Phyllis has mentioned that her hospital thinks that small gifts and lunches are a part of doing business. Of course they are! This is what specifically creates good feelings about the products! Small gifts (pens, note pads, coffee mugs) are what promotes a friendly and cooperative relationship between the formula salesman and the clinician. The size of the gift has no bearing on this cozy relationship. Small gifts engender the same need to reciprocate (look favorably upon infant formula) as do large gifts. See:
 
Katz D, Caplan AL, Merz JF. All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving. Am J Bioethics 2003; 3:39-46
 
There should be a policy that no clinician accepts anything from formula salesmen. Most of these salespeople violate the vendor policy of the hospital and create an environment that causes clinicians to violate the trust between health care provider and patient. Hospital employees usually have the option for conscientious objection to performing care that violates your ethical or moral principles. You have the right to refuse to accept these gifts, avoid attending any formula company sponsored education, and refuse to give out commercial discharge bags.
 
Waller-Wise R. Conscientious objection: do nurses have the right to refuse to provide care? AWHONN Lifelines 2005; 9:283-286
 
Marsha Walker, RN, IBCLC
Weston, MA
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