Want To Promote Breastfeeding? That's A Trade Barrier, Says US Trade Rep
from the milk-of-human-kindness dept
As most people know, babies who are breastfed from birth enjoy a wide range of benefits. Here’s what the United Nations Children’s Fund (Unicef), a global organization with nearly $5 billion of funding, has to say on the topic of breastfeeding:
It has profound impact on a child’s survival, health, nutrition and development. Breast milk provides all of the nutrients, vitamins and minerals an infant needs for growth for the first six months, and no other liquids or food are needed. In addition, breast milk carries antibodies from the mother that help combat disease.
…
Breastfeeding also lowers the risk of chronic conditions later in life, such as obesity, high cholesterol, high blood pressure, diabetes, childhood asthma and childhood leukaemias. Studies have shown that breastfed infants do better on intelligence and behaviour tests into adulthood than formula-fed babies.
Formula milk, by contrast, can actively harm babies:
Formula is not an acceptable substitute for breastmilk because formula, at its best, only replaces most of the nutritional components of breast milk: it is just a food, whereas breast milk is a complex living nutritional fluid containing anti-bodies, enzymes, long chain fatty acids and hormones, many of which simply cannot be included in formula. Furthermore, in the first few months, it is hard for the baby’s gut to absorb anything other than breastmilk. Even one feeding of formula or other foods can cause injuries to the gut, taking weeks for the baby to recover.
The case for breastfeeding, and against formula milk, seems pretty clear. But a new publication from the Office of the United States Trade Representative (USTR), the “2017 National Trade Estimate Report on Foreign Trade Barriers” (pdf), begs to differ. As a post on the Public Citizen site explains, the USTR calls out several countries for promoting breastfeeding over formula as a “technical barrier to trade” that might harm the profits of US industries. These are some of the polices that the USTR wants eliminated:
Hong Kong: The Report criticizes a Hong Kong draft code, designed to “protect breastfeeding and contribute to the provision of safe and adequate nutrition for infants and young children.” USTR labels the policy as a technical barrier to trade due to its potential to reduce sales of “food products for infants and young children.”
Indonesia: USTR labels a draft regulation in Indonesia that would prohibit the “advertising or promotion of milk products for children up to two years of age” as a technical barrier to trade.
Malaysia: USTR questions Malaysia’s proposed revisions to “its existing Code of Ethics for the Marketing of Infant Foods and Related Products” that would restrict corporate marketing practices aimed at toddlers and young children.
Thailand: The report critiques Thailand for introducing a new regulation that would impose penalties on corporations that violate domestic laws restricting the “promotional, and marketing activities for modified milk for infants, follow-up formula for infants and young children, and supplemental foods for infants.”
Although “technical barriers to trade” sound like a minor issue, they lie at the heart of modern trade deals. Traditional tariffs are now relatively low in many parts of the world, which means that the hard part of trade negotiations is often these “non-tariff barriers” (NTBs). Indeed, it was in large part a failure to agree on the removal of NTBs that caused the TAFTA/TTIP talks to grind to a halt, and then end up in limbo when the Trump administration took them over.
The USTR’s attack on policies that promote breastfeeding over formula milk may seem extreme. But they are typical of the way the USTR views the world primarily through the optic of boosting the profits of US companies, with no thought to the harms this may inflict on people in other nations as a result. No wonder that trade deals are viewed so negatively in many parts of the world.
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Filed Under: breastfeeding, trade agreements, trade barrier, ustr
Comments on “Want To Promote Breastfeeding? That's A Trade Barrier, Says US Trade Rep”
What more
What more can those boobs in D.C. do before we finally say enough is enough. I know there are many suckling at the government’s teat, but we needs must cut off their supply, they are just draining us dry!
Re: What more
what you just said is a trade barrier against the USTR! you SHOULD be promoting corporate developed trade formulas, not naturally occurring trade deals!
but think of the childen….. no, think of the profits!
By the same logic, they should be working to prevent men from eating oysters as an aphrodisiac. Cuts into Cialis sales. Even Dali couldn’t create something this surreal.
i would have thought that the best thing would be to tell USTR to go fuck itself! what a fucking cheek! telling other countries, yet again, what can/cant be done because of the effect on the USA! is any notice ever taken of what the USA does and how that affects the economy or business interests of other countries? no! definitely not! so what’s good for the goose is good for the gander, as they say!!
Re: Re:
Were it only so. The issue that needs addressing is that the goose pays and the gander doesn’t, and looking for ways to get the gander to pay the goose so there is more pay available is an ultimate goal.
Re: Re:
I expect that Hong Kong will respond with its own tit for tat trade action.
Isn’t this morally similar to medical equipment manufacturers complaining about mandatory seat belt laws?
Re: Re:
I would think medical equipment manufacturers would be pro seat belt laws. If you’re wearing your seatbelt when you crash, you’ve now a hospital patient. If you’re not wearing your seatbelt, you’re much more likely to be a corpse.
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Which sets up a battle between medical equipment companies and mortuary companies? I don’t know which is more profitable, but one has a larger user base.
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Well, mortuaries are places that most people visit once; hospitals are places that the wealthy visit repeatedly.
What really needs to happen is mortuaries need to figure out a way to ensure repeat business.
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somewhat related: How A Mississippi Funeral Home Showdown Freaked Out The White House
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I can see it now. An international medical equipment corporation sues the US government under ISDS to abolish cemeteries, on the grounds that ‘wasting’ internal organs rather than making them available for transplants cuts into their profits.
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From what you’re saying then, the seat belt issue would cause a big political fight between hospitals and morticians.
Re: Re: Seatbelts
In related news, casket manufacturers and undertakers demand repeal of seatbelt and airbag laws as sales are down due to fewer accidental deaths.
Home breastfeeding is killing trade!
If you’re not feeding on formula milk, you’re feeding on communism.
Re: Home breastfeeding is killing trade!
Are you just going to let Mothers have a monopoly on the baby feeding market? Let the free market decide what to feed the baby.
/s
It’s good to see the USTR aligning itself with the values one of the most perniciously evil companies, Nestle. https://en.wikipedia.org/wiki/Nestlé_boycott#Baby_milk_issue
I wish we could boycott the USTR.
Closest analogy
The closest analogy would probably be to try to outlaw home gardens because they’re cutting into sales from corporate farming. Unfortunately, the ways things are going, they’ll get around to that sooner or later – probably sooner the way things are going.
Re: Closest analogy
Not being a home gardener I am curious if it is possible to plant a home garden without buying seeds from Monsanto or one of their competitors? I hear they patented some naturally occurring plants in Africa not too long ago. Is there any agriculture left that these companies do not control?
Re: Re: Closest analogy
Yes; among home gardeners, “heirloom” seed is making a huge comeback. This is varieties that haven’t been tweaked by Monsanto and friends. It’s more expensive, often isn’t doped, and has a high failure rate, but you can plant from it, and you can harvest its seed at the end of the season to re-plant the next planing season.
I’ve been home gardening my entire life, and have some seeds that have an ancestry that predates Monsanto — scarlet runner beans I got in 1979 from someone who got them who knows where, that still happily grow year after year.
Re: Closest analogy
It’s more like banning laws that restrict tobacco companies’ ability to advertise based on public health concerns—they aren’t cracking down on mothers breast feeding (which would be pretty much impossible anyway), they’re saying that governments shouldn’t have the ability to impose policies that restrict the potential profits of US companies, even if those policies are based on sound public health reasons.
That’s obviously awful and inhumane, and as a fellow coward points out above, seems designed to let shitheels like Nestle manipulate new mothers into unhealthy, unsustainable, but highly profitable (for the company) situations. But it’s also hard to argue that a restriction on a company’s ability to advertise isn’t a trade restriction. By that standard, the USTR is right.
Of course, by many other standards (like morality, common decency and humanity), arguing that governments shouldn’t have the ability to regulate markets if those regulations might impact profitability is downright evil. But it seems like most of the US government chose to side with profit over people a long time ago.
So...
Are US federal drug laws an unfair trade barrier, because they restrict the ability of foreign pot distributors to sell their product in the US?
Ivanka Trump was booed recently while onstage at a presentation for women in the EU. Angela Merkel was sitting with her. Ms. Trump was quoted saying that her father was a great hero or advocate for women and/or for familes, or something similar. She was booed by women in the audience for this palpably false claim. I wish this story about breast milk being a “trade barrier” had been available for Ms. Merkel, when she prodded Ms. Trump about who she represented (her father, the government, or her business interests???).
Re: Re:
It is very likely that this report is a normal annual report that is based on policies put in place by previous administrations. Mr Gresser, the lead name on the document, was hired during the Obama years.
Wonder if other countries consider the US limits on import of prescription drugs a trade barrier?
Do agree that on the surface this seems like a rather stupid position to take given the amount of medical studies on the benefits of breast milk.
These charlatans are clueless
When protecting US sales became more important than (foreign) baby health is the minute the US(TR) made itself quantité négligeable.
After their Special 301 report was publicly denounced by Canada, it’s just another step towards complete obsolence.
Meanwhile, in the United States...
Below is an excerpt from an article published in the American Academy of Pediatrics journal. It references a "spate of recent work" that challenges the ethics of those promoting (and the extent of the benefits of) breast feeding.
As the TD article describes, the various baby formula corporate stakeholders are using these trade agreements’ non-tarrif barriers in an attempt to increase their profits at the expense of the public good. I think it’s very likely that the "spate of recent work" referenced in the AAP article below is a reflection of similar efforts (of those same stakeholders) within the United States.
Unintended Consequences of Invoking the “Natural” in Breastfeeding Promotion
http://pediatrics.aappublications.org/content/137/4/e20154154
"Medical and public health organizations recommend that mothers exclusively breastfeed for at least 6 months. This recommendation is based on evidence of health benefits for mothers and babies, as well as developmental benefits for babies. A spate of recent work challenges the extent of these benefits, and ethical criticism of breastfeeding promotion as stigmatizing is also growing. Building on this critical work, we are concerned about breastfeeding promotion that praises breastfeeding as the “natural” way to feed infants. This messaging plays into a powerful perspective that “natural” approaches to health are better, a view examined in a recent report by the Nuffield Council on Bioethics. Promoting breastfeeding as “natural” may be ethically problematic, and, even more troublingly, it may bolster this belief that “natural” approaches are presumptively healthier. 0_o
Re: Meanwhile, in the United States...
So the word “natural” seems to bother them, where it’s absolutely 100% indisputably true that breastfeeding is “natural”. And worse, they have to quote the word “natural” in order to disparage it as well.
Re: Re: Meanwhile, in the United States...
Well of course. They, (companies, whom the USTR represents), “naturally” want you to buy their products and “naturally” increase their profits. So “naturally”, this is a good thing for them.
Oh? You thought that an entity whose only purpose for existence is to make ever increasing profit actually cares about what it’s impact on the world is? Well, boy are you wrong. “naturally” they don’t give a crap beyond next quarter, and will “naturally” bail out with golden parachutes when the thing goes south. Then they will “naturally” go the next company and do it all over again. The areas they affect cannot do that and have to clean up after them, but that is “naturally” what happens once the profits have dried up.
If you still can’t tell, “naturally” here means “greed”. Paint the USTR in that light, and you might just get a better understanding of them.
You have to draw a line
I think it’s important to draw a clear line between merely promoting something and making a business illegal – including advertising.
I don’t see how promotion of breastfeeding is a trade barrier – billboards, public service ads, school education, etc.
But a law that says a seller of isn’t allowed to advertise their product? I agree – that’s a trade barrier.
If terms like "trade barrier" are going to mean anything legally, there needs to be a clear definition. Passing laws that prevent people from doing business seems like a reasonable place to draw a line.
Re: You have to draw a line
I totally agree with you that that’s a great place to draw the line defining a trade barrier, and by that definition,
But then the question becomes, should certain trade barriers be allowed? Should banning a tobacco company from advertising to minors be allowed, even though it is a barrier to tobacco companies? What about banning their advertising, period, or restricting packaging designs, or mandating labels? How about stricter emissions regulations?
The thing is, most public-interest regulation only exists because it isn’t being incentivized by a free market—almost by definition, regulations will limit profitability in some way. So yes, define trade barriers clearly, make it something that can be discussed reasonably, and make it clear that the important question is whether there is an international right to corporate profitability that trumps sovereign nations’ right to regulate markets in the interest of public health and safety,
Re: Re: should certain trade barriers be allowed?
My answer is simple – consenting adults should be allowed to trade with each other, on the condition that they compensate any 3rd parties who are indirectly harmed ("externalities").
So, I’d say it’s fine to limit advertising to minors, but not to adults.
And it’s fine to prohibit deception and force, because people trading under those circumstances aren’t consenting.
And it’s fine to make polluters pay a tax to compensate for damage done by the pollution.
But it’s not fine to tell consulting adults they’re not allowed to trade with one another.
My position has nothing to do with the interests of corporations or of profitability – I start from the idea that human rights include the right of consenting adults to trade with each other.
So long as there’s no deception involved, and no force.
Re: Re: Re: should certain trade barriers be allowed?
Fair enough. I definitely see where you’re coming from. Personally, I think that the power imbalance between individual consumers and large multinational corporations skews the market to a significant enough degree that public policy is needed as a corrective, even if puts limits on the right to trade–basically that the imbalance is a sort of coercive force in its own right.
That said, I’d much rather have pro-breast milk efforts than anti-formula ones, which seems to be what the USTR is cracking down on here.
Re: Re: Re:2 power imbalance between individual consumers and large multinational corporations
Thanks for the thoughtful reply.
I think a lot of political disagreement between thoughtful and sincere people boils down to this idea of "power imbalance".
I just don’t see it. I certainly see that monopoly creates power imbalances.
But outside of monopoly, if I don’t want to do buy from, or sell my labor to, business A, I just move on to one of their many competitors B, C, or D. In a competitive situation, one of the competitors is bound to offer more attractive terms, to the extent that’s economically possible.
Obviously if I’m looking for something impossible – to buy gold bars at $1/ounce or sell my labor for $1,000,000/hour, nobody is going to offer me that – because in every trade between consenting adults, both sides need to feel they’re ahead on the deal, or one of them walks away.
So I don’t see the origin of any "power imbalance". As long as both sides are consenting adults, not acting under force or deception, then both sides must believe any trade they make benefits themselves. Otherwise they’d walk.
Regardless of how large or small either party is.
Re: Re: Re: should certain trade barriers be allowed?
I think the issue here, and I agree, is deception. Formula companies promote, advertise, what ever word you want to use, their formula as “just like breastmilk” or “similar to mother’s own milk”. It is not at all like human milk. Standard cow’s milk based formulas are made from cow’s milk. Soy based formulas are made from soybeans. Most other formulas are derived from those or chemically made. They are not human milk. When you advertise your product (formula) is just like “human milk” and it is not, that is deceptive advertising.
USTR isn’t wrong that these countries’ policies are trade barriers, even if their motives -profit- are upsetting. What about consumers who actually need formula? Not every mother can nurse successfully; some mothers may need to take medication that would be unsafe for their infant. What if the mother places her infant for adoption, or passes away? Parents should have all of the scientifically accurate information available, as well as access to the products that they need or want. The limitations on marketing prevent these companies from reaching consumers who may need or want their products. We all know breast is best, why do we need the government to protect us from the alternatives (regardless of which country we are a citizen of)? I have no doubt that many people crying foul over USTR would have a fit at a business that paid women to provide breast milk and sold it for a profit. Profit is not the enemy, free trade promotes peace far more than sanctions.
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The issue is that the USTR want’s to stop people from telling people that so that some corp can make more profit. That’s the government telling people to stop telling people that breast is best. If the business of selling natural breast milk was big enough, then the USTR would have a fit about the canned stuff. The problem is business over anything else, including the welfare of the people.
Re: Re:
While there are people who do need to use formula, there is still no need to advertise it. Their doctors, lactation consultants, public health nurses, social workers, adoption agencies, and all the other people who are assisting those women should know about formula if somehow a parent manages to be so unaware of the world that they haven’t heard of it before. Medically necessary products shouldn’t be advertised because only people who need them should be using them and they should have the appropriate support systems to tell them about it rather than having a company try to create additional customers through advertising even though they are harming those new customers.
See also: Why the U.S. drug system is fucked up.
USTR
Well correct me if I’m wrong, but it has been my impression that only direct descendants of His Most Satanic Majesty, i.e. Lucifer, can even be considered for the “job” of USTR.
In that light, the USTR’s anti-breastfeeding jihad is perfectly consistent.
Depending on the specifics of Hong Kong’s legislation, the USTR may just have to bend if they want access to those potential consumers; the policy isn’t described very clearly, but it appears that they promote and facilitate breast feeding. The other nations mentioned above all have policies regulating (ie limiting) the advertisement of formula and baby food.
I don’t want to defend big pharma, but not all of their marketing is evil or harmful to the consumer. Ever suffer from persistent acid reflux, get a few free samples from your doctor to try, and finally get some relief from one of those products? I have, and that marketing allowed me to try a few expensive medications without having to pay for the ones that didn’t work, like the older ones that I had bought over the counter. Now most of those same drugs are available over the counter (it was quite a few years ago) and I can clip coupons to use with my purchase, that’s more marketing. If marketing is severely limited, or even prohibited, like in Indonesia, consumers are not able to obtain free samples or coupons. And because formula is not tolerated by infants like breast milk, the industry has developed numerous formulations to meet the demands of the consumers; Indonesia’s consumers have to buy each kind at full price until finding the right one. How is that protecting consumers?
And what’s more, who decided that mothers should be forced to breast feed, and if that is not possible that government social workers and pediatricians- those supportive services- should be the ones deciding what kind of formula a parent is allowed to feed their infant? That means that instead of advertising and promotional offers that the consumer evaluates,companies are making campaign contributions and flying pediatricians to tropical islands for “formula summits”.
Now I can’t get on board with USTR complaints about using the term “natural”, but that’s because I’m against them rigging the market in their own favor as well. Free markets. Free choices.
(Are my Libertarian colors showing?)
breastfeeding
No comment on the actions of the USTR, but referencing that UNICEF doc on the pros of breastfeeding vs the evils of formula was sloppy.
Breastfeeding might be marginally better in health outcomes, but it’s by no means as clear cut as UNICEF or the OP make it seem.
https://sciencebasedmedicine.org/are-the-benefits-of-breastfeeding-oversold/
http://www.skepticalob.com/2016/02/which-saves-more-lives-in-the-us-formula-or-breastmilk.html
many more references at the above links
Re: breastfeeding
Whether that is true or not the promotion of breastfeeding should not be treated as a trade barrier.
Criminalizing non-tariff barrier activities?
Somewhere in the USA, corporate lobbyists are gathering and secretly making plans to criminalize non-tariff barrier activities. Which will lead to the following warning:
Use a tit, go to jail. It’s the law!
Not a presidential issue...
This is NOT new US policy, even if the language — buried as it is in a huge
report — is now more aggressive. Updated annually, this document has kept much of the same language from year to year and contained similarly concerning remarks regarding countries that are protecting breastfeeding by restricting the marketing of food products for infants and young children before Mr.Trump took office. (see below)
The problem is not presidential; rather, it is twofold:
1. Primarily, the United States’ lack of acceptance of and adherence to the WHO International Code of Marketing of Breastmilk Substitutes “The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.” — Article 1 of the Code
2. And secondarily, in order to protect their commercial interests, formula companies employ powerful lobbyists who have significant influence and are very successful at what they do.
Below are the paragraphs in question from the 2016 (under Mr. Obama) and 2017 (under Mr. Trump) documents.
Hong Kong
2016:
The Hong Kong government published a draft Code of Marketing and Quality of Formula Milk and Related Products and Food Products for Infants & Young Children (Code) in October 2012. If implemented as currently drafted, stakeholders are concerned that the Code, together with related legislative proposals, would pose significant trade barriers to manufacturers and distributors of imported infant and follow-up formula. The United States is continuing to engage with the Hong Kong government on this measure, including with respect to whether it is more restrictive than relevant international standards.
2017:
The Hong Kong government published a draft Code of Marketing and Quality of Formula Milk and Related Products and Food Products for Infants and Young Children (draft Code) in October 2012, and is in the process of finalizing the draft Code. If the draft Code is implemented as originally drafted, U.S. stakeholders maintain that, together with related legislative proposals, it will have significant negative impacts on sales of food products for infants and young children, and is more restrictive than relevant international standards. The United States is continuing to engage with the Hong Kong government on this draft measure.
Indonesia:
2017 (new section not present in 2016 version):
Indonesia Food Law Implementing Regulation
Indonesia’s food and drug regulatory agency, the National Agency of Drug and Food Control (BPOM), has issued a draft regulation, the “Government Regulation Concerning the Label and Advertisement of Food,” to implement provisions of the Law 18 on Food of 2012. Among other things, the regulation would prohibit advertising or promotion of milk products for children up to two years of age, as well as any functional claims to children under three years of age. The regulation also would severely restrict interactions with health care providers, and the draft contains additional restrictions, including a ban on advertising for alcohol and stringent requirements for nutrition labeling. It is unclear when Indonesia intends to finalize this regulation. The United States has asked Indonesia to notify the measure to the WTO TBT Committee before finalizing the regulation.
Malaysia:
2016:
Infant and Follow-up Formula Products
Malaysia’s Ministry of Health has proposed revisions to its existing Code of Ethics for the Marketing of Infant Foods and Related Products, which includes restrictions on the use of trademarked brand names and symbols on product labels or packaging, as well as restrictions on educational, promotional, and marketing activities for infant formula products and products for toddlers and young children. The United States continues to follow the issue, and has raised questions about the evidence Malaysia used in developing the proposed measure.
2017:
Infant and Follow-up Formula Products
In 2014, Malaysia’s Ministry of Health launched an effort to revise and expand its existing Code of Ethics for the Marketing of Infant Foods and Related Products (“Code of Ethics”). The proposed revisions
include restrictions on the use of trademarked brand names and symbols on product labels or packaging, as well as restrictions on educational, promotional, and marketing activities for infant formula products and products for toddlers and young children. The United States has raised questions about the evidence Malaysia used in developing the proposed measure. The draft Code of Ethics is not likely to be finalized until after the first quarter of 2017.
Thailand:
2016:
The United States has raised concerns with Thailand about a draft measure related to infant and follow-up formula products. Thailand’s Draft Marketing Control of Food for Infant and Young Child and Related Products includes additional restrictions on the use of trademarked brand names, packaging, symbols, and educational, promotional, and marketing activities for modified milk for infants, follow up formula for infants and young children, and supplemental foods for infants. The United States has asked for the rationale and scientific evidence that support the proposed measure, as well as the extent to which the measure is based on international standards, as the current draft is more restrictive than relevant international standards, specifically the Codex Alimentarius Commission and the World Health Organization Code of Marketing of Breast-Milk Substitutes. Where other countries in the region regulate marketing of breast-milk substitutes, the marketing restrictions generally do not apply to follow-up formula for young children over one year. After numerous requests, Thailand notified the measure to the WTO. The United States has submitted formal comments on Thailand’s draft and continues to communicate to raise the issue with the Government of Thailand.
2017:
Labeling Restrictions on Foods for Infants and Young Children (0-36 months of age)
In December 2015, following repeated requests from the United States, Thailand notified to the WTO its Draft Marketing Control of Food for Infant and Young Child and Related Products (“Milk Code”). This measure imposes restrictions on the use of trademarked brand names, packaging, symbols, and educational, promotional, and marketing activities for modified milk for infants, follow-up formula for infants and young children, and supplemental foods for infants. The restrictions cover infants and children up to 36 months of age and establish considerable penalties for violations of the Milk Code. In November 2016, Thailand notified to the WTO a revised draft measure that includes a penalty of jail time for advertising violations. Thailand forwarded the revised draft measure to the National Legislative Assembly for its consideration in the fall of 2016. The Assembly is still reviewing the revised measure, including the labeling and health claim prohibitions. The United States is seeking to ensure that Thailand’s final measure is developed transparently and takes into account appropriate scientific and technical information in order to avoid any unnecessary restrictions on trade.
Full text of the NTE Reports below:
2016: https://ustr.gov/sites/default/files/2016-NTE-Report-FINAL.pdf
2017: https://ustr.gov/sites/default/files/files/reports/2017/NTE/2017%20NTE.pdf
and furthermore...
have you ever wondered what the relationship is between the American Academy of Pediatrics and formula companies?
“Outside of advertisements and exhibits at its annual meeting, the AAP receives a total of $3.3 million each year from 4 formula companies, accounting for less than 3% of its annual budget. The funding supports the annual meeting and dissemination of initiatives developed by the AAP, including the Institute for Healthy Childhood Weight, Pediatric Care Online, and the Neonatal Resuscitation Program.”
See http://jamanetwork.com/journals/jamapediatrics/fullarticle/2624070 for the full article.