24 May 15 , 2022
part of an exclusive breast milk diet, compared with those
receiving cow’s-milk-based fortifiers. Currently, nearly 40 per-
cent of all Level 3 and 4 NICUs, which treat the sickest babies, use
Prolacta’s fortifiers.
But in some circles, there remains suspicion about whether
fortifiers are as beneficial as reported. “That body of evidence,
while there’s some strong randomized controlled trials, is colored
by the fact that much of that research has been industry
sponsored,” says Diane Spatz, professor of perinatal nursing at the
University of Pennsylvania.
In addition, nonprofit milk banks worried that a for-profit
company would funnel the limited supply of breast milk toward
those who could pay more, as opposed to those with the greatest
need. “They are saddened by the idea that this product that they
believe in very strongly and think would benefit a lot of babies
would be less accessible if allocated on the basis of company profit
rather than patient need,” says Kara Swanson, a law professor at
Northeastern University and the author of “Banking on the Body.”
“In the history of U.S. medicine, there has never been enough
banked breast milk for all the babies that might benefit.”
There was also controversy over the fact that women were
encouraged to become “donors” to Prolacta, language that
suggested that they were supplying milk to a nonprofit when, in
reality, their raw product was being processed and sold at a
markup to hospitals. After news reports about this emerged,
detractors — including those in the milk bank community —
criticized the company for not properly informing women, and
Prolacta’s first public relations crisis erupted.W
et nurses have existed throughout history, but in the
past, whenever there’s been a transaction for these
services, the commercial advantage has been to em-
ployers. Early wet nursing in the United States relied on enslaved
labor or on poor, unwed mothers who often had to abandon their
own babies to nurse those of wealthier women. Later, in the early
1900s, a new model of “mother’s milk stations” developed that
tried to maximize the benefit for both the milk supplier and
recipient, by providing a decent wage to the supplier and a sliding
scale to the recipient.
But over time, the widespread use of formula reduced the value
of women’s milk, and women’s work opportunities increased. By
the 1970s, most milk banks in America began operating on a
system in which women gave their breast milk to the banks as a
donation. For some, it was empowering, a form of resistance
against formula companies and anti-capitalist support that
women could give one another. But it limited the population of
women supplying milk and perpetuated the gendered idea of
women’s altruism as more noble than financial compensation.
Medo’s failure to disclose the sale of donor breast milk caused
an uproar because she was asking mothers to donate milk,
piggybacking off the nonprofit milk-banking model, while also
seeking corporate profit. In response, Medo quickly revised some
of the wording on the company’s website and consent forms.
Looking back, she feels she could have done better. “That was a
mistake in hindsight. That should have been made a lot more clear
that the company was for-profit,” she says. “We were far from
perfect.”
But soon enough, Medo found herself bemoaning corporate
forces. According to a written statement Prolacta sent me, by the
end of 2005 the board was having concerns about Medo’s ability
to raise funding and run the company. With her agreement, they
decided to transition to a new CEO. Medo disputes that she hadbecause some mothers reported that the White River pumps
caused discomfort. When Medo heard they were disparaging her
product, she sent individual consultants letters threatening legal
action to get them to stop and accused some of being involved with
her competitor Medela. “We tried to avoid [lawsuits],” Medo tells
me, but the episode gave her a reputation as a ruthless business-
person.
“Many are aware of the aggressive way she used legal action to
silence her critics,” says Jodine Chase, a longtime breastfeeding
advocate based in Edmonton, Alberta, who runs the blog Human
Milk News. “I think this contributed to the lack of public debate
when she started commercializing breast milk, though many
privately expressed concern that it was inappropriate.”
I
t was through her work with breast pumps that Medo came up
with the idea of selling breast milk as its own product. In the
mid-1990s, while visiting hospitals that used her devices, she
learned from doctors about the need for breast milk for premature
babies. A perfect storm of events was causing an extreme shortage
at the time. The HIV crisis had prompted the closure of many milk
banks in the 1980s because people were afraid of the spread of
infection through bodily fluid. As neonatology improved, babies
could be saved at earlier and earlier stages of prematurity, and
new research showed the value of an exclusive breast milk diet,
especially for these babies.
Typically at that time, for the smallest and most vulnerable
preemies, a cow’s-milk-based fortifier was used in addition to
their mother’s milk or donor milk to help them gain weight. But it
came with severe risks. It has been correlated with an increased
chance of developing an intestinal infection called necrotizing
enterocolitis that can destroy intestinal tissue and, in the most
severe cases, cause death.
In 1999, Medo started a new company, Prolacta, to develop a
breast-milk-based fortifier. At various points while she was
developing her product, she met with a doctor from Sweden who
had made a small amount of breast milk concentrates for his
research, and another in Italy, who made freeze-dried breast milk
protein concentrate for his patients. The processes they used were
standard in the dairy industry, but they had never been used on a
large scale for breast milk. Medo started making presentations to
investors, who were interested in her idea. In 2002, she got her
first infusion of venture capital, which helped her to build the
company’s first 15,000-square-foot processing plant, in Monro-
via, Calif. By 2005, the company was collecting breast milk.
Medo developed milk depots, collection sites with freezers for
storing milk, in some cases partnering with midwifery clinics and
hospital lactation departments. These sites raised awareness for
milk donation, screened donors and sold milk to Prolacta, which
would test and process it, then sell the resulting fortifier to
hospitals. At the time, Prolacta charged as much as $45 an ounce
for a liquid concentrate that arrived at a hospital frozen until
ready to be used, at which time a mother’s own pumped breast
milk or donor milk was added. (Today, Prolacta’s product is not
sold by the ounce, the company says. Instead, cost varies by
gestational age and weight, and averages $120 per day.)
Prolacta funded and administered research that showed that
use of the fortifier significantly reduced the risk of necrotizing
enterocolitis in extremely premature infants, and the product
took off. NICUs increasingly adopted breast-milk-based fortifi-
ers. A 2016 study published in the Journal of Perinatology found
4.5 fewer days of hospitalization for infants with very low birth
weights receiving Prolacta’s products, along with donor milk, as