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FORUM Not a Formula for Success Photo by Jeff Cleary Imagine a company whose products are readily available to consumers everywhere and, when used, result in increased rates of sudden death, leukemia, diabetes, and obesity, cause higher per capita health system costs, and contribute to 4,000 deaths every day worldwide. Now imagine that doctors not only condone the use of these products but also distribute them free to patients. State and federal governments don't regulate the companies that manufacture these products, despite the evidence of their danger. And health professionals-in-training aren't taught routinely about the harm the products can cause or about the manufacturers' questionable behavior. As incredible as it may sound, these companies don't sell alcohol, tobacco, or over-the-counter drugs. The products in question--responsible for disease and death in the United States and abroad--are artificial baby milks, products of It's as if no one believes--or cares--that a woman has a right to receive excellent breastfeeding education and support from the medical community. large multinational corporations who spend millions of dollars each year distributing their products without charge to doctors and patients. Of course, the real issue isn't the artificial baby milks themselves; in indicated cases, they save infant lives. But outside of these cases, use of artificial milks--as opposed to exclusive breastfeeding--results in higher rates of type 1 diabetes, leukemia, sudden infant death syndrome, and complicated cases of infant ailments like respiratory syncytial virus. Long-term effects can also be seen in increased rates of chronic disorders like inflammatory bowel disease and obesity with its known health sequelae. While long-term and short-term effects can be seen in both the developed and developing world, in the developing world artificial milk is especially harmful. There, the use of these products and other substitutes for breastfeeding alone result in approximately 1.3 million deaths each year. Crying for Attention With such a dangerous product and the heightened attention paid by consumers and health professionals to the marketing tactics of pharmaceutical and tobacco companies, it amazes me that patients and professionals rarely question the influence and presence of the baby milk manufacturers. No one seems to wonder where the hospital's truckloads of free formula and breastfeeding information come from. They don't seem curious about the preponderance of "swag" like brand name pens and stethoscope tags that dominate doctors' offices and hospital floors, giveaways banned by the WHO because of their effects on breastfeeding success and subsequent health outcomes. It especially worries me that despite the myriad issues like work hour regulations that consumers, health professionals, and professionals-in-training have successfully taken up over the years, to date the baby milk industry's interference in medical care has gone largely unchallenged. It's as if no one believes--or cares--that a woman has a right to receive excellent breastfeeding education and support from the medical community without the interference of an industry that loses out on an average of $1,000 per newborn if she should breastfeed successfully. Get Them While They're Young The thought that the next generation of physicians is learning to turn a blind eye to the unfettered influence of formula companies is disturbing, considering the thorough education we receive about the undue influence of drug representatives on medical practice. The pervasive use of free formula and formula company breastfeeding information directly harms breastfeeding success and interferes with optimal medical care--practices as unacceptable as drug company dinners or vacations that are now regulated thanks to consumer activism. Patient and consumer advocates have much work to do in order to regulate the baby milk industry's activities as those of drug companies have been regulated. First, patients deserve to be informed about their hospital or physician's use of free formula products and the possible effect of those products on breastfeeding success. Hospitals also need to be put under public sector pressure to pay for formula and adopt ethical relationships with baby milk manufacturers. As a part of their education in professional ethics, medical and other health professional students should be required to learn about breastfeeding and the medical community's dealings with the baby milk industry and its effect on child health in the United States and abroad. At a minimum, the medical community should be forced to acknowledge its involvement with the industry and the negative effect it has on health outcomes--out of respect for our patients, their families, and the profession. --Tarayn Grizzard, lactation counselor and medical student at HMS The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.