The issue isn't giving formula for the patients for whom this is medically
necessary.  Heck -- that is how formula is supposed to be used.  As IBCLCs
the great irony is that we see the disproportionate share of babies who
need supplementation, precisely because there is a lactation issue.  Too
bad human milk banks aren't on every corner.

The ethical tension arises when **free samples** of the formula (or any
medication, for that matter) are offered to patients, by health care
providers (HCPs).  When the HCPs get free samples from sales reps, it makes
them beholden to the company.  Whole volumes (and doctoral theses) have
been written on this concept of "reciprocity,"  and the inherent problems
of having HCPs (whose job is to provide health care to patients) being
courted by companies (whose job is to sell a product).  I am still
shuddering after reading "White Coat Black Hat"
http://www.whitecoatblackhat.com/.

The kicker is that most of us don't even realize that we are being "played"
this way.  We think we are getting freebies, and saving ourselves or the
patients money, but in reality we are just driving sales for (and loyalty
to) a commercial enterprise.

A facility that wants to entirely avoid any conflict of interest with a
pharmaceutical manufacturer (and comply with the WHO Code to boot) should
simply **pay fair market value** for whatever supplies and medicines it
makes available (or recommends) to its patients.  There should be an
arms-length, business relationship with the supplier of any product used in
an HCP office. The negotiation of the contract terms should be handled by
the business office, not the clinical staff.  And no one (not the clinical
staff; not the business staff) should be accepting gifts and lunches and
freebies from the sales rep.
-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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