The Front

Milking Profits in Pakistan

Islamabad - There is a deep crease in the brow of two-day old Mariam's mother. She fears that she is starving her daughter because she doesn't seem to have enough breast milk to satisfy her baby's hunger.

She has been waiting with her husband more than an hour to see the doctor. When it is finally their turn, she tells the doctor her concern. The doctor nods and scratches out a prescription for infant formula without inquiring further.

Mariam's mother had wanted to breastfeed, but she is relieved that her daughter will no longer be hungry. The formulas are expensive, but she and her husband are prepared to do whatever is necessary for their daughter. As first-time parents, they trust the opinion of the more knowledgeable doctor.

What they don't know is that their doctor recently attended a medical conference sponsored by the same company that manufactures the formula he just prescribed.

Unfortunately, their experience is not unique. It is part of a decades-old problem that has reached epic proportions in Pakistan - the unregulated marketing of infant formulas, cereals and feeding bottles.

A report published earlier this year by The Network, an Islamabad-based health advocacy group, has directed national and international attention back towards the infant feeding issue. "Milking Profits: How Nestlé puts sales ahead of infant health" reveals how Nestlé has institutionalized promotional practices that violate a 1981 World Health Organization international marketing code for baby formulas, cereals and feeding bottles.

"We have original documents providing compelling and irrefutable evidence of this company's irresponsible behavior," says Tracey Wagner of The Network, who authored the report. "The company claims to abide by the Code, but that is clearly untrue."

UNICEF and WHO, as well as other infant feeding experts, recommend exclusive breastfeeding (giving no other food or drink) for the first six months. From about six months up to about two years of age, babies should be given other foods along with continued breastfeeding. Studies have shown that there are no nutritional advantages from earlier introduction of other foods.

"Babies receive complete, balanced nutrition and are protected against illness by mother's milk," says Dr. Sohail, who runs a local clinic. "Mothers who breastfeed delay their next pregnancy and reduce the risk of breast and ovarian cancers. Breastfeeding is also more economical, convenient and environmentally friendly than replacements."

Yet, even with all these benefits, Pakistan's breastfeeding culture is under threat. While 95 percent of mothers initiate breastfeeding, only 16 percent exclusively breastfeed between 0-3 months. Only 56 percent of mothers are still breastfeeding their babies at all at 20-23 months.

But this is nothing new. Heavy marketing by the baby food industry, among other factors, has contributed to falling breastfeeding rates the world over. Only now, as awareness of the industry's tactics has spread, is breastfeeding making a comeback in some parts of the world.

In Pakistan, women know breastfeeding is best, but with a literacy rate of less than 30 percent, they are extremely vulnerable to promotional influence. And doctors, with few exceptions, are doing little to help. Instead, they are becoming the baby food industry's accomplices in return for financial and material kickbacks. With more than 5.5 million babies born in Pakistan each year, it is much more efficient for companies to win the loyalty of doctors, who influence the infant feeding decisions of thousands of women.

Perhaps the most vivid of the internal company documents reproduced in "Milking Profits" is a note in which Nestlé employee Syed Aamar Raza informs his supervisor that he had been requested by a doctor to provide him with an air conditioner. Raza's supervisor wrote to his higher-up, saying the doctor held an influential position and he "strongly recommended" that they pay half the price of an air conditioner - the other half could be paid by a pharmaceutical company.

The higher-up wrote back, "OK. But Nan and al-110 sales should go up." Nan and al-110 are two of Nestlé's infant formulas.

In another case, a doctor at a military hospital in Pakistan wrote a very elaborate letter to Nestlé's Group Brand Manager, requesting two air conditioners and providing their specifications. Some time later the same doctor issued a department circular that only Nestlé products were to be used in the children's ward, nursery, gynecology ward and officer's family ward. Completing the story is a copy of the check issued to pay for the air conditioners.

Other documents include monthly sales target sheets, salary slips showing bonuses and incentives, photographs of staff having direct contact with mothers and a special form for requesting free or low-cost supplies, all practices forbidden by the International Code.

Nestlé is in a furor over the report. Confronted with its own documents, the company has resorted to discrediting the source of the information, former employee Raza, accusing him of blackmail and obtaining his job with the company with fake education documents. Raza claims Nestlé offered him money to keep quiet and threatened him and his family.

"By bad-mouthing Aamar, Nestlé is just trying to distract from the real issue: they violate the International Code and use unethical marketing techniques to promote their baby milks and cereals, increasing their profits at the expense of infant health," says Tracey Wagner of The Network.

The report has received considerable media coverage both within Pakistan and internationally.

As a result, the Secretariat of Pakistan's military ruler General Pervez Musharraf directed the country's health authorities to take appropriate action; the National Accountability Bureau, an official arm which checks widespread corruption in Pakistan, asked the Ministry of Health to investigate the allegations; and the Federal Ombudsman took notice of the reports and called upon the health ministry, Nestlé and The Network to explain the situation. In an endeavor to save face, the multinational food giant commissioned an audit of its marketing practices in Pakistan. The report uncovered a few "minor technical violations," but largely exonerated the company.

Critics call the audit biased since Nestlé paid the auditors and supplied a list of doctors for interviews. The auditors also interviewed Nestlé employees eager to portray their employer in a good light, and admit to having no previous experience with the issue.

"Clearly, anyone conducting an audit of a company's compliance with the International Code should have a thorough understanding of the Code and subsequent World Health Assembly resolutions, as well as the tricks used by the industry to skirt them," says Wagner.

One bone of contention is cereals: Nestlé believes these fall outside the scope of the Code; its critics say cereals are covered by the Code when marketed for use before six months of age, as most of Nestlé's cereal products are, because they replace breastmilk.

The Network published an earlier report entitled "Feeding Fiasco: Pushing commercial infant foods in Pakistan" after conducting a nationwide survey to monitor industry compliance with the International Code.

"ŒFeeding Fiasco' established the urgent need for legislation to regulate the marketing of baby foods and feeding products," says Wagner. "Not a single company was abiding by the International Code. Unfortunately, we still have no legal recourse against violators."

The government of Pakistan is in the process of preparing legislation that would regulate marketing by the baby food industry. A first draft was prepared in 1992. The draft was put forward for cabinet approval last year before the military took over in October. The military government has reviewed the law and circulated it among provincial and federal ministers for comments.

"We have always supported government efforts to enact legislation but are concerned by the delays. Delays allow companies not only to continue having a negative impact on infant health, but also to influence what used to be a very strong draft," says Wagner.

Nestlé, which controls about 40 percent of the world baby food market and sets the marketing trend followed by other companies, continues to be the target of an international boycott in 19 countries. Activists vow to continue the boycott until Nestlé abides by the International Code of Marketing of Breastmilk Substitutes in all countries.

- Muddassir Rizvi

Muddassir Rizvi is a correspondent in Pakistan for InterPress Service.

The "Lawsuit Abuse" Scam

So-called "lawsuit abuse" groups throughout the United States are part of a national, corporate-backed network of front groups that receive substantial financial and strategic assistance from the tobacco industry and some of the largest U.S. corporations, according to an August report issued by the New York City-based Center for Justice & Democracy and the Washington, D.C.-based Public Citizen.

Typically called Citizens Against Lawsuit Abuse (CALA), Lawsuit Abuse Watch or Stop Lawsuit Abuse (collectively referred to as CALAs), these organizations portray themselves as "grassroots" groups manifesting citizen anger against "lawsuit abuse."

The report, "The CALA Files: The Secret Campaign by Big Tobacco and Other Major Industries to Take Away Your Rights," shows that the purportedly grassroots CALA groups are largely the creation of the American Tort Reform Association (ATRA), a Washington D.C.-based coalition of more than 300 major corporations and trade associations, and its "grassroots" lobbying firm, APCO and Associates.

Drawing on the cache of tobacco industry papers uncovered in connection with the U.S. state litigation against the tobacco industry and other materials, investigative journalist Carl Deal and Center for Justice & Democracy Executive Director Joanne Doroshow report that tobacco companies poured millions of dollars into state CALAs and other activities to weaken tort laws in many states. ATRA and APCO supply the CALA groups with strategic guidance, media training and pre-produced radio, television, print advertising and billboards designed for maximum media exposure and legislative impact.

The tobacco companies spent millions annually on ATRA, state CALAs and other elements of their "tort reform" crusade, according to the CALA files, spending as much as $15 million in one year. In 1995, the tobacco industry allocated $5.5 million for ATRA, more than half of its budget.

There are currently at least 27 active CALA groups operating in 18 states.

"This report shows how large corporations seeking to reduce their liability to consumers created and bankrolled the CALA campaign to manipulate the media, the legislative process, the electoral process and the American public," Doroshow says.

Internal tobacco industry documents make clear that tobacco executives understood the importance of concealing their role in the CALAs.

"The primary purpose of [grassroots lobbying] is to substantiate and support [the] Tobacco Institute position presented to Congress, state legislature or local councils by our lobbyists," states a 1986 industry memo. "In order to be totally effective, the grassroots effort must appear to be spontaneous rather than a coordinated effort."

Similarly, Keith Teel, a partner at Covington and Burling, a law firm representing the tobacco industry, wrote in a 1995 memo discussing communications strategies that the industry's "media activities, to be effective, must not be linked to the tobacco industry."

But "The CALA Files" shows that industry, and particularly the tobacco industry, played a central role in directing CALA activities, irrespective of what was apparent to the public.

Some CALAs, such as one in Louisiana, were virtually created by the tobacco industry, according to "The CALA Files." The Tobacco Institute proposed plans to form and fund the Louisiana CALA in 1992, industry documents show, to head off a legislative effort to expand consumers' rights to sue manufacturers. Directly, as well as indirectly through other organizations, the tobacco industry helped finance the Louisiana CALA. When the proposed legislation was defeated in 1992, Philip Morris Vice President Craig Fuller reported that "the coalition Philip Morris helped organized, Louisiana Citizens Against Lawsuit Abuse, led the effort to defeat all trial-lawyer advocated tort proposals."

Another sign of the centralized and coordinating role of APCO in the CALA campaign, according to "The CALA Files," is the use of identical slogans and logos, such as a "Stop Lawsuit Abuse" stop sign logo, among the various and supposedly independent CALAs.

In addition to the legislative victory in Louisiana, "The CALA Files" makes the case that the coordinated CALA campaign is having an impact - by helping achieve passage of legislation limiting consumers' rights to sue manufacturers, conducting "voter education" campaigns that support judges who favor restricting consumers' right to sue and targeting those favoring expanding consumer rights, and by persuading potential jurors that they should take a stand against a legal system that has spun "out of control."

"The report unmasks funding by self-serving megacorporations that secretly spawned a national network of fake citizens organizations," says Public Citizen President Joan Claybrook. "These so-called citizens groups are doing the bidding of the corporate funders and are pushing at all levels to deny Americans access to the courtroom and to create a legal environment that shields corporate wrongdoers from accountability."

- Robert Weissman

THE LAWRENCE SUMMERS MEMORIAL AWARD

The September 2000 Lawrence Summers Memorial Award* goes to the U.S. Patent and Trademark Office (PTO). PTO is the government agency that awards patents for new and useful inventions. Critics complain that PTO has gone overboard in recent years, issuing patents on claims that are not real inventions or that are not new. A series of golf-related patents suggest the critics may have a point.

Examples include the following:

Abstract for US Patent No. 5,616,089 - Method of putting

A method of putting features the golfer's dominant hand so that the golfer can improve control over putting speed and direction. The golfer's non-dominant hand stabilizes the dominant hand and the orientation of the putter blade, but does not otherwise substantially interfere with the putting stroke. In particular, a right-handed golfer grips the putter grip with their right hand in a conventional manner so that the thumb on the right hand is placed straight down the top surface of the putter grip. The golfer addresses the ball as if to stroke the putter using only the right hand. Then, the golfer takes the left hand and uses it to stabilize the right hand and the putter. To do this, the golfer places their left hand over the interior wrist portion of the right hand behind the thumb of the right hand with the middle finger of the left hand resting on the styloid process of the right hand. The golfer presses the ring finger and the little finger of their left hand against the back of the right hand. The golfer also presses the palm of the left hand against the putter grip and squeezes the right hand with the left hand. The golfer then takes a full putting stroke with the above described grip.

(See: http://164.195.100.11/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=/netahtml/srchnum. htm&r=1&f=G&l=50&s1='5616089'.WKU.&OS=PN/5616089&RS=PN/5616089)

Abstract for U.S. Patent No. 6,086,487 - Method for matching golfer with a ball

A method for selecting a golf ball whose performance characteristics match a golfer's critical playing characteristics for the purpose of reducing the golfer's score. The method comprises the steps of determining a golfer's critical playing characteristics, prioritizing ball performance characteristics, and selecting a golf ball from a predetermined set of golf balls which best matches the golfer's critical playing characteristics to ball performance characteristics.

(See http://164.195.100.11/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=2&u=/netahtml/search-bool.html&r= 56&f=G&l=50&co1=AND&d=curr&s1=golf&OS=golf&RS=golf)

Thanks to James Love for identifying these award-winning patents.