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Subject:
From:
Naomi Bar-Yam <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 2 Feb 2006 10:35:10 -0500
Content-Type:
text/plain
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Kathy,

It seems to me that you are combining two issues here, both of which  
should be thought about seriously but not together. Making milk that  
is consistently 20-24 calories is one problem. Indeed, we know that  
mother's milk, delivered directly from the breast changes with each  
nursing and even from the beginning of the nursing to the end. When  
one creates a formula of any kind, whether it is from cow's milk, soy  
milk, or human milk, that is lost. Since we don't understand that  
changeability in nursing very will, I, too would be reluctant to mess  
with it too much.

However, the fact that it is consistently formulated is not related  
to the fact that this is done by a for profit company and that women  
are not reimbursed for their efforts. There are non-profit milk banks  
that also formulate or calibrate their milk to certain number of  
calories.

The issue of for profit vs. non profit milk banking is complicated  
and interesting as we have seen from the number of posts on this  
subject recently. For what it's worth, here is my .02 on this issue.

I think it is possible for for-profit companies to do good in the  
world and to operate ethical businesses. However, in order to do so  
they must address ethical issues that non-profit ventures do not  
face, or at least not in the same way. In the case of milk banking, I  
see 2 main concerns:

1. There is a problem with accepting freely donated milk which will  
then be used in a money making venture. In the US (and in other  
places as well I imagine) it is considered unethical, and also  
illegal to sell body parts and fluids. There are good reasons for  
this, however it has not always been the case. Human milk has been  
sold for centuries, wet nurses supported their families on their milk  
and human blood has also been sold at various times and in various  
places. I don't think this is an insurmountable ethical problem, but  
it must be addressed. It seems that the protocols of Two Maids a  
Milking are an important step in that direction. From what we have  
seen in lactnet posts, they are very clear with potential donors  
about what happens with the milk once it is collected, and women  
welcome the opportunity to donate milk to go to vulnerable babies.  
The donation is local and therefore convenient for these new mothers.  
I am not an expert in business ethics. Is this enough? Does this  
count as informed consent for the issue of profit vs. non-profit? How  
else might this issue be addressed? On the other side, is there a way  
to overcome the ethical and legal barriers to paying for milk? I  
don't have answers, just trying to think about what the appropriate  
questions are.

2. The second issue that I see has to do with accountability. By  
definition, corporations are accountable to their investors. It is  
not hard to imagine situations in which there would be conflict  
between accountability to investors and premature babies who are the  
ultimate consumers. That is further complicated by several layers of  
middlemen including hospitals, physicians and other HCPs, insurance  
companies and parents. Does Prolacta or Two Maids have anyone on  
their respective advisory boards with knowledge of and expertise in  
business and/or medical ethics? These are issues that can be thought  
about as companies are starting up, but things will come up over time  
that cannot be anticipated ahead, and it is good to have a mechanism  
in place for addressing issues that will come up in the future.

There are also ethical issues that all milk banks face whatever their  
financial structure:

1. Distribution of scarce resources. Most milk banks that I know have  
a triage protocol for who gets milk when there is not enough to go  
around. I imagine that the priority list may look different for milk  
banks that are free-standing and accountable to the community, those  
that are hospital affiliated and therefore accountable to the  
hospital's patients first and those that are for profit and  
accountable to investors.

2. The commodification of human milk. The ability to separate the  
milk from its source, the mother's breast, safely has brought with it  
the problem of turning mothers milk into a commodity. This is not a  
new problem, but I think it is changed by the modern technology that  
allows the milk to be stored and transported and that allows many  
mothers' milks to be pooled for distribution. As more human milk  
becomes available, it is more likely to be used by women who, with  
proper support and encouragement, would nurse their babies  
themselves. There will be class issues of poor women giving their  
milk to women who can afford the commodity, however the money changes  
hands. These issues have been addressed in the past, and it may  
behoove us to learn how our predecessors thought about these problems.

Well, this is more like my .10 on this issue.

Naomi Bar-Yam

On Feb 2, 2006, at 12:05 AM, LACTNET automatic digest system wrote:

> Here's my fear--a consistent formulation of 20-24 calories--just like
> formula--may seem more attractive to many physicians and parents  
> than  trusting to
> nature and the superiority of mother's own milk for her own  baby.   
> This just
> doesn't feel right to me--the idea that the milk for sick  and  
> premature babies
> needs to be "consistently formulated" by a  for profit company. And  
> as many
> have pointed out mothers donating are not  reimbursed. And how IS it
> formulated?


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