Controversy over breastfeeding?

Earlier this month, US delegates to the World Health Assembly (the decision-making body of the World Health Organization) in Geneva were said to voice opposition to a resolution aimed at promoting the benefits of breastfeeding over infant formula.  The resolution declared that a mother’s breast milk is the best food for infants and discouraged misleading advertising for formula.  We all know that professional organizations such as the American Academy of Pediatrics recommend breastfeeding as the sole source of infant nutrition for at least the first six months of life.  Not only does breastfeeding protect against infant diseases (e.g. diarrhea, respiratory tract infections, necrotizing enterocolitis, ear and urinary tract infections) and childhood obesity, but for mothers, breastfeeding has been shown to promote quicker recovery from childbirth and reduced rates of breast and ovarian cancer later in life.  In the US about half of new mothers start out breastfeeding, but this drops to ~20% at 6 months.

According to some reports, the US delegates tried to remove language asking governments to protect, promote and support the practice.  They were accused of bullying potential sponsors of the resolution from poor nations in Africa and Latin America by threatening to cut off aid and even suggested that the United States might cut its contribution to the W.H.O.  Contradicting this, Brett Giroir (assistant secretary for health at the Department of Health and Human Services), insisted that the objection was never to breastfeeding per se, but rather to certain language in the guidance recommending that countries impose stringent new regulations on the marketing of any commercially produced foods suggested for children between 6 months and 3 years of age.  Citing the spread of misinformation about the events in Geneva, Giroir claimed that “there are good and valid reasons, both medical and personal, why some mothers cannot breastfeed, or choose not to breastfeed exclusively” and that parents need all the information about choices available.

Another (anonymous) source stated: “women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so,” and President Trump tweeted that “the U.S. simply wanted to protect women who need formula for their babies.”  Though this may have been the intent, a more cynical view of US opposition to the resolution could be that it was a ploy to help support the interests of the $70 billion infant formula industry over what is best for most mothers and children.

Fortunately, the final version of the resolution reaffirms "that breastfeeding is critical for child survival, nutrition and development, and maternal health" and calls on member states "to continue taking all necessary measures in the interest of public health to implement recommendations to end inappropriate promotion of foods for infants and young children."

Judith Wolf, MD

#MeToo in Medicine

 

Physicians are not exempt from sexual harassment. 

A recent on-line survey conducted by Medscape of 4151 practicing physicians and residents in the United States asked respondents about specific harassing behavior they have experienced, witnessed, or been accused of within the past 3 years.  Since definitions and perceptions about sexual harassment or abuse can differ among individuals, specific behaviors were delineated.

The results from Medscape's Sexual Harassment of Physicians Report 2018 show that 7% of physicians said they experienced some form of sexual harassment within the 3 year timeframe with ~ 40% occurring in 35-44 year olds.  The majority of victims (55%) did not say anything or confront the perpetrator, and only 40% reported the behavior to a colleague, supervisor, department head, HR, security or police for fear of being accused of over-reacting, inaction or retaliation.   

Considering the outcomes of reporting, it’s no  wonder that sexual harassment is under-reported.  Less than 25% of incidents reported resulted in an investigation, and more than 50% of respondents stated that the incident was trivialized or resulted in some form of perceived retaliation.  

Most investigations led to exoneration of the accused perpetrator; intentions were 'misunderstood' in 40% of cases.  No action was taken in 37% of cases.

Sexual harassment led ~22% of respondents to consider quitting their job and 14% actually did quit. 

 

Although effective training can reduce workplace harassment, much of it has been focused on avoiding legal liability – not changing the culture and preventing or stopping harassment.   In order to be effective, change must start at the top, and training must be tailored to the specific work environment and employees.  It’s time to act.  No, it’s over due.

                                                                                                                                         Judith Wolf, MD

Source: Leslie Kane.  Sexual Harassment of Physicians: Report 2018.  Medscape June 13, 2018

                                                                                                                                                                                              

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O Canada…

 

Sunday’s Philadelphia Inquirer featured a piece on Hulu’s hit adaptation of Margaret Atwood’s novel “The Handmaid’s Tale”.  The series describes a rigid authoritarian regime known as the Republic of Gilead (no relation to the pharmaceutical giant) controlled by male religious extremists following a coup d'etat against the United States government.

In this reactionary patriarchal society in which laws and customs are based on a very literal, fundamentalist interpretation of the Christian Bible, women have no rights - to education, employment, property, political position or their own bodies.  Fear and brutality are used to maintain power.  Only a lucky few escape to Canada. 

Agonizingly depressing, Gilead is reminiscent of other societies in the world where women and minorities are severely oppressed.  But can it easily be dismissed as inconceivable in a US of the future?  Given the current ideological divide in our country, the concentration of wealth and power in a small segment of the population, and a strongman president who cannot tolerate being challenged, could our basic freedoms one day potentially be in serious jeopardy? 

History warns us never to assume “it could never happen here”.                                                                                       So, is it time to pack for Canada … while we still can?

 

                                                                                                                                Judith Wolf, MD