breastfeeding time. Breastfeeding rates had plummeted in nations like Brazil, Nigeria, Chile, Laos, etc… to such an extent that breastfeeding was now the exception, not the rule.

In 1981, WHO and UNICEF passed a new code [PDF again!] agreed to by 118 nations to regulate how and when manufacturers could advertise formula to mothers. The industry lobbied hard against that code (amusing fact: the US, under Reagan, voted against the code, since it “would hurt industry”), but was unsuccessful. The new code outlawed milk nurses, forced manufacturers to put warning labels, forbade free samples, and tried in general to rein in the manufacturers.

Nestle, the largest manufacturer of formula, had largely ignored calls like the code for reform of the industry. When “Baby killers” came out, Nestle sued the publisher for libel in Switzerland, Nestle’s home. After two years, the judge ruled in Nestle’s favor based on technical law, but fined the publisher less than $300, and wrote a fairly scathing sentencing summary that left no doubt as to who had really won the case. A group in Minnesota, Infant Formula Action Coalition, began a boycott of Nestle, and, relatively untypically, the boycott began to spread from nation to nation. Enough schools banned Nestle products, enough consumers boycotted the merchandise that, six years later, Nestle decided to implement the WHO code in exchange for lifting of the boycott.

Did it all end in rainbows? No.

How much changed post the Nestle agreement?

Ironically enough, the same story is being played out today, just in different geographies. In the Philippines, for example, when the country decided to pass local laws to reflect the UNICEF code, manufacturers sued the government to stop officials from enforcing the new laws. Dutch Lady, a manufacturer, was accused of paying doctors and nurses to promote their products, echoing the techniques of half-a-century ago in other countries.  Manufacturers are not solely copying their predecessors, though – they’ve added new techniques: young mothers are now called at home via phone salesmen, for example, who explain that formula will boost children IQ and make them taller, which was not possible in the 1970s.

Or they make Youtube videos that imply that powdered milk will make babies into Astronauts.

Even Nestle is still occasionally brought before the courts or the European Parliament for breaking the code, but there is essentially no penalty that can be levied against it – the WHO and UNICEF code is voluntary, and lacks enforcement power – it’s up to each country to pass laws to actually implement the code, and as mentioned above, manufacturers have ample resources to block legislation in developing nations. So there is little that is likely to change quickly.

Manipulation can be used for good and for… well, this type of thing. The formula manipulations were very advanced for their time – surprisingly sophisticated, and very difficult for others to counter, mostly because while manufacturers had billions to gain from implementing the manipulations, there were very few organized groups to oppose them. So it has taken decades for these manipulations to gradually lose their power, but as mentioned above they are still going strong in many, many different countries.  But, speaking personally, while I admire the skill and creativity of those early manipulators, I personally would take a long shower if I ever met them in person.