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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 25 Aug 2000 20:41:58 -0500
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I have had concerns for a while about the wisdom of LCs linking themselves
too closely with retail.  I know that the retail/rental income often floats
the boat so that we can afford to stay in the clinical end of things, and
that the vast majority of us bend over backwards to perform our duties
ethically when it comes to equipment provision.  However, the public has
every right to be jaded and suspicious about profit motive.  Indeed,
physicians are grappling with this issue (stories in the press about ethical
complaints against dermatologists selling skin care products, etc).  On the
one hand,  what better provider than a person who understands the product
well, but on the other hand, it creates an APPEARANCE of conflict.  In
ethics, appearance of conflict of interest  is something to avoid as
assiduously as the reality of conflict.  Chiropractors are still struggling
in some communities to over-come the appearance of caring more about selling
hundreds of dollars worth of supplements to the unwary.

  In many ways, there is no cleaner way to proceed than for LCs to primarily
divorce themselves from direct sales and refer people to stores or medical
supply houses.  It would be ok by me for this to be a store or rental
station located in the hospital or outpatient clinic, so the LCs could be
asked about operating instructions.  However, I think the LCs shouldn't be
the ones to sell the stuff.  The seller can be trained to hook up a pump
correctly, and trained to refer appropriate questions to the professional.
The LC certainly can recommend and describe the best product to chose, but
she can be trusted to be displaying  the most dispassionate clinical advice
to her patient/client by being uninvolved with direct sales and any profit
ensuing from the purchase of the device.  I absolutely agree that it is
tacky and akin to "ambulance chasing" to allow anyone to sell anything to a
patient in her bed.  While it might be argued that sick people could profit
from nutritional advice, we don't allow the dieticians in the room marketing
their private dietetic counseling services or selling vitamins to vulnerable
patients.

To have a company rep suggest a plan of action is bound to be more in the
area of advantage to the rep and the company than to the consumer.  That's
just good business for them.  If we bite on that, we become as much the
unpaid marketing reps as other health care workers who shill for formula
reps who sweet talk them with freebies and promises of making life "easier"
for the moms.

One of my friends told me that some months ago they heard a radio talk show
host whose wife had a baby remark about seeing an LC.  Now, since anyone can
call themselves an LC, I have no idea what that actually means, but the guy
said, on air,  that LC must stand for "Lotsa cash" because they'd spent a
fortune on "stuff".  This sort of remark is like a knife in my heart.  I
understand the reality of having to make a living.  As a person who has
always practiced privately, I have to consider economics as well as ethics,
but the two are not mutually exclusive.  In fact, if we ever lose the
confidance of consumers we will quickly learn the difference between the
fast nickle and the slow half dollar.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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