I was invited to attend Dr. Alan Lucas's talk here in Austin a few weeks ago
(sponsored by Ross).  I decided to go because I wanted to hear it, but
rather than eat the feast or drink wine, I had water only.  This made the
physicians I was sitting with somewhat bemused.  "Just take the good stuff"
one said sliding a big piece of chocolate cake in front of me.  "We take it
and just ignore them."  I told him that I didn't want to make a big deal out
of it but I'd prefer to stick to the water.  Dr. Lucas's talk  was very
focused on human milk, contained some provocative insights, and he had lots
of praise for our milk bank, which he'd toured and was SO impressed by:)
But he did state that nutritional requirements of preemies are special and
that he has concerns that these needs can only be met with supplementation.
Following the talk there was a Q&A.  I asked two questions.

The first took him to task for his lack of evidence upon which to base the
recommendation that NICU grads need follow-on formula supplementation.  I
asked him if he had considered that there is such poor (to no) transitioning
home support for these moms and babies that no wonder they don't gain well
bfg.  They are released at 5lbs, still pre-term and feed accordingly.  These
dyads need a lot of help to make sure calorie intake is adequate.  He
admitted that adequately supported bfg would make a "good 4th control group
"  in studies looking at growth in this population of babies.

Then I was able to say "Dr. Lucas, you made the statement that all formula
is not created equal, some being inadequate to meet the special growth needs
of a NICU graduate.  Further, you suggested that the nutritional needs of
NICU grads really requires physician education as to which formula to chose
if extra calories are deemed necessary in order to avoid compromising the
health and growth potential of the baby.  Given the apparent complexity of
these decisions, would you not agree that formula should be prescribed by
physician order and not marketed directly to the public?"

Dr. Lucas correctly identified this as a very political question, and stated
he was not a political person.  After some uncomfortable pauses, he blurted
out that of course in his country, one didn't have to struggle with this
issue as Britain was a signatory to the CODE and public marketing of formula
was banned.  I felt as if I'd done what I came for, and turned to my
neonatologist friend and said "I can't eat their cake and still ask
questions like that."


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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