Wednesday, December 21, 2011

Bloomberg human milk article misses supply side economics

Bloomberg News is reporting on the business of human milk, defining the issue in the narrow terms of the marketplace in its story today, "Moms Selling Breast Milk Online Draw Safety Rebukes From U.S" by Stephanie Armour.

Bloomberg misses a big chunk of even this narrow slice: why is there a sudden strong demand for human milk, appearing to outstrip available supply? And who profits from the scarcity?

The article focuses on calls for regulation as the growing demand for human milk fuels individuals offering it up for sale through, and the emergence of milksharing networks like Human Milk 4 Human Babies.

It's Bloomberg, the business news service, so the perspective on supply and demand, commerce, and human milk as a commodity is to be expected:

"Breast milk is becoming a commodity. With more than $30 million in private funding, Prolacta Bioscience Inc. in Monrovia, California, uses donations to make a human milk fortifier costing as much as $10,000 per hospital stay for a premature infant. Nonprofit U.S. milk banks report they did as much as $9 million in sales last year."

Note though how Bloomberg refers to non-profit milk banks as doing "as much as $9 million in sales..." In fact, North America's network of a dozen woefully underfunded non-profit milk banks under the Human Milk Banking Association of North America umbrella recovered $9M of the cost of processing milk, through a fee. But reporting it this way would distract from the story's main angle - that the commoditization of human milk has resulted in women selling and donating their own milk in an unregulated, or free market.

Where there is a free market, the two sides of human nature come into play: There are non-profit milk banks, and now a company selling human milk products. People are selling human milk on the Internet, others engage in commerce-free milksharing on social media sites.

In a business story, whenever there is a free market, the call to regulate isn't far behind. Bloomberg's story quotes a doctor who says women are "playing Russian roulette." The US Food and Drug Administration's recommendation against the practice of selling or buying or sharing milk on the Internet is featured prominently along with FDA confirmation that it does not have the authority to regulate breast milk sales and donations.

Bloomberg's presumption is that consumers of human milk from any source other than HMBANA milk banks or Prolacta are not taking appropriate precautions. Bloomberg presumes the risk of illness in the ultimate consumer – the baby – from pathogens in human milk, is greater than the risk to the baby of illness from the only other product available to most families, infant formula. Yet available evidence seems to show formula feeding carries greater risk.

Bloomberg briefly quotes HM4HB's Emma Kwasnica who says agencies should develop safe milksharing guidelines and not just issue warnings. Kwasnica has been a strong spokesperson for milksharing and has talked at length to many news organizations about the steps families take to ensure safety. Yet Bloomberg doesn't explore this example of the consumer taking things into her own hands in the absence of a safe, affordable product. Bloomberg reports Kwasnica's objections to safety warnings noting they stem from a patriarchal system that devalues women.

So here we have the lactating mom turned consumer activist portrayed as a radical feminist. Bloomberg retreats quickly to another source with a CEO after his name.

Its closing interviews Bloomberg quotes Prolacta's Scott Estler, saying the company is in fact regulated because its product, a fortifier made from donated human milk and sold at $185/ounce to hospitals, is considered an infant formula, and noting its sales doubled in 2011 over 2010.

And it quotes Pauline Sakamoto of the non-profit HMBANA San Jose Mother's Milk Bank, which has been unable to keep up with the growing demand for donor milk. Sakamoto appears to be calling for action against the informal human milk market, with her comment:

"It's going to take one child to die for someone to do something about this."

It's ironic this call for regulation should come on the same day as a story out of Missouri about a 10-day-old baby who died from infection from a rare bacteria found in powdered infant formula. The FDA has not recalled the product, although the local Walmart did pull it off the shelves. This is not the first illness or death from infant formula, but, unlike other product-caused consumer deaths the story doesn't appear to have legs, at least not in the business press.

Leaving the consumer death angle aside, no business story is complete without a marketing angle, yet Bloomberg misses it.

Here we have strong demand for human milk driven in part by marketing efforts of Prolacta to sell its product. Prolacta has funded research showing what many experts have long suspected - human milk lowers the risk of death in premature babies. NICUs go to great lengths to encourage mothers to express their own milk for preemies, and HMBANA milk banks are seeing more and more demand for their donor milk from NICUs. The smallest of preemies can't get the nutrients they need from human milk alone and the practice is to fortify human milk with additional nutrients. Until Prolacta came along, researchers, governments, and underfunded HMBANA milk banks were unable to provide NICUs with a human-milk derived fortifier, and so NICUs used, and many still use fortifier made from cow's milk.

The cow's milk-based fortifier does improve growth but it also increases the risk of necrotizing enterocolitis (NEC), which costs hundreds of thousands per patient to treat and is a leading cause of death in premature babies. (Yes, that would be a product-caused consumer death.) The $10,000 cost per consumer of providing Prolacta's product as cited above is small change compared to the cost of treating one case of often-fatal NEC.

And here is where the law of supply and demand comes in. Once NICUs, with industry funded research designed to market a product in hand, were able to prove the benefits of human milk for preemies, demand for donor milk from HMBANA milk banks soared, leaving the milk banks with less milk for moms in need in the community.

Bloomberg doesn't explore the supply side of the argument - why do so many babies, outside of the NICU, need donor milk? Kwasnica has argued famously that human milk is not a scarce commodity, and blogger Annie Urban has written about this over on PhDinParenting where she points out:

"formula company profits depend on breastmilk being scarce."

Sales of infant formula in the US are around 3 billion dollars per year, dwarfing the $30 million in private investment for Prolacta and the $9 million in human milk "sales" by HMBANA last year. 

Health care experts, after years and years of watching infant formula companies tell their target market that "breast is best," leaving consumers with the comforting knowledge that when breastfeeding efforts fail, infant formula is perfectly fine, started changing their language. They stopped talking about the benefits of breastfeeding. They started referring to breastfeeding as normal physiological way to feed a human infant, and they started talking about the risks of infant formula. 

Once you move from saying "if you breastfeed, your baby will be healthier" to "if you feed infant formula, your baby will be sicker," women think about infant formula in a new way – as something that could harm their baby. The heyday for infant formula market share was the 1950s. Even at a time when women were mainly at home raising their babies, breastfeeding rates dropped as low as 10 per cent in some areas in the face of strong marketing. In theory almost all women who give birth can make enough milk to feed their babies, and a great number of them can produce more than enough milk. Only 2-5 per cent of women can't physiologically make enough milk to feed a baby. But in practice many things – from health problems to breast surgery to misguided interventions to short maternity leaves – interfere with a new mother's milk production. Some women don't want to breastfeed. But the vast majority of women who are not breastfeeding don't choose to stop. They lack the support to continue.

The sabotaging of the supply line – both inadvertent and deliberate – is unmentioned in the Bloomberg article, but it's the reason why there is a perceived shortage of human milk.

And it represents a failure of health care professionals, hospitals, families, employers, and reporters and the mainstream news media.

Where there is scarcity in the market, prices will be driven up, and consumers will seek out alternatives. Mothers will do what they think is best for their babies, and there's no turning back the clock – health professionals cannot stop talking about the risks of infant formula. They cannot honestly say infant formula is fine, and there's little if no evidence right now that the risk of milksharing is higher than the risk of feeding infant formula. Women will seek out human milk for their babies long as there is a need.

But Bloomberg isn't in the business of delivering news about solving problems that erase the opportunity for profit, so it's not going to explore alternatives to regulating the marketplace.

Governments and health authorities - you have a problem! Breastfeeding is broken. Most mothers under your authority are not able to meet their own breastfeeding goals, let alone the goals you set for them. Mothers in much of the developed world are not meeting your bare minimum recommendation to breastfeed exclusively for six months. You want to fix the problem? Create proper supports for breastfeeding women and fund them properly. Introduce guidelines designed to reduce the risk of milksharing for those who still need it. Fund milk banks. Fund research.

Once the supply problem is fixed, the market for the sale of alternatives to breastfeeding will dry up.

And Bloomberg will see no news value in covering the story of a human milk commodity shortage. Instead it will be covering the scramble by infant formula companies to diversify their product line.

This article is by Jodine Chase, who is a professional news analyst. Jodine is a long-time breastfeeding advocate who, as a volunteer, has worked for years to reestablish human milk banks in Canada. She volunteered some of her time earlier this year to Human Milk 4 Human Babies.

Update, Dec 22, 2011 - is running a shortened version of this story on its website today with this headline: FDA cautions against using secondhand milk. Really? "Secondhand" milk?

Update Nov 2, 2012 - Updated to replace link to original story - SF.Gate has taken it down, but it was syndicated and is still up elsewhere.

6 comments: said...

Thanks for this detailed analysis of what fails to raise a blip on Blooomberg’s radar screen. As I noted in an on-line presentation earlier this month, some observers insist that human milk is a scarce resource, while others consider it sufficient to feed all the world’s babies. Sound familiar? It should, given how closely these polar-opposite perspectives typify what has been repeatedly argued for the last century about global food supplies in general; they, too, depend first on distribution and then on accessibility.

Relying on anecdotal evidence is also instructive, for example multiple accounts of mothers with home freezers full of their expressed breast milk: Past a given storage date and age of child, how many mothers previously thawed their expressed milk only to pour it down the drain? And today, how many mothers are, instead, donating their surplus expressed milk to other mothers via commerce-free human-milk sharing schemes?

Tension between health authorities, milk banks and milk-sharing networks is inevitable only if the parties remain isolated and fail to communicate. It is time to change that, to meet and develop a new approach to which all can subscribe and contribute, and to form fresh alliances based on a common objective – no babies denied their nurturing and nutritional birthright. The choice is clear-cut – continue the standoff or innovate through dialogue and collaboration.

With this common objective explicitly in mind, dialogue and collaboration will sensibly lead to development of realistic guidelines that will permit health professionals, whether acting in a hospital setting or in the community, to advise and support families in their care. Babies need to be safe. Mothers need to be confident. Health professionals need to be enabled.

The only winner in a “Whose milk is this anyway?!” contest is the infant formula industry. Qualitative research needs to clarify which factors facilitate and which factors discourage donations, whether mother to mother or mothers to milk banks. Facts need to replace finger-pointing as a reliable basis for understanding the situation and making adjustments accordingly.

While pondering how to achieve the common objective, bear in mind that the infant-food industry has no intention of remaining passive in the face of creative attempts to bolster Mother Nature’s market share. Experience suggests that this sector is likely already engaging in spirited, if covert, attempts to offset the impact of mother-to-mother milk sharing, including by promoting its “spontaneous” condemnation on public health grounds. And just as the continuing scarcity of human-milk banks and their precious product so neatly coincide with this sector’s generic business plan, we can count on the industry’s energetic interference with any attempt at coalition building along the lines suggested here.

James Akre, Geneva, Switzerland

Jodine Chase said...

Thanks for your remarks, James, I agree. Your call for dialogue and collaboration is timely. I have heard from a number of people involved in milk banking and milk sharing who share this view. Some are working towards a summit of sorts to coincide with the HMBANA conference in Las Vegas in 2012.

working mom (obviously!) said...

"...many things – from health problems to breast surgery to misguided interventions to short maternity leaves – interfere with a new mother's milk production." Majority of mothers in this country are working full-time and part-time outside the home, and most can't afford to take 6 months maternity leave. Furthermore, employers are not providing the support that new mothers need to pump breastmilk in the form of a private room, with seating, a table, electrical outlets, and refrigerator space. I see this as the biggest contributor to the breastmilk shortage.

Maria Parlapiano RN IBCLC said...

Thanks Jodine for tackling this subject . I too believe that the "elephant in the room" is the question - "why do so many babies need other mothers milk?"
We know the real reason but to take down a 3 billion dollar industry - nobody wants to do that!

How did this all get started? When we allowed men to take over the feeding of children! Doctors going into business with the dairy industry in the name of science thinking they could outsmart mother nature and make money doing it. Well, make money they did but outsmart mother nature they did not! The impact on the health & well-being of our culture has been catastrophic!

Also correct me if I'm wrong but Prolacta is a for-profit business, yet they receive DONATED breastmilk for their fortifier. What's wrong with that picture?! So the article comparing them to HMBA milk banks is ridiculous. I don't trust Prolacta any more than I would a formula company.

As far as, human milk as a commodity. Where there is money, there is deceit and corruption. This is exactly what happened when they attempted to regulate wet-nursing. Women were getting paid to nurse so many babies they had no milk left for their own - who often died.
In our times, what would keep the "selling" mom from watering down her breastmilk or adding things to it in order to reflect higher volume? How about asking a friend to contribute to the lot - and split the proceeds? What about the husband who says, " Sure, you can stay home from work but your going to have to pump and sell your breastmilk in order make the money to do that." How about the mother who may give her child formula in order to sell her breastmilk for profit? The scenarios go on and on.

Want to know why so many women have to throw away expired breastmilk or give surplus away? Because there is an obsession surrounding the pumping and storing of milk that has been fueled by the companies who PROFIT from the selling of breastpumps and related equipment. And the medical profession has jumped on that bandwagon as well.

We need to help women NURSE THEIR OWN babies.
Thus the need for infant formula goes down and
the pool of donor milk remains small as it should.
Otherwise, we will just be substituting one money-making enterprise (formula) for another(human milk)

Maria Parlapiano RN IBCLC
Chatham, NJ

Anonymous said...

I was glad to see your response to this article, Jodine. As you have shown, 'economics' articles usually miss the whole picture, especially when it comes to parenting as a whole and infant feeding in particular.

As an aside, I see parallels between non-commercial milk sharing vs milk selling in the way that lay counselling groups like La Leche League give free breastfeeding help while a new profession of board certified lactation consultants (IBCLCs) has developed, and there is room for both.

Jacquie Nutt
South Africa

Jodine Chase said...

Absolutely there is room for both, Jacquie! I appreciate all of the thoughtful comments. I won't be around much through to Boxing Day (Dec. 26). I will try to process further comments over the next few days but do forgive me if it takes time.