Susan:  Just wanted to comment on your suggestion that the reason doctors
prescribe Mylicon despite research evidence of no effect is the source of
their free lunch.  Although that may be true in some cases, there is
probably one other reason that seems to justify it in the minds of some
physicians: the symptoms are self-limited, there is no obvious cause for
them, and there are desperate parents asking the doctor to "do something!"
Since mylicon is generally seen as harmless (please don't jump all over
me -- I'm not saying it *is* harmless), some doctors will use it so
that they are actively doing something which may tide the parents over
while the condition spontaneously resolves.  I don't necessarily agree
with this approach, and it would surely be better to identify and treat
the underlying problem, whether it be breastfeeding mismanagement, lack of
"attachment parenting," allergy or intolerance in the baby, or other
causes.  However, in order to identify the underlying problem, the
differential diagnoses which we lactation professionals are so well aware
of must be known and taught to physicians.  You can't consider something
in your differential diagnosis that you never learned about.  Until
physician education reaches these levels, I'm afraid we'll continue to see
poorly justified use of unproven medications for lack of more
problem-based recommendations.  But it's not always based on greed.

Regards, Alicia Dermer, MD, IBCLC.

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