The International Code, Conflicts-of-Interest, and Halo Adjusting

It’s happening again in Lactation Land. IBCLCs and other lactation support providers are annoyed-as-heck that a well-known celebrity (Shawn Johnson, an Olympic gold medaling gymnast) has teamed up with a formula manufacturer in a heavily-marketed ad campaign to “help new parents.” Proponents of exclusive breastfeeding and supporters of the International Code of Marketing of Breast-milk Substitutes (“the Code”) — a public health initiative about curtailing predatory marketings/ads to new families that derails them from lactation — want to pounce onto social media to explain all the reasons why what she is doing is wrong.

Folks. NONE of this is new. And NONE of us who are healthcare providers and volunteers who work with lactating families have to do a thing about it. Yes, please join me in being annoyed at the reach of commercial entities trying to influence purchasing decisions and brand loyalty. But this is not something we have to “fix.” Much less adjust our halos over, to prove we are such good followers of the Code. I say: Use that adrenaline to get one-on-one care and community-based lactation support/advocacy into the hands of new families, instead of soap boxing on social media.

(1) Celebrity spokesfolks are used for all manner of commercial products, precisely because they will bring customers to the brand. Commercial entities want to build brand recognition and loyalty — this is a tried-and-true method.

(2) Spokesfolks do not owe one iota of a fiduciary duty of care to a lactating family. They can earn every danged dime they want peddling whatever they want. You go, Shawn. Parents have been giving each other lousy (and great!) advice, over the proverbial picket fence, ever since parents starting chatting with one another. But the fiduciary duty of care of a parent extends ONLY to their own kiddos.

(3) Formula manufacturers (and all commercial entities, like pharmaceutical and medical device manufacturers) owe a fiduciary duty of care ONLY to their owners/stockholders. And making more money is how you meet that fiduciary duty in a free market economy. While corporations may bathe their messaging in nicey-nicey talk (“Oooh let’s collaborate to help out all those working moms out there!”), it is a marketing message and the bottom line in marketing is to make money because the bottom line in a free market economy is that this is the only thing that truly, legally matters to the corporation.

(4) IBCLCs, healthcare providers, and lactation support providers of all stripes, whether paid or volunteer, owe a fiduciary duty of care ONLY to lactating families, based on notions of giving good evidence-based information and healthcare/support.

(5) The fastest bestest easiest way for the folks in (4) to be subtley, unintentionally, inherently, unwittingly — and very effectively — biased by the folks in (3), to favor that brand, is to have any kind of entanglement with a commercial entity. ANY entanglement. As simple as accepting a free pen entanglement.

(6) And some folks in (4) are gonna go ahead and “collaborate” with the folks in (3) anyway. And don’t forget — we can ignore the folks in (2) cuz they owe no duty of care to anyone other than their own kids. And this just is what it is, and it is not necessarily even a fatal ethical violation for (4)s to climb into bed with (3)s, because some medical professional organizations allow a de minimus amount of interaction between healthcare providers and commercial interests.

Though I would suggest: Interaction is interaction, and if taking a logo’d-branded pen influences healthcare and prescribing behaviors, then taking a cheapo lunch over a deluxe lunch from the commercial entity will provide just as much influence. And thus I advise: Step. Away. From. The. Company. Stuff.

And my coda is this.

(7) If you are in (4) and you think you canNOT be “influenced” by the folks in (3), you are kidding yourself.

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