AMERICAN ACADEMY OF PEDIATRICS
SECTION ON BREASTFEEDING

Date: December 20, 2002

To:     Members, AAP Board of Directors
        Eileen M. Ouellette, M.D., J.D
        Robert M. Corwin, M.D.
        Alan E. Kohrt, M.D.
        David T. Tayloe, M.D.
        Ellen Plummer Buerk, M.D.
        Kathryn Piziali Nichol, M.D.
        Gary Q. Peck, M.D.
        Jon R. Almquist, M.D.
        Burton F. Willis, M.D.
        Charles W. Linder, M.D.
President:  E. Steven Edwards, M.D. 
Executive Director:  Joe M. Sanders, M.D.

CC:     Carden Johnson, M.D.
    Louis Cooper, M.D.
    Roger Suchyta, M.D.

From: AAP Section on Breastfeeding - Executive Committee & Leadership Group

Subject:  New Mother's Guide to Breastfeeding

    While we appreciate the opportunity of meeting with Dr. Sanders, Dr. 
Suchyta and members of the Board of Directors at our Section Executive 
Committee session in Boston, we must express our disappointment with the 
content of the discussion, the outcome of the meeting and lack of clear 
resolution of the issues.  Considerable discontent remains among not only the 
Executive Committee and Committee Chairs, but section members and members of 
the breastfeeding community within and outside of the AAP membership.  We 
feel that you were not responsive to our concerns and did not fully 
understand the depth of concern that we have with how this matter was handled 
and continues to be handled.  You have not demonstrated an understanding or 
concern that the reputations of the editor of the book, Dr. Joan Meek, and 
those of us who are contributors to the book have been compromised.  No 
apology or effort at remediation has been forthcoming from the Academy 
leadership to us or to the breastfeeding community.  Similarly, there seems 
to be little recognition of the harm that has come to the Academy's 
reputation as a leader in the field of breastfeeding and child health nor any 
effort to repair that sullied image of the Academy.

    The plan presented to us for the next set of books to be purchased by 
Ross, if they choose to do so, with their name and logo again on the front 
cover, albeit with a statement that the book is a "gift from Ross" was made 
without any input from the authors or members of the section and is not 
acceptable.  We request the opportunity to enter into open discussions about 
other ways in which Ross could be acknowledged.  This dialogue is consistent 
with the "first step in establishing a collaborative relationship…" as stated 
in the AAP Policy Manual Chapter V, Page 6.  The same policy manual 
recommends that the name or logo of the commercial organization "be placed, 
when possible, either on the inside cover or the back cover of a 
publication." (Page 4)  Negotiations that include Ross (or other commercial 
enterprises), our leadership group, and Academy leadership may produce 
alternatives upon which we can all agree, such as a book wrapper.  The AAP 
Policy Manual also states that "When the product (in this case infant 
formula) is relevant to the program (breastfeeding) special care must be 
exercised in the recognition language and placement to avoid any implied AAP 
recommendation or endorsement of the product."  

At this time, we would appreciate receiving in writing:
1)  a description of the plan for future sales of the New Mother's Guide to 
Breastfeeding to Ross or any other commercial purchasers.  
2)  a plan regarding commercial sales of all publications which the Section 
on Breastfeeding would produce in the future.  Two of these publications (the 
Physicians' Handbook and the Slide Set for Teaching) are underway, but will 
not be finalized until we know how the issue of sales will be handled.  
These statements in writing would provide an opportunity for discussion, not 
final decisions.  We feel strongly that this is a matter which should be 
decided through discussion with the Section leadership and the authors of the 
publications.   This document may serve as a model for other committees and 
sections of the Academy, many of whom have similar concerns and have 
expressed support for our position in this matter.

    Many members of the Section on Breastfeeding, and others within and 
outside of the Academy, have expressed sufficient concern about this issue 
that they have said they are considering resigning from the Academy.  We have 
urged them not to take that path, but to remain in the Academy as an active 
force for breastfeeding advocacy.  Overt actions on the part of AAP 
leadership to demonstrate a commitment to the principles of ethics in 
marketing and responsible collaborative relationships with corporate sponsors 
are needed now to reassure our membership.

We were encouraged to hear from several board members that there was 
discussion of preparing a general document on commercial relations for member 
and public use.  We urge that this new document be developed with open input 
from all interested AAP members.

    Each of us looks forward to receiving more information from each of you 
regarding these issues and to meeting with you for discussion of these 
matters.  We want the American Academy of Pediatrics remain a respected 
advocate for breastfeeding and we are prepared to make every effort to work 
with all of you to assure that this occurs.

            Leadership Group - Section on Breastfeeding
American Academy of Pediatrics

    Executive Committee
                Lawrence M. Gartner, M.D., Chair
                Audrey J. Naylor, M.D., Dr.PH
                Linda Sue Black, M.D.
                Ruth A. Lawrence, M.D.
                Donna O'Hare, M.D.
                Richard J. Schanler, M.D.

                Liaisons
                Nancy F. Krebs, M.D.
                    (Committee On Nutrition)
                Alice Lenihan, MPH, RD, LDN
                    (National Assoc. of WIC Directors)
                John Queenan, M.D.
                    (Am. College of Obsteticians & Gynecologists)

                Committee Chairs
                Mary Dobbins, M.D.
                Arthur I. Eidelman, M.D.
                Lori Feldman-Winter, M.D.
                Larry Pickering, M.D.
                Susan Landers, M.d.
                Yvette Piovanetti, M.D.
                Nancy Powers, M.D.

                    
Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA

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