>I find the discussion of the legalities/ethics/liabilities of lactation
>consultants "prescribing" treatments to be very interesting.  In the US, we
>are very focused on CYA medicine ("Cover Your Ass") and who might get sued
>under what circumstances.

Parallels here, too, Kathy.

This week I gave a talk to a room full of doctors (GPs and SHAs mainly - ie
family practitioners and Senior House Officers, which is the most junior
sort of trained hospital doctor) doing a module in child health. I told
them (trying not to beg!!) about treating mother and baby for thrush, and
how systemic treatment for the mother could help deal with persistent
thrush that gave the shooting pains we  so often hear about.

Now, systemic anti-fungal treatment for lactating mothers is not licensed
here - doesn't mean it's harmful and in fact the dose recieved by the baby
would be minute and less than what the licensed paediatric oral product
would deliver, anyway.  But these GP docs did not want to *use their
clinical judgement* and prescribe 'off label'.   They said 'it's ok for
hospital doctors, they have the protection of the hospital' and the
hospital docs agreed - a recent study showed that 50 per cent of children
treated in UK hospitals  get off-label meds, so it's done almost casually
in an institution. But outside, in the community.....they want to stick to
the data sheet, which tells them  what to do.

I sympathise. Doctors do feel pressured and unsupported - but it's a shame
mothers  are having an unnecessarily painful time bf. I don't know what the
answer is.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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