At the request of HHS' Office of Women's Health the not-for-profit Ad Council agreed to donate $30 million in air time for ads based off former Surgeon General David Satcher's 2000 report titled, "Blueprint for Action on Breast-feeding," according to the Post. The women's health office hired the ad agency McKinney + Silver to work with scientists from NIH, CDC and elsewhere on the campaign. After officials met with dozens of focus groups, they decided the most effective way to urge women to breast-feed was to "delineate in graphic terms the risks of not breast-feeding," the Post reports. One of the ads created for the campaign featured a nipple-tipped insulin bottle and said, "Babies who aren't breast-fed are 40% more likely to suffer Type 1 diabetes." 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 a hearing with the House Committee on Oversight and Government Reform (Kaufman/Lee, Washington Post, 8/31). Carmona said the Bush administration routinely blocked him from speaking out or issuing reports on human embryonic stem cell research, abstinence-only sex education, emergency contraception and other sensitive public health issues. He also said the administration often edited his speeches for politically controversial content and encouraged him to attend internal political meetings (Kaiser Daily Women's Health Policy Report, 7/16).
The House government reform committee is investigating whether Carmona was barred from participating in the breast-feeding advocacy project and if people working on the campaign were overruled by superiors. "This is a credible allegation of political interference that might have had serious 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 Thompson stating that AAP had "some concerns about this negative approach and how it will be received by the general public." Lawrence Gartner, head of AAP's section on breast-feeding, wrote to Thompson saying that the 800 members of the section did not know about Johnston's letter and did not share his concerns.
In a Feb. 17, 2004, letter to Thompson, Yeutter wrote that IFC wanted to meet with Thompson because the draft breast-feeding ad campaign was inappropriately "implying that mothers who use infant formula are placing their babies at risk," which could lead to class action lawsuits, the Post reports. Yeutter also wrote that McKinney + Silver might "well be correct" in concluding that a toned-down ad campaign would be less effective, but the campaign could give "guilty feelings" to the women who cannot or choose not to breast-feed. He asked, "Does the U.S. government really want to engage in an ad campaign that will magnify that guilt?" Yeutter lauded then HHS 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 meeting with a group that included Levitt and another official.
Change in Ad Campaign
Gina Ciagne, the women's health office's public affairs specialist for the campaign, said, "We were ready to go with our risk-based campaign -- making breast-feeding a real public health issue, when the formula companies learned about it and came in to complain. Before long, we were told we had to water things down, get rid of the hard-hitting ads and generally make sure we didn't somehow offend." According to the Post, the campaign ran ads that showed images of dandelions and cherry-topped ice cream scoops to highlight how breast-feeding could help prevent respiratory conditions and obesity.
Current and former HHS officials said Cristina Beato, then an acting assistant secretary at HHS, was key in changing the ads, telling associates to "be fair" to formula companies, the Post reports. Beato and Christina Pearson, an HHS press officer, also told then Surgeon General Richard Carmona that they did not want him involved in the campaign's launch or in promoting its themes, according to current and former agency officials. Beato and Pearson said they do not recall giving Carmona that advice.
Beato said that complaints from formula companies did not play a role in her decisions, adding, "I brought together our top public health people to examine the health claims, and they examined the science and concluded what should be in and what should be out." Keane said, "We took heat from the formula industry, who didn't want to see a campaign like this. And we took some heat 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 April chose not to promote an analysis of breast-feeding studies conducted by its Agency for Healthcare Research and Quality. The report did not say if there is a direct cause and effect of breast-feeding but said it is associated with fewer ear and gastrointestinal 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 for the women's health office, called for the department to promote the report to the media and medical professionals. Current and former department officials said that Rebecca Ayer, HHS press officer, told Haynes and others in July that there should be "no media outreach" on the 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).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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