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HHS Toned Down Breast-Feeding Ads

Two of the those involved were Clayton Yeutter, an agriculture secretary under President George H.W. Bush and a former chairman of the Republican National Committee, and Joseph A. Levitt, who four months earlier directed the Food and Drug Administration's Center for Food Safety and Applied Nutrition food safety center, which regulates infant formula. A spokesman for the International Formula Council said both were paid by a formula manufacturer to arrange meetings at HHS.

In a Feb. 17, 2004, letter to Thompson (pdf), Yeutter began "Dear Tommy" and explained that the council wished to meet with him because the draft ad campaign was inappropriately "implying that mothers who use infant formula are placing their babies at risk," and could give rise to class-action lawsuits.

Yeutter acknowledged that the ad agency "may well be correct" in asserting that a softer approach would garner less attention, but he said many women cannot breast-feed or choose not to for legitimate reasons, which may give them "guilty feelings." He asked, "Does the U.S. government really want to engage in an ad campaign that will magnify that guilt?"

He also praised Keane, the HHS public affairs official, for making "helpful changes" and removing "egregious statements," but asked that more be done. Two months later, Yeutter wrote Thompson to thank him for meeting with a group that included Levitt and an official of the council. The group members supported breast-feeding, he said, but they wanted HHS to use "positive visual images."

The formula companies also approached Carden Johnston, then president of the American Academy of Pediatrics. Afterward, Johnston wrote a letter to Thompson advising him that "we have some concerns about this negative approach and how it will be received by the general public."

The letter made a strong impression at HHS, former and current officials said. But it angered many of the medical group's members and the head of its section on breast-feeding, Lawrence M. Gartner, a Chicago physician. Gartner told Thompson in a letter that the 800 members of the breast-feeding section did not share Johnston's concerns and had not known of his letter.

"This campaign needed to be much stronger than it was," Gartner said, adding that in his view, the original ads were backed by solid scientific evidence.

According to former and current HHS officials, Cristina V. Beato, then an acting assistant secretary at HHS, played a key role -- in addition to that of Keane -- in toning down the ads. They said she stressed to associates that it was essential to "be fair" to the formula companies.

Beato was then serving in an acting capacity because lawmakers refused to vote on her confirmation because of complaints that she had padded her official resume. In a 2004 interview with the ABC newsmagazine "20/20," which described some of the industry's efforts to change the breast-feeding ad campaign, Beato confirmed that she "met with the industry, because they kept calling my office, every two weeks." She said in a telephone interview that their complaints played no role in her decisions.

"I brought together our top public health people to examine the health claims, and they examined the science and concluded what should be in and what should be out," Beato said.

Duane Alexander, head of the government's National Institute of Child Health and Human Development, was among the officials contacted by the industry who later supported eliminating some of the ads.

"Our concern was that the campaign was going to discredit itself if it included these things -- these wild claims really -- that had no sufficient basis in science," Alexander said.

Another top agency official who weighed in on the campaign was Ann-Marie Lynch, then in charge of the agency's Office of Planning and Evaluation. Lynch, a former lobbyist for the drug industry trade association PhRMA, reversed an HHS decision to finance a $630,000 community outreach effort to promote breast-feeding, according to an e-mail obtained by The Washington Post. Asked to comment, Lynch said she never discussed "baby formula issues with baby formula manufacturers" at HHS.

Speaking to the International Lactation Consultant Association in 2005, Haynes, of the HHS women's health office, said she was "overruled." Veteran pediatrician and breast-feeding researcher Ruth A. Lawrence of the University of Rochester, who was on the initial advisory committee brought together by Haynes, said the science undergirding the ads was "entirely convincing. Everyone on the committee had to agree on a finding before it was approved. We were very distressed by what happened."

After the changes, the advertising company, McKinney + Silver of Durham, N.C., withdrew from the campaign in protest, according to sources inside and outside HHS. A company spokeswoman declined to comment. Carmona, meanwhile, was told that Beato and HHS press officer Christina Pearson did not want him to become involved in the campaign's launch or in any public promotion of the underlying themes, according to current and former HHS officials. Beato and Pearson said they do not recall giving that advice.

The industry substantially increased its own advertising as soon as the HHS campaign was launched. According to a 2006 report by the Government Accountability Office, formula companies spent about $30 million in 2000 to advertise their products. In 2003 and 2004, when the campaign was underway, infant formula advertising increased to nearly $50 million.

Staff researcher Madonna Lebling contributed to this report.

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