Tony Waterston: Infant formula once again at the RCPCH

tony_waterston_cutThere was nervous expectancy in the huge hall at the Liverpool arena as the gathered paediatricians awaited the count on the motion to ban infant formula funding from the Royal College of Paediatrics and Child Health (RCPCH). The president and council had expressed their opposition to the motion, and wrote a piece that was circulated to members along with the briefing paper from those who proposed the motion; members had given their views for and against; and a paper vote was taken.

The motion was over a year in gestation. At the 2015 annual meeting, the film Tigers was shown to quite a small audience—this film dramatically exposes the story of a salesman in Pakistan working for a large multinational who turns whistleblower when he finds out that aggressive selling of infant formula milk has risked the health of many infants. However, the film showing and subsequent debate did not convince the RCPCH’s governing body to alter its new sponsorship framework—ratified by the council in April 2015—which had removed the previous restriction preventing infant formula donations from funding core college work and research.

A similar debate was held at the RCPCH (then the British Paediatric Association) after it emerged in 1994 that Nestle had made a donation, which had been accepted without being discussed and agreed in any BPA council meeting. That vote was lost, but it influenced the later decision to accept no core funding from infant formula manufacturers—although exhibition stands continued to appear every year at the annual conference, to the disquiet of a number of members.

This time the motion was well prepared and featured in The BMJ, and the request was straightforward: to “decline any commercial transactions or any other kind of funding or support from all companies that market products within the scope of the World Health Organization (WHO) code on the marketing of breast milk substitutes.”

The arguments for the motion rest on the view that such funding causes a conflict of interest and interferes with the RCPCH’s reputation as an independent adviser on breastfeeding. It also sets a bad example globally, since the role of the baby food industry in promoting formula feeding in poor countries is well known.

The case against the motion relies on the view that infant formula is necessary for some babies, that paediatricians and the RCPCH need to work collaboratively with companies selling infant formula, and that specialist formulas are essential for babies with certain conditions. Furthermore, the college asserts that its process of “due diligence” will ensure that company practice is scrutinised and that donations will be published in a way that is transparent.

The debate was proposed by Professor Charlotte Wright from Glasgow and opposed by Professor Russell Viner from London and there were many contributions from the audience. One of the most moving was from a junior doctor, who expressed his shock at finding an exhibition stand run by Nestle at the conference.

WHO and UNICEF’s public opposition to company sponsorship was strongly reported in the debate and the words of Dr Liz Mason, recently retired from the WHO as director of maternal, adolescent, child, and newborn health, were quoted: “The real or perceived conflict of interest in receiving funds from infant formula companies compromises the perception of the college as independent of influence. The college needs to be free of this influence to adhere to the code, and subsequent WHO resolutions.”

The vote result was close but convincing: 66 in favour and 53 against. This result is good for breast feeding, but will require a change of culture in the RCPCH and, especially, in the exhibition halls at the annual meeting. The decision will need to be considered at the next council meeting before final policies are developed but this will have a major effect on how the RCPCH manages its donations.

Note: When first published, this blog incorrectly noted that the paper vote taken on infant formula funding at the RCPCH’s 2016 annual meeting was the first time a vote was done by paper and not just a show of hands. This was corrected on 10 May 2016.

Tony Waterston is a retired paediatrician in Newcastle upon Tyne, working mainly in the community with long term conditions, disability, child abuse, and social and mental health concerns. His interests are in child public health, children’s rights, and global child health, and he leads the RCPCH teaching programme in the occupied Palestinian territories.

Competing interests: I am an adviser to the campaigning group Baby Milk Action.