Crystal's supervisor is correct. A woman's initial decision to breastfeed is
not determined by the commercial discharge bags. These bags are a form of
marketing called sampling. HIPAA has defined the practice of giving out these bags
as marketing, even though the patient does not need to be informed that the
product is being given to her to cause her to purchase that brand. Sampling
leads to brand recognition so that when she uses the sample, inhibits her milk
production, suffers insufficient milk, and an infant with slow weight gain, she
will purchase that brand! These bags are designed for one purpose only and
that is to cause the breastfeeding mother to supplement, thus creating a market
where none existed before.

The use of the product that has been endorsed by the hospital, physician, and
nurse has the potential to cause disease as well as chronic conditions such
as allergy, diabetes, and overweight/obesity in susceptible families. Powdered
formula is not sterile and as much as 50% of powdered formula can harbor
Enterobacter sakazakii.

Contact your Risk Management Department to see if they would like the
hospital to place the infants into a high risk category for acute and chronic
disease. Check with your Corporate Compliance Department to see if accepting free
formula and peddling this product could violate the federal anti-kickback statute
and interfere with Medicaid reimbursement. Check with the hospital's attorney
to see if you are liable for injury or damage done to a baby who is given the
formula and whose dose of breast milk is reduced or eliminated. Check your
hospital's mission statement and ask how increasing the risk of disease and
death is compatible with what they are telling the public. Ask your supervisor for
documentation that giving out these bags is safe, necessary, or therapeutic.

These bags have no business in a hospital or any facility that purports to be
involved with enhancing health.

Marsha Walker, RN, IBCLC
Weston, MA

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