I find the discussion of the legalities/ethics/liabilities of lactation
consultants "prescribing" treatments to be very interesting.  In the US, we
are very focused on CYA medicine ("Cover Your Ass") and who might get sued
under what circumstances.  It is fairly clear-cut in the US which drugs are
OTC (over the counter), where anyone can just walk into their local drug
store or pharmacy or grocery store and buy them, and which drugs are
available "by prescription only" where you have to have a written slip of
paper listing the drug, the amount, and dosage schedule, signed by a person
with authority to issue such a prescription.   So, I can buy aspirin or
cough medicine or laxatives OTC, but if I want antibiotics or Zofran
(anti-nausea medicine), I must have a prescription.

In the US, many drugs are sold both OTC and by prescription, with the only
difference being the strength.  Zantac (an anti-stomach acid drug) can be
purchased either way.  The only difference is the strength.  If you take
twice the recommended dosage on the OTC drug, you have the prescription version!

Medical personnel are bound by all sorts of rules and laws, but lay people
don't have to follow those, both with respect to prescriptions and
confidentiality.  Thus, the doctor isn't supposed to discuss what was said
between him and the patient with anyone else, but the patient can tell
everyone they meet exactly what the doctor said (often to the doctor's
detriment).  The doctor may be the only one who can write the prescription,
but once the patient has filled it, they can give the medicine to anyone
they want.  As a lactation consultant, you may have to be careful how you
phrase things to clients, but their friends can recommend anything to them,
or even pass along prescription drugs.

Doctors may want to see new patients before writing prescriptions, but in
cases of ongoing problems, will often write refills or even new
prescriptions for patients over the phone, if they feel they can trust the
patient (or the parent).

In Mali, local people had to have a doctor's prescription to go into a
pharmacy and get medicine, but I -- as a "white person" -- could walk into
any pharmacy and get whatever drugs I wanted just by asking and paying for
them.  This is how I was able to treat schistosomiasis when it was diagnosed
as a result of my gathering urine and stool samples from children.  In the
US, that would be considered "practicing medicine without a license"
(illegal) and yet I felt it was unethical to test people for a disease and
then not offer treatment if they were positive.

Just my musings.

Kathy Dettwyler

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