The American Academy of Pediatrics (AAP) is the yardstick that a lot of American pediatricians and mothers measure by.
They’re often quoted: “Breastfeed until at least 1″ and “Rear-face until at least 2″. There’s also the “Pacifiers don’t cause nipple confusion” and “Co-sleeping is dangerous” comments.
When one actually starts to look into the AAP’s policies and hypocrisy, it doesn’t take a genius, or even a conspiracy theorist, to realize one thing:
They really don’t promote breastfeeding like they claim they do and it’s because their real goal is to benefit their sponsors.
Oh yeah, I went there.
First, let’s look at a couple things they’ve said in 2005 in a position paper:
“Commercial promotion of infant formula through distribution of hospital discharge packs, coupons for free or discounted formula, and some television and general magazine advertising” are obstacles to breastfeeding.
They also go on to call for the elimination of “promotion of infant formula in hospitals including infant formula discharge packs and formula discount coupons.”
So, we all agree there, right? I know I do.
There are two specific movements out in regards to these issues. First, the Ban the Bags movement which has been adopted by the World Health Organization (in the form of a necessity to qualify as a “Baby Friendly” hospital) and Kaiser Permenente’ hospitals, who have seen a fantastic increase in initial breastfeeding rates AND success merely by eliminating formula and pacifiers from hospitals, and not giving any formula or paraphernalia (even coupons) to new moms.
The other movement is huge, and that is the WHO/UNICEF’s International Code of Marketing of Breast-Milk Substitutes. The Code is explicit that: “There should be no advertising or other form of promotion to the general public.” This code has been adopted in multiple countries to great success, and pinpoints everything the AAP claims to stand for.
So, if the AAP believes what they said in their paper, adopting the policies that have helped in other countries and even in hospitals in this country would seem to be a natural progression, right? An easy movement, piggy-backing off someone elses’ effort to attain the goals they set forth.
And yet, the AAP ignores the fact that the WHO, CDC and the last Surgeon General all state that TWO years should be the bare minimum for breastfeeding, and they allow advertising of formula absolutely everywhere… even in their OWN “Pediatrics in Review”, a page for the ongoing education of physicians and their NeoReviews.org webpage as well. Abbot (makers of Similac) support these pages and have their ads plastered everywhere. Talk about a conflict of interest.
But hang on, let me point out their sponsors that I’m aware of:
- Nestle, maker of Good Start formula, Nuk pacifiers and bottles, and now sadly, all Gerber products (bottles, pacifiers, baby food, and now, formula). Nestle gives AT LEAST one million dollars annually to the AAP.
- Enfamil, maker of formula.
- And though I need to check to make sure, I’m pretty sure the JMPA (makers of cribs) are donors as well.
- Abbot, makers of Similac.
So… formula, formula, bottles, pacifiers, cribs, formula, baby food, infant cereal, toddler formulas…
So when the AAP says, “Yeah, we should TOTALLY stop formula advertisements” but plasters their OWN webpages in formula advertisements and refuses to take steps to ban advertisements elsewhere, what do we see? A bunch of dang hypocrites who care more about their sponsor’s money that the actual health of the babies they’re supposed to be the champions for.
What other places do we see the influence of their sponsors?
Pacifiers
The AAP claims that “babies are smart enough” to know the difference between pacifiers and bottles, and that only bottles cause nipple confusion… despite the fact that no other entity actually supports this, and the LLL still maintains that these can cause nipple confusion, and moreso, can even interfere with the mother’s supply as even comfort-nursing (where the baby isn’t eating) is important to the mother’s milk supply, and to other things, as Melanie points out in her post about the chemical “CCK” and the breastfeeding baby.
So, even though there’s multiple studies and experience that shows pacifiers can cause problems, the AAP suddenly says after one fishy study that they’re fine? I wonder which manufacturer of pacifiers paid for that policy change that came about suspiciously quick.
They also stated that pacifier use can prevent SIDS… but yet again, they’re actually replacing breastfeeding and co-sleeping with cribs and pacifiers… but they won’t tell you that.
Co-sleeping
The JPMA absolutely refuses to look at co-sleepers and deem them as safe or unsafe. Why? Because deeming them safe would undermine their own crib sales. The AAP adamantly refuses to even acknowledge potential benefits of co-sleeping, and maintains that it’s just unsafe and shouldn’t be practiced, but says babies need to be in cribs, period. Let’s ignore the fact that EITHER can be safe or unsafe depending on how they’re practiced, and co-sleeping or at least room-sharing is actually shown to be beneficial to infant survival and almost a necessity for exclusively breastfeeding success, the AAP won’t even entertain the idea that co-sleeping might actually be a good idea, even in co-sleepers. They certainly won’t tell you how to safely co-sleep or how to buy a safe co-sleeper. After all, what money is to be gained by women feeding their babies free breastmilk in their bed they already owned? Chalk one up to crib AND formula manufacturers here.
Breastfeeding
As I already mentioned, the AAP maintains that you should exclusively breastfeed for the first six months and then until at least one… despite the fact that they are the only medical group who claims one as a bare minimum instead of two. Let’s look at the fact that there are toddler formulas and Pediasure. So their sponsors show a product that suggests that children need extra nutrition until two or three years old, and yet the AAP only recommends breastfeeding until one? Hmm. Whose wallet benefits from people stopping at one? Especially considering people often will fall short of the “minimum”, and when it’s one year old instead of two, that means they’ll turn to formula for the remainder of that first year. Yay formula company wallets, again.
The absolutely amazing editorial article Sleeping with the Enemy: “More Doctors SmokeCamels” Revisited points out something else disturbing when they read a Babys R Us catalog entitled “Becoming Us: A Comprehensive Resource Guide for Getting Ready for Baby“:
When we perused this resource guide online in late May 2010, we found pictures of Similac, Enfamil, Good Start, & Earth’s Best infant formulas (each hyperlinked to more extensive advertisement) as well as what looks to be a candy for toddlers (Plum Organics Fiddlesticks).
On page 3 of the Babys “R” Us guide we read: The editorial content of this resource guide has been reviewed for consistency with the health & safety recommendations of the American Academy of Pediatrics. Special thanks for reviewing the guide go to: Laura A. Jana, MD, FAAP & Jennifer Shu, MD, FAAP, authors of Heading Home with Your Newborn: From Birth to Reality. Copies of this award-winning AAP parenting book are available for purchase at select Babys “R” Us stores, bookstores nationwide and at HealthyChildren.org, the new AAP Website for parents.
It is troublesome that the Academy puts its endorsement on what is essentially an infomercial for the baby products industry. It is concerning that the “comprehensive resource guide” is all about buying products, presenting this as the essence of preparing for a new baby. But the Academy’s endorsement of advertising materials which include breast-milk substitutes seems to violate the essence of their position paper as well as what we know to be best for mothers and children.
So, despite all the AAP’s talk about being supportive of breastfeeding as the perfect food for infants, and their agreement that advertisements, endorsements and freebies interfere, it’s clear by their actions that they don’t walk the walk. Their bottom line is not the well-being of infants — it’s the well-being of their sponsors’ wallets, and their own.
Shame on you, AAP. The abysmal breastfeeding rates, and as a result, SIDS rates in this country could be directly affected by your influence, if you’d actually choose to put the babies your organization is supposed to stand for ahead of the sponsors who benefit directly from failure of breastfeeding, and as a result, infant death. The blood is on your hands from your dirty money.
Image via erintongay/Flickr
Tags: aap, american academy of pediatrics, breastfeeding, formula, formula feeding, lies, money, parenting choices, research, sponsors
Amazing article.
But, on an editorial note, you didn’t put the close quotes at the end. I think I can tell where your opinion picks back up, though. 
Twitter: RanaAurora
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Thanks for pointing out that I couldn’t figure that out, Mother, LOL!
Well said Christie. The historical link between the medical profession and the formula companies is still alive and well and I can hear nails being hit on the head all over the place here! Whether it’s by insinuation, implication or omissison, the medical profession need to clean up their act, and although the situation in America is undoubtedly worst, the same problem does still exist elsewhere. The AAP need to implement the WHO Code NOW – you are quite right to expose their hypocracy. TWO YEARS AND BEYOND, No formula or propaganda in hospitals and no vested interests. Well said.
Great post! It’s ridiculous that an organization that is supposed to be educating parents about what is in baby’s best interest is really looking out for their sponsors. Yuk. The actual pediatricians are just as bad. I took my son to the supposedly “breastfeeding friendly” doctors’ office and you know what was sitting on the counter? An empty formula can being used as a pen holder.
Subtle messages like that add up and undermine breastfeeding.
This is a really great post that lays out the conflicts of interest so well. I’d always wondered about the 1-year recommendation. I had no idea that the AAP has so many corporate sponsors though. Don’t they go over this kind of thing in medical ethics classes? Why doesn’t anyone speak up?
Will definitely be sharing this on my blog’s facebook feed.
Add infant circumcision to the list of hypocritical money makers for the AAP. If you read the policy statement they state that the risk of complications are “unknown” (why is this unknown? does no one bother to record this data?) but then guess that they are somewhere less than one half of one percent… they then go one to name various complications (about twenty) and ONE of those is “meatal stenosis” if you look up that condition, you will learn that meatal stenosis happens to about 9% of circumcised males and is caused by the fact that they are circumcised… so how can they fit 9% into one half of one percent? I’ve been trying to figure out that inconsistency since that statement was published in 1998.
Why would the AAP purposely try to conceal the known damage of circumcision? More boys who are circumcised need to be circumcised a second time than intact boys ever need to be circumcised a first time!
I’m not sure I agree. As a father of 6, I know that breastfeeding through age two is the OPTIMUM situation, but there are circumstances which prevent this. (One of these being just the choice NOT to.) To those parents, the take home packs and coupons can be a life-saver. I know that when my 5th child was born, I was a single parent, struggling just to keep a roof over our heads. Luckily, I knew a Similac rep who provided me with enough formula to get me through about 4 months! (And coupons for after that.) It was truly a blessing to us.
My eldest daughter, mother of 4, was unable to breastfeed her last two. (The first being a preemie.) She tried EVERYTHING to “do it right”. She just could not produce enough milk! She was in tears because of all the pressure now put upon new mothers that says unless you breastfeed, you don’t care about your child/ you are a failure. Nonsense!
So while you may want the best for everyone, remember those that don’t have that option. Instead of making them feel like failures for NOT breastfeeding for the first two years, why not work on a balance that serves everyone where they are at?
Dave, did you even read the original post? It looks to me like you just walked in and jumped on the opportunity to bash breastfeeders. (You heard me.). Nobody in this thread has criticized any parent for feeding their kids formula. In fact, I’ve read a number of threads recently which WERE about the pros and cons of breastfeeding. I haven’t yet seen any breastfeeding advocates judging other parents for choosing to formula feed. I HAVE seen a lot of formula advocates like yourself crying wolf about it.
Your post was totally off topic. This thread is not the place for you to argue that the World Health Organization is out to make you “feel bad” by advocating breastfeeding. Why don’t you try addressing this clear conflict of interest when it comes to American doctors and organizations thereof taking kickbacks from formula companies (and pharmaceutical companies while we’re at it)? Do you REALLY think what doctors recommend should be based on how full it makes their pockets?
P.S.: Mothers who CAN’T produce milk can make use of milk banks or wet nurses in many places. These are preferable alternatives to formula feeding. Would you rather buy your baby’s food from a faceless and uncaring multinational, or support local women who donate their milk (usually for free)?
Actually, I did read the post. I thought it was well thought out and intelligent. (A nice change of pace from some others I have read elsewhere.) I apologize if I came across in any way suggesting that you were “bash(ing) breastfeeders” here. Not my intent.
I was trying to imply that removing formula from hospitals may not be the best move. Forcing others to “do what is right” rarely works. Education does. And I have seen great strides in that area over the last twenty years when it comes to the benefits of breastfeeding. Many more mothers are choosing to breastfeed now, and that is a GOOD thing.
What I was trying to get across was that the gift packs and coupons and such can be a godsend to many young, struggling couples. Especially in today’s economy.
I agree that many times there are medical staff that make it a bit more difficult to breastfeed wither through lack of care, or active actions, but that is something that new parents have to taught to be on the look out for. (If someone fed my kid formula when my wife was going to breastfeed, I would have raised cane. I did once, in fact.) And they should be taught what to do if breastfeeding fails.
As in which formula is best for what conditions. things they can do to mitigate the loss of bonding. Things like that. (Unfortunately, ‘milk banks’ and such don’t exist where I am. I assume those are found in major urban areas with lots of people. Not many people where I live.)
Do I agree that the med profession is rife with kick-backs and unstated allegiances? Yes. And, as Christie said, that should be stopped. But I believe the REAL changes will be made with education of those having children.
I just want the education to include those that are unable to breastfeed, not put them on the “outside”. Not make them feel poorly because they may have to choose otherwise. Instead I would wish that we would all be a bit more accepting of everyone’s choices.
Twitter: RanaAurora
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Dave, there can easily be a balance. For people who NEED formula, signing up for lists of your own free will (instead of having the hospital or your doctor do it without your knowledge in exchange for kick-backs) would be fine. We do NOT need to provide formula without reason, or formula ads or bad breastfeeding info… especially not from the AAP, who pediatricians often base their recommendations on.
This is not an anti-formula, pro-breastfeeding post.
This is about the organization that is supposed to be responsible for promoting the BEST care of our children not doing so because of monetary gain. You do not have to sacrifice correct recommendations to also support those who are unable to meet them. In fact, by providing correct information instead of formula-biased information, they’d help more women be able to successfully breastfeed, which in turn would take any guilt or shame out of those who really couldn’t.
Now I have to ask whether you read MY post. I asserted that YOU are bashing breastfeeders by putting forth these fallacious claims that breastfeeders guilt or pressure you about feeding your kids formula when they discuss disadvantages of formula and wrongdoing of the companies that produce it.
However, medical professionals SHOULD be openly criticized and guilted for choosing to educate parents based on their own financial interests. How can you in one breath claim that parental education is the solution and use that to excuse the inexcusable behaviour of those responsible for the education?
… How would you like it if your doctor chose which heart medication to prescribe you based on industry kickbacks? (Oh wait, that HAPPENS, doesn’t it?)
This is hard for me, Christie. I’m much closer to the researchers than you are, and the attitude that they’re being bought really, REALLY rankles me, because it is so far from the truth. The actual journals, not the newsmagazine, in which research is published have no affiliation with commercial interests. If research journals do, please tell me where the checks have been going, because we certainly haven’t been seeing them. If you understood how papers are peer-reviewed and published, you’d believe me there. You also should take a look at the process by which the AAP goes about making its recommendations. Understand how the committees work. It’s not all so simple. It’s not so fast. It’s a volunteer job that those people do on top of their full time jobs. Recognize, too, that there is a difference between the doctor in an office who gets visits from pharma reps and the academics—WHO DO NOT. Who’s getting all the money and what are they doing with it?
Correlation does not imply causation.
Now, you know I don’t like formula, and that we agree on many things, but the title of this entry turned my stomach.
Twitter: RanaAurora
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I’m sorry Erica, but I’m not discussing the researchers. I am discussing the public image the AAP puts out and the info they end up promoting with agendas that aren’t all they seem.
Considering now they have officially teamed up with “Nestle Nutritionals”, they’re not even pretending that they’re non-biased now. Doctors have posted from the AAP conferences saying they have Nestle representatives giving speeches on breastfeeding.
You cannot tell me you don’t see the problem with that.
But Christie, AAP policy IS put out by researchers. No, I don’t think that it is the best choice to have Nestle representatives giving speeches on breastfeeding. Perhaps some clinicians need to learn the difference between the different types of activities that go on at the AAP conferences, so they can discern between industry-sponsored events and others. I see looking at the conference catalog that the Section on Breastfeeding held events where IBCLCs and professors of pediatrics taught breastfeeding basics. Look into their credentials. I just have, and none of them work for Nestle. Oh, and the Nursing Mother’s Lounge at the AAP conference was sponsored by Medela. The AAP is a much more complex and multi-layered organization than you make it out to be.
I’ve thought about this a lot, Christie. The thing is, I’ve been forgetting that you’re blogging; you’re not a journalist. You’re job as a blogger is to display the world in black and white. You are allowed to form opinions based upon whatever information that you want to use, and your purpose in doing that isn’t to impart impartial information but sway the reader. I’m sorry for jumping on you!
I think you misunderstand the purpose of the AAP. (It’s ok, everyone does.) They are a trade organization for physicians. They also happen to make recommendations that they feel their members should follow. Just like I would expect the Baby Carrier Industry Alliance to recommend that all mothers use baby carriers and come up with studies why baby carriers are better for babies. Hospitals get paid by formula companies to hand out those “breastfeeding” bags (you know the ones full of formula). Hospitals that make money are hospitals that benefit pediatricians. Circumcision? Makes peds a lot of money, starting with the procedure, followed by selling the foreskin, ending up with “correcting” all those complications. See where I’m going with this? The real problem is that people assume the AAP isn’t a self-serving organization.
Twitter: RanaAurora
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Oh, I totally understand their goals and existence. Thanks for the input Cara! My issue is that regardless of them being intended as a private organization with standards for their Fellows, they’re held as much higher of an authority. Heck, WIC women often even try to follow the AAP’s recommendations, as do lots of pediatricians who aren’t AAP Fellows as well. Rather than being a private organization with recommendations for members only, they’ve become almost the figurehead and authority for infant health in the entire United States, and as such, I feel that they should choose a role — either more clearly define yourselves as NOT the overall authority, or act like the reputation you’ve earned and be more honest.
Regardless, it makes me less likely to trust a doctor who is an AAP Fellow, knowing the pay the AAP to tell them to recommend things that are told to them by formula and crib manufacturers.