TCS Daily


WHO Papers Over Problem

By Duane D. Freese - May 16, 2005 12:00 AM

As the World Health Assembly prepares to meet in Geneva next week, delegates truly interested in promoting child health might take a cue from Michael Crichton's novel, Disclosure.

"Solve the problem." That was the anonymous advice, delivered by e-mail, to the novel's hero. So focused was he on fending off charges he'd sexually assaulted a female senior executive, that he had failed to focus on a problem -- bad computer drives -- that could have led to his dismissal for incompetence.

The health assembly is in danger of digressing from its essential task of promoting health by its focus on ways to discourage women from bottle feeding with infant formula. A proposal from the World Health Organization before the assembly to place new, dire warning labels on infant formula tins and packages emphasizes the wrong problem at the wrong time, while neglecting real actions that can save the lives of both parents and babies.

Let's agree from the start that Breast is Best when it comes to feeding infants, especially during the first six months. Mother's milk possesses immunological protections and nutrition that formula just can't match. Let's also stipulate that until science made that point clear, formula makers were over-zealous in pushing their product at the expense of babies' health.

But that message has been delivered. Thanks to breast feeding advocates' earlier campaigns, formula already comes with statements proclaiming breast feeding is the best alternative. In addition, marketing of formula is strictly limited. Distribution in poorer countries now is done through health agencies.

Furthermore, infant formula contains warnings already about how to mix it and when it must be used. Health agencies, doctors and hospitals in delivering formula to women are supposed to inform them of how on safe usage.

So, what is the purpose behind more dire labels? The only logical one is to simply scare women from using infant formula. And that makes the messages more an indication of anti-formula zealotry than healthy advice. Indeed, in many circumstances it is unhealthy advice.

No one can argue that a woman with HIV/AIDS who breast feeds her infant isn't putting the infant at her breast at risk of being infected. Transmission rates are put at more than 20 percent. And more than 250,000 infants every year become infected.

WHO and UNICEF both recognize this, as they do the risks of transmitting certain other diseases through breast milk, such as maternal tuberculosis. Unlike tuberculosis, though, for which mothers and babies can receive therapies that thwart transmission, that is not the case with HIV/AIDS. And no reputable health care worker in Europe or North America would encourage a woman with HIV/AIDS to breast feed her baby. They would be encouraged to use formula.

But WHO and UNICEF stack the deck against the use of formula in such cases by putting more dire warnings on them while at the same time telling women to not breast feed "only when replacement feeding is acceptable, feasible, affordable, sustainable, and safe."

Why? Because many areas in the Third World lack clean water supplies, decent medical care and consumers that WHO and the advocates consider informed enough to make distinctions related to infant health.

Dr. Scott Gottleib, formerly director of the Food and Drug Administration's Medical Policy Development, summed up the WHO's attitude to breast feeding and formula in a new White Paper for the Independent Women's Forum:

        "WHO understandably favors easily executed, and easily reproduced 
        public health strategies that allow an organization with lean resources 
        to have the widest impact. ... WHO does not seek to achieve a high standard 
        of medical care in the developing world, but a minimum standard necessary 
        to have the widest impact."

In other words, WHO's officials figure that in the balancing of lives, scaring women in developing countries from using formula might save more infants, even taking into account those who will become infected and die from HIV/AIDS transmission.

But this is a false division of the issue that WHO and breast advocates fail to recognize in their bipolar breast-or-formula world. As Gottleib notes in his paper, there are other alternatives to breast milk than infant formula -- and all of them are much more dangerous.

Infant formula from reputable companies must meet strict nutritional requirements mapped out by regulatory bodies such as the FDA. It can be delivered with information that informs women how to properly use it. It can be distributed by appropriate health agencies for free to those who need it most.

The kind of formula from the kitchens of Chinese formula pirates, though, can be delivered to the steps of mothers with no nutritional content and no warnings about its dangers. Women who can't breast feed or fear doing so may also make up their own home formulas if they think legitimate infant formula isn't safe, using the same contaminated water that WHO fears would make formula unsafe. And even if the water wasn't contaminated, the homemade formulas would fall short.

As the FDA notes: "The potential problems associated with errors in selecting and combining the ingredients for the formula are very serious and range from severe nutritional imbalances to unsafe products that can harm infants. Because of these potentially very serious health concerns, FDA does not recommend that consumers make infant formulas at home."

And you can't put a warning label on them.

What WHO and health officials can do is inform women about their options -- give them real choices not scary labels. And they can also work harder to bring clean water -- or information about how to clean water -- to the places that need it.

According to United Nations' estimates, a commitment of $20 a year per capita would solve all the world's water problems in 10 years. And just three weeks ago, at an international forum on access to clean water, a WHO official succinctly made the case for doing that. Kerstin Leitner, WHO's assistant director general, noted: "The return on such investment ... could be as high as 200 percent."

The gains would come not only for mixing formula for HIV-positive mothers, but from the hundreds of thousands of annual deaths from dysentery, cholera and other water-borne diseases. Yet, she said, WHO's best estimate for meeting water sanitation goals and targets for full global coverage was not 2015 but 2025 at the earliest.

Warning labels for formula only paper over the real problems people in the Third World face -- dirty water and ignorance about their options. It's time for WHO to solve them, not waste its scarce resources giving bad advice.

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