(Warning:  fairly long post...skip if tired of topic!)

Liz B- Thanks for the cheers!

Liz D- I hope you know I am not criticizing you individually— you are
obviously an outstanding pediatrician, since you are here on LACTNET!

I completely agree that it would not be easy to stop accepting and handing
out free formula in a general pediatric practice today...mostly because it
is the "norm" currently. But I do think it is important to acknowledge that
we ARE marketing for formula companies when we do it. I believe a lot of
the resistance to changing our behavior about samples in the office is
simply resistance to change itself.  Change is always difficult.  And it is
currently the norm for doctors and nurses to hand out samples of formula in
the hospital and the office (in most areas of the US).  Moms expect it. We
are accustomed to having it.  On the surface, it seems to make our life
easier.  Formula companies make a dizzying, ever-changing array of types of
formula so they can pretend to market something "new" and "better".  But to
me, there is really very little difference. The protein source is either
cow, soy, hydrolyzed cow, or amino acids.  The sugar is corn syrup in most,
sucrose or lactose in very few. Different oils, then vitamins, minerals,
and the "additives" they like to market, like DHA/ARA, rice for spitting,
prebiotics, probiotics, etc. I know physicians are expected to provide
hours of anticipatory guidance and feeding information in 5 minutes at
well-child visits...but one option might be a handout explaining these
basic differences, or if they have internet access they can look at the
formula company propaganda directly, or you could consider fussiness (or
constipation or whatever) as an "illness", and ask mom to come back to
discuss that in detail later at a separate visit where you can be
reimbursed for your time?

Our view of what is normal and expected is completely skewed by our
personal experience.  A striking example is when I went from a general
practice of many formula-feeders and token breastfeeders to exclusively
breastfed and partially supplemented babies and the incidence of reflux and
eczema.  In my "old" practice, most babies spit up often, and most had
eczema to some degree.  I told all the moms it was normal and to ignore
it....that is what I was taught, and what was normal based on my
experience. But very few of the babies I see now spit up much and even
fewer have eczema...unless they are there to see me because of blood in the
stool or "colic" because of a food sensitivity.  So my view of "normal" has
really changed.

And I am convinced that someday in the future, formula WILL be viewed in
much the same way as cigarettes. When we value human milk enough to really
support moms in breastfeeding their babies for at least a year, and have
enough pasteurized donor milk in milk banks to provide for every baby who
needs it, we will look back at big pharma as a very similar villain to big
tobacco. Formula manufacturers are most definitely more interested in the
bottom line than the health of babies.


Kathy Leeper, MD, IBCLC, FABM
Medical Director
MilkWorks-nonprofit breastfeeding support center
5930 South 58th, Suite W, Lincoln, NE 68516
(402) 423-6402, FAX 423-6422,* **www.milkworks.org*<http://www.milkworks.org/>

*Creating a healthier community by helping mothers breastfeed their
babies....*
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