166
preparation, and concern, panicking at the costs, and attacking the health-care providers. Cuts and rate restrictions are said to be, not measures of political sagacity, but the desperate gropings of politicians out of their depth. I feel that those who are elected or appointed to government are faced with very difficult questions of policy, and they should be treated with more respect than this. What can your correspondent offer constructively? We all badly need wise professional leadership. Simply blaming government for all our problems is popular but destructive. Surgical Service, Veterans Administration Hospital, Little Rock, Arkansas 72206, U.S.A., and University of Arkansas for Medical Science
RAYMOND C. READ
INFANT-FOOD INDUSTRY
SIR,-In response to your editorial I wish to draw your attention to hearings on the Marketing Practices of Infant Formula Companies before a U.S. Senate Subcommittee on Health, which took place on May 23, 1978. Witnesses before the subcommittee, chaired by Senator Edward Kennedy, included health workers with first-hand experience in developing countries, professional experts, as well as representatives of the industry. The hearings showed that advertising and marketing of infant formulae have penetrated the most remote regions of developing countries. One witness testified that formulae were sold in a tribal area of the Amazon region accessible only by
footpath or light plane. Many witnesses cited the detrimental
consequences of the dilution of infant formula: to make the formula last longer. Dr Jelliffe, another witness before the subcommittee, noted that tins of puppy formula now contain a warning absent on tins of human formula-namely, that the formula should not be given in the first days of life so that puppies obtain the antiinfective benefits of colostrum (first milk). Jelliffe wondered
whether babies
were not
being
treated
as
"second class pup-
pies". The preliminary results of the World Health Organisation collaborative study on breast-feeding were also reported to the Senate subcommittee. In some countries studied, commercial promotion of infant formula products was widespread. For example, in the Philippines, 41% of the rural poor who delivered babies in hospitals, were given free infant-formula samples. Senator Kennedy repeatedly asked industry witnesses whether their products could be safely used by illiterate parents under the poor sanitary conditions which previous witnesses described as being typical in developing countries. Even severly malnourished mothers can breast-feed for as long as 3-4 months. The solution is not to stop the mothers
breast-feeding but to improve the maternal nutrition especially in pregnancy and also during lactation. The medical profession should encourage the infant-formula industry to produce food for malnourished mothers so as not to deprive infants of colostrum and irreplacable species-specific breast milk. The industry’s code does not prevent misleading or inappropriate advertising, as was testified before the Senate Select Committee on Marketing Practices in the Third World. The lack of commitment of health professionals to breast milk as a preferred method of feeding allows the infant-formula industry to legitimise a code which is, in my opinion, detrimental to breast feeding. Formula by prescription or cheap unadvertised formulæ may be required-but not a weak voluntary code of ethics with no enforcement clauses. The nation must be weighed against the profits of a few.
costs to a
NAOMI BAUMSLAG 5821 Lenox
Road,
Bethesda, Maryland, U.S.A. 1.
Lancet, 1978, i, 1240.
Nutrition advisor, Office of International Health
Commentary From
our
from Westminster
Parliamentary Correspondent
Homoeopathic Medicine A GOVERNMENT inquiry into the future of homœopathic medicine is called for by the Conservative Opposition in the latest move during a Parliamentary campaign now attracting widespread support. Its aim is, quite simply, to prevent homoeopathy from being squeezed out of the National Health Service by a combination of medical hostility and Government inactivity. Homoeopathic medicine in Britain is plainly at a crossroads: it must expand and flourish or wither and all but fade away. The resultsof the campaign could determine the road it takes. The chief target of the Parliamentary assault is the Government, which is being accused of paying lip-service to the continued existence of this form of treatment within the N.H.S. On the one hand, the campaigners say, homoeopathy is recognised by Act of Parliament; yet, on the other, the Government refuses to help doctors to train in this area of medicine by denying them grants for postgraduate tuition. It is this failure to provide financial support for general practitioners which is causing most anxiety. Section 63 of the Health Services and Public Health Act 1968 enables the Secretary of State for Social Services to reimburse G.p.s in the N.H.S. for expenses incurred in attending courses. The subjects for training courses which qualify for this financial help, however, are a matter for the postgraduate medical deans of universities, who have accepted the view of the Council for Postgraduate Medical Education that training in homoeopathy "is not of sufficient relevance to modern medical practice to warrant financial support for courses for G.P.s". Hitherto all the money for training doctors in homoeopathic treatment has come from the Homoeopathic Research and Educational Trust. It has financed the three courses held each year by the Faculty of Homoeopathy at a cost of £5000 a course. It can now no longer afford to meet the full cost, so it is having to restrict the number of doctors attending courses and, for the first time, it must charge a fee. Thus, at a time when more doctors and members of the public are showing an interest in homoeopathy, the Faculty is forced to turn people away. What the campaigners are asking for is either an annual grant of £15 000 from the Department of Health and Social Security to train doctors or recognition under Section 63. In theory it is still up to every individual postgraduate dean to decide what course to recognise for the purpose of section 63. In practice they take their cue from the Council for Postgraduate Medical Education-or at least most of them do. There have been two instances when homoeopathy has been recognised. One was a seminar at Birmingham and the other a one-day seminar last month at Manchester University Medical School. For the latter, the dean went ahead and gave his approval under section 63, despite word from the Council that this would cause much embarrassment to both the Council and the Royal Colleges. But it is not only section 63 which poses a threat to homoeopathy. The existence of three of the five N.H.S.
preparation, and concern, panicking at the costs, and attacking the health-care providers. Cuts and rate restrictions are said to be, not measures of political sagacity, but the desperate gropings of politicians out of their depth. I feel that those who are elected or appointed to government are faced with very difficult questions of policy, and they should be treated with more respect than this. What can your correspondent offer constructively? We all badly need wise professional leadership. Simply blaming government for all our problems is popular but destructive. Surgical Service, Veterans Administration Hospital, Little Rock, Arkansas 72206, U.S.A., and University of Arkansas for Medical Science
RAYMOND C. READ
INFANT-FOOD INDUSTRY
SIR,-In response to your editorial I wish to draw your attention to hearings on the Marketing Practices of Infant Formula Companies before a U.S. Senate Subcommittee on Health, which took place on May 23, 1978. Witnesses before the subcommittee, chaired by Senator Edward Kennedy, included health workers with first-hand experience in developing countries, professional experts, as well as representatives of the industry. The hearings showed that advertising and marketing of infant formulae have penetrated the most remote regions of developing countries. One witness testified that formulae were sold in a tribal area of the Amazon region accessible only by
footpath or light plane. Many witnesses cited the detrimental
consequences of the dilution of infant formula: to make the formula last longer. Dr Jelliffe, another witness before the subcommittee, noted that tins of puppy formula now contain a warning absent on tins of human formula-namely, that the formula should not be given in the first days of life so that puppies obtain the antiinfective benefits of colostrum (first milk). Jelliffe wondered
whether babies
were not
being
treated
as
"second class pup-
pies". The preliminary results of the World Health Organisation collaborative study on breast-feeding were also reported to the Senate subcommittee. In some countries studied, commercial promotion of infant formula products was widespread. For example, in the Philippines, 41% of the rural poor who delivered babies in hospitals, were given free infant-formula samples. Senator Kennedy repeatedly asked industry witnesses whether their products could be safely used by illiterate parents under the poor sanitary conditions which previous witnesses described as being typical in developing countries. Even severly malnourished mothers can breast-feed for as long as 3-4 months. The solution is not to stop the mothers
breast-feeding but to improve the maternal nutrition especially in pregnancy and also during lactation. The medical profession should encourage the infant-formula industry to produce food for malnourished mothers so as not to deprive infants of colostrum and irreplacable species-specific breast milk. The industry’s code does not prevent misleading or inappropriate advertising, as was testified before the Senate Select Committee on Marketing Practices in the Third World. The lack of commitment of health professionals to breast milk as a preferred method of feeding allows the infant-formula industry to legitimise a code which is, in my opinion, detrimental to breast feeding. Formula by prescription or cheap unadvertised formulæ may be required-but not a weak voluntary code of ethics with no enforcement clauses. The nation must be weighed against the profits of a few.
costs to a
NAOMI BAUMSLAG 5821 Lenox
Road,
Bethesda, Maryland, U.S.A. 1.
Lancet, 1978, i, 1240.
Nutrition advisor, Office of International Health
Commentary From
our
from Westminster
Parliamentary Correspondent
Homoeopathic Medicine A GOVERNMENT inquiry into the future of homœopathic medicine is called for by the Conservative Opposition in the latest move during a Parliamentary campaign now attracting widespread support. Its aim is, quite simply, to prevent homoeopathy from being squeezed out of the National Health Service by a combination of medical hostility and Government inactivity. Homoeopathic medicine in Britain is plainly at a crossroads: it must expand and flourish or wither and all but fade away. The resultsof the campaign could determine the road it takes. The chief target of the Parliamentary assault is the Government, which is being accused of paying lip-service to the continued existence of this form of treatment within the N.H.S. On the one hand, the campaigners say, homoeopathy is recognised by Act of Parliament; yet, on the other, the Government refuses to help doctors to train in this area of medicine by denying them grants for postgraduate tuition. It is this failure to provide financial support for general practitioners which is causing most anxiety. Section 63 of the Health Services and Public Health Act 1968 enables the Secretary of State for Social Services to reimburse G.p.s in the N.H.S. for expenses incurred in attending courses. The subjects for training courses which qualify for this financial help, however, are a matter for the postgraduate medical deans of universities, who have accepted the view of the Council for Postgraduate Medical Education that training in homoeopathy "is not of sufficient relevance to modern medical practice to warrant financial support for courses for G.P.s". Hitherto all the money for training doctors in homoeopathic treatment has come from the Homoeopathic Research and Educational Trust. It has financed the three courses held each year by the Faculty of Homoeopathy at a cost of £5000 a course. It can now no longer afford to meet the full cost, so it is having to restrict the number of doctors attending courses and, for the first time, it must charge a fee. Thus, at a time when more doctors and members of the public are showing an interest in homoeopathy, the Faculty is forced to turn people away. What the campaigners are asking for is either an annual grant of £15 000 from the Department of Health and Social Security to train doctors or recognition under Section 63. In theory it is still up to every individual postgraduate dean to decide what course to recognise for the purpose of section 63. In practice they take their cue from the Council for Postgraduate Medical Education-or at least most of them do. There have been two instances when homoeopathy has been recognised. One was a seminar at Birmingham and the other a one-day seminar last month at Manchester University Medical School. For the latter, the dean went ahead and gave his approval under section 63, despite word from the Council that this would cause much embarrassment to both the Council and the Royal Colleges. But it is not only section 63 which poses a threat to homoeopathy. The existence of three of the five N.H.S.
