nestle - zaka (63)
TRANSCRIPT
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2 M i l k i n g P r o f it s
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Milking Profits:How Nestl puts sales ahead of infant healthis published byTheNetwork --Association for Rational Use of Medication in Pakistan60-A, St. 39, F-10/4, Islamabad, PakistanPh: +92-51-281755 Fax: +92-51-291552, E-mail:[email protected], December 1999
Any part of this report may be reproduced on the condition that the source i-
tioned. No part of this report, however, can be reproduced, quoted or used in anway for direct or indirect commercial purposes.
Price: Rs. 75, overseas US$ 8 (including handling and postage)
4 M i l k i n g P r o f i t s
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5M i l k i n g P r o f i t s
Profits Before Health . . . . . . . . . . . . . . . . . . . .6
A Prick to the Conscience . . . . . . . . . . . . . . . . .8
Perks & Persuasions . . . . . . . . . . . . . . . . . . .12
Targets & Sales-Based Incentives: . . . . . . . . .20
Free Supplies/Samples . . . . . . . . . . . . . . . . . .24
Public Relations . . . . . . . . . . . . . . . . . . . . . . .26
Contents
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report * released in April 1998 revealed that
not a single company in Pakistan was market-
ing baby f oods or feeding products in a responsible
w a y. All compan ies were found to be violating the
WHO/ UNICEF Internat ional Code o f Marketing o f
Breastmi lk Substitutes, adopted in 1981 to p rotectmothers and babies f rom the co mmerc ial influences
of this industry.
Milking P rof its of f ers a ra re inside r's view of the hid-
den but common sa les pract ices of a giant t ransna-
tional company. Syed Aama r Raza, a former sales-
man o f Nestl Milkpak Ltd, revea ls concrete evidence
of the systematic and routine manner in which the
company buys the loyalty o f doctors, persuadingthem to p romote commercial products rather than
lif e-saving b reastmilk. His earlier attempt - in the f orm
of a Legal Notice issued on November 12, 1997 - to
conf ront his f ormer employe rs elicited threats to h is
lif e and the sa f ety o f his f amily.
This is not the f irst time the unethical marketing prac-
tices of the baby f ood industry, including Nestl, have
been documented (and it won't be the la st time ).Independent surveys to monito r International Code
compliance all over the world have produced similar
f indings, revealing ho w this company (and others)
markets its products in ways that underm ine breast -
f e e d i n g
In f act, because o f its "prof its-be f ore-health "
approach, Nestl has been the ta rget o f two interna-tional Boycotts. Thousands of individuals and organi-
sa tions in 19 countrie s pledge not to pu rchase the
company's best se lling product Nescaf (many stop
buying other Nestl p roducts as well) until the com-
pany ends its irresponsible marketing of breast milk
subs titutes and abides by the International Code. T h e
Boycotts focus on Nestl, the world's largest f ood
m a n u f a c t u r e r, because it controls about 40 % of the
world market in baby mi lks and u ses its inf luence toset ma rket trends and company behaviour and to
interf ere in government ef f orts to regulate the indus-
try's marketing pract ices.
This is the f irst time, however, that such explicit and
irref utable evidence has come f rom ins ide this mas-
sive co mpany (231,881 employees, 500 factories in
more than 80 count ries, turnover of US$52 bi llion
(1998) - "Are the re countries in which Nestl p roductsare not ava ilable?- Not to ou r knowledge " (Nest l
webs ite) ).
6 M i l k i n g P r o f it s
ProfitsBefore Health
* In March 1997,TheNetwork --Association for Rational Use of Medication in Pakistan conducted a nationwide survey to monitor the baby food industrys compliance with the International Code of Marketing o
Substitutes and the SAARC Code for the Protection of Breastfeeding andYoung Child Nu trition.The resulting report, Feeding Fiasco: Pushing commercial infant foods in Pakistan, was released in April 1998.Alarmingly, not a
single company marketing baby foods or feeding products in Pakistan was abiding by the International Code or the SAARC Code in their entirety.Available fromTheNetwork (see pg..4 for address) for US$ 15 (88pp).
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Nestl, having received much o f the evidence docu-
mented in this repo rt as attachments to Aamar Raza's
Legal Notice, has no doubt had its damage control
team scour each ite m to come up with ways to
explain everything a way. They won't be ab le to. T h eevidence (all provided in original by Aamar) is too
explicit, the v iolations too blatant. But let them try -
past experience has sho wn their ef f orts to expla in
their actions, only revea l more wrongdoing.
As is always the case when monito ring comp liance
with the International Code, the f indings repre sent
only the tip of the iceberg. The evidence contained in
this report has been accumulated ove r only 29months in the district surrounding a sma ll town. By
the time o f Aamar's resignation, Nestl employed 52
medical delegates to car ry out similar activities (on an
even large r scale in city centres whe re the potent ial
f or sales is greate r and the s takes higher).
Unholy AllianceAnd what o f the doctors? Are they not also partiallyrespons ib le for the deaths of these innocents?
TheNetwork believes that the doctors too must share
the blame. For in accepting (or in so me cases even
reques ting) the bene f action of the baby food industry
and igno ring the importance o f mother's m ilk f or
babies, many doctors have put the ir own interes ts
ahead of those o f their small patients. In exam ining
evidence o f Nestl's Code vio lations , so me truly crim-
inal cases o f doctor bet raya l also su rfaced. WhileNestl's unethica l marketing p ractices remain the
f ocus of this report, TheNetwork also wis hes to b ring
to light the wrongdoing o f the medical profession.
7M i l k i n g P r o f i t s
Why is Breastfeeding Important?The lives of 1-2 million babies could be saved each year if their mothers were enabled to breastfeed optimal-
ly (i.e. exclusive breastfeeding for about 6 months, continued along with additional foods for two years or
beyond). Not only does m other's milk provide all nutrients necessary for infant growth and development, it also
contains unique anti-infective properties which protect the baby against common childhood illnesses. Where
clean drinking water is not available, a bottle-fed baby is 25 times more likely to die of diarrhea and four times
more likely to die of acute respiratory infections than an optimally breastfed baby. Even when bottles are pre-
pared properly under sterile conditions the risk of illness and death is greater than among breastfed babies.
Mothers, too, benefit from breastfeeding. Not only is breastfeeding less time consuming and more convenient
than bottle feeding, there are also health benefits. Breastfeeding helps the uterus to return to its pre-pregnancy
state and reduces the risk of post-partum haemorhaging. It also reduces the risk of breast and ov arian can-
cers and of fers protection against subsequent pregnancy.
But breastfeeding - a simple, inexpensive and traditional practice that has the potential to save hundreds of
thousands of infant and child lives each year in Pak istan alone - is being endangered by the aggressive and
unethical marketing practices of the manufacturers of artificial baby foods and feeding products.These com-
panies go to great lengths to com e between a baby and its mother's breasts. Breastfeeding babies are bad
for business.
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yed Aamar Raza joined Nestl Milkpak Ltd. on
December 3, 1994 as a "medical delegate" con-
cerned only with products within the scope of the
International Code. He had seen the position adver-
tised in the newspaper. After a two-day interview
process,Aamar was selected out of about 50 appli-cants. He resigned with immediate ef fect onApril 30,
1997, ending a promising and envied career with a
multinational company. Heres why:
I was on a routine visit to a
doctor in a hospital in Sialkot.
While I w as there a critically ill
infant was brought into the clinic
with chronic diarrhea and severedehydration. The doctor I was visit-
ing rushed off to begin emergency
treatment. But th e baby d ied.
"The detailed medical history
revealed that this four- m o n t h - o l d
baby had been breastfed for his first
month but was then started on for-mula milk by a local doctor. The
mother had been assured that formu -
la milk would help the baby to gain
weight and become healthier and
chubbier. She was also directed to
stop breastfeeding and was told that
her milk was not suitable for her
baby. The baby was being fed formu-
la milk with a feeding bottle and had
been having episodes of diarrhea for
the last tw o months.
"The doctor I had been visiting and
wh o attend ed the baby is trained as a
preventive pediatrician who in his
practice actively pro m otes bre a s t-
feeding. Over my next several visits
he explained to me how formula
feeding was affecting the lives of thousand s of children in Pakistan. I, a
father at that time expecting my sec-
ond child, understood the role I was
playing in this crime and decided to
leave my job.
Syed Aamar RazaDavid takes on GoliathOnce removed f rom the pres sure and compet ition with-in Nestl, Aamar soon decided he s hould do something
to try to change the company s behaviour in Pakistan.
Six months after his res ignation, Aamar issued his f or-
mer employers a Legal Notice (dated 12-11-97), attach -
ing nearly 80 pages o f evidence o f the company's
unethical ma rketing practices. This evidence had been
8 M i l k i n g P r o f it s
A Prick tothe Conscience
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gathered over h is 29-month emp loyment with the com -
pany not systematically with the intention o f taking any
f uture lega l action, but as a job requirement. He had
been told to maintain records o f incent ives to docto rs
so that he could later us e them to p ressure the doctorinto p rescribing more Nestl p roducts. Document s f rom
his super iors, mean while, were kept a s a record of their
directions to him.
Advised by his fathe r in vie w of his legal experience,
Aamar demanded in h is legal notice that the compa-
ny "stop its business o f inf ant f ood manu f acturing in
Pakis tan and withdraw all its infant food products
f rom the Pakistani market within 15 days o f rece ivingthis legal notice ". He also directed the company to
"terminate the se rvices o f sta f f involved in
non-professional and uneth ical practices o f
promoting and selling in f ant f ormu las within the same
period o f 15 days ".
First Bribes, then ThreatsAfte r Aamar is sued the Legal Notice, two senior
employees o f Nestl (Specia l Project Manager/G roupBrand Manage r (GBM) who had come f rom Karachi
and the Area Detailing Executive (AD E) re sponsible
f or A a m a rs district) visited the home o f the pediat ri-
cian who had s hown Aamar the error o f his ways.
They told h im to stop Aama r pursuing the Legal
Notice and th reatened anyone involved in this matter
with him. The pediatrician contacted A a m a r, who
refused to bo w down or to meet with the Nest l sen-
ior employees.
Having failed to deter Aamar through this indirect
approach, the Nestl senior employees contacted a
doctor who had been on the receiving end of N estl's
largesse (see CoolTrade pg. 16) and asked him to call
Aamar to his office the next day on any pretext. Not
suspecting what awaited him, Aamar arrived at the
doctor's office to find his former seniors also there.
The GBM said N estl was such
a giant company that I couldnot harm it. He asked me to
withdraw the legal notice and said
that if the company's interests were
damaged with legal action, I would
s u ffer serious consequences ( I s k e ytumey sunge en nataig bhukatnainpharain gey ). Nestl is a m ultinationalcompany, he reminded me, and has
money to do anything to me. My
ADE off e red m e any a mou nt of
money I like ( Hum tumey moon mongi
rukum company say dila sekhthy hain.Jis say sary omer ash car o gey.) I did n otaccept.
The GBM said that if I continued to
be stubborn, the comp any w ould filecases against me in many different
cities. They said anyone from my
family could be kidnapped ( Tumar eykhandan kay kisi bhi shuks ko aghwa carlia jai ga ), or I could even be killed(Tumey zindagi se bhi hatth dhona pharsekhthy hain ). They said there are lotsof gangsters in Karachi and Lahore
read y to kill for money. I told th em to
go ahead and do what they wanted
to do and I would d o what I wanted
to do.
Syed Aamar Raza9M i l k i n g P r o f i t s
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The Campaign Begins...The respon se f rom Nestl Milkpak Ltd made clear the
company' s intentions. Though shaken and concerned
about his f amily's saf ety, Aamar resolved to perse-
ve re, this time with the help and support o f other
groups working on this iss ue. Aamar had ea rlie r sent
a copy of the Lega l Notice to TheNetwork and sub-
sequently wrote a rev iew for Feeding Fiasco (see pg.
6). (Interestingly, Nestl co rrespondence with Nestl
Boycott supporte rs revealed that the company had
incorrectly concluded that the "former Nestl
employee " anonymous ly ref erred to in Feeding
10 M i l k i n g P r o f it s
It was not u ntil,
up on the expiry of
15 days, Aamar
notified Nestl that
he would hold a
pr ess conference to
reveal the compa-
ny's "malp ractice
and unethical
measures" that
Nestl responded
officially, acknowl-
edging both his
legal notice and
subsequent letter
(dated November
29, 1997). In a letter
(dated 2 December
1997, Nestls lega l
advisor denied all
adverse allegations
and threatened
with legal action
for breach of trust
and d efamation
should
Aamar make them
public.
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Fiasco was Aamar Raza). Now he contacted
TheNetwork aga in, seeking gua rantees of security
and f inancial support f or taking the company to
court. Both requests were out o f our scope, but we
promised to help him make his evidence public
whenever he was p repared to do so.
After many months of contemplation and meetings,
Aamar decided to proceed and took precautions to
protect his family's and his own safety. This report is
the outcome of that decision.
11M i l k i n g P r o f i t s
Redundant and IllegitimateThe Nestl Charter -- Nestl's infant formula policy in developing countries" is the company's own code of con-
duct, which it implies is the same as the International Code. However, there are significant dif ferences betweenthe two - most notably, the International Code covers all breastmilk substitutes in all countries, while the Nestl
Charter applies only to infant formula in developing countries.
Not only was the International Code adopted by 118 countries, its text was prepared by the World Health
Organisation after consultations with governments, NGOs, health workers and the baby food industry itself.A
company-prepared code of conduct such as Nestl's Charter is nothing more than a public relations exercise
and is w ithout legitimacy.
In any case, Nestl's marketing has been sho wn to break even its o wn Charter as well as the International Code.
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ll the support s are with you as usual, " reads a
handwritten note signed by Aamar's immediate
s u p e r v i s o r, an Area Detailing Executive. He is ref er-
ring to the company's un written po licy of "keep ing the
customer happy " through gif ts of products , equipment
and othe r mate rial and f inancial inducements. T h e"custome rs " in this case aren't necessari ly the direct
buyers o f the company's product. They are, mo re
i m p o r t a n t l y, in a position to in f luence th rough their
prescriptions the purchases o f their hundreds and
thousands o f patients. The understanding is that i f
the company gives the doctor something, s he or he
will f eel obligated, or in the very leas t willing, to give
someth ing (i.e. prescriptions f or the company's prod -
ucts) in return.
It is a classic case o f "you-scratch -my-back-and- I'll-
scratch-yours ". The question is , who scratches f irst?
Bribes are not on ly of f ered by the baby food industry,
but also de manded by the many docto rs . Even when
Classification/Contact Data cardsOf course not all doctors are created equal in the eyes of the baby food industry. Number of patients, private practice and-
ernment service and teaching positions determine a doctor's potential to influence and therefore, their value to the ba
industry. The number and value of gifts and services a doctor receives from the company is determined by her or his cl-
tion.The more valuable the doctor (i.e. the more her or his potential to influence), the more the company is willing to "i
her or him.
Nestl's early contact classification system divided all health workers into three classes (A, B and C) according to -
ber of children they see or deliveries they handle, and considering their qualification (i.e. pediatrician, gynecologist/obs
general practitioner, para-medical staff, etc.). Specialists who are professors, assistant or associate professors or influent-
ion leaders areA-class, irrespective of their volume of practice.A new system of contact classification considers practice size
patient income level (considering doctors' fees, patients approximate per month income and area of practice) and in
Doctors were then divided into four classes (AAA,AA,A and B).
A data card is maintained for each contact. Information collected includes date of birth, wedding anniversary, year o-
ation, graduation institution and interests. Gifts and cakes are routinely delivered on birthdays and anniversaries.These vary in
price from Rs. 250 to Rs. 600, depending on the doctor's classification. Data cards are also maintained for hospitals, m
homes and clinics. They are also classified accordingly. These cards record the services provided, number of paeds and gy/
wards, number of beds, w hether there is a pediatric nursery, number of incubators, occupancy, number of children in out-patient
department per day as well as information about the heads of departments and ab out nearby pharmacies.
12 M i l k i n g P r o f it s
PerksPersuasions&
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13M i lk i n g P r o f i t s
the demands are not blatant and acco mpanied with
f lattery of Nestl, a docto r's openness to the co mpa-
ny's largesse and persuasion is perceived as a will-
ingness "to do business " and is quickly exploited by
the medical de legate. Responsibility for theseexchanges lie s with both partie s, the baby f ood
industry and the docto rs - a f act the International
Code clea rly establ ishes in saying that inducementsshould be neither o f f ered by the baby f ood industry,
nor accepted by health workers .
Bribing DoctorsAamar was reimbursed monthly for "promotional
expen ses" or "impres s money". This amount varied
f rom month to month, but could be over Rs. 10,000(e.g. Rs. 12,549, Rs. 15,750).
This budget is used to fulfill
the demands of doctors. The
money is spent according to
the potential of the doctor and is
solely on the Medical delegate's dis-
cretion. The medical delegate is also
authorized to freely use telephone
and courier services for prompt ful-
fillment of doctors' dem and .
Syed Aamar RazaOne gynecologist in f ormed Aamar that she had t rans-ferred her practice and she required a ne w signboard.
Article 7.3No financial or material inducements to promote productswithin the scope of this Code should be of fer ed by manu -facturers or distributors to health workers or members of their families, nor should these be accepted by health
workers or members of their families.
I N T E R N AT I O N A L C O D E
Bank slip sh ow-
ing reimburse-ment of impress
expenses for the
mon th of March
97, amou nt
Rs 12,549.
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When Aamar f orwarded the request to h is supe rvisor,
the reply was: "Is it plastic sign or tin board? Kindly do
it as you feel eas y f rom your budget. " Earlier (27-9-
95), her husband, also a docto r, received a cheque
f rom Nestl f or Rs. 10,000. Another doctor was p ro-vided Rs. 4,500 with which he was to pu rchase his
own signboard.
Nestl a lso provided lunch f or a f ree medica l camp,
f or which one o f the o rganizers received Rs. 4,000
"with a bundle o f thanks ". The same doctor later was
also pleased to accept ("with thanks ") the donation of
a nebu lizor with tubings and accesso ries . On the
request o f another doctor, Aama r's supervisor himsel f
purcha sed a baby weighing s cale to be de livered
by A a m a r.
Another doctor acknowledged receipt of a clinical pa-
diatric nebulizor and stethoscope for the paediatrward of Memorial Christian Hospital, Sialkot.The
director of the hospital was unaware of the "donation
Among other g ifts distributed by Aamar were 1996
Nestl Milk Pak Lt. Diaries and 25 Cerelac
dispense rs /table clocks f or A-cla ss pediatricians.
Routinely he supplied Nestl products (co f f ee, tea
w h it e n e r, etc.), tongue depressors, printed p rescript ion
pads and anyth ing else the doctor needed or requested.
14 M i l k i n g P r o f it s
Goodwill GoodiesUnde r Article 6.8 o f the Internationa l Code, baby f ood companies may donate equipment such as nebu li-
zors and weighing scale s (and these may even bear the company name or logo), but Article 7.3 states No
material and f inancial induce ments to promote products cove red within the scope of the Code . The end
result of such g ifts, espec ially in resource-tight Pakistan) is an inc reased sense o f goodwill to wards the
company and an ob ligat ion to return the favour in the shape o f presc riptions (see "No uncertain terms ",
opposite). As such, all such donation s can and should be considered as financial or mate rial inducements
and the ref ore disallo wed.
Courting CooperationNot on ly doctors, but also nurses a re wooed by Nestl's marketing team. Samples o f the company's prod-
ucts (Milo, Nesca f , yakhni, Cere lac) were regularly supplied to the nu rsing sta f f . Gif ts of lips t ick, nail polish
and pe rfume were also purchased out o f Aamar's "impress money ". Clea rly, s uch items are not f or prof es-
sional use, but mater ial inducements, banned under Article 7.3 of the Code.T
he nurses, in return, p rescribed
Lactogen 1 f or ne wborns rathe r than helping the mothers to breast f eed and admitted Aamar to the wards and
nurse ry outside o f f ice hours to give him d irect contact with the mothers. Whereas doctors may spend on ly a
few minutes with a patient, the nurse s are in the ward for the entire day and have much more contact with
the mothers.
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15M i l k i n g P r o f i t s
No Uncertain TermsSometimes the arrangement works subconsciously, with doctors denying
having been influenced by company inducements. Sometimes the deal is
spelled ou t in no uncertain terms.
On April 9, 1996 Aamar wrote to his supervisor, seeking guidance. He
wrote that he had been "asked for the sponsorship of an air conditioner
(A/ C) by [a doctor] who is a child specialist in DHQ Hospital Sialkot and
also private practitioner
as a consultant". He wrote
that he had told the doctor
he would have to ask his
sup ervisors as to "whetherthere is such type of policy
of sponsorship or not".
Aamar's supervisor, the
Area Detailing Executive,
wrote to the Group Brand
M a n a g e r, "Sir, as you
know he is a district pedi-
atrician. We have verbally
talked to him. I strongly
recommend for Rs. 10,000
instead of full payment
that would be around Rs.
20,000/ -. Rest am ou nt
would be sponsored by
any pharmaceutical com-
pany."
To w hich th e Grou p Brand
Manager replied to
Aam ar, "O.K. But N an an d
al110 sales should go up."
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Cool T rade for Company LoyaltyAmilitary doctor at Combined Military Hospital, Sialkot, on 5 July 1996 requested two air conditioners (a-
vided specifications) "for the comfort/better care of ... patients".The letter was addressed to ZahidAshfaq, who
he assuredAamar was an old friend of his. Aamar sent the letter to his senior.
Later, when he still hadn't received his air conditioner, the doctor
asked m e to inquire from m y seniors about it. My seniors told me that
the doctor should first show w hat he could do for the comp any in the
form of prescriptions.
Syed Aamar RazaB yAugust, Aamar had secured almost a monopoly over the hospital, and the Field Operations Executivs e n t
him a letter o f apprec iation, detai ling the hospital's large purchase o f Nestl products. The lette r was cop ied to
the Group Brand Managers, Brand Managers and Area Detailing Executives throughout the count ry.
On 16 September 1996, the same doctor issued a circular stating that only Nestl products were to be
The circular, having not been signed by the Commanding Of ficer, is also contrary to military service norms.
Aamar forwarded the circular to his seniors.
My seniors then told me to provide them a receipt amounting to the
price of an air cond itioner (abou t Rs. 24,825) so tha t they could release
the m oney. I could not find anyone w illing to issue m e a fake receiptfor such a large amoun t. When I told the d octor this, he said it was no p rob-
lem and he would take care of it. He phoned his friend and asked for a
blank receipt. I went to his friend's home and collected a blank receipt
stamped w ith his company's official stamp . I took it back to the doctor and
we made out the receipt for a hospital bed (which this company does not
even produce) costing Rs. 24,825.
After sending this receipt to my seniors, a cheque for Rs. 24,825 was
issued ("as per Brand Manager's instructions") on N ovember 14, 1996
in the name of the doctor's friend's company. The friend then wrote
back that he did n ot have an accoun t in Pakistan in the compan y name, and
asking that it be re-issued in his own nam e. I was sent the revised cheque
on January 15, 1997 and asked to pass it on.
Syed Aamar Raza16 M i l k i n g P r o f it s
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17M i lk i n g P r o f i t s
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Outside the CodeNestl takes full benefit from its wide range of prod-
ucts, using products not covered by the International
Code to promote the company name and at the same
time create a sense of goodwill among doctors andother health care workers.
Before Eid at the end of Ramazan (the Islamic month
of fasting), the sales delegates receive packaging
material at their homes and products from their distrib-
utors for Eid gifts.Aamar was to give gifts to 20A-class
doctors and 10 to B class doctors, the contents of
which were as follows:
Among the supplies the company regularly de liveredto A a m a rs home were infant cereal sachets,
Eve ryday (tea whitene r) and Yakhni (chicken stock ).
These supp lies were provided f ree o f cost to the
d o c t o r s .
A circular f rom A a m a rs s uperviso r, the A D E
Faisalabad, dated J an 11, 1997, noti f ies the detailing
team that "f rom no w onwards nobody is a llowed to
purchase any company p roduct f or docto rs [except
in] special ca ses. You will have to take pr ior app roval
f rom undersigned."
This indicates that such purchas-es were pe rmitted o f f icially up to that date, and will be
cons ide red in future on a case-to -case basis. Such
purchases were above and beyond the supplies dis-
patched by the company.
Sponsoring LoyaltyA group o f 12 doctors and sta f f nurses f rom Memorial
Christian Hospital reque sted permission to visit the
Nestl plant near Sheikhupura. The letter sa id,"
Ours t a f f looks f orward to visiting your plant and d is-
cussing the va rious products which you o f f er " .
When PPA Gujranwala held a " one-day clin ical meet-
ing" on 27-04-97, Nestl printed invitation cards, dis -
tributed them to doctors and covered all the expense s
18 M i lk i n g P r o f i t s
Nestl is unique
in presenting
doctors with Eid
gifts of compa ny
products.
Verm icelli, trad i-
tionally preparedfor Eid, w as to be
pu rchased from
the market, as
Nestl does not
produce this
product.
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19M i lk i n g P r o f i t s
(break f as t, lunch, co f f ee/tea and excu rsion). The p ro-
gra mme revea ls it was more an excu rsion than a" one-day clin ical meeting " and its purpose f ar f rom
a c a d e m i c :
Nestl took care o f regist ration and accom modation
for a number o f pediat ricians to attend the
8th Nat ional Paediatric Con f erence,
26-28th Februa ry, 1997.
Families w ere a lso a ble to
accomp any the ped iatricians to
the conference. In at least one
case, the doctor's whole family was
issued air tickets as well. These tick-ets were returned unused to Nestl
and the doctor was given cash
instead.
Syed Aamar Raza
Invitation card
to PPA
Gujranwalas
"one-day clinical
meeting" held on
April 27, 1997
and directions
for Aamar to
deliver them to
doctors.
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20 M i l k i n g P r o f it s
Targetsales targets are calculated according to birth
rates and morbidity/mortality rates of a particu-
lar area.The minutes of anAnnual Delegate's Meeting
state that "Targets of Al-110 must be rationalised
according to the real potentiality of the towns."
Mo n t h l y, brand-wise (f or Cerelac, Lactogen 1 &2, A l
110, Nan, Neslac, P re-Nan and Nestum) target
sheets are prepa red by the ADE and hand written on
a Nestl writing pad or any pla in piece o f paper. In
Pakis tan Nestum (r ice cereal that has since been
renamed Nestl Rice ) and most flavours o f Cerelac
are marketed for use f rom four months and a re the re-
f ore within the scope o f the Code (see Living in the
Past, page 25). In se tting targets or calculating sales-
based bonuses, the re is no dist inction made between
cereals intended f or use f rom 4 month s or f rom 6
months. Target sheets a re al ways signed by the A D E .One target sheet also advises Aama r to se ll the items
on a 3 -5% discount.
Pressure to PerformThe sales team is continuously re minded of these tar -
gets and the impo rtance of meeting them. They are
unde r pressure to per f orm. Anotice f romAamar's super-
visor informs hi m, "Please receive your last quarte r
achieve ments report against target. Your small to wnsneed a lot of improvement in all products and special
emphasis is needed in Sialkot... " It adds, "Af ter very
heavy sa mpling your Ce relac sales a re decreasing day
by day. " And to keep the pressure on: "Also receive your
targets for April. I hope you understand that you are in
problem. " Another target sheet directs Aama r to meet
his targets f or Neslac "at any co st and without excuse ".
With his city- wise targets f or Nestum, Aamar was told,"Please take these ta rgets very se riously and positively
and take max imum advantage o f the season ". "The sea-
son" ref ers to the start o f hot weather and increased
incidence of d iarrhea. Anothe r time (March 1996) A a m ar
was in f ormed, "Your most concern area is Cere lac as
well as Nan also special ly in Sialkot. And start tak ing Rx
Tar gets & Sales-Based Incentives:
Brand-wise
and city-
wise target
sheet for the
month of
Ap ril 1996.
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21M i lk i n g P r o f i t s
of A l - 110 also. " A month later special emphasis was
needed in Sialkot on Neslac and Ce relac.
Team SpiritW hile there is stif f competition between medical dele-gates, the company places importance on creating a
sense of "team spirit" and a common goal of increas-
ing sales as a service to the babies of Pakistan.The
sales force is appointed as "medical delegates", in a
single move medicalising the company's infant feeding
products and raising the sales force above the rank of
common salesmen. Addressing the salesmen as
"tigers" incites promotional aggressiveness.
The company is generous with p raise whe re de served
and mora le boosting talks where required. "You are
doing good job. Keep it up with same tempo and dedi-
cation," encourages the note belo w ta rgets f or Sept. 95.
Another ta rget sheet note say s, "These a re your target s
f or the month o f March 96. Now ball is in your 'cou rt'.
This is the right t ime to prove yourse lf. At this time no
product is short and all the supports are with you as
usual. " ("Supports " are discussed in Perks &
Persuasions, pg. 12)
The successes of individual medical delegates were
circulated throughout the country and held out as
examples to be followed (see CoolTrade for company
loyalty, pg. 16)
Article 8.1In systems of sales incentives for marketing personnel, thevolume of sales of pr oducts within the scope of this Codeshould not be included in the calculation of bonuses, norshould quotas be set specifically for sales of these pr od -
ucts. This should not be understood to prevent the pay -ment of bonuses based on the overall sales by a companyof other products marketed by it.
I N T E R N AT I O N A L C O D E
Below: Morale is
kept high and
promotional
aggressiveness
encouraged
through a sense
of team spirit
and a common
goal.
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Fruits of Their LabourA letter from M arshall Rolland, M arketing M anager,
provides the break up of Aamar's salary (1996 Salary
Revision).The letter states: "Please also note that a
level adjustment of Rs. 200/- has been included in yourgross salary which is in addition to your performance
increment." It also informsAam ar that he "will also con-
tinue to be entitled to participate in the Performance
Incentive Scheme", details of which were to be provid-
ed separately. It goes on to say, "Please remember
your actual performance is regarded to be of key
importance and has therefore been duly considered
when revising you r sala ry." A similar letter was
received the following year (1997 Salary Revision)except the "Performance Incentive Scheme" had been
renamed the "Sales Incentive Scheme".
On 12.3 1996, Aamar received a Performance Bon
Payment (Including 10-C) amounting to nearly on
months salary. This was one of four bonuses received
in 1996.
Early salary slips consistent ly list "Fix Pay " and
"Incentive to Salesmen". Fix pay, as its name implies,
remains unchanged. Incentive to salesmen varies fro
slip to slip but is sometimes nearly as much as th
fixed pay. On later salary slips, where fixed pay is bro-
ken down into basic pay and various allowances, th
incentive to salesmen is sometimes more than doub
the basic pay.
The entire sales team is invited to annual sales co-
ferences at the luxurious Pearl C ontinental Bhurban
22 M i l k i n g P r o f it s
Below: Aa mar s
salary and ad di-
tional bonuses
were calculated
according to
his sales
performance.
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The invitation letter informs that the winners of the
Tiger Cup will receive their award during this event, aswill the winne rs of the Achievement and
EncouragementAwards. Awards are given to the
Medical Delegate of theYear. Winners receive plaques
and cash awards of as much as Rs. 25,000. Winners
are determined by their sales performance.
A review of targets vs. achievements and target s vs.
expenses also p laces emphasis on sales per f ormance.
The invitation letter also sets a goal o f sales worth Rs. 8billion by the end o f the year 2000, which presumably
includes sales o f products cove red by the Code.
Local musicians are brought in on the last evening as
the medical delegates dance the night away, in reward
for a job well done and providing incentive for the year
to come.
23M i l k i n g P r o f i t s
Incentives to
Salesmen on
Aamars salary
slips were some-
times as much as
the fixed pay or
more than doublethe ba sic pay.
Awar ds and
entertainment:
reward for a job
well done and
providing incen-
tive for the year
to come.
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24 M i l k i n g P r o f i t s
henAamar forwarded one doctor's request
for 10 packs of Lactogen 1 for free, he was
advised by the GBM to pay for the stock.
The distributor supplied the
doctor and billed me. I paidf rom my imp ress m oney,
which was reimbursed by the com-
pany
Syed Aamar Raza.
A special form was to be filled out for request for fr
or low-cost supplies.The form quotes extracts from the
WHO International Code and the WHO Guidelin
concerning circumstances under which infants need
be fed on breastmilk substitutes. Doctors are to sig
that they have read the extracts and that their reque"is consistent with the same". "In practice, docto
signed without reading anything." - SyedAamar Raza
The extracts quoted ignore subsequent, relevant res-
lutions adopted by the WHAthat specifically address
the issue of free and low-cost supplies, namely (WH
39.28 (1986), WHA43.3 (1990), WHA45.34 (1992
WHA47.5 (1994). Concern over free and low-cost su-
plies intensi f ied unti l resolution WH A47.5 (1994),which clearly states: "..no donations of free or subs-
dized supplies of breastmilk substitutes in any part
the health care system."
The sales representatives are submit these requisitio
forms duly signed by doctors along with an "Al-110
Free Sample Detail" form, which list s the total
received, previous balance, total in hand, month, tot
consumed and closing balance.
Cereal SerialMarch 9, 1995
A circular announced that the Cerelac Wheat 40gm
sachets would soon be "relaunched".This was seen
as a way to improve sales by increasing the number
Free supplies/ Samples
A special
form was to
be filled ou t
for request
for free or
low-cost
supplies.
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25M i lk i n g P r o f i t s
people trying the product and "help to fight against
Farex in small towns where Farex's 150 gm pack is
making ground".
The sachets were to be made available at doctor'spharmacies and sold for Rs 6/-.As "the shelf life of 40
gm sachets is very limited" the "medical delegate/sam-
pling team" was to "generate enough prescriptions to
get it moved from the shelves within 2 months".
August 31, 1995
A circular said:
" Within t wo o r three months you would be ab le to
receive the f ree sa mples of Cere lac 3-Fruit also.Kindly use s amples more ef fectively as you are
already doing. "
April 1, 1996
A letter toAamar dated says, "After very heavy sam-
pling your cereal sales are decreasing day by day."
April 17, 1996
A follow-up note dated says, "I have written an infor-mation to you dated 1-4-96 regarding mention of
Cerelac sachets in front of every doctor but till today
you are not mentioning. Why? I need your written
explanation."
Aam ar regularly collected from the local distributor car-
tons of Cerelac sachets for distribution among doctors.
Sachets were also distributed directly to mothers dur-
ing baby shows arranged by Nestl at local hospitals
(see Public Relations below).A circular informed themarketing team that Cerelac was to be the "first priori-
ty for prescriptions during 1995".
Article 5.2M a n u f a c tu rers and dis t ributors should not provide, d irectlyor indir ectly, to pregnant w omen, m others or m em ber of theirfam ilies, sa m ples of produ cts w ithin the scope of this Code.
Article 7.4Samples of infant formula or other pr oducts within thescope of this Code, or of equipment or utensils for theirpr eparation or use, should not be pr ovided to health work -ers except when necessary for the purpose of pr ofessionalevaluation or resear ch at the institutional level. Healthworkers should not give samples of infant formula to pr eg -nant women, mothers of infants and young children, ormembers of their families.
WHA47.5 (1994)Member States ar e ur ged "to ensure that there ar e no dona -tions of fr ee or subsidized supplies of breastmilk substi -tutes in any part of the health car e system."
I N T E R N AT I O N A L C O D E
Living in the PastComplementary foods marketed for use before they are nutritionally required are unnecessary and potential-
ly dangerous. When marketed for use below six months of age, they fall within the scope of the International
Code as they necessarily replace a baby's intake of breastmilk and are therefore breastmilk substitutes.The
World HealthAssembly (in Resolution 47.5, 1994) and the National Breastfeeding Policy of Pakistan recom-
mend complementary feeding "from about six months".
Nestl, however, prefers to live in the past, when it was recommended that complementary feeding begin
between four and six m onths of age. Given that age bracket, m others and doctors were inclined to begin cere-
als earlier rather than later, resulting in more sales. So while science has established that most babies thrive
on their mother's milk alone for about six months, the company ignores changing national policies and inter-
national recommendations and markets its cereal products openly as though they are not covered by the
International Code at all.
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26 M i l k i n g P r o f it s
organized baby shows in schools
and hospitals, where the winners were given
free gifts and plaques. Sample sachets of cereal were
distributed directly to mothers and children.The area
where the baby show is held is decorated with posters
promoting Nestl products. There are also prominentdisplays of Nestl products, including cereals and for-
mulas (pre-mature, regular and follow-up).
I conducted 13 Baby Shows in
Sialkot during my time with
Nestl, 12 were in schools and
one in a hosp ital. The 13th show was
a gran d finale, where the "Baby of the
Year" was selected from the winners
of all the previous show s.
During these baby shows w e wou ld
promote the company's produ cts and
motivate mothers to buy them. In
direct interaction with the mothers
we w ould ask w hat milk their baby is
drinking and encourage them to useLactogen and Nan. We also gave out
free samp les.
Syed Aamar RazaThese shows were seen as a public serv ice of sorts.
Indeed, an ex- Mayor o f Sialkot handed out prizes and
presented a plaque to Aamar's supe rvisor f or his
service to the c ity. Doctors , too, were pleased to par-
ticipate and had their photograph taken with the prod-
uct display.
Aamar received a letter o f apprec iation f rom a doctor
at the hospital that hosted one baby sho w that said:
"My team members and I ... are grateful for your kin
and sincere cooperation regarding "Baby of theYear
Award, 1995".Your active participation and devotion
was a great honour for us. We hope that your coope-
ation in this activity, launched for the promotion of
PublicRelations
Right: Direct inter-
action with m oth-
ers and d isplays of
products covered
by the Code
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27M i lk i n g P r o f i t s
health and well of the children of this city and aware-
ness of their mother regarding their care and health
needs, will continue in future as well.
"We will always be looking for your comp any with us."
Other direct contact with mothers took place in the
doctors' waiting rooms.
We would talk with mothers
while they were waiting to see
the doctor. We gave free sam-
ples of Cerelac, especially to the
mothers of very young children, butif others requested we would give
samples to them also. The mothers
themselves would ask us about the
benefits of the product and how to
prepare it. We, of course, took full
advantage of this interaction to pro-
mote the company's products.
Syed Aamar Raza
It was not uncommon for medical delegates to visit
hospitals outside office hours. Aamar used to visit the
nursery and wards and ask m others whether their doc-
tor had recommended Nestl products.The nurses
collaborated with him by admitting him to the ward and
writing prescriptions of Nestl products (See Courting
Cooperation pg. 14 for their rewards).
Article 5.1There should be no advertising or other form of promotionto the general public of products within the scope of thisCode.
Article 5.2Manufactur ers and distributors should not pr ovide, dir ect-ly or indir ectly, to pr egnant women, mothers or member of their families, samples of pr oducts within the scope of thisCode.
Article 5.5Marketing personnel, in their business capacity, should notseek direct or indir ect contact of any kind with pr egnantwomen or with mothers of infants and young childr en.
Article 6.2No facility of a health car e system should be used for thepurpose of pr omoting infant formula or other pr oductswithin the scope of this Code...
I N T E R N AT I O N A L C O D E
Hand ing out sam-
ple sachets of
Cerelac, labelled
for use from 4
months of age.
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Nestl must abide by theInternational Code andsubsequent WHAresolutionsNestl must abide by the International Code of
Marketing o f Brea stmilk Subst itutes and subsequentWorld Hea lth Assembly Reso lutions on infant feed-
ing. The company must ful f il its responsibility ( Artic le
11.3) f or taking steps to ensure that it s conduct at
every level conforms to the principle s and aim o f the
Inte rnational Code.
At the 1998 W HA , D r. Tomris Turmen, Executive
Director of Family and Reproductive Health, WHO
said: Infant-food industry needs to be more active andmore responsible to monitor its own marketing prac-
tices and respond promptly to correct all the violations
that are reported.
Though not binding, WH Aresolutions carry moral or
political weight, as they constitute the judgement on a
health issue o f the co llective membership o f the highest
international body in the f ie ld of health. (Shu b b er, S. Th e
International Code, Digest of Legislation, Vol. 36, No.4, 1985. pg. 884).
Nestl must reveal resultsof internal audits andcorrective action takenNestl clai ms to strictly and at all times act in accor-
dance with and cont inuously strive to adhere to the
Internationa l Code o f Marketing o f Brea stmilk
Substitutes (and the Nestl Charte r, which it believes
to be con sistant with the Inte rnational Code). It says
a ll employees are required to adhere strictly to the
Nestl Charter -- but notably not the International
Code. It also s ays that any breach o f the Nest lCharte r -- again, notab ly not the International Code -
- entails ser ious disciplina ry consequence s. Nestl
must make public all cases whe re disciplinary action
was taken as a result o f a breach o f the International
Code (o r even the Nestl Charte r).
M r. Peter Brabeck, worldwide CEO of Nestl, say s that
he has pe rsonally revie wed any hint of wrongdoing
uncove red dur ing 130 internal aud its conducted overthe past 5 yea rs. Nestl must make publ ic the result s of
these audits and the co rrective measures taken).
Nestle must also bring its Instruct ions to sta f f on the
Code into line with the Internationa l Code and sub -
sequent WHA R e s o l u t i o n s .
Nestl must abandon its
CharterAcompany-prepared code of conduct such as N estl
Charter is nothing more than a public relations exe-
cise and is without legitimacy.
Nestl must openly admit and accept the signi f icant di f -
f erences bet ween the International Code and the com
28
What mustbe done?
M i l k i n g P r o f it s
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p a n y s redundant Cha rter. Where gove rnments have
not enacted legislation to regulate the baby f ood indus-
t r y s marketing pract ices, the Internationa l Code and
subsequent, re levant WHAResolut ions should serve as
the company s code of conduct in A L Lc o u n t r i e s .
PPA must take disciplinaryactionDoctors are not innocent bystanders, but in some
cases willing and active accomplices. They should be
held accountable for accepting and even requesting
favours from the baby food industry.
The Pakistan Pediatric Association must be pro-active inensuring that doctors a re aware of their responsibi lities
under the International Code. Se rious notice shou ld be
taken of the role o f its members in the unethical promo-
tion of baby milks and f oods. The membership o f doc-
tors involved in this cruel a lliance should be cancelled.
Nestl must issue a publicapologyFor too many years , this massive co mpany has beenrak ing in prof its while contributing to the su f fering a nd
even dea lth o f the babie s of this country (and many
others ) .
Nestl must issue a public statement accepting that
their promotional push into an inappropriate market
has been unethical and apologizing for its contribution
to infant suf fering and death.
GoP must enact legislationThe text of the proposed Protection of Breastfeeding
and Young Child NutritionAct has been finalised. It
now needs to be enacted without f urthe r delay.
Pakistan, as a signatory to the International Code
nearly 19 years ago, is obligated to enact legislation
implementing the International Code in its entirety.
Such legislation is also in line with obligations under
other international agreements, notably the
Convention on the Rights of the Child.
The Government of Pakistan first drafted the proposed
legislation in 1992, but because of internal debate and
external pressure from the baby food industry, it has
yet to be enacted.