It is actually a problem for many people that their chiropractor has an xray
machine or sells stuff.  It kept me from going back to chiropractors for
many years after an experience (my first with that treatment modality) where
I felt I was hustled for a lot of expensive supplements when I went for an
adjustment.  There is an appearance of conflict even when the practitioner
is scrupulous.  This debate goes on a lot in medicine, where there is an
on-going discussion about whether dermatologists should sell creams, etc.
Doctors have lots of ethical problems of their own, and they need to clean
their own houses, too, but I will share one aspect of how the medical
community looks at this issue.

In general, the medical profession's ethical discussion suggests asking some
questions to help reason out if there is a good ethical reason to provide a
product along with a service.  Does the equipment provide recourse during an
emergency?  In otherwords, if the patient can't make it to the car to go
home without a pair of crutches, the orthopedist may rent or sell crutches
on an as-needed basis.  I think (by this reasoning) there is justification
to provide a hospital grade pump on an emergency basis.  Or to immediately
provide a larger flange if a mother has an ill-fitted one that isn't working
and she is engorged or in pain.  However, if the product is not needed for
emergency care, the question becomes is there somewhere else in the
community where a patient might reasonably access the same product?  If so,
the person should be directed to that resource rather than have the
patient/care giver relationship compromised by profit motive.

These considerations, once I became aware of them, led to my discontinuation
of selling or renting products.  In my city, there are many alternate
resources for any product.  I only direct clients to rental depots where
they will get clean pumps, reasonably priced parts, and some service.  I
personally trained as rental depots two of my clients who wanted to stay
home with their kids.  I don't have any financial relationship with either
of them (one on each side of my city.) But I do send clients to them who
need immed. access to pumps/kits/feeding tube devices, etc.  There are
places that sell herbs, my clients all have doctors for meds, and bras and
pillows and all that stuff can be found all over the place.

I hope this post won't be seen as a slam against LCs who are still grappling
with the realities of staying in practice without renting or selling stuff.
I wasn't sure how that would work, but I am much more comfortable today
about the ethics of my own practice.  We do have to talk about this -- esp.
as it does impact the credential.  As a fledgling profession, we have to
hammer out these issues even if they are difficult and may make us
uncomfortable.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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