Sunday, October 22, 2006

Not Exactly Ag Law

At the risk of entering the fray about breastfeeding (remember the brouhaha when the Health and Human Services ran the pro-breastfeeding commercials comparing the decision not the breastfeed with the log rolling while 9-months pregnant? If you don't, the transcript is available here) I couldn't help from commenting on this development.

Premature babies and critically ill infants in NICUs (like Minnesota's Children's) are more likely to thrive when they get breast milk. Babies whose moms can provide a full supply of expressed milk are the lucky ones (if "lucky" is an appropriate term for any baby in a NICU). For lots of reasons, though, some moms can't meet the demand. Babies whose moms can't fully supply breastmilk benefit enormously from donor milk.

Women have nursed each other's babies since, well, probably since women have nursed. In the past few decades, donor milk banks around the country have supplied NICUs with donor milk. The Human Milk Banking Association of North America quarterbacks the effort (see the website for a quick and interesting history of milk-banking in the US). These milk banks are not-for-profit. Lactating moms (who are screened) donate expressed milk, the milk is minimally processed, and dispensed by prescription to hungry babies around the country.

The University of Minnesota just announced (click for web press release) a collaboration with Prolacta Bioscience, which will set up milk banks around the country. The set-up seems a lot like the not-for-profit donor milk banks already in action. There's a critical difference, though. Prolacta Bioscience is a for-profit organization.

This leads me to a couple questions. But I'll start with a disclaimer. My hat is off to any organization willing to do research on human milk. Futher, to the extent Prolacta Bioscience gets more donor milk into the bellies of preemies who need it, great.

Now the questions: How much is Prolacta Bioscience making per ounce of milk? Shouldn't some of that be going back to the donor moms to compensate them for their time and energy? (Ask any nursing mom, it takes a hell of a lot of energy, not to mention time, to feed your own baby and pump besides.) My guess is that most donor moms are donating out of a sense of altruism. In fact, it looks like that's what Prolacta Bioscience is relying on. On the page of their website dedicated to donor information, they list as a benefit donor moms will receive: "Share in the satisfaction that your donation may save the lives of infants in need." How can you argue with that? At least, how can you argue with that without looking like a jerk? At the risk of looking like a jerk, I submit that the donor model works when the milk banks are not-for-profit. But it doesn't translate as well when the donors are the only unpaid leg of the stool. It doesn't translate as well when patients (more likely, insurers) are being charged upwards of $20 an ounce for milk that Prolacta got for free. (Donors also receive the necessary supplies, and the screening (which apparently involves a blood test) is free).

This issue came to my attention via an article in the Minneapolis Star Tribune. In the article, Lora Harding Dundek, the Fairview person in charge of family education and support services, is quoted as saying that donors aren't paid because "we don't want to provide any incentive to give us milk instead of giving their baby milk." Hmmm. Maybe. But couldn't that concern be taken care of in another way. Like, for example, careful donor screening? The donor mom profiled in the Strib article is an attorney, and mother of three. Somehow, I'm not real worried she'll be starving her baby for the extra dough.

As deep a concern, for me, is the attitude that breast milk needs to be improved upon. Dundeck is quoted on Fairview's website as follows: "By partnering with Prolacta, we can help make a superior human milk product." (Emphasis added). Wow. Sounds a lot like the rhetoric formula companies used to use to convince women to forego breastfeeding entirely. Of course, we now know they couldn't have been more wrong.

I understand that extremely low birth weight babies do need supplemental nutrients, and I understand, too, that breastmilk varies in caloric content as well as nutritional content. It would be tragic, though, if the idea of "improved" breastmilk interfered with women's feeding decisions for their full-term babies.

It's not exactly ag law, but to the extent readers of this Blog are interested in how we feed ourselves, I hope this is interesting as well.


Anonymous Lora Harding Dundek said...

I would like to expand on the issue of payment to donor moms, since you have quoted me in your post. I think the most appropriate comparison of our milk bank to another entity would be to a blood bank. The screening processes that we use for milk donors are very similar to those used by the Red Cross on potential blood donors. There is an extensive health history questionnaire, blood tests, DNA identification/"fingerprinting" and permission forms from both mom's physician/midwife and baby's physician/nurse practitioner. It is true that we don't want to provide an incentive for moms to give us milk rather than their baby. But as I told the reporter for the article (and what she chose not to write about) is that the larger issue is that if there was financial reward for providing milk, we would run the risk that moms might give false or misleading information, especially on the health history form. It is the reason that people are not compensated for blood donation. And yet the Red Cross sells some of its blood products to pharmaceutical companies who make drugs from it and reap a great profit.
My other comment is that I believe the word I used with the reporter was that Prolacta produces an "enhanced" product, not a superior product. It is entirely possible that many, many babies can do fine on regular donor milk, but for those little ones that need more calories or need human milk fortifier, the Prolacta products could be just what is needed.
Lora Dundek

10/30/2006 6:24 PM  
Blogger Morgan Holcomb said...

Thanks for the comment. The analogy to blood donation is interesting, but maybe doesn't cut as clearly in the direction of not compensating moms as we'd think. For example, early on in the blood donation v. sale debate, there was much discussion about accepting blood donations from african americans. The argument that won the day was that african american who altruistically wanted to donate blood would be fine (we wanted their blood) but we shouldn't pay or compensate african americans, because then we'd taint the blood supply. (I give a hat tip to Michele Goodwin of DePaul, who brought this to my attention during a recent talk at the U of MN law school). Of course, the blood supply became tainted in the 1980s, not because we paid folks, but because our screening wasn't sufficient.

Your point is well taken, we want milk that is as safe as possible, but I'm not convinced, given the rigorous screening you already use, that financial reward would cause moms to give false or misleading information that wouldn't otherwise be caught.

It's a tricky issue, I think. Another consideration, that I didn't add to the original post, is that the donation/non-profit model just doesn't seem to be working. I left that out because I don't have my hands on numbers of donor milk needed versus donor milk supplied.

10/31/2006 12:03 PM  
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