Bonny writes:


>
>Because the prescription oral antifungals are marketed directly to the
>public (ostensibly so that the patients/clients can advocate for their own
>treatment options) it is easy to imagine that they are pretty benign
>substances.


Not the case here. Prescription meds are not allowed to be promoted
direct to the public.

Bonny, I think you are being sympathetic to the prescriber, but maybe
a bit too kind! In the UK, flucanazole is not licensed for lactating
mothers, but it is licensed for infants, in quantities which are far
higher than would appear in the breastmilk. I really don't see the
evidence of seeking out of knowledge and information. Many, many meds
are prescribed off-license in the UK, but docs won't do this with
fluconazole because pain on bf  is not considered to be serious,
because the mother can just wean to formula if she is that bothered
about it.  We also have problems getting docs to treat asymptomatic
babies for thrush.

Gentian violet is not an option in the UK. The only way I can bring
the topic up is when a mother is desperate I tell her that it's
widely used in the US and elsewhere, and I direct her to the
Internet. I have never had a mother who has used it, though.

>
>voice in the wilderness. Very few prescribers are going to risk their
>licenses and malpractice records on the exhortations of the one lone voice.
>If a patient gets hurt, juries are notoriously unimpressed with that kind of
>justification for treatment. That's just the way things are in medicine
>today.


Things might be different in the US, but doctors are hardly ever sued
in the UK, or even reprimanded.  I am not exaggerating when I say a
doctor usually has to sexually assault many women, or kill several
people by incomptence or negligence or criminality, and also be
extremely  unpleasant and rude to his (it's usually 'his') colleagues
for several years before anything serious  is done by the authorities.

I agree with Bonny's suggestion that getting another practitoner
involved seems to help. I  suggest to women that they share the
information with their midwfe or health visitor who can then discuss
the prescription with the GP...then the GP might bend (note: mothers
see GPs for themselves and their babies here. Paediatricians and
gynaes do not get involved in primary care).

Heather Welford Neil
NCT bfc Newvcastle upon Tyne UK

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