Babies before business: protecting the integrity of health professionals from institutional conflict of interest

Abstract

Manufacturers and distributors of commercial milk formula (CMF), or breast milk substitutes (BMS), a US$ 55 billion industry,1 have a duty to their shareholders to maximise sales. Marketing increases CMF sales - but reduces breastfeeding. The health system and those who work within it have a primary obligation to preserve and improve health outcomes. Fulfilling this obligation requires that breastfeeding is protected, supported and promoted. These two interests - maximising CMF sales and protecting, supporting and promoting breastfeeding - directly conflict with each other. Conflicts of interest (COI) arise within practices such as sponsorship and funding that bind companies and health systems together.2 In these situations, professional judgement concerning a primary interest (unequivocal support for breastfeeding) tends to be unduly influenced by a secondary interest (sponsorship by or partnership with industry).3 This conflict is even more evident when CMF marketing targets the health system itself.