2023-05-18 04:00:35
First of all, we went to a congress which took place last March, in Brussels. This is the annual congress of the Belgian Pediatric Society. We thought we would only meet pediatricians there to discuss infant nutrition. But we also found ourselves surrounded by brand representatives. Because apart from the sessions of seminars and pediatric information, a series of manufacturers selling products for young children were also represented: Danone, Nestlé, Pampers, GSK, La Roche Posay,… All had a stand to exhibit their ranges to healthcare professionals. “We pay to be here”, explains to us anonymously one of the representatives of these brands. And depending on the money that is disbursed, these manufacturers have a more or less strategic place in this showroom. “There are Platinum sponsors, those who have given a lot of money. Some firms are particularly generous”explains Professor Stéphane Moniotte, vice-president of the Belgian Society of Pediatrics. “Then there are the Gold and Silver sponsors. That, they are the ones who gave a little less money. Platinum sponsors have their badge large at the entrance and Silver sponsors just have their name written small below the form..
The vice-president of the Belgian Society of Paediatrics tells us that paediatricians need brands to know regarding new trends, new molecules and therefore, to develop pediatric practice. But he adds that their presence at this congress also raises ethical questions: “Congresses are very often sponsored for pragmatic reasons too: all this infrastructure is expensive. A two-day congress like this one costs several tens of thousands of euros and it is important for us to have a source of funding because within pediatric associations, there is relatively little funding. The idea of getting rid of sponsorship for events like this has been mentioned, mainly for ethical reasons. We are here to talk regarding scientific issues, to talk regarding the good of the child. And that shouldn’t depend on the goodwill or help of pharmaceutical companies or manufacturers. And so, ideally, we would like meetings like this to be completely free of this sponsorship.
According to Stéphane Moniotte, the Belgian pediatric scientific societies are thinking regarding optimizing their functioning to come together in a single structure, a single federation: “If we only have one secretariat, one website,… we will significantly reduce costs. With payment from members for a single structure, we can potentially get rid of this sponsorship. is an ethical goal, of clarity, of transparency”.
Because the influence of these marketing approaches should not be neglected. The vice-president of the Belgian Pediatric Society concedes it himself: “It can have an impact on the way we scientists, representatives of universities, hospitals or associations tend to organize things and act.”
Hospital visits and gifts
Several pediatricians have explained to us that they are disturbed by the sometimes insistent approach of certain brand representatives. Because they also come to show them their new products and product ranges in hospitals. So far, nothing out of the ordinary since pediatricians need to be kept up to date with new advances in infant nutrition. Except that these visits are regular and sometimes go beyond this scientific framework. This is what Michaël Detienne, head of the pediatrics department at the Nivelles hospital (Jolimont Group), explained to us in particular. “When we leave school, we are fed by milk companies. We see delegates regularly, at least once a month”. And these delegates rarely come to visit healthcare professionals empty-handed: pens or desk pads bearing the image of brands are very often distributed; which gives these manufacturers visibility in the hospital. “There is a great unease among a lot of doctors regarding these approaches… It’s marketing in disguise because it allows brands to enter the consulting room”.
When he began to practice as a pediatrician, Michaël Detienne, then a young father, even knew a delegate who came to his home: “I received a milk repeatedly from a delegate who came to meet me at home. Looking back, I would not accept at all that things happened like that”.
Today, this doctor tries to make his team aware of the delegates’ approach when it goes beyond the professional framework. A markdown which, according to him, can also have an impact on the promotion of breastfeeding: “To give you an example, we are busy, we have an emergency, we have to go to the delivery room; and yet, there is a delegate who really wants to see us. It has already happened that the person is really insistent and that I have to say stop”.
Plane tickets and hotel nights paid for by brands
Several pediatricians also told us that brands sometimes pay pediatricians for plane tickets or hotels for professional events such as congresses. For example, we found an invitation for a pediatric congress in Quebec in 2016. The gala evening was offered to Belgian pediatricians by Nestlé.
Another congress organized by the Belgian Group of French-speaking pediatricians took place this year in Senegal, in a 5-star hotel, near Dakar: a dream setting to talk regarding the health of children with a Senegalese association. of pediatrics. And there too, according to our information, it is a brand of milk which financially helped certain pediatricians to participate in the event. Nestlé was notably represented there.
Distribution of samples prohibited
Brand representatives don’t just come to hospitals. They are also obviously trying to approach the agents of the Birth and Childhood Office (ONE) by going beyond the established rules. This is what we were able to see when we met Delphine Verstraeten. Mother of a little girl under one year old, she went to ONE because she had decided to stop breastfeeding. She was then advised by an employee: “When I stopped breastfeeding, the ONE offered me a sample of Nestlé brand infant milk, telling me that I might test it. It is clear that I would prefer to know all the types of milk that exist and have more information rather than just getting one milk.”
The distribution of samples is however prohibited as stipulated by a European directive dating from 1991. This directive, the Birth and Childhood Office has applied it since its first management contract in 2003. The spokesperson for the ‘ONE, Sylvie Anzalone, therefore wanted to react to the testimony of this young mother: “It’s a situation that is not supposed to happen, which is not supposed to happen since 2003. Until 2003, firms might visit consultations, leave samples there. Today, the idea is to support the ‘breastfeeding”. And to continue: “You have to realize that some firms have very persevering techniques. They call back regularly despite first refusals, they can show up unexpectedly”.
ONE says to make its 800 field agents aware of this marketing: “New ONE agents receive training in a host of areas, including child nutrition and how to receive milk companies or not”. Milk brands are still authorized to meet ONE field agents, provided that these meetings take place in the presence of a doctor and outside consultation hours. “It’s something that is still, for the moment, doable. It can have an influence indeed. All of this is to ponder on how things can unfold in the near future”.
Nestlé: “We sponsor paediatricians”
After several requests, Neslté agreed to meet with us. According to Pierre Allard, head of medical relations at Nestlé in Belgium, samples can be distributed to healthcare professionals or ONE field agents under certain conditions: “We can do it when it’s a new health professional for a professional assessment, when it’s a new formula or a change of formula”. And faced with the European directive which stipulates that this distribution is prohibited, Pierre Allard answers us “It’s an interpretation”. And to specify: “We give a sample on request. If we’re not asked, we don’t give it”. The request for samples would therefore, according to him, come from pediatricians or ONE agents.
Compared to the steps of the delegates described as insistent or persevering by the ONE or by certain paediatricians, this manager at Nestlé wants to be very clear: “If someone refuses to see us, we don’t see it. It must be an exchange where everyone comes out interested in the process. Otherwise, there is no interest”. According to him, no delegate goes beyond the professional and legal framework initially set. And if that were the case, it would have to be reported to Nestlé.
Pierre Allard was also one of the Nestlé employees who accompanied the pediatricians to the congress organized in Senegal last February. We therefore asked him if this presence of Nestlé was really necessary for a scientific event like this: “There are meetings that take place in Belgium and abroad. We do not sponsor the trip, we sponsor the paediatricians. It is the health professional who asks us to support him financially to go to these congresses”. For this congress in Senegal, Nestlé paid for plane tickets and hotel nights. But this is not an ethical problem according to Pierre Allard: “All this support is framed by a code and we respect it. It is important for us to be also aware of everything that is said in these congresses because it also motivates us to improve our formulas and it allows us to ‘be aware of what healthcare professionals expect’.
Once once more, Pierre Allard therefore explained to us that it is not Nestlé who would solicit paediatricians but the reverse. A statement that also raises many ethical questions…
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