With all respect and humility, I must respond to Katherine Dettwyler's
attack on physicians.  To establish my credibility, I must tell you all
that I entered medicine thinking it was an entirely noble profession.  My
eyes were opened pretty quickly and I am now an enthusiastic critic of my
profession. I have come to breastfeeding advocacy a little later, but as
chair of Missouri's new breastfeeding task force, I am struggling with
the ethical issues of formula company participation in health care
systems. When I become queen of the world, all women who can will choose
to breastfeed their children and we will have to find new jobs for
formula company workers.  So now, on to my point.

Physicians are ridiculously ignorant about breastfeeding and this
undermines breastfeeding and undermines the health of our entire
population.  And formula companies have many in health care in their
pockets, providing a frustrating blanket around the ignorance.  But I
cannot agree with or leave unchallenged the argument that physicians
deliberately promote artificial feeding in order to create illness and
therefore line their pockets.  I almost wish it were the case-at least
then my colleagues would admit that breast is best. I have many things that I will change
about doctors (again you will  have to wait until  my universal queenship
is recognized),but I will have to give them (us) credit for trying to do
what they think matters in promoting health.  Physicians quit smoking in
response to the surgeon generals statement and began to advise their
patients to do the same.  I do not know any physicians who advocate
cigarette smoking, alcoholism, drunk driving, avoiding seatbelt use,
obesity, child abuse, domestic violence, unsafe sex, unplanned
pregnancies, starvation, junk food, in order to make more money.  And
most of those would be much more effective in generating revenue. Yes,
we recommend surgeries that we do, lab from labs we own, but those are
different motivators.

Sadly, physicians fail to promote and support breastfeeding because the
whole profession suffers from inertia.  We like being certain, being
experts, knowing the final word, being an authority.  Infallibity has a
price, and that price is rigidity.  If I learn something new today, it
means that I was wrong yesterday, it means that I may have to go back to
being a student, and lay down the expert mantle.  And to give physicians
a break, we are put on such a pedestal that asking questions and being
unsure is sometimes just unacceptable to our patients and our
communities ( I know, part of being an adult is owning responsibility for
who we are, but pressures on physicians come from many places--our
patients are potent motivators).

I strongly believe that most of my colleagues fail to support
breastfeeding out of an entrenched ignorance that it matters.
Medicine embraced science as western civilisation entered the age of
reason.  Science values things imagined in the mind of man and made by
his hands.  Science loves what can be easily measured, is uniform, can
obey rules, and can be manipulated.  Arificial feeding was developed in
a time when men began to walk on the moon, artificial foods for all of
us were being embraced, and people talked of defeating even death.
Many in medicine still live in that time.  Breastfeeding fits this
model poorly and is suffering from this.

Failure to promote breastfeeding has an even more disturbing root.It is an
expression of the ugliness of sexism in medicine.  I believe that  our
limited science about breastfeeding and our failure to educate our
physicians and nurses about it is a part of our failure to value
contributions of women to our culture.  Though I have gained immeasurably
from the women's movement, I cannot help but grieve what the women's
movement has cost us.  It was women and feminists who called for
twighlight anesthesia, hospitalization for birth, and who embraced the
freedom that artificial feeding was to give to women.  Now we face the
challenge of helping each woman find her way through all these choices in
an informed way.  I do not think that guilty feelings help people grow.
I do not think that fear helps people consider alternative ways of
thinking and acting.

Is our anger justified? Absolutely.  Do we have a right to voice this
anger? yes.  Is this anger helpful?  I think it is a potent motivator for
us to do our work--frustration is a way of storing energy until the way
is clear.  But frustrated-sounding people don't get much of an audience.
I am committed to staying clear about my goals.  I am committed to
maximizing the health of my community.  That means reducing tobacco use,
alcohol abuse, domenstic violence, etc, in addition to creating a model
breastfeeding community.  I must stay credible and I must have an
audience in order to acheive that goal.


Elizabeth A. Peyton, MD, physician midwife, [log in to unmask]