Magda, you are ever watchful; thanks for posting about the BMJ pieces and
responses about 'free lunch'.

The phrase about being seen to be independent is something I have lifted
from Magda and for me it is important.  I am a public employee; I am a
representative and servant of the government whose task is to provide a
service to the childbearing population.  That is why it is vital for me to
be seen as being independent - my interests must be coincident with the
public interest and not with a particular commercial agent in the equation.

If I worked as a pump rental agent, anyone could see that I was in a
financial relationship with the pump manufacturer and could reasonably
conclude that my goal would be 1) to provide a high-quality service while 2)
maximizing profit through the use of the products I was an agent for.  If I
were an ethical agent I would hope they perceived my priorities in that
order.

The problem arises, as I see it, if I am working as a lactation consultant
and using various products in my practice, and one or more source has some
kind of incentive for me to move their product, even if use of the product
is not the best care I know how to give.  It could be a matter of choosing a
lesser product over a better one because I have some financial incentive to
recommend the less good one, or it could be a matter of using a product when
another approach would have worked just as well and been cheaper for the
family.  As long as the relationship is not declared, and open to scrutiny,
there is potential for abuse.

Like Magda I am not talking about the judicious use of tools in appropriate
circumstances, but about 'the entwined embrace described by the BMJ'.  Our
endorsements are valued by commercial enterprises because they are worth a
lot of money.  We should probably exploit that fact more ruthlessly than we
do.
Rachel Myr
Norway

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