Dear all:

I think as lactation consultants and even if we are workign in other areas of lactation, we need to 
explore thoroughly the ethical concerns.  Apart from La Leche League leaders, those of us who are 
working in private practice must earn a living and those working in hospital must deal with 
hospital policies that they may not be optimal in terms of supporting bresatfeeding.  Nevertheless, 
I would say our primary concern is the health of the infants and mothers.  That should always 
come first. 

Having worked in International Health for about 20 years, I know first hand how the influence of 
donors and our relationships with industry can be corrupting.  I just watched the Constant 
Gardener and it is entirely the practice of many (but not all) of the pharmaceutical companies to 
dump almost expired or expired drugs and vitamins on the third world market.  One of the worst 
offenders gave a tiny little grant that the President of our not for profit thought was great.  It was 
not enough to do much of anything - a pittance.  In return the "rep" was wined and dined and 
expected glowing reports in his "Newsletter".  Any self-respecting person who worked in 
international development for any length of time could easily recognize the "Newsletter" for what 
it was.  A blatant propaganda piece heavily touting tiny little projects that were poorly planned and 
ineffective.  It was probably less than what we as Americans give as a proportion of our GDP to 
real development projects (<0.01% - a shocking figure to most Americans who think we are givign 
much more than this).  I'd say that what they spent on their little development fund was well under 
0.001% of their corporate profits.  This particular company was later found to be price fixing 
vitamin A because there is a huge market for it in fish farming.  This had extremely negative cost 
implications for the third world countries that were trying to deal with vitamin A deficiency.  I have 
lots of examples that I could trot out from my experience.

That experience has taught me to look closely at the costs of associating yourself with any 
corporation and finding out what is in it for them.  The only example I can think of as a happy 
collaboration that worked well was iodization of salt - but even there I can say that there were 
some quagmires where it did not work and where corruption ensued.  I think we all need to look 
very carefully at potentially hidden hitches that might make our associations with corporations a 
corrupting influence and judge whether or not it is worth our association.

Now, with the situation of a company that is for profit and conducting research on human milk, 
I'm a bit confused about some of the references to the big concern being whether or not the 
research is used for adults.  Isn't the bigger concern about using the research for infants?  Aren't 
infants even more vulnerable and need more protection from research that might potentially be 
harmful?  Will the milk be used for research be used for genetic engineering of breast milk 
substitutes?  If so, what regulations are in place for indepedent research (funding provided from 
sources other than the company promoting the product) to ensure the safety of such products?  
(Even my dentist is complaining that she is finding it difficult to tease out whether research is 
independent in her field or corporate sponsored and leaving out some critical important 
information).  Is there an independent body with independent sources of funding that is 
overseeing the research?  

Will there be a spillover effect?  To give an example, the spillover effect of the initial intervention 
to provide free formula to HIV + mothers in Africa was two-fold.  Health care practitioners 
stopped promoting breastfeeding as vigorously and many non HIV+ mothers started using 
formula.  As we now know the evidence tells us that it is the mixed fed, not the exclusively 
breastfed infants that are getting HIV.

So, as I believe others have already posted we need to think about the larger spillover effect in 
terms of other milk banks that are not for profit and whether this will increase or decrease the 
amount of milk donated to these institutions and whether or not the overall amount of human 
donor milk will increase, stay the same, or decrease if women see human donor milk banks as for 
profit institutions - and then go underground or sell their milk on ebay because "hey, its for profit 
anyway so why shouldn't I get this money directly."  

I don't know what the answers are - I'm just throwing out ideas of some of the issues I think we 
need to explore thoroughly in terms of determining where the ethical boundaries lie.


Best regards, Susan Burger

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