Kelly said that I could forward this on to Lactnet. It is her report on the
presentation to doctors about supporting breastfeeding. She thanked everyone
for the feedback and help. 

 

So, y'all asked for feedback on how my breastfeeding talk went for the
pediatrics faculty here in Roanoke.
First, THANK YOU SO MUCH for your stories, and thoughts. They were a huge
help is putting this together and I couldn't have done it without you. Your
encouragement meant so much. I felt like I was speaking with the voice of
hundreds of breastfeeding mothers.
I felt confident in the way I created- I talked about the 10 steps to
becoming a baby friendly hospital- hoping in that talking about them I could
point out ways to improve on current practices. For example, when talking
about training all staff- I talked about physician training how it is
lacking and how to improve. I honestly have to say that I was a little
scared when I got up there. I didn't get a lot of nods, and I got no
questions, but on the positive note no one made any derogatory comments. The
feedback I got personally from one of the residents was that he learned
about benefits he hadn't been sure of and was shocked but liked the Dept of
health breastfeeding ad (the one with the mechanical bull) that I showed and
thought it was great. One of the professors told me she thought it was good.

However, I got a different story this morning from another professor...
So it started alright, he mentioned how physicians often give bad advice to
breastfeeding mothers and that should be improved, but then noted that some
women are "breastfeeding Nazis" who breastfeed to 3 or 4 years old. But
something even more disturbing came up. He said the reason that the hospital
I am currently training in is not a baby friendly hospital is because they
refuse to comply with The International Code of Marketing of Breast milk
Substitutes. "They give us $300,00-400,000 in formula and tube feeding. What
should we do? Pay for it? That is 6 nurses we would have to fire. Plus, when
talking about monetary savings of breastfeeding- that is to society, not our
institution."
I think it actually brings up a scary deeper issue about the way industry
(not just formula but pharmaceutical too) interact with physicians. I have a
few paragraphs from an article in the Annals of Internal Medicine from 2002
that I think speak to this:
"Recent studies and reports have examined industry influence on physician
objectivity and behavior (15, 16), particularly prescribing practices,
formulary choices, and assessment of medical information (3, 7, 17-25).
Physicians frequently *do not recognize that their decisions have been
affected by commercial gifts and services* (26) and in fact *deny industry's
influence* (3, 15, 17-22), even when such enticements as all-expenses-paid
trips to luxury resorts are provided (23). Research, however, shows a strong
correlation between receiving industry benefits and favoring their products
(23, 25, 27)."
"The issue of industry gifts, hospitality, and subsidies arises as early as
medical school [it has for me] and residency programs (18, 20-22, 27,
38-42). Medical students and physicians in- training often have
opportunities to receive instructional materials [four weeks ago a drug
company came and offered free medical texts to residents that would have
cost them hundreds on their own], medical equipment [I've seen students with
reflex hammers, antimicrobial stethoscope covers and suture practice
material] , or even educational dinner [I have been to 2 such dinners, they
would have cost at least $50 a plate had I paid for it and around 150
lunches] programs. While it is recognized that such arrangements can benefit
the medical education experience and that
medical students and residents have unique financial [we are all poor and
with loans] and work circumstances [we are expected to be at the talk where
the drug company is providing lunch (even if the drug company is not doing
the talk) and not given an opportunity to eat if we don't eat there], it is
also necessary to note that medical training includes instruction on
professional ethics, including appropriate relationships with industry
[false]. Medical students, physicians-in-training, and practicing physicians
should apply the same ethical standards to their interactions with industry
(43)."
(the whole article is here free)
 <http://www.annals.org/cgi/reprint/136/5/396.pdf>
http://www.annals.org/cgi/reprint/136/5/396.pdf
So, I think part of the problem is not just formula and its influence but it
resides within a larger context of pharmaceutical gifts to doctors and
institutions. And physicians are not going to change this relationship on
their own. It has too much personal benefit, and it was ingrained too early
in their training. I encourage anyone who feels strongly about these issues
to consider their stance as a consumer with your own health care provider.
You can educate yourself at  <http://www.nofreelunch.org/>
http://www.nofreelunch.org/
 <http://www.amsa.org/prof/pharmfree.cfm>
http://www.amsa.org/prof/pharmfree.cfm  <http://www.healthyskepticism.org/>
http://www.healthyskepticism.org/ These
are all the same things we have learned about formula companies on a wider
scale. And it is scary. I have realized what it could do to me, and how I
have been wrong to accept the things I have. So from now on I pledge to
you:
I Kelly Beeken am committed to practicing medicine in the best interest of
my clients and on the basis of the best available evidence, rather than on
the basis of advertising or promotion. I therefore pledge to accept no
money, gifts, or hospitality (including but not limited to food, vacations,
etc) from the pharmaceutical industry; to seek unbiased sources of
information and not rely on information disseminated by drug companies; and
to avoid conflicts of interest in my practice, teaching, and/or research.

Kelly Beeken
Doula, Childbirth Educator, Lactation Educator and Medical Student
UVA SMD 08

 


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