I've been following this discussion with lots of interest.  I have clipped
some of the pithy comments from various colleagues that show the breadth of
the discussion.

"...it is in the best interest of educating people about breastfeeding for an
IBCLC to be speaking..."
 Cher Sealy

"This debate alone means that control has been exercised over the
speakers--there are so many of us who would decline to speak--narrowing the
field of speakers drastically. ... As I see it, if a speaker has to search
her ethics in this way, control has been exerted....

"I think we need to contemplate how our choices on this issue effect bf'ing
in a broader way, not just at one event."
Jennifer Tow

"Speakers connected to breastfeeding who speak at a conference sponsored by
an artificial baby milk company cleanse the company's image, facilitate and
justify the promotion of their product....Any objections that you might write
or state verbally might be heard by those who are interested, but for the
most part this message will not be internalized by many of the participants. "
Keren Epstein-Gilboa

"I'm sure that if one refuses to speak because of formula co. sponsorship,
the message will never be heard by the audience."
Johanna Berger

"I happen to believe that the industry exerts tremendous influence when they
DON'T sponsor a meeting, too."
Jay Gordon

"... we wish to be an independent source of information, and .... it is
important not only to be independent, but to be seen to be independent."
Magda Sachs

"It may be the case that the formula company gains credibility, yet net good
for mothers and babies *can* come out of speaking, even at a conference
directly
sponsored by a formula company."
Kathy Dettwyler

Here are some of the issues as I see them.

1. Who is my audience?  Whom do I hope to reach with my message?
Potentially there are 4 or 5 audiences:
 the people sitting in the room at the conference; the organizers of the
conference; the Code-violating sponsors of the conference; plus my colleagues
in the breastfeeding world; and the general public.  I might make my decision
depending on which of these groups I think I can affect the best, or maybe
because I'll get a chance to reach a group that otherwise would never hear
me.  Even though between the IBCLC and the formula company it's a David and
Goliath situation, there could be a lot of merit in being David.

2. What do I know and when do I know it?
It's different making the decision after the contract is signed (or after the
handshake is done).  I hope we have all learned from this debate that it
might be important to make your own position clear BEFORE the deal is made.
On the other hand, if you want that chance to get to the microphone, maybe
it's better not to raise the sponsorship issue beforehand.  Just innocently
assume that any group that puts on a program on breastfeeding "should" have
found non-commercial funding, and then when you learn that your assumption
was mistaken, you grab the chance to make a statement.  (I don't know how
many times you could do this before they catch on that it's less embarrassing
for them just to avoid inviting you.  Once you've been blacklisted, you won't
have to worry any more.)

3. What are my options?
These have been well covered in the debate.  I favor making some kind of
statement to the audience and explaining the policy statements (the Code and
the IBLCE policy) that support your statement.  Then go on and do the
lecture, and make it a good one!

4. What harm can come to me?
Oh, lots of things.  You might find that you get fewer speaking invitations.
Seeing the differences in opinions on Lactnet, you can bet that some other
LCs would chastise or ostracise you, and some would support you.  You'd
certainly want to have a rationale prepared, so you could defend your
decision.

5. What policy statements can I appeal to?
The Code is actually not as stringent as the IBLCE position.  The Code admits
that formula is a legitimate product...and, as long as there are babies in
the world who have no access to human milk, so do I.  The Code is concerned
with marketing, not with manufacturing and selling.  So, just imagine that
there were a bottle or formula or baby food company that complied with the
Code--proper labels, no idealization of their product, no free samples, no
promotion through the health care system, etc. Suppose they complied not only
in the U.S.A. but around the world.  And suppose they staged a conference on
infant feeding and invited me to speak.  Could I be a paid speaker?  I
believe that, under the Code, I could, but under the IBLCE standard, I could
not---or at least, IBLCE would not issue CERPs if I did, so no LCs would want
to come.

"CERPs will not be given for any presentation given by a speaker who has a
relationship with a manufacturer or marketer of artificial infant feeding
products," says IBLCE.

6. Final thoughts:
In general, I support getting information out to more people, and I support
telling the truth.  I would like to believe that our various audiences are
interested in learning the information and hearing the truth.

There's a big problem, though, with funding, when mostly it's the companies
with products to sell that have money to put into getting information
(research) and disseminating information (conferences, journals, news
stories, etc.).  I think it is theoretically possible for a good researcher
to set up a study, using money from a commercial source, and come up with an
independent finding...but I doubt that the funder would be so devoted to
truth-telling as to publish results that did not make their product look
good.  Also, I have doubts about my own ability to read a research study with
the necessary acuteness to find flaws if they are well hidden by someone who
wants to obscure the truth.  So I have a natural suspicion of any information
that comes from a commercial source...and I think we should be teaching our
children to have a healthy skepticism, too.

Chris Mulford, RN, IBCLC
eastern USA

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