Integrity in doubt

The latest scandals have left a question mark over something that's rarely been in doubt before - the integrity of foreign manufacturers of baby formulas.

In reality, the story may go back further than many imagined. Sales reps for foreign infant formula brands have been "working with Chinese hospitals and doctors right from the start", according to Sui Xiangyu, a milk powder dealer in Beijing who has been in the business for more than a decade and has earned a reputation for being outspoken.

"Back in the 1980s, Chinese people barely knew about formulas, let alone foreign brands. These companies opened up the Chinese market by cooperating with the hospitals," he said. "First, they made the doctors believe in the formula and then reached the parents through the doctors."

At first glance, nothing seems amiss, given that infant formula, although not comparable with breast milk, is widely regarded as the best supplement and, in many cases, substitute for it.

But as an increasing number of foreign brands started to make inroads into the burgeoning Chinese market, a number of unseemly twists and turns emerged.

"The rapid growth of the Chinese market, allied to the fierce competition among the foreign brands, has forced many people to trade their professional ethics for a larger share of the pie," said Sui, referring to the fact that China's infant formula market, currently valued at $12.4 billion, is expected to double by 2017.

"The bait these companies throw out to the medical professionals does not always come in the form of cash," he explained.

Qin, a Beijing-based pediatrician, who spoke on condition that her full name and medical institution were not disclosed, said the companies have shown "great caution or, one may say, cunning", when it comes to marketing their products via hospitals.

"Fully aware of the sensitivity of the matter, they've never acted in a foolhardy way, but have taken sensible, well-calculated steps," she said.

According to Qin, in addition to kickbacks, some powerful and well-connected brands have provided doctors with opportunities to speak at national or international conferences related to their field of research or have facilitated publication of their research papers in well-respected academic journals.

"For Chinese doctors, who usually receive 'red envelopes' containing a certain amount of 'thank you' money from patients, the promise of elevated status among their peers amounts to a much more tempting offer," she said.