Looking a gift horse in the mouth

The usual feelings aroused by an unsolicited gift are surprise and gratitude, when you have a positive personal relationship with the giver. However, suspicion is warranted when gifts arrive from sources with vested business interests in such gift-giving. On accepting these gifts, you immediately acquire the obligation of reciprocity. If you are not directly paying this debt–who is? What relationship have you accepted in this transaction?

Many times health care professionals unwittingly become “agents” of marketing companies, having been targeted as access points to the consumer. We have seen how formula companies have used health professionals in hospitals to sell their bottle feeding culture through the distribution of formula packs, teaching materials and gifts displaying trade names. When we accept and distribute these products, we may feel good about supplying free samples, but it is the vulnerable new mother who will pay the price of these unsolicited gifts. Information in an attractive package is mixed in with advertising messages subtly reinforcing a bottle feeding culture, with invitations to join 1-800 numbers, to join clubs or to order products from companies who just happen to be affiliated with formula companies. Many consumers receive formula gift packs in the mail and do not know where they came from.

But we know: Advertising works or they wouldn’t be doing it! Successful marketing has created a multibillion dollar infant formula industry.

Health care professionals, including physicians, should not accept these gifts and gratuities. Managers should decide that these gifts are too costly, given at the expense of breastfeeding families. Physicians, administrators and materials management personnel need to be educated about the consequences of distributing free samples and their responsibility/liability as an agent of multinational corporations. Principle-based policies need to be developed to protect health care consumers from these undesirable commercial influences attaching themselves to the credibility of health care professionals.

Inform companies offering these enticements that they are no longer welcome in health care facilities. Do not sign or renew any binding contracts with marketing companies. Do not allow yourself to be used to transfer a debt of reciprocity to your patients. If over 90% of women giving birth in Canada receive information and products as boasted, this incurs a massive debt, compounding annually. This, gift horse has a hidden price, paid for by the health and lives of mothers and babies.

--Thanks to Jean Burry and Terry Lynn Cann, North Battleford, Saskatchewan.

References:
1. McDonough, McGregor, Proctor. February 16, 1997 letter, Today’s Parent Group Direct
2. Regush, N. Medical Ethics: Baby Formula Maker’s Milk A Strained Health Care System, Equinox, Sept/Oct. 1995
3. Chren, Landefeld, Murray. Doctors, Drug Companies and Gifts, JAMA 262:1989
4. Greer, Apple. Physicians, Formula Companies and Advertising, a Historical Perspective, AJDC 145: 1991
5. Palmer, G. The Politics of Breastfeeding, Pandora Press, 1993 ed.