The campaign, which aired advertisements promoting breast-feeding from 2003 to 2005, was toned down after formula industry representatives hired lobbyists to influence the department. One of the ads created for the campaign featured a nipple-tipped insulin bottle and said, "Babies who aren't breast-fed are 40% more likely to suffer Type 1 diabetes." Some of the proposed ads also featured photos of asthma inhalers topped with rubber nipples. Instead, the campaign ran ads that showed images of dandelions and cherry-topped ice cream scoops to highlight how breast-feeding could help prevent respiratory conditions and obesity.The House Committee on Oversight and Government Reform is investigating whether former Surgeon General Richard Carmona was barred from participating in the breast-feeding advocacy project and if people working on the campaign were overruled by superiors (Kaiser Daily Women's Health Policy Report, 8/31).According to Orent, formula industry lobbyists "pressured" the department to "weaken" the campaign, "even though the science supported" the campaign's message. Orent adds that the "health of millions of infants" now is "at risk because mothers don't have the scientific knowledge the ads would have conveyed to make an informed choice between breast- or formula-feeding.""Formula cannot "compete, nutritionally or immunologically, with something produced by eons of natural selection and tailored to the precise needs of human infants and their mothers," Orent writes. She adds that formula companies "deftly reframed the debate" on breast- or formula-feeding to be about "choice." Women "should feel angry" that they were not told, "in some clear, graphic and unmistakable way, what the health risks of formula-feeding are," Orent writes, concluding that the "terrible thing" is that the government "for political and economic reasons chose -- and still chooses -- to keep that knowledge to itself" (Los Angeles Times, 9/30).

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The study is the first of its kind to estimate the avoidable costs if a serious effort were made to improve Americans' health. Assuming modest improvements in preventing and treating disease, Milken Institute researchers determined that by 2023 the nation could avoid 40 million cases of chronic disease and reduce the economic impact of chronic disease by 27 percent, or $1.1 trillion annually. They report that the most important factor is obesity, which if rates declined could lead to $60 billion less in treatment costs and $254 billion in increased productivity.

Looking even further ahead, the report measures the possible cost to future generations if escalating disease leads to lower investments in education and training. In a snowball effect, the report warns, this loss of human capital and skill building could reduce the nation's economic output by as much as $5.7 trillion in real GDP by the year 2050.

In addition to providing national numbers, the report ranks all 50 states by the reported number of these diseases per capita. According to the Milken Institute State Chronic Disease Index, West Virginia, Tennessee, Arkansas, Kentucky and Mississippi have the highest rates of chronic disease . Those with the lowest rates are in the West: Utah, Alaska, Colorado, New Mexico and Arizona.

To reduce the human and economic cost of disease, the Milken Institute calls for: milkeninstitute/