Dear Friends: Jan has initiated a great dialogue. My response is based upon years of reading my malpractice insurance newsletters, plus my basic educational programs which taught me as a nurse, to be very careful about what I say and do as a licensed professional. And also my state practice act, which does not permit me to prescribe. An example is that midwives have been slapped with lawsuits for practicing medicine without a license in many states in this country. Another example is that the only nurses with prescribing ability are advanced practice nurses (nurse-practitioners, nurse-midwives, and nurse-anesthetists), all of whom have received state permission to prescribe, and who have received training in prescribing. Not all states endorse this, either, which makes it more complicated. Again, it comes back to the public health aspect, which is to provide for minimum safety for the majority of people. I am not trained to prescribe, so legally I can't. Things will probably be alright (meaning I can get away with it) if I suggest to a mother that she use cabbage (which has no evidence to support its use, and is possibly a drug delivery system, that puts "something" into the breast via the subcutaneous route) or take "X" homeopathic remedy or take "Z" over-the-counter preparation. But if anything goes wrong, which it can in this country of lawsuit happy folks, I am out hanging in the breeze when an attorney asks me if I have the legal right to recommend any substance. This is absolutely a conservative view. And when one reads the latest edition of Lawrence, with its tables of possible adverse reactions to various herbs, one must decide if prescribing or recommending or suggesting such things is worth the risk. Especially when folks are notoriously non-compliant with prescription medications. So the options are to change the practice acts, or refer to physicians or certified herbalists or certified homeopaths and other folks who are trained and recognized authorities in the field. Or take the risk, and hope one gets away with it. Another example: as medical liaison for the local nursing mothers' consortium, I receive phone calls from mothers wanting to know about St. John's Wort for treating depression. They haven't a clue if their symptoms mean they are anemic or hypothyroid or in a rotten relationship or being alone most of the time with a new baby and/or small children. They often don't like hearing me recommend seeing their healthcare provider to rule out medical conditions which may mask as depression. I can not, as a recognized authority, condone or encourage this behavior. If someone wants to medicate, they need to see the person qualified to recommend that medication (and herbs are medications). I can't. What program (for LCs, lay counselors, peer counselors, LLLs, CLCs, CLEs or anybody) offers training to provide a basis for safe recommendations of drugs and herbs? I don't know of any. Maybe that is something the IBCLE and other organizations need to consider. Maybe we need the ability to prescribe as part of our practice. I ask you, Jan, where is the legal support for a lactation professional to prescribe or recommend any substance? Your turn....:-) Warmly, Nikki Lee RN, MSN, Mother of 2, IBCLC, CIMI, CSTP Elkins Park (a suburb of Philadelphia, Pennsylvania; northeastern USA) supporter of the WHO Code and the Mother Friendly Childbirth Initiative *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html