June 4, 2004 -- The U.S. government has unveiled a new advertising campaign to promote breast-feeding, after months of fierce lobbying to change its approach, ABC News has learned.
Watch Brian Ross' full report tonight on 20/20 at 10 p.m. ET
The campaign, announced today in Washington, D.C., is much different than what was first produced.
In what has been called a battle between mother's milk and corporate power, the companies that make infant formula put intense pressure on the government to change its approach.
ABC News has obtained the ads that were produced but never aired. One of the ads showed pregnant women at a roller derby violently competing and then the message: "You wouldn't risk your baby's health before it's born. Why start after?"
The other spots obtained by ABC News include pregnant women at a logrolling contest and riding a mechanical bull. They ended with a list of diseases that the ads said were more common among babies not breast-fed, including diabetes, leukemia and ear infections.
The ads were sponsored by the government and produced by the Ad Council, a nonprofit group that produces, distributes and promotes public service announcements. The ads were set to be released last December, but some formula companies complained after getting an early sneak preview of the ads before they hit the airwaves.
A spokesperson for the International Formula Council, the trade group for the formula industry, said they support breast-feeding and only objected to the commercials because they felt they were too negative in tone and inaccurate. No company official would talk to 20/20 about the efforts to kill the ads.
In letters to the Department of Health and Human Services, the lobbyists praised the merits of breast-feeding while adding concerns over the message the ads would send to mothers.
Read the lettters: Concerns From Industry
Pediatricians Weigh In
"Many mothers simply cannot breast-feed, or cannot do so for as long as would be desired, or elect not to do so for persuasive reasons (often economic). For our government to give all those mothers a guilt trip would just be appalling," stated lobbyist Clayton Yeutter in a letter obtained by ABC News.
"When you say 'not breast-feeding is risky,' what you're saying is 'using infant formula is risky,' and that is true and they know it," said Dr. Jay Gordon, a pediatrician in Santa Monica, Calif., and a member of the breast-feeding committee of the American Academy of Pediatrics. Gordon added that there is no substitute for human milk, with all of its immune system benefits for newborns.
The decision to put the campaign on hold was made in Washington at the Department of Health and Human Services, which is sponsoring the campaign.
Officials confirm to ABC News that HHS' Secretary Tommy Thompson met privately with formula industry representatives but turned down meeting requests from breast-feeding advocates.
But the acting assistant secretary for HHS, Christine Beato, speaking for Thompson, said she was "not aware of that," and said the ads were pulled because a review found them scientifically inaccurate. Beato met with formula makers but said breast-feeding advocates did not request a meeting with her.
"I met with the industry. Because they kept calling my office every two weeks," said Beato. "Every two weeks."
While other scientific studies back up claims of an increased risk for leukemia to babies not breast-fed, Beato said the experts who were satisfied with the studies are "not our experts in this department."
The formula industry hired Washington lobbyist Clayton Yeutter, who was the secretary of agriculture for the elder President Bush and a former Republican Party chairman. In a series of letters to Thompson, obtained by 20/20, Yeutter thanked him for making some changes to the campaign and asked for more changes to be made.
The formula industry objected to what it called the "grossly misleading visuals" in the ad campaign and questioned the scientific validity of claims of a higher incidence of diseases in babies who are not breast-fed. Yeutter declined ABC News' request for an interview.
When asked what role the infant formula industry played in putting a hold on this campaign, Beato answered, "To my knowledge, none."
Thompson also received a letter from the American Academy of Pediatrics, which voiced the same concerns as the formula industry, even though they take in millions of dollars each year from the formula makers. The academy's executive director, Dr. Joe Sanders, denies that the money from formula makers had anything to do with their decision to oppose the commercials.
"We saw the information from the Ad Council and there was something about a pregnant woman riding a [mechanical] bull," said Sanders. "I don't think a pregnant woman belongs on a mechanical bull, do you?"
Public Health Issue
But breast-feeding advocates say the science and the figures used in the commercials were valid.
"The ad campaign is backed by scientific research, by good research," said Dr. Larry Gartner, the former chairman of pediatrics at the University of Chicago and the head of the breast-feeding committee of the American Academy of Pediatrics.
In fact, a study released just last month by the National Institutes of Health found that babies who are not breast-fed have a 20 percent higher risk of death in the first year.
"There are risks to the baby who is not breast-fed in terms of getting ear infections, upper respiratory tract infections, certain forms of cancer," said Dr. Bobbi Philipp, a pediatrician at the Boston Medical Center and a breast-feeding expert for the American Academy of Pediatrics, who was involved in the ad campaign.
"I think it's a huge public health issue," said Philipp. "I think it's very similar to smoking in terms of the importance to health of the children and mother."
Philipp added that there are live human cells in breast milk that can't be added to formula. "And the live cells protect against infection," she said.
‘Watered Down’ Ads
The modified ads were released today, but the spot with the roller derby scenes will not air. HHS also left out all references to leukemia and diabetes in babies not breast-fed.
And instead of referring to risks from not breast-feeding, the new commercials cite the benefits from breast-feeding, just as the industry wanted.
Many pediatricians and breast-feeding advocates welcome any campaign to promote breast-feeding, but the staunchest advocates see a sellout.
"The fact that they managed to get this campaign watered down is evidence that money can influence good medicine, and that large amounts of money can influence even good doctors," said Gordon.
He suspects the campaign would have cost the formula manufacturers "hundreds of millions of dollars."
The campaign also killed a series of print ads that claimed that babies not breast-fed were at greater risk of certain diseases. The changes were so substantial that the ad agency that first conceived the campaign no longer wants to be associated with it.
But Gordon sees a need for an aggressive campaign to promote breast-feeding to counter the marketing efforts of infant formula companies which imply that formula is close to mother's milk. "There is nothing that is going to bring artificial milk closer to human milk," said Gordon.
These companies also spend millions of dollars promoting infant formula to doctors and to the parents of newborns. Many hospitals even give new parents bags full of free formula after being discharged.
It's a practice banned at the Boston Medical Center and in many foreign countries. "We're talking about newborn babies here. We're talking about people making money on the heads of newborn babies," said Philipp.
Ultimately, Gartner said, the strong ad campaign was needed because previous attempts to get the message across did not succeed.
"And that was the Ad Council's conclusion … that just saying that breast-feeding was best, or breast-feeding was good, wasn't going to have the impact," said Gartner. "It wasn't going to change behavior."