Dear L,

I am wistful for the breastfeeding talk that is not to be.  But I think you
came up with the best solution under the circumstances, and you deserve a
fuller explanation of my position.

In 1990, the United States signed the Innocenti Declaration.  In 1991, I
signed the Lactation Consultant's Declaration. In 1994, the United States
signed the World Health Organization's International Code of Marketing of
Breast-milk Substitutes.  None of these documents has legislative teeth in
this country, but  all represent an official position by the signer.  I've
enclosed copies or summaries of all three.

You said several times that this is the real world.  I couldn't agree with
you more.  And the real world is one of aggressive, skilled, high-stakes
marketing.  Years ago, the formula industry recognized that breastfeeding
would stage a comeback, and it prepared itself. In a 1980 article entitled
"Baby's milk: soft-sell success", a business writer wrote, "There can't be
many manufacturers... whose main advertising platform is to advise
customers to use a competitive product.  What's more, the competitive
product is free, and no one makes any profit at all.  But the paradox
doesn't end there:  advertising the competitor is very likely the shrewdest
and best way of promoting the product in question.  That product is baby
milk."

If you look at the literature these companies produce, you'll see that it
gives tepid support to breastfeeding, then makes sure the mother
understands that breastmilk-or-our-formula is superior to other brands or
plain cow milk.  All they have to do is sit back and wait for breastfeeding
to fail - as it usually does - and they have a new customer.  But they have
to be first in line.  That's where the hospitals come in.  And that's real
world.

Corporations in this country have an obligation to maximize profits for
their shareholders.  Everything they do is geared, directly or indirectly,
to their bottom line.  The formula companies are no exception.  If  formula
reps didn't generate more than their own income in formula sales each year,
they wouldn't be used.  A rep can't generate that kind of money from
Ricelyte or the specialized formulas.  But he has a large volunteer staff
to help him reach his ultimate market - the average woman who leaves a
hospital with a little voiceless consumer in her arms.

Hospitals stand for health - or that's what the public assumes.  So
hospital endorsement is taken very seriously.  If the surgical unit
distributed, say, Nabisco literature, and sent patients home with little
packets of shredded wheat, don't you think patients would assume shredded
wheat is a healthy choice?   The hospital doesn't do this, of course,
because that would represent product endorsement.  (Although if it agreed
to do so, I'm sure it could get huge supplies of free shredded wheat!)
People are free to choose formula, just as they are free to choose shredded
wheat - or even tobacco.  But they should do so without believing their
health care providers have endorsed their choice.  Especially when the
product represents a negative health choice.

We lag behind the rest of the world, but hospitals in this country are
increasingly reluctant to participate in formula marketing.  (That's why
marketing through doctors' offices has become more aggressive in recent
years.)  A few have severed commercial ties altogether, are putting that
energy into breastfeeding education and support, and are seeing their
breastfeeding rates and durations respond.

I'm too naive to know for sure when Madison Avenue is using me.  Like more
and more health care providers around the world, I know my best defense is
to keep my independence.  Thank you so much for helping me find a graceful
way to do so.  And I look forward to doing a talk for you in the future!

Warmly,
Diane Wiessinger

P.S.  The text of either of the following is fine with me, for a postcard
to be mailed to all those who received the flyer for the April 23
conference:

Through a miscommunication, Diane Wiessinger, MS, IBCLC was recently listed
in conjunction with an formula company-sponsored event.  In support of the
World Health Organization's International Code of Marketing of Breast-milk
Substitutes, Ms. Wiessinger does not accept formula company monies or
gifts.

Diane Wiessinger, MS, IBCLC, was listed on a recent flyer as a speaker at a
formula company-sponsored event.  In accordance with the World Health
Organization's International Code of Marketing of Breast-milk Substitutes,
Ms. Wiessinger accepts no formula company funds or gifts.
******
Thanks to Linda Smith and Maureen Minchin for their direct contributions to
this letter - the quote is from an article cited by Maureen in "Infant
formula:  a mass, uncontrolled trial in perinatal care" Birth 14(1): 25-35
March 1987 - and to every one of the lactnetters whose indirect
contributions are woven through it.