Our ILCA affiliate has been discussing this issue recently, too.  One of our
members, an RD, IBCLC who is quite an expert on DHA and AHA, received an
invitation extended to several health care workers to attend a swanky-poo
restaurant, where a formula company would buy everyone dinner while they
gave a presentation about their "enhanced" formulas.

IBLCE Code of Ethics Principle No. 24 (a "must" rule, requiring we follow
it):  "Adhere to those provisions of the International Code of Marketing of
Breast-milk Substitutes which pertain to health workers."  See
<www.iblce.org>.

What the WHO Code says, at Point No. 5:  No gifts or personal samples to
health care professionals, including "supply food and expensive dinners."
See "Selling Out Mothers and Babies Executive Summary," by NABA;
<www.naba-breastfeeding.org>.

We were all agreed that an IBCLC could not *accept the dinner* without being
in violation of the WHO Code.   We also agreed that we (the LC community)
need to know what the companies are saying.  Who better to hear (and
challenge) what might be said than our own expert?  The quandary:  how to do
it ethically?

The concern is that an IBCLC going to one of these functions -- even
carrying that brown-bag meal --  needs to "cover herself" so that her
attendance at the dinner cannot be misconstrued (by those who later learn of
her attendance), or misrepresented (by those who were there).

I suggested the following tactics. Some methods are more dramatic (even
confrontational) than some may find comfortable.  And one *always* runs the
risk of getting burned, despite the most cautious of approaches to the fire.

(1)  Do NOT sign in.  The sponsors can't (later) parade your name around as
an attendee, or imply that your attendance is an endorsement of their
product.

(2)  Or, sign in, but add explanatory note(s) next to your name: "I am
attending only to hear presentation.  I am paying for my own meal."  Or, get
militant: "It is a violation of the WHO Code for mfgrs of formula to provide
gifts like dinner to health care workers.  As an IBCLC, I do not accept the
proffered meal, and am paying for my own dinner."  They'd be hard-pressed to
misrepresent your attendance with that disclaimer.

(3)  Be direct and up-front the minute the waiter approaches:  "I am
required to pay for this meal myself.  Can you provide me with a separate
check?"  (A restaurant probably has the right to require that you eat their
fare when you're on their premises ... hence the brown bag tactic won't
work.)

(4)  If you have a question or comment, identify yourself AND your role at
the meal.  Use a pleasant voice, and smile, when you say,  "I am Liz Brooks,
an IBCLC in private practice.  The ethics of my profession require that I
refuse the gift of dinner being offered by the presenters, as it is a
violation of the WHO Code.  I am paying for my own meal tonight.  My
question: how can you be sure the seaweed you use in your production process
is pollution-free? [or whatever]"

This puts the presenters -- and the other attendees -- on notice that you
will not allow yourself to be seen as a Code violator.  And don't
underestimate the persuasive power that such a statement can have on
everyone else sitting at the dinner.  Some of the nurses (and LCs!) may not
have any idea that they are violating the Code by accepting the free meal.

(5)  Wear a 75-cent button ("Just Say No to Drug Reps") from
<nofreelunch.org>, an organization of health care workers who believe that
pharmaceutical promotion should not guide clinical practice.

(6)  Have at your own table literature from No Free lunch, or copies of
NABA's Executive Summary about the WHO Code.

(7)  Take notes using a BF-promoting pen.

(8)  Have the ILCA affiliate pay for the meal!  Think of the pre-question
intro now: "I am Liz Brooks, an IBCLC in private practice.  The ethics of my
profession require that I refuse the gift of dinner being offered by the
presenters, as it is a violation of the WHO Code.  My meal is being paid for
by my local ILCA affiliate, so that I may report back to my colleagues about
how the formula companies are the marketing to mothers and health care
workers.  My question: how can you be sure the seaweed you use in your
production process is pollution-free? [or whatever]"

(9)  Bring sign-up forms for your local ILCA affiliate, or ILCA itself, and
scatter them about.

(10)  Wear a button that says, "I'm buying my own dinner," or "My ILCA
Affiliate is buying me dinner tonight."


Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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