FLRF/Medela/Code 3

To recap. I put up two posts, the first about FLRF and the second about Medela. The point was to distinguish between two different entities with two different objectives, and to protest at the latest consequences of conflating the two. 

Those consequences include a deliberate attack on the integrity of individuals who have contributed to a textbook made available by the Foundation.  (Creating a blacklist used to advise conference organisers not to invite certain speakers is an attack on their integrity; to deny that is absurd. It might also be a restraint on trade, favouring the blacklisters over the blacklisted.)

I can think of no positive consequences for the cause of breastfeeding in banning or de-platforming notable speakers and researchers simply because of their connection with even the infant formula industry, much less links with

  • the Swiss charity (FLRF) 
  • whose founding bequest came from a family 
  • who benefit from a holding company 
  • that includes ownership of a breast pump company, 
  • as a small part of a large business empire.

 I outlined some negative consequences of refusing access to conference sponsorship for breastpump companies, and speaking rights for individuals.

In the process of protesting against such discriminatory behaviour I asked two questions about Medela.

1. Should Medela be singled out as violating the International Code?

o which my answer is no, they should be treated fairly, and either 

  • all breastpump companies with online information for parents and selling bottles and teats should be targeted, 
  • or none should be declared Code violators, which technically, they all are so far as I can see.  (5.1 and 5.5)

Singling out one business alters market share but does not change anything else.

And so I agree with Diana Cassar-Uhl that all Code violating breastpump companies should all be treated the same. They are all businesses and have a fiduciary duty to make money for their shareholders. And in the last decade they have all made claims that their teat is closer to breastfeeding than any other rival, and some have been working on improvements. Objective evaluation in 2019 of all brands might find differently, and on that basis it would be reasonable to discriminate. Instead one company has been singled out and material dating back to 2012 used to justify its exclusion. What Medela has said is widely reported and misreported, but not

All marketing claims that are false and misleading should be reported to consumer protection agencies, which have the resources to assess the claims, and to impose penalties if indeed they are false and misleading. Advocates do not need to wait for the implementation of the Code as law; the law of the land can end false and misleading claims. If that is what they want, then they should act now, not call for a day unlikely ever to dawn in WEIRD nations – though I suppose asking for the incredibly unlikely will keep them traveling the world to agitate, for years to come.

The second question in the Medela post was

2.  Is it morally justified or beneficial to the cause of breastfeeding to blacklist or de-platform anyone who has anything to do with them whether or not Medela is a Code violator.?

(Or indeed, is it beneficial to the cause of breastfeeding to so treat anyone who has anything to do with the registered charitable Foundation where some of Medela’s profits ended up.)

To which my answer is no. For reasons I discussed and won’t repeat here. 

Those were the questions I posed and the answers I gave. Most of the commentary didn’t deal with either of them – judge for yourself dear reader! Read and think about them all. I ask people to think about possible consequences in the light of the stated aim of the Code, which is “to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breast-feeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.”

Next I am responding to specific italicized statements excerpted from Facebook comments…

1.Diana, you say Medela claims in multiple places that this teat is associated with better oral development resulting in superior maintenance of *feeding at the breast.* People keep saying this, and citing a press release from 2012.  I still have not read dated evidence that this claim persists despite changes to marketing guidelines that have been made. Finding something online in 2020 is not the same as finding when it was posted, as the internet regurgitates multiple versions of outmoded statements. Any such claims now found would be in breach of recent Medela marketing guidelines I have seen, and that I will shortly ask permission to post a link to. I hope Medela marketing will observe those guidelines!

2. Diana, you say “we do not have evidence that this teat causes or is associated with or leads to better breastfeeding.” (Breastfeeding being defined by you in this context as direct from the mother’s breast.) I agree, that is true. The study said that clearly, and my quick report of the study in my previous post here has been amended to acknowledge that. (My report had assumed the usual definition of breastfeeding, which does not exclude feeding expressed breastmilk.)

And we probably also agree that we will never have undeniable proof of causation, because science proves nothing beyond the possibility of doubt, simply fails to disprove hypotheses. As well, the needed amount of research for virtual certainty will not happen, and there will always be confounding variables to invoke. Though the idea that West Australian families might be “more likely to use breastmilk in the bottle at 3 months because it was the only bottle they had and when they tried feeding formula in it, the babies couldn’t get the milk out” is so unlikely, that I suspect it can be dismissed. [in WA, mothers of prem babies with only one bottle? after trying formula at  3months went back to BF?. Culturally inconceivable for me.]  And we DO now have some evidence of association with desirable outcomes, more breastmilk into babies or for longer, or the careful Perrella study would not have said so.

3. Diana, I accept gratefully your explanation  for your use of the word ‘chattering’ to describe my writing, though to do so rather strained my credulity.  Perhaps in the United States  the word carries a less pejorative meaning. However, I would ask you to realise that I write on this topic only when provoked, whether by persistent untruths or vicious new developments such as a blacklist for the convenience of conference organisers. If my writing is ‘copious and frequent’, so is the reality of what I see as lies and misdirected and counter-productive targeting that damages the cause of breastfeeding. I was very pleased that you wrote that “I’ve never participated in such exclusion or ostracization.” And I hope that continues despite the pressures that may be applied. Academic freedom and fairness is important.

4. You say, I don’t know anyone who “singles out” Medela, all of my colleagues who eschew Code-violating corporations and minimize associations with them to protect themselves from any real or perceived conflict of interest do so across the board.” I am glad that is universal rather than selective for you. Protecting oneself from developing real conflict of interests is essential and requires vigilance, but as you acknowledge, does not require avoidance. As for perceived conflict of interests – people will perceive them, real or not, if that suits their agenda. And in their own personal case, overlook them, real or not, when it suits them. Protecting oneself from criticism is not a strategy that allows for effective advocacy.  Speaking the truth without fear or favour is guaranteed to make both enemies and friends,  all in the same breath. 

But Diana, you move directly on from talking about perceived conflict of interests to talking as though you have established or can establish when there are particular conflicts of interest, judging others

The question then becomes how do you judge who you should exclude?  Would you consider an author or a speaker to have such a real conflict of interest in the current cases, as the blacklist makers do?  authors paid by a German publisher to produce a scientific chapter must have a real conflict of interest? do conference registrants need protection from what they have to say?  That seems pretty arbitrary and unjustified to me.

 And it is certainly a slur on the character of any author, who for all you know is just as careful as you are to avoid any REAL conflict of interest.  How are you to judge, and who are you to judge? are questions for any blacklisters.

In general it’s true that those with clearly established conflicts of interests – such as being a paid employee of a rival company – can be excluded, or should have excluded themselves, or declared their conflict of interest, as appropriate. And surely most would have; certainly all true professionals.

You say “There is nothing arbitrary about excluding those with particular conflicts of interest from certain spaces where health information may be disseminated. This doesn’t have to be a judgement call upon the character of a person who has engaged in such a manner as to have conflicts of interest.”  That last sentence really should read,  “who has engaged in such a manner as to allow me/whoever to think that the person has conflict of interests.”  

If that’s not premature and arbitrary judgmentalism, I don’t know what is. And I think you know it too, which is why you said it didn’t have to be. But it is, IMO. And I don’t know any health professional who wouldn’t consider it a slur on their character. 

You went on on,   “it is how individuals and entities meet OUR responsibilities under the International Code in an environment where others may not care to prioritize it

“care to” is interesting use of emotive language. Why not just “others may not prioritize it.”  There are other ways of meeting such responsibilities,of course. And priorities can be the issue.

People might do more good for the cause of breastfeeding by worrying less about how others might perceive them. Rigid adherence to the letter of the law can do harm. In 1981 there was no internet, no electric breastpump industry. The issue of breastpumps requiring bottles and teats, or indeed, the issue of health professionals as industry speakers, has not been well addressed anywhere as yet. It is capable of undermining other important Code concerns by fostering the image of self-interested lactation consultants restricting even breastfeeding women’s choices and access to useful information

You say, “because I do not want there to be any association, real or perceived, between me and that corporate entity and its practices that harm consumers.” Once again, that self-protection benefits who, beside you?  Can you not perceive ways in which being willing to engage could help the most important cause? (And that is not your own comfort and reputation). I certainly can.

“we cannot argue that they [foundations} also DO NOT exist to bolster the image of the corporations from which their financial security was or continues to be derived.” [Now, I think you left out DO NOT as the sentence doesn’t say what I think you meant here, so i added it in].          

And you’re wrong; I can and do argue, that

when the name of the Foundation bears no relationship to the company who contributed part of the endowment;

when “Medela” is not the “Larsson Breastpump Company”;

when no one but Code activists connect Medela and Larsson and FLRF; and

when under Swiss law a  charitable foundation cannot benefit a commercial entity in any way without losing its tax exempt status.  

Then I can, and I do. Quite reasonably, I think.

Diana, you are angry with what you describe as my “repeated attempts to paint Medela in a favorable light and to pretend their marketing practices are not despicable.”  You misread me here. That’s not what I am trying to do at all. I care nothing about the company (I discourage needless breastpump use) though I do about the Foundation and the family who care about breastfeeding. 

But if any company comes up with an innovation that basic biology suggests is an advance, I am prepared to listen to what they say, to check what research exists, and to test any plausible hypothesis.

I am not prepared to state categorically that there is nothing to it, that it is just marketing hype, that the hype is untrue, until I have had a good look at it. 

The latter is what some Code critics have done about the CALMA teat..

If reputable scientists have developed it and can show me videos that indicate what they’re saying is true, I am much more likely to believe them than to listen to people who reflexively dismiss it, who dogmatically assert that of course it is untrue on the basis of far less knowledge and their obvious prejudice. Trying to counter that sort of dogmatic arrogance and reflexive bias in our profession is an absolute necessity. 

For the rest, Diana, I think few in the lactation field can claim to be as free of conflicts of interest as I am, and always have been. I have not profited financially from a lifetime of hard work, and that has limited my ability to popularise my writing and gain the recognition it deserves. But I never aimed for that either: I know change is slow and building a critical mass so that that cultural shifts occur takes time – and in the meantime, the important thing is to educate and change thinking.  Which I have reason to know I have helped to do.

I am at least as passionate as you about the health of infants mothers and the planet.

Perhaps by the time you are my age you will care less about what others might think or perceive unjustly, and focus more sharply on the likely real-life outcomes of any proposed action. But I get the message that you do indeed really care, as do we all, I trust. For that, I respect you.

Good luck on your journey, a remarkable one from US Army professional clarinetist to IBCLC!