April 12, 2008

DT Headline Update: The International Breast Milk Project Is Also The Milk Supplier For Prolacta Bioscience

ibmp_logo.jpgprolacta_logo.jpg

The ABC News report yesterday on the International Breast Milk Project actually didn't lead off with their donations of breast milk to HIV/AIDS orphans in Africa. Instead, it began with a domestic tragedy, the tale of Kim Sciulli, who gave birth to her daughter Isabella almost three months early, then died suddenly of postpartum cardiomyopathy, a rare, pregnancy-related heart attack. As Isabella struggled in the NICU,

...[family] friends contacted the International Breast Milk Project, a group of mothers who donate their breast milk to orphans in Africa.

The project then connected the Sciullis with another organization that was able to provide milk for Isabella.

"Another organization"? I didn't even notice the phrase yesterday. But after a night of Googling around, I would be shocked if "another organization" is anything besides Prolacta Bioscience, the venture capital-funded, for-profit breast milk banking company which is the major supporter of the IBMP, and which has a contract to buy 75% of the breast milk donors provide. [high five to dt reader Lee for flagging the connection.]

Milk banking is great and important, and the more breast milk that's available for whoever needs it, the better, whether they're NICU babies, formula-intolerant babies, adoptees, or African orphans. And I'll be damned before I pass judgment on any parent who buys breast milk to help his kid.

But first Oprah, and now ABC News have done glowing stories on the IBMP without mentioning the charity's inextricable relationship with a biotech startup that is seeking to create significant value for its investors by commercializing the historically non-profit trafficking in human breast milk.

Prolacta/IBMP's Fresh Embrace Of Transparency
Before having any remotely meaningful discussion of the Prolacta/IBMP relationship, we all have to read Jennifer Laycock's extensive posts from last summer on her blog, The Lactivist:
May 22, 07: Is The International Breast Milk Project a Scam?
Jun 3, 07: Update on Prolacta and the International Breast Milk Project
Jun 5, 07: My Thoughts on the Prolacta / International Breast Milk Project Arrangement

While the IBMP now clearly explains to milk donors that 75% of their milk will be sold to Prolacta for $1/oz., and that that money--$133,000 in 2007--is used to fund other health initiatives in Africa, The Lactivist posts make it clear that such transparency was not the case before last June. Not only was Prolacta's involvement in IBMP apparently obscured or undisclosed until donors received their shipping materials, there was also a significant, undisclosed chance that none of a donor's milk would actually be shipped to Africa by Prolacta/IBMP at all. It was only in an email that IBMP explained how much milk would be shipped--"5,000 ounces twice a year"--and anything beyond that would "go to" premature infants in the US, i.e., be sold, "to enable additional donations to Africa."


"Give us your milk, and we'll sell it to preemies for $35/oz!"
Flip this around for a second. If you were starting a company that pharmaceuticalizes and productizes human breast milk, you would need to secure a steady supply of raw material. The bigger your market got, the more milk you would need. But you can't pay for it; there's already a well-established, non-profit milk bank network across the country, with a national organization, the Human Milk Banking Association of North America, setting safety standards and principles that don't permit the for-profit sale of human milk.

duelling_milkbanks.jpg

The best/only way you could generate an attractive, steady supply of product is with a compelling appeal to donors' altruism. Which the competition--non-profit milk banks--already do, too. So first, you set up a generic-seeming milk bank network of your own that doesn't acknowledge its for-profit status. [Though Prolacta is named as a sponsor and the phone number is located in Monrovia CA, Prolacta's headquarters, the owner of the milkbanking.net domain is deliberately obscured.] And then for successful commercialization, you locate the target of donors' charitable impulses outside of your actual market.

[And speaking of outside the market, does collecting, processing, and shipping American breast milk to Africa even make sense philanthropically? Wouldn't it be far more effective and sustainable to develop a local milk bank infrastructure, using local womens' milk? Or to put wet nursing education programs in place, particularly where the risks of HIV transmission are so high? Is it cause for concern that IBMP's financial initiatives in Africa are not related to developing either local breastfeeding education programs or safe, local milk banks?]


Targeting the NICU Market
While non-profit milk banks serve all babies and parents who need milk--and when they have enough, they even provide milk to adult cancer patients--at the moment, Prolacta is actually only targeting the most potentially lucrative segment of the breast milk market: the NICU.

Prolacta's goal--at it was described by one of its major investors, at least--is to "seek to fundamentally change the way that babies are fed in the NICU." In addition to pasteurized breast milk, Prolacta sells fortified, concentrated, and calorie-pinpointed human milk products that could at once put them in direct competition with mothers' own milk, and might be the most compelling argument for their existence. If NICUs develop specific treatments and protocols around them, Prolacta's pharmaceuticalized products could displace mothers' milk, which might be deemed too variable for reliable use. Is that an acceptable decision for the NICU, where we're already talking about extraordinary medical interventions to save babies who otherwise have no chance of survival? Fine, then let the neonatal medical community have that discussion, and see the results of Prolacta vs. mother's milk vs. milk bank.


What's The Market?
In the last couple of years, as the milk banking concept has gained momentum, Prolacta has really stepped up its presence by raising $12 million in two rounds of funding by Silicon Valley giant Draper Fisher Jurvetson and several other VC's. Though she's still with the company, the founder doesn't have a seat on the board, which is composed entirely of VC reps, plus the two blood plasma industry executives brought in to run the show. The company has filed an application for a remarkably broad-looking patent for a system of collecting and distributing human milk.

Here are some metrics for sizing up the market opportunity: The HMBANA's banks delivered around 750,000 ounces of milk in 2005, a 28% increase over 2004. That could be over 1 million ounces in 2007. According to IBMP's 2007 financial statements, they had 43,000 ounces of milk on hand at the end of 2007, and sold 143,000 ounces to Prolacta. Presumably, that doesn't include the 50,000 ounces delivered to Africa. So right out of the gate, Prolacta's controlling between 15-20% of the donated human milk market.

The non-profits charge $3/oz to recoup their processing costs. Prolacta charges up to $35/oz., though I have to imagine their straight milk is more competitive. Their CEO said product costs can run from $100/day--about the same as the non-profits--to around $250/day. For an average length of stay [ALOS] in the NICU of 30 days, that can be a $5-8,000 sale. With over 500,000 premature births in the US each year, you can start to see the theoretical size of the pie.

Client hospitals get free fridges and equipment as well as support for setting up a milk donor system--and they earn money based on the milk they bring in, a practice the HMBANA now explicitly opposes.

I've got no dog in this race; as a recovering private equity guy from the tech industry, I'm not kneejerk anti-Prolacta, even if they did go to HBS instead of Wharton. The reality is, until the new money came in in 2005-6, the company seemed to be as sleepy and slow as the rest of the cottage-like, milk bank field. If research bears out the efficacy of Prolacta's product vis a vis current NICU options, fine. But except for The Lactivist, I haven't found any discussion of milk banking that isn't completely tainted with either undisclosed self-interest or emotional manipulation. And for all the good IBMP may be doing in Africa or wherever, they're part of the misinformation problem.

9 Comments

It's like the wet nurses the wealthy had before the 20th century. You know insurance companies aren't going to want to cover this, not at the for profit rates.

Wow... I sent that story link figuring it would just be a way to get Uma on the front page again. Turns out I stumbled on a vast international conspiracy! Do I need to watch my back... perhaps I should rent that Woody Allen movie with the giant breast, so I'll know what to watch out for.

Seriously, though... awesome detective work.

Ditto, Robert B.

If I weren't so brain dead from my own K2, I may have been inclined to do some of the research you banged out in record time.

Your excellent work will permit me to overlook the crack about HBS (my employer!).

Lee

This is a difficult issue, no? The most significant point for me is the idea of shipping actual milk to Africa. Shipping costs, especially assuming the milk needs to be refrigerated, can't be cheap, and via the whole local food movement we understand that the environmental costs of shipping food are ridiculously bad for the entire planet.

Shipping educational resources (and monetary donations) to Africa, on the other hand, can't be terribly expensive.

Perhaps we would all be better off eating locally, including babies in NICU. Had I been given the opportunity back when I was (plentifully and dramatically over-) lactating to donate milk to a local hospital's NICU, I absolutely would have done so.

Keeping breast milk non-profit seems to me to be the best idea.

As a donating mother to International Breast Milk Project I have a few points to make regarding you post that I think need to be explained as I do not think you are accurately or fairly portraying the organization. I feel this is a wonderful cause that new moms need to have correct and clear information about if they are looking at the option of donating their breast milk. Only then can they make a clear choice on whether to donate or not.
Firstly, you state "it was only in an email that IBMP explained how much milk would be shipped--"5,000 ounces twice a year"--and anything beyond that would "go to" premature infants in the US, i.e., be sold, "to enable additional donations to Africa." This information is incorrect as of May 31st, 2007 55,000 ounces of milk had been sent to Africa and there is an upcoming shipment of 55,000 ounces that will be sent before the end of the month. The founder provided me with this update.
Secondly, International Breast Milk Project clearly states in their FAQ that they first attempted to partner with the system of non-profit milk banks. The non-profits were very supportive but graciously declined for various reasons. Prolacta is the only company in the world that can provide the services and funding to the organization needs to benefit healthcare for infants in Africa.
Secondly, Prolacta's product is approx. $23 (they do not even put a price on it per ounce since it is not equivalent) versus $3 for breast milk but it is 10X fortifier - which means that it can not be compared price wise or ounce wise to breast milk. The product is concentrated to the ratio of 10 ounces of milk equals 1 ounce of Prolacta fortifier.
Finally, I am not one to usual write on blogs but enough is enough. This organization is doing amazing work one baby at a time. It is true that sending breast milk can seem very backward if local solutions could be created. But at the moment there are 3 million orphans in sub-suharan Africa and 20-40% of mothers are HIV positive. With this large number of HIV positive mothers in Africa and the growing numbers of orphans - local banking would not be able to sustain the need and the project is trying to work on that gap.
Additionally, International Breast Milk Project is funding local initiative to provide long term sustainable development in Africa. Their website clearly states (FAQ) the past and current projects they are funding
I will continue to donate to IBMP until I am done breastfeeding my baby as I feel their mission is absolutely amazing. Their partnership with Prolacta provides extremely safe milk to Africa and made the donating process very easy for me.
In a perfect world infants in Africa would not need my breast milk or all my donated milk would go to Africa but in today's world it needs to be tested, mothers need to be screened and milk needs to shipped - all of which costs an enormous amount of money.

[I will give you the benefit of the doubt that you are as you claim, just a donor--and that your Rochester, MN IP address and your unusually detailed knowledge of Prolacta's pricing and product specifications, which I couldn't find reported anywhere (the $35/oz price was a quote from the SF Chronicle) is typical of involved donors, and does not mean you are an IBMP or Prolacta official misrepresenting herself in any way.

The statement about the email and the 5,000 is a direct reference to The Lactivist's first post. If it's not clear enough above that this was a reference to the ambiguity and obscurity of IBMP/Prolacta before The Lactivist raised the issue, then I'll repeat it here. Obviously, IBMP made a concerted effort last summer to clarify its goals and its relationship with Prolacta, which is to be commended.

The issues you raise about the most effective ways to help an obviously dire situation are worthwhile ones, and the tradeoffs and compromises well-intentioned people make could very well be worth it; it's a decision every donor must decide for herself, and IBMP's decision to be more upfront about how much donor milk is commercialized helps make those choices. But the issues of commercialization and IBMP's involvement in procuring raw materials for Prolacta's supply chain are worth discussing, too. If pharmaceuticalization of breast milk offers significantly better treatment, Prolacta should step up and make that argument. If the non-profit milk banks are too inconsistent or unreliable to support NICU protocols, then make that case, too. But if non-profit milk banks balked at the idea of shipping 350 oz. of leftover milk to Africa when they had immediate need right there in front of them, or if sustainable, non-profit-model African milk banks could be outfitted for the same or less money/effort/time, then the question of why they aren't deserves an answer. -ed.]

i am also an IBMP donor mom...thanks for correcting all of the misinfo in the article.here is a bit more...

100% of the milk before may 31st went to africa accourding to IBMP website - that is 55,000 ounces on prolacta's tab. quite a chunk of change and we should be encouraging pharma companies to do things like this vs. criticizing them and making wild accusations.

also pretty pale to suggest that IBMP was started deliberately by Prolacta to provide charity outside of their market. i would like to see one "ounce" of proof on that.

if you don't want to add to the misinformation out there and before you go around accusing "charities review council" audited non-profit organizations, you should also get your facts right.

[Frankly, it's debatable whether donating and shipping breast milk from the US to Africa in such small quantities--sorry, but the quantities are quite small compared to the scale of the problem the previous donor laid out--at such great expense should be encouraged, or if there's an exponentially more effective way of developing local, sustainable support systems for these kids. But it's hard to debate when the sponsoring organizations obscure their motives and involvement. I have yet to see anyone refuting IBMP and Prolacta's initial vagueness about how much milk is going where and when and for how much money. Or is there evidence or a definitive account refuting the information on The Lactivist about this topic? Their prominent push of their "audited" status now could be interpreted as an attempt to bury or at least make up for their initial misleading--or at least unclear--practices.

I can't tell what you're referring to when you say "100% of milk before May 31st." If that's 2008, then the expected 55,000 oz shipment will be happening before May 31st. If you're talking about May 31st 2007, that shipment was not 55,000 oz., but either 5,000 or 10,000 oz., according to Jill Youse's statement. IBMP's "unaudited" financial statements for 2007, linked above, show they sold 137,000 oz. to Prolacta, though, a relationship and ratio that was only made clear after The Lactivist first raised questions about IBMP.

As for suggesting Prolacta "started" IBMP, I did nothing of the sort. I merely pointed out that it is to Prolacta's strategic advantage that the "target of donors' charitable impulses," i.e., African orphans, are not potential paying customers. If you bother to read the post as carefully as I wrote it, you will note that the initial criticism is directed toward ABC, which reported on two seemingly unconnected stories--the IBMP's, and the domestic use of breast milk therapy in NICU--without identifying the connection, which I believe was Prolacta. If it's not, then someone come forward and refute me, and I'll correct it. But if it is, then ABC is complicit with the IBMP in not clearly identifying where Prolacta's commercial activities start and IBMP's worthy charity efforts begin. Meanwhile, if you have any actual "facts" to correct, I'm always ready to consider them. If you're just spinning and denigrating my legitimate questions by calling them ungrounded accusations, then you can report back to IBMP/Prolacta that you've done your job. -ed.]

I am a milk donating mother who happens to live in Rochester, MN. I find your necessity to look up IP addresses and post my location both inappropriate and petty. I have had the pleasure and honor of meeting and speaking with Jill Youse, the founder and executive director of International Breast Milk Project. She is the one who informed me of the wonderful opportunity to donate breast milk that her organization had set up for new mothers like myself The reason I know so much about IBMP and milk donating issues is that I did my research as I was embarking on becoming a donor and Jill was very open at providing me with answers to any questions I had regarding the donating process and her organization. Which is something that I recommend you do rather than posting inaccurate information. She is very accessible and from my experience would be more than happy to answer any questions that you may have. She provides her contact information on the International Breast Milk Project website
You are disseminating incorrect information and I will one last time try to provide your readership with the correct information for them to make up their own opinion about IBMP.
You stated “I can't tell what you're referring to when you say "100% of milk before May 31st." If that's 2008, then the expected 55,000 oz shipment will be happening before May 31st. If you're talking about May 31st 2007, that shipment was not 55,000 oz., but either 5,000 or 10,000 oz., according to Jill Youse's statement”
It is very clear from IBMP’s FAQs that :
What percentage of milk was shipped to Africa prior to the partnership with Prolacta which became effective may 31, 2007?
100% of all of the milk collected prior to May 31st, 2007, was shipped to Africa in October 2007, which totaled over 55,000 ounces. All of this milk was collected and processed by Prolacta Bioscience pro-bono.

It is also made very clear to any potential donating mother that International Breast Milk Project has partnered with Prolacta as the donating online interview makes each potential donor check a box which states a percentage of milk going to Africa and a percentage going to Prolacta for the use in premature babies in the US. There is no way someone would be donating milk and not aware of this issue. This was implemented as soon as IBMP partnered with Prolacta.
Finally, I know that donating my milk is not going to solve the current crisis in Africa but the 20 minutes a day I spend pumping extra milk to send over allows me, a new mom in Rochester, Minnesota, to feel like I can make a small difference in a child’s difficult start to life. You can discuss all the other options available and talk about the ethics of this versus that but at the end if a baby in Africa gets to drink 4 ounces of my milk than I will keep on pumping and hope other mothers do the same!

[thanks for your corrections, which don't differ in any way from the information I quoted and sourced. Meanwhile, your reference to the "partnership" with Prolacta that "became effective" on May 31, 2007 could easily be misinterpreted as the beginning of Prolacta's involvement with IBMP, which is inaccurate at best. You do not dispute, I assume, the substance of Prolacta's involvement now, which boils down to a supplier agreement whereby 75% of IBMP donor breast milk is sold to Prolacta. PBMP is right and admirable to have made this relationship clear to its donors after May 31, 2007. But the initial criticism I had of the IBMP story on ABC still holds: namely, that there was no disclosure or discussion of Prolacta's involvement at all. It's something that matters to far more people than just IBMP's donors; it also affects donors to non-profit milk banks, and any parent who might find himself in need of breast milk for his baby, whether in a NICU or out of it. So your sense of well-being about donating milk to an orphan in Africa, while valid and even admirable, is not the only thing worth considering; IBMP's effectiveness in channeling and maximizing that altruistic impulse is absolutely worth questioning.

As for your IP information, the numbers you cited about Prolacta's pricing and the concentration of their formula differ from or are more specific than published reports. That made me wonder what your source was. While it is rare for Daddy Types to post a critical post about a company or organization, when it does happen, it is surprisingly common for executives or other affiliated parties to misrepresent themselves, their connection or their interest when they submit comments. Under the circumstances, making a reference to your automatically logged IP information strikes me as entirely appropriate. -ed.]

Yes - the information that I provided in my previous post DOES DIFFER from the information that you quoted and sourced which is incorrect.
You wrote “ if you are talking about May 31st 2007, that shipment was not 55,000 oz., but either 5,000 or 10,000 oz”. This is incorrect as 55,000 ounces were shipped not 5,000 or 10,000.
Additionally I emailed Jill Youse regarding the issue of Prolacta and here is what she emailed me back (very clear and received within 2 hours of me emailing her!)
“In Fall 2007, when our I originally approached Prolacta about processing our milk, we had 10 donors. Prolacta generously agreed to process 100% of the milk for us at no charge. Prior to approaching Prolacta, the other milk banks in the US were asked to help and declined. Prolacta was the only company that decided to help us make a difference, asking nothing in return, no PR, no mention on our website, absolutely nothing.
When we grew at a rate unexpected by anyone in either organization, I had to ask Prolacta to do even more. Prolacta agreed to process 100% of the milk at no charge to donors or International Breast Milk Project up until May 31st, 2007. This means Prolacta donated everything up until this date when we were able to make the announcement of our new partnership that would ensure a steady source of funds to International Breast Milk Project to help accomplish our mission to provide donor breast milk to infants in need and improve health care in developing countries.
During the months of rapid growth, from around November 2007 through May 31st, 2007, International Breast Milk Project stated on its website that a percentage of the donated milk would remain in the US and that Prolacta would donate the processing of 5-10,000 ounces of donor milk per year. This ended up being incorrect. Prolacta donated the processing of 6 times the original amount International Breast Milk Project requested.
60,000 ounces and 100% of the milk collected through May 31st, 2007 went to infants orphaned by disease and poverty at iThemba Lethu in Durban, South Africa, not the original 5-10,000 ounces that was stated on our site.
Once International Breast Milk Project and Prolacta had a clear partnership, announcements were placed on the website and donors are now required to check a box stating that they understand the partnership. This ensures that highest levels of communication. I am extremely proud of our relationship with Prolacta and happy to offer donor moms the opportunity to have their donor milk reach both infants orphaned by disease and poverty in Africa AND the most critically ill infants in the US through Prolacta’s Human Milk Fortifier. “ (Jill Youse)

Regarding the ABC story, if I remember correctly the story was about Baby Isabella and the incredible tough journey she and her father were going through. How about focusing on the real issue of the story and what this father had to say.

I think that your duty as owner of this blog to make sure that all the criticism you post and disseminate is not only valid but worthwhile for the cause. Your negativity about IBMP and lack of valuable options does nothing for mothers who are contemplating donating milk. I in no way feel that IBMP is the only option for donating ones milk but it was the right option for me.
It amazes me that a good cause like this can get criticism from anyone! I hope that your blog will at least have the effect of making people aware of the opportunity to donate their breast milk whether it be at their local milk bank or IBMP!!!!
Finally, I do not think that it was in any way appropriate for you to reference my location and I would think that as the owner and creator of this blog
you would have better judgment and professionalism.

["not the original 5-10,000 ounces that was stated on our site." Sorry, I guess I was wrong because I quoted what was on the IBMP site, and on contemporaneous reports and communications from The Lactivist. As for researching and evaluating your sock puppet status, you're entitled to your opinion, but I stand by my practice. You have amply demonstrated your close involvement with IBMP and Youse, which is forthright enough. My email's right at the top of the page, too, so she was not constrained to use you as a proxy in this debate; that's her choice. As for the ABC story on Baby Isabella and her father, Is it incorrect that the connection between IBMP and their touching tale is Prolacta? The commercial breastmilk company that IBMP is so proud to partner with? Because THEIR INVOLVEMENT WAS EXPLICITLY LEFT OUT OF THE STORY.

And as for my criticism encouraging or discouraging women from donating milk, I highly doubt it will have much effect. It's a choice every woman can make for herself, and as I stated at the outset, I will not be critical or dissuade or question any parents' attempts to provide or procure breast milk for their baby. That said, I have not seen compelling evidence that anyone should donate to either IBMP or a commercial program like Prolacta, at least compared to a non-profit milk bank. IBMP's efforts seem wildly inefficient compared to the benefit--however real--it provides. And the inextricable link to the commercialization of breast milk donation is an ethical position I can't support, at least without evidence of Prolacta's superior medical performance. Beyond any speculation about what it says about the mission's efficacy that no other milk bank organization would help IBMP, the milk bank association has officially taken the position opposing the commercialization of breast milk. These are all issues for potential donors to consider, and saying so should only make for clearer decisions. Unless you have some more ad hominems, I'm done. -ed.]

I am Baby Isabella's aunt. You write about Prolacta's commercialization of breast milk as if this organization is just money hungry. What you may not realize is that Prolacta donated (yes, donated...meaning "provided without charge") milk to Isabella for almost 2 months after her mother's death. They did this without requesting any sort of income information from her father. They don't know if he is poor, middle class, or wealthy. They did this without requesting recognition. Our family will forever be grateful to Prolacta for giving this gift to our beautiful Isabella. It was an awesome tribute to her mother, a true believer in the power of breastmilk.

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