I believe I already posted the AAP Board response to Dr. Gartner. Here is
his 2nd letter in response to the AAP Board letter and his phone
conversation, with permission:
September 26, 2002
Dr. Joe Sanders, Executive Director
American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Dear Joe,
I am glad we had a chance to talk today about the issues pertaining to
the New Mother's Guide to Breastfeeding and Ross Pediatrics, as well as other
related matters. As you know these issues are of great concern to the
Section on Breastfeeding and to many other members of the Academy. I thought
it would be useful to summarize the major points that we discussed.
I appreciate knowing that you prepared your response to me yourself, unlike
many of the other responses that were mailed out. I did not realize until
our conversation that your letter reflected the position of the Executive
Committee of the AAP ( Drs. Lou Cooper, Steve Berman and Carden Johnson).
You also indicated that the letter was endorsed by the AAP Board of Directors
at their meeting this past Friday.
I understand the need for the AAP to meet its budget needs in order to
maintain its current levels of activity. I appreciate the strong commitment
that the AAP and you yourself have to breastfeeding. I remain concerned,
however, regarding the balance between the need to meet budget and the need
to meet the primary goal of the Academy: assuring the very best of health for
all children. Funds from Ross may help meet the financial needs of the AAP,
but infant formula manufacturers achieve financial benefit from their
marketing only if they achieve sales through results directly contrary to the
AAP's own published policy "that breastfeeding continue for at least 12
months and thereafter for as long as mutually desired" by mother and child.
AAP policy further recommends that only "infants weaned before 12 months of
age…should receive…infant formula." Only an increase in premature weaning
(before 12 months) provides potential for growth in infant formula sales to
breastfeeding mothers. The AAP needs to consider that contradiction when
helping a formula manufacturer market its product. I have heard for more
than 30 years now from formula manufacturers that breastfeeding increases
infant formula sales because mothers who breastfeed are more likely to
purchase infant formula for a longer period of time than those who begin on
infant formula initially. It that something we want to promote?
We are both in agreement that we want the book to have the largest
distribution possible and that the opportunity of having 300,000 to one
million copies distributed to mothers and future mothers is very attractive.
Making the book a best seller increases its shelf space in the major
bookstores, as well, further enhancing its sales. There was certainly no
objection to the sale of the book to Ross. The concern was with the nature
of the imprint and the proposed method of distribution. I did not realize
until this phone conversation that Ross had originally asked that the imprint
state "A gift from the Makers of Similac Infant Formula." Quite
appropriately AAP marketing rejected that designation. Ross then suggested
the use of just their company name and their teddy bear logo. While this
eliminated the obvious marketing of infant formula, it allowed the reader or
potential reader to come away with the impression that Ross was somehow
involved in the writing, production or sponsorship of the book. As I
suggested in my first letter, a compromise between these two options would
have been better: "A Gift from Ross Pediatrics." I am relieved to know that
the board has confirmed that any future sales of the book to Ross will have
such an overprint instead of the one that is on the first batch of books. At
the same time I am disappointed to learn from you that Ross will not be
placing a cover label with the new designation on the 330,000 copies that it
has in its warehouse, despite what Ms. Becky Johnson from Ross had not told
me.
I am pleased to hear that Ross is not placing the book in the discharge gift
packs, but will distribute the book only through physicians and other health
care professionals.
Our conversation gave me some assurance that in future situations regarding
marketing of products developed by our Section (and other Sections) the
authors/editors will be consulted as to what is being considered. I also
understand that you believe that it remains in the hands of the Executive
Committee and the Board to make decisions on what and how marketing will be
undertaken. I hope that the Executive Committee and the Board will take the
views of the authors, editors and section leadership into consideration when
making those decisions. In this recent situation, I believe that prior
consultation would have avoided what has become a very uncomfortable
situation for the Academy and for all of us regardless of what final decision
was made. I strongly believe that one can never go wrong in seeking advice
and having open discussion of all matters. Authors and editors of future
publications may be reluctant to contribute their services to the Academy if
they are uncertain about the manner in which their intellectual contributions
will be handled. We have two new items in the pipeline at this time and
these concerns have already been voiced.
Our final discussion focused on the issue that I raised about the need for
the AAP to develop a formal set of principles and practices concerning its
relationship to commercial organizations. Until our conversation today I did
not realize that the AAP had never developed such a formal document or
strategy and that it relied on various recommendations from other medical and
marketing organizations. I strongly believe that the Board should empower a
group of AAP members to undertake a careful review of this relationship and
develop a document which would, with Board approval, become the basis for all
commercial relations, whether marketing, exhibits, gifts or grants. A
transparent policy would avoid the charges of secrecy and ad hoc
decision-making. Many other organizations have developed such principles of
operation. It is time for the AAP to do so, as well. We may learn a great
deal about how other organizations have operated by going through a review of
their documents. We have a number of eminent ethicists within the AAP family
who can certainly help develop this set of principles, along with other
members. I believe you agreed that this was a process that should be
considered by the board.
As we both recognize, this issue is going to be a topic of continuing
discussion and concern at the meeting in Boston in October. Your suggestion
that one or more members of the Board of Directors meet with the Executive
Committee of the Section on Breastfeeding is a good one and we will be making
efforts to arrange a mutually agreeable time for that to occur. We also
extend an invitation to you and to Dr. Cooper to meet with the Executive
Committee, although you felt that someone other than yourself would be more
suitable.
I have offered my services and that of the other members of the leadership
team of the Section on Breastfeeding in helping move these issues into a
productive process that will assure our focus on optimal health and
development for children. I am, as always, willing to serve the needs of the
American Academy of Pediatrics.
I will see you in Boston. Safe travels.
Yours,
Lawrence M. Gartner, M.D.
Professor Emeritus
Departments of Pediatrics and Obstetrics/Gynecology
The University of Chicago
Chair, Executive Committee, Section on Breastfeeding
American Academy of Pediatrics
Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA
Office: 858-541-4180
Fax: 858-541-4135
Pager: 858-493-0198
Email: [log in to unmask]
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