Well, since Rachael posted her note about me "joking" to LactNet, guess I
need to post my response.


>> Sorry folks, I have to pipe in.  I don't know *any* pediatricians or family
>> physicians who actually want children to get sick so they can make more
>> money!!
>> <snip>
>> --
>
>No offense to anyone, but I understood Katherine Dettwyler to be joking when
>she wrote that pediatricians were happy to benefit from the additional
>illnesses caused by formula.  You were joking, weren't you, Katherine?


No, Rachael, I WASN"T joking.  Of course they will never say this to the
patient's face, but the history of collusion between the doctors and the
infant formula industry is well documented, and doctors have "known" for
years of the effects of formula use.  They come up with all sorts of
reasons/justifications why they still advocate formula: not wanting mothers
to feel guilty, not believing the scientific research, leaving it up to the
parent's choice, etc.  But the bottom line is, it is well-known among
medical researchers that breastfed babies are healthier.  Think about who
benefits financially when kids get sick.  The doctors and the drug
companies.  Doren Fredrickson (M.D., Ph.D. in epidemiology) wrote a
wonderful "Commentary" for the book on breastfeeding that I just finished
co-editing, in which he analyses the economic impact of formula use and
talks about how managed-care (HMOs, capitated care systems) should realize
how much more money they will make when women breastfeed and really start
promoting breastfeeding to their patients.  As opposed to doctors in private
practice, HMO/capitated-care system doctors make money by keeping patients
healthy and preventing the necessity of care, so they should be highly
motivated to encourage breastfeeding.  It used to be that HMOs were really
into quit-smoking campaigns because it saved them money if they could
prevent cancer, heart disease, emphysema, etc.  Then their big customers
started hopping HMOs from year to year to get the best deal (this year
Kaiser, next year Blue Cross, etc.) and the HMOs realized that all the money
they spent on quit-smoking programs would end up benefitting some other HMO
-- whichever one the patient belonged to when she or he was older and either
got sick if they were still smoking or didn't get sick if they had quit.
SO, the HMOs stopped funding quit-smoking campaigns because they weren't
cost-effective.  They started them to realize savings for themselves, not
out of concern for their patients, and they stopped them as soon as they
realized their patients would be someone else's patient when it came time to
realize the savings from better health.  On the other hand, as Dr.
Fredrickson points out, programs to encourage breastfeeding will probably
generate their biggest savings in the year following birth, when the baby
doesn't have to come into the HMO for multiple ear infections, allergies,
rashes, upper respiratory and gastrointestinal infections, etc.  So HMOs
should be highly motivated to do these programs as the savings are more
tangible and immediate (before the family has switched to another HMO).
Anyone who thinks doctors are not in business to make money is extremely
naive.  Why do they think plastic surgeons encourage women to think that
their perfectly normal breasts are "too small."  Why have there been such
huge scandals over doctors who invest in independent laboratories, and then
require all sorts of unnecessary lab tests for their patients.  Sorry to
burst anyone's bubble, and again, of course there are many doctors out there
who are noble and altruistic and put the patients' welfare above all else,
but many do not.  Doctors in private practice win both ways by pushing
formula -- they get direct benefits from the formula companies and they get
more business.  Likewise, the U.S. hospital lobby has argued against the
"Baby Friendly Hospital Initiative" because it requires no free giveaways of
formula to new mothers.  Why do the hospitals care one way or the other?
Because the formula companies not only give the hospital all the free
formula they can use, plus cases to send home with each mother, they ALSO
give the hospitals money for new wings, money for continuing education
classes, money for supplies and equipment.  This is BIG BUSINESS folks.  We
have a hospital locally that continued to give out a particular pacifier to
every new mom even though they knew very well that it interefered with
breastfeeding even more than the other brands of pacifiers.  Who supplies
these particular pacifiers to the hospital to give away?  The infant formula
company (NOT the pacifier company).  The infant formula company knows very
well that this particular pacifier is their ally.  I will stop now.


Rachael's partner in rabble-rousing,
Katherine A. Dettwyler, Ph.D.
Associate Professor of Anthropology, Texas A&M University
e-mail to [log in to unmask]