Well, since Rachael posted her note about me "joking" to LactNet, guess I need to post my response. >> Sorry folks, I have to pipe in. I don't know *any* pediatricians or family >> physicians who actually want children to get sick so they can make more >> money!! >> <snip> >> -- > >No offense to anyone, but I understood Katherine Dettwyler to be joking when >she wrote that pediatricians were happy to benefit from the additional >illnesses caused by formula. You were joking, weren't you, Katherine? No, Rachael, I WASN"T joking. Of course they will never say this to the patient's face, but the history of collusion between the doctors and the infant formula industry is well documented, and doctors have "known" for years of the effects of formula use. They come up with all sorts of reasons/justifications why they still advocate formula: not wanting mothers to feel guilty, not believing the scientific research, leaving it up to the parent's choice, etc. But the bottom line is, it is well-known among medical researchers that breastfed babies are healthier. Think about who benefits financially when kids get sick. The doctors and the drug companies. Doren Fredrickson (M.D., Ph.D. in epidemiology) wrote a wonderful "Commentary" for the book on breastfeeding that I just finished co-editing, in which he analyses the economic impact of formula use and talks about how managed-care (HMOs, capitated care systems) should realize how much more money they will make when women breastfeed and really start promoting breastfeeding to their patients. As opposed to doctors in private practice, HMO/capitated-care system doctors make money by keeping patients healthy and preventing the necessity of care, so they should be highly motivated to encourage breastfeeding. It used to be that HMOs were really into quit-smoking campaigns because it saved them money if they could prevent cancer, heart disease, emphysema, etc. Then their big customers started hopping HMOs from year to year to get the best deal (this year Kaiser, next year Blue Cross, etc.) and the HMOs realized that all the money they spent on quit-smoking programs would end up benefitting some other HMO -- whichever one the patient belonged to when she or he was older and either got sick if they were still smoking or didn't get sick if they had quit. SO, the HMOs stopped funding quit-smoking campaigns because they weren't cost-effective. They started them to realize savings for themselves, not out of concern for their patients, and they stopped them as soon as they realized their patients would be someone else's patient when it came time to realize the savings from better health. On the other hand, as Dr. Fredrickson points out, programs to encourage breastfeeding will probably generate their biggest savings in the year following birth, when the baby doesn't have to come into the HMO for multiple ear infections, allergies, rashes, upper respiratory and gastrointestinal infections, etc. So HMOs should be highly motivated to do these programs as the savings are more tangible and immediate (before the family has switched to another HMO). Anyone who thinks doctors are not in business to make money is extremely naive. Why do they think plastic surgeons encourage women to think that their perfectly normal breasts are "too small." Why have there been such huge scandals over doctors who invest in independent laboratories, and then require all sorts of unnecessary lab tests for their patients. Sorry to burst anyone's bubble, and again, of course there are many doctors out there who are noble and altruistic and put the patients' welfare above all else, but many do not. Doctors in private practice win both ways by pushing formula -- they get direct benefits from the formula companies and they get more business. Likewise, the U.S. hospital lobby has argued against the "Baby Friendly Hospital Initiative" because it requires no free giveaways of formula to new mothers. Why do the hospitals care one way or the other? Because the formula companies not only give the hospital all the free formula they can use, plus cases to send home with each mother, they ALSO give the hospitals money for new wings, money for continuing education classes, money for supplies and equipment. This is BIG BUSINESS folks. We have a hospital locally that continued to give out a particular pacifier to every new mom even though they knew very well that it interefered with breastfeeding even more than the other brands of pacifiers. Who supplies these particular pacifiers to the hospital to give away? The infant formula company (NOT the pacifier company). The infant formula company knows very well that this particular pacifier is their ally. I will stop now. Rachael's partner in rabble-rousing, Katherine A. Dettwyler, Ph.D. Associate Professor of Anthropology, Texas A&M University e-mail to [log in to unmask]