1018 ated with high levels of circulating C.T." Telenius-Berg et al.16 reported the value of subcutaneous pentagastrin injection in relatives of families affected by Sipple’s syndrome (association of hereditary M.C.T. and phaeochromocytoma) as a screening test. We conclude that the pentagastrin test is both reliable and practical and should be used for the screening of suspected cases of hereditary M.C.T. and for the early detection of metas- tases of the tumour after surgery. The evaluation of M.C.T. patients with normal or borderline circulating c.T. levels who do not respond to c.T.-secretion tests should include c.T.-R.I.A. with several antibodies to avoid false- negative results. U113-Laboratoire de Biophysique, Faculté de Médecine St Antoine, 75012 Paris, France F. M. RIBEIRO A. JULLIENNE J. TABOULET M. S. MOUKHTAR G. MILHAUD THE INFANT-FOOD INDUSTRY SIR,-May I, as the author of War on Want’s report The Baby Killer referred to by Dr Muller and Dr Fookes of Nestle" (Oct. 23, p. 912) add my comments on the infant-food in- dustry. I am accused of making no mention of inadvisable methods of infant feeding other than bottle feeding. Apart from being untrue, this ignores my brief-to investigate whether the in- fant-milk industry was promoting inappropriate feeding methods. I was made well aware of the others, not least from twelve hours of discussion with Dr Muller and Dr Fookes. My conclusion however, was that these very real problems were being used to divert attention from the problems caused by bottle feeding. Dr Muller and Dr Fookes say that the small amount of milk protein obtained from supplementary feeding with their pro- ducts can have a definite beneficial effect in poor communities. It could, perhaps, if it were given away. With the average household budget of a poor Third World family, however, its only likely effect will be to divert family food income to per- haps the most expensive form of protein on the market, to en- courage the use of feeding methods inappropriate in the typi- cally unsanitary domestic environment, and to discourage the sensible use of affordable local foods during the crucial wean- ing period. Aykroyd is cited as attributing the decline in Third World infant mortality, in part, to improved infant feeding. He has more recently emphasised,1 drawing on experience in Britain over the past century, "The maintenance of breast feeding is desirable in poor countries where sanitary standards are low but efforts to encourage it have had little success". The Nestle workers refer to the use of Institute of Child Health letterheads (by a member of the Institute’s staff) to request up-to-date information on corporate promotion from professional colleagues abroad. Nestle might do better to explain why, despite the peripatetics of their executives who visited at least three continents in search of expert witnesses for the Swiss trial, they produced no witness who could give expert evidence material to their case; and why they are cur- rently asking the "independent" Nestle Foundation to procure some witnesses of suitable stature in the event of an appeal against the court’s verdict. Industry can use its vast resources to build its case-cannot its critics seek the support and assist- ance of fellow professionals? The real issue is simple. Bottle feeding with expensive im- ported milk is not an appropriate method of feeding an infant for the vast majority of the Third World’s population. So it 16 Telenius-Berg, M., Almqvist, S., Hedner, P., Ingemansson, S., Tibblin, S., Wästhed, B. Lancet, 1975, i, 390. 17. Aykroyd, W R, Kevany, J P Ecol Food. Nutr. 1973, 2, 11. should not be promoted as an appropriate alternative, and your editorial (Sept. 4, p. 403) on the proper place for the in- fant-food industry is particularly welcome. But what is happening in the meanwhile? In Malaysia, which I visited recently, promotional activities I encountered included: use of uniformed "company nurses" to promote in- fant milks direct to mothers (a charity antenatal clinic I visited had three company nurses giving out samples and leaflets about free gift offers while two nurses ran the clinic), mass- media advertising for infant milks, with notable use of radio, which reaches the poorer rural population rather than the town dwellers, according to marketing organisations; and Nestle selling, as infant milk, ’Lactogen with Honey’ ;"the added honey gives a natural sweet taste that baby will love’’;, a cheap commercial gimmick to exploit cultural preferences at the expense of rational nutrition. No wonder the National Committee, established by the Prime Minister’s Office to pro- mote breast feeding, is not sure where to start limiting com- mercial activities. Given the resources to do a proper job of research, some real horror stories could be written. But resources are not available for critical examination of the activities of health-based indus- tries. This, together with the uncritical attitude of the medical profession, hinted at in your editorial, does not hold out much hope for the future. 75 Sandnngham Road London E8 2LL MIKE MULLER SIR,-I have recently returned to England from a hospital in rural Africa and have read with interest your editorial (Sept. 4, p. 503) and the subsequent correspondence. Dr Muller and Dr Fookes (Oct. 23, p. 912) suggest that bottle- feeding should be a supplement to and rarely a total replace- ment for breast-feeding. However, there is little doubt that Nestle have promoted their products as an alternative to breast-feeding and not as a supplement. I have in my posses- sion an advertisement which I took from a village clinic in a remote rural area. This shows a well-fed African mother and child with a bottle and the brand name of a milk powder. The advertisement was common in general stores in the area and was presumably distributed by Nestle representatives. It car- ries no instructions or advice and, as far as I know, no attempt was made by Nestle to encourage health education in the area. Dr Muller and Dr Fookes complain of the lack of objecti- vity among the critics of bottle-feeding in developing countnes, but I wonder if they are aware of the dangers of bottle-feeding or have ever personally attempted to bottle-feed a baby under the conditions in which the majority of African mothers live. Like most African villages, the village in which bottle-feeding was being advertised had no modern conveniences, water had to be fetched from the river, and there was no means of boilmg it except over an open fire. There was no electricity supph, and refrigerators were almost unheard of; therefore each bottle had to be prepared separately. Even if the mother understood the dangers, it was difficult to protect the milk and the teat from flies. In these circumstances it was hardly surprising that gastroenteritis was a common cause of death among bottle-fei babies. In addition to these practical difficulties, the majority of mothers were living at subsistence level and could not afford bottle-feeding. Encouraged to buy a small supply of powdered milk, they would find they could not pay for further supplies and would eke out the powder by reducing the quantity in cdeb feed. By this time lactation had ceased and malnutrition lid’ inevitable. In my experience the vast majority of African women could breast-feed their children adequately, and mamuinuo". although common after weaning, was rare in brea-:e; children. St. James’ Hospital, Balham, London SW12 8HW. F. J. C. MILLARD